Pfizer Inc. (2010)

Narrative Description of Program

Pfizer has always demonstrated a commitment to employee health with robust benefits, which include 100% preventative care and prescription medications coverage. In 2005 Pfizer expanded on this commitment by launching Healthy Pfizer, a comprehensive health improvement program that produces positive health outcomes. Healthy Pfizer provides annual biometric screenings, a customized health portal, one-on-one outreach for disease and lifestyle management and easy access to nutrition, exercise and stress management programs.

A high-touch marketing campaign, a medical premium discount incentive and visible support from Pfizer senior leadership garners extremely high employee participation. Health Risk Assessments populated with imported biometric screening data provide an excellent baseline to assess employee health and measure risk reduction. While organizational change and a decreased incentive have at times negatively affected completion rates, the annual HRA campaign engages a minimum of 60% of the population. This enables us to target messages to successfully drive face-face, telephonic and online lifestyle coaching programs.

Healthy Pfizer programs, which are funded as part of Pfizer’s benefit plan, are integrated with all health and wellness efforts to build a culture of health at Pfizer. Two dedicated fulltime employees, with the support of a national group of physicians, nurses, physical therapists and fitness and nutrition professionals, form a grassroots network to deliver customized programs, such as site-based fitness, nutrition and stress management workshops, to employees in diverse workplace settings.

Participation in all programs is measured and part of a comprehensive integrated database managed by a third party. The database also includes medical, prescription and short term disability claims. Together, the data enables us to tailor the program to the needs of the population. This rigorous metrics-driven approach, combined with high-touch and personalized marketing, has effectively decreased risk in the Pfizer population and allowed Healthy Pfizer programs to show a positive ROI over four years.

Ingenix Inc, the research and analytics group, was contracted to evaluate Healthy Pfizer impact. Ingenix created a robust Pfizer-specific integrated database including key data elements: eligibility, medical/drug claims, short-term disability, health risk appraisal, and health management program participation (e.g., biometrics, walking, fitness center, lifestyle coaching, and disease management) spanning four years of the program since its inception in 2005. The evaluation and ROI analyses were conducted annually and designed to capture multiple metrics providing an assessment of program engagement and impact including both health and cost outcomes:

• Participation rates
• Health status and prevalence of individual health risks
• Changes in health risks and health status over time
• Changes in costs associated with changes in health risk status
• Return on investment

The study population included employees eligible for benefits in any year from 2005-2008. The number of employees ranged from 43,500 in 2005 to 30,000 in 2008, was 55% male, and averaged 42 years of age.

Engagement: Leveraging incentives and an active communications strategy, engagement rates remained high throughout this time period: Health Risk Appraisal (58% to 81%), Lifestyle Coaching (15% to 40% of risk eligible), Walking (13% to 38%), Fitness Centers (15% to 28% at selected locations), and disease management (28% to 55% of identified).

Health Outcomes: Weight, physical activity, blood pressure, and cholesterol were the most prevalent health risks identified. Changes in health risks tracked over time showed the greatest improvements in physical activity, cholesterol, nutrition, and smoking. Active smoking cessation strategies reduced population smoking rates from 6% to 3%. Overall, there was an increase in the percentage at low risk for 31,642 repeat HRA participants by 3 percentage points and a decrease in the percentage at high risk by 4 percentage points. The program was characterized by low risk maintenance and risk reduction programming to serve employee health needs across the entire health continuum.

Cost Outcomes: Overall, about 20% of medical and disability costs were associated with excess modifiable health risks. Changes in medical and disability costs followed changes in health risks. Transitions in health status categories among repeat HRA participants demonstrated that those who reduced health risks also reduced costs while those who increased health risks increased costs. Overall, there was a net risk reduction within the target population.

Return on investment: Using the latest advancements in ROI methodology, propensity score weighting was used to reduce case-mix differences between participants and non-participants. Advanced modeling maximized the impact of multiple successive years of participation across programs. Cost outcomes for the ROI included both medical and productivity savings estimates. Overall the Healthy Pfizer program achieved an ROI of 2.15 in 3 years increasing to 2.61 in the 4^th year. Most of the savings were generated from the HRA and wellness programs.

The Healthy Pfizer program is a comprehensive health management program with documented health and cost outcomes including high engagement rates, risk reduction in key health risks, evidence of cost reduction associated with risk reduction achieving an ROI of 2.61 over 4 years.

• Pfizer Evaluation

The following are verbatim remarks made by the reviewers:

A

• 18137/25920
• Program helps maintain ee’s in low risk category and helps facilitate risk reduction.
• Outcomes demonstrated decreased health care spend and positive ROI
• Impressive marketing campaign and senior leadership support
• Incentives are tied to the benefits plan
• Offerings include tailored approach to employees with specific risks

B

• Very comprehensive population health management program design
• Visible senior leadership support is notable in a company this size
• Program is well integrated into organization and other health-related programs
• Incentive integrated into health plan in the form of a premium discount
• Comprehensive evaluation database managed and analyzed by expert third party
• ROI analysis used case-control design based on propensity score matching of participants with matched non-participant controls (although documentation did not provide details on elements of propensity score).
• Program branding and marketing (e.g., BEST) was very impressive
• Renewed commitment to financial incentive to address decreasing participation
• High participation rates vis-à-vis incentive amount suggests strong culture/communications
• Modest risk improvement among repeat participants
• Documented association between risk change and cost change
• Solid ROI made more credible by rigorous analytic methods

C

• Strengths of the Pfizer program include a focus on the entire employee continuum, full coverage of preventative services, leadership support, use of incentives and multi-channel marketing and communication efforts. Additionally, the program is integrated into the benefits structure, takes a personalized data-driven approach and has a dedicated staff. The program utilizes high-quality outcomes researchers for program evaluation and has demonstrated risk reduction and a good ROI.

D

• Good follow-up of 1999 Koop program
• Serious planning
• Good resources
• Outside evaluation
• Smoking down to 3%
• ROI 2.61
• Messaging program

E

• An earlier version of this program won the Koop Award in 1999 (at their NY and research facilities)
• The programs are good and clearly described, and positive ROI was calculated

F

• 60% participation (18,000/26,000)
• 2 FTEs
• Good branding
• Incentives increased participation in 2009
• Focus group research
• Engagement rates in programs good
• Smoking prevalence dropped from 6%-3% -- not clear if it’s a cohort study

G

• Appropriate incentives
• Metrics driven approach, integrated database
• Good, but not great participation rates
• Good ROI – 2.15 in 3^rd year, 2.61 in 4^th year

H

• Good organizational commitment

I

• The program for approx 26K employees is funded by Benefits,  Incorporates a comprehensive strategy addressing risk profile, telephonic coaching and mail follow-up, annual biometrics, chronic condition and lifestyle outreach,  EAP/Work Life, etc. 60% participation in the health assessment.  Visible senior leadership.
• Studied outcomes over 4 years – 2005 to 2009.  Found more low risk and fewer high risk participants.  Confirmed that costs follow risk with an average cost of $1,856 higher for the high risk group vs. low.   Looked at “high intensity” users and found they have the most moderate costs.  Reported ROI of 2.6 to 1, breakeven year number 3.
• Used the take-a-ways from their analysis for program planning – i.e.  HA contributes greatly to changes in risk and cost; disease management and lifestyle management need longer intervention time frames.
• Incentive strategies included discounts on premiums, gift cards, FSA contributions – changing each year to keep/improve engagement.

J

• Participation rates are good.
• The evaluation effort seems to be very well designed.
• Health and financial impacts are impressive.
• Congratulations on taking an objective critical look at the causes of declining participation rates.
• The marketing efforts seem to be very well conceived.
• Congratulations for maintaining a comprehensive program despite reductions in force.

K

• Conflict

L

• Honesty on low return for DM / Lifestyle.

M

• Conflict

N

• Comprehensive program, including environmental reinforcement and plan preventive care coverage.  Good participation, up to 72% HRA in 09 and up to 40% coaching and 55% disease mgmt.  Modest health risk