Pfizer Inc. (1999)

Introduction

Pfizer Inc (Pfizer) has an established reputation for valuing and investing in the health and well being of its employees, and Pfizer’s leadership has set clear direction that Pfizer shall be a premier global employer. As the company celebrates its 150^th year of operation, Pfizer is committed to integrating and aligning its Employee Health and Wellness strategy, goals, and incentives with the broader organization’s mission—"Life is our life’s work". Pfizer recognizes that the health, well being, and positive outlook of their employees are crucial to the company’s continuing success.

The Premier Employer Program is a multidimensional, integrated effort designed to attract, develop, and retain an employee population that embodies the Pfizer values of integrity, innovation, respect for people, customer focus, teamwork, leadership, performance, and community. The company’s health-care and welfare benefit strategy supports this effort by assisting employees to better manage their health and to balance life needs and goals with their professional careers. The strategy uses objective information to evaluate the effectiveness of sponsored initiatives, and drive program improvements. The focus of Pfizer’s health care strategy is on imparting joint ownership of employee health on the employee and Pfizer, and to optimize employee productivity and satisfaction.

Mission Statement

To improve the quality of life of all Pfizer employees by offering accessible, innovative and educational health and wellness programs. In keeping with Pfizer’s commitment to become the premier global employer in the pharmaceutical industry, this leadership affords the Pfizer community with opportunities to live longer, healthier, and more productive lives by supporting lifestyle changes.

Program Objectives

The goals of the program include:

• Assist Pfizer to attract and retain the best people.
• Develop employees into the most productive and engaged workforce possible.
• Enhance employee and dependent health by primary, secondary, and tertiary prevention.
• Maximize the value of the benefits offered by effectively managing health care resources.
• Assist employees and dependents to be informed and efficient consumers of health care.

Program Description

The targeted population for Pfizer’s health care strategy includes employees and their families. Pfizer has approximately 18,500 employees in the U.S. The majority of the employee population is between the ages of 30–40 years.

Pfizer supports health and productivity optimization of its population through a multidimensional, highly integrated approach. Convenient access to initiatives is assured via on-site administration and access. Pfizer’s strategy includes the following (on-site) initiatives and program components:

• Health risk assessment/identification initiatives
• Wellness and health education initiatives
• Disease management initiatives
• Medical clinics
• Fitness centers
• On-site Physical therapy
• Ergonomics program
• Managed disability
• Welfare benefits/health care delivery evaluation/enhancement initiatives
• Employee Assistance Program (EAP)

Program Participation and Promotion

Interest and participation in the Premier Employer Program is very high. In Pfizer’s New York location, 85% of employees participated in one or more of the programs described above, and 80% of employees used on-site health services in 1998. Over 46% (1,300 members) of the total population participates in the fitness center, and there is a waitlist of 200 for enrollment since 1,300 is the highest number of members this center can accommodate. The fitness center in Groton, CT had 672 members and at the time of this analysis was at full capacity (this center has since expanded). Participation rates at other locations are similar for on-site initiatives. Participation rates vary by program component.

The Premier Employer Program is promoted via communication and education to employees delivered via a variety of media. Print materials, on-site communication, and intranet/internet access to information regarding Pfizer health management programs ensures that employees have access to information regarding program initiatives. These media also provide educational support to provide participants with the most up-to-date information regarding health risk reduction.

Many components have been in place for more than 10 years. New initiatives have been added as needs have been reassessed and program effectiveness evaluated. The program is staffed by the Medical and Fitness Center departments, and includes clinical and allied health professionals, and mental health practitioners (EAP program staffing). In addition, Pfizer has research staff who focus on measuring the impact of a wide variety of Pfizer-sponsored health and well-being initiatives, and this group assists with analyses of cost-effectiveness and return on investment (ROI) for the Premier Employer Program.

*refer to program details/evaluation documentation for more specific information

Methodology

Significant investment in integrated data systems and analyses enables Pfizer to effectively monitor and evaluate the impact of existing initiatives, and identify areas for continued improvement so health care resources can be used to their greatest potential. Analyses that support the health care strategy include:

• Data to evaluate program effectiveness are collected by on-site clinics and fitness centers including biophysiological measures, self-reported data, and other methods to allow ecological, before and after, and control comparisons.
• Hewitt Associates’ Integrated Health Information System (IHIS) to maintain on-line three years of individual-level medical claim and enrollment data for the Pfizer indemnity population. Analyses are performed using a total episode of care approach that account for inpatient, outpatient, laboratory, x-ray, and pharmacy services. All data are adjusted for demographic factors.
• For the managed care population, health claims are evaluated for plans that have data available, facilitating longitudinal and comparative analyses. These comparisons involve commercial populations only, therefore adjusting for a healthy-worker effects.
• Hewitt Health Value Initiative (HHVI) utilizes information collected annually from employers (including Pfizer), and hundreds of health plans. This data facilitates longitudinal evaluation of clinical indicators of quality health care. A Pfizer-specific request for information supplements this process and adds more in-depth information regarding quality indicators.

Ergonomic Program

In 1997, Pfizer piloted an ergonomics program for employees in their Manhattan, NY location. The program consisted of group educational sessions and individual workplace evaluations. Participants were asked to respond to a baseline and post-program survey to determine if the ergonomic program resulted in reduction in symptom intensity, increased productivity, and functional status. Standard measures including the SF36 questionnaire were used to compare pre/post values as well as to provide comparisons to national standards for functional status. Program participants reported reductions in symptoms while non-participants reported increased severity. Participants also had increases in SF36 scores, especially in vitality and role/physical areas suggesting increases in productivity post-program.

Participants reported a 1.5% increase in productivity post-program, which translates into savings or ROI of 3.51:1 and net savings of $1,153,206 for participants.

Physical Therapy Program

Since 1992 Pfizer has offered physical therapy services on-site to employees in its Manhattan, NY location. These services are offered to ensure that employees can conveniently access quality therapeutic services, and to reduce the amount of lost work time for these employees. Approximately 210 patients participated in over 3,000 physical therapy sessions on-site from 1994 to 1997. In 1998, a study was performed to evaluate the cost effectiveness of the on-site services. Results include quantitative measures including a reduction in claim costs related to musculoskeletal and physical therapy services and qualitative measures including pain reduction scores and satisfaction with the program. This program generated an average ROI of 2.38:1 over the study time period (1994–1997), and produced over $590,000 in savings related to employee lost time avoided by on-site access to services.

Fitness Centers

On-site centers have been in existence for over 10 years and are staffed by exercise physiologists who assist employees in reaching their fitness and weight loss goals via education, counseling and assistance with regimen compliance by incentive programs and relationship building. In 1998, the ROI for this program was 4.29:1. This was based on average savings per participant when compared to non-participants and reflects saving from absenteeism, turnover, performance, and productivity.

Disease Management Programs

These are administered on-site and include design features such as before and after comparisons and prospective cohort follow-up. Programs have been selected based on high prevalence diseases in a working population and include osteoporosis, hypertension, lipid, and weight management. Interventions include patient monitoring and compliance education, health risk reduction, and provider education.

Result highlights of disease management programs include statistically significant reductions in lipid levels for Lipid Management program participants. Baseline information for the osteoporosis and weight management programs indicate that the risk screening and outreach successfully identified and recruited individuals who are significantly at-risk for illnesses related to these conditions. Baseline measures also have been obtained for the Hypertension Intervention Program and preliminary results suggest that participants achieved reductions in mean systolic and diastolic blood pressure.

Medical Clinics

Pfizer has on-site clinics in several locations. These services are available in Groton (Connecticut), Brooklyn and Manhattan (New York), and Parsippany (New Jersey), Terre Haute (Indiana), and Puerto Rico. They have been in existence in some locations for more than 10 years, and include finite primary care for acute conditions (upper respiratory/urinary tract infections, dermatological, musculoskeletal conditions), case management of chronic health conditions (asthma, diabetes, cardiovascular disease), disability case management, and health counseling. The clinics are staffed by primary care physicians, physician extenders, and occupational health nurses /associates. To enhance coordination with the health plan, the clinics are participating providers in health plans that Pfizer offers in several of these locations.

By improving access to health care, clinic providers are able to treat and manage health conditions earlier in the disease process resulting in better outcomes for the patient and improved demand and cost management for Pfizer. In addition, clinic providers are involved in driving behavioral change in patients. These changes are often driven by the trusting relationships that are established between the provider and patient. The resultant ownership that takes place improves medication compliance and results in dietary changes, smoking cessation and other lifestyle changes that lead to primary, secondary, and tertiary prevention.

Wellness and Health Education Programs

Wellness programs are implemented through the clinics and fitness centers and include breast, prostate, colon, and skin cancer screening and awareness, nutrition education addressing a broad spectrum of health issues (e.g., diabetes, osteoporosis, pregnancy, and weight control), cardiovascular risk screening/reduction, eye care updates, pediatric health, and stress management. Lyme disease prevention education has been targeted to regions where this disease is endemic, in particular for Connecticut employees and dependents. Appropriately credentialed personnel and outside resources including physicians, nurses, and psychologists present programs. Programs can include on-site screenings and 30–60 minute lectures, and individuals in need of additional assistance are referred to targeted disease management programs following the group sessions.

Welfare Benefit Design Initiatives

Pfizer offers to its employees a broad choice of health coverage options including multiple indemnity and managed care options.

• The Pfizer Quality Assessment Initiative has been in existence for three years and is an effort to identify areas for health care quality improvement through assessment of Pfizer’s managed care data collected annually by a survey, then reviewed by follow-up health plan audits. Health care delivery areas assessed include primary prevention (Healthy People 2000 goals for mammography, pap smears, childhood immunizations), disease management, utilization review, and case management, and customer service. This information is then reported to employees as part of Pfizer’s benefits enrollment process to provide assistance in making informed health care coverage decisions.
• The Pfizer Health Plan (indemnity) population claim data are reviewed annually through Hewitt’s IHIS. Primary prevention, disease management, and case management are focused areas for continuous improvement initiatives.

Future Direction

Pfizer is fully committed to creating and maintaining the best health and well-being programs for its population. Future directions for the Pfizer premiere employer initiative include:

• Use of Health Risk Appraisal data as a diagnostic tool to target risk reduction, screening, and educational programming. The HRA will be repeated periodically to provide comparison and to redirect health management efforts.
• Continued thorough assessment of health returns and ROI to ensure efficient and judicious use of health care resources.
• Leverage of leading-edge technology applications (e.g., Internet, intranet, voice response) to ensure convenient access for the entire population, regardless of work location or situation.
• Implementation of all programs to spouses and dependents (some are currently available for employees only).

Expansion of on-site medical clinic services and locations as well as expansion of on-site Fitness Centers to further enhance access to care for the Pfizer population.

• Pfizer - Premier Employer Program

Overall Selection Task Force Criteria for Pfizer

Program strengths were the comprehensive nature of the program and the high participation rates.  Half of all employees use the fitness center.  External evaluation was contracted to Hewitt.  A return on investment of 3.5 was noted.  Results were supported by claims data analyses and professional evaluation and the programmatic strengths involve comprehensive design targeting specific regional exposures such as Lyme disease.  Waiver of deductible, payment format, free and onsite annual screening are commendable features.  This is an ambitious and positive attempt to evaluate an excellent and comprehensive employee health management program.

Reviewer concerns include the observation that the productivity measurement methodology is not adequately described and the economic projections are not necessarily well-designed or based on valid assumptions.  The health-care cost analysis was somewhat rudimentary and piecemeal without perfect controls.  Some of the good cholesterol results had only a small "n" of  24.   Full documentation of the return on investment calculations would have strengthened the presentation.  The self-report productivity measure needs to have its reliability and validity documented.