Pitney Bowes (1996)

Narrative Description of Program

Pitney Bowes is a Fortune 125 company with 23,000 employees nationwide. An analysis of health care expenditures in 1991 revealed that escalation of health care costs would eclipse growth in corporate profits by the year 2000 if Pitney Bowes did not intervene. Health Care University (HCU) was piloted to approximately 5,000 employees under the Medical/Wellness program umbrella in 1993 in response to this challenge.

The strategy is multi-dimensional and highly integrated. The model is conceptualized as a bridge-like trapezoid that allows Pitney Bowes to "bridge" the gap from prior benefit practices to a more efficient, health care management approach. Its building blocks are:

• Education of health care consumers;
• Efficient in utilization and purchasing practices; and
• Employer Design - providing resources to achieve objectives

The program bridges demand management, disability management, and disease management/prevention. Disease management/prevention is a core focus, and includes prevention programs, on-site primary care clinics, and focused disease management.

The program is funded via the corporate operations budget. Savings offsetting costs are noted in specific budget areas (e.g., disability savings, etc).

Program Mission

To optimize organizational and employee health and productivity.

Program Objectives

• Manage costs to 0 percent increase through 1997;
• Enhance health outcomes, and
• Avoid cost shifting/reward healthy behaviors;
• Measure impact;
• Enhance benefits;

Approach

Pitney Bowes supports good health by emphasizing prevention, early detection, wise consumerism, and appropriate, timely care for individuals at all levels of health. Integration of health initiatives creates simplicity, efficient resource use, and consistency for participants. Preventive care is fully integrated with on-site medical and fitness facilities, ergonomic programs, EAP, work/family, and disability and benefit areas. Resources, referral, and data ,analysis link these to create a unified, coordinated, "Total Health" approach. Convenient access is assured through use of technology such as kiosks equipped with health monitoring equipment, and on-site resources.

The HCU program motivates employees by providing credits for participation in selected activities. If an employee earns six credits during the term (September-June), they are awarded $25 toward future benefit purchase. Many activities are provided on-site for convenience, and/or are fully covered under the medical plan if a physician's office visit is required. Programs include:

• Cardiovascular and cancer screenings
• Smoking cessation
• Vaccinations
• Exercise
• Self-care and consumerism education
• Nutrition counseling
• Seminars (lunchtime and multi-day)

On-Site Services

The in-house medical clinics are an integral component of the preventive care process, providing employees with convenient access to primary care, in-house disability management, health screening and diagnostics, on-site asthma management, and health counseling for at-risk individuals. Clinicians also serve as patient advocates to assist participants to select and maintain appropriate care. These centers experience high utilization, logging 20,000 visits per year, and are staffed by primary care doctors, nurse practitioners, physician assistants, certified occupational health nurse, and educators/counselors.

Fitness Centers are staffed by exercise physiologists who provide fitness screening exercise guidance and supervision. HCU coordinators are also active at each site where there is high concentration of employees.

Health Care University-Fact Sheet

The Pitney Bowes Health Care University is a highly integrated total health care approach. It allows employees the opportunity to earn credits for healthy activities. HCU is instrumental in pulling together many of the components offered through the Pitney Bowes Medical and Wellness program such as health screening, educational seminars, self-care education, ergonomics, exercise and nutrition counseling.

On-site Medical Centers

Staffed by highly qualified clinicians including wellness coordinators who advocate services available through HCU, the on-site medical centers offer:

• Primary care
• Patient advocacy
• Diagnosis and Treatment of Illness
• Disease management assistance-asthma monitoring
• Health screening services
• Disease management - depression in the workplace
• Health counseling/treatment compliance assistance
• In-house Disability Management

Services are free, and are offered during work hours to eliminate the issue of "lack of time" for accessing appropriate care.

On-Site Fitness Centers

Staffed by exercise physiologists, the on-site centers offer:

• Fitness assessment
• Exercise guidance and monitoring
• Convenient access

Lunch and Learn Seminars

These 45 minute talks are provided to employees by local experts. At least one per month is offered at sites with high concentrations of employees:

• Self Care
• Skin Cancer
• Heart Disease
• Lyme Disease
• Ergonomics
• Exercise
• Arthritis
• Colon Cancer
• Diabetes
• Stress Management
• Glaucoma
• Nutrition

Multi-day Seminars

Seminars run 5-8 weeks with periodic follow-up:

• Weight Management
• CPR/First Aid
• Stress Management
• Asthma Management
• Smoking Cessation

Screenings

Many screenings are offered at the worksite including:

• Mammography
• Vision
• Diabetes
• Hypertension
• Glaucoma
• Cholesterol
• PSA
• Skin Cancer
• Colorectal Cancer

In addition to mobile mammography at the worksite, a comprehensive awareness program is offered. Breast self-examination literature and instruction, information provided by the American Cancer Society, and awareness and fund-raising events are offered through the Pitney Bowes Medical and Wellness Plan.

Ergonomics

The ergonomics program includes:

• Worksite assessment
• Education
• Change in workstation
• Prevention

Employee Assistance Program

Pitney Bowes partners with providers to offer a comprehensive Employee Assistance Program for employees and dependents. The program uses a counseling and referral model. Program assessment includes measures such as utilization, demographics, referral types, primary diagnosis/reason for visit, and risk status.

Disease Management

Disease Management initiatives are supported through self-care assistance, on-site clinics, and through a provider who assists with identification of candidates, asthma education, and a toll-free hotline. Disease state management programs being phased in this year include: depression in the workplace, diabetes, and migraines.

Wise Consumerism/Self Care

Wise health consumerism and self-care initiatives are integrated with seminars, and are supplemented through a patient "ombudsperson" program staffed by clinicians from the on-site clinics.

Other Initiatives

• Interactive kiosks with self-monitoring observance of national health events
• Public awareness campaigns
• Community involvement;
• Screening coverage through the medical plan (employees and dependents)
• Smoke-free facilities
• Seat belt use promotion through benefit design

Pitney Bowes Medical/Wellness Program Concept

Pitney Bowes has developed an integrated health care strategy that consists of three major building blocks: Education, Efficiency, and Employer design. Pitney Bowes goal is to Educate the health care consumers to effect more Efficient utilization and purchasing. It will provide Employer support and guidance for these objectives internally and externally through plan design, programming and support of internal and community health care resources. This concept is illustrated as a trapezoid that uses the three building blocks to create a stable structure that "bridges" the gap between old paradigms and new benefit and health care approaches.

Pitney Bowes has expanded this strategy into three dimensions that are interlinked to further increase the stability of the structure. These are:

• Demand Management, or a focus on application of health benefits, using education, consumerism, and timely use of appropriate care when necessary.
• Disability Management, or productivity management focused on reestablished or maintaining employees productive employment through the most efficient mix of resources.
• Disease Management/Prevention, or care management that focuses on prevention of disease or slowing of disease progression, efficient treatment as needed, better compliance with care, and promotion of healthy behaviors. Health Care University falls under the Disease Management/prevention umbrella.

Pitney Bowes' Total Integrated Health Care Management strives to impact and improve upon the health status of the employee at all levels of current health and productivity.

 

General Information
Program Name	Health Care University
Company Name and Address	Pitney Bowes, Inc.One Elmcroft Rd.Samford, CT 06926-0700
Contact Person	David Hom, Executive Director of BenefitsKathleen O'Donnell, M.D., Director of Clinical ServicesDavid Tucker, Director, Health Care Planning
Program Information
Program Category	Worksite, Chronic Disease
Year begun	1993
Total number of individual participants	560
Number of currently actively enrolled	156
Number of companies/groups involved	6
Access to Program	Marketed broadly, replicated
Cost per participant per year	$87
Estimated cost savings per participant per year	$245 (net = $158)
Data available to external reviewers or investigators	Yes
Program targeted at Healthy People 2000 goals	Yes
Program goals (in priority order)	(1) Health outcome improvement(2) Cost-benefit(3) Risk factor reduction(4) Cost-effectiveness

Highlights of Program Results

Significant investment in integrated data systems and analysis enables Pitney Bowes to target resources, and monitor progress effectively. The analysis:

• Uses on-line, individual-level data including three years of medical claim, enrollment, and disability experience
• Uses a total episode of care approach to measure provider performance and health status improvement
• Is involved in the creation of a predictive model to identify at-risk individuals at an earlier stage.

To evaluate program results, a longitudinal study was performed of the impact of HCU on participants and non-participants. Health care cost data was integrated with information about HCU program participation. Statistical methods were used to control for differences in the participant and non-participant groups relating to age, sex, and geographic price differences. Participation was measured in several ways: for any HCU program, for all HCU, and programs such as cardiovascular health, psychosocial functioning, etc.

Results - HCU

Participation in the HCU program is approximately one-third of eligible employees. Data analysis shows that HCU participants had significantly less growth in health care costs over time than non-participants. After controlling for age, sex, and geographical cost differences, HCU participants had significantly lower covered expenses than non-participants. In 1995, actual covered expenses were seven percent higher in the non-participant group: $2,317 compared to $2,173. Even more important, the trend for participants showed an actual decrease of five percent over the three years of the study. Non-participants showed a two percent increase in costs. This analysis yielded a 2.8 to 1 cost savings for HCU.

Self Care Program

The self care program uses the Take Care of Yourself guide to self care with an educational session. Data analysis shows that Self Care participants had significantly lower levels of emergency room utilization compared to non-participants. Participants averaged less then 0.1 emergency visits per year, while non-participants averaged over 0.2 visits. Based on this analysis, the Self Care program yielded a three to one savings.

Self Care participants maintained the same number of planned professional visits as non-participants, indicating that the level of access to appropriate primary care was being achieved.

Fitness Center

Pre- and post-participation comparison of on-site fitness center members showed that they have:

• Fewer sick days (47 percent less)
• Reduced smoking prevalence (10 percent reduction)
• Better fitness status (20 percent of participants improved)

In addition, 20 percent of participants report improved nutritional habits and 50 percent report increased work productivity.

Ergonomics

The Corporate Ergonomics Management Group demonstrated a 5:1 ROI ratio and net savings of $2.1 million through accident avoidance, reduced workers compensation and increased productivity. This program used ergonomic review, education, and reconfiguration of workspace to achieve better safety and efficiency. Program expenses of $545,470 were offset by savings of:

• $834,219 for increased efficiency, reduction of work space
• $1,869,911 from avoidance of major injuries

In addition to the above figures, savings from ergonomics are reflected in the $700,000 reduction in Workers' Compensation insurance claims for 1995 and in the reduction in Pitney Bowes insurance experience modifier. Communication and trust between management and employees have also improved since the program's inception.

Disease Management - Asthma

The Asthma monitoring program was piloted in September of 1995 and focuses on education regarding self-management and routine at the worksite. The first step in this process was a mail survey sent to 5,000 employees with a cash incentive for completion. Candidates were identified based on severity, health resource use, and desire to participate. Six-month results show:

• Peak flow values improved by 13 percent
• Quality of life scores significantly improved
• Emergency room and unplanned doctor visits were reduced
• Self-reported productivity improved

Planned doctor visits increased during the study period, indicating better compliance, access to appropriate care, and symptom control versus acute episode occurrence.

Future Study Direction

Pitney Bowes plans to continue integrated analysis of its health management initiatives which will allow Pitney Bowes to make fact-based decisions regarding program evolution and development. Additional data sources under consideration include satisfaction, expanded health status and quality of life measures. Wherever possible, Pitney Bowes will strive to incorporate recognized, standardized measures to facilitate comparison to national and regional normative data.

A pilot Health Risk appraisal that was administered in one location will be offered to all employees in the near future. Data will be used to assist with targeting preventive care initiatives. In addition, disease state management offerings will be expanded: programs addressing depression in the workplace, diabetes, and migraines are being phased in this year. Data gathered from these programs will be integrated for analysis of impact and outcomes.

HCU Evaluation Methodology and Data Analysis Findings

The evaluation of the effectiveness of Pitney Bowes' HCU focused on two questions:

1. Did participants in HCU have significantly lower health care costs than non-participants?
2. Did participants use health care services more appropriately?

These questions were tested using a pre- and post- comparison group design. The pre (or baseline) period was July 1992 - June 1993. The post (or implementation) period extended from July 1993 - December 1995.

Multivariate statistical techniques controlled for differences in the participant and non-participant groups. Differences that were controlled for included age, sex, health plan coverage, and regional price differences.

The health care cost measures that were analyzed included:

Total covered charges:

• Covered charges related to circulatory disorders
• Covered charges related to mental health/chemical dependency
• Covered charges for non-emergency professional services
• Covered charges for emergency room services

The utilization measures studied were:

• Non-emergency professional services
• Emergency room services

• Pitney-Bowes - Health Care University

The following assessment of program strengths and weaknesses has been abstracted from reviews by the Task Force on Program Selection of The Health Project. Where weaknesses are postulated, it must be taken into account that the review Task Force is very critical, that no programs are perfect, that the Award Winning programs have been selected from over 300 candidate programs and represent the very best, that the materials reviewed may have been incomplete, that suggested deficiencies may have resulted from incomplete understanding of the program by the reviewers or that any problems may have been corrected since the time of review.

Evaluation

Pitney Bowes Health Care University bridges a prior patchwork of programs for 5,000 employees to an advanced disability and disease management structure being extended to 23,000 employees worldwide. Results to date include a 5 percent reduction in health care costs over three years, emergency visits by participants down by half, substantially lower sick days and much higher productivity by participants and an ergonomics program that demonstrates 5 to 1 return on investment.

Use of data analysis systems to evaluate health care claims cost and utilization for the program, controlling for differences between participants and non-participants, with 7 percent lower covered expenses in participants and a decrease in emergency room visits for the self-care program. This is an integrated program with many components. Cost-savings are 2.8 to 1 with $245 saved for $87 spent. The savings from Take Care of Yourself are 3 to 1 counting only emergency room visits. Utilizes a $25 incentive payment effectively. Program targets demand management, disability management, and disease management-prevention. There are ongoing research studies and a solid approach to measurement.

PSA screening of asymptomatic men is not recommended by most preventive services analyses. Little longitudinal data is presented here. The participant versus non-participant study design is not the strongest possible and participation is only 1/3. The program should be extended to dependents.