Union Pacific Railroad (1997)

Narrative Description of Program

Union Pacific Railroad (UPRR) is a transportation company consisting of 57,000 employees distributed geographically throughout 27 states.  Most employees are mobile, unionized, blue-collar workers.

The Health Promotion Division (HPD) at Union Pacific Railroad (UPRR) has continued to expand by offering more programs and collected more outcome data since receiving the Koop Award in 1994.  Our cardiovascular program highlighted in the 1994 application has been expanded throughout UPRR’s system.  Our data suggest that we are having a positive impact on health and related costs.

During 1995-1996, our efforts focused on further integrating health promotion within our department (Health Services) and company.  For example, our Health Risk Appraisal (HRA) is now offered along with the regulatory testing conducted by Occupational Medicine.  Also, we expanded the use of our system-wide exercise facilities to assist with the Return-to-Work process.  We have two programs focused on our injury or at-risk for injury population.

Two programs have helped us integrate with the Opening Department:  1) physical agility testing (PAT) for new hire employees, and 2) fatigue management.  The HPD assisted in the design of PAT used to hire train service, engineering and some shop craft employees.  Union Pacific Railroad and the industry have supported the need for behavior-based education in combating fatigue for train crews.  Our program and data have helped lead the industry in addressing this issue.

PRECEDE/PROCEED continues to serve as our program planning model.  Using this model has helped us refine our planning by ensuring the new outcome data sets from our lifestyle claims analysis, cardiovascular and fatigue management program, medical quality assurance process, and vocational rehab program are used to better allocate resources.

Union Pacific Railroad (UPRR) has five new outcome data sets since 1994.  Primarily, we demonstrated a decrease in lifestyle related claims over five years.  In 1990, our Lifestyle Claims Analysis (‘how many health care dollars are spent on lifestyle habits?’) revealed that 29% of our claims were related to lifestyle.  The same question was examined in 1995, and these results showed 24% of our claims were related to lifestyle.  In summary, data suggest a 5% reduction in lifestyle related claims over five years, which converts to a $2 million savings in lifestyle related health care costs.  Moreover, it should be noted that the craft with the greatest participation in our programs has the lowest cost per employee related to lifestyle.

Integrating our health promotion program within our Disability Management Department has been one our most successful integration efforts.  We have numerous joint projects underway that incorporate health/fitness into our Return-to-Work process.  The Medical Quality Assurance (MQA) process designed by the disability management group, has demonstrated its success. In short, MAQ applies the best medical practices to our Return-to-Work process.  Over the last eight years, this program has saved physician visits and lost work days.  A program connected to MQA is our vocational rehabilitation program.  Returning injured employees back to meaningful employment is the goal of our vocational program.

An issue receiving increased attention in the transportation industry is fatigue.  Our department conducted a pilot study among trainmen to help them address fatigue by making behavioral lifestyle changes.  Conservatively, the projected benefit:cost ration from this program is $3.23:1.  Due to these results our top management approved the continuation of this program and other fatigue management initiatives.

Project Health Track, our cardiovascular risk reduction program, continues to demonstrate positive results.  Due to positive results reported in 1994, we expanded our program system-wide.  The projected benefit:cost ratio since we began system-wide delivery is reported at $4.53:1.  Other evaluation results from this program are reported on page 6.

• Union Pacific

The company’s PRECEDE/PROCEED model integrates all of its programs and resources to the benefit of each, e.g. the cardiovascular risk reduction program with a benefit to cost ratio of $4.53 for every $1 dollar invested, a fatigue program with savings of some $1.25 million dollars, and lifestyle-related programs with savings of about $2 million dollars yearly.

Specific Review Comments Included:  A comprehensive program with integrated health promotion and disability management.  Innovative methods for fatigue management are included.  The cardiovascular program has been expanded since 1994.  There is a secular trend in decreasing lifestyle claims following onset of these programs.  They make innovative use of regression models to draw inferences regarding causality.  There is substantial progress on integration of health promotion into the company structure.  This application provides some excellent models for what can be achieved by relatively mature employee health promotion programs in large firms.  About 40,000 of the 53,000 member workforce have participated to date.  Return on investment is greater that $2 dollars for every dollar invested.  Cost savings were defined and measured in all projects.  The effectiveness and cost savings data are of excellent overall quality and well documented.  Injury prevention is a central goal for this program. It is integrated with occupational medicine and uses that integration to combine the health risk assessment (HRA) tool with legally required examinations.  They are beginning to partner with managed care plans to avoid duplication.  There is good external evaluation of program results.

A few concerns were voiced: Cost data is based on assumptions and projections rather than direct claims measurements.  The program could benefit from additional emphasis on self-care.