Wisconsin Education Association (WEA) Insurance Trust

Narrative Description of Program

The Wisconsin Education Association Insurance Trust (WEA), William M. Mercer, Incorporated (Mercer), and The Center of Corporate Health, Inc. (CCHI) collaborated to assess the impact of The Taking Care "demand management" program on complications of pregnancy, medical care utilization and associated benefit expenses.

The goal of the study was to demonstrate that individuals who are provided with information about self care and healthy pregnancy will use fewer health care services inappropriately and will experience fewer complications of pregnancy than individuals who are not provided with information.

WEA funded and provided staff support for The Taking Care program; CCHI staffed training and communication activities; and Mercer staffed the evaluation of program impact.

The study involved approximately 48,000 people covered by WEA's health benefit plan within 285 school districts throughout Wisconsin. The study employed a pre-to-post design that followed a program group and a control group for a two year period. Stratified sampling with matching was used to assign school districts to the program and control groups based upon geographic location, age-sex composition, and large claims experience. Tests of statistical significance showed that the program and control groups were not different (p<.05) for the selection factors. Program and control group enrollees used health care services that were expected to be impacted by the program at virtually identical rates during the baseline period.

In addition to the basic insurance plan, the program group received three services offered by CCHI - The Taking Care service, a 24-hour telephone-based nurse counseling service, the Take Care of Yourself self-care guide and the Bright Futures maternity education program. The school districts included in the control group received no Taking Care programs.

Demand-Management Programs The Award-Winning Alternative

The WEA Insurance Trust (WEA) insures more than 110,000 school district employees and dependents throughout the state of Wisconsin. Five years ago, in response to rapidly escalating health insurance costs. WEA embarked on a four-pronged plan to keep its premium rates under control without shifting costs to its members.

"Because there is no single factor that contributes to the problem of rising costs, we knew there would be no simple solution," said WEA Insurance President Al Jacobs. "Therefore, we developed programs to reduce administrative costs, medically claims, get discounts from providers and reduce the demand for services."

As part of this plan, WEA went off in search of a program to help with "demand management." In a nutshell, demand management is based on the philosophy that individuals can make better decisions about their own health care if they are provided with adequate, understandable and timely information about their health concerns. The result is less inappropriate care.

"We found the Taking Care Program to be one of those rare programs that delivers more than you even hope for. Our members love it, it is easy to administer and it saves almost five times its cost. Because of the success of the Taking Care pilot program, we will introduce it to all 110,000 members this fall along with plan rates 1 to 2 percent lower than expected."

-Al Jacobs, President

WEA Insurance

With a demand-management program to supplement existing benefit programs, the volume of outpatient visits to doctors and emergency rooms (and thus the corresponding costs) declines because enrollees use services more appropriately.

Jacobs recognized that a demand-management program could be an important answer to WEA's health care concerns. And the one that looked most attractive was the Taking Care Program, winners of the C. Everett Koop National Health Award.

The Taking Care Program: Now You Can Have It All

The Taking Care Program is administered by The Center for Corporate Health, Inc., a company headquartered in Oakton, VA, with more than 10 years of experience in leading the demand-management field. Its innovative Taking Care Program delivers health and medical information in a variety of ways.

At the heart of Taking Care is the Informed Care nurseline, a toll-free 24-hour service staffed by trained nurses each with a minimum of 10 years of experience. Enrollees can speak to a nurse counselor when they have questions about their health, concerns about their current course of care or simply need information on health and wellness issues.

Each enrollee receives the Take Care of Yourself self-care guide. What sets this reference apart is that although it is created by two highly credible physicians, it is written to be understood by those of us who do not have a medical degree. It guides readers in handling more than 100 common medical problems.

Another component of Taking Care Program is the Taking Care newsletter, which focuses on key health messages and cutting-edge developments in health care. Here, respected doctors and public health professionals discuss the pros and cons of fad diets, alternative therapies, national health trends, seasonal health concerns and other timely topics.

In addition, Taking Care can include the Bright Futures maternity education program, which combines focused counseling services and communications materials to achieve healthier outcomes for mother and baby.

While Taking Care seemed to have all the answers, WEA would not roll out the program to all its members until it had objective proof that Taking Care could significantly lower health care costs. So WEA asked William M. Mercer, Inc., an independent consulting firm, to perform a study on the effects of Taking Care on a sample of WEA's membership.

"William M. Mercer, Incorporated has performed many return-on-investment studies for clients. The return that we found for the Taking Care Program was much greater than we expected. Eight of my clients use Taking Care. One of them recently told me that it is the most popular program they have ever provided to employees. Based upon our study, it also appears to be a good investment for my clients."

-Bruce Kelley, Ph.D., Principal,  Benefits Consultant to WEA,  William M. Mercer, Incorporated Taking Care Scores High Marks in Extensive Test

• William M. Mercer's study utilized its CHAMP claims analysis system to conduct the measurement and claims analysis. Mercer ensured the validity of the study by identifying and maintaining key standards.
• Two test groups were compared to a control using a pre-to-post study design encompassing two years worth of claims data.
• The groups were statistically matched on demographics, geography, prior utilization of the targeted services and large claims expenses.
• The sample groups, with approximately 24,000 enrollees per group, were large enough to allow statistically significant comparisons.
• The pre-to-post comparisons were based on utilization rates, specifically, services per 1,000.

Four Areas Where You'll Save

While the rate of increase in inpatient costs in Wisconsin's book of business has slowed in recent years, outpatient services have increased correspondingly. It was clear that a successful program would have to realize cost controls in outpatient services. So the impact of the Taking Care Program on the use of pre-specific outpatient medical care services was measured in four areas:

• Outpatient M.D. medical services (office-based medical visits and services)
• Emergency room services
• Hospital outpatient department services
• Outpatient M.D. surgical services

Study Shows Taking Care Can Save Millions

William M. Mercer was able to report to WEA that Al Jacobs original interest in Taking Care was more than justified. In real dollars, adjusted for inflation, the Mercer study showed that WEA yielded a savings of $4.75 for every dollar invested in the Taking Care Program.

The bottom line for WEA was that it has saved more than $1 million in the test group alone, simply by offering supplemental demand-management program. And that was all the objective proof Al Jacobs needed to recommend Taking Care to the entire WEA Insurance Trust.

Your Results May Be Even More Impressive!

The WEA test group that participated in Mercer's study of Taking Care also had access to the Bright Futures maternity program. Because the Mercer study focused on outpatient utilization, the final results of a return-on-investment (ROI) of $4.75 to $1 did not include the savings earned by Bright Futures.

Cost Savings Taking Care vs. Control Groups

Source: William M. Mercer, Incorporated

But maternity costs were tracked for the duration of the study and the return-on-investment is even more impressive when the Bright Futures program is considered: When pregnancy complications are included. WEA's actual ROI was not $4.75 to $1 - it was $5.46 to $1!

When individuals take advantage of all the information sources available with the Taking Care Program, the sponsoring group can get a $5.46 to $1 return on its investment. Taking Care not only pays for itself, it can actually be used to offset the rising costs of traditional health care programs.

The Best Endorsement

WEA has elected to provide all of its enrollees with the Taking Care Program. Because of the program's success. WEA will introduce plan rates that are 1 to 2 percent lower than expected. WEA Insurance President Al Jacobs expects that the savings will continue to grow as enrollees become accustomed to the benefits of the service.

Taking Care is an absolute success for the enrollees of WEA and for WEA's budget. To find out how Taking Care can help you contact a representative at the phone number below.

Comments from WEA enrollees who called the Taking Care Program's Informed Care nurseline:

• "It's reassuring to know I can call and not have to WAIT to see a doctor."
• "This service is long overdue - Informed Care is wonderful! It's nice to be able to speak with professionals about perplexing medical questions."
• "(Informed Care) saved me from having surgery by a podiatrist."
• "The Informed Care counselor was VERY professional, caring and informative. It's a great and useful service!"

Taking Care Program  The Center for Corporate Health Inc.  10467 White Granite Drive  Suite 300  Oakton, VA 22124  (800) 745-1333  (703) 218-8467 FAX Description of Evaluation Results

The return on investment (ROI) for The Taking Care program group was $4.75 savings for each $1 invested in the program. Program savings were estimated at $46.16 per enrollee per year, and amounted to about $1,158,000 during 1994.

The Taking Care program compared to the control group slowed the rate of increase in every type of health care service (except utilization of outpatient surgical facilities).

The lower rates of increase in utilization of prespecified health care services in the program group as compared to the control group indicates that an inexpensive system of written communication and phone-based counseling can have a substantial impact upon the demand for health care services by employees and their dependents.

The pre-to-post changes in utilization per 1,000 enrollees of each specified health care service was calculated independently for The Taking Care and the control group. The Taking Care group's utilization difference from the control group for each specified service was computed and multiplied by the unit price of each service to convert it to a dollar value. The difference values, or savings were summed across the specified health care services for The Taking Care group to compute total savings.

• Wisconsin Education Association (WEA) Insurance Trust

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

"The Taking Care Program" of the Wisconsin Education Association Insurance Trust (WEA) covering some 285 school districts and 48,000 active participants, returned $4.75 per $1 with 24-hour telephone nurse counseling service, a "Take Care of Yourself" self-care guide and a "Bright Futures" maternity education program. William M. Mercer, Inc. evaluated program impact; The Center for Corporate Health, provided training and communication. Low cost programs were shown most effective for even small groups.

There are good experimental designs which are peer reviewable and decent econometric techniques are used. This is an excellent single risk program with good randomized study. There are good cost-savings but little documentation of health risk reduction. It is a randomized controlled trial of a single program, based upon self-care, decision making, and pregnancy education. The evaluation component is very strong. There is a comprehensive medical self-care component. There are very positive cost-benefit results. The ROI for the Taking Care Program group was $4.75 savings for each $1 invested in the program. Program savings were estimated at $46 per enrollee per year and amounted to over one million dollars during 1994.

It does not address health outcomes associated with less utilization of health care services. Evaluates only short-term impact. Program is focused on medical self-care and does not integrate other components of health promotion. The evaluation should include some mention of data on pregnancy outcomes, neonatal outcomes, number of pregnancy complications or other quality of health care parameters. Reviewers generally would encourage other health promotion program options based on the needs of the population along with an equally strong evaluation component.