Healthcare For Corporations

Approaches to 21st Century Employee Healthcare for Corporations The following posts are comprised of a research paper I had to do. It focuses on the American healthcare dilemma and a possible way to reduce exploding healthcare costs. All references will be posted with the last post in this series. Part 1: Introduction Part 2: Teaching People to be Well Part 3: A Successful Model of a Wellness Program Part 4: Creating a Culture of Wellness, the Long Term Return On Investment? Part 5: What Could a Wellness Program for your Company Look Like? Part 6: References I Introduction We are experiencing a wellness crisis. Ours is a culture that looks at health through the focus of disease management rather than teaching the fundamentals of healthy living. This culture led to obscene health care costs as it promoted unhealthy lifestyles with immediate gratification, a pill for every ill, the quick fix. The consumption of chemical laden foods, toxic products by way of slick media advertising, and a lack of physical activity are followed by a rapidly deteriorating level of public health. Epidemic levels of obesity, diabetes, and heart disease are the results (Strohecker, 2005). As employee healthcare costs for corporation of any size continue to climb, management can no longer ignore and be retroactively active to rising healthcare costs. Executives need to become proactive in considering to establish a viable wellness program for a companies employees. Now is the time for corporations large and small to implement a "Whole Person Wellness Program" for the 21st century pertaining to each and every employee. Spiraling health care costs make it impossible for average families to pay for healthcare. According to the Centers for Medicare and Medicaid Services, national health expenditures rose to about $1.4 trillion in 2001. Roughly 95 percent of this goes to direct medical services (Walker, 2003, p. 1). Very few dollars are devoted to promoting health: just 5 percent is allocated to population wide approaches to health improvement. Clearly, the federal government is totally clueless. Medical insurance premiums continue to rise beyond affordability for the average family, with premiums approaching $1,000 a month (Strohecker, 2005). Families are looking to their employers to provide affordable health insurance. Companies, are struggling to pay employee health benefits. Corporations and employees are on their own. This research paper will present a way out of this dilemma, by showing that some companies use effective approaches to bring "out-of-control" spiraling healthcare costs under control, increasing employee productivity, employee retention, overall job satisfaction, and last but not least, corporate profit. II Teaching People to be Well Dr, Travis, the founder of the first wellness center, which opened its doors in 1975 in California, created the first wellness assessment, the Wellness Inventory. A quote of his: "Wellness is a way of life... a lifestyle you design to achieve your highest potential for well-being (Strohecker, 2005)." Companies are going through great lengths to train employees for the job. They even teach their employees what to say, when and how to say it. Companies train people in every aspect of their job, so they may be able to perform at their greatest potential. But yet, most companies leave it to chance for people to actually adopt a wellness lifestyle, which will allow them to be at their highest potential, all the time. It will become imperative for companies to start educating employees about wellness in order to make any headway toward reducing medical healthcare spending. III A Successful Model of a Wellness Program First, a clear definition of a well established, functioning wellness program needs to be settled on. Well received, functioning programs seem to have one thing in common. The purpose of any wellness program, in any company, is to control and/or prevent at-risk workers from developing chronic diseases stemming from poor nutrition, lack of exercises, high blood pressure, obesity, and stress. Eventually the program should cover disease management of rare chronic conditions. To develop a cost effective wellness program, the needs of the program should be based on employee demographics and medical cost drivers. According to Jack Bastable at CBIZ Inc., who believes that most companies should focus on wellness for all workers rather than disease management for a relative few: "The greatest savings, long term, come from the opportunity to keep people who are healthy from getting sick," he explains. The minimum requirement would be distribution of pamphlets to employees, pointing them to free health information, and host seminars with local health care professionals (Hirschman, 2006).

Moving from a clear definition, design principles of a wellness program need to be focused on. Such an approach was used to develop Fairview Health Services' wellness program. This program won the 2003 C. Everett Koop National Health Award and the 2004 Corporate Health and Productivity Management Award from the Institute for Health and Productivity Management. Fairview is a health services company in Minneapolis, with 200 locations all through Minnesota and employees ranging from six to 3,500 per location. The work force is comprised of 18,000 employees, of whom 13,500 qualify for benefits, which start when an employee works 20 hours or more per week (Institute of Management & Administration, 2006). 1. An Effective Wellness Program Must Use a Population Health-Management Approach We need to consider the Illness/ Wellness continuum and the relationship of Wellness and Treatment Paradigms. The center of the continuum is the neutral point. Moving to the left depicts a state of deteriorating health, up to premature death. Moving to the right of the center indicates increasing levels of health through awareness, education, and growth to a high level of wellness. The treatment paradigm can bring a patient only to the neutral point, where disease symptoms have been alleviated. The wellness paradigm moves to a high level of health from any point on the continuum. This approach will also recognize that people are at varying levels of readiness to change, making multiple strategies necessary. 2. A Wellness Program Needs to be Based on Acceptance of Personal Responsibility. It needs to be strictly voluntary. The wellness program needs to provide tools and opportunities, but needs to be left to each individual employee whether or not to participate and do something with it. 3. The Wellness Program Needs to Develop Trust. The employee needs to trust the company that the information gathered would in fact not be used eventually against the employee, because of the information gathered by the HRA (Health Risk Appraisal). According to Valerie Witt, a benefits specialist at Johnson Memorial Hospital in Franklin, Indiana, it is important to let employees know that their healthcare is important to the company. Barbara Eischen, Fairview's Health Services Director of Health and Benefits Services cites the company's mission statement as a guiding principle: "Enhance the overall health and productivity of Fairview employees and their families." Fairview defines health as social, emotional, spiritual, and physical health and well being, pretty close to the definition of health by the World health Organization. It states, "health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity" (WHO, 1946). In more recent years, this statement has been modified to include the ability to lead a "socially and economically productive life." 4. The Wellness Program Needs to Incorporate Evaluation Considering Leading and Lagging Indicators. Analyzing claims records (medical, workers compensation and disability) and unplanned absences such as sick leave will help discover health hazards, using a health risk appraisal, which is the foundation of developing a great wellness program. 5. The Wellness Program Needs to be Integrated Across Multiple Disciplines. Fairview's program started first with health risk appraisals, awareness (health education) and self care. Then it centered on behavioral changes, lifestyle interventions and health coaches. In 2003 Fairview added disease management of rare chronic diseases. And one year later management of high prevalence chronic conditions with the use of predictive modeling to intervene with health care utilizers. IV Creating a Culture of Wellness, the Long Term Return On Investment? A 2002 study of effective health care cost management through the implementation of a wellness program was conducted by Hocakulah and Joseforsky for a company which they refer to as Crandon Corporation's Elcho division*. Elcho division employs 2,500, mostly hourly, persons. Elcho identifies the following health risk factors: Many of Elcho's employees are at an age when illness and disease develops, the average age is 51 years, 80 percent of the employees are male (Kocakulah & Joseforsky, 2002). Many of Elcho's employees suffer from high blood pressure, high glucose, cardiovascular disease, cancer and obesity. Age is not controllable but all the other factors such as poor nutrition, lack of regular exercise, high blood pressure, and obesity are. Reducing a risk factor will help the employee as well as the company's bottom line. The self funded insurance plan provided by Crandon, brings the average health care cost per employee to $5,200. At the time of the 2002 report, the average employer paid $4,164 per employee in annual health care (Kocakulah & Joseforsky, 2002). Another 1999 study suggests that a direct correlation exists between the number of risk factors an employee possesses and their short-long term healthcare costs. The conclusion of the study cites the possibility of a modifiable healthcare risk lowering healthcare costs in as little

as 18 months (Kocakulah & Joseforsky, 2002). Based on this study, on average, Elcho will have the following population of persons with risk factors: Risk Factor, Percent of Employees, Number of Employees Inadequate Exercise 50% 1,000 High Cholesterol 50% 1,000 HighBlood Pressure 24% 480 Cardiovascular Disease 27% 540 Excessive Levels of Stress 44% 880 Smoking 26% 530 Heavy Drinking 10% 200 Irregular Seat Belt Use 60% 1,200 What is the cost of Elcho's employees risk factors? Elevated health risks almost always translate into expensive medical costs. An employee with a cardiovascular disease factor costs companies 150 percent more than an employee without the disease (Kocakulah & Joseforsky, 2002). Applied to the Elcho model, it is known that the cardiovascular risk factor applies to 540 employees. If this number is accurate, then annual medical costs could possibly increase to $7,800 ($5,200x150 percent) for these employees. The per employee increase would mean an annual healthcare cost for Elcho of $1,404,000 for all 540 employees likely to have the disease. The possible savings are astronomical catching this risk factor early and preventing cardiovascular disease. Another study focused on obesity. An obese employee costs companies 21 percent more in annual medical costs, an employee with high blood pressure costs 12 percent more, and an employee who smokes costs 15 percent more (Kocakulah & Joseforsky, 2002). The individual numbers might not appear large, but applied to 750 or 1000 employees one can see a tremendous opportunity for savings. What are the potential savings for Elcho if these numbers were applied to the risk factors of obesity, high blood pressure, and smoking alone? A staggering potential for a savings of $1,272,960. Another area of potential savings for Elcho is the area of unnecessary medical visits. What if unnecessary medical visits were reduced through demand management for illness/injury? Demand management for illness/injury is defined as the right care at the right time at the right place with the right provider (Institute of Management & Administration, 2006). The researchers concluded that Elcho employees visit a doctors office on average 2.8 times per year. The average cost per visit is $50 and about 25 percent of these visits are unnecessary (Kocakulah & Joseforsky, 2002). If Elcho could eliminate unnecessary doctor visits for the work force of 2,000 it could experience annual savings of $70,000. The same analysis applied to unnecessary ER visits could yield a potential of $130,900 in savings per year. Combined savings could be $200,900 annually by eliminating unnecessary medical visits. This could be achieved by printing brochures at a cost of $3 each with a total cost of $6,000, with guidelines on when and when not to seek the services of a physician. Only 35 to 40 percent of corporations offer a comprehensive wellness program. These companies are finding that health promotion can provide returns on investment in healthcare for employees. With the right wellness program, health claims and absenteeism begin to decline from within four to six months of implementation. (Moskowitz 1999). The company cost for healthcare is reduced by 7 to 9 percent, for companies offering a wellness program than those who do not offer a wellness program (Kocakulah & Joseforsky, 2002). On this basis, Elcho could save $728,000 to $936,000 if all 2000 employees participated. One hundred percent participation is very unlikely though, and even if half the employees participate, a savings of $468,000 could be realized. For Fairview's Wellness programs the numbers are encouraging in a similar fashion. Fairview reports a savings per employee due to their Alive Program of $116 per employee when it started in 2001. By 2003 that savings rose to $464 in medical health care savings per employee per year. Overall Medical expenses per employee went from $4,640 in 1999, almost $1,000 above national health care industry averages, to $6,511 or about $200 per employee below average in 2004. The cost of Fairview's Alive Program is $160 per employee, per year. If disease management is added, which is paid through the health plan, the additional cost is $30 per employee (Institute of Management & Administration, 2006). Research clearly supports that effective wellness programs reduce the number of medical claims, but their benefits are difficult to measure because the costs are difficult to be attributed. For example, if high blood pressure is detected in an employee through a health risk assessment, and the employee starts treatment, a possible cardiac arrest could be prevented from happening. The medical savings, however, are hard to measure because it can not be said with certainty what would have happened had the employee not received early treatment. What research shows is that with minimal investment a company could contribute greatly to employee health and to the company's bottom line. But wellness programs aren't just for big

corporations any more. Among employers from 10 to 499 employees, 41 percent offered at least one disease management program (Hirschman, 2006). To quote David Raccagni, head of Cigna Healthcare: "Care management programs are critical for employers of any size, and the only sustainable way to lower healthcare costs by improving health". V What Could a Wellness Program for YOUR Company Look Like? It becomes apparent that it is up to the employee to make proper lifestyle choices. This does not discount a health plan's obligation to help the employees become responsible healthcare consumers and engage them in their health and wellness (Walker, 2003, p.1). What a companies management can do for its employees to take care of themselves better, is to establish educational programs to assist them in the process. A beginning framework for a well developed wellness program could look like this: Hire a Wellness Coach or Health Coach to help implement: A. Individual Employee Assessment Administration of Health Risk Appraisal through offering screenings for blood pressure, cholesterol, body mass index and other basic risk factors. Self reporting of smoking, exercises and other habits. B. Wellness Coaching Offer wellness coaching to help employees who need assistance and motivation in formulating their personalized wellness action plan. One-on-one consultations to explain results to individuals and suggest changes, such as weight loss or more exercise. C. Establish a Health Coaching Program To motivate and guide lifestyle changes in workers at high risk for chronic conditions. D. Monthly Wellness Workshops Ongoing employee education and motivation through a monthly workshop series covering a series of topics E. Wellness newsletter or e-newsletter Wellness newsletter could be distributed with every pay check. F. Company-Wide Need Assessment Identify company wide wellness needs and design programs accordingly. And lastly, when the employee takes the HRA, they are directed to the right health coach, addressing the employees immediate need in order for them to move down the risk assessment ladder. Your company might not realize the success of Fairview's program which has earned them several national awards. Applying the same potentials of savings as in Crandon's Elcho Division to a company with $2 million in health care expenses, after implementation of a comprehensive wellness program, your company could realize a savings in the range of $140,000 to $180,000 annually. If your company could realize savings comparable to Fairview, based on 700 employees, these cost reductions would amount to between $81,200 and $324,800 per fiscal year. These numbers are very encouraging taking into account that your company will be proactive in management of its health care costs providing future savings, when national health care costs will continue to spin out of control. Employees, once they trust management, will participate in a wellness program, as shown by Fairview's experience, participation went from 56% of employees in 2001, to 86% of employees at the end of 2004. A quote by Mark McConnell, vice president of the employer solution group at American Healthways Inc., a disease management firm based in Nashville, Tennessee, sums up the healthcare crisis employers are facing best: "The cost of doing nothing is much greater than the cost of this wellness program," referring to their recently implemented wellness program. VI References Burns, J (1999).Health promotions produce measurable results. Managed Healthcare. 9, 5.p. 42. Cited in Hirschman, C (2006, May 1). Promoting health. Employee Benefits News. Institute of Management & Administration, (2006).Fairview's wellness program cuts cost, number of high-risk employees. Managing Benefits Plans. i06-04, 1-5. Kocakulah, AuthorM., & Joseforsky, H. (2002). Wellness programs: a remedy for reducing healthcare costs. Hospital Topics. 80, 2, p.26. Moskowitz, D. (1999).The bucks behind the wellness boom. Business and Health. 17, 2, p.43-44. Cited in Kocakulah, AuthorM., & Joseforsky, H. (2002). Wellness programs: a remedy for reducing healthcare costs. Hospital Topics. 80, 2, p.26.

Powell, D. (1999).Characteristics of succesful wellness programs. Employer Benefits Journal. 24, 3, p. 15-21. Cited in Kocakulah, AuthorM., & Joseforsky, H. (2002). Wellness programs: a remedy for reducing healthcare costs. Hospital Topics. 80, 2, p.26. Pronk, N., Goodman, M., O'Connor, P., & Martinson, B. (1999). Relationship between modifiable health risksand short-term healthcare charges. Journal of the American Medical Association. 282:2235, p. 39. Cited in Kocakulah, AuthorM., & Joseforsky, H. (2002). Wellness programs: a remedy for reducing healthcare costs. Hospital Topics. 80, 2, p.26. Strohecker, J (2005).Whole person wellness- a 21st century solution. Total Health. 27, 2, p.54. Strohecker, J (2005).Creating a culture of wellness. Total Health. 27, 3, p.58. Walker, T (2003).The road to wellness is a two-way street. Managed Healthcare Executive. 13, 9, 1. World Health Organization, (2006). What is the WHO definition of health? Retrieved October 21, 2006, from Frequently Asked Questions Web site: http://www.who.int/suggestions/faq/en/