HERO Think Tank

e-newsletter

 

Issue number 2

 

 The HERO Think Tank is a nationwide group of employer and provider members who have taken the lead to create and disseminate national employee health management

policy, strategy, leadership, and infrastructure.

 

 It is recommended this e-newsletter be printed and reviewed at your leisure

 Association Between Nine Quality Components and Superior Worksite Health Management Program Results

 

Paul Terry, PhD, Erin Seaverson, MPH

Jessica Grossmeier, MPH, David Anderson, PhD

An abstract by the authors

 

Background - This study which was a “Fast Track” publication in the June 2008 issue Journal of Occupational and Environmental Medicine demonstrates the value and necessity of best-practice wellness program components to superior program engagement rates and health outcomes.  The study was conducted by researchers at StayWell Health Management.

 

Recognizing an industry need for comparative measures to distinguish quality health management programs, the study defines and compares a set of best-practice versus common-practice wellness programs. Previously published research and measures on the HERO Employee Health Management (EHM) Best Practices Scorecard contributed to the development of the nine quality measures included in the study. This study, however, is the first to systematically test the performance of such components in improving key program results in an applied, hypothesis-testing approach. It was conducted as a demonstration project to test the feasibility of using such measures and paves the way for future industry research.

 

Objectives - The study was designed to better understand the differences in engagement rates and health risk outcomes related to the use of best practices versus common practices in health management program design. A secondary research objective was to better understand the prevalence of best-practice program components across a select sample of organizations. Researchers hypothesized that companies that used a best-practice approach to worksite health management would achieve superior health assessment and health coaching participation and program completion rates when compared to common-practice companies. Further, they hypothesized that these organizations would more effectively reduce health risk levels in their populations when compared to the more common “piecemeal” approach to health management programs.

 

Methods - Based on strict criteria to be included in the study, researchers identified 22 organizations (representing 767,640 eligible employees, spouses and retirees) that ultimately met the selection criteria and comprised the study sample. Researchers first performed a literature review to define the key components, or best practices, of comprehensive health management programs as identified by other published studies. Using a retrospective approach, researchers then assigned the organizations to a “best practice” or “common practice” group based on well-defined criteria that scored the organization on each of the identified nine quality components of a superior program. The study examined group differences in employee health assessment participation rates, health coaching program participation and completion rates, and organizational-level health risk reduction.

 

Results and conclusions - Best-practice organizations achieved higher levels of engagement than common-practice organizations in both health assessment and health coaching programs, demonstrating the contribution of quality program components to superior program engagement rates. Population-level health risk reduction—an important factor in controlling health care costs—was 2.35 times higher among best-practice organizations compared with common-practice organizations.  J Occup Environ Med. 2008:50; 633-641.  The full article is available online at: http://www.joem.org/.

A Revisit with the Compression of Morbidity Paradigm

In 1999, James Fries, MD, Professor of Medicine at the Stanford University Medical Center wrote about the Compression of Morbidity in a former HERO hard copy newsletter called “The Health Promotion Research Advocate”.  In the original report, some of the highlights of Dr. Fries report were:

Because of the importance of this research, we asked Dr. Fries to provide an update on his Compression of Morbidity research and reflect on its potential impact on early retirees and Medicare.  

Compression of Morbidity: 1980-2008 –An Odyssey of Aging

By: James Fries, MD – Professor of Medicine, Stanford University

 

 

I introduced the term ‘Compression of Morbidity’ in 1980 to argue that the dominant aging paradigm of the day, that of ever-lengthening longevity and ever-expanding sickness, could be reversed.  The Compression of Morbidity thesis argued that the onset of chronic illness and disability could be postponed and that this postponement could be greater than increases in longevity, compressing morbidity into a shorter period prior to death.  Or as my mother used to say, “You mean if you get sick later in life you won’t be sick as long?”

What is the Compression of Morbidity? –
Finishing your to mile walk and dropping dead on your front porch, at the age of 93.

The Compression arguments were extremely controversial when introduced.  One difficulty was that there were no longitudinal studies of morbidity, nor definitive data on health trends, and as a result discussions tended to feature heat more than light.  And, old dogmas die hard.  The compression thesis, and I, were critiqued by basic scientists, demographers, gerontologists, career pessimists, and even humanists who worried about ‘blaming the victim’.

Then, with an increasing focus on these issues, studies began to yield data, and three major lines of evidence documenting morbidity compression began to grow.  First, longitudinal studies of disability documented postponement of chronic morbidity onset by 8 to12 years, based on lifestyle changes involving smoking, obesity, and lack of exercise.

Second, national longitudinal surveys of disability, now numbering 16, including the National Long-Term Care Survey and the National Health Interview Survey, began to show age-standardized disability rates declining by about 2 % per year from 1982 through 2004, but mortality rates were declining only 1 % a year.  This is the operational definition of Compression of Morbidity: morbidity rates are falling faster than mortality rates.  Demographers and economists have estimated that, other things remaining equal, a sustained 2 % annual reduction in disability would suffice to keep Medicare solvent through 2050 without increased taxes or decreased benefits.

Finally, multiple randomized controlled trials have now documented that lifestyle-oriented health enhancement programs in seniors could be effective, and the prospect of healthy aging programs has become a real one, backed by a new paradigm that made it possible.  People can change, and can benefit, at any age.  The Senior Risk Reduction Program (SRRP), beginning in late 2007, is a large (85,000 person) randomized controlled trial of selected health enhancement programs in seniors sponsored by Medicare.  It is designed to document improvement in health and reductions in Medicare claims. 

What can Employee Health Management learn from this odyssey?  Changes in paradigms require a lot of patience but they can occur. The senior programs can further open the field.  Many companies have health plans where early retiree health costs are large or even dominant when compared with costs of active workers.  The inflection point where costs begin to rise rapidly is about 55 years of age; the following ten years have high costs to employers from early retirees as well as active workers, and healthier senior programs will be greatly aided by healthier pre-senior programs.  There is already discussion of an eventuality where Medicare and the worksite might combine resources to improve pre-senior health.

 

 

Things You May Like To Know

 

Where is Employee Health Management Heading? – For the past three to four years, there has been near universal agreement that the employee health management (EHM) industry is expanding.  Some are bold enough to suggest that the growth is exponential or even ballistic.  A part of this growth equation is to ask smart questions: How long will this EHM growth cycle continue?  How close are we to having a saturated market?  Is this a bubble that will burst?  One way to address this and similar questions is to take a close look at market penetration, which is another way of asking what percent of employers have comprehensive EHM programs.  The 2004 National Worksite Health Promotion Survey(1) indicates that 6.9% of employers have comprehensive EHM programs.  In considering these data, it is important to remember this study was conducted in 2004, about the same time the current expansion in EHM began.  If it is assumed the percent of employers with comprehensive programs doubled during the past four years, the percent of comprehensive EHM programs would be 13.8% today.  This being the case, what should the target be for the percent of comprehensive programs and percent participation?  According to Healthy People 2010, the goals are for at least 75% of employers to have comprehensive EHM programs and a minimum of 75% employee participation.(2)  Based on this, it can be surmised that the future is bright for the EHM industry and filled with high potential for continued growth.  Source: L. Linnan, M. Bowling, J. Childress, et., al.  Results of the 2004 National Worksite Health Promotion Survey.  Am. J. Public Health.  2008; 98: 1-7.(1)  Healthy People 2010 – CDC Health Resources & Services Administration.  Worksite and Community Based Education.  Selections 7-5 and 7-6.(2)

 

Obesity Cost “U.S.”  Companies as much as $45 Billion a year – Several months ago The Conference Board published a report titled “Weights and Measures: What Employers Should Know About Obesity”.  In the event you are not familiar with the 90 year old Conference Board, they publish the Consumer Confidence Index and the Leading Economic Indicators.  The reports suggest:

 

“Employee’s obesity-related health problems are costing companies billions of dollars ($45 billion) each year in medical coverage and absenteeism.  Employers need to pay attention to the worker’s weight, for the good of the bottom line, as well as the good of employees and society”

 

High lights of the reports suggest: 1) obesity is associated with 36% of the increase in health care cost which exceeds the impact of smoking or problem drinking, 2) while ROI is important, EHM programs may give a company advantages in recruiting and retention, 3) employers need to be aware of the risks of being too intrusive in managing obese employees, against the risks of no management and, 4) communication of employee health management programs is as important as the design of the program….employee input is more important than top-down management input.   Source: Weights and Measures: What Employers Should Know About Obesity; Research Report 1419; The Conference Board

 

Benchmark with the Best – A report in the July, 2008 issue of HR Magazine compared several human resource activities across small companies (50-250 employees) and medium size companies (251-999):

 

-       Percent of employers who pay 100% of employee health care premium.

                               >Small – 40%             Medium – 32%

 

-       Percent that allow employees to telecommunicate at least 20% of the time.

                               >Small – 64%             Medium – 56%

 

-       Percent that allow flex hours at least 20% of the time.

                               >Small – 80%             Medium – 60%

 

-       Percent of companies where top HR professionals report to the CEO.

                              >Small – 82%             Medium – 89%

 

The companies surveyed were those identified by HR Magazine as the 50 Best Small and Medium Size Companies to Work for in America.  Source: HR Magazine; July, 2008; 49

 

No Financial Relief in Sight – Recently, PricewaterhouseCoopers published the results for a survey of more than 500 employers and health care plans, which provided health care of over 11 million individuals.  The survey predicts that health care costs will increase 9.9% in 2008 and 9.6% in 2009.  In regard to employee health management (EHM), the report says, “The workplace is seen as an important focal point for successful prevention strategies and employers are seen as influencing individual behavior.  There is emerging evidence to support this push, and some employers that have instituted wellness and prevention programs have seen clear returns on their investments in terms of improved worker productivity and reduced absenteeism”.  PricewaterhouseCoopers – Healthy Choices, Reining in Costs.  Available at: http://www.pwc.com/.

 

Medicare and Employee Health Management – Speaking before the U.S. Senate Finance Committee, Federal Reserve Chairman Bernanke said that increasing government spending on health care will require cuts in government programs, higher taxes, or wider budget deficits.  According to the article in USA Today, Bernanke said, “This will have effects on interest rates, it will have effects on economic growth, and on stability.” (Editor’s Comment):  Based on such alarming predictions, it is only a matter of time before the federal government understands that one way to control Medicare costs is to fund employee health management, which results in a more healthy working population transitioning into Medicare.  USA Today; June 17, 2008.

“Both in importance and time, health precedes disease.  Therefore, we ought to consider first how health may be preserved, and then how one may best cure disease”.

Galen – 185AD

 

“A person who has health has a thousand wishes, a person who doesn’t, has but one.”

Anonymous

 

 

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