On Target

With healthcare costs only going up, employers are getting aggressive about motivating unhealthy and chronically ill workers to get healthy.

Sunday, September 16, 2012
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By the time John had turned 33 years old, he was roughly 30 pounds overweight. He tried everything from exercising to skipping dessert, but the stubborn pounds refused to disappear.

Last spring, his employer -- Medtronic -- piloted a free, 10-week program for employees based at its Minneapolis headquarters called Wellness Transformation that offered face-to-face coaching services. Employees who needed help with nutrition or exercise, or had serious health issues, completed an application that was reviewed by the company's staff at its on-site wellness center. Sixteen employees were chosen. Each coach monitored four workers. For John, that meant also learning about proper nutrition and getting help designing his weekly exercise routines.

Within six months, John dropped the weight and -- just as important -- developed a healthy diet and lifestyle.

"I feel a lot better about how I look and how my clothes fit," says John, a principle mechanical engineer at Medtronic, a medical technology company. "Everybody learned something and everybody gained some benefit." Including his employer.

Medtronic is not alone. Many companies are now aggressively motivating unhealthy workers -- including those who smoke or are obese or chronically ill -- to participate in wellness programs. Since they typically consume the largest amount of healthcare services and dollars, HR is developing strategies to help unhealthy employees assume responsibility for their own bodies, develop healthy lifestyle habits, make healthy choices and better manage their illnesses. Not surprisingly, as pounds are shed and cholesterol, blood pressure and blood sugar levels drop, so do healthcare costs.

According to the 2011 Gallup-Healthways Well-Being Index, which surveyed nearly 110,000 full-time employees, about 86 percent are above-normal weight or have at least one chronic condition. Workers who are overweight and have three or more chronic health conditions experience 42 unhealthy days per year. One unhealthy day equals .31 actual missed days of work. Collectively, such workers cost American employers $153 billion in lost productivity each year.

At Medtronic, about 95 percent of its 26,000 U.S. employees complete an annual health-risk assessment, says Gen Barron, the company's global wellness consultant.

In addition to the Wellness Transformation program offered twice a year, the company also launched a year-long coaching program in October 2011. It's managed by WebMD, which offers free HRAs, then reviews the results and invites those at-risk to participate.

"About 40 percent of the people who are identified are engaged in health coaching or agree to be coached," says Barron, adding that, in 2006, roughly 60 percent of Medtronic's U.S. workers were low-risk, 36 percent medium-risk and 5 percent high-risk. "It's whole-person coaching . . . . It helps them focus on one area initially, holds them accountable and helps them identify additional resources provided through Medtronic or the local community to help them improve their health."

She says the program is unique because it provides a higher intensity of coaching than traditional programs. It's also the first program launched by WebMD, which targeted obesity since it is a contributing factor to numerous health issues.

However, neither program is promoted as obesity coaching for fear of turning off employees. For example, Barron says, the marketing materials for Wellness Transformation asked employees a series of soft questions, such as whether they were concerned about their health-risk factors or being a positive role model for their family.

But that softer approach may not last. WebMD is piloting the same program with two other employers that have promoted it as a weight-loss program. WebMD is piloting the same program with two other employers that have promoted it as a weight-loss program. If they have higher participation rates, Barron says, HR may remarket the program using a more direct approach.

Although both programs addressed the same health issue -- obesity -- did they have an impact at the self-insured company? Absolutely, Barron says, adding that 85 percent of Medtronic employees are now considered low-risk, 13 percent medium-risk and 2 percent high-risk. What's more, the company has also watched its annual increases for overall healthcare costs drop from double digits to single digits.

Hybrid Programs

While many companies offer employees free HRAs and clinical screenings each year, some have also introduced premium differentials, which decrease healthcare premiums for employees who participate in specific wellness programs, says Cheryl Larson, vice president at the Midwest Business Group on Health in Chicago.

Among the most common are those aimed at smokers. If they participate in a smoking-cessation program at least twice a year, they don't have to pay their premium increase, which could amount to $50 more each month. "Employers are saying, 'We're really serious about this and we'll decrease your annual premiums by $400 to $600 if you don't smoke,' " Larson says. "A lot of employers feel if [employees] are going to use tobacco and [the company] is going to have to pay $2,000 or more a year for their healthcare, [then employees] are going to have to have skin in the game."

During 2011 open enrollment, Highmark Inc., a health insurer based in Pittsburgh, introduced a similar annual program called Tobacco Attestation Incentive Program for its 11,000 eligible U.S. employees, according to Heidi Herald, the company's director of employee wellness and model account strategy.

Employees who smoke, along with their spouse or domestic partner, can reduce their health-insurance premium costs by $150 each month by either attesting to being tobacco-free or engaging in five telephonic coaching sessions with a preferred vendor.

This program and others, such as a self-guided tobacco-cessation program with access to a tobacco-cessation specialist introduced in 2007 and nicotine-replacement therapy offered since 2010, helped the company decrease the number of employees who smoked by 3 percent, from 15.6 percent in 2007 to 12.6 percent in 2011, says Herald.

Other programs focus on out-of-pocket expenses, says Larson. She points to Taking Control of Your Health, a voluntary diabetic program coordinated by MBGH that involves pharmacists who double as diabetic coaches and waiving or lowering participant co-pays for diabetic medications and supplies.

However, AFSCME Council 31 in Chicago implemented an extreme approach. Frustrated with double-digit increases in healthcare expenses, it offered its 155 employees and their spouses a choice in 2007. They could either enroll in the Health Improvement Plan, a rich benefit plan requiring them to sign a contract stating they will try to improve their health, or a standard plan that offers much less in benefits but is more costly. Under HIP, employees' premiums are waived but their spouses pay the equivalent of 1.5 percent of the employee's salary to join the plan. Under the standard plan, each covered adult pays 1.5 percent of the employee's salary to join. Likewise, co-pays, deductibles and annual out-of-pocket limits are much higher than under HIP.

"This is a radical departure," says Hank Scheff, health-improvement-plan administrator at the union. "We had five enrollment meetings up and down the state. [There was much to go over, considering] the employee and spouse can each be in a different plan design." Scheff says HIP enrollment fluctuates between 97 percent and 98 percent of eligible participants. Enrollees must complete an annual HRA and biometric screening, select a primary care doctor so a program nurse can communicate health information to the physician, and participate in programs such as weight loss or smoking cessation, based on their health issues. If they fail to lose weight or stop smoking, for example, they must try again the next year in order to remain eligible for the health plan.

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So far, so good. When compared to 2006 data, Scheff says, the company's healthcare claims dropped an average 10 percent. Since 2008, 47 percent of the 236 adult HIP benefit participants (including retirees, employees and spouses) decreased their weight and body mass index, 73 percent increased their HDL (good cholesterol), 59 percent decreased their LDL (bad cholesterol), 53 percent improved their blood-sugar levels, 46 percent have better blood pressure and 20 out of 30 employees who admitted using tobacco stopped.

"By focusing on health, helping them make better decisions and supporting their changes -- rather than bribing them -- we'll get there faster and deeper," he says, explaining that employee outcomes will be more far-reaching and long-term. "Intrinsic motivation is really what gets people going."

Money Talks

While popular employee programs focus on weight loss or smoking cessation, others target the nation's seventh leading cause of death -- diabetes. An estimated 25 percent of the 6,000 U.S. employees at Freescale Semiconductor are diabetic, says Sandi Tomlinson, global benefits manager at the chip manufacturer based in Austin, Texas.

Two years ago, the company developed "Astonishing Clinical Care," which waives participant co-pays for diabetic medicine for one year. Managed by Aetna, its medical provider, the program also supports a patient-advocate team responsible for outreach activities. Besides Tomlinson, members include medical consultants and representatives from Aetna and Freescale's wellness program, pharmacy and vision-care plans and data-analytics groups.

To qualify, participants must complete two phone sessions with an Aetna nurse within four months of joining. Sixty percent of diabetic employees now participate. Based on initial outcomes, says Tomlinson, the self-insured company will continue the program, targeting the remaining 40 percent of diabetics this year, then employees with cardiovascular disease in 2013.

"Some preliminary data is telling us that we have fewer hospitalizations, fewer visits to the ER, and increased adherence and compliance with medication," she says.

UAP Clinic, which has about 600 employees in clinics throughout Terre Haute, Ind., is also being proactive. In 2010, it began offering individualized benefits for employees with specific illnesses such as congestive heart failure. Their drug co-pays were waived if they used the in-house pharmacy and complied with the organization's new wellness-coaching program, says Jeremy Dix, HR manager at UAP.

In August, the self-insured organization stepped up its efforts by introducing the Integrated Health Advocacy Program, developed by Baravia, Ill.-based Benefit Performance Associates. Based on claims between 2010 and 2011, BPA contacts high-risk employees and offers them a team of experts -- a doctor, nurse and psychologist or social worker -- to help alleviate their healthcare issues at no charge.

While BPA has identified about 35 high-risk employees, Dix will be happy if only seven or eight participate this year. "We want to make sure we do this correctly, hoping to see success before reaching out to a wider audience," he says, adding that, since the coaching program and biometric testing were offered, annual healthcare increases have dropped from nearly 15 percent to under 3 percent.

"[Employers] are hesitant to enforce these types of programs," he says, "because of the initial negative response [from employees about] going through a barrage of testing . . . . But once you weather that storm, it's totally worth it."

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