Virtually every large to midsize U.S. employer now offers at least one wellness program. While this focus on improving health and productivity among workers is important, one segment of the employee population might be overlooked—those with chronic conditions such as heart disease and diabetes.
Chronic health conditions account for 83 percent of health care and pharmaceutical costs in the United States. Employees with these conditions cost employers more than $500 billion a year in direct medical spending, and the cost of lost productivity frequently is twice as high as actual medical costs. In addition, unhealthy workers often have higher levels of depression and other co-morbidities and experience higher workers’ compensation costs because it takes them longer to recover from injuries. Improving their health and reducing their future health risks can increase productivity and lower overall health care costs.
Keep in mind that employees with chronic health conditions can represent an organization’s most experienced and valued workers, in part because they might be older, serve in management positions and possess skills that are important to the organization.
Six Steps to Take
In the early 1990s, a new strategy for caring for employees with chronic illnesses emerged—disease management. The basic concept hasn't changed—highly targeted programs aimed at providing education, medical care and drug therapies and support. But a number of innovations, primarily based on technology, benefit integration and care coordination, have entered the picture to ensure better outcomes and controlled costs. The most effective programs to target employees with chronic illnesses will go beyond standard disease management to incorporate the strategies below.
1. Take an assessment
The first, and perhaps most important, step employers can take is to use a health and productivity risk assessment (HPA), which identifies the baseline needs and interests of employees. These surveys are more sophisticated than traditional health risk assessments in that they examine specific factors that affect productivity, including absenteeism and presenteeism—being on the job but performing at sub-standard levels because of conditions such as migraines or illnesses such as asthma and diabetes.
2. Examine the programs offered
A significant benefit of an HPA is that it can reveal the health needs and interests of employees. If a company has a young population, it might not need a chronic disease management program, for example. Instead, the employees might benefit from a maternal health program focused on ensuring healthy pregnancies and providing interventions for expectant mothers at risk. High-risk pregnancies, including conditions that lead to pre-eclampsia, gestational diabetes and preterm labor, can cost $100,000 or more per episode, making early intervention programs well worth the investment.
3. Offer in-home devices and nurse case management
While programs that target the needs of young employees are important, if an employee population is older it might have a high percentage of heart disease, diabetes and other chronic illness. Targeting this group can be challenging because this population historically is difficult to engage. Disease management programs that offer in-home devices and telephonic nurse case management, however, can help to improve levels of engagement by combining cost-effective care options with employee education and support.
4. Encourage collaboration and support of primary care physicians
For any organization seeking to improve the level of engagement in these programs, it’s important to ensure that care is delivered in a way that fosters coordination and collaboration among all health care providers. Employees often have more than one physician, and if they participate in a chronic illness program that includes self-monitoring or at-home monitoring devices, primary care physicians need to be aware of these efforts. In addition, patient care information should be recorded in the employee’s medical record so that all care providers can view that information as needed.
5. Develop complementary and engaging wellness programs
Any program that seeks to improve employee health should incorporate educational offerings for workers. An estimated 63 percent of health care cost increases over the past five years are the result of chronic health conditions, and most of these conditions are a result of employees’ poor lifestyle behaviors. In addition, many employees suffer from co-morbidities such as depression. Educational and personalized support programs can help this population improve their health and wellbeing.
While not all employees with chronic illnesses will join an exercise program, they might be willing to participate in wellness or educational programs that encourage healthier eating and stress reduction. Once they achieve success in such programs, these employees might be more apt to join an exercise program that is designed to meet their needs, interests and limitations. For this reason, it’s important to consider programs that will complement the organization's chronic disease management offerings.
6. Find ways to engage and connect.
The best programs will connect all providers, including physicians, nurse case managers and specialists, and will allow employees to access their personal health record (PHR) information through web portals. Allowing access to PHR data can educate and empower employees about their health. New ways to engage employees, such as social media and game technology, are likely to play a significant role in helping to boost employee participation in wellness programs in the future. To get the most from these efforts, employers should ensure that the programs are fully vetted and integrated with other health programs and that caregivers can access the data from these programs.
The Good News
Finding ways to care for the sickest employees is an important task for employers. A rising number of effective programs and approaches are available to do so. Even small reductions in risk in the sickest populations can produce positive results. A study conducted by Alere Health of more than 90,000 employees across several industries showed that increased involvement in wellness programs among employees with chronic illnesses could save employers more than $100 annually per employee.
Health and wellness programs are effective—even for employees with chronic illnesses. To achieve success, employers must take stock of their goals and the needs of their employees and commit to the steps that will lead to better health for all in the organization.
Scott Schell, MD, is executive vice president and chief clinical officer for Alere Health. He is board-certified in surgical oncology with over 20 years of experience in clinical medicine, research and education.
Treat Depression Along with Chronic Illness for Costs Benefits, SHRM Online Benefits Discipline, November 2011
Chronic Pain Costs U.S. More Than $323 Billion Annually, SHRM Online Benefits Discipline, October 2011
Viewpoint: Avoiding the Chronic Disease Cost Avalanche, SHRM Online Benefits Discipline, September 2011
Lessons from First-Generation Disease Management Programs, SHRM Online Benefits Discipline, September 2011
Digital Health Coaching: Reaching Out to Older Workers, SHRM Online Benefits Discipline, November 2010
Heart Disease Prevention Program Saved Lives, Reduced Cost, SHRM Online Benefits Discipline, November 2010
Managing Diabetes: Incentives and 'Coaches' Improved Health, Lowered Costs, SHRM Online Benefits Discipline, May 2009
SHRM Online Benefits Discipline
SHRM Online Health Care Reform Resource Page