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Targeted Disease Program Leaves Employer, Workers Breathing Easier
 

By Kathy Gurchiek  2/12/2008

Transportation company Schneider National Inc. was losing sleep over the safety concerns it had for its employees, especially the 14,200 drivers who travel a total of more than 7 million miles daily.

The drivers—whose average age was 43—had a high incidence of hypertension, diabetes, heart disease and heartburn. In addition, 45 percent of the company’s male drivers and 48 percent of its female drivers were obese with a body mass index of more than 30, recalled Angela Fish, Schneider’s director of benefits.

Fish was among the speakers at the World Congress’ third annual Employer Health & Human Capital Congress in Washington, D.C., in January 2008.

It was evident, Fish said, that Schneider had an unhealthy employee population. Conversations with employees and fatigue-related accidents led the employer to suspect that some drivers had sleep apnea—a breathing disorder whose symptoms include fatigue, sleepiness, and memory and judgment problems.

Sleep apnea puts 28 percent of any commercial driver fleet at risk, according to statistics cited from the Federal Motor Carrier Safety Administration.

More middle-age adults are estimated to have sleep apnea than asthma (6 percent vs. 4.5 percent, respectively), and at least 75 percent go undiagnosed, according to the National Heart, Lung and Blood Institute.

It’s a disorder that Schneider had to educate employees about, Fish said.

What Schneider needed was a disease management program that targeted the unique health care issues of its employees. Its goal, Fish said, was to:

    • Develop and implement objective criteria for screening employees for sleep apnea and have a process for treating it.

    • Reduce preventable accidents.

    • Make a positive impact on its health costs.

    • Improve retention rates.

    • Get employees in compliance with prescribed treatment.

Schneider started with a 36-month pilot program limited to 339 drivers and developed the pilot with Precision Pulmonary Diagnostics. Schneider’s health care provider then helped it with the health care cost analysis, Fish told SHRM Online. The pilot provided disability coverage if needed and a process for monitoring compliance following treatment.

Because its drivers don’t get paid if they’re not on the road, Schneider structured its program so that drivers were routed into one of eight states—that number is expected to increase—where the sleep labs it used were located.

Testing was not to exceed two days, and drivers left with treatment in hand.

The pilot program resulted in a 71 percent accident reduction after treatment, about an 80 percent compliance rate and a 55 percent improved retention rate, according to Fish.

Schneider provides 100 percent coverage of all sleep studies and associated doctors’ fees, Fish said. That includes the Continuous Positive Airway Pressure (CPAP) machine and related equipment for employees diagnosed with sleep apnea.

Although not a cure, the CPAP is worn when sleeping and delivers air into the nasal passageway.

Although Schneider’s specific dollar investment was not available—coverage for initial testing, as well as treatment, were part of Schneider’s preventive care under its medical plan—it saw a return on investment (ROI) of $538 per driver per month over 12 months, Fish said.

That later increased to $700 per driver per month, she added.

Those ROIs are unusually high and not something other organizations should expect, pointed out Regina A. Levin, director of health services research for UnitedHealth Group, Schneider’s health care provider. “They had very sick people,” Levin noted.

The program resulted in a bump up of pharmacy costs—considered a good thing, as it reflects employees becoming compliant with their prescribed treatments. The pharmacy costs are more than offset by reduced hospital and emergency room visits that resulted from workers following their treatments, Denise M. Callari, told SHRM Online following the presentation. Callari, who presented the session with Fish, is vice president of health care strategies for UnitedHealth Group.

Schneider had 3,872 drivers screened in 2007, and a total of 13, 579 drivers screened as of December 2007 since the program began.

More than 1,000 of its other employees also have been tested and treated for the disorder, and 31 percent were diagnosed with severe sleep apnea in 2007. New hires are screened as part of Schneider’s onboarding process.

No program is without its challenges. For Schneider, whose drivers included independent contractors, it included figuring out whom the program covers. Also, given the safety issues for drivers, there was the question of how to deal with employees who do not follow the treatment.

Creating a Program

Fish advised employers looking to implement a program that targets its employees’ unique health care needs to start by:

    • Looking at its employee demographics.

    • Conducting a pilot program.

    • Developing a screening tool.

    • Considering the logistics involved. Schneider, for example, had to find a way to provide screening without impacting its drivers financially.

    • Getting buy-in from senior leaders, including operational and other organizational leaders.

    • Figuring out how to keep employees compliant with their prescribed treatment.

    • Obtaining competitive pricing for necessary testing and treatment.

    • Leveraging the value of employees who undergo the testing and treatment as a way to get other employees on board with the program.

Take a close look at your employee population—the ages, lifestyles and medical claims, Fish advised. Based on your industry, she said, identify “the most impactful actions that you can take.”

Kathy Gurchiek is associate editor for HR News. She can be reached at kgurchiek@shrm.org.

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