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Despite relatively low employer adoption, on-site health services are not only highly used by employees, but also are the programs employers believed best achieved their intended results relative to other programs aimed at improving employee health and productivity, according to a survey by consultancy Hewitt Associates.
In contrast, many of the most commonly offered health programs—including health/behavior modification programs and those providing patient education and support—had low participation rates among employees and some of the lowest employer satisfaction levels.
Hewitt's survey of 248 large and mid-size companies found that companies are continuing to invest in the health and productivity of their employees by offering a variety of health-related programs that address the spectrum of health risk—from the healthy to the chronically ill. But many experience low participation and satisfaction levels. For example:
• Nurselines. Despite almost two-thirds of companies (73 percent) offering a nurseline, on average, only 7 percent of employees actually used the program and just 45 percent of employers were satisfied with its results.
• Smoking and weight programs. While more than half of companies offered smoking cessation (54 percent) and weight management (53 percent) programs, less than 5 percent of employees who were eligible for the programs participated in them, and less than half of employers were satisfied with the programs' results.
"Companies have implemented a number of health and wellness programs over the past few years aimed at improving employee health, increasing worker productivity and reducing health care costs, but low participation levels and employer satisfaction rates suggest that many of these initiatives are not resulting in the outcomes employers had expected," says Marie Kobos, leader of Hewitt's health and productivity solutions group.
Companies need to assess their current health initiatives to determine whether the programs they offer are accomplishing their goals, Hewitt advises. In some cases, it may mean discontinuing less effective, less attractive programs and adding ones that improve results and encourage positive behaviors. In other cases, it may mean taking a closer look at how to promote or alter existing health programs so they better meet their intended outcomes."
Risk Identification and Prevention
Beyond those targeting behavior modification and patient support, programs that identify and prevent health risks are among the most frequent types of services offered to employees. While employee participation is high relative to other available health programs, employer satisfaction varies, according to Hewitt's survey.
• Flu shots and biometric screenings. Companies offering flu shots (88 percent) and biometric screenings (37 percent) had better levels of employee participation (30 percent and 34 percent, respectively) than other programs. In addition, flu shots and biometric screenings exhibited higher levels of employer satisfaction (81 percent and 75 percent, respectively).
• Health risk questionnaires (HRQs), offered by more than two-thirds (68 percent) of companies, also had better employee participation rates (30 percent) than most programs, though still poor on average. But unlike flu shots and biometric screenings, less than half (47 percent) of companies offering HRQs said they were satisfied or highly satisfied with the program's results.
"Relatively low participation and variability in employer experiences with HRQs likely contribute to the low rate of employer satisfaction for these programs," says Kathleen Mahieu, a Hewitt senior consultant. "To make these tools more valuable to employers and employees, companies should promote greater participation through incentives that are behavior-changing and attractive to their populations and integrate HRQs with other related health programs such as health improvement coaching and condition management. Requiring employee action will ensure that HRQs not only educate employees about their health risks, but encourage and coach them to change overall behaviors to improve their health."
Disease Management Programs
According to Hewitt's research:
• Disease and condition management. More than half (51 percent) of employees or their dependents have a chronic health condition that requires continuing care. As a result, a large majority (74 percent) of surveyed companies offer disease/condition management programs to employees.
• Low participation. Despite the prevalence of these programs, only 10 percent of employees who were eligible to participate did so, and just 39 percent of employers said they were satisfied with program results.
"A major hurdle in maximizing the effectiveness of disease management programs has been engaging those who could most benefit and getting them to change behavior to comply with a course of medical and self-care for their condition," says Mahieu. "In many cases, high touch and face-to-face coaching may be the most effective approaches, but these formats are lacking in current disease management models."
According to Hewitt's study, the factors employers most frequently used to determine the success of their health and productivity programs are:
• Year-over-year changes in overall benefit costs (cited by 89 percent).
• Year-over-year changes in health and prescription drug costs (86 percent).
• Employee participation rates (72 percent).
Very few, however, used formal and comprehensive measurement tools to determine whether these programs achieve their intended results effectively. In fact, less than a quarter (24 percent) used a scorecard system to evaluate or track the level of program participation and compare vendor performance, and less than half (43 percent) received comprehensive engagement and health outcomes reporting regularly from their vendors.
"For most companies, what's missing from their current health and productivity strategy is the ability to measure program performance in actual outcomes, and not just on employer perceptions of the program or employee participation levels," says Elaine Corrough, leader of measurement solutions for Hewitt's health management practice. "Comprehensive analytics that look at medical data, drug compliance and health risk can help companies determine which programs are actually lowering costs and improving employee health."
On-Site Clinics Stand Out
While on-site health care programs have been slow to catch on with employers—likely attributable to the complexities involved in offering them—they are attractive to employees because of their convenience and the level of personal interaction they provide, according to Hewitt.
While just 19 percent of companies offered on-site clinics and 11 percent offered on-site pharmacy services, a quarter of employees used on-site medical clinics when they were made available to them, and half took advantage of on-site pharmacies.
Further, 81 percent of companies that offered on-site clinics said they were satisfied with the results they achieved from the programs, and 95 percent were satisfied with on-site pharmacies.
"One of the benefits to having an on-site health facility,” Mahieu says, “is the ability to coordinate with disease management vendors to provide a convenient place for employees to be counseled and encouraged to follow a treatment and self-care regimen that can prevent future catastrophic illness episodes."
Stephen Miller is an online editor/manager for SHRM.
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