Employers enticed by potential to lower health care spending
By JULIE MINDA
BATON ROUGE, La.
Employers are turning to a health and wellness program from a Catholic health system here to motivate their employees to take control of their health. A health-conscious staff can mean lower health insurance costs and a more productive workforce.
The program called Healthy Lives takes a "relationship-based, holistic approach and is tailored to the individual," said Dr. Stephanie Mills, president and chief executive of Franciscan Health and Wellness. The subsidiary of Baton Rouge-based Franciscan Missionaries of Our Lady Health System developed and runs Healthy Lives. Mills and a colleague will explain how the wellness program can impact population health — and employers' bottom lines — at the 2013 Catholic Health Assembly in June in Anaheim, Calif. Franciscan Health and Wellness analysis shows that over five years, for every $1 a company invests in Healthy Lives, there is the potential for a return of about $4, in terms of reduced spending on health care and reductions in health-related employee absenteeism.
Businesses sign up for Healthy Lives so they can understand, from a company-wide perspective, their employees' health status. Healthy Lives health coaches then work one-on-one with employees — particularly those with health conditions that can take an especially damaging toll physically and financially — to understand their health concerns and to teach employees how to make behavioral changes to improve their conditions.
A plea from business
The Franciscan Missionaries system started Healthy Lives to respond to concerns about the increasing cost of health care, voiced by business leaders in Baton Rouge and in other Louisiana communities served by the four-hospital system. "We heard from the business community, pleading for health care cost reductions" that could lower the cost of insuring employees, said John Finan, the system's president and chief executive.
One of the best ways to help businesses reduce the rate of health insurance cost growth is to help them control their employees' use of expensive health care services — and that requires a plan to keep employees healthier in the first place, said Scott Wester, president and chief executive of the system's Our Lady of the Lake Regional Medical Center in Baton Rouge. Through wellness, prevention and chronic disease management programs, employees can make headway in controlling or preventing chronic conditions. More than 75 percent of health care costs are due to chronic conditions, according to information from the Centers for Disease Control and Prevention.
Mills and a group of colleagues studied different ways to approach employee health management and wellness promotion — including by studying businesses across the U.S. doing this successfully — and learned that the most effective approaches relied on data to "paint a picture" of the employee population's health and to point to targeted interventions that would lead to better health in a particular employee group.
Customized program
Mills and her team developed Healthy Lives and launched it in 2010 with the roughly 14,000 Franciscan Missionaries employees who are on the system's health plan. Last year, Franciscan Health and Wellness began offering Healthy Lives to companies around the U.S. Twenty-seven companies in eight states have contracted for the program. They range from companies with a few dozen employees to businesses employing thousands.
For most clients, Franciscan Health and Wellness staff start with a data crunch, analyzing aggregated, de-identified employee medical claims, pharmacy claims and electronic medical records to develop a profile of the employee population. Healthy Lives staff encourage all employees to fill out a health history form and to take a health screening that includes blood pressure, height, weight and waist size measures as well as a smoking detection test and blood tests for cholesterol and glucose.
Franciscan Health and Wellness provides the employer with a summary report that includes the data analysis and the de-identified health screening information. The Healthy Lives team helps the employer to understand and respond to the warning flags in the report. For example, one Healthy Lives client, an offshore oil drilling company, has a lot of older, male smokers on its payroll, and smokers are costlier to insure than nonsmokers.
Mills said, "We find that employers of every size are really struggling with the insurance premium increases and are looking for assistance with how to stem those costs. Employers feel helpless and unsure of what to do. When we show them the data and help them understand what is driving their costs, they feel empowered and encouraged in knowing that there is something they can do. We help give them the tools for success."
Those tools can include on-site health education programs, health newsletters for employees, webinars on health improvements or — one of the most successful tools — personalized health coaching for employees. Businesses choose whether to offer the coaching to employees. In the case of a company with numerous smokers, for example, smokers may have access to a health coach with expertise in smoking cessation, including with a process called motivational interviewing in which the coach helps the smoker identify practical steps to quitting.
Data from the Franciscan Missionaries system's employee population shows that 80 percent of eligible employees participate in Healthy Lives. Under the program, from 2010 to 2011, there was a 19 percent reduction in hospitalizations, a 7 percent reduction in the length of stay and a 54 percent reduction in readmissions. By combining the Healthy Lives approach with additional initiatives to increase efficiences, the Franciscan Missionaries system managed to reduce its per employee expenses by 20 percent from 2010 to 2011, according to Healthy Lives spokeswoman Nicole Hidalgo.
Behavior change
Key to the Healthy Lives approach is identifying people with high-risk health conditions or unhealthy habits and using evidence-based methods to help them change their behavior or manage their conditions. These conditions can include obesity, diabetes, smoking and high blood pressure.
The Healthy Lives health coaches get in touch — normally by phone, but sometimes in person — with employees with problematic health screening results. Some coaches are based in clients' communities, others work remotely from Baton Rouge.
Melanie Thompson is a nurse and Healthy Lives pregnancy coach. She connects with most of her clients by phone or email, explaining practical steps they can take to promote a healthy pregnancy, including eating right and exercising smartly. She helps them understand their obstetrician's instructions. She counsels on car seats, safe sleeping positions for baby and infant nutrition.
Health coach Claudia Cormier, a registered dietician, counsels Healthy Lives clients on weight loss. She learns their individual motivation for behavior change and then connects those personal drivers to positive change.
Sheila Allgood and Vanessa Barze are using Healthy Lives coaching to stay motivated to achieve healthy weights. The women, who have sedentary desk jobs at the Baton Rouge Orthopedic Clinic, said their health coach Cindy Brizzard provides the heartfelt encouragement and practical advice they need to eat right and exercise.
Allgood had tried dieting many times in the past, but she'd lose interest before making lasting progress. Brizzard suggested the single mother of two rotate new foods — such as a low-fat dressing — into her diet to keep her committed to her goal. Allgood said she thrives on Brizzard's enthusiasm — Brizzard was the first person Allgood called when she got her weight below 200 pounds.
Barze said she struggled to find the time to exercise, until Brizzard convinced her to make exercise a priority. Barze now walks while she waits for her son to finish football practice. And she and Allgood are walking buddies at work.
Barze and Allgood both have dropped dress sizes, results that reinforce their healthy behaviors.
"I wouldn't have done it without Cindy," said Barze.
Allgood said Brizzard "is my inspiration, and she gets as excited as I do about my successes."
Impact of Healthy Lives at Franciscan Missionaries
The Healthy Lives program has had a measurable impact at Franciscan Missionaries of Our Lady Health System. Data analysis has revealed that:
- In 2011, 63 percent of Healthy Lives clients with diabetes exhibited hemoglobin A1C levels below 7 percent, as compared with 4 percent of these members the prior year. Experts recommend the level be below 7 percent for people with a diabetes diagnosis.
- Eighty percent of clients with high blood pressure were compliant with their medication instructions.
- Seventy-six percent of clients with hyperlipidemia were compliant with their medication instructions and about 94 percent received an annual cholesterol measurement.
Also, in a survey conducted in September 2011:
- Ninety percent of clients were satisfied or very satisfied with Healthy Lives.
- Ninety-one percent said the results of their screening encouraged them to make lifestyle changes.
- Eighty-seven percent said they were satisfied or very satisfied with the Healthy Lives health coaching they received.
Copyright © 2013 by the Catholic Health Association of the United States
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