New program helps to control health care costs

With health care costs continuing to rise in this challenging economic environment, it’s more important than ever for municipalities to help employees lead healthier lives and give them the tools to navigate the health care system and better manage health care costs.

The U.S. Centers for Disease Control reports that more than three-quarters of health care costs and productivity losses are related to lifestyle choices. Ninety percent of first-time heart attacks are tied to lifestyle habits like smoking and poor diet, and obesity is directly related to an increased risk of diabetes, heart disease, and joint problems, according to the CDC. Meanwhile, an estimated one-third of all health services provided to patients are unnecessary.

Basic health care education, lifestyle awareness and behavior changes can significantly reduce excess costs and increase productivity.

Over the past year, MIIA Health Benefits Trust in partnership with Blue Cross Blue Shield of Massachusetts, launched a pilot initiative called Well Power in the towns of Amesbury and Danvers.

The premise of Well Power is that the most effective way to contain health care costs is to keep employees and their families healthy and to help them use the health care system efficiently.

Well Power, designed as a model for all municipalities, encompasses customized educational and behavior-change programs, incentives, and benefit design modifications specifically designed for employees and their families.

Data-Driven Program Design
The Well Power model uses health plan claims and other data to identify risk factors and the greatest opportunities for improving health status among a group of employees. By involving unions and management in the pilot program communities, MIIA and Blue Cross identified specific educational and behavior change programs and incentives designed to engage employees in making more effective lifestyle and health care decisions for themselves and their families.

Among the keys to success is the formation of a steering committee, including municipal employees and representatives from MIIA and the health plan provider.

The Steering Committee first looked at the municipality’s health care claims and use history, identifying four major diagnostic categories where use was highest. The committee used this information as the foundation for developing and implementing relevant programs.

In Amesbury, higher-than-average emergency room use was reported, so the goal of reducing ER visits was added as an education area.

The steering committees meet monthly to evaluate employees’ needs and to help shape a culture of wellness.

Implementation
With health care cost drivers and risk behaviors identified, the Well Power program implementation includes the following key elements: communication, incentives and measurement.

• Ongoing and constant communication with employees is essential. A comprehensive campaign to initiate and maintain awareness includes a Well Power website that is updated regularly with program information and health and wellness materials. Kick-off events for employees are followed by email blasts and phone and Televox messaging, as well as posters and flyers at work sites and postcard mailers. In addition, a representative from each municipal department, school, and fire and police department serves on the Well Power committee to facilitate communication among their peers.

• Incentives are used to encourage program participation. For example, employees and their spouses on the Blue Cross plan are eligible to earn $50 gift cards for completing three steps: attending a one-hour consumerism workshop; completing a confidential health assessment (used to help measure and track results); and participating in at least one wellness initiative from a sanctioned list.

• The group’s aggregate data is evaluated to reveal areas of need that are addressed with lifestyle programs. Then, pre- and post-program surveys assess program efficacy, baseline behaviors, topic knowledge, and overall program satisfaction for continual evaluation and refinement.

Program Elements
Municipal employees will take part in several free Well Power programs over the course of three years. These include:

• Confidential Personal Health Assessments: To benchmark their lifestyle behaviors and health status, employees are asked to complete a private, online lifestyle and health assessment. Employees receive a report immediately that lists their health risks and what they can do to reduce them.

• Wise Health Care Consumer workshops: These preliminary sessions educate employees on becoming savvier health care consumers and outline specific actions they can take to save money. It covers preventive health screening guidelines, how to get the most out of a medical visit, and the importance of  identifying a health care proxy. Participants learn the true costs of medical services and how to reduce unnecessary health care use and medical errors, as well as the cost of prescription medication and the role of generics. The programs explore all of the services the health plan offers, including phone and online self-service health resources. Because lifestyle choices play an important role in disease management, the impact of healthy dietary choices, regular exercise, tobacco use cessation, and stress reduction are emphasized.

• Fitness and Wellness Programs: A range of engaging free exercise, nutrition, stress reduction and weight loss activities are offered to employees at convenient times at the workplace. These multi-session behavior change programs are designed to yield measurable results to prevent disease and improve overall health. In Amesbury, a Fit, Fun and Nutritious program combines 45 minutes of aerobic exercise with 45 minutes of nutrition education. After the eight-week program, the average weight loss for the group was nearly 10 pounds, and all participants reported better eating habits and more consistent exercise routines. Web-based workshop alternatives are available for those unable to attend a weekly class, and phone coaching is available to help participants set and meet measurable goals for themselves.

• On-site, Online and Phone Support: Well Power provides convenient support resources to help employees understand their insurance benefits, find programs and doctors, adhere to their goals, and obtain illness counseling from medical professionals. These resources are particularly important for employees with chronic health conditions to help them manage their condition and medications.

Results
The Danvers program only began recently, but Amesbury has seen several results in the first year of its program. Approximately three-quarters of the MIIA/Blue Cross members attended the Wise Health Care Consumer seminar; half completed a confidential health assessment, and about one-third of employees participated in a lifestyle change program. Emergency room visits were reduced by 17.5 percent in one year, resulting in cost avoidance estimated at between $28,250 and $32,500.

The Well Power model may be modified for other municipalities, and the bottom line is clear: better educated health care consumers who work more closely with their primary care providers will make decisions that lead them to high-quality, more cost-effective health care. And a workforce that adopts long-term healthy behaviors is more productive and less costly.

Jayne Schmitz, MPH, is a MIIA Wellness Program Specialist.