Influence of Incentive Design and Organizational Characteristics on Wellness Participation and Health Outcomes.

OBJECTIVE: To explore how changing incentive designs influence wellness participation and health outcomes. METHODS: Aggregated retrospective data were evaluated using cluster analysis to group 174 companies into incentive design types. Numerous statistical models assessed between-group differences in wellness participation, earning incentives, and over-time differences in health outcomes. RESULTS: Four incentive design groups based on requirements for earning incentives were identified. The groups varied in support for and participation in wellness initiatives within each company. All four design types were associated with improved low density lipoprotein (LDL) (P < 0.01), three with improved blood pressure (P < 0.001), and two with improved fasting glucose (P < 0.03). No incentive plan types were associated with improved body mass index (BMI), but designs predominantly focused on health outcomes (eg, Outcomes-Focused) exhibited a significant increase over time in BMI risk. CONCLUSION: Incentive design and organizational characteristics impact population-level participation and health outcomes.

Financial Incentives and Employer-Sponsored Health Activities.

OBJECTIVE: To understand how employer-sponsored incentives and participant-level characteristics drive health activity engagement. METHODS: Multivariable hierarchical logistic regression models evaluated 283,365 individuals eligible for incentives through health savings accounts, health reimbursement accounts, health incentive accounts, gift cards, and other means, and estimated log odds of (1) completing a health survey; (2) participating in a biometric screening; (3) attaining a biometric target; (4) participating in a weight loss program; undergoing (5) breast, (6) colorectal, or (7) cervical cancer screening. RESULTS: Larger incentives were associated with higher odds of participating in biometric screenings only (2% higher for every $25). Obesity, tobacco use, and lack of primary care were associated with lower odds. CONCLUSION: Employers may wish to tailor incentive plans to the unique characteristics and needs of their populations to better drive participation in sponsored health activities.

Incorporating Reporting Efforts to Manage and Improve Health and Wellness Programs.

Wellness programs are designed to help individuals maintain or improve their health. This article describes how a reporting process can be used to help manage and improve a wellness program. Beginning in 2014, a wellness pilot program became available in New Jersey for individuals with an AARP Medicare Supplement Insurance plan insured by UnitedHealthcare Insurance Company. The program has since expanded to include Missouri, Texas, Alabama, and Washington. This wellness program includes an online health portal, one-on-one telephonic coaching, gym membership discounts, and local health events. To assure smooth program operations and alignment with program objectives, weekly and monthly reports are produced. The weekly report includes metrics on member engagement and utilization for the aforementioned 4 program offerings and reports on the last 4 weeks, as well as for the current month and the current year to date. The monthly report includes separate worksheets for each state and a summary worksheet that includes all states combined, and provides metrics on overall engagement as well as utilization of the 4 program components. Although the monthly reports were used to better manage the 4 program offerings, the weekly reports help management to gauge response to program marketing. Reporting can be a data-driven management tool to help manage wellness programs. Reports provide rapid feedback regarding program performance. In contrast, in-depth program evaluations serve a different purpose, such as to report program-related savings, return on investment, or to report other longer term program-related outcomes.

Do workplace health promotion (wellness) programs work?

OBJECTIVE: To respond to the question, "Do workplace health promotion programs work?" METHODS: A compilation of the evidence on workplace programs' effectiveness coupled with recommendations for critical review of outcome studies. Also, reviewed are recent studies questioning the value of workplace programs. RESULTS: Evidence accumulated over the past three decades shows that well-designed and well-executed programs that are founded on evidence-based principles can achieve positive health and financial outcomes. CONCLUSIONS: Employers seeking a program that "works" are urged to consider their goals and whether they have an organizational culture that can facilitate success. Employers who choose to adopt a health promotion program should use best and promising practices to maximize the likelihood of achieving positive results.

Improving employee productivity through improved health.

OBJECTIVE: The objective of this study was to estimate productivity-related savings associated with employee participation in health promotion programs. METHODS: Propensity score weighting and multiple regression techniques were used to estimate savings. These techniques were adjusted for demographic and health status differences between participants who engaged in one or more telephonic health management programs and nonparticipants who were eligible for but did not engage in these programs. RESULTS: Employees who participated in a program and successfully improved their health care or lifestyle showed significant improvements in lost work time. These employees saved an average of $353 per person per year. This reflects about 10.3 hours in additional productive time annually, compared with similar, but nonparticipating employees. CONCLUSIONS: Participating in health promotion programs can help improve productivity levels among employees and save money for their employers.

Effect of an employer-sponsored health and wellness program on medical cost and utilization.

The objective of this study was to examine the impact of PepsiCo's health and wellness program on medical cost and utilization. The authors analyzed health plan and program data of employees and dependents 19-64 years of age, who had 2 years of baseline data (2002 and 2003) and at least 1 year of data from the intervention period (2004 to 2007), resulting in a sample of 55,030 members. Program effects were measured using a difference-in-difference approach based on a multivariate regression model with an individual-level random effect. In its first year, the program was associated with a relative increase in per member per month (PMPM) cost ($66, P<0.01); a relative reduction in PMPM costs of $76 (P<0.01) and $61 (P<0.01) was seen in the second and third year, respectively. Over all 3 years, the program was associated with reduced PMPM costs of $38 (P<0.01), a decrease of 50 emergency room visits per 1000 member years (P<0.01), and a decrease of 16 hospital admissions per 1000 member years (P<0.01). The disease management component reduced PMPM costs by $154 (P<0.01), case management increased PMPM costs by $2795 (P<0.01), but no significant effects were observed for lifestyle management over the 3 intervention years. The implementation of a comprehensive health and wellness program was associated with a cost increase in the first year, followed by a decrease in the following years. These results highlight the importance of taking a long-term perspective when implementing such programs and evaluating their effectiveness.

Do workplace wellness programs reduce medical costs? Evidence from a Fortune 500 company.

The recent passage of the Affordable Care Act has heightened the importance of workplace wellness programs. This paper used administrative data from 2002 to 2007 for PepsiCo's self-insured plan members to evaluate the effect of its wellness program on medical costs and utilization. We used propensity score matching to identify a comparison group who were eligible for the program but did not participate. No significant changes were observed in inpatient admissions, emergency room visits, or per-member per-month (PMPM) costs. The discrepancy between our findings and those of prior studies may be due to the difference in intervention intensity or program implementation.

Medical cost savings for participants and nonparticipants in health risk assessments, lifestyle management, disease management, depression management, and nurseline in a large financial services corporation.

PURPOSE: To compare changes in medical costs between participants and nonparticipants in five different health and productivity management (HPM) programs. DESIGN: Quasi-experimental pre/post intervention study. SETTING: A large financial services corporation. SUBJECTS: A cohort population of employees enrolled in medical plans (n  =  49,723) [corrected]. INTERVENTION: A comprehensive HPM program, which addressed health risks, acute and chronic conditions, and psychosocial disorders from 2005 to 2007. Incentives were used to encourage health risk assessment participation in years 2 and 3. MEASURES: Program participation and medical claims data were collected for members at the end of each program year to assess the change in total costs from the baseline period. Analysis . Multivariate analyses for participation categories were conducted comparing baseline versus program year cost differences, controlling for demographics. RESULTS: All participation categories yielded a lower cost increase compared to nonparticipation and a positive return on investment (ROI) for years 2 and 3, resulting in a 2.45∶1 ROI for the combined program years. CONCLUSION: Medical cost savings exceeded program costs in a wide variety of health and productivity management programs by the second year.

Evaluation of value-based insurance design with a large retail employer.

OBJECTIVES: To measure adherence and assess medical utilization among employees enrolled in a disease management (DM) program offering copayment waivers (value-based insurance design [VBID]). STUDY DESIGN: Retrospective matched case control study. METHODS: Cases were defined as those enrolled in DM, of whom 800 received health education mailings (HEMs) and 476 received telephonic nurse counseling (NC). Controls were eligible for the DM program but did not enroll. Cases and controls were matched 1:1 based on propensity score (n = 2552). Adherence, defined by proportion of days covered, was calculated for 4 diseases using incurred drug claims 1 year before and after the DM program was implemented. Unadjusted and adjusted linear regression compared changes in adherence. Costs and utilization were compared at 1 year and 1.5 years after versus 1 year before implementation. RESULTS: Members receiving NC had improved adherence for antihypertensives, diabetes medications, and statins (ß = 0.050, P = .025; ß = 0.108, P < .001; ß = 0.058, P = .017). Members receiving HEMs had improved adherence only for diabetes medications (ß = 0.052, P = .019). Total healthcare costs for NC members increased by $44 ± $467 versus $1861 ± $401 per member per year (PMPY) for controls (P = .003) at 1.5 years post-implementation. Total healthcare costs for HEM members significantly increased ($1261 ± $199 vs $182 ± $181 PMPY for controls; P < .001) at 1.5 years. CONCLUSION: VBID may be effective in improving medication adherence and reducing total healthcare costs when active counseling is provided to high utilizers of care.

Do employee health management programs work?

Current peer review literature clearly documents the economic return and Return-on-Investment (ROI) for employee health management (EHM) programs. These EHM programs are defined as: health promotion, self-care, disease management, and case management programs. The evaluation literature for the sub-set of health promotion and disease management programs is examined in this article for specific evidence of the level of economic return in medical benefit cost reduction or avoidance. The article identifies the methodological challenges associated with determination of economic return for EHM programs and summarizes the findings from 23 articles that included 120 peer review study results. The article identifies the average ROI and percent health plan cost impact to be expected for both types of EHM programs, the expected time period for its occurrence, and caveats related to its measurement.

Impact of 2 employer-sponsored population health management programs on medical care cost and utilization.

BACKGROUND: Integrated health management programs combining disease prevention and disease management services, although popular with employers, have been insufficiently researched with respect to their effect on costs. OBJECTIVE: To estimate the overall impact of a population health management program and its components on cost and utilization. STUDY DESIGN, SETTING, AND PARTICIPANTS: Observational study of 2 employer-sponsored health management programs involving more than 200,000 health plan members. METHODS: We used claims data for the first program year and the 2 preceding years to calculate cost and utilization metrics, and program activity data to determine program uptake. Using an intent-to-treat approach and regression-based risk adjustment, we estimated whether the program was associated with changes in cost and utilization. Data on program fees were unavailable. RESULTS: Overall, the program was associated with a nonsignificant cost increase of $13.75 per member per month (PMPM). The wellness component alone was associated with a significant increase of $20.14 PMPM. Case and disease management were associated with a significant decrease in hospital admissions of 4 and 1 per 1000 patient-years, respectively. CONCLUSIONS: Our results suggest that the programs did not reduce medical cost in their first year, despite a beneficial effect on hospital admissions. If we had been able to include program fees, it is likely that the overall cost would have increased significantly. Although this study had important limitations, the results suggest that a belief that these programs will save money may be too optimistic and better evaluation is needed.

Testing the DMAA's recommendations for disease management program evaluation.

The objective of this study was to compare and contrast findings regarding the financial savings projections of the disease management (DM) programs of 2 large employers based on different evaluation methods. In particular, this research tests the impact of differences in assumptions on the underlying growth rate of group health costs, exclusions of high-cost conditions and claims, and the length of the baseline period for determined health care costs. A pre-post study design was used. The data for this research came from 2 large employers in the consumer goods industry with comprehensive Health and Productivity Management programs. It contained medical and prescription drug claims and health plan enrollment data as well as program activity data from 2001 to 2005, covering an average yearly sample size of 201,037 members with 12 consecutive months of enrollment. Analyses were done on group-level averages using nominal cost data and were run to reflect the impact of a DM-only intervention. While the trend estimate and length of baseline had the largest effects on estimated program impact, the use of exclusions had an important effect as well. These findings demonstrate the importance of developing and instituting a standardized evaluation methodology. Without increasing consistency in the way evaluators develop their methodologies, it will remain difficult to be able to compare one evaluation to another, or to have faith in the results at hand.

Best practices for an integrated population health management (PHM) program.

Large employers are beginning to create much more robust and potentially effective systems of integrated health management interventions. This organization-wide activity is referred to as a "Population Health Management" (PHM) approach. Best practices are also beginning to emerge in this area, and a number of technical developments are helping shape the patterns of response from innovative employers. This initiative is rapidly emerging as a critical part of overall business and health care strategy.

Building program participation: strategies for recruitment and retention in worksite health promotion programs.

Building program participation is vital for all health promotion programs. There are a large variety of strategies that have been used to enhance recruitment and retention in worksite health promotion programs. Many of these strategies are examined and their significance in the design and operation of health promotion programs in worksite settings is reviewed.