Improvements in an Organization's Culture of Health Reduces Workers' Health Risk Profile and Health Care Utilization.

OBJECTIVE: To examine changes in internal and external cultures of health scores and relate those changes to employees' health risks, health care utilization, and costs for 21 large employers (N = 641,901). METHODS: We measured the relationship between changes in internal and external culture of health scores and changes in employee health risks, health care utilization, and costs. RESULTS: Improvements in a company's internal culture of health predicted lower levels of obesity, poor diet, and tobacco use but higher stress for employees reporting high baseline risk. For those not at high baseline risk, health improved for depression, alcohol consumption, and diet. Improvements in internal culture of health also led to lower prescription drug utilization. CONCLUSION: Investments in internal culture of health predict improvements in some employee health risks and health care utilization.

The Impact of Worksite Wellness Programs by Size of Business: A 3-Year Longitudinal Study of Participation, Health Benefits, Absenteeism, and Presenteeism.

Objective: Worksite wellness programs (WWP) may positively impact employee health, medical expenditures, absenteeism, and presenteeism. However, there has been little research to assess the benefits of WWP in small businesses. The purpose of this study is to prospectively evaluate changes in health, absenteeism, and presenteeism for employees who participated in a WWP. Methods: We conducted an observational, 3-year cohort study of 5766 employees from 314 businesses of differing sizes. We followed two cohorts of employees, who completed at least two annual health risk assessments (HRA) between May 2010 and December 2014. Changes from baseline to the first and second follow-up periods were assessed for chronic and non-chronic health conditions, absenteeism, and presenteeism. Results: Small business employees were more likely to participate in the WWP than were employees from large businesses. Changes in chronic and non-chronic health conditions varied by size of business, with small business employees showing improvements in stress, overall health, depression, smoking status, vegetable and fruit consumption, and physical activity, and in their perceptions of job health culture. In contrast, large business employees experienced improvements in stress, vegetable consumption, and alcohol use. No changes in absenteeism or presenteeism were observed. Conclusions: Small businesses achieve higher employee participation rates and more health improvements when compared to employees from large employers. Findings suggest that small businesses may gain the most from a WWP.

Reoccurring Injury, Chronic Health Conditions, and Behavioral Health: Gender Differences in the Causes of Workers' Compensation Claims.

OBJECTIVE: The aim of this study was o examine how work and nonwork health-related factors contribute to workers' compensation (WC) claims by gender. METHODS: Workers (N = 16,926) were enrolled in the Pinnacol Assurance Health Risk Management study, a multiyear, longitudinal research program assessing small and medium-sized enterprises in Colorado. Hypotheses were tested using gender-stratified logistic regression models. RESULTS: For both women and men, having incurred a prior WC claim increased the odds of a future claim. The combination of incurring a prior claim and having metabolic health conditions resulted in lower odds of a future claim. Behavioral health risk factors increased the odds of having a claim more so among women than among men. CONCLUSION: This study provides data to support multifactorial injury theories, and the need for injury prevention efforts that consider workplace conditions as well as worker health.

Health risk factors as predictors of workers' compensation claim occurrence and cost.

OBJECTIVE: The objective of this study was to examine the predictive relationships between employee health risk factors (HRFs) and workers' compensation (WC) claim occurrence and costs. METHODS: Logistic regression and generalised linear models were used to estimate the predictive association between HRFs and claim occurrence and cost among a cohort of 16 926 employees from 314 large, medium and small businesses across multiple industries. First, unadjusted (HRFs only) models were estimated, and second, adjusted (HRFs plus demographic and work organisation variables) were estimated. RESULTS: Unadjusted models demonstrated that several HRFs were predictive of WC claim occurrence and cost. After adjusting for demographic and work organisation differences between employees, many of the relationships previously established did not achieve statistical significance. Stress was the only HRF to display a consistent relationship with claim occurrence, though the type of stress mattered. Stress at work was marginally predictive of a higher odds of incurring a WC claim (p<0.10). Stress at home and stress over finances were predictive of higher and lower costs of claims, respectively (p<0.05). CONCLUSIONS: The unadjusted model results indicate that HRFs are predictive of future WC claims. However, the disparate findings between unadjusted and adjusted models indicate that future research is needed to examine the multilevel relationship between employee demographics, organisational factors, HRFs and WC claims.

Economic Impact of Tobacco Price Increases Through Taxation: A Community Guide Systematic Review.

CONTEXT: Tobacco use is a leading cause of preventable death in the U.S. and around the world. Increasing tobacco price through higher taxes is an effective intervention both to reduce tobacco use in the population and generate government revenues. The goal of this paper is to review evidence on the economic impact of tobacco price increases through taxation with a focus on the likely healthcare cost savings and improvements in employee productivity. EVIDENCE ACQUISITION: The search covered studies published in English from January 2000 to July 2012 and included evaluations of national, state, and local policies to increase the price of any type of tobacco product by raising taxes in high-income countries. Economic review methods developed for The Guide to Community Preventive Services were used to screen and abstract included studies. Economic impact estimates were standardized to summarize the available evidence. Analyses were conducted in 2012. EVIDENCE SYNTHESIS: The review included eight modeling studies, with seven providing estimates of the impact on healthcare costs and three providing estimates of the value of productivity gains. Only one study provided an estimate of intervention costs. The economic merit of tobacco product price increases through taxation was determined from the overall body of evidence on per capita annual cost savings from a conservative 20% price increase. CONCLUSIONS: The evidence indicates that interventions that raise the unit price of tobacco products through taxes generate substantial healthcare cost savings and can generate additional gains from improved productivity in the workplace.

Racial and Ethnic Disparities in Health Among Employees at Large Firms.

OBJECTIVES: To determine whether race/ethnic disparities in the prevalence of chronic health conditions exist among an employed population. METHODS: We measured racial and ethnic differences in health across a national sample of workers in 46 large US businesses. We examined 15 chronic conditions for six ethnic/racial groups: African American, Hispanic, white, Asian/Pacific Islander, Native American, and Two or More Races. We identified the presence of each condition, using health care claims data. We report unadjusted and adjusted prevalence statistics for each race and ethnic group, controlling for confounding variables. RESULTS: Native Americans and African Americans had a significantly higher prevalence for almost half of the conditions studied compared to one or more other group. CONCLUSIONS: Employers should be cautious when initiating programs that may unfairly discriminate against employee groups with inherent medical conditions associated with certain race and ethnic groups.

Implementation of a worksite wellness program targeting small businesses: the Pinnacol Assurance health risk management study.

OBJECTIVE: To assess small business adoption and need for a worksite wellness program in a longitudinal study of health risks, productivity, workers' compensation rates, and claims costs. METHODS: Health risk assessment data from 6507 employees in 260 companies were examined. Employer and employee data are reported as frequencies, with means and standard deviations reported when applicable. RESULTS: Of the 260 companies enrolled in the health risk management program, 71% continued more than 1 year, with 97% reporting that worker wellness improves worker safety. Of 6507 participating employees, 34.3% were overweight and 25.6% obese. Approximately one in five participants reported depression. Potentially modifiable conditions affecting 15% or more of enrollees include chronic fatigue, sleeping problems, headaches, arthritis, hypercholesterolemia, and hypertension. CONCLUSIONS: Small businesses are a suitable target for the introduction of health promotion programs.

Estimating the return on investment from a health risk management program offered to small Colorado-based employers.

OBJECTIVE: To determine whether changes in health risks for workers in small businesses can produce medical and productivity cost savings. METHODS: A 1-year pre- and posttest study tracked changes in 10 modifiable health risks for 2458 workers at 121 Colorado businesses that participated in a comprehensive worksite health promotion program. Risk reductions were entered into a return-on-investment (ROI) simulation model. RESULTS: Reductions were recorded in 10 risk factors examined, including obesity (-2.0%), poor eating habits (-5.8%), poor physical activity (-6.5%), tobacco use (-1.3%), high alcohol consumption (-1.7%), high stress (-3.5%), depression (-2.3%), high blood pressure (-0.3%), high total cholesterol (-0.9%), and high blood glucose (-0.2%). The ROI model estimated medical and productivity savings of $2.03 for every $1.00 invested. CONCLUSIONS: Pooled data suggest that small businesses can realize a positive ROI from effective risk reduction programs.

Employers' role in cancer prevention and treatment-developing success metrics for use by the CEO Roundtable on Cancer.

As evidence accumulates on the risk factors for cancer, it is becoming clearer that employers can play a significant role in the fight against the disease by creating a workplace conducive to lowering health risks. The CEO Roundtable on Cancer's CEO Cancer Gold Standard Program defines what companies can do to prevent cancer, detect it early, and ensure access to the best available treatments for those who are afflicted with the disease. This article describes how Johnson & Johnson incorporated the Cancer Gold Standard Program into its existing health promotion initiatives. Then, a framework is proposed that employers can use to monitor progress in cancer prevention and treatment enhancement efforts. Finally, health care eligibility, claims, and health risk assessment data are analyzed to quantify Johnson & Johnson's progress since implementation of the Cancer Gold Standard Program. Companies interested in initiating or furthering their health promotion efforts should consider joining groups such as the CEO Cancer Gold Standard. Collectively, companies have the ability to influence policy makers, payers, and the industry at large in changing behaviors and creating a culture of health and wellness in the fight against cancer.

A descriptive evaluation of CDC's LEAN Works! Leading employees to activity and nutrition--a Web-based employer tool for workplace obesity management.

PURPOSE: The study aim was to determine the utility of and satisfaction with a Centers for Disease Control and Prevention (CDC) Web-based employer tool, CDC's LEAN Works!, which provides evidence-based recommendations and promising practices for obesity prevention and control at worksites. DESIGN: This study examined employers' natural usage (i.e., without any study parameters on how, when, or how much to use the Web site and its resources) and impressions of the Web site. SETTING: Employers of varying sizes, industry types, and levels of maturity in offering obesity management programs and from both private and public sectors were recruited to participate in the study. PARTICIPANTS: A convenience sample of 29 employers enrolled to participate. METHOD: Participants were followed over a 12-month period. First impressions, bimonthly use of the Web site, and final assessments were collected using self-report surveys and individual interviews. Descriptive analyses were conducted. RESULTS: Almost all (96%) of participants reported a positive experience with the Web site, noting it provided a wealth of information. Most reported they planned to continue to use the Web site to develop (77%), implement (92%), and evaluate (85%) their obesity management programs. Aspects of the Web site that employers found valuable included a step-by-step implementation process, templates and toolkits, specific recommendations, and promising practices. CONCLUSION: CDC's LEAN Works! is a useful resource for employers wishing to develop and implement evidence-based workplace obesity prevention programs.

Ten modifiable health risk factors are linked to more than one-fifth of employer-employee health care spending.

An underlying premise of the Affordable Care Act provisions that encourage employers to adopt health promotion programs is an association between workers' modifiable health risks and increased health care costs. Employers, consultants, and vendors have cited risk-cost estimates developed in the 1990s and wondered whether they still hold true. Examining ten of these common health risk factors in a working population, we found that similar relationships between such risks and total medical costs documented in a widely cited study published in 1998 still hold. Based on our sample of 92,486 employees at seven organizations over an average of three years, $82,072,456, or 22.4 percent, of the $366,373,301 spent annually by the seven employers and their employees in the study was attributed to the ten risk factors studied. This amount was similar to almost a quarter of spending linked to risk factors (24.9 percent) in the 1998 study. High risk for depression remained most strongly associated with increased per capita annual medical spending (48 percent, or $2,184, higher). High blood glucose, high blood pressure, and obesity were strongly related to increased health care costs (31.8 percent, 31.6 percent, and 27.4 percent higher, respectively), as were tobacco use, physical inactivity, and high stress. These findings indicate ongoing opportunities for well-designed and properly targeted employer-sponsored health promotion programs to produce substantial savings.

Seven-year trends in employee health habits from a comprehensive workplace health promotion program at Vanderbilt University.

OBJECTIVE: To assess long-term changes in health risks for employees participating in Vanderbilt University's incentive-based worksite wellness program. METHODS: Descriptive longitudinal trends were examined for employees' health risk profiles for the period of 2003 to 2009. RESULTS: The majority of risk factors improved over time with the most consistent change occurring in physical activity. The proportion of employees exercising one or more days per week increased from 72.7% in 2003 to 83.4% in 2009. Positive annual, monotonic changes were also observed in percentage for nonsmokers and seat belt usage. Although the largest improvements occurred between the first two years, improvements continued without significant regression toward baseline. CONCLUSIONS: This 7-year evaluation, with high participation and large sample size, provides robust estimates of health improvements that can be achieved through a voluntary incentive-based wellness program.

Recent experience in health promotion at Johnson & Johnson: lower health spending, strong return on investment.

Johnson & Johnson Family of Companies introduced its worksite health promotion program in 1979. The program evolved and is still in place after more than thirty years. We evaluated the program's effect on employees' health risks and health care costs for the period 2002-08. Measured against similar large companies, Johnson & Johnson experienced average annual growth in total medical spending that was 3.7 percentage points lower. Company employees benefited from meaningful reductions in rates of obesity, high blood pressure, high cholesterol, tobacco use, physical inactivity, and poor nutrition. Average annual per employee savings were $565 in 2009 dollars, producing a return on investment equal to a range of $1.88-$3.92 saved for every dollar spent on the program. Because the vast majority of US adults participate in the workforce, positive effects from similar programs could lead to better health and to savings for the nation as a whole.

The Novartis health index: a method for valuing the economic impact of risk reduction in a workforce.

OBJECTIVES: To develop a calculator that measures the potential cost impact of changes in health risks and presents results graphically. METHODS: Demographic and health risk data for Novartis employees were input into a calculator that estimated employer medical care, short-term disability, absenteeism, and presenteeism costs associated with risk prevalence, based on a previous cross-sectional analysis of the association between risks and costs. Estimated costs were presented as a relative score, the Novartis Health Index, which is a measure of the overall costs associated with the risk profile of a population of interest. RESULTS: The population of Novartis employees had an index score of 81.5 (out of 100), indicating a relatively healthy risk profile, and baseline annual costs of $9619 per employee. Risk reduction of 1% and 10% for tobacco, alcohol use, and emotional health risks had the potential to generate annual savings of $91,500 and $915,000, respectively. CONCLUSIONS: The Novartis Health Index framework allows employers to track performance relative to health risk management using a single, accessible, user-friendly measure.

The relationship between modifiable health risk factors and medical expenditures, absenteeism, short-term disability, and presenteeism among employees at novartis.

OBJECTIVE: To quantify the impact of health risks on medical care and productivity costs in an employed population. METHODS: Health risk, medical care, and productivity data were obtained for 5875 Novartis employees in 2005-2006. Factor analysis was performed to identify relationships among health risks. Multiple regression analyses were applied to estimate relationships between combined risk factors and costs. RESULTS: We found a significant and consistent association among three factors (high biometric laboratory values, cigarette and alcohol use, and poor emotional health) and increased presenteeism for both men and women and increased absenteeism for women. Medical care expenditures were 13-22% higher for men and women at risk for the high biometric laboratory values and the emotional health factor. CONCLUSIONS: There is a potential for medical and productivity savings for employers able to reduce health risks among their workers.

Development of a community-wide cardiovascular risk reduction assessment tool for small rural employers in upstate New York.

Employers are implementing workplace health promotion programs that address modifiable health risk factors such as overweight and obesity, smoking, high blood pressure, high cholesterol, physical inactivity, poor diet, and high stress. Research with large employers has found that these programs can improve workers' health and decrease the costs associated with medical care, absenteeism, and presenteeism. Despite their promise, health promotion programs are not widely embraced by small businesses, especially those in rural communities. This article reviews the barriers encountered by small and rural businesses in implementing health promotion programs. We describe an approach developed in cooperation with the New York State Department of Health's Healthy Heart Program and the Cayuga Community Health Network to engage small businesses in health promotion. We review the development and implementation of an assessment tool created to evaluate current workplace health promotion programs, policies, and practices targeting cardiovascular disease among small, rural employers in upstate New York. Potential benefits of the assessment tool are discussed, and the instrument is made available for the public.

First-year results of an obesity prevention program at The Dow Chemical Company.

OBJECTIVE: To examine first-year results from a workplace environmental obesity prevention program at The Dow Chemical Company. METHODS: A quasi-experimental cohort study was conducted among employees at nine treatment worksites (n = 8013) who received environmental weight management interventions and three control worksites (n = 2269). Changes in employees' weight, body mass index (BMI), and other health risks were examined using chi2 and t-tests. RESULTS: After 1 year, a modest treatment effect was observed for weight and BMI largely because the control group subjects gained weight; however, no effect was observed for overweight and obesity prevalence. Other risk factors (tobacco use, high blood pressure, and systolic and diastolic blood pressure values) decreased significantly, although blood glucose (high risk prevalence and values) increased. CONCLUSIONS: Environmental changes to the workplace can achieve modest improvements in employees' health risks, including weight and BMI measures, in 1 year.

The direct and indirect cost burden of Crohn's disease and ulcerative colitis.

OBJECTIVE: To estimate the direct medical and indirect (absenteeism and short-term disability) cost burden of Crohn's Disease (CD) and Ulcerative Colitis (UC). METHODS: Data were obtained from 1999 to 2005 MarketScan databases. Twelve-month expenditures for patients with CD and UC were compared to expenditures among an equal number of propensity score matched comparison group patients. Regression analysis controlled for demographics and case-mix. RESULTS: Annual medical expenditures were significantly higher for commercially insured CD and UC patients compared to matched comparison group patients ($18,963 vs $5300 for CD patients, $15,020 vs $4982 for UC patients, respectively, all P < 0.001). Indirect costs were also high for employed patients with these conditions. CONCLUSIONS: CD and UC are costly diseases with a significant cost burden related to health care utilization and productivity loss.

Baseline characteristics of workers at ten New York City employers recruited for a private-public research collaborative.

OBJECTIVE: To describe a public-private collaborative and present results from the administration of a baseline health risk assessment (HRA). METHODS: A custom-designed HRA was made available to 31,535 New York workers, and 5539 (17.6%) completed the survey. Data from the HRA were used to present a business case to employers urging them to support health promotion efforts at their worksites. RESULTS: Of these, 78.5% of workers in the sample reported poor eating habits, 39.9% were sedentary, and 62.2% were overweight, obese, or extremely obese; 30.4% had high or borderline-high total cholesterol levels, 24.9% reported high or borderline high blood pressure, and 16.8% reported high or borderline high blood glucose levels; tobacco use rates were relatively low (14.0%). CONCLUSION: Results represent a baseline against which future data for the study cohort will be compared to evaluate the health and financial impacts of engaging employees in workplace health promotion programs.

The impact of rheumatoid arthritis on medical expenditures, absenteeism, and short-term disability benefits.

OBJECTIVES: The objectives of this study were to estimate medical expenditures, absenteeism, and short-term disability costs for workers with rheumatoid arthritis (RA) and to estimate the relative costs of RA over a 12-month period. METHODS: Using data from nine U.S. employers, direct and indirect costs for 8502 workers with RA were compared with costs for a matched group without RA. Regression analyses controlled for factors that were different even after propensity score matching. RESULTS: Average total costs for workers with RA were $4244 (2003 dollars) greater than for workers without RA. RA was the fourth most costly chronic condition per employee compared with cancers, asthma, bipolar disorder, chronic obstructive pulmonary disease, depression, diabetes, heart disease, hypertension, low back disorders, and renal failure. CONCLUSIONS: RA is a costly disorder and merits consideration as interventions are considered to improve workers' health and productivity.