Preventing Diabetes in the Workplace: Effects of Coaching and Monetary Incentives.

OBJECTIVE: Prevention of diabetes demonstrated in the diabetes prevention program has not been thoroughly evaluated in workplace settings. METHODS: Glycemic control was assessed by glycated hemoglobin (HbA1c) and its impact on 5-year incidence of diabetes and prediabetes prevalence, in wellness program participants (WPP) of (Group A, with) or (Group B, without) health coaching and monetary incentives. RESULTS: HbA1c fell in Group A WPP (5.52 ±â€Š0.60 vs 5.58 ±â€Š0.36 SD, P = 0.04) as did prediabetes. Incident diabetes was less than expected (24 vs 74, P < 0.001). HbA1c increased in Group B WPP (5.37 ±â€Š0.40 SD vs 5.58 ±â€Š0.54, P < 0.001) and prediabetes increased from 28 to 36 (P < 0.001). CONCLUSIONS: Health coaching and monetary incentives improved glycemic control over 5 years, an improvement not observed in WPP without these interventions.

Nurse practitioner services: three-year impact on health care costs.

OBJECTIVE: In 2005, our initial analysis of the impact on health care costs (HCC) of providing on-site Nurse Practitioner (NP) services showed favorable results. METHODS: We measured the effects of the NP program on HCC in two ways. Method 1 compared actual HCC for 2005 to 2007 versus projected HCC, the latter based on medical payments in 2002 to 2004, before the NP intervention. Method 2 was a microanalytic comparison of the HCC of nine Major Diagnostic Categories responsible for 88.5% of all conditions treated by the NP from July 2005 to December 2006. RESULTS: Annualized cost of the NP program was $124,750. Savings in HCC using the first method were $1,089,466 per year, yielding a benefit-to-cost ratio of 8.7 to 1. Savings in HCC using the second method reflected a ratio of 2.0 to 1. In addition, method 1 reflects HCC savings which may be due to the addition of a 24/7 Nurse Help Line. CONCLUSIONS: This 3-year analysis confirms our preliminary findings that an on-site NP has a favorable benefit-to-cost function. Longer-term analyses are needed to confirm these findings.

A benefit-cost analysis of a worksite nurse practitioner program: first impressions.

OBJECTIVE: This study aimed to assess the initial impact of an on-site nurse practitioner (NP) initiative on the health care costs (HCC) among 4,284 employees and their dependents. METHODS: The authors analyzed HCC by two methods. First, they compared annualized actual values for the first 6 months of the startup year (2004) with those projected for 2004 on the basis of claims paid in 2002 and 2003. Both aggregate and per-individual HCC were used as the basis for comparison. The difference in HCC between projected and observed values for 2004 was defined as the benefit of the NP program. In a second analysis, HCC were calculated using 2003 paid claims for major diagnostic categories (MDC). These HCC were compared with those that would have been incurred had off-site care been used for the (annualized) number of such patients cared for by the NP in 2004 with the same MDC. The cost of the NP program was used as the denominator in calculating the benefit-to-cost ratio using the savings in HCC estimated by the two previously mentioned methods. RESULTS: Annualized cost of the NP program was 82,716 dollars. Savings in HCC using the first method were 1,313,756 dollars per year, yielding a benefit-to-cost ratio of 15 to 1. Using the MDC analysis, the ratio was 2.4 to 1. This difference in ratios between the two estimates may partly be attributable to effects of other initiatives such as the wellness program and the Nurse Health Line. The latter was begun 10 weeks before the NP program, is available at all times, and is intended to minimize the need for workers and families to seek high-cost care at hospital emergency departments. CONCLUSIONS: The first 6 months of a new NP initiative yielded substantial reductions in HCC that warrant further analysis over longer periods of observation. However, the initial estimates may understate the aggregate value of the program because it may also reduce on-site injury and illness patterns and improve productivity, end points that were not assessed in this initial snapshot.