Business Case for Correct Diagnoses and Informed Consumers: A case study

We are facing a growing dilemma in this country. How are we as employers going to provide quality health care for our employees when the costs to do so keep rising at such an alarming rate? According to the most recent survey by the Kaiser Family Foundation, the annual premiums for employer-sponsored health programs increased an average of 6.1 per cent in 2007. While the increase this year is less than we have seen in recent studies, it still is outpacing the rate of inflation which is currently at 2.6 per cent or worker’s earnings which is at 3.7 per cent. In Delaware alone, as an employer, the state’s estimated healthcare expenditures for fiscal year 2008 are $433 million. These facts coupled with the country’s obesity epidemic and rising diabetes and heart disease rates illustrate the need for us to come up with innovative solutions.

In Delaware, our wellness initiatives have been an evolutionary process. We started out small and reviewed the concept and the results of each phase along the way. We embraced a phased in approach by first launching a 100-person test pilot, Health Rewards, in 2003 after looking at successful private sector models. These individuals underwent a health assessment which included a complete health history,

resting and exercise blood pressure, cholesterol level check, body composition and strength testing. Immediate results were given from the screenings that reported high risk conditions that may be present but not yet detected. All participants also received an exercise recommendation to improve physical outcomes in all risk areas. They received feedback and were reassessed after one year.

Our concept for Health Rewards was that participants who were motivated and educated about cardio metabolic risk factors could assume greater responsibility for their own wellness. We wanted to empower our staff to improve their health status by providing them a mechanism to better educate themselves about their own specific risks for the development of cardio metabolic disease. The method we chose to employ was to evaluate, educate, motivate and re-evaluate.

Our test pilot gave us proven results including reductions in hypertension and emergency room visits, which translated into direct savings of more than $62,000. In addition, participants began pursuing a healthier lifestyle as a result of the program. Because of the success of the initial pilot, we broadened the scope and number of participants in subsequent Health Rewards phases.

Guided by the leadership of Governor Ruth Ann Minner and Delaware’s State Employee Benefits Committee, in 2004 Delaware launched the second health awareness pilot, this time to 1,500 state employees. Employees in the expanded Health Awards pilot underwent the same initial health assessment as in the 100-person pilot that included a treadmill stress test, blood pressure check, lipid profile and a weight analysis. Participants were randomized into three intervention groups. Group A had pre and post assessments with fit stops. Group B also had the pre and post assessments with fit stops and a newsletter. Finally, Group C underwent the pre and post assessment with fit stops, plus a $100 financial incentive for achievement or maintenance of five out of six goals.

All employees in the initiative participated in Fit Stops — personalized sessions with exercise physiologists that targeted a specific cardio metabolic risk factor. Results of this program were substantial in cost savings and in improving employee participants’ health and risk factors.

Our latest initiative, known as DelaWELL, starts with a confidential health risk assessment, followed by personalized lifestyle and disease management tools including wellness coaches and an online resource with topics ranging from living with chronic conditions, a drug reference guide, common symptoms for illnesses and diseases, healthy pregnancies, and health tips for men, women, children and older adults.

The program takes a multi-level approach. Those whose health assessment indicates at least two risk factors — such as smoking and obesity — will be eligible to work with a lifestyle coach provided by stayWell Health Management, the St. Paul, Minn.-based company that is administering the program. Those with three or more risk factors will also be eligible for a comprehensive physical examination,

including a stress test that will provide them with detailed information about their health.

The program encourages participants to take a more active role in their health — to become educated and informed consumers on their own personal journeys to wellness. All along, we have encouraged our employees to make the necessary changes to live a more active lifestyle, and our employees are stepping up to that challenge. On May 30, 2007 more than 600 state employees participated in our first ever Governor’s Cup 5K Run/Walk. The interest in the event was so strong that we had to close registrations earlier than expected. A second run/walk was held on October 2, 2007 to accommodate staff that work in the northern county of the state and to allow more people to take part. The run/walks were so successful that we now plan on making them annual events.

In response to the feedback we received from the initial pilot programs, several new and exciting components will be added to the DelaWELL program as of January 15, 2008. First, our state employees told us that they wanted a weight loss component added to the DelaWELL program.

We also learned from our employee feedback that only a small percentage of our participants knew their numbers including their height, weight, blood pressure, cholesterol and blood sugar levels. In response, as of January 15th, the State of Delaware will be offering free biometric health screenings for our employees, pensioners and their dependents at their work locations. The screenings will include height, weight, Body Mass Index, Blood Pressure, Total Cholesterol and HDL and Glucose. A health professional will also review their confidential results and address any questions or concerns they may have. Our employees will now be armed with the information they need to target their risk factors and improve their overall health.

We believe that this new-found knowledge benefits the doctor/patient relationship because participants in the DelaWELL program are more educated about their health than non-participants. Because of our proactive approach to healthcare, our employees are aware of chronic conditions and co-morbidities and are better equipped to help in their diagnosis, treatment, recovery and general medical care. In a nutshell, this program provides our employees an education in wellness which allows them to become better-informed consumers; and better-informed patients will lead to better outcomes in the clinical setting.

Whether we are in the public or private sector, we all face the same challenge of offering quality health benefits for our employees while carefully managing our bottom line. The State of Delaware will not only meet this challenge, but we will continue to lead the way when it comes to successfully controlling the costs associated with health care and promoting the health and wellness of our most valuable asset – our workforce. We know that investing now in the health of our state employees just makes good sense for everyone in Delaware’s future.