How strategizing behavioral change can increase healthcare ROI

WASHINGTON – One employer decided to walk away from the siloed approach to healthcare and instead put in place a program focused on employee behavior change. The result was improved outcomes and a return on investment.

The Northern Arizona Public Employers Benefit Trust went through a nine-month process of researching how they could approach behavioral change and improve access to care. “We didn’t want one or the other,” said Katie Wittekind, wellness manager at NAPEB. “We wanted yes and also.”

Improving access to care is a good thing, but it isn’t the only thing, she said, speaking at the World Health Care Congress on Monday. “We have to think about what changes behavior. If you want to save on costs, we have to take a behavior change approach.”

Wittekind points to three components needed to create true behavior change: quality relationships, an integration of services and company culture.

In 2015, NAPEB partnered with Vera Whole Health, a population healthcare provider for large- and mid-size employers.

“We really ended up falling in love with the Vera model,” she said. “But as you think about whatever approach you take, keep in mind ‘how can I take a more behavior change approach.’”

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Certified nurse practitioner conducts a check-up on a patient at a Community Clinic Inc. health center in Takoma Park, Maryland, U.S. Photographer: Andrew Harrer/Bloomberg

When it came to creating these relationships between employees and their healthcare providers, the quality is much more important than the number of employees you can get to the doctor, she said.

“You’ll likely have someone in leadership that will push back against this concept, as it flies in the face of the traditional business approach of efficiency,” she warned. But if you’re going to consider a behavior change approach, the quality relationship is not just a soft addition, it’s a required part of that model, she added.

Integration is also key, she said. Most employers are used to having a wellness program in place, and a nearby or on-site clinic for primary care, another vendor for biometric screenings and a TPA providing health coaching.

“[It] is not an uncommon thing to have a different vendor for all the services, but the data sharing is a nightmare, not to mention trying to create a cohesive approach toward the health plan,” she said.

If you have a vendor that does it all under one roof, or a data warehouse that collects everything in one place, it’s important employers find a way to integrate them and have them communicating, she said.

Transforming culture is also necessary to help change employee behavior. For example, at NAPEB, they created a whole health council, bringing together employees with feedback from departmental coworkers, offering to help with the marketing and execution of various programs.

As an example, she says the health coach may be utilized by some employees one on one, but that coach may also be brought in to a company meeting to interact with the broader audience, helping to change the culture, she added.

What have the results been like? In the past year, NAPEB has seen a 23% increase in clinic visits and a 63% increase in total primary care among their close to 5,000 employees since before using Vera in 2015.

“And for people who participate in our wellness program, they cost us about $1 million less last year than the people who were not engaged,” she added. For every wellness dollar spent, they got back $1.24, she said of the program’s ROI.

“I think that’s amazing,” she said. But what does she say to the 20,000-staff employer who says the just can’t operate on that kind of level?

“I don’t think you can afford not to,” she said. “Improving access to care is one thing, but if you really want to save money and improve their lives and help people be their best selves, you have to take a behavioral change approach.”

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