How to make wellness programs really work
In the last decade, many employers enthusiastically turned to employee wellness programs in hopes of reducing the financial burden of healthcare costs. That’s because large employers are major sources of health coverage in the United States. An estimated 153 million people receive health benefits through an employer — more than any other source of coverage. For a self-insured employer with thousands of employees, medical costs can easily reach tens, if not hundreds, of millions of dollars annually.
Unfortunately, evidence that conventional employee wellness programs foster health and lower medical expenditures has been elusive. Many CEOs and chief human resource officers I talk to confess that the results of their employee wellness strategies have often been disappointing. Some even wonder if they are worth the investment.
Is it possible to implement an employee wellness program that lowers healthcare costs and improves employee health? What differentiates a program that works from one that doesn’t?
Five years ago, as a large self-insured employer, Quest Diagnostics confronted these same questions. With about 45,000 employees (most in the United States) and a total population of 60,000 insured lives, our costs had ballooned to approximately $350 million annually, with about $100 million of that borne by employees and their families.
And there was no reason to believe that our annual rate of medical cost inflation — pacing in mid-single digits — would slow anytime soon. We knew we had to do something dramatically different to improve our situation or it could spiral out of control.
Appointed chief medical officer and senior vice president for Quest’s employer wellness and population health services in 2016, I was charged with righting Quest’s employee wellness strategy to foster employee wellness and reduce medical costs. Over the next several months, my team and I assessed the situation and put together a new approach to employee wellness.
We exceeded our expectations. Through a combination of smarter benefits design, vendor management and wellness initiatives, Quest lowered healthcare costs annually for the company and its employees for the first time in more than 10 years. Our annual medical cost inflation rate was negative (-1%) in 2017 and flat (0%) in 2018, versus a high of 6% in recent prior years.
We’ve also seen improvements in other areas, including significant declines in smoking, excessive body weight and markers for Type 2 diabetes in at-risk populations.
Achieving these milestones was not easy and involved comprehensive reform. There are three approaches in particular that stand out for their positive impact — and potential to be replicated by other employers.
Measure, measure, measure. Measurement is the first step in improving population health and achieving your wellness goal, whether it’s better health outcomes or lower healthcare costs. Based on my experience, too, many employers skimp on this crucial step and opt for a bare-bones screening program with measurements like a non-fasting glucose. As a result, these screening programs do not collect quality data, and therefore should not be expected to identify trends and segment populations for appropriate interventions.
A case in point is diabetes screening. Type 2 diabetes is a major health epidemic. About 30.3 million Americans have diabetes, and, according to the CDC, another 84 million have prediabetes and are at risk for Type 2 diabetes but are unaware. In some cases, early detection and lifestyle changes, such as diet and exercise, can reverse or delay disease progression.
A fasting glucose test to identify diabetes risk is a mainstay of employee wellness programs. While it does indeed provide valuable insights, research shows that some people with normal fasting glucose results are still at higher risk for diabetes, and a glycated hemoglobin test may be more reliable at helping identify this risk.
Through Quest’s own Blueprint for Wellness program, Quest uses biometric screening data to assess 47 separate measures of health and wellness, from evidence of tobacco use to indicators of chronic inflammation. We also provide a qualitative health questionnaire that asks the individual about a variety of topics including their quality of diet to sleep health. With these insights, we can parse the data to see which employee groups are in most urgent need of intervention — for prediabetes, for example — and assess risk factors for potential medical conditions like cardiovascular disease, cancer, diabetes and chronic kidney disease.
Additionally, each employee receives a personalized report that details his or her risks and ways to address them.
Through effective identification at Quest, we found that among our population, 89% who had a high risk for chronic kidney disease, 59% who had high cholesterol, and 28% who were at risk for Type 2 diabetes first learned of their health condition through our lab-based wellness screening program. These rates seem remarkably high until one is reminded that as many as one in six individuals in our population claim they do not have a primary care physician.
Accompany the individual on the care journey. It isn’t enough to identify health risks — companies must help employees understand them. Following up on screening results with programs that help the employees access interventions to make lifestyle improvements is crucial to reducing disease risks.
When screening programs identify an individual at risk, additional measures should kick in to connect him to care. Every participant should be eligible to speak confidentially, and at no charge, over the phone, with a board-certified physician about his or her results and what he or she should do next. The physician can recommend follow-up care if the participant had a concerning result value, and even refer the individual to an in-network provider.
Employers also should help at-risk employees access behavioral change programs.
Personalize and promote access. Another lesson is that not every employee’s healthcare and wellness needs are the same. It’s vital to provide solutions for different scenarios and with convenient access to prompt engagement.
Our data found that individuals won’t participate in wellness programs unless they are easily accessible. That’s why Quest now makes wellness screenings available to participants in a variety of settings, ranging from our 2,200 patient service centers, to onsite screening events and at-home testing. As a result, participation levels have increased.
Other important programs employers should consider are telemedicine options, nutrition consults, tobacco cessation programs, second option consults and even access to specialized oncology care. Not every employee needs every program, but employees can choose the one that fits their needs and health goals.
Corporations may not be able to completely prevent all disease risks in their employees’ chronic disease, but they can do more to identify those at risk and intervene to lower medical costs for both the employee and the employer.
Measuring risk and managing populations, connecting at-risk individuals to care and personalizing accessible solutions is critical. When a wellness program takes these factors into account, lower costs and better health outcomes are likely to result.