One of the most overlooked factors of comprehensive benefits plans are programs that help identify and reduce health risks for employees.
Unhealthy employees are expensive. A Gallup poll commissioned in 2011 found that unhealthy, absent American workers cost employers as much as $153 billion per year in lost productivity alone. And though unhealthy employees make up only 20 percent of the population, they account for 80 percent of health care expenditures, per the U.S. Department of Health and Human Services.
If your clients want to reverse the trend of rising health care costs, it’s important to have a health benefits strategy in place that gives unhealthy employees access to low-cost, high-quality care. One of the best ways to do this is implementing an onsite health center using a population health risk management program. Population health looks at all the factors impacting an individual’s health, including genetic predisposition to disease, lifestyle risks such as tobacco use, alcohol and substance abuse, eating habits, and levels of physical activity. It focuses on people with chronic conditions such as diabetes and asthma, and helps them manage their condition, ensuring they are at the standard of care, an important factor in preventing serious and costly complications. Chronic conditions may not seem expensive at first glance, but upon closer examination, the costs add up.
It is widely recognized and documented that hypertension, hyperlipidemia, diabetes, obesity, coronary artery disease, COPD, asthma, smoking, anxiety, and depression are among the most common chronic conditions and risk factors in employee populations. We call this list the “Terrible 10” because of the significant excess costs associated with these conditions and risk factors as compared to people without these conditions.
The most common conditions in the Terrible 10 are obesity and hypertension, which the U.S. Centers for Disease Control and Prevention estimates will affect 31 percent and 32 percent of a given population, respectively. Research done by Integrated Healthcare Information Services and the University of Michigan Health Research Center indicates obesity costs an extra $2,600 per case per year, and hypertension costs approximately $3,800. With a population of 6,000, reducing the number of obesity cases by 10 percent can save an employer of this size almost $500,000 annually. Reducing the number of hypertension cases by 10 percent can save an employer $700,000 annually.
With knowledge of the costs of various health risks and chronic conditions, employers can put worksite health and wellness programs in place to reduce these costly risk factors. But first, employers must be able to identify these risk factors across the population. The best way to do this is by stratifying the risk in the population by analyzing claims data, biometric screening data, and health risk assessment survey results.
Once the risk is stratified, the data can be used to guide outreach that best matches the risk profiles. With a strong, patient-centered electronic health record system, clinicians can set up automatic, prioritized alerts to proactively reach out to individuals with risk factors and chronic conditions. Employers can also provide patients with convenient, up-to-date medical content, interactive wellness tools, and secure messaging for clinical questions, appointment scheduling, and reminders, as well as condition-specific programming and challenges.
Onsite health center clinicians can successfully impact the high risk and chronic population because they have longer appointment times and are not burdened with insurance and administrative overhead. The 30-minute appointment gives clinicians the time necessary to get to root causes and underlying issues, to find out where the patient is on their journey, and to help them take the next step toward better health. Clinicians need this time to help their patients take ownership of their own health and harness their motivation to change. Health coaching, appreciative inquiry, and motivational interviewing are methods that will motivate and guide the individual through improvement cycles that lead to lasting, meaningful, behavior change and improved health.
While the hard work to reduce risks comes from the patient, it is vital to have the right clinician in place who can help guide them along the path to better health. Employers should seek onsite clinicians who are not only experts in the medical field, but who also demonstrate coaching skills and can inspire patients to change the way they think about their own health and health care.
Results-oriented employers now have access to reporting tools that will analyze medical and pharmacy claims data to provide a clear understanding of the impact of an onsite health center and overall program effectiveness of a population health risk management approach. Data collected and reported includes encounters, diagnoses, value of care delivered, and health care costs for engaged versus non-engaged individuals.
When we examine the data from screening employees at an onsite health center for county government employees, it shows a 36 percent reduction in health care costs for employees who utilized the onsite health center versus those who did not. And for employees with chronic conditions, health care costs are cut nearly in half.
A closer look at the data also shows that the individuals who use the health center have a higher illness burden than those who do not. Simply put, the employees who are using the health center are sicker than those that do not. The high utilization rates among the employer’s high-risk population and those with chronic conditions — more than 65 percent utilization — contributed to 78 percent of the employee population making measurable progress on risk reduction. When risks are reduced, claims trends are reversed, and this employer was able to save $2.7 million over three years, a 2.5:1 ROI.
The data shows that it’s not just the healthy population that would take advantage of an onsite health center. The highest engagement comes from the high-risk population, and when their health risks are reduced, savings follow closely behind. But more important, the patients with these risk factors and chronic condition feel better, are more productive, and live happier lives. Managing the Terrible 10 should be the highest employer priority and lower cost, healthier employees will follow.