The secret to success in reporting is to tell a credible story about the value of health promotion programs to senior management and other key stakeholders.In 2011 GfK, a leading independent research firm, surveyed benefits decision makers about what they expect from their health promotion programs.1
GfK collected web-based survey responses from 403 people working at companies with at least 3,000 employees. These employers offered disease-management programs for asthma, diabetes, coronary artery disease, or other chronic conditions. They also provided wellness programs including health risk appraisal surveys, biometric screening to gather information about body mass, blood pressure, lipid levels, or blood sugar levels and health coaching programs to help deal with problems in these areas.
About 87% of the survey respondents said it was important to offer a wide range of health-promotion benefits, and 89% said one of their key objectives in doing so was to maximize the productivity of their workforce. Over 80% said their major objectives were to reduce health risks, improve quality of life, and reduce health care costs.
However, more than half said they did not trust the reporting they obtained about these factors.In addition to the trust issue, over 60% of the respondents said getting timely information about program impact on employee health, health care costs, and productivity was a major challenge.
The GfK study made it abundantly clear that employers have difficult objectives to achieve and are unsure about the validity of the measurement strategies their program partners are using to monitor progress. With this in mind, we present an approach to ensure stakeholders have the right information to improve the health and productivity of today's workforce.
A Solid Reporting Process
The ability to manage the health and productivity of the workforce requires information about eight issues:
1. Who You Serve: Major characteristics of the workforce influence health status, health care utilization, quality of life, and productivity. These characteristics include age, gender, worksite location, job type, full-time/part-time status, union/management status, and the types of health plans that are being utilized.
2. The Health Risks They Have: Health risk appraisal (HRA) surveys and biometric tests can provide an understanding of which behavioral health risks are most important. Linking these survey and test results to information about Who You Serve will show how these risks vary for subgroups of employees. This in turn will influence the variety of strategies that may be needed to improve health and productivity for different groups.
Important behavioral health risks include eating, exercise, smoking, drinking, and sleep habits. Key biometric information includes measures of body mass or body fat, blood pressure, blood sugar, and cholesterol levels. This information provides important clues about risks for diabetes, heart disease, stroke, and other major killers.
3. The Health Conditions They Have: Healthcare claims can provide information about the top 10 physical and mental health problems that reduce health care productivity and quality of life, and associated costs. The HRA can provide information about history with these conditions, effects on productivity, treatments that might not be found via analyses of claims, and respondents' willingness to better manage these conditions.
4. Operating Metrics for the Programs Used to Manage These Risks and Conditions: Examples of key program operational metrics include:
a. Engagement rates: How many and what percent of employees qualify for each program? How many of these are contacted about it, and how many of those who are contacted actively participate in each program feature? How do these engagement metrics vary according to the Who You Serve and What Conditions They Have metrics noted above?
b. Methods of engagement: What exactly does engagement entail? Are people engaged via face-to-face contacts, telephone calls, or mailed materials? Are email and text messaging used? What about online services? What triggers these and how often are they used? What operational hiccups occur that might cause unexpected spikes or declines in the use of these technologies? What happens behind the scenes - are frequent referrals to medical doctors, social workers, employee assistance programs, nutritionists, or other professionals required and used?
c. The gaps addressed: It is not possible to address all health risks or manage every chronic condition. Most program providers prioritize these. Which particular risks and issues most heavily influence health and productivity in your population? What is the relationship between methods of engagement and resolution of these, and how do risks and issues change over time? Your reporting should tell you this.
d. When engagement ends, and why: Some people engage until all of their major needs are met, but more likely engagement wanes over time. Some people drop out before reducing all their health risks or closing all relevant care management gaps. Review reasons for case closure and then discuss how to maximize the percentage of people who engage until all major gaps are closed.
5. Quality of Care: Reporting should note what percentages of employees use services in accordance with clinical practice guidelines put forth by the US Preventive Services Task Force3 and major specialty societies. Reports should note how such utilization varies for similar program participants and non-participants, so that stakeholders can estimate the impact of participation on key quality-of-care metrics.
6. Healthcare Utilization and Expenditures: Most care management programs save money by eliminating unnecessary services or reducing risks so that fewer members need emergency room or inpatient services. Also, better management of chronic conditions will increase some types of physician visits and pharmaceutical services but reduce other types, so reporting on inpatient, outpatient, emergency room, pharmacy, and ancillary services should track how these are used and the actual payments to providers for them.
7. Productivity-Related Utilization and Expenditures: Research suggests that the largest savings result from program impacts on the productivity of the workforce.2 Let the reporting entity have access to data about absenteeism, short-term disability program services, or other personal-time-off metrics. Allow these data to be linked to metrics from the Who You Serve, Engagement, Quality of Care, and other sections noted above, so differences in productivity-related services can be tracked periodically for varying levels of program engagement and non-engagement. Also, include presenteeism questions on your health risk appraisal survey, and then link the HRA data to program engagement data, so the reporting strategy can help estimate program impact on productivity at work as well.
8. Access to Care, Health Status, and Program Satisfaction: Supplement the metrics above with periodic surveys about health status, access to program services and providers, and satisfaction with their services. Some of these survey questions will pertain to just the programs and cannot be asked of non-participants, but most questions should be worded in a manner that is pertinent to and identical for people who engage in each health promotion program and similar people who do not. Data for both groups of people allows comparisons to be made, providing information about the relative contribution of program activities to these key outcomes.
How Often Reporting Should Be Conducted
Almost half of the respondents to the GfK survey said they did not receive reporting on medical cost savings and productivity improvements often enough.1 The appropriate time to report the eight categories of information noted above varies by dimension. Information about Who You Serve and The Health Risks and Conditions They Have can usefully be reported annually.
These dimensions will not change much unless your workforce is changing due to frequent mergers or reductions in staff or frequent re-organizations. Quarterly reporting, for a year or two, might be useful if you frequently change program vendors or as program utilization grows over time, because different vendors may focus on different subsets of the population and different programs appeal to different types of people.Information about Operating Metrics should be reviewed at least quarterly, as should most of the Quality of Care, Utilization, Expenditure, and Productivity metrics.
Presenteeism metrics can be reviewed annually, as the HRA survey data are reported. Similarly, information about Access to Care, Health Status and Satisfaction can be reported annually.
Transparency, Accuracy, Credibility, and Brevity
Telling the reporting story in a cohesive and credible way is the single most important issue to confront. It will not matter how well programs work if key stakeholders do not believe the reported results. Disbelief will lead to lower funding, less frequent communication, reduced engagement, and lower effectiveness. Credibility can be enhanced by transparency, accuracy, and collaboration with all major stakeholders.
Finding out which metrics are most important to stakeholders is an early key to success. Agreement on metric definitions, followed by open and periodic reviews of computer code, can assure transparency, consistency and accuracy in reporting. Next, the amount of information needed will depend on the stakeholder. A full examination of all eight areas mentioned above could easily result in hundreds of metrics.
Those who manage the health and productivity of the workforce on a day-to-day basis will need all of these metrics at various times during the year. Those in the C-Suite and on the Board of Directors will have much less time for reporting reviews, however, requiring just a five- or ten-minute overview.
To provide that five- or ten-minute overview, a one-page Key Indicator Report or 'dashboard' can be generated which includes just the top three or so metrics from each of the eight areas mentioned above. These metrics can be provided for the major groups and programs of interest.
Color coding can be used to let stakeholders know if these metrics are within expectation, not within expectation but close, or widely out of the norm. Metrics that are well out of the norm can then be briefly explained. Finally, notions about norms and expectations imply that stakeholders must collaborate to define normality and discuss their expectations.
Some metrics may be deemed so important as to have targets associated with metric values, and contractual performance guarantees that accord with the targets. Other metrics can be tracked over time and discussed as need be, without firm targets or performance guarantees.
Best in class reporting about the health and productivity of your workforce should be timely, accurate, credible, and user-friendly. Focusing on the eight areas mentioned here will provide a complete story about the health and productivity levels and needs of the workforce.
Frequent, ongoing collaborations between employer staff, other key stakeholders, program vendors, and reporting entities will be required to make sure data are accurate and useful.
When that happens, the story that unfolds about the utility of your health and productivity management programs will catch no one by surprise and help you continually enhance the lives of everyone affected.
- GfK Custom Research NA, New York, NY. Third Annual Wellness in the Workplace Study, Sept, 2011.
- Goetzel RZ, Long SR, Ozminkowski RJ, Hawkins K, Wang S, Lynch W. Health, Absence, Disability, and Presenteeism Cost Estimates of Certain Physical and Mental Health Conditions Affecting US Employers. Journal of Occupational and Environmental Medicine, 2004;46,4:398-412
- Agency for Healthcare Research and Quality: The Guide to Clinical Preventive Services. Recommendations of the US Preventive Services Task Force, 2006.
About The Authors
Ronald J. Ozminkowski, Ph.D. Ron Ozminkowski is an economist by training and serves as chief scientific officer at OptumHealth, the health- and wellness-focused business of health services leader Optum. He is an internationally recognized expert in the evaluation of health and productivity management programs and has published extensively on this topic.
Seth Serxner, Ph.D., MPH Seth Serxner is a social scientist by training and serves as chief health officer for OptumHealth, the health- and wellness-focused business of health services company Optum. He is a board member for the C. Everett Koop Health Project and Care Continuum Alliance. He also serves as editorial board member of the American Journal of Health.