Providing health benefits to employees is expensive, but poor employee health carries a high price, too. Increasingly, employers are moving away from viewing health benefits as a cost of doing business and are seeing it as a strategic investment in their human capital.
Health and worksite wellness programs bring value by helping reduce both direct medical costs and the indirect costs of lower productivity. And like any good investment portfolio, this one should be diversified and tailored to each company's needs and goals. Elements of that portfolio are likely to include reinforcing personal responsibility and moving more healthcare services into the workplace.
Creating a Culture of Health
"We're really looking at the creation of a culture of health," says Dr. Lucy Crane, Corporate Medical Director for Walgreen Co. "We're looking to make our workplaces healthier, we're looking at lifestyle modification and we're looking at risk reduction, which will give you a decrease in overall costs.
So the trend today, what we're seeing in the marketplace, is employers buying more healthcare management programs, such as the ones Walgreens offers. We are definitely seeing higher acceptance of investment in health for the employee population, much more so than we were five years ago.
"The return on that investment will be reduced costs-both direct and indirect. In fact, the indirect costs of poor employee health can be two to three times the direct medical costs. 'Presenteeism' is defined as diminished job performance because of impairment by health problems or work/life issues.
A study in the Journal of Occupational and Environmental Medicine showed that the cost of this kind of performance-based work loss far exceeded the costs of absenteeism and medical treatment combined1. "We are definitely seeing a higher number of peer-reviewed articles that quantify health risks and tie them to a dollar figure," Crane says.
"So when you're able to quantify that, it is much easier for the C-level executives to say, 'Absolutely, this makes sense from an ROI perspective.' If you don't have your CEO or your C-suite buy into this healthcare strategy, it's unlikely you're going to have any effect on the culture of health in your employee population.
That rings true whether you're a small company or a very large organization. I think it's really difficult nowadays to find a CEO that is not wholly invested in the healthcare strategy of the organization. It's just too high a risk to overlook. "Many CEOs are looking to consumer driven health plans (CDHP) as part of their healthcare strategies. Walgreens has had a CDHP for five years, and this year saw a jump in enrollment-more than 20 percent of its 238,000 employees are enrolled in the CDHP for 2010."
With consumer driven health plans, we're looking at the impact of the consumer on the utilization of healthcare services. And we're assuming that that process is going to drive higher quality, lower cost and better utilization," Crane says.
But that will only be true if the customer or employee becomes much more educated around healthcare decisions, quality of care, the choice of care, the necessity of care, the cost of care. And I think we've got a long way to go on that end.
Education is Key
"Employee education has to be one of the drivers. From an information delivery standpoint, we need to make sure that information is timely and relevant to employees so that it gets into their hands at the time that they need it and can put it into effect." Health risk assessments (HRAs) are a good educational tool, particularly when they're combined with health screenings to give employees individual wellness scores and recommend actions they should take.
To be most effective, HRAs should also include follow-up coaching to reinforce behavior change. "Employers are looking at health coaching as a way to provide a higher level of awareness and bring information to that employee so that they can then take it to their provider," Crane says.
This gives patients more control and equips them to ask good questions of their physicians. Walgreens offers all its employees an HRA along with online coaching programs specifically targeted at different risks. Coaching is critical, because people follow recommended health practices only about half the time, according to the World Health Organization.2
But will employees feel they're being told how to live their lives? "That's always a concern. But I think when you start looking into your own accountability there's much more acceptance," Crane says. "Is this an entitlement or are you accountable for your own health?
The bottom line is that you can't push people to change. It's going to have to be something they want to do. So it's really trying to find the right programs and meet the employees' needs at a specific point in their lives."
Workplace Wellness Centers Are Growing
And where they are, much of the time, is at work. Workplace health centers are growing in popularity-but they're a far cry from the days of the company nurse. Walgreens Take Care Health Systems SM subsidiary operates worksite health centers for various employers, and can tailor the health centers to offer urgent care, occupational health, primary care, pharmacy services and even fitness centers.
"We operate those health centers for employers so that they can bring healthcare directly to their employees and have a lot more management and control of that population," Crane says. Employees who may be concerned about their employer's access to their health information should know that workplace healthcare professionals are subject to the same privacy and confidentiality laws as hospitals and doctors' offices."
That's one of the things that frequently asked: Where's this data going to go? Is this going to go anywhere on the HR side? And the answer is, absolutely not. That's part of the education process, too, to tell employees where this is going and what we're doing with this information," Crane says.Neither the employer nor Walgreens (if it's operating the health center) has access to individualized patient information.
In most cases, the data go into a third-party data warehouse, which provides aggregate deidentified data for evaluation of programs. "Our experience with this is, as employees come in to be seen by the healthcare providers at the health centers, they're being treated the same way they would be treated in any other professional medical setting."
To improve care and treatment for its own employees, Walgreens has pulled together a multidisciplinary team to develop a new healthcare strategy. The team is looking at the products and services Walgreens offers its customers and how they can be applied to its employee population. It also recommended changes in health coverage.
"In order for us to measure health improvement, we had to be able to understand it and manage it. And managing over 100 health plans was just not feasible," Crane says. "What we've done at Walgreens is consolidate from a large number of HMOs down to a couple of providers, and at the same time we've increased both medical and dental benefits. We're covering all preventive care, and we're instituting a wellness program that is going to be offered to all employees whether they're in the health plan or not."
We're doing feasibility studies into building health centers where it makes sense for our employee population. And we will be developing a robust infrastructure for measurement, because we believe that all of these things show an impact in health outcomes as well as cost control and understanding where our healthcare dollars are going," Crane says.
"Our company is making this investment into the health of the population because it believes that this is an opportunity for the company to win. Win because we're getting a healthier population and improving the productivity of our employees while as the same time decreasing our cost."
About the Author
Lucy Crane, MD, MPH, FACOEM serves as corporate medical director and vice president, Integrated Health and Productivity for Walgreen Co. Dr. Crane is responsible for strategies to optimize the health, well-being and productivity of the Walgreens employee population by integrating and coordinating occupational health, primary care, safety, wellness, benefit design, disability management and behavioral health.
She has a long standing passion for industrial and occupational medicine, enhancing productivity and work-life experiences of the employee/employer population. She is board certified in occupational medicine and is a Diplomat of the American College of Preventive Medicine and the National Board of Medical Examiners.
Dr. Crane is currently on the Board of Directors, New England College of Occupational and Environmental Medicine and has held several positions with the American College Occupational and Environmental Medicine's House of Representatives from 2002-2006. Walgreens is a single-source provider of comprehensive pharmacy and healthcare services.
Through our more than 7,000 community pharmacies, mail service, specialty pharmacy, home infusion and respiratory services and pharmacy benefit solution services, we offer health plans and employer groups cost-effective solutions to meet the changing needs of the healthcare industry. Our dedicated team of client support professionals is committed to creating the best customer experience possible.
Collins J, Baase C, Sharda C, Ozminkowski RJ, Nicholson S, Billotti GM, et al. The assessment of chronic health conditions on work performance, absence, and total economic impact for employers. J Occup Environ Med. 2005; 47(6):547-557.
The World Health Organization. Adherence to Long-term Therapies: Evidence for Action. 2003