An underlying premise of the Affordable Care Act provisions that encourage employers to adopt health promotion programs is an association between workers' modifiable health risks and increased health ...care costs. Employers, consultants, and vendors have cited risk-cost estimates developed in the 1990s and wondered whether they still hold true. Examining ten of these common health risk factors in a working population, we found that similar relationships between such risks and total medical costs documented in a widely cited study published in 1998 still hold. Based on our sample of 92,486 employees at seven organizations over an average of three years, $82,072,456, or 22.4 percent, of the $366,373,301 spent annually by the seven employers and their employees in the study was attributed to the ten risk factors studied. This amount was similar to almost a quarter of spending linked to risk factors (24.9 percent) in the 1998 study. High risk for depression remained most strongly associated with increased per capita annual medical spending (48 percent, or $2,184, higher). High blood glucose, high blood pressure, and obesity were strongly related to increased health care costs (31.8 percent, 31.6 percent, and 27.4 percent higher, respectively), as were tobacco use, physical inactivity, and high stress. These findings indicate ongoing opportunities for well-designed and properly targeted employer-sponsored health promotion programs to produce substantial savings.
Objective: To determine the accuracy of self-reported health care utilizatio and absence reported on health risk assessments against administrative claims and human resource records. Methods: ...Self-reported values of heal care utilization and absenteeism were analyzed for concordance to administrative claims values. Percent agreement, Pearson's correlations, and multivariate logistic regression models examined the level of agreement and characteristic participants with concordance. Results: Self-report and administrative data showed greater concordance for monthly compared mth yearly health care utilization metrics. Percent agreement ranged from 30% to 99% with annua doctor visits having the lowest percent agreement. Younger people, males, tho with higher education, and healthier individuals more accurately reported the health care utilization and absenteeism. Conclusions: Self reported health ca utilization and absenteeism may be used as a proxy when medical claims and administrative data are unavailable, particularly for shorter recall periods.
Abstract Objective To evaluate a multifaceted supermarket intervention promoting healthier alternatives to commonly purchased foods. Design Sales of 385 foods promoted between July and October, 2012 ...in the Eat Right–Live Well! intervention supermarket were compared with sales in a control supermarket. Setting Two supermarkets in geographically separate, low-income, urban neighborhoods. Participants One control and 1 intervention supermarket. Intervention Product labeling, employee training, community outreach, and in-store promotions, including taste tests. Main Outcome Measures Number of items sold; absolute and percent differences in sales. Analysis Difference-in-difference analyses compared absolute and percent changes between stores and over time within stores. Sub-analyses examined taste-tested items and specific food categories, and promoted items labeled with high fidelity. Results Comparing pre- and postintervention periods, within-store difference-in-differences for promoted products in the intervention store (25,776 items; 23.1%) was more favorable than the control (9,429 items; 6.6%). The decrease in taste-tested items' sales was smaller in the intervention store (946 items; 5.5%) than the control store (14,666 items; 26.6%). Increased sales of foods labeled with high fidelity were greater in the intervention store (25,414 items; 28.0%) than the control store (7,306 items; 6.3%). Conclusions and Implications Store-based interventions, particularly high-fidelity labeling, can increase promoted food sales.
Objective: To identify key success factors related to employer-based health and productivity management (HPM) programs. Methods: Data regarding promising practices in HPM were gathered via literature ...review, discussions with subject matter experts, online inventory, and site visits. Results: Promising practices in HPM include 1) integrating HPM programs into the organization's operations; 2) simultaneously addressing individual, environmental, policy, and cultural factors affecting health and productivity; 3) targeting several health issues; 4) tailoring programs to address specific needs; 5) attaining high participation; 6) rigorously evaluating programs; and 7) communicating successful outcomes to key stakeholders. Conclusion: Increased efforts should be directed at disseminating the experiences of promising practices. However, more research is needed in this area, so that additional public and private funding is made avaüable for applied research in "real-life" business settings. Finally, employers should be provided effective tools and resources to support their HPM efforts.
Objective: To evaluate the relationship between modifiable health risks, and health and productivity related expenditures and predict cost savings from improvements in the health risk profile of a ...large US employer. Methods: Information was collected on 11 modifiable health risks for active employees who completed a health assessment and enrolled in a noncapitated health plan. These risks were related to employer medical care costs and employee productivity. Multivariate analyses were performed to estimate costs associated with high risk, as well as potential savings from reducing risk prevalence among employees. Results: Health risks with the greatest impact on total medical care costs included obesity, high blood pressure, high blood glucose, high triglycérides, and inadequate exercise. Conclusions: Modifiable health risks are associated with higher employer costs. Targeted programs that address these risks are expected to yield substantial savings.
Objective: Evaluate innovative, evidence-based approaches to organizational/supportive environmental interventions aimed at reducing the prevalence of obesity among Dow employees after 2 years of ...implementation. Methods: A quasi-experimental study design compared outcomes for two levels of intervention intensity with a control group. Propensity scores were used to weight baseline differences between intervention and control subjects. Difference-in-differences methods and multilevel modeling were used to control for individual and site-level confounders. Results: Intervention participants maintained their weight and body mass index, whereas control participants gained 1.3 pounds and increased their body mass index values by 0.2 over 2 years. Significant differences in blood pressure and cholesterol values were observed when comparing intervention employees with controls. At higher intensity sites, improvements were more pronounced. Conclusions: Environmental interventions at the workplace can support weight management and risk reduction after 2 years.
Objective: To assess long-term changes in health risks for employees participating in Vanderbilt University's incentive-based worksite Wellness program. Methods: Descriptive longitudinal trends were ...examined for employees' health risk profiles for the period of 2003 to 2009. Results: The majority of risk factors improved over time with the most consistent change occurring in physical activity. The proportion of employees exercising one or more days per week increased from 72.7% in 2003 to 83.4% in 2009. Positive annual, monotonie changes were also observed in percentage for nonsmokers and seat belt usage. Although the largest improvements occurred between the first two years, improvements continued without significant regression toward baseline. Conclusions: This 7-year evaluation, with high participation and large sample size, provides robust estimates of health improvements that can be achieved through a voluntary incentive-based Wellness program.
OBJECTIVE:To determine the prevalence and incidence of low back pain (LBP) among workers in the aerospace and defense industry and in a specific company.
METHODS:Claims and demographic data from the ...Truven Health MarketScan normative database representing more than 1 million workers were drawn from a group of 18 US benchmark companies and compared with one particular company, Lockheed Martin Corporation.
RESULTS:The prevalence of LBP in the MarketScan normative group was 15.6% in the final study year (2012), whereas the incidence of new cases was 7.2% and 7.3% in years 2011 and 2012, respectively. Compared with the normative group, the companyʼs prevalence and incidence rates were lower. Women and older workers were more likely to experience LBP compared with men and younger workers.
CONCLUSIONS:The analysis was used to inform the companyʼs leadership about the health burden of the condition and evaluate alternative treatment options to prevent the incidences and reduce the prevalence of clinical back pain among workers.
OBJECTIVE:To determine the ability of the Health Enhancement Research Organization (HERO) Scorecard to predict changes in health care expenditures.
METHODS:Individual employee health care insurance ...claims data for 33 organizations completing the HERO Scorecard from 2009 to 2011 were linked to employer responses to the Scorecard. Organizations were dichotomized into “high” versus “low” scoring groups and health care cost trends were compared. A secondary analysis examined the toolʼs ability to predict health risk trends.
RESULTS:“High” scorers experienced significant reductions in inflation-adjusted health care costs (averaging an annual trend of −1.6% over 3 years) compared with “low” scorers whose cost trend remained stable. The risk analysis was inconclusive because of the small number of employers scoring “low.”
CONCLUSIONS:The HERO Scorecard predicts health care cost trends among employers. More research is needed to determine how well it predicts health risk trends for employees.
Objective: Certain modifiable risk factors lead to higher health care costs and reduced worker productivity. A predictive return-on-investment (ROI) model was applied to an obesity management ...intervention to demonstrate the use of econometric modeling in establishing financial justification for worksite health promotion. Methods: Self-reportedriskfactors (n = 890) were analyzed using X² and t test methods. Changes in risk factors, demographics, and financial measures comprised the model inputs that determined medical and productivity savings. Results: Over 1 year, 7 of 10 health risks decreased. Of total projected savings ($311,755), 59% were attributed to reduced health care expenditures ($184,582) and 41% resulted from productivity improvements ($127,173), a $1.17 to $1.00 ROI. Conclusions: Using an ROI model to project program savings is a practical way to provide financial justification for investment in worksite health promotion when risk reduction data are available.
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