By W. Tom Fogarty, M.D., chief medical officer, Concentra
As part of his first term in office, President Obama was able to put health care reform into law, in part, so employers would “no longer be burdened by the crushing weight of health care costs.” These costs affect every company that offers health care benefits, and the costs continue to increase.
In 2008, health care spending in the United States was $2.4 trillion, up from $1.9 trillion in 2005. This sobering reality reflects the increased demand for health care services due to the worsening health status and aging population, as well as the increased cost of actual care. Employers need a health care plan that aligns costs with results, such as services that actually improve the health of employees and their dependents.
Health Care Spending
In the United States, most employer-sponsored health plans reflect a sharing of costs with employees, and both groups have incurred enormous increases throughout this decade. Employer premiums continue to increase year-over-year; in 2009, they increased by 13 percent, nearly three times the rate of inflation.
Some employers have tried shifting rising costs to employees, but this trend simply transfers the burden onto workers, forcing many to abandon their jobs or health care coverage. Since 2000, employee contributions to health care premiums have risen by 143 percent, and employee copayments have increased by 115 percent.
Shifting costs may offer employers a temporary solution, but it fails to address the actual sources of rising health care costs. These rising health care costs have a broad economic impact on the lives of many Americans and their communities in the form of housing crisis and bad credit ratings. Analysts suggest that without a viable solution, annual U.S. health care spending will exceed $4 trillion by 2015.
The State Of Health
The health of Americans continues to worsen and, compared to 20 years ago, Americans, as a whole, are less physically active while working longer hours and consuming poor diets. A significant side effect to employers of their employees’ poor health is presenteeism, which refers to lost productivity from workers who are on the job but not at full health.
A study on health and productivity quantified presenteeism by calculating that employers absorb at least $2 of health-related productivity costs for every $1 they
spend on a worker’s medical or pharmacy costs. As the health status of employees continues to worsen, employers struggle for ways to manage the increasing health and productivity costs related to poor health.
The Solution
Reforming health care is a multi-disciplinary approach. A health promotion program in the workplace is fundamental to achieving positive results. This kind of worksite program actively engages persons in their own personal health, helps at-risk persons lower their risk of chronic disease and illness, and supports those with already established disease receive evidenced-based care.
Identifying at-risk patients is crucial to helping prevent chronic disease, which accounts for 75 percent of all health care costs. As a result of this comprehensive approach, health and productivity costs are lowered over a longer-term investment period.
Many qualitative studies have examined worksite health promotion services to identify the key elements required to save costs. One study analyzed several programs and identified six best practices to create measurable and effective change:
- 1. Organizational commitment
- 2. Incentives for employees to participate
- 3. Effective screening
- 4. Evidence-based interventions
- 5. Effective implementation
- 6. Ongoing program evaluation
- 7. Health marketing
Those best practices are made even more effective when enhanced by a worksite health center, which is a medical center located in the workplace that offers a customized menu of health care and wellness services designed for that specific employee population. The end result is improved health and wellness for employees from convenient and cost-effective care delivery and a high return-on-investment (ROI) for employers as health care costs continue to drop year after year.
ROI EvidenceThe cost effectiveness of worksite health improvement services has been examined in several recent studies and all concluded that there are significant positive results for employers and patients.
One study looked at several worksite-wellness efforts and calculated a $3-$6 ROI for every $1 invested over a two-to-five-year period.
Additional analysis by a leading health care firm concluded worksite health promotion programs reduce average sick leave, health plan costs, workers’ compensation costs, and disability costs by 25 percent. Many researchers have remarked that this approach to health care represents an efficient way to increase access and affordability of medical care, while reducing the burden of cost on employers.
One Organization Presents a Solution
Given [Concentra’s] work with some of the country’s largest employers, we inherently understood the need for an effective, efficient workplace health promotion program – one that would be centered on a comprehensive health transformation plan. And while the needs of each employer can differ largely, requiring a certain amount of customization, we also knew that the same principles would be needed for all, and are essential to the construction of the program.
The first step is to establish a baseline of health through risk assessments and biometric screenings, in order to provide participants with detailed health information, including his/her potential for developing chronic disease.
By identifying employees who are at-risk and using their personal information as an opportunity to educate and spur behavior change, it can create a positive motivation to begin to make better health choices. If at-risk employees are educated about their health and actively supported to change their behaviors and lower their risk levels, the long-term and future costs associated with chronic disease can be diminished or averted.
Following the collection of health assessments, those employees with higher risk factors – three or more elevated levels related to blood pressure, cholesterol, glucose, height, and weight – are enrolled into a multi-step program to improve their health.
Concentra’s system brings together health marketing, personal coaching, health education, and promotion to challenge employees to change behaviors and make healthier choices. With the right setup, communication, and ongoing motivation – these elements can establish and drive a health-centered organization that tangibly supports wellness among its employee population. One that also sees visible and measured change in the health of its employees.
For many companies, it may be more economically sound to fully utilize Health Specialists in the role of coach, educator, and facilitator. These trained and experienced individuals hold a wealth of knowledge in personal health motivators, and can provide one-on-one and small group interaction with participants. Health Specialists can also lead targeted lifestyle support curriculum, which often includes classes on weight management, fitness and nutrition, and lifestyle support for diabetes.
Depending upon the needs and size of an employer, an on-site health center that can deliver the full health transformation offering may prove the most useful. Concentra has established several dedicated health and wellness centers, where the entire solution set is delivered on-site to employees, in addition to traditional health services that include occupational health, group health, urgent care, and primary care. The central location of such a center also helps to increase employee utilization of health and wellness programs as employers benefit from minimized employee downtime and lower fixed costs.
Conclusion
Employers are the primary source of health coverage for most individuals, and smart companies are working diligently to curb the rise of poor health, unhealthy behaviors and its harmful effect on life expectancy. Countless employers have created a culture of health among their workforces, despite the substantial challenges presented by the existing system. Millions of employees continue to benefit from workplace wellness and prevention programs, even as health costs spiral upwards.
From an on-site clinic, a mobile medical unit, or a personal health coach, a model to deliver medical care is needed that matches the way many Americans work and live today. Worksite wellness programs continue to increase in popularity due to their economical and efficient benefits in reducing health care costs for employers and employees, all while improving access. Both internal and external evidence have demonstrated the effectiveness of a results-oriented worksite health promotion and on-site health center. Workplace centers are an important shift in the health care industry, which present a new and proven option to traditional health needs, and has the capacity to become the new model for the new health care environment. Ì
About the Author
W. Tom Fogarty, M.D., is the chief medical officer of Concentra, a national provider of injury care, physical therapy, and health and wellness services for the workers’ compensation and occupational health industry. Dr. Fogarty is responsible for the ongoing analysis of treatment patterns by physicians in Concentra’s medical center group practice, and for the refinement of clinical best practices. Dr. Fogarty is based at Concentra’s headquarters in Addison, Texas, and can be contacted at tom_fogarty@concentra.com 
