Lessons from a Model Employee Healthcare Management/Wellness Program

Posted in: Employee Benefits

If you’re like many employers, you’re struggling to measure the effectiveness of your employee wellness program. Can you determine the return on investment or the effect on your outcomes and costs? If you are like many companies, data in these areas is lacking.  

In an effort to showcase progressive approaches to controlling healthcare cost, and enhance employee experiences, I’ve reached out to some of the nation’s prominent HR leaders to tell us their success stories.

One such leader is Marta Brito Perez, a preeminent human resources expert with a unique understanding of healthcare systems in the United States. Currently she serves at Adventist HealthCare as the organization’s senior vice president and chief human resources officer spearheading the wellness programs for Adventist, and for the community that they serve.

Prior to joining Adventist, Marta was a consultant for the National Cancer Institute; she headed up Global Talent and Development for AstraZeneca Pharmaceuticals; and served as the chief human capital officer for the U.S. Department of Homeland Security.

Adventist HealthCare’s wellness program has been in place since 2009, and serves well the 6,236 employees who work at the organization’s five nationally-accredited hospitals, mental health facilities, and home health agencies. The program boasts an employee participation rate of 87 percent and has lowered Adventist HealthCare’s annual inflationary cost of health insurance to half that of the national benchmark average of 7.8 percent (trend source: 2015 Segal Health Plan Cost Trend Survey).

At Adventist HealthCare’s headquarters in Gaithersburg, Maryland, 30 minutes outside of Washington, D.C., I talked recently with Marta about her program — and why the time to take action and create better healthcare solutions is now. Here, I share highlights of the conversation.

Q: Do you think employers need to rethink their approach to healthcare, and what advice would you give companies looking to create a more effective, cost-savings solution?

A: The cost of healthcare has been a concern for government and employers for a long time. However, healthcare reform has created more of a “burning platform” for organizations to deal with the uncontrolled medical risks by implementing effective wellness and treatment plans for employees. In large part, the reforms stem from the Affordable Care Act (ACA), which is leveling the playing fields of benefit eligibility and plan design, and leading employees to perceive little difference in plan design when they evaluate one employer versus another or compare benefits available through the exchange. The primary differentiator will be the premium cost to the employee.

Employees are also discovering that they have much more skin in the game, due in part to the growing popularity of high-deductible health plans (HDHPs). So they’re becoming savvy consumers of healthcare.

On the employer side, those struggling to compete must adopt new strategies to reduce medical plan costs. What we’re saying to employers is that you can manage your employees in a way that will first and foremost keep them healthy and, second, manage your costs. The key is to implement a comprehensive risk management strategy that actively manages health, wellness, and outcomes.

Adventist HealthCare, the largest provider of services in Montgomery County, Maryland, is at an advantage because as a healthcare system, we understand both the risks and opportunities available in managing a health plan. We know how the right wellness initiatives can help keep healthy employees healthy and aid in managing employees with health conditions who are moderate or high risk. Additionally, we understand that plan design affects the utilization of services. Data management is key, and most employers are understandably not there yet.

Q: In many ways, the model you created for Adventist exemplifies where healthcare is headed. Can you give us the big picture and explain how it came to be?

A: About five to six years ago, we started to see our healthcare costs increase and decided to take a close look at our claims data to see what was happening. We discovered that about six percent of our employees required constant care and classified as high need. We then used the findings to convince our leadership team that a better system could save us dollars in the long run and improve the health of our employees.

What we came up with is a highly integrated model that incents employees and their dependents using the expertise of our in-house providers; that takes a more proactive approach to health; and that extends our reach across the community. Employees undergo regular health assessments and screenings that allow us to identify at-risk patients and provide the level of care they need, whether for weight loss support, stress management, diabetes prevention, or whatever conditions they may have. We invested a lot of resources in the coordination of care for our employees, and we utilize the expertise of personal health nurses to work with employees to help them adhere to medication regiments and prevention activities. As a result of our efforts, we have reduced the number of high-risk employees by 20 percent.

Our partnerships we have formed with health clubs in the region allow our high-risk members to go to the gym, see a nurse, and exercise under the care of a personal trainer. All of these steps can lower the risk of common health problems festering out of control.

We also incentivize our employees with lower premiums and deductibles, highly subsidized gym memberships, and even penalties for unhealthy behaviors like smoking. It’s in our best interest to help our employees develop healthy habits and lower their risk profile, so a big part of what we do is preventative.

The program evolves every year. This year, for instance, we added an additional incentive to encourage spouses to participate. What we realized is that lifestyle changes are hard to come by without support at home, and getting spouses to participate is critical to our mission to foster health and wellness in our employees.

Q: Can you explain how you use data to drive your program’s treatment and care options, and what are your results?

A: Data is king, and that’s the secret of our success at Adventist HealthCare. Our data analysis is unique, and a big part of how we convinced leadership within Adventist HealthCare to adopt a more robust healthcare model. We analyze data from claims, biometric screenings, physician visits, and prescription drugs. We also have employees complete a comprehensive health assessment with essential questions about diet, lifestyle, and health, so we’re getting information from both the clinical and patient/employee side.

As a healthcare system, we were already doing this kind of data analysis on our patients, so we asked ourselves: why not look at our own population of employees and see if the data substantiates a stronger model? Adventist had an existing wellness program, but the data around the ROI on the program was inconclusive. We knew we needed more to make a convincing case.

Now, our entire program is driven by our data. We use data to stratify where employees are in terms of health, and we intervene with treatment and wellness programs — nutrition counseling, exercise programs, and additional health screenings when employees need it. What used to be a thin layer of data is now rich and multilayered.

One way we measure the impact of the Adventist wellness program is to compare our inflationary costs to national benchmark trends for medical premiums. The benchmark average annual trend (per Milliman) for the past four years has been 6.25%. Adventist’s actual average annual trend for the same period was only 1.33%.  Adventist Healthcare saved approximately $3.8 million in medical plan cost over that same period.

Q: What challenges did you encounter?

A: There’s a tendency to think of employees’ health as a private matter, and we agree that we need to be very sensitive to not violate privacy concerns. That said, we have a fiduciary responsibility to our employees and the organization to manage the millions of dollars spent on the health plan in the most judicious manner. It is important to apply our knowledge of healthcare interventions in a way that helps our employees stay healthy, and to manage health conditions that are diminishing their quality of life.

Part of our mission is to continue to expand our wellness and consulting programs to help employees, patients and the business community achieve healthy outcomes and reduce costs.

Q: Clearly, technology plays a major role in your program. Tell us how it helps you achieve your vision.

A: For one, we communicate and track our wellness initiatives and services on an online platform, and create incentive-driven programs where employees can log physical activity and other health gains. In a single week, we can have more than 500 different users on the site, 300 health assessments taken, and 30,000 minutes of physical activity tracked. We can monitor all of that in an integrated way.

Our program depends on our partnerships with physicians, our medical claims data, and our electronic medical records (EMRs). We use our EMRs and other data to create a strong ambulatory (or outpatient) care program for our employees. We’ve always had data on “sick” people in hospitals, but now we’re using these new technologies to acquire data on people outside of hospitals. So we’re connecting the dots for our employees, and our health management is starting to get real.

If your company is interested in building programs similar to those of Adventist HealthCare, or fine-tuning your employee healthcare offerings, PSA can help. Reach out me at fstrueber@psafinancial.com to find out how. Also read my last post, “Better, Less Costly Healthcare on the Horizon for Maryland Employers and Patients,” to learn more about how the change in Maryland’s hospital revenue model will benefit patients and employers with more options for quality medical care at lower costs.

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