Many employers and insurers have come up with a simple way to avoid the problem for many of their clients: exempt medicine for diabetes and other chronic conditions from deductibles in the first place. But why not break up the rebate checks and send the cash back to the patients who paid for the drugs? Representatives of corporate health plans say it would be impractical to do so because they get the money months after employees bought the drugs. Says Laurel Pickering, chief executive of the Northeast Business Group on Health, a coalition of large employers: “It would be very difficult to figure out how to administer that.”
New research from the Northeast Business Group on Health reveals that targeted, personalized programs combined with nutrition and fitness activities could help increase the effectiveness of employers’ efforts to tackle the obesity epidemic. The study reveals that obesity is one of the biggest drivers of employer healthcare costs, with more than $73.1 billion spent annually. Therefore it is not surprising that NEBGH’s employer members rank weight control as one of the top three conditions that need to be addressed through workplace wellness or disease management. “Obesity of employees is a concern for employees because they want to attract and retain a healthy and productive workforce with high performance capabilities,” says study co-author and NEBGH’s Medical Director Dr. Jeremy Nobel. “There’s also the need to manage healthcare costs, because obesity significantly increases the risk for diabetes, heart disease, kidney disease, musculoskeletal disorders and cancer.” Many organizations offer programs such as nutritional education, onsite healthy eating and subsidized gym memberships. However, employers report that obstacles to success include lack of employee engagement due to stigma or embarrassment plus the cost of implementing new programs. There is also uncertainty about return on investment. Employers can typically determine the health status of their employee population based on aggregate data captured by voluntary, individual completion of confidential health risk assessments. “Individual identities are blinded but average data can be analyzed to gain insight into the particular burden on one employer vs another,” Nobel says. A targeted and confidential plan of attack To avoid violating confidentiality, the design of communications to employees about customized programs must be thoughtful and cautious. “You invite people with very specific and clear messages. For example, you could say ‘if you have a Body Mass Index of 35, this program may be useful for you,’” he continues. “People can self-identify and self-refer into programs like virtual coaching or support groups that are most appropriate and most likely to be effective for them.” The report features a case study describing successful, personalized interventions by the New Jersey-based utility company Public Service Enterprise Group in partnership with the Chicago-based weight-management company Retrofit. PSEG’s employees had an average age of 48, were 85% male and 73% overweight or obese. They work in a highly technical environment. Eligibility for the Retrofit pilot required employees to have a BMI of 30 or above and commit to at least one year of the program. The first six months focused on weight loss and the second half of the year on habit formation. Participants had a coach they could meet with in person or via video, according to their preference. They received a fitness tracker and wireless scale. One hundred and twelve employees enrolled from eight different sites and after four months 92% were still participating. Over the same period, 89% of the group lost weight and a total of 800 pounds were lost collectively. Five employees moved out of the morbidly obese category into a lower risk group. PSEG used data to demonstrate need and identify a strong enough business case to obtain executive leadership, management and obtain union support. Because of the high rate of obesity in the employee population, in order to scale the pilot, PSEG decided to target the most at-risk employees with a BMI of 35 or greater in the first year of a three-year contract with Retrofit. Nobel agrees that it is important to base programming on employee data and establish success metrics for a program before it is rolled out. “In addition to engagement dynamics and weight loss, you can measure improvement in co-morbid conditions like hypertension or diabetes,” he says. “For example you can look at the cohort and say the average abnormal blood pressure of 145 over 95 dropped to a normal reading of 140 over 90 in eight weeks.”
Mental illness can become evident in many different ways. Some conditions affect a person’s thinking, feeling or mood and vary from mild to severe. Mental health problems can also affect someone’s ability to relate to others and function each day. Every person will have different experiences, even those with the same diagnosis. When looking specifically at workplace productivity, depression, anxiety and substance use cast a heavy burden on an employee. These behavioral health conditions exact an enormous personal and social cost, affecting not only a person’s health but also his or her ability to work.
For the most part, reducing workplace weight gain and obesity has been a losing battle, but a new report advises employers that there may be a way to help employees improve their weight loss. The secret to success? Targeted, personalized programs for employee subgroups, combined with nutrition and fitness activities that apply to broad employee populations. The Northeast Business Group on Health (NEBGH) report, “Tipping the Scales on Weight Control: New Strategies for Employers,” says the first step is to differentiate employees by body mass index (BMI), a key weight metric, and focus programs and benefits most appropriate for each segment as a way to help increase the effectiveness in reversing the obesity epidemic.
From serving healthier cafeteria fare to building up an arsenal of digital tools, hospitals and other large employers are trying a wide range of approaches to get employees to lose weight. Now, a new report from the Northeast Business Group on Health, an employer-led coalition that examines health costs and delivery, concludes that employers are most successful in addressing employee weight issues with a customized approach that takes body mass index and personal needs into account. Obesity costs U.S. employers about $73 billion per year, according to a widely cited Duke University study, and health care is among the industries where it is most prevalent, according to a separate study published in the American Journal of Preventive Medicine. As benefits managers shop for solutions to help their employees, they should look at programs that offer personalization, whether it's provided onsite, near-site or online, said Dr. Jeremy Nobel, medical director at the business group and a co-author of the report released Wednesday. "Personalization is fundamental but it can be delivered in lots of ways," Nobel said. "It means really understanding the challenges in weight management a person has." Personalization starts with segmenting employees into groups by body mass index, including those under 30 BMI, and reaching out to them with the appropriate behavioral or medical resources, the report says. Once a person reaches a certain BMI, it's harder to lose weight and easier to gain, Dr. Louis Aronne, director of Weill Cornell Medicine's Comprehensive Weight Control Program, notes in the report. The Centers for Disease Control and Prevention considers someone with a BMI of 25 to 30 to be overweight and someone whose BMI exceeds 30 to be obese. But offering custom interventions may be easier said than done. At Montefiore Health System, it's difficult to truly personalize employee weight loss plans by pairing workers with individual health coaches, said Nicole Hollingsworth, assistant vice president of community and population health at Montefiore. A case study on Montefiore in the report adds, "With more than 28,000 employees, multiple locations and communication guidelines that limit outreach and promotion, continual awareness and high-touch engagement are challenges." In order to accommodate employees' diverse needs, Montefiore aims to offer a wide range of options for weight loss and incorporate those approaches into a broader wellness program, said Hollingsworth. More than 800 employees have seen a registered dietitian since the launch of the health system's Associate Wellness program in 2012, according to the report, and participants in a recent six-week weight-loss program at the health system lost an average of 2.6 pounds. These targeted weight-loss initiatives complement public health approaches, such as keeping sugary drinks out of the cafeteria and adding new onsite exercise facilities, said Hollingsworth. In addition, Montefiore offers employees access to digital nutrition and wellness tools provided through the Cerner Corporation. "What's emerging from our findings is that the convergence of all these things might lead to higher effectiveness and more sustained benefits," said Nobel. —C.L.
Worried about lack of progress on employee obesity? Look to targeted, personalized programs for small groups of employees, coupled with more general nutrition and fitness activities encompassing a broader range of people.
"Critical considerations for increasing engagement include greater personalization to capture and respond to individualized clinical factors such as BMI and blood sugar, attention to behavioral factors like attitudes and beliefs, and establishing relationships that could serve as in-person or digital support networks. Using behavioral economics lessons to understand the roles that intellect and emotion play in behavior change is similarly important in designing rewards and incentives."
Independently of the UNC analysis, the Northeast Business Group on Health (NEBGH), a nonprofit health care consumer advocacy led by employer groups and health care providers, shows cancer treatment costs are top-of-mind for group health plan sponsors. Cancer treatments rank at the top of employer expenses, despite cancer’s lower prevalence relative to diabetes, hypertension and musculoskeletal disorders, said NEBGH. But plan sponsors are concerned by more than just premium costs. Beyond containing runaway expenses that push group premiums ever higher, employers are “equally concerned” about ensuring that employees and their families receive top-quality cancer care. “Employers are invested in the well-being of their employees, and they want to be confident they’re steering people to trusted providers and institutions based on reliable information about outcomes and adherence to quality measures,” said Laurel Pickering, CEO of NEBGH.
On May 2, 2016, National Alliance on Mental Illness of New York City (NAMI-NYC Metro) and Northeast Business Group on Health (NEBGH) co-sponsored their Workplace Mental Health Summit VIII with a measurement theme. The Summit focused on how employers can quantify employees’ mental health and its relationship to diminished workplace productivity, as well as evaluate interventions to track improvement. Research shows that poor mental health not only severely diminishes employee well-being and quality of life; it also decreases productivity at work.
The fact that cancer costs are higher than ever is reason enough for employers to be concerned, but new research is giving them another reason to worry: They may not be doing enough for employees suffering from the disease. Employers are concerned about the high cost of cancer care, but they’re equally concerned about making sure employees and family members diagnosed with cancer are receiving top-quality care, says a new report from Northeast Business Group on Health.