Scott MacStravic, PhD
The first trouble with employee health management results is that there have been so few published reports that even include them. Reports describing the extent to which employee health status and behaviors create added costs for employers have been common for over a decade, but examples of the consequences of efforts aimed at improving both are as rare as hen’s teeth, at least in the U.S. Fortunately, other countries, particularly the UK have produced a significant number of published results, which reinforce confidence in the potential of EHM, though vary widely in both how good results have been and what results are described.
Since government health insurance typically insulates employers from direct sickness care costs, even though developed western countries lagged behind the US in proactive and preventive health, they have focused far more on the overall performance impacts of their investments, rather than focusing mainly on reducing medical care costs. In consequence, they have produced and reported far more results that address broader dimensions of performance, including both cost reductions and revenue enhancements.
As much as ten years ago, Pacific Bell’s “FitWorks” program decreased absence days by 0.8%, saving $2 million in one year in replacement costs, while participants spent an average of 3.3 fewer days on disability, saving an additional $4.7 million. The DuPont Corporation’s comprehensive health promotion program reduced disability days by 14% among participants, where non-participants’ days declined only 5.8%, saving a total of 11,726 disability days. [“Worksite Health Promotion” (www.trale.com/resources/Worksite -- undated, but apparently from around 1997)]
Standard Life Healthcare, a UK insurance firm, offered a web-based EHM program for all its staff, including a health risk assessment with individual scores and recommendations for all participants, and tips for improving health based on particular problems identified, plus onsite general support such as healthier food in canteen, and subsidized massages. It reported a 29% improvement in staff nutrition levels, a 14% reduction in alcohol use, 9% in smoking, a 14% reduction in stress. These improvements yielded a 5% increase in productivity, along with a 25% reduction in turnover, and 9% in sickness absences. It now offers its program to clients. “Employer Health Management” Complinet (UK) Mar 4, 2004 (www.vlelife.com)
It has also reported a 13.3% improvement in employee health scores, a 3% improvement in their self-perceived effectiveness at work, and a reduction of 500 fewer sick absence days. And its CEO gave the EHM program partial credit for increasing revenue by 51% over 3 years. It cited an earlier Sears Roebuck finding that every 5-unit increase in employee satisfaction was linked to a 1.3 unit increase in customer satisfaction, with a 0.5% increase in revenue, as grounds for this attribution. [“Standard Life Healthcare” Vielife.com Case Study 2006]
While adding in such wide-ranging results potentially adds far more benefits to compare to the costs of EHM, and far greater financial returns to compare to investments, it also muddies the waters when attempting to generalize about EHM results. Almost every report of results seems to deal in different results, or at least different ways of measuring the same results. As soon as employers and the vendors they hire move past sickness care, workers compensation and disability costs, where objective measurement is easier, they diverge in terms of both what and how they measure other results.
Most of the US reports of impacts on employee health dimensions, for example, have relied on the popular SF-36 survey scores, addressing both physical and mental health. In the UK, many reports employed Vielife’s Health & Well Being survey. Moreover, there are a half dozen popular surveys for developing estimates of productivity impairment and the reductions therein related to EHM. And while most such estimator surveys have been validated in terms of demonstrated correlation with objective measures of productivity, there have been few cases where the conversion from survey scores to actual productivity impact, or the conversion from validated productivity impact to demonstrated cost savings, have been included.
There are a number of national institutes interested in and publishing EHM results – the Institute for Health and Productivity, the Institute for Health and Productivity Studies, the Integrated Benefits Institute, the Health as Human Capital Foundation and the National Business Group on Health in the US, for example. In the UK, the Confederation of British Industries as well as government agencies have addressed the employee health and productivity connection. It would be helpful if some agreement were reached regarding what results dimensions should be commonly used in EHM studies, and what measurement devices seem to best correlate with objective productivity or other performance data.
Until such a development, as is the case with measuring the results of disease management in the US, we will continue to deal with wide-ranging results dimensions and ways of measuring them, as well with conflicting conclusions based upon them. The potential for EHM to dramatically improve employees’ and their employers’ performance, as well as to reduce the growing threat of uncontrolled inflation in sickness care use and expenditures, should prompt concerted action toward improving the measurement and evaluation of EHM results.
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