Monday, November 29, 2010

Another Wellness Program Demonstrates Value

On the heels of this Health Affairs publication on the economic value of employer sponsored wellness, we now have this "on-line" report from Population Health Management. You know it's going to be an interesting when it simultaneously involves a care management company (HealthMedia), an academic institution (University of Michigan) and a health insurer (a subsidiary of a Blue Cross Blue Shield Plan).

The manuscript is titled " The Economic Value of a Wellness and Disease Prevention Program" and was authored by Steven Schwartz, Caryn Ireland, Victor Strecher, Darren Nakao, Chun Wang and Deborah Juarez. It makes for interesting, if difficult, reading.

The Disease Management Care Blog will try to summarize.

The authors evaluated the Hawaii Medical Service Association's "HealthPass" program. This includes a health risk assessment (HRA), biometrics (like the usual lab tests, blood pressure measurements, assessments of body mass index plus the age/gender recommended screenings), counseling (which could be one-on-one, group or telephonic) and access to online awareness, education and motivational wellness support interventions with or without financial incentives. In other words, it was state-of-the-art.

In order for HMSA enrollees to be included in the study, they had to be between 18-70 years old, a member for at least 9 months between 2002-2005, not exceed $100,000 in claims per year, not have been in a nursing home and not have remained in a hospital for a prolonged period of time. Of the approximate 384,000 HMSA members, 166,201 (43%) met the criteria described above. Of this group, a total of 11,883 participated in HealthPass at some point (it looks like 11,498 in 2002, 5192 in 2003, 4247 in 2004 and 4060 in 2005, suggesting some individuals participated over multiple years). Age, gender, baseline morbidity and baseline costs were used in "propensity matching" to fashion a one-for-one non-HealthPlass comparator control group for each of the four study years.

Compared to the control group, HealthPass participants consistently had lower total average health care expenditures. What's more, those savings exceeded the yearly HealthPass costs (which ranged between $204 and $236 per year). The net savings was $34 per participant in 2003, $132 in 2004 and $124 in 2005. The calculated total "return on investment"was $1.58 in reduced claims expense for very dollar spent.

In addition, there appeared to be a "dose response" curve: more years of participation led to even greater savings. What's more, persons with higher levels of morbidity appeared to achieve greater savings. Finally, the savings appeared to hold up if two year cost trending was used to project future costs.

When the DMCB was reading this, it found it hard to understand which year's savings was being compared to which year's costs. With that caveat, it thinks this study is part of an expanding body of evidence that supports multi-component worksite wellness programs. The authors also deserve credit for correctly pointing out that there may been been ethnic, educational, psychological, attitudinal, behavioral or other unmeasured factors that were not captured by the propensity matching that could have accounted for the observed differences.

Last but not least, two of the University of Michigan authors (Drs. Schwartz and Strecher) are also affiliated with the HealthMedia care management program. Bravo, says the DMCB. It wishes more if its academic colleagues would get into fashioning and evaluating "real world" programs that are not only doing measurable good but are commercially viable. As an added bonus, you check out this video here of Dr. Strecher explaining his passion for web-based health behavior change. Watch it over lunch with your salad, tofu, yogurt or donuts. You won't be disappointed.

Image from Wikipedia

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