Act before, not after, employees develop chronic health problems

Employees often surprised at results

Shock is a common reaction of employees at Ann Arbor, MI-based Domino's Pizza who find out they are at risk for a chronic medical condition after participating in a health assessment. "Many of our team members and their spouses had no idea they had high total cholesterol or were pre-diabetic," says Joe Schuster, benefits manager.

When Domino's set out to target employees who were approaching chronic conditions such as diabetes or cardiovascular disease, they looked for a vendor to do a comprehensive blood analysis and health assessment. The Blueprint for Wellness risk assessment service, offered by Lyndhurst, NJ-based Quest Diagnostics, was chosen. (For more information, see resource information at the end of article.) Employees who complete a survey and undergo diagnostic screening are given a confidential report on their health status and recommended interventions. Employers receive aggregate results and recommended actions.

They deliver compelling results. "A key finding is that many team members were simply not aware that they were already in or approaching a pre-chronic condition state," says Schuster. "The gaps in knowledge were, in several instances, quite alarming." For instance, only about 14% of employees who did the assessment reported that they thought they had high total cholesterol, but lab tests showed that the actual number was 40%.

An employee won't likely participate in a diabetes prevention program if he or she isn't convinced they are at risk, says Schuster. "The unfortunate secret for a lot of plan sponsors like Domino's is that you can build a robust wellness testing program, and even cover the costs of the tests, yet still end up with very poor participation," he says. Domino's offered six on-site events, and the rest of the participants had their blood draws at a Quest Patient Service Center.

During the first year, 40% of employees and 44% of covered spouses participated, says Schuster. "We hope to exceed the 50% threshold for participation when we roll out year two of the program this fall," he adds. "We're just scratching the surface of what could eventually be considered a comprehensive health assessment program for all adult covered lives at Domino's." They have seen increased participation in their condition management programs: an 18% increase for the asthma program and 9% increase for the diabetic program.

A payroll contribution incentive is given to participating employees of $390 for individuals and $780 for families, but covered spouses had to participate to receive the bonus. "One of our concerns was that although spouses make up only 20% of covered lives, they consistently make up 30-35% of our total claims incurred, and we had the least amount of data on potential risk areas for spouses," says Schuster.

The Blueprint panel of tests is an "early warning system" regarding potential health risks today and further down the road, says Schuster. Many of the tests aren't ordinarily run, such as a blood test that can detect slight elevations of C-reactive protein associated with increased risk of cardiovascular disease, because health insurers feel they are not cost-effective or medically unnecessary in a broad-based testing program, he explains. "But a growing number of employers have done the math and determined that the savings from early identification and intervention can exceed the additional costs incurred from having a broader testing panel," Schuster says. "We are learning in concrete ways that physical appearance is not always the best predictor of an individual's health status."

Biggest opportunities ID'd

Domino's is linking its Blueprint data to prior medical claims data, with the goal of initially targeting two specific groups: those who haven't had a lot of claims incurred yet, but are on the cusp of developing a serious condition; and individuals with $25,000 or greater in claims, who are at risk for developing additional medical conditions.

The data will identify the biggest opportunities for return on investment (ROI), with a multiyear proposal presented to the management team. Initial results from the Blueprint program have identified cardiovascular disease and weight as the two areas of intervention that offer the greatest potential financial impact for Domino's, reports Shuster.

To determine ROI, behavior changes or changes in clinical indicators values will be documented, such as out-of-range triglyceride scores that go back into the reference range. "We think we will be identifying a certain number of individuals to make the ROI positive. But we don't expect to see clear ROI until year three," says Schuster.

Ultimately, however, the program's success depends on the employees and spouses taking action on what they learn, says Schuster. Domino's is now looking for a third-party vendor to conduct a "very aggressive outreach" program, to be rolled out in January 2008. Participating employees sign a form agreeing that the identified results will be accessible only to individuals within Domino's HIPAA Privacy Circle and to designated business partners who will provide services such as health coaching and condition management.

"We want to make sure we have the right partners to activate our team members and their spouses to make what will be in some cases very difficult lifestyle changes," he says. "We are also looking at the medical vendors to see which one has the best precondition and condition management programs to support the Blueprint program."

Some employees may not want their employer or even a third-party vendor involved in their overall health status, acknowledges Schuster. "This is one area we plan to test to a greater extent in 2008," he says. "But, being a self-insured company, we are trying to send a message that early interventions are going to benefit all parties involved. We shouldn't have to apologize for wanting better health and a long-term lower medical trend as a goal."

For plan year 2008, Domino's is proposing that certain pharmaceuticals linked to the risk categories identified in the Blueprint data be offered at low cost or no cost. The concern is that a certain number of employees and spouses participating in Domino's medical plan are not taking their pharmaceuticals consistently, or may not take them at all, because of the cost involved, explains Schuster. "The company is concerned about being penny wise but dollar foolish with regard to the pricing of critical maintenance drugs. As much as it is financially possible, the company does not want the ability to pay to be an issue with compliance," says Schuster. "If just one chronic medical condition is prevented, the savings can far outweigh the additional testing and drug-offset costs involved. "

Tailor wellness programs

At Booz Allen Hamilton, a global consulting firm based in McLean, VA, Blueprint for Wellness data is being used to target the best opportunities for wellness programs. Other than paying for the assessment, no incentives are offered for participation, but about 20% of its 17,000 employees participate, reports Natalie Jackson, the company's work-life program specialist.

"The report summarizes our top high-risk conditions and gives us a listing of interventions we might want to offer to our employees. Data can be broken down by site as well," says Jackson. "This gives us some type of direction with where to go with the programs we offer." Using the risk categories identified in the aggregated data, "Brown Bag" wellness opportunities were introduced to target hypertension and stress reduction at the Colorado Springs office, and a 12-week program was added to track activity level of employees, for example. Though employees are not contacted directly about interventions, it is clear that they are happy to gain information on their health. "I have had many employees approach me and say 'thank goodness for this opportunity.'" says Jackson. "They found out they were at high risk and are now taking steps to improve that. That is success to us."


For more information on identifying employees at high risk for chronic conditions, contact:

  • Natalie Jackson, Work-Life Program Specialist, Booz Allen Hamilton, 8283 Greensboro Drive, McLean, VA 22102. Phone: (703) 377-0367. E-mail:
  • Joe Schuster, Benefits Manager, Domino's Pizza, 30 Frank Lloyd Wright Drive, Ann Arbor, MI 48106. Phone: (734) 930-3693. Fax: (800) 374-5330. E-mail:

Blueprint for Wellness is a health risk identification solution and education tool for employers offered by Quest Diagnostics. Blueprint for Wellness services cost from $50 to $200 per participating employee. For more information about Blueprint for Wellness Incentive Programs, contact: Quest Diagnostics, 1290 Wall St. W., Lyndhurst, NJ 07071. Phone: (800) 654-7824. Web: