Wellness programs keep employees healthy, reduce health care costs

CMs can launch a grass-roots effort’

As employers grapple with rising health care costs, they’re starting to realize that the key to cutting costs is to keep their employees healthy, rather than waiting until there’s an illness to manage, says Connie Commander, RN, CCM, ABDA, CPUR.

"When I meet with employer groups, they tell me that they know they have sick people and those with chronic illnesses, but they also want programs that are focused on wellness. If you can prevent someone from getting ill or prevent an exacerbation, it will save money and it’s cost-effective in the long run," adds Commander, owner and president of Commander’s Premier Consulting Corp., and national president-elect of the Case Management Society of America (CMSA).

Employee groups already know the positive outcomes of keeping their employees working. They have more productive hours, and they don’t have to bring people in to cover for someone who is sick, she adds.

Employers know they can’t prevent their employers from being in accidents or getting colds, but they do realize that they can encourage people to alter their lifestyles to stop smoking, lose weight, eat better, and exercise more and, when they do get sick, to follow their treatment plans, she adds.

"Employers are asking for the medical field to teach their employees to be more healthy. It’s a quality-of-life issue that affects everybody’s bottom line," Commander says.

When Commander worked with managed care organizations in the mid-1980s to 2003, some companies would reimburse people or give them a reduction in premium if they joined a health club or engaged in other healthful behavior. They referred to themselves as health maintenance organizations because they did just that, she adds.

"In the ’90s, disease management was a huge initiative, and everybody was going to hit all these populations and educate them. The expectation was that once you gave people information and sent them reminders about what they needed to do that they would be compliant," Commander explains.

The emphasis on health maintenance has come full circle from the infancy of the HMO industry, she says.

"Some companies had gotten away from the health maintenance piece, and now they’re coming back around," Commander says.

Employer groups have begun to approach insurers, looking for ways to keep their employees healthier, cut down on absenteeism, and make sure the employees are well and able to perform 100% when they’re on the job.

"In the face of rising health care costs, more and more companies are seeing the value of promoting healthy lifestyles at work. Our on-site programs give employees convenient access to health screenings and education right at their workplace," says Terri Kachadurian, MS, manager of work site health promotion for Health Alliance Plan (HAP), based in Detroit.

Employer groups are determining that, instead of cutting benefits, the best way to address rising health care costs is to keep their employees healthy in the first place, adds Sarah Weiser, PhD, director of employer health partnerships at Blue Cross and Blue Shield of North Carolina, based in Chapel Hill.

"We help them determine where to focus on wellness efforts. A lot want to do the right thing but don’t know where to start," she says.

"Ask anybody in the health field, and they’ll tell you that health maintenance affects the bottom line in a positive way," Commander adds.

With the emphasis today on obesity, diabetes, and rising health care costs, the time may be ripe for an emphasis on wellness activities, she says.

"It will be a huge initiative. We didn’t get to this place easily. It’s going to be a slow boat to turn around. We have to start somewhere. We can’t just focus on people who become ill," Commander points out.

Employers still are looking for the magic wand that will help them reduce heath care costs, says Catherine Mullahy, RN, BS, CRRN, CCM, president of Options Unlimited, a Huntington, NY-based case management company.

"We’ve tried case management, disability management, disease management, and predictive modeling to see if we can find the people who are likely to be sick down the road. Now may be the time to see if we can do health and wellness programs," she says.

But employers who already are feeling the pinch of rising health care benefit costs may be reluctant to spend more money on wellness programs, Mullahy points out.

"There’s not a lot of data on return on investment for health and wellness activities, and it may take a long time for the effort to pay off. Employers are spending dollars on catastrophic cases and may not have enough left over to pay for wellness programs," she says.

That’s where case managers come in, adds Commander.

As they work with patients who are chronically ill or catastrophically injured, case managers should take the opportunity to work with them on preventive measures, she notes.

"What we need to do is go back to the grass roots and teach people to be more healthy. It’s a shift back to what we knew when our grandmothers told us to eat our vegetables," Commander says.

All of the publicity about the shortages of flu vaccine and the potential for an avian flu pandemic has spurred a hand-washing phenomenon, she reports.

As she has traveled around the country, Commander has noticed the increase in the number of people who are carefully washing their hands in airports now that there is a big concern about the spread of avian flu.

"In one airport, I saw a child with a bottle of hand sanitizer washing her hands. People are trying to prevent themselves from getting sick, and it’s happened because of their awareness about the flu," she says.

The same kind of educational effort on weight management, diet, exercise, and smoking cessation can make a difference, and case managers have the opportunity every day to educate the people with whom they are working and their family members, Commander adds.

"Wellness could become a grass-roots campaign. Case managers may be focusing on a disease or a specific injury or illness, but they can use that opportunity to educate not only the individual but other family members," she says.

If a case manager has a client who has had a stroke, has coronary artery disease, and smokes, that client already fits into a disease management program.

"But what about the family members? We should be doing some wellness education with them. We, as case managers, should use the opportunity talking to families and significant others to help educate them on lifestyle changes," Commander says.

Many people are not aware of the risks associated with their behavior. Case managers have a great opportunity to heighten their clients’ awareness of a healthful lifestyle and to help them understand that the choices they make today can affect their health in years to come, she adds.

"Maybe they can start eating one nutritionally sound meal a week. As case managers, we can motivate people; and as we focus on adherence to treatment plans, we can also help them adhere to a wellness plan," Commander says.

A typical health plan takes claims data, sorts them by DRG, and determines the members who quality for disease management programs, Commander points out.

The health plan sends information to people eligible for the program. The health plan may refer these members to the company web site and call them to remind them it’s time for a vision exam or other procedure, she adds.

"Population management gives people a lot of information, but it doesn’t motivate the individual. They need this individual approach from a case manager to help them follow the treatment plan. They could be in denial. It’s a huge challenge to get people to make lifestyle changes," Commander explains.

"So many people are working two jobs to put food on the table. We’ve got to come up with ways to motivate them," she says.

If someone doesn’t have time to work out, suggest that they get up during commercials and work out. Encourage them to take a break at work and walk up and down the stairs. Maybe they’ll do it once this week and twice next week.

Go one step further and focus on prevention of the chronic disease with the entire population, Commander suggests. Send out a newsletter for the rest of the family or pick an educational topic, such as walking for health, and send out information each month or each quarter.

"If a case manager is coordinating the care of a diabetic with five family members and there are two other diabetics in the family, he or she should look at the other three to see if there are ways to keep them from becoming diabetic," she says.

Reinforce the idea of a healthy lifestyle, including regular checkups, exercise, and proper diet.

"You may get more leverage because the family member has someone who is ill in front of them and they can see the effects of the disease," Commander says.