Wellness metrics point to HCW health risks

Employees learn to avoid chronic disease

When Washington County Health System (now known as Meritus Health) in Hagerstown, MD, first sought to measure the health status of its employees, the results were startling. Thirty-eight employees had undiagnosed diabetes or high blood pressure. More than 500 had glucose levels that placed them at high risk for developing diabetes. Other employees had high blood pressure, high cholesterol, or other risk factors.

Those metrics became the impetus for change. Employees received their own, confidential information on "modifiable risks" that showed how they could avoid the dire health consequences by making lifestyle changes. A comprehensive wellness program gave them support toward healthier habits.

Two years later, the hospital sees promising results. A survey showed that a significant number of employees have quit smoking, started taking medication for high blood pressure or other problems, lost weight, or started exercising. The estimated savings: At least $377,000 in decreased health care costs.

The hospital, which recently moved into a new facility and changed its name to Meritus Medical Center, hopes the metrics-based "Know Your Number" wellness program will help employees make further gains. "The true benefit is long-term, when you're not just treating disease, but you're preventing disease," says Wendy Atkinson, director of operations for THP TriState Health Partners, the health management company affiliated with Meritus Health. "By preventing these diseases and working in earlier points of intervention, we can actually save [health care] dollars."

Tying health assessments to identifiable risk of disease is the basis of BioSignia, a Durham, NC-based company that uses patented algorithms to create "Know Your Number," a calculation of an individual's risk of various diseases, including heart disease, stroke, high blood pressure, and stroke, within a five-year timeframe. With the "Know Your Number" health risk assessment, each employee receives a summary that shows how she or he compares to their peers of the same age and gender.

The bar graphs also show how much of that risk could be modified; often, the modifiable risk is as high as 70% to 80%. Understanding the risk can prod people to make lifestyle changes they wouldn't otherwise have made, says Mark Ruby, BioSignia's senior vice president of corporate business development.

"You have to know you've got a problem before you start going down the pathway to solve it. I may know I've got excess weight. I may know I have high blood pressure. But this is the first time I've had an assessment that actually translates that into my actual risk to getting [heart] disease [or stroke]," says Ruby. "More than that, you're giving me a roadmap to change."

The employee's information remains confidential and is not shared with the employer. But the employer does receive reports that show aggregate numbers. Know Your Number predicts future new disease burden in the screened population — how many of their employees have high health risks, how many new cases of disease will occur, and what percentage of new cases are avoidable. "That's the ultimate solution to health care costs," says Ruby. "A paradigm shift is happening."

At Meritus Health, the Know Your Number employee aggregate report predicted there would be 70 new Type 2 diabetes cases among the employees in the next five years, 59 of them preventable. The primary contributor to the diabetes risk was excess weight.

Ruby notes that nationally, more and more employers are investing in wellness as a way to control the medical costs of employees. For hospitals, there is another imperative. It doesn't make sense if hospitals are "delivering the health care but not living it," says Atkinson. "It's important for health care workers to be role models."

Know what you need to change

Obtaining that detailed health risk assessment requires the collection of key markers. It includes the usual: weight and height to calculate body-mass index, smoking status, blood pressure. The metrics also include fasting glucose and cholesterol.

Meritus Health spurs participation with a premium differential. Employees who decline to take the health risk assessment are required to pay $30 per month in additional health care premiums.

At first, that ruffled a few feathers, but the health system succeeded in winning over employees with a comprehensive wellness program that includes fitness, nutrition, and wellness classes as well as one-on-one health coaching.

"You really can't make any changes if you don't know what you need to change," says Atkinson. "This tool helps you target [areas] where you can make some positive impact."

A wellness committee helped shape the types of programs offered by the health system. It includes some people who were recommended by managers as employees who would be likely users of the program, as well as some skeptics. "A wellness team or a wellness committee needs to be representative of your population," says Atkinson.

The committee conducted surveys to find out what types of wellness activities employees would want and what educational topics would interest them. Atkinson also joined the Wellness Council of America (www.welcoa.org) to gain access to wellness resources. (The Wellness Council offers sample employee surveys, wellness brochures, and guides to creating a program.)

The wellness committee drafted a plan with some basic goals to improve employee weight management and smoking cessation. With the support of senior leadership, the hospital has designed walking paths in its new facility and added healthy choices and nutritional information in the cafeteria.

Even the snacks at in-house meetings changed. "There is alignment that has to happen," says Atkinson. "If you have meetings and serve cookies, you're really working against yourself."

The risk assessment also includes a behavioral health component that can identify employees who suffer from high levels of stress or depression. Once they are identified, THP's behavioral health coach/case manager reaches out to offer help.

Some changes are easy to measure — pounds lost, smokers who quit. But the awareness of health and disease risks will show results over time, says Ruby. After all, rising medical costs are daunting for all employers, including hospitals. "The solution many times is in front of people's noses," he says. "If 70% to 80% of disease is avoidable, why aren't we avoiding it?"