Money motivates HCWs to be healthy

Sentara program slows the rise in HC costs

As with most employers, the cost of health insurance was rising year after year for Sentara Healthcare of Norfolk, VA, an integrated health care delivery system that includes eight acute care hospitals, outpatient centers, long-term care, and Optima Health Plan, an insurance subsidiary.

Employees had access to education programs, Weight Watchers at Work, discounts at local gyms, and some disease management. The programs weren't coordinated, though, says Karen Bray, PhD, RN, CDE, vice president of clinical care services. "We found that they were generally underutilized," she says. In fact, they were mostly used by people who already had a healthy lifestyle, she says.

Sentara worked with Optima Health to create Mission: Health, an incentive-based wellness program.

Six months before the open enrollment period for health insurance, employees participate in a health screening that measures blood pressure, cholesterol, height and weight. Employees also report whether they smoke and if they exercise at least three times a week.

Based on that information, employees with 0 or 1 risk factor receive a premium discount of $550. Employees with two or more risk factors can receive the same discount, but they are required to have telephone sessions with a health coach.

"They have to at least speak with their health coach on a quarterly basis. If they don't, their premium reverts to the higher level and stays that way for the rest of the year," Bray says.

About a third of the employees have two to five risk factors — and about half of those people fail to maintain contact with a health coach, she says.

Taking a closer look, Sentara realized that diabetes, coronary artery disease and congestive heart failure accounted for 14% of the overall health care costs. So an additional incentive program provides an additional $460 in a medical savings account if people with one of those conditions participate in a disease management program.

"We wanted to have at least 80% participation in the programs and we achieved that," says Bray. "We wanted to be able to show improvements in those items we measure in the personal health profile. In every one but body mass index, we showed statistically significant improvements starting in the first year."

Interestingly, Sentara actually saw an initial rise in health care costs — due to the increased treatment of the diabetes and cardiac conditions. In the second year, costs dropped back down by 10%. Since then, the rate of increase in health care costs has been significantly lower than it was before the program began. Employees also have fewer risk factors. "This is an investment in your [employees'] health," says Bray.

At first, some employees were skeptical about their employer being involved in their personal health. The Sentara message: "We care about you. We're a health care organization. We should model good health for the community," says Bray.

The program has evolved, with online education, wellness awards, and eligibility for spouses to participate in the disease management program — for an additional $460 medical savings account incentive.

Coaching is an integral part of the success, says Bray. "People understand intellectually what they're supposed to do. But to execute a plan requires some help," she says.