High-risk program nets savings of $10 million

Return on investment nearly seven to one

Wellness professionals looking for hard proof that their efforts pay off on the bottom line can take heart from the results of a recently released study. A wellness program targeting high-risk employees at New York City-based Citibank has resulted in savings of $10.72 million and a return on investment of 6.7:1, according to a cost-benefit analysis conducted by The MEDSTAT Group, an Ann Arbor, MI-based health care information, strategic consulting, and research decision support company.

The program was developed and implemented by Healthtrac, a Menlo Park, CA-based wellness services company. The study covers a period between January 1994 and the end of 1996, during which Healthtrac's programs were offered to the entire Citibank domestic employee population (and a small group of overseas employees who were domestically based) of 42,000. About 17,000 participated in a health risk appraisal (HRA), of whom 3,000 were identified as high-risk.

From data collected through the questionnaire, high-risk individuals were identified and channeled into a Healthtrac "Accent Module," which addressed their specific risk factors. These included:

· arthritis;

· back pain;

· blood pressure;

· chronic conditions (lung disease and stroke);

· diabetes (with channeling for Type I and Type II);

· heart problems (with channeling for people with history of heart attack and those who are at risk);

· combined risk;

· smoking cessation;

· loss.

In addition to the self-care materials distributed to all program participants, the high-risk participants received three quarterly health assessments focusing on their specific conditions. Following receipt of each questionnaire, the participants received a confidential, personalized letter and report highlighting their health risks and providing information on how they could better manage their condition. They also received a series of health education materials (pamphlets, books, videos, and/or audio tapes).

Targeted programs superior

The return on investment reported in the MEDSTAT study is much higher than the 3:1 ratio most wellness professionals consider a benchmark of success. Are targeted interventions of high-risk employees that much more effective?

They are, argues Nancy Richardson, vice president of business development for Clinical Solutions, LLC, a disease and demand management company based in Menlo Park, CA. Richardson was a Healthtrac vice president during the period of the study, and oversaw the Citibank project.

"The difficulty [with traditional wellness programs] is in knowing who the high-risk individuals are," she explains. "You have an issue of employee confidentiality and you want to protect that. A mail-delivered and telephone approach allow you to identify and help high-risk employees without jeopardizing that confidentiality. You can provide a much more personalized message to support them wherever they are."

In the case of the Citibank program, MEDSTAT employed a claims database it had established over a number of years for the bank. "With the claims data being handled by MEDSTAT, confidentiality was protected," says Richardson.

Personalization also makes these types of interventions more affective, notes Richardson. "You ask people about their habits, their risks, and then you create a personalized message based on that information," she explains. "You are not giving them, for example, a 'canned' diabetes message; you are giving them specific recommendations to reduce their risk factors."

The condition-specific questionnaires helped personalize the messages. "The idea is to give employees a sense of self-efficacy and confidence," Richardson says. "If you are able to impact perception of health status, you can greatly improve outcomes."

So, for example, a diabetic might be asked how confident he is that he can control his diabetes. "If he has a low confidence level, you help him raise it," she says. "You communicate the message that even if you have a chronic disease, you are not helpless. For example, you can eat better, examine your feet for foot ulcers, and talk to your doctor regularly."

There are several reasons this specific program yielded such impressive results, says Ron Goetzel, PhD, vice president of consulting and national practice, in the Washington, DC, MEDSTAT office.

"First of all, it was a fairly low-cost project," he notes. (The cost of the high-risk program was $293 per participant.) "It was not conducted on site, but rather through the mail and telephonically."

In addition, says Goetzel, the program had a relatively high HRA participation rate of 40%-50%, using just a $10 incentive. "A lot of programs waste a lot of money with incentives," he says. "The higher the participation rate in the program, the more likely you are to get the people you need the most."

Finally, he says, intervention programs for high-risk individuals also include demand and disease management programs - which, he claims, are superior to standard health management programs.

"Folks who have these [chronic conditions] cost you the most money," says Goetzel. "If you can somehow affect the group that consumes the most resources, you have a much bigger bang for the buck."

This program worked, he summarizes, because it was "a program that targeted high-risk people and then triaged them into appropriate intervention programs with individual counseling and support within the context of the health promotion model. That's what it takes to change risk factors; that's essentially what we found."