Addressing Chronic Conditions to Improve Health of Employees and Decrease Costs

Chronic conditions represent a burden on employees and employers, and programs that address these conditions have the potential to improve employee satisfaction, reduce costs, and improve employee health, explained speakers at the Midwest Business Group on Health’s 39th Annual Conference, held May 8-9 in Chicago, Illinois.

First, Nicole Jourdan, interim health and well-being manager, benefits, Advocate Health Care, highlighted a program that Advocate Health Care implemented with Inspera Health to help employees who had multiple chronic conditions (MCCs).

“Our problems were very common ones: our high-cost claimants were kind of spiraling out of control,” she said. The more expensive 15% of Advocate’s population accounted for more than 80% of costs.

The good news is that of high-cost claimants, the people who fell into the MCC group were those who Advocate could predict and impact, as opposed to employees who fell into the trauma and tragedy groups. Just among employees in Illinois, 16.4% of Advocate’s members had 3 or more chronic conditions and they accounted for 60% of spend.

The health solutions being offered to the general population weren’t helping, Jourdan said. People with MCCs needed the extra help, so Advocate partnered with Inspera Health, a health improvement company serving people with MCCs. The participants in the program had at least 3 or more chronic conditions from a list that included conditions like obesity, elevated cholesterol, hypertension, diabetes, asthma, chronic joint pain, depression, anxiety, and chronic obstructive pulmonary disease.

Delving into the data on employees with MCCs, Advocate found that they tended to have behavioral health conditions that needed to be addressed as well and that their costs were 20 to 30 times higher than those of employees who did not have MCCs.

While building the program, Advocate followed a few keys to success based on guidelines from the Agency for Healthcare Research and Quality:

• Real-person approach: in-person help with a dedicated support staff
• Integrated whole-person approach: this included physical, emotional, mental, financial, and spiritual well-being
• Duration: a longer program tailored to create sustainable lifestyle changes
• Behavior change: fully integrated behavioral care to sustain health transformation
• Support: a multidisciplinary provider network to offer a wide support system
• Metrics: the impact of the program was measured across 6 metrics including engagement, participant satisfaction, and self-reported behaviors.

According to Jourdan, the personalization of the program led to strong engagement and retention, with 81.7% of participants still engaged at 19 months. As a result of the program, 85% of participants improved their health, 71% lost weight, and 90% improved their physical activity.

Following Jourdan’s presentation, Marlene Muglio, director of global benefits, PwC, outlined how her company addressed musculoskeletal (MSK) issues among its employees. It decided to focus on MSK because it found that costs for the condition were increasing year over year because the majority of employees were leaving it untreated. At PwC, 80% were not receiving appropriate, nonsurgical care for MSK, she said.

With MSK, treatment has to go beyond simply physical therapy in order to have meaningful and lasting improvements, Muglio said. Treatment has to include education and behavioral health care.

“If these are executed, the probability of surgery or the eventual use of opioids can be avoided,” she said.

PwC was looking for a digital solution because 80% of its staff is under the age of 30. So, it landed on a coach-led program from Hinge Health, which utilized tablets and attachable sensors so participants could participate in exercise therapy sessions from anywhere.

A total of 3389 employees started an application to participate in the program, with 2750 (81%) completing their application, 2167 (64%) being accepted into the program, and 1650 (49%) ultimately being onboarded and initiated. Participants averaged 2 to 3 exercise therapy sessions a week and they engaged with coaches 5 or more times a week.

Anxiety and depression were reduced 66% and 52%, respectively, which were gauged using surveys given at the beginning of the program and then again at the end of the 12-week program to measure the efficacy of it. Productivity and absenteeism also decreased 53%.

According to Muglio, there was a 60% reduction in pain, which is 2 times better than the average opioid pain reduction of 30%, and 2 out of 3 surgeries were avoided. The purpose of the program was to see if PwC could address the root of the problem, which opioids don’t do.

“[With opioids] we’re just masking the symptoms, as opposed to identifying the root and building a daily habit and a sustainable practice to keep these patients out of the hospital, out of surgery, and being more productive,” Muglio said.