Employers, insurers turn to wellness as cost elixir

In the ongoing battle to control health-care costs, some area employers and health-care providers are embracing the industrywide dogma that “prevention is cheaper than treatment” and incorporating wellness programs into their health-care plans.

Most are finding that when the wellness approach is taken, everybody benefits: employees, employers and insurance companies.

A good example is the City of Loveland, which recently completed its first year under an innovative wellness program called “Healthsteps.”

“It’s a win-win situation for the employee because he is healthier and happier. The City wins because the employee performs better and has higher morale and misses less work,´ said Wynette Cerciello, human-resources specialist for Loveland.

Healthsteps is based on points employees accumulate over a one-year period. For each dollar employees pay every month for health insurance, one point goes into their Healthsteps account. Additional points may be earned by “making good lifestyle choices, like tobacco cessation,” Cerciello explained.

If an employee, or any family member, needs medical care during the year, insurance pays the costs, and that amount is deducted from the employee’s account.

However, costs for wellness-related activities, such as mammograms, are not deducted from the account. Most importantly, an employee is never denied health-care coverage, even if his or her account reaches a zero balance, Cerciello stressed.

“The purpose of the program is to help employees become better health-care consumers, to make them more aware of what is being spent by the insurance carrier,” Cerciello said.

The City constantly promotes wellness concepts with workshops, health fairs, seminars and literature, including a self-care handbook.

This year, for the first time in six years, the City realized a surplus in health-care costs amounting to $301,543, Cerciello said.

Half of the surplus will be distributed among the City’s 590-plus employees on a predetermined basis. The remainder will go back into the city’s self-funded health-care fund.

“I’m not going to say the surplus was all because of the wellness program, because a lot of variables are involved, and you need to track a wellness program at least four to five years to get an idea of its effectiveness. But, in 1995, before the wellness program was initiated, the city had to supplement the health-care fund,” Cerciello said.

Unfortunately, Loveland may not get to see whether its innovative program can save additional money in the future because citywide budget cuts for next year are being considered, and Healthsteps could land on the chopping block.

Since 1993, HSI Health Plans Inc. in Fort Collins has offered an economic incentive to enroll in its wellness option, said Karen Morgan, vice president of group and member services.

Enrollment saves about 12 percent per month per member, Morgan said. With the industry averaging about $100 per month per member, a family of four can save $576 per year by opting for the wellness program, Morgan explained.

“When people have this choice, we are finding that about 75 percent are signing up. Then, we are retaining close to 97 percent of those who stay in the plan. It’s one of the fastest-growing products HSI has,” she said.

Morgan said it is still unclear whether HSI’s wellness program will survive if the merger with Blue Cross Blue Shield of Colorado is approved by the Colorado Division of Insurance in late June or early July.

Not all insurance providers offer financial incentives to enroll in a wellness program. Some, such as PacifiCare, do not.

But “that does not indicate any lack of commitment to health education,´ said Laura Wegscheid, director of communications for PacifiCare of Colorado, previously FHP Health Care.

Indeed, PacifiCare has had a comprehensive wellness plan since 1989 that focuses on prevention through education.

One aspect of the plan has been to develop skills and confidence in participants to assess whether to seek medical care in managing common health problems and, when care is needed, how to get the most from it, explained Janna West, a health educator for PacifiCare.

Self care is a concept used in many wellness programs and is taught through guideline books. PacifiCare uses “The Healthwise Handbook” in its program,

West said that in 1992, random studies were conducted of Healthwise and non-Healthwise participants to compare the rate of doctor visits (claims filed) between the two groups.

The results showed that Healthwise participants made 90.7 percent fewer trips to a doctor for URI (upper respiratory infection) than nonparticipants. This demonstrated that “Healthwise was helping them develop confidence and competence to manage common health problems,” West concluded.

A similar study regarding ear infections revealed a 49 percent difference in doctor visits with Healthwise participants being higher, “which is exactly what it should have been because ear infections are what people should see their doctor for,” West said.

Focusing on prevention of breast cancer, PacifiCare sends reminders to female members over 40 who have not had a mammogram in the last year and follows up by also informing their physicians.

West said such steps could explain the 6.8 percent increase in mammography exams in 1996 over 1995.

Maureen Balzer, who coordinates the City of Fort Collins’ wellness program, described a study the City conducted three years ago to measure health risks among 400 utility employees. Sixty percent volunteered to participate.

“We asked questions on exercise participation, eating habits, health history, seat-belt wear and use of alcohol and driving. The next year, we took the same group and found a 27 percent self-proclaimed reduction in (the same) health risks. The third year, we found an additional 10 percent reduction, Balzer said.

Although screenings and tests administered in the program have uncovered early cancers and revealed unknown high-risk conditions, Balzer said it is difficult to measure the effectiveness of wellness programs in terms of dollars saved.

“There are ways you can extrapolate the expected savings, like the average amount a smoker costs in health care, but what’s difficult is to really measure what would have been had these people not had the education, the awareness and the opportunity to make changes. So you’ve got to just believe that the benefits will be positive,” Balzer said.

The extent of a company’s participation in a wellness program seems to be based on factors such as size, facilities, commitment and the scope of the company’s health-care plan.

Most offer health-related classes, sponsor lunch-time speakers, hold health fairs, make free preventive screenings available on a regular basis, promote community health-related activities and have on-going tobacco-cessation programs, which may include monetary rewards for the successful.

Some, like the Rocky Mountain regional office of State Farm Insurance in Greeley and the Colorado Division of Eastman Kodak Co. in Windsor, have medical departments with onstaff nurses and/or part-time physicians.

Kodak also provides its 2,400 employees with fitness and exercise facilities in each of its buildings.

Others, such as Advanced Energy Industries Inc. in Fort Collins, does not have onsite wellness and fitness programs “because it would be nonproductive to interrupt manufacturing production lines,´ said Carol Steinbock, human-resource administrative assistant.

“So we try to take the middle of the road by having monthly and yearly events to keep health issues out in the open,” Steinbock said.

MaryBeth Bradley, general manager of Healthworks in Fort Collins, a health and fitness center that actively promotes wellness programs in the workplace, believes, like many others in the health-care arena, that economic incentives are the key to greater participation.

“C. Everett Koop (former U.S. Surgeon General) said that we’re not too far away from health-insurance companies realizing if they can offer a financial incentive from a prevention standpoint, that’s when you’ll start to see the shift,” Bradley said.

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