When hospital leaders look to lower costs, one place they're just beginning to explore is the rising expense of their employees' health claims. That means having some tough discussions about how to weigh their workers' personal lifestyle choices and privacy issues against the fiscal health of their own organizations.
That was the provocative topic of a session on the first day of the American Hospital Association's 19th Annual Leadership Summit in San Diego Sunday.
How does a hospital system convince its own workers that getting healthy and staying healthy is not just good for them, the employees, but that it also is essential for the organization's fiscal viability, and may help the system serve as a model for patients in their community as well?
"We don't make widgets; we take care of people. So let's take care of our own people and make sure that we demonstrate and model that behavior for the community," said Corey Heller, corporate vice president and chief human resources officer for Baptist Health South Florida, a 7-hospital system with 1,728 beds in Miami-Dade.
"Let's take care of them before they become our patients. Why wouldn't we want to have the healthiest workforce in America?"
So three years or so ago, Baptist, which is self-insured, launched Wellness Advantage, a program that seeks to better the health of its own 14,700 workforce. The program offers $150 annual credits on an employee's health plan premium if the employee fills out a lengthy annual health questionnaire and takes routine disease screenings, such as a glucose test to show predisposition to diabetes.
"We've pushed the envelope a little bit," with respect to HIPAA, (the Health Insurance Accountability and Affordability Act) Heller acknowledged. But that was possible because, he said, Baptist functions in a culture that is transparent. Between 40% and 45% of the workforce take the survey each year, which asked questions about such issues as body mass index.
On that basis, the system determined that about 800 were in a high-risk group and another 3,900 were at moderate to high risk.
Baptist decided to target those higher risk individuals to get them on the right track. The hospital system uses health coaches, gym memberships, reminder and checkup calls to employees' homes three times a week and even nutrition experts who make visits to an employee's home to "look in their pantries – that's a pretty serious intervention."
They are even contemplating similar interventions for employees' covered health plan dependents.
The system offers exercise physiologists, onsite fitness centers, 50% discounts for certain "healthy" labeled meals and even buys fresh fruits and vegetables for some of its lower income workers.
"That's an aspect of this program – if employees can't buy nutritious food, we buy it for them, to eliminate financial barriers" that keep them from adopting behaviors to reduce their progression to chronic disease.
Heller quickly acknowledged a deficit that has frustrated many health policy thinkers: that there is little to no solid evidence that aggressively working with employees to improve health will save money. And this was no clinical trial or laboratory test environment.
But intuitively, he says, it should. It makes sense.
In South Florida, statistics show a higher percentage of people with diabetes than many other large metropolitan areas, and at Baptist, there are 1,000 workers already diagnosed, Heller said.
In the Miami-Dade County area, a patient with diabetes costs $20,000 more per year than a patient who does not have diabetes. "If we can prevent one diabetic form becoming a full blown diabetic the program will pay for itself."
After year one, the program actually increased costs by 4%, because more of their employees saw doctors and took more prescription medications. The second year health costs stayed level. But in the third year, the last one measured, "we saw a 30% reduction in overall spending. And that's pretty significant."
That strategy may be working for the time being for Baptist, which has still offers its employees a choice of health plans with no deductible, yet still manages to pay 80% of healthcare costs.
The discussion among the audience moved toward the possibility that employers might be able to require their employees to fill out such questionnaires and agree to such interventions as a condition of employment. For example, some organizations now require their workers to receive annual influenza vaccinations, or else wear a mask while on the premises.
"The EEOC (Equal Employment Opportunity Council) has not made a formal ruling on this," he said, adding frankly, that lawyers have told him "it's a gray area," and could become an issue or rallying cry with labor unions.
In an interview after his talk to the AHA audience, Heller said that participants in Baptist's sponsored Weight Watchers incentive program boasted an 11-pound average annual weight loss and a two-point drop in BMI for 650 participants.
But the hospital system has much more aggressive goals. Now, cost increases for health benefits average 9% a year, but in the next few years, they hope to reduce that to a mere 2% increase.
"Our workers need a partner, someone they can count on. It's peer pressure, and a positive experience with someone else. The probability of success is significantly greater," Heller said.
The AHA Leadership Summit runs through Tuesday. About 1,300 people are attending, organizers say.