Please correct the following errors:
Yet there are gaps in our national health care system we must address to do a better job at keeping people healthy in the first place and, once people become sick or injured, help them from getting worse. In other words, we have a great fire department but need more smoke alarms and fire extinguishers. Health care providers must adapt to bring about needed changes and promising approaches employers can use to get more value for their investment in health care. Working together, we all win—health care providers, employers and employees. In the end, we all share the same goal—better health. As the state’s largest health care system and an employer of more than 10,000 people in Louisiana, we have a unique perspective that may be helpful to the Baton Rouge business community.
The provisions of the PPACA, which will be fully implemented by 2018, attempt to address some of the gaps in the system. In the meantime, hospitals and health systems across the country, including in Louisiana, are adapting to fill this void. As more people are covered through state health exchanges, there will be more patients to treat, but hospitals and doctors will have fewer resources to treat those patients. In short, hospitals and doctors need to innovate in order to deliver increasingly safer and more effective care, for even more patients, and more efficiently than ever. A tall order, yet one that the Franciscan Missionaries of Our Lady Health System, its sponsored organizations, including Our Lady of the Lake in Baton Rouge and St. Elizabeth Hospital in Gonzales, are making significant progress toward each day by adopting new models and approaches.
Improving outcomes and value with fewer resources
The health and cost of caring for our own employees is a focus area that falls within our responsibility and expertise as a health care provider and employer. Several years ago, we recognized that empowering primary care physicians and other clinicians so they can drive proactive patient care is vital to improving the health of our community. This means treating the whole person, not just the specific condition that is bothering them at that moment. Providers do everything they can to work with their patients in these areas, but often they see patients sporadically. This includes health care professionals, who have the same struggles as people in other industries to balance work, life and their personal health.
Because people spend a huge portion of their waking time at work, employers have a great opportunity to bridge this gap and make an impact on employee health. By providing employees with tools and resources, employers can help facilitate better health. Recognizing this great opportunity, the Act creates new incentives and builds on existing wellness program policies to promote employer wellness programs and encourage opportunities to support healthier workplaces. As of 2014, employers will have greater ability to reward employees who meet health status goals by participating in wellness programs and penalize those who do not.1
Finding the ROI in employee wellness
By Stephanie Mills, M.D., MHCM, President and CEO Franciscan Health and Wellness, a subsidiary of Franciscan Missionaries of Our Lady Health System
Since the passage of the Patient Protection and Affordable Care Act (hereafter, the PPACA or the Act) on March 23, 2010, how employers create and administer their health plans is dictated by a new set of rules. And yet, the rulemaking process has only just begun. The PPACA, or “health care reform,” will take years to become fully effective and requires the creation of many new regulations. More than 10,000 pages of regulations have been issued to date—with more to come. With 2014 fast approaching as a critical implementation period, the sponsors will present three installments of the special advertising series Deciphering Health Care Reform, appearing in the March 5, May 28 and Aug. 6 issues of Business Report.
All information in this section is presented by the sponsors. The articles herein are educational and informational only and do not contain legal, tax, financial or medical advice specific to any individual or business.
Understandably, there has been some disappointment in traditional wellness and disease management programs. As the industry has grown, many companies have not been able to meet employer expectations. Yet, there are proven strategies and innovative models that have delivered the value employers want and need. Evidence shows that workplace health programs—when designed, planned and implemented in the right way—can provide significant benefits in employee happiness, health and productivity. It will take time to see the full benefits of a wellness program, but in the short-term, employers and employees alike can gain value.
Delivering a unique approach to employee wellness
Since we face the same challenges to manage health care costs as other employers, we built our own program, Healthy Lives™, drawing on our vast clinical and operational expertise. Our goal was to create a comprehensive and integrated wellness and benefits management program that could be implemented throughout our system and more effectively prevent and properly manage chronic diseases, which are the primary drivers of the poor health and rising costs.
Group health management, commonly referred to as population health management, is the cornerstone of our Healthy Lives™ program. This data-driven approach analyzes how individual, cultural and organizational factors relate to health conditions, lifestyle and behavioral patterns. Through a combination of health assessment and insurance claims, we use the data to identify employees who are most at risk for serious health challenges and then provide them with a realistic path to prevention, wellness and treatment.
Behaviors and habits run deep. By understanding the physical factors like genetics and family history, the environmental factors like access to healthy foods and outdoor areas for exercise, as well as the emotional factors like a strong support system, we can give people the tools that will produce positive behavior change, which can help them improve and maintain their health while lowering costs for the employer. In fact, people who understand their treatment options and are confident in their ability to manage their care cost an estimated 8% less to treat than those who are less knowledgeable about their health.2
One element of Healthy Lives™ that directly addresses behavior change is our team of certified health coaches, who enhance our program and the efforts of primary care physicians by making health care about the person rather than the disease. Programs that are narrowly focused on managing only a specific disease state may not deliver an integrated care experience that encompasses prevention, mental health, multiple chronic conditions, and acute, here-and-now concerns.
Engaged employees, improved health, ROI realized
In November of 2010, we launched Healthy Lives™ with more than 10,300 employees and over 13,000 insured members and an 80% participation rate. Health risk assessment results showed that 9% of our insured members were high risk and 13% were moderate risk for developing costly, chronic diseases such as diabetes. This was the part of our health plan population we knew needed more support and provided us the most opportunity to realize cost savings. Based on this data, we designed the program to address our population’s specific needs, which included obesity, hypertension, high cholesterol and diabetes.
The results are clear. After just two years, Healthy Lives™ has demonstrated great promise to effectively engage patients, improve health and save money. Based on 12 months of data, we have seen a $6.3 million reduction in total health plan expense( >10%), 20% reduction in hospital admissions and 54% reduction in readmissions within our population. Additionally, there have been improvements across the board in quality measures for wellness and prevention, control of diabetes and hypertension, and high blood cholesterol levels. Over the next five years, we project a 4:1 return on our investment.
Hospitals and health systems have been built over many decades to meet a few core community needs. First, help people who are suffering or need emergency care. Second, fix very complicated injuries and cure difficult and life-threatening diseases. Third, provide hope and a better quality of life, especially in seemingly hopeless situations. By fulfilling these promises, the men and women working at hospitals have saved countless lives, helped people live comfortably, and helped people live longer.
A proven solution
We know employers are eager for a comprehensive solution that will help employees get healthier and ultimately save money. The same need was a driving force behind applying our deep clinical experience to create the program for our own employees. We have extended the Healthy Lives™ program to other businesses, with equally promising results. Currently, Healthy Lives™ partners with 28 businesses, including three hospital systems in Oregon, Florida and Mississippi, to improve their employees’ health and get more for their health care dollar.
With the right partner, employers can help make health care work for everyone by creating a culture of wellness that motivates and supports their employees in reaching their health goals. Employees of companies with a strong culture of health are three times as likely as others to report taking action to improve their health. A strong culture of health contributes to higher employee performance, commitment to well-being, overall job satisfaction and lower employee turnover, as well as better financial outcomes.3
Partners for better value, better health
It took longer than a day or a week or a month to get to where we are, and it will take time to get to where we want to be. Health care providers must evolve and employers must become more active. Maximum impact on improving health and reducing costs will only be gained with participation and partnership from all stakeholders—hospitals, physicians, payors, patients and the community. At Franciscan Missionaries of Our Lady Health System we are already making great strides toward our goals and look forward to joining with business leaders and as a community to make Louisiana a healthier state.
1http://www.healthaffairs.org/healthpolicybriefs/brief.php?brief_id=69
2http://content.healthaffairs.org/content/32/2/216.abstract?=right