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How Employee Wellness Can Build a Better Patient - eBook Transcript

Jesse Hercules, President & CEO Extracon Science LLC

Better Patients Are Needed

Employers want a healthy and productive workforce. So most self-insured employers are now holding their own screenings, flu shots and health fairs.

What if they focused on building a better patient instead?   A patient who will get the prevention they need, and keep biometrics under control – using the healthcare system that’s already in place

It doesn’t happen automatically.  Research at the CDC shows that 75% of middle-aged adults are not up to date on all the recommended preventive services.  One-third of prescriptions are never filled.  Patients are less than 50% compliant in taking medications to control blood pressure and cholesterol.  And 42% of follow-up appointments are cancelled or no-show

Typical employee wellness programs can’t measure or manage these issues because they don’t coordinate with the healthcare system.   Most wellness programs have no way of knowing if their participants are getting all the prevention and biometric follow-up they need.

This eBook is your guide to how employee wellness can build a better patient, and deliver measurable results.

Better Patients Have a Primary Care Doctor

Better patients have a primary care doctor, and work with their doctor on prevention and coordination of healthcare.

Unfortunately, 22% of adults don’t have a primary care physician today – and that number rises to 36% of adults under age 35.  (Source:  AAFP)   There’s clear evidence that having a doctor produces better outcomes than not having one.  But we can’t stop there.

Many of those who have a primary care doctor only see their doctor when they’re sick or need a prescription renewed.   A 2007 study in JAMA estimates just 20% of patients are actively working with their primary care doctor on prevention and care coordination each year. 

Better Patients And Primary Care

What kind of primary care builds a better patient?  

Meeting with the doctor on an annual basis to identify care and prevention gaps;  tracking and measuring progress in closing those gaps, and offering resources and support for healthy lifestyle and care coordination.   This approach has produced some very impressive results

Geisinger Health Study

7.9% total healthcare cost savings

$53 PMPM savings over 90 months

Vermont Blueprint for Health Study

$482 per member per year healthcare cost reduction

Costs reduced $5.80 for every $1 spent.

Community Care of North Carolina Study

9% savings per beneficiary

$312 per member per year savings

BCBS Louisiana Study

$25 PMPM total healthcare cost reduction

A well-designed employee wellness program can create the same annual cycle, track progress in closing prevention gaps and improving biometrics, and offer similar resources and support to participants.

Better Patients are Activated

Better patients show higher levels of knowledge, skills and confidence in managing their health.  This is called patient activation.

In a recent study, researchers looked at the effect of patient activation on prevention gaps, unhealthy behaviors, biometrics, and costly medical utilization.  

Patient activation affected 12 of the 13 outcomes studied, including Emergency Department visits, obesity, and smoking.  Patient activation increased the rates of preventive screenings and having biometrics like A1c, HDL and triglycerides in the healthy range. 

There’s a wealth of evidence that patient activation is important to better health outcomes.  This article in Health Affairs discusses 59 relevant studies.

Employee wellness programs that build participants’ knowledge and skills in using healthcare have been implemented and shown to improve activation

Building an Annual Experience for Health

To build a better patient, your employee wellness program needs to create an Annual Experience for prevention and wellbeing, where each step builds on the next.  

It starts with Patient Activation:  offering a clear and engaging set of training and support so your participants are ready for everything that happens on the rest of their wellness journey.  

Then, participants have an Annual Wellness Visit with their doctor.  The purpose of the visit is to identify gaps in prevention, and biometrics that aren’t in the healthy range, and any other care gaps.   Your participant is getting an expert opinion on everything they need to do to stay healthy.

Next, your participants will work with their doctor(s) to close the gaps and improve the biometrics identified at the Annual Wellness Visit.  Your wellness program should include programs for lifestyle change and health coaching throughout the year to support good health.

Finally, your program should celebrate and reward success with recognition and incentives. 

Start with Building Knowledge & Skills

Better patients don’t happen by accident. If you want to build a better patient, your employee wellness program needs to start with building participants’ knowledge and skills in working with the doctor. 

Employers of all kinds train their people for the jobs they will be doing.  They know what works for their culture – whether that’s in person group sessions, online training modules, or one-on-one instruction.  So creating better patients is similar to other kinds of training that employers are familiar with.

Topics should include: how to find a doctor if you don’t have one, how to make the appointment, what to expect at the annual wellness visit, what follow-up may be required, how the visit(s) are billed and paid for, and how lifestyle change can improve the numbers the doctor measures. 

One practical approach is to use online training modules supplied through your wellness vendor, along with health coaches who can answer questions and address specific concerns on a private, one-on-one basis.

Annual Wellness Visit

To build a better patient, the Annual Wellness Visit becomes the centerpiece of your wellness year.  It’s far more comprehensive than an onsite screening, so it can replace the screenings you do today.

The doctor looks at your participant’s prevention needs, based on factors including age and gender.  The doctor determines if they’re up to date on everything they need – from flu shots and other immunizations to mammograms and colonoscopies.  The doctor will make a list of gaps that need to be closed to get the patient up to date.

The doctor will also complete common biometric screenings such as blood pressure, cholesterol, and blood glucose.  The doctor will counsel your participant on whether the results are in the healthy range or not, and whether the patient needs medical treatment and follow-up. 

Your wellness program will send participants to the doctor with a form that lets the doctor share the list of prevention gaps and biometric issues with your wellness vendor – in much the same way wellness vendors collect biometric and prevention data from HRA’s and biometric screenings.

Follow-Up Visits for Biometrics & Gaps

Better patients do the follow-up their doctor recommends. 

Some patients will leave their Annual Wellness Visit with a prescription and a follow-up appointment.  For example, a prescription for a statin and a follow-up appointment to re-test their cholesterol and see if it’s under control.

Others will leave their Annual Wellness Visit with a referral to a specialist for a preventive service like a mammogram or colonoscopy. 

Because your wellness vendor has a list of what the doctor is recommending, it can target information and support to the right participants at the right time – via the web portal, coaching outreach, and other methods.

Your participants who need biometric follow-up will bring a Biometric Follow-Up Form to their visit.  If they work with their doctor and follow the care plan, after one or more visits their doctor can report that the biometrics are successfully treated and are under control for this patient.  

Your participants will bring a Prevention Follow-Up Form to their prevention follow-up visits, so the doctor or specialist can report which prevention tasks were completed.

Engagement with Healthy Lifestyle

Better patients live a healthy lifestyle.

Employee wellness programs know that participants who get regular physical activity, eat a healthy diet, manage stress and get high-quality sleep are much less likely to need medications or develop a chronic disease.   And lifestyle changes are just as important for those who are under medical treatment.

The structure and content of preventive visits require the doctor to ask about lifestyle behaviors and give brief counseling on lifestyle change.   So your participant is getting a clear recommendation from their doctor to be active, eat a healthy diet, stop smoking, and make other changes. 

To follow up on the doctor’s instructions, your wellness program should give participants the support and opportunities they need to improve lifestyle.  

Wellness programs often include components like health coaching, integration with Apps and wearables, Team and Social Challenge programs, and onsite fitness and healthy eating options. 

Building Motivation for Your Participants

To build a better patient, you’ll need to motivate your participants. 

Patient Activation is one way to build motivation:  building health knowledge and skills also builds motivation and confidence.  Onsite and online lifestyle programs can tap into social motivations for participants to eat healthy and be active together.  Health coaches are trained in motivational interviewing and other techniques to boost motivation. 

Incentives are also important.   We recommend having a set of incentives that reduce the health plan premium for your members who do their part to become a better patient.  

A employee wellness program can offer incentives for those who complete an annual wellness visit, get up to date on prevention, and get their biometrics under control, as verified by their doctor. 

The charts on the next two pages show how the data turns into incentives for your participants and aggregate reports for the employer

What About Costs?

It’s possible to have a wellness program that builds a better patient, using the same budget that’s in place at most employers today.

For the same cost as an onsite screening, a wellness vendor can manage the process of building a better patient:

       Getting participants ready for their visit

       Collecting data from the Wellness Visit and Follow-Up Visits

       Having health coaches available to assist participants

       Administering incentives and keeping you compliant

       Providing aggregate reports based on the physician data

So the pragmatic approach is to redirect the budget that’s been used for onsite screenings, and use those dollars toward building a better patient. 

You might worry about adding more doctor visits onto the health plan.  However, studies show that participants who work with their primary care doctor on prevention have lower overall healthcare costs.  That makes it a win/win for the wellness program and health plan.

Why Now Is the Time:

Employee wellness has to change in order to create a better patient.  Employers will need new program structures, to measure and incent new things, and to build participants’ skills and confidence in new areas.  

But this change paves the way for employee wellness to succeed in improving population health.  Building a better patient is the bridge from finding health risks to fixing health risks.    It’s your path to effectiveness.

Employee wellness is uniquely positioned to build a better patient.  We have access to the whole population – including the ones that don’t have a primary care doctor today.  We can provide touchpoints throughout the year- not just when a person is in the doctor’s office. 

And we can tap into a range of different motivations for health.  From building a culture of health at work, to team and social programs for lifestyle, to powerful incentive strategies. 

Some Questions You Might Ask Yourself


       Do my participants have the knowledge, skills and motivation to work effectively with their doctors?  Does my program help them with this?

       How many of my employees work with their primary care doctors on prevention and coordination?  How many do not?

       Does it make more sense for my wellness program to be totally separate from primary care?  Or would a more coordinated approach make sense?

       Am I happy with the kinds of results I present to my leadership each year?  Or would I like to present more tangible results on prevention gaps closed and biometrics brought under control?

       Am I happy with the way my incentives work today?  Or would I rather tie incentives to more tangible outcomes – employees who are up to date on prevention and whose biometrics are under control?

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