Case Studies & Results: Employee Wellness that includes the Primary Care Physician
Jesse Hercules, President & CEO Extracon Science LLC
Employers are Making the Change
Traditional employee wellness programs didn’t include the
primary care doctor. They built a parallel system of screening and coaching –
and found that screeners and coaches couldn’t treat the problems their
participants had.
But now, our surveys show that 40% of employee wellness
programs have at least some basic interaction with the Primary Care
Physician (PCP). The best programs work with the doctor to ensure the
prevention gaps and biometric issues found at the initial visit are actually
resolved that same year.
In this eBook, we share the results from two of our clients
that are including the employee’s doctor in their wellness programs. They had outstanding
biometric results across thousands of participants. They show that working
with the doctor is a practical option that can outperform onsite screenings.
This eBook also provides answers to the most common
questions we get from employer groups about including the doctor: What
are the recommended program designs and how do we make the transition? How do
we ensure HIPAA compliance? And, how do we ensure the doctors do their part?
Program Designs that Include the Doctor
Basic programs allow participants to submit biometric
screening results from their doctor – instead of attending an onsite
screening. This is the most common approach, although it’s very limited.
Better wellness programs ask all participants to complete an
Annual Prevention Visit with their doctor instead of an onsite screening.
That approach goes beyond biometrics to address all the participant’s
prevention needs.
Some programs give participants credit for completing
any age-and-gender appropriate screening or preventive service. However, this
approach does not look at whether the doctor says they are up to date on
everything they need.
In a similar way, some programs track whether the
participant sees their doctor about a biometric issue. However, this approach
does not look at whether the doctor says the problem was treated and
resolved.
The best practice is to use the Annual Prevention
Visit to have the doctor document the participant’s prevention gaps and any
biometrics that need treatment. Then, track and reward participants who close
their prevention gaps and get biometrics under control – as verified by the
doctor.
A Plan for Including the Doctor
Before we get into the case studies, let’s note that
wellness programs that are successful in embedding the primary care
physician follow a clear plan. This plan includes:
•
Decide to include the PCP
•
Gain the support of your management
•
Decide what to measure
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Select the vendor to coordinate
•
Determine incentives
•
Take a comprehensive approach to educating and motivating
participants
•
Execute on the details
•
Measure results & Reap the benefits
In addition, your vendor should have the following
materials to help you:
•
Clear, simple PCP forms for the Annual Visit and Follow-Up
Visits.
•
Guidelines for employees (both video and text versions)
•
Sample questions for the employee to ask the PCP
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Suggested issues for the employee to discuss with PCP
•
Ideas for employee on how to select and evaluate their PCP
•
FAQ for Employees
Client Example: Annual Visit Physician Forms
Wellness leaders often ask us if doctors will do their part
in filling out and returning the annual prevention visit form. Aren’t doctors
very busy?
We have good news: Across thousands of our participants
every year – doctors do an excellent job of completing and returning
annual visit forms.
Client Example: For a large hospital client, we
received 1,708 physician forms in year 1 and 1,965 in year 2. There were 35
cases total where a participant told us they completed the physician screening,
but no results arrived.
With a 98%+ success rate, it was easy to manage the
exceptions by working with the participants, their doctors and cross-checking
claims data.
Keys to Success: Good preparation of participants is
vital. Educate them on how to ask for the appointment, what to bring, and what
to say and do at check-in. Doctors will fill out and return the forms if
wellness programs provide a short, simple form and participants make a clear
request.
Client Example: Follow-up Physician Forms
When wellness programs collaborate with the doctor to track
follow-up, you might imagine a complex process that puts an added burden on the
doctor.
The reality is much simpler. Just as participants
bring an Annual Visit Form to their annual prevention visit, they bring a
one-page Follow-Up Visit Form to their follow-up visit. The doctor fills out
and signs the Follow-Up forms in exactly the same way as the Annual Visit
Form.
The form allows the doctor to sign-off that a participant’s
biometrics were treated, re-tested and are now under control. Or, that a needed
preventive service was completed at today’s visit. It’s a simple, proven
approach.
Client Example: For a higher education client, we
received an average of 1.95 follow-up forms for every Annual Wellness Visit.
Medical follow-up on physician recommendations was 42% more popular than health
coaching.
Keys to Success: Use the existing process that
doctors know how to do– filling out and signing a one-page form, presented at
the time of the appointment. Keep the process simple and low-tech on the
doctor’s end.
Including the Doctor is HIPAA Compliant
Wellness leaders often ask us if including the physician in
the wellness program is HIPAA compliant.
The answer is yes. Almost of half of all wellness
programs today are accepting biometrics from physician’s offices. There’s no
controversy.
Physician forms include a participant consent signature allowing
the doctor to send the information. The data goes to the wellness vendor
– which has policies and procedures in place to handle biometrics and other
health information.
The employer only receives aggregate reports on
health risks, and the list of participants who have earned each incentive level
under the program. The employer does not need to receive or handle any PHI.
What about prevention or follow-up data? Under
HIPAA’s privacy and security rules, there’s no difference between biometric
screening data and other kinds of health data – allowing wellness vendors to
keep track of participants’ prevention gaps and other relevant wellness
information.
Employer Case Study: Integrated Health System
Our first case study is a large, integrated health system
with just over 10,000 employees. They have very high participation
in the wellness program.
They’ve offered their wellness participants a choice of
completing an onsite biometric screening, or visiting their own doctor.
We’ll compare the results from the participants who
completed the physician visit to those who completed the onsite screening. We
used a cohort analysis, tracking changes in the employees who participated in
both year 1 and year 2.
Total Cholesterol – Screening vs. Physician Visit
Although both groups reduced risk, the physician visit group
had better results for Total Cholesterol (TC) than the onsite screening group.
The physician visit group had a 34.5% reduction in
participants with high cholesterol, compared to 30.3% for the onsite
group. The physician visit group had a 7.5% increase in participants with
desirable cholesterol levels, compared to a 3.5% increase for the onsite
group.
Blood Glucose– Screening vs. Physician Visit
The physician visit group reduced risk for non-fasting blood
glucose (NF Glucose). The onsite screening group increased their blood glucose
risk.
The physician visit group had a 5.1% reduction in
participants with high blood glucose, and an increase in participants with
acceptable glucose levels. The onsite screening group had the opposite
– more participants with high blood glucose and fewer with acceptable levels.
Blood Pressure – Screening vs. Physician Visit
The physician visit group lowered blood pressure (BP) and
reduced risk. The onsite visit group had mixed results, adding risk in some
categories and reducing risk in others.
The physician visit group had a 42% reduction in
participants with very high blood pressure, a 13.8% reduction in
participants with high blood pressure, and a 2.1% increase in participants
with normal blood pressure. The small increase in above-normal blood pressure
was caused by participants moving down from high BP.
The onsite group reduced the number of participants with
high blood pressure, but also had 19.6% fewer participants with normal blood
pressure. Those participants’ blood pressure went up, causing an 18.2%
increase in participants with above-normal BP.
Case Study Discussion: Integrated Health System
Participants who visited their own Primary Care Physician
had better results than the participants who completed the Onsite Screening.
They had better results for Blood Pressure, Total
Cholesterol, and Glucose. In many cases, the physician visit group got
healthier while the onsite screening group got worse.
It makes sense that they physician visit group would have
better biometric results, because biometric issues are treated and managed by a
physician – not a screener.
Because the physician visit produces better results, we
often recommend changing from onsite screenings to having all participants
complete an Annual Visit with the doctor.
Case Study: Higher Education
Our second case study is an institution of higher
education with 14 campuses across the western US. They have 850 covered
employees.
Their wellness program asks participants to visit their
doctor for an Annual Prevention Visit, and also gives participants
credit for completing physician-recommended prevention items. This case study
uses a cohort analysis, tracking the changes in employees who participated in
both years.
Case Study: TC Changes with Physician Visit
Participants who worked with their doctor reduced their
Total Cholesterol (TC) risks.
The number of participants with Borderline High TC or
High TC decreased 23.1%. The number of participants with Normal TC
increased 7.7%
Case Study: LDL Changes with Physician Visit
Participants who worked with their doctor also reduced their
LDL Cholesterol risks.
The number of participants with Borderline High LDL or
High LDL decreased 40%. The number of participants with Normal LDL
increased 10%.
Case Study: Triglycerides with Physician Visit
Participants who worked with their doctor reduced their
Triglyceride risks.
The number of participants with Borderline or High
Triglycerides decreased 20.0%. The number of participants with Normal
Triglycerides increased 5.0%.
Case Study: Glucose Changes with Physician Visit
Participants who worked with their doctor reduced their
Blood Glucose risks.
The number of participants with high glucose in the
prediabetes or diabetes range decreased 37.5%. The number of participants
in the desirable fasting glucose range increased 11.4%.
Case Study: BP Changes with Physician Visit
Participants who worked with their doctor reduced their
Blood Pressure risks.
The number of participants with Prehypertension and
Hypertension decreased 12.9% and the number of participants with Normal
Blood Pressure increased by the same amount.
Case Study: BMI Changes with Physician Visit
Participants who worked with their doctor also reduced their
BMI risks. The number of participants with Normal BMI increased 9.5% and the number
of participants with a BMI over 35 decreased 11.1%.
This wellness program promoted healthy lifestyle habits for
physical activity and nutrition – as well as working with the doctor. Their
results show that you can have both lifestyle change and medical prevention.
Case Study Discussion: Higher Education
Participants who completed an Annual Prevention Visit with
their Primary Care Doctor reduced their biometric risk levels.
They also documented a significant number of prevention
tasks completed beyond the Annual Visit. We received an average of 1.95
prevention forms for every Annual Wellness Visit. Follow-up on physician
recommendations was 42% more popular than health coaching.
Participants also improved BMI, indicating that they are achieving
lifestyle change for physical activity and nutrition.
Wellness programs that want to improve biometrics don’t
have to choose between lifestyle change and by working with the doctor. They
can achieve more by using both approaches at the same time.
A Budget for Including the Doctor
Wellness programs often ask us what the additional cost
would be to include the doctor. In our experience, the pragmatic approach is
to redirect the budget that’s been used for onsite screenings – no additional
budget needed.
We’ve found that for the same cost as an onsite screening,
a wellness vendor can manage the process of including the doctor:
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Getting participants ready for their visit
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Collecting data from the Prevention Visit and Follow-Up Visits
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Having health coaches available to assist participants
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Administering incentives and keeping you compliant with HIPAA
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Providing aggregate reports based on the physician data
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.
Some Questions You Might Ask Yourself
•
How does my wellness program work with the employee’s doctor
today? Is it limited to accepting biometrics once a year?
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Do my employees who work with their doctor have better results
than those who go to my onsite screenings?
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Do I have a way to track prevention gaps and reward
employees who become up to date on everything they need?
•
Do I have a way to track and reward employees who get biometric
issues resolved with the help of their doctors?
•
Would my wellness program be more effective if it could
work more closely with participants’ doctors throughout the year?
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