Putting the M.D. In Employee Wellness - eBook Transcript

Results of our 2017 Survey

Who’s missing from your Employee Wellness Program?

Our 2017 survey shows most employee wellness teams are missing a key player – the employee’s primary care physician (PCP).   

Unfortunately, the vast majority of employee wellness programs treat the M.D. as simply a biometric screener.  Their only contact with the doctor is to accept a physician biometric form that duplicates the onsite screening.

They’re missing all the benefits of working with the PCP.  Employers in our surveys say they don’t know if biometric issues found at their screenings were ever treated and resolved.  They don’t know if participants are up to date on the recommended preventive services.   And they can’t reward participants who work with the doctor to close gaps and improve outcomes.

In this eBook, you’ll get the results of our 2017 Survey – showing widespread readiness for new approaches that collaborate with the PCP all year long - to ensure biometric issues are resolved and prevention gaps are closed.

Let’s get started!

Do Current Programs Hit the Target?

Our Fall 2016 and Spring 2017 polls showed the limitations of the current model of using the doctor only as a screener.

We asked, how many issues found at your screenings were treated and resolved by a doctor? 73% said they were unsure, and another 13% estimated that less than half the problems found were treated and resolved.

We asked, how many of your employees are up to date on all USPSTF Prevention Recommendations? 63% said they were unsure, and 19% estimated that less than one in three employees are up to date on prevention.

To us, these responses show a clear need for wellness programs to work more closely with PCP’s to ensure biometric issues are resolved and prevention gaps are found and closed. That’s how programs can be sure they’re on target.

These short polls convinced us to create our landmark survey.

M.D. and Employee Wellness - Survey 2017

In June 2017, we invited more than 6,000 leading employers and wellness consultants to participate in a survey on wellness program effectiveness. We got 66 complete responses, from a representative sample of employers and wellness practitioners.

Responses came from all segments of the employee wellness community:

55% were fulltime Wellness Coordinators at an employer

16% were HR & Benefits leaders who also oversee a wellness program

25% were Wellness Consultants who oversee multiple programs

Responses came from a variety of organization sizes:

38% of programs covered 1,000 to 4,999 employees

26% of programs covered 200 to 999 employees

9% of programs covered more than 5,000 employees

The Annual Wellness Visit

We started our survey by asking about the way employers currently work with the Doctor – as an alternative to their Onsite Biometric Screenings.

In our 2017 Survey, 77% said they offered participants the option of an onsite biometric screening, or completing the screening at the PCP and turning in a biometric form.   They have everything in place to accommodate either approach. 

In the survey, 71% said they believed an Annual Wellness Visit at the PCP is better and more effective than an onsite biometric screening.   This result makes sense to us, because the Wellness Visit covers a broader range of prevention topics, and because many preventive services can be done at the visit.  If a biometric problem is found, it can often be diagnosed and treated before the patient leaves the office.

Data from our client case studies  confirms the effectiveness of the Wellness Visit over the screening.  Participants who completed an Annual Wellness Visit made larger improvements in biometrics over the next year than the ones who completed an onsite biometric screening.

Given the survey answers above, you might wonder why wellness programs continue to offer both options.  Why not cancel the onsite screenings, and focus on Annual Wellness Visits? 

In our survey, 66% of wellness programs in our survey said they did not believe it was practical to stop doing onsite screenings and send everyone to the PCP for an Annual Wellness Visit instead.

Respondents’ top concerns were:  1) Employees not being able to find a PCP, 2) The doctor visit taking too much time away from work, 3) Difficulty in collecting the biometric data, and 4) Cost.

These responses were somewhat puzzling to us.  Isn’t there a big problem with your healthcare benefits if employees can’t find a primary care doctor or get an appointment?   If the Annual Wellness Visit is a better and more effective option, why is it not worth the time away from work?  If you’re already accepting PCP forms, why is it impractical to get the data? 

How to Get the Best of Both:  These survey results suggest a strategy that we’re now recommending to clients.  Keep all your current screening options - but make it clear in your communication and promotion materials that the Annual Wellness Visit is the recommended and preferred option. 

That’s the opposite of what we see in most wellness program communications today – where the onsite screening is heavily promoted and the PCP visit is talked about as exception for those that need it. 

Wellness programs should have a larger incentive available for those who complete the Annual Wellness Visit, as compared to the Onsite Screening.   It’s a better and more effective option, and it takes more time and effort for the participant.  It deserves a higher level of reward. 

We believe that changing the communication and incentive structure to give the Annual Wellness Visit an edge can improve wellness program results, without giving up the Onsite Biometric Screening option for those that need it. 

Shifting to an Annual Wellness Visit approach can also allow the program to collect better data – so participants are flagged for prevention gaps, not just for biometric issues. 

It also means participants who need a medical waiver for outcomes can get it upfront, rather than having to fight an appeal after the screening. 

Embracing PCP Follow-up

After the initial screening (onsite or with the doctor), many participants will need treatment and follow-up.   Our 2017 Survey shows that employee wellness programs would like to take a more active role in working with the Doctor to ensure that biometric issues are resolved and prevention gaps are closed.  

In the past, wellness programs did not track PCP Follow-up.   In our 2016 Effectiveness Survey, only 3% of wellness programs tracked whether the PCP said the biometric problem was resolved.  The rest either tracked nothing at all after the screening (58%), tracked coaching participation only (22%) or tracked whether participants self-reported that they were working with the PCP.  (8%)

But in our 2017 Survey, 90% of respondents said it makes sense to add the additional component of tracking and rewarding those who follow up with their PCP and resolve the biometric/prevention problems – even assuming the program includes Health Coaching already.   Only 5% said cost would keep this from being feasible. 

Survey participants say that it’s feasible to track PCP Follow-up.  In a separate question, 90% of survey participants said that gathering data by sending participants to their follow-up appointment(s) with a one-page physician form would be practical.  The question specified that the follow-up forms would go to a wellness vendor for processing, with the same HIPAA compliance safeguards as their existing physician biometric forms.  It’s essentially the same process used for physician biometric forms today. 

We think this represents a major opportunity for employee wellness.  Wellness programs are often criticized for a lack of follow-up and a lack of tangible results.  Aggregate reports based on PCP data, showing how many biometric issues are being resolved and how many prevention gaps are being closed  would go a long way to silence those criticisms and validate the wellness program. 

Incentives for Follow-Up

Our 2017 Survey shows strong support for rewarding employees who resolve their biometric issues with the PCP, and who close prevention gaps.   These incentives would be powered by follow-up data from the PCP’s office.  In the past, very few wellness programs offered these kinds of incentives. 

82% of respondents supported the idea of rewarding participants who resolved the biometric issues found at the initial screening or wellness visit.  90% supported the idea of rewarding participants who close prevention gaps identified on an HRA or at the wellness visit.  

When biometric issues are found at the onsite screening, many employers currently offer an incentive for the participant to complete a specified number of Health Coaching sessions. 

We asked if it made sense to shift that incentive to rewarding those who follow up with their PCP and resolve the biometric/prevention problems.  A majority (56%) said it would be best to put all of the incentive on resolving the problem – with no incentive remaining for Health Coaching.   Another 18% wanted to shift part of the Health Coaching incentive to resolving the problem. 

Based on this survey, we see an opportunity to change the conversation on incentives and outcomes.   

In the past, wellness programs were caught between two opposite worlds – participation incentives (which often failed to produce results) and outcome incentives - widely seen as harsh and unfriendly.  

Offering incentives based on the PCP’s follow-up and sign-off is an intuitive concept that feels fair to wellness programs and participants.  It’s a way to get results while building the doctor-patient relationship and keeping the wellness program as a fair and positive experience for participants. 

Telemedicine

Telemedicine has grown rapidly in the last decade, with employers partnering with vendors like American Well, TelaDoc and MD Live to make US-based, state-licensed M.D.’s available on-demand to covered employees through an App. 

Telemedicine has the potential to let employee wellness to tap into real physician expertise while avoiding hurdles like PCP access, cost, and time away from work.  (A visit is about $45).  However, our survey found only modest levels of support for including Telemedicine in wellness program design. 

24% of wellness programs in our survey offered Lab Vouchers to employees, enabling them to have their biometric screening at a local LabCorp or Quest facility at a time of their choosing.  Lab vouchers are a popular approach for companies with locations that are too small for an onsite screening event. 

We asked if the approach of sending employees to have their screening done at a Lab facility, and then discussing the results with a Telemedicine doctor, was a viable alternative to onsite biometric screenings. Most respondents (52%) said yes, the Lab/Telemedicine approach was a viable alternative.

However, the wellness programs in this sample (mostly large employers with long-established onsite screening and coaching programs) preferred their current approach.

51% said a Health Coach would be better as follow-up for participants with a biometric issue, compared to only 38% who said the telemedicine doctor was better.  This was surprising – we thought the M.D. would be more valued. 

For employers who don’t fit the onsite biometric screening model, we think the lab / telemedicine approach is a potential solution that may attract employer interest. 

Patient Portals and Employee Wellness

A new set of regulations, scheduled for 2018 implementation, may solve the data bottleneck between doctors and employee wellness.  Our 2017 Survey shows wellness programs are ready to change their program and incentive designs when this new data becomes available. 

Only a decade ago, fewer than 1 in 10 physicians used an electronic medical record (EMR)  The Meaningful Use regulations and incentives encouraged doctors to adopt EMR’s – with 90% using EMR’s today.   Stage 2 of Meaningful Use, implemented in 2015, required doctors to implement Patient Portals to give patients access to their biometric test results and medical records.  Only a few percent of patients currently use them – since their information is still scattered across multiple portals.

The Meaningful Use Stage 3 regulations (MU3), scheduled for 2018 implementation, call for patient portals to include an API allowing patients to connect their biometric and prevention data to a central hub of their choosing.  Consumer-focused central hubs (such as Microsoft HealthVault and the discontinued Google Health) have had limited success up to now, due to the lack of these API’s and the need to manually input data.

We think MU3 has the potential to transform employee wellness programs.  Leading employee wellness portals will offer the ability for patients to bring in and connect their biometric and prevention data from all their doctors.  The portal will be able to determine biometric and prevention needs by looking at the data, and applying a set of rules. 

This data will let the wellness vendors manage health risks and prevention gaps more easily and effectively.  Instead of spending most of our time and budget gathering data, employee wellness will be able to spend its time and budget taking action on the data that’s pulled in from patient portals. 

Patient Portals – Survey Responses

We asked wellness programs if it would be practical for employees to connect their patient portals to the wellness portal, to transfer biometric and prevention data.  66% agreed, with only 9% saying the technology barrier would be too high.   Some commenters raised privacy concerns. 

We think the privacy issues would be addressed in the same way they are addressed today on paper forms  – by limiting the kinds of information that are allowed to be transmitted to the wellness vendor and used in the wellness program; and by limiting what wellness vendor reports to the employer.

We asked wellness programs if they would send everyone to an Annual Wellness Visit, instead of an onsite screening, if the data were easy to pull from the patient portal.  63% said yes, they would stop doing onsite screenings, and send everyone to an Annual Wellness Visit.   This was a surprisingly strong result, and it shows that easy access to PCP data would be a game-changer.  

We asked wellness programs if they would offer rewards for participants who close prevention gaps and get biometrics under control, if the data were easy to pull from the patient portals.  A whopping 92.5% said they would change their wellness program to offer rewards for those who resolve these issues. 

We asked which approach would be a more practical way to create a list of the patient’s prevention needs – asking the doctor to create a list at the Annual Wellness Visit, or having the computer compile a list based on data in Patient Portals.  57% said the Patient Portal approach was the better way to create a list of prevention needs.  This approach is less personalized, but seems more practical. 

Although it’s too early to know the full extent of changes MU3 will bring, we think it’s safe to say that employee wellness is within 5 years of having direct access to a rich set of data for managing population health.   Wellness Vendors whose business is based on biometric screenings will be significantly disrupted by the simple change to pulling biometric data over an API. 

Conclusion

The way that wellness programs currently work with primary care physicians (PCP’s) is broken.  They simply treat the PCP as a biometric screener. 

However, wellness programs are ready to change that model and work with the PCP on follow-up for biometrics and prevention.  The survey shows 70%+ support for collecting follow-up data from PCP’s as an add-on to current screening and coaching programs.  Employers believe a simple, physician form approach is practical in collecting this data.

Wellness programs are ready to change their incentives based on the PCP follow-up data.  The vast majority support having incentives for participants who resolve biometric and prevention issues, and a majority would fund those incentives by reducing or removing incentives for Health Coaching.

PCP coordination will be a significant growth area for wellness vendors, who can offer physician follow-up tracking as an add-on to current screening and coaching efforts. 

By the end of the decade, PCP data will be much more easily available – allowing wellness programs to focus on health improvement rather than data-gathering and screenings.

About the Author

Jesse Hercules is the CEO of Extracon, a leading health promotion company. 

Mr. Hercules is a frequent speaker and writer on health promotion topics, including speaking at the American Journal of Health Promotion’s annual conference,  the Benefits Forum, and the National Wellness Conference.

About Extracon

Extracon specializes in employee wellness programs that include the employee’s primary care doctor (PCP).   The programs run on our robust Extracon wellness platform. 

We offer PCP follow-up tracking and incentives as an add-on to your existing wellness program.  We also offer complete, turn-key wellness programs from the initial screening through PCP Follow-up, Health Coaching, Apps & Trackers, Challenge Programs, and incentives. 

As the leaders in wellness programs that include the doctor, we work with our clients to deliver results in a participant-friendly way. 

Learn more or request a free consultation at www.extracon.com