June 15, 2012

Wellness and condition management in the workplace

As I discussed previously, onsite clinic and pharmacies are one way employers are addressing how to get, and keep, employees healthy. This location shift for traditional health care services can certainly prove beneficial for both the employer and the employee. But what about looking for ways to reduce the overall need for those services?

The importance of prevention isn’t a new concept, but it is receiving additional emphasis lately (see Surgeon General Regina Benjamin’s recently-announced National Prevention Strategy). Many employers are initiating chronic disease management interventions, such as diabetes management.  Employers face a challenge in identifying the most effective strategy, given the variety of programs and lack of definitive guidelines reported in the literature. I worked with Ross Miller, MD, MPH, with the Cerner Employer Services team, and others to perform a systematic review of the literature to determine the effectiveness of interventions designed to manage the clinical and financial outcomes of a population of employees with diabetes1. This research could be used to both validate and prioritize development of diabetes management solutions for the consumer and the provider.

Other condition management programs address musculoskeletal problems, a considerable economic and clinical burden on both employees and employers. In 2010, Cerner introduced chiropractic services at our onsite clinics. To determine their effectiveness, Dr. Miller, myself and others performed a study to determine the influence of onsite chiropractic care on health care utilization and associate-reported outcomes2. The study found lower rates of health care utilization (health care visits, radiology procedures, physical therapy) and musculoskeletal medication use among Cerner associates who received chiropractic care onsite versus offsite. In addition, those receiving care onsite showed improvement in functional status over time. This indicates onsite chiropractic care has potential for reduced indirect costs including absenteeism and productivity losses, and direct cost savings may result through lower rates of health care utilization.

In additional to chronic disease management programs, rising number of companies are sponsoring wellness programs to improve employee health and lower health care expenditures. Dr. Miller, myself and others conducted a review of academic and real-world literature to identify the characteristics and outcomes of employer-sponsored wellness programs and found that companies that implemented and maintained wellness programs demonstrated improved employee health and cost savings3. These companies tended to have strong support and participation from highly motivated senior leadership, management and the rest of the employees; a culture based on the idea that healthy employees are the most productive; and an environment that encouraged participation. While the need to cut costs was a strong motivator for implementing and updating wellness programs, companies were also concerned with the health and well-being of their workforce.

1Gorman K, Foster A, Kaspin L, Kindermann S, Miller R. Systematic review of diabetes disease management interventions. Accepted for presentation at the 17th Annual Meeting of the International Society for Pharmacoeconomic and Outcomes Research (ISPOR), June 4, 2012, Washington, DC.

2Krause CA, Kaspin L, Gorman KM, Miller RM. Value of chiropractic services at an onsite health center. Journal of Occupational and Environmental Medicine, in press, 2012.

3Kaspin LK, Gorman KM, Miller RM. Systematic review of employer-sponsored wellness strategies and their economic and health-related outcomes. Population Health Management, in press, 2012. Also accepted for presentation at the 17th Annual Meeting of ISPOR, June 4, 2012, Washington, DC.

Kathleen M. Gorman, MPH, is a scientist with Cerner LifeSciences and has been involved with a variety of projects that promote best practices and evidence-based medicine. Increasingly, she has been focused on researching the value of employer-sponsored wellness initiatives. Prior to joining Cerner, she was a researcher at The Parkinson’s Institute. Ms. Gorman holds a BS from the University of California, Santa Cruz and an MPH from the University of California, Los Angeles.