Rousmaniere: Does Wellness Work?

What’s our role in wellness? 

Harbor Health has looked at obesity, diabetes, hypertension, addiction, mental health, and tobacco use for their impact on workers’ compensation claims.  Claim duration is 285% longer for the claims involving comorbidities. Claim duration increased by 76% when more than one comorbidity is present, and claims costs increased 341% with multiple comorbidities. 

Sounds like a problem that worksite wellness programs might help reduce?

Noted for creating quality provider networks, Harbor Health wrote that the workers’ compensation industry needs a more comprehensive, system-wide approach to address the risk associated with comorbidities.  It cited more complete intake data, to a system that incorporates comorbidities into the utilization review process, to factoring in comorbidities in the treatment process.

But what about wellness programs?

The firm didn’t delve into prevention at the worksite, but others have. Wellness programs, on the one hand, link rather tenuously to reducing injuries and workers’ compensation costs.  On the other hand, a workers’ comp claims payer can help sharpen an employer’s wellness policy by showing that poor health status could add to injury risk in specific ways.

Risky health behaviors and unhealthy biometrics lead to chronic disease, medical costs, and loss of productivity. So says Robert McLellan, a doctor at Dartmouth Medical School and respected occupational medicine expert, in an article published this year in Health Affairs.  McLellan’s article draws in part from the extensive research and conferences that are part of the federal government’s impressive Total Worker Health initiative.

He reported that almost all employers with more than 200 employees offer workplace wellness programs, typically with a combination of screening and intervention.  These programs are designed to promote healthy behaviors — for example, through health education and coaching, weight management programs, medical screenings, and on-site fitness activities. 

One third of truck drivers smoke (but less than a tenth of school teachers do).  About one quarter of the workforce say that health problems compromise their productivity, according to the Integrated Benefits Institute.   

Pinnacol Assurance, the Colorado state fund, has promoted worksite wellness probably more than any other large workers’ comp insurer. It says that modifiable conditions affecting 15% or more of wellness enrollees include chronic fatigue, sleeping problems, headaches, arthritis, hypercholesterolemia, and hypertension.

This insurer’s health risk management program is a model of how a claims payer can promote wellness, particularly among small employers. But Pinnacol stops short of saying that wellness programs cut workers’ compensation costs.

Counting the gains from wellness is tricky. Ohio State University researchers estimated that an employee who smokes costs a private employer in the United States an extra $5,816 per year compared with a nonsmoker.  Most of the costs come from lost productivity of smoking breaks and from higher health care expenses due to cancers, heart and lung diseases. 

Some studies, McLellan noted, conclude that employer-sponsored health programs are ineffective on healthcare costs, while others have found that health care costs fell by $3.27 and absentee costs fell by $2.73 for every dollar spent.  Rand thinks that the programs pay for themselves, but over five years. Employers interviewed by Rand said that healthcare saving had been achieved, but hardly any had actually measured it.

A lot of complicated math goes into these estimates.  One barrier to clarity about impact is low participation of employees. Rand reported in 2013 that less than half of employees offered a screening service use it, and a fifth of those for whom an intervention was recommended followed through.

Consider the effort to get workers off their butts. Two thirds of employers used financial incentives to induce participation, averaging in total the equivalent of about 10% of the employees’ share of premium costs.  Incentives varied by specific type of intervention, and were mostly around $100. For smoking cessation, incentives averaged over $600. Under the Affordable Care Act, employers can have much higher financial incentives keyed to their employees’ share of health insurance premiums.

A sharp critic of worksite wellness programs, Al Lewis, wrote in a law review article published this year, “On its surface, who can argue with the concept of workplace wellness? ...Wellness programs have conferred no measurable benefit on the American Workforce ...Much of the wellness-vendor community has resorted to making demonstrably false claims about savings in order to maintain its revenue stream.”

Back to our concern: Notwithstanding Harbor Health’s correlations, do health risks add to work injury risk?  Liberty Mutual looked closely at the impact of obesity on work injuries. Prevalence of adult obesity more than doubled between 1980 and 2010. It found one study showing obesity raised by a 25% work injury risk. But it also found that obesity did not appear to be a “useful prognostic factor” for injury recovery.  Obesity does not appear to impede the ability of younger, blue-collar workers to recover from acute low back pain in the early stages of an injury.

Maybe employers and workers’ comp claims payers can find common cause for wellness programs that can lower one risk factor that is a really bad habit: Smoking.  Smoking may or may not increase the risk of injury. But smoking is associated with poor recovery from surgery. And, one East Coast insurer is convinced that smoking is linked to poor coping skills, which sets the injured worker up for extended use of opioids. 

Two words capture the workers’ comp agenda on wellness: Stay focused.

ABOUT THE AUTHOR

Peter Rousmaniere is widely known throughout the workers’ compensation industry, both for his writing and consulting experience. Based in the picture perfect New England town of Woodstock, VT, he is a regular on the conference circuit, and is deeply in tune with trends and developments within the industry. His passion is writing and presenting on issues largely related to immigration, and he maintains a blog on the subject at www.workingimmigrants.com.

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