Use a Multi-Step Approach to Improve Employee Health
Employers seeking to reduce their workers’ comp and other health care-related costs should consider wellness plans that go beyond simple programs, suggests a new report. It found that employers saw greater participation rates when they created a corporate culture that focused on healthy behavior.
The National Business Group on Health examined data from 105 large companies from 2012 to 2013. While most had key strategic elements in place, few had successfully incorporated wellness into the corporate mission.
“Employers should consider a multiple step approach to improve employee health,” the report concluded. “Creating an environment that supports health, providing the programs to support behavior change, and engaging the different levels of the workforce will help move employees to a healthier status.”
For example, they found that while more than nine out of 10 companies offered programs for employees to increase their physical activity, only 65 percent had policies that allowed them time to participate during the workday.
“Because time is an obstacle to maintaining a healthy lifestyle at work, corporate policies offering flexible work time for physical activity can make it easier for employees to take advantage of these programs and resources,” the report said. “Companies that had flexible work policies had a higher percentage of employees who engaged in physical activity regularly.”
The study, “Measuring the Impact of Wellness on Workforce Health,” is based on employers’ WISCORE®, a wellness impact scorecard developed by the NBGH to determine the effectiveness of their wellness programs on workforce health. It includes various healthy behaviors such as physical activity, eating nutritiously, achieving and maintaining a healthy weight, reducing stress, and eliminating smoking.
“For employers who make significant investments in improving employee health, it is critical to be able to show a positive outcome,” the report stated. “One of the critical ways to show improvement is by tracking the healthy behaviors and status of the workforce over time. After implementing various wellness programs, are employers seeing an increase in the workforce engaging in healthy behaviors on a regular basis?”
Employers’ greatest success has been around physical activity — engaging workers in regular physical activity and specific physical activity programs. Employers had a median of 62 percent of employees who were physically active, second only to the 93 percent who were non-tobacco users. Employers also saw a median annual increase in the percentage of employees who were physically active of 3 percentage points.
“The success around physical activity is likely due to the multi-faceted programs that include mobile technologies, social influence through team or individual competitions as well as multiple opportunities to be physically active,” the report noted.
Spouses and dependents are included in the health improvement efforts of the majority of WISCORE users. Employers were often likely to offer them access to wellness programs and most offered incentives for their participation.
Environmental tactics and policies to improve behaviors remain areas of opportunity for employers. For example, just 65 percent of employers subsidize the cost of health food options, and fewer than 55 percent had corporatewide tobacco-free policies. Companies that are able to have tobacco-free campuses had a higher percentage of tobacco-free workers than others.
Changing employees’ health habits remains challenging for employers, especially in getting employees to maintain a healthy weight. The median percentage of employees who were at a healthy weight was 35 percent.
Because time is an obstacle to maintaining a healthy lifestyle at work, corporate policies offering flexible work time for physical activity can make it easier for employees to take advantage of these programs and resources.
Stress management is another area where many companies offer interventions. Relaxation programs such as yoga and meditation are offered by 79 percent of the employers while others offered mindfulness-based stress reduction and resiliency or energy management programs. Many also offered job-related skill building courses dealing with problem solving, conflict resolution. communication, and flexible work policies to eliminate common job stressors.
“To drive significant changes in the health of the workforce, employers need to attain significant participation levels in their wellness programs,” the report said. “Yet, engaging employees, specifically the ones who need to change their behaviors, continues to be a challenge for employers.”
Companies are most successful at driving employee engagement when they use leadership support, including middle management, financial incentives, and communications, the report said.
“Employers whose senior leadership visibly supported their wellness strategy by sending out communications and participating in programs experienced higher participation rates for nearly all programs than those organizations whose leadership did not visibly engage,” according to the survey. “Companies that provided health and wellness metrics (e.g., wellness program participation and health behavior rates) to division heads and line managers were able to connect employee health to business success. These companies found higher participation rates in programs for all six programs measured.”
While employers are having somewhat limited success in increasing participation rates in various health improvement programs, they are seeing improvements in the health behaviors of their workers, the report concluded.
Privacy Options Added to Prescription Monitoring Programs
“Prescription Drug Monitoring Programs have great potential to curtail opioid abuse, misuse, and diversion, and granting a variety of interested parties access to PDMP data may further that objective. However, the more entities that can review PDMP information the more important it becomes to develop standards for patient privacy.”
With that statement, members of the National Council of Insurance Legislators added enhancements to its model law to address opioids in the workers’ comp system. The expanded options seek a balanced approach to ensure data privacy.
A majority of states have adopted PDMPs as a way for health care providers to determine what medications their patients are taking. NCOIL last year adopted Best Practices to Address Opioid Abuse, Misuse and Diversion. It addresses how to establish, evaluate, and fund PDMPs that require real-time reporting; create strong evidence-based prescribing standards that recognize one-size-does-not-fit-all and that crack down on so-called “pill mill pain clinics”; promote education among physicians and the public; and encourage treatment and prevention.
NCOIL is comprised of state legislators whose main area of public policy interest is insurance legislation and regulation. At this year’s summer NCOIL meeting in Boston, members of the committees on Health, Long Term Care and Health Retirement Issues, and Workers’ Compensation Insurance unanimously adopted the enhancements to the best practices.
“As states contemplate what privacy options they wish to pursue, legislators should keep in mind that an assurance of confidentiality is crucial to a patient-physician relationship,” the enhancement stated. “Though courts around the country are divided as to whether state efforts to regulate controlled substances outweigh a need for patient privacy, legislators should consider whether it is appropriate to in some way limit what entities other than the physician have a right to know about a person’s medical conditions and treatment.”
The enhancement calls for safeguards to be clearly stated in statutes and regulations “to avoid confusion and to help empower state officials to take action as needed.”
The potential safeguards are:
- Making PDMP data confidential and excluding it from open records or public records laws.
- Explicitly requiring PDMP administering agencies to adopt policies and procedures that reasonably assure that only those who are legally authorized to access the database actually do so.
- Imposing appropriate legal penalties and administrative sanctions such as actions against someone’s license for violations and ensuring that the penalties/sanctions are enforced.
- Specifying who is authorized to access the data and for what purpose.
- Implementing detailed authentication procedures to verify that a user is qualified to access the PDMP pursuant to state law.
WC Frequency Poised to Continue Long-Term Decline
Injuries involving the arms and shoulders bucked the trend of declining frequencies of most other body parts over the past five years. That’s among the findings in a new report on claims frequency in the workers’ comp industry.
While the Great Recession was likely responsible for frequency changes in recent years, other factors are now apparent. NCCI has drilled down into the particulars driving recent rates of injuries.
“The 2010 increase in frequency, the first increase in 13 years, may have been the result of recession-related factors,” said the research brief. “Despite the 2010 uptick, claim frequency resumed its decline in Accident Years 2011, 2012, and 2013. These are very positive signs that suggest that frequency will continue its historical long-term rate of decline.”
The research brief, Workers Compensation Claim Frequency — 2014 Update, expounds on data presented at NCCI’s Annual Issues Symposium earlier this year. The report also includes detailed information on frequency changes by selected claim characteristics and for policies with versus without small deductibles (see box).
“Claim frequency increased 3.5 percent in Accident Year 2010, the first significant increase in frequency in 20 years,” the report states. “Following the 2010 uptick, claim frequency has declined for three straight years at an average rate of about 3 percent per year.”
Evidence suggests an influx of small lost-time claims contributed to the increase in claims frequency for AY 2010. Workers fearful of losing their jobs may have delayed filing claims in 2009, but then filed them when the economy began to rebound, the authors suggest.
“Despite the 2010 uptick, claim frequency resumed its decline in Accident Years 2011, 2012, and 2013. These are very positive signs that suggest that frequency will continue its historical long-term rate of decline.” — NCCI
One of the changes seen in the most recent figures is the significant decline in frequency of claims above $50,000 in accident year 2012. These claims declined by more than 7 percent, whereas claims between $10,000 and $50,000 declined by 3.1 percent and small claims declined by just 1.4 percent. A closer look reveals two major drivers in the larger claims category.
“Within the Part of Body group, we found that the frequency of lower back claims declined by 11 percent versus 6 percent for all other claims in the category,” the report says. “Similarly, within the Cause of Injury group, we found that the frequency of slip and fall injuries declined by 12 percent versus 4 percent for all other claims in the category.”
Over the last five years, the frequency of injuries for most body parts declined by 13.9 percent while the frequency of injuries involving multiple body parts declined by 22 percent.
The frequency rate for arm and shoulder injuries, which represent 15 percent of injuries, remained flat. “This may be influenced by an older workforce,” the report suggests, “where rotator cuff injuries are not uncommon.”
In terms of the injury type, frequency for permanent partial and temporary total claims were consistent with the overall decline of 13.9 percent for all injury types while fatal and permanent total claims showed more volatility each year, due to the smaller volume of these claims. The authors note that the figures are based on injury type reported as of first report and that the development of claim counts can differ considerably as they reach ultimate level.
“For example, subsequent to first report, some claims will become fatal claims and others will become PTD claims,” the report explains. “Fatal claim frequency at first report is more than three times higher than permanent total disability claim frequency. However, this difference will decline as claims age since more PTD claims than fatal claims will emerge beyond first report.”
Sprain/strain, comprising the majority share of claims by nature of injury, declined by 10 percent. That compares to a decline of 17 percent for all other categories combined. The frequency of carpal tunnel syndrome claims dropped by 25 percent, although the rate of decline has slowed in the most recent years.
In terms of the cause of injury, there was a steep drop in the frequency of cumulative injury claims — more than 18 percent. Injuries in the category of cut/puncture/scrape dropped by 23 percent. “A possible explanation is that the types of injuries in both of these categories may be relatively more preventable through loss control and safety measures.”