Bringing the 'eight dimensions of wellness' to employee-provided health insurance

October 01, 2019
By Nicole Stec

Employer-provided health insurance was originally devised after World War II as a way to attract — and keep — top employees in an exploding, hyper-competitive job market. Yet what we’ve seen is that there is a difference between simply offering health insurance and having employees take advantage of it in a way that promotes actual health and wellness.

Rather than leaving employees on their own to pursue health, some employers are now starting to use data and analytics to create their own health centers, with their own physicians and clinicians, to make it easy for their employees and families to become (and remain) healthier. These programs encompass not just one aspect but what is known as the “Eight Dimensions of Wellness” — Physical, Intellectual, Emotional, Social, Spiritual, Vocational, Financial and Environmental — to address the needs of the whole person.

By delivering both convenient access to care and incentives to use the services in the program, these organizations have been able to increase engagement in better health among employers and employees. The result is reduced absenteeism, improved presenteeism, greater productivity, and a program that helps retain good employees even in the face of higher salary offers elsewhere.

Removing barriers to primary care
Here’s an example of how that works. Like many public and private organizations, a city government in the southwest saw that its healthcare costs were rising without producing better health results. Employees and their families were as sick (or sicker) than ever, and little was being done to address the root causes and improve wellness.

Much of the higher cost was the result of increases in obesity and chronic conditions, which were not being managed effectively. Higher workman’s compensation costs were also a contributing factor.

To address the issue, the city brought in consultants who used advanced data and analytics to take a deep dive into the barriers facing employees around health and wellness. What they found was eye-opening.

The health plans they were offering, which followed the traditional model, weren’t very customized, and most didn’t address any of the eight dimensions of wellness outside the physical. They also found that it often took too long for employees to arrange an appointment with their primary care physicians (PCPs), so they would go to the far more expensive emergency department (ED) at their local hospital or an acute care clinic instead. Having fewer PCPs in the network exacerbated the issue, making it even less likely that employees would focus on wellness.

Using predictive and prescriptive analytics, the city and the consultants came up with a revolutionary plan to help them address these issues. Rather than offering traditional health plans, the city would open its own on-site health clinic with a goal of fulfilling 100% of the primary care needs of employees and their families.

To make it easy for employees to access, the clinic was centrally located within the city. This meant that in most cases employees and their families could now see their PCP the same day. If not, the maximum wait time for an appointment was three days, which was far better than the weeks it typically took before. They could also receive breast, prostate and skin cancer screenings on-site, saving time while encouraging early detection of potentially life-threatening health issues.

Addressing the many dimensions of wellness
Yet it wasn’t just the normal physical health services that were included in the program. Instead, the center was designed to address all eight dimensions of wellness, offering a variety of services (psychological, life and wellness coaching, debt management, assistance with social determinants of health issues, work/life balance, etc.), making it a one-stop shop for help with all the factors that could affect the health of employees and their families. All these services, incidentally, were offered at no cost to the employees, providing even greater incentive to take advantage of them — especially given the rising cost of seeing providers outside the health center.

One of the best aspects to the program was its flexibility, which enabled more services to be added later. For example, employees using personal fitness devices could opt to have their information linked to their electronic health record (EHR). This was particularly important for those in the program with obesity or other chronic conditions. Their PCPs could monitor their activities to ensure they were as active as they should be. If not, a nurse care manager or counselor could follow up to encourage them to increase their activity levels. After the initial successful launch, the program was opened up to retirees, becoming an additional benefit that was offered by other cities or the private sector.

To date, the program has experienced incredible engagement. The wellness center has seen more than 5,000 unique patients, with an appointment utilization rate that rose from 50% prior to the program to 80% today. It continues to grow, adding an average of 60 new patients per month as word spreads. Satisfaction is also high, with 93% of those surveyed saying they are satisfied with the wellness center itself and 90% satisfied with the benefits package.

In 2018, the city estimated that it had reduced absenteeism by $430,360 and improved presenteeism by $171,910. The time saved by reducing travel time, wait time and other factors came to $229,760, and the savings from retaining employees (rather than having to recruit, hire and train new employees) added another $223,780 in savings. In all, the city estimates the total productivity savings to be more than $1 million.

At the same time, by redirecting primary and preventive care, the city was able to reduce utilization of higher-cost providers, specialists and laboratories, resulting in more than $1.3 million in additional savings.

The key, of course, is that rather than passively offering health benefits like everyone else, the city became engaged in ensuring that its benefits were being used. That has been the key difference-maker.

By using data and analytics to discover the current state of utilization and match them against employee needs, employers can devise a whole-person approach to health and wellness that employees will love — and use.

About the author: Nicole Stec is senior well-being manager for Banner Health