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Case Studies & Results:  Employee Wellness that includes the Primary Care Physician

Jesse Hercules, President & CEO Extracon Science LLC

Employers are Making the Change

Traditional employee wellness programs didn’t include the primary care doctor.  They built a parallel system of screening and coaching  – and found that screeners and coaches couldn’t treat the problems their participants had. 

But now, our surveys show that 40% of employee wellness programs have at least some basic interaction with the Primary Care Physician (PCP).  The best programs work with the doctor to ensure the prevention gaps and biometric issues found at the initial visit are actually resolved that same year

In this eBook, we share the results from two of our clients that are including the employee’s doctor in their wellness programs.  They had outstanding biometric results across thousands of participants.  They show that working with the doctor is a practical option that can outperform onsite screenings. 

This eBook also provides answers to the most common questions we get from employer groups about including the doctor:  What are the recommended program designs and how do we make the transition?  How do we ensure HIPAA compliance?  And, how do we ensure the doctors do their part?

Program Designs that Include the Doctor

Basic programs allow participants to submit biometric screening results from their doctor – instead of attending an onsite screening.   This is the most common approach, although it’s very limited.

Better wellness programs ask all participants to complete an Annual Prevention Visit with their doctor instead of an onsite screening.  That approach goes beyond biometrics to address all the participant’s prevention needs.  

Some programs give participants credit for completing any age-and-gender appropriate screening or preventive service.  However, this approach does not look at whether the doctor says they are up to date on everything they need. 

In a similar way, some programs track whether the participant sees their doctor about a biometric issue.  However, this approach does not look at whether the doctor says the problem was treated and resolved.

The best practice is to use the Annual Prevention Visit to have the doctor document the participant’s prevention gaps and any biometrics that need treatment.  Then, track and reward participants who close their prevention gaps and get biometrics under control – as verified by the doctor.

A Plan for Including the Doctor

Before we get into the case studies, let’s note that wellness programs that are successful in embedding the primary care physician follow a clear plan.  This plan includes:

       Decide to include the PCP

       Gain the support of your management

       Decide what to measure

       Select the vendor to coordinate

       Determine incentives

       Take a comprehensive approach to educating and motivating participants

       Execute on the details

       Measure results & Reap the benefits

 

In addition, your vendor should have the following materials to help you:

       Clear, simple PCP forms for the Annual Visit and Follow-Up Visits.

       Guidelines for employees (both video and text versions)

       Sample questions for the employee to ask the PCP

       Suggested issues for the employee to discuss with PCP

       Ideas for employee on how to select and evaluate their PCP

       FAQ for Employees

Client Example:  Annual Visit Physician Forms

Wellness leaders often ask us if doctors will do their part in filling out and returning the annual prevention visit form.  Aren’t doctors very busy? 

We have good news:  Across thousands of our participants every year – doctors do an excellent job of completing and returning annual visit forms. 

Client Example: For a large hospital client, we received 1,708 physician forms in year 1 and 1,965 in year 2.   There were 35 cases total where a participant told us they completed the physician screening, but no results arrived. 

With a 98%+ success rate, it was easy to manage the exceptions by working with the participants, their doctors and cross-checking claims data. 

Keys to Success:  Good preparation of participants is vital.  Educate them on how to ask for the appointment, what to bring, and what to say and do at check-in.  Doctors will fill out and return the forms if wellness programs provide a short, simple form and participants make a clear request. 

Client Example:  Follow-up Physician Forms

When wellness programs collaborate with the doctor to track follow-up, you might imagine a complex process that puts an added burden on the doctor.

The reality is much simpler.  Just as participants bring an Annual Visit Form to their annual prevention visit, they bring a one-page Follow-Up Visit Form to their follow-up visit.  The doctor fills out and signs the Follow-Up forms in exactly the same way as the Annual Visit Form. 

The form allows the doctor to sign-off that a participant’s biometrics were treated, re-tested and are now under control. Or, that a needed preventive service was completed at today’s visit.  It’s a simple, proven approach.

Client Example: For a higher education client, we received an average of 1.95 follow-up forms for every Annual Wellness Visit.  Medical follow-up on physician recommendations was 42% more popular than health coaching.

Keys to Success:  Use the existing process that doctors know how to do– filling out and signing a one-page form, presented at the time of the appointment.  Keep the process simple and low-tech on the doctor’s end. 

Including the Doctor is HIPAA Compliant

Wellness leaders often ask us if including the physician in the wellness program is HIPAA compliant. 

The answer is yes.  Almost of half of all wellness programs today are accepting biometrics from physician’s offices.  There’s no controversy.

Physician forms include a participant consent signature allowing the doctor to send the information.  The data goes to the wellness vendor – which has policies and procedures in place to handle biometrics and other health information.  

The employer only receives aggregate reports on health risks, and the list of participants who have earned each incentive level under the program.    The employer does not need to receive or handle any PHI. 

What about prevention or follow-up data?  Under HIPAA’s privacy and security rules, there’s no difference between biometric screening data and other kinds of health data – allowing wellness vendors to keep track of participants’ prevention gaps and other relevant wellness information.

Employer Case Study:  Integrated Health System

Our first case study is a large, integrated health system with just over 10,000 employees.   They have very high participation in the wellness program.

They’ve offered their wellness participants a choice of completing an onsite biometric screening, or visiting their own doctor. 

We’ll compare the results from the participants who completed the physician visit to those who completed the onsite screening.  We used a cohort analysis, tracking changes in the employees who participated in both year 1 and year 2. 

Total Cholesterol – Screening vs. Physician Visit

Although both groups reduced risk, the physician visit group had better results for Total Cholesterol (TC) than the onsite screening group. 

The physician visit group had a 34.5% reduction in participants with high cholesterol, compared to 30.3% for the onsite group.  The physician visit group had a 7.5% increase in participants with desirable cholesterol levels, compared to a 3.5% increase for the onsite group.

Blood Glucose– Screening vs. Physician Visit

The physician visit group reduced risk for non-fasting blood glucose (NF Glucose).  The onsite screening group increased their blood glucose risk. 

The physician visit group had a 5.1% reduction in participants with high blood glucose, and an increase in participants with acceptable glucose levelsThe onsite screening group had the opposite – more participants with high blood glucose and fewer with acceptable levels.

Blood Pressure – Screening vs. Physician Visit

The physician visit group lowered blood pressure (BP) and reduced risk.  The onsite visit group had mixed results, adding risk in some categories and reducing risk in others.

The physician visit group had a 42% reduction in participants with very high blood pressure, a 13.8% reduction in participants with high blood pressure, and a 2.1% increase in participants with normal blood pressure.  The small increase in above-normal blood pressure was caused by participants moving down from high BP.

The onsite group reduced the number of participants with high blood pressure, but also had 19.6% fewer participants with normal blood pressure.  Those participants’ blood pressure went up, causing an 18.2% increase in participants with above-normal BP.

Case Study Discussion:  Integrated Health System

Participants who visited their own Primary Care Physician had better results than the participants who completed the Onsite Screening. 

They had better results for Blood Pressure, Total Cholesterol, and Glucose.  In many cases, the physician visit group got healthier while the onsite screening group got worse. 

It makes sense that they physician visit group would have better biometric results, because biometric issues are treated and managed by a physician – not a screener. 

Because the physician visit produces better results, we often recommend changing from onsite screenings to having all participants complete an Annual Visit with the doctor. 

Case Study: Higher Education

Our second case study is an institution of higher education with 14 campuses across the western US.  They have 850 covered employees.  

Their wellness program asks participants to visit their doctor for an Annual Prevention Visit, and also gives participants credit for completing physician-recommended prevention items. This case study uses a cohort analysis, tracking the changes in employees who participated in both years.

Case Study: TC Changes with Physician Visit

Participants who worked with their doctor reduced their Total Cholesterol (TC) risks.

The number of participants with Borderline High TC or High TC decreased 23.1%. The number of participants with Normal TC increased 7.7%

Case Study: LDL Changes with Physician Visit

Participants who worked with their doctor also reduced their LDL Cholesterol risks.

The number of participants with Borderline High LDL or High LDL decreased 40%. The number of participants with Normal LDL increased 10%. 

Case Study: Triglycerides with Physician Visit

Participants who worked with their doctor reduced their Triglyceride risks.

The number of participants with Borderline or High Triglycerides decreased 20.0%. The number of participants with Normal Triglycerides increased 5.0%.

Case Study: Glucose Changes with Physician Visit

Participants who worked with their doctor reduced their Blood Glucose risks. 

The number of participants with high glucose in the prediabetes or diabetes range decreased 37.5%. The number of participants in the desirable fasting glucose range increased 11.4%.

Case Study: BP Changes with Physician Visit

Participants who worked with their doctor reduced their Blood Pressure risks. 

The number of participants with Prehypertension and Hypertension decreased 12.9% and the number of participants with Normal Blood Pressure increased by the same amount.

Case Study: BMI Changes with Physician Visit

Participants who worked with their doctor also reduced their BMI risks.  The number of participants with Normal BMI increased 9.5% and the number of participants with a BMI over 35 decreased 11.1%.

This wellness program promoted healthy lifestyle habits for physical activity and nutrition – as well as working with the doctor.  Their results show that you can have both lifestyle change and medical prevention.

Case Study Discussion: Higher Education

Participants who completed an Annual Prevention Visit with their Primary Care Doctor reduced their biometric risk levels.

They also documented a significant number of prevention tasks completed beyond the Annual Visit.  We received an average of 1.95 prevention forms for every Annual Wellness Visit.  Follow-up on physician recommendations was 42% more popular than health coaching.

Participants also improved BMI, indicating that they are achieving lifestyle change for physical activity and nutrition.  

Wellness programs that want to improve biometrics don’t have to choose between lifestyle change and by working with the doctor.  They can achieve more by using both approaches at the same time. 

A Budget for Including the Doctor

Wellness programs often ask us what the additional cost would be to include the doctor.   In our experience, the pragmatic approach is to redirect the budget that’s been used for onsite screenings – no additional budget needed.

We’ve found that for the same cost as an onsite screening, a wellness vendor can manage the process of including the doctor:

       Getting participants ready for their visit

       Collecting data from the Prevention Visit and Follow-Up Visits

       Having health coaches available to assist participants

       Administering incentives and keeping you compliant with HIPAA

       Providing aggregate reports based on the physician data

You might worry about adding more doctor visits onto the health plan.  However, studies show that participants who work with their primary care doctor on prevention have lower overall healthcare costs. That makes it a win/win for the wellness program and health plan.

Some Questions You Might Ask Yourself

       How does my wellness program work with the employee’s doctor today?  Is it limited to accepting biometrics once a year? 

       Do my employees who work with their doctor have better results than those who go to my onsite screenings?

       Do I have a way to track prevention gaps and reward employees who become up to date on everything they need?

       Do I have a way to track and reward employees who get biometric issues resolved with the help of their doctors?  

       Would my wellness program be more effective if it could work more closely with participants’ doctors throughout the year? 


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