A systems-based approach to improving health considers all factors involved in caring for patients and the many factors that influence one's quality of life. The integration of people, processes, policies and organizations is critical to promoting better health at lower cost. For example, we can close the clinic-to-community gap by using an integrated systems approach that connects employers, healthcare providers, community-based organizations and family/community relationships.
Unfortunately, the prevalence of chronic disease continues to have staggering consequences across the U.S. The Centers for Disease Control and Prevention reports that as of 2012, about half of all adults (or 117 million people) have one or more chronic health conditions and 25% have two or more chronic health conditions.
The Robert Wood Johnson Foundation recently noted that 84% of all healthcare spending was for the 50% of the population who have one or more chronic medical conditions. Similarly, the American Heart Association estimates the total cost of diagnosed diabetes in 2012 was $245 billion, including $176 billion in direct medical costs and $69 billion in decreased productivity.
Employers have worked to help improve employee health by providing resources—such as free and discounted gym memberships and fitness programs; healthy options in employer-provided dining rooms and cafeterias; reimbursements for preventive care through managed healthcare; and even nutrition and diet counseling. Employers encourage physical activity with open floor plans, treadmill and standing desks and flexibility for walking or exercising. But despite their best efforts, low engagement and lack of employee compliance has yielded minimal tangible returns on health and wellness-program investments for most employers. Employers attribute this to lack of education; lack of trust in the current screening systems; concern for privacy breaches of personal health information to their employer or insurer; and an overall lack of time, motivation and money.
The complexities of these issues have been explored in the work done by Dr. Soeren Mattke from RAND Health, whose studies in worksite wellness have shown mixed results in the actual engagement of employees in direct solutions or interventions to improve their health. Mattke's research shows that most employers take a one-size-fits-all approach by investing a great deal of resources to engage employees into “wellness programs” that are traditionally focused on all employees, regardless of risk or readiness to change. These programs rely heavily on the insurer to provide oversight and guidance to the employee despite the fact that insurers are reporting low uptake as well.
Employers are now seeking approaches that reach into the community, improve support for individuals at their worksite and at home, engage the entire family unit to support healthy habits and behavioral changes, and, ultimately, increase engagement and compliance rates into evidence-based programs for chronic disease prevention and intervention, particularly for moderate- and high-risk employees. Within the current model, short-term changes may occur, but there is no support network to sustain these changes for long-term success.
At Sodexo, we consider health and well-being programs to be a critical component of improved performance for individual employees, organizations and the community at large. As one of the largest employers in the world, serving 80 million consumers daily, we believe that we have an opportunity and a responsibility to help improve our nation's health and well-being. Despite our size, we cannot do it alone and need to collaborate with strategic partners at the community level. As such, we are taking a systems-based approach to employee health management that leverages community-based organizations (including the public and private sectors), employers, healthcare providers and family/community relationships to improve engagement in and compliance to evidence-based prevention and chronic disease-management programs that ultimately diffuse into the employee's community to yield a greater impact than standard workplace-wellness initiatives.
Our collaborative approach is intended to address the challenges facing employers, providers, insurers and individuals, but also to leverage the collective assets of these sectors to drive employee and family engagement. Using the power of peer-to-peer engagement, the strength of evidence-based programs, the impact of behavioral modification in lifestyle management, and the influence of friends, family and other community-based support, we are positioning ourselves to tackle the barriers that hinder most wellness programs. Other companies can do the same.
Dr. Mattke has evaluated many workplace wellness programs and concluded that most don't have an ROI in the traditional sense—but taking a systems-based approach to improving employee health that applies population health management principles can yield stronger returns, specifically around improved performance. Implementing population health management strategies allows employers to more efficiently spend their wellness dollars by shifting resources to employees with a greater need for intervention. For example, helping to manage chronic illnesses in employees saved almost $4 in healthcare costs for each $1 invested, according to RAND Health research.
To improve employee health and reduce the total cost of care—forward-thinking organizations are taking a systems-based approach to improving employee health and well-being.
Nebeyou Abebe is senior director of health and well-being for Sodexo North America.