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Health Care System "In Pursuit of Excellence" Case Example
Baptist Health South Florida (Baptist Health)
Baptist Health South Florida (Baptist Health) is the largest not-for-profit health care organization in South Florida. The mission of Baptist Health is "to improve the health and well-being of individuals, and to promote the sanctity and preservation of life, in the communities we serve. Baptist Health is a faith-based organization guided by the spirit of Jesus Christ and the Judeo-Christian ethic. We are committed to maintaining the highest standards of clinical and service excellence, rooted in utmost integrity and moral practice."
Consistent with its spiritual foundation, Baptist Health is dedicated to providing high-quality, cost-effective, compassionate health care services to all, regardless of religion, creed, race or national origin, including, as permitted by its resources, charity care to those in need.
Affiliates of Baptist Health include Baptist Hospital of Miami, Baptist Children's Hospital, South Miami Hospital, Homestead Hospital, Mariners Hospital, Doctors Hospital and Baptist Cardiac & Vascular Institute. Baptist Health also offers a variety of health care services, including outpatient diagnostic and treatment facilities and home health care.
Baptist Health created "Wellness Advantage" in 2001 as an organization-wide commitment to improve the health and well-being of its employees and their families. The organization believes that wellness is the key to every success the system enjoys, whether it's the ability to care for patients, to balance personal and professional lives, or to focus on the Baptist Health mission. To achieve its goal of having the healthiest workforce in America, the Wellness Advantage program offers a comprehensive array of health-related employee services, such as free on-site employee health clinics, an innovative weight-loss program, and state-of-the-art nutrition evaluation of cafeteria receipts.
The Wellness Advantage Approach. Baptist Health understands that wellness is not a one-time program, nor is there a "one size fits all" approach. The Wellness Advantage goal is to "keep wellness in front of our employees 24/7 and to keep it fun." The system strives to achieve this through innovative programs that reach out to all demographic groups, especially those that may not be traditionally drawn to wellness activities. Specific program components include:
Free "Employee Care Hours", allowing employees to be treated by a physician or Advanced Registered Nurse Practitioner (ARNP) for minor illnesses or injuries for free, acting as a supplement to their primary care physician when they cannot see their physician in a timely manner;
Free "Health Check Program", a disease management program that uses results from a health risk assessment to provide one-on-one counseling and care with a registered nurse to employees with multiple health risk factors;
Eight no-cost fitness centers open 24 hours a day seven days a week. The fitness centers offer discounted personal training and fitness assessments;
Healthier menus in the cafeterias and vending machines, including no trans fats and complete nutritional information. In addition, all cafeterias serve the Wellness Advantage meal, with menus approved by dieticians that are lower in sodium, calories and fat and are available for $3.00 each;
"Safe Patient Handling Program", which helps employees who lift and transfer patients;
"Return to Work Program", geared to returning predominantly non-workers' comp cases to work;
"Employee Pharmacy Program" with $5 co-pays; and
Free behavior change programs, such as weight loss and smoking cessation.
Program Administration. Wellness Advantage is fully subsidized by Baptist Health. The program has an annual operating budget of $1.4 million, and 15 FTEs. Employees include a full-time wellness coach at each facility, exercise physiologists and exercise assistants who work at the fitness centers.
Conducting Employee Health Assessments. Baptist Health had been conducting a written employee health risk assessment for over ten years prior to the creation of the Wellness Advantage program. When the program began in 2001 the health system hired an outside organization to review employee claims data to determine the primary health challenges Baptist Health employees were dealing with. The claims data review mirrored the findings from the self-reported health risk assessments, identifying the biggest challenges to be inactivity, poor nutrition, high blood pressure, high blood sugar, smoking and the need for weight loss.
The health system then started conducting employee health screenings twice a year. The health screenings include physical screenings as well as requesting that employees complete the written health risk assessment. Employees that are determined to be "high risk" are invited to participate in the organization's disease management program called Health Check. Currently over 2,500 employees participate in Health Check, working one-on-one with a nurse to improve their health. Since the program's inception, fewer than ten people have declined to participate in Health Check.
Using Data to Make Change. Baptist Health reviews its employee health assessment data and claims data to determine the most significant barriers to health improvement. For example, data showed that medication compliance was one of employees' greatest challenges in managing diabetes and hypertension. As a result, Baptist Health created an employee pharmacy. The pharmacy has only 21 medications on its formulary list, predominantly medications for chronic conditions that were in high use and/or expensive through the employee health plan. The co-pay is only $5 per month for all medications.
Data from the self-insured health plan also revealed low compliance for conducting mammograms and colonoscopies. When the health system removed the $250 co-pay for colonoscopies participation rates increased significantly. In contrast, removing the co-pay for mammograms did not make a significant impact on participation, so Baptist Health held an employee forum to gather ideas about ways to increase the rates of mammograms. A suggestion was made to share testimonies from breast cancer survivors to communicate the value of early detection. In response Baptist Health created a seven-minute DVD with the testimony of four employees - three women who had survived breast cancer and one man whose wife had survived breast cancer. The DVD was mailed to every Baptist Health employee in October 2005. By 2007 the percent of female employees over the age of 40 receiving mammograms increased from 33 percent to 62 percent.
Physician Involvement. Physicians are involved in the Wellness Advantage program in a number of ways, providing input and advice about ways to best reach employees. In addition, two preventive cardiologists served as advisors as the Center for Prevention and Wellness was established. The Wellness Advantage approach is supported and well-accepted by physicians, which Baptist Health believes is a critical part of the program's success.
Using Information Technology to Track Utilization. Baptist Health currently uses employee badges to monitor participation in the fitness center. The health system is in the process of implementing a new technology with battery-operated badge swipes to monitor participation in other events, conversations with wellness coaches and more. The handheld devices can be used anywhere, and allow the data to be downloaded into a Microsoft Excel® spreadsheet.
Since the program was implemented in 2001, Baptist Health has included a question about Wellness Advantage on its annual employee satisfaction survey. In 2007, 89 percent of all respondents indicated that they participated in the program in some way. Specific metrics about employee participation and results clearly shows positive outcomes as a result of the program.
The "Health Check" program includes a health risk assessment to determine employees with moderate to high risk factors. Annual participation in the health risk assessment has increased from approximately 1,700 in 2005 to more than 2,700 in 2007. In addition, in 2007 Baptist Health documented health status improvement in 50 percent of the "coached" population, with health stabilization documented in another 26 percent.
Employees lost a combined 3,053 pounds in 2007 due to participation in the Weight-Management Coaching program. In addition, family members with children ages 8 through 12 lost 112 pounds combined, and 95 percent improved their health metrics in the Families Step Up program.
Fitness Center utilization increased by 19 percent from 2006 to 2007.
Attendance at Baptist Health's twice-annual employee health fairs has steadily increased since 2001. More than 8,400 blood pressure screenings were conducted in 2007.
Nearly 100 percent of enrolled employees in Baptist's "Steps to Unstress" completed the program. Pre- and post-participation surveys found that the program was effective in lowering stress levels as well as encouraging increased use of the fitness center, a healthier diet and decreases in weight and blood pressure values.
Nearly 92,000 Wellness Advantage Meals were sold in 2007.
Employees participating in the "Health Metrics Trending" with high cholesterol have declined from 50 percent in 2001 to 32 percent in 2007, and employees with high blood glucose levels have declined from 12 percent in 2002 to four percent in 2007.
The employee smoking rate has declined from 15 percent in 2001 to five percent in 2007.
Both Employees and the Health System Have Realized Significant Cost Savings. As a result of the Wellness Advantage program, both employees and Baptist Health have saved money through a reduction of medical claims costs, free utilization of Employee Care services, a reduction in workplace injuries, and reduced pharmaceutical costs.
Health Check participants had a sharp decrease in medical claims costs in 2007. 320 participants were tracked, with a decrease in medical claims of three percent after the first year and 40 percent after the second year. The total savings to Baptist Health for the 320 individuals tracked was $1.4 million in 2007.
The Employee Care Hours program offering free medical care to employees on campus saved employees $451,000 in 2007 and the health plan $902,200 in direct medical costs. Although it is difficult to measure, Baptist Health also saved the indirect costs of replacing employees who missed work to see an outside physician and/or were ill and missed extended periods of work.
Workplace injuries have declined significantly, in part due to the Minimal Lift program that eases the work of clinical staff transferring patients. In 2007 Workers' Compensation cases declined by 60 percent. In addition, case management reduced average workers compensation costs by one third.
The employee pharmacy has saved employees $518,000 in reduced co-pays, and saved the health plan $959,000 through lower payments for the medications utilized.
Providing Incentives Can Be Challenging. Baptist Health would like to utilize more incentives to encourage employees to participate in the program, however justifying the cost for a not-for-profit organization is difficult. Currently the health system offers a $10,000 life insurance policy to employees that participate in the health risk assessment each year. The challenge is that the life insurance policy does not provide an immediate incentive to employees. Providing a modest tangible incentive that employees can immediately enjoy would cost the system about $100 per person.
Advice for Organizations When Implementing a Similar Program. Support from organizational leaders is essential to any successful wellness program, as senior leaders set the tone for the organization. Getting started does not require a comprehensive program. The wellness concepts can be applied immediately, focusing on small wins and growing the program slowly.
As programs are developed and implemented, keep them fresh and inviting. People continue to look for something new and different. At the same time, ideas for programs don't need to be "reinvented." Seek ideas from colleagues, partner organizations and publications.
Finally, remember that wellness does not have to be expensive, and measure the results. Some initiatives may be small but have a significant impact. The data will demonstrate what works and what doesn't, and is also essential to determine and report your return on investment.
Because Baptist Health is a large system with multiple locations, it is able to reach a greater portion of the South Florida region with the Wellness Advantage approach. Having different facilities also encourages healthy competition between facilities for participation in the program. In addition, the system can participate in corporate wellness events taking place in the region, such as the annual corporate fun run.
Although coordinating the program and maintaining a personal touch throughout the system's 17 locations can be challenging, it also requires all of the employees working together to be successful. This encourages teamwork and a sense of shared purpose.
Contact Name: Maribeth Rouseff
Title: Assistant Vice President/Community and Employee Health
Tel: (786) 596-3330
Fax: (786) 596-1650