Sentara Healthcare - Norfolk, Virginia
Overview: Sentara Healthcare is a non-profit health care organization with more than 100 care-giving sites, including seven acute care hospitals with a total of 1,728 beds, nine outpatient care facilities, seven nursing centers, and three assisted living centers. It is the largest integrated health care provider in southeastern Virginia and northeastern North Carolina, serving more than two million residents.
Sentara Healthcare had offered a wellness program to its employees for several years. After examining data and seeing that the collective medical health of employees was not improving, Sentara leaders realized that a more proactive program was needed. They partnered with the organization's health plan, Optima Health, and developed "Mission: Health," a robust program that provides incentives for healthy behaviors and comprehensive management of high-cost chronic illness.
Beginning in January 2008, all Sentara employees were given multiple opportunities to participate in health screenings in preparation for open enrollment. The health screening measured blood pressure and total cholesterol. During open enrollment, employees were asked five questions regarding blood pressure, cholesterol, height and weight (from which a BMI was calculated), exercise habits and whether or not they used tobacco. If employees elected not to answer those questions, they were informed that they would pay the full premium for their selected health care benefits in the 2008 year. For those who completed the questionnaire, a health benefits premium reduction of $440 over the year was possible. Employees with one or fewer health risks based on the screening received that reduction with no further requirement. Those with two or more health risks were offered the opportunity to work with a health coach via telephone or e-mail over the course of the year to improve their health behaviors. If they agreed to do so, they also received the reduced premium. These employees will maintain the reduction in premium as long as they continue to work with a health coach.
Additionally, for employees with diabetes, congestive heart failure or coronary artery disease, another financial incentive is offered. Once these employees join the appropriate Optima disease-management program, they have the opportunity to earn $440 over the year for following physician orders related to their chronic illness management, including completing all appropriate testing, taking medications appropriately, seeing the physician regularly, and working with the health coach on improved self-management techniques. This money is paid into a Flexible Spending Account for the employee to assist with the burden of managing the costs of chronic illness.
Impact: Prior to implementation of "Mission: Health," 30%-40% of employees completed health profiles; now 98% are completing profiles. Of the 10,995 employees that completed the five-question health survey, 8,030 had two or more health risks, and 7,989 of those agreed to participate with a health coach. More than 1,100 employees were identified with chronic illnesses and have been invited to participate in the disease management program.
One of the elements of the program for participants in the chronic illness program is medication adherence. If program participants meet a Medication Possession Ratio (MPR) of at least 80%, they receive the biannual incentive of $120. At the six-month point of the Mission Health program, Medication Adherence was measured with the MPR for program participants. The results demonstrated a 22.7% improvement in members meeting the 80% MPR.
Sentara program leaders had projected an annual net savings of $300,000-$500,000 for the first year. They are in the process of measuring and analyzing the data. Their measurements include: medical cost and utilization rate; clinical metrics, pharmacy cost and utilization rate, and participation and engagement.
Challenges/success factors: To the surprise of program leaders, some employees without chronic illnesses initially perceived that those employees receiving financial incentives for disease management were being "rewarded" for being sick. Program leaders immediately educated employees to make sure they understood that the incentives were to help offset the costs of doctor visits and medications.
Program leaders also learned that they needed to tailor the risk-assessment guidelines provided by the National Institutes of Health to their population to ensure that people on the verge of high risk were captured in the data.
Future direction/sustainability: A comprehensive measurement methodology has been developed to include pre- and post-program costs, clinical measures, pharmacy measures and degree of participation with the health coach. Sentara believes such programs will energize employees to improve self-management behaviors and reduce the increasing costs of health care. For year two, the risk-assessment guidelines have been expanded to capture more people who would benefit from educational information. Further, a separate incentive for pregnant employees has been added to the program.
Advice to others: Any organization that would like to implement a similar program-whether in partnership with an internal or external health plan-needs to ensure that the data sources are able to talk to each other. Ideally, they should share information in a central repository to provide a truly patient-centered program.
Contact: Terrina Thomas
Director, Health and Preventive Services
Telephone: (757) 552-8925