With drug costs continuing dramatic rise, health-risk assessments could gain momentum
Just before Steve Scanlan stepped on a treadmill as part of a work-sponsored health-risk assessment, he was advised he should first meet with a cardiologist. Tests done earlier at the executive session revealed he had an irregular heartbeat.
“It’s the kind of thing they tell you, ‘Nothing to be alarmed about’ but they just told you you’ve got something abnormal and they can’t explain it,” said Scanlan, head of HR at Macquarie Canada, provider of banking, financial, advisory, investment and funds management services in Toronto. “It does make you worry a little bit... But better that than being among the three per cent (of conditions) that could be fatal if they don’t get the work done.”
The $1,700, five-hour assessment included tests for heart disease, hardening and narrowing of the arteries, bone density, respiratory function, visual acuity and prostate cancer, an abdominal ultrasound, chest X-ray, fitness appraisal, blood and urine tests and nutrition evaluation. At the end, a comprehensive report showed Scanlan where he sat within his norm group.
“They just go into a lot more depth and detail than you would get from your average GP,” he said. “For the average person, you’re probably going to pursue some things you wouldn’t normally because you’re getting that level of data.”
Personalized health-risk assessments have been offered for years but with benefit costs continuing to rise dramatically — almost 10 per cent in 2009, according to a report from the Conference Board of Canada — more employers might start offering the service in an effort to improve the health and wellness of employees. Health insurance company Manulife certainly hopes so, as it just introduced two types of health assessments in partnership with preventive health-services firm Medisys.
“One of the reasons this product has come to be is feedback from employers,” said Scott Ife, product manager, group benefits, business development, at Manulife in Toronto. “What we are seeing from employers… is a desire to improve the health of their organization, a desire to lower costs of their group benefits plan, overall health spending and things like drug and disability.”
Manulife’s half-day executive medicals provide physical and mental health evaluations, lab testing and lifestyle, fitness, nutrition and stress assessments. Participants receive a report with feedback and a customized health-improvement plan.
With Manulife’s Worksite Wellness program, employers can choose from a suite of worksite assessments, based on cost, depth of testing and reporting detail. Feedback is provided individually or to employee groups through a presentation.
Assessments can detect early risk factors
Investing in this kind of preventive program can be the first step in designing wellness programs and lets organizations identify early risk factors, said Ife. Employers can address specific topics highlighted in an aggregate of employee results through initiatives and strategies such as an employee assistance program or targeted lunch and learn.
For example, if a significant portion of a workforce smokes but indicates in the personalized health assessments it is reluctant to change, an employer probably shouldn’t waste its time on a smoking-cessation program, said Leanne MacFarlane, senior director of business development at Halifax-based MHSCI, a pharmacy benefits specialist that offers health-risk assessments. On the other hand, if many employees show an interest in nutrition, that’s where the investment should go.
“It guides where you want to spend your time and effort based on where people are at,” said MacFarlane. “(Employers will) look at aggregate results and be able to pinpoint areas of concern and areas of opportunity. The aggregate, more so, comes into larger organizations that actually want to create some strategy and programming around wellness as an initiative.”
While having “a likely positive impact” on reducing absenteeism, disability and drug expenditures, health-risk appraisals can also help employers improve the health, productivity and engagement of employees, said Ife.
“It’s a great way to get a snapshot of their health. It’s convenient, some individuals may not have a family physician or visit a physician regularly,” he said.
Executives at Macquarie who have participated are pleased with the service and the fact their employer is footing the bill, said Scanlan.
“It acknowledges that our people work pretty hard and they often don’t have time to take care of themselves.”
The assessments don’t replace a complete checkup by a physician but “if the assessors are finding high sugars, high cholesterol, high blood pressure, things that are of a concern to them, they clearly point that out and advise people to go and follow up with their physician,” said MacFarlane.
There are probably many people who lack a physician or don’t go regularly, so “this may be the most thorough health assessment they’ve had done,” she said.
People are interested in staying healthy and curious to know how they’re doing.
“If they are presented information in a respectful way, in an informative way that applies to them and doesn’t cloud it with a whole bunch of information that doesn’t relate to them, it catches their attention and they can document things and take action,” said Zorianna Hyworon, CEO of Winnipeg-based Infotech which offers health-risk appraisals. “If there’s a supportive environment around that, that’s magnified.”
However, participation rates can be a challenge. Some organizations encourage people to take part by working the assessments into flexible dollars or premium settings in benefits. Employees are also more inclined to get involved when reassured the personal medical results are never shared with their employers, said Ife.
“The participation rate is more about an organization’s culture of wellness, more about how it’s promoted within the workplace than it is about the size of the employer,” he said.
Participation runs anywhere from 10 to 95 per cent, said Hyworon, but is particularly good if the assessments are done as part of benefits enrolment.
“(Employers) don’t have to bribe people,” she said. “Many of our clients do not offer any incentives, it’s… really not an accepted concept but there may be team incentives or other ways of creating a buzz or creating value.”
Participation rates for these appraisals “are probably the lowest of all the wellness initiatives that are out there,” said Andrew Tsoi-a-Sue, leader of the Toronto group benefits consulting practice at Eckler. “It’s just a matter of people getting off their tail and doing something… People generally don’t want to know.”
Measuring ROI
Also a challenge is proving the return on investment. When workers are made aware of potential health issues or risks, they will try to lower their risks and that, in turn, can result in lower drug costs and long-term disability costs — at least that’s the theory, said Tsoi-a-Sue.
“But, I mean, measuring this stuff is like pulling teeth,” he said.
Ideally companies start with a baseline year and try to repeat the assessments on an annual basis, to track the therapeutic profile of the benefit plans when it comes to certain drugs, said MacFarlane.
“The really robust assessment piece is still sort of in its infancy, it hasn’t become that sophisticated yet, for most organizations,” she said.
