Six-year cost trends at PPG industries paralleling the introduction of health promotion programs directed at cardiovascular disease prevention.

OBJECTIVE: Over the past several years, PPG Industries (PPG) implemented worksite health promotion programs aimed at improving employees' health and reducing overall medical costs as well as those specific to cardiovascular disease. METHODS: Using medical claims data, we examined trends in these costs among PPG employees for a 6-year period, from 2005 to 2010. RESULTS: Overall medical costs remained relatively flat, increasing by 1.2% compounded annually, unadjusted for inflation, while inflation-adjusted costs declined by 2.9%. Comparing worksites rated "high-high" on both program implementation and leadership support with worksites scoring highly on one or none of those dimensions, the "high-high" group experienced a decreasing cost trend, whereas the "other" group showed an increase. CONCLUSIONS: The analysis suggests that PPG's efforts to reconfigure and intensify its wellness program offerings may have resulted lower health care cost trends.

Obesity in the workplace: impact on cardiovascular disease, cost, and utilization of care.

BACKGROUND: In forecasting the future of cardiovascular disease (CVD), the American Heart Association calls for preventive strategies with particular attention to obesity. The association between obesity and CVD, including coronary artery disease (CAD) and diabetes, is well established. The rising prevalence of obesity in the workforce may have additional implications for employers and employees besides the demonstrated effects on absenteeism and workers' compensation. OBJECTIVE: This study was undertaken to determine the impact of population obesity on care utilization and cost of cardiovascular conditions such as hypertension, CAD, and cerebrovascular disease (or stroke) in a large US population of employees engaged in a major corporate wellness program. STUDY SAMPLE: Using data from a single large industrial employer across 29 geographically distinct worksites in the United States, 179,708 episodes of care from 2004 to 2007 for 10,853 employees were included. METHODS: The population-based economic impact of obesity was calculated on the basis of the frequency of episodes of care per 1000 employees and on the amount eligible for payment per episode of care in US dollars. Data were obtained from a wellness program databases, episode of illness inventories, and pharmacy and medical claims. High and low prevalence rates of obesity, by obesity quartile, were used to create linear mixed models to examine associations with disease outcomes, while controlling for correlation within each worksite. RESULTS: Worksites with a high rate of obesity (ie, in the fourth quartile) had 348.4 more episodes of care of any kind per 1000 employees (P <.001), 38.6 more hypertension episodes of care per 1000 employees (P <.001), and 2.5 more cerebrovascular disease episodes of care per 1000 employees (P = .017) compared with worksites in the lower 3 quartiles. A worksite in the fourth obesity rate quartile had $223 greater cost per any kind of episode (P <.001), $169 greater cost per hypertension episode (P = .003), and $1620 more per CAD episode (P = .005) compared with worksites in the lower 3 quartiles. The overall economic impact per 1000 employees was calculated by combining episode frequency and eligible amount for payment per episode. For sites in the lower 3 quartiles of obesity, the eligible amount per 1000 employees for any kind of care was $4.01 million. However, for sites in the highest obesity quartile, the eligible amount for payment per 1000 employees was $5.26 million. This translates into $1250 greater cost per employee. Similar calculations were used to evaluate the effect of obesity on the amount eligible for payment per employee for hypertension, CAD, and cerebrovascular disease episodes, with an estimated $69, $89, and $8 greater cost, respectively, per employee. CONCLUSION: Worksites with greater obesity prevalence rates were associated with numerically more frequent and more expensive episodes of care than worksites with low obesity prevalence.

The influence of worksite health promotion program management and implementation structure variables on medical care costs at PPG Industries.

OBJECTIVE: To evaluate the relationship between critical factors for successful worksite health promotion programs such as management support and program implementation and health care costs at PPG Industries. METHODS: We analyzed survey data from 37 PPG worksites measuring management support and program implementation. We estimated the relationship between management and implementation scores in 2007 and subsequent health care costs in 2008 using ordinary least squares regression. RESULTS: High program implementation scores were associated with higher health care costs (P < 0.01) as were high management scores (P < 0.05). However, sites with a combination of high management and implementation scores had lower health care costs, while sites with low scores on these dimensions had higher cost trends. CONCLUSIONS: Employers should consider administering worksite health promotion structural assessments to identify gaps in management support and program implementation that may influence program effectiveness.

The effects of health plan copayments on adherence to oral diabetes medication and health resource utilization.

OBJECTIVE: To assess the effects of copayments on oral diabetes medication adherence, health resource utilization, and expenditure. METHODS: Retrospective, observational analysis of medical and pharmacy claims data from PPG Industries employees, retirees, and dependents (2003-2005). Average monthly copayments were stratified low (US$0-9), medium (US$10-19), or high (US$20+). RESULTS: In 2052 individuals, adherence to oral diabetes medication was highest for the low copayment group for both age groups >or=65 years; 84% low, 77% medium, 64% high (P < 0.0001) and <65 years; 74% low, 71% medium, 55% high (P < 0.0001). For patients <65 years, total health care expenditure was 22% lower in the low versus high copayment group (P = 0.024), resulting in average savings of US $3116 per patient per year. Risk of hospitalization was significantly lower in the low versus the high copayment group for patients >or=65 years of age. CONCLUSIONS: High copayments were associated with lower adherence to oral diabetes medications for all patients and higher total health care costs for patients less than 65.

Not Waiting for Godot: The Evolution of Health Promotion at PPG Industries.

PPG Industries is a manufacturer of coatings, chemicals, optical products, specialty materials, glass, and fiberglass. The company's approach to healthcare combines perhaps 2 disparate concepts. The first is that employee health and behavior change relies to a large degree on employee awareness and ownership of their own health and second that "what gets measured gets done." It is widely acknowledged that one of the best tools for employee awareness is the health risk appraisal tool. Additional components of employee awareness include knowing key individual health metrics and effectively engaging with healthcare providers. As a leading global manufacturer, PPG well understands the critical importance of cost accounting and financial metrics to drive business decisions. PPG's perhaps unique approach comes from the strong marriage of individual health/wellness promotion and frequent, timely, and informative financial metrics on health and the cost of care. Combining capacity building through the mobilization of volunteer wellness teams with expert interventions and financial discipline is a feature of the experience here described. This approach has resulted in both management and employee engagement in the issue and has allowed PPG to bend the curve of ever-increasing healthcare costs and achieve cost increases per employee at one half the reported national average for companies of comparable size. Because this journal is dedicated to health and drug benefits, we gathered an appropriately representative team composed of a physician, an epidemiologist who resides in a pharmacy school, and a benefits manager. The team evolved from a common vision to identify ways of improving employee health and well-being. The team presented both as keynote speakers and as contributors to a breakout session at the National Symposium on Work-Life organized in 2007 by the National Institute for Occupational Safety and Health, a federal agency of the Centers for Disease Control and Prevention in the Department of Health and Human Services. This article is an account of why and how such a unique team was formed.