The Association Between Health Program Participation and Employee Retention.

OBJECTIVE: Using health plan membership as a proxy for employee retention, the objective of this study was to examine whether use of health promotion programs was associated with employee retention. METHODS: Propensity score weighted generalized linear regression models were used to estimate the association between telephonic programs or health risk surveys and retention. Analyses were conducted with six study samples based on type of program participation. RESULTS: Retention rates were highest for employees with either telephonic program activity or health risk surveys and lowest for employees who did not participate in any interventions. Participants ranged from 71% more likely to 5% less likely to remain with their employers compared with nonparticipants, depending on the sample used in analyses. CONCLUSIONS: Using health promotion programs in combination with health risk surveys may lead to improvements in employee retention.

Using Propensity to Succeed Modeling to Increase Utilization and Adherence in a Nurse HealthLine Telephone Triage Program.

Propensity to succeed modeling was used to identify characteristics associated with higher utilization of a telephone triage program and adherence to nurse recommendations among callers. Characteristics significantly associated with calling the telephone triage service and engaging in triage services were being female and having an elevated health risk score. Callers most likely to adhere to nurse recommendations were younger than 85 years of age, had called on a weekday, and had received a recommendation to seek care at an emergency department or a doctor's office visit. Additional analyses suggest the propensity to succeed modeling is stable and valid.

An economic analysis of a nurse-led telephone triage service.

Telephone nurse lines help callers to select the most appropriate site and level of care for acute conditions. We examined whether compliance with nurse recommendations was associated with lower average health care expenditure, and identified the employer characteristics associated with higher than average savings. Telephone calls to a nurse-led help line made by commercial health plan members who worked for large employers were identified. The callers' intention before calling and the nurse recommendation regarding site/level of care were recorded. Compliance was determined using medical claims during a 30-day post-call observation period and was based on adherence to nurse recommendations. A total of 132,509 calls during 2012 were identified for the study. Nurse recommendations were that 31% of the callers seek a higher level of care than mentioned at the start of the call, 25% use a lower level of care and 44% pursue their originally intended level of care. After regression-based adjustment, the average medical expenditures were compared between compliers and non-compliers. Overall, 57% of callers were compliant with nurse recommendations. The average expenditures were $328 lower among compliant callers. A logistic regression analysis identified employer characteristics positively associated with achieving higher than average savings. These were having a low employee-to-dependent ratio, a headquarters in the Western region of the US, a low prospective health risk score, and participation by the employer in a targeted communication campaign. Compliance with the triage recommendations resulted in lower average health care expenditures, and several characteristics were positively associated with achieving higher savings.

A more generalizable method to evaluate changes in health care costs with changes in health risks among employers of all sizes.

The objective of this study was to estimate the association between changes in health care expenditures relative to changes in health risk status for employers of all sizes. Repeat health risk assessments (HRAs) were obtained from 50,005 employees and spouses with 2 years of health plan enrollment, and from 37,559 employees and spouses with 3 years of enrollment in employer-sponsored medical coverage. Changes in health care expenditures were measured from the year before completion of the first HRA to the years before and after the completion of the second HRA. Propensity score weighting was used to adjust for those who did not repeat the HRA so results could be extrapolated to the larger population. Propensity score weighted multiple regression analyses were used to estimate the relationship between changes in health care expenditures with changes in risk status for 9 risk categories. Significantly higher health care expenditures were associated with those who moved from low risk to medium or high risk, compared to those who remained low risk. Expenditure reductions estimated for those who improved their health status from high risk to medium or low risk were not statistically significant. This study is unique because of its large sample size, its use of data from a wide range of employer sizes, and its efforts to extend generalizability to those who did not complete both HRAs. These results demonstrate that the potential for short-term health care savings may be greater for programs that help maintain low risk than for programs focused on risk reduction.

An emergency room decision-support program that increased physician office visits, decreased emergency room visits, and saved money.

The objective of this study was to evaluate an Emergency Room having a Decision-Support (ERDS) program designed to appropriately reduce ER use among frequent users, defined as 3 or more visits within a 12-month period. To achieve this, adults with an AARP Medicare Supplement Insurance plan insured by UnitedHealthcare Insurance Company (for New York residents, UnitedHealthcare Insurance Company of New York) were eligible to participate in the program. These included 7070 individuals who elected to enroll in the ERDS program and an equal number of matched nonparticipants who were eligible but either declined or were unreachable. Program-related benefits were estimated by comparing the difference in downstream health care utilization and expenditures between engaged and not engaged individuals after using propensity score matching to adjust for case mix differences between these groups. As a result, compared with the not engaged, engaged individuals experienced better care coordination, evidenced by a greater reduction in ER visits (P=0.033) and hospital admissions (P=0.002) and an increase in office visits (P<0.001). The program was cost-effective, with a return on investment (ROI) of 1.24, which was calculated by dividing the total program savings ($3.41 million) by the total program costs ($2.75 million). The ROI implies that for every dollar invested in this program, $1.24 was saved, most of which was for the federal Medicare program. In conclusion, the decrease in ER visits and hospital admissions and the increase in office visits may indicate the program helped individuals to seek the appropriate levels of care.

Listening to the nurse pays off: an integrated Nurse HealthLine programme was associated with significant cost savings.

AIM: To estimate the relationship between adherence to nurse recommendations about where to seek care and expenditures for health-care services received by callers to a Nurse HealthLine telephone-based triage programme. METHODS: Health-care utilization and claims data from callers to the Nurse HealthLine were included. Adherent callers were those who followed the nurse recommendations, while those who did not were classified as non-adherent. Programme-related savings were estimated using differences in downstream health-care expenditures between adherent and non-adherent callers after using multivariate modelling to adjust for between-group differences. RESULTS: Fifty-five per cent of callers were adherent. Nurses were over three times as likely (41% vs. 13%) to recommend seeking a higher level of care (e.g. emergency room vs. urgent care). Regression analyses showed that the impact of getting members to the appropriate place of care was associated with significant annual savings of $13.8 million (P < 0.05), attributable mostly to Medicare, generating a positive return on investment of $1.59. CONCLUSIONS: This is the first known Nurse HealthLine triage programme exclusively for Medicare beneficiaries with supplemental coverage. IMPLICATIONS FOR NURSING MANAGEMENT: Nurse managers should consider promoting telephone-based triage programmes as complementary to clinical nursing, which has a direct impact on health-care utilization and costs.

A more generalizable method to evaluate the association between commonly reported health risks and health care expenditures among employers of all sizes.

OBJECTIVE: To evaluate the association between health risks and health care expenditures for employers of all sizes, generalizing to all employees, even those who did not complete a health risk assessment (HRA). METHODS: Health risk assessments were obtained from 169,693 insured employees and spouses. Total health care expenditures were measured before HRA completion. Propensity score weighting, adjusting for HRA nonresponse, and multivariate regression analyses were used to estimate the relationship between health risks and health care expenditures. RESULTS: These at-risk categories were significantly associated with increased health care expenditures: elevated blood pressure, body weight and cholesterol, medication/drug use for relaxation, physical inactivity, and stress. CONCLUSIONS: The large sample size, the use of data from small firms, and generalizability made this study unique. Targeted programs that promote management of health risks could result in health care cost savings for employers of all sizes.