Medications for Opioid Use Disorder During the Prenatal Period and Infant Outcomes.

This cross-sectional study explores the association between mothers' receipt of opioid use disorder treatment during pregnancy and their infants' health services use in the first year of life.

Cost Offsets of Treatment for Serious Mental Illness and Substance Use Disorder.

OBJECTIVE: The authors examined whether timely treatment for serious mental illness and substance use disorder reduces overall health care costs in a 3-year period. METHODS: Claims data from the IBM MarketScan Research Databases (2010-2017) were analyzed. The population studied included 2,997 Medicaid enrollees and 35,805 commercial insurance enrollees ages 18-64 years with an index event for a serious mental illness and 2,315 Medicaid enrollees and 28,419 commercial insurance enrollees with an index event for a substance use disorder. Health care costs in the 3 years after an index event were calculated for enrollees who received care that met a minimum threshold for treatment and for those who did not receive such care. The Toolkit for Weighting and Analysis of Nonequivalent Groups was used to control for statistically significant differences in pretreatment characteristics between the groups. RESULTS: All health care spending for enrollees who were engaged in behavioral health treatment for substance use disorder or a serious mental illness increased from year 0 to year 1 but decreased faster than the spending of enrollees who were not engaged in treatment, with larger trends for those engaged in substance use disorder treatment. Expenses for inpatient and emergency department care decreased over the 3 follow-up years; however, spending on outpatient services was significantly higher in all 3 follow-up years for those engaged in treatment. CONCLUSIONS: Health care delivery and payment models that improve access to behavioral health treatment may reduce emergency department, inpatient, and overall health care costs for particular subpopulations.

Ten Modifiable Health Risk Factors and Employees' Medical Costs-An Update.

PURPOSE: To estimate the relationship between employees' health risks and health-care costs to inform health promotion program design. DESIGN: An observational study of person-level health-care claims and health risk assessment (HRA) data that used regression models to estimate the relationship between 10 modifiable risk factors and subsequent year 1 health-care costs. SETTING: United States. PARTICIPANTS: The sample included active, full-time, adult employees continuously enrolled in employer-sponsored health insurance plans contributing to IBM MarketScan Research Databases who completed an HRA. Study criteria were met by 135 219 employees from 11 employers. MEASURES: Ten modifiable risk factors and individual sociodemographic and health characteristics were included in the models as independent variables. Five settings of health-care costs were outcomes in addition to total expenditures. ANALYSIS: After building the analytic file, we estimated generalized linear models and conducted postestimation bootstrapping. RESULTS: Health-care costs were significantly higher for employees at higher risk for blood glucose, obesity, stress, depression, and physical inactivity (all at P < .0001) than for those at lower risk. Similar cost differentials were found when specific health-care services were examined. CONCLUSION: Employers may achieve cost savings in the short run by implementing comprehensive health promotion programs that focus on decreasing multiple health risks.

The Stock Performance of American Companies Investing in a Culture of Health.

PURPOSE: We investigated the relationship between companies' efforts to build internal (COH-INT) and external cultures of health (COH-EXT) and their stock performance. DESIGN: We administered 2 surveys, which measure companies' programs, policies, and supports for improving the health of their employees and communities. We then compared the companies' stock performance to the Standard and Poor's (S&P) 500 Index from January 2013 through August 2017. SETTING: United States. PARTICIPANTS: Representatives from 17 publicly traded companies who completed the COH-INT survey, of whom 14 also completed the COH-EXT. MEASURES: Culture of health scores were dichotomized into high versus low for both surveys. Stock price data for all companies were gathered from public sources. ANALYSIS: We constructed 5 stock portfolios: all 17 companies, high COH-INT, low COH-INT, high COH-EXT, and low COH-EXT companies. We examined total returns for each portfolio compared to the S&P 500. RESULTS: High COH-INT companies' stock price appreciated by 115% compared to the S&P benchmark (+69%), while low COH-INT companies appreciated only 43%. In contrast, high COH-EXT companies underperformed (+44%) when compared to the S&P 500 (+69%) and low COH-EXT companies (+89%). CONCLUSION: This study supports the view that employers' efforts to build an internal culture of health is a sound business strategy. More research is needed, however, to establish whether a link exists between supporting healthy community initiatives and company stock performance.

Improvements in an Organization's Culture of Health Reduces Workers' Health Risk Profile and Health Care Utilization.

OBJECTIVE: To examine changes in internal and external cultures of health scores and relate those changes to employees' health risks, health care utilization, and costs for 21 large employers (N = 641,901). METHODS: We measured the relationship between changes in internal and external culture of health scores and changes in employee health risks, health care utilization, and costs. RESULTS: Improvements in a company's internal culture of health predicted lower levels of obesity, poor diet, and tobacco use but higher stress for employees reporting high baseline risk. For those not at high baseline risk, health improved for depression, alcohol consumption, and diet. Improvements in internal culture of health also led to lower prescription drug utilization. CONCLUSION: Investments in internal culture of health predict improvements in some employee health risks and health care utilization.

Developing Two Culture of Health Measurement Tools: Examining Employers' Efforts to Influence Population Health Inside and Outside Company Walls.

OBJECTIVE: The aim of the study was to develop tools that quantify employers' investment in building cultures of health (COH)-inside and outside company walls. METHODS: Two COH instruments were developed through literature reviews and expert consultation. The first focused on internal culture of health (COH-INT), that is, programs, policies, and attributes of the physical and social environments that support employees' health and well-being. The second focused on external culture of health (COH-EXT), that is, programs, policies, and environmental supports that promote communities' health. We administered these tools to 32 employers and examined instrument reliability, distribution of scores, and correlation between the two instruments. RESULTS: Both tools demonstrated adequate reliability. COH-EXT scores changed minimally over the 3-year study timeframe. There was little correlation between the COH-INT and COH-EXT scores. CONCLUSIONS: More research is needed to further develop and validate COH-EXT instruments.

Workplace Programs, Policies, And Environmental Supports To Prevent Cardiovascular Disease.

Using a novel approach, we provide a preliminary "snapshot" of how the comprehensiveness of workplace cardiovascular health initiatives is related to measures of employees' health risks, disease prevalence, and medical expenditures. We linked scores for the twenty large organizations that voluntarily completed the American Heart Association's newly launched Worksite Health Achievement Index (WHAI) for 2015 to individual-level MarketScan® data for 373,478 of their workers with employer benefits that year. Higher aggregate WHAI scores were associated with lower values for four of seven modifiable indicators of cardiovascular risk and a higher value for one. Although also associated with lower prevalence of cardiovascular disease, higher aggregate scores were associated with higher spending on the condition. These and other findings provide useful benchmarks and norms for employer practices related to cardiovascular disease prevention. As employers continue to complete the annual WHAI, we expect to gain further insights into the policies, programs, and environmental supports employers can implement to positively influence cardiovascular health and related spending.