The Association Between Incentive Designs and Health Assessment or Biometric Screening Completion.

OBJECTIVES: To identify statistically significant predictors for completing a Personal Health Assessment (PHA) or biometric screening from attributes of incentive designs. METHODS: A cross-sectional study was conducted that included 426,694 members from 56 employer groups who required a PHA or screening as part of their incentive during 2016. RESULTS: Incentive designs that combine high-value with immediate disbursement can relatively increase employee PHA participation by as much as 66% over plans with low-value and delayed disbursement (56.7% vs 34.1%, P < 0.001). Surcharge component was a significant predictor of PHA completion (P < 0.001); similar predictors were found for screening completion. CONCLUSIONS: This study identified several significant predictors of PHA or screening completion, including: monetary value, time to disbursement, disbursement method, and frequency. Our findings are consistent with prior research in human behavior responses to positive reinforcement.

Evidence-Based Nonpharmacologic Strategies for Comprehensive Pain Care: The Consortium Pain Task Force White Paper.

Medical pain management is in crisis; from the pervasiveness of pain to inadequate pain treatment, from the escalation of prescription opioids to an epidemic in addiction, diversion and overdose deaths. The rising costs of pain care and managing adverse effects of that care have prompted action from state and federal agencies including the DOD, VHA, NIH, FDA and CDC. There is pressure for pain medicine to shift away from reliance on opioids, ineffective procedures and surgeries toward comprehensive pain management that includes evidence-based nonpharmacologic options. This White Paper details the historical context and magnitude of the current pain problem including individual, social and economic impacts as well as the challenges of pain management for patients and a healthcare workforce engaging prevalent strategies not entirely based in current evidence. Detailed here is the evidence-base for nonpharmacologic therapies effective in postsurgical pain with opioid sparing, acute non-surgical pain, cancer pain and chronic pain. Therapies reviewed include acupuncture therapy, massage therapy, osteopathic and chiropractic manipulation, meditative movement therapies Tai chi and yoga, mind body behavioral interventions, dietary components and self-care/self-efficacy strategies. Transforming the system of pain care to a responsive comprehensive model necessitates that options for treatment and collaborative care must be evidence-based and include effective nonpharmacologic strategies that have the advantage of reduced risks of adverse events and addiction liability. The evidence demands a call to action to increase awareness of effective nonpharmacologic treatments for pain, to train healthcare practitioners and administrators in the evidence base of effective nonpharmacologic practice, to advocate for policy initiatives that remedy system and reimbursement barriers to evidence-informed comprehensive pain care, and to promote ongoing research and dissemination of the role of effective nonpharmacologic treatments in pain, focused on the short- and long-term therapeutic and economic impact of comprehensive care practices.

The Stock Performance of C. Everett Koop Award Winners Compared With the Standard & Poor's 500 Index.

OBJECTIVE: To explore the link between companies investing in the health and well-being programs of their employees and stock market performance. METHODS: Stock performance of C. Everett Koop National Health Award winners (n = 26) was measured over time and compared with the average performance of companies comprising the Standard and Poor's (S&P) 500 Index. RESULTS: The Koop Award portfolio outperformed the S&P 500 Index. In the 14-year period tracked (2000-2014), Koop Award winners' stock values appreciated by 325% compared with the market average appreciation of 105%. CONCLUSIONS: This study supports prior and ongoing research demonstrating a higher market valuation--an affirmation of business success by Wall Street investors--of socially responsible companies that invest in the health and well-being of their workers when compared with other publicly traded firms.

Do workplace health promotion (wellness) programs work?

OBJECTIVE: To respond to the question, "Do workplace health promotion programs work?" METHODS: A compilation of the evidence on workplace programs' effectiveness coupled with recommendations for critical review of outcome studies. Also, reviewed are recent studies questioning the value of workplace programs. RESULTS: Evidence accumulated over the past three decades shows that well-designed and well-executed programs that are founded on evidence-based principles can achieve positive health and financial outcomes. CONCLUSIONS: Employers seeking a program that "works" are urged to consider their goals and whether they have an organizational culture that can facilitate success. Employers who choose to adopt a health promotion program should use best and promising practices to maximize the likelihood of achieving positive results.

Mindfulness goes to work: impact of an online workplace intervention.

OBJECTIVE: The objective of this study was to determine whether a mindfulness program, created for the workplace, was both practical and efficacious in decreasing employee stress while enhancing resiliency and well-being. METHODS: Participants (89) recruited from The Dow Chemical Company were selected and randomly assigned to an online mindfulness intervention (n = 44) or wait-list control (n = 45). Participants completed the Perceived Stress Scale, the Five Facets of Mindfulness Questionnaire, the Connor-Davidson Resiliency Scale, and the Shirom Vigor Scale at pre- and postintervention and 6-month follow-up. RESULTS: The results indicated that the mindfulness intervention group had significant decreases in perceived stress as well as increased mindfulness, resiliency, and vigor. CONCLUSIONS: This online mindfulness intervention seems to be both practical and effective in decreasing employee stress, while improving resiliency, vigor, and work engagement, thereby enhancing overall employee well-being.

Description of a clinical stream of back-pain patients based on electronic medical records.

Back pain consists of a spectrum of conditions, with no common etiology and therefore no dominant method of treatment. The purpose of this study is to describe the complexity of a collection of 8000 back pain patients who appeared in an integrative medicine clinic, as a prelude to conducing comparative effectiveness research on CAM alternatives to conventional therapy. Approximately 23% of all clinic patients were diagnosed at some time with back pain. Nearly half had treatment periods of less than one month, while more than 25% were treated for back pain for more than two years. Women were represented more than twice as often as men. The initial diagnosis categories that occurred most frequently were lumbar symptoms, cervical symptoms, and a general category, with smaller numbers having lumbar anatomic, thoracic symptom, brachial neuritis, or sciatica diagnoses. There were few strong relationships between initial diagnosis pattern and length of back pain treatment period. While 77% of back pain patients presented with diagnoses in only a single category, there were many composite categories each of which was sparsely represented. Between 50% and 75% of patients used some CAM service, depending on their initial diagnosis pattern. Patients with complex initial diagnosis patterns strongly tended to chose CAM, and among CAM-users those with complex diagnoses tended toward chiropractic, as opposed to acupuncture or bodywork. The CAM usage patterns of men and women were highly similar. Again among CAM users, 82% used only a single type of CAM service, and multiple service uses tend to be combined at random. Between two-thirds and three-quarters of multiple CAM service users had very simple temporal patterns of use, dominated by use of one type of CAM at a time.

A review and analysis of the clinical and cost-effectiveness studies of comprehensive health promotion and disease management programs at the worksite: update VIII 2008 to 2010.

OBJECTIVE: This critical review focuses on the 27 new studies focused on the clinical and cost outcomes research focused on worksites and published between 2008 to 2010. METHODS: A comprehensive search was conducted using a multi-stage process that included a MEDLINE, ERIC, ADI, EDGAR, CARL, Inform, Lexis-Nexis databases, and direct inquires to worksite researchers and corporate medical directors. RESULTS: Clearly, these new studies indicate further evidence of positive outcomes since, the quantity and quality of such research continues to improve. CONCLUSIONS: When corporations, government, and health plans are demanding more evidence based outcomes, this increase in rigorous research.

Development and testing of the Workplace Stressors Assessment Questionnaire.

OBJECTIVE: This research was aimed at developing a self-completed questionnaire for use in the assessment of stress-related factors at a US government high-tech worksite. METHODS: A literature review was performed to identify existing scales of workplace stress and strain. An initial pool of potential items was developed and assessed for content validity by using focus groups. This item pool was reduced to 38 items covering eight domains based on focus group results. A pilot study was conducted to examine the measurement properties of selected items and scales. RESULTS: Findings from the pilot study led to the 22-item Workplace Stressors Assessment Questionnaire, which includes six domains/scales that exhibited satisfactory measurement properties. CONCLUSIONS: The Workplace Stressors Assessment Questionnaire is a relatively short and psychometrically sound measure that can be used to systematically monitor employees' perceptions of workplace-related stressors.

Health and medical economics applied to integrative medicine.

Cost-benefit analyses (CBA) of every aspect of health and medical care are a necessity to address both the clinical effectiveness and cost effectiveness of health and medical care for the purpose of allocating limited practitioner, organizational, governmental, and monetary resources while maintaining the highest quality outcomes. In response, there are an array of approaches that emphasize the full continuum of prevention, restructuring primary care, involvement of the workplace and communities, and adoption of innovative strategies and interventions ranging from genomic assessments to complementary and alternative medicine (CAM). Among these approaches is an integrative medicine (IM) model that is consistent with these national objectives and that uniquely and explicitly includes "evidence-based global medical strategies" in its definition. All of these strategies require rigorous, appropriate, state-of-the art medical economic analyses. Since few if any IM models have been rigorously evaluated in terms of CBA, it is possible to draw upon the cost-effectiveness research focused on a limited number of CAM modalities as well as from the work-site/corporate clinical and cost outcomes research to suggest the evidence-based foundation from which a true healthcare system will evolve.

A review and analysis of the clinical and cost-effectiveness studies of comprehensive health promotion and disease management programs at the worksite: update VII 2004-2008.

OBJECTIVE: To conduct the seventh periodic review and analysis of the clinical and cost-effectiveness research conducted in worksite/corporate environments between 2004 and 2008. METHODS: A literature search of US-based research was conducted using a multistage process including MEDLINE, ADI, EDGAR, CARL, Inform, Lexis-Nexis, as well as direct inquiries to key researchers in this area of expertise. RESULTS: From 2004 to 2008, there were 16 new studies that met the Inclusion/Exclusion criteria. These studies are critiqued and entered into a data table consisting of 13 variables and citations of the 16 new studies. CONCLUSIONS: Clinical and cost-effectiveness research in the worksite/corporate environment continues to evolve although there was only one randomized clinical trial conducted during the most recent interval. There are innovations in pilot studies, quasi-experimental methodologies, and econometric modeling as indicative of future trends.

Using a return-on-investment estimation model to evaluate outcomes from an obesity management worksite health promotion program.

OBJECTIVE: Certain modifiable risk factors lead to higher health care costs and reduced worker productivity. A predictive return-on-investment (ROI) model was applied to an obesity management intervention to demonstrate the use of econometric modeling in establishing financial justification for worksite health promotion. METHODS: Self-reported risk factors (n = 890) were analyzed using chi2 and t test methods. Changes in risk factors, demographics, and financial measures comprised the model inputs that determined medical and productivity savings. RESULTS: Over 1 year, 7 of 10 health risks decreased. Of total projected savings ($311,755), 59% were attributed to reduced health care expenditures ($184,582) and 41% resulted from productivity improvements ($127,173), a $1.17 to $1.00 ROI. CONCLUSIONS: Using an ROI model to project program savings is a practical way to provide financial justification for investment in worksite health promotion when risk reduction data are available.

Emerging trends in health and productivity management.

Many large U.S. employers have generally embraced a Health and Productivity Management (HPM) perspective to guide their multiple employee health management efforts. In looking ahead there are a number of emerging trends that are helping to shape these efforts. As health promotion professionals assess the implications of these trends on their respective role and function within the worksite, it may provide a very useful process for refining strategies for programming and professional development. The identified trends also have a variety of implications for health promotion vendors and the growth of the health management marketplace.

Care management program evaluation: constituents, conflicts, and moves toward standardization.

Care management program evaluations bring together constituents from finance, medicine, and social sciences. The differing assumptions and scientific philosophies that these constituents bring to the task often lead to frustrations and even contentions. Given the forms and variations of care management programs, the difficulty associated with program outcomes measurement should not be surprising. It is no wonder then that methods for clinical and economic evaluations of program efficacy continue to be debated and have yet to be standardized. We describe these somewhat hidden processes, examine where the industry stands, and provide recommendations for steps to standardize evaluation methodology.

A review and analysis of the clinical and cost-effectiveness studies of comprehensive health promotion and disease management programs at the worksite: update VI 2000-2004.

This critical review focuses on the 12 new studies focused on the clinical and cost outcomes research focused on worksites and published between 2000 and 2004. Although these new studies indicate further evidence of positive clinical and cost outcomes, the quantity and quality of such research continue to decline. When corporations and health plans are demanding more evidence-based outcomes, this decline in rigorous research marks a serious challenge to the field of health promotion and disease management.

The selection effects of the inclusion of a chiropractic benefit on the patient population of a managed health care organization.

OBJECTIVE: The aim of this study is to measure the selection effects of the inclusion of a chiropractic benefit on a managed care health plan. DESIGN: An analysis of enrollment data from a managed care health plan over a 4-year period was conducted. Employers could select the managed care plan with or without a chiropractic care benefit. Comparisons of demographic and comorbid characteristics were made between employees who had the chiropractic benefit and those who did not, and between individuals who self-selected chiropractic care and those who self-selected medical care. RESULTS: The cohort with chiropractic coverage was younger with fewer subjects in the older age group (>65 years; 6.5% vs 9.6%) and more subjects in the younger age group (0-17 years; 31.9% vs 26.2%). The mean age of the group with coverage was 32.9 compared with 35.5 in the group without coverage. Comparing self-selected chiropractic patients to self-selected medical patients, there were fewer subjects older than 65 years in the chiropractic group (4.9% vs 9.2%) and fewer subjects aged 0 to 17 years (9.4% vs 19.4%). In 6 of the 8 comorbid conditions studied, the rates were lower in the cohort with chiropractic coverage compared with the group without coverage. The rates of comorbid conditions in self-selected chiropractic patients were lower in all 8 categories compared with self-selected medical patients. CONCLUSION: The inclusion of a chiropractic benefit in a health plan produces a modest favorable selection processes resulting in a slightly younger patient population with fewer comorbidities. At the level of patient self-selection, chiropractic patients are considerably younger and healthier than comparable medical patients.

International collaboration in health promotion and disease management: implications of U.S. health promotion efforts on Japan's health care system.

For more than 25 years, health promotion and disease management interventions have been conducted by large employers in the United States. Today there are more than 100 studies of such multifactorial, comprehensive interventions that all demonstrate positive clinical outcomes. For those interventions that have also been evaluated for return on investment, all but one have demonstrated cost-effectiveness. This article is an evidence-based overview of the clinical and cost outcomes research to elaborate on the insights gained from this research in the areas of implementation and evaluation of such programs; integration of health promotion and disease management programs into conventional, occupational medicine; accessing difficult to reach populations, such as mobile workers, retirees, and/or dependents; areas of potential conflict of interest and privacy/confidentiality issues; health consequences of downsizing and job strain; and, finally, recommendations for improved integration and evaluation of such programs for both clinical and cost outcomes. With medical costs rapidly escalating again on a global scale, these interventions with evidence of both clinical and cost outcomes can provide the foundation to improve the health, performance, and productivity of both individuals and their corporations.