The right interventions can reduce costs while improving employee health

Programs to improve employee health can save companies money, according to Steve Goldberg, MD, vice president and chief health officer, Employee and Population Health, at Quest Diagnostics. “Companies that promote a culture of health outperform others in the marketplace, and a culture of health is associated with lower healthcare cost trends,” he says. Dr Goldberg outlines the benefits of such a program, and what companies need to do to institute one, during a recent episode of the podcast “Diagnostics Dialogues.”

There are 4 “key conversations” Dr Goldberg emphasizes when advising executives. “First, the executive team has to model the healthy behaviors they are promoting, because that’s how employees will connect with the program, and that’s how you build sustained change.” Second is the idea that the return on investment of such a program is not only on healthcare costs per se, “but also on things like absenteeism, worker retention, and productivity.” Third, it is vital to recognize that because 80% of spending for healthcare services is on 5% of enrolled employees, and because 80% of employees spend less than $500 per year, understanding the health needs of that 5% is central to reducing costs. “And the fourth is the critical importance of screening,” with questionnaires, lab tests, and measurements such as height, weight, and body mass index, “to get a view of what's going on in your population.” These results are kept private, and deidentified, he adds, and are used to identify major health needs and develop programs that are then offered to all.

In line with the adage that you manage what you measure, data analytics are a key part of the program. “This lets us know how we're doing across multiple different domains,” Dr Goldberg says. In 2018, an analysis of screening results identified metabolic syndrome—a major risk factor for heart disease, stroke, and type 2 diabetes—as affecting a considerable number of workers in Quest call centers. In response, Dr. Goldberg’s team implemented a framework he called “eat, connect, move, and chill,” a coordinated program consisting of offering healthier food choices and diet education; connection to leadership members who were “walking the walk,” by making the same healthy choices they are offering their employees; encouragement and incentives to increase physical activity; and increased emphasis on mental health.

It is also critically important to focus on the external causes of employee stress, including the cost of medical insurance and treatment. “Half of US adults say they have difficulty affording healthcare,” Dr Goldberg says. “If people are stressed financially, it's hard to get some mindshare. But if we take that pressure off, then we can engage them on other topics like health and wellbeing.”

Third-party partners provide much of the programmatic content for health interventions, including for diabetes, behavioral health, and smoking cessation. Among other things, the program includes subsidizing healthy food choices, increasing opportunities and incentives for getting up and moving during the workday, and testimonies from colleagues who worked to control their own health challenges. 

After implementing the “eat, connect, move, chill” framework, Dr Goldberg says, “we were able to show that we bent the curve on metabolic syndrome within a 24-month interval,” which has become the standard period over which he expects to see measurable improvement when instituting a new program.

These types of interventions are one important way Quest has kept healthcare costs under control. “We've been able to show, relative to benchmarks, that we've taken about 80 million dollars out of our run rate through 2021,” Dr Goldberg says, savings that the company has used to avoid increasing the employee share of health insurance, and to create new health maintenance offerings.

Dr Goldberg likens the process of improving employee health to growing a healthy garden. “You take care of the soil, take care of the water, take care of the seeds, watch the weeds, make sure you get sun, make sure you get water, and you need to do it continually. And then year over year, the garden looks better, richer, fuller. When you do it successfully, you get people who feel really good about their care. You feel successful moving the health of the population and bending the cost-care trend.”