A post by Austin Frakt digging deeper into wellness programs looks at recent study by the RAND Corporation and PepsiCo on PepsiCo’s wellness program, Healthly Living.
In 2003, PepsiCo initiated what was to become their Healthy Living program, which included lifestyle management programs (weight, nutrition, and stress management, fitness, and smoking cession) and disease management components (targeting participants with asthma, coronary artery disease, atrial fibrillation, congestive heart failure, stroke, hyperlipidemia, hypertension, diabetes, low back pain, and chronic obstructive pulmonary disease).
After seven years, the average annual reduction in costs was $360 per participant. More interesting, however, is the decomposition of savings by program component, as shown in the chart (see above chart).
The chart shows that no savings can be attributed to the lifestyle management components of PepsiCo’s program. Disease management is where the action is. The authors also found that among disease management participants, those that also participated in the lifestyle management component “experienced significantly higher savings.”
The takeaway is a familiar story. When narrowly targeted wellness programs, like many other health interventions, can be beneficial–even cost saving (a rarity among health interventions). But, when more broadly implemented, they often are not. A focus on workers and dependents with specific diseases makes eminent sense. Not only are they the sickest–and in that sense deserving of greater focus–they are the most expensive to insure, offering a far greater opportunity for savings from disease and lifestyle management than a typical insured. A second lesson is that a long follow up time may be necessary to see benefits from a wellness program. Even a two-year study may not be sufficient.
Army medicine has been campaigning to affect a patient’s white space (the time they do not receive health care services) in order to help improve the health of Army medicine’s beneficiaries. They are focusing on lifestyle management type stuff, like eating healthy, excercising, and getting enough sleep (the Army’s Performance Triad). However, if health care costs are the new threat to the U.S. military, maybe we should look at the lesson PepsiCo provided us in regards to employer based wellness programs. Lifestyle management programs sound good, but the real savings looks like it comes from disease management programs. Granted we HEDIS metrics designed to help with some of the disease management tracking, but I think this needs to be incorporated into a more aggressive disease management program and coupled with a lifestyle management program. if we are only going to focus on one program, focus on managing the sickest of our population. It’s where the real cost savings lie.