01.06.12
Making your workforce healthier
Source: National Health Executive May/June 2012
Gregory Timotheou, senior analyst at Cerner Limited, and Professor Matthew Swindells, the company’s senior vice president and managing director for global consulting, a former NHS CIO who also chairs BCS Health and is a member of NHE’s Editorial Board, discuss employers’ role in improving health outcomes.
Working for an American company in global healthcare can give you some interesting insights into the strengths and weaknesses of different health systems. On the one hand you see the tremendous cost of the American system and equity failure which means that their system provides the finest healthcare in the world to some of its population and ‘safety net minimalism’ to many others. On the other you see creativity and innovation confronting some of their problems that are a model for other to copy.
As virtually every developed health system faces the challenge of growing costs and increasing demand, the question as to how you can control those costs whilst improving health is ubiquitous. In the UK, we have been trying to find ways to get our primary care system to intervene early and more effectively to reduce the demand on hospitals. In Germany they have used charging to try to discourage unnecessary use of medical services. In the US, where health insurance premiums are a significant cost on employers, we have seen the outbreak of innovative schemes where employers focus on improving the health of their staff, to improve productivity and reduce their health bill.
At Cerner, we have gone one step further and terminated our relationship with the health insurance companies and become selfinsured. We made the bold assumption that by eliminating the insurance company overheads and focusing on improving the health of our employees we could provide better health cover at a lower cost, and have a fitter workforce.
While this may seem like a ‘US only’ approach, we were simply taking on the role of the payer and treating our staff as a ‘population’ whose health needed be to be improved whilst costs were reduced. Much of our approach is highly applicable in the UK and is the sort of innovative approach that the NHS, as the UK’s largest employer, ought to take with its own staff; and progressive CCGs ought to consider funding for employers in their local community. It even has some general lessons for commissioners as they look at population health strategies.
We have used individual and team-based programmes, supported by information technology, to help people address the selfinflicted causes of ill health such as lack of exercise, poor diets and smoking. We emphasise the importance of managing one’s own health, and aim to place the power and responsibility back in the hands of individuals.
Cerner’s internal brand for coordinated health and wellness programs and services is called ‘Healthe’. Our team strive to keep our offering simple, personalised and innovative. The aim is to give extra incentive to our staff for starting and maintaining a healthier way of living through both support and reward. We provide many initiatives and incentives for not only our staff, but their family members too, which include inhouse competitions such as our ‘steps’, ‘weightloss’ and weight maintenance competitions which were organised in teams to encourage peer support; access to fitness facilities; and onsite clinics. Healthe has become extremely successful in recent years and has received significant recognition including the National Business Group on Health ‘Best Employers for Healthy Living Platinum Award’ in both 2010 and 2011.
Our personal health portal, known as ‘Cerner Health’, houses a set of personally-controlled health management tools and capabilities that allow people to connect with their health information.
One of the most attractive features of this is the personalised messages it sends with recommendations, alerts and education to help better manage one’s own health. Cerner Health also enables our employees to connect devices to their personal health record – currently we have three: the Fitbit; Withings scale; and a glucometer. All of these devices automatically upload information to the employee’s Personal Health Record and in turn, with their permission, enables the information to be shared with the employee’s care team.
We are engaging people and giving them a reason to interact with their Personal Health Record whilst at the same time automating the process to make it easy and effective.
Our initiatives have yielded strong results and in 2010; we had 96% employee completion rate of their Personal Health Assessment and an 89% completion rate of their biometric draw and meeting with a Healthe advisor. Our population is now actively managing their health; from 2007 to 2010, 80% of a consistent cohort of over 2,800 employees maintained or reduced their number of health risk factors.
In 2011, Cerner staff competed in a global weight loss challenge called the ‘Slimdown-Throwdown’ Challenge. Employees from around the globe formed teams of between four and six staff members and attempted to reach a percentage target weight loss; this was a great success and produced some interesting results. The analysis showed that between the 1,865 participants over 22,000 pounds in weight (10 tons!) were lost. Our competition winners were awarded with an all-expenses paid Caribbean holiday!
At an individual level, there have been some rewarding stories of how employees’ lives have been changed for the better as a direct result of our initiatives. One employee who came into the Healthe clinic met with an advisor to determine her healthy weight range. In an interview the staff member said: “It’s really helped putting a number to it. It’s more concrete than just ‘oh, I need to lose weight.’”
By setting her targets, sticking to a rigid plan of exercise and maintaining a healthy diet, this associate won our February Fit Challenge competition by losing more than 11% of her body weight.
She went on to say: “I used to get out of breath walking down the hallway to conference rooms. Now I can walk anywhere. I can even run a little bit, and I can do stairs. I don’t get out of breath.”
Our initiatives have also met their aims of enabling employees to come off medications and spend more and higher-quality time with their families. We believe that workplace culture and integration are key components needed to obtain successful engagement.
It is through our programs, such as our Healthe Living with Rewards program (a program to encourage members to receive preventative care by rewarding them with points), that employees and their dependents are continuously encouraged to participate in wellness and preventive opportunities.
It is through initiatives and incentives such as these which have made wellness and exercise a huge part of the Cerner culture.
We are continuing the momentum with new competitions and incentives all the time, such as our current ‘Stay Slim’ weight loss competition. We continue to analyse the outcomes of our initiatives in order to make adjustments to achieve optimal engagement and results. This, in turn, further enables us to better understand our population and its health needs.
Oh, and in case you’re wondering, it has saved significant amounts of money. We’re a big, profitable corporation. We haven’t done this just because we love our staff!
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