Online program latest tool for helping high-risk, high-cost workers

Blue Cross and Blue Shield of Louisiana’s new online diabetes prevention program for its workers is the latest addition to a growing portfolio of wellness efforts by employers.

The Prevent program’s goal is to make workers more aware of prediabetes, the early warning stage for diabetes, and help workers take steps to lower or eliminate their risk of developing diabetes, spokeswoman Robin Mayhall said. Blue Cross has joined with Omada Health.

“Any cost savings are dependent on how successful we are in achieving this goal, and we believe Prevent is the right approach,” Mayhall said. “That’s why we are covering the full cost of Prevent as a benefit for our eligible employees.”

People with prediabetes have higher-than-normal blood sugar levels, which can cause kidney, nerve or eye damage. One in three U.S. residents, roughly 87 million people, has prediabetes. Seventy percent of people with prediabetes will eventually develop adult-onset or Type 2 diabetes.

The problem is 90 percent of those with prediabetes don’t know they have it.

Blue Cross is starting Prevent with its own employees but plans to offer the program as a benefit to other employers later this year.

Blue Cross estimates about 500 of the roughly 3,800 adults covered by its employee health plan have prediabetes or risk factors for it, Mayhall said.

The company’s initial projections show Prevent could result in more than $500,000 in savings over a three-year period.

Omada Health projects that every $1,000 invested in the program would generate $3,120 in savings over that time period.

Omada Chief Executive Officer Sean Duffy said each participant will have access to a health coach, a wireless scale and interactive online tools.

The program began in late February. More than 400 people have already applied, and 300 have been accepted.

Mayhall said participants can reach their coaches 24/7 through email, chats and meetings. The workers are organized in 12- to 18-person groups. The idea is to put people with similar needs, attitudes and lifestyles together. Blue Cross is setting up an online social support group, similar to a chat room, where members of each small group can exchange tips and encourage one another.

“Social support is so-o-o helpful,” said LuAnn Heinen, who heads wellness efforts for the National Business Group on Health.

Patients Like Me, a website for patients with rare diseases, took off like wildfire when it was created. These patients felt isolated and wanted to connect with others in similar situations.

The challenge for corporations is that they feel they need to monitor sites under their corporate flag, Heinen said, and that has slowed the growth of these sorts of online programs.

Mayhall said by confining the chat room to the members of the small group, Blue Cross expects to control possible abuses.

Louisiana Business Group on Health Executive Director Cheryl Tolbert said about 75 percent of the 100-plus employers in the association offer some sort of wellness program.

Heinen said wellness is important in recruitment, in retention, in keeping workers engaged and productive, and in freeing up funds for things besides health care.

Employees are also drawn to companies with “a culture of health,” where policies and managers support workers’ wellness, Heinen said.

While there is no panacea for chronic diseases, a focus on wellness at work can help people maintain health. But wellness must also be practiced at home.

Well-designed, well-executed programs with appropriate support can achieve good returns, Heinen said.

Most companies spend so little on prevention that a small increase, like bringing Weight Watchers in, can make a big difference.

Paul Douglas, human resources vice president at Baton Rouge General, said its in-house wellness program offers education and coaching for employees who are prediabetic or predisposed to metabolic disorders.

The program tries to keep its healthy people healthy. The program also uses employee health nurses, and nutrition, fitness and lifestyle management to help at-risk members maintain and improve their health.

The program also offers incentives like cash cards worth up to $250 to induce members to undergo biometric screening, as well as other incentives.

“If someone is predisposed to a metabolic disorder or diabetes, you have a much better chance of success and a lot lower cost, if you’re actually looking at cost, helping them stay well and not become diabetic,” Douglas said.

Nurse navigators help people who are having trouble with diabetic strips or who aren’t testing.

The navigators remove barriers that prevent people from achieving health. That may involve helping cover a co-pay or providing a coupon for the strips.

Suppose a worker without a lot of means is chronically obese and has other health issues.

A navigator can even enroll him or her in a weight management program, which the General will pay for as long as the person stays with the program.

“We’re getting great results with that,” Douglas said. “The navigator may be spending a little money to get people to participate, but it’s driving our cost down, and everyone benefits because our premiums don’t go up.”

Douglas said he doesn’t like to claim a direct return on investment because so many variables are involved.

During the past three years, medical and drug costs for the General’s 4,400 plan members are 31 percent lower than projected.

Those costs were expected to increase by 6 percent to 7 percent a year.

Other results over that time frame include:

Decreasing hypertension costs by 5 percent to 5.5 percent. It’s not a big percentage, but the savings add up because high blood pressure is a progressive disease that affects a large number of people.

Reducing waist circumference, a key measure for metabolic disorders, by 16 percent. About 63 percent of the General’s members have a desirable waist circumference, compared with 54 percent.

Slashing diabetic costs by 20.8 percent and costs for obese members by 27 percent.

“If you really think about it, these are your employees, they’re caregivers,” Douglas said. “These are the people it takes to make our hospital work. We truly want them to be healthy and have a quality of life.”

Paul Johnson, director of MedCom Management for Gilsbar, said the Covington company’s emphasis on wellness comes from CEO Henry Miltenberger Jr., who is still competing in triathlons 37 years after graduating from LSU law school.

“It’s not just a trendy thing we’re doing now. It’s something we’ve always done,” Johnson said.

Employees can work on wellness in a variety of ways, from volunteering with Habitat for Humanity to getting a massage outside of work. But one thing they can’t do is bring boxes of donuts to work.

Gilsbar eliminated that about five years ago, Johnson said. Some employees wanted to rebel at first, but eventually, eating healthy snacks, such as fruit, became second nature.

Gilsbar, a benefits management firm, uses predictive modeling based on medical and pharmacy claims, health risk assessments and biometric data to design wellness programs for its clients.

The company’s innovations include providing a wireless glucose meter for clients with diabetic workers. Employers cover the costs for everything: strips, diabetic drugs and the monitor if a worker agrees to be monitored.

Maintaining the proper blood sugar levels can be the difference between being healthy and productive, and passing out and ending up in the hospital, Johnson said. That’s bad, and expensive, for the worker and the employer.

The annual cost for the mobile monitoring program is $3,000. The cost for a noncompliant diabetic worker is $13,000.

Gilsbar uses data from the monitor to identify workers whose blood sugar is too high or low and calls those workers to educate them at the time of their test.

The company has also partnered with Acadian Ambulance to provide in-home diabetes education via a clinician.