The heart of the matter Featured

10:02am EDT July 22, 2002

Years earlier, John Perkins would have dismissed the pressure between his shoulder blades as a muscle ache. But in April 1996, the president and chief operating officer of OhioHealth Group knew better-and told his wife to call 911.

Three days later at Riverside Methodist Hospital, he was recovering from the balloon angioplasty that had opened a partially blocked artery in his heart. He considers himself lucky: By catching the symptoms early, he received treatment before the blockage damaged his heart.

Perkins, who left OhioHealth Group this November to do consulting work with health care providers, credits his awareness and quick response to one thing-the cardiac risk reduction class he had taken four months earlier through his company's personal wellness program, started as a benefit to its HMO.

Like all HealthPledge HMO members who opt to participate in the wellness program, Perkins had filled out a personal wellness profile, which gave him an on-paper view of his health, including his exercise level, eating habits, stress and medical care.

His profile was forwarded to the wellness program staff for analysis. Shortly thereafter, Perkins received a call from nurse Linda Schilling, the wellness clinical administrator, who explained his four risk factors for heart disease: he had a history of it in his family, he was overweight, he had a high cholesterol level and his lifestyle was too sedentary.

"In other words," Perkins translates, "I was heading for a heart attack."

Schilling directed him to the coronary disease risk reduction program at Riverside. Like all participants in the wellness program, Perkins paid a $10 co-pay for the 10-week program, which educated him about a high-fiber, low-fat diet; taught him how to reduce stress in his work life; and showed him how to identify the symptoms of coronary artery disease. This last bit tipped him off months later that his sudden back pain was more than a pulled muscle.

Perkins isn't the only success story in OhioHealth Group's wellness program.

Barry Shaffer, vice president of sales and marketing, also filled out the assessment. He knew his 30-year smoking habit would be his downfall.

Hypnosis, nicotine patches and gum, acupuncture and "cold turkey" methods had never resulted in successful efforts to quit. The wellness program, however, gave him the push he needed to decide that he really wanted to stop smoking.

"I think the profile just scared the hell out of me," says Shaffer, who credits an eight-week smoking cessation program at Riverside with helping him kick the habit. He also learned about stress reduction and healthier eating-two other areas where his profile showed he was at risk.

A trial run

In addition to the specific success stories of its own employees, OhioHealth Group is beginning to see results of the wellness program at client companies such as Worthington Schools, which piloted the program for OhioHealth Group in 1993.

The impetus was a 1985 study at a Michigan manufacturing company, where researchers documented a correlation between helping employees stay healthier and decreasing health care costs.

Wellness program organizers at OhioHealth Group sought advice from physicians, fitness center managers and other wellness professionals, such as those at the Elizabeth Blackwell Center, then partnered with organizations both within the OhioHealth system, such as Riverside, and others, including Metro V Athletic Club, to offer wellness courses.

The next step was to get employee participation.

"I think the initial fear of members is what the health plan is going to do with this information," Schilling says. "They were concerned about whether it would affect their insurability. We had to assure them the information would not go to their employer; that it would be maintained here."

Each profile is assessed by the wellness group, then summaries are returned to employees. Along the way, employees set personal wellness goals, says Martha Hippler, wellness manager. The goals may not be as specific as losing 20 pounds by the 20th of December, but they all involve changing behavior, such as eating five fruits a day or drinking eight glasses of water daily.

"We just want people to take small, realistic steps so they have some success," Hippler says.

High-risk cases are referred to nurse Debbie Dreier, wellness care manager, who calls the employees for one-on-one consultation.

At the time of the Worthington Schools pilot program, Schilling says, OhioHealth Group sought a partner to determine what would happen if participants identified their health risks and changed their lifestyles. Would people be more satisfied with their health plans? Could people really learn to take charge of their health through the program? If they did, would health care claims dollars decrease?

"We have a strong belief in Worthington Schools that employees need to take charge of their own health," says Bruce E. Mousa, Worthington Schools director of business services. "One of the ways we can model that is by having our people who sponsor our insurance plans also be involved in wellness programs."

Already, OhioHealth Group has found that 80 to 98 percent of Worthington Schools participants are satisfied with the program; 85 to 90 percent believe they are learning to take charge of their health; and 50 percent believe their health has improved as a result of the program.

The numbers show it has. Of the Worthington Schools participants, 2 percent have improved their blood pressure; 14 percent have changed their weight to recommended levels; and 15 percent have moved into the "good to excellent" wellness score range.

"I don't think there's any reason to think we won't see the same results in our HMO population," Schilling says.

Living up to the promise

Perkins made the wellness program part of the new HealthPledge HMO that OhioHealth Group began offering to all its clients in January 1996.

"The HMO's purpose is to hold down costs by emphasizing preventive care, but a lot of companies operating as an HMO really have become insurance agencies, giving lip service to wellness and preventive care," Perkins says.

Participation is growing. In 1997, the rate was 13 percent of all the HMO members. By the fall of 1998, that had increased to 20 percent.

OhioHealth Group, Hippler points out, uses e-mail, fliers, table tents and freebies such as massages to encourage participation of its employees. The rate there is 70 percent.

Among client companies, OhioHealth Group is learning as it goes along. Previously, for example, employers received a 10 percent discounted rate on the HMO for employees who participated in the wellness program. Now, however, OhioHealth Group will directly encourage employees to participate by offering personal incentives such as gift certificates to sporting goods stores or health products such as in-line skates. The employer will receive a 5 percent discount off rates for those employees who join the program.

At Worthington Schools, where participation is 41 percent among HMO members and 55 percent among PPO members, a draw of the wellness program is the ability to make changes in the program at the request of the employees. Low-impact aerobics, nutrition classes and flu shots were added after surveys indicated employee interest.

"Over the six years we've done it, the program has evolved and is dynamic in the way it's presented," Mousa says.

Phyllis Diehl Butler, senior benefits adviser with Battelle Memorial Institute, says OhioHealth Group's wellness program made the HealthPledge HMO an attractive choice for her organization, which offers six different health plans to its Columbus area employees. Battelle also has taken advantage of the program's flexibility.

"We have the wellness nurse here at Battelle twice a month with literature, so anyone in that HMO can walk up to her and ask any questions, for example, about diabetic information, insulin medication, stress or anything about which th ey have a concern," Butler says.

Shaffer calls OhioHealth Group's wellness program unique because it requires participants to make an effort to improve their health - and gives them encouragement to do so.

"Improved quality health care in the community, in the long run, is what we're after," he says.

Lowering health care costs, however, doesn't hurt, either.

"If we identify one high-risk case that saves us $100,000 in hospital bills," Shaffer says, "we've certainly paid for the program many times over."