A Spokane health-care plan administrator has launched a project to link employer-sponsored health-education programs with increases in worker productivityan approach that businesses would like to take, but that theyve historically been unable to achieve because of concerns about jeopardizing workers privacy.


The plan administrator, the Physician Hospital Community Organization (PHCO), is among the first health-insurance organizations nationwide to offer its clients such a service, contends CEO Cynthia Norwood.


The PHCOs first study has to do with the incidence of migraine headaches among workers at Inland Northwest Health Services here, coupled with education efforts on how to deal with migraines. The study aims to show that such targeted disease-management programs can reduce absenteeism caused by chronic conditions.


Based on its early experience with the migraine pilot study, the PHCO already has launched at two other companies customized health-improvement nutrition programs designed to address several diseases, such as high cholesterol and diabetes.


The latter two programs, however, dont include a link to productivity because the companies involved dont differentiate in their records between sick pay and other paid time off, such as vacation time, Norwood says. Nonetheless, she says, the companies stand to benefit if the health of their workers is improved.


Reducing absenteeismand whats called presenteeism, where an employee is at work but isnt 100 percent due to ill healthis an important goal for businesses, and any method that can be conclusively shown to do so would be valuable, says Dennis Ashley, director of training at Associated Industries of the Inland Northwest, an employer advocacy group based here.


Absenteeism is especially expensive right now, he says. Work forces are pretty lean, so when theres somebody absent now, its not like somebody else can step in and do their thing. If somebodys absent now its likely that a customer would go unserved or a product would go unmade.


Brian Schilling, spokesman for the Washington D.C.-based National Committee for Quality Assurance, says the ability to link health care to productivity is pretty powerful for employers because it not only stands to boost their businesses, but also gives them a tool with which to compare the quality of various health plans. The National Committee for Quality Assurance also is undertaking efforts to establish that link, he says. The organization monitors and accredits a range of health-care organizations.


Strategic advantage


The PHCO, which is located at 312 W. Eighth and employs 32 people, is whats known as a third-party administrator. That means it develops and manages health-insurance benefits for companies that have self-funded insurance plans. It was founded in 1995, and currently administers plans for 13 self-insured companies based here that cover a total of 17,000 people.


Norwood says she expects the organizations 6-month-old health-education program to become a strategic advantage for the PHCO when its compared with other health-care insurance options employers might have or look at.


Its an advantage to be able to help an employer on an individual basis help control health-care costs, help employees feel better, and, potentially, help a business run better, she says.


The program works like this: The PHCO analyzes an individual clients data to see when and how its employees use their health coverage, then compares that data with national benchmarks and looks for instances where the two sets of numbers dont jibe, Norwood says. In a test run of the program that still is taking place at Inland Northwest Health Services here, for example, it was discovered that three times as many of the companys workers had sought treatment for migraine headaches as the national average for similar-sized work forces , she says.


After it gathers information about the health of an employers work force and compares it with national figures, the PHCO devises health-education programs to target specific issues. In the pilot program, that involved sending all employees literature on managing migraines, as well as holding a brown-bag information session, led by a registered nurse, at the employers premises, Norwood says.


Such corporate wellness programs are common, she says. Whats unusual in this case was that the PHCO also asked Inland Northwest Health Services for its personnel records, then extracted absenteeism data for the workers whoas the PHCOs records showedhad been treated for migraines. That analysis showed employees with migraines were absent for more time over the course of a year than the average employee was, she says.


The pilot program isnt finished yet, but Norwood says she hopes that when it is, the data will show that migraine sufferers absenteeism at Inland Northwest Health Services will have dropped as a result of the health-education program.


Even if there is no change in absenteeism, however, the health-education program should help the employer, she says. Thats because employees will be likely to manage their migraines better on a daily basis, and thus wont end up needing emergency care as oftennot an unusual occurrence for serious migraine sufferers.


For a self-insured employer, that would mean savings on health-care costs, Norwood says. Companies that self-insure their employees health-care planstypically companies with 100 employees or moreset aside money each year to pay for workers medical claims, so when fewer claims are made, the employer over time can cut costs.


Phyllis Gabel, human resources director at Inland Northwest Health Services, says the organization participated in the pilot program to boost productivity as well as improve employees lives. One of Gabels family members is a migraine sufferer, she says, and she believes the disease creates a huge quality-of-life issue for those who are affected by it.


Were pretty encouraged by the migraine project, she says. We want to do more projects with the PHCO in disease management.


Protecting privacy


In the past, Norwood says, the biggest stumbling block to customizing health-education programs to boost productivity has been the privacy issue. Indeed, the privacy issue was very worrisome to Inland Northwest Health Services, she says.


The PHCO overcame those reservations by setting up stringent privacy measures, which were written into a contract that was signed by both parties, Norwood says.


That contract calls for the PHCO to deliver back to the employer only aggregate data, such as the overall incidence of a disease in their work forces compared with the benchmark number, and the average reduction in sick time, if it occurs as a result of education, she says.


We dont give any information back to the employer thats personal, Norwood says. The employer cant know who in its work force is affected by whatever health condition the program is targeting, she says. That protects the company and protects the (employee), she says.


Even the health-education programs set up to address a health condition must ensure anonymity, she adds. Mailings must be generic in nature and must be sent to every employee. Brown-bag meetings or other open forums can be held only if a company is large enoughto ensure that targeted employees cant be identifiedand if its a common practice at that company to hold such forums, she says.


The PHCO is able to live up to its part of the privacy contract because it already complies with health-care privacy regulations mandated under the federal Health Insurance Portability and Accountability Act, or HIPAA, Norwood says. The deadline for compliance with all parts of that act is several years away, but the PHCO was able to implement it early when it upgraded its technology systems last fall, Norwood says.


We have a tool that we use to guarantee our compliance with the privacy contract the PHCO signs with employers, she says.


The cost to the PHCO of offering this new service to clients is negligible, Norwood says. Health-education materials typically are available free, and health-care workers who take part in education sessions all volunteer their time, she says.


As for the data analysis required to identify trends among different employers, the PHCO already does that as a means of enabling its clients to customize their insurance coverage, she says. For example, the PHCO might tell one client that its pharmacy costs are higher than average, and give the client the option of increasing pharmacy co-pays, changing the coverage to encourage the use of generic medications, or maintaining the same coverage. We customize (the plan) to whatever the employer says they want, Norwood says. Companies know whats the best plan for their data.


The ability to target different issues for individual clientseven if a client opts not to participate in the productivity programmakes such programs inherently more useful, Norwood contends.