Integrating Walk With Ease into a Benefits Structure: A Model for Employers

Submission Date: August 2020

Entry Type: Case Study

State/Territory Submitted on the Behalf of: Pennsylvania

States/Territories Involved: Pennsylvania

Funding Source: CDC, NACDD

CDC Funding:

Yes

CDC Funding (Specified):

Other CDC Funding

Other Federal Funding:

CDC(non CSTLTS)

Domain Addressed:

Environmental Approaches

Public Health Issue:

The Commonwealth of Pennsylvania’s health statistics office estimates that healthcare professionals have diagnosed 30% of Pennsylvanians and more than 1 in 4 Philadelphians with arthritis.¹ Arthritis and other musculoskeletal conditions have a broad and lasting impact including physical limitations and poor mental health. Arthritis also has a significant financial impact on both the individual and their employer.

Osteoarthritis causes higher direct medical and indirect costs for employers. A study using large self-insured employers’ data to identify incidental damages, including short-term disability, workers’ compensation, on-the-job productivity, and absenteeism demonstrated that the resulting mean total care costs for people with osteoarthritis is $17,751 annually compared to $5,057 for those without arthritis.² Further, the United States Bone and Joint Initiative details employees with musculoskeletal conditions reported losing an average of 14.3 workdays in the last year.³

Treating arthritis can be expensive. Osteoarthritis was the costliest condition in “The 20 most expensive conditions billed to private insurance, 2013.”⁴ Data from the same source shows it was the second most expensive condition treated in the hospital, costing more than $8 billion annually. However, increased physical activity, medication adherence, participation in self-management education, and living in community environments conducive to safe and active mobility can help mitigate the economic effects while improving quality of life.

1. Pennsylvania Department of Health. https://www.health.pa.gov/topics/HealthStatistics/VitalStatistics/CountyHealthProfiles/Documents/current/maps-behavior.aspx#arthritis
2. Crockatt, S Targett P, Cifu D, Wehman P. Return to work of individuals with arthritis: A review of job performance and retention. Journal of Vocational Rehabilitation 30 (2009) 121–131 121. DOI 10.3233/JVR-2009-0458
3. Bone and Joint Initiative, USA. https://www.boneandjointburden.org/docs/bmus_e4_t3a.4.1.2_0.pdf
4. Torio CM, Moore BJ. Statistical Brief #204. National Inpatient Hospital Costs: The Most Expensive Conditions by Payer, 2013. Rockville, MD: Agency for Healthcare Research and Quality; 2016. Available: https://www.hcup-us.ahrq.gov/reports/statbriefs/sb204-Most-Expensive-Hospital-Conditions.jsp?utm_source=AHRQ&utm_medium=AHRQSTAT&utm_content=Content&utm_term=HCUP&utm_campaign=AHRQ_SB_204_2016

Project Objectives:

NACDD was funded by CDC to develop a successful model for partnering with community-based organizations (CBO) and other state-based business influencers to deliver evidence-based interventions to employers. In this project, success was measured by the establishment of a commercial offering structure providing non-federal funding to support AAEBI delivery, evidence of embedding or permanency of program offerings or referral processes within a system or organization, and evidence of program delivery sustainability.

Goals include:

• Increasing sustainable adoption of AAEBIs using employer financing for population identified, participant engagement, program delivery, and evaluation of efforts; and
• Increasing the availability of and participation in AAEBIs by implementing the effective intervention and delivery model in organizations that can incent participation and are directly interested in evaluating the short-, mid-, and long-term results.

Program Action:

The National Association of Chronic Disease Directors (NACDD) collaborated with MedWorks Consulting LLC, Health Promotion Council (HPC), and the Greater Philadelphia Business Coalition on Health (GPBCH), collectively “the project team,” to educate employers in the Greater Philadelphia region about Walk With Ease (WWE). The Arthritis Foundation developed the group program to promote increased safe physical activity for people with arthritis and related musculoskeletal conditions. WWE is also offered in a self-directed version where participants adhere to a program guide consisting of six chapters to be read and followed over the course of six weeks. WWE has been shown to reduce pain associated with arthritis, and increase balance and strength, while improving overall health.¹ The Centers for Disease Control and Prevention (CDC) classifies the WWE program as an Arthritis Appropriate, Evidence-Based Initiative (AAEBI).

Developing relationships and partnerships between public health and employers is critical to raising awareness about the burden of arthritis and moving the needle on arthritis care. Employers are financial stakeholders with a direct interest in the health of their employees, dependents, and the broader community. Employers also are interested in the overall health of their employees as it directly affects their on-the-job performance. When employers fund worksite wellness efforts by adopting CDC-identified initiatives, they are joining an effort that links their actions to existing community actions. In the long run, wider adoption of CDC-identified opportunities by both employers and the community can also lead to increased awareness and support of such initiatives among local clinicians.

The project team marketed WWE to GPBCH members as an opportunity to promote physical activity for employees with musculoskeletal conditions. The team followed up with employers who responded to the promotional efforts and engaged other organizations that met their target criteria such as organization size, industry sector, self-insured benefits, and readiness to implement WWE as a sustainable, physical activity component of worksite wellness efforts and as an employee benefit.

Employers were offered a variety of options with respect to WWE implementation:

1. Embed WWE into an existing wellness program offering;
2. Select WWE as a standalone in-house program; or
3. Partner with a community-based organization (e.g., HPC) to administer the program and provide enrollee support, track participation, and more.

1. Arthritis Foundation. https://www.arthritis.org/health-wellness/healthy-living/physical-activity/walking/walk-with-ease/Walk With Ease-about-the-program

Data/Other Information Collected:

The project team developed personal logs and quarterly reports that MedWorks completed to document participation rates and feedback gathered from the self-insured employer prospects and early adopters. The team used this information to create a guidance document called “Leveraging Partnerships to Develop a Sustainable Approach to Increasing Adoption of Arthritis-Appropriate, Evidence-Based Interventions with Employers.” In addition to answering background questions, the document provides a step-by-step approach to engaging employers as payers of WWE.

To evaluate the impact of the program on employees of participating employer sites, the project team developed short web-based baseline and completion surveys. Participants complete the surveys via survey links distributed in emails, which are also used as participant reminders to promote retention and program completion. Metrics include participation (chapters completed), physical activity (walking and other activities), self-rated health status, pain, fatigue, confidence in exercising, and program satisfaction. To assess workplace productivity, the team uses a web-based administration of the Work Productivity and Activity Impairment instrument.

Impact/Accomplishments:

To date, the project team has engaged seven employers. The size, culture, and infrastructure of the organizations differ, providing additional information about different types of employers and what they are looking for when offering a wellness initiative such as WWE. The project team refined the approach for engaging employers and developed tools to help them understand the investment and the benefit to employers, partners, and employees.

While most employers are still in the early stages of engagement, requiring ongoing conversations to assess capacity and approach to WWE implementation, two employers have agreements in place to begin providing the program to their employees.

One employer, Resources for Human Development, started offering WWE in September 2019; one cohort completed the program in November 2019 and a new group began in February 2020. To date, 249 employees enrolled in WWE. Initial data from RHD shows that implementation of WWE had a positive impact on physical activity, improved physical and mental health, reduced activity impairments, and had a positive impact on workplace productivity. There are plans to develop a separate “What’s Working” story in the future that will include a complete account of their successes and challenges.

The other employer, Inframark, has postponed the start of their WWE program due to COVID-19.

Challenges/Lessons Learned:

In its early efforts, the project team identified some best practices for working with employers. These include:

• Translating public health for an employer audience: “Arthritis” is generally not a concern for employers, but “musculoskeletal conditions” are. Adopting musculoskeletal terminology resonates positively with employers as it is one of the top drivers of medical costs.
• Identifying community-based organizations and other providers of AAEBIs as the right partners and local resources: Employers are generally not aware of local CBOs such as the YMCA and the services that they can provide. The CBOs also benefit directly from employer engagement, but typically are unfamiliar with engaging this part of their community.
• Understanding the unique needs of employers: Employers want to improve their employees’ health, but need to ensure personnel decisions are kept separate from information on the individuals’ health. Many employers lack health expertise as well; as such, they look to benefits consultants and other outside experts with knowledge of best practices to make appropriate recommendations regarding policies, benefits, and programs that are most beneficial for their organization. In this framework, it is crucial to focus on specific recommendations rather than to present a generic list of all CDC-reviewed evidence-based interventions. In promoting offerings to employers, identify the solution that best meets each employer’s expectations and ensure that the recommendation is supplemented by reasoning and facts.
• Recommending WWE: WWE is a low-cost walking program that is easy to implement and meets many employers’ needs. WWE is flexible and can be integrated into an employer’s ongoing wellness programs, or it can provide a low-risk starting point for new employee well-being efforts.
• Using data: Employers want to understand the business case behind implementing WWE. The business case depends on program outcomes, yet participants aren’t always willing to complete pre- and post-surveys. For this reason, the project team incorporated an easy to complete tool to help document changes, the lifestyle impact, and assess overall satisfaction with WWE. Tying incentives to program and survey completion reduces attrition and increases program completion.

Next Steps:

The project team meets by phone monthly to report on ongoing engagement and sustainability activities. They will continue to refine the process as additional employers come on board. Overall, the team is looking to scale-up the approach and increase the number of evidence-based programs, beyond WWE, purchased by individual employers.

Program Areas:

Arthritis, Worksite Health

State Contact Information:

Pennsylvania
Lisa Erck, MS
National Association of Chronic Disease Directors
(843) 882-3015
eerck@chronicdisease.org

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