Companies across America have moved into wellness and prevention programs, and they are seeing hospital admissions for their workforce drop. But they have mostly been focused on chronic physical conditions like diabetes, asthma and hypertension.
At Serigraph, for instance, we have cut our admissions in half, from 71 per thousand lives in 2007, about the national average, to half of that today. We saw 36 per 1000 in 2012.
With those kinds of successes, companies are now turning their attention to mental illnesses and behavioral issues. There is also big money to be saved there and big health improvements to be made.
Dr. Rich Brown, a leading advocate in Wisconsin and the country for dealing with those issues, has done the numbers and says $895 per employee could be saved if companies dealt more effectively with smoking, binge drinking (a big Wisconsin problem), depression, and alcohol and drug abuse.
With obesity in the mix, Dr. Brown, a primary care doctor and professor at UW—Madison, says the state could save as much as $18 billion per year. “Wow,” he said, “we could really use that money in Wisconsin for other things.” That total is more than all the taxes raised by the state.
Through the Wisconsin Initiative to Promote Healthy Lifestyles (WIPHL), which he helped to found, Brown advocates for a tool kit called “BSI” – Behavioral Screening and Intervention. This is a proven set of methods for reducing unhealthy, costly and even fatal behaviors. (Smoking is far and away the worst.)
Following his lead, Serigraph introduced a PHQ-9 screen for depression in 2012 as part of our annual health risk assessments for all co-workers and spouses. It is an eight-question survey that has a high degree of validity in identifying people with a depression illness. Our first cut found three people with severe depression and nine more with the next level of risk.
While we in the company are talking about the prevalence of such chronic diseases to eliminate attached stigmas, the individual cases are, of course, kept in complete confidence. Our on-site health team immediately swung into action to help the 12 people.
We have had some success with other programs to address other behavioral challenges. Our smoking cessation program has helped to drop our percentage of smokers to 19% from 25% five years ago. That’s great, but, in fairness, it just tracks the decline across the country.
Our obesity programs were not getting much traction, but we have retooled them and they now appear to be working better. One employee reportedly lost 100 pounds. We expect to see our average BMI (body mass index) trend downward going forward.
We have dropped our average cholesterol by 17 points and our systolic blood pressure average by three points. Some of that reduction is related to improved diet and exercise.
Experts like Brown worry that the knowledge and tools that have been developed over the last couple of decades are not adopted quickly enough. They are looking companies to take the lead.
I heard an example cited about one of the new treatment tools called “motivational interviewing (MI).” The behavior coach simply gets to know the person to find out what really matters in his or her life. One example would be a hypertensive, over-weight woman who wanted to climb Mt. Kilimanjaro as an item on her bucket list. Her coach pointed out that such a goal was impossible given her state of health. Three years later, after a disciplined regimen, she made the climb. That’s a true story that shows what can be done with effective treatment.
The on-site health team at Serigraph has started to use MI to find out what trips a person’s trigger enough to make a major behavior change.
Kevin Moore, deputy secretary of the Department of Health Services, told a WIPHL audience this week that “the business community, the private sector, is going to be the incubator for BSI.”
Once more widely adopted, it should move into public sector in programs like Medicaid.
Dealing broadly with mental health issues in an effective way is a reform in the delivery of health care in America that can’t happen fast enough.