Randomized Controlled Trial of Cost Reductions from a Health Education Program: The California Public Employees' Retirement System (PERS) Study

Abstract

Purpose. This study evaluated the cost trend reduction from a health promotion program. Design. A randomized 12-month trial comparing claims data was conducted. Additional studies, utilizing quasi-experimental designs, analyzed changes in health habits and changes in costs estimated by self-report. Subjects. All active California Public Employees' Retirement System (PERS) employees (21,170), non-Medicare eligible retirees (8,316), and retirees with Medical Supplement coverage (25,416) administered by Blue Shield of California were included. Intervention. The program consisted of mailed health risk assessments at six- or 12-month intervals, with individualized reports and recommendation letters sent to participants emphasizing and encouraging change, self-management materials emphasizing self-care when appropriate, and quarterly newsletters. Passive participants received printed materials only. Measures. Health risks were based upon self-report; summary scores were computed by modified Framingham algorithms. Self-report cost data were estimated from reported doctor visits, hospital days, and days sick or confined to home. Claims data were those paid by Blue Shield of California. Results. The program was associated with: 1) reduction in health risk scores at 12 months, (p less than .001), 2) reduction of subject reported medical utilization from baseline (p less than .05), and 3) decrease in claims cost growth relative to controls (p=.03). Annual claims costs were approximately $3.2 to $8.0 million less than expected had costs for the experimental participants increased at the same rate as the control group. Discussion. Results suggest that appropriately designed health promotion programs can reduce health risks and at the same time reduce the medical care claims cost trend.

The Health and Cost Benefits of Work Site Health-Promotion Programs

“…Although classes appeal to some, Erfurt et al (34) found that offering a menu, including guided self-help, one-toone, mini group, and full-group interventions, is more successful than offering only didactic sessions. Fries analyzed two programs for retirees delivered entirely through the mail and found that tailored print materials had a significant behavioral impact (38,39). However, he did not test whether impacts would have been greater with additional engagement modalities.…”

Self-management support and training for patients with chronic and complex conditions improves health-related behaviour and health outcomes

“…9,[15][16][17][18][19][20][21][22][23][24][25][26] In addition, it is widely recognised that where communities and consumers of health services participate meaningfully in the process of accessing and using those services (that is, share in the process of health care) improved health outcomes are more likely than in situations where this sharing does not occur 27 -effective public participation in the processes of health care delivery is crucial to improving health outcomes. 28 Some organisations are even accepting that self-management processes, as well as being beneficial for patients, can improve patient quality of life and reduce the cost to health systems of providing health care services.…”

Comparing Excess Costs Across Multiple Corporate Populations

“…It also further reinforces the concept of keeping low risk individuals in the low risk category while at the same time trying to reduce the risks of medium-and high-risk individuals. 30 …”