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HERO Studies
The following information and abstracts provide information about published HERO EHM research.
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Below is a chronological listing of articles (most recent first). For an alphabetical listing see the table above. Self-Rated Job Performance and Absenteeism According to Employee Engagement, Health Behaviors, and Physical Health Objective: To better understand the combined influence of employee engagement, health behavior, and physical health on job performance and absenteeism. Methods: Analyses were based on 20,114 employees who completed the Healthways Well-Being Assessment from 2008 to 2010. Employees represented three geographically dispersed companies in the United States. Results: Employee engagement, health behavior, and physical health indices were simultaneously significantly associated with job performance and also with absenteeism. Employee engagement had a greater association with job performance than did the health behavior or physical health indices, whereas the physical health index was more strongly associated with absenteeism. Specific elements of the indices were evaluated for association with self-rated job performance and absenteeism. Conclusion: Efforts to improve worker productivity should take a holistic approach encompassing employee health improvement and engagement strategies. This research project is complete, peer-reviewed and published in the January 2013 issue of the JOURNAL of OCCUPATIONAL and ENVIRONMENTAL MEDICINE (Merrill, Ray M. PhD, MPH; Aldana, Steven G. PhD; Pope, James E. MD; Anderson, David R. PhD, LP; Coberley, Carter R. PhD; Grossmeier, Jessica J. PhD; Whitmer, R. William MBA; HERO Research Study Subcommittee) Purchase this article Ten Modifiable Health Risk Factors are Linked to More than One-fifth of Employer-Employee Health Care Spending An underlying premise of the Affordable Care Act provisions that encourage employers to adopt health promotion programs is an association between workers’ modifiable health risks and increased health care costs. Employers, consultants, and vendors have cited risk-cost estimates developed in the 1990s and wondered whether they still hold true. Examining ten of these common health risk factors in a working population, we found that similar relationships between such risks and total medical costs documented in a widely cited study published in 1998 still hold. Based on our sample of 92,486 employees at seven organizations over an average of three years, $82,072,456, or 22.4 percent, of the $366,373,301 spent annually by the seven employers and their employees in the study was attributed to the ten risk factors studied. This amount was similar to almost a quarter of spending linked to risk factors (24.9 percent) in the 1998 study. High risk for depression remained most strongly associated with increased per capita annual medical spending (48 percent, or $2,184, higher). High blood glucose, high blood pressure, and obesity were strongly related to increased health care costs (31.8 percent, 31.6 percent, and 27.4 percent higher,respectively), as were tobacco use, physical inactivity, and high stress. These findings indicate ongoing opportunities for well-designed and properly targeted employer-sponsored health promotion programs to produce substantial savings.
This research is copyrighted and published by HOPE/Health Affairs
(Millwood):(2012) 31.
NO.11 , Nov. 2012 New Findings and Realistic Solutions to Employee Presenteeism Corporate financial statements and annual reports highlight the effects of the rising cost of employee health care. It has become a substantial budget item that must be carefully monitored and controlled. Because it is a tangible cost, benefits managers and chief financial officers tend to focus these efforts on controlling health care costs. Yet a much larger employee expense and management opportunity lurks in the shadows - on-the-job productivity losses resulting from employee health problems, also called presenteeism. This paper is complete and available
here. Presenteeism According to Health Behaviors, Physical Health, and Work Environment The objective of this study is to identify the contribution that selected demographic characteristics, health behaviors, physical health outcomes, and workplace environmental factors have on presenteeism (on-the-job productivity loss attributed to poor health and other personal issues). Analyses are based on a cross-sectional survey administered to 3 geographically diverse US companies in 2010. Work-related factors had the greatest influence on presenteeism (eg, too much to do but not enough time to do it, insufficient technological support/resources). Personal problems and financial stress/concerns also contributed substantially to presenteeism. Factors with less contribution to presenteeism included physical limitations, depression or anxiety, inadequate job training, and problems with supervisors and coworkers. Presenteeism was greatest for those ages 30–49, women, separated/divorced/widowed employees, and those with a high school degree or some college. Clerical/office workers and service workers had higher presenteeism. Managers and professionals had the highest level of presenteeism related to having too much to do but too little time to do it, and transportation workers had the greatest presenteeism because of physical health limitations. Lowering presenteeism will require that employers have realistic expectations of workers, help workers prioritize, and provide sufficient technological support. Financial stress and concerns may warrant financial planning services. Health promotion interventions aimed at improving nutrition and physical and mental health also may contribute to reducing presenteeism. This research is complete an published in Population Health
Management ahead of print
on line
Toward an Employee Health Management Research Agenda: What Are The Research Priorities? As employee health management (EHM) programs continue to grow and mature, employers are increasingly interested in gaining a deeper understanding of contributing factors to EHM program success. To lead in this effort, HERO has evaluated the current research, established new research priorities and created a strategic road map to guide our direction. This article will give you insight into the process HERO employed to determine what research priorities are most important to our members and the industry, consistent with the HERO mission. This research is complete and published in AJHP The Art of Health Promotion Section:
July/August 2012
A Review of the Knowledge Base on Health Worksite Culture Methods: A cross-sectional survey involving a sample of 500 companies representing a broad spectrum of industries and business sectors. A literature review was conducted. Results: Similar to a culture of safety that encourages safer behaviors and enables a safer workplace, a culture of health provides a supportive work leadership with a favorable work environment and health-related policies that promote employee health and result in substantial decrease in employee health risks and medical costs. Conclusion: Worksite policies and environments supporting a culture of health are important to helping employees adopt and maintain healthy behaviors. This research project is complete, peer-reviewed and published in the April, 2012 issue of the JOURNAL of OCCUPATIONAL and ENVIRONMENTAL MEDICINE JOEM. volume 54, issue 4, p 414 - 419, Aldana, Steven G.; Anderson, David R.; Adams, Troy B.; Whitmer, R. William; Merrill, Ray M.; George, Victoria; Noyce, Jerry purchase this article Evaluation of a Best-Practice Worksite Wellness Program in a Small-Employer Setting Using Selected Well-being IndicesObjective: To measure the effectiveness of a wellness program in a small company using four well-being indicators designed to measure dimensions of physical health, emotional health, healthy behavior, and basic access to health-related conditions and services. Methods: Indicator scores were obtained and compared between Lincoln Industries employees and workers in the neighboring Lincoln/Omaha community during 2009. Results: Nearly all Lincoln Industries employees participated in the wellness program. Physical health, mental health, and healthy behavior were significantly greater for Lincoln Industries employees. Self-perceived access to basic needs was not significantly greater among Lincoln Industries employees. Conclusion: Well-being index scores provide evidence for the effectiveness of the wellness program in this small company setting with respect to better dimensions of physical health, emotional health, and healthy behavior than geographically similar work This research project is complete, peer-reviewed and published in the April, 2011 issue of the JOURNAL of OCCUPATIONAL and ENVIRONMENTAL MEDICINE, volume 53 issue 4 (Merrill, Ray M. PhD, MPH; Aldana, Steven G. PhD; Pope, James E. MD; Anderson, David R. PhD, LP; Coberley, Carter R. PhD; Vyhlidal, Tonya P. MEd; Howe, Greg MS; Whitmer, R. William MBA) purchase this article The Impact of Worksite Wellness in a Small Business SettingObjective: This study evaluates the level of participation and effectiveness of a worksite wellness program in a small business setting. Methods: Three years of wellness participation and risk data from Lincoln Industries was analyzed. Results: All Lincoln Industry employees participated in at least some level of wellness programming. Significant improvements in body fat, blood pressure, and flexibility were observed across time. The largest improvements in risk were seen among older employees and those with the highest baseline values. Conclusions: This small business was able to improve the health of the entire workforce population by integrating wellness deeply into their culture and operations. Replication of this program in other small business settings could have a large impact on public health since 60 million adults in the United States work in small business. This research project is complete, peer-reviewed and published in the Feb, 2011 issue of the JOURNAL of OCCUPATIONAL and ENVIRONMENTAL MEDICINE, volume 53, Issue 2 (Ray, M. Merrill PhD, MPH; Steven, G. Aldana PhD; Tonya, P. Vyhlidal MEd; Howe, Greg MS; David, R. Anderson PhD, LP; R., William Whitmer MBA) Purchase this articleEffect of Lifestyle Modification and Cardiac Rehabilitation on Psychological Cardiovascular Disease Risk Factors and Quality of LifeA prospective and randomized research project to compare the effectiveness of the Ornish Program with traditional cardiac rehabilitation in reducing carotid artery media and intima thickness and a variety of other health parameters. A prospective, controlled and randomized evaluation of heart disease patients who agree to be randomized into either the Ornish or traditional cardiac rehabilitation programs. In addition to all the outcomes evaluated in the above research project, these study subjects also have carotid artery ultrafast-sonography to determine media and intima thickness (a direct measure of vascular disease.) This test will provide hard copy pictures of atherosclerotic (plaque) build up in the carotid artery. There is good evidence that the amount of plaque in the carotid artery corresponds to the plaque in coronary (heart) arteries. In addition, there will be blood analysis for homosystene (HCY), C-reactive protein, ferritin, and fibrinogen. The hypothesis states that those who are randomized and remain in the Ornish program will have less thickening or actual reduction in carotid artery thickness (reversal of cardiovascular disease) over time compared to the traditional rehabilitation group. This study was funded by the Midwest Center for Health and Healing, in Rockford IL. (Aldana, S, Whitmer, R., Greenlaw, R., et al). BEHAVIOR MODIFICATION. Vol. 30, No 4, July 2006; 506-525) Purchase this articleCardiovascular Risk Reductions Associated With Aggressive Lifestyle Modification and Cardiac RehabilitationPatients who have been treated for coronary heart disease can enroll in traditional cardiac rehabilitation, the Ornish program, or no rehabilitation. No study has compared the impact of each on cardiovascular disease (CVD) risk factors. This study compares CVD risk changes in post coronary bypass graft or percutaneous coronary intervention procedure patients who participated in the Ornish Heart Disease Reversing Program, a traditional cardiac rehabilitation program, and a control group that received no formal cardiac risk-reduction program. This was a longitudinal, observational study of 84 patients receiving CVD standard of care who elected to participate in one of the three study groups. Assessments of CVD risk factors and anginal severity were obtained at baseline, 3 months and 6 months. Those patients participating in the Ornish program had significantly greater reductions in original frequency, body weight, body mass index, systolic blood pressure, total cholesterol, low-density lipoprotein cholesterol, glucose, dietary fat and increases in complex carbohydrates than were experienced in the traditional or control groups. (Aldana S., Whitmer R., Greenlaw R., et.al) Heart & Lung (32) (6), Nov/Dec 2003; 374-381.) Purchase this article A Wake Up Call for Corporate America: An Editorial ProjectIn 2003, the cost per employee, for family health care coverage, when averaged across all plan designs was $9,068. Of this amount, the employer paid $6,656. If increases average a conservative 10% per year over the next several years, then in 2008, the cost per employee will be $14,601, with the employer paying $10,659 per employee. This assumes the current percent contribution between employer and employee remains constant. For most employers, this is a crisis situation, with little relief in site. This invited editorial provides a detailed over-view of employer reactions to routine double digit annual increases in health care costs based on numerous published employer surveys. Commentary explores why there is little hope for moderation in health care costs: the baby boomers, the graying of America, escalating hospital charges and the obesity epidemic. The editorial documents that 50% - 70% of all diseases and medical problems are caused by life style choice: smoking, obesity, excess stress, lack of fitness, poor nutrition, lack of compliance in managing diabetes, hypertension, etc. The dichotomy of the health care cost crisis is that of the $1.8 trillion annual budget, less than 6% is devoted to prevention of all kinds, including attempts to influence lifestyle choices. The editorial concludes, “A Wake-Up Call for Corporate America is that an employee health care cost crisis is here. If the employer assumes the responsibility to pay for the diagnosis and treatment of employee/dependent illness, then serious consideration must be given to the reallocation of existing investment in human capital funds. This redirection of funding should be toward health enhancement programs and services that optimize employee/dependent health, which can reduce health care use, moderate cost increases, reduce illness absence and improve work performance”. (Whitmer R., Pelletier K., Anderson D., et.al) Journal of Occupational and Environmental Medicine (45) (9), Sept. 2003; 916-925.) Purchase this article The Gender-Specific Effects of Modifiable Health Risk Factors on Coronary Heart Disease and Related ExpendituresThis research project uses the HERO database. Of the 46,026 employees in the database 2,459 were diagnosed as having CAD through CPT and ICD-9-CM codes. This represents the study group. A variety of risk factors, many of which are controllable through lifestyle changes, contribute to the probability of CAD and health care costs. The risks include: stress, smoking, obesity, hypertension, diabetes, lack of regular exercise, high cholesterol and family history. While there is minimal data available on the comparative economical impact of risk factors on health care cost, there is even less when investigating this question based on gender. Because of this, the following questions are addressed:
Among this large, multi-employer group of workers who completed a health risk appraisal (HRA), the difference between the occurrence of CAD between males (6.3%) and females (5.7%) was only 0.6%. Among males, smoking was the number one predictor of heart disease, while with women, profound obesity and uncontrolled stress were the prime predictors. There was no level of consistency between men and women relative to the association between health risks and costs. For example, men reporting to be depressed most of the time had total health care costs 91% more than men who reported not being depressed. Among women, those reporting to be depressed most of the time had health care costs only 5% more than those reporting not being depressed. Behavioral change intervention application has usually been the same for men and women. If the intent is to provide interventions based on the potential for maximum reduction in medical costs, occurrence of CAD and hospitalization due to CAD, this study suggests different intervention goals between males and females may be appropriate. This study was funded through grant number NAG-6218 from the National Aeronautics and Space Administration (NASA). (Wasserman, J, Whitmer, R, Bazzarre, T, et. al., Jour Occup Env Med, (42)(11), November 2000; 973-985). Purchase this article Projecting Future Medical Care Costs Using Four Scenarios of Lifestyle Risk RatesThis study uses the HERO database. Union Pacific Railroad (UPRR), like many others, has an aging workforce. Prudent financial planning mandates that future medical expenses be understood. UPRR has a long history of providing and promoting aggressive health promotion programs. For this reason, they have a rich database of employee health risks and demographics. The objective was to adjust the HERO database to accurately reflect the demographic characteristics of the UPRR employee population. Multivariate statistical techniques were used to create models predicting health risk prevalence and expenditures based on information contained in the HERO database plus demographic characteristics, risk values and cost data provided by the UPRR database. Risk factors examined are: 1) alcohol consumption, 2) blood glucose, 3) blood pressure, 4) cholesterol, 5) nutrition, 6) fitness, 7) mental health, 8) tobacco use, 9) stress and 10) weight. Demographics included are: 1) age, 2) gender, 3) ethnicity and 4) job classification. These models will be used to estimate future health risks and expenditures. In summary, the study indicates:
This study was funded by and unrestricted grant from the Union Pacific Railroad. (Leutzinger, J, Ozminkowski, R, Dunn, R, et. al. Am J Health Promot, (15)(1), Sept/Oct 2000; 35-44. Purchase this article The Relationship Between Modifiable Health Risks and Group-Level Health Care ExpendituresThis study uses the HERO database in which 46,026 employees met all inclusion criteria for the analysis. The purpose was to assess the relationship between modifiable health risks and total health care expenditures for a large group of employees. This study is different than Research Project Two which examined individual health care expenditures as the outcome. Here the outcome is the total cost impact of a given health risk. Risk data were collected through voluntary participation in health risk assessments (HRA) and workplace biometric screening. These data were linked to health care plan enrollment and employee health care expenditures from employer’s fee-for-service health care plans over a six year period. Several research questions were addressed:
It was found that employees with modifiable health risks were responsible for 25% total expenditures. Those employees who reported being under constant stress with no methods for coping were responsible for 7.9% of total health care costs. Being a former smoker was associated with 5.6% total medical expenditures followed by obesity at 4.1%. The association between risks and expenditures was estimated using a two-part regression model, controlling for demographics and other confounders. Risk prevalence data were used to estimated group-level impact of risks on expenditures. This study was co-funded through an unrestricted grant from HERO and The StayWell Company. (Anderson, D, Whitmer, R, Goetzel, R, et. al., Am J Health Promot, (15)(1), Sept/Oct 2000; 45-52). Purchase this article Association Between Health Risks and Medical ExpendituresA medical economics study using the HERO database, that addresses two questions:
This study was funded by a consortium of 22 HERO sustaining partners. Research design involves a retrospective, two-stage, multi-variate analysis, including logistic and linear regression models. This permits the examination of specific risk factors as independent variables, thus eliminating the impact of other risks. In addition to adjusting for specific risk factors, other confounding factors adjusted for were: gender, age, educational level, race, type of job, employer and number of months employees were followed after the first HRA was completed. Ten risk factors were evaluated, six self-reported and four biometric. The self-reported were: physical activity, alcohol consumption, nutrition, tobacco use, stress and depression. The biometric measurements were: cholesterol, blood pressure, blood glucose and weight. Using the HERO database, research inclusion criteria were: active employees age 18 to 64 at the time of the first HRA and those who could be followed for at least six months after the completion of the first HRA. Based on this, there were 46,026 study subjects, all of whom completed a common HRA and were enrolled in fee-for-service health care plans. They were followed for up to three years after the completion of the first HRA. It was found that those with self-reported, persistent depression (n=997, 2.2% of the study sample) had adjusted annual health care expenditures 70% greater than those who reported not being depressed. Number two was uncontrolled stress (n=8,641, 18%). These individuals had annual adjusted medical costs 46% greater than those who were not stressed. The third most costly risk was high blood glucose (n=2,271, 5%), with adjusted medical expenses 35% greater than those with normal blood glucose. The other most costly risks in descending adjusted order were: obesity (+21%), tobacco use (former +20%, current +15%), high blood pressure (+12%), and poor exercise habits (+10%). There was a dichotomy between the adjusted and unadjusted data relative to high cholesterol levels (n=8,641, 18%). Based on unadjusted data, health care costs were 17% greater than those with normal cholesterol levels, however, when adjusted, health care costs were 0.8% lower. Those at high risk for health problems due to excessive alcohol consumption (n=1,723, 4%) had adjusted health care expenditures 3% lower than those at lower risk. This is not unexpected, as those with drinking problems often avoid the health care system. In the case of nutrition, those who reported poor nutritional habits (n=9,278, 20%) had adjusted health care expenditures 9% lower than those who reported good nutritional habits. This finding was perplexing, because it is in contrary to the body of published nutrition research. It may be explained by the fact that the impact of all other risks usually associated with poor nutrition (obesity, hypertension, high cholesterol, high blood glucose) have been eliminated through the adjustment process. The finding that psychosocial risks were the most costly was unexpected and medically newsworthy. This study suggests that sufficient attention should be directed toward worksite depression and stress screening along with the opportunity for adequate diagnosis and treatment. This research project is complete, peer-reviewed and published in the October 1998 issue of the JOURNAL of OCCUPATIONAL and ENVIRONMENTAL MEDICINE (Goetzel, Anderson, Whitmer, et.al., JOEM, (40) (10). October 1998; 1-12). Purchase this article Creation of The HERO DatabaseHERO has facilitated the creation of a large, retrospective, multi-employer health promotion research database. This was accomplished by collaboration among HERO, the StayWell Company, the MEDSTAT Group, and six large employers: Chevron Corporation, Health Trust, Inc., Hoffmann La Roche, Marriott Corporation and the states of Michigan and Tennessee. All employers are clients of The StayWell Company and The MEDSTAT Group. A top priority in the creation of the HERO database was the ability to examine the impact of risk factors, risk factor combinations and risk factor change on individual medical expenditures. The HERO health promotion research database includes 47,500 employees, all of whom completed a common health risk appraisal (HRA), the StayWell Health Path®, and were enrolled in a fee-for-service, self-insured health care plan for the study period of 1990 to 1996. Approximately 12,000 of the employees completed two or more HRAs during this time. The HERO database was created by connecting the HRA data set with the medical claims data set along with the eligibility data set. Including the eligibility data permitted the inclusion of study subjects that had no medical claims. The confidentiality of individuals was maintained by scrambling personal identifiers across all data sources. The merging of these data sets yielded 113,963 person years experience. The previous largest research database of this kind is the Control Data - Milliman Robertson database which includes about 13,000 study subjects and provides approximately 40,000 person years experience. Creation of the HERO database could have a major impact on the future of health promotion and disease management research. It is amenable to the design of numerous longitudinal research studies that examine the association or impact of single risk factors, risk factor combinations, risk factor change, selected chronic diseases and demographics on: medical costs, diagnosis, treatments, procedures, outcomes, hospitalization or any other parameter usually recorded in a typical fee-for-service medical claims database. A consortium of 20 HERO sustaining partners funded the creation of the database. HERO is willing to facilitate research, using the database, for outside clients. |
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