DALLAS FEDERAL RESERVE BANK
Dallas-Fort Worth Business Group On Health Screening-Education-Treatment Success In Diabetes Management.
The Dallas-Fort Worth Business Group on Health (DFWBGH) is a 110-member coalition of Dallas and Ft. Worth employers that are committed to market-based health care reform. The group includes companies such as American Airlines, EDS, ExxonMobil, the Federal Reserve Bank of Dallas (FRBD), JC Penney, Neiman Marcus, RadioShack, Southwest Airlines, Texas Instruments, TXU, and Verizon. The group strives to empower employers to make informed, value-based health care purchasing decisions and to encourage health care providers toward continuously improving their clinical performance and quality of care.
DFWBGH knew that to control health care costs it needed to help member companies gain better control of their health issues. One area of focus for DFWBGH was diabetes which affects a large number of American workers. Employees with diabetes can dramatically affect a company's bottom line because they are at greater risk for temporary incapacity, permanent disability, and mortality.
Overview of Program
DFWBGH developed a diabetes management workplace model based on screening, education, and treatment called S-E-T for Success. The group wanted to determine whether providing diabetes education in the workplace leads to improved health behaviors and outcomes. The group chose two member companies ― FRBD and TXU ― to participate in its pilot study. This case study will focus on the FRBD because TXU did not complete the program.
FRBD met all the appropriate criteria, including workforce demographics that suggest that high incidence of diabetes and medical/pharmacy claims and indicate a frequent use of the health care system for diabetes-related treatments. GlaxoSmithKline underwrote the project with additional support from Bayer Corporation and Roche Diagnostics.
FRBD, one of 12 regional banks in the Federal Reserve System, serves the 11th Federal Reserve District comprising Texas, northern Louisiana, and southern New Mexico. FRBD has 2,030 employees, retirees, and survivors eligible for medical coverage, of whom 1,037 are female and 993 are male. The American Diabetic Association (ADA) estimates that medical costs per each employee with diabetes are $13,240 compared to $2,650 for each employee without diabetes or another chronic condition. From these ADA estimates, medical costs for FRBD-covered employees and dependents who purchased diabetic supplies in 2002 were $1,602,000.
DFWBGH and FRBD decided to focus on employee education. Program goals included:
- determining the prevalence and costs of diabetes among participants in the pilot study;
- developing a model workplace diabetes education and management program to provide disease management planning, screening, education, and interventions; and
- evaluating the program's effect on employee health status, diabetes management, and health care costs.
Before starting the program, FRBD asked interested employees to complete a waiver giving DFWBGH access to confidential personal health information and to take an A1C test (measures the average blood glucose level in the body over the past three months) for baseline information. Of the 1,000 FRBD employees based in Dallas-Fort Worth invited to participate in the project, 262 were initially screened for diabetes. Seventeen (7 percent) were determined either to have diabetes or to be at risk (positive screening) for diabetes. This result was in line with the national trend of 6 percent of the general population. Of the employees who were screened, 216 showed a tendency for diabetes.
Thirty-five employees volunteered to participate in the 6-month program, which included monthly one-hour meetings with a certified diabetes educator covering educational information for diabetes self-management. The diabetes educator used information from www.diabetesatwork.org to develop lesson plans and fact sheets for the meetings.
The program also offered the following:
- Diabetic supplies through Liberty Direct Services (LDS) without a co-pay (Supplies were provided for a 30-day prescription. FRBD paid the total LDS invoice each month. Note: if the company nurse determined that a participant was not complying with the terms of the program, the individual was deleted from the LDS eligibility file and did not receive free supplies.)
- A free Bayer Elite glucometer, finger sticking device, and lancets for home testing (The glucometer readings were downloaded into a company computer via Glucofacts software, also provided by Bayer.)
- A Diabetes Self-Management Tracking Form, developed by FRBD, which participants were required to maintain.
The campaign was originally scheduled to last for 6 months; however, FRBD decided to extend it for an entire year. At each monthly meeting, participants received charts showing their glucometer readings with a report of their progress. Monthly lunch meetings were videotaped for employees on the second and third shifts. Employees who did not have e-mail or who lacked PC skills were given access to computers and assistance.
DFWBGH S-E-T for Success program piloted at FRBD was successful in providing a health management tool to help employers build a framework for diabetes prevention and treatment programs at the workplace. The Lunch and Learn meetings were well attended and favorably reviewed. Employees reported the program raised their awareness and understanding, led to significant beneficial changes in their health, and gave them the motivation and encouragement they needed.
By December 31, 2003, 35 FRBD employees had completed the program. In addition, the 35 employees decided to continue the program with funding from FRBD. Employee participants can still receive free diabetic supplies through LDS.
- DFWBGH's workplace program proved that employers can make diabetes management programs succeed at work.
- Onsite educational programs go a step further by enhancing employee morale and loyalty.
- Workplace programs like this hold enormous potential for reducing diabetes among employees, enhancing worker productivity, decreasing diabetes-related costs, and reducing other health problems.
Lessons Learned To Date
As DFWBGH considers sharing this program with other employers, the coalition offers the following advice:
- Senior management support is critical. Employers should work with senior management to ensure that resources are allocated appropriately and sufficiently to support the program.
- The corporate culture must emphasize wellness and prevention.
- A 12–18 month commitment by the employer is necessary; six-nine months is not enough to generate the needed behavior changes among participants.
- Participants should complete “Readiness to Change” surveys before they are accepted into the program.
- A weight management component, such as Weight Watchers, should be included because obesity and diabetes are often linked.
- A program should include additional components that address cultural diversity, depression, and stress.
- A psychologist should be involved for behavior modification issues.
- Incentives must be directly tied to participant involvement (e.g., free diabetic supplies to participants).
- Appropriate members of the health care team — provided they have experience in diabetes management — should teach different topics. (The team should include physicians, nurses, dieticians, exercise physiologists, pharmacists, psychologists, podiatrists, and other relevant professionals.)
- Program developers should collaborate with the benefits, wellness, and fitness departments of the firm to ensure program synergy.
DFWBGH plans to offer the S-E-T for Success diabetes workplace management program to other employers as a proven disease management model.