Bringing down health care costs has been bringing innovation to the workplace – and some glimmers of social marketing. An article in The Wall Street Journal by Anna Wilde Mathews reports on an experiment in progress at AmeriGas Propane where, for a number of years, voluntary wellness programs to encourage healthier behaviors, discounted premiums for nonsmokers and cash rewards for completing health risk appraisals were not working to reduce costs – or engage many employees it seems. Rather than focus on improving the marketing of the wellness and incentive programs, management stepped back and decided to mandate that all employees would have to get physical exams including blood pressure, blood cholesterol and blood glucose measurements (and for women, also Pap tests and mammograms for those over age 40) or else lose their health insurance coverage. Then to keep their insurance, they need to continue getting check-ups at least every two years. All tests are 100% covered by their insurance, and the generic drugs for diabetes, high blood pressure, high blood cholesterol and asthma are also covered (co-payments for branded drugs were reduced).
So if you are keeping score so far, we have new products and services at no cost to the employees (physical exam and tests) and new behaviors (get them done and keep it up) at a high cost (lose health benefits). Although the reporter does not get into it, I suspect that the physical exam and tests were always covered by the health insurance plan – what has changed is the nudge to the behavior of getting them done (though some might call it a ‘push’).
From a Promotion or communication standpoint, all the employees received a DVD to review at home that explained the rationale for the new program and the health statistics and costs at the company (such as the fact that 3x as many employees under the age of 60 were dying of ‘natural causes’ – versus unintentional injuries on- or off-the-job I presume – than is expected among that age group). We don’t get much of a perspective on Place except that it seems that employees made appointments with their own physician to have the exams. I wonder what would have happened if there had been an on-site option to have them done? Would it have adverted some of the reported ‘mixups’ such as physicians mistakenly charging the employees for the exams anyway and keeping track of which employees had actually completed all of the testing? And there was some reported confusion and resentments among employees who apparently had the new mandate dropped on them rather than being engaged in some manner in the deliberative process (not even a couple of focus groups?).
Most of the results so far from AmeriGas are anecdotal – stories about people who had physical problems detected that then led to successful treatment or changes in health behaviors and risk status. AmeriGas estimates that about 90% of the employees have had all of their testing done. The company also figures that the mandated testing added about 3% to their health care budget for the year, primarily attributed to the need for follow-up examinations and care for some people. [Note: preventive health screenings do not usually save money because of these additional costs. Behavior changes that lead to decreases in weight and smoking do.] But, the company is hopeful to see payoffs down the road.
Though the company does not refer to any of this as marketing, let alone social marketing, they do demonstrate that using the entire marketing mix, and not relying on persuasive communications to enroll in programs and exhortations to ‘be healthy’, can lead to significant changes in employee health behaviors – getting the physical exams to start with. Prior to the new program, only 6% of employees had had heir blood cholesterol level checked in the past 18 months, 20% had their blood glucose level tested, and 44% of women were getting mammograms and Pap smears.
What a social marketing perspective can bring to employee wellness programs and managing employee health care costs is an integrated heuristic to decide:
Are we delivering the most relevant and useful products and services to the right audience, focused on the right behaviors, with the best incentives, at the best places and times that build on the insights of our employees and make sense to them?