This research is an evaluation of the cost-effectiveness of an innovative health and work-productivity demonstration project that is being carried out under the auspices of the Institute for Health and Productivity Management (IHPM) in Atlanta and Chicago: the Atlanta-Chicago Health and Productivity (ACHP) demonstration project. The intervention will be a value-based health care package that features expanded services for health problems known to have effects on work performance (e.g., obesity, low back pain, seasonal allergies). The calculation of cost-effectiveness will be made from the employer perspective comparing changes in the direct costs of treatment with changes in monetized measures of work performance obtained from annual employee health and productivity tracking surveys. These surveys are already funded by IHPM separately from the current proposal.
The ACHP demonstration project is unlike most health and productivity research in that it is designed to engage entire markets. The participating employer coalitions—the Georgia Healthcare Leadership Council (GHLC) in Atlanta and the Midwest Business Group on Health (MBGH) in Chicago—centrally negotiate standard health care packages for their member companies with major health plans. Both HMO and PPO products are available. The central feature of the ACHP initiative is that the GHLC and MBGH will expand these efforts to develop value-based contracts with between two and four major health plans in their markets. The benefits package in these new products will include standard services plus expanded wellness, outreach, and best-practices treatment programs for health problems that are documented to be commonly occurring, to have high workplace costs, to be undertreated, and to be cost-effectively treated in previous effectiveness studies. Included here, for example, are such problems as obesity, insomnia, low back pain, flu, seasonal allergies, and anxiety-depression. Included will be both risk products and self-insured products.
The aims of the project are to expand this evaluation component in three ways:
- expand the data-collection effort to integrate individual-level data from the surveys with administrative data of three sorts: individual-level pharmacy and health claims data; data on health plan benefits obtained by abstracting employer health insurance contracts; and, where available, objective payroll records on sickness absence, disability, and work performance;
- expand the data analysis to carry out rigorous quasi-experimental before-after case-control evaluations of the extent to which employer investments in expanded employee health care are cost-effective from the employer perspective;
- establish an ongoing system of quality-assurance monitoring that employers can use for continuous monitoring of return on health care investments.
Successful completion of these aims will generate unique data that will rigorously document the workplace consequences of value-based employer health care purchasing on work performance in a unique market-based approach. Our unique commitment to create an ongoing and comparative quality-assurance system that is controlled by a regional employer coalition rather than by a vendor (i.e., health plan, disease management company, demand management company) makes the ACHP demonstration project uniquely positioned to succeed in the goal of institutionalizing value-based health care purchasing.
