Scorecard Quarterly Commentary: A Case for Including Spouses in EHM Programs

By, Dan Gold, PhD

There is evidence that comprehensive communications, the use of incentives and a strong culture of health can all help drive increased participation in EHM programs. An often overlooked element that also contributes to the long-term success of EHM programs, however, is the role of family support—specifically spouses. In fact, it’s missing from the term itself: “Employee Health Management”.

Health behavior research has found that other individuals and groups have a profound impact on an individual’s behavior, with spouses being a key influencer. Social support is not only a predictor of initial engagement, but also of long-term success. Spouse support has been associated with higher quit rates for tobacco users, and predicts weight loss adherence as well. While social support contributes to initial participation, its crucial role is in the maintenance of changed behaviors.

Given that a primary objective for most EHM programs is to reduce medical cost trend, it would seem even more important to include a group of members that is driving nearly a third of the health care costs of an organization.  Although spouses typically represent only about a fifth of covered members, average cost in an average population is about 30% higher for spouses than for covered employees, adding a greater opportunity for savings.

This analysis of HERO Scorecard data investigated the impact of including spouses in an EHM program. Specifically, it examined whether making key components of EHM programs available to spouses: 1) increased employee engagement; 2) improved the program’s likelihood to impact health; or 3) increased the program’s likelihood to demonstrate savings. The analysis also examined whether including spouses in an overall EHM strategy is associated with the use of other best practices (as demonstrated by higher best-practice scores). Because a key focus was on participation rates, the analysis was limited to employers offering, at a minimum, health risk assessments (HRA) and lifestyle management programs.

Including Spouses in EHM Programs
About two-thirds of all Scorecard respondents indicated that they include spouses in key components of their EHM program. Of those that offer both an HRA and a lifestyle management program, about three-fourths said that spouses are included.

Findings

*Of those that offered an HRA
**Of those that offered Lifestyle Management

[1] Responded in the affirmative to the following question: Has your organization taken steps to make key components of the EHM program available to benefit-eligible spouses/domestic partners or dependents (including service offered through health plans or community groups)?
Employers that included spouses in key components of EHM had a higher HERO score than those that did not (117 vs. 100). Both groups were above the database average of 94 because this analysis was limited to employers offering at least an HRA and lifestyle management, which drove up the average score for these subgroups.
While spouse involvement had only a minimal effect on average employee HRA participation rates (52% in programs that included spouses and 50% in those that didn’t), a more dramatic impact was seen in the behavior change programs. Employers that included spouses in key components of EHM reported employee participation rates twice as high as those that did not (28% vs. 14%).  The average employee participation rate in tobacco cessation programs was higher in EHM programs that included spouses as well (10% vs. 8%). As other research also suggests, these findings imply that social support likely has a greater impact on engagement in specific interventions than on initial participation.

*Of those who measured impact and/or outcome.

To assess the impact on health risks and savings, an analysis was conducted on two sets of questions. Respondents were first asked if they measured the impact of their program on health risks and/or medical costs, and if they did this measurement, what they found.
Among those that measured risk change, 88% of respondents that included spouses in their strategy reported at least some improvement in health risks vs. 81% of respondents that did not include spouses.  In addition, 70% of respondents that included spouses reported at least some improvement in medical trend vs. 64% of respondents that did not include spouses. While the magnitude of impact was not evaluated, the findings suggest, at least directionally, that there is a greater likelihood of program success if spouses are included.

Conclusions
While the evidence is supportive, it is important to note that the analysis was descriptive in nature and does not necessarily suggest causation. Other factors, not controlled for in the analysis, also likely influence the results. For instance, larger organizations are more likely to include spouses in their EHM strategies, and as reported in a past commentary, employer size is related to the HERO score.

However, the data support, at least directionally, that those organizations that include spouses in their overall EHM strategy were able to demonstrate increased employee participation, especially in the interventions that matter, as well as a greater likelihood of health improvement and medical cost savings.

While it was encouraging to see that including spouses in EHM strategy is becoming more of the norm, there is still a ways to go. Until we can move Employee Health Management to true Population Health Management, we will be limiting the potential impact of these programs.