SAN BERNARDINO, Calif. -- A pilot program to boost the wellness and productivity of employees of San Bernardino County, Calif., has been expanded after reducing lost-time costs due to sick leaves by nearly 20% over a six-month period.

In April, the county expanded the program to include 3,300 workers, and proposals for extending it to even more of the county's 15,000 employees are being discussed, according to county officials.

The savings projection for the 3,300 employees now involved is $1 million annually in reduced lost-time under sick leaves, according to Myrna Cogan, chief of the county's Employee Benefits and Services Division.

Barbara Musselman, director of the county's Human Resources Department, said, "We think we have found the basic recipe" for reducing lost-time costs.

The county estimates that workers comp costs will be reduced by a percentage similar to sick leave savings, Ms. Cogan said.

"The program is just tackling problems in so many areas," including illness and injury prevention and improved health care administration, said Dr. Phillip Polakoff, president and chief executive officer of Emeryville, Calif.-based Integrated Health Management Associates, a consulting firm that helped develop the pilot.

Two years ago, Ms. Cogan assessed the county's high costs for sick leave, short-term disability and workers compensation programs, particularly in terms of productivity losses: $30 million in direct costs of lost time.

"It was a sizable number, and we had to do something about it," said Ms. Cogan.

Focus groups found that a major reason workers often stayed off work too long was because they had problems navigating through the county's benefits and care system.

Changes to alleviate those problems were tested in a pilot program with 400 employees of the county's Social Services Group from October 1997 to March 1998. Under the pilot program, the county spent about $250,000, according to Ms. Cogan. The approach included prevention and education programs, the streamlining of processes and an administrative integration of workers comp with sick leave

claims.

One part of the program was the introduction of nurse care coordinators, registered nurses certified in occupational health, who act as liaisons among employers, employees, health plans and care providers.

The coordinators, who are employees of the consulting firm IHMA but work in county facilities, provide doctors with a better understanding of an employee's work and needs, and help employees get, among other things, medical appointments and medication. The process gives employees a faster and more effective way through the care system, said Dr. Polakoff.

In another change, the county's modified-duty program that had been in place for occupational illnesses and injuries was expanded to include non-occupational cases.

As a result, employees returned to work faster, performing light duty while healing and going back into their old jobs as soon as they were fully recovered.

The county also educated its health care plans -- Kaiser Permanente, Aetna U.S. Healthcare and Blue Cross of California -- and health care providers about the program and asked for their help in bringing people back to work faster.

Other changes in the pilot included establishing an on-site Center for Employee Health and Wellness to offer conventional

occupational health services as well as prevention programs such as:

* Offering free influenza vaccines, which brought estimated savings of two days of sick leave per person, translating into monetary savings of between $700,000 and $1.4 million annually, Ms. Cogan said.

* Introduction of an at-work walking program, which attracted about 300 people in the pilot program, said Ms. Cogan.

"People who exercise regularly are healthier," which in turn reduces costs and raises morale, she said.

The results of the pilot are encouraging, county officials say.

Instead of a planned reduction in sick leave costs of 10%, the actual numbers were closer to 20%, or $60,000 in total for the pilot group, according to Dr. Polakoff.

The normal sick leave costs for the group for six months would be about $373,000, said Ms. Cogan.

An employee survey showed an "overwhelmingly positive reaction" to the pilot program, said Ms. Musselman.

County officials are confident of the potential to save workers comp costs, as well. Those savings could be even larger than the sick leave savings, Ms. Cogan said.

Besides looking into ways to increase work safety, the pilot introduced a case manager for all workers comp cases requiring medical care.

"We want to change people's mind-set that this is an adversarial program to deny them benefits," Ms. Cogan said.

Further extensions of the program are being discussed.

Ms. Cogan said all county employees might be involved within two to three years. Countywide net savings are projected at $4.5 million, she said.

"But we want to see what happens over the year," said Ms. Musselman, "and, based on that assessment, we will roll out the program further."