STUDY LINKS WELLNESS, COSTS

As do many employers, Chevron Corp. and Marriott International Inc. wondered whether they were conducting enough disease prevention programs to make a dent in overall health care costs.

But the two companies found that preventive programs were, for the most part, uncharted territory. For example, up-to-date data on helping depressed employees find therapy and support programs didn't exist or didn't yield a clear statement on how much the help would improve the companies' bottom line.

Chevron already believed it was doing quite a bit in the area of health services. The San Francisco-based gasoline and chemical company covered preventive health exams at 100%, gave free prenatal health care and maintained fitness centers for its workers, said D'Ann Whitehead, manager of preventive health services.

In the case of Marriott, the Washington-based company already was running some wellness programs out of its corporate headquarters, though most of the hotelier's far-flung workforce had to settle for whatever preventive programs their health maintenance programs offered, said Karen King,

director of benefit operations.

Marriott and Chevron, along with four other large employers, recently engaged in a study to see if such risk factors as stress, depression and diabetes could be associated with higher medical costs. Although this causal relationship has been assumed widely by human resources professionals, the six employers wanted to know just how cost-effective it could be to pinpoint high-risk employees.

The other four employers were: Health Trust Inc., now part of Columbia/HCA Healthcare Corp.; Hoffmann-LaRoche Inc.; and the states of Michigan and Tennessee.

The study, conducted by Birmingham, Ala.-based Health Enhancement Research Organization, underscored what most employers expected but, until now, had no solid evidence of: spotting and treating high-risk workers saves money on the outcomes side of the equation.

The study looked at the experience of 47,500 employees between 1990 and 1996.

Depression, as detected by answers to a common questionnaire used by all six companies, proved to be the most reliable indicator of high medical costs ahead. Employees who reported feelings of depression averaged 70% higher medical costs than those who said they weren't depressed.

Workers who reported feeling stress had 46% higher medical costs than those who did not report stress.

Benefit managers and providers who have shown "a certain tendency to limit coverage for mental and nervous disorders," may in fact be driving medical costs up due to scant preventive programs, said R. William Whitmer, president and chief executive officer of HERO.

"It may be that you should be more aggressive" in detecting emotional problems, he said. "I think this will simply draw attention to the psychosocial diseases that are treatable."

Workers may not wish to disclose feelings of depression or stress to their employer, however. For example, on the HERO questionnaire, only 2.2% of employees indicated they were depressed, and 18% said they were stressed, though many more may have not given open answers for fear of being confronted by employers, Mr. Whitmer said.

Benefit consultants say that some benefit managers might use the study as impetus for additional programs to promote health.

"There will be a mixed bag of reactions out there," said Leslie Schneider, a principal with Buck Consultants Inc. in Atlanta. "Employers have really tried to keep their mental health costs down."

Some employers likely will decide to allow more dollars to be spent for oral medication or therapy to combat depression and stress, and "many employers will want to wait to see what other groups do," she said.

Another consultant was even more confident that wellness programs will garner more corporate funding in the future.

Veronica Hellwig, a senior consultant in the Wellesley Hills, Mass., office of Watson Wyatt Worldwide, noted "there has been a spotlight on prevention and wellness programs" during the past several years.

Employers can find out if this is cost-effective, she said, through the pooling of employment data in surveys such as that conducted by HERO. "I think benefit managers talking to their common (information) vendors about collaborative opportunities makes a lot of sense," she said.

Employers may think they are doing enough in the preventive medicine realm, but few are putting theory into action, said Ron Goetzel, a vp with the MEDSTAT Group in Washington who was the lead author of the HERO study. Only 3% to 5% of corporate medical budgets is spent on prevention activities, he said.

The study "is really the first step in the process of providing documentary evidence of the cost benefits of health promotion," he said.

Marriott's Ms. King said she believes a strong relationship exists between the mind and the body. Poor health in either can lead to "higher absenteeism, higher long-term disability, all of that. We would rather prevent illnesses than cure illnesses."

Free copies of the study, "The Relationship Between Modifiable Health Risk and Health Care Expenditures-An Analysis of the Multi-Employer HERO Health Risk and Cost Database," are available from the Health Enhancement Research Organization, 205-988-4417.