Women’s health programs: Disease management’s next big thing?
Employers are seeking osteoporosis, depression programs
As a growing percentage of women enter the workforce, employers are scrambling to compile benefits packages capable of attracting the best and brightest. As a result, programs tailored to the specific needs of working women have become the hottest properties in disease management, representing significant opportunities for your managed care organization or disease management company, experts say.
"If you look at the data, you really see that, compared with men, women have more acute and chronic conditions, they have more physician visits, and they have more illnesses that are preventable, if you use appropriate screening," says Veronica Goff, a director at the Washington (DC) Business Group on Health (WBGH). "And women are still an increasing population in the workplace. So if you look at those two pieces of information, it makes sense that employers are starting to look at how the health plans that they work with are able to respond to women’s health needs."
One decisive factor in the health care purchasing decisions employers make is the type of disease management programs plans can offer for women employees, Goff adds. "What we hear from employees is that they will be looking more in that area," she says. "Because if you really want to save money, we really need to start doing a better job at managing chronic and recurring conditions. In that way, the disease management model is extremely useful because it allows us to target resources much more efficiently. And I think there will be more employers who’ll want to think about how they allocate their resources by taking a disease management focus."
A survey of companies
Recently, the WBGH released "Corporate Strategies for Women’s Health," a survey of 94 member companies who purchase health care coverage for more than 39 million workers, retirees, and family members. The companies represented were diverse in size, with 20% having 5,000 or fewer employees and 40% having more than 25,000. A few companies reported having more than 200,000 employees.
Major findings of the survey include the following:
• Managed care options consistently provide routine coverage for the widest array of services, particularly in the areas of preventive screening and health promotion for women (see chart, p. 3.).
• Women’s health care services receiving the most attention are breast cancer screenings and prenatal services.
• Women’s health care services given the least attention are programs for depression and osteoporosis.
• Although mental health and substance abuse services are widely covered, full parity for mental health coverage is rare (see chart, p. 3).
• Employers commonly make educational materials and company policies available for sexual harassment and work site violence but rarely for family violence.
The WBGH also found that employers are increasingly focusing on patient-centered outcomes measurements in making health care purchasing decisions, Goff reports. "We’ve been saying for years how we want to buy quality; we don’t just want to buy on cost," she says. "But the reality is there haven’t been very good measures that indicate quality or value." Now, however, with the advent of the Portland, OR-based Foundation for Accountability and reforms to the Washington, DC-based National Committee for Quality Assurance’s HEDIS outcomes tool, such measurements have become more "consumer-focused," Goff says. "That’s pretty different from what happened in the past."
When asked about what women’s health issues their companies will target over the next five years, corporate benefit managers listed the following responses, according to the WBGH survey:
• A large number of companies reported that they plan to expand their benefit coverage and work site health promotion programs in the areas of prenatal care, breast cancer detection, menopause, osteoporosis, and depression.
• A moderate number of companies reported that they would develop or expand lactation support, cancer screenings (including cervical), heart disease, high-risk pregnancy, and post-natal care.
• A smaller number of companies expressed a commitment to improving or developing programs in nutrition, domestic violence, repetitive motion, injury prevention, health risk appraisals, smoking prevention for pregnant women, and annual physicals.
• A few companies expressed interest in improving their wellness programs by adding health risk assessments geared to women and wellness services by phone and by mail.
• Several companies said they would implement work/family programs.
• Several companies reported that they plan to design self-care programs to promote women’s health.
Experts point to osteoporosis and depression as two major opportunities for disease management companies and MCOs to attract corporate contracts. Osteoporosis affects about 20 million American women, with annual health care costs in the range of $10 billion, according to the WBGH. The obstacle to developing effective osteoporosis programs in the past has been the high cost of bone-density screening, a procedure that typically costs between $200 and $300 per test.
"So if you do a cost-benefit study, it’s been determined that to use that test for screening, the way you would cholesterol screening, is not cost-effective," says Janet Meleney, RN, MA, director of the Osteoporosis and Related Bone Diseases National Resource Center, an affiliate of the National Osteoporosis Foundation in Washington, DC. "That doesn’t mean it’s not needed, but it’s usually done in combination with somebody who’s already identified to be at risk of the disease."
Nevertheless, Meleney cites Washington, DC-based Federal National Mortgage Association’s (Fannie Mae) osteoporosis program as a model for how companywide osteoporosis screening can work. (See related story on employer case studies, above.) The program, developed in cooperation with the National Osteoporosis Foundation, offers screening to all female workers and family members, regardless of their age. "They found far more [cases] than they expected," Meleney says. "It’s not necessarily that those people had even reached a point where they’re likely to be fracturing, but they’re certainly in a much higher risk group for future fractures."
Meleney adds that because of Fannie Mae’s example, some companies "might very easily decide that prevention activities are worth the cost, especially if they are planning to keep their employees a long time."
Depression programs are also likely to be in high demand, as new and more effective primary care screening tools are developed, Goff says. "But I think there’s still a lack of understanding about the real costs around depression," she adds. The WBGH estimates that depression affects one in every seven American women.
Maxine Brinkman, BSN, director of Women and Children’s Services at North Iowa Mercy Health Center in Mason City, IA, and president of the National Association of Women’s Health Professionals in Chicago, stresses the importance of behavioral health care because it can affect every aspect of a woman’s physical health.
Survey shows mental health biggest concern
Last year, North Iowa Mercy, the largest employer of women in North Iowa, conducted a survey of its female employees and "came back with the shock of our lives, that psychosocial issues were their biggest health concern," Brinkman says. "It was domestic violence and depression and sleeplessness and stress. We had set up typical health risk screenings for things like breast cancer and osteoporosis. But even if you get osteoporosis screening, if you don’t make behavioral changes to increase your calcium or take hormone replacement, what good does it do?"
The key to addressing the issue of behavioral change is to take a "holistic approach" incorporating the woman’s overall life situation, Brinkman adds. "If you’re 100 pounds overweight and you’re a victim of domestic violence and you’re a single parent, I’m sure you’re not interested in the fact that we’re putting in a new jogging track," she says. "So when we’re not treating underlying issues, all we’re doing is frosting a sick cake."
[For more information on women’s health, contact: Maxine Brinkman, BSN, director of Women and Children’s Services, North Iowa Mercy Health Center, 1000 4th St., SW, Mason City, IA 50401. Telephone: (515) 422-7000. Veronica Goff, director, Washington Business Group on Health, 777 North Capitol St.,NE, Suite 800, Washington, DC 20002. Telephone: (202) 408-9320. Janet Meleney, RN, MA, director, Osteoporosis and Related Bone Diseases National Resource Center, 1150 17th St. NW, Suite 500, Washington, DC 20036. Telephone: (202) 223-0344.]
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