Economic Impact of the Wellness Fitness Initiative

1
Economic Impact of the Wellness Fitness Initiative
Kerry Kuehl MD DrPH Department of Medicine Oregon
Health Science University

2
Cost of Injury and Illness

• In the U.S., total direct and indirect costs
  associated with work-related injuries and
  illnesses are gt 150 billion or nearly 3 percent
  of the gross domestic product (Leigh et al.,
  2000).
• Injuries are responsible for the majority of
  those events, with illness accounting for only
  15.
• These costs are three times that of Alzheimers
  disease and nearly equivalent to the costs for
  cancer.

3
High Risk Combination

• Fire fighters have health risks similar to the
  average American and their work is more
  physically demanding
• This combination places FF at high risk for
  heart disease
• Leading cause of death fighting fires is heart
  disease

4
Risks are similar to other Americans
65 gt 3 cardiac risk factors 40
gt 4 cardiac risk factors

• Sedentary lifestyle
• High fat diet
• Obesity
• Dyslipidemia
• Diabetes
• High blood pressure

5
Background

• The overall economic impact of work-related
  injuries and illness is high.
• Firefighters are an especially high-risk group
  for musculoskeletal injuries and other
  work-related health problems.
• New means to reduce work-related illness and
  injury are needed.

6
8.6X more injuries among FF than private industry
7
Most Hazardous Occupation

• The fire service is one of the most hazardous
  occupations. The incidence of work-related injury
  is eight times that of private industries.
• NFPA estimated gt 80,000 firefighter injuries
  occurred in the line of duty in 2005.
• This was an increase of 5.6, and the highest
  rate since 2002 (Karter Molis, 2006).

8
Incidence of FF Injuries

• Each year, approximately one-third of the more
  than one million U.S. firefighters sustain a work
  related injury.
• National Institute of Standards and Technology
  (NIST) released a study that estimated the 2002
  costs of injuries and efforts to prevent them
  was from 2.8 billion to 7.8 billion per year
  (TriData Corporation, 2005).

9
Balance Sheet OUT
WFIScreening
? Costs of Testing treadmill
stress test strength physical
exam flexibility laboratory tests pulmonary
functions body weight/ fat dietary history
mental health
Many benefits are long-term and wont show up on
a short term economic analysis.
? Costs of Follow up (evaluation abnormal
results, injuries during testing)
? Costs for a Program

Balance Sheet SAVED
10
Comprehensive Medical

• Lipids
• Bloodwork
• BP
• Aerobic Fitness
• Lung Function
• Strength
• Flexibility
• Body Comp
• Questionnaire

11
Testing Only
12
500-1000
Dollar Costs per Firefighter for Testing Only
treadmill stress test physical exam laboratory
tests strength flexibility pulmonary
functions body weight/ fat dietary history
250
100
Full Meal Deal Minus Stress Test Labs Surveys
13
What Level of Testing Is Cost Effective?

• Cost to diagnose 1 case of hepatitis 10,000.
• Cost to diagnose 1 FF with CHD 100,000.
• Hepatitis Quality-Adjusted Life Year (QALY)
  10,000 per QALY for Blood Test.
• CHD 100,000 per QALY for Stress Testing.
• Standard Index for a Cost-Effective Procedure is
  lt 50,000 per QALY.
• Not Cost-Effective to Stress Test all FF.

14
Follow-up Costs For Abnormal Blood Test Liver
Enzymes
Test Number Cost Total Cost
Chem-20 600 11 6600
Follow-up Lab 30 75 2250
Hepatitis Panel 5 250 1250
To identify 1 case of asymptomatic hepatitis
Total 10,000
15
Follow-up Costs For Abnormal Stress Tests
TEST NUMBER COST TOTAL
Stress Test 600 250 150,000
Thallium/Echo 70 1000 70,000
Cardiologist 10 250 2500
Cardiac Cath 10 (3 Severe CAD) 2500 25,000
Bypass Surgery 2 25,000 50,000
Coronary A Stent 1 7,500 7500
Total 305,000
To identify 3 FF who have severe CAD
16
Considerations of Test Selection

• Additional follow-up costs must be considered
  when selecting test
• In addition to picking the package, consider the
  risk profile of those being tested
• Risk Stratification to identify those at high
  risk is cost effective (i.e., not cost effective
  to stress test all FF annually)

17
Balance Sheet IN
Short Term and Long Term Benefits Of A Wellness
Program
WHAT IS THE BOTTOM LINE?
Preventing Injury
Reducing Costs
Decreasing Morbidity and Mortality
18
Business Case For Worksite Wellness

• Majority of studies show positive ROI 3
• Negative studies not published
• Threats to validity (self selection, low
  participation, high dropout, effects difficult to
  measure)
• Savings about 250/employee at 4 years
• What about the fire service?

19
Economics of Fire Fighter Wellness

• Clearly, in other industries, research supports
  the cost-effectiveness of worksite wellness
• Wellness programs among fire fighters less
  obvious
• One of major roadblocks in preventing fire
  departments from implementing WFI is concerns
  about return on investment (ROI)

20
COST OF MAINTENANCE REPAIR (Percent of Budget)
Fire Apparatus Firefighter
Maintenance 70 3
Repair 30 97
TOTAL 100 100
21
Is FF Wellness Cost-Effective?

• Phoenix 6 years after implementing wellness
  program, severity of injuries decreased by 46.
• Wichita 50 reduction in sick leave after
  implementing fitness program.
• South Pasadena Injury rates reduced over 50
  after wellness program introduced.
• PHLAME program in Oregon (retrospective)

22
Injury rates among PHLAME and Non-PHLAME fire
bureaus
23
FD Savings From Reduced Injuries As Compared to
1999

2001
2002
Cost Savings/FF 1353
1600 Total (687 FF) 929,511
1,100,200
24
IAFF Awards OHSU Grant To Review Economic Impact
of Wellness Fitness Initiative

• In 2006-2007, the original 10 cities WFI task
  force fire departments contacted
• Site visits with HR and RM to review data
  availability diversity, and complexity
• 8 departments collected long term data with
  accessible computer data base
• Retrospective study and data analysis

25
Fire Department Personnel WFI Participation Rate in 1997 WFI Participation Rate in 2004
Austin 1032 CONTROL CONTROL
Calgary 983 CONTROL CONTROL
Fairfax Co 1280 65 85
Indianapolis 780 70 95
LA County 3013 10 55
Miami-Dade 1900 CONTROL CONTROL
Phoenix 1588 70 90
Seattle 1015 CONTROL CONTROL
26
Outcome Data

• Data represents aggregate or average of 4 WFI and
  4 Non-WFI fire departments with no ability to
  identify individual FD claims
• Occupational Injury/Illness Claims
• Total Incurred Costs
• Number of Lost Work Days (LWD)
• Average Cost Per Claim

27
RESULTS

• The mean total claims, lost work days, and total
  incurred costs represent service or occupational
  benefits paid per fiscal year for a department.
• Data from these fire departments do not include
  any non-occupational claims and costs due to
  difficulty with tracking this information through
  private insurance and individual medical
  providers.

28
Occupational Claims Between WFI and Non-WFI
Departments
Claim Date WFI Claims Non-WFI Claims
1991-1997 Totals 3,033 2,459
1998-2004 Totals 3,210 3,023
Percent Change 5 Increase 22 Increase
Statistically significant at plt.05
29
Total Incurred Cost Between WFI and Non-WFI
Departments
Claim Date WFI Costs Non-WFI Costs
1991-1997 Totals 21,695,644 17,055,723
1998-2004 Totals 22,276,143 26,991,766
Percent Change 3 Increase 58 Increase
Health care costs increased 7 annually past
decade
30
Lost Work Days Between WFI and Non-WFI
Departments
Claim Date WFI Lost Work Days Non-WFI Lost Work Days
1991-1997 Totals 40,611 26,747
1998-2004 Totals 31,671 41,388
Percent Change 28Decrease 55 Increase
Some departments had lost hours or did not have
lost time calculated
31
Average Cost Per Claim Between WFI and Non-WFI
Departments
Claim Date WFI Average Cost / Claim Non-WFI Average Cost / Claim
1991-1997 Totals 56,845 47,912
1998-2004 Totals 46,225 64,608
Percent Change -23 Decrease 35 Increase
Calculated from Total Incurred Cost divided by
Number of Claims
32
(No Transcript)
33
DISCUSSION - COSTS

• Total incurred costs increased 82,900 per year
  per WFI department and increased 1,419,435 per
  Non-WFI fire department per year (adjusted to
  2001 dollar amounts).
• A difference of 1,336,535 per year was saved per
  WFI fire department as compared to Non-WFI
  department.

34
CONCLUSION

• The information presented suggests there is an
  immediate reduction of occupational
  injury/illness claims and costs among fire
  departments that implemented the IAFF/IAFC
  Wellness Fitness Initiative as compared to fire
  departments that did not implement the WFI.

35
CONCLUSION

• The results also demonstrate that the WFI fire
  departments have a lower rate of increasing
  claims and costs while decreasing lost work days
  and average cost per claim.
• The fact that lost work days and average cost per
  claim are reduced suggests that injury/illness
  severity is reduced, especially in the face of
  rising healthcare costs greater than the rate of
  inflation.

36
CONCLUSION

• Adoption of the WFI confers a savings in the
  short term.
• Long-term economic benefit will be greater by
  addition of a health promotion program through
  prevention and early treatment of fire fighter
  musculoskeletal injuries, cancer, and
  cardiovascular disease

37
LIMITATIONS

• Limitations of this study
• Retrospective
• Data in various sizes, shapes, missing data
• Dosage effect and participation rate varied
• Further research with prospective study needed to
  answer this question of economic benefit of fire
  fighter wellness.

38
FUTURE DIRECTIONS

• We have submitted a grant to CDC and NIH in
  cooperation with the IAFF of a health
  promotion/injury-reduction program for
  firefighters utilizing PFTs with WFI.
• The proposal builds on prior NIH-funded behavior
  change research with firefighters including a
  cost-effective analysis

39
PROSPECTIVE STUDY

• In addition to workmans compensation and
  absenteeism claims, we also will track
  intervention costs, which might be referred to as
  opportunity costs, or the costs that would be
  avoided by forging the intervention.
• Those include direct cost of the program, salary
  of labor inputs (interventionists, scheduling
  personnel), program materials, and management
  inputs.
• Addition of PHLAME Behavioral component

40
THANK YOU!