Jefferson commits to make health care employees walk-the-walk and get fit

The Thomas Jefferson health system is midway through what it hopes will be a transformation - improving the health of employees and then creating a new wellness model to market to area businesses.

Two years ago, after its own health-care costs rose 22 percent in one year, Jefferson implemented a series of incentives to encourage its 12,000 employees to get fit, including a 15 percent discount in what employees pay for health insurance if they meet certain criteria.

"We tried to introduce wellness as a culture," said Pamela Teufel, chief human resources officer.

To prove its commitment to employees, this fall Jefferson started a pilot program with EXOS, a fitness company based in Phoenix that has helped train military special forces. Jefferson built a 1,000-square-foot EXOS gym at the Myrna Brind Center of Integrative Medicine in Center City, which Teufel hopes is just the beginning. She has visions of a 20,000-square-foot facility.

If Jefferson can document the results it expects to achieve, it will try to use them and its name to market a wellness program to companies around the region.

Jefferson might open a clinic on site, offer tele-health access to clinicians, or help with nutrition, stress relief, all aspects of health.

For instance, an employer could ask employees to set fitness goals for the coming year, said Stephen Klasko, Jefferson's chief executive officer, and Jefferson's team would help it achieve it.

"It's a benefit from a very good employer," Klasko said, "but it's powered by Jefferson."

That's the vision.  Experts outside Jefferson say this field is crowded with competitors and Jefferson must prove its product worthy. 

First, Jefferson must get its own unhealthy house in order.

Jefferson is self-insured, meaning that it provides health insurance for its own employees.

And those costs went up 22 percent in 2012.

"We're caregivers, so how are we going to take care of patients if we're not healthy?" said Teufel. "Traditionally, health-care workers are some of the unhealthiest."

Sixty percent of employees didn't have a primary care physician, she said. Rates of obesity, high blood pressure, and diabetes were higher than average for the region.

The hospital pays 75 percent of health insurance premiums, and employees pay 25 percent, deducted from their paychecks.

The total Jefferson paid out in claims in 2014 was $105 million, Teufel said. If it could slow the growth in claims, she said, it could slow the increase in premiums that workers pay.

"We did a huge amount of education with employees," she said. " 'Look, if you're healthy, we're healthy.' "

The first thing Jefferson did was create incentives.

If you went to a dentist, a primary doctor, got biometric screening, exercised regularly, attended meditation class - a range of inducements - you earned points.

Enough points and you got the 15 percent discount.

The company offered classes in retirement planning and personal finance. Research showed employees took better care of themselves after such help.

It offered classes on "mindfulness" at the Brind Center. It gave employees a $650 cut in insurance if they didn't smoke - incentive to quit.

Teufel says 30 percent of employees have qualified for the discount, and improvements have been dramatic. Overall costs have not come down but the rate of increase has plummeted.

After that 22 percent increase in fiscal 2012, Teufel said, costs went up only 5 percent in 2014 and are projected to be up only 1.5 percent midway through fiscal 2015.

She said Jefferson has seen an increase of 16 percent in preventive care, primarily in mammograms and colonoscopies, and an 8 percent reduction in emergency room visits.

 She said biometric screenings detected diabetes and cancer, saving lives.

Last fall, it added EXOS.

Lisa Stanton, 34, is a secretary in the department of otolaryngology (head and neck surgery), what she calls her "OTO family." She is in many ways a typical employee - dedicated to patient care but not so devoted to her own health.

A year ago, weighing 260 pounds, she got diabetes, prompting a dramatic change in attitude and behavior. She changed her diet and dropped 40 pounds, getting her disease under control.

When she heard Jefferson was offering EXOS - a 12-week program with a personal trainer and nutritionist - "I was pretty much a stalker," she said, "calling every week."

She began three weeks ago, in a second round of 120 employees. She's in the EXOS gym three times a week at 6 a.m.

She is at 218 pounds, determined to be under 200 - "I don't care if it's 199.9" - when she and her husband hit Punta Cana, Dominican Republic, in May.

"I think for my height, I'm supposed to be 120 pounds or something," she said. "That's never going to happen. I don't think I came out of my mother's womb at 120. But if I got to 160 or 170, I'd be very happy."

The exercise machines are computerized, "registering every set and rep and pressure and movement the individual is doing and tracking them over time," said Jeff Terrill, EXOS president.

"Not only will it adjust, to increase or decrease your workout as necessary, tailor it perfectly for you," Terrill added, but it also will provide Jefferson with analytics to help measure how effective the program was for employees.

Stanton said she loves working with the personal trainers, getting advice from the nutritionist.

With data, she thrives on knowing if she's getting stronger, slimmer, faster, and developing better balance and more endurance. "The one thing I love best about Exos is you arrive, log-in, and start your workout," added Stanton. "There is no thinking involved! The exercises change every workout and all are challenging." The program costs her $50 a month for three months. She considers it a bargain.

She pays about $120 every two weeks for health insurance for her and her husband, she said, and because of the 15 percent discount, her costs "basically stayed the same this year."

Amanda Melendez, 33, in infection control, signed up for the first EXOS session last fall and took a last-minute vacancy to continue in round two.

"I'm already at work," she explained. "It's easy for me. It's structured. If I go home, there's homework and dinner and laundry, and I never get to the gym. Here, everything is in one station. So it's mine. I have one hour to myself."

Cynthia Sanoski, a pharmacist, is also doing EXOS a second time.

"I hate exercising," Sanoski said. "But I enjoy doing this a lot. It has variety. I've noticed my energy has improved. I've noticed a difference in balance. Last week I started slipping on the ice and I caught myself."

She is no lighter, but lost three inches off her waist. And improved her diet.

"I think it's put me in a routine," she said. "That's why I did it for 12 more weeks. So, after 24 weeks, I hope I can continue to the gym on my own."

That is the big question. Will Sanoski, Melendez, Stanton, and others continue these new behaviors for years to come?

Terrill, the EXOS president, said that because of relationships built with staff, and the focuses on mind-set, nutrition, and recovery rather than just exercise, individuals get more invested and long-term results are better.

That's what Jefferson is hoping for. If the pilot programs work well, Jefferson may offer EXOS free to employees who could benefit from it most.

It would also include EXOS as part of its new wellness model offered to area companies.

Investing in employee health is laudable. Lasting results are hard to achieve.

Kevin Volpp, director of the Center for Health Incentives and Behavioral Economics at the University of Pennsylvania, said "80 to 85 percent of larger employers in the U.S." give some incentives for healthy behavior.

"The underlying premise is tricky," said Volpp, a physician and professor in both the medical and business schools. "It's very hard to save money by getting employees to exercise more. ... It's really hard to get those who don't exercise at all to get going. There's lots of evidence that making services free to people who are high-risk rarely translates to high utilization rates."

He added that "we have to see some peer-reviewed data to feel confident this program achieves what it purports to achieve." As for taking the show on the road, Volpp said, "It's a crowded market," with many competitors.

Volpp agreed that "it's unusual for a health system" to enter this market. He calls what Jefferson is attempting "inherently challenging."

"Whether they're successful," he said, "depends on how good the underlying solution is and how effective they are at convincing employers that what they're offering is better in quality and price."