David R. Anderson is manager of Control Data Corp.'s StayWell/EAR Information Services department and has been a key participant in the StayWell program since its inception. The StayWell program, developed by CDC, is a comprehensive set of health promotion products and services. Originally developed for internal use, the program is now available to business and industry through a nationwide network of authorized distributors. EAR, which stands for Employee Advisory Resource, is also marketed nationwide. EAR is a short-term counseling and referral service for employees experiencing personal and work problems. Anderson's responsibilities involve evaluating both programs to assure that they work as designed and produce the desired outcomes. Prior to joining CDC in 1979, Anderson taught psychology at the University of Wisconsin at Stevens Point.

Employers have traditionally taken the brunt of their employees' unhealthy lifestyle behavior in the form of high health care costs. That trend may come to a healthy halt, as more and more employees, in the face of losing money or benefits, will be forced to take more responsibility for their lifestyle behaviors.

This scenario may one day become a reality because of a recent study which is the first research to widely link unhealthy behavior with high health care costs.

The study and project, "Health Risks and Behavior: The Impact on Medical Costs," was conducted jointly by Control Data Corp. and Milliman & Ro-bertson, Inc., a nationwide actuarial consulting firm specializing in the health care field. The researchers who conducted the study were David R. Anderson, manager of CDC's StayWell/EAR Information Services department, and Stephen D. Brink, principal author of the study and director of health consulting for M&R.

The nationwide, four-year study of 15,000 Control Data employees was based on information gathered through the company's Stay Well health promotion program. Stay Well is a comprehensive set of health promotion products and services available nationally to business and industry.

The purpose of the study was to measure utilization and cost of medical care according to the level of risk produced by a given behavior. While other factors such as family history, age and sex also affect a person's overall health status, only behavioral characteristics can be changed. The seven major behavioral factors studied were: Exercise, weight, smoking, hypertension, alcohol use, cholesterol level and seat belt use, all lifestyle areas addressed in the StayWell program.

Costly users

The study showed that workers with the worst lifestyle habits had the largest medical bills. For example, employees who smoke a pack or more of cigarettes per day have 18% higher medical claims costs than those who do not smoke. Sedentary employees have 30% more hospital days than those who get adequate levels of exercise; seriously overweight employees are 48% more likely to have claims exceeding $5,000 during a one-year period than those at normal weight levels. The largest difference in hospital utilization was associated with seat belt usage; high risk employees used 54% more hospital days per thousand than did those at low risk.

"We believe that this study is the first to demonstrate a statistically proven relationship between a wide range of controllable risk factors and the use and cost of medical care," says Brink. "These results are particularly significant because while overall health status also depends on such factors as age and one's family and medical history, only behavior can be changed. As health costs have a substantial effect on the bottom line of U.S. businesses, the need for this new direction is clear. The relationship we have found has dramatic implications for the way health care is priced and delivered."

The analytical file for the joint study was created for the calendar year 1981-1984 by selecting from the database health care claim data, lifestyle risks and demographic characteristics for employees with one or more Health Risk Profiles, and one or more years of enrollment in the CDC health care plan during the period. This selection resulted in a file of nearly 15,000 employees with more than 40,000 total years of health care plan enrollment.

Employees who completed the Health Risk Profile were grouped according to their level of risk (high, moderate or low) on each of the seven behavioral factors previously mentioned. The researchers examined the relationship of risk level to three measures of health care usage: Medical claim costs, hospital patient days per thousand and percentage of claims over $5,000. Health care claim data were adjusted in the analysis to reflect demographic differences in each lifestyle risk factor. The resulting data were found to be representative of the U.S. labor force and consist¬ent with other national data sources where health care benefits are provided through a traditional fee-for-service plan.

Applications

"The significant differences in health care utilization and costs across lifestyle risk levels found in the study support many specific applications," says Anderson. "Several of these applications have important implications for health promotion."

One such application, one that opens up a whole new realm for insurers, says Anderson, is the development of insurance products that encourage risk reduction. Anderson says a company that is able to gather a lot of risk information about their healthy employees can use these data to get a lower premium rate.

"In turn, a company that knows they can lower premiums for reducing health risks has an incentive to help their employees control their lifestyles and they can do this through programs like StayWell," explains Anderson. Milliman & Robertson believe that if insurers start linking premiums to employees' lifestyle behaviors, employers could see those costs rise or fall 20% or more based on workers' health.

This potentially costly situation may also prompt employers to offer lower contribution requirements to those employees who practice a healthy lifestyle, thus providing employees with a stronger or more flexible benefits package. Those employees who are at higher risk for lifestyle habits within their control - exercise, weight, smoking, seat belt use - would be required to pay more as their higher medical costs dictate.

It's not unusual for employees to contribute to the cost of their health care coverage, says Anderson. According to the Employee Benefit Research Institute in Washington, D.C., 41% of the 22 million workers in U.S. companies with more than 100 employees paid part of their health insurance premiums in 1986. That's an increase of 35% from 1985.

R.O.I.

Still another application of the study and its measured relationship between lifestyle risks and health care costs is that a company can assess its return on investment. By measuring lifestyle risks among an employee group, a company can recognize which risk components and which individuals have the most likelihood for savings. The cost for reducing those risks can then be compared to the projected benefits, thereby guiding a company's investment choices.

Taking action

A very positive outcome of this groundbreaking study has been an increased awareness among employers of the link between employee lifestyle risks and health care costs. The awareness has begun to fuel action, with more and more employers now implementing health promotion.