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Integrating Walk With Ease into a Benefits Structure: A Model for Employers

State: Pennsylvania

Submitted Date: 2020

Public Health Issue

The Commonwealth of Pennsylvania's health statistics office estimates that healthcare professionals have diagnosed 30% of Pennsylvanians and more than 1 in 4 Philadelphians with arthritis.1 Arthritis and other musculoskeletal conditions have a broad and lasting impact including physical limitations and poor mental health. Arthritis also has a significant financial impact on both the individual and their employer. 

Osteoarthritis causes higher direct medical and indirect costs for employers. A study using large self-insured employers' data to identify incidental damages, including short-term disability, workers’ compensation, on-the-job productivity, and absenteeism demonstrated that the resulting mean total care costs for people with osteoarthritis is $17,751 annually compared to $5,057 for those without arthritis.2 Further, the United States Bone and Joint Initiative details employees with musculoskeletal conditions reported losing an average of 14.3 workdays in the last year.3 

Treating arthritis can be expensive. Osteoarthritis was the costliest condition in "The 20 most expensive conditions billed to private insurance, 2013."4 Data from the same source shows it was the second most expensive condition treated in the hospital, costing more than $8 billion annually. However, increased physical activity, medication adherence, participation in self-management education, and living in community environments conducive to safe and active mobility can help mitigate the economic effects while improving quality of life. 

  1. Pennsylvania Department of Health. https://www.health.pa.gov/topics/HealthStatistics/VitalStatistics/CountyHealthProfiles/Documents/current/maps-behavior.aspx#arthritis
  2. Crockatt, S Targett P, Cifu D, Wehman P. Return to work of individuals with arthritis: A review of job performance and retention. Journal of Vocational Rehabilitation 30 (2009) 121–131 121. DOI 10.3233/JVR-2009-0458
  3. Bone and Joint Initiative, USA. https://www.boneandjointburden.org/docs/bmus_e4_t3a.4.1.2_0.pdf
  4. Torio CM, Moore BJ. Statistical Brief #204. National Inpatient Hospital Costs: The Most Expensive Conditions by Payer, 2013. Rockville, MD: Agency for Healthcare Research and Quality; 2016. Available: https://www.hcup-us.ahrq.gov/reports/statbriefs/sb204-Most-Expensive-Hospital-Conditions.jsp?utm_source=AHRQ&utm_medium=AHRQSTAT&utm_content=Content&utm_term=HCUP&utm_campaign=AHRQ_SB_204_2016
Program Action

The National Association of Chronic Disease Directors (NACDD) collaborated with MedWorks Consulting LLC, Health Promotion Council (HPC), and the Greater Philadelphia Business Coalition on Health (GPBCH), collectively “the project team,” to educate employers in the Greater Philadelphia region about Walk With Ease (WWE). The Arthritis Foundation developed the group program to promote increased safe physical activity for people with arthritis and related musculoskeletal conditions. WWE is also offered in a self-directed version where participants adhere to a program guide consisting of six chapters to be read and followed over the course of six weeks. WWE has been shown to reduce pain associated with arthritis, and increase balance and strength, while improving overall health.1 The Centers for Disease Control and Prevention (CDC) classifies the WWE program as an Arthritis Appropriate, Evidence-Based Initiative (AAEBI).

Developing relationships and partnerships between public health and employers is critical to raising awareness about the burden of arthritis and moving the needle on arthritis care. Employers are financial stakeholders with a direct interest in the health of their employees, dependents, and the broader community. Employers also are interested in the overall health of their employees as it directly affects their on-the-job performance. When employers fund worksite wellness efforts by adopting CDC-identified initiatives, they are joining an effort that links their actions to existing community actions. In the long run, wider adoption of CDC-identified opportunities by both employers and the community can also lead to increased awareness and support of such initiatives among local clinicians.

The project team marketed WWE to GPBCH members as an opportunity to promote physical activity for employees with musculoskeletal conditions. The team followed up with employers who responded to the promotional efforts and engaged other organizations that met their target criteria such as organization size, industry sector, self-insured benefits, and readiness to implement WWE as a sustainable, physical activity component of worksite wellness efforts and as an employee benefit.

Employers were offered a variety of options with respect to WWE implementation:

  1. Embed WWE into an existing wellness program offering;
  2. Select WWE as a standalone in-house program; or
  3. Partner with a community-based organization (e.g., HPC) to administer the program and provide enrollee support, track participation, and more.

1. Arthritis Foundation. https://www.arthritis.org/health-wellness/healthy-living/physical-activity/walking/walk-with-ease/Walk With Ease-about-the-program

Impact

To date, the project team has engaged seven employers. The size, culture, and infrastructure of the organizations differ, providing additional information about different types of employers and what they are looking for when offering a wellness initiative such as WWE. The project team refined the approach for engaging employers and developed tools to help them understand the investment and the benefit to employers, partners, and employees.

While most employers are still in the early stages of engagement, requiring ongoing conversations to assess capacity and approach to WWE implementation, two employers have agreements in place to begin providing the program to their employees.

One employer, Resources for Human Development, started offering WWE in September 2019; one cohort completed the program in November 2019 and a new group began in February 2020. To date, 249 employees enrolled in WWE. Initial data from RHD shows that implementation of WWE had a positive impact on physical activity, improved physical and mental health, reduced activity impairments, and had a positive impact on workplace productivity. There are plans to develop a separate "What's Working" story in the future that will include a complete account of their successes and challenges.

The other employer, Inframark, has postponed the start of their WWE program due to COVID-19.

Contact
Lisa Erck, MS
National Association of Chronic Disease Directors
(843) 882-3015
eerck@chronicdisease.org