Introduction

This month GBCHealth presents Lafarge North America’s award-winning health and productivity program, Building a Better You. The program uses wellness and nutrition interventions, financial incentives, free preventive health screenings, and a focus on total health management, to improve the health of its employees and their dependents.

Lafarge, a global construction materials producer, employs over 65,000 people in 75 countries. In North America, the average age of Lafarge’s workforce of 12,000 employees is 46 years old. Among aging populations, chronic diseases are a significant cause of sickness and death, and the company identifies chronic disease as the number one health issue facing the workforce.

According to the U.S. Centers for Disease Control and Prevention (CDC), chronic diseases are the leading causes of death and disability in the United States. Seven out of 10 deaths among Americans are due to chronic disease, with heart disease, cancer and stroke accounting for 50% of all deaths each year. One in every three adults is obese, putting them at high risk for diabetes, the leading cause of kidney failure, lower-extremity amputations, and blindness.

As a result of the Building a Better You program, Lafarge’s annual medical costs have fallen below the market average, saving $30 million in avoidable expenses. The program was awarded Canada’s Good Life Health and Wellness Award this month, the Integrated Benefits Institute and National Business Coalition on Health award in 2010, and the Greater Washington DC Human Resource Leadership Award for Innovation in 2010. It received an honorable mention for the Shape Up the Nation’s Producer Award for the U.S. wellness program that has yielded the most impressive outcomes and return on investment in 2012.

GBCHealth shares this case study of Lafarge’s Building a Better You program as a best practice example of developing targeted interventions that produce measurable change in health outcomes and costs.

Case Study | Lafarge’s Building a Better You Program

About the Program

Lafarge's Build a Better You Program

Prior to the establishment of the program, many Lafarge employees with chronic conditions were not using preventive health care services or taking appropriate medications. They waited until their untreated health conditions became acute emergencies before they accessed care, resulting in excessive medical bills. From 2001 to 2006, the company saw a $5.8 million increase (a 13% increase each year) in catastrophic claims and a 200% increase in the long-term disability rate. To combat these rising costs and to improve employee health, Lafarge introduced the Building a Better You program in 2007.

Instead of shifting costs to employees through higher deductibles and cost-sharing requirements, Lafarge offered:

Free, preventive, on-site, full biometric screenings and lab tests including blood pressure, BMI, cholesterol, prostate cancer, and others to identify and increase awareness of health conditions;
No-cost preventive care visits to in-network providers, including well-woman exams, mammograms, colorectal cancer screenings and PSA tests;
A fitness component called Lafarge Get Active!, a team based, eight week competition that focuses on activity, weight loss and achieving at least 10,000 steps a day. Employees and spouses are eligible to participate, and pedometers, a device for counting one’s steps, are distributed to all participants;
Tobacco cessation, weight loss and stress management interventions offered through the Enforcer Coaching program, led by Dr. Michael Roizen, Chief Wellness Officer and his team at the Cleveland Clinic. The programs focus on behavior change and one-on-one e-coaching. To date, over 900 people across the U.S. and Canada are participating in the program;
A nutrition focus that includes eliminating sugared sodas from on-site vending machines and providing education to employees and their families to learn about proper food choices, portion control and how to grocery shop for the most healthy foods;
Value based formularies in the U.S., which charge less for medications for the most common health conditions such as high blood pressure and diabetes;
Financial incentives to increase employees’ and spouses’ participation and use of all the benefits and programs made available to them.

In addition to significantly reduced co-payments for medications to manage the most common chronic diseases, employees and spouses who participate in either an on-site health screening, an annual wellness exam or an annual cancer screening receive a $75 gift card. In the U.S., those who complete an online health assessment and participate in an on-site health screening and don’t exhibit risk factors for Metabolic Syndrome (a group of risk factors that occur together and increase the risk for coronary artery disease, stroke, and type 2 diabetes) receive a $500 discount on their annual health insurance premium. If the employee is at risk, then s/he must enroll in the Enforcer Coaching program for a minimum of 90 days, or submit a physician affidavit that states he/she is medically incapable of reaching the appropriate lab result goals, in order to qualify for the $500 premium credit.

Building a Better You integrates all clinical resources and benefits through a dedicated team of Lafarge employees and vendors. For example, Aetna provides disability and disease management, and group health services, ensures that participants have a nurse to assist and provides Lafarge with health data. Pharmacy data is integrated with Aetna’s data through a Thomson Reuters database that keeps track of disability and medical claims. By measuring employees’ health outcomes with rigorous data collection and analysis, the program is able to ensure compliance to prescription drug regimens for employees with chronic conditions, leading to reduced absenteeism.

Results

Lafarge employee Andrea Cartwright shares her weight loss insights

As a result of the Building a Better You program, company health care costs per enrollee have declined significantly. The average claim amount has fallen to its lowest level in five years. For example, in 2006 the per-employee per-year cost of diabetes was $9,429. After the program, the cost fell to $6,895, representing a 27% reduction.

Employee participation in the management of chronic diseases and prescription compliance has increased, and the completion rate of health risk assessments grew from 29 percent in 2006 to 90 percent in 2011. Their use of preventive services has increased by approximately 20% for cholesterol screening, colon cancer screening, mammograms, and prostate cancer screening. Employees who participated in a Depression Disease Management Program showed a 40% improvement in their average mental health score. Emergency room visits have plummeted, hospital admissions fell by 5.5% in 2011, there are fewer heart attacks, and cancers are being diagnosed earlier in stage 1 or 2 instead of stage 3 or 4.

About 5,050 employees participated in Lafarge Get Active!, the fitness component of the program. The average weight loss per participant was 10 pounds (5.4% of body weight), and 48 participants lost at least 30 pounds. Participants reduced their body mass index (BMI) by an average of 1.6 points.

Critical Success Factors

Lafarge employee Robert Whetstone shares his first lesson learned from the Build a Better You program

Build regular engagement with ongoing reminders
Lafarge believes that it is crucial to engage and educate employees on a regular basis. Building a Better You staff send out postcards to employees to remind them about health care screenings. In one example, an employee had a prostate-specific antigen test after receiving a reminder postcard. The test diagnosed his prostate cancer in its early stages, allowing the employee to receive proper treatment.

Provide incentives to increase participation
Providing cash incentives can be a powerful motivator for ongoing employee participation and compliance in today’s climate of rising health costs. In addition, the savings reaped from offering preventive health care more than make up for costs associated with providing incentives.

Showcase individuals’ successes to inspire others to join: The “Lafarge 3”
In January 2011, Lafarge embarked on a project with Dr. Michael Roizen from the Cleveland Clinic to have Lafarge employees reverse their chronic conditions, film their journey towards better health, and distribute DVDs to all plant locations throughout North America. Three employees volunteered to change their lifestyle for this project. All three were considered obese, one had Type 2 diabetes and was unaware of his condition, and two were tobacco users. During a three month period, these three employees lost a total of 170 pounds, reversed their chronic conditions, and quit tobacco. One even reversed his sleep apnea and no longer uses his C-Pap machine to sleep at night. This initiative inspired 23 other employees to join Lafarge 3 and improve their health. Eight of these employees have willingly shared their journey towards better health, and a testimonial brochure has been mailed to all employees’ homes in North America. As a result of the Lafarge 3 initiative, employees and spouses continue to enroll in health coaching on a daily basis.

Lessons Learned

Whynona, a Lafarge employee, shares her experience as part of the Build a Better You Program

Tracking data improves program outcomes and relevance
It is important to create mechanisms to integrate different kinds of health data to track program outcomes effectively. The health and wellness strategy has always been based on data from aggregated health insurance claims. Without understanding the chronic conditions that are driving health care costs and disability incidents, a successful wellness program cannot be justified.

It’s not all about the money
At the onset of the introduction of Building a Better You, senior management supported the strategy and understood that cost containment was not the sole factor in offering the program, but employee satisfaction and productivity were key if Lafarge wanted to continue to be a leader in the construction materials industry. Without healthy and productive employees, Lafarge would not be able to deliver products to its customers.