“Impact of Workplace Wellness-Program Participation on Medication Adherence,” and “Differences in Out-of-Pocket Health Care Expenses of Older Single and Couple Households”

Wellness Programs: Workplace wellness programs appear to have a bigger impact on medication adherence for some diseases than others, according to new research from EBRI. <A href="https://www.ebri.org/pdf/PR1152.Gen-Bens.20Jan16.pdf">Press release. </A> Single/Couple Households: Older singles and older couples tend to face sharply different out-of-pocket expenses for non-recurring health care services such as home health care, nursing home stays, overnight hospital stays, and outpatient surgery—possibly because they do not have a spouse to help as caregivers, according to new research by EBRI. <A href="https://www.ebri.org/pdf/PR1153.OldSngls.21Jan16.pdf">Press release. </A>

Impact of Workplace Wellness-Program Participation on Medication Adherence

This study analyzes data from a large employer that enhanced financial incentives to encourage enrollment in its workplace wellness programs. It estimates the effect of wellness-program participation on medication adherence in six chronic conditions: hypertension, dyslipidemia, diabetes, congestive heart failure, asthma/chronic obstructive pulmonary diseases, and depression.
Biometric screenings led to an average increase in medication adherence for dyslipidemia and depression. Biometric screenings had no impact on medication adherence among individuals with hypertension, congestive heart failure, or asthma/chronic obstructive pulmonary diseases. Participation in health risk assessments (HRAs) had no statistically significant effects on medication adherence for any of the chronic conditions examined.
Improvements in medication adherence may signal forthcoming medical-cost offsets and productivity enhancements from biometric screenings. Whether or not these benefits exceed program costs is a research question worthy of future study using data on a greater number of wellness programs, over longer time periods.

Differences in Out-of-Pocket Health Care Expenses of Older Single and Couple Households

The average per-person out-of-pocket spending for households ages 65 and above during a two-year period on doctor visits, dentist visits, and prescription drugs (referred to collectively as recurring health care services) is roughly $2,500 for both single and couple households. This amount does not change with age.
There are large differences in non-recurring health care spending (which includes overnight hospital stays, outpatient surgery, home health care, nursing home stays, and other services) between older singles and older couples, and these differences increase with age. For those 85 and above, singles and couples on average spent $13,355 and $8,530, respectively, on these services during the two-year period of the study.
Some of the largest differences in non-recurring health care spending between older singles and older couples are in home health care and nursing home expenses. This suggests that couples benefit from their spouses or partners acting as their caregivers.

Figure 1 Figure 5 Figure 3 Figure 7 Figure 1 Figure 9 R D Re e ifs f fe e ur r le t es n n c ce es Be tween Singles and Couple Across Different Age Groups for Stuthe dy D households esign studied. These total expenses are conditional on having at least one non-zero expense for at least References I D mp iffe ar ce tn o cfe Wo s in r k O pu la t-c of e -P We oc lk ln ee ts H s-e Pa rlo tg hr C am are P a Er xtp ic ein ps ae ts io n o fo O nl der Percent of Sample Diagnosed With Various Chronic Conditions, by Group Recurring Recurring Recurring Health Care Expenses* Health Care Expenses* Health Care Expenses* of All of A of A gll e AA ll 65+ g A e g65+ Single e 65+ Households Single Households Non-Recurring Health Care Expenses* of All Age 65+ Single Non-Recurring Health Care Expenses* of All Age 65+ Single Households A on s e de its ecr m ib in ed e a in ch groef atth ee r d tw eto ail ca in te e ga orrli ie esr. w If otrh ke , rte he is ea st tim lea as tion t on se trn ao te ng -z ye m ro ae ke xp s e un ss ee o , ft h ae nm atis us rin al g ev xa plu ere im s feonr t o wth he er reitin em ths e Banerjee, Sudipto. “Expenditure Patterns of Older Americans , 2001-2009,” EBRI Issue Brief, no. 368, (Employee Benefit Figures 7 and 8 break down Figures 3 and 4 by age group. It was noted above that the average per-person out-of- Descriptive Statistics During Households a During Two-Y During ear Period a Two-Y a T ear Period wo-Y Betw ear Period een 2010–2012, Between 2010–2012 Between 2010–2012 by Age Group S Mie nd gilc ea a tn io dn C Ao Households d uh pe le re H nc o During e u sea hTo wl o-Y ds ear Period Between 2010–2012 During a Two-Year Period Between 2010–2012, by Age Group Test Group 1: Select Control Group: Other Fronstin, Paul, and M. Christopher Roebuck. "Financial Incentives and Workplace Wellness-Program Participation." EBRI s fo tu r d th y e em hop uloy seh eo r ld alta erre ed a s th su em fin ea d ntcia o bl e in zce ern o tfiv oe r st h ite op fu ferrpeod s e to s o mf eca mlcu ber la st fin og r tth oe ta irl p ha oruts ici ep ha ot ld ion ex in pe H nR sA es s (d ano dn b e iom sepeatrra ic tely Research Institute, February 2012). pocket recurring health care expenses for the two-year period was roughly $2,500. Breaking down the numbers in January 2016 • Vol. 37, No. 1 Figure 1 presents the baseline (2011) sample means (by group) for the prevalence of each of the six chronic diseases. $ $9 60,0 ,000 00 $6,000 $7,000 Union Members Test Group 2: Non-Union Union Members $80,000 Issue Brief, no. 412 (Employee Benefit Research Institute, March 2015). s f B Bo cr y yr e P S re e a un cu u din l ip rFg rtro in so. n g B Is a n atn ce n in ed ,n r jn P te iv o h en e .,D -P ch .r,h e a .E cu D n m .g r,p r eE in loy sm g w p e e e loy e xr p e Be e eim n e ns e B p e fe le it sn ). m R eO e feit s n n e t e R e ae im d rs ch d e pif a o Ifrn re ch tsrate it n In n u t ts ca tia e tit ll ,v u y e a ta a n et cr d : o M. hsesa C ce lt hh rris in ta ts o in u p rg har en o rce u R po s pe ra b en u m d ck iu y,e m P ah s rs .a D . n .B ,d r R ie sx p fE ly eco n , d sn t in a og r m tin o ics n g ,o w L vit L eC h r- Figu res 3 and 4 by age provides an idea of how stable (and hence, predictable) these costs were. Figure 7 shows that All other variable means have been reported els (N=15, ewhe 312) re (see FroE nm stployees in and (N=40, Roebu547) ck 2015a; F(N=16, ronstin 123) and Roebuck Variable . “How Does Household Expenditure Change With Age for Older Americans?” EBRI Notes, Vol. 35, no. 9, (Employee $8,000 t th he e -2 co 01 u2 n tp ela r d nr y ue ga s ra , rn e on no -u t n in ion clu d ee m d pin loyte he is s sw tu ed ry e. offered a $20 per month (i.e., $240 per year) reduction in health the average total recurring expenses for singles in Age Groups I, II, and III were $2,490, $2,490, and $2,429, Hypert $70,00ens 0 ion 21% 21% 19% 2015b). Dyslipid $6 e,m 000 ia (i.e., high cholesterol) was the most common condition—present in 25?28 percent of the study . "Financial Incentives, Workplace Wellness-Program Participation, and Utilization of Health Care Services and $50,000 Paul Fron Be stn in e is fit d Rir ee sct ea orch r of I nth se tit u Hte ea , Se lth pE te dm uca be tion r 20 1 a4 n). d Research Program at the Employee Benefit Research Institute $5,000 insurance premiums if they completed HRAs. Prior to this, all employees received a $50 gift card for participating. The Dyslipidemia 25% 28% 26% I re n st pr eo ctd ive uly c.t F iig ou nr e 8 shows that among couples, the average total recurring expenses for Age Groups I, II, and III population. The second-most prevalent disease was hypertension (19?21 percent), followed by diabetes (7?9 per- Spendi $7 ng ,0.00 " EBRI Issue Brief, no. 417 (Employee Benefit Research Institute, August 2015). F (E ig Bu RrIe ). 1 M. shC oh wrsis tth oe p h re ecu r Rro rin eb gu h ck e ais lt h p rca esrid e e en xt p a en nd se C sE fO or o afll R h xo Eu co se nh oo m ld ics s w , L itL hC a . tT le his as a t rotn icl ee m weam s b werrit a te gn e w 65 it h o ra s asbis otvaen . ce Ov er $60,000 following yDiabet ear (2 es 013), a subset of union employees 9% collectively bargained 7% for this new financial in 8% centive for were $5,163, $ $5 5,0 ,04 007 and $4,963, respectively. So, looking at each age group separately and looking at singles and cen t), depression (6?7 percent), and asthma/COPD (4 percent). CHF affected less than 1 percent of individuals H e a l t h . “U catrie liz e ax tip oe nn Pa sets te a rn re s a a n kd e y O co ut-m ofp -Po oncke ent to Ex f rpe etn irs ee m se fo nr t D ex ifp feere ns ne t s H.e P arlior th C ra ere se a Se rcrv h ib ce y sth Ae m E om ng p loy Ame ee ri ca Ben n e Rfe itt iR reeess e,a ” rch Impact of Workplace Wellness-Program Participation on f tr ho em tw Eo- BRyIe ’sa rr e ps ee ra iod rch , t a hn ed a e ve dritaog re ia (m l ste aa ffn s) . T toh tis al w reocu rkr w rin ag s h co en ad ltu hct ca erde t h er xo pu eg nh s eth s e w E eB re R I$ 3 C,e 4n 9t9 e.r T fo hre R m ee sd ea iarn ch (h oanlf H aebaolt vh e Congestive Heart Failure (CHF) 0.3% 0.2% 0.3% completing HR $ A40,0 s, b 00ut all other union workers continued to receive the gift card. couples within e $4 $6 a, ,ch 0 000 00 age group, it was clear that the recurring health care expenses were very predictable. Recurrin g R ino clu ebdueck, d in M .t h C eh a rin sa toly ps hie s.r, Joshua N. Liberman, Marin Gemmill-Toyama, and Troyen A. Brennan. "Medication Adherence Institute EBR (EB $R 50,0 I I I) ssu 00 ha es Bri she ofw , n no t.h 4a1t 1h , e (Em alth p lca th oyree e e Be xpn ee nfs ite R se rs ee pa re rch se In nts tth ite u ts ee , F co en bd ru-a la ry r g 2e 0s 1 t 5s)h . are of household expenses after B an en de h fit alf s I bn en low ova) tw ion as (E $2 B,R 1I5 C 0 R aH nB dI ). th e 90 percentile was $7,800 (which meant 10 percent of all 65+ households spent Asthma/COPD 4% 4% 4% $4,000 out-of-pocket expenses were almost a fixed expense per person, on average. Of course, there could be variations Medi Lc eaa dst Tioo Ln ow eA r Hd eah lthe Cr are e U n sc e A e nd, Cp. osts 2 Despite Increased Drug Spending." Health Affairs 30, no. 1 (January home-related expenses for older Americans (Banerjee 2012, 2014). Also, health care is the only component of Depression 7% 7% 6% F $o 7r ,8 b 0iom 0 ore tm ric orsecr $5 ).e , 0T e 00 h ne in m gso, satll e e xm pep nloy sive ee rse w cu errre in g giv heen a a lt h n o ca m rin e a itl erm ew waarsd p fo re r sp cr ar ip tici tion pa d tin ru gg b se . f Toh re e a 2v 0e 1r3 a— gem ao m stoly u n in t s th pe e nt $40,000 Average PDC values at baseline for each condition are reported in Figure 2. Patients were most adherent to DeNardi, Mariacristina, Eric French, John B. Jones. “Couples’ and Singles’ Saving After Retirement,” Working Paper No. around th 2e 0 1a1v): e r 9a 1g -99. e d epending on an individual’s health condition, income, and other factors. $30,000 EBRI Employee Benefit Research Institute Notes (ISSN 1085 ?4452) is published monthly by the Employee Benefit Research household expenditures that increases with age, both in terms of a thbsolute dollars and as a share of total household The followS in og urce: E orga mn pliz oya ee B tion enefi s p t R ro ev search I ide th ne sti ftu ute anal nding ysi fs based on adm or EBRI CRH iniB strati I: ve cl Amai em rica s data. n Express Co., Ameriprise Financial, Inc., $3,000 f oonr m pr o es f cr frip eet ion boo dkrsu g os r a b ych th aensce e h to o uw se in h o mld os v ie w a tick s $e2t,s3.6 I9 n a2n 0d 1 3 th , e n o 9n 0-u n pion erce w no tilre k ew rs a s w $ e5 re ,0 r4e0q .u D ireend t is to t p vis aritts ici tp oa otke tin he next th $3,000 med Institute, 1100 13 ication 2015 s u-3 se 2d 2 t . o M St. NW, Suit itch reia gta C nH RFe (8 tie 878, Washington, DC 20005- re 0m ?9 e1 n tp R ee rce sen atrch ). A C m eo nn te gr, e 2m 04 p 1051, at $300 pe loy 5. ees d iagnor seyd ear o witrh is included as part of a membership , and on therapy for, hypertension, Notes: $4,000 expenses. For example, in 2011, average annual out-of-pocket health care expenses for a household between ages Aon Hewitt, Blue Cross Blue Shield Association, Boeing, Deseret Mutual Benefit Administrators, Federal Reserve $30,000 b sp iom osubscription. Pe t,e fto rll ic os wcr ee de bn yin riodicals postag dg osct , o in r a vd isditit sion . e rate paid in to completinWashingt g HRAson, DC, and additional mailing offi , in order to continue to receiveces. th PO e $2STMASTER 0 per mon: Send address th (i.e., $240 D Figi uf refse 9r ae ndn 1c 0 be res ak i dn ow nO Fig u ut re-sof 5 a-nP d 6 o bc y k age e t gr oH up.e Ita wlat sh no tC ed a abr oe ve tE hax t tp hee an ves rae ges n ono -rf e cu O rrl ind g er dyslipidemiaT,e a st Group 1= nd diabe Ntoe is ncenti , avve e for bi rageom PD etri Cc screeni s range ng, i d f nrcenti omv 6 e for heal 8 perce th ri n sk t assessm to 79 pents i erce nn 2013. t. Lower adherence was measured for th 65 and 74 was $4,383, capturing on average 11 percent of total household expenses. For households ages 85 and Emp changes to: loyee BeneEfB itsR I N Sysottes em, 1100 13 , General St. NW, S Mills Inc., uite 878, Washington, DC Healthways Inc., IBM, JP 2000 Mor5-4051. gan ChCop asey , rig Me ht 2016 b rcer LLCy, Em andplo Py fiz ee Benefit er Inc. $20,000 per year) reduct $2 ion ,000 in health insurance premiums. Union workers were not offered financial incentives to participate in expenses we Tr ee st Group 2= much hIig ncenti her v e for bi for sin omg etri lec screeni s than ng i cou n 2013, i ples. n A centi cov m e for heal pariso th ri n b sk e assessm tween ents i Figu nr 2012 and 2013. es 9 and 10 provides another $2,000 $3,000 individuals with depression (53?61 percent), and asthma/COPD (30?38 percent). SiResearch Institute. All rights reserved, Vol. 37, no. ngle $ 20,0 a0n 0 d Couple House 1. holds, p. 7 above, average out-of-pocket health care expenses increased to $6,603, capturing 19 percent of household expenses. Figure 2 shows the non-recurring health care expenses for the same group of households. Over the two-year period, Control Group=No incentive for biometric screening, no incentive for health risk assessments. biometric screenings in 2013, but they did receive prize giveaways in years prior. insig ht: The difference in non-recurring expenses between singles and couples increases with age. For Age Group I, COPD=Chronic obstructive pulmonary disease the average total $1,0non-recurring 00 expenses were $5,277. But 10 percent of these households spent $10,000 or more $2,000 Wellness P $10,0 rog 00 ram Effects on Medication Adherence the average to $ ta 10,0 l n 0o 0n-recurring expenses were $2,790 for singles and $2,024 for couples: a difference of $766. For In a recent study (Banerjee, 2015), EBRI analyzed the utilization and out-of-pocket expenses of different health care Introductio $1 n ,0 00 The Employee Benefit Research Institute (EBRI) was founded in 1978. Its mission is to G on ive non-recurring n that the alte health rations care in in services, centives and for p there articip was atinone g in component HRAs and bof iom non-recurring etric screeninservices gs happe that nedcould for difbe fervery ent Figure 3 presents the impacts of HRAs and biometric screenings on medication adherence from the linear, fixed- Age Group II, the average total non-recurring expenses went up to $5,502 and $3,930 for singles and couples, contribute to, to encourage, and to enhance the development of sound employee benefit services; based $1 o,n 000 the nature of the service and frequency of use, the study d ivided health ca th re services into two A T A G L A N C E $- $- co T expensive: hh iso s rtts u d in y d rnursing e ifp ferreesn etn home y ts e a th rs e, care. tth hir isd sin The tu d ay s average e co rie ns st r th ua ct nursing te adn tahly re zhome e es g d ro au texpense a p s fr foom r a an was la aly rg se is $20,118 e : m ploye and r, w the hich 90 en h percentile anced finawas ncial Total Total Total Dentist Doctor Prescrip- Total Dentist Doctor Prescrip- Total Dentist Doctor Prescrip- Total effeWho we are cts models. Of the 12 estimates, only Ou tp2 a- reached statistical significa Oun tpce a- . First, biometric screening Ous tp a-were shown to programs and sound public policy through objective research and education. EBRI is the only respectively, a difference In -Ho om f e$1 Nu, rs5 ing72Ot . he F ror the o No ld n-est age In -Ho gr mo eu Nu pr, sin t ghe Ot he drifference No nw - ent up In -Ho to m e$Nu 4, rs8 ing25 Ot ($ her 13,355 No fo n-r singles Figure 2 categories: recurrin Ho g sp s itae l Vis rv its ices (d Viso itsctotio r nv Drug is tieit nts s, Rec prue rrin scr g Hosp ip itat Vis lion its dru Vis gs its, an tiod n Drug detie n snt tis Rec t uv rrin isgits Ho) sp Vis a italn itsd noVis n- its recu tior nr Drug ing s ties nRec e t rv urrin ice gs $- Care Home Care Recur- Care Home Care Recur- Care Home Care Recur- in $50,000. centivesIn to -home encoucare rageand parthospital icipationstays in Su it rs ge rwere yworkp the lace next welltwo ness most-expensive prograSu m rgs er. y In prservices, ior wO ourtp kati (F with ent ronthe stinaverage a Tn ota d Sul N rgR eron- o y etwo-year buck 2015a), private, nonprof ringit, nonpartisan, Washington, DC-b ringased organization committed exclusivel ring y to $- 65 ?74 75 ?84 85+ have had a positiv $- e 0.007 Ho efsfp e itct al on meIn d-ica Homteion Care adherNu en rsce ing Ho fome r dyslipid Othe em r ia Care (p<0.05). Second, biometric screenings and $8,530 for couples). This P is ropor quite tion of Da intuitive. A ys s Cov healte hr b erd (P eaks DC) A downm wong Indiv ith age, thiedua adv ls antage of having a spouse or Impact of WorkplacDe e nti W st Vi e sil tslness-Prog Dor cto a r Vi m sits Participa Prt esi co ripn tion o Drug n sMedicat Ti ota ol n Re cA urrd ingherence, Dentist Visits Doctor Visits Prescription Drugs Surgery Total ReRe curr cu inrg ring (overnight hospital stays, overnig 65h ?74t nursing home stays, home75 h ?84 ealth care, outpatient surger85 y, + and special facilities). ? Test Group 1 was comprised of the 15,312 union members who were exposed to the new financial incentive for Median $500 $300public$9 poli 60 cy r $1,440 esearch $500 and edu $300 cation on $960 econ $1o ,400 mic securi $401 ty a $3nd em 00 plo $984 yee b$1 enefi ,376t issues. it expense was con per clud household ed that vobeing luntary $2,865 wellneand ss p$2,178, rogramsrespectively. disproportion Among ately atthe tract non-recurring ed relatively hservices, ealthy ind nursing ividualshome . A Me Me Medidi di anan an $1,000 $375 $5,0 $5 0100 $254 $375 $624 $501$300 $501 $7,701 $250 $300 $9 $760 00 $501 $501 $10,001 $3 $1 50 ,423 $450 $1,656 were also aMe ssdi oan ciated with a$6 075 .026 increase $5 00 in medication $10,0 ad 01herence for $2 d 50 epression (p $3 < 28 0.01). No oth $9 e00 r parameter Dia $6 gnos 15 ed With Various $400 Chronic Conditions $1,200, by Group $2,150 by pa rP tn ae url tF or o an ct s ta in s, ca Ph re .D g.iv , eE rm repsloy ulte se in B low ene efrit s p Re en sd ein arg ch a tI h nig sth ite urte a,g e asn.d T M. C his ish a ris pp to ap rh ee nr t ifR w oe eb loo uck k, aP t hce .Dr.t,a in Rx co Eco mn po om ne ics nt,s Average $1,168 $777 $1,721 $2,490 $1,214 $727 $1,763 $2,490 $957 $890 $1,846 $2,429 As the name suggests, recurring s EBRI’s member ervices are usship includes a ed regularly a cross-section of nd their expen pension funds; businesses; trade associations ses are predictable. The usage and ; comple Avt ein rageg HRA $2,5 s01 sta $7r 88 ting $1 1,in 079 20 $61 543. $791 $2,790 $2,113 $3,817 $17,844 $672 $1,163 $5,502 $2,810 $5,320 $25,540 $4,029 $912 $13,355 Average $1,137 $782 $1,766 $2,476 Average $2,445 $3,957 $21,346 $1,541 $968 $7,122 s care ubse posed quent Average by pafar perthe (Fro biggest nstin a financial n $1 d ,45 Ro 5ebu ck threat 2015 to b)retirees. exa $9 m 41 ined the impact of $2 pa ,36 rt 9icipation in health$3 r,49 isk 9 assessments 90th Percentile $3,000 $2,000 $3,600 $5,500 $3,000 $2,000 $4,800 $5,760 $2,400 $2,001 $4,800 $5,741 90th Percentile $5,001 $3,500 $35,000 $1,800 $2,000 $6,000 $5,000 $5,001 $50,000 $1,800 $2,001 $10,500 $10,001 $20,001 $67,000 $5,001 $2,001 $50,000 e LLC stim ates for biometric screenings or HRAs were statistically different from zero. of non-recurring health care expenses. For Age Group III (85 and above), the average in-home care expenses for labor unions; health care providers and insurers; government organizations; and service firms. 90 90th P th Per erc cent entil ile e $5,00$3 0 ,000 $10,0 Te 00 st Group 1: $2,00 S $5 0e 3,9 lec 00t $2,00$4 0 ,776 $2,00Cont 0 rol Group: $5,62 $2 1 0,0 Ot 00 her expenses of 90 r th P ecu ercrent rin ileg services$3 a ,50 lso 0 remain pretty fla$2 t t ,20 hr 1oughout retireme$5 nt ,04 . O 0 n the other hand$7 , u ,80 s0 age and expenses (HRAs) and biometric screenings on health services utilization and costs. That study made use of the quasi- Union Members Test Group 2: Non-Union Union Members sin ?g leTse a sn t d G rco ou up p le 2 sin w clu erd ee $ d5 t,h 3e 2 0 4 0 a,n 5d 4 7 $ 2 n,o 1n 6-5u,n rion esp e em ctiv ploy elye . e Fso r w th ho e w sa em ree o g ffre oruepds tth he e n ae vw er fain ga en ncia urs l in ing ce hnotm ive e fca orr e costs of non-recurring services go up with age and are generally unpredictable. This distinction is important because it Source: Employee Benefit Research Institute estimates from Health and Retirement Study (HRS), 2012. ? This study analyzes data from a large employer that enhanced financial incentives to encourage enrollment in its experimental design generated by the rollout of the financial incentives to different groups, at different times. This Source: Employ Source: Employ Source: Employ Source: Employ ee ee ee ee Benefit R Benefit R Benefit R Benefit R esearch esearch esearch esearch Institute estimates from Institute estimates from Institute estimates from Institute estimates from (N=15, H Health H ealth Health ealth and and and and 312) R Retirement R etirement Retirement etirement Study Study Study Study E (H (H m (H (H R RS R S ployees R ), ), S S), 2012. 2012. ), 2012. 2012. (N=40,547) (N=16,123) Variable EBRI’s work advances knowledge and understanding of employee benefits and their Differen * Cc onditional e Be on t positiv we e e expenses. n Singles and Couples were $25,540 and $18,331, respectively. participating in HRAs in 2012, and for both HRAs and biometric screenings in 2013. Conclus*i Co * C onditional n onditional s on on positiv positiv e ex e ex penses. penses. * Conditional on positive expenses. means that *h Co ea ndit lth io n ca al on re po co sitsivtes e in xpe r nse etsir . ement can be broken into predictable and unpredictable components. The workplace wellness programs. It estimates the effect of wellness-program participation on medication adherence allowed for control of individual se importance to lection bias th toe nation’s econo derive unbiasmy ed ramong policy esults. The m makers, ain fin the news ding wamedia, and s that biom the public. It etric Hypertension 77% 78% 78% Figures 3 and 4 show the recurring health care expenses of all households ages 65 and above, singles and couples, advantage of doing so is that retirees can prepare differently to meet these expenses. While dedicating a portion of Health risk assessments and biomdoes this b etric screeyn co ing nducting s are incr and p easin ublishing policy re gly used by empsear loye ch, analysis, rs to identifand y exspecial reports on isting or potentia l in six chronic conditions: hypertension, dyslipidemia, diabetes, congestive heart failure, asthma/chronic Dyslipidemia 68% 71% 72% screWhat we do enings served to increase the use of, and spending on, prescription drugs; however the study cited the need for ? Lastly, the 16,123 union employees who never received the $20/month reduction in health insurance premiums respectively. The most important observation from these two figures was that per-person out-of-pocket recurring employee benefits issues; holding educational briefings for EBRI members, congressional and tC ho eirn m clou nts hily o n in come stream seems appropriate to meet recurring expenses (thus adjusting their monthly income health issues among their plan members. The hope is that information derived from these wellness programs will Diabetes 77% 77% 79% obstructive pulmonary diseases, and depression. further research, since wellness programs may take several years to have a meaningful positive impact on health during the three-year study period made up the Control Group. federal agency staff, and the news media; and sponsoring public opinion surveys on employee health care expenses were not any different between single and couple households. For example, Figure 3 shows that stream accordingly), holding onto some precautionary savings or purchasing more insurance seems a better approach Congestive Heart Failure (CHF) 91% 80% 88% prompt patients to make meaningful lifestyle changes, use preventive care, and commence and comply with Health care expenses are a major concern for retirees. But some retirees should be more concerned than others. status, as evidenced through reductions in health services use and spending. benefit issues. EBRI’s Education and Research Fund (EBRI-ERF) performs the charitable, the average total recurring expenses for singles was $2,476 and Figure 4 shows that the average recurring expenses ? Biome At srtic hmsacr /Ce OP enD ings led to an average increa 30% se in medication adhe35% rence for dyslipidemia 38% and depression. for retirees to take to meet their non-recurring expenses. recommended treatment. Indeed, these steps would both reduce the burden of their illnesses and decrease the risk educational, and scientific functions of the Institute. EBRI-ERF is a tax-exempt organization Certainly, those who have existing medical conditions are likely to spend more. But at a more general level, singles Wellness-program-participation impacts on adherence to medications were investigated for six chronic conditions: Figure 8 Figure 10 Figure 4 Figure 6 Figure 2 for couples was $5,109—so the average per-person out-of-pocket recurring health care expenses for a two-year Depression 53% 61% 61% supported by contributions and grants. Biometric screenings had no impact on medication adherence among individuals with hypertension, congestive T ofh is fu tp uarp ee , ra e dx vp elor rsee-s h e wahlteht h ee vre t nhtis s. e mployer’s HRAs and biometric screenings affected medication adherence among are likely to spend more on health care services than couples. It should be noted that health insurance premiums and hypertension, dyslipide Recurring mia, diabetHealth Care Expenses* es, CHF, asthma/COPD, anof d dA ell prA es gse ion 65+ . PaCouple tients we Households re classified as having one or Non-Recurring Non-Recurring Health Care Expenses* of A Health Care Expenses* of ll Age A 65+ Couple ll Age 65+ Couple Households Recurring Health Care Expenses* of All Age 65+ Couple Non-Recurring Health Care Expenses* of All Age 65+ Households Source: Employee Benefit Research Institute analysis based on administrative claims data. T pe hreiod ab o wa ves satruo du yn a dn $ a2 ly ,5 ze 0d 0 .t h Ae s w ex ilp l e bn es s eh so aw t n th la e tin erd,iv th id is u a fin l le din ve gl. w Ba us t p lik re et m ty o rs otb fuin sta n acia crol sm s a atllt e argse , g dreo cis upion s asb r oe vg ea 6 r5 d.in Ig n heart failure, or asthma/chro nic obstructive pulmonary diseases. Participation in health risk assessments (HRAs) those diagnosed with, and on therapy for, six chronic conditions: hypertension, dyslipidemia, diabetes, congestive During a Two-Year Period Between 2010–2012, by Age Group spending on over-the-co During un Households ter da ruTw gs a o-Year Period re n During ot includ a eT dw Betw in o-Y this ear Period een 2010–2012, study. Between 2010–2012 by Age Group more of these diseases if Households they had at lea During st one in a pT aw tieo-Y nt o ear Period r two outpaBetw tient (on een 2010–2012 different dates) medical claims with a During a Two-Year Period Between 2010–2012 Notes: u tesram ge s o off th heea lt inh d ca ivid re u a sl eco rvice mpso a nr ee n EBRI Issue B tasls in o li re kcu elyr rtin or g iefs b e h e m are period aa ltd he ca ar t e icals providing exp t h se e rh vo ice usse,h ito s ld e e lem e vrt evaluati e sl. co Su op , lte h ons of emplo s is s s pte un dty a u lipty d tle ee benefit issues and at e less tsh p ee p r rp ee vriou son s In earlier work, no significant effects of HRAs were found in the first year post-completion. However, biometric had no statistically significant effects on medication adherence for any of the chronic conditions examined. heart failure (C $H 12,0 F), 00 asthma/chronic obstructive pulmonary disease (COPD), and depression. Although past work Test Group 1=No incentive for biometric screening, incentive for health risk assessments in 2013. relevant diag $n 80,0 os0is 0 code during a given year. Condition-specific adherence was calculated using the proportion of days $ $60,0 12,00 00 0 $60,000 trends, as well as critical analyses of employee benefit policies and proposals. EBRI Notes is a Our s th tu ad ny s b in yg le an sa . lyzing these health care expenses at the household level. screenings led to an increase in prescription-drug utilization by 0.31 fills per person per year (p<0.01), and associated This study examines in detail the differences in out-of-pocket health care spending between couple and single older Test Group 2=Incentive for biometric screening in 2013, incentive for health risk assessments in 2012 and 2013. showed an increase in prescription drug utilization due to the wellness program, it cannot be concluded that this monthly periodical providing current information on a variety of employee benefit topics. covered (PDC)—a metric ranging from 0 to 1 that represents the fraction of days in the period that the patient had at ? Improvements in medication adherence may signal forthcoming medical-cost offsets and productivity prescription- Cd ontrol rug Group= costs N (+ o i$ ncenti 56 p ve for bi er peom rso etri nc screeni per yeng, no i ar). D ne centi lvin ve for heal g deepth ri er sk in assessm to the t ents. herapeutic classes comprising this $70,000 households. The major findings include: EBRIef is a weekly roundup of EBRI research and insights, as well as updates on surveys, effect translated into an improvement in medication adherence—a metric arguably more important, since the link publications least one drug for the condition on hand. $10,000 Figures 5 anCOP d 6 D=Chronic obstructi show the diffeve pulm renceonary s be disease tween single and couple households in terms of non-recurring health care enhancem $ $50,0 50,0 ent 0 0s 0 0 from biometric screenings. Whether or not these benefits exceed program costs is a research $10,000 studies, litigation, legislation and regulation affecting employee benefit plans, while EBRI’s additional drug use, it was found that statins and selective serotonin reuptake inhibitors (SSRIs) and serotonin- b D ea tw te ae n medication adherence and decreased other non-drug medical services use and spending has been clearly expenses. T $ h60,0 ere 0 0were some large Blog diff supplements our regular pub erences here. First, the avlications, offering commentary erage total non-recurring e on questions received from xpense for singles in 65+ ? q The uesaverage tion wortper-person hy of future out-o studfy-pocket using dspending ata on a g for rea households ter numberages of we 65 llnand ess p above rogram during s, ovea r lon two- geyear r time period period on s. norepinephrine reuptake inhibitors (SNRIs) were the top-three classes driving the increase in prescription-drug Multivariate regression models of each adherence (dependent) variable were estimated as a function of participation established (Roebuck, et al. 2011). Indeed, finding a positive impact of wellness-program participation on medication The data for this study come from the Health and Retirement Study (HRS), a study of a nationally representative news reporters, policymakers, and others. The EBRI Databook on Employee Benefits is a households was $8 $ ,07 00 ,122, compared with $3,161 for couples. This was an important observation. Not only did couples doctor visits, dentist visits, and prescription drugs (referred to collectively as recurring health care services) is utilization. The $r40,0 efo 0r 0e, the current findings on increased adherence are confirmation of the earlier results, since these $40,000 indicators for HRAs and biometric screenings, as well as F tigur he fe 3 ollowing covariates: geographic region, household size, adherence may $8 b,e 000 an early indicastto atis r o tifcal su re cce fere ss nce work , sugge on stinem g tplo hay t ee he ben alth efit pr care ograms and wor cost savings k force-related are forthcom is in sues. g. sample of U. $ S 50,0 . h0o 0useholds with individuals over age 50. It is the most comprehensive survey of older Americans in enjoy a returns-to-scale, in this case it pushed down their expenses below the singles. This was most likely due to the roughly $2,500 for both single and couple households. This amount does not change with age. are the primary medication Im s p us aec dt of to t B reiaom t dye sli trpiid c eS m cia re aenn di d ng a eprend ssion HR . As on Medication hea D ltihf f in esr ue ran nc ce e p sla in n t yO pe u , ta-nof nu- aP l w oac gk e e am t H oue nta , l ntuh m b C ea r r oe f y E eax rs p o ef n tesne us re o wfit O h tlh d ee er m S ploy ine grl,e a na dn th d e C Ch o au rls p oln e the nation and covers such topics as health, assets, income, and labor-force status in detail. It is a biennial fact that in couple households, spouses or partners could act as caregivers for each other. Looking at some of the Adherence: Linear, Fixed-Effects Models $6,000 $40,000 Contact EBRI Publications, (202) 659-0670; fax publication orders to (202) 775-6312. CoH mo oru bid se ityh Io nd le dxs s , cb oy r eS . u Fd oip r a to m Boarn ee d re jeta eil , ePd h d .D is.cu , E sm sion ploy oe f e th e B em ne ofdit e liR ne gs m ea ertch ho d In os log titu yt ,e p lease see the Appendices $30,000 $30,000 longitudinal survey with survey waves in even-numbered years beginning in 1992. The initial sample consisted of Data and M $6 e ,0t 00hods ? There are large differences in non-recurring health care spending (which includes overnight hospital stays, co Dem cis pion one -n mts a k oef rn so fn ace -redcu writ rh in t gh e ex d pe ecis nsion es w oh f e w rh ee tt hh ee d r if to fe a re lln oce cas te w se ca rer ce lar r ge esso t u m rce ads e H t to eal h im ist h R p po le in is m k t e cle nta w r.e F llo nr e s es x a pm rop gle ra ,m ins- Subscriptions to EBRI Issue Briefs are included as part of EBRI membership, or as part of a from Orders/ previous studies (Fronstin and Roebuck 2015a and Fronstin and Roebuck 2015b). individuals born between 1931 and 1941 and their spouses, regardless of their birth year. Newer cohorts have been Variable $199 annual subscriptionB to iom EB etri RI Not c Scre es en and ing EBRI Issue AssessmBrie ents ( fs. HChange of RAs) Address: EBRI, ? outpatient The average surgery, per-person home out-o health f-pocket care, nursing spending home for households stays, and other ages 65 services) and above between during older a two-year singles and period older on h mou m ste co can rs eid , w $ e30,0 rh tich h 0e 0 in eco mnaon m y ic caco sesst sco an ud ld co ben p se ro qv uid en ece d b sy o a f ssu pch ou p se ro o grr a pm arst.n W erit , h e xsh hib or itte td im la er g he o rd iz ifo fe nrse , n pce ros g rbaem tw s e lie kn e HRAs Study Sample $4,000 1100 13th St. NW, Suite 878, Washington, DC, 20005-4051, (202) 659-0670; fax number, added in the following y H eya prer s.t ens The ion st P ud Dy C is sponsored by the N0 a.t004 ional Institute on A-g 0. in 00 g 5 (NIA) and the Social Security $20,000 couples, and $20,00 these 0 differences increase with age. For those 85 and above, singles and couples on average doctor visits, dentist visits, and prescription drugs (referred to collectively as recurring health care services) is s ain nd g Subscriptions le biom s anedt rco ic u sp cr le ese.n T in hg es a m ve arya n go et t p wro o- vy id ee a ra in n-ehto b m ee n e ca fitr— e e ex sp pe en cia sell y fo if r p sin lag nle sp s o w na ss o r$s3 a ,9 re 5 7 o,f fco erm inp ga frin ea dn w cia ith l in $1 ce ,4n7t8 iv e fo sr As in the two p $4 rior ,000 papers (Fronstin and Roebuck 2015a and Fronstin and Roebuck 2015b), study data came from a An important concern for the analysis was patient-level selection bias. Since wellness-program participation was (202) 775-6312; e-mail: subscriptions@ebri.org Membership Information: Inquiries Dyslipidemia PDC 0.007** -0.001 $20,000 Administration (SSA) and is administered by the Institute for Social Research (ISR) at the University of Michigan. The spent roughly $13,355 $2,500 and for $8,530, both single respectively, and couple on households. these services This during amount the does two-year not change period with of the age. study. co foru m ple em s. b Tehre p a av re tici rap ga et ion nur.s Iin nd ge h eodm , teh co e e sa tsr life or r w sin or gk le co s a nn fir dm co s u th pis le.s H w oe w re ev $ e2 r1 , ,lon 34g 6e arn -d te $ rm 16 m ,1e 6d 9ica , rel sco pe sct t o iv fe fsly e.t sT a hn ed re large manufacturer based in the Mid regarding west, EBRI but w membership an ith employeesd/or con locatetdributio throu ns g to EBRI-ER hout the U.S F. should be dir Health insurea cted nce to eliEBRI gibility voluntary, members may have made their enrollment decisions for unobserved reasons that may have also been Diabetes PDC 0.003 -0.0002 sample includes $2 o ,0n 00 ly the Medicare-eligible panel members (ages 65 and above). A supplement of HRS called the President Harry Conaway at the above address, (202) 659-0670; e-mail: conaway@ebri.org $10,000 w pre ord eu la ctriv git ey d e ifn fe hraenn ce cem s e in n tesx m pean ys b ee s fp oo rs o stib he ler tca hrroeu a gs h w im ep llr ($ ov1 e,d 5 4 m 1e fd oica r sin tion gle asd a hn ed r e$n 6ce 43 m fo ard co e p uo psle sib s). le via information information, m $e 10,0 dica 00l and prescription-drug claims, as well as wellness-program-participation data were obtained for correlated with medicatC ion on ges adh tie vr ee H near ce.t F No aitl ur acco e PD uC nting for this0 p .016 ossibility may lead t0. o 007 biased estimates of the impact $10,000 $2,000 ? Some of the largest differences in non-recurring health care spending between older singles and older couples Co ? nsu Tm he prte ion ar A e ct laiv rg ite ied sif afn ed re Ma nce ils Sin urn vo en y -(C reA cu MS rrin ),g whheich alt h co ca lle rct e s s p de en ta dil in eg d (w infh oich rma in tion clud oen s h oo vu es re nh igohld t h so psep nit da in l g st,a is ys a , lso captured through biometric screenings. Whether these future benefits outweigh the costs is an empirical question the time period 2011?2A 01 s3 th.m Tah /C eO eP m Dp P loy DC er had offered HRAs s0in .0ce 03 at least 2004 an-d 0 .0 im 06 plemented biometric of the wellness programs. In response to this challenge, two analyses were pursued: First, linear, fixed-effects models Editorial Board: Harry Conaway, publisher; Stephen Blakely, editor. Any views expressed in this publication and those of the authors should not are in home health care and nursing home stays. This suggests that couples benefit from their spouses or used for this study. Throughout the study participants are classified into three different age groups: ages 65?74 (Age A rece outpatient nt paper bsurgery, y DeNard home i, Fren health ch and care, Jone nursing s (2015home ) using stays, data f and romother Assetservices) and Healt between h Dynamolder ics “Asingles mong th and e Oolder ldest $- $- Depression PDC 0.026*** 0.002 requiring analysis of longer panel datasets, on a greater number of wellness programs. be ascribed to the officers, trustees, members, or other sponsors of the Employee Benefit Research Institute, the EBRI Education and Research screenings in 2007 $-. Individuals’ responses to H Tot ToR taa lA l s and results of biometric Tot To sa tcr all eenings were also obtainTot ed To atl. al were estimated, which control for all time-invariant personal characteristics that may be confounders. Since this Outpa- Outpa- Outpa- $- Dentist Doctor Prescrip- Dentist Doctor Prescrip- Dentist Doctor Prescrip- In-Home Nursing Other Non- In-Home Nursing Other Non- OIn u-Ho tpati meent Nursing Other Total Non-Non- partners acting as their caregivers. O Grld o u (A p couples H I), E AaD g)” e,s and f 7 in5d?s these 8 t4h a (A t g s differences e in G gle rosu a pt Ia I), g increase e a 7 n0 d liavg e Re e with s s cu h 8 r-o5rage. ta en rd li v For aebso t those vh ea (A n co g 85 eu G p and r le osu p a above, t Re I I tcu I h). e r- s a singles me age and . Bu couples t in spite on o Re faverage cu th r-eir sh orter Hospita S l o urce: Emplo yee Benef tientit ResearHo ch sp I ita ns l titute analysis based o tienn t adminisHo tra sptita iv l e claims data. tient Fund, or their staffs. Nothing her Hospe ita in l is to be constr In-Homeue Care d as an attem Nursin pg Ho t to aid or me hinder Othe the r Care adoption oO f any utpati ent pending legislatio Total Nn on- , regulation, or $- VisiCa ts re Ho Vis me its Catio ren Drugs Recur- Visits Care Vis Hom its e Ca tio re n Drugs Recur- Visits Care Vis Ho its me tio Can re Drugs Recur- Hospital In-Home Care Nursing Home Other Care Surgery Recurring Surgery ring Surgery ring Surgery ring approach does not eliminateDe pnti ot se t Vi nstiia tsl endogeneity Do d cu toe r Vi tso its unmeasured Pr ev sa crr ipia tiob n le Drug s t shat vary ov Te ota r lt R im ece urr,i na gn instrumental- ring ring ring Surgery Recurring interpretative rule, or as legal, Not accounting, act es: uarial, or other such professional advice. life sp spent an, th $13,355 Me e di san tudy fand inds$8,530, tha $6t00 sing respectively, les are m $5o 00reon likthese ely to e services $1n ,50 d 0up in during a nur$2 sthe in 79g two-year home in a period $5 n00 y give of n the year study. .$7 T 00 he study 65 ?65 74 ?74 75 75 ?84 ?84 85 85 ++ The study sMe am dian ple included full-$9 tim 00e active employee$5 s,00 18?64 years old (as $2 o ,04 f 0Dec. 31, 2013), an $3d ,63 co 0 ntinuously Median $600 $501 $7,000 $250 $400 $790 variables (IV) approach w Ha Rs A s a =ls Ho ea u lts h e rid sk t a h sa st e sm sm a ed ne ts .explicit use of the quasi-experimental design of the financial Median $600 $350 $875 $300 $500 $600 $501 $500 $1,650 $232 $304 $700 $800 $501 $4,751 $300 $300 $1,500 Average Median $900$1,905$500 $2,040 $1,478 $3,561 $945 $16,169 $501 $1,992$643$3,819 $900$1,013$651 $2,400 $3,161 $3,700 Average $1,813 $1,129 $3,219 $5,109 concludes th Average at this leads to $ 2, h 1ig 78her medica $2, l 8s65 pending pe$r20 p ,11 er 8son for sin $g 1,le 079 s compared$ 99 w4ith couples.$ 5, T2h 77 e evidence Mean $1,697 $1,153 $8,690 $603 $1,135 $2,024 $1,872 $1,618 $19,058 $459 $797 $3,930 $3,632 $2,165 $18,331 $1,555 $1,042 $8,530 enrolled in the employer’s health plan from 2011 through 2013. Employees in health plans that paid claims on a Out-of-Pocket Expenses for Health Care EBRI Notes Average is registered in the U. $1,788 PDC= S. P $1 Patent and T ro ,146 portion $3 o ,233 fr D ade aym s$5 C ar ,163 o k Office. vered$1 . ,897 ISSN: 1085 $1,088 ?445 $3 2 1085 ,156 ? $5 4452/9 ,047 0 $ . $1,548 50+.5 $1 0 ,174 $3,442 $4,963 90th Percentile $5,000 $5,000 $50,000 $1,000 $2,000 $6,000 incentives rollout. Interestingly, the IV coefficients were similar in both magnitude and significance to their fixed- 90th Percentile $4,210 $2,800 $7,200 $10,720 90 90th P th Peer rcen cent tile il$4 e ,900 $3,0 $5 00,00 $3 05,000 $1,100 $2$5 ,050 ,000 $5,000 $5,001 $ $5 5,00,0 00 00 $63,000 $1,002 $2 $1 ,0,01 600$6,609 $10,100 $2 $7,5 ,00 00 0 $50,001 $1,001 $1 $10,0 ,00000$33,000 ? Some of the largest differences in non-recurring health care spending between older singles and older couples 90th Percentile $4,100 $3,000 $7,200 $11,000 $4,500 $2,650 $7,080 $10,320 $3,511 $3,000 $6,984 $9,315 sho wn in Figures 5 and 6 certainly corroborates this conclusion. COP D=Chro nic Obstructive P ulmo nary Disease. prepaid or capitated basis such as health maintenance organizations were excluded, as were spouses, partners, and All the numbers reported are for a two-year period between 2010 and 2012. Also, all the statistics are calculated effects counterparts. Therefore, results from the latter are presented for brevity. are in home health care and nursing home expenses. This suggests that couples benefit from their spouses or *** Statistically significant at the 0.01 level. Source: Employ Source: Employ ee ee Benefit R Benefit R esearch esearch Institute estimates from Institute estimates from H H ealth ealth and and R R etirement etirement Study Study (H (H R R S S ), ), 2012. 2012. other depeSource: Employ n Source: Employ dents. Tee h ee e Benefit R Benefit R final esearch a esearch naly Institute estimates from Institute estimates from tical dataset co HH ealth n ealth sis and and te Rd R etirement etirement of 71 Study , Study 98 2 (H (H R e R Sm S ), ), 2012. p 2012. loyees. Source: Employee Benefit Research Institute estimates from Health and Retirement Study (HRS), 2012. conditional on having a non-zero expense. This report also includes total recurring and total non-recurring expenses * Conditional on positive expenses. * Conditional on positive *ex * S penses. tatistically significant at the 0.05 level. * C * C onditional onditional on on positiv positiv e e ex ex penses. penses. partners acting as their caregivers. * Conditional on positive expenses. © 2016, Employee Benefit Research Institute ?Education and Research Fund. All rights reserved. e e e e e e e eb b b b b b b br r r r r r r riiiiiiii........o o o o o o o or r r r r r r rg g g g g g g g N N N N N N N No o o o o o o otttttttte e e e e e e es s s s s s s s • • • • • • • • J J J J J J J Ja a a a a a a an n n n n n n nu u u u u u u ua a a a a a a ar r r r r r r ry y y y y y y y 201 201 201 201 201 201 201 2016 6 6 6 6 6 6 6 • • • • • • • • V V V V V V V Vo o o o o o o ollllllll. 3 . 3 . 3 . 3 . 3 . 3 . 3 . 37 7 7 7 7 7 7 7,,,,,,,, N N N N N N N No o o o o o o o. . . . . . . . 1 1 1 1 1 1 1 1 11 15 8 7 6 4 3 2 A monthly new sletter from the EBRI Education and Research Fund © 2016 Employee Benefit Research Institute ebri.org Notes • January 2016 • Vol. 37, No. 1 ebri.org Notes • January 2016 • Vol. 37, No. 1 ebri.org Notes • January 2016 • Vol. 37, No. 1 ebri.org Notes • January 2016 • Vol. 37, No. 1 ebri.org Notes • January 2016 • Vol. 37, No. 1 ebri.org Notes • January 2016 • Vol. 37, No. 1 12 13 10 14 9 5