The challenge: targeting wellness
Staff members at St. Jude Children’s Research Hospital in Memphis, Tennessee, are dedicated to treating children with cancer and other life-threatening diseases. When hospital leaders learned almost one in four employees was hypertensive, they uncovered more information to ensure they were giving staff the best chance to stay healthy. The hospital employs about 4,000 people who cover more than 1,600 unique jobs supporting the mission.
Defining factors for success
St. Jude’s spends about $48 million each year providing health care for its diverse workforce, representing a wide range of education, income and culture. While designing a wellness initiative, staff members discovered how a data-driven approach using Claims and Health Analytics Resource Tool (CHART) could define targeted employee populations and challenges, and help deliver healthy changes while staying within a limited budget.
The CHART data revealed that while most employees were filling their anti-hypertensive prescriptions, those who didn’t fill prescriptions were seeking treatment and being admitted to the hospital more often.
Overall, 72.5 percent of St. Jude’s employees took their antihypertensive drugs as prescribed 80 percent of the time. The measure of taking medication as prescribed is known as a proportion of days covered (PDC). The challenge was to find out what factors reduced the PDC for staff.
Using data to inform a strategy
To create a targeted outreach plan to improve PDC, St. Jude provided additional demographic data to Children’s Hospital Association analysts who incorporated the information into CHART. With this richer data, analysts uncovered significant variation in the PDC by income and gender:
- Only 56 percent of the employees in the less than $35,000 salary band had a PDC of 80 percent or higher
- Within this lower income segment, non-adherent females ages 18 to 49:
- Had the lowest adherence, with just 39 percent having a PDC of 80 percent
- Were least likely to use generics, with a generic dispensing rate of 75 percent vs. 90 percent for the population as a whole
- Had the highest use of the ED, with 842 visits per 1,000. That is more than three times the average of 259 per 1,000
The median cost per month for antihypertensive drugs is $6.30.
Adherent Employee Volume - Antihypertensive Medication Treatment
Employee ER Visits per 1,000
Employee Antihypertensive Medication Generic Dispensing Rate (GDR)
Teaming up to make a difference
From the groups defined by the data, hospital leaders selected a target group for their pilot program. Acknowledging that changing behavior is difficult, St. Jude leaders formed three teams to develop effective plans to educate and inform the target population about hypertension and its management. The initiative centers on three categories:
- Behavior: Well-being coordinators support change management and engagement
- Health: Occupational health team educates staff on medication regimen, knowing your numbers and disease management
- Wellness: Team offers coaching on exercise and diet
To make the initiative relatable, the team consulted with the HR communication team to identify staff members who could tell their real-life stories of overcoming weight issues and chronic medical conditions. “An individual has to be ready to make a change and take control of their health and wellness,” says LaQuita Whitmore-Sisco, manager, Occupational Health in HR at St. Jude. “We wanted our messaging to remind people that they can accomplish anything with effort.”
HR communication also helped organize a hypertension awareness and prevention campaign during heart health month in February 2018. The campaign was an interdisciplinary team approach with Occupational Health, Wellness, HR Communication, Nutritional Services, Critical Care, Methodist EAP, Blue Cross Blue Shield, UT Pharmacy students and the Biomedical Library. Each group provided resources and screenings within their expertise on heart health and hypertension management.
Pilot group members will fill out a health needs assessment designed specifically for them. The next step is for staff to review assessment data to create targeted education addressing needs, barriers and readiness for change. The education components will stem from the three areas defined in their initiative.