Randomized Controlled Trial of Cost Reductions from a Health Education Program: The California Public Employees' Retirement System (PERS) Study

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Abstract
Purpose.: This study evaluated the cost trend reduction from a health promotion program. Design.: A randomized 12-month trial comparing claims data was conducted. Additional studies, utilizing quasi-experimental designs, analyzed changes in health habits and changes in costs estimated by self-report. Subjects.: All active California Public Employees' Retirement System (PERS) employees (21,170), non-Medicare eligible retirees (8,316), and retirees with Medical Supplement coverage (25,416) administered by Blue Shield of California were included. Intervention.: The program consisted of mailed health risk assessments at six- or 12-month intervals, with individualized reports and recommendation letters sent to participants emphasizing and encouraging change, self-management materials emphasizing self-care when appropriate, and quarterly newsletters. Passive participants received printed materials only. Measures.: Health risks were based upon self-report; summary scores were computed by modified Framingham algorithms. Self-report cost data were estimated from reported doctor visits, hospital days, and days sick or confined to home. Claims data were those paid by Blue Shield of California. Results.: The program was associated with: 1) reduction in health risk scores at 12 months, (p<.001), 2) reduction of subject reported medical utilization from baseline (p<.05), and 3) decrease in claims cost growth relative to controls (p=.03). Annual claims costs were approximately $3.2 to $8.0 million less than expected had costs for the experimental participants increased at the same rate as the control group. Discussion.: Results suggest that appropriately designed health promotion programs can reduce health risks and at the same time reduce the medical care claims cost trend.