The Healthy Consortium
The Boston Consortium for Higher Education is composed of 15 colleges and universities throughout the Boston area. In 2006, the consortium's member institution chief human resource officers set out to identify how to better manage their institutions' health-care costs in a way that would improve the health of faculty and staff while reducing their consumption of increasingly expensive health services.
The working group understood that attempts to create a healthy workforce by leveraging wellness programs would not, on its own, be enough to address the growing prevalence among employees of chronic disease conditions such as diabetes and heart disease. (On par with national averages, the less than 20 percent of the consortium's combined employee population who have chronic or acute health conditions account for 70 percent of the institutions' total health-care costs.) The group also knew that any design changes that simply shifted additional costs to employees would likely prompt more employees to forego necessary preventive care or cut back on their use of the prescribed medications that would help them prevent or mitigate the effects of a chronic disease. The group agreed it was important to instead design their health management initiative in a way that would encourage employees to use program benefits wisely. Among the key goals of the initiative:
- Design a program to target the highest-cost and most-prevalent health conditions.
- Include elements to drive greater participation among faculty and staff, including the use of meaningful incentives.
- Develop a strategy that connects to and builds on members' existing programs while remaining sensitive to the unique cultures and health management needs of participating institutions.
- Institute a uniform system of measurement to track progress.
- Incorporate program objectives that link desired outcomes with observable, measurable changes in employee behavior over time.
What resulted from the working group's intensive study and planning efforts is the consortium's "Healthy You" initiative, in which 14 of the consortium's 15 member institutions are currently engaged in various stages of rollout. (See "Key Components of Healthy You" sidebar for a broad description of the initiative.)
According to Phil DiChiara, The Boston Consortium's managing director, and June Kevorkian, director of programs and administration, what is impressive about Healthy You is that such an endeavor was accomplished. Reaching agreement on program parameters and components for something as complex as a health management initiative is daunting enough for an individual institution to tackle, let alone for a diverse group of colleges and universities. On the other hand, it makes perfect sense, notes DiChiara. He believes the vast majority of higher education consortia are underutilized, failing to capitalize on the real economies of scale that can be achieved when groups tackle common, complex challenges. The interview with DiChiara and Kevorkian that follows provides a snapshot of what has made The Boston Consortium successful on numerous fronts.
What is the primary goal of your Healthy You health management initiative?
DiChiara: Our objective is to pull more people voluntarily into better health behavior. Healthy You is also an attempt to bend the rate of rise of health-care costs. We know that our costs will continue to climb, but the degree to which we can slow that rate of increase represents a cost avoidance that our member institutions share. While our immediate attention is on how we can improve the health of employees at our member institutions, one broader aim we have is to consider what we might contribute to the wider body of knowledge about chronic disease and disease management. Because of the size of our total population as a consortium—approximately 70,000 individuals in the greater Boston area—we offer a significant opportunity for research and clinical trials that can essentially provide a case study of the health of an entire city.
To what do you attribute the success of the initiative?
Kevorkian: The time, energy, and commitment made by everyone involved to collectively create this program—in spite of all their other responsibilities—is really testament to the vision members shared to get beyond the day-to-day issues and confront what was coming down the road, knowing they would not realize the real benefits of the program for several years.
How does the governance or organizational structure of the consortium spur this level of participation?
DiChiara: As representatives of our members, June and I, appropriately, have zero authority. Our job is to convene the member schools, listen to their concerns, and offer options and assistance for how they might accomplish their goals and shared vision.
Kevorkian: The true lifeblood of our consortium and what really makes it work is that we have very robust communities of practice among our different professional disciplines. To flesh out the focus for Healthy You, our chief human resource officers met regularly for several years. In fact, we have 23 different communities of practice. These aren't structured as committees with a formal chair. They are simply groups of peers getting together to learn from each other, share challenges, and ultimately assemble projects they want to work on together.
What other initiatives is the consortium working on at present?
Kevorkian: Right now we are working with our emergency preparedness group to improve collaboration across institutions and with local, state, and federal authorities. Our member institutions are about to launch a project with WebEOC (a Web-enabled crisis information management system), which would allow them to better manage emergencies on their campuses, but this is rather expensive. Our institutions are working with the vendor to obtain a consortium umbrella license that would allow them not only the ability to obtain information about area-wide events such as a hurricane, but also to share information and manage specific events on campus—from a water-main break, hazmat issue, pandemic, or storm-related challenge, to graduation ceremonies.
DiChiara: Another benefit of a communities-of-practice approach is that member representatives are routinely working across institutions to identify or envision new technologies or systems that might benefit the entire group. These ideas sometimes morph into a program or a distinct business unit with direct service back to consortium members. For instance, we have a risk-management business unit that the consortium co-employs. We also have an internal audit unit. Another example is a major effort under way in procurement for which we are developing committed volume contracts for the roughly $6 billion that our schools collectively spend. And finally, another big project in the works that is on the scale of Healthy You and for which we have already spent four years in collaborative discussion is a plan to form our own health insurance captive that would extend beyond our consortium. This will be significant and is illustrative of the kind of thing you can accomplish as a group that you would not or could not accomplish on your own.
What makes a consortium work?
DiChiara: The nature of collaboration is often misunderstood. A consortium is not an add-on layer of work, but a different way of accomplishing your job responsibilities. While it may be inherently more complex, it can also be easier because you have the opportunity to start with a blank slate. We think our consortium works because it is based in dialogue, relationships, trust, and opportunity. Dialogue leads to relationships, which lead to trust, and ultimately to opportunity. Healthy You is a prime example. People across institutions recognized a common problem and resolved to address it together.
As more leaders begin to view collaboration as a safe way to experiment with new ideas, they will have confidence to go beyond more common activities like cross registration or faculty development. While those processes are still important and beneficial to partner on, the truth of the matter is that all higher education institutions need to step up their level of innovation going forward. With the current set of challenges that most colleges and universities face, we need to be more aggressive. In fact, the real triumph of a consortium is the opportunity to get beyond a single-institution mind-set to entertain the kind of significant innovations you might accomplish together that you could never imagine on your own.
For more information about The Boston Consortium, contact Phillip DiChiara, managing director, firstname.lastname@example.org, or June Kevorkian, director of programs and administration, email@example.com.
Key Components of Healthy You
Level of involvement. Like other consortium programs, member institutions can choose to implement some health management initiative programs at different times and to different degrees or can opt out of certain programs or the initiative altogether. Benefits include cost efficiency from ability to scale program administration; flexibility to customize individual programs and co-brand communication with institution-specific messages; and access to centralized resources, such as a shared manager/clinician. Programs include diet, fitness, and exercise programs; screenings and preventive care; disease/condition management programs (asthma, coronary arterial disease, congestive heart failure, chronic destructive pulmonary disease, diabetes); EAP; and health coaching (weight reduction, nutrition, stress management, tobacco cessation).
Voluntary participation. Regardless of institution involvement, participation in the health management initiative is up to each employee. Faculty and staff of participating institutions are not penalized for having a serious or chronic health condition.
Privacy of personal health information. All personal health information is handled by credentialed third-party health and insurance professionals in accordance with federal privacy rules. Human resource departments of member institutions will never see personal health information under any circumstances.
Health-risk assessment questionnaire. An annual health-risk assessment questionnaire is completed by each participating individual as a way to track individual behavior change and health improvement and to identify group information, trends, and needs for additional programming or coaching.
Data warehouse. Data from carriers are compiled to interpret clinical changes and financial impacts. Vendor reporting helps to evaluate and monitor programs and activities such as medical, behavioral health, and pharmacy claims, and health questionnaire data. In coming years there may be an opportunity to share claims-related data and reporting with the consortium's provider network to develop enhanced financial contracting related to the delivery of health and wellness programs to consortium member employees. Use of institution-specific scorecards could monitor key areas of program use and cost to identify opportunities for program enhancement as well as best performance and best practices.
Incentives. Individual member institutions can choose how to offer incentives for employee participation. Possible incentives may include a $100 incentive for health-assessment questionnaire completion, a co-pay or co-insurance waiver for disease-management program participation, or fitness-center discount or reimbursement. Incentives in subsequent years can build on prior-year incentives, including a medical premium reduction for program adherence, or fitness-center discount/reimbursement based on proven attendance.
Communication. A co-branded "Healthy You" Web site and co-branded electronic newsletters enhance broad participation from among member institutions while still offering individual institutions flexibility to tailor their messages and delivery to their faculty and staff. Strategies include incorporating an ongoing series of leadership briefings/e-mails, health questionnaire reminders, and testimonial videos from staff members whose health behaviors have been impacted.
Karla Hignite, principal of KH Communication, is editor of NACUBO's HR Horizons. E-mail: firstname.lastname@example.org.