Dynacare Medical Laboratories, the leading Canadian medical laboratory, provides services to millions of Canadian patients and more than 10,000 clinicians, as well as hospitals, corporations and partners such as INTERVENT Canada. It operates an integrated, state-of-the-art laboratory system that collects, transports, tests and reports on tens of thousands of specimens each day. The company employs approximately 1,900 highly dedicated clinicians, scientists, laboratory professionals, couriers and clerical staff to make this possible day in and day out. The Dynacare employee settings consist of both head-office on-site locations (comprising several hundred employees), and decentralized, geographically dispersed labs (comprising fewer than five to 10 employees). Dynacare works closely with INTERVENT Canada to provide blood collection services, ensuring that participants can rely on the most up-to-date health information when starting their INTERVENT Canada program.
To ensure that the INTERVENT model was going to work effectively in Canada, we secured Dynacare Medical Laboratories—a key partner that helps us integrate blood and lab results.
In addition to ongoing research and development, Dynacare plays an active role in working with government, hospitals, professional associations and other key stakeholders to find meaningful solutions to healthcare issues that affect Canadians.
As research has shown, a health risk assessment without supplemental biometric data decreases significantly in accuracy among people who report themselves as low- or medium-risk. We place great importance on having objective measurements like biometric data to ensure the accuracy of our health risk assessment. Self-reports alone cannot ensure an accurate health risk profile, since self-reporting can result in an inaccurate designation of low- or medium-risk.
While implemented extensively in US (and other international) areas, the incorporation of employee health and wellness in Canada remains in its early stages. The reason for the limited application of health and wellness to Canada likely relates to insufficient data on cost-effectiveness and return on investment in the Canadian marketplace. Return on investment must address employers, government, insurers and pharmacies separately, given the unique condition of the Canadian healthcare system.
The Dynacare Medical Laboratories (formerly Gamma-Dynacare Medical Laboratories) Pilot was INTERVENT Canada’s first corporate pilot study, which sought to evaluate the implementation of a Canadian program designed to quantify return on investment to Canadian stakeholders. In doing so, the pilot allowed for the Canadian adaptation of a scientifically proven US program leveraging physician marketing and distribution channels through Dynacare to create a value offering unique to Canada.
Officially launched in April 2008, the pilot project introduced Dynacare employees to the INTERVENT Canada offering. INTERVENT, a program that was originally developed in the US, is a scientifically validated health and wellness program that has been licensed to more than 200 leading academic institutions and US corporations covering more than one million lives.
The program consists of a health risk assessment (HRA), proprietary algorithms used to stratify employees according to modifiable biological and behavioural risk-levels (which also allows for variations in service-delivery intensity to maximize the program’s cost effectiveness), personalized goals and action plans, customized educational kits (delivered as self-help and mentor assisted), and an extensive database allowing for real-time tracking of outcomes for patients on programs.
Through the Dynacare pilot study, INTERVENT required adaptation to Canada. INTERVENT Canada’s adaptation focused on four unique areas.
The first adaption was the necessity that the program’s components were concordant with Canadian metrics and clinical guidelines. To accomplish this, INTERVENT Canada assembled an extensive scientific advisory process consisting of physician leaders and academics.
The second was the development of an innovative biometric assessment program. This program incorporated state-of-the-art technology that integrated Dynacare’s collection process with INTERVENT’s IT platforms to create a seamless auto-integration of objective measures (fasting labs, blood pressure, height, weight, and waist circumference) such that all personalized risk profiles, reports, and goals and action plans were automatically regenerated for employees and patients. Specifically, using proprietary biometric processes and technology, Dynacare and INTERVENT developed an automatic blood collection process. This system associates a patient’s blood test results with their INTERVENT program; it is a fully integrated and standardized biometric module. Blood test results are uploaded from Dynacare directly into the INTERVENT system, easing participation for patients while reducing medical errors and improving the accuracy of risk assessments.
The third adaptation for Canada necessitated a focus on drug-safety medication compliance and appropriateness as key priorities. To accomplish this, a unique drug-safety and compliance program was developed and integrated into all aspects of INTERVENT Canada’s program. Patients with drug-safety, compliance and appropriateness issues were flagged within the system, which in turn sends an electronic alert to a pharmacist who interacts with patients and addresses issues as appropriate. For the Dynacare pilot, such pharmacist mentor responsibilities were outsourced to a third party (Shoppers Drug Mart). These pharmacists were trained as both lifestyle and pharmacy mentors, although pharmacists provided only pharmacy mentorship for the purposes of the Dynacare employee pilot. The integration and parsing out of responsibilities between lifestyle and pharmacy coaches was, to our knowledge, the first of its kind worldwide.
With the last adaptation for Canada came a recognition that, while INTERVENT’s program was delivered outside of usual-care settings and did not constitute the practice of medicine, physicians must be kept engaged for those employees and patients who wish to involve their providers. INTERVENT developed a unique feedback mechanism whereby reports, updates, recommendations, and fee-for-service elements could be provided to physicians where appropriate.
The objective of the Dynacare-INTERxVENT Canada employee pilot was to evaluate the implementation of all of these components. One particular ancillary objective was to evaluate the best method by which such health and wellness programs could be implemented in an employee setting. To do this, we evaluated three different methods of program implementation:
1. Passive uptake with minimal marketing materials.
2. Modest engagement activities that allowed for the direct on-site communication for a proportion of ‘on-site’ employees
3. A more significant engagement activity that attempted to reach all on-site employees
INTERxVENT Canada was able to create awareness of the program through its use of marketing materials, successfully launch GDML employee engagement activities through lunch-and-learns, and create innovative employee incentives to facilitate participation in, and compliance with, the program in its entirety. INTERxVENT’s unique marketing tools such as a postcard-to-landing-page campaign, coupons and incentives (including a $1,000 gift certificate for Fitness Depot and Shoppers Drug Mart Optimum points). The success of the GDML pilot greatly contributed to INTERxVENT’s marketing, IT development and other support initiatives.
In sum, Gamma-Dynacare also proved to be an ideal testing environment, allowing INTERxVENT to test and showcase its offerings in a real-world Canadian setting.
This pilot resulted in a number of important results and findings.
First, the program demonstrated important improvements in patients’ self-management behaviours and outcomes. INTERxVENT Canada and GDML confirmed the successful implementation of all newly adapted Canadian components described above with a high degree of satisfaction and efficiency across all stakeholders, from employers and employees to pharmacists and physicians.
It was also demonstrated that there could be improvements in self-management behaviour. In particular, it was determined that program compliance could be improved over 20-fold with intensive upfront employee engagement activities, including marketing materials, lunch-and-learns, on-site program access, and a single telephone call following completion of the initial health risk assessment. The GDML employee pilot confirmed that self-management behaviours could indeed be modifiable. It was found that the greatest determinant of the numbers of individuals completing programs was the number of employees who participated initially in the health risk assessments and agreed to program mentorship.
It was also determined that a set of organizational (e.g., employee setting), programmatic, and individual factors were associated with the degree of program compliance and likelihood of completion.
Among those who participated in all aspects of the programs (lifestyle and pharmacy mentorship), the pilot determined statistically significant improvements in health status and medication compliance behaviours. There were non-statistically significant trends towards fewer emergency room visits and less productivity impairment. The estimated return on investment from presenteeism alone was estimated to exceed $4.40 for every $1 invested.
Working with Gamma-Dynacare, INTERxVENT was able to compile data that illustrated the significance and impact of drug utilization (namely through its drug-safety and compliance program), absenteeism, healthcare visits and stress management data that it now incorporates into its projects. Additionally, the program provided employers with the incentive and means to offer health and wellness to their employees, while demonstrating that employees are eager to learn about and participate in such programs.
The first phase of the pilot saw the registration of 400 employees, approximately 200 of whom signed up for the program and filled out an HRA. Approximately half of those entered INTERxVENT’s program. The importance of the HRA alone cannot be overstated; the health risk assessment immediately brought health concerns to the attention of employees and the means with which to address any potential risks.
Additionally, there were a number of lessons that emerged from this pilot—improvements that were migrated into a second phase and launched to 600 people in the Greater Toronto Area. It was through this pilot that INTERxVENT was able to detect preliminary issues and further refine its offering.
The GDML pilot demonstrated the feasibility of implementing a successful employee self-management health and wellness / disease-management program for the Canadian workplace. Resource investment in the upfront engagement process was among the most cost-effective components of the program. Integrated standardized biometric and drug-safety / compliance components within the health risk assessment significantly enhanced program accuracy and comprehensiveness.
The validation of a process that led to distinctive responsibilities between health coaches (lifestyle and pharmacy mentors) within a single database platform was the first of its kind in Canada, underscoring its innovative impact. More importantly, it allowed for other pragmatic applications in the workplace, such as the integration of employee assistance providers, whereby a health risk assessment can determine risk-markers for disability that allow early intervention among employees who experience significant stress, anxiety, depression or other mental illnesses.
The improvement in health status and compliance metrics noted among employees who participated in the pilot validated one of the central objectives associated with employee health and wellness and disease-management programs: namely, improvements in patient outcomes. The ability to demonstrate statistically significant improvements in such metrics highlights the importance of integrated databases that allow for the examination of outcomes in real time.
The statistically significant improvements in medication compliance behaviours may suggest that medication-related costs could be improved through decreased drug wastage—which itself is an important determinant of drug expenditures in corporations. Such improvements, accompanied by strong signals towards benefits in productivity and health service utilization, provide proof that the advantages associated with employee health and wellness may extend to multiple outcomes and to multiple stakeholders.
In summary, not only has the GDML employee pilot been used to innovate and Canadianize an already scientifically proven and readily applied US-based program, but its study results have been used to inform the feasibility of the larger INTERxVENT Canada initiative, whose objectives are to quantify the returns on investment associated with health and wellness and disease management in Canada. The GDML employee study has been used as a pilot to refine sample size estimates for larger Canadian workplace studies.
Since the launch of the GDML employee pilot, INTERxVENT Canada has licensed its programs to several corporations, clinics, and health regions across Canada, many of whom continue to partner with INTERxVENT Canada to adapt and modify health and wellness / disease management programs to the Canadian population. In this regard, GDML should be viewed as a pioneer in the health and wellness / disease management industry in Canada.
It was also discovered that these initiatives work best when they shape behaviors (i.e., adherence and compliance) that are ultimately responsible for actions that result in improved health. In particular, it revealed the efficacy of telephone mentoring and the utility of the HRA as a surveillance tool (particularly as a means to stratify by risk).
In terms of compliance tracking, when compared to international averages, Gamma-Dynacare scored significantly higher in a number of categories, including the percentage of employees who complied with the program when completing the HRA (40% higher), when converting to the program (24% higher) and when complying with visits (18% higher).
The pilot also indicated a dramatic difference in success rates depending on whether or not the patient was enrolled in a self-help program or a mentored program; nearly 94% of patients completed their tasks with the help of a mentor, as opposed to 0.2% who did self-help. The program also demonstrated that key health targets could be attained without medications, and that it can be effective in its use in dealing with type 2 diabetes. Those enrolled in the program showed a 20% increase in medication compliance.
Overall, the success of the pilot project revealed that employers can establish objectives based around the health and wellness of their employees and that it pays to increase awareness. This pilot demonstrated that a channel between health and wellness program providers and corporations can be forged, and that there is enough incentive for all parties involved to do so—including employees looking to increase their health and reduce their risks of disease.
The pilot also revealed its potential to be applied in other settings, including other corporations and regions, as improving health and productivity is a concern of both businesses and governments. Specifically for corporations, it was established that return on investment could be determined for drug avoidance and management, as well as for productivity, employee engagement and disability.
Looking at benefits for the government, it was shown that collaborative programs can work to significantly reduce avoidable hospitalizations and emergency room visits.