Schneider National, Inc.
Schneider is the largest long distance truckload carrier in the U.S. employing over 20,000 associates, the majority a high risk population of truck drivers. Schneider’s self insured medical claim history showed cardiovascular expenses trending 30% above the U.S. average. Schneider conferred with the incumbent vendor, Intracorp, and together they decided to introduce a third party, American Healthways. These three companies collaborated, each sharing their learnings and best practices to design a customized disease management that posted remarkable results in the third year: increased participation, fatal heart attacks were down by over 50%, and the ROI for the entire program almost doubled.Situation
Schneider is the largest long distance truckload carrier in the U.S. employing over 20,000 associates, the majority a high risk population of truck drivers. An endemic problem for the entire trucking industry is the unhealthy over-the-road lifestyle with long extended periods away from home. Risk factors include high stress, fatigue, poor diet and lack of exercise. Schneider’s self insured medical claim history has reflected this with cardiovascular expenses trending 30% above the U.S. average. There has also been an inordinate amount of large shock claims with 4% of the covered group accounting for 60% of its total annual claim cost.Schneider’s demographics pose special problems for company sponsored health promotions, because it is a mobile workforce with high turnover and there is a preponderance of males disinclined to change their unhealthy behaviors. Conventional wisdom in the emerging field of disease management cautioned that the ROI (return on investment) for health interventions would be sub-optimal given this difficult population.
Health and safety is an integral part of Schneider’s corporate culture, so the decision was made to invest in a disease management program. This was a leap of faith considering that the truckload industry’s high turnover would mitigate against a long term payback in reduced benefit costs. Schneider worked with Intracorp to launch a pilot program targeting three disease states -- diabetes, asthma and heart conditions. Benefit claims data was extracted to identify and prioritize those at highest risk, and the subsequent intervention included educational home mailings, nurse phone counseling and a drug benefit incentive to encourage compliance. After two years the program was successful from an ROI standpoint, but driver participation plateaued in the 15% to 17% range. While that was deemed acceptable by prevailing industry standards, Schneider’s in-house Occupational Health Department had hoped for more. This disappointment was emphatically brought home in very human terms which more than outweighed any lost savings opportunity. Two drivers that were identified as high risks for cardiac problems had refused to participate in the disease management outreach and then died of heart attacks later in the year.
Solution
Schneider’s Occupational Health Department proceeded to identify the following barriers which needed to be overcome in order to improve driver participation:- Drivers may be on the road for up to ten days straight, so they are typically not available to receive nurse phone calls at home.
- When drivers finally return home, they have an accumulation of mail and tend to ignore unsolicited letters from an insurance company.
- The timing of the outreach is often too late, at least three months after the claims stratification identifies a high risk candidate, so it is often out of synch with the individual’s readiness to change.
- Some drivers had machismo or fatalistic attitudes which predispose them to resist well intentioned advisories to reduce their health risks.
- The program’s administrative process was complex and fragmented, making it difficult for drivers to connect with the right person in what they saw as a very confusing insurance bureaucracy.
- The drug benefit incentive was not effective because many drivers did not like to use the mail order pharmacy due to timing problems or negative perceptions regarding quality.
Schneider actively facilitated the vendor transition by sending a company paid driver to visit the American Healthways office in Phoenix. The driver toured the nurses through the truck cab and helped them understand the unusual rigors of his over-the-road lifestyle.
American Healthways uses an engagement model where drivers are not required to actively “opt in” to participate in the program. The empathic outreach efforts continue unless an individual specifically opts out. To overcome the ongoing problems making phone contact at home, Schneider used it’s onboard satellite communication technology to reach the driver in the truck. Only the Schneider staff could access this proprietary system, but HIPAA privacy concerns were resolved by simply messaging the driver to call American Healthways to receive special benefit services.
Schneider also has its own nurses working in-house in the Occupational Health Department to ensure driver compliance with DOT physical standards. These nurses provide yet another avenue of entry to the disease management program -- sometimes even before the driver has filed an initial insurance claim. They often use their working relationships and DOT certification leverage to convince a reluctant driver to call American Healthways. If motivation is low due to underlying psychological issues, a driver might also be referred to Schneider’s robust pre-paid EAP network. Finally, in a straightforward effort to overcome die-hard denial, Schneider has widely communicated the true story of the two drivers who had refused to participate in the initial disease management program only to suffer fatal heart attacks that same year.
Better Health and Lower Costs
The revised disease management program posted remarkable results in the third year:- Participation increased from 15% to 43%, as measured by drivers actively engaged after a successful phone contact (a more accurate indication than merely counting those who did not opt out).
- There was a 42% increase in the total pool of candidates identified as high risk, from 2,074 to 2,949 per year.
- Fatal heart attacks were reduced by over 50%, down from 17 to 8 per year.
- Medical plan costs for heart-related conditions dropped from 16% to 13.67% of total claim expenditures.
- Sleep apnea interventions increased from 275 to 311 (an Occupational Health Department innovation that identifies safety impaired drivers and convinces them to use c-pap equipment to reduce fatigue).
- Of the 950 associates who had at least two continuous years of medical claims history, there was a significant step change when comparing medical claims before and after the intervention: hospital days decreased 36%; emergency room visits decreased 9%; physician office visits decreased 6%; pharmacy costs increased 13% (better compliance); and average claim cost per diagnosed member decreased 19.5%
- The ROI for the entire program almost doubled increasing from 2.7/1 to 5.0/1 (this metric was conservatively derived only from medical costs without adding savings from life and disability benefits, reduced accident and workers comp liabilities or estimated productivity gains)
