Richard L. Brown, MD, MPH

This month we are running a guest column from Richard L. Brown, MD, MPH, a professor of family medicine at the University of Wisconsin School of Medicine and Public Health, clinical director of the Wisconsin Initiative to Promote Healthy Lifestyles (WIPHL), and CEO of Wellsys, LLC.

It’s been nearly two years since The Alliance published my guest column on how healthcare settings can improve employee health and employers’ bottom lines through delivering behavioral screening and intervention (BSI). In short, BSI involves systematic verbal screening, assessment, intervention and referral for smoking, unhealthy drinking, drug use and depression, which generate more than $650 billion of economic loss per year in the United States. As a group, employers suffer most of these losses through higher healthcare costs, lower productivity and increased workplace injuries.

Since my last column, additional research has made clear that for every employee who completes screening and receives appropriate additional services, BSI would save area employers $895 in just the first year – and more beyond. Alcohol screening and intervention yield a 400% return on investment (ROI) in the first year, 480% ROI over four years for depression services; and for tobacco, even higher ROI over a longer time period. If all regional Wisconsin Medicaid patients received alcohol screening and intervention, Medicaid (and we taxpayers) could save more than $160 million!

Experts have learned that BSI can be delivered systematically only when healthcare settings hire new, specially trained staff, such as health educators. Physicians and nurses simply don’t have the time, and health educators can get the same excellent results at a fraction of the cost.

Unfortunately, few healthcare settings have hired health educators and few routinely deliver BSI despite recommendations from the Centers for Disease Control and Prevention, National Business Group on Health, National Institutes of Health, Wisconsin Medical Society, Wisconsin Manufacturers and Commerce, The Alliance, and many other authorities.

Why are our healthcare systems not delivering this common-sense, cost-saving service? One reason is that healthcare leaders are busy responding to strong regulatory and financial incentives to install and optimize electronic medical record systems, report increasing amounts of quality data and institute various quality improvement programs. In contrast, traditional fee-for-service reimbursement for BSI generates only modest profit. The other reason that healthcare leaders consistently mention is, “Nobody’s asking for it.”

So, what can you do? If your company, like many others, is establishing a workplace primary care clinic, be sure to speak up and ask that BSI be included as a standard service.

Or, like any customer, you have the power of your purse.

  1. Tell your TPA you want to ensure they reimburse when health educators deliver BSI without out-of-pocket payments by patients.
  2. Tell the clinics and hospitals serving your employees that you want to ensure they have dedicated health educators to deliver BSI.
  3. Ask your clinics and hospitals to what degree they meet US Preventive Services Task Force Recommendations. What proportion of their patients is screened at least yearly? What proportion with positive screens receive recommended interventions – which include medication and more than eight one-on-one counseling sessions for smoking cessation; at least a 15-minute intervention for risky or problem drinking or drug use; and “collaborative care and behavioral activation” for depression.

I conclude with a toast: to your health, your employees’ health, and your bottom line – through BSI.