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  1. D. H. Chenoweth,
  2. N. Martin,
  3. J. Pankowski,
  4. L. W. Raymond
  1. Chenoweth & Associates and East Carolina University, Greenville, NC; Carolinas Healthcare System, Charlotte, NC; and University of North Carolina at Chapel Hill, NC


Annual double-digit increases in health care costs (HCC) threaten the sustainability of employer-based health insurance for working families. We thus collaborated with a three-site foundry in providing nurse practitioner (NP) services for workplace care to workers with minor illnesses. All job-related illness and injuries were excluded, such conditions being under the care of occupational health nurses. NP care and referral to neighborhood physicians for co-management of hypertension and other chronic conditions were also provided to workers with no personal physician. We analyzed impacts upon HCC of 4,284 employees and dependents in two ways. First, we compared annualized actual HCC for all family members in the start-up phase vs. those projected on the basis of the previous two years' paid claims. A second analysis employed an annualized benefit-to-cost ratio, in which the numerator was the aggregated HCC of off-site care (of workers only) for low-cost conditions actually treated by the NP (eg, respiratory infections, hypertension @ < $500 per case). The denominator was the cost of the NP program, $82,716. Method 1 yielded annualized HCC savings of $1,313,756 per year, and a benefit-cost function of 15 to 1. Method 2 gave a benefit-cost function of 2.4 to 1. The large difference between these two estimates appears multi-factorial. First, Method 1 deals with HCC of all family members, whereas Method 2 involves only the HCC of workers (no family members were treated on-site). Alternatively, part of the difference may be due to other simultaneous initiatives such as a Wellness Program, and a 24/7 Nurse Help Line aimed at reducing unnecessary utilization of emergency departments and urgent care centers. An on-site NP program, in concert with other initiatives aimed at reducing HCC, yielded substantial savings. The size of the savings is sensitive to the method of analysis and requires further refinement.

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