Health and Wellness Programs for Commercial Drivers (2007)

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40 In addition to the surveys and literature review presented, this synthesis includes four trucking case studies and one bus company case study describing implementation of innovative company-sponsored employee health and wellness practices and programs. The four trucking industry case studies presented here include both large and small carriers from TL, LTL, short- haul carriers, and one very large nationwide (short-haul) waste management company. Case study data were obtained from a single intercity, interstate bus company: Greyhound Lines, Inc. Some of the key points identified from the four trucking and one bus company case studies include • Significant value is placed on drivers as the cornerstone of companies because they are crucial to continued company success. • Recognition of the challenges to driver health and wellness related to the unique nature of the truck driving lifestyle. • Recognition of the connection between driver health and driver safety. • The value of health and wellness initiatives on the compa- nies’ bottom lines through the reduction of health claims, early identification of treatable health issues, and improved driver retention. • The value of an integrated human capital management strategy for controlling overall health care and workers’ compensation costs. The case studies identified some key initiatives being con- ducted by carriers. These initiatives include more extensive pre-employment and annual physical testing, establishment of onsite clinics, health coaches, and training programs such as Gettin’ in Gear, additional efforts to address sleep apnea for all drivers by means of early testing and diagnosis, and implementing more ergonomic cab settings (such as seat adjustments). The carriers emphasized the importance of educating drivers about the availability of the health and wellness programs and working together toward reducing any additional health-related costs for drivers. The carriers described methods for advocating and imple- menting the programs. Some of the carriers conducted claims studies to examine the cost savings of particular programs. All the carriers discussed the importance of identifying the ben- efits to the corporate bottom line and overall reduced health care costs, and conveying those to management. The carriers emphasized the importance of educating all levels of the organization about the importance of health and wellness programs. Some of the benefits discussed by carriers included • Holding rises in claims cost to single digit increases over 1 year compared with an industry norm of expecting dou- ble digit annual increases, • Reduction of claims involving serious musculoskeletal injuries and workers’ compensation claims, • Decreased accident rates, • Decreased personnel turnover rates, and • Early identification and the costs savings associated with identifying potential health problems of individual employees (drivers) early. 4.1 Case Study: Schneider National, Inc. Headquartered in Green Bay, Wisconsin, Schneider National, Inc., is the nation’s largest truckload carrier, employing more than 15,000 drivers and independent con- tractors. Schneider National’s approach to driver health and wellness is based on recognition that drivers are the corner- stone of the operation. Without drivers, the company would not be successful. Schneider National believes that focusing on driver health and wellness results in improvements across the safety continuum from individual drivers, to their fami- lies, to the motoring public who share the highway with Schneider National drivers. C H A P T E R 4 Health and Wellness Program Case Studies

Acknowledging that the lifestyle of a truck driver makes meeting health and wellness goals challenging, Schneider National has instituted a number of initiatives designed to mitigate the impact of the various wellness challenges (long periods sitting, truck stop diet, shift work, being away from home for extended periods of time, etc). Schneider National reports that its health and wellness initiatives have had a pos- itive impact on the company’s bottom line. Sleep Apnea Initiative. In an effort to reduce the risks associated with sleep apnea, Schneider National initiated a program to identify and treat drivers suffering from sleep apnea. An initial cohort of 339 drivers deemed positive for sleep apnea were tested. The one-night study in a sleep malady clinic, conducted with a third-party vendor and paid for by Schneider National, resulted in the diagnosis of drivers with sleep apnea who were sent home with a Continuous Positive Airway Pressure (CPAP) machine. After treatment with a CPAP for 1 year, Schneider National experienced a $538 per driver per month health care savings among the cohort and a 55% greater retention rate among participating drivers than the fleet as a whole. Based on the success of this initial test, Schneider National now pays for all sleep malady testing and CPAP costs for drivers at risk for and diagnosed with sleep apnea. The driver is followed for 30 days post-CPAP intervention to trou- bleshoot any specific issues to assist the driver in getting used to the CPAP treatment. Quarterly follow-up with the driver is done to ensure long-term compliance with the sleep apnea intervention. Ergonomic Improvements in Seating. Truck drivers spend a significant portion of their time in the cab of the truck, specifically in the seat, while driving. Therefore, seat comfort is an issue for commercial drivers who may experi- ence back, head, or shoulder pain as a result of poor seat design or use, combined with the constant vibration from the road. Schneider National wanted to find a way to promote more in-cab comfort for their drivers, believing that it would promote driver satisfaction as well as safety. Schneider National’s solution to the driver seat comfort issue was to invest in a system that works with existing cab and seat ergonomics to provide drivers with the ability to adjust seats and steering wheel for maximum comfort and safety. With the seat and steering wheel customized to each driver’s build and specific needs, Schneider National believes that drivers feel better, perform better, and are less fatigued. In the first year of its implementation at Schneider National, performance metrics calculated included lost time injuries, driver discomfort, and workers’ compensation claims. Schneider National’s results with the ergonomic seating showed a significant decrease in lost time injuries, workers’ compensation injuries, and improved driver dis- comfort complaints by 47%. Schneider National officials comment that while driver sat- isfaction and comfort were the primary drivers of the seat sys- tem, there has been a demonstrated return-on-investment (ROI) as a result of system implementation. Disease Management and Health Coaches. Under the direction of and in conjunction with a full-time Occupational Health medical team and Benefit Administration, Schneider National has several disease management and health coaches who work with the drivers on a regular basis. Areas of focus include cardiac health, diabetes, asthma, chronic obstructive pulmonary disease and congestive heart failure. Schneider National’s focus is on education and prevention, believing that educated drivers will be safer, more productive, and more invested in their overall health and wellness. Overall Program Effectiveness. In an attempt to meas- ure the impact of its various health and wellness initiatives, Schneider National undertook a study to review health care claims costs pre- and post-wellness program interventions. Through July 2005, Schneider National was able to hold claims costs to a single-digit percentage increase from the previous year, which is relatively low compared with indus- try norms. Schneider National cites as a key to the success of its various health and wellness initiatives the education and inte- gration of the programs across the organization from drivers to management. Additionally, with its corporate focus on the health and wellness of drivers as a cornerstone of the com- pany’s success, Schneider National believes that its programs must address a reduction in accidents and the risk of injury to the driver. All these efforts, when used in an integrative model approach, have led to health and safety benefits for the organization. 4.2 Case Study: Trucks, Inc. Based in Jackson, Georgia, Trucks, Inc., is a regional truck- load carrier with hundreds of drivers, operating 300 tractors, primarily in Georgia, Florida, Alabama, and South Carolina. Personal Approach to Health and Wellness. Trucks, Inc., officials believe their personal approach with their driv- ers is a key to the company’s success and this approach includes a health and wellness program. With a self-funded health insurance program, the safety department has done considerable research to correlate their drivers’ physical and emotional well-being to safety performance. Believing firmly in the connection between driver health and wellness and driving safety, the company provides drivers with health and 41

wellness education and with the tools necessary to change drivers’ mindset toward adopting a health and wellness lifestyle. Company Officials Train in Health and Wellness. Company safety officials have completed the Gettin’ in Gear training course and they use materials from the course, along with workers’ compensation materials from their insurance provider, to educate drivers on health, wellness, and safety issues. Trucks, Inc., relies on driver testimonials to encour- age other drivers to participate in the health and wellness activities. Healthier lifestyle choices are often the focus of the education provided and specific topics covered have included instruction on nutrition, exercise, and smoking cessation. Annual Physical Examinations. Included in the health and wellness program at Trucks, Inc., is an annual DOT phys- ical exam, for which the company employs a medical doctor and a physician’s assistant to conduct the exams onsite. The physical form used by Trucks, Inc., exceeds the minimum DOT physical requirements in a number of areas. Physical results from all Trucks, Inc., drivers are tracked to identify driver training needs based on resulting diagnoses. Any drivers with borderline physical exam results are rechecked on a more frequent basis. Trucks, Inc., annually checks drivers’ blood work to identify risk factors such as high cholesterol and to check prostate-specific antigen (PSA) levels. The company also provides exercise equipment for drivers, available 24 hr/day at company facilities. Health and Wellness Program Pays Off. Company offi- cials report that the health and wellness program has had a significant ROI. Early diagnosis of health issues has saved Trucks, Inc., more than $250,000 in medical insurance costs. The company reports that thus far the program has led to early identification of two cancer cases, five pre-heart attack conditions, and numerous pre-diabetic conditions. Trucks, Inc., believes that its personal approach with drivers and the care shown in drivers’ health and wellness have paid dividends in terms of driver retention as well. The personnel turnover rate at Trucks, Inc., is under 30%, com- pared with industry averages in the truckload sector of more than 100%. The company has also been recognized by the Georgia Motor Trucking Association for its safety perform- ance (which Trucks, Inc., believes is closely related to driver health and wellness) for the last 11 years. 4.3 Case Study: JB Hunt, Inc. JB Hunt, Inc., one of the nation’s largest truckload carri- ers, is headquartered in Lowell, Arkansas. Driver Medical Examinations. JB Hunt uses a third- party provider for comprehensive DOT medical examina- tions and early health risk identification of its drivers. The medical exam includes cardiovascular testing, a thorough musculoskeletal evaluation performed by a physical therapist, and job-specific testing to determine abilities to perform job tasks. Once complete, the DOT medical examination is entered into a web-based application so that all data are maintained electronically. Statistical analyses can be performed on all data fields of the DOT exam and trend analyses are conducted regularly. These analyses allow JB Hunt to focus wellness initiatives on specific health risks and allow for health and wellness programs to be more effective. Health Coaching. JB Hunt provides health coaches to individual drivers. Drivers who are determined to have health risks such as hypertension and diabetes are given information that will assist them in initiating a relationship with a health coach who can assist in making lifestyle changes and create accountability. Health Program Results Favorable. JB Hunt has seen many significant results due to the use of health coaches and the electronic tracking of DOT medical examination findings. There has been a reduction in the number of workers’ com- pensation claims and costs, a reduction of claims due to serious musculoskeletal injuries, a reduction in workers’ compensation claims within 90 days of hire, a reduction in accident rates, and a decrease in driver turnover. 4.4 Case Study: Waste Management, Inc. Waste Management, Inc., (WM) is one of the nation’s largest short-haul trucking companies, employing more than 30,000 drivers, about half of whom hold CDLs and drive trash and garbage hauler trucks. Assessing Company Health-Related Costs. In 2002, WM’s health-related costs were high and increasing rapidly. After successes with a Mission to Zero (M2Z) safety program, WM embarked on an effort to address excessive health care costs. Guided by management information produced out of an integrated human capital management data warehouse, WM established a human capital management (HCM) approach to addressing its health and disability challenges and achieving cost savings through focused programs and policy changes. WM’s approach yielded a management infra- structure that supports more comprehensive efforts to man- age human capital in the future. WM admits it takes patience and leadership to follow the road map they identified for itself in controlling health, safety, and job performance risks and 42

costs. However, WM reports outstanding success in the rela- tively new program and currently experiences some success in terms of cost control results. WM’s decreased cost inflation trend dropped from 22+% to a negative 1.3%, and WM reports having saved well over $100 million in just the few years since implementing new HCM programs (Hoffman and Kasper 2006). WM’s new HCM program has numerous facets to it, but only a few that, in particular, pertain directly to employee health and wellness are described. Integrated HCM Data and Information System. WM began to examine total human capital data across all aspects of the company. It incorporated those sources of data into an HCM information system that permitted an examination of the integrated nature of human capital cost situations. This permitted management to “see across” benefit programs and to lead WM to make a critical transition from benefit-centric administration, to people-centered management of the com- pany’s benefit investments that examines costs more precisely and searchers for person-centric solutions. WM’s HCM analysis pointed out how individual employ- ees use portions of the full range of health and absence- related benefits offered. The analysis showed that just over 10% of all WM employees use 80% of the dollars spent on health care, workers’ compensation, absence, and disability benefits. On average, those employees in this high risk group cost WM over $17,000 annually versus an average cost of less than $500 per year for the balance of WM’s lower risk employees. For WM drivers, the average cost of this high risk group was even higher at over $212,000 and a very slim minority (about 1.4%) in the high risk group consumed a broad array of benefits and accounted for 40% of the total benefits spent, whereas a significant majority (over 90%) of employees (the low risk group) consumed only 20% of the benefit dollars. Occupational Health Counselors (OHCs). Among the several HCM initiatives on health, WM partnered with a team of occupational health counselors to establish 19 field-based occupational health specialists as the primary points-of- contact for supervisors to engage immediately on hearing of an injury accident. The OHCs guided employees to the best medical care resources and worked with employees, supervi- sors, safety, and human resource personnel to coordinate a safe and timely return to work when injuries resulted in lost duty time. OHCs were equipped with information that enabled them to address employees as people rather than as injury cases. They treated employees on a broad range of issues related to job satisfaction, safety, return to health, and return to pro- ductive work. Specific Employee Health-Related Programs. Based on analyses of employee health care data, priority health conditions for WM employees include musculoskeletal/back problems, cardiovascular/circulatory problems, obesity, and asthma. WM conducts health and wellness programs including diagnosing and treating sleep apnea, driver safety, managing obesity and blood pressure, lunch-and-learn educational programs, and first aid training. WM treats the CDL physical exam as an opportunity to track and link employees needing follow-up assistance to the appropriate resources to obtain medical help. Overall Strategy. WM actively steps into the breach between what employees need and what the health care sys- tem is geared to provide, especially in support of employees for their chronic medical conditions. WM’s strategy is to get employees and their dependents to change their attitudes and behaviors with respect to their health and health care costs and, as needed, to take advantage of the programs and benefits available to help them improve their health, safety, and job performance. WM is launching a comprehensive communication and education program that will provide all employees and their dependents with a steady stream of reliable information to help them better understand and improve their health. The program will include a wellness newsletter and monthly edu- cation program modules, offering flu shots, health fairs, health screenings, health coaching and counseling, and other health-related activities. 4.5 Case Study: Greyhound Lines, Inc. (Amalgamated Transit Union National Local 1700 Health and Welfare Plan) This plan covers the ATU-represented employees of Grey- hound Lines, Inc. The company is based in Dallas, Texas, but the employees and participants are located throughout the United States. Some of the programs available to the drivers, spouses, and dependents enrolled in the medical plan include: Disease Management. These programs are available for chronic conditions, such as asthma, diabetes, heart disease, low back pain, chronic obstructive pulmonary disease, and weight complications. Each program allows one to design a personalized action plan under the employee’s doctor’s guid- ance. Participants are provided with access to a personal, experienced registered nurse to call for guidance and support who provides educational material about an individual’s medical condition, self-care information, reminders of important tests and exams, and informational newsletters. The goal is to help the person anticipate his/her own symp- toms and manage them better. 43

Various Wellness Options. Participants are able to obtain discounts on fitness club memberships, weight man- agement programs, massage therapy, chiropractic care, and two different smoking cessation options. In addition, there is a program to show members the benefits of consistent shorter sessions of physical activity throughout the day. This pro- gram features a pedometer to measure walking distance and an online tool to log daily steps, track progress, and receive coaching tips. 24-Hour Health Information Line. Helpful health infor- mation is available by phone from a trained registered nurse or from an audiotape library of more than 1,000 health- related topics. Online Tools. Participants can complete a health risk assessment that helps them assess and monitor their health status, obtain a personal analysis of many preventable and common conditions, review details of their contributing risk factors, access recommended steps for improvement, inter- active tools, and wellness information. A hospital informa- tion tool allows them to compare hospitals for over 50 surgical and medical procedures. A prescription drug tool allows the member to research individual drugs or compare several drugs used to treat a specific condition. An interactive library provides information on health conditions, everyday health and wellness, first aid, and medical exams. Miscellaneous. If employees have purchased certain voluntary insurance, they could be eligible to receive cash back for obtaining certain preventive testing or routine examinations. All employees and their dependents are eligible for an employee assistance program free of charge that cov- ers counseling for issues that could relate to health and wellness issues. 44