Critique
The following assessment of program strengths and weaknesses has been abstracted from reviews by the Task Force on Program Selection of The Health Project. Where weaknesses are postulated, it must be taken into account that the review Task Force is very critical, that no programs are perfect, that the Award Winning programs have been selected from over 300 candidate programs and represent the very best, that the materials reviewed may have been incomplete, that suggested deficiencies may have resulted from incomplete understanding of the program by the reviewers or that any problems may have been corrected since the time of review.
The "Aenhance" program for employees of Aetna Life & Casualty promotes healthy lifestyle practices, prudent use of the health care system and a supportive worksite environment. 85 percent of employees have access to programs at 135 field locations. Cost savings average three dollars for every dollar of program cost.
There is medical self-care savings of $3 for each dollar invested. There is data for health risk reduction and for self-efficacy improvement. The program is comprehensive. This is one of few programs to measure changes in self-efficacy and the ability to make better lifestyle medical care decisions. There were significant reductions in health risk factors and improvement in lifestyle practices. The integrated data management system will facilitate ongoing evaluation. The medical self-care program showed immediate positive results. High participation rates are encouraging. The efforts to reach field offices are commendable. The use of "stages-of-change" approaches is excellent. The program is well-documented. Cost-savings of 61 thousand dollars for 1797 participants were associated with the increased self-efficacy scores.
Cost reductions are inferred to a certain extent and selection bias could not be completely ruled out. Evaluation did not involve randomized studies and was based upon projections, albeit reasonable ones. No associated claims analysis were reported. There were no data on the non-participants or control groups. Evaluation data relied heavily on self-reported behavior changes. Objective data such as absentee days from employee records or claims data would strengthen the validity of the results.