Building on a Foundation of Internal Health Programs

Cerner has offered fitness programming at its Kansas City world headquarters campus since 1995. In 2006, however, the company began to emphasize wellness, including a focus on behavioral health contributions, to encompass a broader sense of health and well-being. Cerner has expanded its offerings beyond its own employee population to include its client base as well—in order to prevent, identify, and better treat physical and mental health conditions. CEO Neal Patterson says that Cerner is “committed to a transformational change in the vital task of keeping people healthy,” and the company aims to help healthcare shift from a “present and react” model to a systematic “predict and prevent” model (Cerner, 2012b). That commitment begins with Cerner’s own employees.

A major feature of Cerner’s enhanced approach is the way the company’s benefit and program managers plan, implement, and communicate program components available to their employees (“associates”) to support the continuum between health and care. Arielle Bogorad, Cerner’s director of worldwide benefits and wellness initiatives, works collaboratively with those leading Cerner’s internal benefits administration for the company’s own consumer-directed health plan, onsite health clinics, wellness programs, and employee assistance program (EAP) services (provided by Kansas City-based New Directions Behavioral Health), among other benefits. Having strong alignment between these entities allows for a high level of strategic planning. The staff members meet frequently to keep the various pieces aligned, and a dedicated coordinator within the benefits organization helps to communicate the programs and services to Cerner associates.

The company’s wellness programs are organized under the name “Healthe at Cerner,” and the services are formed using a population health management approach to assess and reduce health risks while providing detailed personalized health plans and proactive intervention and treatment when needed. Preventing costly progression of chronic disease is a primary goal.

The “Healthe at Cerner” Program

Screening and Follow-Up

Associates and dependents complete Cerner’s own health risk assessment, which includes behavioral health questions from the two-item version of the Patient Health Questionnaire (PHQ-2) and biometric screenings. The PHQ-2 assesses the two gateway symptoms of depression: depressed mood and lack of interest/pleasure in activities (anhedonia).

Participants meet with personal wellness coaches to review the results and devise a personalized health plan. A wide variety of online and onsite educational and fitness opportunities, including yoga and stress management, are available along with periodic special events and competitions. The program includes environmental supports, such as a healthy cafeteria, healthful vending options with educational labels about wise choices, full service fitness facilities, and walking paths.

Health screenings are provided at Cerner’s onsite health clinics, where associates may also see healthcare providers for urgent and primary care. Primary care follows a full medical home model, providing coordinated care from a team of many disciplines. Onsite behavioral health services are provided by licensed clinical social workers or marriage and family counselors. Christa Roberts, who is practice manager for employer services, had experience as a behavioral health nurse prior to joining Cerner and was a member of the benefits staff responsible for bringing behavioral health onsite. Roberts says she has been pleased that the associates have found the Healthe Clinics’ services highly convenient. “The high use of the services is a testament to the level of trust that has developed over the eight years since the behavioral health professionals first came onsite,” says Roberts, “and illustrates the high level of confidence associates have in the confidentiality of our services, particularly for behavioral healthcare.”

Behavioral Health Providers and Plan Design Changes

As part of the incentive-based wellness program called Healthe Living with Rewards, subscribers and spouses/ partners complete a personal health assessment that identifies behavioral health concerns. Participants meet with a coach and may be referred either to the onsite therapists or to the EAP, depending on the risks that are identified. Cerner has a longstanding relationship with the external EAP, New Directions Behavioral Health, whose staff provide onsite educational and support to the Healthe Clinics’ behavioral health staff. This high level of involvement builds associates’ comfort level, reduces stigma, and enables referrals with personal introductions from the Healthe Clinics’ clinicians to behavioral health professionals (either onsite or through the EAP). Associates and family members may access the EAP at no cost for six sessions per issue/year. If more sessions are needed, behavioral health coverage is then accessed through the health plan, or an associate may see a behavioral health professional at the onsite clinic with no restriction on the number of sessions.

Cerner and New Directions work together to enhance awareness and promote high quality behavioral healthcare. The two organizations participated together with other employers and EAPs in Kansas City’s Community Initiative on Depression, the first community-wide multi-stakeholder initiative undertaken to address undiagnosed and untreated depression. The initiative was led by the Kansas City employer coalition, Mid-America Coalition on Health Care.

New Directions also interacts with Cerner’s associate relations staff, a part of the company’s human resources group. For example, New Directions helps with trainings, such as leadership seminars and professional development (e.g., for drug screen training), critical incident debriefing (following the death of a long time associate or after an associate experienced a crime), formal management referrals, and fitness for duty evaluations.

Cerner’s Healthe Pharmacy operates as a closed-panel pharmacy and purchases drugs directly from the distributor, passing savings of 20% to 90% on to members and ultimately to the health plan.In 2012, Cerner augmented its health plan to cover generic antidepressant and anxiety medication at 100% to reduce barriers to care in a value-based benefit design concept. Associates benefit directly from savings achieved through Cerner’s closed pharmacy panel. Associates in the Kansas City metropolitan area filled 66% of their prescriptions at the company’s onsite Healthe Pharmacy locations in 2012.

Preventive Approaches

In addition to screenings, health education, and enhanced medical care for employees and their families, Cerner’s preventive approaches include a web-based program designed to protect brain health offered through the Healthe at Cerner programs.

Brain Health Programs

In 2012, Cerner initiated two programs from Brain Resource, a provider of brain health solutions:

• WebNeuro: an objective assessment of a person’s cognitive function and efficiency, compared to normal standards found in the Brain Resource database

• MyBrainSolutions: games scientifically designed to help individuals train their brain for peak performance

First, a pre-assessment examines 1) thinking, 2) emotion, 3) feeling, and 4) self-regulation. Brain Resource then pins 8-10 specific exercises to the individual’s personal dashboard based on their personal needs along with a recommendation to complete the exercises about three times per week over a 30-day period. Brain Resource sends communications and reminders during that time and a post-assessment at the end of the period. Cerner’s participants showed improvements in all four areas.

Brain Resource has assessed the clinical efficacy of the programs and has shown positive effects on productivity, focus, decision-making, stress reduction, and resilience. Benefits director Bogorad thinks the focus on brain health removes the stigma sometimes related to mental health issues and helps associates to develop resilience. “We train our bodies; we should train our brains,” says Bogorad. She reports that the entertaining and game-like rich media format makes the programs particularly appealing to her company’s young, technology-centric employee population. Cerner rolled out the Brain Resource programs to all associates worldwide in August, 2013.

Management Practices

Emma Tapscott, manager of global wellness for associates, points out that Cerner’s career development and performance management practices contribute in a positive way to building optimal mental health in the company’s workforce. Tapscott’s background in human resources, compensation and benefits, and performance management helps her to view wellness from a unique perspective. She believes the following management practices common at Cerner contribute to overall health and well-being:

• Moving associates frequently from one area of Cerner to another and from one role to another to provide new experiences and prevent a sense of stalling in career growth. These frequent role shifts also help build social connectivity between departments.

• Pay-for-performance helps motivate and engage workers in their jobs. Tiered compensation/recognition is commensurate with the level of excellence in performance.

• To enhance goal/role clarity, annual performance goal-setting meetings involve goals that cascade from top leaders down, and individual contributors map back up to how they fit into the organizational mission. Annual associate-supervisor meetings are augmented by frequent meetings to adjust goals as needed.

• The company’s culture has well established acceptance of wellness programming. For example, many senior managers show support and model breaks for gym use and other fitness activities.

Changing the Company’s Mission

Cerner’s internal experiences with its health and well-being efforts have aligned with changes in the company’s mission statement in the fall of 2010 as well. “We are no longer a health care IT company but a company that understands health — overall health — and well-being,” says Mike Heckman, Cerner’s vice president of employer services. (Heckman previously served as director of worldwide benefits, the position now held by Bogorad. When Heckman made his role switch, he brought Roberts and her behavioral health experience with him. Roberts was previously manager of global wellness, the position now held by Tapscott. These role shifts are an example of the management practices described above that Cerner uses to enhance career progression and internal connectedness.

Heckman’s group now promotes many of the services created or piloted within Cerner to external clients, primarily hospitals and health systems. Cerner manages 35 onsite health centers for external clients and has several hundred wellness clients, including 5 million eligible lives. Heckman says the clinics provide a “teamlet” approach to population health management, where multiple professionals are prepared for cross-discipline services and referrals (e.g., primary care physicians or athletic trainers provide stress management interventions and/or make warm referrals to behavioral health providers).

In addition, Cerner is partnering with Advocate Health Care, a large integrated care delivery system in Chicago and one of the largest accountable care organizations (ACOs), in its efforts to change healthcare delivery. ACOs are particularly helpful for individuals with complex and chronic conditions, such as comorbid depression and diabetes. Cerner acquired Anasazi Software, Inc., a comprehensive behavioral health technology provider, to help improve coordination of care and transitions across the healthcare continuum.

Awards

Cerner hopes to contribute to the systemic change in healthcare delivery by supporting evidence-based clinical decisions, preventing medical errors, and empowering patients in their care (Cerner, 2012b). Forbes listed Cerner eighth on its list of the “Most Innovative Companies” in the U.S., and Cerner was also selected as one of the top 100 technology innovators in the U.S. by InformationWeek, both in 2013.

Cerner received a silver award from the National Business Group on Health (NBGH) in 2008 for recognition as one of the nation’s top employers promoting healthy lifestyles, and the company has received NBGH’s highest honor, the platinum award, the last four years. Cerner has also been recognized by The Kansas City Business Journal for being the “Healthiest Employer in Kansas City” in their size division the last three years in a row. They also received the Dee Edington “Next Practice Award” in 2012 and the “Great Beginnings Award” in 2013. The American Heart Association has designated Cerner as being “Fit-Friendly,” and they are Gold Standard-accredited by the CEO Roundtable on Cancer.

Summary

The managers of Cerner’s health programs report that their model of piloting new programs and services among their own employees has been successful in engaging associates in their own health and in their work of serving other health organizations. The video “A Look at Healthe at Cerner” gives viewers an introduction to company’s approach to overall health and well-being. The video can be viewed here.

To apply some of Cerner’s learnings, other employers may consider the following steps:

• Ensure that managers of health-related programs and services collaborate effectively, and devote time and resources to strategic planning.

• Communicate with adequate frequency and clarity among the planning and implementation teams and with employees about the benefits and programs provided.

• Engage leaders as positive examples of health and well-being.

• Evaluate opportunities for benefit plan design to increase incentives and reduce barriers to care-seeking and quality treatment.

• Collaborate with EAP and other service providers to enhance prevention and intervention options.

About Cerner

Cerner offers a comprehensive array of information software, professional services, medical device integration, remote hosting, and employer health and wellness services. Cerner systems are used by a wide range of customers, from individual consumers to single-doctor practices, hospitals, employers, and entire countries. For more than 30 years, Cerner has been executing its vision to make healthcare safer and more efficient. The company started with the foundation of digitizing paper processes, and it is now contributing to the systemic change of healthcare delivery. Cerner has more than 14,000 employees worldwide, of which 66% are based in the Kansas City, Missouri, metropolitan area.