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Kelly
Brandon
RN

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Onsite Occupational Nurse
Proposal for Mohegan Sun
By Kelly Brandon RN

The Value
In the face of rising levels of chronic disease and spiraling
health care costs, any and all efforts to improve employee
health will help combat health care expenses.
A successful health promotion program not only promotes healthy behaviors among
employees but also brings value to the bottom line and supports a companys
profitability and sustainability objectives by reducing costs associated with both
work and non work related injuries and illnesses.

Identifying health risks and implementing strategies to eliminate or mitigate these

risks can reduce costs
Direct costs: workers compensation, and wage replacement during short and
long term disabilities
Indirect costs: worker replacement and retaining costs, loss of productivity from
absences

The Need
The need for occupational nurses continues to grow as
business becomes more competitive and health care costs
escalate at a frightening rate.

Most adults typically spend half or more of their waking hours at work.
Worksites have a powerful impact on individuals health.
Onsite wellness increase morale, loyalty and productivity.
Worksite Wellness represents an investment in human capital.
At least 50 percent of an organizations health care costs are linked to
smoking, poor diet and lack of exercise on the part of employees.
Adding a nurse onsite can produce savings in health plan costs, sick
leave, disability costs and workers compensation of more than 25
percent.
According to a 2012 US Department of Health and Human Services
report, worksites with physical activity programs have:
o Reduced health care costs by 20-55 percent
o Reduced short term sick leave by 6-32 percent
o Increased productivity by 2-52 percent

Summary of the Research

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The ROI on the selected private companies cited below range
from $3.00 to $4.73 saved per dollar spent on providing onsite
nursing care.

Caterpillar, Inc. anticipates long-term savings of more than $700 million by 2015, with current
overall direct cost savings of 23 percent.
Sixty-six percent of USAA participants enrolled in a formal smoking-cessation program
reported success; workplace absences have decreased with an estimated three-year savings
of more than $105 million; and participants have experienced statistically significant decreases
in weight, smoking and other health factors.
Johnson & Johnson estimates an annual savings of $9 to $10 million from reduced medical
utilization, with a weighted overall savings average per employee of approximately $224. Most
benefits were experienced in the 3rd and 4th years after program initiation.
General Motors program identified 815,298 risks and reduced 185,550 risks, with the highest
risk reductions reflected in seat belt use, blood pressure, stress relief and life satisfaction.
Their medical savings to cost ratio after 4 years was 1.2 for all participants. A 2004 University of
Michigan study of GM employees showed that non-exercising employees claimed at least $100
or more/year in costs and that obese employees who began exercising at least twice per week
lowered their costs by an average of $500/year.
Union Pacific Corporation reduced lifestyle-related healthcare claims by 10 percent once the
wellness program and safety initiatives were introduced, with an ROI of $4.07 per program
dollar spent.
Citibanks ROI was estimated between $4.56 - $4.73 per program dollar spent, and there was
statistically significant improvement in 8 out of 10 risk categories (such as exercise, stress,
nutrition, smoking, seat belts, and blood pressure). an employees poor health
Cigna has several wellness programs in place with significant savings realized in each and an
overall ROI of 3 to 1.
Motorolas Wellness Center initiative alone achieved a $3.93 savings per dollar spent.
In 2006 Wal-Mart Stores, the nations largest employer, created an employee initiative called
Personal Sustainability Projects (PSPs) to develop individual goals for improving employee
personal health and the health of the environment (through smoking cessation, weight loss,
recycling and using environmentally friendly products). The results to date include aggregate
employee weight loss of over 2,000 pounds; over 300 employees have quit smoking.
3

Health Care Costs

Per the 2008 Organization for Economic Cooperation &

Development (OECD) report, 8.3 percent of the 2006 US
GDP was spent by the private sector on health
expenditures, and health expenses totaled $6,714 per
capita.
In 2005, GM spent $5.3 billion on medical costs, with an
estimated 25 percent due to overweight/obesity,
physical inactivity, cigarettes and alcohol. This
represents 40 percent more than the company earned in
profits in 2004.
Ninety-five percent of our nations health expenditures
are committed to diagnosing and treating disease.
Indirect costs of poor health (including absenteeism,
disability) are two to three times higher than direct
medical costs, impacting all employers, regardless of
size and ability to fund health benefits.
The Health Enhancement Research Organization
identified seven excess health care cost risk factors, of
which depression and stress have the greatest
correlation with higher costs

Lower Health Care Costs

Many studies demonstrate that health promotion

programs can and do reduce medical expenditures,
resulting in direct cost savings to employers.
Medically high-risk employees are medically high-cost
employees.
US Department of Health and Human Services (HHS)
estimates that 129 million adults in the US are overweight
or obese and that the cost of treating their related
medical conditions is $69 to $117 billion per year.
Per HHS, more than 75 percent of all health care dollars
are spent on chronic conditions such as diabetes,
obesity, cardiovascular disease and asthma, most of
which are preventable.
Per the 2006 Hewitt Associates survey of more than 500
major US employers, targeted companies experienced a
12 percent increase in health care costs in 2005.
Per HHS, the benefit to cost ratios range from $1.49 to
$4.91, with a median of $3.11, in savings for every dollar
spent on a wellness program.

Productivity Costs

Employees that are sedentary,

smokers, or intake a high
amount of alcohol are absent
over 50% more often than
those without the risk factors,
and cost 2-3 times more in
health costs.
Employers pay an extra
$597/year for each employee
who consumes excessive
amounts of alcohol.
Employers pay an extra
$488/year for every
sedentary employee.
Every smoker costs a
company $2500/year.
There is a linear relationship
between these lifestyle risk
factors, and number of
workers compensation
claims, lost workdays, medical
claims costs and insurance

Smoking:
Smokers are absent from work 6.5
more days per year than non-smokers.
Approximately 8 percent of a smokers
working hours are spent on smoking
rituals.
Smoking can cost employers over
$10,000 annually per smoker due to:
Higher absenteeism
Lost productivity
Higher medical care costs
Harmful effect of secondary smoke on
non-smoking workers
o Asthma
o COPD

Occupational Nurse Benefits

Acts as the primary point of contact with employees as it

relates to their occupational health care needs
Provides initial assessment of employee injuries
Follow-ups on employee illnesses and injuries, and
workers compensation
Emergency nursing care for job related injuries and
illness
Provides direct care, including assessment, treatment
and referral to a higher level of care when indicated
Offers health promotion information and education
materials
Promotes employees independence by establishing
patient care goals; teaching and counseling patients, and
reinforcing their understanding of disease, medications,
and self-care skills; answering questions
Refers employees with identifiable health risks to
appropriate resources
Promotes and restores employees health by completing
the nursing process; collaborating with physicians and
multidisciplinary professional staffs.

Works with insurance company to reduce costs

Evaluates the health of employees returning to work
Maintains employee health records
Supports the development and delivery of health and
wellness programs.
Conducts new employee health screenings
Trends employee illnesses/injuries
Adheres to the legal requirements pertinent to employee
health and safety
Performing periodic health assessments
Assists with the administration of health and wellness
initiatives, including group and individual health
education activities.
Works with environmental safety to educate and
implement healthier employees

References
U.S. Department of Health and Human Services, Prevention Makes Common Cents, pp. i-1
and 24; Texas Department of State Health Services, Building Healthy Texans: A Guide to
Lower Health Care Costs and More Productive Employees; and Katherine
Baicker, David Cutler and Zirui Song, Workplace Wellness Programs Can Generate
Savings, Health Affairs (February 2010), pp. 1-2 and 4-7; and U.S. Department of Health
and Human Services, 7: Educational and Community-Based Programs, in Healthy
People 2010: Volume 1, 2nd ed. (Washington, D.C., November 2000), p. 7-5.
Kenneth E. Warner, Wellness at the Worksite, Health Affairs (Summer 1990), p. 71.
Laura Linnan, Mike Bowling, Jennifer Childress, Garry Lindsay, Carter Blakey, Stephanie
Pronk, Sharon Wieker and Penelope Royall, Results of the 2004 National Worksite
Health Promotion Survey, American Journal of Public Health (January 2008), pp. 2-4;
Joyce Gannon, Companies Offer Wellness Programs to Cut Insurance Costs, Pittsburgh
Post-Gazette (May 11, 2008).
Ron Z. Goetzel and Ronald J. Ozminkowski, Thats Holding Your Back: Why Should (or
Shouldnt) Employers Invest in Health Promotion Programs for Their Workers? North
Carolina Medical Journal (November/December 2006), p. 429;
Josh Cable, The ROI of Wellness, EHS Today: The Magazine for Environment, Health and
Safety Leaders (April 13, 2007).
U.S. Centers for Disease Control and Prevention, Healthier Worksite Initiative: Introduction,
Shirley S. Wang; J&J Folds Wellness and Prevention Efforts into Consumer Biz, Wall
Street Journal Health Blog (April 15, 2009),
Governors Council on Physical Fitness and Sports, Council Honors Employers for Wellness
Programs, Burlington, Vermont, September 30, 2008.
Catherine A. Heaney and Ron Z. Goetzl, A Review of Health-related Outcomes of MultiComponent Worksite Health Promotion Programs, American Journal of Health
Promotion (March-April 1997), pp. 302-303 and 305;
U.S. Department of Health and Human Services, 7: Educational and Community-Based
Programs, pp. 7-18 and 7-20.
USAA: Peter Wald, vice president and enterprise medical director, USAA; Texas Comptroller
of Public Accounts, Counting Costs and Calories: Measuring the Cost of Obesity to
Texas Employers, p. 22;
The Health Project, C. Everett Koop National Health Awards, USAA Take Care of Your
Health, Brooke Brownlow, vice president of Human Resources, H-E-B; and Erica
Bartram, Benefits Strategy and Design, H-E-B.
Dell Inc.: Tre McCalister, global benefits manager, Dell Inc.; and National Business Group on Health,
Well at Dell: Creating a Campus Culture of Employee Health, Platinum Awards: Best
Employers for Healthy Lifestyles 2009 (2009), pp. 1-4.
Johnson & Johnson: Johnson & Johnson, Our Company,; Ronald J. Ozminkowski, Davina Ling, Ron Z.
Goetzel, Jennifer A. Bruno, Kathleen R. Rutter, Fikry Isaac and Sara Wang, Long-Term Impact of
Johnson & Johnsons Health & Wellness Program on Health Care Utilization and Expenditures,
Journal of Occupational and Environmental Medicine (January 2002), pp. 21-28;

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Ron Z. Goetzel, Ronald J. Ozminkowski, Jennifer A. Bruno, Kathleen R. Rutter, Fikry Issac and
Shaohung Wang, The Long-Term Impact of Johnson & Johnsons Health & Wellness
Program on Employee Health Risks, Journal of Occupational and Environmental
Medicine (May 2002), pp. 417-419.
Texas Instruments: Texas Instruments, TI Fact Sheet, LuAnn Heinen and Helen Darling,
Addressing Obesity in the Workplace: The Role of Employers, Milbank Quarterly
(No. 1, 2009), pp. 112-113.
Dallas/Fort Worth International Airport: Amanda-Rae Garcia, wellness manager, Dallas/Fort
Worth International Airport; Health Management Research Center, DFW Airport: 2007,
2008 and 2009 3-Time Repeated Health Risk Appraisal Summary Report (Ann Arbor,
Michigan; University of Michigan, June 22, 2009), p. 1;
Texas Chapter of the Public Risk Management Association, Congratulations to This Years
Risk Manager of the Year! Texas Prima Press (April 2010), p. 4
Dallas/Fort Worth International Airport Board, 2008 Champions in Health Award Application:
Non-Profit, Government/Education, Small Company, (DFW Airport, Texas, 2008), pp. 3,
6-8 and 21.
IBM: About IBM,; Medical Highlights,; IBMs Global Wellness Initiatives,; IBM to
Provide Employees with 100% Primary Health Care Coverage, New Wellness Rebate,;
Childhood Obesity: The Way Forward, Susan Dentzer, ed., slides 37-41, available in
PowerPoint format; and Martin-J Sepulveda, Fan Tait, Edward Zimmerman
Dee Edington, Impact of Childhood Obesity on Employers, Health Affairs (March 2010),
pp. 516-518.
City of Hurst: Esther White, wellness coordinator, City of Hurst, Texas; and City of Hurst,
Texas, Wellness Program.
Capital Metropolitan Transportation Authority: Kim Peterson, employee relations manager,
and Michael Nyren, risk manager, Capital Metropolitan Transportation Authority;
Capital Metropolitan Transportation Authority, Capital Metro Wellness Program
Recognized for Improving Employee Health and Reducing Costs, Austin, Texas, June 4,
2009
U.S. Centers for Disease Control and Prevention, A Comprehensive Worksite Wellness
Program in Austin, Texas: Partnership Between Steps to a Healthier Austin and Capital
Metropolitan Transportation Authority, by Lynn Davis, Karina Loyo, Aerie Glowka, Rick
Schwertfeger, Lisa Danielson, Cecily Brea, Alyssa Easton, and Shannon Griffin-Blake,
Preventing Chronic Disease: Public Health Research, Practice, and Policy (April 2009),
pp. 1-5.
Lincoln Industries: Lincoln Industries, Wellness, Marc LeBaron, Corporate Culture, Inside
Supply Management (September 2009), p. 10
Institute of Management and Administration, How Lincoln Industries Hardwired Wellness
Into Its Culture, Builder Jobs (May 13, 2010).