Rigorous Research Supports the eMindful Value Proposition

Mindfulness-based programs that target the root causes of chronic conditions are showing impressive results as a viable solution for improving employees’ health and productivity.

Executive Summary

Every demographic group in America is experiencing a dramatic rise in the occurrence of cancer, diabetes, heart disease, and other chronic illnesses. With that comes a significant rise in healthcare costs shared by employers and consumers. What’s more, decades of scientific research have concluded that highly stressed employees are subject to far greater risk of developing a chronic illness and a less productive professional life. Companies are aggressively seeking solutions. With medical costs associated with chronic illnesses already eclipsing half a trillion dollars each year, several companies have realized that these catastrophic costs require a scientifically balanced approach. This paper highlights the challenge facing companies in America today and how one approach, offered by eMindful, the leading online provider of mindfulness-based programs, is showing promise as a viable solution. As discussed in this paper, research has shown that eMindful’s programs provide an average return of $8.70 for every $1 invested. The reason for employers’ growing interest in mindfulness practices is clear: in addition to myriad health and well-being benefits, there is also a direct impact on healthcare costs1 and productivity2 and thus an employer’s competitive advantage.

Overview

Several decades of scientific research have confirmed that highly stressed employees are subject to considerably greater health risks,3,4 productivity losses5 and medical costs1,5 than those with normal stress levels. Medical cost differences can be seen in a peer-reviewed analysis of one years’ claims data from a large sample of employees with a major insurance company. Covered medical claims of the most highly stressed employees (top quintile) were almost $2,000 greater than those in the lowest quintile1.Not only is elevated stress a common and expensive part of corporate life, but it also contributes to chronic disease through biological and behavioral pathways. In other words, stress affects human biology in ways that negatively affect the immune and metabolic systems. In addition, under high stress levels, people tend to behave in less healthy ways. Research has clearly demonstrated that stress is a critical factor in inducing overeating and plays a major role in the development of obesity. 6-15 Stress, and unhealthy behavior patterns, are the reason for the dramatic increase in chronic disease and resulting loss in productivity.
Aetna selected eMindful to provide two different applied mindfulness programs—one targeting stress, the other targeting metabolic factors. Aetna then rigorously evaluated them through two randomized controlled trials (RCT). Results from these trials and ongoing data collection include impressive findings such as:

• 36.9% Less Stress
• 22.1% Better Sleep Quality
• 61 Minutes – Gain in Productivity weekly
• 32.0% Higher retention in virtual classroom vs in-person classes
• 53.0% Reversal of metabolic syndrome

THE CHALLENGE

Chronic diseases such as heart disease, diabetes, stroke, and their precursor—metabolic syndrome—are on the rise in the U.S. across all demographic groups. Of note:

• The total annual cost in the U.S. of cardiovascular disease and stroke is estimated to be more than $312 billion.16

• The total cost in the U.S. in 2012 associated with diagnosed diabetes was $245 billion. The average annual cost of care for a patient with diabetes is $13,700—of which $7,900 is attributed specifically to the treatment of diabetes itself. 17

• A major risk factor for all of these conditions is overweight and obesity (body mass index greater than 30 kg/m2). The prevalence of overweight and obese adults (over the age of 20) in the U.S. is 68.2%, and of obesity alone is nearly 35%. 16

• A recent estimate suggests that obesity accounts for 21% of medical spending.18

Employers are seeking new solutions to the challenge of keeping their employees healthy, present on the job, and productive. So are health insurers, benefit brokers, and third-party administrators, all of whom recognize that surviving and thriving in their markets will require innovative, value-added solutions to the growing cost and productivity crises.

THE SOLUTION FOR EMPLOYERS

Aetna has been a leader in demonstrating the value of health-related mindfulness programs at work. In 2009, Aetna strategically partnered with eMindful to assess the effectiveness of two mindfulness-based programs of interest. Both rely on eMindful’s ability to scale and deliver applied-mindfulness programs that are convenient to the workplace (generally 55 minutes in length). Through two scientifically rigorous randomized controlled trials (RCTs), Aetna and eMindful evaluated:

• Mindfulness at Work® a mindfulness-based stress reduction program and,
• Metabolic Health in Small Bytes, a program for reversing metabolic syndrome.

Confident from the results of the trials, Aetna then offered these programs to their own 48,000 employees. They subsequently have offered the programs to their middle market and national clients.

Stress Reduction: Mindfulness at Work® Program

The Mindfulness at Work® (MAW) Program was developed by Elisha Goldstein, PhD, a renowned expert in mindfulness and its application for stress in the workplace, and Michael Baime, MD, Director of the Penn Program for Mindfulness and eMindful. The 12-week program meets once per week for 55 minutes, and includes an optional 2-hour online retreat midway through the program.

RCT Results

The original RCT with Aetna, published in the Journal of Occupational Health Psychology19, included 239 employees. Compared to the control group, the MAW program significantly reduced participants’ self-reported stress levels by 36%, sleep difficulties by 29%, current pain levels by 34%, and improved the heart rhythm coherence ratio of heart rate variability19—a biological measure of how well the autonomic nervous system processes stress. This physiological finding showed that not only were participants’ perceptions of stress, sleep, and pain improved, but their biology confirmed these shifts. Just as importantly, the findings for participants taking the course in eMindful’s live, online classroom were equivalent to the findings of those taking the program through conventional “in-person” on-site classes. Furthermore, those taking the online program had a 96% retention rate in the study, compared to 73 % of those who took the program through the traditional on-site classroom.19

Ongoing Results for MAW®

eMindful has continued to collect pre- and post-data on the thousands of participants who have taken the program since the original study. The findings parallel the results of the RCT, with a consistent 36–37% improvement in stress. In addition, participants complete a validated productivity measure called the Work Limitations Questionnaire.20 The MAW program consistently results in about an hour per week improvement in productivity—which equates to approximately 6 additional workdays per year per employee.
Metabolic Health in Small Bytes Program

The Metabolic Health in Small Bytes Program is a 10-week, 20-session course developed by Ruth Wolever, PhD. Dr. Wolever led a team of clinicians from Duke Diet and Fitness Center and Duke Integrative Medicine to augment and adapt lessons from her NIH-funded research on mindful eating and decades of successful clinical treatment. The program incorporates a cognitive-behavioral mindfulness-based approach that also includes nutrition and exercise content to reduce weight and/or reverse risk factors defining metabolic syndrome.

The Results

To evaluate the effectiveness of the program, 569 employees from Aetna were randomly assigned to one of three conditions: a control group, a comparative online program where participants worked through a self-paced (rather than live) intervention, and the Metabolic Health in Small Bytes program. Eighteen months after enrollment, 433 participants remained in the trial, allowing for ongoing analysis from claims data. While the final analyses are not yet completed, a subset of the analysis suggests that 53% of those with metabolic syndrome reversed this toxic health condition across the 20 weeks of the program. Ongoing data collection also demonstrates improvement in health behaviors such as aerobic, strengthening and stretching exercises, as well as stress levels, sleep difficulties and productivity.

Companies Are Getting The Message

Other large companies are following suit. eMindful provides mindfulness-based programs to Florida Power and Light, Kaiser Permanente, and Humana. The State of Arizona, including administrators, child protective services, and the department of transportation, has been offering eMindful’s mindfulness-based programs to its 65,000 employees for several years. The data is rapidly accumulating and the results continue to support our value proposition: teaching participants mindfulness practices to better manage stress and understand their own behavior patterns allows them to change in ways that improve health and the bottom line.

References:

1) Baime, M. J., Wolever, R. Q., Pace, W., Morris, W. M., & Bobinet, K. J. (2011, April) Perceived stress scale correlates with health care costs. Poster session presented at the 32nd Annual Meeting and Scien-tific Sessions of the Society of Behavioral Medicine, Washington, DC
2) 2) Langer, E.J. & Moldoveanu, M. (2000). The construct of mindfulness. Journal of Social Issues, 56(1), 1-9.
3) “There is medical evidence that stress can adversely af-fect an individual’s immune system, thereby increasing the risk of disease. Numerous studies have linked stress to back pain, colorectal cancer, infectious disease, heart problems, headaches and diabetes. Job stress may also heighten risky behaviors such as smoking, drug and alcohol abuse, discourage healthy behav-iors such as physical activity, proper diet and increase consumption of fatty and sweet foods.” Reduction in Workplace Stress Could Curb Health Care Costs By Rick Nauert PhD Senior News Editor Reviewed by John M. Grohol, Psy.D. on August 26, 2011.
4) “In work published in the journal BMC Public Health, Concordia University researchers report that the number of visits to health care professionals is up to 26 percent for workers in high stress jobs. Improving stressful working conditions and educating workers on stress-coping mechanisms could help to reduce health care costs.” Reduction in Workplace Stress Could Curb Health Care Costs By Rick Nauert PhD Senior News Editor Reviewed by John M. Grohol, Psy.D. on August 26, 2011.
5) “Managing workplace stress can also foster other economic advantages, such as increased productivity among workers, reduced absenteeism and diminished employee turnover.” Reduction in Workplace Stress Could Curb Health Care Costs By Rick Nauert PhD Senior News Editor Reviewed by John M. Grohol, Psy.D. on August 26, 2011.
6) Vicennati, V., Pasqui, F., Cavazza, C., Pagotto, U. & Pasquali, R. (2009) Stress-related development of obesity and cortisol in women. Obesity (Silver Spring) 17, 1678–1683.
7) Wardle, J. (1987) Eating style: a validation study of the Dutch Eating Behaviour Questionnaire in normal subjects and women with eating disorders. J. Psychosom. Res. 31, 161–169.
8) Brunner, E.J., Chandola, T. & Marmot, M.G. (2007) Prospective effect of job strain on general and cen-tral obesity in the Whitehall II Study. Am. J. Epidemi-ol. 165, 828–837.
9) Rosmond, R., Lapidus, L., Mårin, P. & Björntorp, P. (1996) Mental distress, obesity and body fat distri-bution in middle-aged men. Obes. Res. 4, 245–252.
10) Lee, E.S., Kim, Y.H., Beck, S.H., Lee, S. & Oh, S.W. (2005) Depressive mood and abdominal fat distribution in overweight premenopausal women. Obes. Res. 13, 320–325.
11) Zellner, D.A., Loaiza, S., Gonzalez, Z., Pita, J., Morales, J., Pecora, D. & Wolf, A. (2006) Food selection chang-es under stress. Physiol. Behav. 87, 789–793.
12) Freeman, L.M. & Gil, K.M. (2004) Daily stress, cop-ing, and dietary restraint in binge eating. Int. J. Eat. Disord. 36, 204–212.
13) Lowe, M.R. & Kral, T.V. (2006) Stress-induced eating in restrained eaters may not be caused by stress or restraint. Appetite 46, 16–21.
14) Schur, E., Noonan, C., Polivy, J., Goldberg, J. & Buchwald, D. (2009) Genetic and environmental influences on restrained eating behavior. Int. J. Eat. Disord. 42, 765–772.
15) Williamson, D.A., Martin, C.K., York-Crowe, E., Anton, S.D., Redman, L.M., Han, H. & Ravussin, E. (2007) Measurement of dietary restraint: validity tests of four questionnaires. Appetite 48, 183–192.
16) Go, A., Mozaffarian, D., Roger, V., et al (2013, December) American Heart Association. Heart Disease and Stroke Statistics−−2014 Update: A Report from the American Heart Association. Circu-lation 2014;129:e28-e29 2; originally published online December 18, 2013; doi: 10.1161/01.cir.0000441139.02102.80
17) Yang, W., Dall, T., Halder, P., Gallo, P., Kowal, S., & Hogan, P. (2013, March) American Diabetes Associ-ation. Economic costs of diabetes in the U.S. in 2012. Diabetes Care, 36:1033–1046.
18) Cawley, J & Meyerhoefer, C. (2012). The medical care costs of obesity: an instrumental variables approach. Journal of Health Economics, 31, 219-30.
19) Wolever, R. Q., Bobinet, K. J., McCabe, K. A., Mack-enzie, E. R., Fekete, E., Kusnick, C. A., & Baime, M. J. (2012, April) Effective and viable mind-body stress reduction in the workplace: A randomized controlled trial. Journal of Occupational Health Psychology, Vol 17(2), Apr 2012, 246-258. doi: 10.1037/a0027278
20) Lerner, D., Amick, B. C. III, Rogers, W. H., Malspeis, S., Bungay, K., & Cynn, D. (2001). The Work Limitations Questionnaire. Medical Care, 39(1), 72-85.

About eMindful

eMindful is a leading provider of evidence- based programs targeting the largest healthcare cost drivers today: stress, obesity, chronic pain, stress-related health issues, smoking, diabetes, cancer, and more. Our scalable, online applied mindfulness-based programs target the root causes of chronic conditions that undermine health and productivity. Developed with top universities and luminaries in the field of mindfulness, our online and mobile interactive courses have been delivered to a wide range of individuals, corporations and government institutions. Our programs are delivered through a live, virtual classroom where participants see, hear, speak to, and interact with an expert instructor as well as other class participants. Participants enjoy the flexibility of joining the classrooms from any location with a broadband internet connection.eMindful has successfully delivered weekly and monthly programs to participants around the world since 2007. A detailed program catalog is available upon request. For more information about how we can deploy a customized, private platform and begin offering benefits to your employees, contact us at info@emindful.com. Visit eMindful.com