Do Employees From Less-Healthy Communities Use More Care and Cost More? Seeking to Establish a Business Case for Investment in Community Health

Do Employees From Less-Healthy Communities Use More Care and Cost More? Seeking to Establish a Business Case for Investment in Community Health

IMPLEMENTATION EVALUATION — Volume 16 — July 25, 2019

Russell K. McIntire, PhD, MPH1; Martha C. Romney, RN, BSN, MS, JD, MPH1; Greg Alonzo, MBA2; Jill Hutt, MSHP3; Lauren Bartolome, PharmD, MS1; Greg Wood4; Gary Klein, PhD5; Neil I. Goldfarb3 (View author affiliations)

Suggested citation for this article: McIntire RK, Romney MC, Alonzo G, Hutt J, Bartolome L, Wood G, et al. Do Employees From Less-Healthy Communities Use More Care and Cost More? Seeking to Establish a Business Case for Investment in Community Health. Prev Chronic Dis 2019;16:180631. DOI: http://dx.doi.org/10.5888/pcd16.180631external icon.

PEER REVIEWED

On This Page

• Abstract
• Introduction
• Methods
• Results
• Discussion
• Acknowledgments
• Author Information
• References
• Tables

Summary

What is already known on this topic?

Peer-reviewed literature discusses economic consequences of poor health and the association between community health, the built environment, and individual health.

What is added by this report?

Minimal research has directly examined the effect of poor community health on employees’ medical costs, use of emergency departments, and hospitalizations. We explored whether employed adults and their adult dependents living in less-healthy communities in the greater Philadelphia region used more care and had higher costs than employees from healthier communities.

What are the implications for public health practice?

Our findings suggest a need for more primary care access. Business leaders expressed interest for guidance on how to invest in community health improvement.

Abstract

Introduction

Few studies have examined the impact of community health on employers. We explored whether employed adults and their adult dependents living in less-healthy communities in the greater Philadelphia region used more care and incurred higher costs to employers than employees from healthier communities.

Methods

We used a multi-employer database to identify adult employees and dependents with continuous employment and mapped them to 31 zip code regions. We calculated community health scores at the regional level, by using metrics similar to the Robert Wood Johnson Foundation (RWJF) County Health Rankings but with local data. We used descriptive analyses and multilevel linear modeling to explore relationships between community health and 3 outcome variables: emergency department (ED) use, hospital use, and paid claims. Business leaders reviewed findings and offered insights on preparedness to invest in community health improvement.

Results

Poorer community health was associated with high use of ED services, after controlling for age and sex. After including a summary measure of racial composition at the zip code region level, the relationship between community health and ED use became nonsignificant. No significant relationships between community health and hospitalizations or paid claims were identified. Business leaders expressed interest in further understanding health needs of communities where their employees live.

Conclusion

The health of communities in which adult employees and dependents live was associated with ED use, but similar relationships were not seen for hospitalizations or paid claims. This finding suggests a need for more primary care access. Despite limited quantitative evidence, business leaders expressed interest in guidance on investing in community health improvement.