Time to Upshift on Driver Wellness Programs

Managers, here are five reasons not to wait for DOT to tell you what to do.

We have officially entered the Compliance, Safety, Accountability (CSA) era of regulation from the Department of Transportation (DOT). Its Federal Motor Carrier Safety Administration (FMCSA) has replaced SafeStat with the Safety Measurement System (SMS) to collect more data and make it more visible to the public, shippers, and insurers. The new behavior analysis and safety improvement categories (BASICs), backed by more aggressive efforts to identify carriers and drivers with poor safety performance records, have companies scrambling to cover all the bases.

And CSA is just getting started.

In remarks at the California Trucking Association's Annual Management Conference in January, FMCSA Administrator Anne S. Ferro noted upcoming rulemaking actions in commercial driver's license standards, entry-level driver training, and driver physical qualifications. New sleep apnea standards seem imminent. And efforts are underway to standardize training and testing on the federal physical qualifications for those conducting physical examinations. A National Registry of Certified Medical Examiners is coming, with required electronic submission of DOT medical certificates allowing enforcement officials to crack down on previously unverifiable or forged certificates.

FMCSA is also increasing its focus on driver health and wellness. "Fitness" (one of CSA's BASICs) already dictates standards for blood pressure, diabetes, vision, and so on. But there is increasing emphasis on wellness factors that influence those conditions, such as being overweight. In November 2010, FMCSA/DOT, along with NIOSH, sponsored its first International Conference on Commercial Driver Health and Wellness. As Ferro said in an opening address, "Keeping the driver healthy so that they can do their job is critical to safe operations but has been an area left untouched by many in the industry." To amend that, the agency is working on a template to help carriers define the core elements of an effective driver health and wellness program.

Whether such efforts lead to outright regulations or not, there are good reasons to ramp up driver wellness programs without waiting for DOT. As Ferro points out, "irregular schedules, long hours of work, poor diet and nutrition and the stress of driving in heavy traffic and bad weather often negatively impact a driver's health." In fact, according to the Centers for Disease Control and Prevention, life expectancy for commercial truck drivers is 16 years shorter than the national average. That alone is a good argument for doing more to improve the health of those who literally "drive" a company's success, but there are also strong business reasons to invest in wellness.

FMCSA's 2007 "Commercial Truck and Bus Safety Synthesis 15," an extensive study of health and wellness challenges and best practices, notes that "most industrial health professionals say the return on investment (ROI) for a good wellness/disease management program is somewhere in the neighborhood of 3:1 or 4:1." It adds that the leading transportation companies in this area report a range of bottom-line benefits, including:

  • Decreasing health care and workers' compensation costs
  • Controlling insurance premiums
  • Continually improving safety records
  • Maintaining corporate leadership
  • Improving employee morale and job satisfaction
  • Helping to attract and retain healthier, safer drivers

The road to those benefits is not without challenges, but today's affordable, software-based solutions for training, safety, health, and related areas can help considerably. Should your company ramp up driver wellness efforts? Here are five decision drivers.

Risk Management
Statistically, there is solid evidence that drivers who don't attend to wellness (diet, exercise, not smoking, stress, etc.) present increased risks for high-cost health problems and accidents. With CSA's new ratings putting more emphasis on the performance of individual drivers, that could even translate into increased risk of inspections and fines.

In the 2002 article "Selling Health to High-Risk Workers," S.F. Gale estimates that 10 percent of employees consume 80 percent of health care costs. FMCSA's "Synthesis 15" reinforces that estimate in a case study of Waste Management, Inc., one of the nation's largest short-haul trucking companies. Internal analysis showed that just over 10 percent of Waste Management's employees used 80 percent of dollars spent on health care, workers' compensation, absence, and disability benefits. This high-risk group racked up average annual costs of $17,000 per person -- compared to less than $500 per person for the rest of its employees. The numbers were even worse when focusing only on drivers: 1.4 percent of high-risk employees were responsible for 40 percent of total benefit dollars.

Numbers like that make driver wellness programs a logical allocation of risk prevention resources to a high-cost area with correctable risk factors. After analyzing employee health care data to spot problem areas, Waste Management launched an integrated campaign including managing obesity and blood pressure, diagnosing and treating sleep apnea, driver safety, lunch-and-learn educational programs, enhanced physical exam processes and tracking, and more. As a result, a key cost metric went from a 22 percent increase to a 1.3 percent decrease, and the company has tracked savings of more than $100 million over several years.

The link between wellness and accidents may be less obvious -- but the numbers are convincing. FMCSA's 2007 "Large Truck Crash Causation Study" determined that 87 percent of crashes involved driver-related causes: non-performance, recognition, decision, or performance. That suggests that most accidents are preventable. Does wellness really impact such driver-related causes? One National Transportation Safety Board study listed "health" as a major factor in or probable cause of 10 percent of crashes involving truck driver fatalities. A high percentage of those involved cardiovascular disease, which afflicts many commercial drivers due to lifestyle and work-related factors. It's a real crash risk factor, and driver wellness programs, which directly address many leading causes of cardiovascular disease, are an effective way to reduce the risk.

Sleep apnea is another example. In 2006, a Joint Medical Association Task Force recommended sleep apnea screening for commercial drivers based on studies showing it represented a twofold to sevenfold increase in risk of motor vehicle crashes. A 2009 study by the American Academy of Sleep Medicine analyzed data from seven electronic databases and also concluded sleep apnea raised the risk of crashes, with a mean crash-rate ratio between 1.21 and 4.89. Even a University of Pennsylvania study that questioned some conclusions of previous studies still confirmed that drivers with severe sleep apnea were 4.6 times more likely to be involved in a severe crash.

It's easy to be distracted by emotional arguments about whether such statistics justify Big Brother monitoring a driver's sleep or mandating CPAP devices. But the real point is that sleep apnea is often preventable and almost always manageable; weight and physical activity, for example, are contributing factors. Compliance issues aside, minimizing this risk -- and any risk impacted by wellness -- is just good business.

Cost Control
In an industry known for low profit margins, controlling costs is critical. Even relatively small driver wellness initiatives can deliver big results in this area. The Health Enhancement Research Organization (HERO), a leading researcher on health care costs and management strategies for more than a decade, estimates that 50 percent to 70 percent of all illnesses and medical problems can be tied to a handful of lifestyle choices: obesity, smoking, inadequate exercise, poor nutrition, and inability to manage stress. To add specific costs to just one of those, a 2003 American Lung Association study estimated that an employee who smokes costs employers at least $1,000 extra per year in direct and indirect health care costs. That's especially relevant because the percentage of commercial drivers who smoke is much higher than that of the general population.

Would a 20 percent reduction in health care costs help your company? According to a 2008 Indianapolis Business Journal article, that's how much trucking industry leader Celadon saved with its Highway 2 Health wellness initiative. The company's program includes a fully staffed wellness clinic, health screening for blood pressure, body mass, glucose and lipid profiles, individualized health reports with proactive health improvement plans, health coaching, and educational resources.

"Synthesis 15" likewise touts the bottom-line value of health and wellness initiatives "through the reduction of health claims, early identification of treatable health issues, and improved driver retention." The report supports that claim with an impressive list of examples:

* Schneider National's sleep apnea initiative has saved the company $538 per driver each month in health care savings and yielded a 55 percent greater retention rate among participating drivers. Additionally, Schneider's annual health care claims cost increase has remained lower than industry norms.

* J.B. Hunt's personal health coaches and other measures targeting at-risk drivers have helped reduce workers' compensation claims and costs, crash rates, and driver turnover.

* Trucks, Inc., a regional truckload carrier, implemented a health and wellness program that has saved the company more than $250,000 in medical insurance costs and enabled early detection and treatment of pre-heart attack and pre-diabetic conditions, as well as several cancer cases. The company has low turnover rates for its sector and has earned recognition for safety performance, both of which it attributes in part to its driver health and wellness program.

Health Matters -- More than Ever
DOT medical certification has been a fact of life for decades. Physical qualifications have become more rigorous over time, and that's likely to continue regardless of regulatory politics, simply due to advances in medical knowledge and technology. But even if regulations didn't exist, there are numerous business benefits from helping your company's drivers overcome their health challenges.

First, let's acknowledge that drivers face unique challenges just by the nature of their jobs. Long hours of being sedentary while dealing with elevated stress from traffic, bad weather, deadlines, and so on are the norm. Options for good nutrition and exercise on the road are limited and require more planning and commitment. Additionally, drivers often face exposure to high noise levels, diesel exhaust, carbon monoxide, and other hazards. Some of these factors are unavoidable, which makes it even more critical to address health factors that can be improved.

The lifestyle choices and resulting conditions that affect drivers most are the staples of any good wellness program: weight, smoking, exercise, stress, cholesterol, and high blood pressure. Improving these areas has a double payoff: lower health care costs and better productivity. For example, "Synthesis 15" refers to a 2002 study showing that regular exercisers achieved higher job performance ratings, stayed longer with their company, and had lower medical and prescription claim expenses, as well as lower absenteeism rates, than those who did not exercise. Another cited study showed that employees who received stress management assistance saw doctors 34 percent less than did other employees.

Addressing health and wellness is also becoming more important because of the aging workforce. As more workers enter their 50s and 60s, companies could see potentially devastating spikes in health care costs, lost time, and other age-related problems. The percentage of older workers is even higher in transportation than in most industries, with the Transportation Research Board estimating that up to 25 percent of truck drivers will be older than 65 by 2025. Putting strong health and wellness programs in place now is the best long-term strategy to cope with this trend.

Of course, a wellness program pays off only if drivers participate. Low participation undermined some early programs in the 1990s and remains a legitimate concern. But drivers, like the general population, are more aware of health today and have more reasons to see health and wellness efforts as benefits rather than intrusions. That starts with their livelihood. Beyond increasingly stringent qualifications to keep their license, CSA's new focus on individual performance makes it important to manage anything that could compromise their performance, including health. Some individuals are motivated by the fact that if they stay healthy, they have to get medical certification only every two years, whereas conditions such as high blood pressure require more frequent exams. With the high payoff to companies, many are also encouraging driver participation through discounts on health benefits and other incentives.

But the experience of Schneider National reported in "Do Wellness Programs Have a Role in the Trucking Industry?" at BigTruckTV.com suggests that many drivers are also motivated by health itself. Two years after launching a driver wellness program, Schneider's participation rate was only 15 percent. Then two drivers suffered fatal heart attacks. Screening had identified them as high-risk, yet they'd chosen not to join the wellness program. That tragic wake-up call nearly tripled program participation to more than 40 percent. As the workforce ages, more drivers are seeing firsthand the consequences of ignoring health -- and the benefits of improving it.

The Benefits of Today's Technology
Perhaps the biggest difference between today's wellness programs and those of the 1990s is the technology available to deliver and manage them. From online training and specialized health management software to web-based solutions that connect related functions enterprise-wide, today's technology can help you make health and safety information more engaging, automate tracking and reporting, improve accountability and transparency, gauge ROI, and much more. Today's leading solutions are also affordable, easy to use, and no more intimidating to today's workforce than GPS, smartphones, and other technologies they already use.

Two areas where technology has proven especially valuable are training and health management. Interactive, multimedia training solutions ensure a more enjoyable, more effective learning experience and cover topics, risks, and goals that are specific to your organization, rather than just what's in Getting in Gear and government-sponsored programs. Available solutions range from pay-as-you-go On Demand training to complete systems with powerful analysis, tracking and reporting tools. Leading health management software suites add time-saving features for scheduling and tracking medical exams, promoting and managing driver wellness initiatives, compliance reporting, and much more. All of these solutions are especially valuable in making it easier to reach (and manage) the industry's highly mobile workforce.

The "Synthesis 15" case study on J.B. Hunt, one of the nation's largest truckload carriers, provides a nice snapshot of how such technology can be used: "DOT medical examination is entered into a web-based application so that all data are maintained electronically. Statistical analyses can be performed on all data fields of the DOT exam and trend analyses are conducted regularly. These analyses allow J.B. Hunt to focus wellness initiatives on specific health risks and allow for health and wellness programs to be more effective." Bottom line? The company reports "a reduction in the number of workers' compensation claims and costs, a reduction of claims due to serious musculoskeletal injuries, a reduction in workers' compensation claims within 90 days of hire, a reduction in accident rates, and a decrease in driver turnover."

Another benefit of today's technology solutions is that they help even the playing field with DOT. A common complaint about the CSA rating system is that it's too complex. But that depends on the tools used to collect and analyze data. We can be sure that the government is not limited to clipboards and Excel spreadsheets, so it is important for companies to keep pace with tools that allow them to manage the required quantity and quality of information with accuracy and minimal staff resources.

On a larger scale, web-based enterprise systems are helping today's most innovative companies integrate related areas such as health, safety, training, risk management, and case and claims management -- an approach that can deliver potentially game-changing efficiency and business performance benefits.

To be clear, technology alone won't make your drivers healthier. Numerous programs have shown that the most effective approach combines the benefits of technology with health coaches and other types of personalized contact. Of course, one benefit of technology is that it minimizes administrative time and costs, freeing up more resources for those in-person interactions.

Run With the Leaders
With rising fuel prices and operational costs hitting already slim profit margins throughout the industry, anything that provides a competitive edge is critical. And as examples in this article show, many top transportation companies see strong driver wellness programs as part of what keeps them at the top. In reviewing such companies, "Synthesis 15" concludes that "such programs lead to improved employee morale, lower driver turnover, reduced medical and workers' compensation costs, and improved profits. Such forward thinking human capital strategies can help a company to maintain a position of excellence in the transportation industry." In the report's Trucking Industry Manager Survey, the reasons that company managers provided for investing in driver wellness were equally telling: 84 percent said "to reduce health care costs," "to reduce occupational injury," and "to enhance productivity," while 74 percent said "to reduce accidents," and 68 percent said to "reduce absenteeism." No matter what size your company is or what sector you're in, those all mean stronger business performance, reputation, and competitive position.

That’s not to ignore the challenges in implementing a program that delivers such results. But you may be better prepared for the task than you think. The "Synthesis 15" researchers found many companies that said they did not have a "health and wellness program" actually did have elements and resources for a good program already in place. And, as the report put it, "Health and wellness programs do not need to be all-encompassing to begin to address driver health issues. Programs can be started simply by administering a health risk appraisal to drivers to determine the most pressing needs."

You have resources in place for driver safety and health compliance. Shouldn't you get more out of those resources than mandated certificates and temporarily appeased regulators? Clearly, everyone must find an approach that fits their culture, budget, and business objectives. But if you explore today's emerging best practices and technology solutions for driver wellness and related areas, such as training and risk management, you may well find that realizing the benefits discussed in this article will be an upshift more than a need to rebuild the whole engine.

This article originally appeared in the July 2011 issue of Occupational Health & Safety.

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