Impact of updated hypertension guideline on eligibility for an employee wellness program

Pharmacists reduce overall healthcare spending in employee wellness programs (EWP). Employers implementing disease state management in an EWP must define the eligibility criteria. Clinical practice guidelines establish diagnostic criteria; therefore, updated guidelines have the potential to change the number of eligible beneficiaries in an EWP. No studies have analyzed the effects of using updated guideline-recommended criteria on the change in eligibility, enrollment, and indirectly, workload for program practitioners which may impact program administration cost.

The objective was to determine the impact of changing the blood pressure (BP) threshold for eligibility on the number of eligible beneficiaries in an EWP to that recommended by the ACC/AHA 2017.

Balls Food Stores (BFS) provides services within an EWP called Start Now including annual biometric screenings, a health risk assessment (HRA), and pharmacist-led disease-state coaching for select beneficiaries with diabetes, cardiovascular disease, or both (SN-DM and SN-CV, respectively). Enrollment in SN-CV is offered to beneficiaries if they have a qualifying diagnosis or biometric screening result. To determine the process for evaluating the effect of new eligibility criteria on potential enrollment in SN-CV, a retrospective evaluation was conducted using 2018 beneficiary data. The primary outcome measure was the difference in number of beneficiaries identified using current eligibility criteria (based on JNC8) and those potentially eligible using ACC/AHA 2017.

There were 1427 beneficiaries, of which 309 beneficiaries were eligible for disease-state coaching prior to 2018 and 187 beneficiaries were identified in 2018 using current eligibility criteria. Using proposed ACC/AHA 2017 criteria, 113 additional beneficiaries would potentially be eligible for SN-CV.

The effect of the change in SN-CV eligibility criteria would increase effort to determine eligibility, number of beneficiaries eligible for the program, and labor cost.