Two-year results of a randomized controlled trial of a health promotion program in a retiree population: the Bank of America Study.
OBJECTIVE
To evaluate the effectiveness of a health promotion program in a retiree population in terms of health risk reduction and reduction in medical costs.


METHODS
Randomized controlled trial.


METHODS
Bank of America retirees (n = 4,712), divided into 33 retiree club regions, were randomized into 3 groups and followed for 24 months by patient report and claims experience. Group 1, the intervention group, received a low-cost ($30/year), individualized, serially reinforcing health promotion program including risk appraisal, recommendation letters, and self-management materials, delivered entirely through the mail. Group 2 received risk appraisals only, without feedback, for the first 12 months and subsequently the full intervention for the second 12 months. Group 3 was followed with claims data only. Participation rates of 57% at 1 year and 47% at 2 years were achieved.


RESULTS
Overall health risk scores improved by 12% at 12 months compared with control (p < 0.001) and by 23% (from baseline) at 24 months (p < 0.001). Individual health habit changes were favorable for all parameters studied, and were highly statistically significant for most variables. Similar health risk reductions were seen in age groups of 55 to 65 years, 65 to 75 years, and over 75. Cost reduction differences were more than 20% by self-report (p < 0.01) and 10% by claims experience (p = 0.02) at 12 months. For the randomized controlled period of the first 12 months, reductions averaged $164 in the intervention group contrasted with an average increase of $15 in the combined control groups.


CONCLUSIONS
Risk reduction programs directed at retiree populations can improve health risk status and can reduce costs.
From the Department of Medicine and Division of Biostatistics Stanford University School of Medicine, Stanford, California USA.
James F
JF
Fries
From the Department of Medicine and Division of Biostatistics Stanford University School of Medicine, Stanford, California USA.
Daniel A
DA
Bloch
Blue Shield of California, San Francisco, California USA.
Harry
H
Harrington
Blue Shield of California, San Francisco, California USA.
Nancy
N
Richardson
Bank of America, San Francisco, California USA.
Robert
R
Beck
D000367:Age Factors; D000368:Aged; D054598:Blue Cross Blue Shield Insurance Plans; D002140:California; D005260:Female; D015438:Health Behavior; D017048:Health Care Costs; D006293:Health Promotion / Q000191:economics* / Q000379:methods; D006299:Health Services for the Aged / Q000191:economics*; D006801:Humans; D007345:Insurance Claim Review; D008297:Male; D008875:Middle Aged; D012179:Retirement / Q000191:economics*; D012307:Risk Factors; D011795:Surveys and Questionnaires