Specific Review Comments Included:  

A comprehensive program with integrated health promotion and disability management.  Innovative methods for fatigue management are included.  The cardiovascular program has been expanded since 1994.  There is a secular trend in decreasing lifestyle claims following onset of these programs.  They make innovative use of regression models to draw inferences regarding causality.  There is substantial progress on integration of health promotion into the company structure.  This application provides some excellent models for what can be achieved by relatively mature employee health promotion programs in large firms.  About 40,000 of the 53,000 member workforce have participated to date.  Return on investment is greater that $2 dollars for every dollar invested.  Cost savings were defined and measured in all projects.  The effectiveness and cost savings data are of excellent overall quality and well documented.  Injury prevention is a central goal for this program. It is integrated with occupational medicine and uses that integration to combine the health risk assessment (HRA) tool with legally required examinations.  They are beginning to partner with managed care plans to avoid duplication.  There is good external evaluation of program results. 

A few concerns were voiced.  Cost data is based on assumptions and projections rather than direct claims measurements.  The program could benefit from additional emphasis on self-care.