Caterpillar Case Study

Since its inception more than 80 years ago, Caterpillar has grown to be the world’s largest maker of construction and mining equipment, diesel and natural gas engines, and industrial gas turbines. Worldwide, Caterpillar has nearly 95,000 employees and more than 100,000 dealer employees, plus thousands of suppliers on every continent.

Promoting Wellness

“We strive toward a standard of excellence in all that we do, which extends to the well-being of our employees; they are the foundation of our business’s successful operations.” Michael Taylor, M.D., Medical Director for Health Promotion

In the 1990s, Caterpillar developed its employee health promotion program,“Healthy Balance,” using evidence-based resources to create and integrate the following components:

• Web site on healthy living
• Free health education materials for employees, spouses, and retirees
• Quarterly newsletter presenting evidence-based health information
• Health risk appraisals (HRAs) twice-yearly; data used to guide high-risk
• individuals into appropriate programs
• Personal health coaches for employees at risk for disease
• Diabetes disease management programs
• Tobacco cessation program

To date, more than 100,000 employees, spouses, and retirees have participated in “Healthy Balance,” including 93 percent of the eligible employee population. Results of “Healthy Balance,” as well as the overall healthcare management strategy at Caterpillar, include:

• Improvements in employees’ health risk factors
• Significant healthcare cost reductions
• Several awards, including the 2000 C. Everett Koop Award, 2002 Well Workplace Gold Award, and 2006 Corporate Health Achievement Awardfrom the American College of Occupational and Environmental Medicine

Implementing a Smoking Cessation Program

Based on high smoking prevalence rates reported on its HRA, as well as increasing evidence that smoking cessation benefits are cost-saving to employers, Caterpillar developed a tobacco cessation program in 2002. Between 2002 and 2006, participants in the program maintained a 34 percent annual quit rate.In 2006, all of Caterpillar U.S. facilities went smoke free. To provide support for employees to quit smoking, Caterpillar hired Free & Clear, Inc., a highly specialized tobacco treatment provider that uses a clinically proven,comprehensive approach to treat physical addiction, psychological dependence and behavioral pattern.

Program Overview

Caterpillar established its tobacco cessation program around the following core elements:

• Using the HRA to help identify employees’ readiness for change and open lines of communication between health educators and employees
• Removing all barriers (copayments and deductibles) for prescription and over-the-counter smoking-cessation products
• Toll-free, in-depth telephone counseling support services with a professional quit coach (up to five outbound calls) scheduled at the participant’s convenience
• Recommendations on the type, dose, and duration of medication, if appropriate
• Access to print and online resources, including:Evidence-based quit guides written with a health literacy expert and tested with actual smokers for usability and comprehension; Demographic-specific materials, e.g., for smokeless tobacco users, pregnant smokers, and Spanish-speaking participants;WebCoach™ e-learning tools, online social support and information,and stage-appropriate printed materials
• Evaluation of employee satisfaction and outcomes

The comprehensive plan was designed to lead up to the adoption of stringent smoke-free workplace policies. All Caterpillar U.S. facilities went smoke-free in 2006 and a global ban on smoking was introduced in January 2007.

Outcomes

“Success equates to more than providing tools to help people quit smoking. It is about providing comprehensive support and then creating – and maintaining – a
culture of wellness.” Michael Taylor, M.D., Medical Director for Health Promotion

Since 2002, Caterpillar has assessed smoking status and tracked quit rates for all 1,200 employees enrolled in the tobacco cessation program. Between 2002 and 2006, participants maintained a 34 percent annual quit rate. This rate contrasts greatly with the 6 percent quit rate among eligible employees who did not enroll in the program. Of note, quit rates have been as high for employees who are members of labor unions as those for non-union employees.

Lessons Learned

Caterpillar cites the importance of the following in achieving its success:

• Using evidence as the basis for establishing and verifying the program
• Identifying and empowering a program champion
• Engaging a vendor with a long-term track record that specializes in supporting tobacco cessation
• Introducing the program in advance of smoke-free worksite policy implementation
• Communicating programs and policies to employees, including new hires, effectively and continuously
• Linking the program to existing programs, e.g., the HRA
• Building on local laws that promote or require smoke-free work environments
• Coordinating with offices internationally to implement an aligned, effective program

CDC Guidelines

This case study illustrates one example along the broad spectrum of steps employers have taken to improve the health and quality of life of their employees while protecting their company’s own financial health. The U.S. Centers for Disease Control & Prevention recommends the following actions for a comprehensive smoking cessation benefit:

• Cover at least four counseling sessions of at least 30 minutes each, including telephone and individual counseling sessions
• Cover all FDA-approved nicotine replacement products and tobacco cessation medications
• Provide counseling and medication coverage for at least two smoking cessation attempts per year
• Eliminate or minimize co-pays or deductibles for counseling and medications

This case study was developed by NBCH as part of an educational initiative supported by Pfizer Inc. More about this project is available at www.nbch.org.

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