It almost sounds like an episode from the television show "House." In 2003, the occupational nurses working at Schneider National, a trucking company, started to hear more drivers complain about fatigue, sleepiness, memory loss, irritability, difficulty concentrating and personality changes.

"Given that we had high incidences of obesity, hypertension, diabetes, heart disease and heartburn among our workers, the nurses started to connect the dots and realized we had a sleep disorder in our fleet," said Angela Fish, director of benefits at Schneider, a Wisconsin-based company employing nearly 14,500 drivers.

The disorder turned out to be sleep apnea, a breathing illness characterized by closure of the upper airway that cuts off airflow.

Its underlying conditions include hypertension, which up to 50% of patients have reported, and cardiac arrhythmias during sleep.

For a trucking company, sleep apnea can be driving factor in fatigue-related accidents.

The Federal Motor Carrier Safety Administration, which regulates the trucking industry, indicates 28% of any commercial driving fleet is at risk for sleep apnea.

Fighting fatigue

Fish and her team wanted a health vendor who could offer a disease management program focusing on sleep apnea.

The company faced several challenges, including:

• Schneider's relatively unhealthy population, where 45% of male drivers and 48% of female drivers are obese.
• The company in 2005 replaced its PPO plan with a tiered consumer-driven health plan, offering three health reimbursement account plan options.
• Officials realized that the diagnosis and treatment had to allow for no more than two days out of service because "our drivers don't make money unless they are driving," Fish said.

Schneider selected Houston-based Precision Pulmonary Diagnostics to manage the sleep apnea program, which aimed to reduce preventable accidents, reduce employer-funded health costs and improve employee retention rates.

Under the program, the drivers receive disability coverage if needed and leave the sleep lab with treatment in hand, which includes a continuous positive airway pressure machine, a device that helps with their respiratory ventilation.

It also was important to Schneider that Precision Pulmonary develop and implement objective screening criteria and processes for sleep apnea.

Seeing results

Before rolling out the program to the entire fleet, the company launched a pilot program involving 339 drivers in pre- and post-treatment for sleep apnea.

The program yielded a 71% accident reduction post-treatment and an 80% compliance rate with federal trucking rules, said Fish.

The company also saw a 55% improved retention rate.

"We looked at health care costs prior to the treatment and compared that to post-treatment, and we saw [savings of] $538 per driver per month [over] a period of 12 months. It was primarily driven by inpatient and emergency room reductions," she explained.

She adds that, when the driver is treated longer, the savings increase from $538 to about $700.

When the company rolled out the program for the entire fleet, it removed one barrier.

"We were covering testing as 100%. But in the pilot program, [preventive and treatment] equipment were not covered, except if you were in a health reimbursement arrangement. People in our medical plan were struggling to pay for the equipment, so we removed that barrier. We are now covering testing and treatment."

For example, the company provides a special preventive benefit for sleep apnea claims that includes testing and supplies, such a CPAP machine and related equipment to help prevent and manage sleep apnea.

Moreover, all sleep studies and associated physician fees are paid at 100%.

In April 2006, the company screened its existing driver fleet - more than 8,000 drivers - during spring training.

High-risk drivers were referred to Precision Pulmonary for diagnosis and treatment. All new hires are screened as a part of the onboarding process.

In 2006, 28% of drivers were tested with severe sleep apnea, increasing to 31% last year.

"We had drivers who were adamant that they were not going to go and get tested or treated, and that they do not have the disease. Now, some of those drivers are our biggest advocates," Fish said.

"They are now being treated and say, I lost weight. I feel so much better. I have more energy and my blood pressure is under control.'"

Even bigger than that, Fish said, "Spouses are calling us and saying, I can now sleep at night. My spouse is a new person when [he or she] comes home. They don't fall a sleep as soon as they come home. They have energy to play with the kids.

They are living healthier and more aware of their health.'"