State Wellness Program

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1 The State Wellness Program EBC works hard to balance benefit levels, cost, and choice. However, successfully managing health benefits today involves more than plan design and cost management. It involves building a culture of health by providing a resource for state employees to better manage their health, in turn lowering health care utilization and reducing health insurance premiums. In January 2006, EBC implemented the OK Health Mentoring program as a benefit for employees to address unhealthy behaviors and learn to live State of Oklahoma Employees Benefits Council State Wellness Program OK Health Mentoring Program healthier lifestyles. Now going into its third, the OK Health Mentoring program continues to promote healthy lifestyle choices and encourage healthy behaviors and attitudes. The OK Health program has helped over 4,000 employees lower their risks for cardiovascular disease and/or diabetes. EBC s wellness program is an award winning, nationally recognized, program that received the Best in Class award in May, 2007, from the SouthWest Benefits Association. The OK Health program offers employees a unique and effective solution for better health by incorporating wellness, disease management, and health mentoring into a single, comprehensive wellnessmentoring program. Employees are required to complete a detailed health risk assessment, which stratifies participants into one of five risk tiers, based on potential health problems. Each risk tier determines the frequency of mentoring as well as goals and action plans for the employee. In 2006, more than 6,400 employees expressed an interest in the program with 70 percent of those employees completing the health risk assessment. With direction from a dedicated staff of eight professional health mentors, employees participating in the program at twelve months have already been successful in lowering elevated systolic and diastolic blood pressure, LDL cholesterol, triglycerides, weight, blood glucose, and quitting cigarette smoking. To Nancy A Haller Manager, State Wellness Program Employee Benefits Council 120 N. Robinson Suite 1100 Oklahoma City, OK

2 encourage participation in the program, employees are eligible to receive two wellness incentives. The first incentive includes an initial visit to a primary care physician and lab work at no out-of-pocket cost to the participants. The second wellness incentive is a discount at a participating fitness center. A third possible incentive offered by some agencies is the OK Health pay incentive. More than 64 state agencies have elected to offer pay incentives and are authorized to pay participants $100 (Bronze), $300 (Silver), or $500 (Gold) for successfully completing the program. There are many other ancillary benefits from having healthy employees such as less absenteeism and increased productivity. Overall Goals of the OK Health Mentoring Program: To reduce the risk of cardiovascular disease and diabetes among Oklahoma state employees. To suspend or decrease the rising costs of healthcare premiums paid by state government. To improve our risk as a group and attract additional health care companies. Community/population served: The Employees Benefits Council (EBC) is the state s benefits office. We design, select, and administer benefits for 37,000 active state employees. Our mission is to provide expert benefits management that includes designing for choice and cost effectiveness, superior administration, and promoting healthy lifestyles. Program origins and who was involved: EBC considers wellness and disease management programs the New Frontier in managing health care costs for state employees. As the State s benefit department, EBC recognizes the importance of protecting the State s investment in each employee by promoting and preserving good health and longevity. Good employee health increases productivity and lowers healthcare costs. EBC s State Wellness Program was created in 1994 to promote and preserve healthy state employees. EBC is responsible for the coordination of the State s Wellness Council, which is made up of approximately 110 state agency representatives. The Wellness Council coordinates, develops, and encourages participation in wellness programs. For more than a decade, the State Wellness Program has been active with regional health fairs across the State and a main health fair held at the State Capitol each October in Oklahoma City. Since 1997, a monthly electronic health news brief called the Wellness Gram is distributed to all agency wellness coordinators statewide. In 1997, the Wellness Program expanded to include the development of the Rural Oklahoma Health Awareness Development Project R.O.A.D., which provided for health screening for all full-time state employees. The R.O.A.D. program successfully screened over 4,000 employees and traveled statewide for over four years. The R.O.A.D. program was redefined and changed in 2002/2003 to a cardiovascular disease and diabetes risk reduction program called the OK Health Mentoring Program. OK Health Mentoring Pilot Program: The pilot program began in June 2003 and is a collaborative effort between EBC, Oklahoma State Department of Health (OSDH)/Chronic Disease Services, and the Department of Human Services (7,500 employees), which serves as the pilot group. Plan Year 2002 through 2005 utilization data for the group is being provided by the Oklahoma State and Education Employees Group Insurance Board (State s Indemnity plan) in an effort to measure utilization patterns of program participants prior to enrolling in the program at base line, during the program, and upon completion of one year. As of July 2004, the pilot program was successful in lowering health claims costs by 31% among the participants completing one year. The improvements have been made by lowering elevated systolic and diastolic blood pressures, total cholesterol, HDL and LDL cholesterol, triglycerides, body weight, blood glucose levels, and reducing cigarette smoking. 2

3 The objective of the pilot program is to lower health utilization and insurance premiums by mentoring employees with high risk factors to good health. The State of Oklahoma provides a benefit allowance to employees and their eligible dependents for the purpose of purchasing four core mandated benefits: (1) health, (2) dental, (3) basic life, and (4) disability insurance. For Plan Year 2005, the cost to the State to fund the employee benefit allowance was $244.5 million. Over the past four years, that expense has increased an average of 17 percent, or $28.7 million, each year. Through improved health, employees will experience less health care utilization and a reduction in health care-related expenses. The program uses a web-based interactive program licensed through INTER x VENTUSA, Inc, Savannah, Georgia, and now program of Nationwide Better Health, with one-on-one telephone health education mentoring and behavior change techniques. This comprehensive program includes exercise training, proper nutrition, weight management, stress management and smoking cessation. Lifestyle management interventions in the program are based on behavior change models, primarily social learning theory, the stages of change model, and the single concept learning theory. During the pilot program, participants received twenty-four mentoring sessions regardless of severity or risk classification. The OK Health Mentoring Program uses state-of-the-art behavior change techniques that provide a comprehensive program that includes weight management, exercise, nutrition, stress management, and, and smoking cessation. The program includes: An initial assessment of the participants past medical histories, current health status, family medical histories, readiness for change, and eating and exercise habits. Determination of participants current risk factor values and realistic short-term and longterm goals based on standards established by national expert groups. Personal Action Plans with specific recommendations for improving important aspects of participants lifestyles. Aerobic Exercise Plans for exercise, including individualized target heart rates and/or exertion ratings. Individualized Meal Plans that recommend the number of daily servings of foods from the five food groups to eat at breakfast, lunch, dinner, and for snacks. Target goals for the maximum number of grams of fat to eat each day. Recommendations for participants to see their personal doctors about new medications or medication changes, if appropriate, to help reduce the risk for heart attack and stroke. Easy-to-understand educational kits and audios covering more than 67 specific topics and skills. Self-management tools to monitor eating and exercise habits. Follow-up evaluations at 12-weeks and at 1 year with revisions of the participants Personal Action Plans. Approximately twenty-three one-on-one counseling sessions (specific to number of risk factors), per participant, with a professional health mentor. Participants are evaluated on clinical effectiveness at baseline, at twelve weeks, and at one year. Participants are referred to their personal physicians for the following measurements: fasting lipid profile fasting glucose blood pressure resting pulse rate height & weight hip and waist exercise clearance 3

4 Participants with abnormal baseline CVD risk factors (based on national clinical guidelines) are referred back to their physicians for medication changes and further assessment. Program Incentives: In an effort to encourage employees to participate in the Program, OK Health offers three types of incentives: (1) incentive pay from the agency level, (2) waiving the PCP visit and lab workup cost for the initial visit, and (3) fitness center discounts. EBC manages all incentives and interfaces with contracted health carriers for coordination of the incentives. Incentive Pay: Appointing authorities may offer pay incentives to employees participating in the Program. The pay incentives shall consist of separate lump sum payments payable to an employee upon completion of the following three program components: (1) enrollment process, (2) twelve-week process, and (3) the yearend follow up evaluation for each participant. OK Health verifies completion of each program component by the participant. Upon completion of each component, and as certified by OK Health, the appointing authority may reward the participant with a pay incentive. The pay incentives shall be available for only the first twelve months of an employee's participation in the program. A participating Appointing Authority may select one of the three following pay incentive packages: Bronze Plan: $ total financial incentive payable as follows: $25.00 for completing enrollment process; $25.00 for completion of twelve-week process; and, $50.00 for completion of year-end follow-up evaluation. Silver Plan: $ total financial incentive payable as follows: $75.00 for completing enrollment process; $ for completion of twelve-week process; and $ for completion of year-end follow-up evaluation. Gold Plan: $ total financial incentive payable as follows: $100 for completing enrollment process; $ for completion of twelve-week process; and, $ for completion of year-end follow-up evaluation. Waiving Cost for Initial PCP Visit and Lab Work: Waiving the PCP and lab work co-payment for the initial visit is another very important incentive. Health plans contracted by EBC are required to waive the cost of the initial PCP visit and lab work for participants enrolled in the Program. HealthChoice, the State s indemnity plan has also agreed to waive the cost as well. The following shall be provided at no charge to the employee: Biometric information including: Height Weight Blood pressure Resting pulse rate Hip and waist circumference measurements Lab information including: Fasting Lipid profile 4

5 Total Cholesterol LDL HDL Triglycerides Fasting Blood Glucose A1C (if applicable) Fitness Center Discounts: Fitness centers located throughout the State of Oklahoma are licensed and regulated by the Oklahoma Department of Consumer Credit under the Oklahoma Health Spa Act. Currently, there are eighty-eight facilities licensed by the Department. To date, approximately eighty-five facilities, including YMCAs, have agreed to offer a membership discount to employees enrolling in the Program. Funding: Funding for the State Wellness Program is through the Employees Benefits Council. Presently the budget for the State Wellness Program is approximately $300,000 and for the OK Health Mentoring program approximately $650,000. This initiative connected to other state program and polices: The OK Health Mentoring program is part of Oklahoma Governor Brad Henry s State health initiative for a Strong and Healthy Oklahoma. The Governor announced bold reforms to help our State employees stay healthy and set examples for all Oklahomans. During a health summit held in December 2005, Governor Henry said, You know as one of Oklahoma s largest employers, State government must lead the way. And we must create an effective health program for State employees. I am very proud of the Employees Benefits Council that has lead the development of an initiative, an innovative, successful initiative, a wellness program, a program that will offer every State employee the opportunity to learn how to take control of their health. The program is optional. It s voluntary. We won t force it on anyone. But, the idea is to get people excited about health, to actually encourage healthy habits in State government, throughout the largest employment system in the State of Oklahoma. In 2004, an assessment of 20,000 paid claims for state employees revealed that 30% of state employees were diagnosed with Cardiovascular Disease and/or Diabetes and 30% were at risk for developing Cardiovascular Disease and/or Diabetes. Also, Oklahoma has the second highest heart disease death rate in the nation. The State also has one of the highest smoking rates, sedentary lifestyle rate, as well as a growing obesity and diabetes epidemic. Compared to all 50 states in the U.S., Oklahoma ties for first in the prevalence of Cardiovascular Disease (CVD) at deaths per 100,000. Oklahoma also ranks ninth in the nation in prevalence of diabetes. The estimated total annual cost of CVD in Oklahoma is $3.7 billion and the total cost of diabetes is $1.8 billion. Of the 3.5 million Oklahoma residents, 37,000 active State employees are no exception to these same health challenges. Challenges in our work with the health of State Employees: As the largest employer in the state of Oklahoma, the State Wellness Program/OK Health Mentoring program has its challenges and many victories. Our main challenge is to Provide the foundation for state entities to modify work environments and develop policies and activities to support the health and wellbeing of state employees. 5

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