Methodology of WISCORE, the Wellness Impact Scorecard

Transcription

1 Methodology of WISCORE, the Wellness Impact Scorecard. 1. Scorecard Concept and Purpose As more and more employers implement wellness programs to improve employee health, the National Business Group on Health s Institute on Innovation in Workforce Well-Being has found that employers struggle with understanding: The program s impact; If they are using the right measures to understand the program s true impact; and How they compare against other employers. The Institute felt there was a need for a new tool that allowed employers to objectively and quantitatively assess the value of their wellness programs and initiatives. As a result, we have developed an online tool called WISCORE, the Wellness Impact Scorecard ( Scorecard ). The purpose of the Scorecard is three-fold: Share guidance with employers on the appropriate data elements they should use to determine the impact of their wellness efforts; Offer a tool for employers to quantify the impact they are having and follow trends over time; and Provide a process for employers to benchmark against other employers. The Scorecard is unique in that it advances wellness program evaluation from counting health risks to measuring healthy behaviors that increase the level of health status among the entire employee population. Specifically, employers need to be asking: Are these at risk groups improving their health behaviors? Are the healthy behaviors already in place being maintained? Is the employee population moving toward overall better health status? Because achieving a substantial impact on health is difficult, it is expected that overall scores from this Scorecard will be in a lower range than other scorecards available. As the Scorecard was developed, the National Business Group on Health ( Business Group ) considered this fact and decided it was more valuable for companies to measure true impact and follow meaningful trends over time rather than have easily achievable program data elements. WISCORE, the Wellness Impact Scorecard software is an online service of the National Business Group on Health to its members and the public National Business Group on Health. All rights reserved.

2 2. Development Process and Timeline Initial Development: The development of the Scorecard began in the summer of 2007 when a workgroup was created. This workgroup consisted of Business Group staff from the Institute on Innovation in Workforce Well-Being and the Benchmarking and Analysis Unit, as well as an external preventive medicine consultant, Joyce Young, MD. The workgroup began by conducting a scan of the wellness landscape to understand the types of programs that employers were undertaking and what tools were available to conduct assessments. The scan included a review of materials by companies/vendors who offer wellness programs as well as independent organizations such as HERO and WELCOA. In addition, we reviewed our own database of wellness program information collected through the Best Employers for Healthy Lifestyles awards to gain further knowledge of what employer-leaders in the field of wellness were doing. In addition, the Business Group conducted primary and secondary research on the topic of wellness programs as well as fielded several surveys to employers to understand how they approach measuring the value of their wellness programs. All of these materials were reviewed as part of this process. After this environmental scan, we conducted extensive literature reviews on the types of program evaluations that have been conducted, what data elements are currently being used to evaluate programs, and what had been documented in terms of the value of wellness programs. The purpose of this literature review was to gain additional knowledge on what has already been studied and determined to be a valid method of evaluation. After our review of the literature, we also conducted additional research on available scorecards to understand the characteristics of effective scorecards. This review was not limited to scorecards related to wellness programs but went beyond that to include any health-related scorecard. The purpose of this task was to better understand how scorecards are created and the ease of use of various scorecards. Based on this research, an alpha version of the Scorecard was developed in the fall of 2007/winter of It was during this initial development phase that we determined there would be three levels to the Scorecard: Level 1: The first level focuses on the strategies, tactics and communications efforts that the employer has undertaken in promoting healthy lifestyles. Level 2: This section captures employee participation in a variety of wellness programs. Level 3: The last level quantifies the impact that an employer has had on employee behavior by looking at changes in healthy/unhealthy practices, outcomes and cost savings over time. The concept of adding different levels to the Scorecard was presented to the Board of the Business Group s Institute on Innovation in Workforce Well-Being in the fall of 2007 and additional feedback was received and incorporated.

3 We then determined the most valid data elements that we believe employers should use in evaluating their program. A discussion of these data elements is included below. Please note, in the development of these data elements, we were aware that some employers may not currently have this information available to them. However, we feel strongly that the data elements included in the Scorecard are the ones that are the most beneficial to study and the ones employers should be using. The initial version of the Scorecard was developed in Microsoft EXCEL. Pilot Testing: After this initial version of the Scorecard was developed, we wished to understand the applicability of the Scorecard to employers. In the spring of 2008 we pilot tested the Scorecard s initial version with five large employers to test its applicability and ease of use. These companies included IBM Corporation, GlaxoSmithKline, Union Pacific Railroad Company, Verizon Communications and Meijer, Inc. These employers were selected because they were in different stages of the health improvement efforts, from new wellness programs to all-encompassing cultures of health that permeated all aspects of their business. The Business Group is grateful that these companies agreed to pilot test our Scorecard and provide valuable feedback. Below is a summary of the key findings we received from these organizations: i. Clearly Defining Fields: A fair number of comments revolved around what we were truly asking. Suggestions were offered on how to word particular definitions, what should and should not be included in those definitions as well as ways to make these definitions consistent across the levels of the Scorecard. ii. Format Change: Due to the Scorecard s complexity, it needed to be redeveloped for improved usability. The EXCEL format did not allow for ease of use and at times added to the complexity of the process. iii. Variability of Wellness Programs: Because of the variability of the different types of programs, it was suggested that the Scorecard have the ability to account for the differences that exist and allow employers to only have to answer questions pertinent to their programs. iv. Addition of Comments/Notes Boxes: The selected companies agreed that the ability of end-users to provide additional context on how particular values/data elements were derived or how targets were determined was important to the further development of the Scorecard. The concept of the Scorecard and the results from the pilot testing were presented to other employers in attendance at the Business Group s Health at Work: Changing Culture, Behavior, Environment: the Fifth Annual Leadership Summit held in Washington, DC in May Additional feedback was received from other large employers who were not part of the initial development process.

4 Refinement of Scorecard: Based on the initial research, pilot testing and additional employer feedback, we determined that the Scorecard must meet the following four principles: i. Easy to utilize; ii. Flexibility to account for the vast differences in wellness programs; iii. Clear definitions; and iv. Reporting that provides value to employers. With these four principles in mind, the Business Group workgroup spent the summer of 2008 refining the field measurement, clarifying the definitions, developing automated reports and redesigning the functionality. This process included conducting additional literature searches to ensure values throughout the Scorecard were based on the latest research and that definitions were based on possible industry standards. In addition, it was determined that this Scorecard would become an online tool that employers could access through our website. By moving to an online version, it offered us greater flexibility in the look and overall mechanics of how the Scorecard would function. Online Development: After the final specifications of the Scorecard were determined, the online development of the Scorecard began. During the fall of 2008, this functionality was further refined to ensure ease of use for employers. The Scorecard went through a rigorous testing process and review before becoming available to the membership. Launch: In February 2009, version 1.0 of the Scorecard was launched to Business Group members for their use. These early adopters of the Scorecard provided additional feedback on the tool, including what worked well and suggestions for improvement. Version 2.0: Based on this first year of use of the Scorecard, we developed Version 2.0 of the Scorecard. In addition to being more user-friendly, this new version of the tool included some definition refinements, a new stress management metric as well as several new reports. Lastly, the decision was made that going forward in 2010 the Scorecard would be available to all employers, regardless of whether they are members of the Business Group. Version 3.0: In this update, the Healthy People 2010 targets in Level 2 Part A of the Scorecard were substituted with targets based on benchmarks from previous users of the Scorecard. Additionally, some of the automatically generated reports were updated. Version 4.0: In the 2012 update, the Business Group made significant changes to the Scorecard based on a thorough review of WISCORE. These changes included: updates to the components of a successful stress management program; changes to the communications portion of the Scorecard to focus more on all engagement strategies; and moving questions relating to the health status of the employee population to Level 3 of the Scorecard.

5 Version 5.0: In 2013, minor changes were made to the actual questions within the Scorecard. A new question was added in Level 2, to look at the participation rate of spouses and domestic partners in an employer s health assessment. Additionally, some of the tactics in Level 1: Part B were refined based on employer feedback and additional evidence. Beyond changes to questions, the largest change to the Scorecard in version 5.0 was to require that scores in Level 2 and Level 3 be based on employer benchmarks, rather than allowing a user-specified target. This change allows for a more comparable assessment amongst employers. Version 6.0: In 2014, changes to the Scorecard focused on three areas: In Level 1, adding an additional question that focuses on understanding what types of business metrics employers are using to evaluate the impact of their wellness programs. These business metrics include absenteeism, safety incidents, turnover and engagement. In Level 3, we removed a question asking employers about their medical trend over time. There has been much focus recently on moving away from connecting wellness programs to health care costs and rather focus on the impact of wellness on other relevant areas, specifically productivity. As a result, we have added a new question on business metrics (described in the bullet above) to understand measuring wellness program impact beyond just health care cost savings. Also in Level 3, we have changed scoring to account for employers who have already achieved success in engaging their workforce in particular health behaviors and/or outcomes. For employers who have a workforce that is at 95% of the benchmark, full points are given automatically. For employers who are between 75% and 90% of benchmark, partial points are awarded. For example, if an employer has 98% of their workforce that is tobacco free and the employer benchmark is 97%, the company receives full points (10 in total). They do not need to show an improvement over time.

6 3. Section Descriptions A. Demographic Information We collect a series of demographic information to understand the characteristics of the employee population and their program maturity. In this section, we ask respondents to provide details on the size of their employee population, their health care and wellness expenditures as well as how comprehensive their wellness programs are. Please note: no scores are associated with this information. B. Level 1: Strategy and Tactics Level 1 focuses on understanding employer efforts in health improvement. The purpose of this level is to recognize the value of building a foundation and strategy that supports and drives engagement in employer s health improvement programs. Level 1 consists of a series of discreet questions, generally in the form of a Yes/No or checkbox format. Level 1 has three parts. Part A is the strategy of the company. Part B consists of the tactics the company undertakes and Part C comprises questions around what tactics employers are using the engage their employees in health. Overall, Level 1 is worth a total of 60 points. C. Level 2: Participation The purpose of Level 2 is to gather information about how successful employers are in getting their employee population to participate in wellness programs. WISCORE tracks participation around health assessment (employee and spousal participation), biometric screening, tobacco cessation programs, weight management programs, physical activity programs and stress management programs. We expect much of the data for Level 2 to be collected via the health assessment or through other employee surveys/biometric screenings. The methodology for Level 2 is different from Level 1. In Level 2, we are measuring the extent to which actual participation achieves the predetermined target based on employer benchmarks. For example, if an employer has 50% of their population completing the health assessment, and the target is 70%, they are scored on how close they come to their target. The targets were developed based on data from previous WISCORE users. Level 2 is worth a total of 30 points.

7 D. Level 3: Impact on Workforce Level 3 focuses on the impact that employers have been able to have on employee behavior and health status. Level 3 consists of two parts. Part A is measuring changes in several health behaviors over time. Part B focuses on outcomes around health. In each part, we are capturing information from multiple years. The Scorecard was designed to allow the employers to determine how many years and which years they wish to include in their evaluation. We expect the data for Level 3 to come from several years of health assessment data, health claims data as well as other similar sources. Level 3 is similar to Level 2 in that the scoring is dependent on how actual employer experience compares to the predetermined target based on set of criteria. Although extensive reviews of the literature were conducted to determine realistic targets for moving a population s behavior, much of the literature reviewed looked at measuring the difference in how participants in a program fared at the beginning and the end of a program. We could not find substantial data indicating how implementation of a health improvement program impacted an entire employee population for a specific health risk. Initially, we developed targets based on consultations with experts in the field. With the collection of several years of employer data, we have been able to set targets based on actual employers experiences. Note: if an employer is providing measurement for more than one year, the Scorecard is designed to calculate a target level across multiple years. In the development of Level 3, we realized that measuring outcomes can vary based on the maturity of a program. Generally speaking, health improvement programs have the greatest impact in the beginning years of the program but as the program matures, it can become harder to shift the remaining percentage of people out of an unhealthy behavior and into a healthy one. As a result, in Level 3, the target will fluctuate based on where an employer s employee population is starting. If the employee population is predominately engaged in an healthy behavior, then the target will be lower than that of an employer whose employee population is less engaged in that healthy behavior. In addition, if an employer is able to achieve high levels of engagement in health behaviors and outcomes (95 th percentile of the benchmark), the employer is given full points. For employers who achieve between 75 th and 90 th percentile, partial points are provided automatically. In addition, we acknowledge that measuring outcomes over time can be problematic because of changes in your employee population due to retirement, attrition, mergers/acquisitions as well as layoffs. Therefore, we recommend that when possible you choose measurement years where there were minimal changes in the population. For example, if you had a merger in 2005 that expanded your employee population substantially. We suggest you measure changes in outcomes from 2005 going forward. Level 3 is worth a total of 110 points.

8 4. Summary of Scoring The table below provides a summary of each of the parts of the three levels along with the total points assigned. Level Section Total Score Level 1: Strategy and Tactics 60 Part A: Strategy 15 Part B: Tactics 30 Part C: Engagement 15 Level 2: Participation 30 Level 3: Impact on Workforce 110 Part A: Healthy Behaviors 50 Part B: Outcomes 60 TOTAL 200