Wellness Plan: 2014 Accomplishments & 2015 Priorities

2014 marked the City-wide launch of the wellness program and the grand opening of the Health Service System Wellness Center. Wellness Plan: 2014 Accomplishments & 2015 Priorities Prepared for the Health Service Board, February, 2015

Wellness Plan: 2014 Accomplishments & 2015 Priorities INFRASTRUCTURE GOALS 1. Engage City department leaders and management. 2. Engage labor and City departments and leaders as partners. 3. Engage health plans and other vendors as partners. 4. Develop and maintain a network of Champions. ACCOMPLISHMENTS Wellness Sponsors Health Service System (HSS) collaborated with the Mayor s Office (MR), Controller (CON), and the Department of Human Resources (DHR) to draft the Wellness Plan that was approved by the Health Service Board in August 2014. The Sponsors worked to secure funding to support key initiatives, such as the Well-being Assessment and incentives as well as additional staffing for the wellness program (a Health Program Coordinator in 1/2015 and an Employee Assistance Counselor in 10/2015). Meetings with Labor A series of meetings from May to September were held to engage Labor in the wellness plan. Local 21 and Municipal Executives Association (MEA) actively supported the rollout of the wellness initiative, specifically the Well-being Assessment (WBA). Both featured articles in their newsletters and MEA invited HSS to present at a meeting. Local 21 also promoted the grand opening of the Wellness Center. Mayor s Wellness Kickoff: : July 29 Representatives from 41 of the 74 departments attended a HSS presentation about the new wellness initiative. Department heads were asked to: 1) identify Champion(s), 2) achieve 40% participation in the Well-being Assessment, and 3) support quarterly initiatives. Achievement of the first two tasks will be included in the Mayor s performance appraisal of the department head. 16 of 52 (30%) departments exceeded the 40%. 13 (25%) additional departments exceeded 30%. Champion Network 177 Champions were recruited in late third quarter and 150 of those attended one of the five, in-person trainings in September. The current ratio of HSS Coordinators to Champions is 1:89. It will improve slightly to 1:59 when the new Health Program Coordinator is hired in 2015. 30 departments have an adequate number of Champions per employee. Six departments are without Champions and nine departments have over 200 employees per Champion, which is too many. 147 Champions completed the Getting to Know ou Survey. o On average Champions have worked for the City for 10 years and in their current department for 8 years. o 36% volunteered, 10% applied and 15% reported Other (the most common other response was that the Champion was asked and accepted). 38% of Champions were assigned. 1

Wellness Plan: 2014 Accomplishments & 2015 Priorities o 33% of Champions reported that there would be a time of year that would make it difficult to dedicate 4-8 hours to support wellness. o On average, Champions reported that they would support an average of 244 employees. Champions were instrumental in spreading the word about the WBA in fourth quarter. Health Service System Wellness Team Wellness/EAP expanded from four to six employees. Health Program Coordinator III (2593) Carrie Beshears, and Management Assistant (1842) Lisa Ocampo joined the team in April and June respectively. Stephanie Fisher, Wellness Manager, received her Certified Worksite Wellness Specialist (CWWS) and Certified Worksite Wellness Program Manager (CWWPM) certifications. Margaret O Sullivan, Health Promotion and Wellness Plan Coordinator, received her Certified Worksite Wellness Specialist (CWWS). Jean Miranda, Senior EAP Counselor, renewed her Marriage and Family Therapist (MFT) license through 5/2016 and attended the 2 nd Annual David E. Smith, MD Symposium: Advances in Addiction Medicine and Recovery. Jeff Lintner, EAP Counselor, renewed his Marriage and Family Therapist (MFT) license through 2/2016 and attended the Department of Public Health s (DPH) Transforming Stress and Trauma 101 which is mandatory training for all 9,000 DPH employees and contractors. Carrie Beshears, Health Program Coordinator, received her Diabetes Prevention Program (NDPP) facilitator certification. Partnership with San S Fran rancisco Recreation & Parks (REC) In May 2014 to help support Wellness Week, the Grand Opening of the Wellness Center, HSS and REC partnered to pilot a series of group exercise classes. After a successful pilot, REC and HSS entered a work order that allowed REC to provide consistent classes. In September, City Hall instructors were no longer permitted to collect participation fees. This caused the transition of four of the five City Hall classes from contracted instructors to REC instructors. To support the expansion of group exercise classes at various worksites around the City as well as to track the participation in such classes, HSS has partnered with REC and created a standard work order that includes consistent participation reporting to HSS. Partnership with Kaiser Permanente (KP) KP provided a variety of wellness services at the Wellness Center as well as departmentspecific initiatives including the flu shots, health fairs, biometric screenings, and interactive seminars, and an onsite health coaching pilot. KP and HSS began discussions about a wellness-related research project to address prediabetes that will begin in 2015. KP provided giveaways and prizes to support special events like Wellness Week, the Shape Up Walking Challenge, the Champion training, as well as other initiatives. KP loaned HSS two Body Mass Index (BMI) machines that will be available at the Wellness Center and at a department to be determined in 2015 and provided 10,000 Building a Balanced Meal educational books to support nutrition awareness in 2015. KP communicated its support of the wellness initiative with a postcard delivered in late 2014 that encouraged KP members (including retirees) to watch a motivational video about making lifestyle changes. 2

Wellness Plan: 2014 Accomplishments & 2015 Priorities Partnership with w Blue Shield of California (BSC) HSS expanded two of the existing BSC wellness programs, the Well-being Assessment (WBA) and Daily Challenge (DC) to all City and County of San Francisco (CCSF) employees (including those who waive coverage) and to all City College District (CCD), Unified School District (USD), and Superior Court (CRT) employees. Additionally, BSC transitioned BSC members away from a $75 for completion of the WBA to the WBA Rewards Contest offered to all CCSF and CRT employees and BSC members of CCD and USD. BSC supported the Wellness Center as well as department-specific initiatives by attending health fairs, coordinating Affordable Care Organization (ACO) participation, and coordinating ACO-sponsored interactive seminars. BSC provided giveaways and prizes to support special events like Wellness Week, the Shape Up Walking Challenge, the Champion training, as well as other initiatives. United HealthCare (UHC) Support UHC provided giveaways and prizes to support special events like Wellness Week, the Shape Up Walking Challenge, and the Champion training. UHC supported the Wellness Center as well as department-specific initiatives by attending health fairs and sponsoring an interactive seminar. Deferred Compensation/Prudential Support Deferred Compensation participated in Wellness Week and Open Enrollment vendor weeks. Prudential provided raffle prizes and interactive seminars for special events and at the Wellness Center. Pacific Union Dental (PUD),, Delta Dental (DD),, and VSP Support PUD, DD, and VSP attended health fairs and the Wellness Week Exhibition. Department Wellness Councils HSS supported the existing PH Central Administration Worksite Wellness Group, HSS Wellness Council and the Municipal Transportation Agency (MTA) Wellness Council by attending their regular meetings. 2015 PRIORITIES 1. Increase personalized communications with department leaders. 2. Strengthen the Champion network by developing engaged Champions and recruiting Champions in departments with few, no, or unengaged Champions. 3. Regularly communicate with Labor. Work to build relationships with more unions. 4. Enhance the relationship with DHR: Collaborate with Worker s Compensation, enhance crosspromotion of services, like EAP and Workforce Development. 5. Hire an additional Health Program Coordinator (2593) (approved for 1/2015) and Employee Assistance Counselor (2594) (approved for 10/2015). 6. Request Health Service Board approval of a communications position for the Wellness Program using the Trust s sustainability fund per the charter. 7. Build relationships with CRT, USD, and CCD to enhance wellness programming for these employers. Discuss expansion of the Champion program to include these employers. 8. Build relationships with retiree organizations. 3

Wellness Plan: 2014 Accomplishments & 2015 Priorities MOTIVATION GOALS 5. Leverage communications and leadership support to encourage participation. 6. Offer rewards to promote engagement in wellness. 7. Provide individual and group recognition to promote engagement in wellness. 8. Remove barriers to increase access to wellness services. ACCOMPLISHMENTS Wellness Guide and Website Expansion This year s Open Enrollment mailing included a special Wellness Guide for all active employees. The Guide was designed to highlight 1) HSS s commitment to the wellness of employees, and 2) existing and expanded wellness offerings by HSS. To support the printed material, the wellness portion of myhss.org was expanded to include over 10 more pages of content. Wellness Center Monthly Email 1033 individuals including any HSS member who attended an activity at the Wellness Center, those who take City Hall classes, Civic Center area Champions, and Departmental Personnel Officers received a monthly email highlighting the upcoming month s programs at the Wellness Center. Well-being Assessment (WBA) Communications The WBA communication strategy included printed and electronic materials. It included materials sent to the home and provided at the workplace. The messages came from the Mayor, HSS, leaders, labor, and peers (Champions). After the initial Champion training, 87% of Champions reported that the training prepared them to promote the WBA, 87% reported confidence in promoting the WBA to colleagues, 90% reported confidence that they could communicate about the confidentiality of the WBA, 56% reported that they thought employees would be interested in taking the WBA, 88% reported that employees had computer access, and 89% reported that they were excited about the launch of the wellness program. Well-being Assessment (WBA) Rewards Contest WBA Rewards Contest promoted participation in the Well-being Assessment in two ways: 1) by providing the chance to win money for completion of the WBA, and 2) generating conversation among co-workers about the WBA. 3,661 HSS members (54%) earned rewards. HSS members earned a total of $272,480 ($8/eligible employee, $40/WBA participant). Blue Shield was responsible for incentives paid to BSC members totaling $123,200 and the City was responsible for incentives paid to non-bsc members totaling $149,280. Wellness Center and City Hall Group Exercise Classes at No Cost All services (excluding some EAP trainings) at the Wellness Center are offered at no cost to City employees and HSS members. Traditionally, City Hall group exercise instructors charged participants $2-5 per class. 4

Wellness Plan: 2014 Accomplishments & 2015 Priorities o Participation increased by 60% increase after September compared to the previous three months. September marked the month instructors stopped charging fees and the four out of the five instructors transitioned to REC instructors. o oga class participation increased by 240% on average and the Friday Zumba class increased by 195% on average. Completion of WBA on Work Time The Department of Human Resources (DHR) approved and encouraged the use of work time for completion of the WBA. Departments were encouraged to arrange a time that would not unduly interfere with completion of regular work. 2015 PRIORITIES 1. Enhance Well-being Assessment communications based on employee, Champion, and stakeholder feedback. Engage the Mayor, Superintendent and Chancellor in communications. 2. Collect individual and group success stories (including selfies and videos) for promotional materials. 3. Implement a formal recognition process for individuals, departments, and Champions. 4. Increase access to wellness services by bringing wellness activities to the workplace. 5. Support DHR s creation of a policy outlining the appropriate time use for various wellness activities. 6. Expand incentives to non-bsc USD and CCD members. Support worksite communications related to the Well-being Assessment for these employers. PROGRAMS GOALS 9. Increase utilization of existing wellness benefits offered by health plans and HSS. 10. Identify and promote new wellness services. 11. Engage health plans in promoting health and wellness to employees. 12. Build a culture of wellness to support and sustain wellness choices. ACCOMPLISHMENTS Employee Assistance Program (Details in 2014 EAP Report) A staff of two EAP counselors had direct contact with 2,036 employees in 2014. 345 of the employees participated in counseling. 30% of employee contact hours came through organizational wellness services (orientations, trainings, consultations, and mediations), and 70% were a result of direct clinical counseling services. 50% of the organizational wellness services are employee seminars and trainings. The number one reason to seek EAP counseling, representing 37% of clients, was workrelated issues. EAP provided 21 group Critical Incident Stress Debriefings between 2012 and 2014. EAP responded to 31 cases of Workplace Violence between 2012 and 2014. 5

Wellness Plan: 2014 Accomplishments & 2015 Priorities Wellness Center (Details in 2014 Annual Wellness Center Report) The Wellness Center opened with a week-long celebration (Wellness Week: May 19-23) that included 792 visits by 488 individuals. From June-December, there were 3,784 visits, an average of 541 per month. Overall 437 different people have visited the Wellness Center, an average 140 each month. 87% of the visits were for group exercise, 9% for seminars, and 4% for coaching. EAP visits were included in the 2014 EAP Report. City Hall Group Exercise Classes (Details in 2014 Annual Wellness Center Report) Participation tracking for City Hall lacked until June 2014, so these results represent June through December. On average, there were 16 participants per class and a total of 258 participants per month. Flu Shot Clinics (Details in the 2014 Annual Flu Shot Clinic Report) 19 clinics served 3,174 employees and retirees. This represents 473 more vaccinations and two more clinics than in 2012. 2014 marked the first-ever retiree-only clinic (52 vaccinations) and Health Service System (HSS) Wellness Center clinic (203 vaccinations). Three other additions included two San Francisco Recreation and Parks (REC) clinics and a combined biometric screening and flu shot clinic at the Department of Public Works (DPW) Cesar Chavez ard. The Department of Emergency Management s (DEM) early morning clinic was transitioned to a late night clinic and participation increased. HSS staff hosted a wellness services/well-being Assessment table at 16 clinics serving a total of 2,662 people. Well-being Assessment (De Details in the 2014 Well-being Assessment Implementation Report) Participation rates varied from 0-22% across the 4 employers and between departments based on incentives and communications. o USD and CCD KP/UHC members received no incentive and one home mailing which resulted in 0-1% participation. o USD and CCD BSC members and CRT benefit-eligible employees received an incentive and three home mailings without worksite promotion of the program and incentive resulted in 6-7% participation. o CCSF employees received an incentive, home mailings, and worksite promotion resulted in an average of 22% participation, but it ranged greatly between departments (0-80%). Aggregate well-being scores and more detailed analysis for the WBA will be available in 2015. Daily Challenge (Details in the 2014 Well-being Assessment sessment Implementation Report) 7,333 CCSF and CRT employees enrolled in Daily Challenge: Of those, 6,954 (95%) are still enrolled. 58% of participants are female and 42% male. In January 2015, 1656 individuals (24%) completed the challenge on weekdays and 1246 (18%) completed it on weekends (overall January average = 1,547 or 22%). Of those enrolled in the program for 120 days (enrolled before October), 69% have completed a challenge in the past 30 days. Retention is slightly higher earlier in the program: Of those enrolled for 60-89 days (enrolled in November), 73% have completed a challenge in the past 30 days. 75% of users report that the activity helped their well-being, 68% reported that it is fun, 42% reported that it is challenging, and 52% reported that the activity was new. 6

Wellness Plan: 2014 Accomplishments & 2015 Priorities Additional participation, retention information, and social networking data will be available in 2015. Ad-hoc Department Wellness Services HSS coordinated health plan participation at the Department of Public Works (DPW), the Airport (AIR), and retiree health fairs, biometric screenings for HSS, AIR, and DPW, wellness presentations for HSA, Police (POL), AIR, and onsite coaching for Municipal Transportation Agency (MTA) and AIR. HSS (EAP) conducted one tobacco cessation course. Exercises for our Workstation was offered to Department of Public Health (DPH) as a part of their quarterly trainings. There were at total of six trainings offered over the course of three months and a total of 85 participants were engaged. UCSF Stress S & Resiliency Training Eight trainings were conducted: two for the Public Library and six for the Public Utilities Commission. 124 employees attended, with an average of 15.5 employees/training. 2015 PRIORITIES 1. Support a culture of wellness by providing quarterly-themed activities for Champions to implement. Examples include biometric screenings, seminars, onsite coaching, walking programs, healthy meeting activities, flu shot clinics, group exercises classes by REC (fees for departments), wellness challenges, educational activities, and informal and formal wellness policies. 2. Partner with DPH to promote the Shape Up Walking Challenge and track aggregate participation for City employees. 3. Partner with KP to conduct a research analysis that seeks to reduce the risk of developing diabetes in a pre-diabetic population through the CDC s National Diabetes Prevention Program. 4. Provide the Non-Violent Crisis Intervention training (EAP) to customer service employees in selected departments to reduce stress in the workplace and analyze the impact of the training. 5. Leverage EAP to provide a Crisis Response Package to selected departments in which employee safety and/or secondary trauma may negatively impact employee health. The Crisis Response Package is a combination of Psychological First Aid (PFA) training for section supervisors; CISD (Critical Incident Stress Debriefing) as needed for employees; and brief, targeted support groups for employees focusing on stress management and psychological resiliency. 6. Facilitate relationships between REC and interested departments to provide onsite group exercise classes. 7. Plan a Wellness Leadership Summit to train department heads, managers, and/or supervisors on the role of wellness in the workplace. 8. Continue to promote existing wellness services available through HSS (including EAP and the Wellness Center) and the health plans. 9. Re-assess employee well-being using the Well-being Assessment and WBA Rewards Contest in late 2015. 7

Wellness Plan: 2014 Accomplishments & 2015 Priorities DATA, REPORTING & ANALTICS GOALS 13. Assess employee well-being periodically. 14. Review existing data and conduct periodic assessments to identify population needs. 15. Evaluate the implementation of the program. ACCOMPLISHMENTS Well-being Assessment Aggregate Scores In addition to providing individuals with a baseline assessment of their personal well-being overall and in the six domains (healthy behaviors, physical health, emotional well-being, work environment, basic access), the Well-being Assessment (WBA) provides aggregate data in for these seven measures as well as for three productivity measures for departments with greater than 30 employees. The WBA will be repeated in late 2015 to assess the progress of the wellness program. All-Payer Claims Database (APCD) The Request for Proposal (RFP) selection process for an All-Payer Claims Database was completed and a vendor selected. Contract negotiations are underway. Inclusion of the Well-being Assessment data will allow for deeper analysis of the WBA data as well as combined analysis of WBA and claims data. Analyses using claims data including gaps in care, utilization of preventive services among others, will be used to assess population health and identify areas for future targeted interventions. Wellness Week Survey (Details in the 2014 Wellness Center Report) 382 of the 488 (78%) Wellness Week attendees completed surveys about their preferences for activities, days for activities, and times of day for activities at the Wellness Center. These results were used to determine the expanded group exercise schedule that launched in July and to guide topics for seminars and series. Champion Surveys 147 Champions completed the introductory Getting to Know ou Survey which provided feedback on the initial training, Champion confidence in supporting the wellness program, and the department s past experience with wellness activities. Champions were instructed that they would be asked to complete surveys quarterly. A survey specific to the WBA implementation was sent in late 2014. Results will be used to enhance the program in 2015. Standard Wellness Center Reporting HSS Data & Analytics created a Wellness Center log-in system that allows HSS to collect Wellness Center users emails, to track total and unique participation as well as participation by class. In June, HSS adopted a standard class satisfaction survey for seminars to streamline reporting. In 2015, quarterly Wellness Center reports will be available to the Health Service Board. 8

Wellness Plan: 2014 Accomplishments & 2015 Priorities Reporting Timeline HSS developed a tentative timeline for reporting in 2015 that maximizes efficiency and provides consistent insight into wellness initiatives. o January: early WBA participation results o February: Annual 2014 Wellness Report (includes accomplishments and detailed reports about major projects including, but not limited to Well-being Assessment Implementation, Wellness Center Report, EAP Report, Flu Shot Clinics) o March: update on special projects o April: Well-being Assessment outcomes o May: Q1 Wellness Center update o June: Q1 Worksite Wellness (Champion update and department wellness programs) update o August: Q2 Wellness Center and Q2 Worksite Wellness updates o September: update on special projects o November: Q3 Wellness Center update o December: Q3 Worksite Wellness update 2015 PRIORITIES 1. Finalize the Well-being Assessment Implementation Report by including Champion and employee feedback collected in early 2015. 2. Analyze the aggregate well-being scores by department. 3. Develop and implement a dissemination plan for the results of the WBA. 4. Begin initial analyses with combined WBA and claims data using the APCD. 5. Begin initial population health analyses 6. Add data elements to Shape Up registration that allow for the analysis of City employee and retiree aggregate data. 7. Collaborate with Wellness Plan Sponsors about the analysis of other relevant data, such as Worker s Compensation and Leave. 8. Develop standard reporting to track department engagement in wellness. 9. Conduct a needs assessment about retiree wellness. 9

2014 2014 WELL ELL-BEING ASSESSMENT (WBA) IMPLEMENTATION REPORT (WBA) I very much appreciate that my employer is putting an emphasis on well-being. It makes it a little easier to work on becoming or staying more healthy and happy. EXECUTIVE SUMMAR Highlights Participation rates varied from 0-22% across the 4 employers and between departments based on incentives and communications. o USD and CCD KP/UHC members received no incentive and one home mailing which resulted in 0-1% participation. o USD and CCD BSC members and CRT benefit-eligible employees received an incentive and three home mailings without worksite promotion of the program and incentive resulted in 6-7% participation. o CCSF employees received an incentive, three home mailings, and worksite promotion resulted in an average of 22% participation, but it ranged greatly between departments (0-80%). CCSF participation averaged 22% of all employees, 32% by department, and ranged from 0-80% across departments. 54% of participants earned rewards. HSS members earned a total of $272,480 ($8/eligible employee, $40/WBA participant). Blue Shield was responsible for incentives paid to BSC members totaling $123,200 and the City was responsible for incentives paid to non-bsc members totaling $149,280. 7,333 CCSF and CRT employees enrolled in Daily Challenge: Of those, 6,954 (95%) are still enrolled. 58% of participants are female and 42% male. In January 2015, 1656 individuals (24%) completed the challenge on weekdays and 1246 (18%) completed it on weekends (overall January average = 1,547 or 22%). Next Steps 1. Meet with the Sponsors to present implementation findings and reflect on lessons learned. 2. Analyze the data and reports. 3. Develop a dissemination plan for department heads, Labor, and employees. 4. Work with Blue Shield on a list of requested changes for the vendors, determine priorities and feasibility. 5. Work internally on HSS-controlled changes for next year s implementation. 6. Increase personalized communications with department leaders. 7. Strengthen the Champion network by developing engaged Champions and recruiting Champions in departments with few, no, or unengaged Champions. 8. Regularly communicate with Labor. Work to build relationships with more unions. A glossary for department codes can be found on the last page.

2014 WBA Implementation Report 02.12.2015 WELL ELL-BEING ASSESSMENT Traditionally, the Health Service System (HSS) has had little to no insight into the well-being of its membership. Each of the three health plans, Kaiser Permanente (KP), Blue Shield (BSC), and United HealthCare (UHC) have made a different health assessment available to members with little participation. Of the three health plans, BSC achieved the greatest success in 2013 leveraging a $75 incentive and three home mailings to produce 9% participation. This success was achieved after three years of similar communications and incentives. As part of the City and County of San Francisco s (CCSF) wellness needs assessment and Wellness Plan, it was recommended to offer one assessment to all employees. This baseline assessment provided individuals with insight into their personal well-being and would provide HSS and the City insight into the well-being of the population (summary-level data). Upon a review of the three existing assessments offered by the health plans, HSS pursued the Wellbeing Assessment (WBA) rolled out in January 2014 by Blue Shield (BSC). Unlike many health assessments, the WBA had several distinct advantages: 1. It focused on well-being instead of health risk. 2. It included a productivity section that provided insight in the workplace s impact on employee well-being and the impact of employee well-being on productivity. 3. It included the Daily Challenge (DC) which provided small actionable steps employees can take daily to improve their well-being. Additionally, since BSC was already offering this product to almost 50% of the HSS covered population, the additional cost was minimized. BSC agreed to continue to cover the administration cost of the WBA and DC as well as cover the cost of the incentives for BSC members. HSS covered the administration costs, incentive administration fees for all those eligible for incentives, and incentives for all non-bsc members. Eligibility Seeing the value of promoting wellness to all HSS members, HSS expanded the accessibility to the WBA to KP and UHC members of all four employers. The WBA officially launched to non-bsc members on September 15, 2014 (BSC members could take the WBA as of January 1, 2014). Additionally, CCSF benefit-eligible employees who waive medical coverage were added to the eligibility in November. The first communication that all employees received was in the Open Enrollment packages mailed home in late September/early October. WBA REWARDS CONTEST Traditional incentives provide a dollar amount to all participants upon completion. ear over year this dollar amount needs to increase to sustain the same levels of participation. Instead, for those eligible, HSS selected an incentive strategy that leveraged several concepts from behavioral economics: regret aversion (inform people they missed out on benefits or rewards), and overweigh small probabilities (provide probabilistic rewards for self-interested behavior). Eligible employees who take the WBA were automatically entered to have a 1 in 5 chance of winning $20 and a 1 in 100 chance of winning $500 every week during the six-week contest. Advantages associated with this incentive design were: 1. It costs fewer dollars per employee for similar or greater participation. 2. It reduces employee expectation that wellness assessment or other wellness programs will always bear a financial reward for completion. 3. It increases enthusiasm around the activity and increases word of mouth communications. 2

2014 WBA Implementation Report 02.12.2015 4. It creates urgency by providing a six-week timeframe in which employees can win, and it rewards those who participate earlier with greater opportunities to win. Incentive Eligibility BSC members transitioned from the $75 incentive for completion to the WBA Rewards Contest in September 2014. BSC members who had already completed the WBA received the $75 and were automatically entered in the WBA Rewards Contest. At the time of the transition, approximately 300 BSC members had completed the WBA. In addition to BSC members, CCSF dedicated incentive dollars to not only cover the KP and UHC populations, but also added incentives for benefit-eligible employees who waive coverage as of November 15, 2014. COMMUNICATIONS Communications Timeline Late September WBA announced in Open Enrollment (OE) Guides CCSF leaders encourged to send email to all employees and managers CCSF Champions provided first flyer to post Email sent to CCSF employees via active directory October WBA promoted at 16 flu shot clinics, OE, and offsite OE events Champions provided posters a 2nd flyer, talking points, and a presentation template 10/23 Email sent to employees via active directory 10/31 CCSF departments are told their "baseline" participation 11/3 Postcards mailed to all CCSF employee homes 11/14 Email to CCSF active directory announces contest and waived employee eligibility 11/17 Letter mailed to CCD and USD employees eligible for rewards 11/17-12/22 12/22 WBA Rewards Contest 2nd postcard mailed to CCSF homes Weekly standings and winners sent to Champions and leaders Champions provided thermometer flyers and Ask me how I won stickers Weekly standings send via CCSF active directory 3

2014 WBA Implementation Report 02.12.2015 Communication Intensity by Employer Communications breadth and depth varied by employer group. CCSF launched a wellness program with leadership support and a grassroots Champion network. The other employers received only the home mailings. Employer Incentive Eligible Home Mailings Leadership Communications Champion Support Workplace Communications CCD BSC KP/UHC N 3 1 N N N USD CRT CCSF BSC KP/UHC BSC/KP/UHC BSC/KP/UHC/ Waived N N Minimal N 3 1 3 N N N 3 Employee and Champion Feedback on Communications Approximately one-third (55) of Champions and 1,300 employees provided feedback via survey about the Well-being Assessment communications. Their survey responses mark the beginning of soliciting feedback to improve communications in 2015. Employees found the emails most helpful (this response may be biased by the fact that the survey was also sent via email). Lower rates for Wellness Champion, managers, and the HSS Wellness Team may be a result of lack of contact more so than a lack of helpfulness. According to Champions, the materials they found most helpful in promoting were the materials related to winning the rewards contest. Forms of Communication that were Helpful in Promoting the Well-being Assessment According to Employees Emails Myhss.org/well-being Co-workers Wellness Champion Managers/supervisors Printed posters/flyers Wellness Guide mailed home HSS Wellness Team 16 20 19 23 26 29 32 0 10 20 30 40 50 60 57 Materials that were Effective in Promoting Well-being Assessment According to Champions Enter to Win Poster Enter to Win Flyer Take the Well-being Assessment Flyer WBA Instructions and FAQs Email templates during contest Daily Challenge Instructions and FAQs Email templates before contest Online FAQs related to rewards Online FAQs related to confidentiality Online FAQs related to eligibility Thermometer Flyer Online FAQs related to score WBA Rewards Stickers 12 11 14 19 17 25 24 33 33 37 42 42 40 0 10 20 30 40 50 4

2014 WBA Implementation Report 02.12.2015 PARTICIPATION RATES Worksite communications combined with incentives are the most powerful strategy for motivating participation. USD and CCD KP/UHC members received no incentive and one home mailing which resulted in 0-1% participation. USD and CCD BSC members and CRT benefit-eligible employees received an incentive and three home mailings without worksite promotion of the program and incentive resulted in 6-7% participation. CCSF employees received an incentive, home mailings, and worksite promotion resulted in an average of 22% participation, but it ranged greatly between departments (8-80%). The varied participation rates provided valuable insight into engagement strategies related to communications and incentives: Worksite communications combined with incentives are the most powerful strategy for motivating participation. With only preliminary data available, the success of CCSF to achieve 22% participation demonstrated the importance of a comprehensive engagement strategy. The additional CCSF funds dedicated to incentives and development of a Champion network Employer CCD USD CRT CCSF BSC (incentives) KP/UHC BSC (incentives) KP/UHC BSC/KP/UHC (incentives) BSC/KP/UHC/Waived (incentives) as well as support from CCSF leadership resulted in CCSF employees receiving greater exposure to the WBA as reflected in the 22% participation rate. Deeper research (planned in 2015) into the CCSF departments that achieved 20 or more percentage participation will hopefully reveal vital information to driving participation. Participation by Department Note: A glossary for department codes can be found on the last page. Eligible # Completed WBA % Completed WBA 1,673 3% ISS ISS 6% ISS ISS 0% 6,552 169 3% 1,945 129 7% 4,607 40 1% 440 31 7% 29,995 6,627 22% Note: ISS means that data has been suppressed due to insufficient sample size. 25.00% Participation Over Time by Employer For the purpose of this analysis, we examined 20.00% CCSF departments and Superior Court employees. Due to small number of employees 15.00% (<30) LLB, PAB, CSC, WOM, SCI, HRC, CFC, ETH 10.00% were grouped together into one department (DEPTS <30). Therefore, there were a total of 5.00% 45 departments in this analysis. For 0.00% departments with fewer than 30 participants in the WBA, participation percentages were rounded. If participation was between 0-19%, it was rounded down to 0%, if it was between 20-39%, it was rounded to 20% and if it was between 40-100%, it was rounded down to 40%. 10/20 10/31 11/18 11/25 12/2 12/9 12/16 12/23 CCSF CRT CCD USD 5

2014 WBA Implementation Report 02.12.2015 The participation goal for each CCSF department was 40%. Average participation by department was 32% for CCSF. 36% of CCSF departments reached the goal: 7 departments achieved >50%, 9 departments achieved 40-49%. Smaller departments were more likely to reach the goal. Departments that achieved or exceeded the goal had an average employee size of 281, whereas the average size of a department that had less than 20% participation was 1675 employees. Departments with Champions and those with a lower employee to Champion ratio were more likely to have greater participation. Of the departments with 0-19% participation, only 64% had Champions, compared to 93-94% in departments with 40+% and 20-39%. Additionally, those with lower participation had an employee to Champion ratio of 893:1, which was nine times higher than the higher performing departments. Dept. n % Avg. Size <100 EEs % 100-499 EEs % 500-999 EEs % 1000+ EEs % # Employees to Champs * Dept. with Champs (%) 40+% 16 281 31% 57% 6% 6% 73 93% 36% 20-39% 17 341 29% 47% 17% 6% 108 94% 38% 0-19% 12 27% 1675 17% 25% 17% 42% 893 64% Note: *The 6 departments with zero Champions were excluded from the # Champions/Employees calculation The following graph shows participation percentage by department from lowest to highest starting on the left. The dark blue line represents the number of employees and the orange line represents the number of employees represented by each Champion. A gap in the orange line means that the department did not have a Champion, so a ratio is not possible. Of the 12 departments with lowest participation, 33% did not have a Champion and 92% had a Champion ratio of more than 1 Champion for every 500 employees. Of those 12, POL had the highest participation and was the only department with a low employee to Champion ratio. Of those 12, 50% had >1000 employees. Two departments with greater than 1000 employees were not in the bottom 12 departments: DPW had 21% participation and an employee to Champion ratio of 144:1, and HSA surpassed the 40% goal with 42% and an employee to Champion ratio of 121:1. Additionally, when CWP, WTR, HHP, and PUC are combined they have 2,075 employees, 27% participation and an employee to Champion ratio of 231:1. Two departments without Champions were not in the lowest 12 departments: TIS reached 22% and DAT reached 40%. One reason TIS participation may have been higher without a Champion because the WBA emails came from the DTISHELPDESK. Although DAT didn t have a Champion, an employee agreed to send an email referencing the number of employees who had participated and won specifically at DAT. The week after the email was sent the participation had doubled from 17 to 34% participation. DAT was the only department without a Champion to reach 40%. 6

2014 WBA Implementation Report 02.12.2015 7000 6000 5000 4000 3000 2000 1000 0 WBA Participation Rates, Number of Employees, and Ratio of Champions to Employees by Department Final Participation # employees Ratio of Champion to Employees AAM* FAM* PDR* CRT FIR MTA AIR WTR CWP DPH SHF POL RNT* REG* WAR* DPW REC JUV HHP TIS CAT ADM DBI BOS CPC PRT DEPTS. <30 LIB TTX CHF* ART* DAT ASR HSA ECN ADP RET PUC ENV DEM CSS MR HRD CON HSS 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% To determine if department size or employee to Champion ratio was a better predictor of participation, HSS conducted additional analyses on the nine largest departments. For the purpose of this analysis CWP, WTR, HHP, and PUC are combined (PUC Combined). Employee to Champion ratio appears to be a stronger predictor than department size of participation. Four of the large departments reached at least 20%: Their average employee to Champion ratio is 135:1. Among the five that did not reach at least 20%, the employee to Champion ratio was 1027:1. However, there are still variations among departments with a low employee to Champion ratio that will require additional exploration. One hypothesis is the type of work setting. For instance, HSA and POL both had low employee to Champion ratios, but their work varies greatly. Having more Champions in large departments appears to be critical to reaching at least 20%, but cannot explain the variation after that threshold. Department size and employee to Champion ratio are two of the more easily quantified factors impacting participation rates. Leadership engagement, management engagement, communication saturation, Champion engagement, confidentiality concerns, computer access, and computer literacy are a few other factors related the participation. Additional investigation by department is required to determine which of these factors is most significant for each department, so that solutions can be identified and correct resources provided. The Employee Feedback Survey (results presented later in this report) provides some insight into the barriers to participation. 7

2014 WBA Implementation Report 02.12.2015 Participation in Well-being Assessment vs. Employee:Champion Ratio in the Nine Largest Departments Participation in Well-being Assessment vs. Number of Employees in the Nine Largest Departments 3000 2500 2000 1500 1000 500 0 45% 40% 35% 30% 25% 20% 15% 10% 5% 0% 7,000 6,000 5,000 4,000 3,000 2,000 1,000 0 45% 40% 35% 30% 25% 20% 15% 10% 5% 0% % participation employee:champion % participation # employees One proxy measure for department engagement is the amount of participation before the rewards contest began. Departments that reached the 40% goal had an average of 20% participation before the Rewards Contest began. Participation was recorded for each department on 10/20, 10/31, and weekly from 11/18-12/23 (the weeks of the contest). Promotions began in late September/early October. On average departments achieved 10% by the end of the first month (10/31) and increased an additional 22% from that 60% 50% 40% 30% 20% 10% Average Participation Over Time for Departments Grouped by Final Participation Rate point through the end of the contest period. 63% of departments that achieved or exceeded the 40% goal reached 20% participation by 10/31, Additional emphasis on reaching 20% by the beginning of the contest period seems valuable to increase the number of departments that reach the goal. 0% 10/20 10/31 11/18 11/25 12/2 12/9 12/16 12/23 >40% 20-39% 0-19% 8

2014 WBA Implementation Report 02.12.2015 Final Participation by Department HSS CON HRD MR CSS DEM ENV PUC RET ADP ECN HSA ASR DAT ART* CHF* TTX LIB DEPTS. <30 PRT CPC BOS DBI ADM CAT TIS HHP JUV REC DPW WAR* REG* RNT* POL SHF DPH CWP WTR AIR MTA FIR CRT PDR* FAM* AAM* 22% - City wide participation average 32% - Department participation average 40% - Goal 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% *For departments with fewer than 30 participants in the WBA, participation percentages were rounded. If participation was between 0-19%, it was rounded down to 0%, if it was between 20-39%, it was rounded to 20% and if it was between 40-100%, it was rounded down to 40%. 9

2014 WBA Implementation Report 02.12.2015 WBA BA REWARDS CONTEST WINNERS 33,119 employees were eligible for incentives if they completed the Well-being Assessment (this included all CCSF employees, CRT employees, and CCD/USD BSC members). Of those, 6,834 (21%) employees took the WBA. This section applies to those individuals. Cost of Incentives Employees earned a total of $272,480 ($8/eligible employee, $40/WBA participant). Blue Shield was responsible for incentives paid to BSC members totaling $123,200 and the City was responsible for incentives paid to non-bsc members totaling $149,280. On average employees won $74. Population Winning Drawings* $500 Winners Average $ Won Total Winnings (n) (n) Health Plan BSC 2944 134 $71 $123,180 KP/UHC/Waived 3143 180 $78 $149,300 Employer CCD (BSC-only) 47 3 $80 $2,380 USD (BSC-only) 144 6 $67 $5,760 CRT (BSC, KP & 38 3 $105 $2,200 UHC members Winnings by Health Plan eligible) and Employer CCSF (all benefiteligible 5859 302 $74 $262,140 There were no differences in the proportion of employees) winners between health Overall plans: 11% of BSC 6088 314 $74 $272,480 members eligible for *Employees were able to win more than once during the WBA Rewards Contest. incentives (15,838) won Winning Drawings represents the total number times a winning number was drawn incentives as did 11% of and Winners represents the number of individual employees who won. KP/UHC/Waived employees eligible for incentives (CCSF/CRT only: 17,281). There were differences in the proportion of winnings and average dollars won between the health plans: BSC members represented 48% of winners and won $71 on average, where KP/UHC/Waived employees represented 52% of winners and won an average of $78. Winnings were evenly distributed among the employers based on their percentage participation. CCD constituted 3% of the participation and winnings, USD constituted 2% of the participation and winnings, CRT constituted 0% participation and 1% of winnings, and CCSF constituted 96% of the participation and winnings. 10

Dollars Won 2014 WBA Implementation Report 02.12.2015 Winners by Health Plan and Employer The percent of winners was consistent with the proportion of members in each health plan: 48% of winners were BSC members Population Winners Percent of Average and 48% of the eligible * (n) Participants Times population had BSC. At this who Won Won time, we do not have access Health Plan to the number of WBA BSC 1743 Unknown 1.7 completions by health plan in KP/UHC/Waived 1918 Unknown 1.6 order to calculate the Employer percentage of winners by CCD (BSC-only) 30 64% 1.7 health plan. Additionally, USD (BSC-only) 86 67% 1.9 participation rates between CRT (BSC, KP & UHC 21 68% 1.7 the other health plans cannot members eligible) be teased out at this time; CCSF (all benefit-eligible 3524 53% 1.7 however, KP members employees) represent 88% of this group, Overall UHC members represent 3%, and waived employees 3661 54% 1.7 *Employees were able to win more than once during the WBA Rewards Contest. represent 8%. Winning Drawings represents the total number times a winning number was drawn and Winners represents the number of individual employees who won. 54% of incentive eligible employees who completed the WBA were rewarded and they won an average of 1.7 times. CCD (64%), USD (67%), and CRT (68%) employees had a higher rate of reward. This may be explained by the fact that more of those employees completed the WBA earlier in the contest period or it may be a result of small sample size. During the six-week contest, employees could win up to six times. 54% of employees who completed the WBA won at least one time. Of the winners, 50% won more than one time. 51% of all winners won more than $20 and 9% of employee winners won $500 or more. Percentage of Winners by Frequency of Winning* 19% 27% 7% 1% 46% Non-Winner Won 1x Won 2x Won 3x Won 4x 10% Percentage of Winners by Amount Won ** 30% 3% 2% 1% 5% 0% 49% $20 $40 $60 $520 $540 $80 $500 $560 *This chart includes all incentive eligible employees, even those who did not won. ** This chart includes only those who won. 11

2014 WBA Implementation Report 02.12.2015 DASHBOARD RESULTS The following results were retrieved from the real-time dashboard as of January 31, 2015 for CCSF and CRT employees. They describe the Well-being Assessment participants, provide high-level information about health behaviors, and engagement in the Daily Challenge. WBA Participation by Age Group 2% 1% Well-being Assessment Dashboard Results Note: The following results were retrieved from the realtime dashboard as of January 31, 2015 for CCSF and CRT employees. 20% 29% 21% 27% 19-24 25-34 35-44 45-54 55-64 65-74 7,394 employees logged into the Well-being Assessment. Of those, 6,687 (92%) completed the Well-being Assessment. Reasons for not completing the WBA may include interruption without return, clicking the Skip this step option, or stoppage due to discomfort with the questions. 1% of users canceled their accounts or were removed due to lack of eligibility (i.e. the employee retired or left the organization). WBA participants were more likely to be less than 45 years old and female compared to all eligible employees. 51% of participants were 45 and older compared to 60% of employees who are 45 and older ((16% of employees are 25-34. 23% of employees are 35-44. 31% of employees are 45-54. 25% of employees are 55-64. 4% are 65-74.) 58% of participants were female compared to 48% in the CCSF population. In terms of self-reported health behaviors, among participants 94% are non-smokers 35% participate in 30 minutes of physical activity on most days of the week 17% report eating at least five servings of fruits and vegetables a day 96% report limited alcohol use (no more than one drink/day women, no more than two drinks/day men). At the completion of the WBA, participants land on a page with six options: WBA Rewards, Daily Challenge, Prevention, Nutrition, Movement, and Peace of Mind. WBA Rewards explains the reward contest, Daily Challenge allows them to configure their settings and see their Daily Challenge page. Prevention, Nutrition, Movement, and Peace of Mind link back to myhss.org and provide information about the resources available to them through HSS, the health plans, and other City departments. There have been 15,979 clicks to learn more about those topics that have results in 9,977 clicks (62%) to visit those pages. 12

2014 WBA Implementation Report 02.12.2015 Daily Challenge Dashboard Results Note: The following results were retrieved from the real-time dashboard as of January 31, 2015 for CCSF and CRT employees. 7,333 CCSF and CRT employees enrolled in Daily Challenge: Of those, 6,954 (95%) are still enrolled. 58% of participants are female and 42% male. 75% of users report that the activity helped their well-being 68% reported that it is fun 42% reported that it is challenging 52% reported that the activity was new. Approximately 20% of registered employees participate each day: More complete the challenges on weekdays compared to weekends which may be due to the fact that many employees received the challenges to their work email accounts. On Average, 1656 individuals (24%) completed the challenge on weekdays and 1246 (18%) completed it on weekends (overall January average = 1,547 or 22%). It appears that the majority of users are not taking advantage of the 45 tracks available and are simply enrolled in the Everyday Well-being track. However, the top five most popular tracks are Active Life (10%), Emotional Enrichment (3%), Better Eating (3%), Agile Back (1%), and Conquering Clutter (1%). Of those enrolled in the program for 120 days (enrolled before October), 69% have completed a challenge in the past 30 days. Retention is slightly higher earlier in the program: Of those enrolled for 60-89 days (enrolled in November), 73% have completed a challenge in the past 30 days. 13