APPLICATION FORM Title of Entry: Worksite Wellness A Key to Population Health Division: Large Organizations Award: Community Champions Entrant s Name and Title: Nancy Urick, MSN, RN Manager Community & Government Relations Phone: (724) 832-5068 Email: nurick@excelahealth.org Organization: Excela Health 532 West Pittsburgh Street Greensburg, Pennsylvania 15601 Date Implemented: 2007 Date Results Achieved: 2014 Team Members: Laurie English, Sr. VP, Chief Human Resource Officer Ronald Ott, Sr. VP Community & Government Relations Patrick Martin, Supervisor, The Well Being Center Ginger Fritz, Manager, Total Rewards Lisa Basinger, HR Generalist Ed Benson, HR Generalist Norene Auer, Tobacco Cessation Specialist Tina Chappell, The Well Being Secretary Edith Nault, RD Diana Flinn, RD Elizabeth Minerva, RN, Stress Management Specialist Ryan Taucher, Exercise Physiologist Jyl Glunt, Exercise Physiologist Dino Morell, System Manager, Food & Nutrition Services Vicki Maley, Human Resources
EXECUTIVE SUMMARY: According to the National Prevention Strategy, an emphasis on prevention and wellness is key to the creation of a healthier society where people can live longer and more productive lives and reduce their P spects of our lives, including where and how we live, learn, work and play. Everyone- government, businesses, educators, communities and every single American has a CDC ). The Prevention and Public Health Fund of the Affordable Care Act includes the key prevention area of research and surveillance focused on workforce wellness. Understanding the issues that affect the American workforce is critical to improving prevention efforts (CDC, 2013). From 2007 to 2008 our organization faced a 27.5% increase in health care costs. The decision was made to implement an employee worksite wellness program to provide opportunities and incentives to encourage healthy lifestyle choices. A wellness platform and health risk assessment were provided by our health care insurer. Annual biometric screenings were implemented. Several incentivized wellness initiatives including a weight loss program and walking program are offered. Nutrition counseling, health coaching and tobacco cessation services are provided at no cost to the employee/spouse. A mandatory flu vaccine program is in place. A healthy environment was created through the provision of worksite gyms, healthy options in our cafeterias and a healthy vending and catering program. Through the design of the wellness program the participation rate has increased from 2% in 2007 to 92% in 2014. The preventive screening rate for our employees and book of business. The non- employees received flu vaccines in 2014. Shock claims for late stage preventable cancers have greatly diminished. The number of smokers has also decreased. A cost savings of over six million dollars was realized from where we were in 2007 through 2012 in health care claims which enabled us to go from insured to being self-insured. Healthy employees are also safer employees, reflected in our employee injury rate of 1.9 cases per 100 employees. This compares to the Bureau of Labor Statistics 2013 data showing all hospital average of 6.4 per 100 employees. Our safety program reduced injuries from 233 OSHA recordables in 2008 to our A W compensation liability by $2 million. Our organization has been named the Healthiest Employer by the Pittsburgh Business Times for the last four consecutive years in the 1,500 to 4,999 employee category and in 2014 was named a Healthiest 100 employer, ranking 34 th nationally. We have been designated for 2015 locally and will know if we are the winner on June 4 th and we have also been selected to apply for the national 100 status again this year. In 2012 we began working with other employers to implement employee wellness programs. Worksite Community Health Needs assessment implementation plan. Many people spend the majority of their waking hours at work. If employees can create a culture of wellness within their organization the results can dramatically impact the health of our population. Our mission is to engage and educate employers on worksite wellness program design and provide reasonably priced wellness services to employers in our area with the ultimate goal of achieving improved population health in our community.
Assessment In 2007 our organization had a $1.9 million dollar increase in health care claims and in 2008 experienced an increase of $5.3 million. Our shock claims included many late stage preventable cancers, such as breast and colon cancer. The non-user rate for employees in 2012 was 37% which translated to one in seventeen employees not seeking medical care. Preventive screening data from Highmark revealed that only 23.7% of our employees were getting preventive screenings. 30% were getting a mammogram, 22.7% were getting a colorectal screening. Department of Health data for our county for 2008 2010 included 69% of adults were overweight or obese. 15% of adults were smokers and 25% reported have no leisure time or physical activity in the past month. In addition, the rates of breast, lung and colorectal cancers were higher than the Pennsylvania average. Our organization has been an active participant in the Pennsylvania State Health Improvement Plan. Key health issues to be addressed in the 2015 2020 plan includes obesity, physical inactivity and nutrition and primary care and preventive screenings. Worksite wellness programs have a tremendous ability to address these health concerns. According to The American Institute for Preventative Medicine, health care costs account for over 16% R conducted by Indiana University Purdue University in 2006 demonstrated that 87.5% of health care claims are due to lifestyle. Benefits of a worksite wellness program are reduced costs, improved employee morale, health and productivity and reductions in workers compensation claims and absenteeism. The American Institute for Health found that the return on investment for worksite health promotion is $3.48:1, primarily due to decreased health costs and absenteeism. The Centers for Disease Control believes that the workplace, as a microcosm of society, has the U that make it easier for employees to make healthy M workforce can lower direct costs such as insurance premiums and workers compensation claims and The health of the individual is inseparable from the health of the community and the health of the community is inseparable from the health of the nation (CDC, 2014). Healthy People 2020 defines a comprehensive worksite wellness program as having health education focused on skill development and lifestyle behavior change, a supportive social and physical environment, integrating the program into the EAP to medical care to ensure follow up. The Wellness Council of America (WELCOA) ing high-performing healthy workplaces that has a patented protocol that is key to developing, delivering WELCOA of significant concern, a healthy high-perform A and prosperity, much of the illness in the United States is preventable, the workplace is an ideal setting to address employee health and well-being and that worksite wellness programs can transform corporate culture and change lives (WELCOA, 2015).
Intervention The Wellness Steering Committee created the Smart Choice Wellness Program based on claims data from our insurer as well as results of a health risk assessment and biometric screening data using the WELCOA 7 benchmarks for worksite wellness programs that are capturing CEO support, creating a cohesive wellness team, collecting data to drive efforts, crafting an operating plan, choosing appropriate interventions, creating a supportive environment and evaluating outcomes. Wellness program participation W C over the years and is now linked to the level of health benefits received. The program is a points-based system with some required elements. Participants receive points for various activities such as obtaining preventive screenings, participating in corporate wellness initiatives and not using tobacco. In 2010 spouses were also included in the wellness program based on review of health care claims data. The program has been revised annually to keep it congruent with current health issues in the organization. T for tracking program participation. In 2014 we purchased a new platform that gives us more capabilities for wellness program customization and immediate access to tracking reports. This platform can be offered to other employers. Employee surveys are done annually to determine program satisfaction and new ideas. Four low-cost employee gyms are available to employees, as well as on-site exercise classes and personal training sessions. Food and Nutrition Services implemented a Smart Choice dining option daily and other initiatives including designating healthy options on the salad bar, reducing portion sizes, healthy vending and developing healthy menus for all in house catering. Nutrition counseling and health coaching and tobacco cessation services are available to employees and spouses at no cost. An incentivized weight loss program and walking program are also offered. In 2012 a new paperless biometric screening ipad application was purchased. This application produces biometric screening results in a report card format that employee can easily relate to, providing an overall screening letter grade and GPA as well as for each component of the screening. The screening includes weight, BMI, blood pressure, lipid profile, glucose, smoking status and waist circumference. Participants are strongly recommended to designate a primary care physician and results are electronically faxed to their office within one hour after the screening is completed and a copy is printed and given to the participant at the completion of their screening. The application also red flags individuals with metabolic syndrome which puts them at a higher risk of developing diabetes and/or heart disease and offered free health coaching. An aggregate report is provided to the employer, also in report card format, comparing their results to national norms. The application also provides a year to year comparison of results for both the individual and the employer. All wellness services are provided by a department of the health system that includes registered nurses, registered dietitians, exercise physiologists, as well as a certified stress management and tobacco cessation specialists. All professional staff in the department are also certified wellness/health coaches. In 2012 the wellness department began reaching out to other employers in our area. An annual health care business symposium is held to educate employers on changes in the health care arena and the value of worksite wellness programs. A goal of the Community Health Needs Assessment Implementation Plan is to engage at least five new employers annually for worksite wellness services. We have also initiated a project with our employed primary care physicians to improve the health of our employees/spouses through collaborative efforts for engagement in our wellness initiatives. Initial data collection has been completed and will be reviewed annually.
Results: Overall program participation for employees and eligible spouses increased from 89% in 2013 to 92% in 2014. The number of employees and spouses who received a biometric screening also increased from 2986 in 2013 to 3679 in 2014. Of the total population of employees and spouses screened 95.5% designated a primary care physician to whom the results were electronically faxed. The Highmark average lifestyle score, which aggregates health data from the health risk assessment improved from 61 in 2013 to 63.7 in 2014. This compares with an average lifestyle score of 61 in the Highmark book of business. High cost members comprised 0.7% of the insured population as compared to the norm of 1.1%. This translates to a cost savings of $675,000. An additional $370,000 cost saving was achieved through changes in risk status data with 25% of the insured population improving their health risk status. The current non-user rate is 78 per thousand members. This compares with the average Highmark book of business rate of 142 per thousand members. The preventive screening rate comparing 2012 to 2013 for colorectal cancer increased from 61.4% to 65%. Mammography screening rate increased from 81.4% to 84%. These rates are higher than the Highmark norm and the highest rates in their book of business. Employee compliance with flu vaccine was 92% in 2014. In 2014, 400 employees signed up for the annual weight loss campaign. The average weight loss was 2.1 pounds with a total weight loss of 835 pounds. The percent of smokers decreased from 9.1% to 8.1% from 2013 to 2014. In December 2014, 235 employees/spouses were actively participating in the pedometer walking program and averaging 8970 steps daily. In 2014 1226 employees obtained on-site gym memberships with almost 6000 total gym visits. Six employees participated in the pilot six month health coaching program. Five of the participants lost weight (average 19.4 pounds) and decreased their blood pressure, total cholesterol and waist circumference. Three participants decreased their blood glucose, HDL and triglycerides. Two of the participants were no longer considered to have metabolic syndrome. All six participants made healthy lifestyle changes related to diet, exercise and stress management. Thirteen area employers were engaged in fiscal year 2013. Sixteen were engaged in fiscal year 2014 and twenty six have been engaged through April for the current fiscal year. Wellness services include biometric screenings, weight loss campaigns, health education classes and exercise classes. The number of biometric screening provided in fiscal year 2014 increased to 1968 compared to 641 in fiscal year 2013. Two of the employers engaged have also been named a Healthiest Employer by the Pittsburgh Business Times. A contractual arrangement has been completed with one employer that waives co-pays for office visits with our employed primary care physician group. Our wellness department has also established contractual agreement with insurance brokers, wellness vendors and health insurer to provide services to their clients.
Adaptability We know that this worksite wellness model is able to be easily replicated in other organizations because it is currently happening. Worksite wellness can be implemented in any organization regardless of type of business or size. Several organizations that we are currently working with have implemented our program with some revisions to better fit their workforce. Our goal is to share our wellness program with other organizations and help them to develop one that will fit their organization. Keys to success include following the WELCOA 7 steps for building an effective worksite wellness program starting with capturing the support of the CEO. This is critical to acceptance of the program in the organization. Be sure to include the right people on the Wellness Team. Include the elements of a comprehensive program as outlined by Healthy People 2020. Set program goals and evaluate outcomes. Most importantly, elicit input and feedback from your employees on a regular basis to ensure that you are providing a meaningful program and meeting their needs. Also, keep current with all federal regulations related to employee wellness programs to ensure that your program is compliant. Implementing an employee wellness program creates a great deal of change within the organization. Mistrust and anger are not uncommon. Communicate effectively and often to the workforce. In our W T e that explains the wellness program and includes frequently asked questions and answers. Direct mailings to the employees as well as social media venues are also used. Start small and build your program annually. Work on one or two issues at a time to not overwhelm your employees and ensure program success. Additionally, do not let the program stagnate. Review and revise the program annually to keep employee engagement at a high level. Finally, be patient and stay the course. The employee concerns diminish and engagement will grow. Over the past five years we have seen an actual culture change within our organization. Employees now understand that the purpose of the program is to keep them healthy and productive and the organization can keep health care co I -win program for the employees and the organization.
December 2014 Non-User Rate Per Thousand Members - 2014 250 223 200 150 142 114 137 161 130 100 50 78 68 83 58 50 97 42 72 28 93 0 Overall 0-17 18-34 35-44 45-54 55-59 60-64 Over 65 Age Client Excela Health Total Business Highmark Blue Shield
Number of Employers Engaged for Worksite Wellness Services 30 26 25 20 16 15 10 10 6 5 0 2012 2013 2014 2015(YTD)