A Population Health Management Case Study The Wellness Challenge

A Population Health Management Case Study The Wellness Challenge What we ve learned about criteria-based health incentive programs in the past 18 years Ron Burt, M.Ed. Director, Health Management HealthForce Partners

Agenda What is the Wellness Challenge - Background and History Features of the Wellness Challenge Meeting Company Goals: Program Design Considerations Roadmap to Success - Wellness Criteria: elements to consider for engagement Wellness Criteria Options Incentive Challenges and Solutions: What we have learned and practiced Incentive types and structures within the Wellness Challenge Wellness Challenge Case Studies

Program Background & History of the Wellness Challenge Created and first implemented at Providence Hospital, Everett 1992 Program spearheaded by VP of HR, Benefit Manager and Health Promotion Proposed to administration as a cost containment/employee benefit program strategy Program was in place for 12 years 1992-2004 Survived four major layoffs and budget cuts Merger Four CEOs

Purpose of the Wellness Challenge Assist in curbing the rising cost of healthcare Assist in reducing sick-time usage Increase the value of benefit package Implement formal wellness program Improve employee health Improve upon employee and employer relations and recruitment

Program Highlights Employee participation was over 50% each year (1992-2002) Program Hghlights Employee success was over 50% each year 2500 Participation (10 years experience = 55% of benefit eligible population) Experienced a 22% decrease in sick-time hours (N=7) among successful participants. of Employees 2000 1500 1000 Generated a 1:6 Cost to Benefit Ratio over a 10 year cycle No 500 0 1992 1993 1994 1995* 1996 1997 1998 1999 2000 2001 Eligible Population Total WC Participants Successful Participants *Merger

Case Study 1: Return on Investment The Wellness Challenge helped PEMC produce an impressive 1:6 cost-to-benefit ratio over a 10-year period. $300 Per Em mployee Per Mo onth $250 $200 $150 $100 $50 $0 Control PEMC 1991 1992 1993 1994 1995 1996 1997 1998 1990 2000 2001 6

Wellness Challenge Case Study: Providence Everett Medical Center

What is the Wellness Challenge? A criteria based, health incentive program that provides a financial reward for eligible participants who meet selected wellness milestones within a specific cycle or time frame.

Strategic Approach to the Wellness Challenge Support Culture of Wellness Improve Work Area Stabilize Healthcare Costs Health Awareness Health Improvement Reduce Unscheduled Leave Maximize Productivity Wellness Challenge Employee Satisfaction Employee Morale Recruitment & Retention Injury Prevention Employee Participation

Key Features of the Wellness Challenge Tailored to clients needs and goals Web-based Financial incentive design Flexible program design Operates on a flexible cycle Heavy focus on program evaluation Integrates with existing wellness programming Voluntary

What factors should be considered in the program design?

Program Design Considerations Company goals and expectations Previous HRA Aggregate Data Past and Present Wellness Efforts Medical and Rx claims data overtime Employee feedbacks surveys Industry and Job Types

Program Design Considerations Distribution of eligible participants Access to computers (work/home) Internal resources and budget Leadership support Corporate mission Linkage to health plan benefits

Roadmap to Success: Wellness Criteria What are wellness criteria, key elements to consider for engagement and behavior change?

Wellness Criteria Examples Physical Activity Five-a-Day Work Life Balance Tb Tobacco Free Blood Pressure My Wellness Goal Stretch & Flex Fatigue Management Sick Days Prevention Awareness Waist-to-Hip Ratio Know Your Numbers Lifestyle Management Injury Prevention HRA Completion Community Health Events

Key elements of wellness criteria for long-term participation, success and sustainability what we have learned Design for personal responsibility Promote good behavior Reward and support smart decisions Minimize complexity and number Focus on long-term health sustainability Achievable by all

Key Elements (continued) Supported by science and national guidelines Focus on diversified risks Align with organizational goals Avoid drastic changes from year to year Avoid strict data entry requirements Establish reasonable timeline for completion and success Integrate with existing wellness resources Collect data and report outcomes modify program elements if necessary

Options for Criteria Design OPTION 1: Achieve (#) of (#) criteria within a specific program period to earn an incentive OPTION 2: Achieve specific individual criteria to earn individual incentive OPTION 3: Achieve specific criteria levels within a program period to receive different incentive levels

Criteria Design Option 1 Example client: Achieve four of seven criteria i between each program period and earn a $100 or $75 cash incentive Physical Activity it Prevention Awareness Stretch & Flex Blood Pressure Six-a-Day My HRA Goal Work Life Balance/Fatigue Management Incentive: Eligible to earn $100 (employee), $75 (spouse/partner) each program period

Criteria Design Option 2 Example client: Each individual id who achieves an individual id criteria i achieve receives a specific HAS contribution Healthy Heart $15 HSA Physical Activity $15 HSA Nutrition $15 HSA Blood Pressure $10 HSA Waist-to-Hip Ratio $10 HSA Prevention Awareness $10 HSA Incentive: Eligible to earn up to $75 each program period or a total of $300 in HAS contributions each year

Criteria Design Option 3 Example client: Meet specific criteria i point levels l within a program period and receive a specific incentive level Physical Activity it Five-a-Day Blood Pressure Work-Life Balance My Wellness Goal Prevention Awareness Incentive: Gold Level: $100 cash - meet 6 or more wellness credits Silver Level: $50 cash - meet 5 or wellness credits Bronze Level: $40 cash - meet 4 wellness credits

Incentive Trends: Why incentives and what is driving their use? Obesity Trends* Among U.S. Adults BRFSS, 1990, 1998, 2007 (*BMI 30, or about 30 lbs. overweight for 5 4 person) 1990 1998 2007 No Data <10% 10% 14% 15% 19% 20% 24% 25% 29% 30%

Incentive Trends: Why incentives and what is driving their use?

Incentive challenges and solutions what we have learned and practiced as part of the Wellness Challenge Motivation is a fire from within. If someone else tries to light that fire under you, chances are it will burn very briefly. -Stephen Covey

Why invest in incentives as part of a wellness program? The employee population is not making the necessary health changes on their own Incentives alone are not sufficient to improve long-term outcomes but can create momentum Belief that wellness programs linked to incentives are effective at improving health and reducing costs Increase the likelihood that employees will embrace, and ultimately adopt, healthier behaviors Move personal health behaviors from extrinsic to intrinsic motivation health is greatest reward

Top Ranking Healthcare Tactics and Priorities 2009 Utilize healthcare data and measurement to drive healthcare strategy 69% Offer incentives to motivate sustained healthcare behavior change 61% Provide health and productivity management programs tailored to member risk levels 49% Hewitt 10 th Associates Annual Health Care Report A total of 343 executives, whose companies employ more than five million employees from many industries took part in the survey www.hewittassociates.com

Making Sense of Incentives and Disincentives IBI survey conducted on more than 500 employers about incentives and disincentives that they use to promote health and productivity. www.ibiweb.org

IBI Incentive Survey Finding #1 Employers appear to use a shotgun approach in developing incentive programs. The incentives they offer aren t related systematically y to employer goals.

IBI Incentive Report Finding #1 Employer Goals by Incentive Type: Participation Behavior Change Outcomes Cash-based 82% Cash-based 68% Cash 50% Benefits-related 80% Benefits-related 70% Benefits-related 57% Prizes/gifts 83% Prizes/gifts 70% Prizes/gifts 54%

Wellness Challenge Solution to Finding #1 Focus on incentives in areas of organizational need and concerns (health risks of employees, productivity, healthcare and Rx use etc.) Engage employees in what they value (cash, premium discounts etc.) Provide feedback about employee progress to achieving wellness criteria Provide positive feedback and encouragement Focus design of program on organizational goals and expectations

IBI Survey Finding #2 Employers target participation as their most frequent incentive goal, outcomes much less so. Yet, positive outcomes would best serve employers bottom-line targets. Resources: WELCOA and HERO www.welcoa.org www.the-hero.org

Wellness Challenge Solution to Finding #2 Participation is defined as engagement not enrollment HRA completion as part of the Wellness Challenge is a prerequisite to program engagement Wellness criteria are selected based on organizational goals, employee health status and claims data Real time feedback is provided to participants regarding their activities and level of engagement

IBI Survey Finding #3 Corporate culture is critical to a successful incentive program. Incentives and disincentives that drift too far from the culture of the company and it s workforce are unlikely to meet the employer s goals

Wellness Challenge Solution to Finding #3 Distribute interest survey to assess employee interest Review options with leadership Create brand around the program Support non-work and family programs Effective communication strategy Top down communication

Incentive Options Health insurance premium reductions Co-pay reductions Health account contributions (HSA, FSA or HRA) Cash bonuses PTO Gift cards Incentive Design Options for Wellness Challenge Achieved a minimum number of criteria to receive incentive (4 of 6) Achieved a specific criteria and receive a weighted incentive (Five-a-Day $30) Achieve defined criteria levels and receive specific incentive amount (Gold, Silver, Bronze)

Wellness Challenge Case Studies

Case Study: BCBSNE

Program Design Example client: Wellness Criteria i Healthy Heart $15 HAS Lifestyle Management Personal Health Assessment Preventive Health Goals Community Health Events Health Education Self Study Physical Activity Nutrition Know Your Numbers

Program Design Example client: Meet Level 1,2 or 3 criteria point levels within the program period to receive a specific incentive level. Incentive 1: Level 1 Meet 8 of 9 wellness goals - $125 Level 2 Meet 7 of 9 wellness goals - $75 Level 3 Meet 6 of 9 wellness goals - $50 Incentive 2: Individuals who complete the program at any of the below levels will have a chance to win one of six $1000 Visa gift cards Level 1 8 of 9 wellness goals achieved name entered three times Level 2 7 of 9 wellness goals achieved - name entered two times Level 3 6 of 9 wellness goals achieved - name entered one time

Program Details Program in place four years (average of 80% enrollment for length of program) Top down leadership support WELCOA Platinum Well Workplace Award Winner Approximately $125 cash incentive possible to earn, plus $20 monthly premium discount for HRA completion Over 50% of participants receive wellness incentives

Program Details Program in place four years (average of 80% enrollment for length of program) Top down leadership support WELCOA Platinum Well Workplace Award Winner Approximately $125 cash incentive possible to earn, plus $20 monthly premium discount for HRA completion Over 50% of participants receive wellness incentives

Program Details Team Challenges via the Wellness Challenge portal to foster group support, mentoring and healthy competition 9% decrease in employee sick days Total number of workers compensation claims declined by 44% Medical costs rose by 6.05% in 2006, 11% below the national average Percentage of employees who smoke dropped from 20 to 14% 80% of employees feel the program helps them be more consistent with pursuing a healthier lifestyle 82% satisfied with program

Case Study: The Everett Clinic Ready for The Everett Clinic s WELLNESS CHALLENGE? Join the Fun! TEC.THEWELLNESSCHALLENGE.COM

Program Details Wellness Criteria Physical Activity Five-a-Day Blood Pressure Work-Life Balance My Wellness Goal Prevention Awareness

Program Incentives Meet specific criteria credit levels within the program period to receive a specific incentive level Incentive Levels: Gold Level - $100 cash - meet 6 or more wellness credits Silver Level - $50 cash meet 5 or more wellness credits Bronze Level - $40 cash meet 4 wellness credits

Program Details Wellness Challenge began in 2007 Strong leadership support Health promotion programming provided at each clinic location Employee recognition encouraged Total of $425 in cash incentives possible during program year

Program Details Enrollment was twice as high as goal (63% average enrollment over 2 years) 50% success rate/high engagement (75 +physicians enrolled) 50% increase in frequency of physical activity for cohort group

Program Details 43% increase in number of participants consuming a minimum of five fruits and or veggies 90% of participants reported significant value in the program 93% of participants viewed their health as improved by participating in the program Top three modifiable risk areas improved from year one to year two based on HRA aggregate data

My Wellness Goal While we are free to choose our actions, we are not free to choose the consequences of our actions. -Stephen Covey

TEC Program Outcomes

TEC Program Outcomes

TEC Program Outcomes

2008 Golden Apple Award

Wellness Incentive Design Resource www.welcoa.org

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