Is Your Employee Wellness Program Working? July 12, 2015

Is Your Employee Wellness Program Working? July 12, 2015

Housekeeping Please silence all mobile devices. This session is being recorded. To view the recording please visit www.naco.org/educational-recordings. Questions will be answered at the end of the session.

Workshop Evaluations Workshop evaluations forms can be found in the NACo conference app and online at www.naco.org/workshopevals. Please visit itunes or Google Play to download the 2015 NACo Annual Conference App!

Today s Speakers Moderator Hon. Lenny Eliason, Athens County, Ohio Speakers Polly Thomas, Director, Employee Benefits and Onsite Clinic Services Sarah Spaeth, Legislative Policy Advisor, Waukesha County, Wis.

Wellness Trends NACo 2015 Polly Thomas July 13, 2015

Agenda: Wellness Trends & Topics Increasing use of outcomes based wellness program Compliance considerations Emerging strategies to address obesity and sedentary lifestyles Onsite Clinics and Telemedicine

Wellbeing and ROI Career Community Social Person Physical Financial

Outcome-Based Programs: Increasing Usage Employers are seeking new ways to increase engagement in wellness programs and, ultimately, influence employees to change health behaviors Outcome-based programs tie incentives to achieving a health goal (i.e. tobacco free status, and/or BMI, blood pressure, cholesterol targets) As a result, interest in outcome-based programs and incentives has never been higher. 22% of companies adopted outcome-based incentives (other than for tobacco)* Expected to reach 45% in 2015* Two-thirds of companies also have participation-based incentives (22% of those design them as penalties for non participation) Average incentive is $50 per month 40% of companies extend wellness incentives to spouses Source: *2014 19th Annual Towers Watson/National Business Group on Health Employer Survey on Purchasing Value in Health Care

Practical Considerations Best practice reflects that employers who have Created a moderate baseline (65% of their population) of awareness and education, Achieved at least some rate of participation (30%) in programs and interventions, Provided for access to specific programs that help the employee achieve the desired risk mitigation (tobacco cessation program, weight loss programs, coaching, disease management programs, employee assistance programs), Removed any barriers time, costs, access, etc. Created a positive, discount or reward incentive which motivates the employees to engage are then prepared to move to outcome-based incentive structures.

Regulatory Considerations Be mindful of incentive limits - ACA/HIPAA and EEOC have different proposed limits HIPAA/ACA has no set limit for participatory programs and distinguishes between tobacco and meeting standards in health contingent programs. 50% and 30 % of cost of coverage. EEOC s proposes 30% of cost of employee only coverage for all rewards and penalties. EEOC proposed ADA rule would apply to ALL programs with incentives. Denial of coverage or plan options ( premium plans ) HIPAA/ACA allows for denying coverage or access to premium plan for participation only plans but not for health contingent plans. EEOC proposal that ties an incentive for medical examination would not allow to deny coverage for non-participation and not allow denying access to premium plans for non participation. Reasonable Design and Reasonable Alternatives HIPAA/ACA does not require a reasonable design for participation based programs, however does require reasonable design for health contingent programs. EEOC would require that all programs be reasonably designed. A reasonable alternative would not be required under HIPAA/ACA provisions for participatory programs. Under EEOC proposed rules reasonable accommodations would be required for all employees.

Regulatory Considerations (cont.) Notice Requirements pay special attention to notice requirements Areas of concern or in need of additional clarification; GINA impact to EEOC isn t yet addressed Conflict in spouse involvement pertaining to incentives Effective date is yet to be defined will it be retroactive? Definition of a medical exam vs health inquiry may challenge tobacco surcharges for employers.

Addressing Health Risks with Emerging Strategies

Sitting: The New Smoking Over the course of a lifetime, per-person costs for obesity were similar to those for smoking. 2 Per capita medical spending was $2,741 higher for obese individuals than for individuals who were not obese a 150 percent increase. 1 Taking the frequency of obesity into account, as well as the overall gender makeup of the workforce, for a firm with 1,000 employees, obesity would cost about $285,000 a year Source: 1. Cawley J, Meyerhoefer C. The medical care costs of obesity: an instrumental variables approach. J Health Econ. 2012; 31:219-30. 2. Thompson D, Edelsberg J, Colditz GA, Bird AP, Oster G. Lifetime health and economic consequences of obesity. Arch Intern Med. 1999; 159:2177 83.

Wearable Technology Wearable device penetration is significant: 1/6th of U.S. adults own one. Many users make the tracker part of their life. Survey data indicates that about 50% of owners still use their device 12 months after purchase, and the trend appears to level off at about 40% longterm 1 10% of users are Quantified Selfers who monitor their data and take motivation from it. Another 20%-30% can change behavior with some encouragement in addition to the data tracker 2 Source: 1. Endeavor Partners, Inside Wearables, January 2014, www.endeavourpartners.net. 2. New York Times, http://well.blogs.nytimes.com/2014/03/10/the-monitoredman/?_php=true&_type=blogs&ref=science&_r=0

Use of Emerging Engagement Strategies 46% 18% 40% 38% 19% 16% 36% 35% 33% 18% 21% 20% Plan to use in 2 yrs Plan to use in 1 yr Currently use 28% 21% 22% 18% 14% 13% Online competitions/ challenges Social networks Activity tracking/ wearable devices Game-like features Mobile apps Mobile messaging Source: Annual Wellness in the Workplace Study: An Optum Research Update, 2014.

TeleMedicine Over 70% of all ER, urgent care, and doctor office visits can be safely handled over the phone. -Wellness Council of America Can be offered in most states and in most cases the provider can diagnose and write prescriptions. Offered via mobile device, tablet, phone and computer depending upon the provider. Most effective solutions offer employee choice and integrate with benefit plan design. Can be offered on a voluntary basis or contributory basis.

Onsite Health Clinics Increased Public Sector Adoption Moving down market to smaller employers with the creation of shared clinics Ability to leverage fixed costs across multiple employers Geography, culture and workforce demographics are key considerations Thoughtful and analytical approach critical to success

Questions? Polly Thomas Director of Onsite Clinic Consulting Services CBIZ Benefits & Insurance Services of Kansas City P: (816) 945-5509 E: pthomas@cbiz.com

Shared Employee Health and Wellness Center Partnership between Waukesha County, Waukesha County School District and City of Waukesha NACo Annual Conference July 12, 2015

Benefits of Employee Onsite Clinic Employees: Access to convenient, high quality healthcare Better management of chronic health conditions Low copays Diagnosis and treatment start earlier County: Reducing overall insurance costs by minimizing outside medical expenses Reduction in absenteeism, more productive workforce Reinforcement of wellness culture Employee retention

Why Does it Work? Onsite Clinic Employer Cost Employee Visit Fee Health Plan Cost Community Employee Copay Office Visit $45 $5 $112 $28 Medication $2 $5 $4 $10

Feasibility Study In 2013 Waukesha County contracted with CBIZ Benefits and Insurance, Inc. to determine whether an onsite medical clinic would offer beneficial cost savings while providing more convenient access to quality healthcare Number of benefit eligible employees Health claims data Workers compensation claims data Employee survey Location analysis Stakeholder interviews Scope of services Staffing models

Feasibility Study Enrolled Employees Enrolled Dependents Enrolled Retirees Total % of Total Waukesha County School District City of Waukesha 1,194 1,853 268 3,315 40% 1,045 2,179 351 3,575 44% 432 755 106 1,293 16% Total 2,671 4,787 725 8,183 100%

Strategic Partners Key to Success The consultant s study said the proposal would save the trio $7 million in total health care costs over a five-year period. Waukesha County savings without partners estimated at $700,000 over five years Waukesha County s savings with partners estimated at $2.4 million over five years

Strategic Partnerships Key to Success Partnership allowed sharing in fixed costs for the facility Start up costs Building repair and maintenance Splitting the cost of billable hours for doctors and staff Laboratory fees Technology fees Dues and licenses Marketing and communication Professional development Equipment

Feasibility Study: Health Indicators Waukesha County, School District and City of Waukesha share many of the same health conditions allowing for shared scope of service Average paid prescription is high for each entity generic drug utilization could be higher Engagement in health coaching is under 10% of each organization Majority of enrolled employees not utilizing preventative exams despite being covered 100% Waukesha County 38% School District 38% City of Waukesha 59%

Feasibility Study: Employee Survey 58% of County and 59% of School District employees indicated they would probably or definitely use the onsite health clinic Employees indicated they value cost savings, no waiting and the ability to fill prescriptions onsite Interest in weekend hours was high 44% Employees indicated they are willing to utilize the clinic even if it s a 15 minute drive

Feasibility Study: Location Analysis 97% of County and 100% of City and School District employees work within 5 miles of clinic location Over 80% of employees from all three entities live within 15 miles of clinic Ci ty h al l

Feasibility Study Services and Staffing

Factors to Achieving ROI Utilization Waukesha County offers two health care plans Co-pays for the onsite clinic are lower than what an employee would currently pay Choice Plus Plan Office visit co-pay of $5 for employees in the Choice Plus plan and a drug co-pay of $2 Health Savings Account $35 copay rather than the full price of an office visit ($100- $120)

RFP process Technical Criteria Financial Criteria

RFP Process 12 Responses to RFP 5 Selected for Finalist Presentations 2 Finalist Selected Reference Site Visits Selected Vendor: Healthstat

Governance Structure Intergovernmental Agreement: Start up costs Facility and grounds Operating costs Term and renewal Expulsion or addition of parties Waukesha County 40% Waukesha County School District 44% City of Waukesha 16%

Governance Structure Advisory Council One representative from each party Comply with open meetings law and Robert s Rule of Order Negotiate and make changes to provider contract Scope of services Staffing Hours of operating

Legislative Process Government programs such as this seem to have a way of getting out of hand I m concerned about creating a system of privilege for employees that have access to health care that I and others won t SuperviSor wants the County to stay out of the healthcare business My personal opinion is that the County is trying to force this new government health clinic through, in order to save themselves money on the backs of city and school district employees I m having a problem with our employees having an exclusive service provided by tax dollars while the taxpayers stand in line for health care "Why do we get into this type of thing?" The county s proposed government health clinic would likely lead to a reduction in quality and choice in health care services over time for our city employees and their families

Legislative Process Waukesha County Board of Supervisors 19-4 Waukesha County School Board 6-2 Waukesha Common Council 10-4

Six Month Results

Six Month Results 2,863 Total Visits 40% County 41% School District 19% City 126% Preventative Physicals 52% 258 Health Coaching Visits 227%

Questions? Sarah Spaeth Legislative Policy Advisor Waukesha County Board of Supervisors sspaeth@waukeshacounty.gov

Questions and Answers If you would like to ask a question, please go to the nearest microphone.

Evaluations NACo values all feedback. Evaluation forms can be found in the NACo Conference app and online at www.naco.org/workshopevals. Please visit itunes or Google Play to download the 2015 NACo Annual Conference App!