From the Perfect Storm

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From the Perfect Storm

• To the Sea of Tranquility

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We have a problem!
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We are aging
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Age Drives Cost
But So Does Risk
N43,687
Source StayWell Health Management
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Days Absent
N941
StayWell Health Management
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Workers Comp
N23,916
StayWell Health Management
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STD Claims
N23,916
StayWell Health Management
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Health care costs are erupting
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Costs for Each Person (2009)
8,160
Centers for Medicare and Medicaid Services
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Costs for Each Person (2018)
13,100
8,160
Centers for Medicare and Medicaid Services
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Annual Spending per Capita
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Infant Mortality
General Accounting Office, 2004
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Life Expectancy in the World
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Life Expectancy in the World
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Portion of Total Health Care Costs Caused by
Chronic Diseases
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Most of the rise in spending is associated with
the doubling of obesity and changes in the
treatment of people with risk factors
Lancet 2007 370 192938
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Obesity Trends Among U.S. Adults1985
No Data lt10 1014
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Obesity Trends Among U.S. Adults1986
No Data lt10 1014
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Obesity Trends Among U.S. Adults 1987
No Data lt10 1014
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Obesity Trends Among U.S. Adults1988
No Data lt10 1014
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Obesity Trends Among U.S. Adults1989
No Data lt10 1014
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Obesity Trends Among U.S. Adults1990
No Data lt10 1014
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Obesity Trends Among U.S. Adults1991
No Data lt10 1014
1519
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Obesity Trends Among U.S. Adults1992
No Data lt10 1014
1519
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Obesity Trends Among U.S. Adults1993
No Data lt10 1014
1519
35
Obesity Trends Among U.S. Adults1994
No Data lt10 1014
1519
36
Obesity Trends Among U.S. Adults1995
No Data lt10 1014
1519
37
Obesity Trends Among U.S. Adults1996
No Data lt10 1014
1519
38
Obesity Trends Among U.S. Adults1997
No Data lt10 1014
1519 20
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Obesity Trends Among U.S. Adults1998
No Data lt10 1014
1519 20
40
Obesity Trends Among U.S. Adults1999
No Data lt10 1014
1519 20
41
Obesity Trends Among U.S. Adults2000
No Data lt10 1014
1519 20
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Obesity Trends Among U.S. Adults2001
No Data lt10 1014
1519 2024 25
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Obesity Trends Among U.S. Adults2002
No Data lt10 1014
1519 2024 25
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Obesity Trends Among U.S. Adults2003
No Data lt10 1014
1519 2024 25
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Obesity Trends Among U.S. Adults2004
No Data lt10 1014
1519 2024 25
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Obesity Trends Among U.S. Adults2005
No Data lt10 1014
1519 2024 2529
30
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Obesity Trends Among U.S. Adults2006
No Data lt10 1014
1519 2024 2529
30
48
Obesity Trends Among U.S. Adults2007
No Data lt10 1014
1519 2024 2529
30
49
Obesity Trends Among U.S. Adults2008
No Data lt10 1014
1519 2024 2529
30
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Obesity Trends Among U.S. Adults1990, 1999, 2008
No Data lt10 1014
1519 2024 2529
30
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Excess Body Weight and Reduction of Lifespan
-3.1
-3.3
-5.8
-7.1
Ann Intern Med. 200313824-32
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Diabetes Among Adults in the U.S.,BRFSS 1990
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Diabetes Among Adults in the U.S.,BRFSS 1992

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Diabetes Among Adults in the U.S.,BRFSS 1994
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Diabetes Among Adults in the U.S.,BRFSS 1996
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Diabetes Among Adults in the U.S.,BRFSS 1998
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Diabetes Among Adults in the U.S.,BRFSS 2000
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Diabetes Among Adults in the U.S.,BRFSS 2001
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Diabetes and Reduction in Lifespan
-14.3 yrs
-11.6 yrs
JAMA 20032901884-1890
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Lifetime Risk of Diabetes for Children Born in
2000
49
Venkat Narayan, JAMA 20032901884
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What happened?
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Indicator 24 Physical Activity
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16 oz
32 oz
44 oz
52 oz
64 oz
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Lifestyle Associated with CD
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Lifestyle Reduces Risk of CD
36
50
83
91
Arch Intern Med 2009169(15)1355-1362
Study in Germany
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Lifestyle Reduces Risk of Death
Healthiest got 14 extra years
1.4x
2x
2.5x
4x
Study in UK
Arch Intern Med 2009169(15)1355-1362
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The Cause Behind the Cause
Unhealthy behaviors
Health risks
Chronic disease
Health care costs
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Whats the Matter With Your Problem?
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CD threatens vitality of the global eco-system
which hampers sustainability of already burdened
social security systems of industrialized
societies
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Main Points

• CD drives healthcare costs
• Productivity loss from CD is even greater
• Wellness can impact human capital
• Sustainability is threatened by CD

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What Should We Do?
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The Cause Behind the Cause
Unhealthy behaviors
Health risks
Chronic disease
Health care costs
Healthy Behaviors Happen in Healthy Cultures
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Break
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How to Build a
Program That Works
Hellness
Wellness
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Building a Program

• 1. Leadership support
• 2. Change culture and environment
• 3. Assess employee health
• 4. Plan and implement wellness strategies
• 5. Evaluate your efforts

3. Assess employee health 4. Plan and implement
wellness strategies 5. Evaluate your efforts
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1. Leadership Support
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Employee Related Costs

• Salary
• Health care
• STD
• LTD
• Workers Comp
• Life Insurance
• 401K
• Vacation
• Sick leave

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You Want How Much for What?
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Painful Comments

• We have a high turnover rate
• Employees dont care
• Employees wont change
• We would only be subsidizing the well
• Dont believe in wellness pixie dust

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Towers Perrin report

• High performing companies
• Will pay 12 less PEPY
• Will receive a health dividend that is linked to
  other workforce management outcomes such as
  higher employee engagement

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ROI
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What was the problem?

• Performance was not real

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What was the problem?

• Took credit for something he did not create

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ROI - The Wellness Hook

• Sometimes we
• talk about ROI in ways that are not real
• take credit for an ROI that we did not create

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7
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1. Reframe ROI
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2. It is not Investment ROI
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3. ROI is a Fraction
Calibrate the Investment
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Against the size of the problem
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What Companies Invest PEPY

• 5000 45
• 1000 - 5000 75
• 50 - 1000 120
• Under 50 250

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You get what you pay for

• Low Intensity
• HRA, marketing campaigns and/or printed materials
• Under 20 PEPY
• Average ROI of 3.751

1. Aldana SG, Jacobson BH, Harris CJ, Kelley PL,
Stone WJ. Influence of a mobile worksite health
promotion program on health care costs. Am J
Prev Med 19939(6)37883. 2. Berg GD, Thomas E,
Silverstein S, et al. Reducing medical service
utilization by encouraging vaccines Randomized
controlled trial. Am J Prev Med 2004
27(4)284-8. 3. Fries JF, et al. Two-year
results of a randomized controlled trial of a
health promotion program in a retiree population
the Bank of America study, Am J Med, 1993 94
455-462. 4. Fries JF, McShane D. Reducing need
and demand for medical services in high risk
persons. West J Med, 1998 169(4) 201-207. 5.
Gibbs, JO, et al. Work-site health promotion
Five year trend in employee health care costs, J
Occup Med1985 27(11) 826-830. 6. Leigh, JP et
al. Randomized controlled study of a retiree
health promotion program The Bank of America
study, Arch Int Med, 1992152 1201- 1206. 7.
Schultz ALC, Barnett T, et al. Influence of
participation in a worksite health promotion
program on disability days. J Occup Environ Med.
200244776780.
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You get what you pay for

• Medium Intensity
• Low intensity plus any type of intervention
• About 20 up to 50 PEPY
• Average ROI of 61

1. Aldana SG, Merrill RM, Price K, Hardy A, Hager
R. Financial impact of a comprehensive multisite
workplace health promotion program. Prev Med
200540(2)131-137 2. Chapman L, et al. Ten-year
economic evaluation of an incentive-based
worksite health promotion program, Unpublished
data. 3. Golaszewski T, et al. A benefit-to-cost
analysis of a work-site health promotion program,
J Occup Med1992 34(12) 1164-1172. 4.
Hall-Barrow J, Hodges LC, Brown P. A
collaborative model for employee health and
nursing education. AAOHN J, 200149(9)429-36. 5.
Henritze J, Brammell HL. Phase II cardiac
wellness at the Adolph Coors Company. Am J Health
Promot 1989 4(1) 25- 31. 6. Leutzinger J, Hawes
C, Hunnicutt D, et al. Predicting the ratio of
benefit to cost in a cardiovascular disease
prevention program. Manag Employee Health
Benefits. 1995110. 7. Maniscalco P, Lane R,
Welke M, et al. Decreased rate of back injuries
through a wellness program for offshore petroleum
employees. J Occup Environ Med. 199941813820.
8. Mills P, Kessler RC, Cooper J, Sullivan S.
Impact of a Health Promotion Program on Employee
Health Risks and Work Productivity. AJHP.
200722(1)45-53. 9. Ozminkowski, Ronald J., et
al. A return on investment evaluation of the
Citibank, N.A., Health Management Program. Am J
Health Promot 1999 14(1)31-43. 10. Shephard
RJ, et al. The influence of an employee fitness
and lifestyle modification program upon medical
care costs. Can J Public Health, 1982 73
259-263. 11. Shi L. Health promotion, medical
care use, and costs in a sample of worksite
employees, Evaluation Review,1993 17(5)
475-487. 12. Stave GM, et al. Quantifiable
impact of the contract for health and wellness
Health behaviors, health care costs, disability,
and workers' compensation. JOEM
200345(2)109-17. 13. Thorsen N, Khalil L. Cost
savings associated with smoking cessation for
low-income pregnant women. WMJ 2004 103(5)67-9,
73. 14. Wood FA, et al. An evaluation of
lifestyle risk factors and absenteeism after two
years in a worksite health promotion program. Am
J Health Promot,1989 4(2) 128-133.
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You get what you pay for

• High Intensity
• Medium intensity plus cultural or environmental
  change
• About 50-150 PEPY
• Average ROI of 7.751

1. Bertera, RL. The effects of workplace health
promotion on absenteeism and employment costs in
a large industrial population, Am J Pub Health
1990 80(9) 1101-1105. 2. Bowne DW, Russell ML,
Morgan JL, Optenberg SA, Clarke AE. Reduced
disability and health care costs in an industrial
fitness program. J Occup Med 198426(11)80916.
3. Dalton, BA, Harris J. A comprehensive approach
to corporate health management, J Occup Med1991
33(3)338-348. 4. Harvey MR et al. The impact of
a comprehensive medical benefits cost management
program for the city of Birmingham results at
five years. Am J Health Promot,1993 7(4)
296-303.
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ROI Evidence
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2. Change culture and environment

• Physical Environment
• Policy
• Culture

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Wellness Committee
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Wellness Committee

• Sets vision and goals
• Adds credibility and importance
• Helps with program PR
• Provides stability
• Helps change culture
• Oversees the wellness efforts
• Decide to use vendors or go it alone

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• Its not
• We want a vendor to solve this problem for us
• It is
• How can the vendors help us create a worksite
  culture of health?

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Tools to change culture
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Wellness and benefits design

• Differential health plans for participants
• Lower co-pays, deductibles and premiums
• Contribution to FSA or HRA
• Many more

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Policies

• Coverage for preventive services
• No smoking policies
• Flex time
• Time on the clock to be healthy
• Free from overly stressful work

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Supportive Environments

• Would we intentionally expose employees to
  harmful substances
• Polluted water?
• Arsenic?
• Soda?
• Donuts?
• MMs?

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100 Calories
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71.2 Million
56 Billion
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Supportive Environments

• Physical environment
• Healthy food in cafeteria
• Healthy food in vending machines
• Farmers market onsite
• Realistic work demands
• Support to be physically active
• Walking paths
• Onsite shower or lockers

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4. Plan and implement wellness strategies
How to Approach This
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Well
Risk
Urgent
Disease
25
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Well
Risk
Disease
Urgent
5
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Well
Risk
Urgent
Disease
60
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Well
Risk
Urgent
Disease
10
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Which group is high cost?
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Well
Risk
Urgent
Disease
25
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Well
Risk
Urgent
Disease
10
60
5
25
Top 15 of employees with disease 85 of costs
The rest 15 of costs
150
Disease
25
59 Turnover
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Which group is really high cost?
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Who Needs Help Adopting and Maintain Healthy
Behaviors?
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Who Needs Help Adopting and Maintain Healthy
Behaviors?
Everybody
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Individual
Family
Worksite
Community
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Simple is Sustainable
Small deviations over time or distance make a
huge difference
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FAQs
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Biometric Screening

• The Community Guide
• US Preventive Services Task Force
• Prevent.org

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Doing a Screening Program

• Assess Risk
• http//www.thecommunityguide.org/worksite/ahrf.ht
  ml
• BMI and Blood Pressure http//www.ahrq.gov/clinic
  /uspstf/uspsobes.htm http//www.ahrq.gov/clinic/us
  pstf/uspshype.htm
• Use data with age sex to recommend screenings
• Cancer screening (mammography) for women 40
  http//www.ahrq.gov/clinic/uspstf/uspsbrca.htm
• Diabetes screening for asymptomatic adults with
  sustained BP gt 135/80
• http//www.ahrq.gov/clinic/uspstf/uspsdiab.htm
• Elevated lipid screening for men 35, and women
  20 and men 20-34 with at least one risk factor
  http//www.ahrq.gov/clinic/uspstf/uspschol.htm

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Health Risk Appraisal

• Free?
• Vendor?
• Provider?

An HRA is NOT a wellness program!
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Effective Wellness Programs

• Promote change by
• Creating awareness
• Motivating
• Providing tools and skills
• Promoting wellness policies and environments

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Awareness

• Flyers
• Posters
• Email notifications
• Television/video programs
• Books

• Payroll stuffers
• Internet sites
• Magazines
• Lunch and learns
• Special speakers
• Newsletters

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Motivate

• Before/after stories in newsletters
• Incentives can jump start some employees, but
  dont create an entitlement mentality
• Small incentives with each program
• Work toward a larger, benefit-based incentive

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Impact of cash incentives
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Build Skills

• How to overcome barriers
• Goal setting, contracts
• How to strategies
• Healthy substitutions
• Making healthy movement choices
• How to prepare healthy foods
• Finding inexpensive healthy foods

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Thank You!
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What about HIPAA?

• Wellness programs and incentives
• Incentive amount is lt20 of health benefit
• Program must promote health
• Employees can try every year
• Alternative way to earn incentive
• The award rules are disclosed