Health Rewards: State of Delaware Employee Wellness Project

1
Health RewardsState of Delaware Employee
Wellness Project

• National Governors Association
• Healthy America Meeting
• December 15, 2005

2

• A company cannot be considered successful unless
  it takes responsibility for the physical
  well-being of its employees.
  
• -Kenneth Cooper, M.D. , M.P.H.
• Founder, Cooper Wellness Center

3
Background

• Health care costs are growing at unsustainable
  double digit increases
  
• For the current fiscal year, the State of
  Delawares General Fund increase for health costs
  totals over 35 million out of a total General
  Fund budget for employee and retiree health care
  of just over 300 million.
• In addition to insuring the poor through
  Medicaid, the State of Delaware is one of the
  largest employers in the state
  
• State Health Plan covers over 105,000 lives, from
  newborn dependents to all state retirees
  
• In a time when technology offers exciting
  advances, health conditions are not improving
  
• Plans continue to see prevalence of high risk
  disease conditions such as asthma, diabetes,
  congestive heart failure, and coronary artery
  disease
• Employee health and wellness is a critical
  component of an efficient and productive
  workforce. States must be adaptive and recognize
  the changing needs of employees, at the same time
  they are bound by budget constraints that limit
  compensation increases.

4
Efforts to Control Costs

• Members of the State of Delawares Employee
  Benefits Committee have taken a comprehensive
  look at the quality of health care offered to
  employees
• The State of Delaware has been innovative by
  adding programs that target quality care for
  employees at the same time as curbing utilization
  trends or harnessing price efficiencies and
  economies of scale.
• Comprehensive Disease Management (including
  asthma, congestive heart failure, coronary artery
  disease, diabetes)
  
• Multi-State prescription drug purchasing
  alliance
  
• Plan Design changes (tiered co-pays for
  ambulatory surgery centers)
  
• Aggressive vendor negotiations
• Generics, Step Therapy and prescription formulary
  compliance programs
  
• Enhancing existing federal programs (e.g.
  Medicare COB)

5
Beyond the Traditional Approach

• The State recognizes that controlling costs are
  only one side of the equation
  
• A major drawback is that most wellness programs
  such as Disease Management target those who are
  already sick
  
• True employee wellness programs are an often
  missing, but essential piece to promoting health,
  well-rounded employees
  
• Encourage and reward positive behavior
• Increase productivity and employee satisfaction
• Saves money by reducing future claims costs
• The biggest challenge for employers, particularly
  state governments, is funding now for future
  rewards

6
Pilot Project - 2003

• The State looked at the private sector for models
  of success
  
• Delaware companies had begun to introduce health
  care consumerism through high deductible plans or
  incentive-based bonuses for employees.
  

Difficult to have a paradigm shift in state
government, but moved forward on the basis
that change can happen through
demonstrated success and research data.
Started with an initial 100 person pilot pro
ject with Blue Cross Blue Shield of Delawar
e and Cardio Kinetics.
7
The Concept

• EVALUATE
• Provide a comprehensive health assessment to help
  
  
• individuals learn about their current health
  condition
  
• Assessment includes complete health history,
  resting and exercise blood pressure, blood work
  to measure total cholesterol, lipids and glucose
  levels, smoker-lyzer to test carbon monoxide
  levels, body composition measurements including
  body mass index, and strength testing including
  lower back.
• EDUCATE
• Offers immediate results by screening for high
  risk conditions that may be present, but not yet
  detected
  
• All participants receive exercise prescriptions
  and recommendations for improving physical
  outcomes in all risk areas
  
• MOTIVATE
• Employees are offered regular feedback through
  fit-stop check-ups.
  
• RE-EVALUATE
• Reassess after one year to encourage behavior and
  test improvement
  

8
Preliminary Pilot Data

• Preliminary results confirmed high health risks
  for state employees (overweight, high blood
  pressure, elevated
  
• blood sugar, high cholesterol combined with
  sedentary/low fitness activity) that reflects
  national trends in general population.
  
• Confirmed Cooper model
• 55 people participated in fit stop follow-up
• 26 of the 55 were sedentary, but became active at
  least 3x per week
  
• Of the 5 smokers who attended the fitstop, 2 quit
  between the time of the original assessment and
  follow-up
  
• Of the 5 members with hypertension, all were
  treated and none tested with high blood pressure
  after 6 months
  
• The number of emergency room visits for pilot
  group was 70 per 1,000 vs. 157 per 1000 for the
  remaining population
  
• Direct savings from the last two categories
  translate to over 62,000 for the 100 person
  pilot in the first year alone.
  

9
Project Expansion - 2004

• Expanded pilot study to 3000 assessments
• Improved study by determining the most effective
  motivator
  
• Participants broken into 3 groups of 500.
• Each group will receive the identical assessment,
  fitness
  
• prescription, fit-stop follow-up and one year
  reassessment.
  
• In addition, group B participants are receiving
  intense intervention including monthly coaching
  and newsletters.
  
• Group C participants have been offered a 100
  financial incentive to maintain/improve their
  health status at the time of the one year
  reassessment.
• Study has been reviewed by Institutional Review
  Board for compliance with human subjects protocol
  and all HIPAA privacy regulations.
  
• Expected date of completion May 2006

10
Preliminary Findings Self reported

• Current Risk Status
• 3 or more risk factors 50
• 1 2 risk factors 43
• 0 risk factors 6
• Risk Factor Summary
• Overweight 70
• Family/personal history of cardiovascular disease
  43
  
• Cholesterol (Known-High Cholesterol) 33
• Sedentary Lifestyle 30
• Hypertension 23
• High Psychological Stress 19
• Presently smoking 19
• Diabetes 5

11
Preliminary Findings - Study

• BMI
• 38 with BMI 30
• 33 with BMI of 25 to 29
• Diabetes
• 17 with fasting glucose 110 (pre-diabetic
  condition)
  
• Cholesterol
• 45 with total cholesterol 200
• 21 with HDL
• Hypertension
• 9 with systolic blood pressure 140

12

• As scientific research has shown, it is easier
  to maintain good health through proper exercise,
  diet, and emotional balance than it is to regain
  it once it is lost.
• -Kenneth Cooper, M.D. , M.P.H.
• Founder, Cooper Wellness Center