Wellness Programs

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Wellness Programs
Not Why But How
Derek J. Boyce President, Interra
Health Formerly On-Site Health Care
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Introduction

• Set Goals
• Address Participation
• Use of Incentives
• Communication Plan
• Interventions
• Data Collection
• Data Action
• Compliance
• Outcome Measurement
• Case Studies

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Introduction

• Set Goals
• Address Participation
• Use of Incentives
• Communication Plan
• Interventions
• Data Collection
• Data Action
• Compliance
• Outcome Measurement
• Case Studies

Create Metrics
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Introduction

• Set Goals
• Address Participation
• Use of Incentives
• Communication Plan
• Interventions
• Data Collection
• Data Action
• Compliance
• Outcome Measurement
• Case Studies

Create Metrics
Improve Metrics
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Introduction

• Set Goals
• Address Participation
• Use of Incentives
• Communication Plan
• Interventions
• Data Collection
• Data Action
• Compliance
• Outcome Measurement
• Case Studies

Create Metrics
Improve Metrics
Measure improvements
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Goal Setting
What is the purpose of the wellness program?

• Yes, we have a wellness program

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Goal Setting
What is the purpose of the wellness program?

• Yes, we have a wellness program
• Feel Good program

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Goal Setting
What is the purpose of the wellness program?

• Yes, we have a wellness program
• Feel Good program
• Employee perk

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Goal Setting
What is the purpose of the wellness program?

• Yes, we have a wellness program
• Feel Good program
• Employee perk
• Investment

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Goal Setting
What is the purpose of the wellness program?

• Investment
• What are you going to measure (metrics) ?
• What determines success?
• When do you expect results?

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Goal Setting
Early Measurements

• Program Participation
• Surveys
• Health Status Measurements
• Individual and/or Group
• HRA Data
• Biometric Data

Middle Measurements

• Productivity, Absenteeism, and Disability

Long-Term Measurements

• Claims Data
• WC Data

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Goal Setting
Early Measurements

• Program Participation
• Surveys
• Health Status Measurements
• Individual and/or Group
• HRA Data
• Biometric Data

subjective
Middle Measurements

• Productivity, Absenteeism, and Disability

Long-Term Measurements

• Claims Data
• WC Data

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Goal Setting
Early Measurements

• Program Participation
• Surveys
• Health Status Measurements
• Individual and/or Group
• HRA Data
• Biometric Data

subjective
objective
Middle Measurements

• Productivity, Absenteeism, and Disability

Long-Term Measurements

• Claims Data
• WC Data

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Goal Setting Return on Investment
Early Measurements

• Program Participation
• Surveys
• Health Status Measurements
• Individual and/or Group
• HRA Data
• Biometric Data

5 improvement () ROI
Middle Measurements

• Productivity, Absenteeism, and Disability

Long-Term Measurements

• Claims Data
• WC Data

Do you have access?
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Participation
2 areas of participation

• Health Risk Assessment and Screen
• Follow-up Programs

On-Site Health Care
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Participation HRA/Screen
How many people are going to complete the
HRA/Screen

• Is it voluntary without much marketing?
• Is it provided as a separate initiative?
• Example wellness vendor
• Is there an incentive to take the HRA?
• Example cash

2-5 participation
5-20 participation
20-50 participation
How much?
On-Site Health Care
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Participation HRA/Screen
How much?
Incentives on HRA participation rates
On-Site Health Care
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Participation HRA/Screen
Who Participates HRA and Health Screen
Next Step Include this group
Mandatory for spouses on plan

• Employees Only
• Lose 50 of users

• Include Spouses
• Still not perfect, but better

• Voluntary
• Lose 50 of employees

• Mandatory
• 100 of employees

On-Site Health Care
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Participation HRA/Screen
Who Should Participate HRA/Screen

• Employees should be mandatory
• Covered spouses should be mandatory
• Children can be voluntary

Why?

• Includes population you are paying for
• Can get up to 100 participation
• Improves outcome of program if whole family
  involved!!!!!
• Saves incentive money for FOLLOW-UP PROGRAMS
• Collect real data on your population

On-Site Health Care
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Participation HRA/Screen
How

• Health Risk Assessment and Screen
• Mandatory
• Premium differential (ex. COBRA rates)
• Good vs. Bad plan (ex. eligibility to Good
  plan)

On-Site Health Care
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Participation Follow-up
Who Should Participate Follow-up

• Employees use incentives here (voluntary)
• Covered spouses use incentives here
  (voluntary)
• Children should be voluntary

Why?

• Mandatory follow-up
• creates resentment
• destructive to others
• Incentives on behavior change works well
• Attempt behavior change of entire population

On-Site Health Care
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Participation Follow-up
How

• Follow-up Programs use incentive budget here
• Voluntary (One idea is a point-based program)
• Initial points based on health risk (screen)
• Earn additional points based on participation
• Points get redeemed for incentive perceived
  value

On-Site Health Care
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Participation Follow-Up
Best Incentives

• Benefit Plan
• Premium reduction
• Contribution to a health account
• Deductible reimbursement
• PTO (paid time off)
• Cash
• Be aware of tax implications

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Interventions
Data Collection

• Health Risk Assessments
• Biometric Screening

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Biometric Testing
Biometric components may include

• Fitness
• Height/Weight (BMI)
• Body Fat
• Blood Pressure
• Blood Profile
• Basic tests
• Glucose, Total Cholesterol, HDLs, LDLs,
  Cholesterol Ratio and Triglycerides
• Additional Tests
• Cotinine (Nicotine), PSA, Chem20, etc.
• Fingerstick vs. Venipuncture

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Communication Plan
Program Rollout

• Employee Meetings / Kickoff Seminar
• Program Handouts
• Program description
• Points program
• Contact information
• Flyers, Posters, Tent Cards, etc.
• Emails
• Mail
• Etc.

KEEP EMPLOYEES INVOLOVED!!
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Interventions
Will participants take an active role by
themselves?

• Individual Reports
• Raise awareness
• Change lifestyle
• Take to doctor
• Aggregate Reports
• Corporate programs
• Smoking cessation
• Diabetes management
• Seminar series
• Benefit Changes
• Prevention tests
• Smoking surcharge
• Etc.

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Interventions
Must Have Features for optimal outcomes

• Proactive
• Verifiable
• Ongoing
• Custom built
• Active targeting
• Ability to integrate with outside / existing
  programs
• Provider referrals
• EAP programs
• Disease management programs

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Interventions

• Raising Awareness
• Health Newsletters
• Desk-Drops
• At-Home Mailers
• E-mails
• Website Content
• Health Events
• Self-Care Guides
• Pricing Information
• Quality Information
• Low Level Intervention
• HRA Reports inc. Screening Results
• Post Report Consult
• On-Line Program / Website
• Active Intervention

• Feel Good Programs
• Important as part of comprehensive program
• As independent programs
• Do you expect an ROI?
• How do you calculate ROI?
• If you dont expect an ROI, why do you do it?

Extremely Important Behavior Change ROI
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Active Interventions
Examples

• Active health coach targeting
• Smoking cessation programs
• Lunch-n-Learns
• Weight Watchers
• EAP, disease management, etc.

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Active Interventions Coaching
Forms of Coaching (Interra Program)

• Telephonic
• On-Site
• Combination Telephonic / On-Site

Integrating with Screen

• Screener / Greeter
• Post Report Consults (mandatory?)

Active Intervention Targeting

• High Risk Participants (consult includes moderate
  and low risk)
• Biometric Alerts
• Diagnosed with disease
• Other Targets

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Evaluation Management
Dont Forget

• Set Measurements Ahead of Time
• Set Reasonable Goals

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Wellness Doesnt Work
..Or Does It?
YES!

• Is 5 improvement successful?

• Only need small changes to be effective
• 3-5 change of total risks across population a
  () ROI
• High costs associated with each risk
• Up to hundreds of dollars annually
• Even higher costs when multiple risks in same
  person
• Close to 2,000 annually per high risk person in
  direct health care costs alone
• Low risk employees average of 4,000-5,000 lower
  annual health and productivity costs than
  high-risk counterparts
• Smoking cessation only need a very small to
  actually quit to save money due to cost of each
  smoker

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Calculating ROI
ROI is Well Documented

• 31 to 181
• What is the main difference?
• Direct costs
• Including indirect costs
• What indirect costs
• How are they calculated?
• Actual or perceived
• HRA comparisons
• Biometrics
• Question is not do they work? but Is this the
  right program?

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Calculating ROI
How is your actual ROI calculated?

• Watch ACTUAL health risks decrease
• Rely on statistical data for first 2-3 years
• Associate HRA/Screening data with claims

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Calculating ROI
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Increasing Costs
Worsening Health - Risk Factors
On-Site Health Care
Surviving the Perfect Storm D.R. Anderson,
PhD Source StayWell Data analyzed by University
of Michigan N43,687
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Things to Think About
What is the Purpose of the Wellness Program?

• Reduce the NEED
• for Care

(NOT Limit Access)
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Things to Think About
Reducing the Need for Care by.
Modifying Behavior of Consumers

• Correct Corporate Culture
• Strong Senior Management Support
• Healthy Environment
• Accessible Programs
• Risk Level Appropriate
• Constant Communication
• Ongoing programs
• Not an 8 week fitness program
• Not a fad diet

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Things to Think About
Reducing the Need for Care by.
Modifying Behavior of Consumers

• Correct Corporate Culture
• Strong Senior Management Support
• Healthy Environment
• Accessible Programs
• Risk Level Appropriate
• Constant Communication
• Ongoing programs
• Not an 8 week fitness program
• Not a fad diet

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Things to Think About
Reducing the Need for Care
Modifying Behavior of Consumers

• Long-Term, Sustainable, Positive Changes

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Things to Think About
Who Are We Targeting?
20 Unhealthy High Cost
10 Healthy Low Cost
70 Unknown
Critical Phase
Low Level Intervention
High Level Intervention
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Things to Think About
Bona-Fide Wellness Program

• Nondiscrimination in Group Health
• Bona Fide Wellness Rules
• Can discriminate based on risk if
• Qualified wellness program in place
• Allows Adjustment of Premiums, Contributions,
  etc.
• Lower risk people pay less (ex. Auto insurance)
• Higher risk people pay same if actively
  participate in program
• Maximum Adjustment 20 of Total Individual
  Premium Cost

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Things to Think About
Wellness Program Rules

• If tied to a health standard
• The total reward must not exceed 20 of the cost
  of employee only coverage under the plan.
• The plan must be reasonably designed to promote
  health and prevent disease.
• Eligible employees must have the opportunity to
  qualify for the reward at least once per year.
• The reward must be available to all similarly
  situated individuals and provide a reasonable
  alternative standard for obtaining the reward to
  any individual who does not satisfy the initial
  standard.
• The plan must disclose the terms of the program
  and the availability of a reasonable alternative
  standard.

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Things to Think About
Population Health Management
The Old Way
The New Way
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What Went Wrong?
Manufacturing Company

• 60 to take HRA, 120 if pass 7/9 screening tests
• Follow-up Nothing

Manufacturing Company

• 10 to take HRA 50 participation
• No incentive on follow-up lt2 compliance

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Case Study 1
Manufacturing CWP, HC (RN), Chiro, NP 95
Participation in screen Screen Incentive
Premium Discount Follow-up Incentive Paid Time
Off
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Case Study 2
Manufacturing CWP, Chiro, HC 70-80 Participation
in screen Screen Incentive - None Follow-up
Incentive Premium Reduction / into Health
Account
Fully Insured No Increase (w/o cost shifting)
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Case Study 2
Manufacturing CWP, Chiro, HC Started WC program
fall 2001
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Case Study 3
Manufacturing CWP, HC 45-90 Participation in
screen Screen Incentive Premium
Discount Follow-up Incentive Additional Cash
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Summary

• Risk Detection
• Entire Population Mandatory?
• Stratify Risks
• Subjective and Objective Information
• Risk Resolution
• Program has to be proactive and ongoing
• Create Healthy Culture
• Address all risk categories
• Targeted, customized programs
• Use incentive here
• Compliance
• Integrated into whole wellness objective (benefit
  plan)
• Easy to use
• Incentives on health status/risk resolution (not
  risk detection)
• Measure Outcomes
• Know what and when

If designed properly
Win / Win Employee Benefit / Controls Costs
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Questions and Answers
Derek J. Boyce [phone] ext.
2104 dboyce_at_interrahealth.com www.interrahealth.co
m Thank You!