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©2008 Trion. All Rights Reserved.
1
DESIGNING AND IMPLEMENTING AN
EFFECTIVE CORPORATE WELLNESS PLAN
Dick Tewksbury, Client LeaderTrion Group
DISCUSSION OUTLINE
• Strategic Considerations
• Design and Implementation Process
©2008 Trion. All Rights Reserved.
2
18%
6%
11%
13%
21%
23%
30%
31%
34%
42%
Other
Substance Abuse
Mental health stigma
Fatigue/Sleep problems
Presenteeism
Mental health conditions
Unscheduled absence
Chronic Conditions
Physical Conditions
Lifetyle risks
Source: 2007/2008 Staying @ Work Report
*Percentage of respondents indicating “to a great extent” or “to a very great extent”.
HEALTH ISSUES AFFECTING BUSINESS PERFORMANCE *
Preventable/manageable factors top the list of business performance health issues
©2008 Trion. All Rights Reserved.
3
POPULATION HEALTH MANAGEMENT: Risk Perspective
Patient Safety
HEALTH MANAGEMENT
PROGRAMS
Prevention & Wellness
Care Management
Disease Management
5% o
f mem
bers
0%
10%
20%
30%
40%
50%
-3 -2 -1 0 to 1 1 2 3
80% of members 15% of members
+ + +
Years of Significant Health Care NeedsSource: University of Michigan Health Management Research Center
20% of costs
30% of costs
50% of costsMember annual
cost trend
©2008 Trion. All Rights Reserved.
4
Review of 73 published studies of workplace health promotion programs summarized these results over a 3 – 5 year period:
• $3.50 savings in health-care costs for each dollar invested
• 28% reduction in absenteeism
• 30% reduction in workers’ compensation and disability claims
• 26% decrease in health care costs per member
Source: Partnership for Prevention 2007
WELLNESS AND HEALTH MANAGEMENT: Worth the Investment
©2008 Trion. All Rights Reserved.
5
POPULATION HEALTH MANAGEMENT: Change Perspective
Greatest challenges to successful health management programs are employers’ commitment and/or employees’ willingness to change health behaviors.
Raise Awareness and knowledge
Establish the need and develop the desire to change
Provide access to programs and tools that support change
Recognize and reward behavior change
Reinforce new habits and behavior
Behavior Change Model
Not willing
Not able
Not knowing
Overcome Resistance
Set goals, measure, provide coaching and feedback, reward and recognize.
Educate and train new skills, habits and management techniques
Communicate the what, why, how, when and who
©2008 Trion. All Rights Reserved.
6
POPULATION HEALTH MANAGEMENT: Funding Perspective
• A greater percentage of annual plan cost should be allocated to health improvement and health risk reduction
Pro Forma Spending Allocation for Treatment and Health Improvement
Time Period % Spent on Treatment % Spent of Health Improvement
Current 97% 3%*
Future 90% 10%
*NBGH 2008, Improving Employee Health in Six Steps
• As employers move towards a defined contribution funding approach to health benefits plans, a greater percentage of the employer subsidy should go towards health improvement
Pro Forma Spending Allocation for Treatment and Health Improvement
Time PeriodAllocated to Treatment Allocated to Health Improvement
Employer Employee Employer Employee
Current 80% 20% 3%* n/a
Future 65% - 75% 25% 5% - 10% 0% - 5%
©2008 Trion. All Rights Reserved.
7
PREVENTION & WELLNESS PROGRAM: Strategic Logic
80% of health care & absence costs are preventable
Poor diet, lack of exercise, stress & risky lifestyle cause
most health problems/ medical care needs
Improving these personal health behaviors will prevent health problems and reduce health care & absence costs
The medical community isn’t the solution – it’s designed and
reimbursed to treat the symptoms and results of poor
health, not the causes
The health care services payor is the solution for treating the causes – by encouraging personal health
behavior improvement
Employer-sponsored prevention & wellness programs are a primary solution to long-term health care cost & productivity improvement
©2008 Trion. All Rights Reserved.
8
PREVENTION AND WELLNESS PROGRAMS: Best Practices
• Senior management leadership and financial support
• Internal staffing and corporate and local resources
• Culture that encourages wellness and change
• Ongoing, targeted communication campaign
• Long-term strategies for overall population with targeted, personalized initiatives to each risk segment of the population
• Program design based on employee input and plan cost & utilization data
• Dynamic program integrating risk-identification, benefits plan design, wellness interventions and personal performance incentives
• Comprehensive reporting on program performance metrics and improved cost and outcomes results
©2008 Trion. All Rights Reserved.
9
PREVENTION & WELLNESS PROGRAMS: Delivery Process
IdentifyExpectations
Define Appropriate
Strategy
Assess Current State and Needs
Develop 3-yearStrategy
Implement Strategy
• Define purpose, goals, ROI target of program
• Identify senior management & budget commitment
• Basic provider design
• Interested provider design
• Committed provider design
• Assess current program results
• Identify population health risks
• Determine plan cost and prevalence baselines
• Create the vision
• Discuss strategy elements
• Identify annual programs and incentives
• Set the metrics
• Communicate • Select vendors
• Manage vendors
• Set up incentives administration
• Establish reporting systems
• Monitor & tune-up process
©2008 Trion. All Rights Reserved.
10
IDENTIFY EXPECTATIONS: Discussion Guide
• Why are you considering a prevention and wellness program?
• List the objectives
• Prioritize objectives
• What’s your vision of the program 3 years from now?
• Define scope, timing, and intensity, and who participates in the program
• How involved is senior management in the program’s support and success?
• Identify level of C-suite commitment
• Define senior management awareness and program approval process
• What’s in next year’s budget for the program? Who’s budget is it in?
• Determine how future funding is obtained or increased
• Discuss program “ownership” and leadership within organization
• How does the company culture respond to significant change in accepted behavior?
• Use as guide to design of programs, incentives and ongoing communication
• How will you know the program is successful?
• Develop annual program metrics over 3-year period
©2008 Trion. All Rights Reserved.
11
HEALTH MANAGEMENT/WELLNESS: Types of Providers
TYPE OF PROVIDER NOT ENGAGED BASIC INTEREST MODERATE
COMMITMENT COMMITTED
Level of senior management commitment
• None • Minimal • Typically benefits
management initiative
• Moderate• Typically senior HR
support/involvement
• Substantial & long-term• Active C-suite support• Part of corporate culture
Annual budget commitment
• None• Accepts what built into
medical vendor fees
• Limited• Cost-sensitive• $5 - $25 PEPY range, +
incentives
• Modest• Budget limits define
scope of strategy• $25 - $100 PEPY range,
+ incentives
• Significant• Budget reflects employer
goals• $100 - $300 PEPY range, +
incentives
Program Focus • No strategy• Vendor standard
services, or siloed health management programs
• Voluntary participation• HRA with personal risk
& aggregate activity reports
• Online education, resource & coaching tools
• HRA & biometrics• Personal phone
coaching• Modest participation &
results incentives• Aggregate risk analysis
& results reporting
• Targeted strategy & programs based on HRA and claims risk analysis
• Creative incentives for participation and results
• Integrated wellness, DM and patient safety
Savings and ROI Opportunity
• None should be expected
• Demonstrates doing something
• Limited direct cost savings
• EE morale improves
• Meaningful cost savings• 2:1 – 5:1 ROI expected
over 3 years
• Substantial cost savings• 2% - 4% reduction in annual
trend• 3:1 – 8:1 ROI expected over 3
years
©2008 Trion. All Rights Reserved.
12
ASSESS CURRENT STATE/NEEDS
Purposes• Establish baseline costs and risk/condition prevalence• Compare future annual results to baseline numbers to measure success• Identify primary group health risks and conditions for targeted health
management programs• Identify participants by specific health risks and conditions to develop group risk
profiles and individual risk and health management strategies
Data Elements• Personal Information and Overall Group Results
– Personal interests & engagement in health improvement
– Annual Health Risk Assessment
– Annual biometric screening
– Periodic preventive screenings: Pap smear, mammography, PSA, colonoscopy,
– Personal Health Record
©2008 Trion. All Rights Reserved.
13
CLAIMS-BASED RISK ANALYSIS: Cost Assessment
Health conditions by prevalence
# medical
claimants
Medical/Rx
Annual Cost
# inpatient admissions
# STD
claimants
STD benefit annual cost
Annual days absence
1. X
2. X
3. X
4. X
5. X
6. X
7. X
8. X
9. X
10. X
11. X
12. X
13. X
14. X
15. x
TOTAL
©2008 Trion. All Rights Reserved.
14
RISK-BASED COST ANALYSIS
Health conditions by risk category
# medical
Claimants
Medical/Rx
Annual Cost
# inpatient admissions
# STD
claimants
STD
annual cost
Annual days
absence
Complex/Acute• Health Condition• X• X• X• X
Chronic/Comorbidity• Health Condition• X• X• X• X
Moderate• Health Condition• X• X• X• X
TOTAL
©2008 Trion. All Rights Reserved.
15
DEVELOP and IMPLEMENT 3-YEAR STRATEGY
Vision and Mission
• Keep it simple
• Define how client “sees” the wellness program and/or its results 3-5 years from now
• Brand and communication messages should align with the vision/mission and business plan
Phased Behavior Change Program
• 4 phases to achieve long-term health improvement
• Implement strategy elements consistent with the behavior change phase
Awareness/Education
Awareness/Education MotivationMotivation
BehaviorChange
BehaviorChange
Behavior Reinforcement
Behavior Reinforcement
©2008 Trion. All Rights Reserved.
16
DEVELOP and IMPLEMENT 3-YEAR STRATEGY
Strategy Elements
• Program Participation
• Eligible, enrolled or all employees?
• Dependents?
• If turnover a concern, service-based participation?
• Phased Communication Program
Phase Content
1. Branding/identity • Employee survey and feedback• Logo, program name, tagline, themes
2. Awareness • Issue information• Company commitment and strategies
3. Education & logistics
• Program design, features and value• Instructions on program access, operations
4. Reporting • HRA and biometrics report/risk analysis/next steps• Initiatives participation & results feedback
5. Reinforcement • Individual progress, feedback, recommendations• Overall progress, feedback and program updates
©2008 Trion. All Rights Reserved.
17
DEVELOP and IMPLEMENT 3-YEAR STRATEGY
Strategy Elements (cont.)
• Education Tools
• Online health reference resources
• Personal health records
• Medical/Rx evidenced-based treatment resources
• Benefit plan option comparison tools
• Health Benefits Plan Design/Provisions and Workplace Policies
• Employee Assistance Program and stress management
• Benefits incentives for preventive care services utilization
• Coverage for alternative medicine services
• Smoke-free workplace
• Healthy food choices in cafeteria/vending machines
• Personal Risk Analysis
• Health Risk Assessment
• Biometric evaluation
• Personal health awareness/satisfaction/engagement surveys
©2008 Trion. All Rights Reserved.
18
DEVELOP and IMPLEMENT 3-YEAR STRATEGY
Considerations in Selecting Initiatives• Objective addressed by initiative?• # in population expected to participate?• Participation at multiple sites and multiple work schedules?• What behavior change phase is applicable?• Incentives that should be used?• Timing and awareness/communication of initiative?• Duration and follow-up of initiative?• Internal and vendor resources to deliver initiative?• Total cost to complete initiative?• Success metrics tied to initiative?
©2008 Trion. All Rights Reserved.
19
DEVELOP and IMPLEMENT 3-YEAR STRATEGY
Strategy Elements (cont.)
• Population Lifestyle Initiatives
• Weight loss
• Nutrition
• Stress
• Physical activity
• Smoking cessation
• Alcohol
• Sleep
• Maternity risk management
• Personal Initiatives
• Risk analysis-based intervention
• Multiple risk interventions
• Online, phone or on-site coaching
• Nurse advice line
©2008 Trion. All Rights Reserved.
20
DEVELOP and IMPLEMENT 3-YEAR STRATEGY
Strategy Elements (cont.)
• Incentives
• Incentives are a motivator/reinforcement to change behavior
• Positive incentives encourage adopting new behaviors; negative incentives encourage stopping/reducing bad behaviors
• Three general categories of incentives
• health benefit plan enhancements,
• direct cash payments and
• merchandise
• Think about group and/or individual incentives based on:
• program objectives,
• corporate culture, and
• type of initiative
• Beware of legal considerations – HIPAA, ADA, tax laws
©2008 Trion. All Rights Reserved.
21
DEVELOP and IMPLEMENT 3-YEAR STRATEGY
Strategy Elements (cont.)
• Program Performance Metrics
• Setting up measurement systems and targets are key for several reasons:
• program performance evaluation and level of change,
• demonstrate overall program value and secure continued funding, and
• identify and improve low-performing initiatives.
• Typical metrics categories are:
• Participation
• Participant satisfaction
• Aggregate HRA and/or biometric risk level improvement
• Medical/Rx and disability benefits plan claims costs and trends
• Unscheduled absence improvement
• Overall productivity improvement