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Improving business and employee health through business strategies.
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Employee WellnessThe new business strategy shaking things
up!
Benjamin PrinzingFounder / Managing PartnerKadalyst Health Partnerswww.kadalyst.com
Wellness Lingo
Business Case
• Chronic diseases related to lifestyle account for 75% of national medical costs. Eleven separate studies by the Centers for Disease Control suggest that worksite wellness programs can produce significant improvements in employee health.
• Heart disease remains the #1 killer of Americans• Approximately, 45% of diseases and deaths are preventable
• People with chronic disease often drive 50% of costs• 20% of members drive 80% of costs• Those with lifestyle risk factors can cost 10% - 70%
more than those not at risk
Business Case
Genetics Behavior Environment Access to Care
20% 50% 20% 10%
Employee Behavior Determines 50% of Health Status and Associated Costs…
…Plus, employees spend a 1/3 of their waking hours at work. Making it an ideal place to promote healthy behaviors that will increase productivity while on paid time.
Iceberg Phenomenon
1 Diseased, diagnosed & controlled
2 Diagnosed, uncontrolled
3 Undiagnosed or wronglydiagnosed disease
4 Risk factors for disease
5 Free of risk factors
Diagnosed disease
Undiagnosed orwrongly diagnosed
disease
25%
75%
Visible Costs
Non-visible Costs
Direct Medical Costs• Medical
• Pharmacy
Indirect Medical Costs• Presenteeism
• Short Term Disability• Long Term Disability
• Absenteeism • Workers Compensation
Indirect costs represent 2-3 times Direct Medical Costs
An Inside Look
Tangible Benefits to Employer
• Increased productivity• Reduced absenteeism• Increased employee retention
• Lower turnover: reduced recruiting and training costs• Worker’s compensation
• Address stress, ergonomics, and other risks that can cause on-the-job injury• Weight Reduction• Enhanced physical activity• Work/Life balance• Improved company morale• Improved employee awareness and engagement• Increase loyalty
Obstacles – Top 10
1. Low program participation2. Little to no executive level buy-in and/or support3. No formal plan4. Inappropriate or wrong programs and/or tools5. Wrong or poor messaging6. Little to no customization (making it your own)7. Unrealistic expectations8. Little to no formal budget9. Not a part of company culture10.Little to no evaluation strategy
What’s a Wellness Program?
Source: Chapman, Planning Wellness, Chapman Institute, 2008, p. 213.
Integrate Health & Wellness Services
Total Health & Productivity
Management
Medical Care•Diabetes education pilot• Injury and medical management
Health Advocate• Provide Direction• Get the Care You Need• Coaching & Outreach Health Plan Design
Environmental DesignBehavioral Health• Work/Family•Work Life Plus
Health Portal•Stay healthy•Health information• Make informed choices
Health Risk Assessment • Assess and track health behaviors• Maintain health• Address health risks
Fitness Centers•Low risk maintenance•High risk reduction
Wellness Programs•Active expansion•Retiree communications/awareness program
Disease Management•High Acuity (identified high cost disease)
•Low Acuity (identified lower cost disease; lifestyle behavior focus)
Case Management
• STD, LTD• Workers’ Compensation• Scattered Absence
Absence Management
Long Term Strategy
Health & Wellness Workflow
Funding Wellness
The Healthy Driver Discount
Results-based wellness is like a good driver discount for group health.
• Drivers with fewer tickets and accidents pay less.
• Non-smokers pay less for life insurance.
• Homeowners with security alarms pay less.
Do you think it is fair for employees who live healthy lifestyles to pay a
lower contribution for their insurance?
• For example, non-smokers pay less than smokers?
Market acceptance and adoption of results-based design programs
Outcomes-based
Outcomes-Based • High Impact ROI – Year one. • Transformative behavior change
in year one with corresponding high member engagement. (97%)
• Requires compliance with 2008 Final Wellness Rules.
• Preferred model of budget conscious employers searching for cost neutral solution.
• Creates cultural shift in employee population with instilled sense of urgency to achieve personalized wellness objectives.
Participation-Based • Promise of projected pay-off in five
years dependent upon % of participation.
• No ability to track participation relative to member behavior change with member engagement limited to the working well.
• Self Reported Participation requires little oversight and zero compliance.
• Preferred model of BUCAs: low cost/low impact, maintains “socialized” status quo contribution strategy, fulfills wellness offering mandate.
• Requires no cultural shift in employee population.
HIPAA Final Wellness Rules
If an incentive is “contingent upon the satisfaction of a health standard”:
It must be re-assessed at least once per year
It must be designed to promote health and wellness
It may not exceed 20% of the total cost of coverage offered (to be raised to 30% effective January 1, 2014)
It must be available to all “similarly situated individuals”
Appeals and “reasonable alternatives” must be included
The availability of appeal must be disclosed in all plan materials
12
3
456
Outcomes-based
NOTE: vendor to manage appeals and gives alternatives if these goals are medically inadvisable or unreasonably difficult due to a medical condition.
Participation and Result Requirements
Category NIH Goals Revised “Gentle” Goals Points
Tobacco/Nicotine: Negative Negative 1
Blood Pressure: <120/80 <140/90 1
Cholesterol: <100 (LDL) <160 (LDL) 1
Body Mass Index:(Body Fat % and Waist Measurements are also considered – automatically!)
<25 <30 1
Kadalyst coordinates biometric screenings for all employees
Each employer can design goals for their culture and budget.
Sample design
Outcomes-based
Choose Plan(s) from Any Carrier or TPA
Total Monthly Premium
Current Employee
Contribution
“Gentle” Contribution Adjustments Based on Wellness Results
$515 $103 +$40 +$20 +$10 +$5 +$0 -$5
$1,212 $242 +$60 +$40 +$25 +$15 +$0 -$10
Employee earns contributionreduction or penalty.
Sample design
Single
Family
Adju
st b
ased
on
poin
ts e
arne
d Non-Participation
Pass 0 Pass 1 Pass 2 Pass 3 Pass 4
Outcomes-based
A minor shift with MAJOR results!Immediate ROI that drives participation.
Outcomes-based
Potential Uses of Funding For Rewards Based Incentives
• Cash Rewards
• HSA Contributions
• 401K Contributions
• Gift Cards
• Voluntary Product Offerings
• Paid Vacation Days
Outcomes-based
Results-based programs drive RESULTS!Employees earn points by achieving healthy and reasonable goals
10-Step Plan Design
10-Step Wellness Plan Design
STEP 1:Planning Committee
STEP 2:Needs Analysis
STEP 3:
Setting Goals
STEP 4:Pick a Framework
STEP 5: Mission & Brand
STEP 6:
Select Initiatives
STEP 7:
Action Plan
STEP 8:
Prepare the Budget
STEP 9:
Communication Plan
STEP 10:Evaluate Plan
Step-1: Planning Committee
• Keep it small (3-5 members)• Appoint a chair person• Include an Influencer (Exec. OR Exec. Assist.)
• Establish a Meeting Calendar • (wkly, monthly, qrtly)
Step-2: Needs Analysis
1. Organizational structure/locations2. Employee demographics (age, gender,3. health status)4. Benefit plan enrollees5. Company policies & procedures
(employee handbook)6. Cultural audit7. Industry & facility functions8. Health claims data:
– Total health care cost per employee per year and top ten leading physical and mental health claim conditions
9. Employee health risk data (via HRA)10. Biometric data
– Full lipid panel, blood glucose
11. Physical assessment data– Height, weight, blood pressure, BMI, heart
rate, body-fat%
12. Job satisfaction13. Pharmacy data14. Absenteeism data15. Accident reports16. Short and long-term disability claims17. Workers compensation claims18. Presenteeism data through self-reported
surveys19. Review of current health promotion
activities such as participation and completion rates of specific initiatives
20. Employee turnover report21. Health plan benefits22. Other health benefits including
Step-2: The Findings
Worksite Wellness Assessment
(Wellness Program Scorecard)
Senior management completed a comprehensive survey that takes a subjective look at specific program components, such as leadership support and environmental policies. Findings (as assumed due to year-1 programming) identified all aspects of programming either need to be implemented or enhanced. Out of 70 possible points, our company scored 12, or 17%. Improvement opportunities include each evaluated component:
Infrastructure – including program branding, wellness committee and operating plan
Program Components – including education, awareness and incentives
Physical Activity Programs Nutrition Programs Mental Health / Stress Tobacco Use Assessment & Evaluation
Employee Interest Survey
The following were identified as areas of interest by our employees:
Health screenings Physical activity Stress management
Educational programs Healthy eating Financial wellness
Health Risk Assessment
The following were identified as areas for improvement: 56% of the employee population is either overweight and obese 20% frequently use tobacco products 51% frequently consume sugary foods 51% have not had a physical exam in over 24 months 71% do not have a primary care doctor 33% have depression symptoms and 26% have frequent stress
Workforce Demographics
125 employees 35 store locations 70% Caucasian
Median age of 27 Staff members mainly work within a retail environment Easy access to smartphones, email and the Internet
Step-3: Set Realistic Goals
Goal1. Rationale
2. Objectives
3. Strategies• Promotion• Actvities
• Policies, etc.
4. Resources Needed
5. Timelines
6. Evaluation
Step-4: Program Focus
Accountability
Action
Activity
Awareness
Program Requirement Samples
Step-4: Program Model
Step-5: Purpose & Branding
• Based on goals you can now…• Establish a clear mission & vision statement• Create a brand; name, logo, tagline and theme
Step-6: Select Initiatives
Individual
Environment
Policy
Step-7: Action Plan
Activity/Program/Policy Materials & Resources OwnerTime frame
Evaluate P I EEst. Hrs.
Budget
Provide educational handouts on physical activity via Newsletters
Materials available on coaching portal and additional resources can be provided on company Intranet
Nancy Ongoing n/a ✔ ✔ 1 $.12/per
Create a walk-and-talk meeting policySupervisors will support this as a standard work practice. An informal policy can be written.
Tony Aug. 2013 n/a ✔ 0.5 n/a
Activity/Program/Policy Materials & Resources OwnerTime frame
Evaluate P I EEst. Hrs.
Budget
Promote physical activity challenge(s)Separate action plan tracker (use Appendix D), communication plan, announcement letter, sign-up, etc.
JodyAug. 2013Jan. 2014
Participation & Sat. Survey
✔ ✔ 8-10 $2 PEPM
Promote health coaching to develop individual exercise routines
Coaches within session will setup individual trackers
Bill Aug. 2013Activity Tracker Report
✔ N/A$20/per session
Activity/Program/Policy Materials & Resources OwnerTime frame
Evaluate P I EEst. Hrs.
Budget
Provide health tracking deviceOnline, sign-up, Order devices,
setup online platformJohn TBD
Participation / Sat.
Surveys ✔ ✔ $40/ea.
Low
Mod
erat
eH
igh
Step-7: Calendar of Events
Step-8: Budget
Step-9: Communication Plan
Members to Include Activity Communication Strategy Resources Needed Assigned to:
Date to Launch
Internal Office Staff
HRA Launch
Emails via Mailchimp, dept., meetings, posters on
Wellness Wall
HTML email template, posters
from vendor, talking points for
managers
Nancy 10/1/13
Remote Office Email, conference callConference line
and email templates
Nancy 9/28/13
DriversHandouts in vehicle, text
messaging, posters on lockers.
Materials printed Bill 9/25/13
Production (ESL) Posters in lunch room, payroll stuffers
Translate Promotional
MaterialJohn 10/1/13
Spouses Not participating
Step-10: Evaluation Plan
Method or Type Description
Program ParticipationTrack all program participation by sign-in rosters and/or online sign-up surveys. The survey tool also tracks non-participants for further outreach.
Program SurveysOnline surveys are sent to every activity participant for reporting purposes, employee comments and suggestions are used to improve future initiatives.
Online Health TrackersEmployees will have the opportunity to track various health metrics via a HIPAA compliant health portal.
Online QuizzesHealth promotion challenges may consist of quizzes to establish a knowledge baseline to further adjust programming.
Online PollsOnline polls are an easy to way to quickly identify employee interest or stats on a specific topic, which can be emailed out or posted on website to show instant results.
Health Coaching Report Health coaching reports illustrate total sessions and session types.
HRA Summary ReportAnnual summary report of employee health risks are used for baseline analysis and year-to-year comparison.
Wellness Program Awards
Healthiest Employers of Oregon (HEO) and the American Heart Association’s “Fit Friendly Company,” are rewards that provide recognition to companies that achieve certain levels of wellness programming.
Wellness Program Scorecards
A subjective look at your wellness program that covers an array of program components. A side-by-side comparison from year-to-year can help push efforts forward and show opportunities for improvement or enhancement.
Culture of Health
Culture
HealthierPeople
ProductiveEmployees
Gains for TheOrganization
1. Health Status 2. Life Expectancy 3. Disease Care Costs 4. Health Care Costs5. Productivity
a. Absence b. Disability c. Workers Comp. d. Presenteeism e. Quality Measure
6. Retention 7. Company Visibility8. Social Responsibility
Leadership Vision Environmental SupportBenefits & PoliciesIndividual Strategies Population Strategies Incentives Measurement
Integrating Health Status into the Culture of the Company reduces barriers,
activates engagement and sustains healthy behaviors.
Incentives
No Incentives 2% - 10%Passive Incentive 15% - 25%
Small item incentive 20% - 35%
Cash incentive 20% - 40%
Benefit plan improvement 30% - 60%
Benefit plan plus cost reduction 50% - 70%
Combination of benefits and cash 75% - 100%
*Dee W. Edington, PhD, Zero Trends
Devices & Gamification
Wellness Awards
Learning Points
3. “Total Population Management” is the effective healthcare strategy and to capture the “Total Value of Health”
2. Refocus the definition of health from “Absence of Disease to High Level Vitality.”
4. The business case for Health Management indicates that the critical strategy is to “Keep the Healthy People Healthy” (“keep the low-risk people low-risk”).
5. The first step is, “Don’t Get Worse,”then develop a long-term strategy to embed wellness into your company culture
1. The “Do Nothing” strategy is unsustainable.