The Caesars Palace, Las Vegas November 2 nd 6 th,

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1 The Caesars Palace, Las Vegas November 2 nd 6 th, The use, disclosure, reproduction, modification, transfer, or transmittal of this presentation with out the written permission of the Employer Healthcare & Benefits Congress is strictly prohibited Employer Healthcare & Benefits Congress

2 Introduction to Corporate Wellness Beginning Steps to Implementing a Corporate Wellness Program Denise Holland Director, Employee Healthcare Hog Slat, Inc.

3 Presentation Overview Basic elements of a successful wellness program Incentive philosophies, design, and legal issues Wellness program solutions vendors vs. in house Program Measurement Wellness program design examples

4 Basic Elements of a Wellness Program Starting Data, Problem Identification, Goal Setting Health Screenings (Biometrics) Health Risk Assessment/Survey Supporting Programs/Initiatives Incentives and legal considerations Communications/Tone Setting Program Measurement Continuous Quality Improvement

5 Reality Check Self Funded Health Plans vs Underwritten Health Plans Modifiable Health Conditions Catastrophic Illness and Claims Untouchables This is a marathon, not a sprint

6 Problem Identification/Starting Data/Goal Setting Before you can decide where you are going, you have to know where you are! Who are your employees? What are the key cost drivers? What is your claims cost trend? What are other metrics that could be improved by a wellness program? Absenteeism? ER utilization? Generic drug usage? Knowing this information at the beginning will help you measure change in the end.

7 Starting Data Your Third Party Administrator or insurance company can provide aggregate health reporting ask them for it! Number of diabetics Number of heart disease Number on blood pressure meds Using a basic spreadsheet you can pull together demographic information from HR data collected upon hire. Gender Age Race Number of heart surgeries Number of physicals by gender/age Language preference Where do they work? What type of work?

8 Claims Data Limitations Your TPA or insurance company or broker will be more than happy to provide you with aggregate data based on your employees health insurance claims. While this is good information, it has one large drawback: THIS DATA IS ONLY FOR THOSE EMPLOYEES ALREADY GOING TO THE DOCTOR AND GENERATING HEALTH CLAIMS. This data will not help you understand the health behaviors and risks of those in your population who are not seeing a physician or getting preventive care.

9 Goal Setting Decide how you are going to measure success Medical cost only? Absenteeism? Preventive screenings? Employee participation? Employee lifestyle improvements? All of the above?

10 Health Screenings (aka Biometrics Screenings) Employee biometric screenings provide clear data on an employee s health status and risk. Typical data collected: Height and Weight (can then calculate BMI) Waist Circumference Blood Pressure Glucose Cholesterol Lots of Pros and Cons..

11 Biometrics Screenings: Pros Valid indicator of employee population health Not based on employee self reports Employees get a health report that provides them with critical lab scores. Some screening providers do real time health coaching Measured year after year, employers can see aggregate health improvements.

12 Biometrics Screenings: Cons Expensive! Employees or unions might pushback on providing this level of health information Just because employee sees their health scores does not mean they will do anything about them. Lots of privacy concerns to think about if you get individual health data.

13 Annual Physicals If biometric screenings are unaffordable, consider providing an incentive for employees to have an annual physical Provides two major benefits: 1) Employee establishes (or reinforces) usual source of medical care. 2) Doctor then can discover and manage any health issues, promoting preventive care and treatment of chronic conditions.

14 Annual Physicals, Cont. You will be able to measure the increase in the number of people getting physicals. Typically also leads to increase in preventive care screenings. You WANT these expenses. These will help you reduce the risk of the higher costs of chronic conditions and major health events. If you want aggregate, valid lab data Have employees voluntarily submit lab work results and reward them.

15 Health Risk Assessments Surveys employees about lifestyle and health behaviors. Purpose is to better understand the habits, attitudes, and knowledge of employees with regards to their health. Many of these tools provide a risk score that lets employees know how at risk they are for developing chronic conditions. Biggest limitation: Self reported data

16 Find a Health Risk Assessment The health risk assessment combined with biometric data should be the base of your wellness program It enables you to collect aggregate health data on employees and if done annually will provide longitudinal data. This should be the requirement for entry into the wellness program. No other rewards should be available without completing this step. You should reward people for participating you can t have a program without this information!

17 Find a Health Risk Assessment From a privacy perspective you want a vendor to handle the HRA. Ask your health insurer or TPA if they offer an HRA with an available management report. Look online for HRAs available to employers Some popular options: Know Your Numbers BioSignia Wellsource University of Michigan

18 Choosing a Health Risk Assessment When choosing an HRA, make sure it at least meets the following specs: It is modifiable at an affordable cost The survey AND report are available in multiple languages, if necessary The survey is available electronically and in paper form, if necessary Both the paper and e-version are available in other languages, if necessary Not too long think about what you program really need to know to set goals The survey is at the correct reading level base this on the lowest education level of your employees.

19 Supporting Programs/Initiatives The health risk assessment and/or biometric screening is only the base of the program. Unless you encourage and reward people to make lifestyle changes, you just have a load of data. The first year of a wellness program should focus on behaviors, not outcomes. Find healthy behaviors that can be measured number of workouts, number of pounds lost, having a physical or preventive screening, lunch and learn attendance.

20 Supporting Programs - Examples Gym or Weight Watchers reimbursements Weight loss competitions Walking programs Rewards for preventive care screenings Rewards for annual physicals Culture Changes Healthy vending machine fare Policy on company supplied lunches or dinners

21 Smoking Cessation One of the most popular behaviors for employee wellness programs to tackle is tobacco use Tobacco users, an average, cost employers $3,400 more per year due to medical costs, absenteeism, and productivity losses. Tobacco cessation has to be more than a part of the wellness program to be effective. It must also be a part of the corporate environment and philosophy. You can reward employees for individual health behaviors such as smoking as long as you meet all of the HIPAA Non Discrimination Standards.

22 Wellness Program Incentives: Philosophy Used to motivate and reward people for healthy behaviors or outcomes There is a 70% increase in wellness program participation when an incentive is offerred*. Two types of incentives: Intrinsic: intangible award of recognition or a sense of achievement motivation Extrinsic: award that is tangible or physically given for accomplishing something as recognition of ones endeavor.

23 Wellness Program Philosophy What is your Wellness Philosophy? Make em do it? (stick) Make em want to do it? (carrot) Make em want to do it so bad it hurts (carrot so large it feels like a stick)

24 Wellness Program Incentives Incentives are the carrot the bigger they are, the more they act like a stick Know what incentives make the biggest impact on your employees Premium reductions Vacation days Casual days Gift certificates Cash Water bottles, bags, t-shirts, etc. All rewards are taxable over a nominal amount make sure your employees are aware of this.

25 Vendor vs In House If program progress is easy to measure, you could manage the incentives in house. There are a number of great vendors who will do this for you, but it is an added cost. Partner with payroll and HR to see how easy or difficult it is to implement a financial incentive. Keep an eye on tax laws.

26 Wellness Program Incentives: Laws Always get legal guidance on your wellness program design. The information about to be presented is not intended to provide legal advice for any specific individual or organization. Two Types of Wellness Programs Non-HIPAA Programs HIPAA Programs Main distinguishing feature: Whether or not the incentive is based on only behavior or is based on a Health Factor

27 Examples Non HIPAA Program: Provide incentives for completing a health surveym regardless of the results Reimburses fitness center dues Waive co pays or deductibles for preventive care Rewards for attending lunch and learns HIPAA Program: Offers different premiums for smokers vs non smokers Offers different premiums or other discounts based on acceptable biometric values (weight, bp, cholesterol, etc) Any reward that is based on achieving a health status

28 HIPAA Programs Employers can discriminate against unhealthy employees with respect to financial rewards, but they must meet the following 5 HIPAA Non- Discrimination rules: Reward or penalty cannot exceed 20% of total premium cost for employee coverage. Must be reasonably designed to promote good health. Must be able to qualify for the reward at least once a year Reward must be available to all similarly situated individuals. Program must disclose the availability of alternative in all program materials.

29 Alternative Standard Disclaimer If it is unreasonably difficult due to a medical condition for you to achieve the standards for the reward under this program, or if it is medically inadvisable for you to attempt to achieve the standards for the reward under this program, call us at [insert phone number] and we will work with you to develop another way to qualify for the reward. -US Dept of Labor

30 Some Words of Advice Don t make your program mandatory Don t base rewards on outcomes your first year Don t think of the program as something you are doing to your employees, but for them For those with health issues, bend over backwards to accommodate Put the disclaimer on everything

31 Communication Methods You must find the communication vehicles that will reach the most people Know your population How do people in each work location find out company information? What are the primary languages people read and speak in? What is the lowest level of education most employees have? Write to that level. Do not assume that people have internet availability at home or that they are willing it to use it for tracking wellness activities.

32 Communication Methods, Con t Communicate in as many different ways as possible. Pay stub stuffers Home mailings s Voic s Posters, flyers, etc Management briefings You can t over communicate. Keep it as simple as possible

33 Program Measurement If you design your program with measurement in mind, at the end of the year measuring results will be simple How you decide to measure success will directly impact how you design the elements of your wellness program. Some basic measurement will remain year after year. Some will be added as years go on.

34 Program Measurement It is easier to move employee biometrics than claims costs initially. A well designed program will move these key health indicators. If possible, stick with the same HRA each year so you can compare results. Repeat all of the initial aggregate health data that you pulled when designing the program and compare the before and after. Use these results to identify areas of needed health improvement and change your program accordingly

35 Program Measurement, Con t Don t underestimate the important ace of qualitative measurement. Make changes that make sense and that directly impact your goals. Use all of the measurement data to redefine your program goals annually and tweak the program as necessary to get the results that you need. There is no such thing as an insignificant improvement Tom Peters

36 Program Design Advice Make sure that your company HR policies support your wellness goals Do all employees have sick leave or able to be paid while at a doctor s appt? If not, those who work by the hour may not be able to afford to see a doctor for a physical. Make sure that all employees have the same opportunity to meet the goal(s) If you want them to have a physical, do they all work 9-5 making seeing a doctor easy? Do they all have wellness benefits, making seeing a doctor affordable? If you want them to work out at a gym, is there an affordable location for all worksites? Do you give them time on the job for this? If you want them to eat healthier, do you provide healthy items in the snack machines? Are there local eateries with healthy options? Do you have a microwave, refrigerator, and/or oven at each location?

37 Vendors Should Use for A reliable health risk assessment tool. A way to collect biometric data on site, if necessary. Translation of communication materials

38 What you could use a vendor for, but could probably do in house: Employee demographic data Program communications Program award distribution Program design based on health risk assessment/biometrics results

39 In Conclusion Design your program with measurement in mind Wellness programs should not be static, but goal oriented and evolving Pay attention to the laws governing incentives Wellness needs to be not only a project, but also a culture change Design the program based on the unique needs of your employee population. Be sure that your benefits and HR policies are consistent with your wellness goals.

40 Thank You! Denise Holland President Inside Employee Wellness & Consulting (919)