Corporate Wellness Programs 101

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2 Corporate Wellness Programs 101 Creating an Affordable and Effective Wellness Program Denise Holland Director, Employee Healthcare Hog Slat, Inc

3 Presentation Overview Basic elements of a successful wellness program Wellness program solutions vendors vs. in house Processes and tools you need to create a wellness program most you already know and already have! The future of wellness programs High level outline of an effective wellness program for small to medium sized employer

4 Wellness Program Creation Process Design it Obtain support for it Redesign it (if necessary) Sell it Administer it Measure it Repeat annually

5 Basic Elements of a Wellness Program Starting Data Program Goals Health Risk Assessment/Survey Adoption Employee Biometric Screenings Supporting Programs/Initiatives Incentives, Incentives, Incentives Communication Methods Measurement Tools

6 Should use a vendor for: A reliable health risk assessment tool. A way to collect biometric data on site, if necessary. Translation of communication materials

7 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

8 Starting Data Your TPA 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?

9 Program Goals 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)

10 Program Goals, Con t Decide how you are going to measure success Medical cost only? Absenteeism? Preventive screenings? Employee participation? Employee lifestyle improvements? All of the above?

11 Program Goals, Con t 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?

12 Program Goals, Con t 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. Management must allow employees the time to attend onsite health screenings or health education events if they are a part of the wellness program

13 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.

14 Find a Health Risk Assessment The health risk assessment 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!

15 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 TRALE wellness Wellsource

16 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.

17 To Draw Blood, or Not Draw Blood. Employee biometric screenings provide clear data on an employee s health status. Typical data collected: Height, Weight, Waist Circumference, Blood Pressure, Glucose, Cholesterol. Lots of Pros and Cons..

18 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. Measured year after year, employers can see aggregate health improvements.

19 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.

20 Personal Recommendation - 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.

21 Personal Recommendation - 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.

22 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. If possible, include insured spouses and children. These folks increase your medical costs too.

23 Incentives, incentives, 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. Most successful programs offer premium reductions

24 Incentives, Con t 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.

25 Incentives, Con t There are laws governing how much premium can be impacted by wellness program participation. Rewards cannot exceed 20% of total cost of coverage under the health plan. This will increase to 30% in Start low you so have some where to work up to.

26 HIPAA Non-Discrimination Standards Rewards cannot exceed 20% of total cost of coverage under the health plan. Must be reasonably designed to promote good health. Must be able to qualify for the reward at least once a year Must provide alternatives for any individual who may not be able to meet requirements for medical reasons. Program must disclose the availability of alternative in all program materials.

27 Smoking Cessation One of the most popular behaviors for employee wellness program 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 Discrimintation Standards.

28 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

29 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

30 Program Measurement If you design your program with measurement in mind, at the end of the year measuring results will be simple 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 health improvement. Each year you should be able to better hone in on your workplace s health education and lifestyle change needs.

31 Program Measurement, Con t Bring together a group of employees and ask what they liked or didn t like about the program. Make changes that make sense and that directly impact your goals. Use all of the measurement data to redefine your program goals and tweak the program as necessary to get the results that you need. There is no such thing as an insignificant improvement Tom Peters

32 Health Care Reform Impacts Mandated Coverage With no real way to offset the cost of this, wellness program will be more important than ever. More small employer tax credit for offering insurance As more small employers begin offering health insurance, more will want to implement wellness programs.

33 Health Care Reform Impacts All Plans will have to cover preventive care services at 100% starting in Since this become a larger cost, employers will be even more interested in reducing the costs and incidence of major events again, wellness programs can help. Premium Discount Limits Increase from 20 30% enables employees to make those carrots or sticks bigger.

34 Real Life Example Hog Slat Primary Data 70% male 30% Spanish speaking 15 States 41 worksites 100% rural communities Rising medical trend (5-7%/year) Primarily 40 s 50 s age range, men Heart disease, cancers, premature births highest cost drivers in 2007

35 Real Life Example Hog Slat Goals Participation 75% of insured employees % Medical Cost reduction within 3 yrs. Current trend increasing Number of annual physicals 60% No 07 baseline

36 Real Life Example Hog Slat Health Risk Assessment Know Your Numbers by BioSignia Survey available in English and Spanish Reports available in English and Spanish Physician report sent to PCP Relatively short survey Not based on readiness to change Partnership with DM and CM group

37 Real Life Example Hog Slat Supporting Programs Fitness reimbursement program Weight Watchers reimbursement program Walking program Free gym memberships Healthier options in vending machines

38 Real Life Example Hog Slat Benefit Changes Free annual mammograms Co payment waived for physicals Deductible-free colon cancer screenings Policy Changes 3 hour paid time off for doctors appts Included children, spouses, and parents

39 Real Life Example Hog Slat Incentives Weekly discounts on premiums HRA/Biometric screening Physical with personal physician Increased 2009 discount for goal achievement Financial rewards Quarterly rewards for workouts/ Weight Watchers participation Gift Cards for spouses getting their physicals Walking Program Pedometer, walking logs, lunch bags

40 Real Life Example Hog Slat Communications Mandatory wellness presentation Live Webinars Manager rewards for employee attendance Wellness Booklets Given out at presentations Pay check stuffers s employees and mgmt Flyers specific wellness info locations Home mailers Quarterly health newsletter

41 Real Life Example Hog Slat Measurement tools Participation Count of number of people completing screenings from biometric vendor Employee completed forms for support programs Faxable, -able, mail-able No incentive unless form returned Created simple access database for recording and reporting to payroll Physician required forms confirming physical No results information just confirmation of visit Recorded and reported from database

42 Real Life Example Hog Slat Measurement tools, con t Medical Trend Quarterly report from TPA reporting physicals, medication adherence, new prescriptions, etc. All in the aggregate. DM group provides quarterly update on employees in disease mgmt and case mgmt.

43 Real Life Example Hog Slat Results Participation 78% of insured employees participated 30% of insured spouses All but 1 location had at least one participant 50% of insured employees participated in walking program Medical Costs 2% reduction in year 1 of program Improved medication adherence Physicals 52% of insured employees got an annual physical

44 Real Life Example Hog Slat Changes for Years 2 and 3 Year 2 Moved from HRA/Screening participation goals to behavior change goals. Re allocated premium rewards to support fitness/weight program participation Sent specific preventive care reminders Year 3 Focus on spouse involvement Reallocated premium rewards to increase likelihood of spouses participating in program

45 Real Life Example Hog Slat Results Participation 2008 : 78% / 2009: 78% / 2010: 83% Spouses: 2009: 35% 2010: 49% Health Improvements 7.4% decrease in employees with high cholesterol 8.2% decrease in employees with high blood pressure 9 Employees quit smoking Medical Costs 2% reduction in year 1 of program Year 2 additional 2% Year 3 increase in medical trend due to catastrophic cases Improved medication adherence

46 Mount Olive Pickle Primary Data 56% male / 44% female 15% Spanish speaking 1 States 1 worksites Primarily early 40 s men and women Majority of premium paid by employer

47 Mount Olive Pickle Goals Have a wellness program in place by first quarter of 2011 Participation 70% of insured employees Affordable, most work completed in house

48 Mount Olive Pickle Health Risk Assessment Created in house Created by wellness committee with input from consultant and occupational health nurse Designed to get basic behavior data: Frequency/intensity of exercise Healthy eating habits Tobacco Use Frequency/type of preventive care Data entered and analyzed by consultant using basic Access database.

49 Mount Olive Pickle Biometric Screenings Onsite occupational health nurse conducted biometric lab work. Results provided to nurse and employee only Nurse met with employees to go over the results

50 Mount Olive Pickle Incentives Point Design Premiums would be increasing by $10/week beginning on Jan 1, 2012 In order to avoid premium increase, employees had to earn 25 wellness points between April and Oct. 31, 2011 Points were awarded for various wellness activities Additional incentives such as lunch bags and gift cards were also provided for certain activities

51 Mount Olive Pickle Points Activities Completing the screening, health survey, nurse review of results Workout goals (frequency) over 3 mos or Weight Watchers participation for 3 mos Annual Physical Flu Shot Tobacco Cessation

52 Mount Olive Pickle Early Results 74% Participation 25% Use tobacco 73% Want to quit using tobacco 9% High glucose levels 98% of those are already under a doctors care.

53 Mount Olive Pickle Unintended Benefit While participation in the screenings was high, the completion of all points required was lower. The additional revenue collected form those paying the higher premium will completely fund the second year of the wellness program,

54 Mount Olive Pickle Pros/Cons of Design Allows employees flexibility in how to earn points Employees may need more immediate tangible rewards to stay motivated throughout the year While additional premiums earned will pay for program, at what cost? If behavior change did not take place, only benefit of program was employee education on personal health. Could still see significant benefit from physical requirement. Too early to tell.

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