Program Outcomes. The Wellness Challenge is a registered trademark of HealthForce Partners.

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1 Program Outcomes

2 Introduction HealthForce Partners HealthForce Partners offers extensive expertise designing and delivering highly effective population health management programs. HealthForce is deeply committed to helping our customers evalute the effectiveness of their program. Key health and productivity measurements include: a Healthcare and Productivity Savings a Health Improvement and Risk Reduction a Biometric Improvements a Preventive Healthcare a Program Success a Employee Satisfaction The Wellness Challenge The Wellness Challenge Program Outcomes report is an assorted collection of program evaluation results from Wellness Challenge customers. The primary objective of this report is to: a Justify why investing in this population health management program makes good business sense. a Demonstrate the long-term engagement and sustainability of the Wellness Challenge program in multiple customer settings. a Provide a brief overview of the impact of the Wellness Challenge related to key organization initiatives. a Support the business and investment case for implementing a criteria-based, health incentive program as part of an organization s long-term employee health and productivity strategy. Results will vary depending on the customized wellness program structure, incentive designs, marketing efforts, data collection limitations and leadership support. NOTE: The Wellness Challenge has been featured in several national publications and has received a number of awards for its innovative and outcomes-based approach. To learn more about the Wellness Challenge or to schedule a live web demo, please visit us at: 2

3 Healthcare and Productivity The Wellness Challenge helped this customer produce an impressive 1:6 cost-to-benefit ratio over a 10-year period. $300 Average Monthly Healthcare Cost Per Employee Control Customer $250 $200 $150 $100 $50 $ * * Merger: 1996 reflects the first full year of combined benefits after company in The Wellness Challenge generated a 1:2.7 cost-to-benefit ratio over a one-year period for this customer. $600,000 $500,000 $487,134 $400,000 $300,000 $200,000 $178,200 $100,000 1:2.7 $0 Direct Cost Healthcare Cost to Benefit Ratio and Productivity Savings* * Associated with reductions in healthcare costs and unscheduled leave of absences. 3

4 Healthcare and Productivity continued Three customers located in rural settings enrolled in the Wellness Challenge program. Third party administration data for the three customers demonstrated the following gross savings associated with health and productivity measures. 1 Worker Comp. Reduction 7% Healthcare Cost Reduction 28% Absenteeism 37% 5% 15% 25% 35% Total net savings for the three-year period was $1.6 million, which translated to $762 per Wellness Challenge participant. 1 Medicine and Science in Sports and Exercise, May Volume 33; Issue 5, p 5255 This Wellness Challenge customer also experienced consistently lower sick leave usage for participants versus non-participants during an eight-year program cycle. Sick Time Usage Non-Participants Participants Average Sick Hours Per Year Year 1 Year 2 Year 3 Year 4 Year 5 Year 6 Year 7 Year 8 4

5 Healthcare and Productivity continued Based on multiple customer survey over a 3-year ( ) Wellness Challenge cycle, employee feedback indicated the following: I have taken less sick days since participating in the Wellness Challenge. Participant Responses (%) EMPLOYER SIZE N = >2,000 42% 58% 42% 47% Customer A Customer B Customer C Combined 3-Year Average Customer Group NOTE: Customers selected for this data analysis have offered the Wellness Challenge program for five or more years. I have used my health insurance less since participating in the Wellness Challenge. Participant Responses (%) EMPLOYER SIZE N = >2,000 34% 52% 39% 42% Customer A Customer B Customer C Combined 3-Year Average Customer Group NOTE: Customers selected for this data analysis have offered the Wellness Challenge program for five or more years. 5

6 Healthcare The Wellness Challenge helped this customer experience the following healthcare differences between participants and non-participants during a four-year program cycle.* $4,500 Cost Per Employee Per Year Non-Participants Participants Per Employee Per Month $4,000 $3,500 $3,000 $2,500 $2,000 $1,500 $1,000 $2,009 $1,039 $3,394 $1,064 $3,667 $861 $3,982 $1,854 $500 $ NOTE: Pre-program data was not available. The Wellness Challenge helped this customer experience the following healthcare change between the pre-program and current program period. HEALTHFORCE CUSTOMER A HEALTHCARE TREND PEPM Healthcare Costs $1,400 $1,300 $1,200 $1,100 $1,000 $900 $800 $700 $600 $500 $400 $300 $380 $445 $ % +13% $476 $429 $590 $ % $547 $684 $ % $610 $793 $ % $587 $920 $751 + $684 $1,067 $826 + $659 $1,237 $900 +9% $ $1,435 $972 +8% $ Pre-Program Period (without Wellness Challenge) Program Years (with Wellness Challenge) Projected Healthcare Trend (without Wellness Challenge) 16% Annual Increase Puget Sound Healthcare Trend Number of Employees Average Per Month 2005: 1, : 1, : 1, : 1, : 1, : 1, : 1, : 2, : 1, : 1,809 Pre-Program Period Program Year 1 Program Year 2 Program Year 3 Program Year 4 Program Year 5 Program Year 6 Program Year 7 Year 1 Program Length: Year 2 Program Length: Year 3 Program Length: Year 4 Program Length: Year 5 Program Length: Year 6 Program Length: Year 7 Program Length:

7 Health Improvement and Risk Reduction This 6-year Wellness Challenge customer found that employees who participated in the program and achieved any incentive level averaged $1,779 less in medical costs than those who did not achieve an incentive level. In addition, the analysis showed that a significant and inverse relationship existed between wellness participation points and medical costs. Migration of Modifiable Health Risks This Wellness Challenge customer experienced migration of health risks when comparing HRA data over a three-year period. Migration of Modifiable Health Risks 0 to 5 Low Risk 6 to 10 Moderate Risk 11+ High Risk Year 1 Year 2 Year 3 Wellness Participation, Job Performance and Unscheduled Leave Highly engaged employees (those who participated and achieved an incentive level) in this customer s Wellness Challenge program received better job performance ratings and took fewer hours of unscheduled paid-time-off when compared to other employees. 7

8 Health Improvement and Risk Reduction continued Based on multiple customer survey over a 3-year ( ) Wellness Challenge cycle, employee feedback indicated the following: Reduced 1 or more health risk factors since participating in the Wellness Challenge. 84% Participant Responses (%) EMPLOYER SIZE N = >2,000 65% 57% 67% Customer A Customer B Customer C Combined 3-Year Average Customer Group NOTE: Customers selected for this data analysis have offered the Wellness Challenge program for five or more years. I am healthier when I participated in the Wellness Challenge. Participant Responses (%) EMPLOYER SIZE N = >2,000 79% 86% 76% Customer A Customer B Customer C Combined 3-Year Average Customer Group NOTE: Customers selected for this data analysis have offered the Wellness Challenge program for five or more years. 8

9 Health Improvement and Risk Reduction continued Based on multiple customer survey over a 3-year ( ) Wellness Challenge cycle, employee feedback indicated the following: The Wellness Challenge helped me make positive lifestyle changes during the year. Participant Responses (%) EMPLOYER SIZE N = >2,000 75% 77% 71% 74% Customer A Customer B Customer C Combined 3-Year Average Customer Group NOTE: Customers selected for this data analysis have offered the Wellness Challenge program for five or more years. The Wellness Challenge helped me be more consistent with my exercise and nutrition habits. Participant Responses (%) EMPLOYER SIZE N = >2,000 81% 79% 74% 78% Customer A Customer B Customer C Combined 3-Year Average Customer Group NOTE: Customers selected for this data analysis have offered the Wellness Challenge program for five or more years. 9

10 Health Improvement and Risk Reduction continued Data collected on four Wellness Challenge customers who have offered the program for 5 or more years found the following results for physical activity and five-a-day consumption. Cohort data (pre- and post-program survey) was used in this analysis in order to measure the level of long-term engagement of participants. Physical Activity DETERMINED AS EXERCISE FOR 30 MINUTES OR MORE OF ACCUMULATED PHYSICAL ACTIVITY PER DAY Customer 3-Year Cohort Analysis of Physical Activity Physical Activity Frequency 3-4 x per week 5 or more x per week Cohort Group Exercising 3-5 or more times per week each year Customer A 48% 26% 73% Customer B 43% 42% 85% Customer C 48% 25% 73% Customer D 51% 33% 84% Combined Customer Group 48% 32% Five-A-Day DETERMINED AS CONSUMING AT LEAST FIVE FRUITS AND VEGETABLES PER DAY Customer 3-Year Cohort Analysis of Five-A-Day Consumption Five-A-Day Frequency 3-4 x per week 5 or more x per week Cohort Group Consuming Five or More Fruits and Vegetables 3-5 or more days per week Customer A 41% 37% 78% Customer B 38% 51% 89% Customer C 41% 37% 78% Customer D 53% 27% Combined Customer Group 48% 38% 81% NOTE: A cohort group was defined as all participants for each customer that completed a pre- (month one) and post- (month 12) program survey as part of the evaluation of the yearly Wellness Challenge program. 10

11 Biometric Improvements HealthForce Partners employees who participated in their internal Wellness Challenge program experienced significant reductions in their individual biometric measurements. Healthy Heart Assessment COHORT RESULTS Percentage of cohort group reducing their biometric measures Average decrease of 20 mg/dl Total Cholesterol Average decrease of 17 mg/dl LDL Cholesterol 33% Average decrease of 14 mg/dl 78% Average decrease of 13 mm/hg 57% Average decrease of 10 mm/hg Blood Glucose Systolic BP Diastolic BP Biometric Measures 11

12 Preventive Healthcare Compliance One of the key tactics of the Wellness Challenge program design is to increase the awareness, importance and benefit of utilizing the preventive health benefits offered. By encouraging and rewarding employee s participation with preventive services, the Wellness Challenge program is assisting in mitigating chronic disease and promoting the value and cost effectiveness of early detection. Based on data gathered and reported from a Wellness Challenge customer, there was a 45% increase in Preventive Exams since the beginning of the program. Number of Subscribers Using Preventive Exam Benefit Year 3 1,062 Year Year Year Number of Subscribers 12

13 Program Success This 7-year Wellness Challenge customer (2,000 plus employee population) experienced the following level of engagement for a four-year program cycle. Engagement was measured by successful achievement in the following wellness criteria: physical activity, nutrition, stress management, blood pressure, prevention awareness and individual wellness goal setting. Average Level of Engagement By Year Percent of Successful Participants 58% 64% 62% 59% Year Average NOTE: Average is based on the total eligible population achieving each program period (four program periods per year) for a 12-month program cycle. 13

14 Employee Satisfaction Year-End Participant Satisfaction Survey data from multiple Wellness Challenge customers demonstrates that in several different program categories employees were satisfied with the Wellness Challenge. Program is important part of the culture I took part in the program because I care about my health 76% 82% The program helped keep me on track towards a healthy lifestyle I took part because I could receive an incentive I am healthier when I participate in the program 81% 82% Program motivates employees to improve health habits 83% Nutrition emphasis has been beneficial to my health 77% Helped me be more consistent with my exercise program 73% Like the flexibility of the web-based approach to wellness 94% Program helped me feel positive about the organization 75% Taken fewer sick days since participating in the program 75% Used my health insurance less 59% Very satisfied with the Wellness Challenge 86% 10 14

15 Employee Satisfaction continued Data collected and analyzed over three consecutive years for multiple customers indicate a high level of satisfaction of the Wellness Challenge program for an extended period of time. All customers surveyed had an eligible population of between 1,000 and 2,500 eligible employees. Average Level of Engagement By Year 10 88% 89% 88% Level of Employee Satisfaction Customer A Customer B Customer C Cusotmer D 3-Year Average NOTE: Average is based on the total eligible population achieving each program period (four program periods per year) for a 12-month program cycle. 15

16 Physical Activity Organizational Dashboard ORGANIZATIONAL DASHBOARD Physical Activity CUSTOMER A CRITERIA DEFINITION Earn a minimum of 45 points per period (worth 1 credit) or 75 per period (worth 2 credits). A maximum of two points can be accumulated per day. Each period consists of three months. COMPANY SIZE 2,035 TOTAL PARTICIPANTS 1,790 88% of eligible TOTAL PARTICIPANTS BY CATEGORY Employees 1,558 Physicians 232 TOTAL POINTS EARNED 445,578 TOTAL MINUTES RECORDED DURING PROGRAM YEAR 13,367,340 AVERAGE INDIVIDUAL MINUTES DURING PROGRAM YEAR 143 TOTAL PARTICIPANTS WHO AVERAGED 150 OR MORE MINUTES DURING PROGRAM YEAR 944 TOTAL PERCENT OF PARTICIPANTS WHO AVERAGED 150 OR MORE MINUTES DURING PROGRAM YEAR % 1 The United States government recommends adults get at least 2.5 hours of moderate-intense exercise each week or one hour and 15 minutes of vigorous-intense exercise or a combination of both. Adults should also engage in muscle strengthening activities like lifting weights or doing push-ups at least twice per week. 2 According to CDC (2013 Press Release), about 20 percent (or one in five adults) are meeting both the aerobic and muscular strengthening components of the physical activity recommendations. Nationwide, nearly 50 percent of adults are getting the recommended amounts of aerobic activity and about 30 percent are meeting the recommended muscle-strengthening activity. NOTE: Icons made by SimpleIcon 16

17 About HealthForce HealthForce is a single-source provider of workplace health solutions, serving thousands of local, regional and national employers. We are an innovator in employee health, offering superior care to injured and ill employees, and designing and delivering workplace health services to improve employee health and productivity. HealthForce Partners North Creek Parkway, Suite 106 Bothell, WA