©2008 trion. all rights reserved. 1 designing and implementing an effective corporate wellness plan...

©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


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


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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


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


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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


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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%


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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


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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


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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


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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


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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


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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


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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


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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


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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


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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


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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


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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?


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• 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


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• 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


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• 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

©2008 trion. all rights reserved. 1 designing and implementing an effective corporate wellness plan...

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