copyright © health behavior innovations 2008 accountability-based employer wellness programs...

Copyright © Health Behavior Innovations 2008Copyright © Health Behavior Innovations 2008

Accountability-BasedAccountability-BasedEmployer Wellness ProgramsEmployer Wellness Programs

Darrell Moon, CEOHealth Behavior Innovations

Developing Value-Based Programs to EnhanceEmployee Health Productivity and Outcomes


Presentation OutlinePresentation Outline

Program designProgram design

ResultsResults

Financial Impact & Return ModelFinancial Impact & Return Model

Federal guidelinesFederal guidelines

Wellness at no-net cost to employerWellness at no-net cost to employer


Program DesignProgram Design

MeasureEveryone’s

HealthStatus

HealthyIndividuals Participate

In HealthPromotionCampaignsThose with

Health Riskswork

with a coach

Must adhereto program

requirementsto get

incentive


Fair to Each PersonFair to Each Person

Create an Alternative StandardCreate an Alternative Standard– IndividualizedIndividualized– Unique to specific health conditionUnique to specific health condition– Designed by the personDesigned by the person– Approved by the coachApproved by the coach– Individual accepts ownershipIndividual accepts ownership


Accountability is KeyAccountability is Key

Accountability to a health coachAccountability to a health coach

Accountability for tracking progressAccountability for tracking progress

Accountability for goal successAccountability for goal success


Individualized SupportIndividualized Support

Support of a personal health coachSupport of a personal health coach

Key to sustained participationKey to sustained participation


ResultsResults

FinancialFinancial

Employee SatisfactionEmployee Satisfaction

ProductivityProductivity

Health StatusHealth Status


FinancialFinancial

Case Study 1 Ken GarffCase Study 1 Ken Garff

Case Study 2 Utah CountyCase Study 2 Utah County


Case Study 1Case Study 1

Ken Garff:Ken Garff: Multiple locations throughout UtahMultiple locations throughout Utah

730730 Total Benefited Employees Total Benefited Employees

453453 Wellness Plan Participants Wellness Plan Participants

1 Year period: 2005 1 Year period: 2005 (Jan.-Dec.)(Jan.-Dec.)

Analysis of claimsAnalysis of claimsto calculate actual savingsto calculate actual savings

Average Change in Annual Claims for Non-Participants

Minus

Average Change in Annual Claims for Participantswho stayed involved

$151.22(outliers excluded for statistical validity )

11stst Year Claims Savings Year Claims SavingsFrom Employees Who Stayed InvolvedFrom Employees Who Stayed Involved

$50,507

0

10,000

20,000

30,000

40,000

50,000

60,000

$151.22 X 334Savings PerParticipant

Number ofParticipants

Total ClaimsSavings

Financial ImpactFinancial ImpactCosts versus Savings 1Costs versus Savings 1stst Year Year

Total Program Costs

Total Claims Savings

0

10,000

20,000

30,000

40,000

50,000

60,000

Saved Over

109%of Costs

in1st Year

$46,005$50,507



Utah County:Utah County: government entitygovernment entity

950950 Total Benefited Employees Total Benefited Employees

808808 Wellness Plan Participants Wellness Plan Participants

420 Coached Participants420 Coached Participants

1 Year period: 2007 1 Year period: 2007 (Jan.-Dec.)(Jan.-Dec.)

Prio

r to

Inte

rven

tion

Prio

r to

Inte

rven

tion

Prio

r to

Inte

rven

tion




Employee SatisfactionEmployee Satisfaction

Happier WorkforceHappier Workforce

Ken Garff Participant Satisfaction Survey

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15

Agree or Strongly Agree No Opinion Disagree or Strongly Disagree

Customer Satisfaction


Customer Satisfaction Survey Questions:

1. Positive overall impression of the wellness program.

2. Insurance discount played a significant role.

3. Assessment process was helpful.

4. Coach took the time to learn about me and my health concerns.

5. Coach educated me about things I could do to improve my health.

6. Coach helped me develop goals I could own and am willing to do.

7. My goals are realistic and will stretch me but not overwhelm me.

8. Coach is knowledgeable and professional.

9. Coach is caring and compassionate.

10.Coach has been a motivation for me to improve my health.

11.Coach has helped me understand the wellness program.

12.Communicating with my coach has not been difficult.

13.I have made personal changes that will improve my health.

14.I have become healthier through my participation.

15.My participation has helped me increase my personal productivity.



ProductivityProductivity

More Productive WorkforceMore Productive Workforce

Question 16 - Percent Productivity Improvement

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

0-20% more productive 30-40% moreproductive

50% more productive 60-80% moreproductive

90-100% moreproductive



Health Status ImprovementHealth Status ImprovementHBI’s aggregate results:HBI’s aggregate results:

All at-risk participants = 70%All at-risk participants = 70%

Men = +6%Men = +6%

Women = +9% Women = +9% All High-risk participants = 25%All High-risk participants = 25%

Men = +10% Men = +10%

Women = +14%Women = +14%

Coach

Inte

rventi

on



Financial Impact & Return Model®Financial Impact & Return Model®


Recent National PollRecent National Poll

91% of employers91% of employers““Believe that they could reduce their health Believe that they could reduce their health

care costs by influencing employees to care costs by influencing employees to adopt healthier lifestyles”adopt healthier lifestyles”

Source:Michelle M. Mello, J.D., Ph.D., and Meredith B. Rosenthal, Ph.D.“Wellness Programs and Lifestyle Discrimination – The Legal Limits”;The New England Journal of Medicine, Health Law, Ethics, and Human Rights; July 10, 2008; 359;2. www.nejm.org.


Large Employers Reported in 2007Large Employers Reported in 2007

40% plan to pay employees40% plan to pay employees-Health enhancing behaviors-Health enhancing behaviors

-Next 2-3 years-Next 2-3 years

40% supported higher premiums40% supported higher premiums-Obese persons-Obese persons

-Declined participation weight management -Declined participation weight management programsprograms



IncentivesIncentives

Can employers treat employees Can employers treat employees differently based on their health differently based on their health status?status?

Reward the healthyReward the healthy

Engage the resistant majorityEngage the resistant majority

Employers can now use Employers can now use benefit design to benefit design to engage employees in engage employees in healthy behaviorshealthy behaviors

Attorney Greg Matis Presentation Utah SHRM Conference 2007

Federal Wellness GuidelinesFederal Wellness Guidelines

HIPPA – HIPPA – AmendsAmends

– Internal Revenue CodeInternal Revenue Code– Employee Retirement Income Security Act Employee Retirement Income Security Act

(ERISA)(ERISA)– Public Health Service ActPublic Health Service Act

ADA – ADA – The Americans with Disabilities ActThe Americans with Disabilities Act


Federal LawFederal Law

The Departments of Labor, Treasury and the The Departments of Labor, Treasury and the Health and Human Services issued joint proposed Health and Human Services issued joint proposed regulations on nondiscrimination in wellness regulations on nondiscrimination in wellness programs in 2001. programs in 2001.

Those regulations have now been finalized in Those regulations have now been finalized in regulations issued December 13, 2006. regulations issued December 13, 2006.


HIPAAHIPAA

HIPAA bars discrimination on the HIPAA bars discrimination on the basis of “health factors” with basis of “health factors” with respect to employer health plan respect to employer health plan eligibility, benefits, premiums or eligibility, benefits, premiums or

contributionscontributions..


HIPAAHIPAA

ButBut, HIPAA also states that plans and issuers , HIPAA also states that plans and issuers may: “establish premium discounts or rebates may: “establish premium discounts or rebates or modify otherwise applicable co-pays or or modify otherwise applicable co-pays or deductibles in return for adherence to deductibles in return for adherence to programs of programs of health promotionhealth promotion and and disease disease preventionprevention,” ,” i.e. wellness programsi.e. wellness programs..


HIPAAHIPAA

The regulations are aimed at providing The regulations are aimed at providing guidance to those plans that do wish to guidance to those plans that do wish to provide a reward based on a health provide a reward based on a health factor.factor.


Blood Pressure Body Fat %

Glucose

Cholesterol Obesity

HIPAAHIPAA

1.1. The total reward (for all features The total reward (for all features that contain a reward based on a that contain a reward based on a health factor) must not exceed health factor) must not exceed 20%20% of the total (unsubsidized) cost of of the total (unsubsidized) cost of employee onlyemployee only coverage. coverage.


5 Requirements5 Requirements

Final Guidelines added: 20% of Family coverage if other Family members are invited to participate.

2.2. The wellness The wellness program must be program must be reasonably reasonably designed to designed to promote health or promote health or prevent disease. prevent disease.



3. The wellness program must give 3. The wellness program must give eligible individuals the opportunity eligible individuals the opportunity to qualify for the reward at least to qualify for the reward at least once per year.once per year.



4. 4. The reward must be available to all The reward must be available to all similarly situated individuals. similarly situated individuals.



According to the DOL, this means the According to the DOL, this means the Wellness Program must provide Wellness Program must provide reasonable alternative standardsreasonable alternative standards for those for whom, due to a medical for those for whom, due to a medical condition, it is unreasonably difficult or it is condition, it is unreasonably difficult or it is medically inadvisable to attempt to satisfy medically inadvisable to attempt to satisfy the normal standard.the normal standard.



The regulations provide examples of The regulations provide examples of reasonable alternative standards:reasonable alternative standards:

– Instead of having a body mass index Instead of having a body mass index between 19 and 26, walking 20 between 19 and 26, walking 20 minutes 3 times a week.minutes 3 times a week.



5. The plan or issuer must disclose in 5. The plan or issuer must disclose in all plan materials that describe the all plan materials that describe the program the availability of program the availability of reasonable alternative standardreasonable alternative standard



The Americans with Disabilities Act The Americans with Disabilities Act (ADA) generally prohibits employment (ADA) generally prohibits employment discrimination against disabled discrimination against disabled individuals and limits the individuals and limits the circumstances in which an employer circumstances in which an employer may require physical examinations or may require physical examinations or answers to medical inquiries.answers to medical inquiries.


ADAADA

Q:Q: Does this affect your wellness Does this affect your wellness program?program?


ADAADA


ADAADA

The EEOC Technical Assistance Manual says The EEOC Technical Assistance Manual says that the ADA permits employers to:that the ADA permits employers to:

““conduct voluntary conduct voluntary medical examinations medical examinations and inquiries as part of an employee health and inquiries as part of an employee health program (such as medical screening for high program (such as medical screening for high blood pressure, weight control, and cancer blood pressure, weight control, and cancer detection), provided that: participation in the detection), provided that: participation in the program is program is voluntaryvoluntary;”;”

““Limits an employer’s ability to Limits an employer’s ability to collect employee health collect employee health information”information”

Use a third party provider for confidentialityUse a third party provider for confidentiality

ADAADA


HIPAA & ADA SummaryHIPAA & ADA Summary

Nondiscrimination and Wellness Programs in Health Coverage in the Group Market, Federal Registry/Vol. 71, No. 239/Wednesday, December 13, 2006/ Rules and Regulations

HIPAA HIPAA prohibits discrimination prohibits discrimination in in health coverage.health coverage.HIPAA does make an HIPAA does make an exception:exception:Wellness Programs that reward based on Wellness Programs that reward based on

individuals satisfying a health standard individuals satisfying a health standard or that meet specified requirementsor that meet specified requirements

ADA – Make sure your program is ADA – Make sure your program is voluntary & confidential.voluntary & confidential.



Can employers afford big Can employers afford big enough incentives?enough incentives?

How many companies have hundreds of dollarsto hand out to each employee each year toengage them in being healthy?


Wellness with No Net-CostWellness with No Net-Cost

Zero-based budgetingZero-based budgeting

Increase employee contribution then discount the increase to create a cash incentive that won’t cost anything.

Employers Can Be CreativeEmployers Can Be Creative


Transfer program costs fromTransfer program costs from

ParticipantsParticipants

Non-participantsNon-participants

Those who don’t participate pay for those who do

How Do You Fund Program?How Do You Fund Program?



HIPAA Section IIIHIPAA Section IIIEconomic ImpactEconomic Impact

““Costs can be shifted to workers Costs can be shifted to workers through increases in employee through increases in employee premium shares...”premium shares...”

Nondiscrimination and Wellness Programs in Health Coverage in the Group Market, Federal Registry/Vol. 71, No. 239/Wednesday, December 13, 2006/ Rules and Regulations


Financial Case for WellnessFinancial Case for WellnessTraditional – ROITraditional – ROI

New Trend – Benefit Design-no costNew Trend – Benefit Design-no cost


Cost by MemberCost by MemberStandard Claims Distribution by Member

Claims Per Person for One Year

$0

$20,000

$40,000

$60,000

$80,000

$100,000

$120,000

Each Member of Plan (Sorted from Lowest to Highest)

DemandManagement

Supply Management


SummarySummary

Accountability Based DesignAccountability Based Design

Multiple ResultsMultiple Results

Financial Impact & Return ModelFinancial Impact & Return Model

Federal guidelines – HIPAA & ADAFederal guidelines – HIPAA & ADA

Wellness at no-net cost to employerWellness at no-net cost to employer

copyright © health behavior innovations 2008 accountability-based employer wellness programs...

Documents

health coach accountability

health risks

health concerns

employee health productivity

employer slide

personal health coach

incentive slide

ownership slide