Health Care Survey:Results & Potential Strategies to Promote Wellness
Scott Streator, Director of Health CareDonna Meyer, RN MSN, Operations and Clinical Manager
May 18, 2005
Ohio Public Employees Retirement System
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-Member Advocate/Educate-Optimize Expenditures-Plan Design-Utilization Management-Healthcare Management
“Continuum of Care”
OPERS Health Care Strategies
Pre-Retirement
Retirement 65 Years End of Life
Prevention&
Education
Channel &Disease Management
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Background Health Statistics
Obesity/Overweight Health Implications• 25% of Ohioans are considered obese. • Health care costs for obese workers were 36% more than for
normal weight workers and 77% more for prescription medications.
• Among those between 50 and 60 years old, health spending is 60% higher for obese and 36% higher for overweightindividuals when compared to those of normal weight.
Smoking • Ohio also has a 25% prevalence of smoking.• 56% of OPERS hospital claims result from cancer, cardiac and
respiratory illnesses.• U.S. Surgeon General describes smoking as the largest single
preventable cause of death and disability for the US population.• Smokers have 18% higher medical claims than non-smokers.
Two large employers revealed they paid $285-$960 more per year for smokers and $222-$401 more for obese workers.
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Wellness Initiatives
OPERS Wellness Survey
• Objective: Establish key baseline health data for designing future benefit programs with goal of reducing (preventing) member and/or OPERS health care costs.
• Sample Size: 2,950 Active and 2,950 Retirees.
• Broad range of questions to assess weight, smoking, nutritional status and assess interest in incentives.
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Survey Scope
– Health information resources– Physical activity– Weight management– Nutrition– Smoking– Incentive interest level
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Survey Methodology
OPERS Communications Department helped design and tabulate results from survey sent 1st Quarter 2005 and reviewed in April-May, 2005.
MEMBERS:– 23% response rate (671* Members out of 2,950)– Female 51%, Male 49%
RETIREES:– 45% response rate (1334* completed retiree surveys
out of 2,950)– Female 43%, Male 57%
*Provides a 97% confidence level with a +/- 3% margin of errorAverage mail survey response rate is 25%
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Where do you obtain health information to help you decide if medical care is needed?
MembersMembers RetireesRetirees
746
1013
322
0 20 40 60 80
Doctor's officeOther healthcare professionals
InternetPrinted information
FamilySelf
Other/ none
895
310
113
0 20 40 60 80 100
Doctor's officeOther healthcare professionals
InternetPrinted information
FamilySelf
Other/ none
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Do you regularly exercise?
MembersMembers RetireesRetirees
24%
76%
Yes No
33%
67%
Yes No
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How often do you exercise?
MembersMembers RetireesRetirees
24%
43%
33%
1-2 times/ week3-4 times/ week5 or more times/ week
29%
40%
31%
1-2 times/ week3-4 times/ week5 or more times/ week
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What type of exercise do you do regularly?
MembersMembers RetireesRetirees
7816
640
1918
76
21
0 20 40 60 80
WalkingAerobics
SwimmingWeight training
JoggingBicycling
SportsMachines (treadmill)
YogaFarm/ garden/ yard work
7917
614
312
231
4
0 20 40 60 80
WalkingAerobics
SwimmingWeight training
JoggingBicycling
SportsMachines (treadmill)
YogaFarm/ garden/ yard work
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Overall Body Mass Index (BMI)
OPERS Total PopulationOPERS Total Population
29%
40%
30%1%
Underweight (BMI <18.5)Normal (BMI 18.5-24.9)Overweight (BMI 25-29.9)Obese (BMI 30 or greater)
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Body Mass Index
MembersMembers RetireesRetirees
18%
44%
37%
1%
Underweight (BMI <18.5)Normal (BMI 18.5-24.9)Overweight (BMI 25-29.9)Obese (BMI 30 or greater)
29%
41%
29%1%
Underweight (BMI <18.5)Normal (BMI 18.5-24.9)Overweight (BMI 25-29.9)Obese (BMI 30 or greater)
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Have you ever tried to lose weight?
MembersMembers RetireesRetirees
30%
70%
Yes No
45%
55%
Yes No
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How many times have you tried to lose weight in the last 12 months?
MembersMembers RetireesRetirees
26%
1%
1%
12%
60%
1-2 times3-4 times5-6 times7 or more timesOngoing
31%
4%
2% 15%
48%
1-2 times3-4 times5-6 times7 or more timesOngoing
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On average, how much weight have you tried to lose?
MembersMembers RetireesRetirees
20%
8%
20% 19%
33%
5-10 pounds11-15 pounds16-20 pounds21-30 pounds31 or more pounds
16%
12%
19% 18%
35%
5-10 pounds11-15 pounds16-20 pounds21-30 pounds31 or more pounds
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How interested are you in losing weight?
MembersMembers RetireesRetirees
27%
29%
44%
Very InterestedNeutralNot Very Interested
40%
30%
30%
Very InterestedNeutralNot Very Interested
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How many servings a day do you eat from the fruit/ vegetable group?
MembersMembers RetireesRetirees
2%7%
36% 52%
3%
None1-2 servings3-4 servings5-6 servings7 or more servings
2%8%
32% 56%
2%
None1-2 servings3-4 servings5-6 servings7 or more servings
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How often do you eat sweets (chocolate, snack bars, ice cream, pastries, doughnuts) each day?
MembersMembers RetireesRetirees
2%9%
66%
23%
None1-2 times3-4 times5-6 times7 or more times
1%1%9%
68%
21%
None1-2 times3-4 times5-6 times7 or more times
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Do you currently smoke?
MembersMembers RetireesRetirees
88%
12%
Yes No
90%
10%
Yes No
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For those who currently smoke, how many years have you been smoking?
MembersMembers RetireesRetirees
58%13%
11%
10%8%
Less than 1 year1-5 years6-10 years11-15 years16 or more years
84%
8%4%4%
Less than 1 year1-5 years6-10 years11-15 years16 or more years
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For those who currently smoke, have you ever tried to stop smoking?
MembersMembers RetireesRetirees
16%
84%
Yes No
21%
79%
Yes No
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For those who currently smoke and have tried to stop smoking, how many times have you tried to stop smoking?
MembersMembers RetireesRetirees
11%15%
37%
37%
1-2 times3-4 times5-6 times7 or more times
14%10%
36%
40%
1-2 times3-4 times5-6 times7 or more times
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For those who currently smoke, how interested are you in stopping smoking?
MembersMembers RetireesRetirees
17%
29%54%
Very InterestedNeutralNot Very Interested
27%
26%
47%
Very InterestedNeutralNot Very Interested
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In general, if OPERS were to start offering incentives to encourage healthy lifestyles, would incentives encourage you to:
MembersMembers RetireesRetirees
60
58
56
10
0 10 20 30 40 50 60
Become morephysically active
Obtain a healthyweight
Eat morenutritious foods
Quit smoking
44
47
46
6
0 10 20 30 40 50
Become morephysically active
Obtain a healthyweight
Eat morenutritious foods
Quit smoking
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Please rank in order of preference what types of incentives would encourage you to live a healthier lifestyle: reduced premiums or health rebates
MembersMembers RetireesRetirees
5%7%8%
24%56%
1 highest preference2345 lowest preference
9%8%12%
25%
46%
1 highest preference2345 lowest preference
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Two-thirds of the OPERS’ member and retiree populations are either overweight or obese.• Members tend to be more inclined to be overweight than retirees.• Male members and those with 11-20 years of service tend to be
obese.• Younger retirees age <50-60 are more inclined to be obese.
Most members and half of retirees have tried to lose weight, females more so than males.
Most members are very interested in losing weight while most retirees are not.– Almost half of members and retirees have tried to lose 16-31+
pounds.
Health Survey Conclusions
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• Reduced premiums and health rebates would encourage both members and retirees to live a healthier lifestyle such as:– Obtain a healthy weight.– Become more physically active.– Eat more nutritious foods.
• Based on the survey results, smoking rates seem low compared to other statistics possibly due to:– Smokers being less likely to complete a health related survey.– “Closet smokers” -- since the survey is health related, some
smokers may be inclined to deny they smoke.• Approximately half of the respondents who smoke are very
interested in stopping.
Health Survey Conclusions
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• Johnson and Johnson offered a $500 health insurance “rebate” on premiums. Survey participation shot up to 90 % and the company realized a reduction in worker’s health risk associated with lifestyle (tobacco, lack of exercise, diet, high blood pressure) and cut medical costs by $225 per employee per year.
• Hewitt reported 40% of the large 960 employers nationwide used incentives or disincentives last year to promote healthier behaviors, up from 14% in 1993.
• Staff has begun discussions with various experts and academicians in the field of behavioral health, obesity and health management. One possibility is a strategic alliance with Ohio State University School of Public Health to leverage local expertise and research.
Potential Strategies: Incentives
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Potential Incentive Strategies for Reducing Obesity/Overweight: • Incentive plan (reduced premiums) for results, not just activity. • Incentive plan for all new and existing retirees for obtaining an Ideal
Body Weight ( or within a specified range of IBW)• At regular frequencies, every year/every other year, a health risk
assessment is completed by retiree and physician certifying weight status up to a specified age.
• Administration and Communication are key considerations in program development. Staff can leverage Health Plan capabilities, various State-wide wellness centers, Weight Watchers, etc…
• Operational flow, legal review and financial modeling to be determined for each strategy.
Weight Control Incentives
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Potential Strategies for Reducing Smoking Prevalence:• Offer an incentive plan for all non-smoker enrollees in the
OPERS Health Plan as of a specific date ( I.e. January 1, 2007).• At regular frequencies, a health risk assessment is completed
by member and physician certifying smoking status.• Administration and Communication are key considerations in
program development. Will need to leverage Health Plan capabilities with various State-wide smoking cessation programs while highlighting OPERS covered smoking cessation programs and prescription products.
• Operational flow, legal considerations and financial modeling tobe determined.
Smoking Reduction Strategies
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• Require retirees/ new retirees to complete a Health Risk Assessment form.
• Risk stratification of OPERS population for identifying appropriate health programs.
• Expand incentive program for achieving individual Health Risk Assessment “score” improvements.
• Partner with employers on communication strategy to give membersadequate preparation time to retire in good physical health, not just financial.
– Use pre-retirement seminars.– Written communication emphasizing the member involvement/responsibility,
and associated advantages with the OPERS Health Plan.
Other Considerations
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“Your Partner in Securing Health Care for the Future”
Mission Statement
The OPERS Health Care Department will provide the highest quality, most cost effective health care benefits, while empowering members to make informed decisions.
OPERS Health Care
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Supplemental Slides
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Age of Respondents
Member Group: Retiree Group:• <29 10% <50 1% • 30-49 47% 50-55 5% • 50-55 20% 56-60 7% • 56-60 13% 61-65 15% • 61 and older 10% 66-70 19%
71 and older 53%
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Respondent Base
Member Retiree – Region:
• Northeast 35% 36% • Northwest 15% 16% • Central 22% 23% • Southeast 6% 7% • Southwest 22% 18%
– Highest level of educational background:• Less than high school diploma 2% 11%• High school diploma or equivalency 38% 52%• Associates/2-year/junior college 24% 17%• Bachelors degree 23% 13%• Masters degree 10% 6%• Doctorate 3% 1%
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Respondent Base
Total annual household incomeMember Retiree
• <$20,000/ year 4% 22%• $21,000-30,000 9% 29%• $31,000-40,000 15% 17%• $41,000-50,000 13% 12%• $51,000-60,000 10% 6%• $61,000-70,000 11% 5%• $71,000-80,000 12% 3%• $81,000 or more 26% 6%