health care survey: results & potential strategies to ......jogging bicycling sports machines...

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

1

-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

2

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.

3

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.

4

Survey Scope

– Health information resources– Physical activity– Weight management– Nutrition– Smoking– Incentive interest level

5

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?


24%

76%

Yes No

33%

67%

Yes No

8

How often do you exercise?


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

9

What type of exercise do you do regularly?


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


18%

44%

37%

1%


29%

41%

29%1%


12

Have you ever tried to lose weight?


30%

70%

Yes No

45%

55%

Yes No

13

How many times have you tried to lose weight in the last 12 months?


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?


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

15

How interested are you in losing weight?


27%

29%

44%

Very InterestedNeutralNot Very Interested

40%

30%

30%


16

How many servings a day do you eat from the fruit/ vegetable group?


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

17

How often do you eat sweets (chocolate, snack bars, ice cream, pastries, doughnuts) each day?


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

18

Do you currently smoke?


88%

12%

Yes No

90%

10%

Yes No

19

For those who currently smoke, how many years have you been smoking?


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?


16%

84%

Yes No

21%

79%

Yes No

21

For those who currently smoke and have tried to stop smoking, how many times have you tried to stop smoking?


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

22

For those who currently smoke, how interested are you in stopping smoking?


17%

29%54%


27%

26%

47%


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In general, if OPERS were to start offering incentives to encourage healthy lifestyles, would incentives encourage you to:


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


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%

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