onsite wellness programs: options and results bruce caldwell area sr. vice president gallagher bpi...

Onsite Wellness Programs:Options and Results

Bruce CaldwellArea Sr. Vice President

Gallagher BPI

Dan SangerDirector of Health Benefits

ASCIP

Judi UlreyPresident

Fitness Consulting

Onsite Wellness Programs

• Current Range of Design Options

• Programs In Practice – El Monte City SD Onsite Care Pilot and Lawndale Elementary SD Education and Awareness Pilot– Design Details– Results– Lessons Learned

Onsite Wellness ProgramsEmployers: Why Do it?

• Deteriorating Individual Health Status– Higher rates of inactivity, obesity, diabetes, high

BP, high cholesterol– 50-85% of all diseases from modifiable risks

• Fragmented Delivery System– Primary Care, Specialty Care, Rx, ER, Hospital• Incentives based on volumes vs. outcomes• Limited connectivity

Onsite Wellness ProgramsEmployees: Why Do it?

• Easier to Engage– Does not require extra effort to participate– Engagement with peers increases morale– Easy to become part of a routine

• Quality of Life– Reduce debilitating/life threatening conditions• Remain active longer – really enjoy golden years• Reduce medical treatments / chronic conditions

Onsite Wellness ProgramsCurrent Barriers to Better Health

• Changing Habits Developed Over Decades– Diet, physical inactivity

• Using Healthcare Proactively– Convenience

• 2-3 Hour Office Visit: drive to & from the office, waiting room, exam room, 7 minute appt. duration

– Compliance• No incentives for outbound follow up contact from clinicians• Non-compliance rates typically 30% to 50%.

– Cost• Copay avoidance drives down maintenance medication compliance

Range of Onsite Wellness Programs

Option 1: Education and Awareness– Emails, posters, quizzes, etc.

– Advantages: Awareness is the first step toward action. Begins the process of adopting a wellness culture.

– Considerations: Goals, content development and distribution, long term engagement, success measures.


Option 2: Wellness and Prevention Activities– Walking Programs– Incentives for enrolling in weightwatchers, going to the

gym, biggest loser contests

– Advantages: Even limited exercise can have significant benefits

– Considerations: Goals, success measures, logistics – incentives (budget and distribution), waivers, activity tracking, recognition events, scheduling, facilities, hair & makeup


Incentives vs. Participation

– Trinkets and T-shirts 10% - 15%

– Merchandise (gift cards, movie tickets) 15% - 50%

– Cash ($25 - $50) 35% - 75%

– Premium Reductions ($100 - $250) 50% - 80%

Range of Onsite Wellness ProgramsOption 3: Health Plan Utilization Activities– Onsite HRA, blood draw– Telephonic health coach– Annual Physical, preventive screenings (colonoscopies,

mammograms, etc.) – Advantages: Objectivity of biometric data better than

accuracy of HRA answers, early detection of potentially catastrophic health events

– Considerations: Goals, success measures Logistics – incentives (budget and distribution), privacy, activity tracking, scheduling


Option 4: Direct Care Delivery via Onsite Clinics

• Primary Care (physicals, health screens, infections, prescriptions, chronic disease management, sprains, strains, etc.)

– Typically no copays for care or Rx– Clinicians range from RN to PA to MD– Flexible hours or 24/7, on-call physician


Direct Care Delivery: Onsite Clinics

• Advantages: Addresses barriers to care (convenience, compliance and cost), may reduce Rx, hospital admit and referral rates

• Considerations: Physical space buildout requirements, enrollment vs. participation, adoption and trust, privacy, promotional activities, costs, metrics, gradual adoption rates, HMO ROI

Current ProgramsEl Monte City School District

Onsite Health Screens

Current Programs

El Monte City SD– Health Screens

HealthFair

•Onsite Screens with Imaging Technologyo Blood chemistry, BMI, HRAo Echocardiogram, EKG, Carotid Ultrasound, Abdominal Aortic Ultrasound, Ankle Brachial Index, Bone Density

Ultrasound

•Why not just blood draw and HRA?o Non-fasting results easy to discounto Blood chemistry correlated to chronic disease progressiono Imaging results show actual affect – greater call to action

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Current Programs


Logistical Issues

•Bargaining Unit Endorsemento Business Case – personal health, take-home payo Concerns – privacy, secret drug testing

•Promotion and Incentiveso Intro Letter from District Supervisor

-Participation, scope, locations, confidentialityo Posters with Bargaining Unit Logoso $10 Gift Cards, raffle prizes

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Current Programs


Logistical Issues:

Timing

• Back to school, holidays, summer break• January – February relatively quiet, New Year’s resolution

momentum

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Current Programs


Logistical Issues

•Locationso 19 school siteso 55 employee median headcounto 875 actives, 425 retireeso 40 minutes per screen / HRA

•Mobile Screening Vehicle parked at each location for several dayso Substitute teachers hiredo ~6 weeks duration

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Current Programs


Costs

•~$225 per participant (~$160k)•~3% of average medical premium

•Contributions from Kaiser and UnitedHealthcare

•$10k budget for gift cards and raffle prizes

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Current Programs


Results

Participation• 718 employees & dependents• 75% female, 52% Hispanic (consistent with district demographics)

Satisfaction• Rated 4.91 out of 5 (5 = excellent)• 83% felt it was very important that their employer provide the screens

• Top three reasons for participation:1. No cost2. Convenience3. Medical concern

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70%

46%

35%

21%

20%

12%

10%

0% 20% 40% 60% 80%

No Exercise

High BP

Smoker

Obesity

Blood Sugar

Stressed

Depressed

Percent Higher Annual Health Plan Costs

Health Screen Results

District Prevalence

26%

48%

15%

35%

4%

27%

47%

Clinical Measure % or # Abnormal

Echocardiogram 4.2%

EKG 14.3%

Arterial Hardening 22.4% moderate or severe

Peripheral Artery Disease 8.9%

Blood Pressure 307 pre-hypertensive

Blood Sugar 90 pre-diabetic, 15 diabetics

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Current Programs


Results - Impact on Utilization

• Short term difficult to measure:o Participants from Kaiser, UHC HMO, Anthem PPO

-- Only Anthem FFS data availableo Dependent on current progression of any chronic conditions

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Current Programs


Next Steps

Participants:o Sharing results with PCPso Modifying personal habits (hopefully)o CDC motto: “Prevent, delay, detect, and control chronic

diseases”

District: o Launching and Onsite Care Model-- Convenience and Cost top 2 reasons for participation

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Current ProgramsLawndale Elementary School District

Fitness ConsultingEducation and Awareness Pilot

Old Dogs, New Tricks

Most of your employees have spent 30-40-50+ years fine tuning their unhealthy habits.

Think Out of the Box

“Most of us have our favorite influence methods – just pass a law, just threaten a consequence,

or offer a training program. … Bringing a simple solution to a complex and resistant problem

almost never works….. It takes a combination of strategies aimed at a handful of vital

behaviors to solve profound and persistent problems.” Influencer

Management MissionIs your senior management team:

• Discussing the company wellness program at every Department Director meeting?

• Making wellness program participation part of your management team's job description and evaluation?

• Wellness promotion part of Mission and Value Statements• Participating in screenings and posting personal goals? • Participating in contests?• Attending educational programs?• Exercising regularly? Visibly moving at work? Maintaining

a healthy weight?

Health vs. Disease

• Risk Factors • Highest Risk Population • Disease Management • John Weaver, Psy.D. • “As a man thinketh...”

Vital Behaviors

What do you want people to

DO??

How will you measure success?

Social Motivation

• Management Acknowledgement & Visible Participation

• Multi-level Wellness Team• Engage Opinion Leaders• Buddy System • Team Competition• Community Coaches• Blogs & Bravo! Board• Stories/Testimonials• Movin’ with a Mission

Environmental Support

• Company Food• Cafeteria Food Labeled• Movement Friendly Workplace• Core Corner• Stand-up Desks • Friendly stairways• Marked walking routes• Quiet Room

Make it Fun!

• Laugh• Sing• Dancing with Dumbbells • Cooking contests• Fridge Fitness• Team Competition

A Success StoryLawndale School District

1. ASCIP intro2. Presented to senior management/thought leaders3. Engaged established Wellness Committee4. Multiple schools/single message5. Vital Behaviors – weekly action step6. Social Motivation – bean cookbook7. Seasonal communications - “Why am I eating this?”8. Slowly expanding - incentives for Quizzes

Action Steps• Determine your definition of success.

What are your Vital Behaviors?• Engage senior management.• Create and continually to grow your team• Establish a 12-month plan with small,

measurable goals i.e. xx% walking 4x/week• Consider Competition• Have fun!

The Wisdom of Dilbert

Containing Health Insurance Costsvia

Employee Wellness Programs

Questions?

onsite wellness programs: options and results bruce caldwell area sr. vice president gallagher bpi...

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