CULTURE
MAKES A
DIFFERENCE
Creating a culture of well-being: A long term strategy for cost savings
panelist
Lindsey Mangus – Health Promotion Specialist for the
Carolinas of Cigna Health Services
Ben Buchanan – Product Ma...
why does better
health matter in
the workplace?

Healthier workforce
__
Lower benefit costs
__


employee retention


...
cost savings of healthier individuals
• Fewer smokers
• Fewer heart attacks

Potential savings
per individual health
impro...
what is a
culture of
well-being?
It’s more than just encouraging physical wellness.
It supports and fosters happier, healt...
key components
for a culture of
well-being
1
Strong
Leadership

2

3

Targeted
Solutions

4

Proper
Incentives

Ongoing
Co...
building a solution tailored to
your organization
Health
Awareness

Help people
“know their
numbers” and
understand their
...
certain
components
drive higher
engagement
key
engagement
influencers:

1 2 3 4 5
leadership
commitment

tailored
programs...
engagement
boosting best
practices

Creating a culture of well-being
is more than providing programs
that promote health. ...
bottom line

develop
culture
of well-being

•Identifying participants’ health status, is a key first step in
motivating in...
“It’s clear that the cost of

doing nothing is greater than
the cost of doing something.
The natural flow of risks is to h...
Carolinas HealthCare System:
“A Culture of Wellness”
Wellness…Historically
CHS LiveWELL – Guiding Principles
• Achieving optimal health and well-being…Through an
integrated and customized care expe...
1. To Create a Culture of Wellness you must
choose your metrics accordingly.
Communication
2. To Create a Culture of Wellness you must
use your data wisely.
• Data sources to leverage:
– Health risk assessment dat...
Completing the 360º View
Consumer Data
provides sociogeographic
consumption trends

Personal
Health
Survey

Consumer
Data
...
3. To Create a Culture of Wellness you must
Meet your Employees Where they are.
• A one-size fits all strategy
will not wo...
“It is common sense to take a method and
try it. If it fails, admit it frankly and try
another. But above all, try somethi...
•

Leverage

•

Executive Support

•

Departmental Support

•

Public Recognition

•

Activities that are educational and ...
Wellness Passport Program




Reward Based Wellness Program
Tracking Mechanism
Activities and Points Address the Risk B...


Wellness Kickoff

◦ Vendor Fair
◦ Biometric Screenings



10K Step Walking Program
◦ 8 Weeks



Wellness Seminars

◦ ...
331 Total Participants
Blood Pressure

Note:

Normal
Pre Hypertension
Hypertension

38%
55%
7%

62% of the participants ar...
331 Total Participants
Body Mass Index

Below Recommended
Recommended
Overweight
Obese
Extreme Obesity

1%
25%
31%
34%
10%...


Recognized by the American Heart Association as a
GOLD LEVEL recipient for fulfilling the following
parameters:
 Offer...
◦ Employees have had for years…
 Access to Mecklenburg County’s 11 fitness centers with
classes where employees may parti...


Established -Internal Wellness Program, myTotalHealth, supported by a Wellness
Team ; Wellness Ambassadors from differe...
“YOU can do a lot with healthy life style
changes”
30
City of Asheville

Employee Health & Wellness
December 2013

Cheryl Walker, SPHR
Employee Health & Wellness
•

The Asheville Project®
City of Asheville, North Carolina
•

•

On-site Medical Clinic
•
•

•...
Asheville’s Workforce
 1,100 Full Time Employees & 200
Retirees
 Self-Insured Health Program
 2,300 Covered Lives
The Asheville Project Disease
Management Program®
(1997 Inception)

The Foundation Principles

•
•
•

We want you to feel ...
The Asheville Project®
Diabetes:

1997

106 participants

Asthma:

1998

51 participants

CV Health:

1999

229 participan...
Incentives
Removing the barriers to patient compliance:





Patient Education
Ongoing counseling with Pharmacist Care...
The Asheville Project: 2013
Patients
enrolled in 1
Program

Patients enrolled in
2+ (Co-morbidities)

Total
Enrollment

Di...
Use of Incentives
• Modification of prescription drug
formulary
• Remove brand-name medications with
generic equivalents f...
Wellness & On-site Medical Clinic
Wellness & On-site Medical Clinic
• Occupational Services: work-related injuries,
vaccinations, drug testing, MRO, Hearing...
Asheville Balanced Choices Wellness
Phase 1: Designing our Wellness Program
Determining our goals –
What you want to achieve determines the behavior you rewar...
Asheville Balanced Choices Wellness Program
Phase 2: Implementation
•
•

All or nothing approach 89% participation
To part...
Asheville Balanced Choices Wellness Program
• Use Health Risk Assessments and Health Screenings to measure
current health ...
Next Steps
The Asheville Project®, On-site medical clinic, & Wellness Program
•
•
•
•
•

Expanding Provider Collaboration ...
Lindsey Mangus – Health Promotion Specialist for the
Carolinas of Cigna Health Services
Ben Buchanan – Product Manager, Co...
Culture Makes a Difference (Creating a culture of well-being)
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Culture Makes a Difference (Creating a culture of well-being)

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"Culture Makes a Difference" presented by Lindsey Magnus, Cigna, during Winter 2013 NCLGBA Conference.

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  • Began by offering basic occupational services: work related injuries, required vaccinations, pre-employment, random, promotional and reasonable suspicion drug testing helped to reduce WC and medical plan costs. Contracted with a local physician with experience in occupational health and primary care.
    To further reduce Medical plan costs, we began to offer additional clinic hours and offered employees the option to use for personal illnesses.
  • Culture Makes a Difference (Creating a culture of well-being)

    1. 1. CULTURE MAKES A DIFFERENCE Creating a culture of well-being: A long term strategy for cost savings
    2. 2. panelist Lindsey Mangus – Health Promotion Specialist for the Carolinas of Cigna Health Services Ben Buchanan – Product Manager, Corporate Health & Wellness of Carolinas Health System Christie Dean – Wellness Coordinator of Mecklenburg County Government Cheryl Walker – Health & Benefits Manager of the City of Asheville, NC 2
    3. 3. why does better health matter in the workplace? Healthier workforce __ Lower benefit costs __  employee retention  sick days __ Better __ Fewer  __ Higher productivity Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2012 Cigna 3
    4. 4. cost savings of healthier individuals • Fewer smokers • Fewer heart attacks Potential savings per individual health improvement $1,623 $5,176 • Employees who reverse their risk for metabolic syndrome $3,200 • Employees bringing BMI to a healthy range 2 $952 • Employees having cardiovascular diseases and bringing their stress under control 1 $393 3 1 1 Organizations with highly effective Health and Well-Being programs. 1.Cigna Internal Analysis and Proof Points 2.Cardiovascular Even Average Monthly Cost: Milliman’s review of MedStat MarketScan TM Commercial Data 2004 Trended to 2006, Metabolic Syndrome and Employer Sponsored Benefits, An Actuarial Analysis, Milliman, March 2006. 3. Metabolic Syndrom and Employer Sponsored Benefits, An Actuarial Analysis, Milliman, March, 2006 4.2009/2010 North American Staying @ Work Report: The Health and Productivity Advantage. Towers Watson. Link: http//www.towerswatson.com/research/648 Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2013 Cigna 4
    5. 5. what is a culture of well-being? It’s more than just encouraging physical wellness. It supports and fosters happier, healthier, more productive employees. Built into your overall business goals and a routine part of operations, it’s promoted at all levels of your company through programs, policies, benefits and the physical environment. It motivates and inspires people to take action to feel their best and perform their best leading to lower total benefit costs. culture influences engagement Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2013 Cigna 5
    6. 6. key components for a culture of well-being 1 Strong Leadership 2 3 Targeted Solutions 4 Proper Incentives Ongoing Communication Optimal Engagement Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2013 Cigna 6
    7. 7. building a solution tailored to your organization Health Awareness Help people “know their numbers” and understand their health status and potential risks Education Prevention Lifestyle Easy-tounderstand resources to help individuals learn how to be well for life Helpful programs aimed at preventing illness and disease Highly engaging behavior-change programs that encourage your employees to practice healthy habits for a lifetime Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2013 Cigna Activity Motivational programs and challenges to inspire people to actively participate in their health Coaching Expert guidance and consultation to support organizations and individuals throughout the process 7
    8. 8. certain components drive higher engagement key engagement influencers: 1 2 3 4 5 leadership commitment tailored programs long-term wellness strategy Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2013 Cigna easy to access programs available to all employees incentives to motivate 8
    9. 9. engagement boosting best practices Creating a culture of well-being is more than providing programs that promote health. It’s a commitment to improving health. And a plan to make it a way of life. set the tone walk the talk eye on the ball recruit help communicate make it clear you value employee health model the behavior make health improvement a standard agenda item develop a wellness committee to share ideas, work on promotions and help execute plans make goals clear, address obstacles, celebrate success Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2013 Cigna 9
    10. 10. bottom line develop culture of well-being •Identifying participants’ health status, is a key first step in motivating individuals to take the right actions to achieve meaningful and lasting healthy behavior changes. identify employee health risk motivate and influence behavior improved health lower cost Maintain strong culture of well-being Behavior Service manager quits smoking, starts walking and avoids stroke $5,176/month1 Head of finance avoids chronic high blood pressure through exercise, nutrition and stress management 1. Cardiovascular Event Average Monthly Cost: Millman's review of MedStat MarketScan(TM) Commercial Data 2004 trended to 2006. 2. "An Unhealthy America: Economic Burden of Chronic Disease" 2010 Hypertension direct/indirect costs PPPY. www.milkeninstitute.org Savings $1,116/year2 Ten people in sales department lose 25 lbs. each and bring weight into a healthy range $5,760/year1 Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2013 Cigna 10
    11. 11. “It’s clear that the cost of doing nothing is greater than the cost of doing something. The natural flow of risks is to high risk. The natural flow of costs is to high cost.” – Dee Edington, PhD Former Director, Health Management Research Center, University of Michigan Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2013 Cigna 11
    12. 12. Carolinas HealthCare System: “A Culture of Wellness”
    13. 13. Wellness…Historically
    14. 14. CHS LiveWELL – Guiding Principles • Achieving optimal health and well-being…Through an integrated and customized care experience. – It is our goal to improve the total health and well-being of our teammates so they can provide the best care to our patients – We are committed to providing a comprehensive and optimal health experience to our teammates and their families, based on experience, research, analytics and communications – We will use our integrated System resources to consistently deliver a high-quality health experience throughout our teammates’ life stages
    15. 15. 1. To Create a Culture of Wellness you must choose your metrics accordingly.
    16. 16. Communication
    17. 17. 2. To Create a Culture of Wellness you must use your data wisely. • Data sources to leverage: – Health risk assessment data – Biometric data – Claims data • Use the data to help you choose the most appropriate partners within your community for assistance.
    18. 18. Completing the 360º View Consumer Data provides sociogeographic consumption trends Personal Health Survey Consumer Data Personal Health Survey captures health and lifestyle risks not readily available elsewhere Clinical Biometrics Biometric and Clinical Data identify the status of disease not just its presence Person Claims supply a wealth of medical and cost data at the member level Claims 18
    19. 19. 3. To Create a Culture of Wellness you must Meet your Employees Where they are. • A one-size fits all strategy will not work for all three population segments. • Each group has it’s own unique challenges, and will need its own resources to maintain or improve their health status. • Focusing on high risk members only, will only return short term success. High Risk High Risk Rising Risk Rising Risk Well Well 19
    20. 20. “It is common sense to take a method and try it. If it fails, admit it frankly and try another. But above all, try something.” -Franklin D. Roosevelt
    21. 21. • Leverage • Executive Support • Departmental Support • Public Recognition • Activities that are educational and engaging Although, we don’t yet have the ROI from our newly created enterprise wellness program, we certainly have insight on what needs to happen first! 22
    22. 22. Wellness Passport Program    Reward Based Wellness Program Tracking Mechanism Activities and Points Address the Risk Behaviors of Population Wellness Passport Activity Log 2011 Wellness Wellness Passport myTotal Awards for Healthy Passport Behavior myTotal Awards for Healthy Behavior 23
    23. 23.  Wellness Kickoff ◦ Vendor Fair ◦ Biometric Screenings  10K Step Walking Program ◦ 8 Weeks  Wellness Seminars ◦ ICMA Webinar Sessions  Health Risk Assessment  De-stress and Relaxation Techniques  Flu Clinics  Wellness Boot Camp 24
    24. 24. 331 Total Participants Blood Pressure Note: Normal Pre Hypertension Hypertension 38% 55% 7% 62% of the participants are at risk or abnormal. Total Cholesterol Desirable Borderline High 26% High 65% 9% Did You Know? A 2001 University of Michigan study showed that for every employee who reduces their cholesterol levels from 240 to 190, employer’s save an average of $1,200 per year. 25
    25. 25. 331 Total Participants Body Mass Index Below Recommended Recommended Overweight Obese Extreme Obesity 1% 25% 31% 34% 10% Note: 75% of County employee participants that were measured are in or above the Overweight category. Waist Circumference Desirable Abnormal 60% 40% Did You Know? Fat around the waistline is strongly associated with coronary heart disease, diabetes and colon cancer. 26
    26. 26.  Recognized by the American Heart Association as a GOLD LEVEL recipient for fulfilling the following parameters:  Offer employees physical activity support  Provide/increase healthy eating options at the worksite  Promote a wellness culture  Implement at least 9 criteria as outlined by the AHA in the areas of physical activity, nutrition and culture. 27
    27. 27. ◦ Employees have had for years…  Access to Mecklenburg County’s 11 fitness centers with classes where employees may participate at a discounted price.  Mapped and Marked walking trails in a secure environment.  No Smoking Policy (Implemented in the 1990’s). 28
    28. 28.  Established -Internal Wellness Program, myTotalHealth, supported by a Wellness Team ; Wellness Ambassadors from different departments and divisions  Offered - Free tobacco cessation classes  Promoted a walking challenge, including pedometers, information on walking distributed through e-mails, County websites, with prize incentives  Showcased - Artwork in the stairwells that encourages employees to take the stairs rather than riding the elevator, with the County Manager leading by example  Sponsored - Numerous Healthy Cooking classes throughout various County locations  Provided - On-Site Biometric screenings as part of our “Know Your Numbers” campaign to educate and help employees with awareness  Support and commitment – From the County Manager, The Executive Team, Dept. Directors, Managers and Front Line Supervisors. 29
    29. 29. “YOU can do a lot with healthy life style changes” 30
    30. 30. City of Asheville Employee Health & Wellness December 2013 Cheryl Walker, SPHR
    31. 31. Employee Health & Wellness • The Asheville Project® City of Asheville, North Carolina • • On-site Medical Clinic • • • Overview Overview Coordination Wellness Program • • • Design & Implementation Coordination Next Steps
    32. 32. Asheville’s Workforce  1,100 Full Time Employees & 200 Retirees  Self-Insured Health Program  2,300 Covered Lives
    33. 33. The Asheville Project Disease Management Program® (1997 Inception) The Foundation Principles • • • We want you to feel better; We care about your health; We will remove barriers to get you the treatment you need
    34. 34. The Asheville Project® Diabetes: 1997 106 participants Asthma: 1998 51 participants CV Health: 1999 229 participants Depression: 2006 55 participants
    35. 35. Incentives Removing the barriers to patient compliance:     Patient Education Ongoing counseling with Pharmacist Care Managers Disease-specific Lab tests Disease-specific medication and supplies ALL ARE PAID AT 100%
    36. 36. The Asheville Project: 2013 Patients enrolled in 1 Program Patients enrolled in 2+ (Co-morbidities) Total Enrollment Diabetes 17 93 110 Asthma 28 32 60 Cardiovascular 135 131 266 Depression 24 50 74 Total participants: 340 15% of the covered lives on the city’s plan
    37. 37. Use of Incentives • Modification of prescription drug formulary • Remove brand-name medications with generic equivalents from copay waiver program • Removal of copay waiver for participants if City not primary insurance (dependents or retirees with Medicare) • • Meeting with patients in on-site medical clinic to enroll in disease management program and help in maintaining compliance Tying participation & compliance to Asheville Balanced Choices
    38. 38. Wellness & On-site Medical Clinic
    39. 39. Wellness & On-site Medical Clinic • Occupational Services: work-related injuries, vaccinations, drug testing, MRO, Hearing testing • Personal minor illness, flu vaccinations, allergy shots, etc. • Increase personal visits for employees • Increasing access • Staff – PA, nurses and non-medical staff • Dependents may utilize clinic services
    40. 40. Asheville Balanced Choices Wellness
    41. 41. Phase 1: Designing our Wellness Program Determining our goals – What you want to achieve determines the behavior you reward • • • • • • Design Wellness programs to reward healthy members (the other 85%) and achieve financial goals Coordination with On-site Health Clinic Utilize all available data (medical claims, On-site Medical Clinic and Health Risk Assessments) to: • • identify members without annual wellness screenings provide early warning diagnosis’ Encourage compliance through financial incentives $600 per year per adult drives behavior Continue to develop, track, and expand disease management
    42. 42. Asheville Balanced Choices Wellness Program Phase 2: Implementation • • All or nothing approach 89% participation To participate you must agree to: • • • • • Complete Annual Health Risk Assessment (employee & spouse) Annual health screenings Be tobacco free or agree to participate in Tobacco Cessation program Participate in 4 additional Wellness Activities (web-based, employer sponsored activities and preventive care) each year Tobacco Cessation Program • • Combined group classes with medical supervised nicotine replacement aids and/or prescription drugs at $5.00 copay Accountability for 90 days following graduation and semi-annual updates
    43. 43. Asheville Balanced Choices Wellness Program • Use Health Risk Assessments and Health Screenings to measure current health of all adult participants. • Include verifiable biometric data • Use all future data to determine impact/effectiveness of Wellness program offerings. • Gradually change mindset of Wellness program before implementation of Outcomes-based program. • Use Employee Clinic to follow-up on biometric screening concerns and identify participants for enrollment in disease management programs. • Tobacco Cessation Programs -140 graduates • Current quit rate for members still actively employed 12 months post graduation 58%
    44. 44. Next Steps The Asheville Project®, On-site medical clinic, & Wellness Program • • • • • Expanding Provider Collaboration using electronic medical record systems • Determine high frequency services to add to employee health clinic that accomplishes cost savings for City and employees • • Designing Phase 3 of Wellness program to include outcomes-based requirements Weight Management Program Integration of The Asheville Project® & Wellness programs to ensure compliance Care Manager Report Cards Identification of participants not receiving recommended ‘wellness’ screenings or procedures (eye exams, flu shots, annual physicals, etc.) and offering services through on-site health clinic Partnerships with community to consider new or unique approaches to Wellness to accomplish Wellness objectives
    45. 45. Lindsey Mangus – Health Promotion Specialist for the Carolinas of Cigna Health Services Ben Buchanan – Product Manager, Corporate Health & Wellness of Carolinas Health System Christie Dean – Wellness Coordinator of Mecklenburg County Government Cheryl Walker – Health & Benefits Manager of the City of Asheville, NC 46
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