Wellness Program Selection & Integration


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Considerations in Selecting Wellness Programs

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  • Examples in these categories include:Benchmarks defined for short and long term program results # walking program participants/distance and continued participation nutrition program participation/pounds lost (within HIPPA rules)tobacco cessation program participation/# that quit # that complete HRA/# and type of follow up) Participation# identified for programs # with program contact # who participateDrop out rateWhich programs are most popular and effective?Program cost vs. participationAre web-based information tools available to support programs?HRA resultsParticipation rateIs personalized feedback report informative/meaningful?Greatest area of opportunity and method for follow up # receiving outreachData integration that fosters integration with other programs# and types of data sharing and referrals between programs are identified?
  • Involvement and support for the wellness program is an important factor in its success and the vendor should have identified and engaged executive sponsors who will be engaged and support the program. Key stakeholders should be identified in the vendor proposal and their roles detailed. Approaches to building interest and enthusiasm for the various campaigns in the program should be part of the wellness program publicity. Messaging must be ongoing and varied to hold interest in the program and should be described for various campaigns for the client’s program.
  • In partnership with you, I can provide these services to help your clients select results oriented wellness strategies , eliminate fluff that that contribute to program costs, assure programs are and reporting is executed as promised, andtrack execution against performance guarantees.
  • Over the previous decade, thinking around the approach and value of care management, disease management and wellness activities has changed with experience.Clearly, member cost share increases cannot modify consumer behavior to adequately address medical cost inflation, andInformation about the contribution of unhealthy behaviors to the development of chronic and catastrophic diseases has grown.
  • As experience with care management, disease management and wellness activities has accumulated, A more integrated approach to health promotion has evolved – One that recognizes the value of cost containment from well executed case management activities - that is the intervention of medical professionals (usually RNs) at the beginning of an episode of acute illness through its resolution and the patient’s stabilization,Recognition of the value of more focused disease management activities that identify those with chronic disease who are at a point in their lives at which the are interested and motivated to change unhealthy behaviors and focusing on these individuals and a move away from the sort of blanket or shot gun approach to communication with disease management programs, andImprovements have developed in designing wellness programs that are more focused on the nature and character of the groups that they target to obtain improved participation in wellness activities.
  • In previous decades, management activities focused primarily on the end of the continuum in which most of the current costs were appearing: those with serious and chronic diseases.
  • But, as we gained more experience in caring for and tracking the health of individuals as they developed serious chronic diseases, we began to see evidence that make compelling arguments for use of wellness screening and promotion activities –We see three examples of how wellness screening and promotion activities may dramatically alter the progression to serious and chronic disease:Starting on the left of the page: Identification of elevated blood pressure and the fact that a relatively small change in blood pressure can reduce one’s risk of heart attack, stroke and death by one quarter,In the middle column: The evidence has shown a solid link between obesity and many types of cancer, andOn the right side: Screening for elevated blood sugar can identify those who are unaware they have diabetes
  • As we see obesity increasing in adults, adolescents and children ,and we recognize that even in the Northwest where tobacco use is lower that the average, that the evidence for the importance of changes in behavior before development of serious chronic mounts. So, how can we help our clients make well informed choices in wellness programs and the integration of their health promotion programs?
  • Many vendors have entered this market, but only a few can offer the entire range of services:Lots of Health Plans, DM and wellness vendors, HRA and other specialty vendors operate in this spaceFair amount of purchasing, partnering, and outsourcing among vendors and these relationships continue to changeSome vendors have superficial offerings that lack design and execution capabilityTo support the client in selecting the best program to meet their needs and budget, you really have to look at:what health promotion programs that they have now,what is offered in the wellness program, and thendig into the details of the proposal for the client to evaluate how it will be delivered and integrated with existing programs and vendors.
  • Here are some examples of considerations in program selection and success:Lifestyle risk factors age/sex mix, type of work, environmental risk factors, educational levelPrevalence of chronic diseasesmay influence wellness program emphasis Current activities and programsidentify existing champions, what existing wellness activities are popularReadiness to changeHow will it be identified and acted upon – tools such as PAMMotivation techniques Techniques and incentives should be selected to fit the particular group
  • The Wellness vendor should provide a written and well defined strategy or approach that addresses all of the se elements, and the strategy should be tailored specifically to the population ,considering the characteristics of the population,and planning how integration between existing programs (DM , CM, EAP and worksite programs) will be accomplished (What # and type of follow up will be made?)
  • Wellness Program Selection & Integration

    1. 1. Selecting and Integrating Wellness Programs into Client Health Promotion Initiatives Barbara H. Wall President Hagen Wall Consulting
    2. 2. Why Include Health Promotion Benefits? Most growth in health care spending is due to risk factors  that can be modified Stress, smoking, poor diet, sedentary lifestyle  Obesity and morbidities related to it causes 27% of cost increase  (1987-2002)1 Benefit design and member cost sharing changes  are helpful but do not address the entire problem of cost increases 90% of spending is for sickest members who spend  >$1,000 a year out of pocket Thorpe, et al, “The Rise in Health Care Spending and What To Do About It,” Health Affairs, Nov/Dec 2005 1 2
    3. 3. Health Promotion is Prevention and Management Health Promotion =  Identifying those with health risks and promoting healthy  behaviors (wellness) + Teaching chronic disease patients to maintain best  possible health (disease management) + Intensive management of acute illness (case  management) 3
    4. 4. Health Promotion Continuum Wellness Care Case & Disease Management Management Staying Healthy Getting Better Living with (70% population) (14% population) Chronic Illness (16% population) 15% of Costs 25% of Costs 60% of Costs Risk Factors Acute Isolated Complex Cases • Alcohol/tobacco use • Transplants Episodes • Sedentary lifestyle • Broken leg • Cancer • Poor diet • Respiratory infection • Trauma • Health history • Appendicitis • Chronic Disease • Unmanaged stress • Diabetes • Heart Disease • Depression 4
    5. 5. Impact of Chronic Diseases Heart Disease & Stroke Cancer Diabetes • 1st and 3rd cause of • 2nd leading cause of • 6th leading cause of death in the US (40% death death • Screening tests now • Over 18 million people total) • Affects 70 million in US exist for many of the in the US have diabetes • Much of the impact of • 27% of those who have most common types of diabetes don’t know it these diseases could be cancer • It is now known that • Lifestyle changes can prevented, for example: a 13% reduction in blood obesity increases the reduce the risk of pressure can reduce: risks for breast, colon, diabetes by 60% in • heart attack by kidney, endometrial and overweight adults with 21% esophageal cancers pre-diabetes • stroke by 37% • deaths by 25% Source: Department of Health and Human Services Fiscal Year Budget Appropriations 5
    6. 6. Impact of Behavioral Risks Obesity Tobacco Use • Now viewed as epidemic in the US • Represents the single most • Affects > 31% of the adult population preventable cause of death and • 16% of children/teens and growing disease in the US • Contributes to metabolic syndrome • Causes 440,000 deaths each year • $150 billion in medical costs and (increased blood pressure, increased cholesterol levels) and risk of serious lost productivity • Approximately 22% of adults in the disease • Obesity and sedentary lifestyle US smoke • Healthy People 2010 calls for contribute to development of stroke, diabetes, cancer and heart disease reduction in smoking rate to 12% Source: Department of Health and Human Services Fiscal Year Budget Appropriations 6
    7. 7. Focus on the Best in Program Design and Execution for the Client Wellness and disease management programs vary in  program design, integration, intensity, participation rates and results: Too much variation exists to generalize across vendors  Comparisons on key features among vendors is necessary  Predictions of ROI are less dependable than analysis of  program design and execution Vendors create their own ROI methodologies and calculations  Vendor ROI predictions may create false expectations  Incentives to spark interest and participation for the high  risk segments of the client’s own pool are essential to success Incentive range  7
    8. 8. Factors for Health Promotion Program Success The program must be tailored to the target  population The group’s characteristics and risks are considered  Lifestyle risk factors  Prevalence of chronic diseases  Current activities and programs  Readiness to change  Motivation techniques  8
    9. 9. Wellness Program Strategy Elements A well-defined strategy considers  Program objectives  Program criteria  Financial resources  Human capital  Participation incentives  Ability to leverage existing vendors/programs  Integration with other programs  Measurement  9
    10. 10. Measurement & Reporting Should include  Short term and long term  Participation  HRA results  Data integration  10
    11. 11. Communication Plan for the Program An intensive communication campaign is a key  success factor Executive sponsors  Key stakeholder involvement  Advance publicity  Frequent, clear messaging  11
    12. 12. Services to Support Program Selection Client education and strategy  Group profile  Vendor market scan  Current program assessment  Analysis of proposals and guidance on  Participation incentives  Communication  Metrics  Implementation  Competitive bid  With BRG as point of communication with client  Negotiations with vendors  Metrics  Competitive pricing  Implementation oversight  Coordination between client and vendor  12
    13. 13. Questions and Comments? Contact:  Barbara Wall, JD President, Hagen Wall Consulting (206) 629-4174 Barbara.Wall@HagenWallConsulting.com 13