Strategies to Enhance the ROI of Wellness Programs                     Webinar
Agenda•   Introductions•   Current Landscape•   A Strategic Wellness Framework•   Wellness Interventions•   Total Health M...
The Landscape: Medical Costs and Access• Medical cost inflation continues rapidly (8-10%)• 2011 health care spend estimate...
The Landscape: Health Continues to Decline  • Out of 100 U.S. adults….     – Only three are non-smokers, not overweight, a...
What does this mean for the employer? “It is not the strongest of the species that survives, nor the    most intelligent, ...
Keys to Success                             Employee                            Engagement             Total Health       ...
Outcomes and Quality                                                         Assurance   WellnessFramework: Six           ...
Quality of                                            Population                               Traditional    Work/Life   ...
Strategic Plan for Population Health Management includes   the following broad objectives:   – Year One:     Branding/Cult...
Intervention and Engagement Progression Flow                                                               Greater        ...
Participation to Outcomes Achievement Matrix                       Year One                        Year Two               ...
Engagement Strategies to Enhance ROI•   Provide autonomy, employee decides their choices, creates accountability = Self-di...
ROI Measurement: Scorecards and Dashboards               Wellness Scorecard                                               ...
•   Low hanging ROI fruit:     – Annual Exam and Preventive Screenings     – Medical self-care     – Flu vaccinations     ...
TOTAL HEALTH MANAGEMENT = VALUE                                 Plan Design                                 Value Based   ...
Sustainable Operating Environment Interventions – Onsite FitnessGoals Typically Considered:•    Convenience, removes barri...
Trends in employer sponsored clinicsTrends•       Onsite Clinics•       Near-site or shared clinics•       Concierge physi...
Scope of Services for ConsiderationUrgent Care• Colds and Sinus Infections• Prescriptions• Flu Shots• Routine labsWellness...
Scope of Services for ConsiderationOccupational• Safety Seminars• Post-Employment• DOT Physicals• Functional Exams• TB tes...
Onsite Clinic Profile and ConsiderationsCharacteristics of Organizations implementing onsite clinics•   Organizations with...
Critical Success Factors•   Determine opportunity using the client specific claims data•   Coordinate with current benefit...
• Thank you for attending!• Questions?• Contact Information:   – Polly Thomas, Director, Onsite Clinic Consulting,     pth...
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Strategies to Enhance the ROI of Wellness Programs

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Strategies to Enhance the ROI of Wellness Programs

  1. 1. Strategies to Enhance the ROI of Wellness Programs Webinar
  2. 2. Agenda• Introductions• Current Landscape• A Strategic Wellness Framework• Wellness Interventions• Total Health Management• Recent Trends – Onsite fitness – Onsite clinics 2
  3. 3. The Landscape: Medical Costs and Access• Medical cost inflation continues rapidly (8-10%)• 2011 health care spend estimated at $3 trillion• Health reform bill mandates coverage and penalizes employers to pay the costs, but does little to address the rising cost of health costs, unhealthy behaviors, or the current fee for service medical payment model• The current bill increases access to care in a system that is already at capacity- 32 million more patients will now have access to the same number of physicians• Reduction in Medicare and Medicaid reimbursement schedules has hospitals and physicians looking to private insurance to fill the gap *Source: Segal, Kaiser, Aon studies 3
  4. 4. The Landscape: Health Continues to Decline • Out of 100 U.S. adults…. – Only three are non-smokers, not overweight, are physically active, and eat a healthy diet • 60% of healthcare expenditures are attributable to preventable illness or modifiable risks • For every 100 employees…. – 20% of healthcare expenditures are attributable to preventable illness – 40% of healthcare expenditures are attributable to modifiable risk – 11,500 hours of productivity per year are lost due to health conditions • Inpatient hospital stays represent the largest portion of medical inflation *Source: CDC, Segal 2011 Study 4
  5. 5. What does this mean for the employer? “It is not the strongest of the species that survives, nor the most intelligent, but the one most responsive to change.” Charles Darwin•Employers have a unique ability to change the trend ifthey are willing to adapt•Requires a comprehensive strategy that addresses: •Plan design that supports the population’s unique needs- driven by analytics •Access to high quality and high value care that is convenient •Employee engagement: From participation to outcomes •Coordination of clinical and various vendor resources 5
  6. 6. Keys to Success Employee Engagement Total Health Consumerism Management 6
  7. 7. Outcomes and Quality Assurance WellnessFramework: Six Engagement and Rewards Components Benefit Plan Design and Intervention Data Analysis and Strategic Plan Sustainable Operating Environment Organizational Commitment © Copyright 2011 – CBIZ, Inc. NYSE listed: CBZ. All rights reserved 7
  8. 8. Quality of Population Traditional Work/Life Health Approach Approach Management Broader access to Broader range of evidence-Fun activity focus education and on-line based, interactive programsCreate awareness programs Integration of providers toGenerate interest Assess population risk provide member centricEducate with health risk focus on overall wellbeingVoluntary assessment/biometrics High engagement strategiesNo risk reduction Modest incentives for Behavioral coaching, diseaseNo high risk focus participation management, EAP utilizationNo meaningful Tracking participation Strong risk reduction incentives Wellness Committee Strong high risk focusNo link to benefit plans Modest evaluation Major use of external andNo three year strategic Modest risk reduction intrinsic motivatorsplan Mostly health focus Required activityNo specific Voluntary Strongly personal goals/scorecard Some personalization Developed three year strategicNo personalization Few spouses planNo spouses included Modest (annual) planning Rigorous evaluation/scorecard Modest goals Spouses and dependents served Morale Participation Results Oriented Oriented Oriented 8
  9. 9. Strategic Plan for Population Health Management includes the following broad objectives: – Year One: Branding/Culture/Organizational Commitment Define Vision and Strategy Setting Expectations Rewarding Participation – Year Two: Rewarding Participation and Improvement Expanding Engagement Capturing Process and Impact – Year Three: Rewarding Participation and Achievement Reporting Outcomes Return on Investment 9
  10. 10. Intervention and Engagement Progression Flow Greater Improved Awareness Participation Engagement Performance Wellbeing, and and External and Intrinsic and Positive Vitality, and Education Motivation Motivation Clinical Energy Impact 10
  11. 11. Participation to Outcomes Achievement Matrix Year One Year Two Year Three • Goal: change over Participation Criteria term ParticipationbiometricsandEmployee Meets ParticipationEngagement Criteria Meets the longYear One Meets specified Criteria improves biometrics over and achievesand Reward Saves $20 per month Saves $30 per month Saves $40 per month – Organization working to maintain the change Goal: 60% Goal: 30% Goal: 60% – Individuals working $15 per month to maintain theMeets$20 per monthCriteria Meets Participation Criteria Saves change Saves Participation Goal: 50% Goal: 30% Non Participant pays Non Participant Non Participant additional $20 per month Pays additional $30 per month Pays additional $40 per monthEmployee •Biometric Screening •Biometric Screening •Biometric ScreeningParticipation •Health Risk Assessment •Health Risk Assessment •Health Risk AssessmentCriteria •Annual Physical/Medical •Annual Physical/Medical Home •Annual Physical/Medical Home Home •Preventive Screening •Preventive Screening •Preventive Screenings •Wellbeing Planning Session •2 Wellbeing Sessions •Wellbeing Planning •Non tobacco user •Non tobacco user Session •2 Intervention programs •3 Intervention programs •Non tobacco user •DM if chronic condition •DM if chronic condition •Pregnancy program if applicable •Pregnancy program if applicable 11
  12. 12. Engagement Strategies to Enhance ROI• Provide autonomy, employee decides their choices, creates accountability = Self-directed• Enhance the employee’s belief that they can do something (exercise regularly, quit smoking), and provide the opportunity to get incrementally better at something that matters to the employee = Self-efficacy and Mastery• Enhance the employee’s belief that a particular behavior will produce a desired consequence (quitting smoking will help them breathe better when playing with kids) = Behavioral efficacy• Provide opportunities that are part of or impact the employee’s personal purpose, meets their unique needs and interests = Purpose. Provide a session for employees to create their personal purpose that includes their passions, long-term goals and current priorities• Create an environment that: – makes people feel good about participating; positive marketing – Little or no cost to employee (cost barrier removed) – Is as open as possible: interventions are readily available and accommodating, they fit into employee’s lifestyles and schedules (access and time barriers removed) – Shows employees how to (not telling “what to do”) perform the actual behaviors they should perform, how to integrate the behaviors into their lives and how to change their environment outside of work so they can practice the behaviors (experiential learning) 12
  13. 13. ROI Measurement: Scorecards and Dashboards Wellness Scorecard [Date] Measure Year One Year Two Year Three Total Employee Count Number of Employees Eligible for Medical Plan Number of Total Members Enrolled in Medical Plan Number of Employees Enrolled in Medical Plan Number or percentage of members in a Consumer Driven Plan Design Male Employee Population in Medical Plan 80.30% Measure Year One Year Two Year Three Female Employee Population in Medical Plan 19.70% Screening Participation Total (ees only)Population Demographics Employee Average Age 41.1 Biometric Screenings At Risk and Obese BMI (BMI > 25) Number of Dependents Enrolled in Medical Plan At Risk Waist Circumerence (male > 40, female > 35) Child Dependents in Medical Plan Pre-Hypertension/High Blood Pressure (Stage 1 & 2) Female Adult Dependents in Medical Plan High Cholesterol (> 200) Male Adult Dependents in Medical Plan Pre-Diabetes (Fasting) Member Demographics by Age Band High Glucose (Fasting and Non-Fasting) <01 Members with Chronic Conditions (Diabetes, High BP, High Choles., Asthma) 01 - 19 Members with Chronic Conditions (Stress and Anxiety, Depression) 20 - 29 Prescription Classes Top Number of Prescriptions (per 1,000) Year One Year Two Year Three 30 - 39 Antidepressants 603.1 40 - 49 Lipotropics 432.3 50 - 59 Diabetic therapy 298.9 Antiarthritics 230.0 60 - 64 Bronchial Dilators 222.2 65+ Anti-ulcer/gastrointestinal 188.8 Measure Year One Year Two Year ThreeQualifying Events Participation Medication Adherence Rate Health Risk Assessment 92 Measure (Benchmark is 80%) Year One Year Two Year Three 2011 Weight Loss Challenge (10% of body weight) Hypertension/Cardiac 84.4% 2011 Walking Challenge (150 miles) Diabetes 83.3% Routine Annual Physical Exam Cholesterol 91.9% Preventive Screenng Depression 86.3% Biometric Screenings Antipsychotics 88.5% Non-Tobacco Waiver Asthma 74.1% Two organization-wide intervention programs engagement Osteoporosis 87.2% Measure Year One Year Two Year Three HRA Participation Total (employees) 92 (4%) HRA Participation Total (dependents) 0.0% Male Population in HRA 42.0% Female Population in HRA 58.0% Average Age Wellness Population Score 38.7 13 Risk Stratification
  14. 14. • Low hanging ROI fruit: – Annual Exam and Preventive Screenings – Medical self-care – Flu vaccinations – Stress/resiliency programs – Injury prevention: work, home, vehicular and recreational – High risk pregnancy prevention program – Tobacco cessation program with NRT – Positive communication, communication, communication 6 – 18 month ROI• A Way to Approach ROI: – First focus on impacting risks and costs associated with the health plan – Second, look closely at absence and sick leave costs and those than can be affected by a wellness program – Third, reduce workers compensation risks and costs – Fourth, focus on reducing risks and costs associated with disability – Finally, review the ‘harder to measure’ areas that can be positively impacted, including work effectiveness, employee morale, productivity, decision-making ability, improved service and increased revenue generation potential 14
  15. 15. TOTAL HEALTH MANAGEMENT = VALUE Plan Design Value Based Benefits Wellness and Absence Condition Management Management Consumerism Wellness and employee Physical Activity engagement Center Safety and Communication Occupational and Education Medicine High Performance Networks 15
  16. 16. Sustainable Operating Environment Interventions – Onsite FitnessGoals Typically Considered:• Convenience, removes barriers to access, and medium for other wellness programming• Cultural message in support of wellnessGeneral Considerations:• Space planning and construction, budgeting for equipment purchase and maintenance• How will each individual get access to the fitness center?• What will the hours of operation be? Will you have cameras or key cards?• Will it be staffed by a fitness professional? Concern for an individual working out alone?Policies and Procedures:• Individual must complete a pre-activity screen• If there are any cardiovascular risk factors they must have a signed physician release form• Develop a written policy for cleaning and disinfecting equipment• Apply appropriate signage that clearly indicates they are assuming personal responsibility for engaging in the use of the facility without staff supervision, and that as a result, certain risks exist that they should be prepared to deal with.• Consider a formal orientation processRisk:• Consult with your property and casualty advisor regarding insuring equipment and risk• Ensure legal counsel is supportive• An automated external defibrillator should be placed in or near the facility• Facility staff should be CPR and AED certified• Safety/incident reporting and management process in place 16
  17. 17. Trends in employer sponsored clinicsTrends• Onsite Clinics• Near-site or shared clinics• Concierge physician relationships with local providers or health systems• Part-time clinics (scalable model)• Increased adoption of these services as cost saving measures in the public sector• Outcomes based performance metrics• Carrier Support Why are employers evaluating these options? • Improve access to quality care for their employees in light of healthcare reform • Healthcare reform does not address the rising cost of healthcare, it addresses access • Provide the necessary access to enable employees to be accountable for their health • Creation of a predictable and fixed liability for services performed in these arrangements • Cost savings through reduction of over-utilized and expensive services • Improve employee recruitment and retention during tough economic times • Improve access to preventative services • Make consumer driven plans more palatable • Improve the quality of the employee and provider relationship—personalize the approach • Creation of a happy and healthier workforce • Provide a consistent and trusted relationship to employees, improving the healthcare experience 17
  18. 18. Scope of Services for ConsiderationUrgent Care• Colds and Sinus Infections• Prescriptions• Flu Shots• Routine labsWellness• Biometric Screenings• Health Assessments• Coaching and EducationPrimary Care• Communication with other providers• Patient Centered Medical Home• Physicals• Specialty Referral Networks• FMLA CertificationAncillary Services: PT, Chiropractic, Radiology 18
  19. 19. Scope of Services for ConsiderationOccupational• Safety Seminars• Post-Employment• DOT Physicals• Functional Exams• TB tests and Immunizations• DOT Drug Screens• Random Drug Screens• Post employment physicals• Roles and responsibilities definitions• Supervisor trainingWorker’s Compensation• Occupational Medical Services• Communication with other providers• Coordination of light duty and return to work programs• Record Management/DOT file maintenance• First Report of Injury 19• Case Management
  20. 20. Onsite Clinic Profile and ConsiderationsCharacteristics of Organizations implementing onsite clinics• Organizations with or 450 or more benefit enrolled employees or a large percentage of retirees or dependents who live within 7 miles of the proposed site location• High prevalence of chronic conditions within the population• Low utilization of primary care and preventative services• ER and specialist visit utilization is high• Occupational medicine costs are high or are not decreasing• Health risk factors in the population are not decreasing, despite wellness programs• Implement or are willing to consider consumer driven plans• High absence or lost time replacement costs• High pharmacy utilization, or low generic or therapeutic alternative utilization• Smaller employers in close proximity with shared demographicsOnsite Clinic Considerations• Feasibility Employer Sponsored Clinics• Cost and Measuring Return on Investment• Staffing Model• Scope of Services to offer• Who will have access to utilize the clinic• Will you charge for use of the clinic• What is your primary objective for opening a clinic• Compliance and Regulatory issues 20• Funding arrangement
  21. 21. Critical Success Factors• Determine opportunity using the client specific claims data• Coordinate with current benefit programs• Select partners, not vendors, based on their willingness to work within your model• Develop scope of services based on your specific needs• Communication is key- over communicate in a variety of medium• Do not under-estimate time commitment• Align plan design, incentives and scope of services• Prioritize and phase in services based on demand and greatest return on investment• Set realistic expectations• Provide and show executive level engagement• Hire clinicians for cultural fit• Integrate data and provide for coordinated care• Engage employees early in the process• Develop relationships with community-based providers 21
  22. 22. • Thank you for attending!• Questions?• Contact Information: – Polly Thomas, Director, Onsite Clinic Consulting, pthomas@cbiz.com, (913) 234-1013 – Gina Payne, National Director of Wellness, gina.payne@cbiz.com, (913) 234-1064 – www.cbiz.com 22

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