Maine HR Summit 2010- Rules for Wellness Programs
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This document discusses the growing costs and prevalence of chronic health conditions and how employers can promote employee wellness to improve health and reduce costs. It provides data showing chronic conditions and obesity are increasing in the US workforce. Poor health contributes significantly to medical and productivity costs. The document outlines MaineGeneral Health's successful wellness program which reduced health risks and costs through health coaching, incentives, and measuring outcomes. Their program shifted many employees to lower risk categories, lowering claims costs by nearly $1 million. The summary emphasizes how wellness programs can systematically improve workforce health and enhance business performance if they take a long-term, data-driven approach to health behavior change.
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Maine HR Summit 2010- Rules for Wellness Programs
- 1. Becky Lamey SVP of Human Resources Denise Dumont-Bernier, PT Director, Workplace Health What are the âRulesâ for Wellness Programs? How can your company learn from MaineGeneralâs success in promoting wellness and achieving healthier employees?
- 2. Why Wellness? ⢠Prevalence of chronic conditions is growing ⢠Inactivity and obesity contributes to chronic diseases ⢠Our workforce is aging ⢠Poor health costs more ⢠Employers can make a difference
- 3. Occupational Injury Trends, US & Maine, 1995 â 2008 10.1 9.4 9.2 8.8 8.4 8.4 7.8 6.56.76.97.2 6.4 6.3 6.2 0 2 4 6 8 10 12 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 InjuriesinMillions U.S. Maine * Bureau of Labor Standards
- 4. Prevalence Of Chronic Conditions Is Growing 118 125 133 141 149 157 164 171 100 120 140 160 180 1995 2000 2005 2010 2015 2020 2025 2030 Year NumberofPeople(millions) Wu, Shin-Yi and Green, Anthony. Projection of Chronic Illness Prevalence and Cost Inflation. RAND Corporation, October 2000
- 5. Inactivity And Obesity Contributes To Chronic Diseases
- 6. 1999 Obesity Trends* Among U.S. Adults (*BMI âĽ30, or about 30 lbs. overweight for 5â4â person) 2008 1990 No Data <10% 10%â14% 15%â19% 20%â24% 25%â29% âĽ30%
- 7. Source: Mokdad et al., Diabetes Care 2000;23:1278-83; J Am Med Assoc 2001;286:10. Diabetes Trends Among Adults: U.S. 1990 1995 2001 No Data <4% 4%â6% 6%â8% 8%â10% ⼠10%
- 8. A new diabetes diagnosis doubles the risk of stroke within 5 years Stroke: June 2007
- 9. Our Workforce is Aging
- 10. % of Population with Chronic Conditions by Age Group 25% 40% 67% 87% 5% 67% 40% 15% 0% 25% 50% 75% 100% Age 0-19 Age 20-44 Age 45-64 Age 65+ One or more chronic condition Two or more chronic conditions Source: Medical Expenditure Panel Survey, 2001, Johns Hopkins University, Partnership for Solutions
- 11. Poor Health Costs More
- 12. The Real Problem: The Full Cost of Employee Poor Health Personal care costs Medical Care Pharmacy 25% Productivity costs 75% STD LTD Overtime Turnover Temporary staffing Administrative costs Replacement training Off-site travel for care Customer dissatisfaction Variable product quality Absenteeism Presenteeism Medical & Pharmacy Costs $3,376 PEPY Health-related Productivity Costs $10,128 PEPY Total: $13, 504 PEPY Sources: Edington DW, Burton WN. Health and Productivity. In McCunney RJ, Editor. A Practical Approach to Occupational and Environmental Medicine. 3rd edition. Philadelphia, PA. Lippincott, Williams and Wilkens; 2003: 40-152. Loeppke, et.al., JOEM, 2003; 45:349-359 and Brady, et.al., JOEM, 1997; 39:224-231
- 13. Top 10 Costly Medical Conditions: Medical & Pharmacy Costs Only CoronaryDiseaseChronic Pain HighCholesterolGERD Diabetes SleepingProblem Hypertension Arthritis Back/Neck Cancer (otherthanskincancer ) $200,000 $160,000 $120,000 $80,000 $40,000 $0 Outpatient Inpatient Drug Med/Rx Cost by Annual Medical + Pharmacy Cost Per 1000 FTEs Average for Four Employers (N=15,380 ees) Source: Loeppke R, et.al., âHealth and Productivity as a Business Strategyâ, J Occup Environ Med. Vol 49, No. 7, July, 2007. Pages 712-721.
- 14. Top 10 Costly Medical Conditions: Total Costs $600,000 $500,000 $400,000 $300,000 $200,000 $100,000 $0 Annual Total Cost Per 1,000 FTEs Average from all Four Employers (N=15,380) Source: Loeppke R, et.al., âHealth and Productivity as a Business Strategyâ, J Occup Environ Med. Vol 49, No. 7, July, 2007. Pages 712-721. Back/Neck Depression Fatigue Chronic PainSleeping Problem HighCholesterolArthritis Hypertension Obesity Anxiety Outpatient Inpatient Drug Absenteeism Presenteeism
- 15. Lost Productivity: Age & # of Chronic Conditions
- 16. By helping employees to adopt healthy lifestyles as we age Employers Can Make A Difference
- 17. Develop a Game Plan ⢠Identify goals ⢠Build a long-term strategic plan ⢠Measure results
- 18. Identify goals â What are you trying to accomplish? ⢠Reduce health insurance premium increases? ⢠Implement a âWellness Programâ because itâs the right thing to do? ⢠Identify the key cost drivers and remove or reduce barriers so the health plan supports the overall health and wellbeing of employees and their families? ⢠Enhance productivity? ⢠Employee morale & retention? ⢠Other?
- 19. Build a long-term strategic plan â Chose your team ⢠Leadership ⢠Commitment? ⢠Goals and Expectations? ⢠Data and investments? ⢠Communication ⢠Insurance Broker ⢠Resources ⢠Other vendors â TPA/insurance carrier, Wellness vendor, HRA vendor ⢠Wellness team ⢠Approach ⢠Tools and Incentives ⢠Communication
- 20. Measure results â Keep score ⢠Know what you are going to measure and have a baseline. ⢠Communicate both personal and organizational successes. ⢠Report on Return On Investments.
- 21. Know your stats ⢠Health care costs are expected to increase 6½% - 9% in 2010. ⢠67% of employers identify employeeâs poor health habits as a top challenge to maintaining affordable benefit coverage. ⢠58% of employers indicated the biggest obstacle to changing employeeâs health related behavior is the lack of employee engagement. ⢠Employees are 8 times more likely to be engaged in their work when their employer makes wellness a priority.
- 22. Measuring Success at MGH
- 23. Actual Claims Costs Per Risk Category 2008 actual average claims costs per risk category : $0 $2,000 $4,000 $6,000 $8,000 $10,000 Low Risk Medium Risk High Risk $4,025 $6,600 $9,750 Low Risk Medium Risk High Risk
- 24. Employees CAN change Behaviors % Count % % Begin Date End Date Change Count Count Low 620 42% 945 63% 325 19% 155 52.4% Medium 584 39% 393 26% -191 -32.7% 10% -134 -46.4% Total 1493 1493 High 289 0 200 400 600 800 1000 Low Medium High 620 584 289 945 393 155 Risk Level #ofParticipants
- 25. MaineGeneral Results Net Change among risk categories (1493 participants) Count Per Person Risk Variance in Costs Total Variance 325 moved into low risk category 843 stayed in low risk -191 moved out of medium risk category $ 2,575 $ (491,825) -134 moved out of high risk category $ 3,150 $ (422,100) TOTAL POTENTIAL SAVINGS $ (913,925)
- 26. Medical claims history 4.2% $705,473January 1, 2005 - December 31, 2005 -4.3% ($793,067)January 1, 2006 - December 31, 2006 0.5% $96,750January 1, 2007 - December 31, 2007 2.7% $594,327January 1, 2008 - December 31, 2008 9.0% $1,337,340January 1, 2009 â December 31, 2009 (+ / - ) Variance To Budgeted # HRA Coaching Participants 2002 1724 900
- 27. MGH Bends the Cost Curve $7,901 $8,471 $6,703 $8,431 $8,369 $6,703 $7,306 $7,964 $8,680 $9,462 $0 $2,000 $4,000 $6,000 $8,000 $10,000 2005 2006 2007 2008 2009 Year Cost Per Employee Per Year Actual Cost PEPY Estimated Cost PEPY
- 28. MaineGeneral Health $0 $2,000 $4,000 $6,000 $8,000 $10,000 2005 2006 2007 2008 2009 Year Cost Per Employee Per Year Actual Cost PEPY Estimated Cost PEPY MGH Bends the Cost Curve
- 29. Ballooning Costs of Poor Health Dealing only with the financial transactions of healthcare doesdoes notnot lowerlower totaltotal costscostsâit tends to only shift them Health Enhancement programs can reduce the Burden of Illness and Burden of Health Risks leading to healthier population and measurable total cost DECREASES Š R Loeppke, MD â Reprinted with Permission
- 30. How to get started ⢠Youâve quantified and evaluated your current information ⢠Youâve defined your goals ⢠Youâve defined your target audience ⢠Youâve organized your team ⢠Leadership is on board ⢠Now, what do we do?
- 32. Wellness Interventions ďźHealth awareness interventions? GOOD âFeel good wellnessâ- âwellness for fun and pleasureâ- no appreciable risk burden change or economic impact ďźHealth education interventions? BETTER âSomething for everyoneâ- variable risk burden change and some economic impact ďźBehavior change interventions? BEST â Serious wellness!â- maximal risk burden and economic impact- a health and productivity partnership emphasizing company and participant health behavior change
- 33. Personalized, Behavior Change One size does not fit all One size fits one
- 34. Understand Behavior Change Stage Person Approach Pre- contemplative Not thinking about change Motivational Interviewing Contemplative Weighing benefits and costs of behavior Motivational interviewing Preparation Experimenting with small changes Setting goals Action Taking definitive action to change Executing Maintenance Maintaining new behavior over time Support Relapse Normal part of change process Motivational Interviewing
- 35. Reach IndividualIndividual CoachingCoaching Group ProgramsGroup Programs Self Help GuidesSelf Help Guides Lunch & LearnsLunch & Learns PamphletsPamphlets Low High InterventionEffectiveness High Mass MediaMass Media Choose Interventions that Educate & Affect Behavior Change
- 36. Personalized Health Coaching ⢠Supports individuals with personal health challenges and goals ⢠Builds accountability ⢠Provides personalized resources and education
- 37. Reward & Recognize Success ⢠Research indicates that $200- 300/year is effective for most organizations ⢠Tied to participation and achievement Cash, Time off, Drawings, Gift Cards/Certificates, Reductions in health premiums, Goodies, Health savings account contribution
- 38. Measure Results- MGH: (2072 participants) 70% Low Risk 23% Medium Risk 7% High Risk Cost Risk for Total Population
- 39. 15 Behaviors Contribute to Costs ⢠Absenteeism ⢠Alcohol Abuse ⢠Existing Medical Condition ⢠High Blood Pressure ⢠Total High Cholesterol ⢠Inactivity ⢠Life Dissatisfaction ⢠Low Back Pain ⢠Low LDL Cholesterol ⢠Negative Health Perception ⢠No seatbelt/helmet use ⢠Overweight ⢠Seriously Overweight ⢠Stress ⢠Tobacco Smoke
- 40. Measure Results! A Small Employer with less than 50 employees Change in Health Risk Scores: Q1 2008 to current
- 42. Change In Incidence Rates Over Time Depression 82 40 -51.2% No Preventative Aspirin Discussion 87 71 -18.4% No Colon Cancer Screening 92 56 -39.1% Chronic Back Pain 124 139 12.1% Children At Risk 132 114 -13.6% Life Dissatisfaction 132 85 -35.6% High Blood Pressure 146 106 -27.4% Negative Health Perception 150 124 -17.3% Asthma 173 160 -7.5% Absenteeism 188 184 -2.1% Overweight 207 212 2.4% Low Back Pain 209 146 -30.1% Tobacco Smoke 213 202 -5.2% Stress 242 117 -51.7% Arthritis 300 293 -2.3% Poor Nutrition 412 274 -33.5% Allergies 495 413 -16.6% Prehypertension 528 476 -9.8% Seriously Overweight 578 556 -3.8% Presenteeism 608 307 -49.5% Inactivity 701 551 -21.4% Begin End % change Total Participant Population: 1,570 Osteoporosis Screening 4 7 75.0% Alcohol Abuse 9 13 44.4% No Prostate Cancer Screening 11 3 -72.7% Lung Disease 12 12 0.0% Stroke 13 15 15.4% Abnormal Glucose Metabolism 18 16 -11.1% Low BMI 19 10 -47.4% Low HDL Cholesterol 22 20 -9.1% Medication Noncompliance 22 14 -36.4% Overdue PAP Screening 32 28 -12.5% No Self Care 34 19 -44.1% No Testicular Cancer Self-exam 35 17 -51.4% Heart Disease 42 32 -23.8% No Seatbelt/Helmet Use 45 80 77.8% Alcohol Binge Drinking 55 21 -61.8% High Total Cholesterol 57 51 -10.5% No Mammogram Screening 62 25 -59.7% Cancer 65 59 -9.2% Second Hand Smoke Exposure 74 40 -45.9% Diabetes 77 83 7.8%
- 43. Reductions in Health Risks All WPH Wellness Companies- as of Jan 2010 778 741 426 1204 548 194 0 200 400 600 800 1000 1200 1400 Low Medium High Health Risk Category Numberofpraticipants Program Start Program Current Count % Count % Count % Low 778 40.0% 1204 61.9% 426 54.8% Medium 741 38.1% 548 28.2% -193 -26.0% High 426 21.9% 194 10.0% -232 -54.5% Total 1945 1946 Program Start Program Current Change over Time
- 44. Good for the Bottom Line Well designed wellness programs can: ďź Reduce Health care costs ďź Reduce Sick Leave/Absenteeism ďź Reduce Workerâs Compensation Costs ďź Reduce Presenteeism ďź Enhance Productivity ďź Increase morale, loyalty, job satisfaction, retention ďź Enhance business reputation
- 45. ⢠Take a systematic approach to quantify, evaluate and optimize your companyâs investment in its workforce ⢠Analyzing medical & pharmacy data only provides a look at a portion of the problem ⢠As employees age and experience multiple chronic conditions, employers must establish wellness strategies to maintain a healthy productive workforce ⢠Health is a performance driver ⢠Investing in health is fundamental to a healthier bottom line Summary
- 46. Resource Guide Books: ⢠ACSMâs Worksite Health Promotion Manual-A Guide to Building and Sustaining Healthy Worksites, by Carolyn C. Cox ⢠Worksite Health Promotion by David Chenoweth ⢠Health Promotion in the Workplace by Michael P. OâDonnell ⢠Zero Trends: Health As a Serious Economic Strategy, Dee W. Edington
- 47. Check out the Health in your Community: http://www.communityhealth.hhs.gov
- 48. Contact us: ⢠Denise Dumont-Bernier denise.dumont-bernier@mainegeneral.org 207-242-3924 ⢠Becky Lamey rebecca.lamey@mainegeneral.org Thank You
Editor's Notes
- Address Survey Audience Wellness Programs in Place? Measuring success? What do you hope to learn? Take away?
- 40% decrease We paid attention to WC and have reduced costs⌠now need to focus on health care costs
- Obesity-related Illness and Disease Type II Diabetes Stroke Cardiovascular Disease High Blood Pressure High Cholesterol Pulmonary Disease Sleep Apnea Respiratory Problems Cancers Acid Reflux Disease Psychological/Social Effects Gallbladder Disease Bladder Control Problems Uric Acid Kidney Stones Gout and osteoarthritis Reproductive Issues Women â pregnancy complications, irregular menstrual cycles Men - infertility Musculoskeletal problems In past 15 yrs⌠Walking trips declined 40% Children walking to school dropped 60% Workers have more sedentary jobs Leisure includes more screen time
- &lt;number&gt;
- Overweight&gt;&gt;&gt; Diabetes&gt;&gt; Stroke Waterville based company- had a 42 YO employee have a stroke on the job, very visible, well liked, passed away a few days laterâŚ. Unfortunate tragedy jump-started their wellness program last year
- Results from Phase 1 of the study determined the top 10 conditions when only an employerâs medical and pharmacy costs are considered. Cancer, back and neck pain, coronary disease and chronic pain are the top drivers of health care costs using these parameters.
- But when absenteeism and presenteeism costs were added to medical and pharmacy costs as a part of the study, a different set of conditions emerged. Using these parameters, back and neck pain is the costliest disease, followed by depression and fatigue. the some of the top conditions driving overall health costs â depression or fatigue, for example â may not be fully represented when an employer totals medical and pharmacy costs. They may not be medically diagnosed, and thus may not show up in medical or pharmacy claims. But they are real when it comes to their impact on overall health costs.
- Relationship of chronic conditions to lost time/lost productivity
- Reduce health insurance premium increases â plan design, contribution levels, overall improvement in employee health status. Implement a âWellness Programâ because itâs the right thing to do â HRA, Wellness committees, increase participant awareness. Identify the key cost drivers and remove or reduce barriers so the health plan supports the overall health and wellbeing of employees and their families â preventative screenings, pharmacy benefits, target efforts on key conditions, reward individuals for reaching their goal.
- Know what you are going to measure organizationally and individually. Org-claims costs or loss ratio, employee productivity, engagement, participation rates, preventative screenings. Personal- biometrics (history) changes in health status, preventative screenings. Coaching for change and referral. Communication- identify venues, company newsletter, wellness newsletter, community news, overall results and individual results. Share stories to motivate and encourage. Website links. Change the culture â encourage activity, healthy foods, safety. ROI-from baseline-claims expenses, loss ratio, beating medical trend projections, increasing the use of generic drug use, productivity, ee engagement, WC exp. Mod, change in health conditions.
- Towers Watson and Manpower Inc. surveys. Current health claims. Future health claims, disability, WC, absenteeism, low productivity costs. Incentivizing HRA participation and motivational coaching. Employee satisfaction = customer satisfaction, lower turnover, higher productivity.
- January 1, 2008 through September 2009âŚ.. 1493 employees followed Yellow column = first round, green column = 3rd round.
- Actual budget variance running $1.4 million.
- MGH is self insured which allows for a lot of flexibility in plan design and directing health care dollars. Wellness programs can save money for fully insured plans as well giving insured plans a negotiating chip at plan renewal time. Data is key. Moved to new TPA in 2005 that partnered with us. 2006 loss lead to plan design changes $500 deductible. HRA program was face to face coaching as our philosophy is based in changing behaviors. $257,000 is built into 2009 premiums for incentives. $170,000 Wellness program. Total investment $427,000/3800 eeâs= $112/year
- Now letâs discuss the third element of an HPM program: optimizing. After measurement and evaluation we optimize in order to determine the most cost-effective ways to improve health -- and ultimately, productivity -- through action steps in the workplace. When faced with rising medical and pharmacy costs, some workplaces may opt for traditional solutions, such as increasing deductibles and co-pays. But these solutions do not lower total costs. They tend to simply shift expenses from one aspect of health-related costs to another. To be successful in decreasing health-related costs, we must promote a healthier workforce through health-enhancement programs. This is the heart and soul of the HPM concept â which moves from a focus on reducing health expenditures to a strategy of investing in health outcomes. Decreasing the overall health risks of the employee population through health enhancement programs leads to a healthier, more productive workforce and measurable total cost decreases.
- The better the intervention/investment, the better the results
- More personalized, behavior change approach (coaching) produces the best results.
- These 15 behaviors have been proven to most contribute to costs Wellness programs need to address ALL of these if present in the population
- Begin Date End Date Change Count % Count % Count% Low 10 23% 24 56% 14 140.0% Medium 19 44% 15 35%â4â21.1% High 14 33% 4 9%â10â71.4% Total 43
- Claims Costs Savings: If the following represents Average Medical & Pharmacy Costs per Risk Score Low$4,025 Medium$6,600 High$9,750 Assuming that all companies had similar average claims costs, then the potential for savings with the above changes from higher to lower risks would be: Variance between High & Medium Risk Cost($3,150) Variance between Medium and High Risk Cost($2,575) Savings Number of People who changed from High to Medium-232$730,800 Number of People who changed from Medium to Low-193$496,975 Total$1,227,775 Lost Productivity Costs are said to be 75% of the Total Costs while medical/pharmacy are only 25% Potential Savings in lost productivity is estimated at$3,683,325
- Health and Productivity Management is a systematic approach to measure, evaluate and optimize a companyâs investment in its workforce. The growth of HPM in the workplace is being driven by intense health, demographic, economic and business trends. HPM is built upon the strong connection between health and human capital â which is the proportion of an individual employeeâs total productive output in the service of an organization. HPM is not possible without a full-cost assessment method. Basing strategic decisions on medical and pharmacy costs alone is not enough; it tends to simply shift costs. Other measures must be included as part of the strategic assessment, such as short-term and long-term disability, workers compensation, family medical leave, quality of work, employee turnover and more. With accurate measurement and evaluation, employers can then turn to the task of building new strategies and programs for health enhancement of the workforce. These programs will be critical as employees age and experience multiple chronic conditions. Optimized programming should reflect HPM in six key elements: General Philosophy, Organizational Structure, Goals and Metrics, Intervention and Outcomes, Integration and Trends, and Incentives.