DC Wellness Solution

Why DC Wellness?
• Constellation of financial vulnerabilities surrounding the typical
employer.
– Group Health
– Workers’ Compensation
– Non-occupational Disability
– Unscheduled Absence
– Turnover
• We assist our brokers and consultants in tying together all of the risks
their employer groups face. Our risk management strategy will:
– Improve the loss ration for your employer groups
– Increase your commission or consulting dollars while securing new lines of business
• Workers’ Compensation
• Life and Disability plans
• Placement of wellness remedial solutions

Proprietary and Confidential

The Next Generation of Wellness
Participation-Based Outcomes-Based
• Introduced over 20 years ago • Introduced in 2001; Final in 2008
• Health Risk Assessments • Biometric screening results
• BP-LDL-Nicotine-BMI
• Disease management
• Premium contribution / benefit
• Health coaching differentials
• 10% to 50% employee participation • Appeals and alternatives
• Incentives/penalties for • 90% to 99.9% employee participation
participation • Impact for passing tests
• ROI difficult to measure • 3% to 10% first year cost reduction

The use of penalties is expected to climb in 2012 to almost 40 percent of large and
mid-sized companies, up from 19 percent in 2011 and only 8 percent in 2009.


Integrated Wellness Solution
• Expert consulting and predictive modeling to help you illustrate potential “hard-
dollar” savings.

• Our state-of-the-art technology tracks program participation, biometric screening
results, appeals and alternative goals, and generates a custom eligibility and/or
payroll file

• Preparation of plan documents and compliance checklist(s)

• Available logistics support and online scheduling tool to support biometric
screenings

• Review of your strategy & communications to ensure compliance with federal
laws and regulations

• Strict adherence to HIPAA Privacy and Security regulations


The DC Wellness Approach
1. Identify Risk
Modify &
Identify Risk
2. Plan & Incent Adjust

3. Implementation
4. Measure & Report
5. Modify/Adjust
Measure & Plan &
Report Incent

Implementation

Identify Risk

Medical
Data
Pharmacy
Data

Wellness
Data

ABC Co. Specific
Measures

Plan and Incent based Upon
The Federal Wellness Rules
Federal legislation allows employer-sponsored health plans to give rewards or
assess penalties based on the results of a health assessment
• Premium contribution differentials
• Benefit plan differentials (deductibles,
co-pays, co-insurance levels)

Regulations are complex but achievable. Savings to health plans can be
significant (short and long term)

2010 National Healthcare Law preserves and expands the model


HIPAA Final Wellness Rules – We can help!
If an incentive is “contingent upon the
satisfaction of a health standard”:

It must be re-assessed at least once per year

It must be designed to promote health and wellness

It may not exceed 20% of the total cost of coverage offered.
(Raised to 30% effective January 1, 2014)

It must be available to all “similarly situated individuals”,
appeals and “reasonable alternatives” must be offered

The availability of the appeal must be disclosed in all
plan materials

Plan and Incent
• Legislation allows employer sponsored health plans to give
rewards or assess penalties based on the results of a health
assessment.
• A focus on immediate employer cost savings and employee
rewards.
• Biometric Screening SCORES set deductibles, coinsurance
and/or contribution amounts based on the following:
– Body Mass Index (BMI)
– Cholesterol Level (LDL)
– Blood Pressure
– Tobacco/Nicotine
– Glucose (Optional)


Implementation
• Custom Communications
• Customized communication pieces for employees and
program participants
• Online Scheduling Tool and Wellness Portal
• Coordination and Execution of On-Site Screenings
• Establish New Hire Screening Protocols
• IT Programming / Legal Compliance
• Programming and setup as well as review of all SPD’s and
program literature to insure compliance


Online Payroll Wellness
Registration Scheduling Screening Reports Appeals
HRA Tapes Portal

NATIONAL
WELLNESS INSTITUTES OF POINTS EARNED IF GOALS
ABC Co. 2012 GOALS
REQUIREMENTS HEALTH (NIH) MET*
GOALS
Blood Pressure ≤ 120/80 ≤ 130/85 1 Credit
Body Mass Index ≤ 24.9 ≤ 30 1 Credit
LDL Cholesterol ≤ 100 ≤ 130 1 Credit
Employee
Negative Negative 1 Credit
Tobacco/Nicotine
Spouse
Negative Negative 1 Credit
Tobacco/Nicotine


Appeals & Reasonable Alternatives
Administration
Administration of Appeals
• Appeals can be an overwhelming, time-consuming process, especially
for those who are unfamiliar with the rules.
• We have extensive experience with all types of appeals:
• Type 1: Disputing the accuracy of results
• Type 2: Exceptions due to medical issues
• Type 3: Improvement goal (optional)

Medical Issues
• We also work with individuals and their physicians to set alternative goals and complete healthy
lifestyle coaching programs when appropriate.


Measure & Report
• Employers receive:
– Aggregate Summary Report
– Results of the Biometric Screenings
• Employee receives:
– Personal Report
– Biometric Results
– Information regarding the Appeal Process


Traditional Risk Projection and Management
Typical Population

.6 .6 .6 .6

$$ Risk
.6 .6 .6 .6

In Reality… .2 .7 .8 .4

$$ Risk .6 .3 .1 .9


Raw Data From Insurer & Employer

Occupational
Health Care Health Risk
Pharmacy Biometric Risk /
Utilization Appraisal
Data Data Workers
Data Data
Comp

Control Panel - Query Data to Identify Cost Drivers

Output

Risk-Specific Money-Saving Solutions

Relational data-base with infinite
query capability and solution mining
Example Query Variables Example Questions
Age, Gender, Ethnicity How many individuals have Type 2 Diabetes?
Amount Paid, Date of Service How many females have Heart Disease?
Provider Type, Location, Biometric What are the top 10 most costly uses of the ER?
Data, Drug, Procedure Code, Type What are the top 10 most costly Inpatient cases?
Of Service, Dependent, Spouse, Employee, How many people over 50 have a diagnosis of
Diabetes, Heart Disease, Asthma, Hypertension?
Hypertension, Dyslipidemia, Depression,
(ICD9code)

Unlimited queries for the purpose of identifying cost drivers and
deriving risk mitigation solutions


Population Query for
Hypertension
John Doe;
Existence/Treatment
Hypertension?

NDC for
Report
ICD9 for Blood Injury BP
History
401-405? Pressure Data? reading?
of BP?
Meds?

Health Care Pharmacy Workers Health Risk Biometric
Utilization Data Comp Appraisal Data
Data Data
Output: Diagnosis = No
Meds = No
Injury = Fall
HRA = History BP
BP = 150/92 Proprietary and Confidential

Fundamental Research Questions
Based upon each client’s wellness strategy, clients often times request that
some fundamental research questions be answered with regard to their
population health management strategies.
1. What is the financial impact of the wellness program?

2. How effective has the wellness program been at reducing risk factors?

3. What is the relationship between biometric data and overall spending?

4. What were the gaps in care associated with the population?

5. What were expenditures related to chronic disease?

6. What members within the employee population are projected to have the highest future
expenditures?

7. What are the suggested risk mitigation solutions to reduce cost and risk within the overall
population?


Modify/Adjust
• Moving year over year incorporate:
– Medical Claims, Pharmacy Claims, Biometric
Screening Results, Wellness Program Data,
Workers’ Compensation Data, Disability Data and
anything else for which you can produce an
output.
• Based on most current data:
– Make appropriate Wellness Program Adjustments


Our Results
West Virginia based Millwork Company 1700 lives, 1,520 Participants, (99.6%)
• Every incentive category improve:
• 305 (16.2%) more participants passed their blood pressure goal
• 194 ( 10.3%) participants went from obese to non-obese
• 207 (11%) participants lowered their cholesterol to a desirable level
• 37 (2%) participants quit smoking
• Non-incentives measures (i.e. glucose) did not improve. Everything tied to money did
• Rate Increases have reduced from 21.2% to 14% to 6.5% to 1.2% our solution was adopted.
• Total Return on Investment for the first two years of the program, including risk reduction, was
$3.16 saved to $1 spent
• Included spouses in year 4, will include spouses in the fall of 2012 as well


Producing Savings
Non-
Pass 0 Pass 1 Pass 2 Pass 3 Pass 4
Participant

70% +$70 +$70 +$35 +$0 +$0

$700,000
$590,590
$600,000
$456,000 $515,970
$500,000 $448,000
$410,000
$400,000
$246,000 $297,890 $292,700 $295,920
$300,000
$202,000 $220,050
$200,000
$46,000
$100,000

$0
Jan 09 Oct 09 Oct 10 Oct 11

Program Cost Cost Shift Savings Wellness Budget


DC Wellness Mission Statement
The mission of DC Wellness is to be
recognized as the leader in improving
employee health and lowering
healthcare costs using innovative data
driven solutions and evidence based
guidelines to manage the unique
exposure of every plan participant.

DC Wellness Solution

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