A Tale of Two Wellness Programs:Comparing a high incentive/low programming model

with a low incentive/high programming model

Rob Davenport, Wellness Program Manager

NASA – Johnson Space Center

High Incentive Model

• Organization: Pacific Coast Building Products (PCBP) Privately owned diversified building materials company.

• Data period: 2008 & 2009

• Location: HQ in Rancho Cordova, CA Over 70 locations in 10 western states and Canada.

• Employee population: 2700 union and non-union EEs Predominately hourly workforce – 23% RIF 2008-2010; 3500 employees in „08.

Large percentage of Hispanic speaking employees.

High cost claims

All claims

Un-diagnosed

conditions

All current and potential health

risk behaviors that lead to high

cost chronic disease conditions

Health Care Iceberg

Factors that Influence

Health Status

Lifestyle

Behavior

50%

Medical Care

10%

Environment

20%

Genetics

20%

Obesity

PhysicalActivity

Smoking

Stress

66% obese or overweight

78% not regularly active

23% smokers

36% high stress

Key Drivers of Health Status

Aging 22% > 55 years, aging population

Driver Prevalence

Incentive Program History

• 2008 Incentive activities/amounts HRA = $25/month

Screening = $15/month

Tobacco affidavit = $10/month

• 2009 Incentive activities/amounts HRA/screening = $30/month

Health pledge = $10/month

Tobacco affidavit = $10/month

• 2010 Incentive activities/amounts Biometric results = $30/month

HRA/screening = $10/month

Tobacco affidavit = $10/month

Program Progression

• 2008 – Implement incentive program Initially based on participation; activities purposely made easy.

Program implementation coincided with end of free health coverage.

• 2009 – Adjust incentive amounts & activities Combined HRA with screening into one activity.

Added “Health Pledge” as transition to prepare employees for 2010.

• 2010 – Link incentive to biometric outcomes Criteria purposely made easy to allow education and transition.

Criteria to be more stringent in future years.

Incentive Details

• Incentive Type (benefits integrated) Credit toward employee‟s health insurance premium contribution.

Meets HIPAA – doesn‟t exceed 20% of total contribution.

• Incentive Distribution Credits distributed following year on 1st pay period.

Credit shown on every paystub for reinforcement.

• Tax consequences Incentive is tax free since no cash payment is made.

Gross income is reduced.

Impact of Incentives

• 2010 California home buyer tax credit Only 3 months to exhaust $100 million program - 33,760 applicants.

• Federal first time home buyer tax credit Up to 600,000 homes purchased because of tax credit in ‟09 & ‟10.

Up to 300,000 people purchased homes this summer to meet deadline.

• Federal “Cash for Clunkers” tax credit 690,114 total applications for $3 Billion incentive program.

1 month to exhaust original $1 Billion; Congress extended it 2 months.

California Franchise Tax Board; Mortgage Bankers Association; Wikipedia.

Other Companies Results

• StayWell incentive study 36 companies with 559,988 employees eligible to take HRA.

49% of eligible employees (275,100) participated in HRA.

3 incentive types: “trinkets,” cash based and benefits integrated.

Non-cash trinkets: up to $25 in value resulted in < 40% participation rate

Cash based: $25-$100 range resulted in an average participation rate of 45%

Benefits integrated: $50-$600 range resulted in highest participation rates

$200 incentive drove participation near 65%

$400 incentive drove participation up to 80%

Conclusion: incentives have a positive impact on HRA participation.

ACSM Health & Fitness Journal, Vol.12/No.4, 2008.

Wellness Results & Goals(* percent of workforce)

Wellness Metric 2008 Result 2009 Result 2010 Goal

* Health screening participation 92% 94% 95%

# of risk factors/person 2.7 2.5 2.3

* Unhealthy body mass index (BMI) 79% 79% 76%

* High Total Cholesterol Reading 11% 12% 10%

* High Blood Pressure Reading 36% 23% 20%

* High Blood Sugar Reading 11% 11% 9%

2010 Biometric Credit Details

• Wellness vendor will confidentially evaluate 4 biometric health factors:

- Body Mass Index (BMI) - Total Cholesterol

- Blood Pressure - Blood Glucose

• Two ways to earn biometric credit; vendor will check results to:

1. Determine if employee meets criteria for any 2 out of the 4 factors, or

2. If step one isn‟t met, compare employee‟s results from 2010 to 2009 to

determine if there was improvement in any 2 out of the 4 factors.

Biometric Credit Criteria

Eligible for Biometric Credit Not Eligible for Biometric Credit

Biometric Health Factor Healthy Range Borderline Range Unhealthy Range

BMI – Body Mass Index 18.5 – 24.9 (desirable) 25 – 29.9 (overweight) 30 and above (obese)

Total Cholesterol 199 and below (desirable) 200 – 239 (elevated risk) 240 and above (high risk)

Blood Pressure* 119 and below (systolic) &

79 and below (diastolic)

120 – 139 (systolic)

80 – 89 (diastolic)

140 and above (systolic) or

90 and above (diastolic)

Blood Glucose 139 and below (non fasting)

70 – 110 (fasting)

N/A 140 and above (non-fasting)

111 and above (fasting)

Wellness Programming

• Subsidized health club membership 24 Hour Fitness - $10/mo (good to 95% of 375 US clubs).

16.5% of employees are members (2008).

• Tobacco cessation $150 reimbursement for tobacco cessation aids and programs.

Referred to CA state quit line and health carrier‟s resources.

• Weight loss Internal support group.

Referred to health carrier‟s resources.

0.00%

10.00%

20.00%

30.00%

40.00%

50.00%

60.00%

70.00%

January Feb March April May June

0 visits

1-4 visits

5-8 visits

> 9 visits

24 Hour Fitness Utilization Trend - 2008

Wellness Programming

• Stretch/relaxation breaks 10 minute break in the lunch room at 2pm Monday – Friday.

Relaxation breaks: Mon-Fri; stretch breaks: Tues & Thurs.

• Monthly wellness information E-mail broadcast of national health observance and events.

• Quarterly wellness newsletter Vendor created newsletter distributed to all sites.

Wellness Programming

• Monthly “poker” walks “Fitness Friday” walks open to all employees.

Gift cards to best poker hands every 6 months.

• Challenges Active for Life (ACS program) – 82% participation in 2008.

“Beat the CEO” & “Biggest Loser.”

• Health & Fitness Week Health screening/Health fair/group health trivia game.

Free healthy lunch one day and free healthy snacks every day.

Keys to Success

• Planning and execution

• Management support All levels: executive, mid-management & supervisors.

• Communication plan Transparent, regular and easy to understand.

Comprehensive: home mailing, e-mail, meetings, bulletins, etc.

• Culture Integrate with corporate values.

Pervasive throughout operations.

Keys to Success

• Promote health carrier resources/EAP 24/7 Nurse care phone line.

Healthy pregnancy, weight loss, tobacco cessation, etc.

• Select incentive/s meaningful to population Integrate into benefits: lower premium, HSA contribution, etc.

Cash has tax consequences.

• Evaluate and modify Collect data: health claims, HRA and surveys.

Review data regularly and target key risk areas.

Effective Program Strategies

• Capitalize on human assets Wellness committee – engaged hourly, salaried & mgmt employees.

Skilled employees – leverage existing employees who can lead

activities; martial arts, exercise class, etc. (liability)

• Wellness incentive program Customize fit – audit your population and select incentives that will

motivate employees to participate and sustain engagement.

Communication Plan – develop a clear plan that utilizes all forms of

communication, delivered by management and reinforced regularly.

Effective Program Strategies

• Low/no cost activities Health fair, on-site activities (walks), health challenges.

Themed days or months, stretch breaks, healthy pregnancy kits.

Meetings: wellness is a large part of CEO led annual meetings.

• Culture/environmental change Signs, banners, healthy vending/meals, policies.

Program branding: “WELLth Builder – building a better you.”

Corporate values: integrate wellness into your company‟s values.