Strategies to Enhance the ROI of Wellness ProgramsWebinar

September 14, 2011

Agenda

• Introductions

• Current Landscape

• A Strategic Wellness Framework

• Wellness Interventions

• Total Health Management

• Recent Trends

– Onsite fitness

– Onsite clinics

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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

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

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 if

they 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

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Keys to Success

Employee Engagement

ConsumerismTotal Health

Management

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Wellness Framework: Six

Components

© Copyright 2011 – CBIZ, Inc. NYSE listed: CBZ. All rights reserved

Organizational

Commitment

Sustainable Operating

Environment

Outcomes and Quality

Assurance

Data Analysis and Strategic

Plan

Engagement and Rewards

Benefit Plan Design and

Intervention

Quality of Work/Life Approach

Population Health

Management

Traditional Approach

Morale Oriented

Participation Oriented

Results Oriented

Fun activity focus

Create awareness

Generate interest

Educate

Voluntary

No risk reduction

No high risk focus

No meaningful

incentives

No link to benefit plans

No three year strategic

plan

No specific

goals/scorecard

No personalization

No spouses included

Broader access to

education and on-line

programs

Assess population risk

with health risk

assessment/biometrics

Modest incentives for

participation

Tracking participation

Wellness Committee

Modest evaluation

Modest risk reduction

Mostly health focus

Voluntary

Some personalization

Few spouses

Modest (annual) planning

Modest goals

Broader range of evidence-

based, interactive programs

Integration of providers to

provide member centric

focus on overall wellbeing

High engagement strategies

Behavioral coaching, disease

management, EAP utilization

Strong risk reduction

Strong high risk focus

Major use of external and

intrinsic motivators

Required activity

Strongly personal

Developed three year strategic

plan

Rigorous evaluation/scorecard

Spouses and dependents served

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Strategic Plan for Population Health Management includes the following broad objectives:

– Year One: Branding/Culture/Organizational CommitmentDefine Vision and StrategySetting ExpectationsRewarding Participation

– Year Two: Rewarding Participation and ImprovementExpanding EngagementCapturing Process and Impact

– Year Three: Rewarding Participation and AchievementReporting OutcomesReturn on Investment

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Awareness and

Education

Participation and External Motivation

Engagement and Intrinsic Motivation

Improved Wellbeing,

Vitality, and Energy

Greater Performance and Positive

Clinical Impact

Intervention and Engagement Progression Flow

Participation to Outcomes Achievement Matrix

• Goal: change over the long term

– Organization working to maintain the change

– Individuals working to maintain the change

Year One Year Two Year Three

Employee Engagement and Reward

Meets ParticipationCriteriaSaves $20 per monthGoal: 60%

Non Participant pays additional $20 per month

Meets Participation Criteria and improves biometrics over Year OneSaves $30 per monthGoal: 30%

Meets Participation CriteriaSaves $15 per monthGoal: 50%

Non ParticipantPays additional $30 per month

Meets Participation Criteria and achieves specified biometricsSaves $40 per monthGoal: 60%

Meets Participation CriteriaSaves $20 per monthGoal: 30%

Non ParticipantPays additional $40 per month

Employee ParticipationCriteria

•Biometric Screening•Health Risk Assessment•Annual Physical/Medical Home•Preventive Screenings•Wellbeing Planning Session•Non tobacco user

•Biometric Screening•Health Risk Assessment•Annual Physical/Medical Home•Preventive Screening•Wellbeing Planning Session•Non tobacco user•2 Intervention programs•DM if chronic condition•Pregnancy program if applicable

•Biometric Screening•Health Risk Assessment•Annual Physical/Medical Home•Preventive Screening•2 Wellbeing Sessions•Non tobacco user•3 Intervention programs•DM if chronic condition•Pregnancy program if applicable

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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)

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ROI Measurement: Scorecards and Dashboards

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%

Female Employee Population in Medical Plan 19.70%

Employee Average Age 41.1

Number of Dependents Enrolled in Medical Plan

Child Dependents in Medical Plan

Female Adult Dependents in Medical Plan

Male Adult Dependents in Medical Plan

Member Demographics by Age Band

<01

01 - 19

20 - 29

30 - 39

40 - 49

50 - 59

60 - 64

65+

Measure Year One Year Two Year Three

Health Risk Assessment 92

2011 Weight Loss Challenge (10% of body weight)

2011 Walking Challenge (150 miles)

Routine Annual Physical Exam

Preventive Screenng

Biometric Screenings

Non-Tobacco Waiver

Two organization-wide intervention programs engagement

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 38.7

Wellness Population Score

Risk Stratification

Low Risk (0-2 risks) 68% (norm* 71.0%)

Medium Risk (3-4 risks) 28% (norm* 20.0%

High Risk (5+ risks) 4% (norm* 9.0%)

Most Prevalent Population Risks based on HRA data:

1. Overweight/Obesity (BMI > 27.5) 39% (norm* 32.9%)

2. Stress 25% (norm* 21.9%)

3. Physicial Activity 12.0%

4. Life Satisfaction 15% (norm* 13.7%)

5. Medication for Relaxation 24% (norm 13.6%)

6. Blood Pressure 12% (norm* 21.9%)

7. Tobacco Use 7.6% (norm* 8.5%)

Top Self Reported Health Conditions:

1. Allergies 45% (norm* 29.2%)

2. Back Pain 34% (norm* 15.3%)

3. Heartburn/Acid Reflux 20% (norm* 13.9%)

4. High Cholesterol 17% (norm* 17.5%)

5. Arthritis 12.0%

Po

pu

lati

on

De

mo

grap

hic

s

Wellness Scorecard

[Date]

HR

A R

ep

ort

Dat

aQ

ual

ifyi

ng

Eve

nts

Par

tici

pat

ion

Measure Year One Year Two Year Three

Screening Participation Total (ee's only)

At Risk and Obese BMI (BMI > 25)

At Risk Waist Circumerence (male > 40, female > 35)

Pre-Hypertension/High Blood Pressure (Stage 1 & 2)

High Cholesterol (> 200)

Pre-Diabetes (Fasting)

High Glucose (Fasting and Non-Fasting)

Members with Chronic Conditions (Diabetes, High BP, High Choles., Asthma)

Members with Chronic Conditions (Stress and Anxiety, Depression)

Top Number of Prescriptions (per 1,000) Year One Year Two Year Three

Antidepressants 603.1

Lipotropics 432.3

Diabetic therapy 298.9

Antiarthritics 230.0

Bronchial Dilators 222.2

Anti-ulcer/gastrointestinal 188.8

Measure (Benchmark is 80%) Year One Year Two Year Three

Hypertension/Cardiac 84.4%

Diabetes 83.3%

Cholesterol 91.9%

Depression 86.3%

Antipsychotics 88.5%

Asthma 74.1%

Osteoporosis 87.2%

Bio

met

ric

Scre

enin

gsM

edic

atio

n A

dh

eren

ce R

ate

Pre

scri

pti

on

Cla

sses

• 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, communication6 – 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

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TOTAL HEALTH MANAGEMENT = VALUE

Wellness Center

Plan Design Value Based

Benefits

Wellness and Condition

Management

Physical Activity

Safety and Occupational

Medicine

High Performance

Networks

Communication and Education

Consumerism and employee engagement

Absence Management

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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

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Trends in employer sponsored clinics

Trends• 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

Urgent Care

• Colds and Sinus Infections

• Prescriptions

• Flu Shots

• Routine labs

Wellness

• Biometric Screenings

• Health Assessments

• Coaching and Education

Primary Care

• Communication with other providers

• Patient Centered Medical Home

• Physicals

• Specialty Referral Networks

• FMLA Certification

Ancillary Services: PT, Chiropractic, Radiology

Scope of Services for Consideration

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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 training

Worker’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

• Case Management 19

Characteristics 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 demographics

Onsite Clinic Profile and Considerations

Onsite Clinic Considerations• Feasibility

• 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

• Funding arrangement

Employer Sponsored Clinics

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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

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• 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

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