Effective Strategies for Improving the Health of Your Employees Scottie Gaskins, Administrator ViQue

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Effective Strategies for Improving the Health of
Your EmployeesScottie Gaskins,
AdministratorViQuestA Health Management Company
of University Health Systems of Eastern
CarolinaOctober 11, 2006
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The Cost of Bad Habits

• Obesity, poor nutrition, physical inactivity, and
  tobacco-related illness cost NC employers an
  average of 5,000 per employee per year.
• 50 of all disease, injury and premature death is
  preventable

• Lifestyle triggers of preventable disease
• Tobacco
• Poor diet

• Obesity
• Stress
• Lack of exercise

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The Cost of Bad Habits

• Excess risk factors account for 25 of medical
  costs and lead to higher absenteeism/lower
  productivity.
• In NC, three health behaviors are related to
  two-thirds of all preventable death and
  disability poor nutrition, physical inactivity,
  and tobacco use.
• Preventable death and disability cost NC 15
  billion per year.
• Nationwide, 33 of health care expenses are for
  preventable conditions.
• Smoking alone costs US 157 billion each year
  (ACS).
• 50-60 of hospital admissions are due to chronic
  conditions.

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Where are Most of the Costs?Typical U.S. Health
Care Spending Behavior
Catastrophic
30
3
High Risk
50
17
People

40
Moderate Risk
17
40
3
Healthy / Low Risk
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Success Story

• Northwest Law Firm
• Comprehensive Program
• Outsourced to Vendor
• Incentive - Insurance premium reduction
• New enrollment every six months
• Outcomes
• Five year annual participation avg 84
• Over two years, 25 reduction in avg claim cost
  per emp
• 25,000 reimbursement from reinsurance carrier

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Success Story

• City of Asheville, NC
• Disease Management Program for 3 Conditions
• Diabetes, Asthma, CAD (Htn Lipids)
• Four-week education and pharmacy case manager
• Incentive Free Prescription Meds Supplies
• Outcomes
• Total medical expenses fell more than 2000 per
  participant

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Success Story

• SCANA
• Fortune 500 Energy Company in Columbia, SC
• HRA
• Health Coaching
• Incentive Premium rate freeze for HRA
  completion
• Outcomes
• 94 participation in HRA
• 80 of eligible members enrolled in follow-up
  health coaching with no incentive

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Success Story

• Manufacturer in SE US
• HRA and Telephonic Health Coaching for High Risk
• Outsource to Vendor
• Incentive 200 flex dollars for HRA completion
• Outcomes
• 99.5 HRA participation
• Savings per high risk enrollee 768
• Program Benefit-Cost Ratio 111

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Success Story

• Small Engineering Firm in NC
• Onsite comprehensive wellness disease mgmt
• Outsource to Vendor
• Incentive Wellness prizes
• Outcomes
• 71 total participation
• 45 of participants lost weight
• 32 lowered LDL cholesterol
• 77 decreased blood pressure

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Typical Menu

• Health Fairs
• Health Risk Appraisals
• Clinical Screenings
• Weight Management
• Tobacco Cessation
• Stress Management
• Lunch and Learns
• Wellness Challenges
• Newsletters
• Bulletin Boards
• Payroll Stuffers / Mailers
• Incentives
• How do you choose and package these to
  achieve results?

• Disease Management Programs
• Health Coaching
• On-site Clinic
• Medication Management
• EAP Counseling Services
• Occupational Health
• Labs Drug Screens
• Vaccinations
• Fitness Center or Programs
• Executive Physicals
• Utilization Management
• Case Management

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Population Health vs Silo Model

• Silo Approach
• Separate programs for each disease state
• Little to no connectivity
• Typically catastrophic and highest risk only
• Fragmented incentives

• Population Health
• Management of comorbid conditions, health risks
  and behaviors simultaneously
• All programs and services interconnected
• Serves the whole population to promote downward
  risk migration
• Integrated incentives

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Goals of a Comprehensive Population Health Program

• Increase early identification of those at risk
• Identify actionable issues that can be managed
• Connect each participant with appropriate service
• Integrate program design to treat the person not
  the condition
• Develop lifelong practice, not dependency on
  program
• Promote downward migration of risk for long term
  benefits
• Improve clinical outcomes and decrease
  complications
• Improve health and quality of life of employees
• Reduce risk of future claims
• Reduce rate of inflation for health care
• Engage all parties in an effort to manage costs
• Enhance recruitment, retention and satisfaction
  of employees
• Decrease time away from work / absenteeism

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Develop In-house or Outsource?

• Assess existing internal resources
• Occupational Health
• Wellness
• Fitness
• Clinic
• Role of HR
• Carrier / TPA services
• Existing or available
• Evaluate cost vs value add
• The untold story
• Wellness Disease Management Vendors
• Turn key
• Support services to aid your inhouse program

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Step 1 - Define Eligibility

• Employees
• Full-time, part-time, benefited, all?
• Only those enrolled in the medical plan?
• Spouses enrolled in the medical plan
• Additional benefits for management / executives
• Programs free as an added benefit or fee?

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Step 2 - Identify Modifiable Health Issues of the
Population

• Risk Assessments
• Claims Review prevalence, utilization,
  compliance rates
• Health Risk Appraisal behaviors in nutrition,
  exercise, tobacco use, and stress, family
  personal medical history, readiness to change
• Clinical Assessments lipid panel, glucose, BP,
  BMI
• Risk Stratification
• High
• Moderate
• Low

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Step 3 Intervention Design

• One Size Does NOT Fit All!
• Use the assessment data, risk stratification and
  company profile to select ideal program elements.
• Stage launch of specific elements if necessary to
  show outcomes and ramp up budget.

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Intervention Design - Comprehensive Program May
Include

• Annual health risk assessment
• Disease management health coaching program
• onsite, telephonic or blend
• frequency varies by risk level High, Moderate,
  Low
• Nutrition and exercise counseling
• Seminars and monthly wellness campaigns
• Risk reduction programs/series on weight mgmt,
  smoking cessation, cholesterol control, BP
  control
• Onsite fitness programs or center
• Onsite clinic or onsite physicals
• Onsite pharmacy
• Incentive design
• Collaboration with Medical Plan (UM, CM), EAP,
  Occ. Health

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Health Coaching

• On-site, telephonic or blend
• Defined criteria high risk only,
• high moderate, everyone
• Evidencebased protocols
• Uses stages of change model
• Behavior modification motivational interviewing
  techniques
• Reinforce provider plan of care
• Focus on health behaviors, risk reduction, self
  management skills, and disease management
• Dedicated health coach(es) to each client

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Risk Reduction Programs

• Smoking Cessation
• Weight Management
• Stress Management
• Cholesterol Control
• Blood Pressure Control
• Nutrition Counseling
• Exercise Counseling

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Wellness Lifestyle Management

• Seminars
• Wellness challenges
• Fitness programs / discount memberships
• Nutrition services
• Pregnancy wellness program
• Environment that supports practice of healthy
  behaviors

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Is an Onsite Clinic Right for Your Company?

• High absenteeism due to minor illness
• High ED Urgent Care utilization for minor
  illness
• Many covered lives with no established primary
  care
• Poor compliance rates of preventive exams
• Frequent flyers for chronic disease complications
• Desire and financial resources to offer a benefit
  to attract and retain employees, impact health
  care costs and utilization, decrease time away
  from work for sick and preventive care and
  increase employee satisfaction.

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On-site Clinic

• Typical Model
• NP or PA with MD oversight
• Minor sick care
• Preventive exams
• Medication management
• Chronic disease management
• On or off the clock
• Free or run through medical plan with applicable
  co-pay

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Effective Incentive Design

• Frontload -
• Through Medical Plan / Benefit Design
• Pharmacy Incentives Lower or eliminate pharmacy
  copays for specific conditions like Diabetes,
  Asthma, Tobacco Cessation. Outcome improved
  medication compliance, fewer complications,
  decreased ED utilization.
• Preventive Care 100 covered to increase
  compliance with age/gender appropriate preventive
  exams. Outcome earlier detection, higher
  treatment success, less costly treatments.
• Wellness Allowance for tobacco cessation,
  weight mgmt, gym memberships, etc.

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Effective Incentive Design

• Backload -
• Reward for Enrollment, Participation, Compliance
• Risk Assessment (HRA, Screening, Health Coach)
• Health Coaching / Disease Management Care Plan
  Treatment Compliance
• Preventive Care Compliance
• Program Attendance
• Company Wide Goals for Participation

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Effective Incentive Design

• Frequently Used Prizes
• Premium Reductions
• Deductible Reductions
• Free or Reduced Meds
• FSA Employer Contribution
• Cash or Gift Certificates
• Prizes WellBucks, logo items
• Recognition
• Door Prizes / Drawings
• Company or Dept. Rewards

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Effective Incentive Design

• Other Considerations
• Define eligibility criteria
• Real time rewards most effective
• Something for all who qualify vs big prize
  drawing
• What amounts drive desired participation?
• limit for Bona Fide Wellness Program
• Taxable income
• Reward for each program element vs point system
  
• Tracking / administration time consuming

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Keys to Success

• Top-Down Engagement
• Supportive Company Culture Environment
• Effective Incentive Design
• Population Approach vs Silo Programs
• Appropriate Staffing Model
• People and Outcome Driven

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Measuring Success

• Enrollment
• Clinical Improvements
• Behavioral Improvements
• Preventive Care Compliance
• Compliance with Care Plan
• Migration of Risk
• Action Report
• Cost Avoidance
• Claims Review medical cost trends participants
  vs non-participants longitudinal review of
  participants

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Legal Implications

• DOL
• ADA
• EEOC
• IRS
• HIPAA

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Resources

• Wellness Councils of America WELCOA.ORG
• Quit Now NC quitnownc.org/businesses.asp
• Fit Together NC fittogethernc.org
• NC Coalition for Healthy Solutions
• ViQuest Works Corporate Heath Solutions
• sgaskins_at_pcmh.com 252-847-5958
  www.viquestwellness.com