How to Deliver Healthy Results in Your Wellness Program

Transcription

1 How to Deliver Healthy Results in Your Wellness Program This session will help you understand the elements and case study outcomes of Health Management Incentive Strategies, as design elements of your health care plan and premium allocation.

2 Studies Finding It Does, Indeed, Pay to Become a Healthy Company Sibson, Healthy Enterprise Study- 300 employers representing over 2 million employees 2013 Harvard University study of over 100 peer reviewed studies 2010 Chapman Meta-Evaluation meta-study of 56 employers

3 The Other Side of the Coin Sibson also found 40% of wellness programs are not considered effective Many wellness programs fail to illustrate their value much less an ROI The mere presence of a wellness program does not demonstrate effectiveness

4 Budgets & Funding On average employers invest less than onehalf of 1% to sustain the health and well-being of their people (excluding cost of medical coverage) Average of $126/year for those reporting a wellness budget

5 Which Model Do You Deploy Focus on Treatment Focus on Prevention/Management Focus on Optimal Behavior

6 The Bus Analogy

7 Common Elements In Programs Demonstrating Outcomes and Effectiveness? Strategic Drivers Behavior-Change Support Environmental Support Focus on Optimal Behavior ****These factors highlight the need for proper wellness program design***

8 Delivering Healthy Results Strategic Focus- is important to program effectiveness- to show results you have to have a plan endorsed by leadership Metrics Matter- lower health care costs, turnover, absence, and workers compensation Most employers narrowly focus on health issues after they occur, and largely fail

9 Prevalence & Effectiveness Are Your Programs Hitting The Mark? Program leadership was the most highly correlated strategic driver with outcomes and effectiveness but the least prevalent Disease management was least effective, but also was the most prevalent Smoke-free worksite was perceived to be most effective practice, but did not correlate to overall effectiveness or outcomes

10 Incentives & Participation While Incentives can drive participation in some cases, they are not the sole driver and should be designed within a broader strategy to deliver effectiveness and outcomes Deploy techniques for Influencing Thinking- Intrinsically motivated demand high-quality resources Extrinsically motivated demand easy-to-use resources Disengaged need personal intervention to get behavior change

11 Behavioral Economics Can be useful in crafting program design and communication Applying the science behind How people make financial choices and The way in which decisions are influenced based on how the choices are presented

12 Spreading the Health Percentage of Surveyed Companies Offering Wellness Incentives Value of Wellness Incentives Per Employee Note: No data for 2012 due to change in survey design. Sources: National Business Group on Health/Fidelity Investments surveys data is based on responses from national sample of 120 companies.

13 Carrots Vs. Sticks Behavior Change is the key factor in addressing rising costs A Blended Approach customized to company demographics has shown the highest ROI Acute Behaviors respond better to Sticks Carrots reward movement to healthy habits

14 Types Of Incentives Cash or Gift Cards Premium Differentials/Plan Based Incentives Negative Incentives Pros Immediate/ Instant Gratification Pre-Tax (EE s get full value) For Acute Behaviors up to 3x more motivating Cons Does Not Sustain Longterm Change Completion of items prior to OE does not solely sustain health behavior; needs to be year round engagement Creates Adversarial Environment if not sold properly

15 Participatory Wellness Programs Programs that are made to available to all individuals and that either do not provide reward or do not include any conditions for obtaining a reward that are based on an individual satisfying a standard that is related to a health factor. These programs do not include walking programs, weight loss programs, or exercise programs.

16 Health Contingent Wellness Programs Health-contingent wellness programs require an individual to satisfy a standard related to a health factor to obtain a reward, or require an individual to do more (based on a health factor) than a similarly situated individual to obtain the same reward. The annual reward available under a health-contingent wellness program may not exceed 30 percent of the cost of coverage. If the health-contingent program is tied to tobacco cessation, an additional 20 percent incentive may be provided. Plans have the flexibility to determine apportionment of the reward among family members, as long as the method is reasonable. This final rule divides health contingent wellness programs into two subcategories: activity only and outcomes based. Activity-only wellness programs require an individual to perform or complete an activity related to a health factor to obtain a reward. Activity-only wellness programs do not require an individual to attain or maintain a specific health outcome: Walking program Diet program Exercise class Outcomes-based programs require an individual to attain or maintain a specific health outcome (such as not smoking or attaining certain results on biometric screenings) to obtain an award.

17 Key Requirements for Health-Contingent Wellness Programs Frequency of Opportunity to Qualify- at least once per year Size of Reward- Not to exceed 30% of the total cost of coverage, except for increase to 50% if it includes tobacco prevention or use Reasonable Design- provides reasonable chance and not overly burdensome or suspect methodology Reasonable Alternative Standard- waiver of the otherwise standard due to unreasonably difficult due to medical condition or medically inadvisable; further detailed guidance on this as well. Notice of Availability of Reasonable Alternative Standard

18 Incentive Triggers Participatory Based Incentive given for engagement in various programs Health Contingency- Incentive given for successfully meeting a specific health outcome (or alternative standard) Must Meet Five Benchmarks: The reward cannot exceed 30% of the cost of the employee-only coverage under the plan (30% of the cost of family coverage if the program applies to dependents) The program must be reasonably designed to promote health or prevent disease The program must give employees the opportunity to qualify for the reward at least once per year All employees must have the opportunity to gain the reward, and if an employee has a medical condition that would make it unreasonably difficult to meet the standard, the employer must offer a reasonable alternative The plan must disclose in its written materials that this reasonable alternative standard is available

19 Well Designed Programs Establish Personal Relevance Trigger Emotional Responses Define Clear Choices Convey the Value of Making Smart Choices Ask employees to complete a small, relevant task Guide employees and integrate best available resources

20 ROI Challenges Gold Standard Studies usuaslly not feasible Employees cannot be allocated to treatment and control groups Most resort to quasi-experimental approaches differences-in differences models Selection bias with voluntary aspects of programs Rigorous ROI studies very costly ($50,000 and up) Increasingly complex due to incentives eroding true non-participant comparison groups

21 Where Does That Leave Us? Overwhelming evidence that having healthy workforce is prudent Focus on medical cost trends, slowing of medical cost trends to a sustainable level Zero Trends Philosophy

22 Focus Areas to Show Value and Results Health Care Use Trends- Lowering of high cost claimants w/ lifestyle related claims, less in-patient costs, medication adherence Health Trends- Look at health metrics (BMI, BP, Diabetes, etc) Engagement- Leadership drives culture change Year-round employee engagement drives health improvement Demand metrics that illustrate true engagement

23 Focus Areas Con t. Performance Trends- Absence Disability Medical Cost Trends Better than before, better than actuarial projections, better than outside benchmarks

24 CLIENT ILLUSTRATIONS

25 Mandatory Screenings and Surcharge for Metabolic Syndrome Participants Who Decline Health Coaching PRO: Risk Recognition and Coaching Work Total Cholesterol 40% identified with Med to CRIT risk reduced their risk HDL 31% identified as HIGH risk reduced their risk category LDL 48% identified as HIGH risk reduced their risk category Triglycerides 52% identified as Med to CRIT risk reduced their risk Glucose 45% identified as Med to CRIT risk reduced risk category Blood Pressure 73% identified as HIGH or CRIT risk reduced to Med or Low risk BMI & Waist Circumference 14% identified as HIGH to CRIT BMI reduced risk Cardio-Metabolic Disease Net positive results: 22 more with Zero markers and 12 less with 3 or more markers T1 T Total Cohort Repeat Particpants ARGO Matched Pairs Biometric Screenings 971 Non-duplicate records available for analysis as of Interim Matched Pair Analysis n=971 Con: Negative Impact on Morale Created Culture of Compliance not Alliance 5/2/2014 PEPR ARGO Cohort Comparison 25

26 Focusing on High Risk Only Unintended Effect of Incentive Strategy: Those not required to do anything but Health Screenings got worse picked up 53 new Metabolic Syndrome Members from 2011 to % of them engaged in 1 or no programs during the year with no incentive to do so

27 METRICS & BENCHMARKING Regional Social Services - Texas High Risk Statistics CR v. USA 60.0% USA CR 50.0% 50.8% 40.0% 34.6% 34% 35% 30.0% 20.0% 10.0% 13.6% 7.7% 10.4% 15.0% 12.0% 3.3% 0.0% High Cholesterol >= 240 High Glucose > 125 Blood Pressure Sys >= 140 or Dias >= 90 Obesity BMI >= 30 MetS >= 3 Markers

28 IDENTIFYING CRITICAL BIOMETRIC SCREENING RESULTS Independent School District - Texas Of the 5,523 ISD employees who participated in the 2012 Annual Biometric Screening: 3,797 (69%) were noted to have one or more unhealthy biometric measures 705 (13%) employees had at least one critical health reading (includes morbid obesity) 1,460 of the assessable 4,864 participants (34%) have been identified with Metabolic Syndrome 31% (1,701/5,523) of the participants have at least one critical health value and/or MetS 71 Diabetics with elevated HBA1c levels have controlled levels in year 2

29 Opportunities for Medical Cost Avoidance Reporting Large Texas School District 5300 EE s Critical Alert Intervention Potential Opportunities for Medical Cost Avoidance Condition Cost Employees Aggregate Cost Hyperlipedimia* $16,313 x 124 = $2,022,812 Thyroid Disorder* $14,861 x 8 = $118,888 Diabetes* $7,709 x 181 = $1,395,329 Hypertension* $10,216 x 18 = $183,888 $3,720,917 *Estimated hospital costs subject to network discount from the 2009 Hospital Charge Data for ICD Diagnosis Note: employee count reflects adjustment for individuals with overlapping critical alerts for same condition Estimated Annual Cost of Overweight and Obesity

30 Data Drill Down Awareness of Regional Differences Manufacturer Biometric Screenings were conducted in August-September 2012 at ten locations and off-site labs. 695 employees took part in at least one aspect of the biometric screening activities. This report analyzes the aggregate differences recorded between the eight site groups with more than 30 screening participants. CHOLESTEROL MULTI-SITE ANALYSIS % of Site Employees in Risk Categories Cholesterol Low < 200 Medium >= 200 High >= 240 Critical > % 74% 73% 63% 82% 60% 63% 61% 32% 31% 29% 29% 32% 22% 15% 11% 12% 11% 3% 5% 6% 6% 9% 5% 1% 1% 2% Gibson City Indianola Selma Huntsville Leavenworth Seguin Sioux Falls Corporate n = 130 n = 47 n = 176 n = 80 n = 34 n = 90 n = 35 n = Measures of Central Tendency MEAN MEDIAN High+ Risk v. USA (NHANES 2010) Low Risk < % 10.6% 5.7% US High+ Risk 13.6% 6.3% 5.9% 11.1% 8.6% 7.1% 160 Gibson City Ind ianola Selma Huntsville Leavenworth Seguin Sioux Falls Corporate Gibson City Ind ianola Selma Huntsville Leavenworth Seguin Sioux Falls Corporate

31 Looking At Matched Pairs to Illustrate Effectiveness Matched Pairs Corporate + Field Biometric Screenings T1 T2 T3 T Total Yearly Cohort > Year/count of most recent matching records 2012 Participants with Prior Screenings (64%) 114 Field 680 Corporate

32 LOOKING AT SUB GROUPS FOR INTERVENTION EFFECTIVENESS Medical Device Distributor Multi-state HEALTH COACHING REPORT - Matched Pairs HDL Changes in Health Risks/Raw Scores T1:T2 60% 58% % in Risk Categories S: Standard Program = 712 HC: Health Coaching = 81 50% 40% 41% 43% 42% 65 Raw Scores - Changes in Central Tendency 30% 20% 10% 33% 27% 27% 15% 35% 31% 28% 22% S HC % T1 Raw Score Changes T S Up Same HC Down 30 T1 T2 Mean SM Median SM Mean HCM Median HCM LR > 60 Mean SF 0% 20% 40% 60% 80% 100% Median SF Mean HCF Median HCF HEALTH COACHING REPORT - Matched Pairs Glucose Changes in Health Risk Categories T1:T2 Glucose Low < 100 Medium >= 100 High > 125 Critical > 250 HEALTH COACHING REPORT - Matched Pairs Glucose Changes in Health Risks/Raw Scores T1:T2 Glucose Low < 100 Medium >= 100 High > 125 Critical > 250 Risk Shift Numbers & Profile of Current Risk Levels LH MH Standard Program n = LL ML HL LM MM HM CH HH HC 2 Health Coaching n = 81 LL ML HL LM MM HM LH MH HH CH HC US High Risk 3.3% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Summary of Aggregate Risk Shifts Standard Program n = 713 Health Coaching n = 81 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% % in Risk Categories 81% 79% 59% 57% 30% 27% 15% 15% 16% 10% 4% 5% 1% 1% 0% T1 T2 S HC S: Standard Program = 713 HC: Health Coaching = 81 Raw Scores - Changes in Central Tendency Reduced Risk (RR): 57 Reduced Risk (RR): Increased Risk (IR): 71 Increased Risk (IR): 9 Raw Score Changes % 9% Net: 14 (2%) IR Net: 6 (13%) RR % 0% 0% 82% 70% 1% 0% 0% -1% -2% -8% -16% None S HC Down Same Up T1 T2 Mean S Median S LR <100 S HC 0% 20% 40% 60% 80% 100% Mean HC Median HC

33 Low < 100 Medium >= 100 High > 125 Critical > 250 LH 2 MH 6 US High Risk 3.3% US High Risk 15% 5 Acceptable M < 40" Acceptable F < 35" High Risk M >= 40" High Risk F >= 35" # of Risk Factors Risk Factors IDENTIFYING MEANINGFUL INTERVENTIONS (MANUFACTURING CO. IN TEXAS) HEALTH COACHING REPORT - Matched Pairs HDL Changes in Health Risk Categories T1:T2 Risk Shift Numbers & Profile of Current Risk Levels HEALTH COACHING REPORT - Matched Pairs Blood Pressure Changes in Health Risk Categories T1:T2 Risk Shift Numbers & Profile of Current Risk Levels Standard Program n = 506 LL 4 LL 61 ML 5 ML 23 Health Coaching n = 63 LM 1 LM 39 MM 26 MM 234 HM 6 MH 4 HM 35 MH 41 HH 17 HH 73 Standard Program n = 505 ML 3 LL 73 Health Coaching n = 63 HL 3 LM 2 ML 53 MM 12 HL 2 LM 58 HM 14 MM 169 MH 14 HM 44 LH 7 MH 61 HH 15 HH 33 CH 1 MC 1 HC 2 CC 1 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Summary of Aggregate Risk Shifts Standard Program n = 506 Health Coaching n = 63 Reduced Risk (RR): 58 Reduced Risk (RR): 11 Summary of Aggregate Risk Shifts Standard Program n = 505 Health Coaching n = 63 0% 0% 16% 8% 73% 75% 0% 0% Increased Risk (IR): 80 Net: 23 (5%) IR Increased Risk (IR): 5 Net: 6 (10%) RR 24% 25% Reduced Risk (RR): 100 Increased Risk (IR): 129 Reduced Risk (RR): 20 Increased Risk (IR): 16 0% 0% 55% 43% 2% 0% 0% 0% Net: 29 (6%) IR Net: 4 (6%) RR -11% -17% <1% -5% -19% -2-1 None % S HC None S HC HEALTH COACHING REPORT - Matched Pairs Waist Circumference Changes in Health Risks/Raw Scores T1:T2 Waist " Risk Shift Numbers & Profile of Current Risk Levels Standard Program n = 502 LL 273 HL 39 LH 26 HH 164 Health Coaching n = 63 LL HL 1 3 HH 59 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Summary of Aggregate Risk Shifts 87% 5% 95% 0% Standard Program n = 502 Reduced Risk (RR): 39 Increased Risk (IR): 26 Net: 13 (6%) RR Health Coaching n = 63 Reduced Risk (RR): 3 Increased Risk (IR): 0 Net: 3 (5%) RR -8% -5% -1 None +1 S HC HEALTH COACHING REPORT - Matched Pairs Glucose Changes in Health Risk Categories T1:T2 Risk Shift Numbers & Profile of Current Risk Levels Standard Program n = 508 LL 304 ML 54 HL 4 LM 51 MM 68 Glucose HM CH HH HC 1 HEALTH COACHING REPORT - Matched Pairs MetS Changes in Number of Indicators T1:T2 Standard Program = 494 MetS 144 (29%) MetS 167 (34%) Health Coaching n = 63 MetS MetS 51 (81%) 41 (65%) MetS Health Coaching n = 63 LL 13 ML 10 HL 2 LM 4 MM 12 HM 6 MH 6 HH 8 CHHC % 90% % 90% 9 8 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% 80% 70% % 70% Summary of Aggregate Risk Shifts Standard Program n = 508 Health Coaching n = 63 17% 11% Reduced Risk (RR): 64 Increased Risk (IR): 60 Reduced Risk (RR): 19 Increased Risk (IR): 11 60% 50% % 50% 19 0% 0% -1% -3% 76% 52% 0% 0% 0% 0% Net: 4 (<1%) RR Net: 8 (13%) RR 40% 30% % 30% 23-12% 20% 20% 17-27% None % % 12 S HC 0% T1 T2 0% T1 T2

34 PROGRAM PARTICIPATION TIED TO OUTCOMES HEALTH SCREENINGS AND INTERVENTIONS FOR THOSE WITH METS MULTI-PROGRAM PARTICIPATION ASSOCIATED WITH HEALTH GAINS (NO LONGER HAVE METABOLIC SYNDROME)

35 ENGAGED VS. NON-ENGAGED CLAIMS IMPACT OF ON-SITE INTERVENTIONS RESULT : (HEALTH SCREENINGS / HRA AND ON-SITE TIERED COACHING SESSIONS BASED ON RISK) Engaged in Coaching sub-group is older and has higher risk scores, but had lower claims cost and are more efficient with their care (less ER visits and more preventive visits, scripts) The Engaged in Coaching sub-group vs. those at high risk choosing not to engage shows a major cost difference. The engaged high risk cost 17.8% less PMPY. Year over Year change shows an 8% Increase in PMPM cost for non-engaged vs. a 4% decrease PMPM for engaged population. The Paid PMPM is lower than the predicted for the Engaged group (based on their age, gender, and risk factors, their claims were less than the modeler predicts.) Claims Cost for all Engaged populations, regardless of risk was less: Low Risk- 12.7% less Moderate Risk -54.7% less High Risk High Risk 17.8% less

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