Presented By: Mike Demman, CEO SimplyWell LLC

Transcription

1 Presented By: Mike Demman, CEO SimplyWell LLC

2 Disclaimer The information contained herein should not be construed as legal advice, and readers should not act upon such information without the advice of counsel. The author makes no representations, nor guarantees regarding the contents of the information contained herein.

3 He who represents himself has a fool for a client and an idiot for a lawyer Moral of the Story Always have an attorney review incentive strategies.

4 Who is SimplyWell? Headquarters in Omaha, NE Launched study in 1998 Serve 175 businesses 50 States and 17 countries

5 Today s Agenda We Know Why We Are Here Today We Understand an Integrated Model The Rules We Play By Case Studies: Participation vs. Outcomes Incentives

6 U.S. Corporations Profits and Healthcare Costs in Billions After Tax Profits Health Benefit Costs C H A L L E N G E S Employment Policy Foundation, HR Benchmarks 2004 & Econoday 2005 Corporate Profit Report

7 Employer s Burden Employers Shoulder Most of the Financial Burden Health Insurance Coverage of Nonelderly Americans, by Source Coverage, % 6% Employer-based coverage Uninsured 17% 60% Public Individually Purchased Employee Benefit Research Institute estimates from the March Current Population Survey, 2004 Supplement.

8 An Effective Model Integration and Commitment Address the health needs of the entire population Include cost-effective interventions Data driven & medically based Strategically integrated

9 How Do You Drive Participation?

10 The Rules of The Game The HIPAA nondiscrimination provisions generally prohibit group health plans from charging similarly situated individuals different premiums or contributions or imposing different deductible, co-payment or other cost sharing requirements based on a health factor. Source:

11 For Every Rule, There is an Exception A wellness program complies with the Non Discrimination Provisions IF The reward is not based on an individual satisfying a standard related to health factor, or no reward is offered (assuming participation in the program is made available to all similarly situated individuals) EXAMPLES: Completion of an HRA A program that reimburses all or part of the cost for memberships in a fitness center. A program that reimburses employees for the costs of smoking cessation programs without regard to whether the employee quits smoking. Source:

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13 The Carrot Approach

14 Organization Information Energy Company 52 locations Third year with SimplyWell 2374 eligible employees

15 Incentive Structure Pedometers for those reaching 10,000 points by July 1 st Duffle Bag for those reaching 13,400 by December 31 st $20.00 a month reduction in health insurance premium beginning July 1 st Incentives similar to 2007 to encourage continued activity.

16 Repeat Participant Results Year Blood Pressure (120/80-139/89) Blood Pressure (140/90+) Total Cholesterol (moderate high risk) LDL (Bad) Cholesterol (moderate high risk) HDL (Good) Cholesterol (moderate high risk) Triglycerides (moderate high risk) Glucose (moderate high risk) % 24.4% 35.1% 27.1% 47.7% 34.1% 25.8% % 19.4% 41.1% 34.2% 45.4% 31.4% 20.3% Change % Improvement % Improvement % Improvement % Improvement % Improvement = Category Shows Improvement Source: Repeat Risk Summar Report as of 9/20/2007

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18 Manufacturing Company 8 locations Third year with SimplyWell 2,500 eligible employees

19 Monthly reduction in health insurance premium 2008 Outcomes based

20 Comparing Top 5 Risk Factors current to benchmark year Improving Fitness % showing need for improving fitness levels Cancer Risk Reduction % having moderate to high cancer risk Weight Management % above recommended weight range Better Nutrition % showing need for improving nutrition Coronary Risk Reduction % having moderate to high coronary risk 2005 Benchmark Year 76% 72% 70% 64% 60% 2007 Results 73% 58% 69% 56% 57% = Category Shows Improvement Source: Executive Summary Reports

21 Repeat Participant Data Year Blood Pressure (120/80-139/89) Blood Pressure (140/90+) Total Cholesterol (moderate high risk) Bad Cholesterol (moderate high risk) HDL Cholesterol (moderate high risk) Triglycerides (moderate high risk) Glucose (moderate high risk) Benchmark % 11.1 % 39.6 % 30.4% 38.4 % 35.2 % 18.5 % % 7.9 % 41.0 % 32.2% 44.9 % 33.5 % 17.9 % = Category Shows Improvement Source: Repeat Risk Summary Report

22 Why tying incentives to outcomes is so important

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24 5 requirements for wellness programs which base a reward on satisfying a standard related to a health factor. 1. Not to exceed 20% of the cost of employee-only coverage under the plan. 2. Must give individuals eligible to participate the opportunity to qualify for the reward at least once per year. 3. Must be reasonably designed to promote health and prevent disease. 4. Must allow a reasonable alternative standard. 5. Must disclose in all materials the availability of a reasonable alternative standard. Source:

25 A tool that allows employers to reward participants for improvement/ change in their health on an annual or semiannual basis. Based on 7 categories of objective data collected at the health screenings. Can be tied to company awards/ incentives. Allows ability to measure health improvement from year to year.

26 Body Mass Index Systolic Blood Pressure Diastolic Blood Pressure HDL Cholesterol LDL Cholesterol Triglycerides Fasting Blood Sugar

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28 MY HOME FOR HEALTH

29 MY HOME FOR HEALTH

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32 Chemical Manufacturing Company 3 Locations 350 Insured Eligible Employees Third Year with SimplyWell

33 $40 premium incentive for participation Health Score Incentive POINTS CATEGORY GIFT CARD REWARD Platinum $ Gold $ Silver $ Bronze $25 < 80 No Reward

34 Comparing Top 5 Risk Factors Current to Previous Years Improving Fitness % showing need for improving fitness levels Weight Management % above recommended weight range Coronary Risk Reduction % having moderate to high coronary risk Cancer Risk Reduction % having moderate to high cancer risk Managing Cholesterol Levels % showing need for lowering cholesterol levels % 80% 68% 62% 46% % 72% 63% 58% 51% = Category Shows Improvement

35 Repeat Participant Risk Data Year Blood Pressure (120/80-139/89) Blood Pressure (140/90+) Total Cholesterol (moderate high risk) Bad Cholesterol (moderate high risk) HDL Cholesterol (moderate high risk) Triglycerides (moderate high risk) Glucose (moderate high risk) Benchmark % 17.6% 54.2% 43.2% 34.6% 32.9% 31% % 11.5% 44.9% 34.1% 41.8% 28.5% 34.4% % change 11% 34% 17% 21% 20% 13% 10% = Category Shows Improvement Source: Repeat Risk Summar Repor

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37 White Collar Company Offices Nationwide 3 rd year with SimplyWell 1,200 Eligible Participants Health Score Incentive Implemented in 2007

38 New Participants Current Participants Attain a health score of 85 or above Improve prior year health score by 5 points or attain a health score of 85 or above

39 $25/month medical premium discount 2/$1000 drawing for participation

40 Comparing Top 5 Risk Factors Current to Benchmark Year Improving Fitness % showing need for improving fitness levels Weight Mgt % above recommended weight range Coronary Risk Reduction % having moderate to high coronary risk Cancer Risk Reduction % having moderate to high cancer risk Better Nutrition % showing need for lowering cholesterol levels % 57% 45% 51% 48% % 58% 39% 40% 41% = Category Shows Improvement

41 2007 Risk Data Total Participants Comparison to SW Year Blood Pressure between 120/80-139/89 Blood Pressure Greater than 140/90 Total Cholesterol (moderate high risk) Bad Cholesterol (moderate high risk) HDL Cholesterol (moderate high risk) Triglycerides (moderate high risk) Glucose (moderate high risk) % 13.8% 39.0% 27.2% 26.7% 25.6% 7.1% SW Comparison 3 rd year 47.0% 19.1% 41.2% 31.1% 29.9% 21.6% 21.1% = Category shows better than SW average Source: Group Summary Report March 2008

42 2007 Risk Data Eligible for Incentives 85 or above and 5% increase Participants with a health score of 85 or above Participants with less than 85 but increasing health score by 5% over previous year Total eligible for incentive Out of 484 screened participants, 302 qualified for incentive = 62% Source: Online Reports

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45 You Must First Answer the Following: Is it Participation? Outcomes? Or Both? And then consider the following: 1. Culture 2. Budget 3. Management 4. Insured Status Fully vs. Self 5. Union 6. Eligibility 7. Plan Incentive is King 8. Cash is Queen

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