An integrated wellness and insurance model Dr Dawn Richards, Medical Affairs Director, VitalityHealth
The genesis of Vitality, and the need to make people healthier: Overview of the South African healthcare system South Africa Ghana Indonesia Thailand Brazil Columbia US UK Canada Germany SA Russia Brazil China India France Germany US UK Australia Burden of disease (Indexed, SA = 100) Doctors per 10,000 Regulatory system 100% 80% 50 45 40 Emerging Developed 60% 35 30 40% 25 20 20% 0% 15 10 5 0 Risk adjusted premium Average premium per family R1,200 R4,500 R3,000 R3,000 SA has an absolute burden of disease 4 times higher than UK Significant undersupply of doctors, with levels aligned with low income countries Non-discriminatory and egalitarian private health care funding system 2
The genesis of Vitality, and the need to make people healthier: An insurance model that integrates prevention and health promotion with sickness care Health insurance Life insurance Behaviour link Behaviour link Vitality Age Personal pathways Points and statuses Rewards Technology 3
The use of incentives is a critical enabler of the model: Issues of behavioural psychology Individual behaviour is irrational and difficult to change The health wellness paradox Other behavioural psychology issues Benefits are immediate, price is hidden Benefits are hidden, price is immediate Conflicting information True impact of different health and wellness approaches is not well understood Healthcare Wellness Overoptimism People tend to overestimate their current state of health and their ability to improve it in the future Third-party payer system Cost borne by the consumer Hyperbolic discounting Future rewards of a healthy lifestyle are significantly undervalued relative to cost today 4
Evidence from the Vitality programme: Vitality motivates simple and complex behaviour change Vitality Age (Health risk assessment) completion Biometric screening completion 2.8x Free Healthcheck 2.9x Free movies 1.7x Non- Smoker cash back 1.7x 2012 2013 2014 2012 2013 2014 Source: Vitality UK member data 5
Evidence from the Vitality programme: Vitality motivates simple and complex behaviour change example of physical activity 1 Register and track your activity Active Rewards benefit design 2 Reach minimum thresholds Impact of Active Rewards on physical activity Members meeting weekly Active Rewards threshold 34% of inactive members in 2014 are engaged in Active Rewards in 2016 8 fold increase 3 Earn weekly rewards 13 14 15 16 Source: Vitality UK member data 6
Evidence from the Vitality programme: Vitality motivates simple and complex behaviour change example of nutrition Discounts of 10% and 25% for healthy foods resulted in... 7
Evidence from the Vitality programme: Engagement in wellness results in a reduction in risk Reductions in Vitality Age are evident across the board Engagement results in reduced risk factors Change in Vitality Age gap after 1 year Reduction in risk factors (2015 vs. 2014) 34.9 22.6 16.8 11.6 9.7 20.7 26.2 41.4 51.2 62.5 78.7 23.7 Up to 0 0 to 3 3 to 6 More than 6 Starting Vitality Age gap (Vitality Age Actual Age) Reduced < 3 months Increased Two-thirds of engaged Vitality members reduce their Vitality Age gap over a period of 1 year Source: Vitality UK member data % at-risk in 2014 who moved into healthy range in 2015 Of 5,355 members: 35% Of 37,733 members: 43% Of 47,033 members: 30% 8
Evidence from the Vitality programme: Healthcare outcomes are amplified in a full indemnity system (akin to the NHS) Vitality s experience in South Africa Risk-adjusted hospital costs for engaged Vitality members are 10% 40% lower than non-engaged members for non-chronic conditions, including 34% lower for mental illness Risk-adjusted hospital costs for engaged Vitality members are 10% 30% lower than non-engaged members for chronic conditions, including 21% lower for mental illness Admission rates are 10% lower, length of stay in hospital 25% lower and hospital cost per patient 14% lower for highly-engaged Vitality members relative to members not registered on Vitality Each additional gym visit per week over a 3-year period resulted in a 2-3% reduction in the probability of hospitalisation of members in years 4 and 5 9
< 0 Are the benefits of good health limited to claims costs? Healthier people perform better on a range of important outcomes 0-2 2-4 4-6 6-8 8-10 10-12 12 + < 0 0-2 2-4 4-6 6-8 8-10 10-12 12 + < 0 0-2 2-4 4-6 6-8 8-10 10-12 12 + < 0 0-2 2-4 4-6 6-8 8-10 10-12 12 + < 0 0-2 2-4 4-6 6-8 8-10 10-12 12 + Sleep better Suffer less from stress More engaged at work More productive Enjoy life more % of employees who sleep < 7 hours % of employees with 2 or more dimensions of work stress % of employees who are not engaged in their jobs Number of productive days lost per employee per year % of employees with low or moderate life satisfaction Vitality Age gap (Vitality Age actual age) Vitality Age gap (Vitality Age actual age) Vitality Age gap (Vitality Age actual age) Vitality Age gap (Vitality Age actual age) Vitality Age gap (Vitality Age actual age) Source: Britain s Healthiest Workplace 2016 10
Percentage of employees Considerations for mental wellbeing: There is a strong correlation between physical and mental health the direction of the relationship is unknown 0 < 2h 2-4h 4-6h 6-8h 8-10h 10-12h 12-14h 14h + < 18 18-20 20-22 22-24 24-26 26-28 28-30 30-32 32-34 34-36 36 + Percentage of employees with at least mild symptoms of depression 11.3 12.6 11.1 8.5 8.5 6.5 5.8 4.0 4.3 4.5 3.9 4.1 5.9 6.7 5.2 4.9 4.7 5.1 6.0 7.4 Hours of physical activity per week Body mass index Source: Britain s Healthiest Workplace 2015 11
An integrated wellness and insurance model Dr Dawn Richards, Medical Affairs Director, VitalityHealth