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ACA Hangover: Don't Overlook Wellness in 2014 February 25, 2014
HEALTHCHECK360.COM 866.511.0360
PRESENTED BY MICHAEL KELLY
AGENDA
• Why Wellness • Impact of Reform on Wellness Programs • Key Components of Effective Wellness Programs • Quantifiable Outcomes
2
Why Wellness
THE EVOLUTION OF OUR EMPLOYEES
COSTS ARE CORRELATED TO HEALTH RISKS & AGE
Ideal (85+)
Low Risk (71-84)
Moderate Risk (61-70)
High Risk (51-60)
Very High Risk (<=50)
$-
$2,000.00
$4,000.00
$6,000.00
$8,000.00
$10,000.00
$12,000.00
$14,000.00
<30 30-40
40-50 50-60
60+
Heal
th R
isk
Leve
l
Clai
ms C
ost
Age
HC360 Sample Population Study, N=10262, 2012
WHY WELLNESS – BARRIERS TO CONTROLLING COSTS
0% 10% 20% 30% 40% 50% 60% 70%
Changes in workforce demographics
Poor information on provider quality
Poor quality or misue of care because primary, specialy and facility care are not integrated
Overuse of care through providers recommending too many services
Higher costs due to new medical technologies
Poor information on provider costs
Overuse of care through employees seeking inappropriate care
Poor employee understanding of how to use the plan
High-cost catastropic cases and end-of-life care
Underuse of preventative services
Employees' poor Health Habits
11%
11%
13%
14%
19%
21%
24%
30%
41%
41%
67%
2010 Employer Survey on Purchasing Value in Health Care Report, Towers Watson & National Business Group on Health
Can be impacted by effective and integrated wellness programming
FLAWS IN WELLNESS MARKETPLACE
• Poor access and high costs in geographically dispersed populations
• No accountability or effective behavior change models
• Actionable data was not transparent or accessible
• Carrier programs dominated marketplace • Lack of integrated data-driven tools for
engagement
7
Impact of Reform on Wellness
VERY SIMPLE…
• Costs will rise for most plans • Access to care is going to become restrictive • Employers will have more flexibility in design of wellness
initiatives • Outcome based wellness must become more flexible to
accommodate HIPAA
INTENT OF REGULATORS – THE CHALLENGE
• Stated in preamble – – …to ensure that the program is reasonably designed to improve health and is not
a subterfuge for underwriting or reducing benefits based on health status. – The intention of the Departments in these final regulations is that, regardless of the
type of wellness program, every individual participating in the program should be able to receive the full amount of any reward or incentive, regardless of any health factor.
• Clarify the 5 requirements of health contingent wellness programs
• However…
INTENT OF REGULATORS - THE GOOD NEWS
• These final regulations continue to permit plans and issuers flexibility in designing reasonable alternative standards (including using reasonable alternative standards that are health-contingent).
• No defined reasonable alternatives as it was viewed to stifle innovation in the wellness space.
PARTICIPATORY V. HEALTH-CONTINGENT WELLNESS
Participatory • Reward Not Based on
Health Factor • 5 HIPAA Wellness Rules
NA • But Other Laws May Apply
– ERISA, ADA, GINA, Tax, Privacy
Health-Contingent • Reward Based on Health
Factor • 5 HIPAA Wellness Rules Apply • Two New Subcategories:
– Activity-Only Wellness Programs
– Outcome-Based Wellness Programs
HIPAA COMPLIANCE UNDER REFORM
• Standard #1 – Frequency of Opportunity to Qualify • Standard #2 – Size of Reward (30%/50%) • Standard #3 – Uniform Availability and Reasonable
Alternative • Standard #4 – Reasonable Design • Standard #5 – Notice of Other Means of Qualifying
for the Reward
WELLNESS PROGRAM DEFINITIONS
Old Rules
Wellness Programs
Participation Only
Outcome Based
New Rules Wellness Programs
Participatory Health Contingent
Activity Only
Outcome Based
NEW RAS PROCESS
Wellness Programs
Participatory Health Contingent
Activity Only
Outcome Based Must provide reasonable
alternative standard… PERIOD!
Must provide RAS based on health status if: 1. Medically inadvisable, or 2. Unreasonably difficult
OTHER POSSIBILITIES
• Employer can waive standard or reasonable alternative at any time (just give the incentive to the employee).
• The employee’s primary care doctor can recommend reasonable alternative plan (and plan/vendor must accommodate).
ONUS OF RESPONSIBILITY
• Employer: Communication/ Payroll Admin • Employee: Action/ Request for reasonable alternative • Vendor: Administering reasonable process and reporting to
employer eligibility
HEALTHCHECK360 MODEL – YEAR ONE
• HealthCheck360 provides 0-100 score based on biometric results
• Activity Based Health Contingent Program – Participant receives preferred
cost sharing (typically through premium contribution) by participating in the program and establishing baseline score.
– If a health issue prevents employee from participating, HealthCheck360° will provide alternative participatory program (HRA only, health coaching, activity, etc).
Health Contingent
(Activity Only)
Participatory
Outcome based (HRA Score – 71+/5+)
Complete Activity Program (Track 2x week)
Participatory (Optional/ Not Recommended)
Primary Care Physician Recommendation
HEALTHCHECK360 MODEL – YEAR TWO
• Complete Biometric screen/ HRA/ ROF call
– If unable, we CAN require medical necessity • If outcome is not met, all failures are
entitled to reasonable alternative – Call HealthCheck360 – HC360 provides physician review form – Participant returns form to HC360 – Participant must complete activity or weight loss
program – If completed to satisfaction, company must
reimburse contributions – If not completed, participant continues on higher
contribution • If participant refuses or cannot
complete suggested program… – we CAN require medical necessity
Medical need for alternative
Call HealthCheck360 - Physician Review
Or
5 BEST PRACTICES
20
You have to collect biometrics… and objectively measure health!
Biometric Screening
The Why • Participants do not “know their
numbers” • Participants are not honest • Objective data points for measuring
progress over time • Enables integration with disease and
case management teams
The What • Comprehensive assessment of major
risks – used to create a health score • Core Panels
– Body Composition – Blood Pressure – Lipid Panel – Cholesterol/Triglycerides – Glucose – Diabetes Risk – Nicotine/ Alcohol
• Additional panels to identify potential catastrophic issues – liver function, kidney function
• Optional preventative screenings based on age/gender – e.g., PSA screenings
ACCESS TO CARE UNDER REFORM
• Access to Care – Plans required to cover preventative services at no cost – Barriers to preventative care are removed and newly insured demand
service, access will become an issue – Primary Care Network already at a deficit
• Opportunity – Wellness programs will bridge the gap, providing new and expanded
options for basic care – Educates employees on appropriate level of care and responsible
utilization
OBJECTIVE SCORING SYSTEM
• Our scoring algorithm is directly correlated to present and future cost drivers
• Developed and reviewed by a panel of
physicians
• Balanced across all major cost drivers
• Transparent to participant
• Designed to reward positive change across health spectrum
• Designed to integrate with medical management
• Easily understood 0-100 scale
24
YOU DON’T KNOW WHAT YOU DON’T KNOW
Biometric Screening Findings
• 111 with glucose in diabetic range • 580 with glucose in pre-diabetic
range
• 549 individuals with elevated systolic and diastolic blood pressure readings
• 815with elevated cholesterol • 883 with BMI readings > 30, of
which 396 (44.8%) are also pre-diabetic
Claims Information
• 50 have claims with a diagnosis suggesting diabetes or pre-diabetes
• 78 have claims with a diagnosis suggesting hypertension
• 98 individuals have claims with a diagnosis suggesting being at risk of a heart attack
25 Proprietary & Confidential
N = 1,750 Mfg Firm
Outcome Based Incentives!
B e s t P r a c t i c e # 3 :
OUTCOME BASED INCENTIVE MODELS
Proprietary & Confidential
EMPLOYER MARKET IS TRENDING…
0% 10% 20% 30% 40% 50% 60% 70% 80%
Reward (or penalize) based on biometric outcomes other than smoker, tobacco-use
status (e.g., achievement of weight control or target cholesterol levels)
Require employees to complete a health management program/activity (beyond simply
enrolling in a program) in order to receive reward (or avoid penalty)
12%
35%
10%
44%
33%
70%
Planned for 2013 2012 2011
Performance in an Era of Uncertainty | Towers Watson/National Business Group on Health 2012
INCENTIVE VALUE AND PARTICIPATION
• Results for completion of Health Risk Assessments/Biometrics show a direct correlation between incentive value and participation
• Incentives reward those who make healthy lifestyle choices
Proprietary & Confidential
0%
20%
40%
60%
80%
100%
$0 $100 $200 $400 $600 $800 $1000
Incentive (Annual Cash Value)
Enro
llmen
t Per
cent
age
RECOMMENDED INCENTIVE STRUCTURES
Premium Contribution Model
•Each participant receives score from 0-100 based on health risks
•Monthly contribution rates are dependent on maintaining good health, improving health, or compliance
Premium Refund (Safeway) Model
• Similar to premium contribution model except all contributions are the same and incentive is refunded participant in following year
• Can be integrated well with HSA/HRA plans
Biometric Tier Model
•Participant earns contribution or plan design rewards by meeting requirement in one or more biometric measurements
• For example: Anyone with a BMI<30 receives $10 off premium per month.
EXAMPLE MODEL
Preferred Rate • Health score of 71+ • Repeat participants with <71 AND 5+ pt improvement • All new participants
Participation Rate • Participants who fail to meet health goals
Standard Rate • Non-participants
Data Driven Interventions
DATA DRIVEN ENGAGEMENT
33
• Biometrics • HRA responses • Demographics • Claims
Data
• Ideal, Low, Moderate, High, & Very High Risk
Stratification • Communications • Technology • Health Coaching • Medical Mgmt
Engagement
FOLLOW-UP EMPLOYEE COMMUNICATION
POST HRA COMMUNICATION CAMPAIGN
• Each participant will receive risk-specific quarterly communications.
• Monthly Wellness newsletter
• Monthly lunch and learns from HealthCheck360° health coaches – http://www.youtube.com/watch?v=Y5lgvnUplW4
• Regular updates on www.healthcheck360blog.com
• Daily wellness tips on www.twitter.com/healthcheck360
• Blog , twitter, and lunch and learns are all integrated with Facebook
34
MYHEALTHCHECK360.COM
• Company branded
• Personalized content
• User specific tracking tools
– Weight
– Nutrition
– Activity
– Steps
– Water
– Nicotine Use
• Client specific challenge
management
35
PROGRAM MANAGEMENT
• www.myHealthCheck360.com gives your wellness team the ability to plan, track, and manage programs and design:
• Weight loss contests • Activity programming • Pedometer programs • Sleep, nicotine, and other
options
• HealthCheck360° has developed employee communication plans to support these initiatives.
36
MYHEALTHCHECK360° MOBILE APPLICATION
• iPhone and Android • Linked to personal weight
management goal • Tracking tool • Access to company challenges • Tips of the day • Personal Account management
37
HEALTH COACHING MODELS
• Review of Findings Call (ROF) • Targeted • Comprehensive • Opt-in • Custom
38
System promotes improved health
34%
67%
80%
89%
92%
92%
0% 20% 40% 60% 80% 100%
Alerted me to medical condition I wasn't aware of*
Articles I received motivated me to improve health
Premium Incentive motivated me to improve my health
Report helped me understand where to change
Provided valuable insight into my health
Program made it more likely for me to improve health
Somewhat Agree, Agree and Strongly Agree
* Using Agree/Disagree scale only
There was very strong agreement that the HC360° program not only provided good insight into health, but also help foster the desire to improve health. One-third of participants found out about a health issue that they were unaware of before the program.
Proprietary & Confidential N = 6,000
Client Specific Reporting! Is it working?
B e s t P r a c t i c e # 5
Reporting: Is the program working?
THREE PRIMARY QUESTIONS
• Is the population getting healthier? – If so… program is succeeding
• What is the impact of the incentive structure on program costs? – Design can self fund program for 1:1
• How has reduction in risk correlated to claims experience (trend)?
– Specific correlation tests to health risks – Examine event rates: chronic care, ER visits, compliance, et.c
5. CLIENT SPECIFIC REPORTING
42
* If applicable
• Individual Report • Executive & Aggregate Report • Claims analysis* • Health Coaching Reporting* • Risk Migration Analysis • Critical Value Reporting • Executive Review Presentation
– Provides synopsis of various reports – Identifies key issues – Compares company data to industry cohorts
IMPORTANCE OF PARTICIPATION
Proprietary & Confidential
$3,800.00
$4,000.00
$4,200.00
$4,400.00
$4,600.00
$4,800.00
$5,000.00
Biometric Participant Non-participant
$4,194.13
$4,967.48
Participation Correlation to Claims
HC360 Sample Population Study, N=10262, 2012
18% Increase in non-participant costs
WHAT HAPPENS IF YOU DO NOTHING?
72.00
73.00
74.00
75.00
76.00
77.00
78.00
79.00
80.00
81.00
82.00
30 31 32 33
75.67
77.57
79.55
81.01
77.19 76.52
76.11 75.54
HRA
Tot
al S
core
Age
4-Year Repeat Participants vs. Baseline in HealthCheck360° Population
4-Year Repeat Participants Baseline Average
44
HealthCheck360° Sample Population Study
67.00
68.00
69.00
70.00
71.00
72.00
73.00
74.00
75.00
76.00
45 46 47 48
70.74
72.67
74.94
75.93
71.19 70.89 70.74 70.53
HRA
Tot
al S
core
Average Age
4-Year Repeat Participants vs. Baseline in HealthCheck360° Population
4-Year Repeat Participants Baseline Average
HEALTH METRICS IMPROVE WITH PARTICIPATION
R² = 0.9662
R² = 0.8815
66
68
70
72
74
76
78
80
82
84
30 35 40 45 50 55 60 65
HR
A T
otal
Sco
re
Age
HC360 Repeat Participants vs Baseline
Baseline HC360 Participants
45
CONTINUED POSITIVE IMPACT
R² = 0.9663
R² = 0.9326
R² = 0.8504 R² = 0.6612
65
70
75
80
85
90
20 25 30 35 40 45 50 55 60 65
HR
A T
otal
Sco
re
Age
Age vs. Total Score
1-Year Participants
2-Year Participants
3-Year Participants
4-Year Participants
46
BIOMETRIC CORRELATION TO CLAIMS COST
$3,445.88 $3,601.02
$4,183.42
$5,249.77
$6,356.69
y = 2748.2e0.1602x R² = 0.9554
$2,500.00
$3,000.00
$3,500.00
$4,000.00
$4,500.00
$5,000.00
$5,500.00
$6,000.00
$6,500.00
$7,000.00
Ideal (18.5-24.9)
Low Risk (25-29.9)
Moderate Risk (30.0-
34.9)
High Risk (35.0-39.9)
Very High Risk (40+)
Allo
wed
Cla
ims
(Ann
ual)
BMI Risk Level
BMI Correlation to Claims
47
HC360 Sample Client Report, N=10262, 2012
$3,730.05
$5,265.33
$7,406.44
y = 2648.6e0.343x R² = 1
$2,000.00
$3,000.00
$4,000.00
$5,000.00
$6,000.00
$7,000.00
$8,000.00
Ideal (<100) Moderate Risk (100-125)
Very High Risk (>=126)
Allo
wed
Cla
ims
(Ann
ual)
Glucose Risk Level
Glucose Correlation to Claims
WHY THIS IS IMPORTANT
48
$0
$1,000
$2,000
$3,000
$4,000
$5,000
$6,000
$7,000
$8,000
18-29 30-39 40-49 50-59 60+
Nicotine Use Correlation to Claims by Age
NEG POS HealthCheck360°/SISCO Population Study, 2011.
WORK COMP CORRELATION
$366.25
$703.24
$771.36
$952.22
y = 314.75e0.2959x R² = 0.8591
$250.00
$350.00
$450.00
$550.00
$650.00
$750.00
$850.00
$950.00
$1,050.00
$1,150.00
Ideal Risk Low Risk Moderate Risk High Risk
Average WC Cost by Health Level
Avg WC Expon. (Avg WC)
Figure 1 2000 EE manufacturing and distribution company – Significant correlation in high health risk levels and workers compensation expense.
49
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Alerted me to medical condition I wasn't aware of*
Articles I received motivated me to improve health
Premium Incentive motivated me to improve my health
Report helped me understand where to change
Provided valuable insight into my health
Program made it more likely for me to improve health
34%
67%
80%
89%
92%
92%
Somewhat Agree, Agree and Strongly Agree * Using Agree/Disagree scale only
EMPLOYEES RECOGNIZE BENEFIT
50
N = 6,000
51
Outcome based wellness drives health improvement!
YEAR 1 TO 3 HEALTH MIGRATION
0
1000
2000
3000
4000
5000
6000
7000
8000
Ideal Low Moderate High Very High
5320
7275
4409
2888
2145
6061
7538
4072
2587
1779
6518
7578
3977
2363
1601
3 Year Repeat Migration – Participants: 22,037
Year 1 Year 2 Year 3 22.5% Increase 25.5% Decrease
YEAR 1 TO 4 HEALTH MIGRATION
0
500
1000
1500
2000
2500
3000
3500
Ideal Low Moderate High Very High
1863
3205
2064
1389
1071
2205
3298
1929
1270
890
2545
3289
1891
1105
762
2749
3223
1788
1097
735
4 Year Repeat Migration – Participants: 9,592
Year 1 Year 2 Year 3 Year 4 47.6% Increase 31.4% Decrease
KEYS TO SUCCESS
• Delivering a consistent program to all employees at all locations • Ability to provide and evolve outcome-based incentive structure • HealthCheck360° integrated tools – communications, coaching, mobile, online,
and program management – enable all employees to be engaged throughout the year and at every location.
• Ability to integrate claims, disability, & other data with biometric tracking creates best in class reporting
• Motivation + Engagement + Data = Improved Health • Improved Health = Lower cost & happier employees
54
QUESTIONS?
Michael P. Kelly Director, HealthCheck360° Ph: 563.587.5186 | 866.511.0360 Cell: 563.845.8085 Fax: 563.587.5836 [email protected] HealthCheck360° 800 Main Street | PO Box 28 Dubuque, IA 52004-0028 www.healthcheck360.com