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Engaging Employees in Wellness Initiatives: Lessons Learned

Emily Talley, CEBS, SPHRBenefits ManagerTanner Health SystemCarrollton, GA

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It’s Been a Marathon, Not a Sprint!

1990s—Laying the Foundation◦ Health risk assessments with biometrics for

spouses and employees◦ Variety of on-site exercise and nutrition programs

with limited participation◦ Limited annual benefit for preventive care or

reimbursement for wellness items

Tanner’s Road to Wellness

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2000s—Broadening the Effort◦ 2002—Telephonic disease management program◦ 2003—Discounts at local gyms◦ 2005—Preventive care benefits incorporated into

health plan◦ 2008—Leadership and community challenges;

Tobacco Free workplace; Exercise facility on main campus◦ 2009—Employee weight loss challenge; Additional

exercise facilities; System-wide health fairs

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2010s—Building Accountability◦ 2010—Wellness credit program; Expanded exercise

facility & educational offerings◦ 2011—Requirement of all 5 target areas and

disease management participation; In-house healthy dining options; Family access to exercise facilities◦ 2012—In-house disease management program with

co-pay waiver incentive; Streamlined alternative means

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Like many other employers, Tanner’s health plan costs were unsustainable

Why Engagement Matters

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Who are We Trying to Engage?Demographics◦ Demographics◦ 82% female◦ Average age: 43◦ Varied education levels

Cultural◦ Traditional southern food◦ Caregiver (not care-taker) mentality◦ Busy lifestyles and competing priorities

Work Challenges◦ Long work hours◦ Short meal breaks◦ Sedentary jobs◦ Knowing ≠ doing

Designing an Effective Program

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Where Do We Focus Our Efforts? Use claims data analysis to:◦ Identify cost drivers e.g., Avg. cost/EE broken down by biometrics

◦ Focus on conditions directly impacted by wellness e.g., Cardiovascular and diabetes

◦ Use industry benchmarking to identify areas of potential savings e.g., Reduce in-patient admissions for CAD

Use HRA results to determine leading risk factors◦ e.g., Overweight, inactivity

Measurement is key!

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What Targets Should We Set? Goal: Targets that motivate healthy behaviors◦ Direct link to healthy behaviors◦ Set at achievable level◦ Easy and relatively inexpensive to measure to allow to

check progress◦ Credibility—supported by physicians and recognized

authorities Issues encountered◦ Self-reporting vs. independent verification◦ Alternative measures◦ Tobacco usage as separate consideration

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How Do We Get Employees to Participate? Goal: Make it worth it to employees to engage◦ Taking into account avg. salary, current health plan

design and premiums, cost to organization Incentives considered◦ Carrot vs. stick approach◦ Type of incentive: lower deductible, co-pay waivers,

FSA/HSA contribution, premium credit, etc. Issues encountered◦ Making it visible to employees e.g. separate line item on paycheck

◦ Qualification for new hires/newly enrolled

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Taking inventory of current programs Selecting the right partner◦ e.g., Broker, Consultant, TPA, Carrier

Ensuring HIPAA, GINA & ADA complianceDetermining administration ◦ e.g., in-house, external or combination

Keeping communication in mindDetermining how success will be measured

Other Key Steps in Design

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Year 1: All employees given credit up front with opportunity to qualify by May 31

Healthy Advantage Program

WAYS TO QUALIFY FOR THE CREDITHealth Targets(Meet 3)

Meet theTarget

OR Complete a Health Source Program

OR Other Methods

BMI 30 or Lower

Weight Loss ChallengeOR

12 Week Exercise Log

Physician-supervised Programs

and Medication

Therapy

Blood Pressure 140/90 or Lower

Hypertension EducationOR

12 Week Exercise Log

Blood Glucose 130 or Lower

Diabetes EducationOR

12 Week Exercise Log

HDL-LDL Ratio 0.5 or Higher

Cholesterol EducationOR

12 Week Exercise Log

Tobacco Use None Tobacco-Free Education

Included disclaimer regarding consulting physician and if unreasonably difficult or medically

inadvisable due to medical condition.

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Year 2: Meet all 5 targets and participate in disease management

Year 3: Streamlined alternative means

Healthy Advantage Program

HOW TO QUALIFY FOR THE CREDITOption 1: Complete HRA and Meet the 5 Healthy Advantage Targets

Healthy Advantage TargetsBMI 30 or LowerBlood Pressure 140/90 or LowerBlood Glucose 130 or LowerLDL High Risk: 100 or Lower Low Risk: 130 or LowerTobacco Use None

Option 2: Complete HRA and Customized Health Source ProgramHealth Source Alternative Programs

If You Missed One Target Complete Online Health Education Module

If You Missed Two Targets Complete Online Health Education ModuleAND 8 Week Exercise Log

If You Missed 3 or More Targets Complete 12 Week Health Coaching ProgramIncluded disclaimer regarding consulting physician

and if unreasonably difficult or medically inadvisable due to medical condition.

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THS Average Measurements 2010 2011

Body Mass Index 35 29.4Blood Pressure 124.6/75.8 122.5/74.4Total Cholesterol 186.5 180.2HDL Level 51.4 52.7LDL Level 114.6 101.5Glucose 92.4 95.3Tobacco Usage 9% 6%

Program Results

Based on 1,543 participants who completed health risk assessment in both years

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Bending the curve through wellness initiatives and plan design (including HDHP)

Why Engagement Matters

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Incentives matter◦ The power of a t-shirt and a cup◦ Keep financial incentives visible

Keep it simple◦ Easily determined measurements◦ Easy to follow alternative means

Make it fun◦ Competition, games, immediate feedback

Walk-the-walk◦ Top leadership involvement◦ Cafeteria menu

Offer support◦ Smoking cessation and other educational programs◦ Reinforce small changes

The power of individual stories, positive peer pressure and a culture of wellness

Lessons Learned

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Get releases up front ◦ e.g., Disease management eligibility and data analysis

Use measures that are easily benchmarked Have back up measurement plans◦ e.g., Waist-to-hip ratio, cholesterol screening

Have a single point of contact for administration◦ e.g., Submission of materials, verification of eligibility

Incorporate accountability into self-reporting◦ e.g., Measurements with exercise logs, tobacco tests

Require detail and follow up in physician reporting Videotape classes to allow for future viewing Determine how to handle exceptions

◦ e.g., Pregnancy, cancer treatment, other health concerns Review program for HIPAA, ADA & GINA compliance

How to Avoid Common Pitfalls

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Brand your program Know your audience and tailor the message

◦ e.g., “You take care of others, now it’s time to take care of yourself” Communicate first to leaders (formal & informal) Convey what’s in it for the employee

◦ e.g., live active and healthy life, keeping premiums affordable Use employee stories and testimonials Determine timeline of communication

◦ e.g., program awareness, initial notification, reminders, confirmation of qualification, notification of failure to qualify

Determine the methods to be used (multiple recommended) Print—newsletters, flyers, brochures Meetings—managers, program champions, employees Electronic—intranet, internet, e-mails, texts

Make it easy to find information◦ e.g., HR policies, handbook, enrollment guide, orientation, intranet

Target the family as well

Communication Checklist

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Next Steps: Targeting Chronic Conditions

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Engaging those with chronic conditions◦ Comprehensive program involving using nurse

practitioner, health coach, dietitian, pharmacist, diabetes education, and EAP◦ Challenges—identification of candidates, setting

measurable goals, meaningful Rx co-pay incentives, physician coordination

Engaging spouses Keeping the program moving forward◦ Tougher health targets, more challenging

alternative means

Next Steps

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Questions?

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