Implementing a Best Practice Wellness Program

7/28/2019 Implementing a Best Practice Wellness Program

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Berkshire Health SystemsOccupational Health and Wellness

Bobbie Orsi, MS, RN

J enna Grelle Laramee, MA, RN

Implementing a Best PracticeWellness Program


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Berkshire Health Systems

3,600 employees

Mean age 46

75% Female

Self-insured (5 plans)

Health costs total $32 M

600 RNs - unionized

Top 5 key cost driversMusculoskeletal

CancerIll-defined

Digestive

Cardiovascular


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Program History

Accenton Health

CommunityOutreach

EducationScreening

2000

ExternalWorksites

EducationScreeningCoaching

2003

BHSWellness

atWork

2005

Increase inExternalWorksites

OCC Health

CommunityHealth Van

2007 - 2010


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What is a Best Practice Program?

Best Practice in health promotion is theset or sets of continually evolving actions(utilizing science-based evidence) andassociated attitudes which are most likelyto achieve health promotion goals in a givensituation, and which are consistent with the

values of health promotion.

Kahan/Goodstadt, 1998


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Best Practice

Health Management Strategy

HERO Best Practice Program Design

Health Enhancement Resource Organization

www.thehero.org

WELCOA's Seven BenchmarksWellness Councils of America

www.welcoa.org

5 Fundamental PillarsDee Edington, Zero Trends, 2009

Goetzel and MEDSTAT Group at American Productivity and Quality Center.

A 25% reduction in costs can be realized with a best practice program.
http://www.thehero.org/http://www.thehero.org/


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Gray Ellrodt M.D.Chairman, Department of Medicine

Berkshire Medical CenterWellness Leadership Team


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Best Practice Core Component:Senior Level Support

The BHS Wellness Leadership Team:

Chief Financial Officer

VP Human Resources VP Strategic Planning and Development

Chairman, Department of Medicine

VP Home Care Division

Director of Wellness and Outreach

Wellness Coordinator


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Arthur MilanoVice President, Human Resources

Berkshire Health SystemsWellness Leadership Team


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BHS Guiding Principles

1. Driven by Senior Leadership

2. Build a multilevel program

3. Target the most important health issues

4. Offer something for everyone

5. Communicate - communicate6. Reward successes

7. Allow outcomes to drive the strategy

8. Make it sustainable9. Commit to aculture of health

10. Keep it fresh and fun!


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Wellness Program Goals

To improve employee healthand well-being

To achieve an age-adjustedbelow industry averagecost per covered life

To create a culture ofhealth

To improve the perception of

BHS as a leader in Wellnesswithin the greater BerkshireCounty community.


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Core Program Components

Health Risk Assessment (HRA)Insurer HRA vs. Vendor Access to our own data

Screening (Biometrics) Coaching for high risk employees

Connect to Primary Care Programs addressing common risks

Utilize internal resources vs. purchase

Focus on confidentiality

Different types of incentives Visible culture change

GOAL: Continue to grow participation!


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Healthy

Employees

Promotion ofhealthy

lifestyles Healthy Culture

Follow up

Early detectionand prevention

Customizedrisk reduction

ConfidentialEarly

interventionReferrals

Ongoingsupport

Easilyaccessible

Strategies to Improve Healthand Wellness


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Arthur MilanoVice President, Human Resources

Berkshire Health Systems

Wellness Leadership Team


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Sent: Wednesday, January 11, 2006 9:05 AMSubject: Wellness Meeting

The proposed agenda for the meeting this afternoon is below.

AgendaStatus of current participation and findingsHRA, screenings, classes, risk factors, etc

Space progressStaffingDietitian progressBudget updateCommunicationMost of next Scope dedicated to Wellness

Letters homePlans for raffle drawingsIncentivesNew Live longer in 2006 proposalAlternative ideas

Time permitting, review other standing agenda items

Agenda 2006


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Prevention

Screenings

Promotion

- fitness

- education

- nutrition

Health risk

assessment

Targeted risk

reduction

programs

Risk modeling

Nurse advice line

Decision support

Web tools

Consumer

directed plans

Disease

management

Incentive design

Self management

training

Case

management

Predictive

modeling

85% members = 15% cost

15% members = 85% cost

Well Risk Urgent Disease

Well

No Disease

At Risk

Obesity HighCholesterol

Acute Illness/

Discretionary

Care

Doctor VisitsEmergency Visits

Chronic Illness

Diabetes

Coronary Heart

Disease

Catastrophic

Head Injury

Cancer, MI, Stroke

Address the entire care continuumStop risk progression

(Dont get worse)

Mercer Human Resource Consulting


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Healthyemployees Employees withisolated risk Employees with highBlood pressure, cholesterol,or pre-diabetesEmployees withdiabetes, poststroke, MI, PAD

Website with HRA

Healthy Steps

Challenges

Nutrition programs

Fitness programs

Worklife programs

Fitness benefit

Smoke Free

Fun events

Back Health

Self-Care

Tobacco Treatment

Weight Watchers

Weight benefit

Nutritioncounseling

Modified Coaching

EAP

Health Coaching

Hardwired for Health

(8-week lifestyle classes)

Pre-Diabetes Classes

Early Intervention Program

DiabetesEducation

Cardiac Rehab

OP Rehab

CHF program

Cancer Support

Offer Something for EveryoneAll program components are cumulative


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Program Staff

Total

Mgmt

Coach

Support

3.5 FTEs

.5 Director

1 RN

1 Prog Coord1 Assistant

4.5 FTEs

.5 Director

2 RNs

1 Prog Coord1 Assistant

5.5 FTEs

.5 Director

2 RNs

1 Prog Coord1 Assistant.8 RD /.2 EAP

5.3 FTEs

.44 Director/Mgr

.19 Business Mgr

2 RNs

.5 Hlth Ed

.5 Prog Coord1 Assistant

.6RD/.1 EAP

5.2 FTEs

.38 Director/Mgr

.12 Business Mgr

2 RNs.5 HealthEducator

.5 Program Coord1 Assistant.6RD/.1 EAP

Staff 2006Year 1

2007Year 2

2008Year 3

2009Year 4

2010Year 5

YR 2 Added 1 RN to accommodate employees (Increase coaching)YR 3 Added Registered Dietitian (increase focus on weight reduction)

Added EAP counselor (increase EAP utilization for high% depression)YR 4 Skill mix (Program Coord/Health Educator) non-RN strategy for mod risk employee

Integration with OCCH (added Business Manager)YR 5 1FTE Health Educator


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Program GrowthHistory 2006

Year 12007

Year 22008

Year 32009

Year 42010

Year 5

HRA 705HFIT

1186HFIT

1051HFIT

1418ScoreHealth

TBD

BiometricsScreening

953 1227 1250 1348 TBD

Incentives$3000 for

participation

$25 peremployee for

HRA/screening$6000

participation

Connectionto benefits$350/700

$6000participation

Same Same

Benefitsrequirements

None None 1) HRA2) Screening

1) HRA2) Screening3) Self Care4) Flu/declin

1) HRA2) Screening3) Action4) Flu/declin

BenefitsDesign

None None BCBS planHMO Blue +

Wellness

Wellness HNEplan

BCBS/HNEwellness


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22%

30%

16%

52%

37% 38%

29%

53%

33%39%

31%

61%

44% 42% 40%

92%

HRA Wellness Screenings Completed Both Screeningand HRA

Program "Touch Points"(Number of employees

completing at least one

initiatve)

2006 2007 2008 2009

Program Participation Trends


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SCOREHEALTH: Smart Software

Documents client informationGuides process

Uses evidence-basedguidelines

Individualized goals

Easy-to-read educationalmaterial

Reports for

Client

Counselor

Provider

Group

Tracks outcomes over time

Finds at-risk clients & groups


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Report viewer with Group Stratification Profile

SCOREHEALTH: Group Reports


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Programs Targeting Major Health Risks

Risk: CVD / Diabetes

Data (n=1,348)

HTN 5% PreHTN 27%Non-HDL >160 21% BMI 25-29 29%BMI >30 - 25% Risk 1 & 2 43%Diabetes - 3%

Programs

Screening/coaching Weight WatchersBP sweeps Healthy Steps

Nutrition counseling/programsPre diabetes classesWalk It Off: Weight mgt.Fitness benefit THR program

Self-directed and group challenges


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Risk: MSC injury (EE Claims/ WC)

Data (n=1,348)

290 employeesArthritis / back / neck / joint / soft tissue

(6 hip and 2 knee replacements)Programs

MSC task force recommendations(ex. Early Intervention Program)

Fitness incentive and programsWeight management


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Risk: Depression (EE BCBS Claims)Data: 123 employees

Programs: EAP Worklife CoachResiliency / Stress Mgmt Programs

Risk: Cancer (EE Claims)Data: 135 employees

Programs: (breast, colon and skin)Weight management/PAScreening programs


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Average change in 1,322 EEs(2 or more screenings in past 5 years)

First Last ChangeChol >=240 135 128 2%

Non-HDL >= 160 346 306 1%

Borderline Chol 398 350 4%

Optimal Chol 789 844 4%

Stage 2 Hypertension

BP >=160/100

24 5 1%

Stage 1 Hypertension

BP 140-159/90-99

128 54 6%

Pre-Hypertension

BP 121-139/81-89

453 400 4%

Optimal BP< =120/80 717 863 11%


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Changes in Blood Pressures 2006-2009 (n=1,322)

0

0.1

0.2

0.3

0.4

0.5

0.6

0.7

Optimal BP

(

140-159/90-99

mmHG)

Stage 2 HTN

(>=160/100 mmHg)

Initial Screening Last Screening

11% increase in Optimal BP

4% reduction in Prehypertension

6% reduction in Stage 1 HTN

1.7% reduction in Stage 2 HTN


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Changes in Risk Levels 2006-2009 (n=1,322)

14%

28%

54%

4%

20%

32%

43%

5%

0%

10%

20%

30%

40%

50%

60%

Low Risk Moderate Risk High Risk Very High Risk

Initial Screening Last Screening


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Berkshire Medical Center

Wellness Leadership Team

Participation and Engagement Leads

to Positive Outcomes!


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Referrals Into the SystemBHS delivers excellent health programs and services to our community. OurBHS referral network is utilized to help support our employees and their

families achieve optimal health and wellness.

EAP

Mammography Colonoscopy

Tobacco

Treatment

PCPDiabetesEducation

Lab

CardiacRehab Nutrition

BPReferrals

2009

Referrals

38 42

57

358

84

2191

166

39

156


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BHS Cardiovascular HealthRisk Reduction Program

Independent analysis

Conducted by LifestyleResearch Group & BrighamYoung University

502 BHS employees,participants inwellness screening process2006-2007

Research question: Did healthrisk improvements occurbetween an initial nursewellness screening encounter

and a follow up screening?


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Aldana Summary (2009)

The Berkshire cardiovascular risk reduction program works:

96% of employees improved at least one risk factorFor entire population significant decrease in total and non-HDLcholesterol

High risk patients decreased risk most dramatically (the goal of theprogram) including:

Systolic BP (149 to 133) (P


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Marketing and Communication

Employee Portal

SCOPE Newsletter

Bulletin Boards

Home Mailings

Emails

Program visibility

and exposure

Personal Touch


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BHS Health Cost Trends compared to

Milliman Medical Index

7.7% 7.4%

17.3%

16.2%

3.3%

8.4%

0.00%

5.00%

10.00%

15.00%

20.00%

2007 2008 2009

Milliman Index

BHS

Health Cost Savings


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Employee PMPM Wellness Standard Wellness vs. Standard

Medical PMPMDrug PMPM

Total PMPMPMPM Net Claims

>$30,000

$450.70$98.88$548.58$432.63

$517.65$109.90$627.55$455.35

-14.9%-12.3%-14.4%-5.3%

% of EE >Age 45 56.7% 60.1% -6%

Inpatient Admissions/1000Average Cost Per Admission

69.8$11,512

90.8$14,921

-30%-29.6%

Average Paid Per EmployeeClaimant

Wellness Standard Wellness vs. Standard

Osteoarthritis (non-spine)Musculoskeletal (spinalconditions)Obesity and lipid disordersGastrointestinal

$16,017$6,593$7,286$8,622

$35,376$9,478$8,968$8,968

-120.9%-43.8%+11%-4%

Increase in EmployeesUsing Prevention RX

Wellness Standard

AntihyperlipidemicsAnti-hypertensivesBeta Blockers

+36%+24%+36%

+11%+2.5%-8.4%

Berkshire Health Systems 2009HealthCareCostSavings


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Berkshire Health Systems 2009 Health Care Cost Savings

Health Cost Trend Differential $2,135,268Differential of BHS cost vs. national average (Milliman Index)IF BHS incurred same rate as benchmark (7.4% vs. actual 3.3%) =would result in another 2.1 million spentBHS cost with 3.3% increase $29,793,267, Milliman 2009 cost increase of 7.4% - $31,928,535BHS cost differential 31,928,535 29,793,267 = $2,135,268

Shift in Multiple Health Risk PrevalenceShift in number of employees with 0-1, 2-3, 4+ risk factors $35,000*0-1 Risk factors =average cost $1,3892-3 risk factors =average cost $1,7304+risk factors =$2,701Savings estimated due to severity of risk factors used (i.e. smoke, stage 1 & 2 HTN, cholesterol >240 and BMI >30)and exclusion of costs related to lifestyle-related factors(American J ournal of Health Promotion, 15(5) 2001.

Weight Reduction (60 employees) $84,000(Criteria moving fromBMI of >30 to 1cm in 67 employees/spouses10-15% of adenomas >1cm progress to Colon Cancer

Expected Cost of Medical Services related to colon cancer survivor (initial treatment x average yearly cost) $141, 000(Emedicine via WebMD, December 2009)

Total cost avoidance $2,664,070Total cost of program 2009 (cost of related services and salaries) $692,000

Program Return on Investment 3.84 to 1


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Total Health ManagementOpportunities for Engagement

Injury Management

Drug Free Worksite Program

X-ray and physical therapy services

Ergonomics, vision/hearing testing

Pulmonary function and computerizedrespiratory fit testing

Pre-employment physicals

Comprehensive vaccination program

Environmental exposure lab testing

Electronic HRAs

Wellness Screenings (Risk ID)

Personal Health Coaching

Nutrition Consultations

Lifestyle programming:nutrition, physical activity stressmanagement, etc.

Employee Assistance Program

BHS Wellness

Program Components

Traditional

OccHealth Services


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Berkshire Medical CenterWellness Leadership Team

Vid00963.wmv


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Never doubt that a smallgroup of thoughtful,committed people can

change the world.

Indeed, its the onlything that ever has.

Margaret Mead

Occupational Healthand Wellness