PARTNERS FOR HEALTH How Iowa Businesses, Health Care Providers and Employees are Collaborating to Create Value

November 2015

PARTNERS FOR HEALTH

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Introduction More than ever, providing health care is a costly and complex proposition that has a vast impact on Iowa’s economy and the businesses that support it. Health care providers are seeking to move beyond reactive, episodic and expensive “sick care” to more proactive approaches that create health through prevention, wellness, care coordination and population health. These approaches hold the promise of generating greater value in the health care system, but they also require ongoing and productive relationships between providers and patients. A crucial link for sustaining those relationships – and for cultivating value – are the businesses that cover employee health care. As the shift from cost to value moves forward in the health care system, health care resources and innovation must be focused on ways that promote better outcomes and emphasize prevention. At the same time, businesses must align incentives for those who provide care, those who consume it and those who sponsor it to make everyone more accountable for improving value. Through investment, innovation and collaboration, Iowa businesses, including Iowa hospitals and health systems, have found ways to drive greater value and better outcomes in the health care they cover for employees. As a resource for both businesses and health care providers, the Iowa Business Council and the Iowa Hospital Association have collaborated on this report to offer case studies from all over Iowa that the public and private sectors can replicate, helping Iowa to remain a national leader in delivering high-quality, affordable health care. We hope you find this information useful and perhaps even inspiring as you consider opportunities to improve the health of your employees and your communities.

Marie Knedler Board Chair, Iowa Hospital Association President, CHI Health Mercy Council Bluffs

Michael C. Wells Board Chair, Iowa Business Council President and CEO, Wells Enterprises

PARTNERS FOR HEALTH

Employee wellness positively impacts the lives of Alliant Energy employees and their families. It also helps manage health care costs and enhances our ability to serve our customers. We help employees by offering robust and competitive benefit programs focused on wellness, medical coverage, time away from work and financial well-being.

Engaging and personalized wellness: Our wellness program, Power Your Health, focuses on employee engagement, wellness activities and healthy outcomes. Our program includes on-site biometric screenings, health risk assessments, lifestyle management, chronic disease-management coaching and a fitness program using company-provided activity trackers. Employees and their covered spouses/domestic partners earn cash and premium-reduction incentives by completing health and wellness activities. These efforts received recognition from the American Heart Association, the Iowa Healthiest State Initiative and others. Activating employee health care decision-making: Our comprehensive Consumer-Driven Health Plan is coupled with a Health Reimbursement Account to allow employees more control over their health care spending. This helps manage costs by giving our employees the resources to be better health care consumers. Additionally, we are working toward offering consumer advocacy tools and resources to help members better understand and manage their health care expenses. Taking time for life beyond work: Alliant Energy supports our employees’ needs for more flexibility to pursue time with family and personal interests. Recently updated time away from work benefits help to provide this flexibility, as well as improve their ability to be refreshed and productive at work. Planning for a secure financial future: We believe financial wellness supports an employee’s overall well-being. To help them make informed decisions, we provide a retirement guidebook, online retirement planning tools and a Professional Retirement Management program through our 401(k) administrator. Employees who are actively engaged in healthy behaviors make a big impact on their own well-being as well as their expenses. We want to be a partner in their wellness journey – to help them achieve what matters most. Contact: Alissa Spencer, Communications Program Manager, AlissaSpencer@alliantenergy.com, 608-458-4802

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Buena Vista Regional Medical Center (BVRMC) in Storm Lake strives to improve the health of the people and the communities we serve, including our employees. We believe our real strength is the people who work at BVRMC and

we are committed to their well-being. Our culture encourages regular participation in programs that combine medical advice and wellness programs to encourage a healthy lifestyle. Healthy Lifestyle Program Program includes a wellness exam and blood sample. Data creates a personalized report to help

individuals proactively identify life-threatening risk factors which can lead to chronic illness.

Employees and spouses on BVRMC’s health insurance plan who participate can earn a monthly health insurance premium discount.

Program has been in place nearly 10 years, and has made positive modifications along the way. We

have up to 85 percent employee participation. Nearly 90 percent of participants are on BVRMC’s health insurance.

Fitness and Mentally Fit Environment The BVRMC Fitness & Health Center has a dedicated staff to support employee fitness goals.

Employee membership package is free of charge. Members have access to racquetball courts, weight and cardio equipment and fitness classes. Personal trainers consult with employees for no charge and set up fitness plans.

The Wellness for YOU! committee plans and implements various wellness activities throughout the year. Some activities include: Biggest Loser Challenge, pedometer program, nutritional wellness education, 5K prep to walk, jog or run, healthy lifestyle prep with monthly weigh-ins/body fat screenings.

Financial peace education helps employees learn how to budget and avoid financial debt. An employee assistance program provides up to five hours of counseling service per year for

assistance with personal problems. Contact: Coleen Imming, Marketing Specialist, imming.coleen@bvrmc.org, 712-213-8634

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Headquartered in Ankeny, Casey’s General Stores owns and operates more than 1,850 convenience stores in 14 Midwestern states. Our employees are the heart of our business, regularly providing a friendly smile and a warm conversation in the communities across our operations. For this reason, we know that the well-being of our employees is important to our business. As a Blue Zones Worksite and in conjunction with our Healthy Directions wellness program, our goal is to consistently provide education and engaging programs to support our employees and their families on their journey to good health.

• Casey’s senior leadership takes an active role in the company’s wellness initiatives by participating in events whenever possible. In addition, Casey’s CEO and president can often be found briskly walking the halls of our corporate campus during the early morning hours.

• Our health benefits are designed to support being tobacco free by providing coverage for

tobacco cessation prescription drugs while also offering reduced health premiums to employees who are tobacco-free.

• We know preventive exams look for disease early, usually when the condition is easier and less

costly to treat. For the last three years, we have utilized every mode of communication to emphasize the importance of preventive health and provided an incentive to members who complete their preventive exams.

• We offer a variety of health challenges each year and structure our program, including

communication and incentives, to encourage teamwork and ongoing engagement. A recent company-wide virtual race down the Mississippi was a success.

• Casey’s believes in giving back to our communities. As such, the company strongly supports

employee volunteerism in the communities in which they live, both during work hours and on their own personal time.

• A variety of additional tools are used to promote wellness through various communication channels

such as flyers in our stores, newsletters to the home, online resources, health fairs and an opportunity to join “Leadership Walks” to promote brisk walking during the workday.

Contact: Casey’s Human Resources, 515-965-6555, extension 4290

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HNI Corporation’s member-owner culture is founded upon a belief in shared responsibility and shared rewards. Members think like company owners, actively involved in managing and improving the business. This carries through to our health care strategy, which focuses on engaging members in two key ways: providing opportunities to reduce personal health risks and providing resources to drive health care consumerism. Our benefits department and leadership team continuously monitor and adapt health plan design and vendor relationships to support the strategy.

We focus our efforts in three key areas: Reducing personal health risks: We reduce the prevalence of disease through a variety of tactics.

• Ongoing communication introduces risk awareness • Onsite health screenings for members and spouses promotes early identification of disease • Health programs improve wellbeing through tobacco cessation, weight loss and physical activity • Premium incentives are tied to accountability for health • Worksite wellness teams build local engagement

Improving health care consumerism: We focus on health care cost and quality when providing member support.

• Ongoing communication educates members on the basics of consumerism • Transparency tools help members understand treatment options and find highly-rated care at

the right price Responsible health plan design and vendor partnerships: We aggressively manage plan design and build strong vendor partnerships.

• Consumer-driven health plans (including health savings accounts with company contributions) drive cost transparency

• Coalition opportunities maximize group purchasing solutions, data analytics and clinical oversight

• Dependent certification ensures coverage is only provided for eligible dependents Programs are driving desired results, most recently including 51 percent elimination of metabolic syndrome and 40 percent reduction of tobacco use in the targeted population, higher utilization of generic prescriptions than PBM Book of Business and higher-than-benchmark enrollment in our consumer-driven health plan. Our four-year running average cost-per-covered-life trends below national averages. Despite our competitive position, our commitment to constructive discontent – always striving to improve – drives us to continuously search for ways to better manage our health care spending and engage our members in improving their well-being. Contact: Kelly Livingston, Director of Benefits and Compensation, Livingstonk@hnicorp.com, 563-272-4878

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Jefferson County Health Center (JCHC) in Fairfield considers employees our greatest asset. Our employees have voted us two years in a row as a Top 100 Workplace in Iowa, which is a testimony to our values. Employee health and wellness is critical to our success. Our goal is to provide the tools

and opportunities to help our employees achieve optimal health and well-being. JCHC is a Certified Blue Zones Worksite, achieving a score of 108 out of 117 points (78 required). This enhances our culture of wellness by empowering our employees to live longer, healthier and happier lives. Our employee-designed building features a healthy healing environment, including natural lighting and elements of nature and a campus with many gardens and a soothing pond with a fountain. JCHC employee wellness initiatives include: • A comprehensive, free, annual health risk assessment with insurance reduction incentives; co-pays

for health care and wellness participation, pharmacy in-network discounts; free health and wellness coaching, wellness classes and monthly screenings.

• On-site exercise facilities for employees and families, including outdoor game equipment as well as reduced rates to employees and families for gym and pool memberships.

• Indoor/outdoor walking clubs. • Beautiful .9 mile campus loop trail featuring 12 fitness stations, all connecting to a 16-mile

community loop trail. • Annual subsidized participation in Live Healthy Iowa. • Staff who participate in JCHC’s WellCheck program are offered Fitbits for $50 with the option to

purchase a second Fitbit for their exercise buddy. Organization-wide “Fitbit Challenges” are available.

• Free massage or equivalent for each birthday. • Campus café with healthy choices and monitored healthy choices vending machines. • Vaccination program. • Free artist series tickets. Finally, JCHC has developed a Championship Culture People Team to foster a culture of excellence that values, engages and enables our organizational team and is made up of representatives from every department. JCHC values: • Transparent corporate communication • Fun in the workplace • Employee satisfaction • Employee safety • Staff achievement recognition Our corporate aggregate wellness score has improved every year. Employee wellness is one of our organization’s goals targeting annual corporate aggregate wellness score improvement. Contact: Jonean Parker, Vice President of Clinical Services, JParker@JeffersonCountyHealthCenter.org, 641-469-4313

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Mercy Health Network (MHN) exists for two fundamental purposes: the provision of health care services and the improvement of the health of the populations we serve. MHN and its 40 member hospitals, 150 physician clinics and other related organizations have understood for many

years that success in helping individuals and communities throughout the state of Iowa improve their health status requires a commitment to making a real difference and the ability to show results. Today, we are able to do just that. MHN’s health and wellness initiatives for employees have resulted in real improvements in their health. This has led, in turn, to a reduced use of health care services, such as declines in emergency visits of up to 21 percent in 2014, and to significant cost savings. Mercy’s expenditures for employees’ health care have increased at rates far below state averages. This has been accomplished through comprehensive programs and services. A few examples of those initiatives include: • Use of health coaches to provide one-on-one support to employees with chronic diseases or other

special needs. This innovation was pioneered in Iowa by Mercy Clinics in Des Moines and won the highest national award for quality.

• Easy on-line access to health and well-being information and resources to support a holistic

approach to health for mind, body and spirit. • The use of economic incentives to encourage participation in health status assessments and in

specific healthy activities. • Encouragement of employees, through their benefit design, to better coordinate their care through

the use of the clinically integrated network. Many of these same techniques, such as proactive management of chronic disease, health coaching and better coordinated care, have been used by the Mercy Accountable Care Organization (ACO) to achieve similar results for Medicare beneficiaries and other groups. The results have been equally dramatic. The Mercy ACO was the most successful in Iowa in lowering Medicare’s expenditures in the first 18 months. Medicare spent $9 million less on the people cared for by Mercy, than it spent on the same group in the previous similar time period. Now MHN is bringing these same programs and services to other employers across Iowa. Custom-designed programs are being developed for employers to help them achieve similar results. As MHN has taken its innovative approaches to health and wellness into the new areas of Medicare patients and employer groups, it has been a huge step forward in making the second part of our Mission – the improvement of the health of the populations we serve – a reality. Contact: Joe LeValley, Senior Vice President, JLeValley@mercydesmoines.org, 515-247-3121

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Montgomery County Memorial Hospital (MCMH) in Red Oak has made employee health a priority. We are using four different strategies and taking a holistic approach to our wellness program to change the culture at MCMH. We began a population health project in January 2015 in an effort to reduce chronic disease among our employees. Communication, access, price and point-of-decision strategies are helping employees make the healthy choice the easy choice. MCMH is implementing policy and environment changes to impact how our employees view and value health focusing on nutrition and physical activity. Nutrition changes include:

• Changing our dietary plan, which includes limiting deserts, removing our fountain soda machine and high-calorie snack options.

• Updated our hospital event request form to offer healthy choices for meetings and meals. • Adding daily calorie lists for all menu options offered. • Adding campaign flyers to increase water consumption and reduce high calorie beverage sales. • Sponsoring the Red Oak Farmers Market and holding an onsite market every other week to promote

fresh fruits and vegetables. Physical activity changes include: • Promoting walking through employee team challenges and movement campaigns. • “Stay Well in the Stairwell” campaign, including the stairwells in a designated walking path in the

hospital. • Adding a personal trainer and certified health coaches to MCMH staff to actively engage employees

in their health. • Updating the onsite fitness facility that is offered free to employees for use. In future phases, MCMH will be incorporating more nutrition labeling including carbohydrates, sodium and fat content and will begin replacing high calorie entrée options with lower calorie more nutritious options. We are also rebuilding our employee wellness incentive plan to actively engage our employee population in their health. We are moving forward and hope to see positive health outcomes for MCMH employees. Contact: David Abercrombie, Chief Executive Officer, davabe@mcmh.org, 712-623-7141

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Myrtue Medical Center (MMC) in Harlan fosters workplace wellness and is committed to investing in the health of its employees and community. Healthier behaviors are encouraged and supported, resulting in improved employee health, productivity, retention

and health care cost savings. MMC initiatives include: • Employee Wellness: MMC tracks and communicates aggregate well-being metrics and provide

employee outcome-based incentives. By completing a series of health-related actions which include blood analysis screenings, biometrics, confidential health risk assessments, exercise and prevention activities and participation in wellness-focused lunch-and-learn seminars, an employee can earn a $400 incentive. At the beginning of each year, each employee receives baseline test results. Based on their year-end assessment and participation in exercise and prevention activities, the employee may receive the full benefit amount. During 2015, participation in the employee wellness program increased from 62 to 73 percent.

• Blue Zones Project: Harlan is a certified Blue Zones Community and MMC is one of 10 worksites in Harlan that achieved designation as a Blue Zones Worksite. In that capacity, MMC has shown a commitment to the physical, mental and social well-being of its employees. Building on many current programs, the hospital enhanced its employee wellness program and implemented several health initiatives while satisfying Blue Zones Project requirements and recommendations.

• Community Wellness: Community wellness offers customized employee wellness programs to businesses in the community. MMC works closely with each business to assess their wellness needs and offer blood analysis screenings, health risk assessments, biometrics, flu shots and lunch-and-learn seminars. Our partnership with the Harlan Community Schools has also provided outstanding wellness opportunities for school employees.

• On-Site Fitness: The Petersen Family Wellness Center and Lewis Family Aquatic Complex is owned and operated by the hospital. Our employees receive a 50 percent discount on membership fees to support fitness and well-being.

• Ergonomics/Work Environment: MMC is committed to the physical well-being of employees and we continually work to improve ergonomics in our health care settings by holding ergonomic classes. The hospital’s occupational (OT) and physical therapists (PT) offer the WorkWell program to our facility and to local businesses. Currently, OT and PT staff are conducting a functional job analysis and developing functional job descriptions for areas in the hospital. In addition, OT and PT staff provide customized programs for businesses that focus on prevention, early intervention and return-to-work/other activity solutions. This can prevent injuries, lead to healthier employees and reduce expenses caused by work-related injuries.

Contact: Janelle Sorfonden, Marketing Specialist, Janelle.sorfonden@myrtuemedical.org, 712-755-4598

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At Pella, we believe a creative and productive workplace thrives in an environment where people are encouraged to do and be their best. Physical, emotional and social well-being are important aspects of such an environment. As a result, wellness has evolved into a strategic initiative that encourages healthy life-style choices through investments in education, fun and empowering activities and supportive benefits. Education is paramount to well-being and starts with the individual. All team members, spouses and retirees are encouraged to “know their numbers” by participating in free health screenings annually. It takes a sizable – yet strategic – investment to ensure 100 percent of team members, the majority of which work in our manufacturing facilities, have

the opportunity to participate on paid time. Eleven consecutive years offering free health screenings with a 99 percent participation rate for insured team members is strongly linked to a reduction in Pella’s health care cost trend. An empowerment initiative encourages individuals to take charge of their personal well-being and health. The path to maintaining or improving one’s well-being isn’t one-size-fits-all. Monthly “I-Decide” campaigns empower team members to personalize solutions through education, activities and a top-of-mind communication philosophy. Testimonials of triumph provide inspiration for others. Additionally, annual wellness fairs or “Invest in Yourself” days provide access to experts and vendors who offer a wide range of wellness related products and services. Participation is high, as manufacturing lines are shut down, enabling 100 percent of team members to attend on paid work time. Support through preventative efforts and access to quality care completes Pella’s holistic approach to well-being. In addition to competitive and comprehensive medical and dental options, mental health is supported through a counseling program that provides 24/7 availability at no cost. A smoking cessation program reimburses the cost of cessation aids and reinforces a smoke-free campus. Measurement is key for sustainable success. Progress is assessed regularly against goals and data helps drive the direction of Pella’s wellness strategy in realizing our vision: Provide opportunities for team members and their families to maintain or improve their best possible well-being to manage benefit costs below the national trend for both Pella and team members. Contact: Karin Peterson, Vice President Human Resources, KAPeterson@Pella.com, 641-621-6007

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Employees are our greatest asset, so their well-being is critical. We use extensive data to identify targeted interventions, encourage informed use of health care services and create a culture of wellness. Meaningful incentives drive participation: • Annual health screenings: Employees/spouses/domestic partners complete a health screening to save $520 per person in medical

plan contributions. Ninety percent of employees enrolled in our medical plan participate. • Healthy pregnancy program: Pregnancy and childbirth represent a significant cost for us.

Participation in our healthy pregnancy program offers a $600 incentive. • Centers of excellence: We provide travel and lodging expenses for employees who work with

centers of excellence for transplants and bariatric services. These centers have demonstrated good outcomes and lower costs.

Transparency is key: • Plan design: Employees choose a traditional PPO plan or an account-based health plan

(ABHP)/health savings account. As we’ve focused more on health care consumerism, ABHP enrollment has nearly doubled.

• Onsite pharmacy: Onsite pharmacy staff educates employees on lower-cost alternatives and the importance of drug therapy compliance.

• Telemedicine: Employees and their dependents can consult with a network physician via video or phone for routine medical conditions. Online visits are significantly less expensive (for the employee and the company) than emergency room or urgent care visits.

Creating a wellness culture: • Year-round wellness: We kicked off 2015 with a Live Healthy Principal 10-week wellness challenge

followed by our mid-year health screening program. Then for the fourth consecutive year, Chairman Larry Zimpleman challenged employees/spouses/domestic partners to train for and participate in a road race. He leads training runs and blogs about his experience. Over the years, thousands have participated!

• Environment: The current full-scale remodel of our corporate campus incorporates well-being with

open staircases, more access to natural light, sit/stand desks and more. Outcomes As a result, our health care plans have outperformed national and industry metrics. Currently, 80 percent of our employee population is considered low risk (just 0–2 risk factors), a best-in-class result. We’ve diverted an estimated $10.1 million in health-related expenses since 2010. Contact: Polly Heinen, Assistant Director of Benefits, Heinen.Polly@principal.com, 515-235-1230

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For the last 16 years, Genesis Health System and UnityPoint Health-Trinity have partnered to improve the health of the Quad Cities community through sponsorship of the Quad City Health Initiative (QCHI). QCHI was developed after a series of conversations between health system trustees and community leaders determined that a multi-sector collaborative could best create the foundation for sustainable community health improvement. QCHI’s mission “to create a healthy community” is rooted in a model of action that acknowledges the social determinants of health and the interrelationships between health status, health behaviors, access to care, education, employment, income, safety and the physical environment. With the financial support of the founding health systems and other

community partners, QCHI has become a planning and communications infrastructure that harnesses the collective work of about 140 team members and 70 organizations and reaches thousands of community members living in the cities of Davenport and Bettendorf in Iowa and Rock Island, East Moline and Moline in Illinois. A critical success factor for our work together has been creating a partnership governance model that supports regional collaboration. QCHI is governed by a 25-member community board that includes the CEOs of both Genesis Health System and UnityPoint Health-Trinity. The composition of this leadership group has been shaped by three primary considerations: • Geographic inclusiveness: QCHI strives to maintain a balance of representatives from organizations

located in each state while rotating representatives from our cities. • Multi-sector representation: QCHI includes representation from the business, health care,

education, public health, government, community and philanthropic sectors. • Individual diversity: QCHI has sought to achieve diversity in content knowledge, gender, age and

race/ethnicity. The QCHI partnership has created a solid foundation of leadership for community health improvement across geographic and organizational borders. Notably, the partnership has facilitated joint community health assessment processes since 2002, thus providing a common understanding of current health status indicators. Working together has clearly enhanced our ability to implement health improvement projects, policies and systems changes at a regional level. Contact: Nicole Carkner, QCHI Executive Director, carknern@genesishealth.com, 563-421-2815

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In Manchester, Regional Medical Center’s employee wellness program, titled “For the Health of It”, consists of three focus groups to encourage healthy choices in all aspects of wellness: fitness, nutrition and mental

health. For the Health of It consists of three target areas: Move More, Eat Smart and Manage Stress. Move More provides tools to help employees be physically active:

• Free personal training and wellness coaching. • Reduced cost body composition testing and counseling. • Why Weight, Take the Stairs promotion through signage to encourage using the stairs. • Group activities and challenges.

Eat Smart helps employees eat better through promotion of healthy food choices:

• Healthy entrées and desserts featured and provided in the employee dining room. • Vending machines updated and color coded with healthy options. • Rethink Your Drink campaign to encourage water consumption. • Education of the My Plate guidelines to create awareness on correct serving sizes. • Lunch and learns regarding nutrition topics.

Manage Stress promotes the mental well-being of employees and helps to educate about the signs and symptoms of stress:

• Promotion of volunteerism by educating employees on volunteer opportunities. • Provide reminders to take a mental break via overhead chimes. • Themed mid-winter treat day consisting of healthy snacks, decorated breakrooms and business

cards with relaxation techniques. • Lunch and learns regarding stress management and relaxation techniques.

Employees are also educated on all three target areas through a quarterly For the Health of It newsletter. Contact: Julie Woods, Human Resources Assistant, Julie.woods@regmedctr.org, 563-927-7764

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Rockwell Collins has recently shifted its health care focus to create a consumerism mindset among its employees. In 2014, we moved the majority of our population to consumer-driven health plans (CDHPs). This has been a huge transition for many of our members. Over the

previous two years, we had been educating our employees to help them leverage their health care buying power and we’ve made it a priority to provide them with the tools and resources they need to be better consumers. Mercy Telehealth Clinic at Rockwell Collins: Know where to go In April 2015, Rockwell Collins partnered with Mercy Medical Center in Cedar Rapids to open an onsite telemedicine clinic. The new telehealth clinic, located on the Rockwell Collins main campus, offers employees and dependents (over the age of five) who utilize certain health plans a convenient location to be seen by a medical provider via audio-visual telehealth technology for personal illness. The cost of these visits is lower than an average family practice visit by anywhere from $30-$50. The lower cost visit and less time away from work and family helps facilitate the consumer mindset. Castlight: It pays to shop around Early last year Rockwell Collins began providing Castlight to all employees who are covered under one of the CDHP options. This free-to-employees tool provides pricing for specific medical procedures and quality ratings on doctors and medical facilities so they can make informed decisions before a visit is scheduled. The information provided is personalized for individuals based on location, benefits and health care needs. Health Savings Accounts: Taking advantage of triple-tax-savings The vast majority of Rockwell Collins employees covered under our medical plans have opened and are actively contributing, tax-free, to health savings accounts (HSAs). They are then able to use these accounts to pay for their expenses as they occur. Employees like the “yours to keep” feature of the accounts and through several educational opportunities, have become quite adept at utilizing all of the advantages HSAs have to offer. These tools and workshops are just steps on the path to achieving an informed workforce. Health care costs continue to rise, but creating a savvy, consumer mindset among our population is helping to keep our health care costs per person much lower than national averages. Contact: Marcy Dent, Senior Manager, Benefits Strategy, marcy.dent@rockwellcollins.com, 319-263-4693

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As an employer and a provider of health care, it is UnityPoint Health – St. Luke’s Hospital’s goal to promote a culture of health and wellness for our associates and their families. Our wellness program began

taking shape in 2007 and continues to evolve today. See below for a summary from our recent annual report: Participation

• Annual health screening participation has increased to 95 percent of the total eligible population.

• By participating, associates are eligible to receive a wellness premium credit and other great benefits.

Engagement

• More than 75 percent of the total St. Luke’s population engages in wellness initiatives at least once a quarter.

• Initiatives range from self-managed online tools to one-on-one coaching sessions targeted to meet the participant’s clinical and lifestyle goals.

• Participants are empowered to reach goals through a network of 75 Wellness Champions. Outcomes (2013-2014 program year)

• Average paid medical and prescription claims per covered associate decreased by 29 percent. • 53 percent of participants in the high-risk Health coaching program improved to a lower risk. • 61 percent of metabolic syndrome participants improved to a non-metabolic syndrome status.

Culture Using resources from the Iowa Healthiest State Initiative, The Blue Zones Project, WELCOA and a strategic wellness partner, St. Luke’s has earned the following recognitions as we strive to support a culture of wellness:

• Designated Blue Zones Project Worksite – 2013 • Best Wellness Program in the Corridor for organizations with 750+ employees – 2012 & 2014

As one of two major hospitals located in Cedar Rapids, St. Luke’s understands the competitive advantage healthy associates provides over competitors. We provide services and support to our associates and their families to help them live up to our mission statement: “To give the health care we'd like our loved ones to receive,” because we can’t achieve this mission without a healthy, productive workforce. Contact: Mikki Scott, Senior Account Manager, mikkiscott@hsi-rx.com, 319-734-3625

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The University of Iowa (UI) supports employee health and well-being through a number of programs and initiatives offered through liveWELL. A few highlights on the value of UI investment in these programs: • Estimated annual cost savings and cost avoidance of up to $3 million due to decreased employee sick leave. • 95 percent of participants using the Health Coach Service report improvements in health and higher

satisfaction with the workplace. • The liveWELL initiative yields an annual return on investment of 2.37 (Study conducted by Truven

Health Analytics Inc.). Select examples of program offerings include: Wellness Grants: UI departments can request funding to implement a health and wellness-related initiative or event at the local level. Recreation Membership Incentive Program: Employees receive a 50 percent incentive toward campus recreation membership for participating annually in the personal health assessment, which measures individual health behaviors and trends and provides a tailored feedback report to participants, as well as attending a campus recreation facility at least four times per month. Membership includes access to five fitness facilities, three indoor tracks, two swimming pools and more than 70 weekly fitness classes. Health Coach Service: This service provides one-on-one support for employees to build new skills in meeting their personal health goals. Annual UI Health Fair: The UI Health Fair for faculty and staff provides an excellent opportunity for employees to learn about new health and wellness opportunities at the university. Faculty and staff can also take advantage of free health screenings and receive their free flu vaccination as part of the event.

Urgent and Preventive Care: All faculty and staff have free access to UI QuickCare, a walk-in medical clinic with six convenient locations in Iowa City, Coralville and North Liberty and UI Health Care provides free flu shots annually to all employees. UI also supports the Iowa Healthiest State Initiative, including: Iowa City Blue Zones Project: UI achieved designation as a Blue Zones Worksite in February 2015 and supports the Iowa City Blue Zones Project through membership on the project advisory board, membership on a number of work committees, engagement of faculty and staff in the project and volunteer efforts in support of project initiatives. Live Healthy Iowa 10 Week Wellness Challenge: UI regularly participates in this annual physical activity, healthy eating and weight loss program and most recently recorded the largest number of employee participants (1,076) in the state. Contact: Joan M. Troester, Interim Assistant Vice President of Benefits, Health and Productivity, joni-troester@uiowa.edu, 319-335-2692

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The University of Northern Iowa’s (UNI) 2,000+ faculty and staff are the foundation of our campus community. UNI employee well-being is essential to supporting a healthy campus culture and ultimately the success of our students and university. In the last two years the university has been designated as a Blue Zones worksite. In 2014, UNI was chosen for the Healthy Iowa Award

university category by the Iowa Department of Public and the Iowa Healthiest State Initiative. These honors substantiate the University’s investment toward a healthy campus and further highlight our commitment to a culture of well-being. This can also be demonstrated through the following programs and services: Biometric Health Screening: Biometric screenings are offered four times per year on campus along with the option of additional screenings or a walk-in health screening at a local provider for a small fee. Ergonomic Workstations: Ergonomic analyses are offered to employees through the University Safety Manager. In addition, the University offers the choice of standing or sitting through flexibility in workstation furniture upon request. Well-being Challenges: UNI encourages and supports Live Healthy Iowa Challenges by providing incentives, email resources, and regular communication to participants. Participation is encouraged in community and state initiatives, such as Bike-to-Work-Week and the Healthiest State Walk. Tools and Resources: UNI provides both a Fitbit check-out program and well-being book collection, available for check-out through the campus library. Annual Benefits and Well-being Fair: UNI hosts an annual well-being fair with university benefit vendors, on-campus well-being providers and community well-being vendors. Employee Well-being Committee: This employee-led committee’s mission is to enhance the health and well-being of UNI faculty and staff through holistic programs and initiatives that support a healthy lifestyle and create a healthy environment in which to live and work. The committee meets monthly during the academic year with the UNI Health and Safety Committee. Local Food Box Program: This employee option is provided through collaboration with the Buy Fresh, Buy Local program. Each week the food box has different locally-grown produce and options with or without dairy and/or meat. Well-being Champion: Employee Well-being maintains a monthly champion on our website to recognize employees who contribute to and support the promotion of well-being among faculty and staff. On-Site Wellness Facilities and Recreation: UNI Wellness and Recreation Services offers three on-site wellness facilities, various recreation services, as well as fitness leisure, and personal training sessions available to all faculty and staff. Contact: Therese Callaghan, Employee Health & Well-being Coordinator, therese.callaghan@uni.edu, 319-273-2422

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PARTNERS FOR HEALTH

Under our 4P Philosophy, which values Biblical principles, people, product and profit, Vermeer team members are an integral part of the business and their personal well-being is critical. Our health and well-being programs focus on the whole health of the individual, not just the physical well-being, allowing our team members to truly live well. Vermeer self-funded benefits aim to keep team members healthy and happy. These benefits include health insurance, life insurance, dental care, medical leave and some voluntary benefits such as vision care and legal services. As we’ve focused more on consumerism in health

care, enrollment in the high deductible health plan has grown by 28 percent. At the same time, per-member, per-month claim costs have also trended below the national average since 2012.

Vermeer also provides Pella-based team members and their family health care services at work. An onsite clinic provides medical care at little cost to team members. Being onsite, the clinic helps take care of their health promptly and efficiently, allowing them to be more productive. The onsite clinic averages more than 6,000 episodic care appointments each year.

The Vermeer Family Pharmacy is also available to team members within the onsite health clinic. It offers team members generic, name brand and over-the-counter medications at lower-than-retail pricing. The pharmacy is utilized by 80 percent of our team members and has a 90 percent generic dispensing rate. Since 2012, the pharmacy has provided an average savings of $1.9 million per year over retail pharmacies.

To encourage team members to take care of their whole-person well-being, we sponsor annual, voluntary health screenings and personal online health assessments. Onsite health and well-being coaches use the screening and assessment results to work one-on-one with team members who request it, helping set personal goals and encouraging use of our health care services and make wellness part of our internal culture. Team members and their spouses also participate in voluntary incentive-based health and well-being programs like wellness classes, 5Ks and cooking classes, for which they receive a health and well-being credit. The screenings, health assessment and wellness activities had a 60 percent participation rate in 2014. In 2014, there was a 21.6 percent improvement in glucose levels and an 11.8 percent improvement in optimal HDL cholesterol levels. The percentage of people in both the low-health-risk and moderate-health-risk categories have increased and team members in the high-risk and active disease groups have stabilized and are actively working with onsite health and well-being coaches to improve their overall wellness. Contact: Bob Smith, Vice President and General Counsel, bsmith@vermeer.com, 641-621-7727

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PARTNERS FOR HEALTH

At Waverly Health Center, each employee is valued for the unique perspectives they bring to work. Our values come alive with the mix of skills and passion from our employees.

Likewise with our wellness program, we understand that no two employees are alike. Our wellness program is designed to allow each employee’s nature to come through resulting in individualized growth. The culture we live in enables unhealthy lifestyles. To help our employees find success, we encourage activities in the following three areas. • Behavior: Employees assess their baseline to find areas of behavioral improvement. An individually

tailored online tracking program, health risk assessments, health screen and employee needs and interest surveys help employees find their baseline. Employees are encouraged to make little changes to improve their wellness. They can receive free wellness coaching to improve health behaviors.

• Environment: Employees focus on things that allow healthy decisions to become easier if not automatic. Bright, colorful environments with live plants, spa services, exercise equipment, easily accessible healthy food options and walking paths all add to creating an environment of health.

• Social: Employees surround themselves with people who will help them reach their goals. Interest

and social groups provide mental stimulation, reduce stress and create a sense of belonging that strengthens mental health. Sponsoring and promoting community events allows our employees the opportunity to connect with our neighbors.

Outcomes Prior to implementing an employee wellness program in 2011, Waverly Health Center’s loss ratio for health care was 120 percent. After almost four years of programming, we have reduced that number to 66 percent and it has held for two years. We were rewarded with a 0 percent increase to our fully insured health insurance plan for 2015. Moving Forward Just as our health care is ever changing, so is our wellness program. Regular assessment of the program ensures it meets the needs of our employees. We empower our employees to be smart health care consumers. Through contributions to employee health savings accounts, promotion of high-deductible health plans, encouraging employees to use onsite medical care, utilization of generic prescriptions, various clinic visit options and preventative health care, our employees have accepted the challenge to reduce health care spending. Contact: Brian Pins, Community Health Specialist, BPins@WaverlyHealthCenter.org, 319-483-1361

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PARTNERS FOR HEALTH

Wells Enterprises, Inc. is the largest privately held, family-owned ice cream and frozen treat manufacturer in the United States and our people are our most important asset. The Total Rewards strategy was built with this guiding principal in mind. The expected outcome: Healthier employees and families which have been provided choices enabling them to make decisions on how to invest their time and money in

regards to their future well-being and retirement. Based on the expected outcome, we developed four key strategies:

Engage Participants: Educate employees on their total reward for working at Wells which includes the total cost of benefits, the employee and employer portion, by providing each employee Total Rewards statements annually.

Design with intent: Provide employees choices of how to “spend” their total rewards by offering multiple plan options. A low premium/high deductible PPO and a high premium/low deductible PPO.

Reduce unnecessary expenses: Recognize that health care happens between a patient and a provider. Emphasize those interactions to drive out costs while improving employee health and Participate in the Wellmark’s Accountable Care Organization pilot. Improve health and performance: • Identify, intervene and then measure the progress of those most in need of treatment and

intervention, while focusing on maintaining health and reducing risk factors. • Provide a wellness program that focuses on the physical, financial and emotional/community

wellness of our employees and their families. • In 2015, employees will complete biometric screening, personal health assessments and activity

points. Spouses will complete biometric screenings and personal health assessments.

Wells has been in business for 102 years and is proud to be positively affecting 15 local communities with the outcomes from the Total Rewards Strategy: • Recipient of the 2015 World of Work Seal of Distinction for Work/Life.

• In 2014, 92 percent of production employees and 81 percent of professional employees completed

biometric screening and a personal health assessment.

• Year over year cost projections have been cut in half since our benefit strategy started while preventive screenings and exams have increased.

• Adherence to prescribed treatments including pharmaceuticals have increased and in-network usage is up to 98.5 percent.

Contact: Jeff Stanley, Chief Human Resources and Administrative Officer, jstanley@bluebunny.com, 712-548-5548

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