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Agenda:
Why Wellness?
Why is behavior change so hard?
Wellness Solution
Engagement Solution
Case Studies
Agenda:
Why Wellness?
Why is behavior change so hard?
Wellness Solution
Engagement Solution
Case Studies
Why do employers want to change employee behavior?
Universal client challenges Rising healthcare costs
Employees unengaged in
managing their health
Employees lack
knowledge of benefits
Client Challenge: Rising healthcare costs
• Employers are struggling with the impact of the rising cost of healthcare.
Client challenge: low engagement
Lack of employee engagement
Lack of sufficient financial incentives to encourage participation in programs
Lack of adequate budget to support effective health management programs
Too many other demands on employees
Not enough time on the part of employees
Poor or inadequate communication of health management programs
Source: Towers Watson
Population
Medical
Costs
Healthy Worried
Well
Chronically
Ill Multi-Chronic
Acute /
Catastrophic
End of
Life
70% 20% 5% 4% 1
13% 22% 14% 28% 23%
87%
Health
Condition
30%
What problems are employers facing?
Why focus on Wellness?
Dee Edington: “Keep people from getting worse”
Population
Healthy Worried
Well
Chronically
Ill Multi-Chronic
Acute /
Catastrophic
End of
Life
70% 20% 5% 4% 1
Health
Condition
30%
What problems are employers facing?
Onsite Fitness
Wellness (Comprehensive)
Condition Mgmt
Onsite Clinics
Case Mgmt
HRA to Nowhere
Health Fairs
Flu Shots
Continuously Driving Engagement
Program Integration
Medical & pharmacy costs
Just the tip of the iceberg
22%
18%
60%
Source: Edington, Burton: A Practical Approach to Occupational
and Environmental Medicine (McCunney). 140-152/2003
Question:
– What percent of our health is impacted by Genetics alone?
Employers can impact 80% of the “influencers of health”
Source: Centers for Diseases Control and Prevention, University of California at San Francisco, Institute for the Future. Reprinted from Advances, Robert Wood Johnson Quarterly Newsletter, 2000; 1:1
Influencers of Health
Access to Care
Environment Genetics Health Behaviors
Health Behaviors
U.S. Healthcare Expenditures 88%
Other Access to Care (treatment)
4% 8%
10% 20% 20% 50%
22
Employer Impacts
12
Employer-based wellness works! ROI studies of wellness programs:
• Bank of America • Blue Shield of CA • Duke University • Citibank • City of Birmingham • Coors • DuPont • General Foods • General Motors • GlaxoSmithKline • Indiana BCBS • Johnson & Johnson • Life Assurance • Nortel • Prudential • Travelers • Union Pacific • Washoe County
Source: Chapman, L., Proof Positive: An Analysis of the Cost-Effectiveness of Worksite Wellness, Chapman Institute, Seventh Edition, 2011.
Traditional
Newer Programs
Outliers C
/B R
ati
o
Study Number
C/B = 1:5.8
© Chapman Institute. All rights reserved.
Agenda:
Why Wellness?
Why is behavior change so hard?
Wellness Solution
Engagement Solution
Case Studies
Why is behavior change so hard?
Behavioral economics: the study of
predictably irrational decision making
2002 Nobel prize in economics is awarded to Daniel Kahneman for “integrating insights from psychological research into economic science”
What do you get when you cross a psychologist with an economist?
An internal “battle” can influence our choices in seemingly illogical ways….
Behavioral Economics
Anchoring
Framing
Gamblers Fallacy
Group Think
Loss Aversion
Hyperbolic Discounting
“Fairness”
This is due to different regions of the brain having different purposes…
Reward Circuitry – Medial Forebrain Bundle often referred to as the “Hedonic Highway”
“Executive Function” Or Reflective Cognitive
“Emotional Function” Or Automatic Cognitive
Two cognitive systems
Automatic system: • Uncontrolled • Effortless • Associative • Fast • Unconscious • Skilled
Reflective system: • Controlled • Effortful • Deductive • Slow • Self-aware • Rule-following
One approach: rider vs. elephant
Three steps to bring change
1.Direct the rider
2.Motivate the elephant
3.Shape the path
We like to think we are rational…. but sometimes we are not…
Isn’t it obvious from these drawings why you should always buckle up?
Maybe if we explained it to you…. Physics-based appeal from an engineer:
During collisions, a car is able to stop in a fraction of a second, whereas the speed at which the passengers are moving remains unchanged until they are stopped by impact with the steering wheel, seat in front of them or the windshield. In the case of a car traveling at 30 miles per hour, this type of impact is equivalent to the impact the passenger would feel if he fell three stories. Seat belts help to distribute the collision forces across the passenger's pelvis and chest--areas that most effectively withstand collision forces.
Or reminded you
Or ???
We can influence the elephant’s behavior by choosing our future
path and goals…
So why won’t we do it?
I’m always in charge.
Sure you are. Except when I
decide otherwise.
Answer: We systematically over-project the rider’s future control of immediate decisions.
When choosing between a healthy and unhealthy snack for delivery in one week, do people correctly predict future desires?
Does the future me want different things?
← next week→ predicted preference
← right now→ actual preference
D. Read (Leeds U.) & B. van Leeuwen (Leeds U.), 1998, Predicting hunger: The effects of appetite and delay on choice. Organizational behavior and human decision processes, 76, 189-205.
26% chose the unhealthy snack for delivery in one week right after lunch.
Does the future me want different things?
D. Read (Leeds U.) & B. van Leeuwen (Leeds U.), 1998, Predicting hunger: The effects of appetite and delay on choice. Organizational behavior and human decision processes, 76, 189-205.
26% 74% ← next week→
predicted preference
One week later, when allowed to change their choice at the delivery, 70% chose the unhealthy snack for immediate consumption
Does the future me want different things?
D. Read (Leeds U.) & B. van Leeuwen (Leeds U.), 1998, Predicting hunger: The effects of appetite and delay on choice. Organizational behavior and human decision processes, 76, 189-205.
26% 74%
30% 70%
← next week→ predicted preference
← right now→ actual preference
• Power of Framing - Which would you rather hear from your doctor? “10% of people die from this
procedure” or
“90% of people are cured
following this procedure”
We do not make perfect choices….
Incentives:
Q: Can’t we just pay people to make good
decisions? A: You get what you pay
for… and pay… and pay…
Incentives can effectively drive activity, but not engagement…
Example: carrot vs. stick
Challenge: Incentives appeal to rider, not the elephant…
Engagement: Wouldn’t it be better if people took control of their health for the right reasons?
eHealth Platform Incentive Examples Incentive Reward Tracking Icons
Can we get more people to choose the stairs by making it fun to do?
Agenda:
Why Wellness?
Why is behavior change so hard?
Wellness Solution
Engagement Solution
Case Studies
Typical Employer Wellness Solutions
Participant Experience: Provide a “path” to identify & address their risks
Health Advising Personal
Wellness Plan
Condition Management
ENGAGE: Web Portal, Communication of Programs, Health Advocacy, Incentive Administration
Participant Experience: Overarching Framework
ASSESS ADVISE
Lifestyle Management: EMPOWERED Coaching
TAKE ACTION
Complementary Programs and Allied Programs
eHealth (web portal) Resources and Tools:
Personalized Online Programs Wellness Challenges
Biometric Screening Scheduling Worksite Non-worksite alternatives
Health Assessment Online Print option
Client Third-party Resources
Claims Data Medical Pharmacy
Various Approaches: Seek Balance and a fit for your culture • Carrot vs. Stick
• High-tech vs. High-touch
• Emphasis on incentives vs. Behavior change programs
• Focused on top issues vs. wide breadth of programs
INSIGHT® HRA
• 15 to 25 minutes to complete
• 6th- to 8th-grade reading level
• Biometrics uploaded into HRA
• Lifestyle questions, stages of change methodology, optional productivity (WLQ) and psychosocial
• 22 customizable questions
• Immediate tailored report and recommended programming based on results
• “Electronic bonding” pushes relevant content
• Aggregate reporting and sub-reporting
• Paper solution integrates with eHealth platform
• Integrated with wellness program
Biometric Screening Solutions Worksite and Remote
Scope:
• On-site delivery
• Alternative means screening processes (e.g., lab, PCP—fax/mail form)
Benefits: CLIENT and Participants
• Dedicated leadership team
– Onsite program manager
– Screening coordinator
– Onsite event leader
• Same-day results and personalized advising
• Online and telephonic scheduling
• Automated data upload to HRA
• Participant options (onsite and remote)
• Integrated with health management services
• Experience: 2011 conducted 2,500 events and 175,000 screened
99% satisfaction
eHealth Platform Web Portal
Participant Benefits
• Personalized and 24/7 access
• Real-time updates via coordinator
• Online coaching (Personalized Lifestyle Programs)
• Real-time incentive update
• Wellness challenges
• Mobile device access
• Tools and resources (plus scheduler)
CLIENT Benefits
• CLIENT-specific configurable
• Integrated — custom program pages
• SSO option
• Ongoing enhancements and innovations
Health Advising Personalized Wellness Planning
Participant Benefits
• In person or phone
• Personalized feedback
• Listening approach—trained health educator
• “MY” plan moving forward
• Recommendations based on stage of readiness/multiple factors
CLIENT Benefits
• Leverages teachable moment
• CLIENT specific — full inventory of your resources applied
• Program enrollment rates 2 to 4 times higher 92% Participant Satisfaction
EMPOWERED Coaching Lifestyle Management • Individual assigned coach model
• Behavior focused rather than risk-based
• Participant choice (onsite, telephonic, online)
• 13 focus areas (behaviors)
• Supports risk reduction including high blood pressure, weight management, high cholesterol, overweight/obesity, pre-diabetes
• Participants create customized programs based on their readiness to address specific lifestyle behaviors
Physical Activity 1. Aerobic
exercise 2. Flexibility 3. Strength
Healthy Eating 4. Unhealthy fats 5. Fruits 6. Overeating 7. Skipping meals 8. Sodium 9. Sugary drinks 10.Vegetables 11.Whole grains
Healthy Living 12. Smoking
cessation 13. Stress
anagement
12.2% risk reduction 67% enrolled and completed
92% satisfaction
EMPOWERED Coaching Condition Management Key Objectives:
• Helps chronically ill members achieve and sustain compliance with evidence-based medicine
• Makes a positive impact on improving health and controlling costs
Key Features:
• Sophisticated data analytics identifies high-risk, high-cost participants
• Opt-in enrollment
• High-touch primary nurse coach model
• TeleHealth technology: transmits clinical data and empowers behavior change
Managed Conditions: Asthma Diabetes CAD CHF COPD Additional Offerings: Back and neck pain Hypertension Maternity
Management
• 10.5% reduction in hospital admissions
• 13.1% reduction in emergency room visits
• 1.5–2.0 to 1 average program ROI
Personalized Lifestyle Programs Participant Benefits
• Variety of tools and resources to support behavior change over time
• Personalized, individually tailored action plan based on initial “consultation”
• Embedded in eHealth platform
• Tools: BMI Calculator, Food Fight, Portion Sizes Tool, Step By Step
• Check-ins: 30, 90, and 180 days
• iPhone® and iPod® touch supported trackers and videos
• Alternative delivery option for participants who prefer self-directed program
Core 5 Programs
Weight management
Stress management
Healthy eating
Physical activity
Smoking cessation
Health Action Programming and Challenges
Via eHealth • Access to a full lineup of health action
programs:
– Walk This Way
– Great American Fitness Adventure™
– Feel Like a Million™
– NutriSum™
• Team competitions and challenges
• Custom/site-specific
• CLIENT group-specific programs
• Mind Your Health seminars
• Team competitions
Engagement Personalized messaging
• Engages the entire population
• Data-driven personalization
• Increases overall adherence rates up to 20%
• Extracts value from health plan covered services
• Increases engagement in wellness programs and services
• Provides cost savings via early detection and avoidance
Areas of Messaging:
Preventive care
Chronic care
Program Engagement
Physician finder
Life, Health & Wealth Case study: Rural Hospital
• Client: Rural Regional Medical Center
• Opened in February of 2010
• Rural hospital in Arkansas
• Features modern, state-of-the-art medical equipment & a friendly staff
Get rising healthcare costs under control, successfully launch a turnkey wellness & engagement solution without the added expense of incentives.
OBJECTIVE
Case study: Rural Hospital
Case study: Rural Hospital
Solution
• LifeHealth & Wealth engagement campaign
• One-on-one communications
• LifeHealth & Wealth Wellness Solution (including onsite screenings)
• Enabled by voluntary products enrollment
Result
• High participation rates in health screening & HRA
• Early identification of some high-risk health issues.
• Will know biometric impact year-over-year in second year of program
Learn more. View case study #1 at: http://trustmarksolutions.com/brokers/case-studies
EXPERIENCE • Leadership
• Complex client needs & integration
PERSONALIZATION • Client customization
• Person centric
ENGAGEMENT • Intrinsic behavior change • Tailored & sustained marketing
Infusing Health into your Culture
What should you look for in a Wellness partner?
Experience and Leadership Commitment to Service and Excellence
Industry Awards
• NBGH Best Employers for Healthy Lifestyle Award (10)
• C. Everett Koop National Health Award: (4)
• WELCOA—Well Workplace Award: (5)
• IHPM—Corporate Health and Productivity Management Award (2)
Industry Leadership
• NBGH Committees
• Care Continuum committees
• HERO Think Tank
• NCQA Wellness Accreditation with Performance Reporting (AWPR)
Wellness Solution - Reporting
HRA client reporting • The HRA aggregate group data includes:
– BMI and body fat – Level of stress – Dietary habits – Days/week of exercise – Tobacco use – Depression – Cholesterol
Health coach reporting • Aggregate summary report • Participation & interaction metrics • Goal progress & satisfaction
– Alcohol use
– Blood pressure
– Vehicle safety
– History of illness
– Blood glucose
– Stages of change
Reports provide the number of employees at risk, by risk
and stratification, as well as aggregate readiness to
change information.
Program impact: ROI and cost benefit
• University and Medical Center (Year 1)
– 3,750 eligible
– ROI = 2.7 (5.0 with incentive costs/revenue)
• Medical Technology and Manufacturing (Year 1)
– 9,400 eligible
– ROI = 1.4 (1.2 with incentive costs/revenue)
• Utility Company (Year 2)
– 38,500 eligible
– ROI = 2.7 (1.7 with incentive costs/revenue)
– Medical claims savings = $7.86 M
• Chemical Company (Year 3)
– 7,600 eligible
– ROI = 3.2 (3.6 with incentive costs/revenue)
– Medical claims savings = $6.3M
HealthFitness clients
We capture individual health risk information.
Reporting / Data
Identifies risk profile of the group…
Reporting / Data
Reporting / Data
Compares client risks to other peer companies
Reporting / Data
Estimates initial health risk cost exposure
Reporting / Data – “Derived ROI Impact”
Tracks program impact over time
Remember: We are not always rational…
Until we are aware, motivated and shown the path!
Agenda:
Why Wellness?
Why is behavior change so hard?
Wellness Solution
Engagement Solution
Case Studies
Employee Engagement Educate the rider, appeal to the elephant, provide a path
Pre-enrollment 1-on-1 enrollment Wellness program
Learn more.
Sample communication
E-mail from employer
Pre-enrollment communication sample
Preventive campaign Sample communication: Week 3
Learn more.
Engagement solutions
Campaign leads to personal dialog with a benefits counselor • The one-on-one meeting uses an
employer tailored discussion guide and presentation.
– Reinforces cost-containment messages AND messages the employer chooses
– Asks employee for a personal commitment – “one small step”
– Assesses financial well-being, and the need for a voluntary product
1-on-1 Enrollment communications
Call to Action to “what is the first step for you?”
1-on-1 Enrollment communications
Trustmark Wellness Solution
Engagement strategies • Established marketing
campaign – print-ready template elements: – Executive letter
– Flyer
– Poster
– Email & direct mail template
• One-on-one employee meetings to gain participation commitment.
Post-enrollment communications
Question:
– Can you significantly impact wellness program participation without monetary incentives?
Case study: Large school system
• Client: Fourth largest school district in the United States
• Comprised of: – 392 schools
– 345,000 students
– More than 40,000 employees
To drive awareness, participation and higher employee engagement in the existing wellness program, which had less than 1% participation.
OBJECTIVE
Case study: Large school system
Case study: Large school system
Solution
• Customized engagement campaign
• One-on-one communications
• Enabled by voluntary products enrollment
Result
• Of employees seen, 77% completed one or more targeted wellness activities
• 4,700 new policies were also provided to meet the needs of their employees
Learn more. View case study #2 at: http://trustmarksolutions.com/brokers/case-studies
What were the real roadblocks?
What if we just asked?
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
Yes No Not Sure
83%
9% 9%
Do you think your employer* should take steps to reduce healthcare costs?
2010 DCPS Focus Group N=118
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Agree Disagree
95%
5%
I am open to participating in wellness activity.
2010 DCPS Focus Group N=118
0%
5%
10%
15%
20%
25%
30%
35%
40%
HealthAssessment
Health Screening On-lineEducational
Programming
Chronic DiseaseManagement
Walking FitnessProgram
8%
33%
3%
16%
40%
Which wellness activity would you be most interested in participating in?
2010 DCPS Focus Group N=118
Recognized all M-DCPS work locations that successfully achieved a 30% “commitment” to participate in the new Well Way initiates. Walk to be Fit Health Coach and Advisor Disease Management Health Assessment
Large School District The Green Light Incentive Program
Reward: $100 fitness package for School Board recognition (top locations) Trophy/plaque
77%
23% Engaged in a WellWay Program
Did not engage
Of the employees that were seen…
Green Light Incentive The Results
8,006 EEs committed to enrolling in a Well Way
Program
Question:
– Would similar engagement solutions be effective for groups smaller than this large school system?
– We’ve seen successful solutions implemented at entities ranging from 97 to 50,000 employees!
Anchoring bias:
We are heavily influenced by where we start our thought process…
You might guess something like 1 million.
Most people guess around 300,000.
If instead I told you, “The population of Green Bay is 100,000. What is the population of Milwaukee?
The actual population is around 580,000.
Regardless of where we were “anchored” before on Wellness
programs and outcome – we need to be open to the possibilities…
Thank You!
Questions?
