People
Helping
People
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Return on Investment with Performance-Based Health Management
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Objectives
• Explain why traditional wellness has failed• Identify the 6 best practices of a successful health • Identify the 6 best practices of a successful health management program• How to design an effective incentive strategy• Demonstrate real Return-On-Investment
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Why Traditional Wellness Has Failed
Price Waterhouse Coopers Study 71% of employers offering wellness program… few
said they are effective at lowering costs
Participation remains low <50% of those who are eligible actually participate Participation in disease management remains low…
less than 15% eligible actually participate Opt-in health coaching participation in the single digits
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The Reality
Despite the popularity and prevalence of employee wellness programs, we are not getting healthier.
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Obesity Trends * Among U.S. Adults BRFSS
(*BMI 30, or about 30 lbs. overweight for 5’4” person)
1990
2009
1999
No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%
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Diabetes Trends
Diagnosed Diabetes among Adults aged ≥ 20 years
2004 2007
2009
Percent
0 - 6.5
6.6 - 8.0
8.1 - 9.4
9.5 - 11.1
> 11.2
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Life is Getting Easier
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Doing Nothing is a Losing Strategy
Migration study of 43,312 Individuals Over 3 Years
Key Findings• Risk profile of a population
gets worse over time• Number of High Risk
individuals increased 11.4%• Number of Medium Risk
individuals increased 7.7%• Number of Low Risk
individuals decreased 4.9%• Results are a function of
American lifestyle habits and the realities of age
Year 0
Low Risk (0-2 Health Risks)
27,951
Medium Risk (3-4 Health Risks)
10,670
High Risk (5+ Health Risks)
4,691
Year 3
Low Risk (0-2 Health Risks)
26,591
Medium Risk (3-4 Health Risks)
11,495
High Risk (5+ Health Risks)
5,226
High Risk (5+ Health Risks)
5,226
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You Don‘t Know What You Don’t Know
HRA FindingsClaims information
Diabetes
Hypertension
• 111 with glucose in diabetic range
• 580 with glucose in pre-diabetic range• 50 have claims with a diagnosis
suggesting diabetes or pre-diabetes
• 549 individuals with elevated systolic and diastolic blood pressure readings
• 78 have claims with a diagnosis suggesting hypertension
Heart AttackRisk
• 815with elevated cholesterol
• 883 with BMI readings > 30, of which 396 (44.8%) are also pre-diabetic
• 98 individuals have claims with a diagnosis suggesting being at risk of a heart attack
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6 Best Practices
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Best Practice #1 Objective and Outcome-Based
Objective measurement is key to success
• Set baseline
• Track trends
• Real information, not a guess
Importance of on-site venipuncture biometric screening
• Objective data points to measure over time
• Participants don’t “know their numbers”
• Uncover hidden risks
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Employee Perception of Health
- 88% of participants self-reported a good or great health status
- 70% of participants scored a 71 or higher (ideal or low level of risk)
1% of participants self-reported a below average or poor health status
12% of participants scored a 60 or below (high or very high risk)
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Best Practice #2 Clear-Cut Scoring
• Easy to understand scoring drives engagement and participation
• Scored model translates risks into compliant measurement model
• Long term measurement tool
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Personal Report
Overall WellnessDear “Participant”,
By completing this assessment, “Participant”, you have taken the first step toward a healthier lifestyle! This guide will give you valuable information to help you achieve a healthier way of life. Better health increased productivity, in both your professional and personal life.
This guide is not meant to take the place of a physician visit nor can it diagnose illness or medical problems. It is designed to give you information relating to your health risks and overall wellness. This information is provided to help you develop a plan of action to make healthy lifestyle changes. This program uses scientifically validated research to help you identify risks or behaviors that may cause or lead to chronic illness. Our program concentrates on risk factors that can be modified and that you should be able to effectively control, maintain and/or improve.
To get the most out of this guide, you may want to read it more than once.
Your Health Score is 58
Your score qualifies as High Risk. The ranges of scores are as follows:
An overall score of 71 or above indicates your lifestyle is on the right track. A score below 71 means that you might be at risk for developing certain diseases or health conditions.
Very High Risk
50 or less
High Risk
51 to 60
Moderate Risk
61 to 70
Low Risk
71 to 84
Ideal Risk
over 85
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Best Practice #3 Carrie Independent
Don’t share proactive risk data with risk bearer
Keep program consistent over time
You OWN the data
More flexibility in program design
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Best Practice #4 Meaningful Incentives
Direct Correlation Between Value & Participation
• Results for completion of Health Assessments show a direct correlation between incentive value and participation
• Incentives reward those who make healthy lifestyle choices
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Best Practice #5 Support Behavior Change
Personal Intervention Group Programming
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Best Practice #6 Measure Results
Participation Track participation by employee/dependent, location, and job codes Goal: 70% participation (minimum)
Program Engagement Track activity in health coaching, online utilization of sites, goal
tracking, classes and challenges to determine outcomes and impact
Health Risk Analysis and Migration Break out specific risk factors and risk category to track annually
Claims Analysis and Impact
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Designing an Effective Incentive Program
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Effective Incentive Design
Various studies show that 85% of people are wired to not change unless there are consequences
Myth: People won’t change Reality:
Seat belt use 30 years ago compared to today Drunk driving 30 years ago compared to today Worksite/Job safety 30 years ago compared to today
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HIPAA Compliance
Wellness Program conditions and rewards MUST comply with HIPAA Wellness Program Regulations:
1. Limit on Reward
2. Reasonably Designed To Promote Good Health or Prevent Disease
3. Annual Opportunity to Qualify For Reward
4. Reasonable Alternative Standard
5. Disclosure Required
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Example of Implementation
Year 1 - Actions Increase contribution rates by $25 per month for non-participants Offer employees $25 per month discount for participating in assessment program
Year 2 - Performance Offer $10 per month discount for repeat participants (participation incentive) Offer $15 per month discount for repeat participants who maintain a high level of
health, improve by at least 5 points on the scored algorithm, or provide a letter from
MD that states compliance with care (outcome incentive)
Year 3 and beyond- Increase premium rates as necessary- Include spouses
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Cost Difference by Participation
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Claims Experience Related to Health Score
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Repeat Participation Demonstrates Reduction in Claims Expense
*Non-Participants are costing $2,000 more than Year 1 Participants and more than $3,000 more than those continuously participating in the biometric screenings
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Medical Claims Correlation to Glucose
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Workers Comp Claims by Participation
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Workers Comp Claims Correlation to BMI
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Excess Risk Equals Excess Cost
Cost Area Low Risk (N=671)
Medium Risk
(N=504)
High Risk
(N=396)
Short-Term Disability
$160 $288 $444
Worker’s Compensation
$304 $325 $662
Absence $327 $455 $703
Medical & Pharmacy
$1,544 $1,983 $4,929
Total $2,335 $3,052 $6,738
High Risk employees cost $4,403 more per year!
Source: University of Michigan Health Management Research CenterInflation adjusted to 2009: http://www.halfhill.com/inflation.html
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Return on Investment
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Questions?
Sarah KuretzkyHealth Solutions [email protected]
888.263.4656 x1157