Presentation on theme: "Investing In Employees and Building the Wellness Culture"— Presentation transcript:
1 Investing In Employees and Building the Wellness Culture USAA WellnessInvesting In Employees and Building the Wellness CulturePeter Wald MD, M.P.HVice President, Enterprise Medical DirectorJuly 2014
2 Employees are the “secret sauce” of our competitive advantage USAA2006 C. Everett Koop National Health Award-sole winnerComprehensive, multi-discipline, and integrated health & productivity management program (http://www.sph.emory.edu/healthproject)Multiple local Wellness awards (Healthiest Employer, SA Healthy Worksite Recognition, Local Chambers of Commerce, etc)Diversified financial services companyThe leading provider of competitively priced financial planning, insurance, investments, and banking products to members of the U.S. military and their families.10+ million members rely on the convenience and accessibility of USAA financial products backed by industry-leading service.Business Week #1 Customer Service 2007 and 2008Business Week #2 Customer Service 2009 and 2010Employees are the “secret sauce” of our competitive advantage
3 Menu-Wellness Journey and Strategy Wellness StrategyHow we do itMeasures and SuccessesFuture Directions- Internal and External
4 What-Wellness and our Benefits Strategy We want to maximize health and quality of life for employees and their families so we can better serve our members.We are “investing” in our employees and building a wellness “culture” for the long term.Culture is what employees “hear” and what they “see”Wellness is tightly integrated with routine Medical and Retirement BenefitsWe are actively creating and supporting behavior change.Our focus is employee productivityKeeping employees healthy through primary prevention (Wellness)Management commitment is the single most important factor for success.We monitor program efficacyExecutive management briefed before implementation that there is a 3-5 year delay for financial returns.
5 How-Targeting employee risk groups Three domains: Physical, Financial and Emotional HealthHealthWealthBalanceSick At-Risk WellPopulationWellAt RiskSick / UnwellGoalKeep well people wellIncrease awareness and response levelImprove condition of sick people
6 Prevention is our Primary Strategy PhysicalFinancialEmotionalPrimary(Well)Health Risk Assessment (HRA)Wellness ProgramsJoint Safety and ErgonomicsFinancial HRAAuto-enrollment in Target fundsPersonal Balance toolMy HelperFlexible WorkResiliency ImprovementInterpersonal SkillsSecondary(At-Risk)On-site ClinicsPharmacy and Medical prevention tiersCenters of ExcellenceFinancial planningTargeted messagingWork-Life Balance ProgramsEmployee Assistance Program (EAP)Tertiary (Sick)Individual Health ManagementTime Off ProgramsTransitional DutyTargeted remedial classesWork-Life ReferralMental Health and Substance Abuse Benefits
7 “Brand” strategy. Always on message, but always simple Wellness MessagesDon’t SmokeBe ActiveEat RightPrevention“Brand” strategy. Always on message, but always simple
8 Strategic Wellness Model Clinical servicesIntegrated disability managementWellness programs.Data warehouseWellness PartnersSafetyFitness and RecreationFood servicesCommunicationsCompany storeCorporate Real EstateMultiple Outsourced VendorsUSAA is the integrator.Assembled “Best of Breed” programIndividually selected by RFP process.Completely internal selection process
9 Building the “Wellness Culture.” Key Program ElementsIdentity/BrandHealth Risk AssessmentsHealth Promotion Tools and InterventionsFinancial IncentivesOn-site Services and the “Built Environment”Healthy Food ServicesPopulation Data Analysis-Total Cost & Employee TrendsBuilding the “Wellness Culture.”
10 Specific Examples Intervening Population Targeted Preventive benefits ($300/y)Wellness benefits ($350/y)Smoking Cessation and Weight ManagementHRAs and biometricsOn-site fitness rebate (25/50/75%)“Healthy Points”Wellness breaksRecreation and nontraditional fitnessCalorie balance toolWorkplace safety (Be Safe)Healthy food services (The 4 P’s)Tobacco-free campusTargetedIndividual Health ManagementBMI ReductionIntegrated disability mgmtTransitional dutyErgonomics AssessmentsIntervening
11 Snapshot-USAA population health summary (2013) Healthy employees use less resources85% of employees use 20% of resources12.5% of employees use 40% of resources2.5% of employees use 40% of resources50-80*% of total costs are related to behaviors associated with preventable diseasesSmokingPhysical InactivityPoor nutrition/obesityInattention to preventive practicesIndicators for high risk conditions.Glucose > %Cholesterol> %Cholesterol> %Blood pressure>120/ %BMI > %BMI > %*Modifiable Behavioral Factors as Causes of Death JAMA. 2004
12 Measures- Sustaining Management Commitment to Wellness SatisfactionParticipationRisk factor reductionEconomic impactShort-term gains in productivity and disability sustain management commitment to longer-term gains that result from healthier employees.
13 Context: HRA Participation * Represents two campaigns: Sept 03 and Feb 04** No incentives offered*** Fitness Equipment incentive ended 12/31/09Participation increases employee awareness and ability to respond to risks.
15 Context: Healthy Dining Utilization Components of Healthy Dining 2.0 include:- EducationMessaging, Branding, Nutritional Guidelines, Wellness Café, My Plate (Portion Guide),Menu Re-engineering, MIND Devices, and Calorie Posting- IncentiveHealthy Points, Eat Right Rewards, Healthy Gap, and Limited Time Offers- AccessibilityMenu Design, Product Placement, Station Enhancements, Catering, Markets,Vending, and Fitness Centers- EngagementFocus Groups, Surveys, My Life, Technology, Innovation, Cooking Demonstration,myFitnessPal, See Green Eat Lean, and Wellness Committee- Community/FamilyPor Vida, My Plate, and Local ResourcesResults% of healthy items vs all items purchased
16 2009-13 Trends - Health Risk Assessments and Body Mass Index-Updated Trend is moving in the right directionBMI3.7% ReductionAverage BMI (‘09 to ‘13)24% ReductionAverage Risk Factors-11%-19%Percent of ParticipantsThe chart on the left shows improved trending and a reduction in the number of health risks. The risks which are monitored include:Individual health risks are identified through health risk assessments (HRAs) which are conducted onsite during the months of January to March. A more limited, web-based version is offered online from January to November.1 Ended fitness equipment reimbursementYTD is through March 31, 20133 Participation rate denominator is from Congos report – non European headcountThe chart on the right, which is a second area of focus for USAA, is on employee health using body mass index (BMI) as a critical population health metric. Over the past 4 years (2009 – 2012), USAA has seen a reversal of our initial 5 year ( ) trend of population weight gain.Community BMI growth is /yr, while USAA BMI has changed from an average of 29.3 in 2009 to 28.3 in 2012.One challenge: Entering employees have higher age adjusted BMI than existing employees:Age Adjusted BMI OF Employees*Location New ExistingTXCOFLAZ2009 HRA2013 HRAT1 = First HRAT2 = Last HRALack of Physical activityDepressionStressInsufficient consumption of Vegetables & fruitBlood pressureNegative Health perceptionCholesterolTobaccoAlcohol20092010120112012 (YTD)2HRA Participants18,51014,56315,05013,254Participation Rate384.8%66.0%64.4%56.9%
17 Bending the cost curve… Employee2.0% annual increaseDependent2.4% annual increaseDep (Adjusted)2.8% annual increaseBackgroundFull replacement CDHPSame health plan for both groupsNo Wellness services delivered to dependents vs. full suite of services to employeesComprehensive wellness services flatten cost curve for this large employee populationAdjusted for Inflation
18 Controlling Lost time… STD1.1% Annual DecreaseWC37.2% Annual Decrease(Through 2013 Q3)LTD12.3% Annual DecreaseLTD/WCSTDBackgroundTransition Duty, medical case management and safety interventions.Work and non-work related disability managed in same systemIntegrated Disability Management services reduce all disability lost time
19 Working Closely to Deliver Primary Prevention for Injury Reduction Ergonomics Evaluation Totals by Location5169total ergoevaluations from Jan. 1-Jun 18, 2013Short urlon Connect: go\ergoTargeted interventions for RMI’s and Slips, Trips and Falls - Leveraging the Wellness Culture
20 Integrated Disability Management for 2012 Better management of cases$6.38M returned to businessTransitional Duty441 completedPhysical Demand Job Audits283 jobs covering 83% of employeesStandardized and ready to goJob Adjustments506 completedAt Work, Focused and Productive
21 Context: TurnoverThe retention rate for employees who receive a rebate (at least 50 visits in a single year) is higher than retention for both member contact and non-member contact employeesComponents of Healthy Dining 2.0 include:- EducationMessaging, Branding, Nutritional Guidelines, Wellness Café, My Plate (Portion Guide),Menu Re-engineering, MIND Devices, and Calorie Posting- IncentiveHealthy Points, Eat Right Rewards, Healthy Gap, and Limited Time Offers- AccessibilityMenu Design, Product Placement, Station Enhancements, Catering, Markets,Vending, and Fitness Centers- EngagementFocus Groups, Surveys, My Life, Technology, Innovation, Cooking Demonstration,myFitnessPal, See Green Eat Lean, and Wellness Committee- Community/FamilyPor Vida, My Plate, and Local ResourcesResults% of healthy items vs all items purchased
22 Context: “Built Environment” Communication Solutions What messages do the physical environment send? Are they all aligned?Create a “surround sound” environment of Wellness messagesFoster wellness communitiesInclude fiscal and emotional wellnessProvide financial incentivesCommunication Impact on Driving Behavior:61% Leadership (“Personal voice”: what managers do, who they recognize, what they ask)7% Formal (“official” products: memos, publications, meetings)32& Infrastructure / Built Environment (“Institutional voice”: rewards, programs, systems, policies)
23 Context: BMI is a Leading Indicator of Health Risk Total PopulationDiabetes PrevalenceHeart Disease PrevalenceMusculoskeletal PrevalenceAverage Integrated Cost< 254,5851.6%9.1%33.7%$4,54925 – 29.995,0413.2%15.3%35.5%$5,07530 – 34.992,8527.4%22.4%38.1%$5,710≥ 352,12213.8%31.5%41.5%$7,243Total14,6005.1%17.1%36.3%$5,348Assumptions:2013 dollars and employee countIndividuals with BMI ≥ 30 have a higher prevalence of acute health conditionsOne study found that people with BMI between 25 and 27 were the least costly:Re- ran by HCMS w/ full file on 10/11/2013**data for those who took the HRA in 2012
24 Focus-We Need to Move Employees and Their Families to Healthy BMI. 10% weight loss annuallyEmployee begins BMI: 35End of 1st year BMI: 31.5End of 2nd year BMI: 28.4End of 3rd year BMI: 25.5!!Reducing weight by 10% annually dramatically improves BMI
25 Wellness 2.0-Encouraging healthy behaviors BMI > 27Earn points throughout year to receive valuable rewardEmployee completes HRAHealthy PointsEat more fruits and vegetablesIncrease physical activityParticipant in Community physical activity eventsParticipate in Healthy ChallengesComplete onsite biometric screeningComplete spouse/dependent online HRAActivity (examples)Reduce weight by 10% or reach BMI of 27, $250Premium discount ($300/600/900)Use at open enrollment$350 for Weight Management, Smoking CessationALLValuable reward optionsIncentives effective for behavior change but not for long term maintenance.
26 Wellness 2.0- Healthy Points GET HEALTHYOn-site Health Screening (HRA) Participation100Online HRA EmployeeCardiologic - ~2x/week300Eat Right Rewards - 6 healthy items each week225Fitness Assessment – Completion25Fitness Assessment – Improvement50Ultimate Slim Down – CompletionUltimate Slim Down - Improvement (>3% loss)Personal Balance Tool - 5 pts ea. x 5 visitsCommunity Exercise EventHealthy Eating Challenge 1TOTAL1,000*Assumes no screening results, which could add up to 400 additional points (100 points each for healthy BMI, BP, BS and cholesterol).Moving from participation to results.
27 Wellness 3.0- The Road Ahead… Corporate Healthy PointsIncremental incentive for overall population health improvementMust meet individual Healthy Point goal to be eligibleUnhealthy behaviors by individuals effects health costs for everyoneFitness EverywhereGateway for physical activity for 60% of employees who are not fitness membersEvolution from fitness center centric to activity where YOU areCreate and reinforce a Be Active cultureInvest in Food“Eat This, Not That” pricing modelCreate and reinforce an Eat Right cultureCommunity Based InterventionsBMI is our primary intervention targetShared destiny and shared responsibility.
28 External Strategy-New Employees drive up Population BMI Community BMI growth is /yr, while USAA BMI growth over the past 3 years is -0.06Entering employees have higher age adjusted BMI than existing employeesAge Adjusted BMI of Employees*NewExistingTX30.3728.90CO30.3328.17FL30.1628.92AZ30.4729.07*.25 BMI increase/yrWe need to engage the community to avoid diluting our internal success.
29 Project Results Improve Community Health in USAA Operating Cities Improve Community Health through Wellness in our schoolsReplicate our internal strategy in the communityPosition USAA as a community leaderLeverage our expertise to assist Community institutionsMayor’s Fitness Council (www.fitcitysa.com), San Antonio Business Group on Health, San Antonio Medical FoundationHealthier dependents, retirees and new hires return savings to the Enterprise
30 Investing in our Populations Keep employees and their families healthyExecutive management support is critical for success. Program metrics are critical to allow them to stay engagedManagement has to be comfortable seeing the overall return of all the integration working together, not individual component partsInternal Medical expertise adds opinion diversity and valueRequires a long term vision, and internal and external Wellness strategyTight integration improves value