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USAA Wellness Investing In Employees and Building the Wellness Culture Peter Wald MD, M.P.H Vice President, Enterprise Medical Director July 2014.

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Presentation on theme: "USAA Wellness Investing In Employees and Building the Wellness Culture Peter Wald MD, M.P.H Vice President, Enterprise Medical Director July 2014."— Presentation transcript:

1 USAA Wellness Investing In Employees and Building the Wellness Culture Peter Wald MD, M.P.H Vice President, Enterprise Medical Director July 2014

2 . 2 USAA 2006 C. Everett Koop National Health Award-sole winner  Comprehensive, multi-discipline, and integrated health & productivity management program (  Multiple local Wellness awards 2005-2014 (Healthiest Employer, SA Healthy Worksite Recognition, Local Chambers of Commerce, etc) Diversified financial services company  The 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 2008  Business Week #2 Customer Service 2009 and 2010 Employees are the “secret sauce” of our competitive advantage

3 . 3 Menu-Wellness Journey and Strategy Wellness Strategy How we do it Measures and Successes Future Directions- Internal and External

4 . 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 Benefits We are actively creating and supporting behavior change.  Our focus is employee productivity  Keeping employees healthy through primary prevention (Wellness) Management commitment is the single most important factor for success.  We monitor program efficacy Executive management briefed before implementation that there is a 3- 5 year delay for financial returns.

5 . 5 How-Targeting employee risk groups Population WellAt RiskSick / Unwell Goal Keep well people wellIncrease awareness and response level Improve condition of sick people Three domains: Physical, Financial and Emotional Health Health Wealth Balance

6 . 6 Prevention is our Primary Strategy PhysicalFinancialEmotional Primary (Well)  Health Risk Assessment (HRA)  Wellness Programs  Joint Safety and Ergonomics  Financial HRA  Auto-enrollment in Target funds  Personal Balance tool  My Helper  Flexible Work  Resiliency Improvement  Interpersonal Skills Secondary (At-Risk)  On-site Clinics  Pharmacy and Medical prevention tiers  Centers of Excellence  Financial planning  Targeted messaging  Work-Life Balance Programs  Employee Assistance Program (EAP) Tertiary (Sick)  Individual Health Management  Time Off Programs  Transitional Duty  Targeted remedial classes  Work-Life Referral  Mental Health and Substance Abuse Benefits

7 . 7 Wellness Messages Don’t Smoke Be Active Eat Right Prevention “Brand” strategy. Always on message, but always simple

8 . 8 Strategic Wellness Model Wellness  Clinical services  Integrated disability management  Wellness programs.  Data warehouse Wellness Partners  Safety  Fitness and Recreation  Food services  Communications  Company store  Corporate Real Estate Multiple Outsourced Vendors  USAA is the integrator.  Assembled “Best of Breed” program  Individually selected by RFP process.  Completely internal selection process

9 . 9 Key Program Elements Identity/Brand Health Risk Assessments Health Promotion Tools and Interventions Financial Incentives On-site Services and the “Built Environment” Healthy Food Services Population Data Analysis-Total Cost & Employee Trends Building the “Wellness Culture.”

10 . 10 Specific Examples Population  Preventive benefits ($300/y)  Wellness benefits ($350/y)  Smoking Cessation and Weight Management  HRAs and biometrics  On-site fitness rebate (25/50/75%)  “Healthy Points”  Wellness breaks  Recreation and nontraditional fitness  Calorie balance tool  Workplace safety (Be Safe)  Healthy food services (The 4 P’s)  Tobacco-free campus Intervening Targeted  Individual Health Management  BMI Reduction  Integrated disability mgmt  Transitional duty  Ergonomics Assessments

11 . 11 Snapshot-USAA population health summary (2013) Healthy employees use less resources  85% of employees use 20% of resources  12.5% of employees use 40% of resources  2.5% of employees use 40% of resources 50-80*% of total costs are related to behaviors associated with preventable diseases  Smoking  Physical Inactivity  Poor nutrition/obesity  Inattention to preventive practices *Modifiable Behavioral Factors as Causes of Death JAMA. 2004JAMA. Indicators for high risk conditions. Glucose >100 7.2% Cholesterol>240 6.2% Cholesterol>20029.5% Blood pressure>120/8024.2% BMI >2568.3% BMI >3034.2%

12 . 12 Measures- Sustaining Management Commitment to Wellness Satisfaction Participation Risk factor reduction Economic impact Short-term gains in productivity and disability sustain management commitment to longer-term gains that result from healthier employees.

13 . 13 Context: HRA Participation * Represents two campaigns: Sept 03 and Feb 04 ** No incentives offered *** Fitness Equipment incentive ended 12/31/09 Participation increases employee awareness and ability to respond to risks.

14 . 14 Context: Successful Healthy Points Participation 28.1% of population 34.8% of population 31.7% of population

15 . 15 Context: Healthy Dining Utilization

16 . 16 24% Reduction Average Risk Factors Percent of Participants BMI 2009 HRA Trend is moving in the right direction 2009-13 Trends - Health Risk Assessments and Body Mass Index-Updated 3.7% Reduction Average BMI (‘09 to ‘13) 2013 HRA -19% -11% T1 = First HRA T2 = Last HRA

17 . 17 Bending the cost curve… Comprehensive wellness services flatten cost curve for this large employee population Background  Full replacement CDHP  Same health plan for both groups  No Wellness services delivered to dependents vs. full suite of services to employees Background  Full replacement CDHP  Same health plan for both groups  No Wellness services delivered to dependents vs. full suite of services to employees Adjusted for Inflation Employee 2.0% annual increase Dependent 2.4% annual increase Dep (Adjusted) 2.8% annual increase

18 . 18 Controlling Lost time… Integrated Disability Management services reduce all disability lost time Background  Transition Duty, medical case management and safety interventions.  Work and non-work related disability managed in same system Background  Transition Duty, medical case management and safety interventions.  Work and non-work related disability managed in same system STD 1.1% Annual Decrease WC 37.2% Annual Decrease (Through 2013 Q3) LTD 12.3% Annual Decrease LTD/WC STD

19 . 19 Working Closely to Deliver Primary Prevention for Injury Reduction Ergonomics Evaluation Totals by Location 5169 total ergo evaluations from Jan. 1-Jun 18, 2013 Targeted interventions for RMI’s and Slips, Trips and Falls - Leveraging the Wellness Culture Short url on Connect: go\ergo

20 . 20 Integrated Disability Management for 2012 At Work, Focused and Productive Better management of cases  $6.38M returned to business Transitional Duty  441 completed Physical Demand Job Audits  283 jobs covering 83% of employees  Standardized and ready to go Job Adjustments  506 completed

21 . 21 Context: Turnover The 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 employees

22 . 22 Context: “Built Environment” Communication Solutions  What messages do the physical environment send? Are they all aligned?  Create a “surround sound” environment of Wellness messages  Foster wellness communities  Include fiscal and emotional wellness  Provide financial incentives

23 . 23 Context: BMI is a Leading Indicator of Health Risk Assumptions: 2013 dollars and employee count BMI Total Population Diabetes Prevalence Heart Disease Prevalence Musculoskeletal Prevalence Average Integrated Cost < 25 4,5851.6%9.1%33.7%$4,549 25 – 29.99 5,0413.2%15.3%35.5%$5,075 30 – 34.99 2,8527.4%22.4%38.1%$5,710 ≥ 35 2,12213.8%31.5%41.5%$7,243 Total14,600 5.1%17.1%36.3%$5,348 Individuals with BMI ≥ 30 have a higher prevalence of acute health conditions

24 . 24 Focus-We Need to Move Employees and Their Families to Healthy BMI. Employee begins BMI: 35 End of 1 st year BMI: 31.5 End of 2 nd year BMI: 28.4 Reducing weight by 10% annually dramatically improves BMI End of 3 rd year BMI: 25.5!! 10% weight loss annually

25 . 25 Wellness 2.0-Encouraging healthy behaviors BMI > 27 Earn points throughout year to receive valuable reward Employee completes HRA Healthy Points  Eat more fruits and vegetables  Increase physical activity  Participant in Community physical activity events  Participate in Healthy Challenges  Complete onsite biometric screening  Complete spouse/dependent online HRA Activity (examples) Reduce weight by 10% or reach BMI of 27, $250  Premium discount ($300/600/ 900)  Use at open enrollment BMI > 27 $350 for Weight Management, Smoking Cessation ALL Valuable reward options Incentives effective for behavior change but not for long term maintenance.

26 . 26 Wellness 2.0- Healthy Points Moving from participation to results. GET HEALTHY On-site Health Screening (HRA) Participation 100 Online HRA Employee 100 Cardiologic - ~2x/week 300 Eat Right Rewards - 6 healthy items each week 225 Fitness Assessment – Completion 25 Fitness Assessment – Improvement 50 Ultimate Slim Down – Completion 50 Ultimate Slim Down - Improvement (>3% loss) 50 Personal Balance Tool - 5 pts ea. x 5 visits 25 Community Exercise Event 25 Healthy Eating Challenge 1 50 TOTAL1,000 * Assumes no screening results, which could add up to 400 additional points (100 points each for healthy BMI, BP, BS and cholesterol).

27 . 27 Wellness 3.0- The Road Ahead… Shared destiny and shared responsibility. Corporate Healthy Points  Incremental incentive for overall population health improvement  Must meet individual Healthy Point goal to be eligible  Unhealthy behaviors by individuals effects health costs for everyone Fitness Everywhere  Gateway for physical activity for 60% of employees who are not fitness members  Evolution from fitness center centric to activity where YOU are  Create and reinforce a Be Active culture Invest in Food  “Eat This, Not That” pricing model  Create and reinforce an Eat Right culture  Community Based Interventions BMI is our primary intervention target

28 . 28 External Strategy-New Employees drive up Population BMI *.25 BMI increase/yr We need to engage the community to avoid diluting our internal success.  Community BMI growth is +0.2-0.3/yr, while USAA BMI growth over the past 3 years is -0.06  Entering employees have higher age adjusted BMI than existing employees NewExisting TX30.3728.90 CO30.3328.17 FL30.1628.92 AZ30.4729.07 Age Adjusted BMI of Employees*

29 . 29 Project Results Improve Community Health in USAA Operating Cities  Improve Community Health through Wellness in our schools  Replicate our internal strategy in the community  Position USAA as a community leader  Leverage our expertise to assist Community institutions  Mayor’s Fitness Council (, San Antonio Business Group on Health, San Antonio Medical Foundation Healthier dependents, retirees and new hires return savings to the Enterprise

30 . 30 Investing in our Populations  Keep employees and their families healthy  Executive management support is critical for success. Program metrics are critical to allow them to stay engaged  Management has to be comfortable seeing the overall return of all the integration working together, not individual component parts  Internal Medical expertise adds opinion diversity and value  Requires a long term vision, and internal and external Wellness strategy Tight integration improves value

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