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©2008 Trion. All Rights Reserved. 1 DESIGNING AND IMPLEMENTING AN EFFECTIVE CORPORATE WELLNESS PLAN Dick Tewksbury, Client Leader Trion Group DISCUSSION OUTLINE Strategic Considerations Design and Implementation Process
©2008 Trion. All Rights Reserved. 2 Source: 2007/2008 Work Report *Percentage of respondents indicating “to a great extent” or “to a very great extent”. HEALTH ISSUES AFFECTING BUSINESS PERFORMANCE * Preventable/manageable factors top the list of business performance health issues
©2008 Trion. All Rights Reserved. 3 POPULATION HEALTH MANAGEMENT: Risk Perspective Patient Safety HEALTH MANAGEMENT PROGRAMS Prevention & Wellness Care Management Disease Management
©2008 Trion. All Rights Reserved. 4 Review of 73 published studies of workplace health promotion programs summarized these results over a 3 – 5 year period: $3.50 savings in health-care costs for each dollar invested 28% reduction in absenteeism 30% reduction in workers’ compensation and disability claims 26% decrease in health care costs per member Source: Partnership for Prevention 2007 WELLNESS AND HEALTH MANAGEMENT: Worth the Investment
©2008 Trion. All Rights Reserved. 5 POPULATION HEALTH MANAGEMENT: Change Perspective Greatest challenges to successful health management programs are employers’ commitment and/or employees’ willingness to change health behaviors. Behavior Change Model Not willing Not able Not knowing Overcome Resistance Set goals, measure, provide coaching and feedback, reward and recognize. Educate and train new skills, habits and management techniques Communicate the what, why, how, when and who
©2008 Trion. All Rights Reserved. 6 POPULATION HEALTH MANAGEMENT: Funding Perspective A greater percentage of annual plan cost should be allocated to health improvement and health risk reduction Pro Forma Spending Allocation for Treatment and Health Improvement Time Period% Spent on Treatment% Spent of Health Improvement Current97%3%* Future90%10% *NBGH 2008, Improving Employee Health in Six Steps As employers move towards a defined contribution funding approach to health benefits plans, a greater percentage of the employer subsidy should go towards health improvement Pro Forma Spending Allocation for Treatment and Health Improvement Time Period Allocated to TreatmentAllocated to Health Improvement EmployerEmployeeEmployerEmployee Current80%20%3%*n/a Future65% - 75%25%5% - 10%0% - 5%
©2008 Trion. All Rights Reserved. 7 PREVENTION & WELLNESS PROGRAM: Strategic Logic 80% of health care & absence costs are preventable Poor diet, lack of exercise, stress & risky lifestyle cause most health problems/ medical care needs Improving these personal health behaviors will prevent health problems and reduce health care & absence costs The medical community isn’t the solution – it’s designed and reimbursed to treat the symptoms and results of poor health, not the causes The health care services payor is the solution for treating the causes – by encouraging personal health behavior improvement Employer-sponsored prevention & wellness programs are a primary solution to long-term health care cost & productivity improvement
©2008 Trion. All Rights Reserved. 8 PREVENTION AND WELLNESS PROGRAMS: Best Practices Senior management leadership and financial support Internal staffing and corporate and local resources Culture that encourages wellness and change Ongoing, targeted communication campaign Long-term strategies for overall population with targeted, personalized initiatives to each risk segment of the population Program design based on employee input and plan cost & utilization data Dynamic program integrating risk-identification, benefits plan design, wellness interventions and personal performance incentives Comprehensive reporting on program performance metrics and improved cost and outcomes results
©2008 Trion. All Rights Reserved. 9 PREVENTION & WELLNESS PROGRAMS: Delivery Process Identify Expectations Define Appropriate Strategy Assess Current State and Needs Develop 3-year Strategy Implement Strategy Define purpose, goals, ROI target of program Identify senior management & budget commitment Basic provider design Interested provider design Committed provider design Assess current program results Identify population health risks Determine plan cost and prevalence baselines Create the vision Discuss strategy elements Identify annual programs and incentives Set the metrics Communicate Select vendors Manage vendors Set up incentives administration Establish reporting systems Monitor & tune-up process
©2008 Trion. All Rights Reserved. 10 IDENTIFY EXPECTATIONS: Discussion Guide Why are you considering a prevention and wellness program? List the objectives Prioritize objectives What’s your vision of the program 3 years from now? Define scope, timing, and intensity, and who participates in the program How involved is senior management in the program’s support and success? Identify level of C-suite commitment Define senior management awareness and program approval process What’s in next year’s budget for the program? Who’s budget is it in? Determine how future funding is obtained or increased Discuss program “ownership” and leadership within organization How does the company culture respond to significant change in accepted behavior? Use as guide to design of programs, incentives and ongoing communication How will you know the program is successful? Develop annual program metrics over 3-year period
©2008 Trion. All Rights Reserved. 11 HEALTH MANAGEMENT/WELLNESS: Types of Providers TYPE OF PROVIDER NOT ENGAGEDBASIC INTEREST MODERATE COMMITMENT COMMITTED Level of senior management commitment NoneMinimal Typically benefits management initiative Moderate Typically senior HR support/involvement Substantial & long-term Active C-suite support Part of corporate culture Annual budget commitment None Accepts what built into medical vendor fees Limited Cost-sensitive $5 - $25 PEPY range, + incentives Modest Budget limits define scope of strategy $25 - $100 PEPY range, + incentives Significant Budget reflects employer goals $100 - $300 PEPY range, + incentives Program Focus No strategy Vendor standard services, or siloed health management programs Voluntary participation HRA with personal risk & aggregate activity reports Online education, resource & coaching tools HRA & biometrics Personal phone coaching Modest participation & results incentives Aggregate risk analysis & results reporting Targeted strategy & programs based on HRA and claims risk analysis Creative incentives for participation and results Integrated wellness, DM and patient safety Savings and ROI Opportunity None should be expected Demonstrates doing something Limited direct cost savings EE morale improves Meaningful cost savings 2:1 – 5:1 ROI expected over 3 years Substantial cost savings 2% - 4% reduction in annual trend 3:1 – 8:1 ROI expected over 3 years
©2008 Trion. All Rights Reserved. 12 ASSESS CURRENT STATE/NEEDS Purposes Establish baseline costs and risk/condition prevalence Compare future annual results to baseline numbers to measure success Identify primary group health risks and conditions for targeted health management programs Identify participants by specific health risks and conditions to develop group risk profiles and individual risk and health management strategies Data Elements Personal Information and Overall Group Results –Personal interests & engagement in health improvement –Annual Health Risk Assessment –Annual biometric screening –Periodic preventive screenings: Pap smear, mammography, PSA, colonoscopy, –Personal Health Record
©2008 Trion. All Rights Reserved. 13 CLAIMS-BASED RISK ANALYSIS: Cost Assessment Health conditions by prevalence # medical claimants Medical/Rx Annual Cost # inpatient admissions # STD claimants STD benefit annual cost Annual days absence 1.X 2.X 3.X 4.X 5.X 6.X 7.X 8.X 9.X 10.X 11.X 12.X 13.X 14.X 15.x TOTAL
©2008 Trion. All Rights Reserved. 14 RISK-BASED COST ANALYSIS Health conditions by risk category # medical Claimants Medical/Rx Annual Cost # inpatient admissions # STD claimants STD annual cost Annual days absence Complex/Acute Health Condition X Chronic/Comorbidity Health Condition X Moderate Health Condition X TOTAL
©2008 Trion. All Rights Reserved. 15 DEVELOP and IMPLEMENT 3-YEAR STRATEGY Vision and Mission Keep it simple Define how client “sees” the wellness program and/or its results 3-5 years from now Brand and communication messages should align with the vision/mission and business plan Phased Behavior Change Program 4 phases to achieve long-term health improvement Implement strategy elements consistent with the behavior change phase Awareness/ Education Awareness/ Education Motivation Behavior Change Behavior Change Behavior Reinforcement Behavior Reinforcement
©2008 Trion. All Rights Reserved. 16 DEVELOP and IMPLEMENT 3-YEAR STRATEGY Strategy Elements Program Participation Eligible, enrolled or all employees? Dependents? If turnover a concern, service-based participation? Phased Communication Program PhaseContent 1. Branding/identityEmployee survey and feedback Logo, program name, tagline, themes 2. AwarenessIssue information Company commitment and strategies 3. Education & logistics Program design, features and value Instructions on program access, operations 4. ReportingHRA and biometrics report/risk analysis/next steps Initiatives participation & results feedback 5. ReinforcementIndividual progress, feedback, recommendations Overall progress, feedback and program updates
©2008 Trion. All Rights Reserved. 17 DEVELOP and IMPLEMENT 3-YEAR STRATEGY Strategy Elements (cont.) Education Tools Online health reference resources Personal health records Medical/Rx evidenced-based treatment resources Benefit plan option comparison tools Health Benefits Plan Design/Provisions and Workplace Policies Employee Assistance Program and stress management Benefits incentives for preventive care services utilization Coverage for alternative medicine services Smoke-free workplace Healthy food choices in cafeteria/vending machines Personal Risk Analysis Health Risk Assessment Biometric evaluation Personal health awareness/satisfaction/engagement surveys
©2008 Trion. All Rights Reserved. 18 DEVELOP and IMPLEMENT 3-YEAR STRATEGY Considerations in Selecting Initiatives Objective addressed by initiative? # in population expected to participate? Participation at multiple sites and multiple work schedules? What behavior change phase is applicable? Incentives that should be used? Timing and awareness/communication of initiative? Duration and follow-up of initiative? Internal and vendor resources to deliver initiative? Total cost to complete initiative? Success metrics tied to initiative?
©2008 Trion. All Rights Reserved. 19 DEVELOP and IMPLEMENT 3-YEAR STRATEGY Strategy Elements (cont.) Population Lifestyle Initiatives Weight loss Nutrition Stress Physical activity Smoking cessation Alcohol Sleep Maternity risk management Personal Initiatives Risk analysis-based intervention Multiple risk interventions Online, phone or on-site coaching Nurse advice line
©2008 Trion. All Rights Reserved. 20 DEVELOP and IMPLEMENT 3-YEAR STRATEGY Strategy Elements (cont.) Incentives Incentives are a motivator/reinforcement to change behavior Positive incentives encourage adopting new behaviors; negative incentives encourage stopping/reducing bad behaviors Three general categories of incentives health benefit plan enhancements, direct cash payments and merchandise Think about group and/or individual incentives based on: program objectives, corporate culture, and type of initiative Beware of legal considerations – HIPAA, ADA, tax laws
©2008 Trion. All Rights Reserved. 21 DEVELOP and IMPLEMENT 3-YEAR STRATEGY Strategy Elements (cont.) Program Performance Metrics Setting up measurement systems and targets are key for several reasons: program performance evaluation and level of change, demonstrate overall program value and secure continued funding, and identify and improve low-performing initiatives. Typical metrics categories are: Participation Participant satisfaction Aggregate HRA and/or biometric risk level improvement Medical/Rx and disability benefits plan claims costs and trends Unscheduled absence improvement Overall productivity improvement
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