1. Wellness: It’s Not Just for Health Claims Anymore Conni Huber, City of Cedar Rapids HR Director Lisa Powell, Linn County HR Director

2. City

3. Program Background Began in 2007 Utilized 3 vendors Current vendor in place for 5 years Initial incentive = $50 Current incentive = premium reduction of $40/month up to $78/month Participation rate – 70%

4. Program components Biometric screening Health questionnaire Monthly coaching for high and moderate risk individuals Monthly wellness events planned by employee group

5. Culture changing components Wellness activities, education and celebrations Policies on healthy vending machines, food at City functions, etc. Health Fair Newsletter articles including wellness champion highlights Fitness centers for very low cost

6. Linn County Wellness Annual Health Risk Assessment (HRA) and Biometric Screening - $50 gift card incentive Monthly on-site Health Coaching for eligible employees (chronic condition or risk reduction) Health Awareness Team – department wellness liaisons Annual Health & Safety Fair – blood typing, skin cancer screenings, massages, etc. Challenge Activities – Lose It Linn County!; Walking Moai; Summer Fun Fitness Competition Healthy Lifestyle Education Seminars – exercise, nutrition, stress management Financial Education and Retirement Planning

7. Linn County Wellness Healthy Steps Newsletter – highlight wellness champions, Preventative Exams – 100% paid Smoking Cessation – 100% paid Blue Zones Certifications Employee Well-Being and Healthy Vending Policies On-site Fitness Centers Fitness Reimbursement Program Targeted disease management for top diagnoses

8. Linn County Wellness Annual screening is voluntary, currently at 50% participation. Compare results between participants and non- participants. Each employee’s point where they decide to change an unhealthy behavior is different and what causes them to change is different. A comprehensive program designed to engage ALL employees increases ROI potential.

9. Linn County Wellness Is it working? Engaged wellness vendor in 2005 Had resistance from AFSCME union/ULP Rebounded from that in 2007 Participation now up to 50% of ee population Low single digits increases in claims (3% last 6 years) even with blips in 2008 and 2013 Employee testimonials as to how participation in the wellness program has made them healthier, changed their lives, etc.

10. Linn County Wellness Health Solutions Data show the following: Average health claims for participants are lower Average workers’ compensation claims for participants are lower

11. City of Cedar Rapids Results

12. Comparison Trend 2013 & 2014 Same 789 Participants 12 108 participants In Summary… 1.61% of High Risk participants improved risk status 2.95% of Moderate Risk participants maintained or improved risk status 3.77% of Low Risk participants remained low risk status 2014 305 participants 376 participants

13. 13 Medical and Rx Claims Analysis

14. 14 *Total Employee, Spouse and Dependent Claims

15. 15 20122013 Number of Covered Members **14081392 *Total Employee and Spouse Claims **Includes Assessors, all Active City Employees, Linn County SLWST, Cobra and Retirees

16. 16 Member** Participants Member** Non-Participants Spouse Participants Spouse Non-Participants 201385255628893 201490648610896 *Total Employee and Spouse Claims **Includes Assessors, all Active City Employees, Linn County SLWST, Cobra and Retirees

17. 17 Total ParticipantsHigh RiskModerate RiskLow Risk 201491679295542

18. Workers Compensation Results

19. Linn County Worker’s Compensation Aggregate Trend 19 Total ParticipantsParticipantsNon Participants 2010541143 2011692247 2012621151 2013561937

20. Worker’s Compensation Participants versus Non Participants Total Spend per Year 20 Total ParticipantsParticipantsNon Participants 2010541143 2011692247 2012621151 2013561937 378% Net Difference

21. 21 Total ParticipantsParticipantsNon Participants 2008NA 2009NA 2010541143 2011692247 2012621151 2013561937 Worker’s Compensation Participants versus Non Participants Average Spend per Year

22. 22 *Total employee and spouse claims Program Overview $50.00 gift card for participating in annual HRA and health screening 45% of eligible employees participated in the annual HRA and health screening Follow up coaching is offered to high and moderate risk participants on a voluntary basis 8% of the total population participate in follow up coaching

23. 23 2006200720082009201020112012 Number of Covered Employees 805801808813825 826787 *Total employee and spouse claims Program Overview $50.00 gift card for participating in annual HRA and health screening 45% of eligible employees participated in the annual HRA and health screening Follow up coaching is offered to high and moderate risk participants on a voluntary basis 8% of the total population participate in follow up coaching

24. 24 Employee ParticipantsEmployee Non-ParticipantsSpouses 2009313500528 2010329496522 2011401425522 2012387452492 Program Overview $50.00 gift card for participating in annual HRA and health screening 45% of eligible employees participated in the annual HRA and health screening Follow up coaching is offered to high and moderate risk participants on a voluntary basis 8% of the total population participate in follow up coaching

25. Linn County Return On Investment Based on Medical Claims Analysis 25 2007 and 2008 247 Participants Savings $1,574 per participant = $388,778 total savings Total 2007 and 2008 Spend: $55,060 ROI 6:1 2009 313 Participants; 500 Non Participants Savings $2,725 per participant = $852,925 total savings Total 2009 Spend: $70,785 ROI 11:1 2010 329 Participants; 496 Non Participants Savings $3,745 per participant = $1,232,105 total savings Total 2010 Spend: $86,128 ROI 13:1 2011 401 Participants; 425 Non Participants Savings $4044 per participant = $1,621,644 total savings Total 2011 Spend: $72,465 ROI 21:1 2012 387 Participants; 452 Non Participants Loss $784 per participant = $303,408 net loss Total 2012 Spend: $74,741 ROI 1:3

26. Wellness Research A Harvard University report, published in the journal Health Affairs, found that the average medical cost savings per dollar invested in wellness programs was $3.27. Typically takes 3 years to see a 3:1 ROI; this means investing about $250 per employee annually on health and well-being. Lowering risk factors to their theoretical minimums (if possible) would reduce average annual costs per working-age adult by 18.4%. (January 2013, Journal of Occupational & Environmental Medicine) Align investments with goals Example: If health plan costs are increasing 7% annually per employee and the goal is 2%, an employer would have to reduce its trend by over $500 per employee plus the additional cost of the wellness program.

27. Wellness Research “The imperfect evidence that wellness programs reduce medical costs is better than the data corporate executives have for most key decision.” (David Anderson, Chief Health Officer for StayWell Health Management) 2012 employer study by StayWell Health Management and Towers Watson showed that: If you reduce health risks, lower costs accrue quickly, so immediate savings from risk reduction makes the financial case for prevention stronger. Financial implications for prevention may be greater than for risk reduction. For every health risk added, costs increased by 45% above the cost savings resulting from eliminating a risk. In other words, preventing employees from adding new health risk over time produces greater cost savings than focusing on eliminating a health risk after it emerges. A long-term solution is better than a quick fix – greater savings realized from reducing health risks for people with chronic conditions; cost savings were 4 times greater for those with CC who reduced their health risks compared to those without CC!

28. Wellness Research Other studies indicate that wellness programs can produce immediate savings in productivity-related costs, including reduced absenteeism, disability and workers’ compensation costs, as well as enhanced work performance. The combination of direct health care savings and indirect productivity savings support the business case for investing in a prevention-focused, population-based health management strategy.

29. Wellness Research Bottom line for employees is that if you start to change employee behaviors, you will start seeing health care cost savings quickly. An employer can save an average of $100 in health care costs per employee per health risk eliminated in the year of change, and $105 per risk reduced in the year following the reduction. But if healthy people don’t stay healthy and start accumulating new health risks, not only are savings negated but health care costs increase by $145 per employee per health risk added in just one year.