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

City

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%

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

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

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

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

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.

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.

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

City of Cedar Rapids Results

Comparison Trend 2013 & 2014 Same 789 Participants 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 participants 376 participants

13 Medical and Rx Claims Analysis

14 *Total Employee, Spouse and Dependent Claims

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

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

17 Total ParticipantsHigh RiskModerate RiskLow Risk

Workers Compensation Results

Linn County Worker’s Compensation Aggregate Trend 19 Total ParticipantsParticipantsNon Participants

Worker’s Compensation Participants versus Non Participants Total Spend per Year 20 Total ParticipantsParticipantsNon Participants % Net Difference

21 Total ParticipantsParticipantsNon Participants 2008NA 2009NA Worker’s Compensation Participants versus Non Participants Average Spend per Year

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

Number of Covered Employees *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 Employee ParticipantsEmployee Non-ParticipantsSpouses 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

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

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.

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!

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.

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.