1. Employee Wellness Solutions
Kevin J. Klobucar
President and CEO
Blue Care Network of Michigan

2. Introduction
Rising health care costs and the fact that only about three percent of U.S. health care expenditures are for prevention and wellness while 97 percent is spent on acute and chronic illnesses indicated a need to develop a wellness based product that incorporated a partnered accountability approach
This need was supported by national polls that showed that U.S. adults thought that it was fair to ask people with unhealthy lifestyles to pay higher out-of-pocket costs
The approach that the Blues came up with aligned wellness with financial incentives and included the following elements:
Member accountability to follow a healthy lifestyle
Employer commitment to wellness
Primary care physician cooperation and support
Health plan tools and support
Healthy Blue Living℠, introduced in October 2006, was the first participation-based HMO health plan in Michigan to offer financial incentives to individuals for working toward healthy goals
Data Sources: Centers for Disease Control; Harris Interactive Health Care Poll

3. Health Plan Product Solutions
Healthy Blue LivingSM, the first of a family of wellness-based Blue products, has received an overwhelmingly positive response
Enrollment currently stands at more than 118,000 members and 900 groups as of August 2010
52 percent of the groups represent new HMO business
Employers have received premium reductions or reduced claim costs by approximately 10 percent
Other wellness based products followed:
Healthy Blue IncentivesSM – participation based PPO option was introduced in 2008
Healthy Blue OutcomesSM – PPO plan introduced in 2010 offers financial awards tied to member health outcomes
Healthy Blue Living RewardsSM – HMO plan recently introduced expands on original participation based Healthy Blue Living with an outcome-based component
The Healthy BlueSM family of products are wellness-based HMO and PPO plans from Blue Cross Blue Shield of Michigan and Blue Care Network that reward employees for making better health choices.

4. Healthy Blue LivingSM Product Design Overview
Healthy Blue Living is structured around six health measures that focus on high-impact health areas that individuals can manage. Measures selected based on potential to impact health care costs and likelihood that an individual will develop a chronic or disabling condition
Maximum benefit level with lower copays and deductibles is based on commitment to achieve wellness targets (Enhanced benefit vs. Standard benefit)
Program designed to promote partnership with primary care physician in achieving improved health outcomes
Health plan care management programs offered to support targeted areas
Employer commitment to support healthier lifestyles through worksite wellness programs, healthier meal options and smoke-free work environments
Health measure
Wellness target
Tobacco
Non-tobacco user
Weight
Body mass index below 30
Blood pressure
Below 140/90
Cholesterol
LDL-C below target (based on risk factors: <100, <130 and <160)
Blood sugar
At or below target (fasting blood sugar or A1C)
Depression
Any depression is in full remission

5. Healthy Blue LivingSM Three Year Results
Members in product for three years show improvement while others have opportunity
Good news:
52 percent of members who agreed to stop smoking did
14 percent of members who agreed to get weight under 30 BMI did
71 percent of members who agreed to get blood pressure under control did
55 percent of members who were identified as having high cholesterol are now at an acceptable level
61 percent of members who were identified as having blood sugar issues are now at an acceptable level
Concerning news:
25 percent of members who agreed to stop smoking are still smoking
75 percent of members who agreed to get their weight under control still have a BMI above 30
36 percent of members who agreed to get cholesterol to an acceptable level have not been able to
28 percent of members who agreed to get blood sugar under control have not been able to

6. Healthy Blue LivingSM Three Year Results
Claim utilization show cost associated with risk categories
Member Health Behaviors - Adults with Enhanced Benefits Only
Morbidity by Risk Category - Adults Only

7. Healthy Blue LivingSM Three Year Results
Weight Control was the area most resistant to change
After three years, 74.6 percent of members who agreed to get their weight under control still have a BMI above 30
Claims costs for those with a BMI above 30 were significantly higher than members without a risk factor
Prevalence of Obesity in Enhanced Group
Claim Costs PMPM - No Risk vs. Weight Risk
100
200
300
400
500
600
700
20-29
30-39
40-49
50-59
60-64
Age
Claims PMPM ($)
0.05
0.1
0.15
0.2
0.25
0.3
0.35
0.4
Percent Difference in Claim Cost
No Risks
Weight
Percent Difference in Claim Cost (Weight)
Note: Based on active HBL Members (as of January 1, 2009) with Enhanced benefits and a BMI over 30 on their most current qualification form (members with BMI’s lower than 30 were excluded)

8. Healthy Blue LivingSM Results Lead to Change
Changes in original Healthy Blue Living Product
Replaced alcohol use with depression as a health measure
Require on-line Health Risk Assessment annually
Require cotinine testing to determine smoking status
Urine test or blood test
Members with any health issue must participate in improving health for maximum benefit
Previously determined based on point system
Require members with a body mass index greater than or equal to 30 to participate in Weight Watchers® or Pedometer Program
Creation of next generation product, Healthy Blue Living Rewards, for groups with desire to promote wellness at a higher level
Outcome-based product with three tiers of benefit levels
Highest tier for members with no health conditions

9. Complementary Program Solutions
Workplace wellness toolkit for groups
Information on implementation of workplace wellness programs, healthy food choices, and smoke-free workplace environments
Health and wellness messages for employees (for example, paycheck stuffers, newsletters, articles to support communications , monthly health tips, posters and fliers for each month's national health observance)
Support tools through BlueHealthConnection®
Online Health Assessment and Digital Coaching
WebMD® Healthcare AdvisorSM, quality and cost information for providers and treatment options
24/7 Nurse Line
Quit the Nic Program, telephone based smoking cessation
Wellness Social Networks
Affinity programs to support wellness focus
Healthy Blue XtrasSM offers access to savings on groceries, fitness equipment and memberships, and weight loss programs from Michigan-based vendors
Blue 365® offers access to national health, wellness and fitness vendors

10. BCN Employee Wellness Works Program
Wellness Works was created to support BCN employee efforts to live healthier lives
Implemented smoke-free campus and offered free smoking cessation classes.
Placed automatic blood pressure machines in all facilities.
Marked indoor and outdoor walking paths at the facilities.
Changed the items in the vending machines to 75 percent healthy choices and 25 percent less healthy. Decreased the price of healthy food choices by 25 percent and increased the price of the unhealthy food choices by 25 percent.
Supplied employees with pedometers and health journals.
Offer $300 fitness reimbursement to all full time employees.
Hold onsite fitness classes
Utilization Measures
2008  
2009
Change
Hospital Admissions
72.3/1,000 
64.3/1,000
11.0% decrease
ER Visits 
300.2/1,000
268.4/1,000   
10.9%  decrease
Long Term Disability Cost per Employee   
$291
$257  
11.6%  decrease
Healthy Blue Living Employees
Agree to work on weight loss
26.7%
 36.8 %
37.8% increase
Cholesterol level in normal range
 77.1% 
   81.4% 
5.5% increase