An Independent Licensee of the

Blue Cross Blue Shield Association

HRA Management Report 2005

2

Agenda

• Context for the program

• Background on the HRA report

• Major findings

• Interpretation of results

• Update on coaching activity

• The challenge ahead

• What’s needed next?

3

Health Cost Increases: The “Problem”

Another year of double-digit health cost increases

0%2%4%6%8%

10%12%14%16%

1990 1993 1995 1999 2000 2001 2002 2003 2004

Health Insurance Premiums Medical Inflation

Overall Inflation Workers Earnings

4

$1,160

$955 $955$906

$571 $568$520

$363

$1,931

$-

$200

$400

$600

$800

$1,000

$1,200

$1,400

$1,600

$1,800

$2,000

Depression HighGlucose

BMI >30 BMI >25 Stress Tobacco No Exercise High BloodPressure

HighCholesterol

Health risks push costs up!Yet preventable through lifestyle change

Average annual per capita excess health costs when risk is present.

Average annual per capita excess health costs when risk is present.

Goetzel, R et al.  The Relationship Between Modifiable Health Risks and Health Care Expenditures,  Journal of Occupational and Environmental Medicine.  1998;10:843-854

5

Effect of single risk factors

150%

140%

131%

118%

116%

0% 50% 100% 150% 200%

Mental Health

Back pain

Stressed

No Exercise

Obesity

Source: Serxner, S., et al., (2001). The impact of behavioral health risks on worker absenteeism. JOEM, 43(4), 347-354

Percent higher sick leave absenteeismPercent higher sick leave absenteeism

N = 35,451

6

Effect of single risk factors

255%

556%

836%

1243%

1989%

0% 500% 1000% 1500% 2000% 2500%

Low Life Satisf.

No Exercise

Poor Health

Smoking

Low OWS

Source: Musich, S., et. al., (2001, June). The Association of Health Risks with Workers’ Compensation Costs, JOEM,, p. 534-541.

Percent higher Workers’ Comp costPercent higher Workers’ Comp cost

N = 3,388 X 4 years

7

Effect of multiple risk factors

8.1

3.72.8

1.81.0

0123456789

0 1 2-3 4-5 6+

Multiples of annualhealth care costscompared to someonewith no health risks

Number of Health Risks

Mu

ltip

les

Source: Yen, Louis, et al., (1991, Sept/Oct). Associations between health risk appraisal scores and employee medical claims costs in a manufacturing co., AJHP, 6(1), p. 46-54.

Multiples of Annual Health Plan CostMultiples of Annual Health Plan Cost

N = 1,838

8

Preventable claims costGroup Level health care expenditures

75%

25%

Not Related

Preventable

Source: Anderson, et. al., (2000, Sept/Oct). The Relationship Between Modifiable Health Risks and Group-Level Health Care Expenditures, AJHP, 15(1), p. 45-52.

DepressionStressBlood SugarSmokingObesityBlood PressureSedentary Life

N = 46,026 X 6 years

9

Wellness has evolvedROI goals determine model

10

Summex Health ManagementStrategic approach

Control costs by reducing risks

• Maximize HRA participation• Identify health risk cost

drivers• Reduce risks through

coaching for behavior change• Incent people for wellness• Keep low risk low• Measure outcomes• Determine ROI

11

University of Alaska The THAW Program

1. Tri-Fold brochure sent to participants homes

2. Mayo Clinic Self-Care Guide sent to participant homes

3. Deploy Online HRA4. Paper HRAs sent to all non-participants5. Incent HRA ($100 Benefit Credit)6. HTML EMAIL Weekly Campaign 7. Enroll into IMPACT™ and IMPACT™ MR

12

• Participation – 2,927 HRA Participants = 45.7%

Participation Rate • 58.4% of Participants were Female

• 41.6% of Participants were Male

• 26.3% of Participants were spouses

• 73.7% of Participants were employees

• 28% were paper

• 72% were online

University Of Alaska HEALTH MONITOR™ HRA

45.7%54.3%

HRA

No HRA

13

Risk Status of HRA Completers

54.3%45.7%

HRA

No HRA

24.3%

26.0%

49.7%

0.0%

20.0%

40.0%

60.0%

80.0%

100.0%

Risk Status

High

Moderate

Low

N = 2,927

N = 6,399

14

Risk status of HRA completers

24.3%

26.0%

49.5%

0.0%

20.0%

40.0%

60.0%

80.0%

100.0%

Risk Status

High

Moderate

Low

Total Eligible = 6,399

N = 2,927

<76.3

76.4 to 80.4

>80.5

(1,449)

(764)

(714)

15

Are HRA participants healthier?

$406.50 $408.64

$0

$50

$100

$150

$200

$250

$300

$350

$400

$450

2005*

HRA Group

All UoA

Per Member Per Month (PMPM)

Source: Premera, Knowledge Services

* = 7/1/2004 to 6/30/2005

16

55.6%

44.4% 45.6% 47.7%

0.0%

20.0%

40.0%

60.0%

% o

f c

am

pu

s p

art

icip

ati

on

Campus Breakdown

Campus HRA Participation

SW UAA UAF UAS

17

University of Alaska Multiple Risk Factor Prevalence

18

Cost of Multiple Risk Factors Multiple risks multiply costs

8.1

3.72.8

1.81.0

0123456789

0 1 2-3 4-5 6+

Multiples of annualhealth care costscompared to someonewith no health risks

Source: Yen, Louis, et al., (1991, Sept/Oct). Associations between health risk appraisal scores and employee medical claims costs in a manufacturing co., AJHP, 6(1), p. 46-54.

Number of Risks

Mu

ltip

les

19

Overall Wellness Score (OWS)Risk Factors Used in OWS

• Aerobic• BP• Weight• Stress• Fat• Cholesterol• Alcohol• Lift• DUI• Seatbelt• Speed• Screen• Self Care• Depression• Pre-Diabetes• Tobacco• Multi-CVD• Multi-Stroke• Multi-Psych

20

Overall Wellness Score

Average OWS

70

72

74

76

78

80S

W

UA

F

UA

S

UA

A

U o

f A

KT

otal

Sum

mex

Dat

abas

e

OW

S

21

Overall Wellness ScoreComparison of U o A with Summex database

0

510

1520

2530

3540

45

<75 75-79 80-84 85-89 90-100

Overall Wellness Score

% P

artic

ipan

ts U of AK

Database 2004

22

Identifying your “low hanging fruit”

• Intervention Opportunity Index (IOI)• Located on page 27 & 28 of

the management report• “Low hanging fruit”

• The IOI ranks your organization’s top risk factors based on:

• Your risk prevalence• Your excess costs• Your readiness to change

• Your top “3” IOIs• CVD prevention• Physical inactivity• Stress

23

#1 IOI Target:Cardiovascular Disease Prevention

24

Cardiovascular Disease RisksParticipants with multiple risks

25

#2 IOI Target:Inactivity

26

University of Alaska Weight management

27

#3 IOI Target:Stress management

P roblems w ith Stress

68.967.7

6061626364656667686970

U of AK Summex Database

Perc

enta

ge a

t Ris

k

Stress A ffec ts Health

40.236.9

202224262830323436384042

U of AK Summex Database

Perc

enta

ge a

t Ris

k

28

University of Alaska Readiness to change profile

29

pre-contemplation

contemplation

preparation

action

maintenance

Risky behavior

Permanent behavior change

IMPACTTM Stages of Change

• Pre-contemplation

• Contemplation• Preparation• Action• Maintenance• Termination

termination

High-risk individuals will change health behaviors given the right coaching at the right time.

30

• Engaging

• Lifestyle-focused

• Goal-oriented

• Personal

• Confidential

• Supportive

IMPACTTM

Personal health coaching

“About 40% of high risk move out of high risk the first year of coaching.”

31

• Welcome Kit or Physician Letter

• Telephone & mail-based counseling

Impact: Up to 12 counseling sessions per year

Impact MR: Up to 6 counseling sessions per

year

Stage-of-change protocol

• Personal health journal

• Integration of health resources: EAP, DM, worksite

activities

• HEALTHSTAGESTM

change guides

• Quarterly management reports

IMPACTTM and IMPACTTM MRPersonal health coaching

32

IMPACT™• 1,189 enrolled (82.0%)

IMPACT™ MR• 440 enrolled (57.6%)

As of February 1, 2006

Current IMPACTTM Program Personal

health coaching

33

What needs to happen now

• Statewide is not driving the site-based wellness activity, so…

• Each campus needs to organize for wellness and…

• Then focus on the IOIs– CVD prevention– Inactivity– Stress

34

Virtual and site-based wellness: Options for University of Alaska

VirtualVirtual

Site-basedSite-based

++ ++ ++ ++ ++ ++

35

• CVD prevention?– Cholesterol?– Blood pressure?– Weight management?– Tobacco use?– Nutrition?

• Inactivity?

• Stress?

What can be done?

36

Summary of Key Points• Health risks drive a large proportion of your health

costs.• You have made an excellent start! (45.7%)• The infrastructure for measurement and

intervention with individuals is in place.• Awareness and coaching are usually required for

behavior change.• There is much that can be done at each location.• Each location must organize and conduct

programming and help create healthy cultures.• Volunteers are available.• Site leadership is needed.• Wellness produces benefits and value for

everyone.

37

Questions