“I have long been profoundly convinced that in the very nature of things, employers and employees are partners….that in the long run the success of each is dependent on the success of the other” John Rockefeller, Jr

April 27, 2011

Implementing a “Best Practice” Wellness Program

♥ Health Status of America ♥ Cardiovascular disease is the #1 cause of death and disability

(American Heart Association, 2006)

Most health care spending (1.6 trillion) is on chronic disease care – heart disease, stroke, diabetes, and asthma. (Dept of Health and Human Services, 2003)

Overweight, physical inactivity, tobacco (modifiable risk factors related to lifestyle) account for 50% of all premature deaths and 25-50% of all health costs (Health Promotion Advocates, 2006)

Majority of patients with chronic diseases are inadequately treated (Bodenheimer, 2002).

Americans receive only 55% of health recommendations (Asch, et, al, 2006)

Why Wellness…and Why Now? Poor Health Status Aging Workforce 46 Million Uninsured Baby Boomers System Focus on Sick Care “Tyranny of the Urgent” Poor Quality of Care Obesity Epidemic Diabetes in Children

The Perfect Storm!

National Prevalence of Health Risk

21%30% 30%

67%

0%10%20%30%40%50%60%70%80%

smoke highcholesterol

high BP overwt/obese

inactive poor diet

CDC, BRFSS, 2002

78% 80%

Why Worksites? No end in sight for double-digit increases (and NO Plan!)

85% of the health care dollars spent on 15% of the population

72% of disease is preventable – yet 3% spent on prevention

Working population is aging, with greater health risk

75% of Americans are connected to worksites

Employees spend most awake time at work

Workplace initiatives reach into families and communities

Berkshire Health Systems 3,600 employees Mean age 46 75% Female Self-insured (5 plans) Health costs total

$32 M 600 RNs - unionized Key top 5 cost

drivers MusculoskeletalCancerIll-definedDigestiveCardiovascular

Program HistoryAccent on Health

Community Outreach

Education Screening

2000

External Worksite

s

Education

Screening

Coaching

2003

BHS

Wellness

at Work

2005

Increase inExternal Worksites

OCC Health

Community

Health Van

2007 - 2010

What is a “Best Practice” Program?

“Best Practice” in health promotion is the set or sets of continually evolving actions (utilizing science-based evidence) and associated attitudes which are most likely to achieve health promotion goals in a given situation, and which are consistent with the values of health promotion.

Kahan/Goodstadt, 1998

“Best Practice” Health Management Strategy

HERO “Best Practice” Program Design Health Enhancement Resource Organization www.thehero.org

WELCOA's Seven Benchmarks Wellness Councils of America www.welcoa.org

5 Fundamental PillarsDee Edington, Zero Trends, 2009

Goetzel and MEDSTAT Group at American Productivity and Quality Center. A 25% reduction in costs can be realized with a best practice program.

Wellness Leadership Team

Chief Financial Officer VP Human Resources VP Strategic Planning and

Development Chairman, Department of Medicine VP Home Care Division Director of Wellness and Outreach Wellness Coordinator

BHS Guiding Principles1. Driven by Senior Leadership2. Build a multilevel program3. Target the most important health issues4. Offer something for everyone5. Communicate - communicate6. Reward successes7. Allow outcomes to drive the strategy8. Make it sustainable9. Commit to a “culture of health”10. Keep it fresh and fun!

Wellness Program Goals To improve employee health and well-being To achieve an age-adjusted “below industry” average cost per covered life. To create a “culture of health” To improve the perception of BHS as a leader in Wellness within the greater Berkshire County community.

HealthyEmployees

Promotion of healthy lifestyles Healthy Culture

Follow up

Early detection and prevention

Customized risk

reduction

Confidential

Early interventi

on

ReferralsOngoing support

Easily accessible

Strategies to improve Health and Wellness

Core Program Components Health Risk Assessment (HRA)

Insurer HRA vs. Vendor – Access to our own data Screening (Biometrics) Coaching for high risk employees Connect to Primary Care Programs addressing common risks Utilize internal resources vs. purchase Focus on confidentiality Different types of incentives Visible culture change

GOAL: Continue to grow participation!

Sent: Wednesday, January 11, 2006 9:05 AMSubject: Wellness Meeting The proposed agenda for the meeting this afternoon is below. 

Agenda• Status of current participation and findings • HRA, screenings, classes, risk factors, etc• Space progress • Staffing • Dietician progress • Budget update • Communication • Most of next Scope dedicated to Wellness• Letters home • Plans for raffle drawings • Incentives • New Live longer in 2006 proposal • Alternative ideas

Time permitting, review other standing agenda items

Agenda 2006

Prevention Screenings Promotion

- fitness- education- nutrition

Health risk assessment

Targeted risk reduction programs

Risk modeling

Nurse advice line Decision support Web tools Consumer

directed plans

Diseasemanagement

Incentive design Self management

training

Case management

Predictive modeling

85% members = 15% cost

15% members = 85% cost

Well Risk Urgent Disease

WellNo Disease

At RiskObesity High Cholesterol

Acute Illness/Discretionary Care

Doctor VisitsEmergency Visits

Chronic Illness Diabetes

Coronary Heart Disease

CatastrophicHead Injury

Cancer, MI, Stroke

Address the entire care continuumStop risk progression (Don’t’ get worse)

Mercer Human Resource Consulting

Healthyemployees

Employees with

isolated risk

Employees with highblood pressure,

cholesterol,or pre-diabetes

Employees with diabetes, post

stroke,MI, PAD

Website with HRAHealthy StepsChallengesNutrition programsFitness programsWorklife programsFitness benefitSmoke FreeFun eventsBack Health Self-Care

Tobacco TreatmentWeight WatchersWeight benefitNutrition counselingModified CoachingEAP

Health Coaching

“Hardwired for Health” (8-week lifestyle classes)

Pre-Diabetes Classes

Early Intervention Program

Diabetes EducationCardiac RehabOP RehabCHF programCancer Support

Offer Something for Everyone All program components are cumulative

Program Staff

Total

Mgmt

RNs

Support

3.5 FTEs

.5 Director

1 RN

1 Prog Coord1 Assistant

4.5 FTEs

.5 Director

2 RNs

1 Prog Coord1 Assistant

5.5 FTEs

.5 Director

2 RNs

1 Prog Coord1 Assistant.8 RD /.2 EAP

5.3 FTEs

.44 Director/Mgr.19 Business Mgr

2 RNs

.5 Hlth Ed

.5 Prog Coord1 Assistant.6RD/.1 EAP

5.2 FTEs

.38 Director/Mgr.12 Business Mgr 2 RNs

.5 Hlth Educator.5 Prorgam Coord 1 Assistant .6RD/.1 EAP

Staff 2006Year 1

2007Year 2

2008Year 3

2009Year 4

2010Year 5

•YR 2 Added 1 RN to accommodate employees (Increase coaching)•YR 3 Added Registered Dietician (increase focus on weight reduction) Added EAP counselor (increase EAP utilization for high% depression)•YR 4 Skill mix (Program Coord/Health Educator) non-RN strategy for mod risk employees

Integration with OCCH so added Business Manager •YR 5 1FTE Health Educator

Program GrowthHistory 2006

Year 12007

Year 22008

Year 32009

Year 42010

Year 5

HRA 705HFIT

1186HFIT

1051HFIT

1418ScoreHeal

th

1,352

BiometricsScreening

953 1227 1250 1348 1,238 (Risk 4 not req)

Incentives

$3000 for participation

$25 per employee for

HRA/screening

$6000 participation

Connection to benefits$350/700

$6000 participation

Same Same

Benefits requiremen

ts

None None 1) HRA2) Screening

1) HRA2) Screening3) Self Care4) Flu/declin

1) HRA2) Screening3) Action4) Flu/declin

Benefits Design

None None BCBS planHMO Blue +

Wellness

Wellness HNE plan

BCBS/HNE wellness

Program Participation

22%30%

16%

52%

37% 38%29%

53%

33%39%

31%

61%

44% 42%

54%

92%

HRA Wellness Screenings Completed Both Screening andHRA

Program "Touch Points"(Number of employees

completing at least one initiatve)

2006 2007 2008 2009

OCCUPATIONAL HEALTH AND WELLNESS

2010-2011 SEASONAL FLU VACCINE REPORT

 

TOTAL SEASONAL FLU VACCINE DOSES ADMINISTERED 2271

       

Employees (BMC, BFS, BMS)

Medication Total Employees Total Percentage

SEASONAL FLU VACCINATION: 2501  1838 73.49%(RECEIVED ELSEWHERE INCLUDED = 184)      

SEASONAL FLU DECLINATIONS   642 25.67%EMPLOYEE COMPLIANCE 2480 99.16% 

Non Scheduled and Non-BHS Employees

Medication Totals

SEASONAL FLU VACCINATION 433SEASONAL FLU DECLINATIONS 47

Programs Targeting Major Health RisksRisk Data (n=1,348) ProgramsCVD/Diabetes HTN – 9%

PreHTN – 27%Non-HDL >160 – 21%BMI 25-29 – 29%BMI >30 - 25%Risk 1 & 2 – 43%Diabetes - 3%

Screening/coachingBP sweepsNutrition counseling/programsPrediabetes classesSelf directed and group challengesWeight Watchers - Healthy Steps - Walk It Off - Weight managementFitness benefit – THR program

Depression(EE BCBS Claims)

123 employees EAP – Worklife CoachResilience/stress programs

MSC injury(EE Claims & WC)

290 employeesArthritis/back/neck/joint/soft tissue(6 hip and 2 knee repl)

MSC task force recommendations (ex. Early Variance Program)Fitness incentive and programsWeight management

Cancer (EE Claims)

135 employees(breast, colon and skin)

Weight management/PAScreening programs

Average change in 1,322 EE’s who had 2 screenings in past 5 years

First Last Change

Chol >=240 135 128 ↓2%

Non-HDL >= 160 346 306 ↓1%

Borderline Chol 398 350 ↓4%

Optimal Chol 789 844 ↑4%

Stage 2 HypertensionBP >=160/100

24 5 ↓1%

Stage 1 HypertensionBP 140-159/90-99

128 54 ↓6%

Pre-HypertensionBP 121-139/81-89

453 400 ↓4%

Optimal BP< =120/80 717 863 ↑11%

Changes in Blood Pressures 2006-2009 (n=1,322)

0

0.1

0.2

0.3

0.4

0.5

0.6

0.7

Optimal BP(<120/80 mmHg)

Prehypertension120-139/80-89

mmHg)

Stage 1 HTN (>140-159/90-99

mmHG)

Stage 2 HTN(>=160/100 mmHg)

Initial Screening Last Screening

11% increase in Optimal BP4% reduction in Prehypertension6% reduction in Stage 1 HTN1.7% reduction in Stage 2 HTN

Changes in Risk Levels 2006-2009 (n=1,322)

14%

28%

54%

4%

20%

32%

43%

5%

0%

10%

20%

30%

40%

50%

60%

Low Risk Moderate Risk High Risk Very High Risk

Initial Screening Last Screening

Referrals Into the SystemBHS delivers excellent health programs and services to our community. Our BHS referral network is utilized to help support our employees and their families achieve optimal health and wellness.

EAP

Mammography Colonoscopy

TobaccoTreatment

PCPDiabetesEducation

Lab

CardiacRehab Nutrition

BPReferrals

2009 Referrals

38 42

57

358

84

2191

166

39

156

BHS Cardiovascular Health Risk Reduction Program

Independent analysis Conducted by Lifestyle Research Group & Brigham Young University 502 BHS employees, participants in wellness screening process 2006-2007 Research question: Did health

risk improvements occur between an initial nurse wellness screening encounter and a follow up screening?

Aldana Summary (2009)The Berkshire cardiovascular risk reduction program works:

96% of employees improved at least one risk factor For entire population significant decrease in total and non-HDL cholesterol High risk patients decreased risk most dramatically (the goal of the program) including:

• Systolic BP (149 to 133) (P<0.0001)• Diastolic BP (95 to 84) (P<0.0001)• Total cholesterol (P<0.0001)• Blood glucose in diabetics 145 to 109 (P<0.0001)

Program Highlights“Walk with Me” in the Berkshires

BHS organized, County-wide effort 2009 (7th year): 2700 participants 1200 BHS, 1500 community

“Live Younger” Challenge Robust incentive program rewarding program participation, health improvements and maintenance of healthy behaviors and “low risk” status

Over 250 participated to date!

Colonoscopy Incentive

Employees receive 8 hours earned time for baseline colonoscopy at 50, 4 hours for spouse colonoscopy

183 participants to date! (employees & spouses)

Weight Watchers

400 participants… 1.5 TONS LOST!

Health Cost Savings

Everything that can be measured doesn’t always matters, and everything

that matters, cannot always be measured.

BHS Health Cost Trends compared to Milliman Medical Index

7.7% 7.4%

17.3% 16.2%

3.3%

8.4%

0.00%

5.00%

10.00%

15.00%

20.00%

2007 2008 2009

Milliman Index

BHS

Employee PMPM Wellness Standard Wellness vs. Standard

Medical PMPMDrug PMPMTotal PMPMPMPM Net Claims> $30,000

$450.70$98.88

$548.58$432.63

$517.65$109.90$627.55$455.35

-14.9%-12.3%-14.4%-5.3%

% of EE >Age 45 56.7% 60.1% -6%

Inpatient Admissions/1000Average Cost Per Admission

69.8$11,512

90.8$14,921

-30%-29.6%

Average Paid Per Employee Claimant

Wellness Standard Wellness vs. Standard

Osteoarthritis (non-spine)Musculoskeletal (spinal conditions)Obesity and lipid disordersGastrointestinal

$16,017$6,593$7,286$8,622

$35,376$9,478$8,968$8,968

-120.9%-43.8%+11%-4%

Increase in Employees Using Prevention RX

Wellness Standard

AntihyperlipidemicsAnti-hypertensivesBeta Blockers

+36%+24%+36%

+11%+2.5%-8.4%

Berkshire Health Systems – 2009 Health Care Cost Savings

Health Cost Trend Differential $2,135,268Differential of BHS cost vs. national average (Milliman Index)IF BHS incurred same rate as benchmark (7.4% vs. actual 3.3%) = would result in another 2.1 million spentBHS cost with 3.3% increase $29,793,267, Milliman 2009 cost increase of 7.4% - $31,928,535BHS cost differential 31,928,535 – 29,793,267 = $2,135,268

Shift in Multiple Health Risk Prevalence Shift in number of employees with 0-1, 2-3, 4+ risk factors $35,000*0-1 Risk factors = average cost $1,3892-3 risk factors = average cost $1,7304+ risk factors = $2,701Savings estimated due to severity of risk factors used (i.e. smoke, stage 1 & 2 HTN, cholesterol >240 and BMI >30)and exclusion of costs related to lifestyle-related factors(American Journal of Health Promotion, 15(5) 2001.

Weight Reduction (60 employees) $84,000(Criteria – moving from BMI of >30 to <=29 or from overweight to optimal weight)$1,400 x60 (Data Watch July 2009)

Tobacco cessation (50 employees) $236,500(Criteria – 6 months or longer tobacco free) $4,730 x50 (Inquiry 41:1,2004)

Influenza vaccination (2365 employees) $32,305(Criteria – flu vaccination in 2009)$13.66 x2,365 (Centers for Disease Control, February 2006)

Colonoscopy Screening and Early Detection6 cases of adenomas >1cm in 67 employees/spouses 10-15% of adenomas >1cm progress to Colon CancerExpected Cost of Medical Services related to colon cancer survivor (initial treatment x average yearly cost) $141, 000 (Emedicine via WebMD, December 2009)

Total cost avoidance $2,664,070Total cost of program 2009 (cost of related services and salaries) $692,000 Program Return on Investment 3.84 to 1

Total Health ManagementOpportunities for Engagement

Injury ManagementDrug Free Worksite ProgramX-ray and physical therapy services Ergonomics, vision/hearing testing Pulmonary function and computerized respiratory fit testingPre-employment physicalsComprehensive vaccination program Environmental exposure lab testing

Electronic HRA’sWellness Screenings (Risk ID)Personal Health CoachingNutrition ConsultationsLifestyle programming: nutrition, physical activity stress management, etc. Employee Assistance Program

BHS Wellness Program Components

Traditional OccHealth Services

C.E Koop Honorary Mention 2009 and 2010 Best practice

design Evidence-based Risk reduction

and/or cost reduction outcomes

Strong evaluation methodology

HERO Scorecard