Cbiz Wellness Webinar Slides
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Transcript of Cbiz Wellness Webinar Slides
Strategies to Enhance the ROI of Wellness ProgramsWebinar
September 14, 2011
Agenda
• Introductions
• Current Landscape
• A Strategic Wellness Framework
• Wellness Interventions
• Total Health Management
• Recent Trends
– Onsite fitness
– Onsite clinics
2
The Landscape: Medical Costs and Access
• Medical cost inflation continues rapidly (8-10%)
• 2011 health care spend estimated at $3 trillion
• Health reform bill mandates coverage and penalizes employers to pay the costs, but does little to address the rising cost of health costs, unhealthy behaviors, or the current fee for service medical payment model
• The current bill increases access to care in a system that is already at capacity- 32 million more patients will now have access to the same number of physicians
• Reduction in Medicare and Medicaid reimbursement schedules has hospitals and physicians looking to private insurance to fill the gap
*Source: Segal, Kaiser, Aon studies 3
The Landscape: Health Continues to Decline
• Out of 100 U.S. adults….– Only three are non-smokers, not overweight, are physically
active, and eat a healthy diet
• 60% of healthcare expenditures are attributable to preventable illness or modifiable risks
• For every 100 employees….– 20% of healthcare expenditures are attributable to preventable
illness– 40% of healthcare expenditures are attributable to modifiable
risk– 11,500 hours of productivity per year are lost due to health
conditions
• Inpatient hospital stays represent the largest portion of medical inflation
*Source: CDC, Segal 2011 Study 4
What does this mean for the employer?
“It is not the strongest of the species that survives, nor the most intelligent, but the one most responsive to change.” Charles Darwin
•Employers have a unique ability to change the trend if
they are willing to adapt
•Requires a comprehensive strategy that addresses:•Plan design that supports the population’s unique needs- driven
by analytics
•Access to high quality and high value care that is convenient
•Employee engagement: From participation to outcomes
•Coordination of clinical and various vendor resources
5
Keys to Success
Employee Engagement
ConsumerismTotal Health
Management
6
7
Wellness Framework: Six
Components
© Copyright 2011 – CBIZ, Inc. NYSE listed: CBZ. All rights reserved
Organizational
Commitment
Sustainable Operating
Environment
Outcomes and Quality
Assurance
Data Analysis and Strategic
Plan
Engagement and Rewards
Benefit Plan Design and
Intervention
Quality of Work/Life Approach
Population Health
Management
Traditional Approach
Morale Oriented
Participation Oriented
Results Oriented
Fun activity focus
Create awareness
Generate interest
Educate
Voluntary
No risk reduction
No high risk focus
No meaningful
incentives
No link to benefit plans
No three year strategic
plan
No specific
goals/scorecard
No personalization
No spouses included
Broader access to
education and on-line
programs
Assess population risk
with health risk
assessment/biometrics
Modest incentives for
participation
Tracking participation
Wellness Committee
Modest evaluation
Modest risk reduction
Mostly health focus
Voluntary
Some personalization
Few spouses
Modest (annual) planning
Modest goals
Broader range of evidence-
based, interactive programs
Integration of providers to
provide member centric
focus on overall wellbeing
High engagement strategies
Behavioral coaching, disease
management, EAP utilization
Strong risk reduction
Strong high risk focus
Major use of external and
intrinsic motivators
Required activity
Strongly personal
Developed three year strategic
plan
Rigorous evaluation/scorecard
Spouses and dependents served
8
Strategic Plan for Population Health Management includes the following broad objectives:
– Year One: Branding/Culture/Organizational CommitmentDefine Vision and StrategySetting ExpectationsRewarding Participation
– Year Two: Rewarding Participation and ImprovementExpanding EngagementCapturing Process and Impact
– Year Three: Rewarding Participation and AchievementReporting OutcomesReturn on Investment
9
10
Awareness and
Education
Participation and External Motivation
Engagement and Intrinsic Motivation
Improved Wellbeing,
Vitality, and Energy
Greater Performance and Positive
Clinical Impact
Intervention and Engagement Progression Flow
Participation to Outcomes Achievement Matrix
• Goal: change over the long term
– Organization working to maintain the change
– Individuals working to maintain the change
Year One Year Two Year Three
Employee Engagement and Reward
Meets ParticipationCriteriaSaves $20 per monthGoal: 60%
Non Participant pays additional $20 per month
Meets Participation Criteria and improves biometrics over Year OneSaves $30 per monthGoal: 30%
Meets Participation CriteriaSaves $15 per monthGoal: 50%
Non ParticipantPays additional $30 per month
Meets Participation Criteria and achieves specified biometricsSaves $40 per monthGoal: 60%
Meets Participation CriteriaSaves $20 per monthGoal: 30%
Non ParticipantPays additional $40 per month
Employee ParticipationCriteria
•Biometric Screening•Health Risk Assessment•Annual Physical/Medical Home•Preventive Screenings•Wellbeing Planning Session•Non tobacco user
•Biometric Screening•Health Risk Assessment•Annual Physical/Medical Home•Preventive Screening•Wellbeing Planning Session•Non tobacco user•2 Intervention programs•DM if chronic condition•Pregnancy program if applicable
•Biometric Screening•Health Risk Assessment•Annual Physical/Medical Home•Preventive Screening•2 Wellbeing Sessions•Non tobacco user•3 Intervention programs•DM if chronic condition•Pregnancy program if applicable
11
Engagement Strategies to Enhance ROI• Provide autonomy, employee decides their choices, creates accountability = Self-directed
• Enhance the employee’s belief that they can do something (exercise regularly, quit smoking), and provide the opportunity to get incrementally better at something that matters to the employee = Self-efficacy and Mastery
• Enhance the employee’s belief that a particular behavior will produce a desired consequence (quitting smoking will help them breathe better when playing with kids) = Behavioral efficacy
• Provide opportunities that are part of or impact the employee’s personal purpose, meets their unique needs and interests = Purpose. Provide a session for employees to create their personal purpose that includes their passions, long-term goals and current priorities
• Create an environment that:
– makes people feel good about participating; positive marketing
– Little or no cost to employee (cost barrier removed)
– Is as open as possible: interventions are readily available and accommodating, they fit into employee’s lifestyles and schedules (access and time barriers removed)
– Shows employees how to (not telling “what to do”) perform the actual behaviors they should perform, how to integrate the behaviors into their lives and how to change their environment outside of work so they can practice the behaviors (experiential learning)
12
13
ROI Measurement: Scorecards and Dashboards
Measure Year One Year Two Year Three
Total Employee Count
Number of Employees Eligible for Medical Plan
Number of Total Members Enrolled in Medical Plan
Number of Employees Enrolled in Medical Plan
Number or percentage of members in a Consumer Driven Plan Design
Male Employee Population in Medical Plan 80.30%
Female Employee Population in Medical Plan 19.70%
Employee Average Age 41.1
Number of Dependents Enrolled in Medical Plan
Child Dependents in Medical Plan
Female Adult Dependents in Medical Plan
Male Adult Dependents in Medical Plan
Member Demographics by Age Band
<01
01 - 19
20 - 29
30 - 39
40 - 49
50 - 59
60 - 64
65+
Measure Year One Year Two Year Three
Health Risk Assessment 92
2011 Weight Loss Challenge (10% of body weight)
2011 Walking Challenge (150 miles)
Routine Annual Physical Exam
Preventive Screenng
Biometric Screenings
Non-Tobacco Waiver
Two organization-wide intervention programs engagement
Measure Year One Year Two Year Three
HRA Participation Total (employees) 92 (4%)
HRA Participation Total (dependents) 0.0%
Male Population in HRA 42.0%
Female Population in HRA 58.0%
Average Age 38.7
Wellness Population Score
Risk Stratification
Low Risk (0-2 risks) 68% (norm* 71.0%)
Medium Risk (3-4 risks) 28% (norm* 20.0%
High Risk (5+ risks) 4% (norm* 9.0%)
Most Prevalent Population Risks based on HRA data:
1. Overweight/Obesity (BMI > 27.5) 39% (norm* 32.9%)
2. Stress 25% (norm* 21.9%)
3. Physicial Activity 12.0%
4. Life Satisfaction 15% (norm* 13.7%)
5. Medication for Relaxation 24% (norm 13.6%)
6. Blood Pressure 12% (norm* 21.9%)
7. Tobacco Use 7.6% (norm* 8.5%)
Top Self Reported Health Conditions:
1. Allergies 45% (norm* 29.2%)
2. Back Pain 34% (norm* 15.3%)
3. Heartburn/Acid Reflux 20% (norm* 13.9%)
4. High Cholesterol 17% (norm* 17.5%)
5. Arthritis 12.0%
Po
pu
lati
on
De
mo
grap
hic
s
Wellness Scorecard
[Date]
HR
A R
ep
ort
Dat
aQ
ual
ifyi
ng
Eve
nts
Par
tici
pat
ion
Measure Year One Year Two Year Three
Screening Participation Total (ee's only)
At Risk and Obese BMI (BMI > 25)
At Risk Waist Circumerence (male > 40, female > 35)
Pre-Hypertension/High Blood Pressure (Stage 1 & 2)
High Cholesterol (> 200)
Pre-Diabetes (Fasting)
High Glucose (Fasting and Non-Fasting)
Members with Chronic Conditions (Diabetes, High BP, High Choles., Asthma)
Members with Chronic Conditions (Stress and Anxiety, Depression)
Top Number of Prescriptions (per 1,000) Year One Year Two Year Three
Antidepressants 603.1
Lipotropics 432.3
Diabetic therapy 298.9
Antiarthritics 230.0
Bronchial Dilators 222.2
Anti-ulcer/gastrointestinal 188.8
Measure (Benchmark is 80%) Year One Year Two Year Three
Hypertension/Cardiac 84.4%
Diabetes 83.3%
Cholesterol 91.9%
Depression 86.3%
Antipsychotics 88.5%
Asthma 74.1%
Osteoporosis 87.2%
Bio
met
ric
Scre
enin
gsM
edic
atio
n A
dh
eren
ce R
ate
Pre
scri
pti
on
Cla
sses
• Low hanging ROI fruit:– Annual Exam and Preventive Screenings– Medical self-care– Flu vaccinations– Stress/resiliency programs– Injury prevention: work, home, vehicular and recreational– High risk pregnancy prevention program– Tobacco cessation program with NRT– Positive communication, communication, communication6 – 18 month ROI
• A Way to Approach ROI:– First focus on impacting risks and costs associated with the health plan– Second, look closely at absence and sick leave costs and those than can be
affected by a wellness program– Third, reduce workers compensation risks and costs– Fourth, focus on reducing risks and costs associated with disability– Finally, review the ‘harder to measure’ areas that can be positively impacted,
including work effectiveness, employee morale, productivity, decision-making ability, improved service and increased revenue generation potential
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TOTAL HEALTH MANAGEMENT = VALUE
Wellness Center
Plan Design Value Based
Benefits
Wellness and Condition
Management
Physical Activity
Safety and Occupational
Medicine
High Performance
Networks
Communication and Education
Consumerism and employee engagement
Absence Management
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Sustainable Operating Environment Interventions – Onsite FitnessGoals Typically Considered:• Convenience, removes barriers to access, and medium for other wellness programming• Cultural message in support of wellnessGeneral Considerations: • Space planning and construction, budgeting for equipment purchase and maintenance• How will each individual get access to the fitness center?• What will the hours of operation be? Will you have cameras or key cards?• Will it be staffed by a fitness professional? Concern for an individual working out alone?Policies and Procedures:• Individual must complete a pre-activity screen• If there are any cardiovascular risk factors they must have a signed physician release form• Develop a written policy for cleaning and disinfecting equipment• Apply appropriate signage that clearly indicates they are assuming personal responsibility for engaging in
the use of the facility without staff supervision, and that as a result, certain risks exist that they should be prepared to deal with.
• Consider a formal orientation processRisk:• Consult with your property and casualty advisor regarding insuring equipment and risk• Ensure legal counsel is supportive• An automated external defibrillator should be placed in or near the facility• Facility staff should be CPR and AED certified• Safety/incident reporting and management process in place
16
Trends in employer sponsored clinics
Trends• Onsite Clinics
• Near-site or shared clinics
• Concierge physician relationships with local providers or health systems
• Part-time clinics (scalable model)
• Increased adoption of these services as cost saving measures in the public sector
• Outcomes based performance metrics
• Carrier Support
Why are employers evaluating these options?• Improve access to quality care for their employees in light of healthcare reform• Healthcare reform does not address the rising cost of healthcare, it addresses access• Provide the necessary access to enable employees to be accountable for their health• Creation of a predictable and fixed liability for services performed in these arrangements• Cost savings through reduction of over-utilized and expensive services• Improve employee recruitment and retention during tough economic times• Improve access to preventative services• Make consumer driven plans more palatable• Improve the quality of the employee and provider relationship—personalize the approach• Creation of a happy and healthier workforce• Provide a consistent and trusted relationship to employees, improving the healthcare
experience 17
Urgent Care
• Colds and Sinus Infections
• Prescriptions
• Flu Shots
• Routine labs
Wellness
• Biometric Screenings
• Health Assessments
• Coaching and Education
Primary Care
• Communication with other providers
• Patient Centered Medical Home
• Physicals
• Specialty Referral Networks
• FMLA Certification
Ancillary Services: PT, Chiropractic, Radiology
Scope of Services for Consideration
18
Scope of Services for ConsiderationOccupational
• Safety Seminars
• Post-Employment
• DOT Physicals
• Functional Exams
• TB tests and Immunizations
• DOT Drug Screens
• Random Drug Screens
• Post employment physicals
• Roles and responsibilities definitions
• Supervisor training
Worker’s Compensation
• Occupational Medical Services
• Communication with other providers
• Coordination of light duty and return to work programs
• Record Management/DOT file maintenance
• First Report of Injury
• Case Management 19
Characteristics of Organizations implementing onsite clinics• Organizations with or 450 or more benefit enrolled employees or a large percentage of retirees or
dependents who live within 7 miles of the proposed site location
• High prevalence of chronic conditions within the population
• Low utilization of primary care and preventative services
• ER and specialist visit utilization is high
• Occupational medicine costs are high or are not decreasing
• Health risk factors in the population are not decreasing, despite wellness programs
• Implement or are willing to consider consumer driven plans
• High absence or lost time replacement costs
• High pharmacy utilization, or low generic or therapeutic alternative utilization
• Smaller employers in close proximity with shared demographics
Onsite Clinic Profile and Considerations
Onsite Clinic Considerations• Feasibility
• Cost and Measuring Return on Investment
• Staffing Model
• Scope of Services to offer
• Who will have access to utilize the clinic
• Will you charge for use of the clinic
• What is your primary objective for opening a clinic
• Compliance and Regulatory issues
• Funding arrangement
Employer Sponsored Clinics
20
Critical Success Factors• Determine opportunity using the client specific claims data
• Coordinate with current benefit programs
• Select partners, not vendors, based on their willingness to work within your model
• Develop scope of services based on your specific needs
• Communication is key- over communicate in a variety of medium
• Do not under-estimate time commitment
• Align plan design, incentives and scope of services
• Prioritize and phase in services based on demand
and greatest return on investment
• Set realistic expectations
• Provide and show executive level engagement
• Hire clinicians for cultural fit
• Integrate data and provide for coordinated care
• Engage employees early in the process
• Develop relationships with community-based providers
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• Thank you for attending!
• Questions?
• Contact Information:
– Polly Thomas, Director, Onsite Clinic Consulting, [email protected], (913) 234-1013
– Gina Payne, National Director of Wellness, [email protected], (913) 234-1064
– www.cbiz.com
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