1. County wellness program update

PhD; Ronald C. Kessler, PhD; Kimberly Jinnett, PhD. Health and Productivity as a Business Strategy: A Multiemployer Study JOEM 51(4):411-428, April 2009 Satcher D. The prevention challenge and opportunity. Health Affairs. Jul-Aug 2006;25(4):1009-1011. Serdula MK, Gillespie C, Kettel-Khan L, Farris R, Seymour J, Denny C. Trends in Fruit and Vegetable Consumption Among Adults in the United States: Behavioral Risk Factor Surveillance System, 1994–2000. Am J Public Health. 2004;94:1014–1018. Special Reports, State Tobacco Settlement. Campaign for Tobacco-Free Kids. January 22, 2003; Washington, DC. Stamler J, Stamler R, Neaton JD. Low risk-factor profile and long-term cardiovascular and noncardiovascular mortality and life expectancy. Findings for 5 large cohorts of young adult and middle-aged men and women. JAMA 1999;PRIVATE “TYPE=PICT;ALT=Author Information”( 282:2012-2018 The World Health Report, 2006. World Health Organization, 2006. Healthy life span data is located in Annex Table 1, which is accessible at http://www.who.int/whr/2006/annex/06_annex1_en.pdf Thorpe KE, Howard DH. The Rise In Spending Among Medicare Beneficiaries: The Role Of Chronic Disease Prevalence And Changes In Treatment Intensity. Health Affairs. 2006;25(5):378-388. U.S. Department of Health and Human Services. Healthy People 2010 Objectives 1999; U.S. Government Printing Office, Washington, DC. Vita AJ, Terry RB, Hubert HB, Fries JF. Aging, health risks, and cumulative disability. N Engl J Med 1998;338:1035-1041. Weil, Andrew. 2009. Why Our Health Matters. NY: Hudson Street Press. Wilson M, Holman P B, Hammock A. A Comprehensive Review of the Effects of Worksite Health Promotion on Health-Related Outcomes. American Journal of Health Promotion 1996;10:429-436. References ©2 0 1 1 W e l l n e s s C o u n c i l o f A m e r i c a w w w . w e l c o a . o r g 9 M a k i n g T h e C a s e F o r W o r k p l ac e W e l l n e s s P r o g r am s PH: 402-827-3590 | FX: 402-827-3594 | welcoa.org CASE STUDY 4 Update—Summer 2008 Mike Collard, the human resources director of Sheboygan County, Wisconsin, is aware that many employee wellness programs receive a bad rap for being “soft.” In other words, they offer few measurable results, such as verifiable cost savings, to justify their expense. In our conversation, he made it clear that Sheboygan County’s wellness program is not one of those. In fact, Collard is remarkably focused on “verifiable” numbers and cost savings. He is even critical of the customary return on investment (ROI) analysis that many employers conduct to evaluate their wellness programs. Collard agrees that reducing employees’ chronic illnesses leads to lower health insurance costs for the employer—and that improved health promotes employee satisfaction and productivity, which in turn improves the bottom line—but he opts to discount this evidence when calculating his program’s initial ROI. “We look at numbers that are very easy to verify,” he said. “I’ll look at a report that [Associated Financial Group Senior Benefits Consultant] Jay Scott puts together for me to find out how much we pay for employees to use outside clinics as opposed to our employee clinic. Then I can determine what percentage of office visits must be made to our employee clinic for us to break even. All we need to break even is about 23 percent of our office visits to be to our employee clinic. Fortunately, we’re close to that number already.” Sheboygan County adopted its employee clinic in June 2008. The Employee Clinic The county’s clinic allows Collard to be picky and disciplined about which factors to include when calculating ROI. The clinic, currently staffed by a single nurse practitioner and located near the county courthouse, is the center of a robust program for which Collard has high expectations. Collard talks about the program as if it’s a gifted child who needs to be challenged—rather than patronized with goals that are too easy or vague. How Sheboygan County Is Earning Bottom-Line Results From an Ambitious Wellness Program and Employee Clinic by Doug Pond, Associated Financial Group Facts about Sheboygan County’s Employee Clinic The following is a partial list of facts and services offered by the clinic. Nurse Practitioner Training • Master’s Degree • Specialized training in family practice • Passed a National Certification Exam in family practice Nurse Practitioner Scope of Care • Provides primary and preventive medical care • Diagnoses and treats illnesses • Prescriptive authority • Focuses on health promotion and wellness • Partners with patients to manage chronic illnesses (diabetes, asthma, etc.) • Orders, performs and interprets diagnostic studies such as lab work and x-rays Health Promotion and Wellness • Conducts Health Risk Assessments (HRAs) • Nurse practitioner shares results with patients • Nurse practitioner coordinates plan for wellness at patient’s request Disease/Case Management • Identifies high-risk employees through completion of HRA • Develops customized plan based on individual results • Monitors each case continually associatedfinancialgroup.com 5 CASE STUDY “I disregard most of the studies that show the payoff of wellness programs,” he said. “They are too speculative.” Collard’s senior benefits consultant, Jay Scott, agreed. “When you have a truly excellent program, you don’t feel the need to inflate its success. You want to be rigorous in your assessment so that you can improve the program even further. Also, Sheboygan County’s employee clinic allows us to factor in verifiable numbers more than most wellness programs do because we have distinct costs and savings that can be attributed directly to the clinic.” Associated Financial Group Wellness Specialist Lisa Mansavage expressed another point of view. “For some wellness programs, the costs and savings are not so clear cut,” she said. “In such a case, including the reduction of chronic illnesses and major medical claims from one year to the next in your ROI study is appropriate. Your evaluation should depend on the type of program you have. If you have an employee clinic, of course, your assessment will be more definite. Yet you should still look at the softer data, such as health patterns as well as related costs and savings, when evaluating your program.” For example, Chippewa County, Wisconsin, implemented a wellness program centered around health screenings—but without an employee clinic. The person in charge of the program, Connie Goss, would see eye to eye with Collard. Goss is a risk manager whose rigorous, number-centered approach helped reduce the employer’s health insurance premiums by 15 percent in just three years. However, Goss credited her program with the reduction of chronic and catastrophic illnesses as well as the related cost savings. “One year,” Goss explained, “an employee had a heart attack that cost the organization $365,000 in doctors’ fees and a long-term nursing home stay. Not long afterwards, another employee received a health screening which resulted in a quadruple bypass surgery instead of a heart attack, and that cost the organization only about $57,000.” Therefore, Goss attributed a potential savings of $308,000 to the county’s wellness program. While this evidence is more anecdotal and speculative than Collard would prefer, it’s clear that health screenings result in cost savings. In fact, Collard said the Sheboygan County program identified similar health risks after only one week of health screenings. He does not deny that such resources offer bottom-line advantages. “Those harder-to-identify, long-term savings are gravy,” he said. “They are very nice to have. But I place them in a different conversation than the one about the program’s ROI.” Why Adopt an Employee Clinic? According to a recent survey by the National Business Group on Health, 23 percent of surveyed employers with more than 1,000 employees reported offering on-site medical services in 2007, while 29 percent plan to offer a program in 2008. Smaller employers are jumping on the bandwagon too because an employee clinic can reduce health plan costs significantly in the long term—and can pay for itself even in the short term, as Collard indicated, while offering an outstanding benefit to employees. “For the employee clinic to pay for itself each year, we just need about 23 percent of healthcare utilization to go to the clinic instead of outside sources,” he said. “In other words, the clinic saves us money when it comes to things like office visits, lab work and referral patterns. In a short time, we have received an overwhelmingly positive reaction from employees, and as time goes by I expect participation, as well as the cost savings, to improve.” Collard can list many reasons for maintaining the clinic now that it’s functioning successfully. But what were the factors that led him to consider implementing an employee clinic in the first place? How did the need for such a resource present itself? Collard said the high cost of health insurance was the driving factor. He discussed the problem and possible solutions with Jay Scott, who broke down the issue into contributing factors and explained how an employee clinic could help. Scott discussed the following factors that can lead to high health insurance costs—and can be remedied by an employee clinic: • Unhealthy behavior • People wait until it is too late to be treated – 75 percent of illness is preventable • Chronic illness consumption • Unnecessary treatment. Studies report that: – 41 percent of patients self-refer to a specialist – 60 percent went to the wrong specialist – 79 percent had received unnecessary tests • Lack of knowledge among employees about where to go, whom to talk to, and what to do • Low consumerism by patients and employees All of these issues made sense to Collard, and he made particular mention of unnecessary treatment and employees self-referring to specialists. “That’s a big issue to me,” he said. “We had a lot of people self-referring to specialists. Some of that can be avoided by going to a nurse practitioner who can identify more precisely what the needs are for the patient.” Collard explained how the issue relates to a bigger picture—to all of the issues Scott outlined. “A health care provider is a business,” he said, “and must look out for its own interests. That can lead to unnecessary treatment, and that’s why I wanted our nurse to be an independent. She looks for opportunities to help employees, not generate business—so she helps reduce our costs related to referral patterns in doing so.” The final key to the program’s success is employee communication and education. Wellness resources are successful only to the extent that employees use them. While Collard ran articles about the program in the employee newsletter, he said the high participation owes a lot to Jay Scott’s employee meetings in which he explained the advantages of the clinic. “Education is crucial,” Scott said. “Otherwise, it’s like throwing a big party without inviting anyone.” T H E W E L L N E S S C O U N C I L O F A M E R I C A P R E S E N T S Case Study A WELCOA First Of Its Kind: The State Of Nebraska’s Integrated Plan For Health ABOUT ROGER WILSON Administrator of Central Services -State of Nebraska Roger Wilson is responsible for managing a staff of over 25 people that provide financial, human resources, and payroll services for the 11 divisions of the Administrative Services agency, as well as three other divisions totaling 500 employees. In addition, he manages the wellness and benefits program for all of state government. Prior to joining the State in 2006, he was a consulting partner for 15 years, specializing in national and international retail strategies for technology companies including Microsoft, IBM, HP and Adobe. Wilson has a bachelor’s degree in mathematics and actuarial science with a concentration in business, finance, and computer science from the University of Nebraska – Lincoln. 17002 Marcy Street, Suite 140 | Omaha, NE 68118 PH: 402.827.3590 | FX: 402.827.3594 | welcoa.org Wellness Council of America (WELCOA) was established as a national notfor-profit organization in the mid 1980s through the efforts of a number of forward-thinking business and health leaders. Drawing on the vision originally set forth by William Kizer, Sr., Chairman Emeritus of Central States Indemnity, and WELCOA founding Directors that included Dr. Louis Sullivan, former Secretary of Health and Human Services, and Warren Buffet, Chairman of Berkshire Hathaway, WELCOA has helped influence the face of workplace wellness in the U.S. Today, WELCOA has become one of the most respected resources for workplace wellness in America. With a membership in excess of 5,000 organizations, WELCOA is dedicated to improving the health and wellbeing of all working Americans. Located in America’s heartland, WELCOA makes its national headquarters in one of America’s healthiest business communities—Omaha, NE. ABOUT WELCOA ABOUT BRITTANY STOHL Brittany Stohl is the Graphic Designer for the Wellness Council of America. She has a Bachelor’s of Fine Arts Degree from the University of Nebraska -Lincoln, and is in the process of obtaining a Holistic Health Coach Certification through the Institute for Integrative Nutrition. She brings a fresh perspective to WELCOA’s line of publications and lends creative energy to advancing WELCOA’s mission on a national playing field. ABOUT DAVID HUNNICUTT PhD Dr. David Hunicutt is the President of the Wellness Council of America. As a leader in the field of health promotion, his vision has led to the creation of numerous publications designed to link health promotion objectives to business outcomes. Known for his ability to make complex issues easier to understand, David has a proven track record of publishing health and wellness material that helps employees lead healthier lifestyles. David travels extensively advocating better health practices and radically different thinking in organizations of all kinds. ABOUT MIKE WANETKA Wellness Coordinator -Health Fitness Corporation Mike Wanetka holds a Master’s degree in nutritional science with emphasis in exercise physiology. Mike has over 17 years of corporate wellness experience, including international and Fortune 500 companies. Achievements include the 2002 Platinum Well Workplace Award by the Wellness Council of America in addition to earning the 2003 and 2006 Corporate Health and Productivity Award. Mike is currently employed by Health Fitness Corporation, which is contracted with the State of Nebraska to provide the wellness program. Mike works within the State of Nebraska Wellness & Benefits team to integrate wellness into the benefits and medical plan. In addition, Mike oversees the launch, implementation, communication and reporting of the wellness initiatives for the State of Nebraska, who recently became only the second state to earn WELCOA’s Gold Well Workplace Award in 2011. ABOUT MADELINE JAHN MOL Madeline Jahn is the Director of Communications for the Wellness Council of America. Her role is to coordinate the development of new publications and pool existing resources for WELCOA members, serving the mission of health promotion through editing and planning support. She has a Master’s Degree in Organizational Leadership from the College of Saint Mary. For questions about this publication, or to obtain permission for reprinting, please contact Maddy at mjahn@welcoa.org. ABOUT CARLOS CASTILLO, Jr. Director Administrative Services -State of Nebraska Carlos Castillo is responsible for leading the 11 divisions of Administrative Services that provide accounting, procurement, personnel, risk management, building management, wellness and benefit services, as well as many other services to all of Nebraska state government. In addition the agency provides financial operations, human resources, payroll, and legal services for the 250 employees in its 11 divisions, as well as 250 employees in three other divisions. Prior to joining the State in 2007, he served as a campaign manager for several successful congressional and statewide political campaigns and served as the Election Commissioner for the state’s largest county. Castillo has a bachelor’s degree in political science from the University of Nebraska-Omaha. w w w . w e l c o a . o r g ©2 0 1 2 W e l l n e s s C o u n c i l o f A m e r i c a Table of Contents Section I: The State Of Nebraska’s Wellness Program Design 2 Setting An Example For The Public Sector Demographics & Wellness Program Overview Implementation History Unique Public Sector Challenges Making The Case: “What If We Do Nothing?” Employee Participation Incentives Comprehensive Preventive Coverage: An Additional Wellness Plan Attraction Section II: Delivering The Program 8 Qualifying For The Wellness Plan Year-Round Wellness Program Offerings Wellness Champions: A Resource To The Employee Wellness Program Senior Leadership Support Governor Wellness Awards Luncheon Section III: Health Improvements & Early 10 Detection Efforts Pay Off Improved Lifestyles, Reduced Risk Factors And Increased Preventive Care Personalized Messaging Like No Other Personalized Messaging Outcomes Life-Saving, Cost-Saving ‘Catches’ Bucking The Health Care Cost Trend Case Study A WELCOA ©2 0 1 2 W e l l n e s s C o u n c i l o f A m e r i c a w w w . w e l c o a . o r g 1 W E L C O A C A S E S T U D Y Section I: The State Of Nebraska’s Wellness Program Design Setting An Example For The Public Sector In 2009, the State of Nebraska first launched its health plan—called the Wellness Plan—in conjunction with its wellness program called wellnessoptions. Its unique, value-based benefit package emphasizes smart use of health care and offers individually tailored wellness programs to help employees and spouses stay healthy. The Wellness Plan provides lower out of pocket premiums than most other State health plans, in addition to offering comprehensive preventive coverage that targets many of the greatest health risk factors among the employee population. The State of Nebraska has set a strong example for others in the public sector to follow because it’s the only state to earn two prestigious national awards: the 2011 Gold Well Workplace Award from WELCOA and the 2011 Innovations Award from The Council of State Governments. First Of Its Kind The State of Nebraska was one of the first state governments in the US to launch an integrated plan for health coverage tied to wellness program participation. Now, as one of America’s healthiest employers, the State of Nebraska is enjoying a $4.2 million reduction in claims, best-in-class participation rates and a majority of employees touting how the program has improved their lives. The amazing part is that all this was accomplished in just three years. So how did they do it? In the following pages of this WELCOA case study, we’ll reveal the inner workings of this public sector powerhouse, highlighting one of the nation’s top examples of workplace wellness at work. 2 w w w . w e l c o a . o r g ©2 0 1 2 W e l l n e s s C o u n c i l o f A m e r i c a W E L C O A C A S E S T U D Y Wellness Program Overview Two full-time Health Fitness Corporation staff members are located on-site to support over 80 Agencies, Boards and Commissions (e.g. Health & Human Services, Corrections, Roads, Games & Parks, Labor, Insurance and Revenue are just a few examples). Wellness motto: Wellness is a journey we take together. Eligible wellness program participants live in all 93 counties across the State of Nebraska. About Health Fitness Corporation The wellnessoptions program is professionally managed by Health Fitness Corporation, an outside third-party company. Results are confidentially managed by Health Fitness Corporation, in which personal health information is not released to the State of Nebraska in compliance with federal privacy regulations. Demographics Industry: State Government Average Age of Employee: 45.7 Average Length of Services: 13 years Gender: 51% female Bargaining Units: 75% union Health Plan Enrollment: 13,500 employees, retirees, cobra participants, and 7,000 spouses In 2009, the State of Nebraska began its pursuit of wellness for a typical reason—its costs had been getting out of control. Now, just a few years later, its wellness program is demonstrating the positive outcomes it set out to achieve—and Nebraska is getting calls from other states who want to model this successful approach. PASS IT ON! Know someone who would enjoy this? Click here to send them a copy. www.welcoa.org ©2 0 1 2 W e l l n e s s C o u n c i l o f A m e r i c a w w w . w e l c o a . o r g 3 W E L C O A C A S E S T U D Y Implementation History Under current state statute, the State of Nebraska contributes 79% of the premium associated with each plan that’s offered to state employees. This factor, along with rapidly rising medical costs, was creating financial challenges to the State’s health insurance program just a few years ago. For example, in 2006, health insurance premiums increased 22%. The State also saw an increase of 10% in 2007 and 14% in 2008. During this time, the State offered a portfolio of health plan options with minimal preventive care benefits. These plans included a low-deductible PPO, a high-deductible PPO, a no-deductible POS and no-deductible HMO. The State of Nebraska health claim costs were far exceeding budget, while reserves were reaching an all-time low. This pressing situation drove the State of Nebraska’s Wellness and Benefits team to take immediate action. Main Drivers For Change: • Overutilization of health care services • Poor preventive adherence • Lack of attention towards early detection /late diagnosis of conditions (with a lack of preventive coverage, employees were typically reactive, not pro-active) • Continual escalation of premium rates. Developing Solutions After identifying the main drivers for change, the State launched a feasibility study to provide the framework for rebuilding their approach to offering employee health care. As a result, the State developed a new, innovative wellness strategy known as wellnessoptions, which was built on three important principles: 1. Provide premium incentives for employees who meet wellness program criteria. 2. Increase preventive adherence with an effective communication strategy. 3. Reduce health care costs by building a culture that promotes and encourages healthy lifestyles. Become a WELCOA member today! www.welcoa.org PASS IT ON! Know someone who would enjoy this? Click here to send them a copy. www.welcoa.org 4 w w w . w e l c o a . o r g ©2 0 1 2 W e l l n e s s C o u n c i l o f A m e r i c a W E L C O A C A S E S T U D Y Unique Public Sector Challenges The main challenge to implementation was a two year approval process that involved obtaining buy-off from the Legislature and Union regarding the funding of the wellness program. In addition, time was needed to address the associated state statute implications. Ultimately, it was determined that the wellness program would be funded through health plan premiums among all those enrolled in a State of Nebraska health plan. Because state statute included incentive limitations for those meeting wellness program criteria, employees could be offered lower premiums for their participation, but not cash or gift incentives. (See Figure A on page 6 for premium reduction rates.) In January of 2009, the State issued an RFP to accept proposals for a wellness vendor and wellness programs. Health Fitness Corporation was selected over 20 bidders to implement a wellness program for the State. A key element in the State’s selection process was to ensure that all personal data and results would be confidentially managed in compliance with all federal privacy regulations. Prior to the launch of the wellness program, the State of Nebraska held a massive visibility campaign to educate employees about what was to come. The State held over 25 employee town hall meetings throughout Nebraska, introducing the wellness program to its diverse work force. Decision makers also used a number of other communication measures to educate employees at all levels—from agency heads to front line employees. “wellnessoptions” Earns Two National Wellness Awards In 2011, The State of Nebraska won WELCOA’s Gold-level Well Workplace Award for its exemplary implementation of a results-oriented workplace wellness program. In meeting rigorous criteria around seven critical benchmarks of successful programs, the State of Nebraska is one of only two states that have earned WELCOA’s Gold Well Workplace Award. The State of Nebraska was also awarded the 2011 Innovations Award from The Council of State Governments for its breakthrough program within the first three years of operation. The Innovation Award is given for the development and implementation of exemplary programs, so the successful ideas and experiences can be applied to other states. The award recognizes newness, creativity, effectiveness, transferability and significance. Q: “What’s In It For Me?” A: A Quality Of Life & Premium Savings! ©2 0 1 2 W e l l n e s s C o u n c i l o f A m e r i c a w w w . w e l c o a . o r g 5 W E L C O A C A S E S T U D Y Annual Employee Wellness Plan Premium Savings (per EE) 2012-2013 Wellness Plan Savings Comparison Plan Name Single Four Party Two Party Family Choice Plan $526.56 $1,081.44 $1,397.52 $1,869.12 Regular Plan $218.40 $448.56 $579.84 $775.44 Making The Case: “What if we do nothing?” To illustrate the benefits of wellness and justify the importance of the program to both employees and senior leadership, the State of Nebraska presented a “donothing” perspective. They asked: “What if we do nothing?” and leveraged that if no wellness program were offered, the following negative results would apply: • The health of the workforce would continue to decline; • Obesity rates would continue to rise; • Diabetes rates would continue to rise; • Coronary and other chronic health conditions would continue to rise; • Unnecessary doctor and emergency room visits would continue to rise; • Health care costs would continue to increase at double-digit rates annually; • Employees would pay more out of pocket for health care coverage; • Employees would pay more out of pocket for prescription coverage; • The quality of life for their workforce would suffer; and • The 1.8 million taxpayers across the state of Nebraska would brunt the cost of these modifiable opportunities. These challenges became opportunities when the State realized it could positively impact health care costs—and the health of employees—among its large workforce. Employee Participation Incentives The State of Nebraska offers four self-insured health plans. Employees contribute 21% of the total premiums while the State contributes 79% of the total premiums. The total premiums account for all the health-related costs as provided with the health plans including medical, pharmacy and wellness program administrative costs. Health care premium costs among each of the four health plans are independently determined based on each plan’s utilization experience. When comparing the health care and prescription utilization among each of the four State of Nebraska health plans, the Wellness Plan utilization is significantly lower. Here’s an example of the significant out of pocket premium savings when comparing the Wellness Plan against two other State plans: Figure A PASS IT ON! Know someone who would enjoy this? Click here to send them a copy. www.welcoa.org 6 w w w . w e l c o a . o r g ©2 0 1 2 W e l l n e s s C o u n c i l o f A m e r i c a W E L C O A C A S E S T U D Y Comprehensive Preventive Coverage: An Additional Wellness Plan Attraction! In addition to the Wellness Plan premium savings, additional plan benefits provide further cost savings to participants while addressing the most prevalent risk factors within the population. The purpose of the comprehensive preventive coverage is to help overcome barriers to employees managing their risk factors. In fact, preventive coverage within the Wellness Plan is greater than health care reform guidelines, in an effort to encourage the use of preventive care. The State of Nebraska’s coverage includes the following: • All blood work (including preventive) is covered up to $500 • No age restrictions for preventive screenings • Routine and follow-up mammograms covered at 100% • Routine and follow-up colonoscopies covered at 100% • Cholesterol medications at a reduced co-pay or no cost for generics • Hypertension (high blood pressure) medications at a reduced co-pay or no cost for generics