7 Key Steps to an effective wellness program

1. 7 Key Steps to an effective wellness program With Brad Cooper, CEO US Corporate Wellness, Inc.

2. 7 Key Steps to Success

3. Effective Employee Wellness and Insurance? • Helps keep claims costs under control • Enhances value of other benefits and insurance-based programming already in place (if done well) • Offers some good news that can be shared with clients (& employees) during annual meetings • Provides additional revenue stream and/or additional value proposition for you/your firm (and another reason to reach out to clients/potential clients) • Low maintenance, high value for HR and/or Benefits Team and you

4. 1 - Remove the Blindfold

5. The Problems… • Health Care Costs Rising 8-14% Annually • Disability costs are directly correlated to BMI levels (2-7x’s normal) • Sick Time Costs Employers $602/employee/year • One out of two adults will be diagnosed with a chronic disease • Over 2/3rds of Americans are overweight/obese, with prevalence in new hires under the age of 40 actually higher than in those over 40 • Smokers cost employers up to $5,600 additional/year • Health care claims for employees who don’t exercise were $350/year higher than those who exercised just 1-2 days/week • Direct health care costs are only part of the picture. Health related productivity costs are estimated to be equal to 3-4x’s direct costs.

6. Obesity Trends* Among U.S. Adults1994 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) <10% 10%–14 15%–19% Source – CDC Behavioral Risk Factor Surveillance System

7. Obesity Trends* Among U.S. Adults1995 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) <10% 10%–14% 15%–19% Source – CDC Behavioral Risk Factor Surveillance System

8. Obesity Trends* Among U.S. Adults1996 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) <10% 10%–14% 15%–19% Source – CDC Behavioral Risk Factor Surveillance System

9. Obesity Trends* Among U.S. Adults1997 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) <10% 10%–14% 15%–19% ≥20% Source – CDC Behavioral Risk Factor Surveillance System

10. Obesity Trends* Among U.S. Adults1998 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) <10% 10%–14% 15%–19% ≥20% Source – CDC Behavioral Risk Factor Surveillance System

11. Obesity Trends* Among U.S. Adults1999 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) <10% 10%–14% 15%–19% ≥20% Source – CDC Behavioral Risk Factor Surveillance System

12. Obesity Trends* Among U.S. Adults2000 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) <10% 10%–14% 15%–19% ≥20% Source – CDC Behavioral Risk Factor Surveillance System

13. Obesity Trends* Among U.S. Adults2001 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) <10% 10%–14% 15%–19% 20%–24% ≥25% Source – CDC Behavioral Risk Factor Surveillance System

14. Obesity Trends* Among U.S. Adults2002 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) <10% 10%–14% 15%–19% 20%–24% ≥25% Source – CDC Behavioral Risk Factor Surveillance System

15. Obesity Trends* Among U.S. Adults2003 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) <10% 10%–14% 15%–19% 20%–24% ≥25% Source – CDC Behavioral Risk Factor Surveillance System

16. Obesity Trends* Among U.S. Adults2004 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) <10% 10%–14% 15%–19% 20%–24% ≥25% Source – CDC Behavioral Risk Factor Surveillance System

17. Obesity Trends* Among U.S. Adults2005 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30% Source – CDC Behavioral Risk Factor Surveillance System

18. Obesity Trends* Among U.S. Adults2006 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30% Source – CDC Behavioral Risk Factor Surveillance System

19. Obesity Trends* Among U.S. Adults2007 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30% Source – CDC Behavioral Risk Factor Surveillance System

20. Obesity Trends* Among U.S. Adults2008 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30% Source – CDC Behavioral Risk Factor Surveillance System

21. How about Disability Costs? Source – Archives of Internal Medicing (Duke University – 11,700 people in sample size)

22. Exclude “Severely Obese” and examine data… Source – Archives of Internal Medicing (Duke University – 11,700 people in sample size)

23. One more step (“overweight” category only) Source – Archives of Internal Medicing (Duke University – 11,700 people in sample size)

24. Health Care Inflation? • If food prices rose at same rate as medical costs since the 1930’s… • Dozen Eggs would now cost $85.08 • One Pound of Apples … $12.97 • One Pound of Sugar… $14.53 • A Roll of Toilet Paper… $25.67 • One Pound of Butter… $108.29 • One Pound of Coffee… $68.08 • One Pound of Bacon… $129.94 Source – American Institute for Preventive Medicine, 2009

25. Wellness Initiative Plans for the Remainder of 2009 *Health Care Plans – Impact of Financial Crisis International Foundation of Employee Benefit Plans, 2009

26. A Little History Lesson Wellness 1.0 … Group Activities Wellness 2.0… Disease Management Wellness 3.0… Web Tools Wellness 4.0… Generic Call Center Added Wellness 5.0… Personalized Approach

27. Outcomes:The Children’s Hospital of Denver* Pre- Wellness Program: Average annual increase in medical costs from 2002-2006 was 10.8% Post-Wellness Program: Average annual increase in medical costs from 2007-2010 was 4.6% *US News Best of Children’s Hospitals Honor Role Medical plan trends have offset nearly $5 million in two years

28. 2 - Move Forward… Not Sideways

29. Beware the “Token” Wellness Effort “If you look at people after coronary-artery bypass grafting two years later, ninety (90!) percent of them have not changed their lifestyle.” -Alan Deutschman Change or Die (Note: Lifestyle changes don’t just happen because they’re “important.” Must involve pattern of Relate… Repeat… Reframe)

30. Let’s take a look at the literature… (Research brief from National Institute for Health Care Reform on Effectiveness of Employee Wellness Initiatives, 2010, covered by the Wall Street Journal) “Most experts believed that effective coaching is essential to improving health behaviors.” "Some employers focus coaching efforts solely on high-risk individuals, but there appears to be increasing recognition among employers of the importance of making health coaching available to a broader population.” There is a great deal of variation between HRAs.  However, the research was clear on this:  "What most experts do agree on is that HRAs can be a valuable screening tool, but only if they are followed up by effective health coaching and wellness activities.” "One-size-fits-all programs purchased off-the-shelf from health plans and wellness vendors are unlikely to make a significant impact. Least likely… are programs consisting only of online HRAs and Web-based educational tools, with no individualized follow-up activities to engage employees."

31. 3 – Choose Wisely

32. Where is your trend line heading? Total Health Care and Disability Costs = ______ Annual Increase of 10% (?) = ______ What if that annual increase were diminished by 2%? 4%? 8%? And then there’s productivity, retention, sick time, stress reduction…

33. When Comparing Programs… • Option 1 - $7 PEPM • 1000 Employees • “Active” Approach produces 50% Participation (REAL Participation) • **500-600 Employees actively engaged** • Option 2 - $3.50 PEPM • 1000 Employees • Restricted Access to “bottom” 40% • “Passive” Approach results in 10-15% Actual Utilization (or less) • **40-60 Employees actively engaged** • (Making comparable “cost” of #2 at least 5 times the cost/employee of #1)

34. 4 – Individualize (Listen)

35. Place in Life? Goals? Weight Focus? History? Temperament? Activity Level? (And what happens if it changes next year?)

36. 5 – Incentivize (Or – painting the stick orange)

37. Incentives* • Usually (always) necessary in some format (varies by industry) • Research indicates $200-300/yr is effective in most organizations • Can be “cost neutral” (ie, balanced out by increase in deductible) • Tie to pursuit vs. achievement is recommended • Various forms available (note tax implications for each): • Cash • Time Off • Drawing for prize (among participants) • Gift Certificates • Reduced Insurance Premium • Goodies (shirts, water bottles, exercise equipment…) • Health Saving Account tie-in • * Note - Laws vary by state – confirm legal issues with counsel

38. Participation (real participation) Trumps All

39. Only one in twenty adults consistently engage in the five most important health behaviors: • Regular exercise • Healthy levels and types of fat intake • Five daily servings of fruits and vegetables • Moderate drinking • Non-smoking

40. Source – Institute for the Future, Center for Disease Control and Prevention; Midwest Business Group on Health; Annals of Internal Medicine, 2002

41. The Tipping Point The Rule of Seven

42. 7- Track (and use!) Results

43. Track… but then USE the Data

44. Costs for a sample organization… (based on 11,000 benefit eligible employees) The above CDC Data includes only BMI-Related Medical and Work Loss Costs. How about Disability Costs? Turnover? Inadequate Sleep? Poor Eating Habits? Presenteeism/Lack of Energy?

45. Outcomes:Sample Client Wellness program participants are more compliant with recommended preventative care

46. Likelihood of EIB Claim at The Children’s Hospital Wellness Program Participant Non-Participant

47. Additional ROI Data for Sample Client The difference in total EIB hours was 2.85/employee, translating to over $185,000 (Estimated at double if sick time separate) 10% improvement in BMI produced $100,000 in savings 8% increase in exercise levels correlated to $96,000 saved 7.7% in blood pressure translates to over $60,000 saved Impact on Depression, Smoking and Immunizations produced an additional $240,000 in annual savings Note that Edington assigns a value of $350/year/employee who has been kept from moving into higher risk category

48. 7 Key Steps to Success

49. Cutting through the Noise of Options…

50. Wellness Program Micro Audit • Program is built around individual employee goals, created by each employee (vs. limited number of generic curriculum) ___ • Employee engagement and satisfaction with the program are monitored and tracked regularly _____ • Design of the program drives cultural changes across the entire organization _____ • Time commitment required on part of the HR Professional or Wellness Champion within organization is < 2 hrs/month ____ • Momentum is sustained throughout the year (rather than seasonal or launch-dependent) _____