“I have long been profoundly convinced that in the very nature of things, employers and employees are part

1. Implementing a “Best Practice” Wellness Program “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

2. ♥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)

3. 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!

4. National Prevalence of Health Risk 80% 78% CDC, BRFSS, 2002

5. 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

6. 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 Musculoskeletal Cancer Ill-defined Digestive Cardiovascular

7. Program History Accent on Health Community Outreach Education Screening 2000 Increase in External Worksites OCC Health Community Health Van 2007 - 2010 External Worksites Education Screening Coaching 2003 BHS Wellness at Work 2005

8. 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

9. “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.

10. 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

11. BHS Guiding Principles Driven by Senior Leadership Build a multilevel program Target the most important health issues Offer something for everyone Communicate - communicate Reward successes Allow outcomes to drive the strategy Make it sustainable Commit to a “culture of health” Keep it fresh and fun!

12. 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.

13. Strategies to improve Health and Wellness Early detection and prevention Promotion of healthy lifestyles Healthy Culture Healthy Employees Customized risk reduction Easily accessible Early intervention Confidential Referrals Follow up Ongoing support

14. 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!

15. Agenda 2006 • 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

16. Address the entire care continuumStop risk progression (Don’t’ get worse) 15% members = 85% cost 85% members = 15% cost Well No Disease At Risk Obesity High Cholesterol Acute Illness/Discretionary Care Doctor Visits Emergency Visits Chronic Illness DiabetesCoronaryHeart Disease Catastrophic Head Injury Cancer, MI, Stroke • 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 managementtraining • Case management • Predictive modeling Well Risk Urgent Disease Mercer Human Resource Consulting

17. Offer Something for EveryoneAll program components are cumulative

18. Program Staff • 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

19. Program Growth

22. Programs Targeting Major Health Risks

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

26. Referrals Into the System BHS 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. Mammography Colonoscopy 38 42 Tobacco Treatment EAP 156 57 Diabetes Education PCP 2009 Referrals 358 39 BP Referrals Lab 166 84 Cardiac Rehab Nutrition 219 1

27. 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?

28. 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)

30. Program Highlights

31. Health Cost Savings Everything that can be measured doesn’t always matters, and everything that matters, cannot always be measured.

35. Total Health ManagementOpportunities for Engagement Traditional OccHealth Services BHS Wellness Program Components

36. 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