Recommending a Benefits Strategy

1. Recommending a Benefits Strategy for Today and Tomorrow

2. What is your Health Care Cost Containment Strategy? for Today and Tomorrow

3. How far can an employer go toward mandating wellness in the workplace?

4. By 2016 Health Care Costs are projected to reach $4.2 trillionThis represents 20% of every dollar we spend! Here comes a “perfect storm” in the workplace driven by three factors. One: Medical costs are accelerating Two: Employees and dependents have more health needs than ever before with an obesity epidemic, tobacco related illness and sedentary life styles Three: A great skilled worker shortage lies just ahead

5. Having a healthy workforce is enormously beneficial.Wellness Works!

6. Results of a Healthy Workforce… • Productivity goes up • Turnover goes down • Workplace injuries decline • Disabilities decline • Work life expands • Morale improves • Applicants gravitate to a healthy workplace

7. Tomorrow’s Challenge:Mandating Employee Wellness • What is a mandatory Wellness Plan? • Requires employees to participate • Imposes a penalty if you do not participate • Must take a health risk assessment, blood pressure, cholesterol, BMI, fasting glucose etc. • If an employee refuses to participate they lose coverage • Some plans even assign professional “health coaches” who will draw up action plans and will follow up to monitor progress Note: An incentive that is conditioned on participation in a health program, rather than achievement of a particular health target or standard, generally is not discriminatory under HIPAA.

8. Tomorrow’s Challenge:Mandating Employee Wellness “While it may seem like a contradiction that an employer can maintain a health fitness program targeting obesity while protecting overweight employees from rude or demeaning treatment, this is exactly what the future promises. In a sense, this is no more complex than applying the golden rule to wellness. Almost all people want “wellness,” yet few want to be insulted or teased in their efforts to become well.” Source: The 2008-2009 Littler Report “Employer Mandated Wellness Initiatives: The Continuum from Voluntary to Mandatory Plans.”

9. Mandatory Wellness Plans ROI is from $2 to $10 for every dollar invested in a wellness plan. • OUTSIDE THE PLAN • Disability discrimination • Age discrimination • Workers compensation • retaliation claims • Lawful off-duty conduct • Privacy statutes • Collective bargaining agreements • Retaliation claims INSIDE THE PLAN: HIPAA • Rewards or penalties cannot exceed 20% of total cost • Reasonably designed to promote health or prevent disease • Annual eligibility • Alternative standards for participants with medical conditions • Plan material must disclose alternatives and waiver

11. Obesity Trends* Among U.S. AdultsBRFSS,1990, 1999, 2008 (*BMI 30, or about 30 lbs. overweight for 5’4” person) 1999 1990 2008 No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

12. Obesity Trends* Among U.S. AdultsBRFSS, 1985 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14%

13. Obesity Trends* Among U.S. AdultsBRFSS, 1990 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14%

14. Obesity Trends* Among U.S. AdultsBRFSS, 1991 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19%

15. Obesity Trends* Among U.S. AdultsBRFSS, 1995 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19%

16. Obesity Trends* Among U.S. AdultsBRFSS, 2000 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% ≥20%

17. Obesity Trends* Among U.S. AdultsBRFSS, 2001 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% ≥25%

18. Obesity Trends* Among U.S. AdultsBRFSS, 2002 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% ≥25%

19. Obesity Trends* Among U.S. AdultsBRFSS, 2005 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

20. Obesity Trends* Among U.S. AdultsBRFSS, 2006 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

21. Obesity Trends* Among U.S. AdultsBRFSS, 2008 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

22. Medical Complications of Obesity Idiopathic intracranial hypertension Pulmonarydisease abnormal function obstructive sleep apnea hypoventilation syndrome Stroke Cataracts Nonalcoholic fatty liver disease steatosis steatohepatitis cirrhosis Coronary heart disease Diabetes Dyslipidemia Hypertension Severe pancreatitis Gall bladder disease Cancer breast, uterus, cervix colon, esophagus, pancreas kidney, prostate Gynecologic abnormalities abnormal menses infertility polycystic ovarian syndrome Osteoarthritis Phlebitis venous stasis Skin Gout

23. Health Risk Factors Matter .. • Let’s learn about each employee’s • Metabolic Syndrome Risk Cluster • HDL Cholesterol • Triglycerides • Waist Circumference • Blood Pressure • Fasting Glucose

24. Now let’s Graph these Important Risk Factors ... • Complete a Health Risk Assessment Form • Perform Biologics (BP; HDL vs. LDL; Waist Size, Glucose) Recommended Obesity Class I Obesity Class II Obesity Class III

25. Increase your Wellness Score! • Losing weight • Feeling better • Looking better • Living Life better—Long Term Culture Change will focus on: What does this 10 week program look like?

26. 10 Week Program will address: • Eating habits • Hunger • Hydration • Exercise • Personal health habits

27. Program Specifics: • Initial Requirements: • Health Risk Assessments must be completed • Health Screenings (offered on-site) • A personalized Health Profile and Summary is provided on-site • If a person has three or more of the five Risk Factors out of synch then a Health Coach is made available to go over the results with the person. • If a Classroom Experience is deemed necessary the person is enrolled • The simple Program message is, “It is not what you eat, but how and when you eat that matters!”

28. Classroom Specifics: • Instructor Led: • 30 to 40 participants at a time • One day per week over the lunch-hour • Weigh in and hear status updates from participants • Weekly lesson • Attendance is mandatory • There is a $150 charge if you do not complete the course (otherwise it is free of charge) • Can get an on-line instructor led program too

29. How Do you translate clinical information into Savings? • As you improve basic health you reduce the frequency and severity of health plan claims, resulting in: • More appropriate use of Dr. office visits and Rx usage • Fewer unnecessary Dr. office visits • Less Rx use for modifiable behavior-driven medical needs • Fewer Emergency Room visits • Fewer inpatient admissions • Shorter length of stays for appropriate hospital inpatient care

30. How Do you translate clinical information into Claims Savings? • If your BMI is under 30 and your Glucose is 50 to 99 then let’s say the health plan cost is $1000 per claimant. • If your BMI is over 30 and your Glucose is 50 to 99 then the cost per claimant is $1,134. • If your BMI is under 30 and your Glucose is 100 to 150 then the cost per claimant is $1,768. • If your BMI is over 30 and your Glucose is 100 to 150 then the cost per claimant is $2,252.

31. First things first • Get a physical! • Your physician MUST be involved in this process with you. They can check for any asymptomatic pre-existing conditions and will provide you with ideal body composition stats just for you. (Avoid the generic “recommended” weight tables)

32. Motivation • What/who made you think you need to lose weight? • Where does your motivation come from? • The only motivational source that will facilitate success is internal emotional motivation • True strength comes from your heart not your muscles!

33. Support • Who is on your side? (friends, family, spouse, co-workers) • Is there anyone who will do it with you? • Get commitment for the long haul and be open to accountability • Find a source that will be compassionate and not critical

34. The human body, what an amazing MACHINE! • Like a car; no maintenance + bad fuel = long-term problems and premature failure GUARANTEED! From this To this

35. I feel fine, why do I need to change anything? • Currently 34% of U.S. Adults 20+ morbidly obese (was 15% in 1976) • Currently 31.9% of U.S. Children 2 – 19 morbidly obese ( was 5% in 1976) • Currently up to 1/3 of U.S. medical care expenditures Obesity or lifestyle related • Heart disease at the top of the list for death 10 years running, only ¼ of the cases genetically linked, otherwise categorized as preventable! • See a trend here? This is just the tip of the iceberg! Source: cdc.gov

36. Body systems • Musculoskeletal (muscle & bone) • Cardiovascular (heart, veins, arteries) • Respiratory (lungs) • Neurological (brain and nerves) • Digestive (stomach, intestines, etc) • Endocrine (hormones/glands) • Metabolic (liver, pancreas, etc)

37. Optimal system function and care • Musculoskeletal: resistance exercise! • Promotes muscle strength, promotes connective tissue strength (ligaments and tendons), promotes bone density strength • System is designed to work hard, lack of exercise causes atrophy, energy loss, and radically increases potential for injury

38. Optimal system function and care cont……. • Cardiovascular: cardio respiratory exercise! • Bouts of long duration cardio respiratory exercise not only burn calories, it increases the efficiency of the heart to distribute blood to all of your body’s systems • Lack of exercise causes: fatigue, promotes poor circulation efficiency, diminished stroke volume, increased risk of heart disease, risk of premature death

39. Optimal system function and care cont……. • Respiratory system: cardio respiratory exercise! • Increases oxygen uptake efficiency, increases carbon dioxide eradication efficiency, increases energy, increases endurance, facilitates long duration activities • Smoking not only increases potential for lung cancer, it can impair lung function by up to 90% in just 10 years! YOU ONLY GET ONE SET FOLKS, TAKE CARE OF THEM OR IT WILL COST YOU!

40. Optimal system function and care cont……. • Neurological system: ALL EXERCISE AND ACTIVE LIFESTYLE! • The human brain is the worlds most powerful and complex computer, the more you use it and stimulate it the more powerful and efficient it becomes! WARNING! MOST HERBAL AND STIMULANT BASED DIET PILLS AFFECT YOUR NEUROLOGICAL SYSTEM AND CAN PERMANENTLY IMPAIR FUNCTION OR EVEN KILL YOU! THEY ARE NOT FDA REGULATED!

41. Optimal system function and care cont……. • Digestive system: quality fuel for life! • Primary function is to breakdown and allocate fuel resources for all body systems. • Care: eating whole/natural foods in modest, balanced portions 4 – 6 times per day and staying sufficiently hydrated, consuming sufficient fiber • This system was not designed to break down and process chemical preservatives, shelf stabilizers, color additives, chemical flavor enhancers, or artificial foods • Lack of care will decrease energy, slow metabolism, increase fat storage, can lead to stored toxins in digestive tract, impair total body systems function, can and will cause permanent organ damage!

42. Optimal system function and care cont……. • Endocrine system: chemical/hormone balance • Includes: Pancreas, pituitary, hypothalamus, adrenal glands, reproductive glands • Affected adversely by poor lifestyle habits (bad nutrition, smoking, alcohol use, drugs, and again DIET PILLS!) • Care: caring for all of the afore mentioned systems will directly promote endocrine health WARNING! FAILURE OF THESE SYSTEMS HAVE DISASTROUS CONSEQUENCES THESE CHEMICAL BALANCES ARE EXTREMELY SENSITIVE!

43. Optimal system function and care cont……. • Metabolic system: fuel + exercise=ENERGY! • Fed by digestive and muscle systems, the metabolic system regulates energy allocation through fuel processing/storage • Becomes more efficient with increased demand! The more you exercise (demanding energy resource, the more efficient your metabolic rate is) Bad fuel + bad lifestyle=poor energy WARNING! HERBAL AND STIMULANT BASED DIET PILLS ADVERSELY AFFECT METABOLIC FUNCTION AND CAN LEAD TO PERMANENT LIVER DAMAGE!

44. This is what can happen if you do not take care of yourself • Obesity • Type II diabetes • Congestive heart failure • Cancer • Hypertension • Osteoporosis • Liver disease • Joint problems • Breathing difficulty • Chronic injury • Depression • DEATH! MOST OF THESE CAN BE AVOIDED BY JUST SIMPLY BECOMING MORE AWARE OF YOUR HEALTH AND MAKING CONSCIOUS DECISIONS ABOUT NUTRITION, EXERCISE, ACTIVITY, HABITS, AND LIFESTYLE!

45. Preventable disease • Smoking/tobacco use • Alcohol, health effects and increased risk • Obesity, cause and effect

46. Smoking • Tobacco is the only product in the U.S. that causes death and disability when used as intended — the single, most preventable cause of death in the U.S. •    Every year, tobacco use kills more Americans than World War II and the Vietnam War combined. That’s more than 440,000 smoking-related deaths every year — the equivalent of three 747s being downed every day without any survivors. Source: gdcada.org

47. What makes smoking so lethal? • Short-Term EffectsThe body’s response to nicotine is immediate — causing short-term increases in blood pressure, heart rate, and blood flow from the heart. Nicotine also causes arteries to narrow,5 while carbon monoxide reduces the amount of oxygen the blood can carry — two side effects which create an imbalance in the demand for oxygen by the cells and the amount of oxygen the blood is able to supply.6 • Long-Term EffectsSmoking can cause chronic lung disease, coronary heart disease, and stroke, as well as cancer of the lungs, larynx, esophagus, mouth, and bladder.7  Smoking is also known to contribute to cancer of the cervix, pancreas, and kidneys.8 •    Smokeless tobacco and cigars also have deadly consequences — including lung, larynx, esophageal, and oral cancer. Source: gdcada.org

48. What smoking looks like from the inside Throat cancer

49. Benefits of cessation • Your body begins to heal within 20 minutes after your last cigarette. The poison gas and nicotine start to leave your body. Your pulse rate goes back to normal. The oxygen in your blood rises to a normal level. Within a few days you may notice other things: • Your senses of taste and smell are better. • You can breathe easier. • Your "smoker's hack" starts to go away. (You may keep coughing for a while, though.) • The nicotine leaves your body within three days. Your body starts to repair itself. At first, you may feel worse instead of better. Withdrawal can be hard. But they are a sign that your body is healing. Source: cdc.gov

50. How to quit • First step is to make the decision based off of the right motivational factors • Expect withdrawal and cravings, plan diversions accordingly • Eliminate opportunity for temptation • Be accountable to someone (friend, family, spouse) • Understand that every cigarette you refuse to smoke is an investment in your life and family • Know that each day you go without gets easier • Do not pass out when you see how much money you will save long term (can literally be a second college or retirement fund!)