Onsite Wellness Programs: Options and Results Bruce Caldwell Area Sr. Vice President Gallagher BPI Dan Sanger Director o

1. Onsite Wellness Programs: Options and Results Bruce Caldwell Area Sr. Vice President Gallagher BPI Dan Sanger Director of Health Benefits ASCIP Judi Ulrey President Fitness Consulting

2. Onsite Wellness Programs • Current Range of Design Options • Programs In Practice – El Monte City SD Onsite Care Pilot and Lawndale Elementary SD Education and Awareness Pilot • Design Details • Results • Lessons Learned

3. Onsite Wellness ProgramsEmployers: Why Do it? • Deteriorating Individual Health Status • Higher rates of inactivity, obesity, diabetes, high BP, high cholesterol • 50-85% of all diseases from modifiable risks • Fragmented Delivery System • Primary Care, Specialty Care, Rx, ER, Hospital • Incentives based on volumes vs. outcomes • Limited connectivity

4. Onsite Wellness ProgramsEmployees: Why Do it? • Easier to Engage • Does not require extra effort to participate • Engagement with peers increases morale • Easy to become part of a routine • Quality of Life • Reduce debilitating/life threatening conditions • Remain active longer – really enjoy golden years • Reduce medical treatments / chronic conditions

5. Onsite Wellness ProgramsCurrent Barriers to Better Health • Changing Habits Developed Over Decades • Diet, physical inactivity • Using Healthcare Proactively • Convenience • 2-3 Hour Office Visit: drive to & from the office, waiting room, exam room, 7 minute appt. duration • Compliance • No incentives for outbound follow up contact from clinicians • Non-compliance rates typically 30% to 50%. • Cost • Copay avoidance drives down maintenance medication compliance

6. Range of Onsite Wellness Programs Option 1: Education and Awareness • Emails, posters, quizzes, etc. • Advantages: Awareness is the first step toward action. Begins the process of adopting a wellness culture. • Considerations: Goals, content development and distribution, long term engagement, success measures.

7. Range of Onsite Wellness Programs Option 2: Wellness and Prevention Activities • Walking Programs • Incentives for enrolling in weightwatchers, going to the gym, biggest loser contests • Advantages: Even limited exercise can have significant benefits • Considerations: Goals, success measures, logistics – incentives (budget and distribution), waivers, activity tracking, recognition events, scheduling, facilities, hair & makeup

8. Range of Onsite Wellness Programs Incentives vs. Participation • Trinkets and T-shirts 10% - 15% • Merchandise (gift cards, movie tickets) 15% - 50% • Cash ($25 - $50) 35% - 75% • Premium Reductions ($100 - $250) 50% - 80%

9. Range of Onsite Wellness Programs Option 3: Health Plan Utilization Activities • Onsite HRA, blood draw • Telephonic health coach • Annual Physical, preventive screenings (colonoscopies, mammograms, etc.) • Advantages: Objectivity of biometric data better than accuracy of HRA answers, early detection of potentially catastrophic health events • Considerations: Goals, success measures Logistics – incentives (budget and distribution), privacy, activity tracking, scheduling

10. Range of Onsite Wellness Programs Option 4: Direct Care Delivery via Onsite Clinics • Primary Care (physicals, health screens, infections, prescriptions, chronic disease management, sprains, strains, etc.) • Typically no copays for care or Rx • Clinicians range from RN to PA to MD • Flexible hours or 24/7, on-call physician

11. Range of Onsite Wellness Programs Direct Care Delivery: Onsite Clinics • Advantages: Addresses barriers to care (convenience, compliance and cost), may reduce Rx, hospital admit and referral rates • Considerations: Physical space buildout requirements, enrollment vs. participation, adoption and trust, privacy, promotional activities, costs, metrics, gradual adoption rates, HMO ROI

12. Current ProgramsEl Monte City School DistrictOnsite Health Screens

13. Current Programs • El Monte City SD– Health Screens • HealthFair • Onsite Screens with Imaging Technology • Blood chemistry, BMI, HRA • Echocardiogram, EKG, Carotid Ultrasound, • Abdominal Aortic Ultrasound, Ankle Brachial Index, Bone Density Ultrasound • Why not just blood draw and HRA? • Non-fasting results easy to discount • Blood chemistry correlated to chronic disease progression • Imaging results show actual affect – greater call to action

14. Current Programs • El Monte City SD– Health Screens • Logistical Issues • Bargaining Unit Endorsement • Business Case – personal health, take-home pay • Concerns – privacy, secret drug testing • Promotion and Incentives • Intro Letter from District Supervisor • -Participation, scope, locations, confidentiality • Posters with Bargaining Unit Logos • $10 Gift Cards, raffle prizes

15. Current Programs • El Monte City SD– Health Screens • Logistical Issues: • Timing • Back to school, holidays, summer break • January – February relatively quiet, New Year’s resolution momentum

16. Current Programs • El Monte City SD– Health Screens • Logistical Issues • Locations • 19 school sites • 55 employee median headcount • 875 actives, 425 retirees • 40 minutes per screen / HRA • Mobile Screening Vehicle parked at each location for several days • Substitute teachers hired • ~6 weeks duration

17. Current Programs • El Monte City SD– Health Screens • Costs • ~$225 per participant (~$160k) • ~3% of average medical premium • Contributions from Kaiser and UnitedHealthcare • $10k budget for gift cards and raffle prizes

18. Current Programs • El Monte City SD– Health Screens • Results • Participation • 718 employees & dependents • 75% female, 52% Hispanic (consistent with district demographics) • Satisfaction • Rated 4.91 out of 5 (5 = excellent) • 83% felt it was very important that their employer provide the screens • Top three reasons for participation: • No cost • Convenience • Medical concern

19. Health Screen Results Percent Higher Annual Health Plan Costs District Prevalence

20. Current Programs • El Monte City SD– Health Screens • Results - Impact on Utilization • Short term difficult to measure: • Participants from Kaiser, UHC HMO, Anthem PPO • -- Only Anthem FFS data available • Dependent on current progression of any chronic conditions

21. Current Programs • El Monte City SD– Health Screens • Next Steps • Participants: • Sharing results with PCPs • Modifying personal habits (hopefully) • CDC motto: “Prevent, delay, detect, and control chronic diseases” • District: • Launching and Onsite Care Model • -- Convenience and Cost top 2 reasons for participation

22. Current ProgramsLawndale Elementary School DistrictFitness ConsultingEducation and Awareness Pilot

23. Old Dogs, New Tricks Most of your employees have spent 30-40-50+ years fine tuning their unhealthy habits.

24. Think Out of the Box “Most of us have our favorite influence methods – just pass a law, just threaten a consequence, or offer a training program. … Bringing a simple solution to a complex and resistant problem almost never works….. It takes a combination of strategies aimed at a handful of vital behaviors to solve profound and persistent problems.” Influencer

25. Management Mission Is your senior management team: • Discussing the company wellness program at every Department Director meeting? • Making wellness program participation part of your management team's job description and evaluation? • Wellness promotion part of Mission and Value Statements • Participating in screenings and posting personal goals? • Participating in contests? • Attending educational programs? • Exercising regularly? Visibly moving at work? Maintaining a healthy weight?

26. Health vs. Disease • Risk Factors • Highest Risk Population • Disease Management • John Weaver, Psy.D. • “As a man thinketh...”

27. Vital Behaviors What do you want people to DO?? How will you measure success?

28. Social Motivation • Management Acknowledgement & Visible Participation • Multi-level Wellness Team • Engage Opinion Leaders • Buddy System • Team Competition • Community Coaches • Blogs & Bravo! Board • Stories/Testimonials • Movin’ with a Mission

29. Environmental Support • Company Food • Cafeteria Food Labeled • Movement Friendly Workplace • Core Corner • Stand-up Desks • Friendly stairways • Marked walking routes • Quiet Room

30. Make it Fun! • Laugh • Sing • Dancing with Dumbbells • Cooking contests • Fridge Fitness • Team Competition

31. A Success StoryLawndale School District ASCIP intro Presented to senior management/thought leaders Engaged established Wellness Committee Multiple schools/single message Vital Behaviors – weekly action step Social Motivation – bean cookbook Seasonal communications - “Why am I eating this?” Slowly expanding - incentives for Quizzes

32. Action Steps • Determine your definition of success. What are your Vital Behaviors? • Engage senior management. • Create and continually to grow your team • Establish a 12-month plan with small, measurable goals i.e. xx% walking 4x/week • Consider Competition • Have fun!

33. The Wisdom of Dilbert

34. Containing Health Insurance CostsviaEmployee Wellness Programs Questions?