Why Wellness? Why is behavior change so hard? Wellness ... · • Opt-in enrollment • High-touch...

transcript

Agenda:

Why Wellness?

Why is behavior change so hard?

Wellness Solution

Engagement Solution

Case Studies

Agenda:

Why Wellness?

Wellness Solution

Engagement Solution

Case Studies

Why do employers want to change employee behavior?

Universal client challenges Rising healthcare costs

Employees unengaged in

managing their health

Employees lack

knowledge of benefits

Client Challenge: Rising healthcare costs

• Employers are struggling with the impact of the rising cost of healthcare.

Client challenge: low engagement

Lack of employee engagement

Lack of sufficient financial incentives to encourage participation in programs

Lack of adequate budget to support effective health management programs

Too many other demands on employees

Not enough time on the part of employees

Poor or inadequate communication of health management programs

Source: Towers Watson

Population

Medical

Healthy Worried

Chronically

Ill Multi-Chronic

Acute /

Catastrophic

End of

70% 20% 5% 4% 1

13% 22% 14% 28% 23%

Health

Condition

What problems are employers facing?

Why focus on Wellness?

Dee Edington: “Keep people from getting worse”

Population

Healthy Worried

Chronically

Ill Multi-Chronic

Acute /

Catastrophic

End of

70% 20% 5% 4% 1

Health

Condition

What problems are employers facing?

Onsite Fitness

Wellness (Comprehensive)

Condition Mgmt

Onsite Clinics

Case Mgmt

HRA to Nowhere

Health Fairs

Flu Shots

Continuously Driving Engagement

Program Integration

Medical & pharmacy costs

Just the tip of the iceberg

Source: Edington, Burton: A Practical Approach to Occupational

and Environmental Medicine (McCunney). 140-152/2003

Question:

– What percent of our health is impacted by Genetics alone?

Employers can impact 80% of the “influencers of health”

Source: Centers for Diseases Control and Prevention, University of California at San Francisco, Institute for the Future. Reprinted from Advances, Robert Wood Johnson Quarterly Newsletter, 2000; 1:1

Influencers of Health

Access to Care

Environment Genetics Health Behaviors

Health Behaviors

U.S. Healthcare Expenditures 88%

Other Access to Care (treatment)

10% 20% 20% 50%

Employer Impacts

Employer-based wellness works! ROI studies of wellness programs:

• Bank of America • Blue Shield of CA • Duke University • Citibank • City of Birmingham • Coors • DuPont • General Foods • General Motors • GlaxoSmithKline • Indiana BCBS • Johnson & Johnson • Life Assurance • Nortel • Prudential • Travelers • Union Pacific • Washoe County

Source: Chapman, L., Proof Positive: An Analysis of the Cost-Effectiveness of Worksite Wellness, Chapman Institute, Seventh Edition, 2011.

Traditional

Newer Programs

Outliers C

Study Number

C/B = 1:5.8

Agenda:

Why Wellness?

Wellness Solution

Engagement Solution

Case Studies

Behavioral economics: the study of

predictably irrational decision making

2002 Nobel prize in economics is awarded to Daniel Kahneman for “integrating insights from psychological research into economic science”

What do you get when you cross a psychologist with an economist?

An internal “battle” can influence our choices in seemingly illogical ways….

Behavioral Economics

Anchoring

Framing

Gamblers Fallacy

Group Think

Loss Aversion

Hyperbolic Discounting

“Fairness”

This is due to different regions of the brain having different purposes…

Reward Circuitry – Medial Forebrain Bundle often referred to as the “Hedonic Highway”

“Executive Function” Or Reflective Cognitive

“Emotional Function” Or Automatic Cognitive

Two cognitive systems

Automatic system: • Uncontrolled • Effortless • Associative • Fast • Unconscious • Skilled

Reflective system: • Controlled • Effortful • Deductive • Slow • Self-aware • Rule-following

One approach: rider vs. elephant

Three steps to bring change

1.Direct the rider

2.Motivate the elephant

3.Shape the path

We like to think we are rational…. but sometimes we are not…

Isn’t it obvious from these drawings why you should always buckle up?

Maybe if we explained it to you…. Physics-based appeal from an engineer:

During collisions, a car is able to stop in a fraction of a second, whereas the speed at which the passengers are moving remains unchanged until they are stopped by impact with the steering wheel, seat in front of them or the windshield. In the case of a car traveling at 30 miles per hour, this type of impact is equivalent to the impact the passenger would feel if he fell three stories. Seat belts help to distribute the collision forces across the passenger's pelvis and chest--areas that most effectively withstand collision forces.

Or reminded you

Or ???

We can influence the elephant’s behavior by choosing our future

path and goals…

So why won’t we do it?

I’m always in charge.

Sure you are. Except when I

decide otherwise.

Answer: We systematically over-project the rider’s future control of immediate decisions.

When choosing between a healthy and unhealthy snack for delivery in one week, do people correctly predict future desires?

Does the future me want different things?

← next week→ predicted preference

← right now→ actual preference

D. Read (Leeds U.) & B. van Leeuwen (Leeds U.), 1998, Predicting hunger: The effects of appetite and delay on choice. Organizational behavior and human decision processes, 76, 189-205.

26% chose the unhealthy snack for delivery in one week right after lunch.

26% 74% ← next week→

predicted preference

One week later, when allowed to change their choice at the delivery, 70% chose the unhealthy snack for immediate consumption

26% 74%

30% 70%

← next week→ predicted preference

← right now→ actual preference

• Power of Framing - Which would you rather hear from your doctor? “10% of people die from this

procedure” or

“90% of people are cured

following this procedure”

We do not make perfect choices….

Incentives:

Q: Can’t we just pay people to make good

decisions? A: You get what you pay

for… and pay… and pay…

Incentives can effectively drive activity, but not engagement…

Example: carrot vs. stick

Challenge: Incentives appeal to rider, not the elephant…

Engagement: Wouldn’t it be better if people took control of their health for the right reasons?

eHealth Platform Incentive Examples Incentive Reward Tracking Icons

Can we get more people to choose the stairs by making it fun to do?

Agenda:

Why Wellness?

Wellness Solution

Engagement Solution

Case Studies

Typical Employer Wellness Solutions

Participant Experience: Provide a “path” to identify & address their risks

Health Advising Personal

Wellness Plan

Condition Management

ENGAGE: Web Portal, Communication of Programs, Health Advocacy, Incentive Administration

Participant Experience: Overarching Framework

ASSESS ADVISE

Lifestyle Management: EMPOWERED Coaching

TAKE ACTION

Complementary Programs and Allied Programs

eHealth (web portal) Resources and Tools:

Personalized Online Programs Wellness Challenges

Biometric Screening Scheduling Worksite Non-worksite alternatives

Health Assessment Online Print option

Client Third-party Resources

Claims Data Medical Pharmacy

Various Approaches: Seek Balance and a fit for your culture • Carrot vs. Stick

• High-tech vs. High-touch

• Emphasis on incentives vs. Behavior change programs

• Focused on top issues vs. wide breadth of programs

INSIGHT® HRA

• 15 to 25 minutes to complete

• 6th- to 8th-grade reading level

• Biometrics uploaded into HRA

• Lifestyle questions, stages of change methodology, optional productivity (WLQ) and psychosocial

• 22 customizable questions

• Immediate tailored report and recommended programming based on results

• “Electronic bonding” pushes relevant content

• Aggregate reporting and sub-reporting

• Paper solution integrates with eHealth platform

• Integrated with wellness program

Biometric Screening Solutions Worksite and Remote

Scope:

• On-site delivery

• Alternative means screening processes (e.g., lab, PCP—fax/mail form)

Benefits: CLIENT and Participants

• Dedicated leadership team

– Onsite program manager

– Screening coordinator

– Onsite event leader

• Same-day results and personalized advising

• Online and telephonic scheduling

• Automated data upload to HRA

• Participant options (onsite and remote)

• Integrated with health management services

• Experience: 2011 conducted 2,500 events and 175,000 screened

99% satisfaction

eHealth Platform Web Portal

Participant Benefits

• Personalized and 24/7 access

• Real-time updates via coordinator

• Online coaching (Personalized Lifestyle Programs)

• Real-time incentive update

• Wellness challenges

• Mobile device access

• Tools and resources (plus scheduler)

CLIENT Benefits

• CLIENT-specific configurable

• Integrated — custom program pages

• SSO option

• Ongoing enhancements and innovations

Health Advising Personalized Wellness Planning

Participant Benefits

• In person or phone

• Personalized feedback

• Listening approach—trained health educator

• “MY” plan moving forward

• Recommendations based on stage of readiness/multiple factors

CLIENT Benefits

• Leverages teachable moment

• CLIENT specific — full inventory of your resources applied

• Program enrollment rates 2 to 4 times higher 92% Participant Satisfaction

EMPOWERED Coaching Lifestyle Management • Individual assigned coach model

• Behavior focused rather than risk-based

• Participant choice (onsite, telephonic, online)

• 13 focus areas (behaviors)

• Supports risk reduction including high blood pressure, weight management, high cholesterol, overweight/obesity, pre-diabetes

• Participants create customized programs based on their readiness to address specific lifestyle behaviors

Physical Activity 1. Aerobic

exercise 2. Flexibility 3. Strength

Healthy Eating 4. Unhealthy fats 5. Fruits 6. Overeating 7. Skipping meals 8. Sodium 9. Sugary drinks 10.Vegetables 11.Whole grains

Healthy Living 12. Smoking

cessation 13. Stress

anagement

12.2% risk reduction 67% enrolled and completed

92% satisfaction

EMPOWERED Coaching Condition Management Key Objectives:

• Helps chronically ill members achieve and sustain compliance with evidence-based medicine

• Makes a positive impact on improving health and controlling costs

Key Features:

• Sophisticated data analytics identifies high-risk, high-cost participants

• Opt-in enrollment

• High-touch primary nurse coach model

• TeleHealth technology: transmits clinical data and empowers behavior change

Managed Conditions: Asthma Diabetes CAD CHF COPD Additional Offerings: Back and neck pain Hypertension Maternity

Management

• 10.5% reduction in hospital admissions

• 13.1% reduction in emergency room visits

• 1.5–2.0 to 1 average program ROI

Personalized Lifestyle Programs Participant Benefits

• Variety of tools and resources to support behavior change over time

• Personalized, individually tailored action plan based on initial “consultation”

• Embedded in eHealth platform

• Tools: BMI Calculator, Food Fight, Portion Sizes Tool, Step By Step

• Check-ins: 30, 90, and 180 days

• iPhone® and iPod® touch supported trackers and videos

• Alternative delivery option for participants who prefer self-directed program

Core 5 Programs

Weight management

Stress management

Healthy eating

Physical activity

Smoking cessation

Health Action Programming and Challenges

Via eHealth • Access to a full lineup of health action

programs:

– Walk This Way

– Great American Fitness Adventure™

– Feel Like a Million™

– NutriSum™

• Team competitions and challenges

• Custom/site-specific

• CLIENT group-specific programs

• Mind Your Health seminars

• Team competitions

Engagement Personalized messaging

• Engages the entire population

• Data-driven personalization

• Increases overall adherence rates up to 20%

• Extracts value from health plan covered services

• Increases engagement in wellness programs and services

• Provides cost savings via early detection and avoidance

Areas of Messaging:

Preventive care

Chronic care

Program Engagement

Physician finder

Life, Health & Wealth Case study: Rural Hospital

• Client: Rural Regional Medical Center

• Opened in February of 2010

• Rural hospital in Arkansas

• Features modern, state-of-the-art medical equipment & a friendly staff

Get rising healthcare costs under control, successfully launch a turnkey wellness & engagement solution without the added expense of incentives.

OBJECTIVE

Case study: Rural Hospital

Solution

• LifeHealth & Wealth engagement campaign

• One-on-one communications

• LifeHealth & Wealth Wellness Solution (including onsite screenings)

• Enabled by voluntary products enrollment

Result

• High participation rates in health screening & HRA

• Early identification of some high-risk health issues.

• Will know biometric impact year-over-year in second year of program

Learn more. View case study #1 at: http://trustmarksolutions.com/brokers/case-studies

EXPERIENCE • Leadership

• Complex client needs & integration

PERSONALIZATION • Client customization

• Person centric

ENGAGEMENT • Intrinsic behavior change • Tailored & sustained marketing

Infusing Health into your Culture

What should you look for in a Wellness partner?

Experience and Leadership Commitment to Service and Excellence

Industry Awards

• NBGH Best Employers for Healthy Lifestyle Award (10)

• C. Everett Koop National Health Award: (4)

• WELCOA—Well Workplace Award: (5)

• IHPM—Corporate Health and Productivity Management Award (2)

Industry Leadership

• NBGH Committees

• Care Continuum committees

• HERO Think Tank

• NCQA Wellness Accreditation with Performance Reporting (AWPR)

Wellness Solution - Reporting

HRA client reporting • The HRA aggregate group data includes:

– BMI and body fat – Level of stress – Dietary habits – Days/week of exercise – Tobacco use – Depression – Cholesterol

Health coach reporting • Aggregate summary report • Participation & interaction metrics • Goal progress & satisfaction

– Alcohol use

– Blood pressure

– Vehicle safety

– History of illness

– Blood glucose

– Stages of change

Reports provide the number of employees at risk, by risk

and stratification, as well as aggregate readiness to

change information.

Program impact: ROI and cost benefit

• University and Medical Center (Year 1)

– 3,750 eligible

– ROI = 2.7 (5.0 with incentive costs/revenue)

• Medical Technology and Manufacturing (Year 1)

– 9,400 eligible

• Utility Company (Year 2)

– 38,500 eligible

– Medical claims savings = $7.86 M

• Chemical Company (Year 3)

– 7,600 eligible

– Medical claims savings = $6.3M

HealthFitness clients

We capture individual health risk information.

Reporting / Data

Identifies risk profile of the group…

Reporting / Data

Compares client risks to other peer companies

Reporting / Data

Estimates initial health risk cost exposure

Reporting / Data – “Derived ROI Impact”

Tracks program impact over time

Remember: We are not always rational…

Until we are aware, motivated and shown the path!

Agenda:

Why Wellness?

Wellness Solution

Engagement Solution

Case Studies

Employee Engagement Educate the rider, appeal to the elephant, provide a path

Pre-enrollment 1-on-1 enrollment Wellness program

Learn more.

Sample communication

E-mail from employer

Pre-enrollment communication sample

Preventive campaign Sample communication: Week 3

Learn more.

Engagement solutions

Campaign leads to personal dialog with a benefits counselor • The one-on-one meeting uses an

employer tailored discussion guide and presentation.

– Reinforces cost-containment messages AND messages the employer chooses

– Asks employee for a personal commitment – “one small step”

– Assesses financial well-being, and the need for a voluntary product

1-on-1 Enrollment communications

Call to Action to “what is the first step for you?”

1-on-1 Enrollment communications

Trustmark Wellness Solution

Engagement strategies • Established marketing

campaign – print-ready template elements: – Executive letter

– Flyer

– Poster

– Email & direct mail template

• One-on-one employee meetings to gain participation commitment.

Post-enrollment communications

Question:

– Can you significantly impact wellness program participation without monetary incentives?

Case study: Large school system

• Client: Fourth largest school district in the United States

• Comprised of: – 392 schools

– 345,000 students

– More than 40,000 employees

To drive awareness, participation and higher employee engagement in the existing wellness program, which had less than 1% participation.

OBJECTIVE

Case study: Large school system

Solution

• Customized engagement campaign

• One-on-one communications

• Enabled by voluntary products enrollment

Result

• Of employees seen, 77% completed one or more targeted wellness activities

• 4,700 new policies were also provided to meet the needs of their employees

Learn more. View case study #2 at: http://trustmarksolutions.com/brokers/case-studies

What were the real roadblocks?

What if we just asked?

Yes No Not Sure

Do you think your employer* should take steps to reduce healthcare costs?

2010 DCPS Focus Group N=118

Agree Disagree

I am open to participating in wellness activity.

HealthAssessment

Health Screening On-lineEducational

Programming

Chronic DiseaseManagement

Walking FitnessProgram

Which wellness activity would you be most interested in participating in?

Recognized all M-DCPS work locations that successfully achieved a 30% “commitment” to participate in the new Well Way initiates. Walk to be Fit Health Coach and Advisor Disease Management Health Assessment

Large School District The Green Light Incentive Program

Reward: $100 fitness package for School Board recognition (top locations) Trophy/plaque

23% Engaged in a WellWay Program

Did not engage

Of the employees that were seen…

Green Light Incentive The Results

8,006 EEs committed to enrolling in a Well Way

Program

Question:

– Would similar engagement solutions be effective for groups smaller than this large school system?

– We’ve seen successful solutions implemented at entities ranging from 97 to 50,000 employees!

Anchoring bias:

We are heavily influenced by where we start our thought process…

You might guess something like 1 million.

Most people guess around 300,000.

If instead I told you, “The population of Green Bay is 100,000. What is the population of Milwaukee?

The actual population is around 580,000.

Regardless of where we were “anchored” before on Wellness

programs and outcome – we need to be open to the possibilities…

Seriously? Wellness Coaches can change lives?

Thank You!

Questions?

Why Wellness? Why is behavior change so hard? Wellness ... · • Opt-in enrollment • High-touch...

Documents