Culture Makes a Difference (Creating a culture of well-being)

CULTURE MAKES A DIFFERENCECreating a culture of well-being: A long term strategy for cost savings

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Lindsey Mangus – Health Promotion Specialist for the Carolinas of Cigna Health Services

Ben Buchanan – Product Manager, Corporate Health & Wellness of Carolinas Health System

Christie Dean – Wellness Coordinator of Mecklenburg County Government

Cheryl Walker – Health & Benefits Manager of the City of Asheville, NC

panelist

why does better health matter in the workplace?

__ Healthier workforce

__ Lower benefit costs

__ Better employee retention

__ Fewer sick days

__ Higher productivity

3Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2012 Cigna

• Fewer smokers

• Fewer heart attacks

• Employees who reverse their risk for metabolic syndrome

• Employees bringing BMI to a healthy range

• Employees having cardiovascular diseases and bringing their stress under control

Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2013 Cigna 4

$1,6231

$5,1762

$3,2003

$9521

$3931

Potential savings per individual health improvement

Organizations with highly effective Health and Well-Being programs.

1.Cigna Internal Analysis and Proof Points 2.Cardiovascular Even Average Monthly Cost: Milliman’s review of MedStat MarketScan TM Commercial Data 2004 Trended to 2006, Metabolic Syndrome and Employer Sponsored Benefits, An Actuarial Analysis, Milliman, March 2006. 3. Metabolic Syndrom and Employer Sponsored Benefits, An Actuarial Analysis, Milliman, March, 2006 4.2009/2010 North American Staying @ Work Report: The Health and Productivity Advantage. Towers Watson. Link: http//www.towerswatson.com/research/648

cost savings of healthier individuals


what is a culture of well-being?

It’s more than just encouraging physical wellness. It supports and fosters happier, healthier, moreproductive employees. Built into your overall businessgoals and a routine part of operations, it’s promotedat all levels of your company through programs,policies, benefits and the physical environment.

It motivates and inspires people to take action

to feel their best and perform their best

leading to lower total benefit costs.

culture influences engagement


1 2 3 4

Strong Leadership

TargetedSolutions

Proper Incentives

OngoingCommunication

Optimal Engagement

key components for a culture of well-being


Help people “know their numbers” and understand their health status and

potential risks

Easy-to-understand resources to help individuals learn how to be well for life

Helpful programs aimed at preventing illness and disease

Highly engaging behavior-change programs thatencourage your employees to practice healthy habits for a lifetime

Motivational programs and challenges to inspire people to actively participate in their health

Expert guidance and consultation to support organizations and individuals throughout the process

HealthAwareness Education Prevention Lifestyle Activity Coaching

building a solution tailored to your organization


certain components drive higher engagement

key engagement influencers: 1

leadershipcommitment

2tailored programs

3long-termwellness strategy

4easy to access programs available to all employees

5incentives to motivate


set the tone walk the talk eye on the ball

make it clear you valueemployee health

Creating a culture of well-being is more than providing programs that promote health. It’s a

commitment to improvinghealth. And a plan to make it a

way of life.

engagement boosting best practices

recruit help communicate

model thebehavior

make healthimprovementa standardagenda item

develop a wellnesscommittee to shareideas, work onpromotions and help execute plans

make goals clear,address obstacles,celebrate success


bottom line •Identifying participants’ health status, is a key first step in motivating individuals to take the right actions to achieve meaningful and lasting healthy behavior changes.

Behavior Savings

Service manager quits smoking, starts walking and avoids stroke

$5,176/month1

Head of finance avoids chronic high blood pressure through exercise, nutrition and stress management

$1,116/year2

Ten people in sales department lose 25 lbs. each and bring weight into a healthy range

$5,760/year1

identify employee health risk

motivate and influence behavior

improved health lower cost

develop culture of well-being

Maintain strong culture of well-being

1. Cardiovascular Event Average Monthly Cost: Millman's review of MedStat MarketScan(TM) Commercial Data 2004 trended to 2006.

2. "An Unhealthy America: Economic Burden of Chronic Disease" - 2010 Hypertension direct/indirect costs PPPY. www.milkeninstitute.org


“It’s clear that the cost of

doing nothing is greater than

the cost of doing something.

The natural flow of risks is to high risk.

The natural flow of costs is to high cost.”

– Dee Edington, PhDFormer Director, Health Management Research Center, University of Michigan

Carolinas HealthCare System:“A Culture of Wellness”

Wellness…Historically

CHS LiveWELL – Guiding Principles

• Achieving optimal health and well-being…Through an integrated and customized care experience.– It is our goal to improve the total health and well-being of our

teammates so they can provide the best care to our patients– We are committed to providing a comprehensive and optimal

health experience to our teammates and their families, based on experience, research, analytics and communications

– We will use our integrated System resources to consistently deliver a high-quality health experience throughout our teammates’ life stages

1. To Create a Culture of Wellness you must choose your metrics accordingly.

Communication

2. To Create a Culture of Wellness you must use your data wisely.

• Data sources to leverage:– Health risk assessment data– Biometric data– Claims data

• Use the data to help you choose the most appropriate partners within your community for assistance.

Completing the 360º View

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Person

Personal Health Survey

Clinical BiometricsClaims

Consumer Data

Personal Health Survey captures health and lifestyle risks not readily available elsewhere

Biometric and Clinical Data identify the status of disease not just its presence

Consumer Data provides socio-geographic consumption trends

Claims supply a wealth of medical and cost data at the member level

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3. To Create a Culture of Wellness you must Meet your Employees Where they are.

• A one-size fits all strategy will not work for all three population segments.

• Each group has it’s own unique challenges, and will need its own resources to maintain or improve their health status.

• Focusing on high risk members only, will only return short term success.

High RiskHigh Risk

Rising RiskRising Risk

WellWell

“It is common sense to take a method and try it. If it fails, admit it frankly and try

another. But above all, try something.” -Franklin D. Roosevelt

• Leverage

• Executive Support

• Departmental Support

• Public Recognition

• Activities that are educational and engaging

Although, we don’t yet have the ROI from our newly created enterprise wellness program, we certainly have insight on what needs to happen first!

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2011Wellness Passport

myTotal Awards for Healthy Behavior

Wellness Passport

myTotal Awards for Healthy Behavior

Wellness Passport Activity Log

Wellness Passport Wellness Passport ProgramProgram Reward Based Wellness Program

Tracking Mechanism Activities and Points Address the Risk Behaviors

of Population

Wellness Kickoff◦ Vendor Fair◦ Biometric Screenings

10K Step Walking Program◦ 8 Weeks

Wellness Seminars◦ ICMA Webinar Sessions

Health Risk Assessment

De-stress and Relaxation Techniques

Flu Clinics

Wellness Boot Camp

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331 Total Participants

Blood PressureNormal 38%Pre Hypertension 55%Hypertension 7%

Note: 62% of the participants are at risk or abnormal.

Total CholesterolDesirable 65%Borderline High 26%High 9%

Did You Know?A 2001 University of Michigan study showed that for every employee who reduces their cholesterol levels from 240 to 190, employer’s save an average of $1,200 per year.

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Body Mass IndexBelow Recommended 1%Recommended 25%

Overweight 31%Obese 34%Extreme Obesity 10%

Note: 75% of County employee participants that were measured are in or above the Overweight

category.

331 Total Participants

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Waist CircumferenceDesirable 60%Abnormal 40%

Did You Know? Fat around the waistline is strongly associated with coronary heart disease, diabetes and colon cancer.

Recognized by the American Heart Association as a GOLD LEVEL recipient for fulfilling the following parameters:

Offer employees physical activity support

Provide/increase healthy eating options at the worksite

Promote a wellness culture

Implement at least 9 criteria as outlined by the AHA in the areas of physical activity, nutrition and culture.

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◦ Employees have had for years…

Access to Mecklenburg County’s 11 fitness centers with classes where employees may participate at a discounted price.

Mapped and Marked walking trails in a secure environment.

No Smoking Policy (Implemented in the 1990’s).

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Established -Internal Wellness Program, myTotalHealth, supported by a Wellness Team ; Wellness Ambassadors from different departments and divisions

Offered - Free tobacco cessation classes

Promoted a walking challenge, including pedometers, information on walking distributed through e-mails, County websites, with prize incentives

Showcased - Artwork in the stairwells that encourages employees to take the stairs rather than riding the elevator, with the County Manager leading by example

Sponsored - Numerous Healthy Cooking classes throughout various County locations

Provided - On-Site Biometric screenings as part of our “Know Your Numbers” campaign to educate and help employees with awareness

Support and commitment – From the County Manager, The Executive Team, Dept. Directors, Managers and Front Line Supervisors.

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“YOU can do a lot with healthy life style changes”

City of AshevilleCity of AshevilleEmployee Health & WellnessEmployee Health & Wellness

Cheryl Walker, SPHR

December 2013

Employee Health & Wellness

• The Asheville Project®City of Asheville, North Carolina• Overview

• On-site Medical Clinic• Overview• Coordination

• Wellness Program• Design & Implementation• Coordination• Next Steps

Asheville’s Workforce

1,100 Full Time Employees & 200 Retirees

Self-Insured Health Program 2,300 Covered Lives

The Asheville Project Disease Management Program®®

The Foundation Principles

• We want you to feel better;

• We care about your health;

• We will remove barriers to get you the treatment you need

(1997 Inception)(1997 Inception)

The Asheville Project®

Diabetes: 1997 106 participants

Asthma: 1998 51 participants

CV Health: 1999 229 participants

Depression: 2006 55 participants

Incentives

Removing the barriers to patient compliance:

Patient Education Ongoing counseling with Pharmacist Care Managers Disease-specific Lab tests Disease-specific medication and supplies

ALL ARE PAID AT 100%

The Asheville Project: 2013

Total participants: 340 15% of the covered lives on the city’s plan

Patients enrolled in 1

Program

Patients enrolled in 2+ (Co-morbidities)

Total Enrollment

Diabetes 17 93 110

Asthma 28 32 60

Cardiovascular 135 131 266

Depression 24 50 74

Use of Incentives• Modification of prescription drug formulary

• Remove brand-name medications with generic equivalents from copay waiver program

• Removal of copay waiver for participants if City not primary insurance (dependents or retirees with Medicare)

• Meeting with patients in on-site medical clinic to enroll in disease management program and help in maintaining compliance

• Tying participation & compliance to Asheville Balanced Choices

Wellness & On-site Medical Clinic

Wellness & On-site Medical Clinic

• Occupational Services: work-related injuries, vaccinations, drug testing, MRO, Hearing testing

• Personal minor illness, flu vaccinations, allergy shots, etc.

• Increase personal visits for employees• Increasing access

• Staff – PA, nurses and non-medical staff• Dependents may utilize clinic services

Asheville Balanced Choices Wellness

Phase 1: Designing our Wellness Program

Determining our goals – What you want to achieve determines the behavior you reward

• Design Wellness programs to reward healthy members (the other 85%) and achieve financial goals

• Coordination with On-site Health Clinic • Utilize all available data (medical claims, On-site Medical Clinic and

Health Risk Assessments) to:• identify members without annual wellness screenings• provide early warning diagnosis’

• Encourage compliance through financial incentives• $600 per year per adult drives behavior

• Continue to develop, track, and expand disease management

Asheville Balanced Choices Wellness Program

Phase 2: ImplementationPhase 2: Implementation• All or nothing approach 89% participation• To participate you must agree to:

• Complete Annual Health Risk Assessment (employee & spouse)• Annual health screenings• Be tobacco free or agree to participate in Tobacco Cessation

program• Participate in 4 additional Wellness Activities (web-based,

employer sponsored activities and preventive care) each year• Tobacco Cessation Program

• Combined group classes with medical supervised nicotine replacement aids and/or prescription drugs at $5.00 copay

• Accountability for 90 days following graduation and semi-annual updates

Asheville Balanced Choices Wellness Program Asheville Balanced Choices Wellness Program • Use Health Risk Assessments and Health Screenings to measure

current health of all adult participants.• Include verifiable biometric data • Use all future data to determine impact/effectiveness of Wellness

program offerings.• Gradually change mindset of Wellness program before

implementation of Outcomes-based program.

• Use Employee Clinic to follow-up on biometric screening concerns and identify participants for enrollment in disease management programs.

• Tobacco Cessation Programs -140 graduates• Current quit rate for members still actively employed 12 months

post graduation

58%

Next StepsThe Asheville Project®, On-site medical clinic, & Wellness Program

• Expanding Provider Collaboration using electronic medical record systems

• Weight Management Program

• Integration of The Asheville Project® & Wellness programs to ensure compliance

• Care Manager Report Cards

• Identification of participants not receiving recommended ‘wellness’ screenings or procedures (eye exams, flu shots, annual physicals, etc.) and offering services through on-site health clinic

• Determine high frequency services to add to employee health clinic that accomplishes cost savings for City and employees

• Designing Phase 3 of Wellness program to include outcomes-based requirements

• Partnerships with community to consider new or unique approaches to Wellness to accomplish Wellness objectives

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Lindsey Mangus – Health Promotion Specialist for the Carolinas of Cigna Health Services

Ben Buchanan – Product Manager, Corporate Health & Wellness of Carolinas Health System

Christie Dean – Wellness Coordinator of Mecklenburg County Government

Cheryl Walker – Health & Benefits Manager of the City of Asheville, NC

Culture Makes a Difference (Creating a culture of well-being)

Economy & Finance

distribution

mecklenburg

site medical

corporate

health risk

carolinas

employer sponsored

cigna health