Implementing a Best Practice Wellness Program

Berkshire Health Systems Occupational Health and Wellness Bobbie Orsi, MS, RN Jenna Grelle Laramee, MA, RN

Berkshire Health Systems

3,600 employees Mean age 46 75% Female Self-insured (5 plans) Health costs total $32 M 600 RNs - unionized Top 5 key cost drivers
Musculoskeletal Cancer Ill-defined Digestive Cardiovascular

Program History
Accent on Health Community Outreach Education Screening 2000 External Worksites Education Screening Coaching 2003 Increase in External Worksites OCC Health Community Health Van 2007 - 2010

BHS Wellness at Work

2005

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

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 Pillars

Dee 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.

Chairman, Department of Medicine Berkshire Medical Center Wellness Leadership Team

Gray Ellrodt M.D.

Best Practice Core Component: Senior Level Support

The BHS 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

Vice President, Human Resources Berkshire Health Systems Wellness Leadership Team

Arthur Milano

BHS Guiding Principles

1. 2. 3. 4. 5. 6. 7. 8. 9. 10.

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!

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.

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!

Strategies to Improve Health and Wellness

Early detection and prevention Customized risk reduction Early intervention Referrals Follow up Promotion of healthy lifestyles Healthy Culture Easily accessible

Healthy Employees

Confidential Ongoing support

Vice President, Human Resources Berkshire Health Systems Wellness Leadership Team

Arthur Milano

Agenda 2006
Sent: Wednesday, January 11, 2006 9:05 AM Subject: 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 Dietitian 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

Address the entire care continuum Stop risk progression (Dont get worse) 15% members = 85% cost
Well No Disease

At Risk Obesity High Cholesterol

Acute Illness/ Discretionary Care Doctor Visits Emergency Visits

Chronic Illness Diabetes Coronary Heart 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

Disease management Incentive design Self management training

Case management Predictive modeling

Well

Risk

Urgent

Disease

85% members = 15% cost

Mercer Human Resource Consulting

Offer Something for Everyone

All program components are cumulative
Healthy employees Employees with isolated risk Employees with high Blood pressure, cholesterol, or pre-diabetes Employees with diabetes, post stroke, MI, PAD

Website with HRA Healthy Steps Challenges Nutrition programs Fitness programs Worklife programs Fitness benefit Smoke Free Fun events Back Health Self-Care Tobacco Treatment Weight Watchers Weight benefit Nutrition counseling Modified Coaching EAP Health Coaching Hardwired for Health (8-week lifestyle classes) Pre-Diabetes Classes Early Intervention Program Diabetes Education Cardiac Rehab OP Rehab CHF program Cancer Support

Program Staff
Staff
Total

2006 Year 1
3.5 FTEs

2007 Year 2
4.5 FTEs

2008 Year 3
5.5 FTEs

2009 Year 4
5.3 FTEs

2010 Year 5
5.2 FTEs

Mgmt

.5 Director

.5 Director

.5 Director

.44 Director/Mgr .19 Business Mgr

.38 Director/Mgr .12 Business Mgr

Coach

1 RN

2 RNs

2 RNs

2 RNs

2 RNs .5 Health Educator

.5 Program Coord 1 Assistant .6RD/.1 EAP

Support

1 Prog Coord 1 Assistant

1 Prog Coord 1 Assistant

1 Prog Coord 1 Assistant .8 RD /.2 EAP

.5 Hlth Ed .5 Prog Coord 1 Assistant .6RD/.1 EAP

YR 2 YR 3 YR 4 YR 5

Added 1 RN to accommodate employees (Increase coaching) Added Registered Dietitian (increase focus on weight reduction) Added EAP counselor (increase EAP utilization for high% depression) Skill mix (Program Coord/Health Educator) non-RN strategy for mod risk employee Integration with OCCH (added Business Manager) 1FTE Health Educator

Program Growth
History 2006 Year 1
705 HFIT 953

2007 Year 2
1186 HFIT 1227

2008 Year 3
1051 HFIT 1250

2009 Year 4
1418 ScoreHealth 1348

2010 Year 5
TBD TBD

HRA Biometrics Screening Incentives

$3000 for participation

$25 per employee for HRA/screening $6000 participation None

Connection to benefits $350/700 $6000 participation 1) HRA 2) Screening 1) 2) 3) 4)

Same

Same

Benefits requirements Benefits Design

None

HRA Screening Self Care Flu/declin

1) HRA 2) Screening 3) Action 4) Flu/declin BCBS/HNE wellness

None

None

BCBS plan HMO Blue + Wellness

Wellness HNE plan

Program Participation Trends

2006 2007 2008 2009

92%

61% 52% 53% 44% 37% 22% 16% 33% 30% 42% 38% 39% 29% 31% 40%

HRA

Wellness Screenings

Completed Both Screening and HRA

Program "Touch Points" (Number of employees completing at least one initiatve)

SCOREHEALTH: Smart Software

Documents client information Guides process Uses evidence-based guidelines Individualized goals Easy-to-read educational material Reports for Client Counselor Provider Group Tracks outcomes over time Finds at-risk clients & groups
20

SCOREHEALTH: Group Reports

Report viewer with Group Stratification Profile

21

Programs Targeting Major Health Risks

Risk: CVD / Diabetes Data (n=1,348) HTN 5% PreHTN 27% Non-HDL >160 21% BMI 25-29 29% BMI >30 - 25% Risk 1 & 2 43% Diabetes - 3% Programs Screening/coaching Weight Watchers BP sweeps Healthy Steps Nutrition counseling/programs Pre diabetes classes Walk It Off: Weight mgt. Fitness benefit THR program Self-directed and group challenges

Programs Targeting Major Health Risks

Risk: MSC injury (EE Claims/ WC) Data (n=1,348) 290 employees Arthritis / back / neck / joint / soft tissue (6 hip and 2 knee replacements) Programs MSC task force recommendations (ex. Early Intervention Program) Fitness incentive and programs Weight management

Programs Targeting Major Health Risks

Risk: Depression (EE BCBS Claims) Data: 123 employees Programs: EAP Worklife Coach Resiliency / Stress Mgmt Programs

Risk: Cancer (EE Claims) Data: 135 employees Programs: (breast, colon and skin) Weight management/PA Screening programs

Average change in 1,322 EEs

(2 or more screenings in past 5 years)
First Chol >=240 Non-HDL >= 160 Borderline Chol Optimal Chol Stage 2 Hypertension BP >=160/100 Stage 1 Hypertension BP 140-159/90-99 Pre-Hypertension BP 121-139/81-89 Optimal BP< =120/80 717 863 11% 453 400 4% 128 54 6% 135 346 398 789 24 Last 128 306 350 844 5 Change 2% 1% 4% 4% 1%

Changes in Blood Pressures 2006-2009 (n=1,322)

Initial Screening 0.7 0.6 0.5 0.4 0.3 0.2 0.1 0 Optimal BP (<120/80 mmHg) Prehypertension 120-139/80-89 mmHg) Stage 1 HTN (> 140-159/90-99 mmHG) Stage 2 HTN (>=160/100 mmHg) Last Screening

11% increase in Optimal BP 4% reduction in Prehypertension 6% reduction in Stage 1 HTN 1.7% reduction in Stage 2 HTN

Changes in Risk Levels 2006-2009 (n=1,322)

Initial Screening
60% 54% 50% 43% 40% 32% 30% 20% 20% 14% 10% 4% 0% Low Risk Moderate Risk High Risk Very High Risk 5% 28%

Last Screening

Chairman, Department of Medicine Berkshire Medical Center Wellness Leadership Team

Gray Ellrodt M.D.

Participation and Engagement Leads to Positive Outcomes!

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 38 EAP 156 Colonoscopy
42

Tobacco Treatment
57

Diabetes Education 39

2009 Referrals

PCP
358

Lab 166 Cardiac Rehab

1

BP Referrals
84

Nutrition
219

BHS Cardiovascular Health Risk Reduction Program

Independent analysis Conducted by Lifestyle

Research Group & Brigham Young University participants in wellness screening process 2006-2007 risk improvements occur between an initial nurse wellness screening encounter and a follow up screening?

502 BHS employees,

Research question: Did health

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)

Marketing and Communication

Employee Portal SCOPE Newsletter Bulletin Boards Home Mailings Emails Program visibility and exposure Personal Touch

Health Cost Savings

BHS Health Cost Trends compared to Milliman Medical Index
20.00% 17.3% 15.00% 10.00% 5.00% 3.3% 0.00% 2007 2008 2009 16.2%

8.4%

Milliman Index 7.7% 7.4% BHS

Employee PMPM Medical PMPM Drug PMPM Total PMPM PMPM Net Claims > $30,000 % of EE >Age 45 Inpatient Admissions/1000 Average Cost Per Admission Average Paid Per Employee Claimant Osteoarthritis (non-spine) Musculoskeletal (spinal conditions) Obesity and lipid disorders Gastrointestinal Increase in Employees Using Prevention RX Antihyperlipidemics Anti-hypertensives Beta Blockers

Wellness $450.70 $98.88 $548.58 $432.63 56.7% 69.8 $11,512 Wellness $16,017 $6,593 $7,286 $8,622 Wellness +36% +24% +36%

Standard $517.65 $109.90 $627.55 $455.35 60.1% 90.8 $14,921 Standard $35,376 $9,478 $8,968 $8,968 Standard +11% +2.5% -8.4%

Wellness vs. Standard -14.9% -12.3% -14.4% -5.3% -6% -30% -29.6% Wellness vs. Standard -120.9% -43.8% +11% -4%

Berkshire Health Systems 2009 Health Care Cost Savings

Health Cost Trend Differential
Differential of BHS cost vs. national average (Milliman Index) IF BHS incurred same rate as benchmark (7.4% vs. actual 3.3%) = would result in another 2.1 million spent BHS cost with 3.3% increase $29,793,267, Milliman 2009 cost increase of 7.4% - $31,928,535 BHS cost differential 31,928,535 29,793,267 = $2,135,268

$2,135,268

Shift in Multiple Health Risk Prevalence

Shift in number of employees with 0-1, 2-3, 4+ risk factors 0-1 Risk factors = average cost $1,389 2-3 risk factors = average cost $1,730 4+ risk factors = $2,701 Savings estimated due to severity of risk factors used (i.e. smoke, stage 1 & 2 HTN, cholesterol >240 and BMI >30) and exclusion of costs related to lifestyle-related factors (American Journal of Health Promotion, 15(5) 2001.

$35,000*

Weight Reduction (60 employees)

(Criteria moving from BMI of >30 to <=29 or from overweight to optimal weight) $1,400 x60 (Data Watch July 2009)

$84,000

Tobacco cessation (50 employees)

(Criteria 6 months or longer tobacco free) $4,730 x50 (Inquiry 41:1,2004)

$236,500

Influenza vaccination (2365 employees)

(Criteria flu vaccination in 2009) $13.66 x2,365 (Centers for Disease Control, February 2006)

$32,305

Colonoscopy Screening and Early Detection

6 cases of adenomas >1cm in 67 employees/spouses 10-15% of adenomas >1cm progress to Colon Cancer Expected Cost of Medical Services related to colon cancer survivor (initial treatment x average yearly cost) (Emedicine via WebMD, December 2009)

$141, 000 $2,664,070 $692,000 3.84 to 1

Total cost avoidance Total cost of program 2009 (cost of related services and salaries) Program Return on Investment

Total Health Management

Opportunities for Engagement
Traditional OccHealth Services
Injury Management Drug Free Worksite Program X-ray and physical therapy services Ergonomics, vision/hearing testing Pulmonary function and computerized Pre-employment physicals Comprehensive vaccination program Environmental exposure lab testing Electronic HRAs Wellness Screenings (Risk ID) Personal Health Coaching Nutrition Consultations Lifestyle programming:

BHS Wellness Program Components

respiratory fit testing

nutrition, physical activity stress management, etc.

Employee Assistance Program

Chairman, Department of Medicine Berkshire Medical Center Wellness Leadership Team

Gray Ellrodt M.D.

Vid00963.wmv

Occupational Health and Wellness

Never doubt that a small group of thoughtful, committed people can change the world. Indeed, its the only thing that ever has. Margaret Mead