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HEM Evaluation Study

Bill J. Wright, PhD
Center for Outcomes Research & Education Providence Health & Services Bill.Wright@Providence.Org

SUMMARY OF THE STUDY

Surveys designed to assess program satisfaction, participation, and short-term outcomes (results now) Interviews designed to explore key findings in greater depth (results in two months) Claims analysis designed to look for long-term cost savings (results in early 2014)

TODAYS PRESENTATION:
Findings from the first mail survey

See also: Attached report with more detailed findings

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The Questions
A comprehensive evaluation of the HEM program designed to answer three broad types of questions: Psychosocial & Behavioral Impacts Does HEM change participants health behaviors? Does HEM help people work toward their health goals? Employee Satisfaction Do employees like HEM? Does it impact overall job satisfaction? Is satisfaction with HEM changing over time? Health and Cost Impacts Does HEM result in better health over time? Does HEM result in lower costs of care over time?
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The Survey
Todays Report: Findings from the first mail survey Representative sample of employees Included both participants and non-participants This is our first survey; future surveys would be needed with this study panel to assess trends/changes over time

We tried to reach...

3,500 Enrolled in HEM

=

57%

Survey Completed (n=1,989)

=
Overall Response Rate (n=2,347)

4500 PEBB Beneficiaries

52%
=

1,000 Not Enrolled in HEM

36%

Survey Completed (n=358)

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The Results: Participation

Participation Varies Widely by Department/Agency
Department or Agency Universities (including Oregon University System) Environmental/Agriculture Justice Health/Social Services (DHS, OYA, OHA) Misc. (smaller depts, offices, commissions) Judicial Dept. of Transportation (ODOT) Boards (free-standing) BenefitHelp Solutions Corrections (including State Police) Total (49,116 employees in sampling frame)
HEM Participation Rate

Most Common Reasons for Not Participating

Reasons Information was too personal Unhappiness with how the program was introduced Concerns about information security Concerns that it would impact their job or pay Believed they were healthy and so did not need HEM
*Multiple responses allowed, will not total to 100%

91% 90% 89% 84% 88% 86% 85% 84% 80% 77% 86%

67% 60% 40% 18% 17%

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The Online Health Assessment

KEY FINDING: Most participants (97%) completed the initial assessment and found it easy to use. Most (56%) reported that they did use the information in some way.

How easy or hard was it to complete? (n = 1857)

What was difficult about it? (n = 264)

Online system hard to use Too long Questions too complicated Did not know specific test results Didnt have easy computer access Wasnt in preferred language Other (various) 51% 39% 20% 14% 14% 1% 21%

53%
Easy

33%
Neither

14%
Hard

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The E-Lessons
KEY FINDING: About eight in ten completed the e-lessons. Of those who didnt, most claimed to have not understood the requirement.
Did you complete the e-lessons? (n = 1714) Why didnt you complete them? (n = 300) Didnt know they were required Didnt know about the deadline Hard to find time Online system hard to use Did your spouse? (n = 1293 with a covered spouse) No computer access Forgot Security of information 44% 39% 31% 24% 7% 6% 5%

82%
Yes

18%
No

77%
Yes

19%
No

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The E-Lessons
KEY FINDING: The most commonly chosen e-lessons were stress, healthy eating, weight management and sleep.
TOP FIVE MOST COMMON E-LESSONS:
Providence (n = 1350) Dealing with stress Healthy eating Sleeping well Healthy weight Getting active Percent 45% 39% 32% 26% 21% Kaiser (n = 217) Lose weight Eat healthy Reduce stress Overcoming insomnia Overcoming depression Percent 52% 50% 45% 24% 17%

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The E-Lessons
KEY FINDING: Just under half of respondents made changes based on the e-lessons. Most had success maintaining.
Did you try changing anything about your health or lifestyle after your most recent elesson? (n = 1346) What changes did you try to make? (n = 599 who tried to make a change) Increased my physical activity Changed the way I eat Stress management Management of health condition Something else Follow-up with doctor 43% 42% 38% 13% 13% 8%

54%
No

46%
Yes

In general, how successful have you been in maintaining those changes? (n = 605 who attempted to make a change)

What are the main reasons youve had a hard time maintaining changes?
Lack of motivation Too busy Stress/mental health Physical health Other (various) 36% 20% 20% 8% 36%
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21%
Very successful
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73%
Part successful

6%
Not Successful
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Employee Satisfaction
KEY FINDING: Employees were not satisfied with the HEM rollout. Concerns about privacy and coercion were widespread.
Overall Satisfaction with the HEM rollout:
HEM Participants (n = 1953) HEM Non-Participants (n = 313) Very Satisfied 5% 2% Satisfied 23% 8% Neutral 39% 28% Dissatisfied 19% 22% Very Dissatisfied 15% 41%

If you could change one thing about the HEM rollout, what would it be?
Ask for less personal or private information Provide more information about other changes happening at the same time (like changes to deductibles) Make it feel more collaborative Allow different ways to enroll, not just online Allow more flexible deadlines Multiple reasons (provided more than one)
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HEM Participants (n = 1927) 18% 16% 12% 10% 8% 6%

HEM Non-Participants (n = 296) 20% 10% 22% 9% 3% 17%

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Employee Satisfaction
KEY FINDING: We found few signs that satisfaction with HEM was improving over time.
Compared to when it was first introduced, how has your opinion of the HEM program changed? More Satisfied Now HEM Participants (n = 1661) Non-Participants (n = 142) All Employees (n = 1803) 8% 7% 8% About the Same 71%* 61%* 70% Less Satisfied Now 21%* 32%* 22%

*Indicates statistically significant difference between participants & non-participants

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Employee Satisfaction
KEY FINDING: When asked about their happiness with different elements of the benefits package, HEM was the lowest rated element, even among participants.
Percent Very Good or Excellent HEM Participants HEM Non-Participants ALL Employees (n = 1874) (n = 287) (n = 2162) 33%* 22%* 31% 28%* 16%* 26% 42%* 31%* 41% 16%* 4%* 14% 37%* 22%* 35%

Rating of premiums Rating of deductibles Rating of benefits (what is covered) Rating of HEM Program Overall rating of benefits

*Indicates statistically significant difference between participants & non-participants

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Employee Satisfaction
KEY FINDING: HEM contributed to an overall decline in satisfaction with benefits over the last year.
Why are you LESS satisfied? HEM Participants
Changes in deductibles 69% 60% 56% 8% 6% 6% 1% 20% 82% 74% 54% 25% 6% 5% 2% 26% Dont like the HEM program Changes in premiums Smoking surcharge Reduced coverage Higher out of pocket costs Spouse surcharge Something else

4%
More

50%
The Same

46%
Less

Non-Participants

Dont like the HEM program

3%
More

37%
The Same

60%
Less

Changes in deductibles Changes in premiums Smoking surcharge Reduced coverage

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Higher out of pocket costs Spouse surcharge Something else

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Health Efficacy
KEY FINDING: Self-efficacy was roughly comparable overall, with no evidence of large differences between groups.
Health Self-Efficacy Questions How sure are you that you can accomplish your health goals even when You have worries and problems? You feel down or depressed? You feel tense? You feel tired? You feel busy? You dont get much support from others? Percent very sure or sure HEM Participants (n = 1880) 76% 68% 76% 65% 65% 77% Non-Participants (n = 272) 82% 76% 80% 68% 70% 81%

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Health: Smoking
KEY FINDING: HEM participants were much less likely to report smoking than non-participants.
Smoking Percent who are current smokers Percent former smokers --Of current smokers, percent currently trying to reduce or quit HEM Participants (n = 1901) 3%* 25% 88% Non-Participants (n = 312) 15% 25% 80%

*Indicates statistically significant difference between participants & non-participants Smokers may be significantly less likely to participate in HEM, perhaps out of fear of being penalized. HEM participants may also under-report smoking for similar reasons.
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Health: Obesity
Key Finding: HEM participants were less likely to be obese, were more able to correctly assess whether they were obese or not, and were more likely to be actively trying to lose weight.
HEM Participants (n = 1881) 51% 86%* 30%* 16%* Non-Participants (n = 286) 56% 75%* 42%* 23%*

Percent who consider themselves overweight --of those, percent actively trying to lose weight Percent with calculated BMI 30+ (obese) Percent who say they are not overweight, but whose BMI score indicates they are

*Indicates statistically significant difference between participants & non-participants

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Health: Exercise & Diet

KEY FINDING: There were no significant differences in activity levels, but some signs of improved diet among HEM participants.
HEM Participants (n = 1900) Percent who are the same or more active compared to other their age Percent more active than they were a year ago 84% 29% HEM Participants (n = 1999) Average times/week eating fast food Average servings/day of non-diet soda Average servings/day of fruit Average servings/day of vegetables
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Non-Participants (n = 290) 85% 31% Non-Participants (n = 323) .96 .34 1.80 2.33

.89 .29 2.00* 2.64*

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Health: Overall Health Profiles

KEY FINDING: Participants and non-participants had broadly similar overall health profiles. We did find a slightly higher incidence of depression and diabetes among non-participants. .
HEM Participants (n = 1943) Overall Health: Percent good, very good, or excellent Health Trends: Percent who say their health is same or better as it was at this time last year Percent Diabetic Percent screening positive for current depression on PHQ-2 assessment Percent with at least one chronic health condition 92% 94% 7%* 5%* 48% Non-Participants (n = 301) 90% 96% 10%* 8%* 49%

*Indicates statistically significant difference between participants & non-participants

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Summary of Key Findings

LOW PROGRAM SATISFACTION: Employees were dissatisfied with the HEM program, citing concerns about privacy and coercion in the program rollout. HEM may have contributed to a general decline in benefits satisfaction. E-LESSONS HAVING AN IMPACT: Employees who participated in the e-lessons reported making changes in their lives as a result, and most had at least some success maintaining those changes. EARLY SIGNS OF HEALTH: Though it is too early to assess full health impacts, some promising early signs around obesity and diet measures may hold promise for future findings. Additional survey work would be necessary to track these changes and determine whether they play out over time.

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Next Steps
INTERVIEWS: We are currently fielding a series of in-depth, open-ended interviews to explore the key findings and themes from the mail survey. The results, available in several months, should help refine understanding of these findings and increase their usefulness for future program development. CLAIMS ANALYSIS: A claims analysis, scheduled for late 2013, will explore whether there are any signs of cost savings among HEM participants. POTENTIAL FOR FUTURE SURVEYS: These surveys represent an initial measure comparing participants to non-participants. Additional surveys with this same panel of respondents would allow for assessment of trends in outcomes over time, creating the opportunity to understand the real impacts of the HEM program on health efficacy, health behaviors, and health outcomes.

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