koop award winner medical mutual of ohio with connie beutel

©2009 Medical Mutual of Ohio

Medical Mutual Employee Wellness Program:

Implementation and Results

June 8, 2011


22

Purpose and Mission

Fundamental purpose:

Improve the health and productivity of our population by modifying lifestyle behaviors that negatively impact well-being

Medical Mutual Program Mission:

“To provide the means and opportunities for employees to reach and maintain their best possible well-being”


33

Medical Mutual’s Employee

Program

Makes a strong commitment to wellness ensuring that Medical Mutual

will meet and exceed strategic goals:

Keep our healthy employees healthy

Reduce the risks of the medium and high-risk employees

Positively impact healthcare cost/trend

Enliven and rejuvenate our corporate culture


44

Employee Program Direction

Shift in Focus…

From: Basic Awareness and Program Participation

To: Concrete, Measurable Outcomes

– Reduction in employee health risk

– Economic Analysis


5

Company Demographics

•Approx. 2700 employees •Years of Service: Less than 5= 32%

•75% Female; 25% Male Over 5= 68%

Over 10= 51%

Over 20= 25%

Employee Breakdown by Age

0%

5%

10%

15%

20%

25%

30%

35%

20-29 Year

Old

30-39 Years

Old

40-49 Years

Old

50-59 Years

Old

60-64 Years

Old

Over 65

Years Old

Employee Breakdown by Age

0%

5%

10%

15%

20%

25%

30%

35%

20-29 Year

Old

30-39 Years

Old

40-49 Years

Old

50-59 Years

Old

60-64 Years

Old

Over 65

Years Old


66

Medical Mutual’s

Program Timeline

•Corporate Wellness

Proposal approved

by executive team

•Full implementation

of health promotion

practices into day-to-

day operations

•First Health

Assessment (HA)

•Walking for Wellness

•Weight Watchers

•Onsite Health

Screenings

•Onsite Immunizations

•Enhanced employee

preventive benefits

•Toledo Wellness

Center Opening

•Roll-out of

REWARDS program

•Lunch and Learn

Seminars

•Smoking Cessation

Program

•Annual employee

wellness survey

•Nurse Line

•Cleveland Cafeteria

Grand Opening –

healthy menu choices

•Web-based Healthy

Living Programs

•Cleveland Wellness

Center Opening

•Education Modules

•Health club

membership

reimbursement

•Recipient of NBGH

Platinum Award and

Local Healthy 50

Award

• Transition from

gift incentives to

healthcare premium

discount

2003 2004 2005 2006


77

Medical Mutual’s

Program Timeline

•Onsite Mammography

Screening

•Pilot Program: Onsite

BP Machines

•Employee Assistance

Program Integration

•HA and HLPs Made

Available to Non-

Insured Employees

•Incentive Options

Added to REWARDS

Program

•HR Dept. Includes

Wellness Initiative in

Company Survey

•Continual

Programming

Analysis/Evaluation

•Weight Loss

Challenge

•Cooking

Demonstrations

•ROI Calculation

•Measurement of

Obesity in the

Population

•Rollout of Incentive

Tracking and

Fulfillment Program

•Expansion of

Employee Preventive

Benefits

•Incentives for

Preventive Care

•Implementation of New

Fitness Center

Management Team

•Implementation of

Telephonic/Online

Lifestyle Coaching

•Fresh Produce Home

Delivery Program

•Rollout of SuperWell for

Life Web site

•Analysis of Cafeteria

Food Purchases

•Benchmarking with

NBGH and HERO

20092007 2008 2010•SuperLoser Weight

Loss Challenge

•C. Everett Koop Award

•Amer. Heart Assoc. Fit

Company Award

•Rollout of Onsite

Hypertension Pilot

•Quarterly Fitness

Contests through

Wellness Centers

•SuperWell for Life Web

site Enhancements

•Program Evaluation

against Industry

Benchmarks

•Smoking Surcharge

Implemented


8

Wellness Program Offerings

Health Promotion

Health Assessment-400

Onsite Health Screening-300

Goal Getter Program-300

Flu Immunization-100

Dental Visit-50

Preventive Care Visit-50

Quarterly BP/ Weight Clinics-75

Healthy Habits

Weight Watchers-120

QuitLine Program-120

Chiricosta SupeLoser Challenge-150

The Chef’s Garden Purchase-50

Lifestyle Coaching-100

Disease Management Program-100

Fitness

Join Company Fitness Center-50

Join Community Fitness Center-50

Company Fitness Center Check-in-120

Quarterly Fitness Center Contests-40

Fitness Evaluation-150

Physical Activity Cardio Log-120

Walking Program-160

Company Sponsored Fitness Walks-25

Community Fitness Event Participation-25

Education

Education Modules/Quiz-120

Virtual Health Guides-100

Lunch & Learn Seminars-240

Healthy Environment/Culture

Tobacco Free Campus

Healthy Cafeteria/Vending/Catering Options

Accessible Stairwells

Coordination with Employee Assistance Program

Wellness Integrated into Orientation Sessions

Visibility/ Accessibility of Wellness Team and Program

Comprehensive and Multi-Modal Communications

Executive Team Communications

Point System allows us to heavily weight programs that we feel are most

important for employees to utilize.


9

Employee Wellness Site


Participation Results


11

Participation Analysis: Annual Growth

76 %8 1% 8 1%

8 7%

75%

8 6 %9 2 % 9 2 %

9 8 %

0

9 4 %9 1%

8 3 %

9 2 %

6 8 %

79 %73 %

8 2 %

6 1% 6 2 %6 9 %

4 9 %

57%

0 %

2 0 %

4 0 %

6 0 %

8 0 %

10 0 %

12 0 %

2005

(N=2,549)

2006

(N=2,577)

2007

(N=2,500)

2008

(N=2,928)

2009

(N=2,835)

2005-2009

(N=1,813)

Yearly Participation Cumulative Participation 2+ Time Participants

3+ Time Participants 4+ Time Participants


12

Participation: Employee Healthcare Costs

By Rewards Points Earned

$ 4,520

$ 2,107

$ 4,177

$ 2,290

$ 4,565

$ 3,009

$ 4,592

$ 3,129

$1,000

$1,500

$2,000

$2,500

$3,000

$3,500

$4,000

$4,500

$5,000

2005 2006 2007 2008 2009

0-2000 (N=257)

2000-3999 (N=242)

4000-5999 (N=244)

6000 + (N=954)

Average Annual

Healthcare Costs Increase

$ %

$581 28%

$465 20%

$415 14%

$320 10%

•There is a strong correlation between participation intensity and averaged

annual healthcare cost increases

Cla

ims

Pa

yo

ut

Pe

r E

mp

loye

e

Points


13

Participation: Average Lost Workdays by

Rewards Points Earned

2.24

1.36

3.09

0.95

1.88

1.38

2.28

1.7

0.0

0.5

1.0

1.5

2.0

2.5

3.0

2005 2006 2007 2008 2009

0-2000 (N=257)

2000-3999 (N=242)

4000-5999 (N=244)

6000 + (N=954)

Average Annual Lost

Workday Increases

Days %

0.26 19%

0.49 51%

0.17 13%

0.18 11%

• Fewer clean trends in lost workdays associated with program involvement.

• Those earning greater than 4,000 points show less lost workday increases

as compared with those earning less than 4,000 points.

Points

Lo

st

Wo

rkd

ays


14

Wellness Points/T1, T2 Risk Status

Time One Risk Status

Time Two Risk Status

Wellness Rewards Points

(Cumulated 2005 ~ 2009)

N Average

0-2 0-2 871 8,801

3-4 112 8,037

5+ 15 7,659

3-4 0-2 188 8,953

3-4 223 8,503

5+ 39 7,023

5+ 0-2 20 7,442

3-4 78 8,684

5+ 86 6,905

Among two time HRA Participants (2005/2006 vs. 2007/2008), N=1,632


15

Participation Analysis

• Program participation remains high, with a cumulative participation of 98%

• Repeat participation was especially high, with 94% of employees participating at least two years from 2005 through 2009.

• In 2009, 75% of employees took part in at least one program.

• Strong correlation between participation and averaged annual healthcare cost increases.

• Correlation between participation and remaining low risk or moving to lower risk from T1 to T2 HRA.


Risk Analysis and Economic Results


1717

Risk Analysis:

Shift in Risk Groups

Risk 2004/2005 2007/2008 2009/2010 % Change

Low Risk

(0-2)61.1% 66.1% 68% 6.9%

Medium Risk

(3-4)27.6% 25.3% 23.4% 4.2%

High Risk

(5+)11.3% 8.6% 8.6% 2.7%


1818

Risk Analysis: Shift in Risk Measures

Time 1 High Risk %

Time 2 High Risk %

Net Change % Point*

Physical Activity 13.4% 8.7% -4.7%

Safety Belt Use 12.7% 10.4% -2.3%

Life Satisfaction 5.8% 3.8% -2.0%

Smoking 8.4% 6.6% -1.8%

Job Satisfaction 5.5% 4.4% -1.1%

Medication to Relax 0.9% 0.5% -0.4%

Alcohol 1.4% 1.1% -0.3%

Perceived Health 8.6% 8.3% -0.3%

Illness Days 3.4% 4.4% 0.9%

Existing Disease 12.9% 14.0% 1.1%

Cholesterol 5.4% 7.3% +1.9%

Blood Pressure 34.1% 36.5% +2.4%

Weight (BMI) 48.3% 51.3% +3.0%

•While improvement is evident in several measures, there is still a negative shift in cholesterol (+1.9%), blood pressure (+2.4%) and weight/BMI (+3.0%).

Targeted for Intervention


19

Risk Analysis :

Impact of Risk Categories on Medical Cost

MED/HIGH RISK

Medical Costs

$6965

LOW RISK

Medical Costs

$2,879

MED/HIGH RISK

Medical Costs

$9180

+$2215 -$1522

LOW RISK

Medical Costs

$5543

MED/HIGH RISK

Medical Costs

$6314

LOW RISK

Medical Costs

$3502

+$3435 +$623

N=1,599; MMO Employees

2008 Healthcare

Costs

2009 Healthcare

Costs


20

Excess Medical Cost Due to Excess

Risk Status

$ 3,489 $ 3,489 $ 3,489

$ 1,020

$ 9,090

$ 4,509

$ 6,994

$ 12,579

$ 3,489

$ 3,505

$ 0

$ 2,000

$ 4,000

$ 6,000

$ 8,000

$ 10,000

$ 12,000

$ 14,000

Lo w R isk

(0-2 R isks)

N o n P art icipants M edium R isk

(3-4 R isks)

H igh R isk

(5+ R isks)

Number of Risks

M

e

d

i

c

a

l

C

o

s

t

s

Excess C o st

B ase C o st

*2010 HRA and 2009 Medical Costs


21

Excess Lost Work Days Due to

Excess Risk Status

1.8 1.8 1.8

1.7

4.33.5

4.6

6.1

1.8

2.9

0.0

1.0

2.0

3.0

4.0

5.0

6.0

7.0

8.0

9.0

10.0

Low Risk

(0-2 Risks)

Non Participants Medium Risk

(3-4 Risks)

High Risk

(5+ Risks)

Number of Risks

S

T

D

D

a

y

s

Base Cost Excess Cost


22

Healthcare Cost/T1, T2 Risk Status

Time One

Risk Status

Time Two

Risk

Status

N

Average Annual Healthcare Paid

2005 2006 2007 2008 2009

Average

05-09

0-2

0-2 871 $2,070 $2,717 $2,558 $2,936 $3,687 $2,794

3-4 112 $2,348 $4,041 $4,566 $3,716 $4,467 $3,828

5+ 15 $6,495 $4,921 $6,696 $5,580 $5,309 $5,800

3-4

0-2 188 $2,956 $2,828 $3,080 $3,369 $3,721 $3,191

3-4 223 $3,777 $3,625 $4,046 $3,724 $5,132 $4,061

5+ 39 $2,900 $3,985 $6,276 $5,977 $5,728 $4,973

5+

0-2 20 $2,510 $2,734 $5,453 $2,869 $4,593 $3,632

3-4 78 $6,536 $7,560 $7,201 $7,520 $9,583 $7,680

5+ 86 $5,555 $6,958 $7,144 $8,455 $11,905 $8,003

Among two time HRA Participants (2005/2006 vs. 2007/2008), N=1,632


23

Lost Work Days/T1,T2 Risk Status

Time One

Risk Status

Time Two

Risk Status N

Average Work Lost Days (STD)

2005 2006 2007 2008 2009

Average

05-09

0-2

0-2746 0.86 0.67 1.18 1.08 1.85 1.13

3-4103 0.54 2.24 3.17 2.54 2.50 2.20

5+ 13 8.85 0.00 1.37 0.00 3.20 2.68

3-4

0-2162 2.66 0.56 0.71 1.74 2.41 1.62

3-4194 2.20 0.88 2.36 2.15 2.94 2.11

5+ 36 0.00 0.89 3.87 4.86 3.92 2.71

5+

0-218 2.56 2.00 2.14 0.00 1.05 1.55

3-471 3.39 2.66 6.32 5.56 4.42 4.47

5+ 72 4.07 5.79 10.26 4.64 8.41 6.63

Among two time HRA Participants (2005/2006 vs. 2007/2008), excluding women with pregnancy claims N=1,415


24

Excess Cost by Risk/Condition

Risk Factor/

Disease StatePrevalence

Adjusted* Mean

At RiskNot

at Risk

Excess

Cost

Hypertension 37.4% $3,733 $3,387 $346

Cholesterol >=240 6.4% $3,578 $3,523 $55

Obesity (BMI>=30) 37.1% $4,757 $3,511 $1,246

Diabetes 6.8% $10,115 $3,524 $6,591

Coronary Artery Disease 6.2% $6,087 $3,827 $2,260

Asthma 11.4% $4,516 $3,899 $617

Smoking 6.1% $3,517 $3,429 $88

Depression 11.7% $5,641 $3,755 $1,886

None of the listed risks 28.6% $2,633

*Adjusted for age, gender and all listed risks

Study population: N=2,047 (2009 HRA and 2009 Medical and Drug Paid Amount)


25

Studying Relationships…

•BMI and Lost Workdays

•BMI and Healthcare Costs

Then Developing Strategic Initiatives


26

1.56 1.49 1.17

2.18

3.16

4.5

0

1

2

3

4

5

<25

(N=355)

25-27.4

(N=216)

27.4-

29.9

(N=197)

30-34.5

(N=270)

35-39.9

(N=187)

40+

(N=144)

BMI

Day

s

Obese (BMI >30)

BMI vs. Lost Workdays


27

$3,290 $3,227 $3,094

$4,113

$5,374

$6,871

$0

$1,0 0 0

$2 ,0 0 0

$3 ,0 0 0

$4 ,0 0 0

$5,0 0 0

$6 ,0 0 0

$7,0 0 0

$8 ,0 0 0

<25

(N=355)

25-27.4

(N=216)

27.4-

29.9

(N=197)

30-34.5

(N=270)

35-39.9

(N=187)

40+

(N=144)

B M I

Pai

d A

mo

un

t

Obese (BMI >30)

BMI vs. Healthcare Costs


28

BMI Initiatives

Chiricosta Challenge

• Six-Month Weight Loss/Get Healthier Challenge

• CEO Endorsement and Ownership of Program

• CEO Blogs and Communications

• 1400 Participants

• 6500 Pounds Lost


29

BMI Initiatives (cont’d)• Fitness Center Reimbursements

• Onsite Fitness Facility Check-in Points

• Onsite or Community Facility Membership Points

• Fitness Center Contests

• Cardio Log Entry Points

• Walking Program

• Company Sponsored Fitness Walks

• Lunch and Learn Seminars

• Education Modules

• Healthy Choices: Cafeteria, Vending, Catering, Company Meetings

• Cafeteria Promotions, Educational Displays

• Healthy Cooking Demos


Benchmarking –

How are we doing against national standards?


3131

Health Enhancement Research

Organization

HERO Scorecard Results

The scorecard is a tool designed to determine employee health management best practice. It can be used as an inventory, an indicator for program success and as a benchmarking tool.

"The greatest value of the Scorecard is in providing an inventory of EHM best practices for consideration; your scores provide an indication of where you can identify opportunities to enhance your program."

2008 2009

Medical Mutual of Ohio Score 147 162

Total possible points: 200

National Average: 96


3232

National Business Group on Health

Wellness Impact Scorecard

The scorecard was developed to assist employers in understanding levels of achievement in improving health, the strengths and weaknesses of their programs and to help them benchmark against the programs of other employers.

Overall Progress

Total Potential

Points

MMO’s Score

2008 2009

Company’s Efforts to Improve Health (Level 1) 50 43 50

Employee Engagement (Level 2) 50 39 50

Outcomes and Analysis (Level 3) 100 75 87.5

Total 200 157 187.5

http://www.wbgh.org/index.cfm


3333

Cultural Analysis:

Impact of Wellness Program

Wellness Program Survey Results

– 94% of employees surveyed feel that the Wellness programs are making a positive impact on the culture at MMO.

– 90% of employees surveyed feel that the Wellness programs are making a positive impact on their health.

– 82% of employees responded that they are very satisfied or satisfied with the Wellness program.


Executive Summary and Analysis


3535

• Participation in the wellness program showed a positive impact on healthcare cost trends for three consecutive study periods.

• The low risk population continues to grow, a key achievement in our health management strategies.

• Employees who earned more reward points had smaller healthcare cost increases and smaller lost workday increases than those who earned less points.

• In general, an increased participation level (years of participation or number of wellness points) was associated with an increase in the percentage of individuals at low risk.

• The wellness program had the most impact on percent risk reduction for those employees with risk factors for: physical activity, safety belt use, life satisfaction and smoking.

• The number of employees at risk for weight (BMI), blood pressure, and elevated cholesterol increased over time and will remain a focus of programming and interventions.

Executive Summary and Analysis


36

Future of Wellness/Next Practices…

1. Focus on the individual and how to impact:

Personal buy-in and personal significance of change in health status

Sustainable behavior

Health in the context of life

2. Moving the general public to healthier lifestyles

Employer involvement in community health

Role of the community in employee/family health

Health as a social trend; social “movement”

3. Standardization of program offerings, measurement, evaluation and performance metrics

4. Continued focus on the influence and impact of corporate culture

koop award winner medical mutual of ohio with connie beutel

Health & Medicine