Capital BlueCross: CCA Members Employee Wellness Showcase

Here’s what Capital BlueCross President and CEO Gary D. St. Hilaire had to say about the strategic importance of the comprehensive wellness program available to company employees:

“Employees are our most important asset, and without question nothing is more important than their good health.  A key corporate priority is to enhance organizational and employee performance, which includes our comprehensive employee wellness program.  When employees are healthier, they are happier and more engaged in seeing the company succeed.  Living healthier is important for each of us personally and for the business.  On behalf of the entire management team, I wish all employees much success with their healthy endeavors.”

According to the Health Enhancement Research Organization (HERO), a national non-profit organization that serves as a leader in the creation of employee health management research, education, policy, strategy, and infrastructure, Capital BlueCross offers its employees one of the most comprehensive employer-based wellness programs in the nation.  The Capital BlueCross Employee Wellness Program achieved a HERO Scorecard rating of 183 out of a possible 200 points. The average rating nationwide is 93.  Capital BlueCross also recently achieved the prestigious American Heart Association Fit Friendly Award.

Likewise, the wellness incentives Capital BlueCross offers employees are among the best in the nation.  According to standards set by the Wellness Council of America, taking into consideration the many programs that qualify for incentives, the different types of incentives available (gift cards, HSA contributions, special promotions), and the dollar value of incentives available.  By participating in a variety of voluntary screenings, wellness activities and healthy community events, employees have the opportunity to earn up to $650 in incentives for their healthy endeavors.

Capital BlueCross provides employees all of the following onsite:

  • Health clinics and fairs
  • Biometric, blood pressure and skin cancer screenings
  • State-of-the-art fitness facilities
  • One-on-one fitness, nutrition, stress management, weight management, tobacco management and other classes and coaching
  • Zumba, yoga and tai chi classes
  • Lactation area
  • Care management counseling
  • etc.

The Capital BlueCross Employee Wellness Program also offers employees an array of digital coaching and activity trackers to help employees successfully achieve their healthy endeavors.

A near $50,000 (127.7%) return on investment was achieved in 2012 for company-paid flu shots, when considering the impact to medical costs and productivity.  All told, Capital BlueCross realized a $1.7 million savings based on programs offered, participation and health/disability-related cost avoidance.

Active Health: CCA Members Employee Wellness Showcase

Empowering better health and wellness: A member success story

Meet Joe.* At 200 pounds, Joe realized he was overweight. He wanted to start eating right and exercising, but he couldn’t seem to find a way to make these activities a priority. Fortunately, Joe connected with ActiveHealth and gained support that helped him lose 40 pounds. Today he is healthier, happier and has reduced his risk for a variety of chronic conditions.

As a leading provider of integrated population health improvement services, ActiveHealth Management partners with employers to develop customized solutions that empower better health and wellness. We have recently enhanced our offerings by developing a multi-modal and personalized approach to health improvement. Joe is one of those members we were able to connect with and help along each step of his unique journey.NEWM_2013_Supporter_Logo_f

ActiveHealth’s Care Engine® technology continuously reviews population health data and matches it with evidence-based clinical best practices to proactively identify gaps in care and opportunities to improve employee health. This system identified Joe, who had significant risk factors because of his sedentary lifestyle and the fact that he was 40 pounds overweight. ActiveHealth also captured Joe’s preference for one-on-one support through self-reported data. As a result, he was immediately referred to an ActiveHealth coaching program.   

A health coach connected with Joe to help him develop a personalized roadmap to reach his wellness goals. Our coaches are expertly trained at building strong relationships with individuals and determining the right course of action to meet their unique challenges. In Joe’s case, he needed help implementing an exercise plan, staying motivated and dealing with stress. His health coach helped him set realistic goals and provided the tools, information and support he needed.

Joe also had access to other ActiveHealth programs and services, including a completely refreshed online portal, on-site biometric screenings, mobile health applications, employee communications, incentive programs and much more.  Wherever Joe is, he has access to the guidance and resources he needs to stay on the path to better health. In addition, the tools give employers visibility into the impact the programs are having on population health so they can also see the success.

Over a nine month period, Joe reached a weight of 178 pounds. His early success, along with ongoing support from his ActiveHealth lifestyle coach, continues to motivate him to make positive lifestyle changes.

Visit activehealth.com to learn more. 

* Joe is a real member — we’ve simply changed his name to protect his privacy. 

Engage with Active Health in Social Media

Twitter: @ActiveHealth

The Joslin Diabetes Center: CCA Members Employee Wellness Showcase

The Joslin Diabetes Center’s Center of Excellence for People with Complex Diabetes

The economic impact of the diabetes pandemic has been estimated at some $245 billion each year by the American Diabetes Association. A significant portion of that cost falls on small businesses and corporations as the result of increasing cost of healthcare insurance, lost work and employee disability.

Diabetes can be managed, as a rule, with proper care (medication and education) and lifestyle modification. But there is mounting evidence that the “usual care” does not work for those employees who are most at risk for disease progression and increased complications leading to disability and high and costly utilization of the healthcare system.  Estimates maintain that this applies to about 25% of adults with diabetes, or about 2% of the adult workforce.NEWM_2013_Supporter_Logo_f

Joslin Diabetes Center, in Boston, MA, has created the Center of Excellence (COE) for People with Complex Diabetes to address the need for an alternate form of care for these patients.  This program builds on Joslin’s long history of innovative clinical programming for individuals needing interventional re-orientation to their diabetes self-management. And it supported by a new, custom-built on-line infrastructure.

The COE program involves an intensive, one-week assessment, treatment and educational program at the Joslin Diabetes Center in Boston. At the end of the week, the patient returns home and is followed for three months of e-clinical support, assessment and adjustment of medications and self-management programs (including the Weight Management on line program), as well as six months of e-coaching, web-based education and group interactions using an on-line chat room monitored by a Joslin educator.

Unlike standard diabetes treatment regimens in which the components are most often isolated and poorly coordinated, the COE follows the JoslinCare model of multidisciplinary, highly integrated care. Each patient is assessed for a full range of diabetes complications (eye, kidney, nerve, etc.) and is seen by a comprehensive team of doctors, nurses, psychologists, nutritionists, and educators who are all part of the Joslin Clinic staff.

At the conclusion of the one-week on-site visit, patients return home to their primary care providers. Joslin clinicians partner with patients’ home physicians throughout the program to maintain communication and ensure that the patient’s individualized plan has a sustained impact on medical care and self-care.

At six months, a virtual clinical assessment is conducted and reported to the patient, the primary care physician and the employer. Based on Joslin’s experience in similar programs, we anticipate that at six months, most patients will have achieved a clinically-meaningful drop in their blood glucose levels, along with weight loss, an increase in exercise frequency and compliance to a suggested diet.

For employers the cost of this program will be more than offset over two years through savings in the direct costs of care for diabetes and its complications and improvements in cost of work loss due to diabetes complications and disability.

Contact: Cathy.carver@joslin.harvard.edu

Twitter: @JoslinDiabetes

Moda Health: Walk the Talk: CCA Members Employee Wellness Showcase

Walk the TalkModa Health: Walk the Talk

As a society, we are less physically active than we have ever been. The digital workplace and extended work days have made it difficult to find time for exercise. That’s where we come in.

As members of the wellness team at Moda Health, a Pacific Northwest company of high quality health plans, we decided to take a stand. We asked the hard questions. Imagine if we change the way we think of ourselves as company. Instead of focusing on treatment, symptoms, injury and disease, we work upstream to keep the healthy people…healthy.NEWM_2013_Supporter_Logo_f

The Moda Health employee wellness program, known as Walk the Talk, began in August 2004. The most popular program to date is the Charity Challenge, a hybrid pedometer competition and charity fundraising event. This 5-week challenge consists of teams of employees tracking daily steps, participating in health activities and attending nonprofit walks in the community. Teams also create baskets and sell tickets to raise funds for charities. At the end of the competition, the top teams and individuals are recognized and are celebrated at a companywide event.

This year, 258 employees participated in Charity Challenge – 78 more than last year. The total number of steps taken was 101,081,038 and money raised was a whopping $10,133 for our nonprofit partners.

One Moda Health employee said of the challenge, “I am journaling my food and exercise and am down 11lbs. I’m really excited!” Another employee states, “It’s important [to participate] because we are a health company”.

Due to programs such as Charity Challenge, Moda Health executives have also taken note.

They hope it will assist employees in increasing or sustaining optimal health, so we can serve our customers more efficiently and effectively. They also look to the wellness program to increase awareness and self-efficacy to ultimately improve employee morale and job satisfaction.

Moda Health employees continue to have positive, health-conscious attitudes as a result of the Walk the Talk program. Since 2009, 96 percent of survey respondents have agreed (or strongly agreed) that a wellness program is worth their time and effort. Moda Health looks forward to continuing to improve the health of our greatest asset — our employees — in the future.

Engage with Moda Health in Social Media

Many of the Moda Health Charity Challenge resources can be found online at:

www.modahealth.com/employers/wellatwork/physicalactivity.shtml

For more information about this program, contact wellatwork@modahealth.com

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Vitality: CCA Members Employee Wellness Showcase

Vitality LogoRunning from a 16-year Habit

Vitality GroupIn the six years since he’d been in the U.S. Marine Corps, Brandon Bahlawan went off track and away from the physical fitness routine he’d known as a Marine. While he made some sporadic attempts to get back into healthy routines, they were short lived, usually lasting only a matter of months. Particularly when he was working toward an MBA degree, he made poor health decisions, did not exercise, gained weight and smoked.

When Aggreko, the company for which Brandon works as a damage claims administrator, offered the Vitality program, he didn’t immediately engage. One day, he decided that he could no longer make excuses – he had smoked enough. He would use Vitality’s online smoking cessation tools in an attempt to break his smoking habit.

Brandon participated in the smoking cessation course, conversation and calculator that lead Vitality members toward smoke-free lives. Initially, these educational tools gave Brandon the courage and motivation to take the first steps necessary to conquer smoking once and for all. In addition, he took advantage of the many interactive tools and action steps located in the virtual Vitality Library. “I can honestly say that the program offered on the Vitality website worked for me, and I know that this time it is for real.” Brandon has permanently quit smoking – for the first and last time in 16 years.NEWM_2013_Supporter_Logo_f

Quitting smoking also inspired Brandon to work on other aspects of his physical health. As a Marine, he always enjoyed running, so he put his running shoes back on and took to the streets. In doing so, he regained his strength and endurance, and within three months time, lost 20 pounds.

Having often dreamed of running a marathon, he decided to begin training for one. He has established a routine and remains focused on achieving his goal of completing two half marathons. Brandon believes that he will have the motivation necessary to cross the finish line of a full marathon next year.

Brandon advises his colleagues: “Set challenging but achievable goals and work toward them. Try to avoid expecting ‘instant gratification’ when working toward your goals. Let the Vitality Points you earn through the program be your ‘instant gratification.’ Keep in mind that consistency and dedication are key to achieving your goals. When you accomplish a goal, reward yourself! Then set a new goal!”

Rand Report on Workplace Wellness: What Employers Must Know (Part II)

Q&A about the Rand Report on Workplace Wellness (Part II)

What Employers Must Know

Read Q&A about the Rand Report on Workplace Wellness (Part I)

Questions and Answers: A Conversation with Soeren Mattke and Hangsheng Liu

How were the final sample sizes (N) determined?

Due to the potential for future publication of the study analysis, we cannot provide additional information that was not included in the final report. However, we can point you to Table B1 (p. 122) in the appendix and to the footnotes throughout the report for sample size data.

In Table B3 (p. 126), we see a column labeled, “Variables Not Balanced After Matching,” but no detailed percentages or averages are stated. Can we see the statistics on the matching variables before and after the match?

None were imbalanced between groups.

Other risk factors (e.g., glucose, blood pressure, alcohol consumption, overall health status, fruit/vegetable consumption) were provided in the data but not included in the report. Why?

There were several reasons. First, due to the length of the report we were unable to include all risk factors. We prioritized the list and analyzed the most common risk factors. Data availability was also a factor.

In the obesity analysis, Figure 4.17 (p. 50) indicates a 14% difference between the participant and nonparticipant rates. How does this relate to a 1-pound reduction?

Using the same regression analysis and underlying sample, we simulated a final analytic sample supposing all participants participated in the program all five years. This simulated hypothetical cohort of participants and nonparticipants was then projected over time. The dichotomy between the actual regression and the simulation makes it difficult to explain how the numbers were derived but provides an elegant way of translating parameter estimates in a nontechnical way. Since the model runs on BMI units, we then assumed the characteristics of a standard man and woman (based on CDC data) and translated the change in BMI to change in pounds. This finding of a 1 pound per year reduction is significant since it represents the average weight loss of participants compared to nonparticipants on a population level (i.e., 1 lb. times the number of participants). Furthermore, participants continued to lose an average of one pound/year in the first and second years after the year of participation.

Regarding the cost analysis (pp. 53-57). a. Is this cohort over the whole time horizon? b. Were outliers excluded? 3. Did you use company cost or company + employee cost?

a. Not all employees were involved for all years.

b. We used 99% threshold for outliers. 3. Analysis was based on allowable claims data, or company cost + employee cost.

Can you explain further the conclusion that incentives were associated with significant improvements in smoking, BMI and exercise, yet the effect size was small (p. 87)? How were these conclusions determined?

The challenge with this estimation was that the employers included in the analysis had little variation with incentives offered, both across employers and within each employer over time. Therefore, we had a large sample size with little variation to run the regression. Figure 5.19 (p. 87) indicates that higher incentives impact reduction in BMI with significant effect. When translated to pounds, we still detect a significant effect. However, given the small effect size and little variation, it is difficult to make a strong statement on the effect of incentives on health outcomes. Furthermore, employers in the sample used incentives for participation only, not outcomes.

Did you adjust for the differences in benefit plans between employers?

No, we did not have access to benefit information, but we did match by employer, candidate year, employee comorbidities, prior utilization and cost. While this limitation could confound the results, the problem should be minimal. One might speculate that analysis of the benefit design might show that the impact was underestimated. This would make and interesting empirical study for future research.

Was there any adjustment for cost differences for the same service in different facilities and regions of the country? For example, an individual living in a high cost region of the country pays $4,000/year with a 6%/year increase, while another living in a low cost region pays half the amount. Even in a difference-in-difference model, the analysis would indicate a cost increase when the % change favors the participant.

Yes, but the analysis matched on baseline cost also. However, this introduces another issue, which is matching on services or on baseline costs, not both. Ideally, the groups would be matched by geographical area, and in one regression analysis geographical region was considered.

How was participation defined? Without a minimal threshold of participation, there may be little to distinguish a participant from a nonparticipant, and thus little expectation of savings.

We used the definition from each respective data contributor, including their definition of minimal threshold, for the comparison group. We did consider the effect that the definition might have on the analysis and assumed program responsibility to engage the participant. With that technique, we arrived at a real-world estimate of the program’s impact. We would like to do further research to include a dose-response curve and examine efficacy of continuous participation.

Was there any attempt to measure presenteeism, absenteeism, or productivity impact other than asking employers what they liked about the program? Do you plan to do so in future research?

We did not have data on presenteeism or absenteeism. However, we would like to have this data for additional analysis. See Section 7.4.2 (p. 109) regarding future research.

Read Q&A about the Rand Report on Workplace Wellness (Part I)

Rand Report on Workplace Wellness: What Employers Must Know (Part I)

Q&A about the Rand Report on Workplace Wellness (Part I)

What Employers Must Know

The RAND Corp Workplace Wellness Programs Study, presented to Congress, brought about much needed discussion and questions about the state of workplace wellness programs, their outcomes, and their long term role in the transformation of our health care system and the attainment of a better health status for all in our Nation. Questions abound on the report, its methodology and its findings. CCA received and studied many of those questions and, on Wednesday June 19, convened a group of researchers and experts to go over the methodology, data and conclusions of the RAND Workplace Wellness Programs Study with the authors.

Soeren Mattke and Hangsheng Liu, senior scientists at RAND, answered the questions received and the follow up clarifications posed by those on the call. The following is a summary of that long and in depth conversation.

Read Q&A about the Rand Report on Workplace Wellness (Part II)

The RAND Corp Workplace Wellness Programs Study, presented to Congress, brought about much needed discussion and questions about the state of workplace wellness programs, their outcomes, and their long term role on the transformation of health care and the attainment of a better health status for all in our Nation.

Did anything surprise you?

I was surprised that the cost curve did not reach statistical significance, due to random noise in the model. Another surprise…high-powered incentives tied to health outcomes are much less common than the literature would have us think. Nine percent of employers use health contingent incentives and use them in modest amounts. Public debate is ahead of the actual state of the field.

Did the study look at all at components – online, in-person counseling, content, classes, support, communications, etc.?

No. The limited time and funding prohibited that level of granularity. Our wish list for future research includes amount of exposure, level of interventions, and level of exposure.

Among the nonparticipants who also receive the benefits of health promotion, a. Is there a motivation selection bias or in fact could the nonparticipants be receiving benefits? b. Could savings, therefore, be underestimated?

a. Yes, there is still the possibility of some bias because it was not a randomized, controlled trial. The difference-in-difference method is powerful in observing those, but we can’t rule out unobservable differences between participants and nonparticipants. It is possible that some nonparticipants were exposed to health promotion activities (e.g., better food offerings, exercise messaging) at the worksite but didn’t participate in personalized counseling program and would not be picked up by the analysis.

b. These estimates, given the research design used, reflect the marginal impact of a lifestyle management component. Changes in environment would impact both participants and nonparticipants, and we would have no way of comparing to other employers to get to that effect.

How does the report affect the current position of wellness in the market? For example, do you feel it does anything to temper the “rosy” expectations that came from earlier meta-analyses?  Will the current data in the report help us to better manage more realistic expectations around workplace wellness?

Some past numbers were too rosy. Look at what wellness programs are doing. It is not unrealistic that cost neutrality is a positive result because these programs are intervening in a workforce population that is not sick. These programs are a preventive effort to avoid future healthcare costs, so if we can get to cost neutrality and better health this is a good result for the industry and the programs.

Given the fact that some of these presentations are somewhat old now, a. What’s your thought about some of the newer strategies/approaches to wellness program engagement, including outcomes-based interventions? b. Were there sufficient data to look specifically at the outcomes-based programs for their impact on healthcare costs?

a. These types of programs remain rare, so there is not enough good data for meaningful statistical assessment.

b. No, there was not enough data and no employers tied to outcomes. A fine line exists between shifting risk and cost to more vulnerable employees and dependents and making employees feel compelled to take advantage of the programs offered. More research and more data are needed to find the right balance between appropriate risk sharing and inappropriate cost shifting.

a. What value do you think there’d be in formulating a clearly established list of wellness-sensitive conditions, so that outcomes can be more specifically studied? b. What about process measures – the outcomes of wellness on use of preventive care services, disease-specific preventive care, and medication adherence?

a. Hard question. In essence, we know many conditions are sensitive to health behaviors. The former surgeon general attributes 75% of healthcare costs to behavior. Many cancers, and potentially asthma and COPD, can be tied to obesity. We must find a way to quantify the strength of relationship in order to call it “wellness sensitive.” To begin to unpack the “black box,” we should define conditions and look more closely at what can be done for a quicker response versus what can be expected to happen later in the process.

b. The more clinical outcomes are better tied to disease management, the better, because that is the intervention strongly tied to medication adherence. There would be value in looking at the use of preventive services, either through employer screenings or healthcare providers, but really only those recommended by USPSTF.

I saw a tweet that approximately says, “…see? Wellness doesn’t work.” I would assume, seeing your presentations, that you would not make such a strong statement. Comment?

Workplace wellness involves complex interventions, and success will always depend on the particular intervention within the particular context and the particular measures of outcomes used. From what we see here, there is clear evidence for a qualitative and meaningful effect on health risks, but no strong evidence for savings of healthcare costs. Here we see a roughly cost neutral intervention that achieves a gain in health risk reduction.

a. What costs were or were not included in the cost analysis?  b. Were there any assessments of costs directly related to the interventions versus costs unrelated to interventions?

a. We included medical and prescription drug costs. We did not have data on work loss, workers comp, disability, etc.

b. We did not analyze whether changes in healthcare utilization were for wellness sensitive conditions. Rather, this was a high level look at overall costs without attempting to attribute at a more granular level. We did, however, take out years in which an employee was pregnant or participating in a case management program for high cost, high-risk conditions.

Can you comment on suggestions for future research?

Future research should seek to get more granular with related versus unrelated costs. Another area to consider is different type of outcomes, like productivity and other work-related impacts. A larger sample size may show significant effect on cost, so more employers in the database and a longer time series may indicate at what difference the curves converge and reach statistical significance. Also, we need to begin to unpack the black box. We can’t assume that all programs are effective or all programs are ineffective, and we need to understand the distinctions, i.e. how do employer (e.g., culture, support) and employee (e.g., health literacy, age, gender, ethnicity) characteristics drive changes so that targeting interventions becomes more effective.

Read Q&A about the Rand Report on Workplace Wellness (Part II)

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