building a sustainable infrastructure for ehm: a vision for the future
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Building a Sustainable Infrastructure for EHM: A Vision for the Future. Presented by Larry Chapman M.P.H. Chairman and Co-Founder Summex Health Management. Agenda. The mistake most employers make The key pieces of your program infrastructure - PowerPoint PPT PresentationTRANSCRIPT
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Building a Sustainable Infrastructure for EHM: A Vision
for the Future
Presented byLarry Chapman M.P.H.Chairman and Co-Founder
Summex Health Management
© Summex Health Management
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Agenda
The mistake most employers makeThe key pieces of your program infrastructureMatching your infrastructure to your program modelResource implicationsA vision for the future
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The Mistake Most Employers Make
They fail to build a sustainable EHM program infrastructure.
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“Sustainability” includes…
Enterprise-wideHighly “actionable”Administratively efficientStrong metricsSimplifying in natureWell-integratedStrategicViable over the long term
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Key Definitions
Infrastructure- “The basic structure or features of a system or organization.”
Structure- “The manner of construction of something and the arrangement of its parts.”
System- “Instrumentality that combines interrelated and interacting artifacts designed to work as a coherent entity.”
Program-“..an organized response to eliminate or reduce one or more problems where the response includes one or more objectives, performance of one or more activities, and the expenditure of resources.”
-The Free Dictionary by Farlex
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Perspective…
Health and Productivity Management(HPM)
"The integrated management of health risks, chronic illness, and disability to reduce employees' total health-related costs including direct medical expenditures, unnecessary absence from work, and lost performance at work (i.e., presenteeism).”
-IHPM
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Fun activity focusNo risk reductionNo high risk focusNot HCM orientedAll voluntarySite-based onlyNo personalizationMinimal incentivesNo spouses servedNo evaluation
Mostly health focusSome risk reductionLittle high risk focusLimited HCM orientedAll voluntarySite-based onlyWeak personalizationModest incentivesFew spouses servedWeak evaluation
Add productivityStrong risk reductionStrong high risk focusStrong HCM orientedSome reqd activitySite and virtual bothStrongly personalMajor incentivesMany spouses servedRigorous evaluation
Quality ofWorkLife
TraditionalApproach
Health andProductivityManagement
Fun-Oriented Activity-Oriented Results-Oriented
Program Model
Main Features
Primary Focus
Major Wellness Program Models
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Key Pieces of the Program Infrastructure
HRA and personal reportTelephonic coaching & referral networkSelf-directed change materialsAnnual program kit Medical self-care bookMailings and emailsWellness newsletterPCP oriented-summaryFull-function E-Health sourceWellness incentives
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Core Program Infrastructure Plus….
Core Program Core Program InfrastructureInfrastructure
Site-based Site-based ActivityActivity
++ ++
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Schematic of the Infrastructure
Eligibility Files
HRA
TelephoneCoaching
PersonalReport
Follow-upFulfillment
Mailingsand
EmailsNewsletters
Data forPCP
Self-DirectedChange
Materials
ProgramKit
FullService
E-HealthWebsite
IncentivesSite-
BasedPrograms
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Key HRA Features
HRA
Identity & demographicsPersonal and family medical historyCurrent symptoms and treatment statusPreventive screening statusPCP relationshipMedical self-care book useClinical and behavioral risksReadiness to changeSelf-efficacy levelsPsycho-social indicators Injury risk issues (W,H,V & R)Health care utilization levelsHealth consumer skills levelPresenteeism statusOption for use of biometric valuesOverall Wellness Score (OWS)Report of past OWS scores
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Schematic of the Infrastructure
Eligibility Files
HRA
TelephoneCoaching
PersonalReport
Follow-upFulfillment
Mailingsand
EmailsNewsletters
Data forPCP
Self-DirectedChange
Materials
ProgramKit
FullService
E-HealthWebsite
IncentivesSite-
BasedPrograms
© Summex Health Management
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Key Coaching Features
TelephoneCoaching
Everyone gets a call (Opt-out)Call at home – then at-work“No reach” protocolModerate risk 2-4 calls/yrHigh risk 5-12 calls/yrStrong use of SOCStrong use of motivational interviewing techniquesFollow-up materials providedReferrals providedEveryone asked to have personal wellness objectivesIncentive for coaching adherence
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Schematic of the Infrastructure
Eligibility Files
HRA
TelephoneCoaching
PersonalReport
Follow-upFulfillment
Mailingsand
EmailsNewsletters
Data forPCP
Self-DirectedChange
Materials
ProgramKit
FullService
E-HealthWebsite
IncentivesSite-
BasedPrograms
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Key E-Health FeaturesSSO access from company website
Personal health record
HRA data linked
Query with depth
Symptom reference and advice
Benefit decision support
Health cost estimator (FSA, HSA, etc.)
Provider decision support
Treatment decision support
Two-way communication system
Incentives for use
Integration with benefits and services
Report generation on use patterns
FullService
E-HealthWebsite
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Schematic of the Infrastructure
Eligibility Files
HRA
TelephoneCoaching
PersonalReport
Follow-upFulfillment
Mailingsand
EmailsNewsletters
Data forPCP
Self-DirectedChange
Materials
ProgramKit
FullService
E-HealthWebsite
IncentivesSite-
BasedPrograms
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Key Incentive FeaturesUse “play or pay” conceptRequire annual HRAUse $500 to $1,000 per year of value Use premium discount and/or debit cardUse 4/5, 6/8 or 8/10 Wellness criteriaTighten and change criteria over timeEveryone who “plays” gets a prizeProvide a waiver opportunityUse “sentinel” featuresConnect it to open enrollmentConsider a “zero base budget” approach
Incentives
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4/5*Non-tobacco userBMI < 30OWS > 85Physical activity > 4 times per weekCompletion of 30 minute webinar on wellness and consumer health
6/8, 8/10*Non-tobacco userBMI < 30OWS > 85Physical activity > 4 times per weekCompletion of 30 minute webinar on wellness and consumer healthCurrent on preventive screening (MD form)100% seat belt useHave a PCPUse of your medical self-care book in previous 3 monthsNo more than 3 sick leave in last 12 months
* = All “HSRF” criteria would also have participation options
Large employers could further customize the criteria
Examples of Wellness Criteria
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Schematic of the Infrastructure
Eligibility Files
HRA
TelephoneCoaching
PersonalReport
Follow-upFulfillment
Mailingsand
EmailsNewsletters
Data forPCP
Self-DirectedChange
Materials
ProgramKit
FullService
E-HealthWebsite
IncentivesSite-
BasedPrograms
© Summex Health Management
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Infrastructure Linked to Model
Little to none
Event-oriented
Fluid design
Ad hoc in nature
Boutique style
Minimum
Activity-oriented
Fixed design
Calendar-based
Smorgasbord style
Significant
Data-driven
Flow design
Cycle-based
PHM style
Quality ofWorkLife
TraditionalApproach
Health andProductivityManagement
Fun-Oriented Activity-Oriented Results-Oriented
ProgramModel
ProgramInfrastructure
PrimaryFocus
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Resource Implications
TraditionalApproach
Resources for Program Infrastructure
No cost or very low cost (<$25/EE/yr)
Moderate cost (Between $26 and $140/EE/yr)
Major cost (Between $141 and $340/EE/yr)
Quality ofWorkLife
Health andProductivityManagement
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Program Infrastructure and Effects
Type of Emphasis or Major Effects
Option #1
QWLProgram
Model
Option #2
Traditional Program Model
Option #3
HPM Program Model
Information + + + + + + + + +
Motivation + + + + + + + +
Behavior Change
+ + + + + + +
Economic Change
+ + + + + + + +
Cultural Change
+ + + + + + + +- Chapman, Planning Wellness, 2005
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Major Phases
IntroductionExperimentationShakedownRefinementsRealignmentExpansionPartnershipOptimal effectiveness
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How to Develop an Infrastructure
Define needs Establish prioritiesSelect metricsDefine technical specificationsMake or buyEvaluate regularly Refine specificationsRedefine needs
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Summary of Key Points
Few employers have sustainable program infrastructuresMost Wellness activity is episodic and short term orientedThere are standard components to program infrastructuresThe extent of your infrastructure depends on your modelYour infrastructure is the “core” of your programYour program model will drive your infrastructure costsThe three basic models result in different levels of effects Program infrastructure should be built in phasesThe process of building your infrastructure should be rationalA sustainable infrastructure is key to long term successThe quality of the infrastructure will have a major impact The program infrastructure must have an appropriate administrative infrastructure