creating a culture of health – putting theory into practice joyce young, md, mph
DESCRIPTION
April 7, 2010. Creating a Culture of Health – Putting Theory into Practice Joyce Young, MD, MPH. Key Components of Strategy. EMPLOYEE-CENTERED INVESTMENT. INCENTIVES FOR HEALTHY LIVING PROGRAM. One no-contribution medical and dental option “Per-person” pricing for dependents - PowerPoint PPT PresentationTRANSCRIPT
© 2009 IBM Corporation
Creating a Culture of Health – Putting Theory into Practice
Joyce Young, MD, MPH
April 7, 2010
© 2009 IBM Corporation
IBM Integrated Health Services
April 2010Page 2
Key Components of Strategy
Commitment to Quality & Prevention
Commitment to Quality & Prevention
Voice for Health Care Reform
Voice for Health Care Reform
Employee-centeredEmployee-centered
Foundation inPrevention & Primary
Care
Foundation inPrevention & Primary
Care
FOCUS ON PREVENTION AND VALUE IN MEDICAL CARE
FOCUS ON PREVENTION AND VALUE IN MEDICAL CARE
EMPLOYEE-CENTERED INVESTMENT
EMPLOYEE-CENTERED INVESTMENT
• One no-contribution medical and dental option
• “Per-person” pricing for dependents
• Preserve access and choice• “No coverage” cash back
• Free coverage for primary care and preventive care
• Aggressive support for chronic illness
• Personalized electronic health management tools, content, and Personal Health Record
INCENTIVES FOR HEALTHY LIVING PROGRAM
INCENTIVES FOR HEALTHY LIVING PROGRAM
HEALTH CARE REFORM
HEALTH CARE REFORM
Option to earn $300 in cash rebates for completing two programs:
• Personal vitality program• Physical activity or nutrition
program• Children’s healthy weight
program
• Building quality into medical plans/provider relationships
• Leader for Patient-Centered Primary Care & Medical Home
• HIT, clinical decision support and administrative efficiency
© 2009 IBM Corporation
IBM Integrated Health Services
April 2010Page 3
The Wellness Program Continuum
Healthy Workplace
Environment
Integration Strategic Outcome Focused
Programming
Evaluation
Les
s C
om
pre
he
nsi
ve
Mo
re
Co
mp
reh
en
sive
Health Risk Assessment
Employee Education & Awareness
© 2009 IBM Corporation
IBM Integrated Health Services
April 2010Page 4
Wellness for Life Center
© 2009 IBM Corporation
IBM Integrated Health Services
April 2010Page 5
EVOLUTION OF THE IBM HEALTHY LIVING REBATE PROGRAMS
2003 / 2004 / 2005 2006 2007 2008 / 2009 2010
Non-Smokers Discount:
$11/mo. premium discount
Not smoking or smoking cessation program
Physical Activity Rebate:
$150 cash rebate 20 min. 3 days/wk for 10
out of 12 weeks Log activity on Virtual
Fitness Center
Smoke-Free Rebate:
$150 cash rebate
Preventive Care Rebate:
$150 cash rebate Complete online HRA Set action dates for
preventive screenings & risk reduction activities
Review hospital quality using Web-based resources
Physical Activity Rebate:
$150 cash rebate 30 min. 4 days/wk for 10 out
of 12 weeks Or, 30 min. 2 days/wk for 10
out of 12 weeks, plus Web-based coaching
Log activity on Virtual Fitness Center
New Hire Smoke-Free Rebate:
$150 cash rebate Not smoking or smoking
cessation program
Preventive Care Rebate:
$150 cash rebate Complete online HRA Confirm completion of
overdue screenings Begin or update online Personal Health Record
Physical Activity-Nutrition Rebate:
$150 cash rebate 12-wk online nutrition or weight
management on Virtual Food Pro
Or, logging-free physical activity program with self-tests and online interaction with fitness pro
Or, same physical activity logging options from 2006 on Virtual Fitness Center
New Hire Smoke-Free Rebate:
$150 cash rebate Not smoking or smoking
cessation program
Children’s Health Rebate:
$150 cash rebate Complete family inventory of
healthy weight behaviors Set family action goals Repeat family inventory at 12
weeks to identify successes
Preventive Care Rebate:
$150 cash rebate Complete online HRA Confirm completion of
overdue screenings Use online Health Optimizers
for individualized support
Physical Activity-Nutrition Rebate:
$150 cash rebate Complete a Personal
Outcomes Assessment 12-wk online nutrition or weight
management on Virtual Food Pro
Or, logging-free physical activity program with self- tests and online interaction with fitness pro
Or, 30 min. 3 days/wk for 10 out of 12 weeks logged on Virtual Fitness Center
New Hire Healthy Living Rebate:
$150 cash rebate Complete online HRA Begin use of online Personal
Health Record Register on Wellness for Life
Web site
Personal Vitality Rebate:
$150 cash rebate Personal Vitality
& Energy Assessment Complete 3 vitality-building
practices over 12 weeks Re-assess Personal
Vitality & Energy
Children’s Health Rebate:
$150 cash rebate Complete Family Meal Analysis,
create action plan, & choose action tools
Check-in-mid-way to adjust action plan
Evaluate achievements after 12 weeks
Physical Activity-Nutrition Rebate:
$150 cash rebate Complete a Personal Outcomes
Assessment 12-wk online nutrition or
weight management on Virtual Food Pro Or, logging-free physical activity
program with self-tests and online interaction with fitness pro
Or, 30 min. 3 days/wk for 10 out of 12 weeks logged
on Virtual Fitness Center
New Hire Healthy Living Rebate:
$150 cash rebate Complete online HRA Begin use of online
Personal Health Record Register on Wellness for Life
Web site Indicates yearly changes made to the programs
Healthy Living Rebate Evolution
© 2009 IBM Corporation
IBM Integrated Health Services
April 2010Page 6
Virtual Fitness Center
© 2009 IBM Corporation
IBM Integrated Health Services
April 2010Page 7
Virtual Fitness Center (continued)
© 2009 IBM Corporation
IBM Integrated Health Services
April 2010Page 8
Virtual Food Pro
© 2009 IBM Corporation
IBM Integrated Health Services
April 2010Page 9
Children’s Health Rebate
© 2009 IBM Corporation
IBM Integrated Health Services
April 2010Page 10
Overview of Outcomes 2003 – 2008
Program Outcomes
Non-Smokers1 Up 2%
Adequate Physical Activity (3x/wk)
2 Up 28%
BMI < 27.52 Up 3%
Low Risk2 Up 23%
Health Care Costs3
Participants’ HC Cost Increases 19% Less than Non-
Participants’
Current Employee Population
Health Behaviors
% Non-Smokers1 90%
% Adequate Physical Activity (3x/wk)
2 76%
% BMI < 27.52 65%
% Low to Medium Stress2 76%
% Low Risk2 68%
1 Based on smoking status designations during annual benefits enrollment (2003-2005).
2 Based on 336K HRAs completed by 121K employees 2004-2008.
3 Based on UMich analysis of 2003-2005 health care claims for rebate program participants vs non-participants
(JOEM Nov 2008).
© 2009 IBM Corporation
IBM Integrated Health Services
April 2010Page 11
IBM Population Risk Has Moved to Improved Health
2005 2006 2007 20084 Year Total
Est. savings between IBM health risk improvement &
expected cost increase with no risk improvement*
$12M $29M $38M $33M$112M Total
Wellness programs have had a dramatic impact on the health of our employees 2004 to 2008
High health risk population reduced 59% Low health risk population increased 23%
Reduction in health risks translates into savings in health claims costs compared to expected trends with no wellness interventions
$112M estimated savings for 2005 to 2008 period
2004 - 2008 Health Risk Assessment Participation
68.4%68.3%64.8%59.2%
55.4%
26.3%26.0%28.7%30.2%31.8%
5.3%6.5%10.6% 5.7%12.8%
0%
20%
40%
60%
80%
100%
2004 2005 2006 2007 2008
% o
f A
ll H
RA
Part
icip
an
ts
High Risk (4+ risks)
Medium Risk (2-3 risks)
Low Risk (0-1 risk)
Estimated Healthcare Savings 2005-2008from Improved Employee Health Risk Profile
$112M
$0
$20
$40
$60
$80
$100
$120
2004 2005 2006 2007 2008Cu
mu
lati
ve E
stim
ated
Sav
ing
s in
IBM
Med
& R
x P
aid
Cla
ims
($M
s)
*Expected risk increase with no intervention based on Edington (2001) AJHP 15(5):341-349.
© 2009 IBM Corporation
IBM Integrated Health Services
April 2010Page 12
The New Face of Wellness
Reaping the Benefits Now
© 2009 IBM Corporation
IBM Integrated Health Services
April 2010Page 13
The Personal Vitality Rebate
The new Personal Vitality Rebate is designed to help employees build energy, vitality, and optimal health by using simple techniques
that boost personal energy and enhance vitality.
Employee Actions
Build Personal Vitality and Energy Profile to understand current energy and vitality levels
Use 3 Energy Building Practices to optimize personal energy and vitality over 12 weeks
Rebuild Personal Vitality and Energy Profile after 12 weeks to assess achievements in energy management, and recognize impacts on personal health and vitality
© 2009 IBM Corporation
IBM Integrated Health Services
April 2010Page 14
How do you build vitality?
© 2009 IBM Corporation
IBM Integrated Health Services
April 2010Page 15
Personal Vitality Rebate: Dimensions
© 2009 IBM Corporation
IBM Integrated Health Services
April 2010Page 16
Personal Vitality Rebate
Practice 1 (4 weeks)
Personal Vitality & Energy Assessment
(week 1)
Practice 2 (4 weeks)
Practice 3 (4 weeks)
Personal Vitality & Energy Re-Assessment
(week 12)
Evaluate current vitality & energy levels
Select techniques for optimizing energy & vitality
in the 4 dimensions
Reassess vitality & reflect on any changes to
personal energy & health
I usually wake up feeling refreshed.
PhysicalMental
EmotionalValues
I typically have the energy to do the things I want when I get home
from work.
© 2009 IBM Corporation
IBM Integrated Health Services
April 2010Page 17
Personal Vitality Rebate: Energy Profile T1
© 2009 IBM Corporation
IBM Integrated Health Services
April 2010Page 18
Personal Vitality Rebate: Practices
© 2009 IBM Corporation
IBM Integrated Health Services
April 2010Page 19
Example Practice: Daily Oscillation
© 2009 IBM Corporation
IBM Integrated Health Services
April 2010Page 20
Personal Vitality Rebate: Energy Profile T2
© 2009 IBM Corporation
IBM Integrated Health Services
April 2010Page 21
The Wellness Program Continuum
Healthy Workplace
Environment
Integration Strategic Outcome Focused
Programming
Evaluation
Les
s C
om
pre
he
nsi
ve
Mo
re
Co
mp
reh
en
sive
Health Risk Assessment
Employee Education & Awareness
© 2009 IBM Corporation
IBM Integrated Health Services
April 2010Page 22
Good starting place Prepares employees for more impact-focused interventions Inexpensive
Makes Wellness intentions visible Sets an example Includes policies for tobacco, food and flex time supporting non-smoking,
weight management & physical activity
Raises personal awareness Identifies specific options for individual improvement Provides aggregated data that characterizes workforce health status May assist participants in making positive health behavior changes
Key Learnings
Employee Education & Awareness
Healthy Workplace Environment
Health Risk Assessment
© 2009 IBM Corporation
IBM Integrated Health Services
April 2010Page 23
Health plan interface Overall health benefit and employee well-being strategy
Define purpose and strategy Develop & implement effective program management Fund for meaningful impact Implement effective health risk reducing interventions
Evaluate for outcomes– Levels of:
• Participation• Behavior change• Risk reduction• Health cost impact• User satisfaction
Key Learnings (continued)
Integration
Strategic Outcome-Focused Programming
Evaluation
© 2009 IBM Corporation
IBM Integrated Health Services
April 2010Page 24
• Provide proven wellness and prevention strategies that help employees:- maintain good health and resilience - reduce lifestyle related health risks - encourage utilization of valid clinical preventive health services- support the management of chronic conditions
• Facilitate workplace environments that are:- smoke free, safe and ergonomically sound - support physical activity and other healthy lifestyle practices - where food is provided, offer and promote options for healthy
food choices
• Incorporate methodology that generates data sufficient to determine outcomes and measure program performance
• Ensure protection of personal health information and support for IBM’s position on nondiscrimination in the workplace
• Leverage health information technology to facilitate: - behavior change
- health literacy - health consumerism
GLOBAL WELLNESS GUIDING PRINCIPLES
© 2009 IBM Corporation
IBM Integrated Health Services
April 2010Page 25
Summary: The Experience of Early Adopters
Start with what you have & prepare for a long run
Use continuous improvement to advance program and increase impact