HarbinStrong: Outcomes-Based

Employee Wellness Program

By: Dresden MaddoxSummer Compliance Intern

MPH Candidate, Rutgers University

Agenda Definition Purpose Significance Methodology

Research Background Comparing other programs

Legislation Current Program Health Contingent Programs

Definitions Spectrum

Agenda (cont.) Comparing Different Programs

Case studies Implementation Health Benchmarks New Hires Data Tracking Outside Counsel Other Feedback

Recommendations Contacts

Outcomes-Based Wellness Programs

Definition: A wellness program put into place to encourage employees to take action to improve his/her own health by incentivizing the achievement of specific biometric goals

We want to evolve HarbinSTRONG as it is from a participation-based program to a program that rewards our employees for meeting health goals that are important aspects to quality, healthy life.

Purpose The Purpose of this project is to create and launch

an outcomes-based wellness program for employees that promotes health and well-being.

The use of goal-focused incentives will be key to encouraging employees’ active participation in eliminating unhealthy habits and increasing quality of life.

We will focus very strongly on complying with state and federal laws pertaining to outcomes-based wellness programs.

Significance The Patient Protection and Affordable Care Act (PPACA) encourages the

creation of employer wellness programs. PPACA released final regulations in 2014 protecting employees who

may be unable to meet incentivized goals put into place by employers. Case studies have shown that employers who make the shift from a

participatory to an outcomes-based program can increase employee participation to greater than 95% and decreased the employer’s claims to less than 3%.

Can improve the health and well-being of employees, which can decrease the company’s healthcare costs.

Can also aid in the decrease of healthcare costs nationwide.We hope to create similar results as our predecessors by developing a plan that remains in compliance with PPACA and improves employee health.

Methodology: Research Identify and summarize legislation behind the creation

of wellness programs, especially those that are health-contingent.

Read cases and documents on the differences between outcomes-based and progress-based wellness programs.

Identify other organizations with health-contingent wellness programs that can be used as examples. Note the participation rates, the impact on insurance,

and different incentives used in specific case studies of these organizations.

Methodology: Background Present findings on legislation. Define the current structure of HarbinSTRONG. Define and contrast the two types of health-

contingent wellness programs:1. Progress-based2. Outcomes-based

Methodology: Comparing Other Wellness Programs

Present a spectrum ranging from fully participatory to fully outcomes-based wellness programs and note where each example falls on the spectrum.

Create a chart that compares the example wellness programs based on three characteristics. Participation rates Insurance claims trends/costs Types of incentives

Basic Legislation A health-contingent wellness program offered to

employees must be voluntary, and an organization cannot deny health coverage to individuals who do not wish to participate.

Incentives for those who successfully participate cannot be more than 30% of the cost of the health coverage in place.

Employees who cannot achieve goals outlined in the wellness program for reasons such as medical must be provided with a reasonable alternative to earn the incentive.

Employees must be given a chance to qualify for the incentive every year.

Current Participatory Wellness Program: HarbinSTRONG

Participatory Wellness Program: A program that provides either no incentive or an incentive based strictly on participation in programming for the wellness program and is not related to a health factor.

HarbinSTRONG currently offers employees the chance to qualify for Wellness/Standard Premium Rates if they complete a series of tasks outlined in the HarbinSTRONG manual. Because none of the tasks dependent upon a health factor, the program is considered participatory.

health-contingent Wellness Programs

health-contingent Wellness Program: A wellness program that incentivizes or penalizes the achievement or lack thereof of health goals set out by the program; these programs must meet requirements outlined by the legislation to avoid discrimination of certain employees.

Two Types:Progress-based: Incentives are given based on an improvement of specific health factors such as an improvement in blood pressure or a decrease in BMI.Outcomes-based: Incentives are given when an employee meets a certain biometric goal i.e. blood pressure must be 120/80 or less to get the reward or avoid penalty.

Examples of Employee Wellness Programs

Participatory-

HarbinSTRONG

health-contingen

t-Valeo’s Healthy

Rewards-Southwest

General

Combination-MaineHealth’s Works on Wellness

• MaineHealth used a combination of the two types of programs by attaching the incentive of enrollment into the lower cost health insurance plan to simply participating in the online HRA and biometric screening. They also provide bonuses in the form of additions to paychecks or deposits into HSAs to employees who meet biometric goals or progress rates specified by the program. (the program has evolved some since 2012).

• Valeo has an outcomes-based program that provides credits toward the company health insurance premiums to employees who meet specific goals provided by the program.

• Southwest General rolled out a wellness program that started as participatory and is now wholly outcomes-based. Incentives are applied to health insurance premiums for employees who meet the biometric standards.

Comparing Different Wellness ProgramsValeo MaineHealth Southwest

GeneralParticipation No indication of

participation rates in the case study

An increase from 53% in 2011 to 95% in 2012

A greater than 99% participation rate each year of the rollout plan

Insurance Impact Those enrolled in the wellness program had a 2.5% increase in claims cost trend (national trend, 10.25%)

No indication of impact on health insurance costs in the case study

Those enrolled in the wellness program had a 1% increase in claims cost trend (before the program, 16%)

Incentives • $450 credit applied to the health insurance premium for each biometric goal met

• Bonuses given into pay check or health savings account based on biometric results (i.e. healthy BMI or 10% weight loss since first screening)

• $1,200 per year penalty for tobacco use

• The program began by providing a $200+ a month credit toward the health insurance premium for participation

• As the company made the shift to outcomes-based, $50 more was added to the credit for specified goals or rates of progress met

Implementation Valeo

No gradual roll out plan – the program was implemented as is right away. Every employee was required to receive the screening from

implementation. Southwest General

Rolled out – stopped – restarted the rollout process. Employees were unhappy with the requirements and there was a lot of

pushback. Human resources decided to stop the process, use the measurements as a

baseline, and give employees one year to work toward the goals. MaineHealth

Took a couple of months to implement the outcomes-based incentives. The whole program has evolved from participatory to what it is today;

benchmarks have changed over the years.

Health BenchmarksValeo MaineHealth* Southwest

GeneralCholesterol LDL < or equal

to 125LDL < 130 or HDL > 60

LDL < or equal to 120

A1C/Blood glucose

No measurement Blood glucose < 126

A1C < or equal to 6.0

Weight BMI 18-28.5 BMI 18.5-29.9 or 10% weight loss since last screening

BMI < or equal to 27.5

Blood Pressure < or equal to 130/85

<140/90 < or equal to 130/85

Tobacco Use Incentive given to non-tobacco users

Penalty on tobacco users

Incentive given to non-tobacco users

Appears based on benchmarks that employees in pre-risk areas are not excluded from the incentive unless they move into the high risk categories

*As of this year, MaineHealth is only screening for healthy weight, tobacco use and BP

New Employees: If New Hires Miss the Screening Date

Valeo: New Hires who miss the screening deadline are enrolled into the New Hire benefits plan. During open enrollment, new employees then receive the screening and decide whether or not they want to enter the wellness program benefits plan.

Southwest General: New hires are allowed to slide through on the wellness benefits plan until the next open enrollment. HR used to send out nurses to take measurements in-home, but that proved to be too much trouble.

MaineHealth: New hires are allowed to choose whichever plan they want but do not qualify for incentives. This begins at the next open enrollment.

Data Tracking Valeo – Bravo Wellness

A representative from Bravo walked through the process of the setting the program up with the staff at Valeo

MaineHealth – WebMD Southwest General – Bravo Wellness

Same as Valeo

Outside Counsel Valeo: Used a 3rd party vendor called Group

Associates (consulting firm for benefits solutions). MaineHealth: WebMD provided much of their

resources but they also went internally for advice and other resources; used a 3rd party vendor for marketing and communications.

Southwest General: Used a 3rd party vendor for case management – Human Resource director could not give me the name.

Other Feedback Valeo: Employee Reactions

No major pushback from employees. Many are shocked by some of their scores which can either be positive or negative.

MaineHealth: Employee Reactions & Hindsight Mainly tobacco users were upset due to the $1,200 fine imposed on them. Employees found it intrusive; concerned about where their PHI was going. She advises that you cannot explain the mission, costs, and PHI concerns enough; make sure the

employees understand. Be transparent about why this program is being implemented whether its to control costs or to improve

noticeable health issues. Keep it simple and easy to communicate. Include spouses and dependents from the beginning; they are experiencing all the issues with pushback all

over again. Southwest General: Employee Reactions & Advice

Employees were very unhappy with the implementation. Make sure the biometric screening days are well thought about and organized – she described their first one

as a circus. Great program – participating employees have lost a total of 24,000 lbs and 68 have quit smoking; she is

open to giving any advice necessary.

Recommendations Health-contingent programs can greatly increase

employee participation and can improve health significantly.

Having a combination of both progress and outcomes-based incentives would be a good option. Employees who cannot reach the set number goals all at

one time can improve by losing a certain amount of weight or reducing blood pressure in general.

Incentivizing progress along with outcomes would also be encouraging to those who feel the goals are daunting numbers.

ContactsMy Contact Info:

Dresden Maddox – By Email or Phone Email: dgm74@scarletmail.rutgers.edu Phone: (770)-905-6814

Other Organizations: MaineHealth – Laurie Mitchell, RDN, Director of Health & Productivity

Email: MITCHL1@mainehealth.org Southwest General – Judy Murphy, SPHR, Vice President of Human Resources

Email: JMurphy@swgeneral.com Valeo – Jaye Parker, Human Resources

Email: jaye.parker@valeo.com

Questions?