Wellness at Dartmouth College

Medical Care and the Corporation November 16, 2010

The MCC Team

• Chase Eldredge, D’11 • Boyd Lever, D’10 • Tom Perry, TDI’11 • Anuradha Ramanath, TDI’11 • Jeff Wang, T’11

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Project Overview

• Dartmouth College aims to improve the health of its employees, retirees, and dependents

• The college is interested in exploring innovative health and wellness programs, and how comparable institutions effectively implement these programs

• Improved health and wellness among beneficiaries may result in reduced healthcare expenditures

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Agenda

• A profile of Dartmouth College • An implementation model for wellness at

Dartmouth College • Case Studies: Wellness at other larger

employers • Immediate opportunities at Dartmouth • A path forward

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Dartmouth College is a large employer, with 50% of self-insured employees 40 years of age or older

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Self-Insured Employees At a Glance

No. of Subscribers

3,892

No. of Members

8,251

Avg. Contract

Size

2.1

Male 48%

Female 52%

0.00%

5.00%

10.00%

15.00%

20.00%

25.00%

65+60-6450-5940-4930-3918-297-170-6

Distribution of Members by Age Group

40-49705

40-49845

50-59776

50-59914

60-64321

60-64339

65+131

65+82

0 500 1,000 1,500 2,000 2,500

Male

Female

Member Composition, By Gender, >= 40 Years Old

Source: Anthem 2009 Report, p. 5

The largest drivers of healthcare spending at Dartmouth are the usual suspects troubling many employers

• Spending on Gastroenterology, Endocrinology, Behavioral Health, Cancer, Cardiology, and Orthopedics account for 50% of total healthcare claims paid in 2009

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Inpatient Outpatient Professional Rx Total

Gastroenterology

$ 291,515 $ 1,078,451 $ 554,219 $ 242,236 $2,166,421

Endocrinology 252,624

471,800 529,469 934,839 2,188,732

Behavioral 181,577

463,607 1,298,740 871,295 2,815,219

Cancer 119,572

2,133,295 614,837 92,409 2,960,113

Cardiology 1,470,075

1,193,760 658,028 282,074 3,603,937

Orthopedics 735,832

2,841,003 2,104,620 315,168 5,996,623

Sub-Total $19,731,045

Total Claims Paid

$39,464,188

% of Total 50.0%

Source: Anthem 2009 Report, p. 7-8

There has been a high concentration of spending on a small cohort of employees

• In 2009, claims paid on 83 employees accounted for $8.9 million, more than 20% of total claims paid

• The top three conditions presented by these employees are:

7Source: Anthem 2009 Report, p. 29

Condition Number of Claimants

Expenditure Expenditure / Claimant

Cancer 16 $1,997,787 $124,862

Cardiology 15 $1,889,802 $126,987

Orthopedics 18 $1,289,266 $71,626

• Not all of these high-cost employees may be susceptible to intervention by a wellness program; 8 of these 83 employees were terminated by year-end

• But if each of these conditions can be reduced by one claimant, the potential cost saving could exceed $300,000

For each of the major cost drivers, we know many of the contributing factors and what to do in response

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Common Ailments Contributing Factors Potential Mitigation

Gastroenterology (5.5% of total claims) IBD, ulcers, heartburn Poor diet, smoking,

alcoholImproved diet, tobacco and alcohol cessation

Endocrinology (5.5% of total claims)

Diabetes, hyperlipidemia, thyroid disorder

Obesity, sedentary lifestyle, poor diet, smoking

Exercise, improved diet, tobacco cessation

Behavioral (7.1% of total claims)

Depression, bipolar disorder, anxiety, substance abuse

Job stress, family stress, inactive lifestyle, trauma

Stress management, exercise, counseling

Cancer (7.5% of total claims)

Breast, lung, colon-rectal, prostate, etc. Many, including genetic Screening, disease

management

Cardiology (9.1% of total claims)

Heart disease, hypertension, circulatory, irregular

Obesity, smoking, poor diet, inactive lifestyle, stress

Exercise, tobacco cessation, improved diet, stress

Orthopedics (15.2% of total claims)

Arthritis, back pain, joint injury, fractures

Obesity, inactive lifestyle, worker safety

Improved diet, exercise, safety training

Source: Anthem 2009 Report, p. 23-28

What is necessary today is a strategy for implementing a wellness program at Dartmouth

• A wellness program at Dartmouth College will likely need to include the following: – Exercise – Tobacco cessation – Improved diet – Stress management

• In order to successfully implement a wellness program, Dartmouth will need to have a clear way forward that involves all constituents of the College

• Our team has focused on creating an implementation framework, as well as developing action items that can be executed on immediately

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Agenda

• A profile of Dartmouth College • An implementation model for wellness at

Dartmouth College • Case Studies: Wellness at other larger

employers • Immediate opportunities at Dartmouth • A path forward

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EMPLOYEES

WELLNESS LEADERSHIP

Commitment & Establishment • What do I need to

do to create institutional buy-in?

• What do I need to succeed in establishing a wellness program?

• How do I prepare myself for engaging with a wellness program?

Design & Execution • What role do I

play in administering a wellness program across my institution?

• How do I execute an effective wellness program?

• How do I best participate in my wellness benefits?

Tracking & Modification • How do I

continuously manage a wellness program?

• How do I improve the wellness program over time?

• How do I continue to improve my health over time?

DARTMOUTH COLLEGE

ADMINISTRATION

Implementing a wellness program must involve all constituencies of the Dartmouth College community over time

EMPLOYEES

WELLNESS LEADERSHIP

Commitment & Establishment • - Understand the financial and cultural value of

employee health • - Commit capital to employee wellness • - Establish a culture of wellness as part of my

institutional’s identity • - Wellness needs to be a significant portion of the scope

of my work • - Assess the available wellness resources • - Have access to decision-makers • - Increase my self-awareness of my health and wellness • - Tie wellness to what’s important to me (e.g., wealth,

life satisfaction) • - Prioritize health and wellness more highly in making

lifestyle decisions

DARTMOUTH COLLEGE

ADMINISTRATION

The Commitment and Establishment phase creates the conditions that make a wellness program successful

EMPLOYEES

WELLNESS LEADERSHIP

Design and Execution • - Establish reporting structures for wellness • - Set expenditure budgets for wellness • - Adopt incentive structures for wellness • - Create systems of accountability for wellness • - Analyze wellness opportunities and challenges within the

population • - Establish robust channels of communication with

constituents • - Proactively engage employees and their health status • - Promote participation in wellness using approved

incentive structures • - Explore my benefits and wellness opportunities • - Make rational health decisions based on incentives and

opportunities • - Develop “health-based” relationships with colleagues • - Bring healthy-living back home to my family members

DARTMOUTH COLLEGE

ADMINISTRATION

The Design and Execution phase involves the day-to-day activities and choices that result in improved wellness

EMPLOYEES

WELLNESS LEADERSHIP

Tracking and Modification • - Integrate employee health status as part of financial

reporting • - Assess benefits provisions based on wellness outcomes • - Include wellness results as part of employee development • - Reinvest savings to further wellness promotion • - Make periodic health assessments • - Respond to employee feedback • - Continue to innovate based on employee needs and

responses • - Raise the bar to the next level • - Provide feedback to wellness leadership and

administration • - Self-assess my successes and failures • - Enjoy my better health, and have more fun • - Set new goals

DARTMOUTH COLLEGE

ADMINISTRATION

The Tracking and Modification phase provides mechanisms to continuously assess and improve the wellness program

Agenda

• A profile of Dartmouth College • An implementation model for wellness at

Dartmouth College • Case Studies: Wellness at other larger

employers • Immediately opportunities at Dartmouth • A path forward

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Success Stories with Fitness• MetLife:

– Challenge: Improving cardiovascular health – Expended $550,000 per year on fitness center for employee access – Saved $1.38 million per year by improving cardiovascular risk

profiles of 2,100 members in its fitness centers

• Aetna: – Aetna measures ROI for its wellness programs using medical claims

data and productivity studies – 2004 study of fitness center usage under the Healthy Lifestyles

program indicated: • Lower combined medical and pharmacy costs for fitness-

center users • Annualized savings of $340 per member per year for fitness

center users • Comparison of participating members to non-participants

indicated an ROI of 3.4:1

16Source: Business Roundtable. Doing Well through Wellness: 2006-2007 , p. 47-48

• General Motors

- Challenge: Educating a diverse employee population on health and wellness

- Utilizes lifestyle-based wellness education

- Example: Deer Hunting Module - Proper deer lifting routines - Nutritious venison recipes

- Each program provides: - Topic information - Skill building and group support - Tracking of individual behaviors

and outcomes

• FedEx Express

- Challenge: Diabetes management - Provides simple $50 cash-reward for

diabetes patients that comply to regular screening (e.g., retinopathy screening)

- Participation increased from 55% to 100%

- Diabetes-related ER visits dropped 13%

- Cost-per-episode for diabetes patients dropped 75%

Source: Business Roundtable. Doing Well through Wellness: 2006-2007 , p. 13-16

Other Success Stories

Agenda

• A profile of Dartmouth College • An implementation model for wellness at

Dartmouth College • Case Studies: Wellness at other larger

employers • Immediately opportunities at Dartmouth • A path forward

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What Dartmouth has today

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Dartmouth Brown Cornell Yale Harvard Columbia Princeton U. Penn.

EAP ♦ ♦ ♦ ♦ ♦ ♦ ♦ ♦

Fitness ♦ ♦ ♦ ♦ ♦ ♦ ♦ ♦

Nutrition ♦ ♦ ♦ ♦ ♦ ♦ ♦ ♦

Stress Mgt ♦ ♦ ♦ ♦ ♦ ♦ ♦

Smoking Cessation

♦ ♦ ♦ ♦ ♦ ♦ ♦

HRA ♦ ♦ ♦ ♦ ♦

Gym Cost $297-480 Free $175 $300 $184 $295 $212 $460

Source: Analysis performed by Carl Pratt

• A first glance, Dartmouth College seems to be competitive with the other Ivy League institutions in providing wellness benefits to its employees

• However, further study indicates that there are many opportunities to improve Dartmouth’s wellness offerings

Improving Dartmouth’s Web Content On Health and Wellness

• Example 1: Finding employee health information on website – Click, scroll, click from Dartmouth.edu

• Example 2: Faculty/Employee Assistance Program – Does not communicate well to employees seeking assistance

with stress management and other mental health needs

• Improving the website would prioritize

– Easy access to wellness content (1-click) – Motivating employee participation – Keeping employees informed on their wellness benefits – Receiving employee feedback regarding their wellness needs

Improving Employee Access to Dartmouth’s Fitness Center

Disadvantages to current offerings • Gym membership cost is still second-highest

compared to other Ivy-League schools - Cost at Dartmouth - $433 - Average of other Ivies - $232 - Brown’s fitness center is free for employees

• Employees have to pay a higher price than students to access exercise and stress management programs

• No programs designed specifically for employees

What employees can access today • On-site fitness center available • $349 membership discount from street prices • For fee, 19 exercise programs and 6 stress

management programs are available • Members who exercise 12 out of 20 weeks receive

$200 discount off of health premiums

Agenda

• A profile of Dartmouth College • An implementation model for wellness at

Dartmouth College • Case Studies: Wellness at other larger

employers • Immediately opportunities at Dartmouth • Next steps

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Next Steps

• Start on the immediate-run items: –Website – Gym access

• Begin the implementation process: – Commitment and Establishment: • Dartmouth Administration • Create a wellness leadership team • Begin to engage employees on their health status

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