2009. 6-16
Joint Health Care Committee Notes
2:00 – 4:00 p.m. via video and phone
Anchorage: Admin 204
Fairbanks: Butrovich 212b
Juneau: Egan 116
Present
Unions: John O. Riley, UNAC; Jacob Joseph, UNAC; J. Sowell, 6070; Tim Powers, UAFT (via
phone)
Management: Beth Behner, Stuart Roberts, Wendy Tisland (Alternate), Heather Swanson, Lisa
Sporleder (Alternate)
Staff: Mike Humphrey, Director of Benefits; Erika Van Flein, Benefits Administrator
Staff: Cyndee West, UNAC Contractor Administrator; Jane Reilly, UNAC
Guests: Summer Neuroth, Shannon Brady Garman, and Amy Martin, WIN Alaska; Ilona Smith,
CVS/ Caremark; Pat Ducher, CVS/Caremark/Accordant; Ron Goetzel, Consulting and Applied
Research at Thomson Reuters; Carl Shepro, UNAC President
Absent
Union: Tim Hinterberger (UNAC Alternate); Jane Weber (UAFT Alternate); Rick McDonald,
UAFT; Colin Clausson, 6070; Jennifer Madsen (6070 Alternate)
Management: Yvonne Boyce
John Riley convened the meeting at 2:10pm.
Introductions of attendees were made. Approval of minutes was postponed.
Presentation
Dr. Ron Goetzel, Research Professor and Director of the Institute for Health and Productivity
Studies from Emory University, presented various means to assess and evaluate UA’s wellness
program. There are two main approaches, one is to evaluate the structure of the program, its
design and components, and the second is to measure participation rates, satisfaction outcomes,
and health related outcomes. The latter includes biometric measures (such as weight,
cholesterol, blood pressure, etc.), emotional measures (such as stress and depression), and
behavioral measures (such as alcohol use, weight loss, etc.). Changes in these measures can be
assessed by comparison to a baseline with following years, or comparison of the UA population
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to a comparable group without a wellness program. Financial outcomes can include two
approaches. One, a survey or health risk assessment from self reporting by applying monetary
values to the items assessed, and two, an analysis of claims data including utilization, cost,
workers compensation (WC) and disability claims as well as rates of absenteeism .
Databases that would be relevant for wellness evaluation would include program participation
(the number of eligible employees vs. those actually utilizing the program), self-reporting health
risk information such as the Personal Wellness Profiles (PWPs), the lab data on measurements
such as blood pressure, cholesterol, weight, and glucose, the medical claims and WC data,
disability claims and absenteeism.
Summer Nueroth was asked to clarify the participation rates in the wellness program and she
quoted figures from the April report to be presented later. The summary data was unclear for
purposes of audit as she reported 12,894 “touchpoints”, but these include multiple contacts from
single members and include all provided services from telephone contacts to biometric
screenings.
Mike Humphrey said that we have only one health provider (BCBS) but we cannot access the
data warehouse independently; we have to ask BCBS for a special report. Dr. Goetzel noted that
Cook County researched and collected its own data and Dr. Goetzel’s company provided the
auditor/mentor to the county. This individual used the data to evaluate their plans and help
design further plan development. He said we should assume the charge to audit a wellness plan
will be 5% to 10% of the cost of the plan to be evaluated. (On a $1,200,000 wellness plan, this
cost could run from $60,000 to $120,000.)
Dr. Goetzel said there were instruments available to assess things like “culture of wellness” and
that we may wish to look at the NIH “Leading by Example” study.
Dr. Goetzel reviewed the basics of evaluation, control vs. program receivers*, participants vs.
non-participants (obvious adverse selection) or pre/post design. The latter is the most feasible;
we would establish the baseline on data before the implementation of the program and compare
it to subsequent years. We could then make projections on future performance and compare this
to actual results.
The video connection to Anchorage was lost for several minutes so Dr. Goetzel reviewed that
last part of his presentation.
Ilona Smith introduced Pat Ducher from CVS/Caremark/Accordant who gave a power point
presentation on the Accordant disease management (DM) program. Accordant is a wholly
owned subsidiary of CVS/Caremark and they have 150 clients ranging from 2000 member to
multimillion member health plans. Their DM plan has two levels of participation, the common
chronic program (diseases which have greater incidence but lower cost) and the rare chronic
program (diseases which have lower incidence but greater cost). She presented profiles of
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prevalence and cost for various conditions based on actual UA pharmacy claims as well as
Accordant experience for both 2007 and 2008. They estimate 11.5% of our population with
chronic conditions will result in 47.8% of our Rx costs and 29.3% of our total healthcare
spending. Accordant proposes their ability to target chronic conditions through pharmaceutical
claims will result in quicker and more effective intervention than targeting through the current
system of health claims. Ms. Ducher gave several scenarios in how the system works in both
common and rare disease conditions and the advantages of the Accordant system. Vendor
prices, including ROI guarantees, were quoted but are based on review of the most recent 12
months of medical data. Heather mentioned she liked the idea that Accordant would work with
other UA vendors like WIN to share and incorporate various health measurements on individual
members. She also asked if the hours of clinical outreach would be compatible with Alaska’s
time zone and Ms. Ducher said they accommodate clients in Hawaii and Alaska should be
commensurate. Heather Swanson asked if the nurses would be consistently working with
particular members and Ms. Ducher said that each member would be assigned a case worker who
would be the main consultant and this assigned relationship was a valuable part of the diagnostic
and treatment process.
Summer Neuroth, Shannon Brady Garman, and Amy Martin presented the UA Health in Action
Monthly Program Report for April 2009. The report gave a breakdown of participation numbers
by activity and summary services. Overall, the numbers continue to increase, particularly the
number of biometric screenings in wellness breaks. The numbers of abnormal biometric
screenings were reported as were comments from participants. They also presented a team
challenge idea that would “cultivate health connections among staff/faculty and encourage GTP
usage” at a nominal cost. A tentative date proposed by WIN for the group activity was 9/01/09,
which was discussed as perhaps being a poor time as it is the beginning of a new term. No
alternatives seemed any better, with the general consensus being that all proposed dates would
have limitations for some segment of the member populations. Ms. West expressed concern that
there would be more money spent on awards, we need to stop spending as someone has to
explain and justify these increasing expenses to the members. The idea of a team challenge will
be revisited by the committee later, after an opportunity for adequate discussion. WIN would
like to present the results of the PWP (personal wellness profile) at our July meeting and give an
annual report at the September meeting, including an analysis of the Individual Health Plan
(IHP) sessions.
The next JHCC meeting is scheduled for July 21, 2009.
The meeting was adjourned at 4:00 p.m.
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*With 4500 eligible employees, UA would have a statistically sound basis for a
control/intervention analysis of claims data, but UA offers the wellness to all employees, which
precludes this approach. There are 6600 members and partners currently covered under UA
health care; of which 4500 are employees eligible for UA’s wellness program. As there is no
available control group, the question was raised whether the 2000 partners not receiving the
wellness program could be used for evaluation as we would have access to their medical claims
data and the two groups share several issues specific to UA (such as limited providers, inflated
costs and social-psycho-geophysical stressors unique to Alaska). Ron felt this would not work as
the dependent population might be too dissimilar and there may be a “trickle down” effect from
the wellness program the employees bring home.
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