Onsite Wellness Programs:
Options and Results
Bruce Caldwell
Area Sr. Vice President
Gallagher BPI
Dan Sanger
Director of Health Benefits
ASCIP
Judi Ulrey
President
Fitness Consulting
Onsite Wellness Programs
• Current Range of Design Options
• Programs In Practice – El Monte City SD
Onsite Care Pilot and Lawndale Elementary
SD Education and Awareness Pilot
– Design Details
– Results
– Lessons Learned
Onsite Wellness Programs
Employers: Why Do it?
• Deteriorating Individual Health Status
– Higher rates of inactivity, obesity, diabetes, high
BP, high cholesterol
– 50-85% of all diseases from modifiable risks
• Fragmented Delivery System
– Primary Care, Specialty Care, Rx, ER, Hospital
• Incentives based on volumes vs. outcomes
• Limited connectivity
Onsite Wellness Programs
Employees: Why Do it?
• Easier to Engage
– Does not require extra effort to participate
– Engagement with peers increases morale
– Easy to become part of a routine
• Quality of Life
– Reduce debilitating/life threatening conditions
• Remain active longer – really enjoy golden years
• Reduce medical treatments / chronic conditions
Onsite Wellness Programs
Current Barriers to Better Health
• Changing Habits Developed Over Decades
– Diet, physical inactivity
• Using Healthcare Proactively
– Convenience
• 2-3 Hour Office Visit: drive to & from the office, waiting room,
exam room, 7 minute appt. duration
– Compliance
• No incentives for outbound follow up contact from clinicians
• Non-compliance rates typically 30% to 50%.
– Cost
• Copay avoidance drives down maintenance medication compliance
Range of Onsite Wellness Programs
Option 1: Education and Awareness
– Emails, posters, quizzes, etc.
– Advantages: Awareness is the first step toward
action. Begins the process of adopting a
wellness culture.
– Considerations: Goals, content development
and distribution, long term engagement, success
measures.
Range of Onsite Wellness Programs
Option 2: Wellness and Prevention Activities
– Walking Programs
– Incentives for enrolling in weightwatchers, going to
the gym, biggest loser contests
– Advantages: Even limited exercise can have
significant benefits
– Considerations: Goals, success measures, logistics –
incentives (budget and distribution), waivers,
activity tracking, recognition events, scheduling,
facilities, hair & makeup
Range of Onsite Wellness Programs
Incentives vs. Participation
– Trinkets and T-shirts
10% - 15%
– Merchandise (gift cards, movie tickets)
15% - 50%
– Cash ($25 - $50)
35% - 75%
– Premium Reductions ($100 - $250)
50% - 80%
Range of Onsite Wellness Programs
Option 3: Health Plan Utilization Activities
– Onsite HRA, blood draw
– Telephonic health coach
– Annual Physical, preventive screenings
(colonoscopies, mammograms, etc.)
– Advantages: Objectivity of biometric data better
than accuracy of HRA answers, early detection of
potentially catastrophic health events
– Considerations: Goals, success measures Logistics –
incentives (budget and distribution), privacy, activity
tracking, scheduling
Range of Onsite Wellness Programs
Option 4: Direct Care Delivery via Onsite
Clinics
• Primary Care (physicals, health screens,
infections, prescriptions, chronic disease
management, sprains, strains, etc.)
– Typically no copays for care or Rx
– Clinicians range from RN to PA to MD
– Flexible hours or 24/7, on-call physician
Range of Onsite Wellness Programs
Direct Care Delivery: Onsite Clinics
• Advantages: Addresses barriers to care
(convenience, compliance and cost), may
reduce Rx, hospital admit and referral rates
• Considerations: Physical space buildout
requirements, enrollment vs. participation,
adoption and trust, privacy, promotional
activities, costs, metrics, gradual adoption
rates, HMO ROI
Current Programs
El Monte City School District
Onsite Health Screens
Current Programs
El Monte City SD– Health Screens
HealthFair
• Onsite Screens with Imaging Technology
o Blood chemistry, BMI, HRA
o Echocardiogram, EKG, Carotid Ultrasound,
Abdominal Aortic Ultrasound, Ankle Brachial Index, Bone Density
Ultrasound
• Why not just blood draw and HRA?
o Non-fasting results easy to discount
o Blood chemistry correlated to chronic disease progression
o Imaging results show actual affect – greater call to action
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Current Programs
El Monte City SD– Health Screens
Logistical Issues
• Bargaining Unit Endorsement
o Business Case – personal health, take-home pay
o Concerns – privacy, secret drug testing
• Promotion and Incentives
o Intro Letter from District Supervisor
-Participation, scope, locations, confidentiality
o Posters with Bargaining Unit Logos
o $10 Gift Cards, raffle prizes
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Current Programs
El Monte City SD– Health Screens
Logistical Issues:
Timing
• Back to school, holidays, summer break
• January – February relatively quiet, New Year’s resolution
momentum
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Current Programs
El Monte City SD– Health Screens
Logistical Issues
• Locations
o 19 school sites
o 55 employee median headcount
o 875 actives, 425 retirees
o 40 minutes per screen / HRA
• Mobile Screening Vehicle parked at each location for several days
o Substitute teachers hired
o ~6 weeks duration
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Current Programs
El Monte City SD– Health Screens
Costs
• ~$225 per participant (~$160k)
• ~3% of average medical premium
• Contributions from Kaiser and UnitedHealthcare
• $10k budget for gift cards and raffle prizes
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Current Programs
El Monte City SD– Health Screens
Results
Participation
• 718 employees & dependents
• 75% female, 52% Hispanic (consistent with district demographics)
Satisfaction
• Rated 4.91 out of 5 (5 = excellent)
• 83% felt it was very important that their employer provide the screens
• Top three reasons for participation:
1.
2.
3.
No cost
Convenience
Medical concern
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Health Screen Results
Percent Higher Annual Health Plan Costs
70%
Depressed
46%
Stressed
0%
35%
4%
20%
Smoker
No Exercise
15%
21%
Obesity
26%
48%
35%
Blood Sugar
High BP
District Prevalence
27%
12%
47%
10%
20%
40%
60%
80%
Clinical Measure
% or # Abnormal
Echocardiogram
4.2%
EKG
14.3%
Arterial Hardening
22.4% moderate or severe
Peripheral Artery Disease
8.9%
Blood Pressure
307 pre-hypertensive
Blood Sugar
90 pre-diabetic, 15 diabetics
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Current Programs
El Monte City SD– Health Screens
Results - Impact on Utilization
• Short term difficult to measure:
o Participants from Kaiser, UHC HMO, Anthem PPO
-- Only Anthem FFS data available
o Dependent on current progression of any chronic conditions
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Current Programs
El Monte City SD– Health Screens
Next Steps
Participants:
o Sharing results with PCPs
o Modifying personal habits (hopefully)
o CDC motto: “Prevent, delay, detect, and control chronic
diseases”
District:
o Launching and Onsite Care Model
-- Convenience and Cost top 2 reasons for participation
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Current Programs
Lawndale Elementary School District
Fitness Consulting
Education and Awareness Pilot
Old Dogs, New Tricks
Most of your employees
have spent 30-40-50+ years
fine tuning
their unhealthy habits.
Think Out of the Box
“Most of us have our favorite influence methods
– just pass a law, just threaten a consequence,
or offer a training program. … Bringing a simple
solution to a complex and resistant problem
almost never works….. It takes a combination
of strategies aimed at a handful of vital
behaviors to solve profound and persistent
problems.” Influencer
Management Mission
Is your senior management team:
• Discussing the company wellness program at every
Department Director meeting?
• Making wellness program participation part of your
management team's job description and evaluation?
• Wellness promotion part of Mission and Value
Statements
• Participating in screenings and posting personal goals?
• Participating in contests?
• Attending educational programs?
• Exercising regularly? Visibly moving at work?
Maintaining a healthy weight?
Health vs. Disease
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Risk Factors
Highest Risk Population
Disease Management
John Weaver, Psy.D.
“As a man thinketh...”
Vital Behaviors
What do you want people to
DO??
How will you measure success?
Social Motivation
• Management Acknowledgement & Visible
Participation
• Multi-level Wellness Team
• Engage Opinion Leaders
• Buddy System
• Team Competition
• Community Coaches
• Blogs & Bravo! Board
• Stories/Testimonials
• Movin’ with a Mission
Environmental Support
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Company Food
Cafeteria Food Labeled
Movement Friendly Workplace
Core Corner
Stand-up Desks
Friendly stairways
Marked walking routes
Quiet Room
Make it Fun!
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Laugh
Sing
Dancing with Dumbbells
Cooking contests
Fridge Fitness
Team Competition
A Success Story
Lawndale School District
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ASCIP intro
Presented to senior management/thought leaders
Engaged established Wellness Committee
Multiple schools/single message
Vital Behaviors – weekly action step
Social Motivation – bean cookbook
Seasonal communications - “Why am I eating this?”
Slowly expanding - incentives for Quizzes
Action Steps
• Determine your definition of success.
What are your Vital Behaviors?
• Engage senior management.
• Create and continually to grow your
team
• Establish a 12-month plan with small,
measurable goals i.e. xx% walking 4x/week
• Consider Competition
• Have fun!
The Wisdom of Dilbert
Containing Health Insurance Costs
via
Employee Wellness Programs
Questions?