Health Rewards:
State of Delaware
Employee Wellness Project
National Governors Association
Healthy America Meeting
December 15, 2005
“A company cannot be considered
successful unless it takes responsibility
for the physical well-being of its
employees.”
-Kenneth Cooper, M.D. , M.P.H.
Founder, Cooper Wellness Center
Background

Health care costs are growing at unsustainable double digit increases


In addition to insuring the poor through Medicaid, the State of Delaware is
one of the largest employers in the state


State Health Plan covers over 105,000 lives, from newborn dependents to all state
retirees
In a time when technology offers exciting advances, health conditions are not
improving


For the current fiscal year, the State of Delaware’s General Fund increase for health
costs totals over $35 million out of a total General Fund budget for employee and
retiree health care of just over $300 million.
Plans continue to see prevalence of high risk disease conditions such as asthma,
diabetes, congestive heart failure, and coronary artery disease
Employee health and wellness is a critical component of an efficient and
productive workforce. States must be adaptive and recognize the changing
needs of employees, at the same time they are bound by budget constraints
that limit compensation increases.
Efforts to Control Costs

Members of the State of Delaware’s Employee Benefits Committee
have taken a comprehensive look at the quality of health care offered to
employees

The State of Delaware has been innovative by adding programs that
target quality care for employees at the same time as curbing utilization
trends or harnessing price efficiencies and economies of scale.






Comprehensive Disease Management (including asthma, congestive heart failure,
coronary artery disease, diabetes)
Multi-State prescription drug purchasing alliance
Plan Design changes (tiered co-pays for ambulatory surgery centers)
Aggressive vendor negotiations
Generics, Step Therapy and prescription formulary compliance programs
Enhancing existing federal programs (e.g. Medicare COB)
Beyond the Traditional Approach

The State recognizes that controlling costs are only
one side of the equation

A major drawback is that most “wellness” programs
such as Disease Management target those who are
already sick

True employee wellness programs are an often
missing, but essential piece to promoting health, wellrounded employees
 Encourage and reward positive behavior
 Increase productivity and employee satisfaction
 Saves money by reducing future claims costs

The biggest challenge for employers, particularly state
governments, is funding now for future rewards
Pilot Project - 2003
The State looked at the private sector for
models of success




Delaware companies had begun to introduce
health care consumerism through high deductible
plans or incentive-based bonuses for employees.
Difficult to have a paradigm shift in state government, but
moved forward on the basis that change can happen through
demonstrated success and research data.
Started with an initial 100 person pilot project with Blue Cross
Blue Shield of Delaware and Cardio Kinetics.
The Concept

EVALUATE
Provide a comprehensive health assessment to help
individuals learn about their current health condition

Assessment includes: complete health history, resting and exercise blood pressure,
blood work to measure total cholesterol, lipids and glucose levels, smoker-lyzer to
test carbon monoxide levels, body composition measurements including body mass
index, and strength testing including lower back.

EDUCATE



MOTIVATE


Offers immediate results by screening for high risk conditions that may be
present, but not yet detected
All participants receive exercise prescriptions and recommendations for
improving physical outcomes in all risk areas
Employees are offered regular feedback through fit-stop check-ups.
RE-EVALUATE

Reassess after one year to encourage behavior and test improvement
Preliminary Pilot Data


Preliminary results confirmed high health risks for state
employees (overweight, high blood pressure, elevated
blood sugar, high cholesterol combined with sedentary/low
fitness activity) that reflects national trends in general
population.
Confirmed “Cooper” model






55 people participated in fit stop follow-up
26 of the 55 were sedentary, but became active at least 3x per week
Of the 5 smokers who attended the fitstop, 2 quit between the time of
the original assessment and follow-up
Of the 5 members with hypertension, all were treated and none tested
with high blood pressure after 6 months
The number of emergency room visits for pilot group was 70 per 1,000
vs. 157 per 1000 for the remaining population
Direct savings from the last two categories translate to over
$62,000 for the 100 person pilot in the first year alone.
Project Expansion - 2004


Expanded pilot study to 3000 assessments
Improved study by determining the most effective motivator




Participants broken into 3 groups of 500.
Each group will receive the identical assessment, fitness
prescription, fit-stop follow-up and one year reassessment.
In addition, group B participants are receiving intense intervention including
monthly coaching and newsletters.
Group C participants have been offered a $100 financial incentive to
maintain/improve their health status at the time of the one year reassessment.

Study has been reviewed by Institutional Review Board for
compliance with human subjects protocol and all HIPAA
privacy regulations.

Expected date of completion: May 2006
Preliminary Findings – Self reported

Current Risk Status




3 or more risk factors – 50%
1 – 2 risk factors – 43%
0 risk factors – 6%
Risk Factor Summary








Overweight – 70%
Family/personal history of cardiovascular disease – 43%
Cholesterol (Known-High Cholesterol) – 33%
Sedentary Lifestyle – 30%
Hypertension – 23%
High Psychological Stress – 19%
Presently smoking – 19%
Diabetes – 5%
Preliminary Findings - Study

BMI



Diabetes


17% with fasting glucose >110 (pre-diabetic condition)
Cholesterol



38% with BMI > 30
33% with BMI of 25 to 29
45% with total cholesterol > 200
21% with HDL < 40
Hypertension

9% with systolic blood pressure > 140
“As scientific research has shown, it is
easier to maintain good health through
proper exercise, diet, and emotional
balance than it is to regain it once it is
lost.”
-Kenneth Cooper, M.D. , M.P.H.
Founder, Cooper Wellness Center