Building a Sustainable
Infrastructure for EHM: A Vision
for the Future
Presented by
Larry Chapman M.P.H.
Chairman and Co-Founder
Summex Health Management
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Agenda
The mistake most
employers make
The key pieces of your
program infrastructure
Matching your
infrastructure to your
program model
Resource implications
A vision for the future
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The Mistake Most Employers Make
They fail to
build a
sustainable
EHM program
infrastructure.
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“Sustainability” includes…
Enterprise-wide
Highly “actionable”
Administratively
efficient
Strong metrics
Simplifying in nature
Well-integrated
Strategic
Viable over the long
term
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Key Definitions
Infrastructure- “The basic structure or features of a
system or organization.”
Structure- “The manner of construction of something
and the arrangement of its parts.”
System- “Instrumentality that combines interrelated
and interacting artifacts designed to work as a
coherent entity.”
Program-“..an organized response to eliminate or
reduce one or more problems where the response
includes one or more objectives, performance of one
or more activities, and the expenditure of resources.”
-The Free Dictionary by Farlex
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Mission…
Optimizing the
productivity of your
human capital
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Perspective…
Health and
Productivity
Management
(HPM)
"The integrated
management of health
risks, chronic illness, and
disability to reduce
employees' total healthrelated costs including
direct medical
expenditures,
unnecessary absence
from work, and lost
performance at work
(i.e., presenteeism).”
-IHPM
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Platform…
For
Health and
Productivity
Management
(HPM)
=
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Major Wellness Program Models
Program
Model
Main
Features
Primary
Focus
Quality of
WorkLife
Fun activity focus
No risk reduction
No high risk focus
Not HCM oriented
All voluntary
Site-based only
No personalization
Minimal incentives
No spouses served
No evaluation
Fun-Oriented
Traditional
Approach
Mostly health focus
Some risk reduction
Little high risk focus
Limited HCM oriented
All voluntary
Site-based only
Weak personalization
Modest incentives
Few spouses served
Weak evaluation
Activity-Oriented
Health and
Productivity
Management
Add productivity
Strong risk reduction
Strong high risk focus
Strong HCM oriented
Some reqd activity
Site and virtual both
Strongly personal
Major incentives
Many spouses served
Rigorous evaluation
Results-Oriented
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Key Pieces of the Program Infrastructure
HRA and personal report
Telephonic coaching &
referral network
Self-directed change
materials
Annual program kit
Medical self-care book
Mailings and emails
Wellness newsletter
PCP oriented-summary
Full-function E-Health source
Wellness incentives
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Visual Diagram of the Infrastructure
Referrals
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Core Program Infrastructure Plus….
Core Program
Infrastructure


+

+
Site-based
Activity
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Schematic of the Infrastructure
Personal
Report
HRA
Eligibility Files
Telephone
Coaching
SelfDirected
Change
Materials
Program
Kit
Mailings
and
Emails
Newsletters
Follow-up
Fulfillment
Data for
PCP
Full
Service
E-Health
Website
Incentives
SiteBased
Programs
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Key HRA Features
HRA
Identity & demographics
Personal and family medical history
Current symptoms and treatment status
Preventive screening status
PCP relationship
Medical self-care book use
Clinical and behavioral risks
Readiness to change
Self-efficacy levels
Psycho-social indicators
Injury risk issues (W,H,V & R)
Health care utilization levels
Health consumer skills level
Presenteeism status
Option for use of biometric values
Overall Wellness Score (OWS)
Report of past OWS scores
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Schematic of the Infrastructure
Personal
Report
HRA
Eligibility Files
Telephone
Coaching
SelfDirected
Change
Materials
Program
Kit
Mailings
and
Emails
Newsletters
Follow-up
Fulfillment
Data for
PCP
Full
Service
E-Health
Website
Incentives
SiteBased
Programs
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Key Coaching Features
Telephone
Coaching
Everyone gets a call (Opt-out)
Call at home – then at-work
“No reach” protocol
Moderate risk 2-4 calls/yr
High risk 5-12 calls/yr
Strong use of SOC
Strong use of motivational
interviewing techniques
Follow-up materials provided
Referrals provided
Everyone asked to have personal
wellness objectives
Incentive for coaching adherence
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Schematic of the Infrastructure
Personal
Report
HRA
Eligibility Files
Telephone
Coaching
SelfDirected
Change
Materials
Program
Kit
Mailings
and
Emails
Newsletters
Follow-up
Fulfillment
Data for
PCP
Full
Service
E-Health
Website
Incentives
SiteBased
Programs
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Key E-Health Features
SSO access from company website
Full
Service
E-Health
Website
Personal health record
HRA data linked
Query with depth
Symptom reference and advice
Benefit decision support
Health cost estimator (FSA, HSA, etc.)
Provider decision support
Treatment decision support
Two-way communication system
Incentives for use
Integration with benefits and services
Report generation on use patterns
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Schematic of the Infrastructure
Personal
Report
HRA
Eligibility Files
Telephone
Coaching
SelfDirected
Change
Materials
Program
Kit
Mailings
and
Emails
Newsletters
Follow-up
Fulfillment
Data for
PCP
Full
Service
E-Health
Website
Incentives
SiteBased
Programs
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Key Incentive Features
Incentives
Use “play or pay” concept
Require annual HRA
Use $500 to $1,000 per year of value
Use premium discount and/or debit
card
Use 4/5, 6/8 or 8/10 Wellness criteria
Tighten and change criteria over time
Everyone who “plays” gets a prize
Provide a waiver opportunity
Use “sentinel” features
Connect it to open enrollment
Consider a “zero base budget”
approach
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Examples of Wellness Criteria
4/5*
Non-tobacco user
BMI < 30
OWS > 85
Physical activity > 4 times
per week
Completion of 30 minute
webinar on wellness and
consumer health
* = All “HSRF” criteria
would also have
participation options
Large employers could
further customize the
criteria
6/8, 8/10*
Non-tobacco user
BMI < 30
OWS > 85
Physical activity > 4 times
per week
Completion of 30 minute
webinar on wellness and
consumer health
Current on preventive
screening (MD form)
100% seat belt use
Have a PCP
Use of your medical self-care
book in previous 3 months
No more than 3 sick leave in
last 12 months
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Schematic of the Infrastructure
Personal
Report
HRA
Eligibility Files
Telephone
Coaching
SelfDirected
Change
Materials
Program
Kit
Mailings
and
Emails
Newsletters
Follow-up
Fulfillment
Data for
PCP
Full
Service
E-Health
Website
Incentives
SiteBased
Programs
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Infrastructure Linked to Model
Program
Model
Program
Infrastructure
Primary
Focus
Quality of
WorkLife
Traditional
Approach
Health and
Productivity
Management
Little to none
Minimum
Significant
Event-oriented
Activity-oriented
Data-driven
Fluid design
Fixed design
Flow design
Ad hoc in nature
Calendar-based
Cycle-based
Boutique style
Smorgasbord style
PHM style
Fun-Oriented
Activity-Oriented
Results-Oriented
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Resource Implications
Resources for Program Infrastructure
Quality of
WorkLife
Traditional
Approach
Health and
Productivity
Management
No cost or very low cost
(<$25/EE/yr)
Moderate cost (Between $26 and
$140/EE/yr)
Major cost (Between $141 and
$340/EE/yr)
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Program Infrastructure and Effects
Type of Emphasis or
Major Effects
Option #1
Option #2
Option #3
QWL
Program Model
Traditional
Program Model
HPM
Program Model
Information
++
+++
++++
Motivation
+
++
+++++
Behavior Change
+
++
++++
Economic Change
+
++
+++++
++
++
++++
Cultural Change
- Chapman, Planning Wellness, 2005
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Major Phases
Introduction
Experimentation
Shakedown
Refinements
Realignment
Expansion
Partnership
Optimal effectiveness
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How to Develop an Infrastructure
Define needs
Establish priorities
Select metrics
Define technical
specifications
Make or buy
Evaluate regularly
Refine specifications
Redefine needs
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Summary of Key Points
Few employers have sustainable program infrastructures
Most Wellness activity is episodic and short term oriented
There are standard components to program infrastructures
The extent of your infrastructure depends on your model
Your infrastructure is the “core” of your program
Your program model will drive your infrastructure costs
The three basic models result in different levels of effects
Program infrastructure should be built in phases
The process of building your infrastructure should be rational
A sustainable infrastructure is key to long term success
The quality of the infrastructure will have a major impact
The program infrastructure must have an appropriate
administrative infrastructure
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Your Questions?
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