1 building a sustainable infrastructure for ehm: a vision for the future presented by larry chapman...

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Building a Sustainable Infrastructure for EHM: A Vision

for the Future

Presented byLarry Chapman M.P.H.Chairman and Co-Founder

Summex Health Management

© Summex Health Management

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Agenda

The mistake most employers makeThe key pieces of your program infrastructureMatching your infrastructure to your program modelResource implicationsA 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-wideHighly “actionable”Administratively efficientStrong metricsSimplifying in natureWell-integratedStrategicViable 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 health-related 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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Fun activity focusNo risk reductionNo high risk focusNot HCM orientedAll voluntarySite-based onlyNo personalizationMinimal incentivesNo spouses servedNo evaluation

Mostly health focusSome risk reductionLittle high risk focusLimited HCM orientedAll voluntarySite-based onlyWeak personalizationModest incentivesFew spouses servedWeak evaluation

Add productivityStrong risk reductionStrong high risk focusStrong HCM orientedSome reqd activitySite and virtual bothStrongly personalMajor incentivesMany spouses servedRigorous evaluation

Quality ofWorkLife

TraditionalApproach

Health andProductivityManagement

Fun-Oriented Activity-Oriented Results-Oriented

Program Model

Main Features

Primary Focus

Major Wellness Program Models


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Key Pieces of the Program Infrastructure

HRA and personal reportTelephonic coaching & referral networkSelf-directed change materialsAnnual program kit Medical self-care bookMailings and emailsWellness newsletterPCP oriented-summaryFull-function E-Health sourceWellness incentives


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Visual Diagram of the Infrastructure

Referrals


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Core Program Infrastructure Plus….

Core Program Core Program InfrastructureInfrastructure

Site-based Site-based ActivityActivity

++ ++


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Schematic of the Infrastructure

Eligibility Files

HRA

TelephoneCoaching

PersonalReport

Follow-upFulfillment

Mailingsand

EmailsNewsletters

Data forPCP

Self-DirectedChange

Materials

ProgramKit

FullService

E-HealthWebsite

IncentivesSite-

BasedPrograms


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Key HRA Features

HRA

Identity & demographicsPersonal and family medical historyCurrent symptoms and treatment statusPreventive screening statusPCP relationshipMedical self-care book useClinical and behavioral risksReadiness to changeSelf-efficacy levelsPsycho-social indicators Injury risk issues (W,H,V & R)Health care utilization levelsHealth consumer skills levelPresenteeism statusOption for use of biometric valuesOverall Wellness Score (OWS)Report of past OWS scores


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Eligibility Files

HRA

TelephoneCoaching

PersonalReport


Mailingsand

EmailsNewsletters

Data forPCP

Self-DirectedChange

Materials

ProgramKit

FullService

E-HealthWebsite

IncentivesSite-

BasedPrograms


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Key Coaching Features

TelephoneCoaching

Everyone gets a call (Opt-out)Call at home – then at-work“No reach” protocolModerate risk 2-4 calls/yrHigh risk 5-12 calls/yrStrong use of SOCStrong use of motivational interviewing techniquesFollow-up materials providedReferrals providedEveryone asked to have personal wellness objectivesIncentive for coaching adherence


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Eligibility Files

HRA

TelephoneCoaching

PersonalReport


Mailingsand

EmailsNewsletters

Data forPCP

Self-DirectedChange

Materials

ProgramKit

FullService

E-HealthWebsite

IncentivesSite-

BasedPrograms


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Key E-Health FeaturesSSO access from company 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

FullService

E-HealthWebsite


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Eligibility Files

HRA

TelephoneCoaching

PersonalReport


Mailingsand

EmailsNewsletters

Data forPCP

Self-DirectedChange

Materials

ProgramKit

FullService

E-HealthWebsite

IncentivesSite-

BasedPrograms


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Key Incentive FeaturesUse “play or pay” conceptRequire annual HRAUse $500 to $1,000 per year of value Use premium discount and/or debit cardUse 4/5, 6/8 or 8/10 Wellness criteriaTighten and change criteria over timeEveryone who “plays” gets a prizeProvide a waiver opportunityUse “sentinel” featuresConnect it to open enrollmentConsider a “zero base budget” approach

Incentives


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4/5*Non-tobacco userBMI < 30OWS > 85Physical activity > 4 times per weekCompletion of 30 minute webinar on wellness and consumer health

6/8, 8/10*Non-tobacco userBMI < 30OWS > 85Physical activity > 4 times per weekCompletion of 30 minute webinar on wellness and consumer healthCurrent on preventive screening (MD form)100% seat belt useHave a PCPUse of your medical self-care book in previous 3 monthsNo more than 3 sick leave in last 12 months

* = All “HSRF” criteria would also have participation options

Large employers could further customize the criteria

Examples of Wellness Criteria


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Eligibility Files

HRA

TelephoneCoaching

PersonalReport


Mailingsand

EmailsNewsletters

Data forPCP

Self-DirectedChange

Materials

ProgramKit

FullService

E-HealthWebsite

IncentivesSite-

BasedPrograms


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Infrastructure Linked to Model

Little to none

Event-oriented

Fluid design

Ad hoc in nature

Boutique style

Minimum

Activity-oriented

Fixed design

Calendar-based

Smorgasbord style

Significant

Data-driven

Flow design

Cycle-based

PHM style

Quality ofWorkLife

TraditionalApproach


Fun-Oriented Activity-Oriented Results-Oriented

ProgramModel

ProgramInfrastructure

PrimaryFocus


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Resource Implications

TraditionalApproach

Resources for Program Infrastructure

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)

Quality ofWorkLife



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Program Infrastructure and Effects

Type of Emphasis or Major Effects

Option #1

QWLProgram

Model

Option #2

Traditional Program Model

Option #3

HPM Program Model

Information + + + + + + + + +

Motivation + + + + + + + +

Behavior Change

+ + + + + + +

Economic Change

+ + + + + + + +

Cultural Change

+ + + + + + + +- Chapman, Planning Wellness, 2005


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Major Phases

IntroductionExperimentationShakedownRefinementsRealignmentExpansionPartnershipOptimal effectiveness


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How to Develop an Infrastructure

Define needs Establish prioritiesSelect metricsDefine technical specificationsMake or buyEvaluate regularly Refine specificationsRedefine needs


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Summary of Key Points

Few employers have sustainable program infrastructuresMost Wellness activity is episodic and short term orientedThere are standard components to program infrastructuresThe extent of your infrastructure depends on your modelYour infrastructure is the “core” of your programYour program model will drive your infrastructure costsThe three basic models result in different levels of effects Program infrastructure should be built in phasesThe process of building your infrastructure should be rationalA sustainable infrastructure is key to long term successThe quality of the infrastructure will have a major impact The program infrastructure must have an appropriate administrative infrastructure


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Your Questions?

1 building a sustainable infrastructure for ehm: a vision for the future presented by larry chapman...

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