Selecting and Integrating Wellness Programs into

Client Health Promotion Initiatives

Barbara H. Wall

President

Hagen Wall Consulting

2

Why Include Health Promotion Benefits? Most growth in health care spending is due to risk factors

that can be modified Stress, smoking, poor diet, sedentary lifestyle Obesity and morbidities related to it causes 27% of cost increase

(1987-2002)1

Benefit design and member cost sharing changes are helpful but do not address the entire problem of cost increases 90% of spending is for sickest members who spend

>$1,000 a year out of pocket

1 Thorpe, et al, “The Rise in Health Care Spending and What To Do About It,” Health Affairs, Nov/Dec 2005

3

Health Promotion is Prevention and Management

Health Promotion = Identifying those with health risks and promoting healthy

behaviors (wellness) + Teaching chronic disease patients to maintain best

possible health (disease management) + Intensive management of acute illness (case

management)

Health Promotion ContinuumWellness Care

ManagementCase & Disease

Management

Staying Healthy(70% population)

Getting Better(14% population)

Living with Chronic Illness

(16% population)

15% of Costs 25% of Costs 60% of Costs

Risk Factors• Alcohol/tobacco use• Sedentary lifestyle• Poor diet• Health history• Unmanaged stress

Acute Isolated Episodes• Broken leg• Respiratory infection• Appendicitis

Complex Cases• Transplants• Cancer• Trauma• Chronic Disease• Diabetes• Heart Disease• Depression

4

Impact of Chronic Diseases

Heart Disease & Stroke Cancer Diabetes

• 1st and 3rd cause of death in the US (40% total)• Affects 70 million in US• Much of the impact of these diseases could be prevented, for example: a 13% reduction in blood pressure can reduce:

• heart attack by 21%

• stroke by 37%• deaths by 25%

• 2nd leading cause of death• Screening tests now exist for many of the most common types of cancer • It is now known that obesity increases the risks for breast, colon, kidney, endometrial and esophageal cancers

• 6th leading cause of death• Over 18 million people in the US have diabetes• 27% of those who have diabetes don’t know it• Lifestyle changes can reduce the risk of diabetes by 60% in overweight adults with pre-diabetes

Source: Department of Health and Human Services Fiscal Year Budget Appropriations

5

Impact of Behavioral Risks

Obesity Tobacco Use

• Now viewed as epidemic in the US• Affects > 31% of the adult population• 16% of children/teens and growing• Contributes to metabolic syndrome (increased blood pressure, increased cholesterol levels) and risk of serious disease• Obesity and sedentary lifestyle contribute to development of stroke, diabetes, cancer and heart disease

• Represents the single most preventable cause of death and disease in the US• Causes 440,000 deaths each year• $150 billion in medical costs and lost productivity• Approximately 22% of adults in the US smoke• Healthy People 2010 calls for reduction in smoking rate to 12%

Source: Department of Health and Human Services Fiscal Year Budget Appropriations

6

7

Focus on the Best in Program Design and Execution for the Client Wellness and disease management programs vary in

program design, integration, intensity, participation rates and results: Too much variation exists to generalize across vendors Comparisons on key features among vendors is necessary

Predictions of ROI are less dependable than analysis of program design and execution Vendors create their own ROI methodologies and calculations Vendor ROI predictions may create false expectations

Incentives to spark interest and participation for the high risk segments of the client’s own pool are essential to success Incentive range

8

Factors for Health Promotion Program Success The program must be tailored to the target

population The group’s characteristics and risks are considered

Lifestyle risk factors Prevalence of chronic diseases Current activities and programs Readiness to change Motivation techniques

9

Wellness Program Strategy Elements A well-defined strategy considers

Program objectives Program criteria Financial resources Human capital Participation incentives Ability to leverage existing vendors/programs Integration with other programs Measurement

10

Measurement & Reporting Should include

Short term and long term Participation HRA results Data integration

11

Communication Plan for the Program An intensive communication campaign is a key

success factor Executive sponsors Key stakeholder involvement Advance publicity Frequent, clear messaging

12

Services to Support Program Selection Client education and strategy

Group profile Vendor market scan Current program assessment

Analysis of proposals and guidance on Participation incentives Communication Metrics Implementation

Competitive bid With BRG as point of communication with client

Negotiations with vendors Metrics Competitive pricing

Implementation oversight Coordination between client and vendor

13

Questions and Comments?

Contact:

Barbara Wall, JDPresident, Hagen Wall Consulting(206) 629-4174Barbara.Wall@HagenWallConsulting.com