2. Agenda
Definition
Purpose
Significance
Methodology
Research
Background
Comparing other programs
Legislation
Current Program
Health Contingent Programs
Definitions
Spectrum
3. Agenda (cont.)
Comparing Different Programs
Case studies
Implementation
Health Benchmarks
New Hires
Data Tracking
Outside Counsel
Other Feedback
Recommendations
Contacts
4. Outcomes-Based Wellness Programs
Definition: A wellness program put into place to
encourage employees to take action to improve his/her
own health by incentivizing the achievement of specific
biometric goals
We want to evolve HarbinSTRONG as it is from a
participation-based program to a program that rewards
our employees for meeting health goals that are
important aspects to quality, healthy life.
5. Purpose
The Purpose of this project is to create and launch an
outcomes-based wellness program for employees that
promotes health and well-being.
The use of goal-focused incentives will be key to
encouraging employees’ active participation in
eliminating unhealthy habits and increasing quality of
life.
We will focus very strongly on complying with state and
federal laws pertaining to outcomes-based wellness
programs.
6. Significance
The Patient Protection and Affordable Care Act (PPACA) encourages
the creation of employer wellness programs.
PPACA released final regulations in 2014 protecting employees who
may be unable to meet incentivized goals put into place by
employers.
Case studies have shown that employers who make the shift from a
participatory to an outcomes-based program can increase employee
participation to greater than 95% and decreased the employer’s claims
to less than 3%.
Can improve the health and well-being of employees, which can
decrease the company’s healthcare costs.
Can also aid in the decrease of healthcare costs nationwide.
We hope to create similar results as our predecessors by developing a
plan that remains in compliance with PPACA and improves employee
health.
7. Methodology: Research
Identify and summarize legislation behind the creation
of wellness programs, especially those that are health-
contingent.
Read cases and documents on the differences between
outcomes-based and progress-based wellness programs.
Identify other organizations with health-contingent
wellness programs that can be used as examples.
Note the participation rates, the impact on insurance,
and different incentives used in specific case studies of
these organizations.
8. Methodology: Background
Present findings on legislation.
Define the current structure of HarbinSTRONG.
Define and contrast the two types of health-contingent
wellness programs:
1. Progress-based
2. Outcomes-based
9. Methodology: Comparing Other
Wellness Programs
Present a spectrum ranging from fully participatory to
fully outcomes-based wellness programs and note where
each example falls on the spectrum.
Create a chart that compares the example wellness
programs based on three characteristics.
Participation rates
Insurance claims trends/costs
Types of incentives
10. Basic Legislation
A health-contingent wellness program offered to employees
must be voluntary, and an organization cannot deny health
coverage to individuals who do not wish to participate.
Incentives for those who successfully participate cannot be
more than 30% of the cost of the health coverage in place.
Employees who cannot achieve goals outlined in the wellness
program for reasons such as medical must be provided with a
reasonable alternative to earn the incentive.
Employees must be given a chance to qualify for the incentive
every year.
11. Current Participatory Wellness
Program: HarbinSTRONG
Participatory Wellness Program:
A program that provides either no incentive or an incentive
based strictly on participation in programming for the
wellness program and is not related to a health factor.
HarbinSTRONG currently offers employees the chance to
qualify for Wellness/Standard Premium Rates if they
complete a series of tasks outlined in the HarbinSTRONG
manual. Because none of the tasks dependent upon a health
factor, the program is considered participatory.
12. health-contingent Wellness Programs
health-contingent Wellness Program:
A wellness program that incentivizes or penalizes the achievement or
lack thereof of health goals set out by the program; these programs must
meet requirements outlined by the legislation to avoid discrimination of
certain employees.
Two Types:
Progress-based: Incentives are given based on an improvement of
specific health factors such as an improvement in blood pressure or a
decrease in BMI.
Outcomes-based: Incentives are given when an employee meets a
certain biometric goal i.e. blood pressure must be 120/80 or less to get
the reward or avoid penalty.
13. Examples of Employee Wellness
Programs
Participatory
-HarbinSTRONG
health-
contingent
-Valeo’s Healthy
Rewards
-Southwest General
Combination
-MaineHealth’s Works on Wellness
• MaineHealth used a combination of the two types of programs by attaching the incentive of
enrollment into the lower cost health insurance plan to simply participating in the online HRA and
biometric screening. They also provide bonuses in the form of additions to paychecks or deposits
into HSAs to employees who meet biometric goals or progress rates specified by the program. (the
program has evolved some since 2012).
• Valeo has an outcomes-based program that provides credits toward the company health insurance
premiums to employees who meet specific goals provided by the program.
• Southwest General rolled out a wellness program that started as participatory and is now wholly
outcomes-based. Incentives are applied to health insurance premiums for employees who meet
the biometric standards.
14. Comparing Different Wellness Programs
Valeo MaineHealth Southwest General
Participation No indication of
participation rates in the
case study
An increase from 53% in
2011 to 95% in 2012
A greater than 99%
participation rate each
year of the rollout plan
Insurance Impact Those enrolled in the
wellness program had a
2.5% increase in claims
cost trend (national trend,
10.25%)
No indication of impact on
health insurance costs in
the case study
Those enrolled in the
wellness program had a 1%
increase in claims cost
trend (before the
program, 16%)
Incentives • $450 credit applied to
the health insurance
premium for each
biometric goal met
• Bonuses given into pay
check or health savings
account based on
biometric results (i.e.
healthy BMI or 10%
weight loss since first
screening)
• $1,200 per year
penalty for tobacco use
• The program began by
providing a $200+ a
month credit toward
the health insurance
premium for
participation
• As the company made
the shift to outcomes-
based, $50 more was
added to the credit for
specified goals or rates
of progress met
15. Implementation
Valeo
No gradual roll out plan – the program was implemented as is right away.
Every employee was required to receive the screening from implementation.
Southwest General
Rolled out – stopped – restarted the rollout process.
Employees were unhappy with the requirements and there was a lot of pushback.
Human resources decided to stop the process, use the measurements as a baseline,
and give employees one year to work toward the goals.
MaineHealth
Took a couple of months to implement the outcomes-based incentives.
The whole program has evolved from participatory to what it is today; benchmarks
have changed over the years.
16. Health Benchmarks
Valeo MaineHealth* Southwest
General
Cholesterol LDL < or equal to
125
LDL < 130 or HDL >
60
LDL < or equal to
120
A1C/Blood glucose No measurement Blood glucose <
126
A1C < or equal to
6.0
Weight BMI 18-28.5 BMI 18.5-29.9 or
10% weight loss
since last
screening
BMI < or equal to
27.5
Blood Pressure < or equal to
130/85
<140/90 < or equal to
130/85
Tobacco Use Incentive given to
non-tobacco users
Penalty on tobacco
users
Incentive given to
non-tobacco users
Appears based on
benchmarks that
employees in pre-
risk areas are not
excluded from the
incentive unless
they move into the
high risk
categories
*As of this year,
MaineHealth is
only screening for
healthy weight,
tobacco use and
BP
17. New Employees: If New Hires Miss
the Screening Date
Valeo: New Hires who miss the screening deadline are enrolled
into the New Hire benefits plan. During open enrollment, new
employees then receive the screening and decide whether or not
they want to enter the wellness program benefits plan.
Southwest General: New hires are allowed to slide through on the
wellness benefits plan until the next open enrollment. HR used to
send out nurses to take measurements in-home, but that proved to
be too much trouble.
MaineHealth: New hires are allowed to choose whichever plan they
want but do not qualify for incentives. This begins at the next
open enrollment.
18. Data Tracking
Valeo – Bravo Wellness
A representative from Bravo walked through the process of the
setting the program up with the staff at Valeo
MaineHealth – WebMD
Southwest General – Bravo Wellness
Same as Valeo
19. Outside Counsel
Valeo: Used a 3rd party vendor called Group Associates
(consulting firm for benefits solutions).
MaineHealth: WebMD provided much of their resources
but they also went internally for advice and other
resources; used a 3rd party vendor for marketing and
communications.
Southwest General: Used a 3rd party vendor for case
management – Human Resource director could not give
me the name.
20. Other Feedback
Valeo: Employee Reactions
No major pushback from employees.
Many are shocked by some of their scores which can either be positive or negative.
MaineHealth: Employee Reactions & Hindsight
Mainly tobacco users were upset due to the $1,200 fine imposed on them.
Employees found it intrusive; concerned about where their PHI was going.
She advises that you cannot explain the mission, costs, and PHI concerns enough; make
sure the employees understand.
Be transparent about why this program is being implemented whether its to control costs
or to improve noticeable health issues.
Keep it simple and easy to communicate.
Include spouses and dependents from the beginning; they are experiencing all the issues
with pushback all over again.
Southwest General: Employee Reactions & Advice
Employees were very unhappy with the implementation.
Make sure the biometric screening days are well thought about and organized – she
described their first one as a circus.
Great program – participating employees have lost a total of 24,000 lbs and 68 have quit
smoking; she is open to giving any advice necessary.
21. Recommendations
Health-contingent programs can greatly increase employee
participation and can improve health significantly.
Having a combination of both progress and outcomes-based
incentives would be a good option.
Employees who cannot reach the set number goals all at one
time can improve by losing a certain amount of weight or
reducing blood pressure in general.
Incentivizing progress along with outcomes would also be
encouraging to those who feel the goals are daunting numbers.
22. Contacts
My Contact Info:
Dresden Maddox – By Email or Phone
Email: dgm74@scarletmail.rutgers.edu
Phone: (770)-905-6814
Other Organizations:
MaineHealth – Laurie Mitchell, RDN, Director of Health & Productivity
Email: MITCHL1@mainehealth.org
Southwest General – Judy Murphy, SPHR, Vice President of Human Resources
Email: JMurphy@swgeneral.com
Valeo – Jaye Parker, Human Resources
Email: jaye.parker@valeo.com
