Nationwide Mutual Insurance Company

Narrative Description of Program

Nationwide’s integrated comprehensive program, My Health, is open to associates, spouses, dependents and retirees and includes: health assessment, lifestyle behavior coaching, integrated absence/disability/workers’ compensation/disease management, health advocacy/education, consumer directed health care, occupational health clinics, walking programs, healthy dining options, free/discounted fitness centers and EAP/behavioral programs. It is the management of health and injury risks, chronic illness and disability to reduce associates’ risk profile, total health costs, unnecessary absence from work and lost performance at work and coordinated within the larger healthcare benefit strategy.

Health Assessments (HA) are available online and paper format in English and Spanish. Yearly incentives ($260/year HRA/HSA and $260 annual premium reduction) are linked to completing the HA and one wellness activity (telephonic coaching, web courses, integrated disability/disease management, walking programs, fitness centers and self-reported activities).

Ownership and funding is sponsored by our CEO, BOD, senior and associate VPs of HR. Responsibility for implementation is shared by a team of specialists from Health & Productivity, Associate Health Services, Benefits Planning, Communications, and General Counsel.

Program results are reported back at the business unit level so that targeted interventions and customized programs can be developed for the specific needs of each business unit. This allows associates to receive individualized programs at the local level in addition to national initiatives such as free flu shots, mobile mammography and health screenings.

Key components are:

• Commitment – Giving associates and retirees the support they need to live healthier and help them and Nationwide better control health care costs.
• Confidentiality – Assure associates and retirees that confidentiality is a priority. Nationwide does not have access to their individual health information.
• Culture of health – Create lasting behavioral change. Associates and retirees have the power to make a difference in their health and health care costs by the lifestyle choices they make.

The program delivered significant results in 2008. Evaluation involves setting specific performance targets and monitoring those to benchmarks, a quality review of the data, measuring program savings, ROI and evaluating program impact for enhancements.

Program Evaluation Highlights

• In 2008, 79% of associates (85% of medical plan participants) completed the health assessment (HA) with a biometric evaluation; 23% increase in 2008, 39% increase in 2007; an 88% overall increase since 2006.
• 12.2% associates’ health improvement from Chronic Disease/High Risk to Low/Moderate Risk based on stratification results; net reduction of 2,714 associated risks for an estimated savings of $990K.
• Based on WPAI survey for the last three years, productivity has improved 56.2% (average associate loss of 3.24 hours/week in 2006 to 1.42 in 2008). Productivity improvement and related estimated savings of $7.8M, based self-reported difference between 2007 and 2008.
• Disease management cost avoidance savings of $1.2M.
• Annual increase in healthcare spend trending at 5% after budgeted increases of 8-12% each year since 2000. Savings as a result of a 5% trend represents $5.3M.
• Annual cost of health care benefits averaged $6,165 per associate in 2008, 5.3% less than 2007 and 29.5% less than the $8,785 average per employee cost of employers participating in the Hewitt Health Value Initiative, a cost and performance analysis database of more than 1,800 US health plans.
• Analysis shows cost drivers were obesity, smoking, and physical activity. Improvement over the past three years:
  • Smoking 17.5% reduction in tobacco usage. In addition to tobacco cessation coaching, we reimburse $300 for tobacco cessation prescriptions including OTC.
  • Physical activity 37.7% improvement. More than 27% of associates participated in the walking program and logged > 6.5 billion steps in two years. Free fitness centers offered at larger locations. Fitness center discounts available nationally.
  • Obesity 0.1% improvement in 2008; significant because of move from self-reported biometrics to third party measurement. Participants Year 1 over Year 2 had a 7% obesity reduction.

• Associate results:
  • 58% completed one wellness program (16.4% > two).
  • 38.4% of associates received seasonal flu immunization.
  • 42.4% reduction in reported physical abuse among associates involved in the integrated EAP outreach/referral efforts and an overall 52% reduction in the prevalence of emotional abuse (20072008).
  • 300% increase in maternity management with new nurse-driven program.
  • 400% increase HDHP, increased from 1,485 to 9,316.

• Awards:
  • 2009 IBI/NBCH Employer/Employee Innovation in Health & Productivity
  • 2009/2008 AHA Start! Fit-Friendly Companies - Platinum
  • 2008 NBGH Best Employers for Healthy Lifestyles - Gold

Overview of Evaluation Methods

The program encompasses a wide range of health and productivity interventions involving behavior change, medical care utilization support and direct care interventions: health screenings and on-site clinics. The direct costs in 2008 were $4.8 million, excluding EAP/disability management/incentives; an estimated $116 per associate. Total savings for the program are estimated at $16.1 million in savings, excluding EAP/disability management/incentives, representing $271 per associate; an estimated 2.5:1 return on Nationwide’s investment in the health and productivity of its associates.

• nationwide_my_life

A

• Offered to spouses, retiree’s and dependents
• High Participation—79% (HRA)
  HRA and one wellness program tied to benefits plan
• CEO buy-in
• Tailored to each worksite
• Improvements in smoking, PA, and obesity
• Coaching offered to those “Ready to Change”
• On-site fitness centers/discounts
• Success stories published

B

• Strong leadership commitment and support
• Comprehensive population health strategy integrated with disability management program and health plans
• High rates of health assessment, screening, and follow-up intervention participation
• Reduction in obesity rate, although modest, bucks national upward trend and is especially noteworthy given the shift from self-report to screening. Self-report is generally quite accurate but there is a small, positive bias that makes the observed trend a likely underestimate.
• Significantly above average investment in health management of $116/employee is tangible evidence of management commitment.
• Strong program and data integration and primary coach model with solid referral processes.
• Strategy encompasses worksite culture and work environment support for health, as well as building family support
• Domestic violence innovation and depression triage/outreach drives high EAP utilization

C

• Complex program with fairly convincing data
• Health risk decreases, projected savings
• Good focus on smoking, exercise, obesity
• Award winning
• Use their own data for health risk-cost associations
• Methodology detailed far better than most

D

• $520 incentives (HRA/HAS premium reduction) linked to completing HA and one wellness activity
• Program sponsored by CEO/BOD/Sr. VPs
• Results reported to businesses
• 79% of associates completed HA w/biometrics – 58% completed wellness program
• Productivity improvements – hours lost 2006-2008 3.24->1.42

E

• High participation rates.
• Good strong evaluation.
• Highly integrated program.
• Comprehensive program.
• Appropriate incentives
• Sr level support
• Impressive risk factor reduction
• Mental health – violence prevention focus. Few programs tackle this issue.

F

• Health & Productivity scorecard laid out as a summary
• Good results
• Recognition of work environment
• Good increase in participation over time

G

• This program is fully integrated and comprehensive including disease management, behavioral health, online education modules, 1 year of telephonic coaching, and biometric testing.  They have a 79% health assessment (HA) completion rate and 58% of the population completes at least one activity.  The annual HA and completion of one other activity qualifies an employee for $260 to their HAS and $260 premium reduction.  There is senior level support with cross-organizational planning and implementation.  Reports are analyzed by business unit so that interventions can be targeted.  Their key principles are commitment, confidentiality and culture of health.
• They have incorporated  “point of contact” referral and enrollment capacity.  Outreach is based on readiness.  There is also outreach for any indicator of depression.
• Adult dependents included.
• Overall, 12% of participants have moved from high risk to low risk.  Health care cost trend at 5% (vs. 10 to 12). Smoking is down 17%, Exercise increased by 37% and obesity down 7%.
• Well written and presented application.

H

• The program seems very comprehensive, which a nice blend of assessments, skill building, engagement methods and environmental supports.  It also seems to be integrated nicely into the health plan and occupational health programs.
• Offering programs to families and retirees is excellent.
• Health and financial improvements were excellent.

I

• Conflict

J

• Wide access to all employees, spouses, dependents and retirees.  Goes beyond health to include disability, work comp, and behavioral health.  Strong incentives of health account contribution and premium contribution credit.  Senior leadership sponsorship.  Very high participation in health assessment and screening.  Broad range of program evaluation metrics.  Comprehensive set of program elements with an effort toward data sharing and integrated approach with a multi-year strategy.  Addresses domestic violence and behavioral health.