Baylor College of Medicine (BCM) is a medical system, academic health sciences university, and research institution with a dynamic workforce of 10,000+ faculty, staff, residents, and post-doctoral fellows across the globe. The wellness program began in 2011 and expanded in 2014 when it became known as “BCM BeWell.” The mission of BCM BeWell is to educate, inspire, and create a culture of health and well-being throughout the College and serve participants wherever they are in their health and well-being journey. Between 2014 and 2018, participation in the program grew from 25% to 62% and at the same time BCM employees significantly improved their overall health. With physical wellness being the most highly utilized aspect of the program, the percentage of participants reducing their risk for physical inactivity activity was increased by 12.8% and those reducing risk for poor nutrition was 9.7%. According to an annual company survey, 86% of respondents reported BCM BeWell contributed to improvements in overall health and well-being. Because of positive health trends, Baylor experienced a medical budget surplus in 2018 and was able to keep the employee-paid medical insurance premiums static for 2018/2019. Senior leadership at Baylor endorses the BCM BeWell program and continues to support its growth.
Located at the heart of the Texas Medical Center in Houston, Texas, Baylor College of Medicine (Baylor) is a multifaceted non-profit corporation that specializes in three unique aspects of medicine. Baylor is an acting medical system, an academic health sciences university, and a research institution. Baylor has a dynamic workforce of 10,000+ faculty, staff, residents, and post-doctoral fellows that span the globe and have unique needs. Baylor’s medical professionals focus their efforts on improving human health in the communities they serve.
In 2011, Baylor Human Resources (HR) wanted to create a culture of health and well-being among the individuals who performed this task for others on a daily basis. HR began with newsletters and internal social events, “Wellness Wednesdays,” where HR employees were asked to create and share healthy food items with the team. In 2012, HR enlisted the help of their actuarial firm and consulting partner, Mercer, to assist with developing strategy that would expand the wellness program to all benefit eligible employees. The first steps for Baylor included hiring wellness coordinator, beginning a partnership with a wellness portal provider (Vitality Group), and using biometric screenings (Quest Diagnostics) to gauge the needs of Baylor’s community. The mission of the new wellness program, BCM BeWell, has been to educate, inspire, and create a culture of health and well-being throughout the College. BCM BeWell’s goal is to meet participants where they are in their health and well-being journey. Since the expansion in 2014, BCM BeWell has become a staple benefit of Baylor College of Medicine.
Using analytics provided by Vitality Group, reports show Baylor College of Medicine employees have significantly improved their overall health since 2014. With physical wellness being the most highly utilized aspect of BCM BeWell, the percentage of participants meeting recommended guidelines for physical activity1increased by 14.7% and those meeting the guidelines for nutrition2 increased by 9.7% between 2014 and 2018. According to BCM BeWell’s annual company survey, 86.48% of respondents reported BCM BeWell has contributed in the improvements in their overall health and well-being over the last five years. Because of these trends, the increased health awareness, and the program design enhancements from the benefits team, Baylor has experienced a medical budget surplus in 2018 and was able to keep the employee-paid portion of medical insurance premiums static for 2018/2019. In 2017, highly engaged BCM BeWell members helped create a $1.4 million medical claims savings. Because of the community’s improvements to health and demonstrated financial impact, senior leadership of Baylor endorses the BCM BeWell program and in turn continues to allot for program growth including increased breadth and depth of resources available to employees.
BCM BeWell uses a wide variety of data outlets to track and report outcomes for the wellness program. They use feedback surveys and questionnaires to gauge participants’ thoughts on programming and what they feel the wellness program should implement. BCM BeWell uses health claims data and pharmacy data to determine the long-term impact of the wellness initiatives to the self-funded health care plan. Lastly, they use the wellness portal and screening vendor to determine real-time needs for wellness interventions.
In 2018, 1,561 employees completed BCM BeWell’s annual survey and 86.48% reported BCM BeWell has assisted them in improving their overall health and well-being over the last 5 years. They offer biannual on-site biometric screening events with multiple date and physical location options to accommodate a mobilized workforce. Screenings are followed by a presentation with in-person and streaming options to educate employees on their results with the goal of bridging the gap between participants and their primary care physicians. BCM BeWell facilitates these onsite screenings at 95% of the locations. Participants may also opt to attend an off-site screening through any clinic at their convenience.
• Holistic approach evidenced by broad range of programs across multiple dimensions and attention to aligning culture and work environment with wellness
• Incentive strategy offering choice and combining immediate small rewards with larger rewards for sustained activity/outcomes
• Extensive, multi-channel communication approach
• High HERO Scorecard, especially strategic planning, org support, participation strategies, eval
• Analysis to verify that program is reaching high-risk, high-cost eligible individuals
• Increase in physical activity for a growing segment of population supporting well-conceived strategy encouraging regular activity, although still a minority of population participating
• Six dimensions of wellness
• Understanding of inclusion with incentives and individuals learning in different ways
• Cohort analysis on risks
• Root cause analysis on increased fasting glucose
• Comprehensive program activities mapped and aligned with wellbeing dimensions
• Integrated with benefits and built environment supports
• Multidimensional incentive platform
• Varied communications
• Includes dependents
• Include spouses/domestic partners
• Participation rates have increased 2014-2018 – 25%-62% -- including HAs, portal touches, activities
• HERO Scorecard
• Generally good risk trends
Overall assessment: Application describes a very comprehensive program, with good base levels of participation, and strong health impacts. Health impact methodology relies on pre/post comparisons and also leverages Vendor book of business comparisons when available. Clear links between health outcomes reported and the types of programs that contributed to the change.
Very Strong and Comprehensive Program with Many Unique Features
• Program began in 2011 so more than 3 years old. 10,000+ employees.
• Built environment supports for physical activity and stress management.
• Like the list of programs/resources listed by dimension of wellness. Includes specific offerings to address physical, social, emotional/spiritual, financial, environmental, and intellectual wellness.
• Strong description of incentives and how they address disparities.
• HERO Scorecard score of 159 ranks it among the top scoring organizations.
Strong Participation Rates but Not Exceptional
• Program participation table details time over time trends by element and includes average number of elements completed each year.
• 42% completion of at least 2 activities in 2018. This represents a more rigorous level of participation than we often see.
• 62% of population was enrolled in wellness portal in 2018 and 7.2 average wellness portal activities indicates exposure to program is strong.
• Comparison to Vendor book of business participation in activity portal indicates stronger than typical participation.
• Compared portal participation rates by high health care claimant status to demonstrate they were not just attracting healthy to participate.
Solid health risk impacts reported with pre/post comparisons and some Vendor book of business comparisons.
• Improvements in physical activity, nutrition, safety, preventative physicals.
• Use of verified workouts to observe changes in physical activity, with trends tracked over time and compared against Vendor book of business.
• Statistical tests of pre/post biometric measures reported for blood pressure, tobacco use, alcohol use, nutrition and physical activity. Number of employees in analysis ranged from around 2400 to 3900. That’s about 25% to 33% of their overall population.
• Cohort analysis of 1,795 employees found count of health risks decreased by 15% over 3 years.
• Risk reduction comparisons made between individuals participating all four years versus those not participating and demonstrated improvement in overall risk reduction for those most active. However, there are no controls mentioned for selection/motivation bias.
• Accrued a medical budget surplus in 2018 and kept premiums static in 2018/2019.
• Medical cost impact methods clearly reported. Used propensity score matching to attempt to control for selection bias. Compared most engaged to least engaged employees over time. Use of a conservative 1.25:1 ratio for estimated indirect:direct cost savings.
• I appreciated the analysis that looked specifically at the high cost claimants vs. the 80% of others
• Well formatted participation table with evidence of increasing enrollment and activity completion over time.
• Attempt to address self-selection bias with reporting of high cost claimants. Although note around benefits eligibility under program weaknesses deserves attention.
• Reporting of risk factors by risk level across cohort, demonstrating risk decrease over an average of 3 years.
• Cost savings using propensity score matching for engaged vs. non-engaged
• Health and well-being align with the Baylor College of Medicine
• Early description stated that there was less than 1% utilization of tobacco – assuming this is among the population that is participating in their wellness program and may demonstrate that tobacco users are not participating. Of note, later description (figure 5 had 8% at elevated risk – may have been previously used tobacco).
• Program addresses health, well-being, health literacy and a healthy environment with the addition of spouses/domestic partners in 2019.
• Walking tracks, stair well campaigns, and walking/standing conferences.
• Multi-dimensional wellness model (physical, social, emotional/spiritual, financial, environmental, intellectual).
• Strategic communication plan to include wellness champions (n=80) and peer role models with integration of some internal health resources to include the DiBEATes program.
• Overall improvements in health factors (with the exception of BMI, Cholesterol, Glucose and Stress) during the 2014-18 period. Of note, less than 2440 with repeat biometric measures or 24% of the population.
• Propensity score matching was completed (excellent) with an indirect (Vitality) factor of 1.25 based on 2011 Koop Award winner. This may/may not hold relevance.
• Partnerships and services to the community and employers is excellent to improve the overall health of their communities.
• Used budget surplus to fund program
• Added resources to program since 2014
• Continuous evolution of program
• Strong communications channel
• High cost claimant study – good results and addresses an area of criticism
• Good results shown in cohort analysis
• Good results with increasing physical activity
• Able to contain health care cost increases for employees
• Communication strategies seem well developed
• Working to engages spouses is important. Are spouses included as eligible participants?
• The scope of program offerings seems strong.
• Comparing participation rates of high and low risk employees provides some controls to the impact analysis.
• The decrease in risk factors is encouraging.
• Efforts to reduce measurement error, including being strict about pre-screening fasting and verifying workouts through download are smart.
• Utilizing the walkability of the campus in the 6-year virtual step challenge is smart.
• Medical cost savings are encouraging. Thank you for providing methodology details.
• Beginning to engage the student community is commendable.
• Thank you for recognizing study limitations.
• Comprehensive program spanning many years
• Program coverage across all wellbeing domains
• Strong environmental support
• Community activities
• Robust communication plan
• Strong digital health platform and incentive administration (Vitality)
• HERO scorecard = 159
• Participation in the minimum to good range however increasing each year
• Significant impact on health risk change – 15% net risk reduction
• Portal with supporting environment, communications, and employee involvement
• Rewards and premium reductions based on portal activities
• Health assessment, linked devices, and a variety of rewardable activities and achievements
• Good participation improvements since 2014 (enrolled 62%, HRA 39%, at least two activities 42%)
• Improvements in BP, physical activity, nutrition, alcohol, tobacco (overall 15% improvement over 3 years)
• 1.76 ROI calculated for 2017 (medical savings and modeled indirect savings) n=5446
• Analysis conducted to assess self-selection bias
• Lack of improvement in glucose triggered additional intervention planning
• Assessment of employee perceived value and exit survey feedback
• Strong premium incentive program
• Focus on BP, diabetes, CHD and obesity