Dell, Inc

Narrative Description of Program

Dell in 2004 launched a comprehensive wellness and health-improvement program, branded "Well at Dell." Since its inception, the program has demonstrated consistent population health improvement for Dell families and mitigation of healthcare cost trends and cost avoidance for the company. From a benefits design perspective, Well at Dell provides competitive health plans and innovative health-management programs, which support Dell's business goals and people strategy by enabling our team members to do their best and be their best. Team members and their families are encouraged to access education and transparency tools to assist with navigating important healthcare decisions and selecting the most cost effective and highest quality providers, medication options and services. Participants are encouraged to take accountability for their health through use of health decision support tools and incentives designed to engage and motivate participants to maintain, and improve their health, as well as managing health conditions through evidence based guidelines. Dell partners with best-in-class third-party suppliers, who attend annual training on Dell's culture, to enable Well at Dell to provide company appropriate, confidential and secure resources to support and improve the overall health of approximately 40,000 team members, as well as their more than 16,700 medically covered spouses and domestic partners.

[fullwidth_blue]Dell participants are asked to receive and annual physical or attend convenient on-site annual health screenings to "Know Their Numbers" and complete the health survey annually. Depending on the results of their survey and current risk status of each participant following the completion of a health survey, eligible participants fall into three categories;[/fullwidth_blue]

1. Those that demonstrate they meet Dell's annual health goals for healthy weight, blood pressure, being tobacco free and maintaining CDC recommended levels of weekly physical activity
2. Those who miss a health goal who will be invited to work with a telephonic or on-site health coach, to demonstrate progress towards the annual health goal over a 10-12 month period.
3. Some participants choose not to engage in programs and pay higher medical premiums.

All participants are offered a variety of resources and programs relevant to their specific health needs to maintain, improve or manage their health, typically at no cost. Some of these programs include but are not limited to: Condition Management Programs (Heart Disease, Diabetes, Back Pain, and Pregnancy), Digital Health Assistants, which help set and track wellness goals, and telephonic Lifestyle Coaching Programs. Participants are provided with a variety of additional resources.

General Information
Program Name	Well at Dell
Company Name and Address	Dell Inc. One Dell Way Round Rock, Texas 78682
Contact Person	MAILTO LINK
Program Information
Year Program Started	2004
Target Population	Employees and spouses/domestic partners
Participation Rate	70%
Program Mission	To create a culture of wellbeing that encourages a healthy lifestyle for Dell team members and their families, while mitigating healthcare cost increases for the company.

Narrative Description of Evaluation Results

The independent third-party research team created a robust Dell-specific integrated database including eligibility files, medical/drug claims, short-term disability program files, health risk appraisals, and health management program participation files for Dell's lifestyle coaching and disease management programs. A rolling four years of the program data were used, reflecting program experience during 2009-2012.

Two types of analyses were conducted. First, the "risk and cost evaluation" looked at relationships between health risks and various sorts of medical, pharmacy, and productivity-related expenditures. Second, the "return on Investment (ROI) analyses" estimated the return on Dell's investment in its programs.

Outcome metrics used in these analyses reflect:

• Participation rates and demographics for participants and non-participants, by program;
• Health status metrics and prevalence estimates for individual health risks;
• Changes in health risks and health status over time;
• Changes in medical associated with changes in health risk status; and,
• Return on investment by selected program and for the overall program.

Program Evaluation Highlights

• Substantial risk reduction improvements. For employee population, there was an increase in percentage at low risk (0-2 health risks) by 7 points and a decrease in percentage at high risk (5 or more health risks) by 5 points. Similarly, spouses in low risk (0-2 health risks) increased by 5 points and those in high risk (5 or more health risks) decreased by 2 points.
• Employee average health risks dropped from 3.1 to 2.5 counting 12 risks. Spouses dropped from 2.3 to 1.9
• 9 of 12 health risks for employees improved. Most improved included physical activity, nutrition, stress, weight and stress
• Physical activity improved by over 50% during this time period and is no longer a top risk.
• Overall, the Well at Dell Program ROIs increased from 1.86 in 2009 to 2.11 in 2010 to 2.21 in 2011. Most of the savings were generated from participation in the HRA and associated wellness programs.
• Changes in medical payments followed changes in health status that occurred over the time period. Those who transitioned from medium to low or high to low risk reduced costs.

The following are verbatim remarks made by the reviewers:

REVIEWER 1

• 4 + years of data. Program has been running for 8 years, with a positive ROI since 2009. ROI has increased from 1.86 in 2009 to 2.11 in 2010.
• Well at Dell is integrated into Dell's worksite culture, providing onsite annual health screenings, and an effective health coaching program to assist employees in reaching company wellness goals.
• Well at Dell incorporates an outcomes based incentive program to encourage employees to take charge of their personal health.

REVIEWER 2

• Cultural alignment with "pay for performance" with sizable incentive added to salary
• Strong brand and comprehensive scope of program across health continuum
• Gradual evolution of incentive strategy from participation to culturally aligned outcome-based, including recognition for improvement of one goal
• Use of both HRA and claims data to stratify population and triage participants
• Comprehensive, multi-channel communication strategy achieving high utilization
• Social program strategies and on-site support
• Annual participation now exceeding 80%
• Broad improvement in health risks based on large employee and spouse cohorts, including population improvement in BMI as a key indicator of potency of strategy
• Consistent and growing ROI estimates based on medical/pharma/STD in a mature program

REVIEWER 3

• Pre-Post w/ controls
• Health risk reduction
• ROI has improved three years running
• Tied to business goals
• Use of decision support tools and incentives
• Effective use of communication
• Good participation

REVIEWER 4

• Since 2004
• Incentives, $800 individual, $1600 family
• Cohort analyses of subset
• Health Coaching
• Capable advisors
• Most risks decreased each year
• Costs divided by risks
• ROI ↑ 1.8 2009 to 2.11 in 2011

REVIEWER 5

• Large incentives driven program -- $1690 can be "earned" by employees for positive results in the outcomes based program – largest I've seen
• Good policies and leadership support
• ROI methods sound right – but no documentation
• HRA participation rates (for ees 50-73% -- for spouses 34-48%) are good
• Weight, tobacco, depression, stress, nutrition, cholesterol risks are decreasing

REVIEWER 6

• Conflict

REVIEWER 7

• High participation rates
• Includes spouses and partners
• 24-hour hotline nurse line
• Results: physical activity improved over 50% and no longer a top risk, significant risk reduction across most categories
• The company also caters to remote workers using a variety of resources
• Quasi-experimental design
• Positive financial incentives for spouses and partners to participate in disease management activities
• Positive ROI

REVIEWER 8

• 8yr program presenting the past 3 yrs worth of data; ROI 2.21:1 in 2011, HERO scorecard used & best practices of leadership and creative comms, integration with benefits design; competitive incentive premium reductions;

REVIEWER 9

• Comprehensive health management program with increasing participation among both employees and spouses through stronger benefit plan design, incentives, and communication strategies.
• Favorable health improvements noted in overall health risk status (improvement of low risk from 40 to 55%)
• Positive return of investment noted with increased cost savings each year.
• Favorable integration of nurse call line that provides coordination with other health related services.

REVIEWER 10

• Broad-based program with centralized referral to programs and incentive system that is based on outcome attainment. Includes ability to work with a personal coach if goals are missed. Design of incentives is purposeful to fit with pay for performance comp system. Extensive communications approach. Evaluation was performed by OptumInsight, which built an integrated data base using four years of data. A strength is reporting of participation rates using eligible person den's. Most analysis addresses the group with two HA measures. The risk migration analysis shows a decline in crude percentages at mod or high risk based on number of risk factors. Other analyses examine medical and disability payment per employee (possibly means) with health classified on the basis of risk severity (not defined) and number of risk factors. Costs increase in relation to health burden. To track the relationship of change in health to change in cost, the mean cost of groups defined by change in risk status (# of risk factors) suggests there is a relationship. The ROI analysis used propensity scoring.

REVIEWER 11

• Premium reduction incentive ranged from $845 -- $1690; Annual HRA process focuses on goal achievement; Smoke free work environment; Focus on the top four population health risks – BP, Weight, Nutrition and Physical Activity; Includes Condition Management and Nurse Hotline; Has Wellness Teams and uses multi-media communications; Low-risk factor cluster increased by 7%; Strategies in place for remote workers; Greater than a 50% reduction in smokers (3% to 1%); Participants and non-participants weighted and adjusted for differences; Did pre/post analysis of risk factors and cost; Quasi-experimental design for ROI determination; Descriptive and multivariate analysis; Trend data showed that those with improved health status had reduced medical costs; Participation benchmarks well; Spouses included.

REVIEWER 12

• Program offerings seem to be very comprehensive and are promoted through an extensive communication effort.
• Participation rates are excellent, even among spouses.
• Incentives seem to be integrated into the program well.
• Use of quasi-experimental design with controls for confounders and separate calculations for employees and spouses is good. The overall study methodology is excellent.
• Health improvements are very encouraging.

REVIEWER 13

• ROI increased from 2009 (1.86) to 2011 (2.21)
• Launched in 2004 so an 8 year old program
• Medical premium discounts
• HERO scorecard
• Optum evaluation from 2009-2012
• Clear explanation of ROI methodology
• Appropriate use of propensity score weighting

REVIEWER 14

• Conflict

REVIEWER 15

• Excellent documentation . Excellent identification of opportunities to modify risk.