Vanderbilt University

Narrative Description of Program

Vanderbilt’s Go for the Gold (GFTG) Wellness Program is a comprehensive health promotion program designed with incentives and tools to help employees and their families lead healthier and more productive lives. Program goals are to have a high annual participation rate, keep the low risk low, coach the high risk to improved health, and minimize the rise in health care cost. This program is one component of Vanderbilt’s overall health and wellness initiative.

More than 10,000 employees have participated in each of the previous 5 years. Among those currently employed, 87.5% have completed at least one health risk assessment during the past 3 years.

GFTG is available to all full-time Vanderbilt employees, and their spouses or domestic partners covered on the Vanderbilt health plan. An Olympic-themed, 3-tiered structure based on the honor system encourages extensive engagement.

• The Bronze level, which requires completing a health risk assessment (HRA), helps identify risks. Individuals are rewarded with $10 added to their monthly paycheck the following calendar year.
• The Silver level, which requires completing a Wellness Actions Log (WAL) in addition to the HRA, encourages action to reduce risks. Individuals are rewarded with $15 per month.
• The Gold level, which requires viewing a short online video in addition to the HRA and WAL, helps develop skills to become a wise health care consumer. Individuals are rewarded with $20 per month. To maintain program appeal, the topic for the Gold level is changed each year.
• Employees earn an additional $10 per month if their spouse or domestic partner on the Vanderbilt health plan completes the HRA and WAL.

Participants are required to complete these levels by November 30th to be eligible for financial incentives the following year. This structure provides high annual participation, essential for both wellness improvement and outcome analysis.

Narrative Description of Evaluation Results

Vanderbilt's Go for the Gold program has resulted in significant improvements in health and productivity over a 5-year period. The incentive for annual participation has resulted in a cohort of 4,512 participants who have completed the health risk assessment every year for 5 years. The evaluation of both these paired data from the cohort and the unpaired data from the set of participants who completed the HRA in each year provides strong evidence regarding the effectiveness of the program. As an academic medical research organization with physicians and a biostatistician integrated into the program, the evaluation is scientifically and statistically rigorous, using state-of-the-art methods such as data reduction methods, recursive partitioning, proportional odds logistic regression, and propensity score analysis to account for selection bias, as well as modern graphical methods, such as restricted cubic splines to assess nonlinear associations.

Program Evaluation Highlights

• 87.5% of the current benefits-eligible faculty and staff have participated in the program and completed the health risk assessment at least once during the past 3 years.
• In 2007, 80.0% were low risk, defined as 0 to 2 risk factors, using the factors defined by Edington.
• A cohort of 4,512 has participated in all of the previous 5 years (2003-2007). This is the major strength of this wellness program since it allows for an unbiased assessment of the true changes on an annual basis.
• The slope of health care cost per employee was reduced in the 5-year period after the program began, with an estimated savings of $214.87 per employee, per year. In addition to health care savings, there are other savings (including workers¿ compensation, absenteeism and presenteeism) estimated to be twice this amount.
• The program has succeeded with participation across a broad spectrum of socioeconomic levels and job categories, including physicians, faculty members, nurses, and staff.
• Major improvements were seen between the first and second year of the program, with incremental but consistent improvements in years three through five.

The specific goals for the program were based on Healthy People 2010.5 In addition, progress in relation to both national and state data has been tracked to evaluate trends. Ongoing evaluation provides feedback for quality improvement and information about populations that require additional support for participation.

Overview of Evaluation Methods

The evaluation includes annual de-identified data from health risk assessments, Wellness Actions Logs, the Healthy Steps coaching program, workers¿ compensation data, health care claims data, and absenteeism data. To protect the confidentiality of employees, there is an extensive de-identification and data security system.

The program has received direction and professional assistance from outside consultants and internal advisors from across the University. The Go for the Gold team includes two physicians, a faculty-level biostatistician, two health educators, a registered dietitian, an exercise specialist, a health promotion coordinator, a registered nurse, a CPA/nurse practitioner, and four fitness associates to ensure high-quality planning, implementation, and evaluation.

• Program Evaluation

The following are verbatim remarks made by the reviewers:

A:

• Moderately high participation 15811/19810 faculty and staff 2450/6492 spouses
• HRA, wellness action log, view online videos
• Health care savings $214.87 PEPY
• Communication: email, newsletter, targeted marketing, newsletters, booths at events, etc.
• On-site fitness center
• Some healthy cafeteria options, healthy vending being piloted
• Seatbelt initiative through campus police

B:

• Comprehensive, integrated health management strategy with incentives designed to drive engagement
• Worksite environment and policy changes reinforce creation of a culture of health
• Multi-modal communication strategy
• 80% participation rate in incentive/HA component
• Overall savings estimate and estimates based on risk shifts both indicate considerable savings and add reasonable evidence for ROI estimates

C:

• Conflict

D:

• Broad, comprehensive cohort study over 5 years
• Well-documented health improvement
• Strong, well-targeted

E:

• High participation rate (80%)
• Program open to spouses (38% partic rate)
• Program participation tied to benefit plan design
• Cohort group of 4,512 followed for 5 years
• Health care savings estimated at $214.87/emp/yr
• Integrated well designed health management program
• Leadership support and funding
• Fitness center free to employees
• Policies (e.g., campus-wide smoking ban) support healthy lifestyle
• Health food options/farmers’ markets
• Walking trails
• Seat belt compliance incentive
• Goal setting
• Health risks decreasing 2003-2007
• Well documented health improvements
• Positive absenteeism/productivity results

F:

• Good participation in figures reported.
• Nice incentive layout and options.
• Good staffing model.
• Met 2010 health goals.
• Acceptable evaluation methodology.
• Well written application.

G:

• 80% of faculty and staff participate as well as 38% of spouse.  87% have completed at least one HRA.  Their approach to engaging the population is creative, straight forward and substantive.  The three levels of awards make it possible for everyone to get something as long as they, at least, do the HRA.  Extra incentive for the spouses is included.
• The program is broad based, has management support (Senior Leader Walk) and includes  physical environment initiatives (farmer’s market, smoke free buildings).  High risk participants receive one-on one coaching.
• 80% of the population is classified as low risk and the movement of all key risk variables has been in the right direction.  The analysis relative to HP 2010 and US averages was meaningful.
• A data warehouse is in place and hcc increases have slowed since the beginning of GFTH.
• Liked the vision for ’09 and 10.  Their creativity is not about to end.

H:

• Conflict

I:

• Inclusion of dependent spouse
• tiered incentives
• HRA with added self-directed programming
• high risk coaching
• multiple depts.
• Management commitment
• policies, org changes
• screenings