Vanderbilt University’s Go for the Gold Program is a comprehensive and integrated health management program with incentives that drive engagement and participation. It enjoys leadership support and adequate funding. The program has achieved high participation rates among employees (80%) and spouses (38%). Program participation is tied to benefit plan design. High-risk participants receive one-on-one coaching. The University has instituted several policies (e.g., campus-wide smoking ban, seat belt requirements) that support healthy lifestyles. It offers healthy food options in cafeterias and vending machines, and supports open farmer’s markets. It provides walking trails for employees and permits them to use on-site fitness centers for free. A five year study by Vanderbilt University followed a cohort group of 4,512 workers for the period of 2003-2007. The study documented significant health improvements for its employees and annual cost savings estimated as $214.87 per employee.
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.
|Program Name||Go for the Gold Wellness Program|
|Company Name and Address||Vanderbilt University1211 21st Ave South, Suite 640Medical Arts BuildingNashville, TN 37212|
|Contact Person||Mary Yarbrough, MD, MPH (Director of Health & Wellness)|
|Program Category||Chronic disease, high risk, web-enabled, worksite-based|
|Total number of individual participants||24,881 Faculty/Staff; 2,915 spouse/partner|
|Number of currently actively enrolled||15,811 Faculty/Staff, 2,450 spouse/partner|
|Access to Program||Target populations for this program are the 19,810 Vanderbilt faculty/staff who are eligible for benefits, as well as their spouses/domestic partners covered on the Vanderbilt health plans (6,492). All are eligible to participate. This past year, 15,811 faculty/staff (80%) and 2,450 spouses/domestic partners (38%) participated, bringing the total number of participants for all years to 24,881 faculty/staff and 2,915 spouses/partners (Eligible beginning 2006)|
|Program targeted at Healthy People 2000 and/or Healthy People 2010 goals||Yes|
|Program goals (in priority order)||(1) To create an innovative workplace wellness incentive program that will lead to improved health, disease prevention, and reduced need and demand for medical services.(2) To build a completely voluntary program that will allow for the measurement of outcomes over time, encourage a high rate of annual participation, and maintain a high level of trust among the faculty and staff.(3) To build a completely voluntary program that will allow for the measurement of outcomes over time, encourage a high rate of annual participation, and maintain a high level of trust among the faculty and staff.(4) To increase the proportion of employees who follow healthy lifestyle characteristics, as defined by the Healthy People 2010 report, with a specific emphasis on: nonsmoker, normal body mass index, good nutrition (5 or more portions of fruits and vegetables per day), regular exercise, and coping well with stress.|
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.
The following are verbatim remarks made by the reviewers:
- 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
- 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
- Broad, comprehensive cohort study over 5 years
- Well-documented health improvement
- Strong, well-targeted
- 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
- Good participation in figures reported.
- Nice incentive layout and options.
- Good staffing model.
- Met 2010 health goals.
- Acceptable evaluation methodology.
- Well written application.
- 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.
- Inclusion of dependent spouse
- tiered incentives
- HRA with added self-directed programming
- high risk coaching
- multiple depts.
- Management commitment
- policies, org changes