L.L. Bean, Inc. (2009)

Narrative Description of Program

L.L.Bean has provided onsite, comprehensive Wellness programming for its employees for more than 25 years. What began in 1982 with a single onsite fitness facility has evolved into a comprehensive Employee Wellness program that reaches out to well over 5,000 employees, family members and retirees.

The goal of L.L.Bean’s Employee Health, Safety and Wellness program is to provide an environment that encourages people to take individual responsibility for achieving their personal best in health and safety. We achieve this by:

• Creating a strong corporate culture - Safe & Healthy Living Core Value, strong leadership support (see resource guide)
• Providing comprehensive onsite wellness programming (see 25^th Anniversary Resource Guide)
• Maintaining a healthy environment (Tobacco free campuses, healthy food subsidies, OSHA VPP sites for Safety)
• Incenting participation in a comprehensive Health Risk Appraisal program tied to our Benefit plan (see Healthy Lifestyles brochure and WebMD case study)
• Integrated communication & marketing efforts  (see brochures, newsletter and resource guide)
• Ongoing program evaluation focused on participation, health risk changes, health care cost containment and ROI (see WebMD documents)

We have experienced significant improvements in employee health risks, reduced health care costs and increased program participation over time. (see results, part II Narrative Description and attached documentation).

Today, the company’s wellness program staffed by four professionals has grown to include: thirteen on-site fitness facilities, subsidized exercise and health education classes, smoking cessation programs and subsidized gym memberships. Programming targets a variety of outcomes including nutrition and weight management, increased physical activity, improved heart health, diabetes education and more.

In 2007, L.L.Bean introduced the Healthy Lifestyles Program, a comprehensive Health Risk Appraisal program that is linked to the company’s health insurance plan. Employees and spouses/domestic partners who choose to participate in the program pay up to $1,000 less for their health insurance premiums. First year results included an 85% participation rate and a 95% completion rate, the highest of any WebMD clients (see WebMD case study).

Funding for the core wellness program was approximately $400,000 in 2008. Funding for Healthy Lifestyles is managed through our Benefits department and is approximately $500,000.

Narrative Description of Evaluation Results

Program evaluation has proven to be critical to the success of our Employee Wellness program. We look at participant satisfaction, health risk reduction, health care cost trends and ROI in an effort to make sure that we are doing the right things to help employees achieve and maintain a healthy lifestyle.

Regular surveys show participant satisfaction is high in all areas from the health education and activity classes we offer to our communication efforts and most recently, all aspects of our Healthy Lifestyles Program.

Our greatest success in health risk reduction comes in the area of tobacco use. In 1985, our smoking rate was 24%. Through smoking cessation programs, free nicotine patches and gum and creating a tobacco free environment we have reduced our smoking rate to 9% in 2008. This means that out of 5000 employees, there are approximately 750 fewer employees who smoke today compared to 1985.

L.L.Bean’s total medical claims have averaged 25% below the Maine state average for the past five years and 6% below regional averages for the same period (see L.L.Bean Medical Claims comparison chart).

The Healthy Lifestyles Program (HLP) showed measurable results in its first year of operation, 2007. The program produced an 85 percent HRA participation rate among its eligible population, an overall ROI of 3.66:1 with high levels of participant satisfaction.

As part of the HLP, participants were asked to complete a Health Questionnaire (HQ -Health Risk Assessment) between February and July 2007. Based on self-reported levels of modifiable risk individuals were grouped into one of three telephonic coaching programs:

• High risk (unlimited outbound and inbound coaching sessions).
• Moderate risk (up to 2 outbound and unlimited inbound coaching sessions).
• Low risk (1 outbound and unlimited inbound coaching sessions).

Results were compiled by WebMD, the coaching vendor, along with L.L. Bean and Aetna, its health care provider. A “pre-to-post” study design was used to assess differences in the actual medical claim growth-rate from the expected growth rate of the population. Medical and pharmaceutical claims were monitored for the year prior to coaching (baseline period: April 1, 2006 to March 31, 2007) and through the year following the onset of coaching (study period: April 1, 2007 to March 31, 2008).

The study also calculated absenteeism-related savings based on the change in self-reported absenteeism and imputed presenteeism-related savings based on data in published literature.

Among first-year results based on a conservative estimate of return (see WebMD documentation for further details):

• The program saw a first year ROI of 1.72:1 using avoided medical claims only.
• The program yielded more than $384 per employee in avoided health costs related to medical claims, absenteeism and presenteeism and $148 per spouse in avoided medical claim costs.
• The interventions with the highest level of intensity demonstrated the biggest impact. The high and moderate coaching groups had the lowest medical claims trend rates and the largest decrease in modifiable health risks.
• Overall medical trend rates were 8.8%, comparing favorably with an expected 13.13%.
• 69.4% of high risk and 62.2% of moderate risk coaching enrollees improved at least one modifiable risk factor.

• L.L. Bean Inc, Healthy Bean

The following are verbatim remarks made by the reviewers:

A

• On-site fitness facilities with coaching staff
• HRA participation tied to benefits plan
• Decrease in smoking from 24% to 9% in 25 years
• Medical claims are 25% fewer than Maine state average
• Telephonic coaching for high-risk group
• Several healthy living classes available
• Improvements in risk factors
• Positive ROI
  High participation 80-90%
• Offerings available to retiree’s
• Impressive communication materials

B

• Consistent and strong senior leadership support and alignment with business strategy
• Formal safe and healthy living core value statement
• Supportive culture and work environment including smoke-free campus and health food subsidies
• Significant incentives integrated into health plan premium for both HA and follow-up coaching
• Strong communications and marketing of program offerings and employee testimonials
• Significant investment in comprehensive population health management strategy integrated with related benefit programs
• 9% smoking rate is excellent in the demographic mix of this population
• Medical costs 25% below state average and well below regional average
• Net risk reduction reported between 2007 and 2008 in health assessment cohort that totaled 66% of eligible population, which suggests some program effect versus selection bias

C

• Good 25 year program, one of few
• Long-term trends convincing
• High participation
• New health coaching
• Strong corporate culture
• Smoking down to 9%
• Medical claim 25% below region
• All in all, convincing data for effectiveness and cost-effectiveness

D

• Strong leadership support
• Comprehensive program
• Tobacco free campus
• Strong safety emphasis
• HRA tied to benefit design
• Four wellness professionals
• $1,000 credit on health insurance tied to program participation
• 85% participation rate – 95% completion rate
• Funding for program - $500,000 – does this include the $1,000/ee incentive?
• Tobacco rate 24%->9% (1985-2008)
• Medical trend 8.8% compared to expected 13.1%

E

• This would appear to be a superb program.
• They have passed the test of “will the program last” because it’s 25+ years old. And they keep innovating and improving it, further tailoring it to be responsive to changing needs and demand.
• Wellness and fitness benefits are free or very well subsidized.
• Clearly not lip service -- wellness is obviously a core value.  It is integrated with management, leadership goals.
• Participation by current and former employees.
• Can request new classes – program reinvents itself.
• Extremely comprehensive.
• Incentives for participation – lots of them.
• Integrated with EAP.
• Stretch breaks to reduce occ injuries.
• Home safety as well as work safety and wellness
• Participation high.  Focus on environment and culture.

F

• Notes programming costs for ROI comparison
• Good result on comparative medical claims
• Good result for year one
• Good results

G

• Front and center in their goals is to create an environment that encourages personal responsibility.  Includes programming aspects that address culture, environment, incentives, assessment and broad scope of programming.
• Applies a tiered approach to risk assessment follow-up (i.e., High risk participants get unlimited calls with health coaches).
• Health assessment participation at 85%.
• Applying a pre-post design, evaluated claims as expected vs. actual, looking at those receiving the most intense intervention.  Expected claims increase – 13% -- actual 8%.
• LL Bean is to be applauded for their long history of programming (over 25 years) – certainly reflects a cultural commitment.
• Their 25^th Anniversary publication is great.

H

• The long program duration is very impressive.  Funding and staffing levels seem very appropriate.
• Program offerings seem to be very comprehensive, with a nice mix of assessment, skill building and environmental offerings.  Integration of the incentive plan into the health plan is an effective strategy that has produced very good results.
• Promotional materials are very engaging.
• The drop in smoking rates is remarkable.  The medical cost containment success is excellent.
• Comparing changes in medical costs with changes in the state, the region and the nation is a good strategy when it is not possible to structure an experimental design.

I

• Incentives with better medical plan rates ( @ $ 500/Year less)
• “Employee Wellness Resource Guide” – Very extensive classes
• Pre-post cohort of 1,535 employees
• Reported per person cost savings of $ 215.18 I cohort

J

• Enhanced incentive design driving very high levels of participation.  Good communications, integration with safety, occupational health and wellness.  Long-term history and commitment to wellness creating a healthy culture.  Comprehensive program elements including HRA, coaching, on-site fitness, campaigns and on-line resources.  Demonstrated impact on tobacco use.  Program seems to have in impact on risks and trend is lower than expected.  Evaluation attempts to address direct and indirect savings.