Medical Mutual of Ohio

Narrative Description of Program

In 2003, Medical Mutual adopted the fundamental elements of WELCOA’s Well Workplace Process to create a results-based wellness program.  The initiative has steadily matured into a comprehensive, integrated  program intended to encourage healthy  behaviors and mitigate health risk. The initiative is fully endorsed by senior leadership and recognized by employees as a core component of our Company culture. It is supported by the Wellness Team, a department of six  professionals with unique skill sets that cohesively create a formula for success. Funding is reviewed and approved annually by the Executive Team. As the program matures, we strive to retain and encourage program participation while shifting our focus to concrete, measurable outcomes – a reduction in health risks and a return on investment. These goals are integrated into program objectives, vision/mission statements

A core component of our initiative is the Rewards Program, designed to help employees understand the relationship between health and healthcare expenses.. The program offers incentives to keep employees engaged in activities designed to improve their well-being.  The Rewards Program consists of programs that support four main categories of Wellness: Health Promotion, Health Education, Fitness and Healthy Habits. Within these categories, the major risk areas of tobacco cessation, physcial activity, stress, healthy weight maintenance and nutrition are targeted. Employees earn and accumulate Rewards points by completing programs throughout the program year and “cash in” points for an incentive at annual program completion. In the spirit of smart consumerism, employees with Company healthcare coverage receive incentive dollars toward their healthcare costs, and employees without coverage receive gift cards. The Rewards program is housed on our own internally developed Web site, providing access to and encouraging engagement in programs, tools and resources. Employees are driven to the site to track and monitor their point progress and the Wellness Team benefits from the participant data stored within it.

Because of the desire to obtain a high standard of evaluation and assess the true health risks of our employee group, Medical Mutual advances our program scope by utilizing the University of Michigan Health Management Research Center for data analysis. Aggregate Health Assessement data, medical/pharmacy claims, absenteeism, disability, worker’s compensation, wellness program participation rates, and disease management program enrollment data are submitted annually  to  the Research Center who performs an in-depth analysis including:: risk and cost transition by program participation, medical and pharmacy cost transition by risk status, lost workdays by risk status, participation trending, areas of risk, etc. to help us guage the impact of our programs on health status and medical trend.  This information is used by the Wellnes Team to identify areas of risk specific to our population and to develop program objectives and activities that motivate and sustain behavior change.

During the study period 2005-2008, our program has seen positive results in the following areas:

• Participation in the wellness program showed a positive impact on healthcare costs trends.
• The number of low risk employees has increased 5%, while the number of medium and high risk employess decreased by 2.3% and 2.7% respectively.
• An increased participation level (years of participation or number of wellness points) was associated with an increase in the percentage of individuals at low risk.
• Employees who participated in the program for two, three or four years had smaller healthcare cost increases than non-participants and one-year participants.
• Employees who engaged in wellness programs and earned more Rewards points had significantly less healthcare cost increases than those who earned less points ($196 vs. $530)
• The wellness program had the most impact on percent risk reduction for those employees with risk factors for: physical activity, safety belt use , smoking, stress, perceived health and life satisfaction.

We are also using NBGH and HERO scorecards to compare our programs annually to industry benchmarks.

• The NBGH Scorecard was initally completed in May of 2009 and we scored 157 out of 200 possible points.
• The HERO Scorecard was first completed in June of 2009. We received a score of 147, which was well above the national average of 100.

In addition to our data analysis and benchmarking practices, we feel that surveying our participants regularly is important for making sure their needs, interests and satisfaction are considered. This is also an important gauge into the employees’ perception of our corporate culture. The survey is performed annually, after the conculsion of the Rewardscycle. Our last survey took place in November of 2009, and responses indicated the following positive outcomes:

• 94 % of employees surveyed felt that the Wellness programs are making a positive impact on the culture at MMO.
• 89 % of employees surveyed feel that the Wellness programs are making a positive impact on their health.
• 82 % of employees responded that they are very satisfied or satisfied with the Wellness program.

• Medical Mutual of Ohio Evaluation

The following are verbatim remarks made by the reviewers:

A

• 1831/2684 participation
• Program has support of senior leadership and all employees are invited to participate.
• Program has focused on improving culture and includes a very strong marketing campaign.

B

• Senior leadership support and cultural focus with specific actions to create healthier culture clearly identified (e.g., healthy cafeteria)
• Strategic plan including vision/mission, goals, objectives, and operating plan
• Strong staffing level – 1 FTE/447 eligible
• Rewards incentive program with points tied to a menu of activities across four categories and linked to value of activity
  • Integration into health plan premium
  • Extending incentive to those without health care coverage via gift card demonstrates commitment and strengthens integration
  • Incentive program integrated into website to drive traffic
• Score of 147 on HERO Scorecard indicates broad use of best practices
• Use third party (U Michigan HMRC) to warehouse and analyze evaluation data
• Multiple regression analysis to evaluate program impact on costs, disability, risk status. Level of participation associated with lower cost trends, and risk change related to cost change
• Positive risk trend based on high participation rate (87% last year), which increased over time

C

• Strengths of the Wellness for Life program include recent increases in participation rates, focus on a healthy culture, as well as programming to meet needs of the entire employee population. The program is tied to the company’s benefits structure, has strong leadership support and a dedicated staff and takes a data-driven approach to program refinement. Additionally, the program benchmarks against quality scorecards (HERO and NBGH) and works with the U. of Michigan for data analysis and program evaluation. The program has demonstrated risk reduction and costs reduction for employees who had greater participation in the program.

D

• Follows Welcoa process
• U. Mich evaluation
• Positive trends
• Modest drop in high risk
• Dose-duration response
• Incentives

E

• The program is straightforward and well implemented, with good results (and realistic results), and increasing participation.

F

• Participation rate 43% (2003) -> 87% (2008) – (1831/2684)
• Cohort analysis of N=1632 generally shows risk reduction
• Cost analysis shows that higher participation leads to lower rates of growth in medical costs
  • Low-21%
  • Med I- 17%
  • Med II – 8%
  • High- 6%
• Use HP 2010/2020 targets
• Disability costs (N=1780) – similar trends as for medical – higher participation rates lead to lower cost increases
• Use several structure/process assessment tools – HERO/NBGH – but no change in scores

G

• Pretty good participation 1831/2684 = 68%
• Corporate culture employed – emphasis on fun with health
• Senior management support
• Been around for 7 years – since 2003
• Positive results, health and financial
• Use HERO Scorecard
• Like fact that they evaluate satisfaction of program – and results were positive

H

• Good program progression

I

• This program has established goals of reducing high risk and overall wellness.  They have established a link with benefits through the incentive, allowing use of points accumulated to be applied to $$ for benefits costs.  In addition, those not covered by the plan, have the opportunity to get gift certificates with their points.
• Requires the HRA as the starting point for accumulation of incentive points.
• Health Habits’ groupings for Health Promotion, Health Education, Fitness and Healthy Habits.
• Integrated database with U of Mich.  ’05 to ;08 study found risk change to low group increased and high group increased; that those who accumulate the greatest number of points have sig. lower health care costs and those with 6+ risks have highest costs.
• Do surveys for satisfaction.
• Strong participation.

J

• Program goals are well thought out and reasonable.
• Participation rates are very good.
• The health improvements and medical cost reductions are very encouraging, but the methodology used to measure them is not described in sufficient detail to know if they provide a valid measure of the impact of the program on health and medical costs.

K

• “Rewards” incentive is simple, clear, and flexible.
• University of Michigan data analysis.
• From 2005-2008, a positive change in risk stratification
• High employee participation and satisfaction
• Participation increased 44% from 2003-2008

L

• Increasing participation is impression – what carrot/stick was used?  Smarter, more honest than others.  2nd best.

M

• Rewards program to address four areas of wellness.  Rewards in the form of health account dollars or gift cards for those not enrolled in the plan.
• Wellness committee, and executive team very involved in reviewing the program and budget.
• Risk migration to low risk is positive
• Greater tenure in the program was associated with healthcare care cost increases lower than non-participants.
• Use of both NBGH and HERO scorecards.  High marks on both.
• Survey of members in addition to using credible 3rd party for data analysis.
• Comprehensive program elements including disease and lifestyle management, on –line tools, health portal and tracker.
• Evaluation includes health care costs, disability and health risks.  Repeated measures statistical analysis.

N

• Comprehensive program; from assessment/screening to workplace environment initiatives.  Increasing overall participation levels, up to 87% in 08 and 97% cumulative 05-08 with modest incentive; good participation in healthy living programs, eg 50%+ weight mgmt.  Health risk profile improvement.  Participant healthcare cost increases better than non-participants, and best with higher intensity participation.