Eastman Chemical

Narrative Description of Program

Eastman Chemical Company is a global producer of more than 1,200 chemicals, fibers, and plastics. Over 10,000 global employees blend technical expertise and innovation to deliver practical solutions that help make the world a better place. Of the 10,000 employees 8,691 are eligible for the health promotion program and 7,637 (88%) have participated in the program.

The success we have seen at Eastman has been based on the relationships that have been built with other internal Eastman organizations over the last 10 years. We recognized that in order to build a culture of health we have to first build relationships with our internal Eastman manufacturing and functional organizations. Because of these relationships we have been able to form division wellness teams and site steering teams. With assistance from HealthFitness these teams develop their own goals and objectives to improve the health and productivity of their employees. They generate their own reports and develop programs and contests to engage their employee population. Health & Wellness needed to become just as important as safety in order for the programs and services offered to be successful.

Health Management Strategy/Programs

Eastman has offered a health improvement program to its employees for over 20 years.  Many programs have been offered to employees and their spouses including:

• Health Risk Assessments
• E-Health Platform with customizations
• Onsite biometrics screenings and Health Advising
• HealthE Living – onsite face to face Health Coaching
• Physical Activity Programs – six onsite fitness centers and three onsite group fitness studios, Walk This Way, Eastman Triathlon, Boot Camp, and 60+ group fitness classes weekly
• Health Promotion and Wellness Programs – Screenings, Weight No More, Lunch n Learns, Health Improvement Programs
• Weight Management Programs
• JOBFIT Data Management & Outcomes – Injury prevention, worker conditioning, back health, and physical abilities testing for pre-employment within specific organizations
• Shift worker programming
• Telephonic Stress Management Program

In addition to the programs listed above, Eastman has an organization called Eastman Integrated Health that coordinates all vendors and local provider programs.  The goal of this organization is to control medical spending while engaging employee and spouse populations to encourage them to take control of their health.  Along with the Eastman Integrated Health organization, several sites have a Wellness Steering Team.  In the Tennessee corporate headquarters there are eight Division Wellness Teams each having a budget for programs and incentives.  The Wellness Steering Teams and Division Wellness Teams all consist of  management as well as shift workers to promote and build a healthy culture within Eastman.

There are also special corporate-wide offerings including:

• HRA completion benefits
• Potential to earn money for Health Savings Account or Health Reimbursement Account
• BodE Mass Project
• JOBFIT Physical Abilities Testing
• HealthE Living
• Telephonic Stress & Weight Management

Each employee/spouse that completes an HRA receives $600 lower benefits premiums.  Also, employees and spouses can earn up to $300 each for completion of the HealthE Living, BodE Mass Project, Cigna Programs, and local diabetes programs.  This money earned is put into either a Health Savings Account or Health Reimbursement Account.

The 12 month BodE Mass Project sets weight loss goals annually of up to 10% of the participant’s body weight.  Those that achieve their quarterly goals are rewarded.  Lastly, the JOBFIT Physical Abilities Testing was designed by HealthFitness to test specific candidates as a post offer; pre-employment screening to assess if a candidate can do a specific job.

Executive Summary of Program

Eastman’s health improvement program has been in place since 1991.  Along with a Health Risk Assessment, coaching program, and a portal, employees and their spouses have been provided other offerings including:

• Onsite biometric screenings
• Shift worker programming
• Physical activity programs
• Weight management and physical activity
• Health promotion and wellness programs

The Eastman Integrated Health organization plays a role in coordinating all vendors and local provider programs.  Several sites also have a Wellness Steering Team with representation from all employee population groups to promote and build a healthy culture within the company and the specific site.

Incentives are used to promote program participation among employees and spouses.  For example, a maximum of $600 in benefits premium reduction can be earned for completing the HRA.  To earn the $600, an employee who is single, must complete the HRA, or if the employee is married, the employee and their spouse must complete the HRA to receive the incentive.  They also have the option to earn up to $300 (employees/spouses) for participation and completion of other health improvement/maintenance programs such as HealthE Living Program, BodE Mass Project, CIGNA Condition Management and Lifestyle Programs, and/or local diabetes programs. Dollars earned by completing these programs are deposited into employees’ Health Reimbursement Accounts or Health Savings Accounts.

Over the past five years Eastman has averaged over 90% employee participation in the Health Risk Assessment.  During this period the average number of risks has consistently decreased among participants.  Eighty percent of the low-risk participants remained at low-risk and 454 (7%) participants moved to the low risk category.  In 2010, the majority of employees for all three work schedules (i.e. days, shift workers, and other) ranked in the low-risk category – days: 70.5%; shift workers: 59.1%; and other: 70.6%.

The HealthE Living Program had 5,827 graduates (participants who completed onsite face-to-face health coaching) from 2003-2010.  From Time1 to Time2, the average number of risks decreased among all graduates and repeat graduates (those participants re-enrolled in coaching).  The number of risks among all graduates decreased significantly from 2.97 risks at baseline to 2.80 risks, using a t-test analysis (p = 6.76).  Among all graduates, 45.27% either reduced or controlled their risks during their participation in the HealthE Living Program.

In 2010, an ROI study for Eastman demonstrated a $3.20 return for every dollar invested in the program after three years (details on page 13).  When taking incentives into consideration, Eastman saw a $3.62 return for every $1.00 spent on the program.  A total medical and drug claims savings of $6.38 million was documented at Eastman.

• Erratum Statement: ECC
• Eastman Evaluation

The following are verbatim remarks made by the reviewers:

Reviewer A

• Excellent participation that includes spouses.  3.2:1 ROI.  Program offerings include HRA, biometric screenings, coaching, physical activity programs, weight management, & lunch & learn’s.
• Program outcomes have demonstrated a decrease in risk among all groups.

Reviewer B

• Benefits-integrated incentive design encourages participation by both employees and spouses.
• Comprehensive program offerings, including to spouses
• Active wellness champions and teams across population from executives to shift workers.
• Excellent participation including coaching programs
• Good evidence of population risk reduction based on 8.4% drop in number of risks from T1 to T5 for most engaged group of 6196 employees
• Good evidence of cost impact based on claims analysis, especially since reference group included HRA-only participants
• Attention to the unique needs of shift workers
• Organizational and vendor integration

Reviewer C

• Spouses eligible
• Longstanding program
• Integrated approach including vendors and local programs
• Incentives for participation
• High HRA participation
• High percentage of employees in low risk category
• 3:1 ROI and significant claims savings
• Comprehensive program
• Onsite steering teams
• Case matched design
• Health risk reduction
• Multiple studies

Reviewer D

• Fairly standard program with a variety of components including HRAs, screenings, and some programs and telephone & web-based resources.  Uses strong incentives for participation.
• The face-to-face coaching is a worthwhile program, primarily for CVD risk factors – actually mainly lipids, blood pressure, and weight and physical activity.

Reviewer E

• 88% participation rate (N=7637) – 90% HRA partic
• Long-term program – since 1991
• Incentive -- $600 to complete HRA + $300 to participate in program
• Good study design for HRA analysis – case controlled – P-NP match
• Overall, achieved population risk reduction
• T1/T2 hi/lo analysis looks good – need to show net risk reduction

Reviewer F

• Conflict

Reviewer G

• Offers a rich incentive -- $600 premium reduction for HRA completion (participation 90%) with a maximum of another $300 deposited to Health Reimbursement Account for participation in other available programs (i.e., Health Living Coaching, Diabetes, etc.).   Spouses are eligible. There is a special initiative for shift workers.  Wellness Steering Teams at each site include both sr. managers and shift workers as members.  Evaluated a cohort of 6,196 individuals who had 5 HRAs.  Risk groupings migrated in the right direction and there were single risk changes for BP, Cholesterol, Smoking, Diabetes, lack of exercise and overweight.  Analyzed treatment groups (2005-2008) and found a claims savings of $6.38M with an ROI of 3.2 to 1.  Also examined absenteeism and presenteeism based on the HPQ and evaluated a targeted program for Migraine Headaches.

Reviewer H

• Participation rates are very impressive, especially among spouses are very impressive.
• Allowing decentralized groups to direct their own programs is wise

Reviewer I

• Employees and families included.
• 2. 90% participation in HRA average over last 5 years with a $ 600 benefits premium reduction.
• Reasonable ROI of 3.62:1.
• Evaluation methodology of a matched, case control design.
• HRA participation at 90% over 5 years (p 8).
• Lost productivity monetized (10% decrease = $ 39 Million).
• High number of program graduates reduced their measured biometric risks.

Reviewer J

• Eastman acknowledges the decline in enrollment over the 5 years (but they don’t show enrollment decline, just participation decline).

Reviewer K

• Programs across the continuum
• Significant incentive program
• Multiple years in place
• High participation
• Includes employee and spouse
• Successful with challenging population (shift workers)
• Demonstrated impact on risk reduction and cost savings
• Face to face coaching
• Evaluation includes estimates on productivity impact.  Healthcare claims uses 2 stage matched case control.  Attempts to understand impact by program type.

Reviewer L

• Good program components and very strong participation.  Strong health risk reduction analyses and results.