AMERICAN Cast Iron Pipe Company

Wellbody - A Good Health Movement

The health management strategy at AMERICAN begins with senior management. Health, wellness and safety objectives are incorporated into the annual goals. Departments and individuals then set goals that align with corporate’s annual goals. A dedicated wellness team provides onsite programming in nutrition, weight loss, back injury prevention, life style management and physical activity in the Eagan Center for Wellness for all employees, families and retirees. With a high touch, hands on approach, the wellness team delivers these same services and programming out in the offices and manufacturing areas to maximize participation and impact. The wellness team works closely with the onsite ACIPCO Medical Group to see referrals and provide services such as diabetes education, nutrition and weight loss, physical therapy and tobacco cessation. Individuals that participate in the tobacco free program receive prescription cessation products with no co-pay.

The WellBody Program campaigns and services include

1. THRIVE: Assessment and coaching campaigns
   • WellBody club health assessment
   • WellBody Plus goal setting and coaching
   • Disease management
   • Diabetes education program
   • Tobacco free cessation program
   • Bodyworks: Healthy posture and Movement

2. FUEL: Nutrition and weight Management Resources and Campaigns
   • Nutrition for Lifestyle Conditions
   • Nutrition on-site presentations
   • Nutrition education and cooking
   • Individualized weight management coaching and menu development
   • Ht the spot- healthy options cafeteria program
   • Healthy meeting guidelines

3. GO: Physical Activity resources and campaigns
   • Wellness and fitness center
   • Individualized exercise prescription and personal training
   • Walking programs
   • Fitness based incentive programs
   • Coordination of community walking events and special inters fitness groups
   • Subsidized entry fees
   • AHA Start! Gold award

4. NURTURE: Integrated program partners
   • On-site medical and dental practice
   • Free preventive exams
   • Employee assistance Programs
   • Baby yourself- healthy prenatal care program
   • Ergonomics, safety and training programs
   • Partnership with local health professionals for on-site education
   • On-site ACIPCO federal credit Union
   • Financial planning and debt avoidance counseling
   • Safety and Ergonomics program

Participation in the WBC program is tracked in a customized online data system that was built in-house.

AMERICAN measures success of the WBC program by evaluating employee satisfaction, participation, active and ongoing engagement, risk factor change, health status change, impact on health care claims and absenteeism. Results of Biometric screening and health coaching are integrated into the internal AMERICAN “e-wellness” data platform. The types and frequency of evaluating are as follows:

• Monthly active report- utilization and participation numbers
• Monthly status reports- Participation of internal teams and average health status leaves and changes
• Annual Participation reports at numerous levels
• Health care claims (medical, pharmacy and dental) report
• Absentee data related to sick leave
• Onsite physical therapy, work conditioning, functional capacity evaluations

Ongoing surveys and focus groups yield favorable satisfaction with the WBC program.  The retention of 80% participation demonstrates continued commitment of senior leadership and high engagement of employees Focus group interviews are conducted with both participants and non-participants to gain better understanding.

Based on the results of the health risk factor review, improvements were noted in the areas of blood pressure, body mass index, abdominal obesity, cholesterol levels, and tobacco use. Significant changes were not noted in the areas of blood pressure and physical activity.

Cost Saving and Financial Impact

The financial impact of the WellBody program was evaluated by using direct medical and pharmacy claims. Taken together, the overall net cost saving of both medical costs and productivity costs related to absenteeism has resulted in a total cost savings of $361,783 for medical as well as $316,404 for absenteeism totaling $678,187. The program cost was $396,952 which includes the financial cash incentive, the program material, program staffing, and additional operations expenses. The overall net cost savings was estimated at $281,235. The net cost saving results in a return of investment ratio of 1.7:1.0 similar to experience generated in the program analysis conducted during the initial five years of the program.

• AMERICAN Cast Iron Pipe Company

REVIEWER 1

• The program is offered to the employees, dependents, and retirees.
• They are attempting to form a culture of health.
• Great participation rate- 80%.
• They have a comprehensive program that is supported by senior leadership.
• Their studies show significant health improvements.
• Financial ROI.
• Their studies followed the same people over 5 years.
• Financial incentives offered.
• An outstanding program from a smaller company.

REVIEWER 2

• Long-term commitment and strategy building on existing cultural focus
• Health/wellness objectives in annual company and departmental goals
• Well-staffed comprehensive programs and services integrated with safety/medical
• HERO Scorecard results, especially strong leadership/employee engagement metrics
• 80% annual participation in screening and coaching programs
• WellBody “Club” aligns health, rewards and cultural elements
• Large long-term and intermediate-term shifts to low-risk “Club 200” category, along with large reduction in the two highest-risk categories
• Significant cohort improvement in biometric risk factors
• Sick leave regression analysis estimating $396/participant annual savings
• Positive ROI in medical/absence cost reduction based on credible estimation approach

REVIEWER 3

• Onsite health services.
• Longstanding program.
• Includes dependents and retirees.
• Focus on culture.
• Focus on senior and mid-level management.
• Heavy emphasis on communication.
• Program integration with internal departments, champions, employee leaders, vendors and community resources.
• Full-time program manager and administrative staff reporting through Human Resources, as well as two contract registered dietitians/health coaches and group exercise instructors.
• HRA, biometrics and preventive screenings.
• 80% participation, with 75% - 80% over last eight years.
• Since 1993, 340 employees have quit tobacco use, 1,250 have initiated and sustained an exercise program, and more than 600 have lowered their blood pressure to within normal limits.
• 9% risk reduction in past five years.
• 1.7:1 ROI – includes incentives, program costs, staffing.
• Based on claims and absenteeism data.
• Good operational outcomes, e.g., turnover, longevity.
• DM, smoking cessation 100% covered, health education, nutrition, EAP, ergo.
• Addresses high-risk, difficult population.
• Programs available all shifts.
• HERO scorecard.
• Evaluate employee satisfaction, participation, active and ongoing engagement, risk factor change, health status change, and impact on health care claims and absenteeism.
• Significant shifts in risk categories between 1996 and 2012.
• Looked at cohort, multi-year.
• BMI, waist circumference, cholesterol, and tobacco use reductions.

REVIEWER 4

• Corporate commitment, excellent and relevant outcomes, well-focused on important issues, serious exercise program, excellent HERO score, strong results, clearly described

REVIEWER 5

• F/T health promotion manager and administrator + 2 contract RDs/coaches/instructors
• 5,000 sq ft fitness center
• Pension plan
• Diverse population racially – 91% male
• Low turnover – 21 years of service on average
• Spend over $200/PEPY on program – good investment
• Have health/safety objectives as part of organizational goals
• Dedicated wellness team
• Offer tobacco cessation products at no cost
• Comprehensive program
• Good branding
• On-site medical/dental/x-ray
• Integration of health & safety
• High participation in HRAs (80+ %) and screenings (60-70%)
• High trust
• Financial incentives -- $10-200
• Participants set personal goals
• HERO scorecard=177
• Focus groups and interviews with participants and non-participants
• Risk stratification scores have improved 1996->2012 – low risk 15->45% (cohort=788)
• Good results on BMI/BP/Chol/PA/Tobacco
• Cost trends – P=11.9%, NP=17.3%
• 1.7: 1.0 ROI

REVIEWER 6

• Long-standing program
• Very good engagement
• Top 5% HERO Score
• Senior Executive and mid-level management support
• Champion network
• Long-term risk change- 2.8% in 3.7 years
• Absence analysis

REVIEWER 7

• Structure: core program structure in place; HERO scorecard 177; programs tied to communication plan and good leadership support, longevity of program since 1990’s and more focused in 2000’s; addresses disparities; small population about 1500
• Participation rates – 75-80%- very good and strong engagement methods
• Evaluation- good and improving data from 1996 to 2012
• Cost savings projected at 361K for productivity and health

REVIEWER 8

• Good long standing program

REVIEWER 9

• Good program design
• Targeting population top health risks and demonstrating health risk impact in multiple year analysis; 2008-2009 to 2011-2012.
• Good cultural support for initiative.

REVIEWER 10

• The Golden Rule philosophy is inspiring
• Offering onsite facilities
• Including spouses and retirees
• Dedicated program staff with high touch approach
• Including health objectives in annual performance goals
• Wide range of program offerings, especially for a mid size employer
• Integration into medical benefits plans and reducing health disparities
• Long standing program
• Use of incentives
• Use of HERO Scorecard
• Multiple evaluation measures (participation, satisfaction, outcomes), and tools (e.g. focus groups).
• Change in risk status is impressive
• Study design for health is acceptable
• Study design for absence is better (quasi-experimental), even though the comparison group is small.

REVIEWER 11

• Fairly fancy analytics.
• Innovative benefit cost-sharing structure

REVIEWER 12

• Program: Comprehensive program with on-site services, integrated with EAP, safety, financial services.
• Leadership support, champion networks, and dedicated staff.
• Long-term sustained program with high program participation (80% HA and 60% screenings).
• On-going program assessment with reporting, surveys and focus groups.
• Covers employee, spouse/partner and retirees.
• Evaluation: Uses a risk migration model based on program categories (club levels=risk level).
• Ability to conduct analysis on absence using time and attendance data.
• Impact on individual risks was positive over a multi-year period.

REVIEWER 13

• Long-standing, comprehensive program, with strong leadership support.
• High-touch, onsite programming, staffing, facilities.
• Tiered incentive strategy based on health status.
• High levels of participation.
• 5-year cohort analysis of health and financial outcomes.
• Net health risk reduction.
• Cost savings, and positive return when combining healthcare costs and absenteeism.

REVIEWER 14

• Sustained interest by management and employees over many years.
• Program appears well designed for relatively high risk population