Boise School District

Starting in 2011, Boise School District began offering a comprehensive employee wellness program to its 3,284 eligible employees. The aim of this multi- year program was to improve employee health behaviors, lower elevated health risks, prevent chronic diseases, and curb rising healthcare costs.

Boise School District hired WellSteps LLC to provide the design, implementation, administration, and evaluation of its wellness program. The decision to hire a vendor was based on limitations within the district due to its size, budget, and lack of wellness support staff. The decision was also based on the fact that the district’s insurance carrier provided access to a variety of population health management tools such as case management, a nurse hotline, an EAP, and disease management, but not wellness.

The wellness model used for the program combines elements of the RE-AIM Framework and the AMSO Model proposed by O’Donnell. Employees and spouses could qualify for lower premiums, co-pays, and deductibles when they participated in the program. The program was also made available to spouses and retirees (employees who retired from the district but were not yet eligible for Medicare). Baseline health risk appraisal data revealed that this employee population mirrored the health risks and behaviors of other employee populations located in Idaho.

The program incorporated administrative planning, baseline data evaluation, culture change and communication strategy, biometric screening, behavior change campaigns, and more. Four different behavior change campaigns, lasting four to eight weeks, were offered each year. Campaigns are designed to improve health behaviors and build self-efficacy by reducing the behavior change process to manageable weekly tasks. They may include short videos, simple quizzes, games, materials, wearable device integration, demonstrations, team competitions, behavior change strategies, incentives, and peer support.

Isabel Kurita
Employee Wellness Coordinator
Boise School District
(208) 854-4083
isabel.snell@boiseschools.org

One and two year improvements were seen in exercise, fruit and vegetable consumption, days of quality sleep, tobacco and alcohol use, and self-rated health. Significant improvements were seen in mental health-related outcomes such as stress, depression, and life satisfaction.

Evaluation of health risk changes was based on repeated measures data from 2,411 employees. Participants’ BMI, SBP, DBP, glucose, and total cholesterol levels were measured at baseline and again after one year. Among participants, 47.4% lowered BMI, 36.2% lowered systolic blood pressure, 57.4% lowered diastolic blood pressure, 66.9% lowered blood glucose, and 40.4% lowered total cholesterol. The percentages moving out of the high-risk categories after one year were 11.4%, 39.4%, 70.7%, 38.9%, and 40.7%, respectively.

From 2012 to 2014, the program participants cost the district $5,025,138 less in medical costs than non-participants. The cost of providing the wellness program during the same three-year period was $1,412,736. After subtracting program costs, the cost savings from the wellness program was $3,612,402. Thus, the benefit to cost ratio for the program was 3.56 ($5,025,138/$1,412,736). During this study there were no changes in the district’s health plan design. The district medical costs in 2014 ($11,390,481) were lower than the costs in 2009 ($11,590,407) demonstrating a zero trend across the six-year evaluation period.

• BoiseSchoolDistrict2016

REVIEWER 1

• Addresses culture
• Comprehensive approach
• Improved nutrition, physical activity, sleep quality, and reductions in tobacco and alcohol usage
• Reductions in stress and depression, and improvements in life satisfaction
• Reduced elevated levels of systolic and diastolic blood pressure, cholesterol, and glucose
• $3.50 ROI
• 2009-2014 trend of zero
• Healthy behaviors were significantly associated with a reduction in presenteeism and an increase in job performance and job satisfaction
• Multichannel communication
• Good use of technology
• Good use of psychological principles (e.g., behavior change, self-efficacy)
• Connect incentives to intrinsic motivators
• Addresses disparities/barriers to access
• Peer-reviewed publications
• Increased participation (81.1%)
• HERO Scorecard

REVIEWER 2

• Program available to Spouses and Retirees for over 3 years
• Reach and Impact components drive accessibility, communication channels via technology resulting in reduced health risks and costs with increases in healthy behaviors
• Leadership support provided via messages and budget resources
• Zero health cost trend from 2009 – 2014
• ROI: 3.50:1
• HERO score 162/200
• Several published articles have presented positive program attributes and results

REVIEWER 3

• Well-designed and well-implemented
• Positive cost trends
• Behavior changes
• Results in press “preventive medicine”

REVIEWER 4

• Participation increased from 66% to 81% over three years (2011->2013) – most employees (not specified) completed 2+ campaigns
• Most risk factors improving over 2 years – smoking is perplexing – number of days people reported smoking increased and then decreased
• Good HERO Score
• Comprehensive program
• Well done analytics

REVIEWER 5

• Strong program structure and strategy
• Several peer reviewed journal articles
• Program since 2011
• Strong data
• ROI stated 1:3.50

REVIEWER 6

• Use of mobile technology to engage employees across multiple locations
• Senior leadership support
• Targeted disease management (diabetes, CVD, asthma) and medication adherence focus
• Information in incentives and increasing participation over time including 58% of eligible employees completing at least one behavior change campaign
• Table 3 presents mixed model repeated measure results – targeted individuals with worst health behaviors at baseline (why not mixed model repeated measures across all individuals regardless of baseline status?). Those worse at baseline have a lot of room to improve.
• Appear to use difference-in-difference method per page 11 description of removing pre-existing differences
• Includes absence and presenteeism measures (correlational relationship between behaviors and these outcomes)

REVIEWER 7

• Comprehensive and well-designed wellness program that began in 2011 for 3,384 employees dispersed in 58 locations
• Improved overall three-year participation (2011-13) from 65.6% to 74.1% to 81.1%
• Experienced Vendor/partner - WellSteps LLC involved in the design, delivery and evaluation of the program
• Program framework is based upon elements of the RE-AIM framework and AMSO Model (O’Donnell)
• Two years of comprehensive health data for comparison - Baseline and years 1 and 2
• Overall improvements in all categories of health except sleep and depression - may not have needed significant improvements
• Excellent program evaluation - research methodology used with significant improvements in both health indices as well as health care costs trend improvement
• As noted, the district medical costs in 2014 were lower than their costs in 2009, demonstrating a zero trend across the six-year evaluation period
• Very good HERO Scorecard results; 162/200
• The link with established researchers is very beneficial for our industry and this program

REVIEWER 8

• This is a relatively organized, coordinated and documented effort with a very good presentation
• The applicants are to be commended for their comprehensive and thoughtful approach to the program and the analysis of results
• The program integration with management support, benefits design and state of the art behavior change approaches demonstrates excellence in program design and implementation
• The participation rates, though likely related to monetary incentives, showed appropriate growth for the health assessment and biometric screening but less so for participation in behavioral change campaigns
• Nevertheless, there are clear signs of progress and movement towards full participation
• The analysis of claims costs is well done generally

REVIEWER 9

• Good program mix
• Four published studies on program
• Six years of results
• Relationship between costs and risks
• Health and productivity outcomes

REVIEWER 10

• Six years of medical cost and three years of risk data included in the analysis
• Program use of multi-modal communications and engagement means is a strength
• Good leadership and environmental support, as well as inclusion of behavior change program components
• Nice use of culture change strategies including “checklist to change”
• Strong participation (80% HRA, 81% screening, 59% Behavior change)
• Attempts to control for baseline cohort differences using pre-program data/costs and use of significance testing for risk change
• Publication in press/review for evaluation

REVIEWER 11

• The program seems to be strategically planned and very comprehensive
• Use of focus groups to test reactions to the program is smart
• The combination of technology and face-to-face interaction seems well planned
• The efforts to address disparities are commendable
• The combination of fun and benefits based incentives is smart
• The range of factors considered in the evaluation is comprehensive
• Health improvements are impressive

REVIEWER 12

• ROI on (p. 11)
• Other + measures (p. 12)
• HERO 162 of 200
• Published outcomes (p. 15)

REVIEWER 13

• Strong evidence based program design, technology enabled, using best practices across communications, culture and incentives
• Comprehensive program evaluation design addressing behavior change, risk reduction, claims impact and productivity using appropriate statistical analysis
• Demonstrated impact on health behavior, health risks, healthcare costs and productivity
• Addressed a challenging population in that the group was geographically dispersed
• Zero cost trend for 6 years is impressive with no plan design changes and aging workforce

REVIEWER 14

• Comprehensive program approach grounded in best-practice evidence
• Includes assessment/screening, disease management, culture initiatives, skills building campaigns, tracking, and rewards/incentives
• Improvements in most behavior areas and biometrics
• Apparent healthcare cost savings based on claimants in and out of the wellness program
• Measured association between health metrics and productivity indicators

REVIEWER 15

• Concise application
• Good communication
• Good focus on unhealthy lifestyle as driver