The Volvo Group

Narrative Description of Program

The Volvo Group introduced the Health for Life program in 2004 as a comprehensive employee health management program designed for all employees in North America. The Health for Life program’s purpose is to build a culture of health that supports and encourages healthy lifestyles by providing all employees with ongoing opportunitiesto maintain or improve their health status across a variety of health management interventions. The comprehensive program design includes programs and services to meet the needs of individuals across the continuum of health and also provide foundational cultural support for a healthy lifestyle.

Main program components include:

• Senior Management Support
• Population-Based Health Awareness Programs
• Biometric and Preventative Health Screenings
• Comprehensive Program Design
• Comprehensive Communication Strategy
• Dedicated On-Site Staff
• Multiple Coaching Program Delivery Modalities
• Integrated Incentive Models
• Program Integration (internally and across vendors)

A best practices program design is complemented with a best practices evaluation strategy that is comprehensive, ongoing, and used to continually improve programs. Participation, engagement, satisfaction, health risk reduction, and financial outcome data is regularly assessed and shared with appropriate levels of leadership. The Health for Life program has been well-received by employees and has produced positive outcomes in risk reduction and return on investment, which has in turn contributed to managing Volvo Group’s overall health care trend.

The Health for Life program is supported at the highest level ofthe organization which includes the global CEO as well as the senior leadership at the country level. Dedicated funding is allocatedsolely for the program to ensure quality design and implementation. Despite the recent economic developments globally, health and well-being is a company virtue that the Volvo Group feels is fundamental in fulfilling the mission. The program has received global company recognition as well as national industry recognition.

Stakeholders expect annual improvements in health status and health-related costs. Year-over-year data comparisons are provided to demonstrate improvement in participation rates, health risk status, preventive exam completion, and estimated savings in medicaland productivity-related costs.

Program Participation

Participation in all program offerings is tracked in an integrated data management system and reported for each activity along with time-over-time participation trends, and participation across multiple programs.

Since program launch in 2004:

• 80% completed an HRA at least once
• 73% completed an HRA in the past year
• 63% completed an annual biometric screening
• 63% repeated the HRA to provide health impact results
• 40% have participated in at least one health education campaign
• 25% of coaching eligible employees participated in a health coaching program in 2009
• >50% of eligible employees are members of onsite fitness facilities
• 40% to 66% of fitness center members utilize the centers at least once each month
• 40% of employees enrolled in population-based campaigns
• 91% of those enrolled in a phone-based or mail-based health coaching program completed the program

Health Risk Reduction

Health risk reduction is measured and tracked using the annual HRA and biometric screening.

• 17.5% population level net risk reduction since program launch
• 84% improved or maintained healthy eating habits
• 85% increased or maintained recommended levels of physical activity
• 79% decreased or maintained healthy stress management behaviors
• 90% decreased weight or maintained a healthy weight
• 98% improved or maintained low depression risk.

Productivity Impacts

Measures of work days and productivity lost due to poor health were embedded into the HRA1to enable an estimate of productivity savings that could be attributed to participation in the Health for Life program.

• 8% decrease (1,087 days) in self-reported absenteeism (from 2.04 days to 1.87 days)
• 0.4% increase (6,009 days) in self-reported on-the-job productivity (from 93.65% to 94.04%)
• Absence and on-the-job productivity loss declined by a total of 7,096 days
• $242 per participant productivity-related cost savings

Medical Cost Impacts

Impact on medical costs was assessed using a quasi-experimental study design that merged 4 years of medical claims data (2003-2006) with the first two years of program participation data.4Cost savings were calculated using a “differences in differences” approach comparing participant changes in health care costs from pre-program launch to two-year follow up costs with changes in non-participant health care costs for the same time period. Multivariate regression models were used to control for group differences in age, gender, health plan enrollment, union status, and baseline health care utilization. Adjustments were made for health plan design changes and inflation.

• $249 per participant medical cost savings
• 3% decrease in participant health care trend vs. 5% increase in nonparticipant trend
• Total health care cost trends increased more than 10% each year prior to program launch and decreased to only 5.5% increase in 2008.

1 Riedel JE, Grossmeier J, Haglund-Howieson L, Buraglio C, Anderson DR, Terry PE. Use of a normal impairment factor in quantifying avoidable productivity loss because of poor health. J Occup Environ Med. Mar 2009;51(3):283-295.

4 Grossmeier, Terry, Cipriotti, Burtaine. Best practices in evaluating worksite health promotion programs. American Journal of Health Promotion. 2010 January/February; 24(3):TAHP 1-10.

• Volvo Group Evaluation

The following are verbatim remarks made by the reviewers:

A

• 5166/7045
• Program has support of senior leadership and employs an aggressive marketing campaign.
• Wellness offerings include behavior change initiatives and coaching.
• Outcomes have demonstrated positive ROI

B

• Conflict

C

• Strengths of the Volvo program include good participation, management support, multi-channel communication and the use of incentives. Additionally, Volvo works to create a healthy culture, ties its efforts to the company’s mission, makes good use of the research literature to support its efforts, includes mental health and takes a broad view of the organizational benefits, going beyond an overreliance on ROI to include other stakeholder value. The program is comprehensive and has demonstrated both risk reduction and cost savings. Quasi-experimental design with statistical controls used in evaluation.

D

• Trend Analyses/correlations
• Relatively little change
• Haphazard, uncoordinated program

E

• The program is impressive, clear and straightforward.
• The case study of the weight loss challenge helped to illustrate how high levels of participation and impact are being achieved.

F

• Good participation rates (5166/7045) – HRA (80%), biometrics (63%), FC (>50%)
• Absenteeism – 2.04->1.87 days – years not clear and whether this is statistically significant is not determined
• Medical study (2003-2006) – N=5,408 – overall cost trends are good -- from 10%/yr to 5%/year
• Risk reductions cited but no Ns and not a cohort design

G

• Culture of Health and support for this at all levels, particularly senior management. Committees support this work as well.
• High program participation rates – 73%
• Risk reduction rates quite high
• Coordination across vendors and health partners
• Impressive financial and productivity gains
• Trying to build this approach globally
• Been around 6 years
• Measured in productivity and medical costs
• Done in conjunction with unions – not easy

H

• Productivity-related savings reported

I

• This is a program for 7K NA employees; union endorsed.  There is CEO leadership, a wellness committee and wellness champions.  They coordinate and integrate vendors by holding “health partner summits.”
• The program targets lifestyle as a results of HRA and screening.  Follow-up is telephonic and mail based.
• Back problems are the #1 cost; there is a special focus on back care.
• Active on-site programs – health fairs, screenings, challenges.
• Incentives -- $$$ for HA completion as well as reduced contribution for plan coverage.  $50 cash for each of – normal weight, BP and cholesterol.
• Very good participation – 80% HA, 63% screen and 91% follow-up.
• Self-reported absence decrease was 8%.  Cost comparisons between participants and non-participants – (controlled for inflation – regression --)   Participant trend down 3%, non- part trend up 5%.
• 78% obese/overweight – Weight challenge implemented

J

• Program participation rates are very good.
• Programs seem to be very comprehensive.  It was refreshing to hear that enhancing self efficacy is part of the program.
• Health improvements and cost savings are impressive.

K

• Long standing – started in 2004
• High participation of 5,166 out of 7,045 eligibleS in 2009
• HRA completion by 73% of the employees in 2009

L

M

• Comprehensive program components
• Senior management support
• High level of participation
• On-site services and screenings
• Significant net population risk reduction
• Self reporting productivity improvement
• Documented impacted on medical costs using strong quasi experimental design
• Communications strategy including champion network
• Evolving incentive design which currently involves both premium contribution reduction for HRA, screening and non-tobacco use as well as additional cash for meeting biometric criteria
• Weight Loss challenge with separate incentive – Raffle based
• Reported ROI of 31 including productivity

N

• Comprehensive, integrated program offerings.  Good participation, eg 73% HRA, 25% coaching among eligible.  Successful weight loss campaign.  Positive health risk reduction indications.  Cost savings from healthcare and self-reported productivity calculations.