USAA

Narrative Description of Program

In 2002, USAA launched an aggressive strategy to enhance the health and productivity of its workforce through an integrated Wellness Program. The goal of this program, branded “Take Care® of your health,” has been to imbed wellness into USAA’s culture by creating an environment that promotes health and wellness for USAA’s 22,000 employees and their families. USAA’s integrated Wellness Program encompasses multiple components that include more than 20 unique wellness initiatives and activities, ranging from on-site fitness centers and healthy food choices in cafeterias to integrated disability management and health risk assessments.

The Wellness Program is unique because it represents the next generation of totally integrated employee health and disability support. In addition to the numerouswellness initiatives and activities, the program is aligned with USAA’s Consumer-Driven Health Plan (CDHP), its integrated disability management program, and its paid time off (PTO) plan. A customized data warehouse pulls together the full spectrum of employee health and wellness information by capturingdemographic information, population health consumption data, health and wellness participation data and intervention outcomes. Data analysis provides ongoing opportunities to fine-tune all wellness initiatives and benefits programs in order to continually improve the health of employees and their families.

Program activities educate employees about risk factors and provide tools and financial incentives to assist behavior change. Wellness activities are voluntary and challenge employees to ask themselves why they “want to change,” not why they “have to change.”

Leading the Wellness Program is Employee Benefits with a cross-company team of partners and stakeholders, including Fitness, Food Services, Corporate Safety and Corporate Communications. This team, referred to as the USAA Wellness Council, meets regularly to strategize, plan, and review program results. The Wellness Program is funded internally and reports to Human Resources.

Narrative Description of Evaluation Results

Wellness Program initiatives are evaluated at least quarterly to ensure outcomes are consistent with goals, to track participation, and to identify components needing refinement.

Program Evaluation Highlights

Evaluation highlights include:

• Overall Wellness Program participation increased to 68.5 percent companywide in 2005.
• 45 percent of current active employees have completed at least one HRA.
• Program participants have experienced statistically significant decreases in weight, smoking rate, and health risk factors.
• Participants have seen statistically significant increases in worksite productivity.
• Workers’ Compensation has seen reductions of 3 percent in frequency, 8 percent in rate, and 24 percent in severity, with 427 days of potential-gained productivity.
• Workplace absences have decreased, with an estimated three-year savings of more than $105 million.
• USAA’s medical plan cost trend (5.6 percent in 2005) continues to outperform the national average.
• The program received external recognition by winning the 2005 California Fit Business Award.

Data Warehouse

Data warehouse management and analysis services are contracted through a vendor whose analysts and reviewers have credentials and experience in statistics, mathematics, economics, health care, and public health. Program evaluation is based on total costs accrued by each employee, including costs associated with medical care, pharmacy and mental health care, short- and long-term disability, and Workers’ Compensation. Specific health plan analysis includes both employee and dependent costs.

Health Risk Appraisals

A health risk appraisal (HRA) is used for periodic evaluation of personal risk factors, with comparative analysis of wellness participants versus non participants. Quarterly analyses include integrated reports on workplace absences and costs for medical/drug and indemnity claims. HRA information provided to employees serves as their personal dashboard to better health. HRA results direct employees to Wellness Program components, tools, and benefits available to help them improve their health. Individual results are aggregated and used to track program goals based on the Healthy People 2010 guidelines.

Consumer Driven Health Plan

In addition to the highlights above, in 2004 USAA changed its employee health insurance options from multiple medical plans to a single Consumer Driven Health Plan (CDHP). Early analysis of our CDHP claims experience indicates lower overall plan utilization for discretionary medical care (outpatient visits and hospital days), without corresponding reductions in utilization for either required care (OB visits) or preventive care. Further evaluation of medical plan performance through the data warehouse reveals a small number of high-risk participants responsible for a disproportionate share of the costs. This group comprised of about 2.5 percent of participants, accounts for about 40 percent of total claims costs. Total costs in the high-risk group double every four years for a compound annual growth rate of 17 percent, compared to essentially flat growth in lower-risk groups. To control costs attributed to this high-risk group, and to improve overall employee health, USAA is embarking this year on an Individual Health Management (IHM) intervention service to assist these participants.

• Program Evaluation

The following are verbatim remarks made by the reviewers:

A

• The applicant has very good data management and use.
• The applicant has demonstrated efforts to reach spouses and dependents.
• They have implemented worksite policy changes that support behavior change and have been able to demonstrate some limited productivity data.
• The program appears to have very good management and financial support.

B

• This is a well-designed, comprehensive strategy that truly integrates workenvironment/policy/cultural level, population level, and individual level interventions
• Communication is organized around clear, simple message – don’t smoke, be active, etc.
• Communications are supported by program components at all three levels, e.g., don’t smoking message is underpinned by a campus-wide smoking ban, HRA assessment and messaging, and individual coaching programs
• Evaluation design includes solid process, risk impact and cost outcome measures linked in a data warehouse with multiple health-related cost measures (i.e., medical, absence, disability, workers’ compensation). Participant versus non-participant comparisons are reinforced by population trend analyses. Effective data mining to target key population segments.
• Good annual participation in most recent program year.
• Whole person as opposed to disease-focused strategy for high-risk, high-cost group.
• Incentives and/or subsidies tied to key behavioral issues, e.g. Wellness Benefits, smoking prescription co-pay waivers, fee reduction for regular fitness facility use.
• Plan to integrate financial incentives into health plan.

C

• Excellent presentation
• Comprehensive effort
• Use data warehouse
• Uses multiple measurement documentation
• Strong epidemiological model
• Data rich in graphic form
• Multiple areas of utilization reduction

D

• Sound, diverse, integrated program
• Good participation
• Worker’s comp better
• Medical cost trend pretty flat (5.6)
• Award-winning
• Consumer-driven health plan integration – very important
• Savings over trend-lines impressive
• Huge Savings

E

• Comprehensive analysis – well written and documented
• Multi-discipline, integrated health & productivity management program – integrated HPM structure
• Established Wellness Council
• High participation rate – 68%
• On-site fitness center shows senior management commitment
• Healthy food choices in cafeteria & vending machines
• Good program design
• Well written application
• $300-350 incentives for healthy lifestyles
• Excellent tracking of participation in programs
• Good goal setting process – USAA vs. HP 2010 goals
• Statistical analyses adjust for confounders
• Company provides reimbursement for USPSTF recommended preventive services up to $300/year
• Company provides 20 minute wellness breaks twice a week
• Dependents’ fees for HP programs are reimbursed by the company – for smoking cessation, weight management, fitness center
• Company measures worker productivity using the WLQ and then quantifies productivity improvements in terms senior management understands – 187,200 hours of increased productivity which translates to an additional 90 employees on the job – very creative

F

• Vision
• Integration of program components (e.g., CDHP, disability management, paid time off)
• Employee participation in program
• Data management (data warehouse, data integration, data evaluation)
• Evaluation of outcomes (e.g., productivity)
• Evaluation of financial impact of program (e.g., decreased absenteeism)
• Excellent description of programs and outcomes provided in application (e.g., presentation of extensive data on program performance and outcomes)

G

• Participation rates are acceptable
• Integration efforts – 20 programs integrated – great effort and direction
• Statistically significant decreases - good findings
• Good program overview and integration examples
• Results range from acceptable to very good
• Good policy and organizational changes to support health
• Great application, this is how they should be written

H

• Very strong program with comprehensive population health management elements (HRA, lifestyle coaching, incentives, communications, campaigns), consumerism plan design and integrated productivity management.
• Data driven program with comprehensive reporting and evaluation reaching the family as well as the employee.
• Also notable is the effort to engage call center employees through allowing company time to participate in certain programs.