© 2008 The Regents of the University of Michigan, Ann Arbor, Michigan Five-Year Strategic Plan FY09 –FY13 LaVaughn Palma-Davis Senior Director, University Health and Well-Being Services

Our Unique Opportunity to Improve Health “We have the means to mount a broad, collaborative effort to fashion a prototype program to: promote healthy living, contain health care expenditures, and define optimal insurance coverage for individuals and families. We can use our intellectual resources to help the nation in addressing the growing crisis in health care.” - President Mary Sue Coleman Future Directions Presentation UM Regents, 4/22/04

UM Benefit Contributions Percentage of Total Operating Budget 33 “Other Benefits” includes dental, LTD, life insurance, opt out cash and Medicare Part B premium reimbursements; does NOT include University contributions for FICA, nor vacation or sick pay.

The Real Cost of Worker Health Source: Goetzel, JOEM, 2001:43(1): Adjusted to 2006 dollars Total: $13,988 Does not include presenteeism costs

Health Care Cost Drivers  Insufficient prevention – 70% of health care costs are related to lifestyle and safety practices  Growth in chronic illness  Noncompliance and poor self-management  Aging population  Mental illness  Current US health care reimbursement system  Other socio-economic issues

Population Health Management An Integrated Strategy Across the Health Continuum Health & Well-Being Low Risk Optimal Health At Risk Inactivity, Obesity, Stress, High Blood Pressure Acute Illness/Injury Doctor Visits ER Visits Chronic Disease Diabetes Heart Disease Disability Traumatic Injury Neurological Conditons Wellness Management Information Motivation Preventive Screening Risk Factor Management Targeted Screening Targeted Interventions Reinforcement Demand Management Self Care Information Nurse Advice Line Decision Support Disease Management Clinical Management Compliance Support Disability Management Case Management Decision Support Risk Management 85% of employees; 15% of costs 15% of employees; 85% of costs Source: David Anderson, Ph.D., StayWell Health Management 16 th Annual Art and Science of Health Promotion Conference, 3/24/06

Narrow Focus Misses Key Cost Drivers Health & Well-Being Low Risk Optimal Health At Risk Inactivity, Obesity, Stress, High Blood Pressure, High Cholesterol, Smoking, Alcohol Use, etc. Acute Illness/Injury Doctor Visits ER Visits Chronic Disease Diabetes Heart Disease Disability Traumatic Injury Neurological Conditions 15% of employees; 85% of costs Source: David Anderson, Ph.D., StayWell Health Management 16 th Annual Art and Science of Health Promotion Conference, 3/24/06 StayWell medical claims study Multiple employers/51,200 employees 5 years of data ( ) Compared each year with next High-cost 5% = 78% NEW each year! 59% of next year’s high-cost group

Key Drivers of Health Care Cost Containment and ROI  Participation – Need to achieve optimal participation/engagement (70-80+%).  Program effectiveness – Program performance must be monitored to assure risk reduction is being achieved.

Communications, Culture and Incentives Drive Engagement Comm.CultureComm.CultureComm.Culture Non-Cash Incentives Cash Incentives Benefits-Integrated Incentives HA Participation Rate (%) Source: StayWell Financial Incentives Impact Study, 2007 Copyright  2007 StayWell Health Management. All rights reserved.

Vision The University of Michigan will be a model community of health where people thrive.

MHealthy: Five Year Strategic Health and Well-being Plan  Builds upon best practices and research  Considers existing resources and gaps  Identifies foundational priorities, critical to achievement of MHealthy goals  Guided by principles of rewarding healthy behaviors, protecting confidentiality and reducing barriers to health improvement

An integrated strategy across the health continuum HealthyAt Risk Short Term Illness Chronic DiseasesDisability Wellness Promotion (Low Risk)  Information  Motivation  Preventive Screening  Opportunities to Maintain Health Risk Factor Reduction  Targeted Screening  Targeted Risk Factor Interventions (smoking, high blood pressure, lipids, overweight, etc.)  Reinforcement Use of Health Care Services (for Acute Injury/Illness)  Sufficient Access  Self Care Information  Help in Making Treatment Decisions Disease Management  Effective and Timely Clinical Care  Patient Education, Compliance and Self Care Skills  Care Coordination Disability Management  Care Coordination  Help in Making Treatment and Life Decisions  Risk Management  Return to Productivity Effective Population Health Management The goal is to move people to lower risk and improved health.

Components of Strategic Plan  Leadership support  Supportive environment, culture & infrastructure  Communication  Data management & evaluation  Program coordination  Benefit design & incentives  Wellness assessments with follow-up coaching  Targeted risk reduction  Disease management  Disability management  Demand management  Innovation

Highlights of Strategic Plan: Communication  Develop and implement a comprehensive, multi-year communications plan, including identification of specific strategies to market/communicate issues, programs and services and move people to action

Leadership Commitment and Support - Provide leadership engagement and training at all levels - Incorporate employee health performance expectations into leader evaluation process - Develop/modify organizational policies to advocate optimal health

Supportive Environment, Culture and Infrastructure - Develop plan to improve fitness center access - Continue to offer fitness center and equipment discounts - Expand efforts to establish a smoke-free environment across the university - Sustain and expand other environmental supports in the areas of physical activity, healthy eating, safety and cleanliness

Benefit Design and Incentives - Establish a cost-effective benefit design that supports prevention, risk reduction and improved compliance - Ensure that design reduces barriers to obtaining care - Provide incentives that promote the adoption and/or maintenance of healthy behaviors

Health Risk Assessments with Follow-Up Coaching - In FY09, launch a University-wide health risk assessment program with biometric screenings, follow- up coaching and referral

General and Targeted Interventions - Identify existing and new resources for targeted interventions based on UM health data profile - Enhance availability and accessibility of services in key areas such as: weight mgmt., healthy eating, physical activity, stress mgmt., ergonomics, back health, tobacco cessation, and cardiovascular disease prevention

Mental/Emotional Health and Substance Dependence Services - Continue awareness campaign to reduce stigma & promote prevention - Maintain robust website including self-help tools and resource assistance - Conduct manager and HR training - Improve the return to work process - Complete study of optimal mental health benefit design and equity/access issues with recommendations

Disease Management Programs - Evaluate existing health plan offerings and make recommendations to assure effectiveness and optimal utilization - Evaluate existing pilot programs (Focus on Diabetes, Focus on Medicines) for efficacy and determine future direction - Work with the UM/BCN Joint Venture to identify other valuable pilot programs to address improved approaches to care

Getting Started – Year 1 FY09  Free and confidential wellness assessments offered to all benefit eligible employees beginning in January, 2009  On-line health risk questionnaire,  Blood pressure,  Cholesterol, HDL & glucose  Height, weight and waist circumference  Results coaching  Referral to helpful programs and resources at low or no cost  High risk individuals will have an opportunity to have a personal health coach  $100 incentive for participation in wellness assessment in 2009

FY09 B&F Key Initiatives 3.1 Effective internal implementation and early adoption of relevant University-wide initiatives  At least 40% of benefits eligible B&F staff will participate in a free and confidential MHealthy Wellness Screening by June 30, 2009.

Measuring MHealthy Program Outcomes

Conclusion  The University has made a commitment to invest in MHealthy to improve the health of our community and try to contain future health care costs.  We cannot achieve the high level of participation necessary to be successful without your leadership commitment as well.  We will do our part to help you with  Communication tools and messages  Delivering programs in your schools & departments  Creating a supportive environment, policies and appropriate incentives