Health Rewards: State of Delaware Employee Wellness Project National Governors Association Healthy America Meeting December 15, 2005

“A company cannot be considered successful unless it takes responsibility for the physical well-being of its employees.” -Kenneth Cooper, M.D., M.P.H. Founder, Cooper Wellness Center

Background Health care costs are growing at unsustainable double digit increases  For the current fiscal year, the State of Delaware’s General Fund increase for health costs totals over $35 million out of a total General Fund budget for employee and retiree health care of just over $300 million. In addition to insuring the poor through Medicaid, the State of Delaware is one of the largest employers in the state  State Health Plan covers over 105,000 lives, from newborn dependents to all state retirees In a time when technology offers exciting advances, health conditions are not improving  Plans continue to see prevalence of high risk disease conditions such as asthma, diabetes, congestive heart failure, and coronary artery disease Employee health and wellness is a critical component of an efficient and productive workforce. States must be adaptive and recognize the changing needs of employees, at the same time they are bound by budget constraints that limit compensation increases.

Efforts to Control Costs Members of the State of Delaware’s Employee Benefits Committee have taken a comprehensive look at the quality of health care offered to employees The State of Delaware has been innovative by adding programs that target quality care for employees at the same time as curbing utilization trends or harnessing price efficiencies and economies of scale.  Comprehensive Disease Management (including asthma, congestive heart failure, coronary artery disease, diabetes)  Multi-State prescription drug purchasing alliance  Plan Design changes (tiered co-pays for ambulatory surgery centers)  Aggressive vendor negotiations  Generics, Step Therapy and prescription formulary compliance programs  Enhancing existing federal programs (e.g. Medicare COB)

Beyond the Traditional Approach The State recognizes that controlling costs are only one side of the equation A major drawback is that most “wellness” programs such as Disease Management target those who are already sick True employee wellness programs are an often missing, but essential piece to promoting health, well- rounded employees  Encourage and reward positive behavior  Increase productivity and employee satisfaction  Saves money by reducing future claims costs The biggest challenge for employers, particularly state governments, is funding now for future rewards

Pilot Project The State looked at the private sector for models of success  Delaware companies had begun to introduce health care consumerism through high deductible plans or incentive-based bonuses for employees. Difficult to have a paradigm shift in state government, but moved forward on the basis that change can happen through demonstrated success and research data. Started with an initial 100 person pilot project with Blue Cross Blue Shield of Delaware and Cardio Kinetics.

The Concept EVALUATE  Provide a comprehensive health assessment to help individuals learn about their current health condition Assessment includes: complete health history, resting and exercise blood pressure, blood work to measure total cholesterol, lipids and glucose levels, smoker-lyzer to test carbon monoxide levels, body composition measurements including body mass index, and strength testing including lower back. EDUCATE  Offers immediate results by screening for high risk conditions that may be present, but not yet detected  All participants receive exercise prescriptions and recommendations for improving physical outcomes in all risk areas MOTIVATE  Employees are offered regular feedback through fit-stop check-ups. RE-EVALUATE  Reassess after one year to encourage behavior and test improvement

Preliminary Pilot Data Preliminary results confirmed high health risks for state employees (overweight, high blood pressure, elevated blood sugar, high cholesterol combined with sedentary/low fitness activity) that reflects national trends in general population. Confirmed “Cooper” model  55 people participated in fit stop follow-up  26 of the 55 were sedentary, but became active at least 3x per week  Of the 5 smokers who attended the fitstop, 2 quit between the time of the original assessment and follow-up  Of the 5 members with hypertension, all were treated and none tested with high blood pressure after 6 months  The number of emergency room visits for pilot group was 70 per 1,000 vs. 157 per 1000 for the remaining population  Direct savings from the last two categories translate to over $62,000 for the 100 person pilot in the first year alone.

Project Expansion Expanded pilot study to 3000 assessments Improved study by determining the most effective motivator  Participants broken into 3 groups of 500.  Each group will receive the identical assessment, fitness prescription, fit-stop follow-up and one year reassessment.  In addition, group B participants are receiving intense intervention including monthly coaching and newsletters.  Group C participants have been offered a $100 financial incentive to maintain/improve their health status at the time of the one year reassessment. Study has been reviewed by Institutional Review Board for compliance with human subjects protocol and all HIPAA privacy regulations. Expected date of completion: May 2006

Preliminary Findings – Self reported Current Risk Status  3 or more risk factors – 50%  1 – 2 risk factors – 43%  0 risk factors – 6% Risk Factor Summary  Overweight – 70%  Family/personal history of cardiovascular disease – 43%  Cholesterol (Known-High Cholesterol) – 33%  Sedentary Lifestyle – 30%  Hypertension – 23%  High Psychological Stress – 19%  Presently smoking – 19%  Diabetes – 5%

Preliminary Findings - Study BMI  38% with BMI > 30  33% with BMI of 25 to 29 Diabetes  17% with fasting glucose >110 (pre-diabetic condition) Cholesterol  45% with total cholesterol > 200  21% with HDL < 40 Hypertension  9% with systolic blood pressure > 140

“As scientific research has shown, it is easier to maintain good health through proper exercise, diet, and emotional balance than it is to regain it once it is lost.” -Kenneth Cooper, M.D., M.P.H. Founder, Cooper Wellness Center