1. Rules of Engagement Optimizing Employee Participation in Wellness Programs Robin Rager Director of Health Management, Keenan & Associates Dana Rasmussen Senior Administrative Analyst/Risk Management, City of Livingston Charlotte Dixon Director, HEAL Cities Campaign, CA Center for Public Health Advocacy

2. About the League Partner Program Why Workforce Health What is the HEAL Cities Campaign Cities for Workforce Health Overview Questions The Health Management Continuum

3. Source: National Business Group on Health, 2010 Effects of Financial Incentives on Employee Participation 3

4. Incentives Administration Prizes Immediate gratification Participant-perceived value—low to moderate Tends to drive enrollment and completion in programs, not as effective in behavior change Gift Cards/Checks Immediate to long-term gratification Participant-perceived value—varies on dollar amount Tends to drive enrollment and completion in programs, not as effective in behavior change Premiums, Deductibles, Co-Pays Long-term gratification Participant-perceived value— high Non-taxable Can drive long-term engagement, as it ties s participation directly to the health plan 4

5. Wellness Program Incentive Scenario A Wellness Program Components: Biometric screening Personal health assessment (PHA) Wellness website with online resources (health info, e-courses, health/fitness trackers, etc.) Online wellness challenges Incentives: $50 cash card for completing the biometric screening Additional $50 cash card for completing the PHA Entry in prize raffles for completing wellness challenges Projected Yr 3 ROI: 1.0-1.5 Wellness Program Scenarios 5

6. Wellness Program Incentive Scenario B Wellness Program Components: Biometric screening Personal health assessment (PHA) Wellness website with online resources (health info, e-courses, health/fitness trackers, etc.) Online wellness challenges Incentives: $360/year lower medical premium contribution* in next benefits year for: a)completing the biometric screening b)completing the PHA Entry in prize raffles for completing wellness challenges *Compared to individuals not completing the incentive requirements Projected Yr 3 ROI: 1.5-2.0 Wellness Program Scenarios 6

7. Wellness Program Incentive Scenario C Wellness Program Components: Biometric screening Personal health assessment (PHA) Lifestyle coaching (online) Wellness website with online resources (health info, e-courses, health/fitness trackers, etc.) Online wellness challenges Incentives: $600/year lower medical premium contribution* in next benefits year for: a)completing the biometric screening b)completing the PHA c)completing certain wellness activities *Compared to individuals not completing the incentive requirements Projected Yr 3 ROI: 2.5-3.0 Wellness Program Scenarios 7

8. Wellness Program Incentive Scenario D Wellness Program Components: Biometric screening Personal health assessment (PHA) Health management coaching (telephonic) Wellness website with online resources (health info, e-courses, health/fitness trackers, etc.) Online and onsite activities (e.g., wellness challenges, Weight Watchers, yoga, walking groups) Incentives: $720/year lower medical premium contribution* in next benefits year for: a)completing the biometric screening b)completing the PHA c)completing specified health management actions based on risk classification Entry in prize raffles for earning 1000 wellness activity points $600/year surcharge for tobacco use (waived if enrolled in tobacco cessation program) *Compared to individuals not completing the incentive requirements Projected Yr 3 ROI: 3.0-6.0 Wellness Program Scenarios 8

9. Wellness Program Incentive Scenario E Wellness Program Components: Biometric screening Personal health assessment (PHA) Preventive health screening (USPSTF recommendations) Health management coaching (telephonic) Wellness website with online resources (health info, e-courses, health/fitness trackers, etc.) Online and onsite activities (e.g., wellness challenges, Weight Watchers, yoga, walking groups) Incentives: Lower-deductibles and lower co-payments for medical care* in next benefits year for: a)completing the biometric screening b)completing the PHA c)completing the preventive health screening d)completing specified health management actions based on risk classification Entry in prize raffles for earning 1000 wellness activity points $600/year surcharge for tobacco use (waived if enrolled in tobacco cessation program) *Compared to individuals not completing the incentive requirements Projected Yr 3 ROI: 2.5-6.5 Wellness Program Scenarios 9

10. I. Participatory Wellness Incentive Program – Reward is not based on a standard relating to a health factor; and – Must be made available to all similarly situated individuals Federal Regulations 10

11. Examples of Participatory Wellness Program Incentives: – Lower premium contribution for participating in biometric screening or lifestyle coaching – Lower medical co-pay for participation in a tobacco cessation program – Waiver of deductibles for participating in certain preventive care 11

12. II. Health-Contingent Wellness Incentive Program Reward is based on satisfying a standard relating to a health factor, and the program complies with the following: 1.Employee must qualify for the reward at least annually; 2.The reward is limited in amount to 20% of the cost of coverage (30% in 2014) with a maximum of 50% if designed to reduce tobacco use 3.Reasonable in Design – not overly burdensome – alternative standards must be made available for rewards based on initial health standards 12

13. Examples of Health-Contingent Wellness Program Incentives : – Lower premium contribution for participating in an annual cholesterol screening and having a total cholesterol of <200 – Surcharge for tobacco use – Provision of a group health plan with lower deductibles and co-pays for employees whose biometrics are within the recommended ranges for 3 out of 5 of the measures 13

14. Case Study: City of Livingston 14

15. Incentives Design 15

16. Participation Results 16

17. Contact Information 17

18. Questions? 18