1. Evolution of the City of Hickory Wellness Program

2. 2 Free medical care in the clinic Co-workers do not clock out Co-workers completing Health Risk Assessments and visiting clinician to go over results will be in the “Wellness Plan” Clinician can provide the following services  Treat minor medical conditions  Write prescriptions  Referrals for diagnostic services  Referrals for physician visits  Personal education and advice 2005 – Phase 1 – Provide Information and Resources - Opening Onsite Clinic

3. 3 In order to give all of us the best chance at keeping our current benefits and rates Each co-worker getting a little healthier can make a big difference We must all do something Co-worker Partnership

4. 4 Initial Health Improvements Total Number of Participants with High Risk Factors Risk Factor2005 to 2007 Triglycerides-22.4% Cholesterol-20.7% Glucose-5.6% Blood Pressure-21.1% BMI 30+-4.0%

5. 5 Dee Edington, PhD, Health Management Research Center, University of Michigan Based on 43,312 adults over three years, if an employer has no wellness program, you will see the following changes in employee health risks: # of high health risksChange 0 – 1-4.9% 2 – 3 +7.7% 4++11.4% Total +4.7% Natural Flow of Risk Transitions

6. 6 Wellness participants will need to visit the clinic or their personal physician to discuss health concerns based on their number of high risk health factors: Risk FactorsVisits 0-11 time per year 2-32 times per year 4+Quarterly visits 2007 – Phase 2 – Active Participation

7. 7 Continued Health Improvements Total Number of Participants with High Risk Factors Risk Factor2005 to 20062007 to 2010 Triglycerides-22.4%-22.8% Cholesterol-20.7%-10.3% Glucose-5.6%-6.4% Blood Pressure-21.1%-8.5% BMI 30+-4.0%-1.3% We again saw significant health improvements by employees that initially did not improve

8. 8 Starting next fiscal year, all nicotine users will need to pay a surcharge of $10 per week for medical coverage Smoking cessation classes will be available Nicotine quitting drugs will be paid under the medical plan 2011 – Tobacco Surcharge

9. 9 Staring is 2013, there will be a $10 per week Healthy Co-worker Discount All co-workers that have no high health risks on the 2013 HRAs will receive the $10 per week discount All co-workers that improve a high risk from 2012 to 2013 will also receive the Healthy Co-worker Discount. Added an onsite Registered Dietician 2012 - Phase 3 – Standards Based Incentives

10. 10 2012 – Health Improvement Screening TestHigh Risk% Improvement Required Blood Pressure-Systolic140 or higher10% Blood Pressure-Diastolic90 or higher5% Blood Glucose100 or higher5% Triglycerides200 or higher10% Total Cholesterol240 or higher10% HDL Cholesterol 40 or less (Males) 30 or less (Females) Increase 5% LDL Cholesterol160 or higher10% Body Mass Index30 or aboveReduce 1 BMI point

11. 11 HRAs are not until April, however, our onsite clinician states: “Employees that have never really listened to what I was saying are now stopping me so that I can explain again the results of the HRA and what they need to be doing. I am going to need the clinic to be open more hours so that I can get to all the employees!” In addition to higher value visits, total disease management visits have increased  Prior58.2%  After70.5% Health Improvements???

12. 12 Create an employee partnership Ensure direct access to data Onsite resources make a difference, you must have very good communication with onsite vendors Participation compliance programs are not easy to administer Don’t take 7 years to implement standards based improvement programs Health improvement program can be the basis for all the wellness initiatives Lessons Learned

13. 13 Reduce Risk Reduce Demand on the Health Plan Reduce Cost