1. Saint Mary’s College Employee Benefits Advisory Committee (EBAC)
March 2014 Meeting
March 24, 2014

2. EBAC Meeting – March 2014 Agenda –
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EBAC Meeting – March 2014
Agenda –
Welcome / Introductions – EBAC Update
Review of draft EBAC tenets
Wellness Program Discussion
Plan for Community Meeting ?
Timeframe and Schedule for 2014 Process
March 28, 2014

3. EBAC Meeting – March 2014 2014 – Proposed New Tenets
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EBAC Meeting – March 2014
2014 – Proposed New Tenets
1.     Employee Benefits are part of the college’s total compensation strategy and must be  considered  as part of a holistic employee engagement (We stressed the importance of the term employee engagement)
2.     The  employee benefits program(s) offered should align with Catholic and Lasallian principles (It was suggested that we consider adding Catholic, social teachings, and Liberal Arts traditional or principles to the Lasallian principles with which employee benefits should align. 
March 28, 2014

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EBAC Meeting – March 2014
3.  Programs offered will treat all members of the College community with fairness;  and support our families.  (It was noted that we need to clearly and explicitly define what we mean by the terms "fairness" and "family" ... that we are taking a particularly broad and inclusive perspective on both counts.
4.  Programs offered should contain choices for employees that match to their individual needs, beliefs and circumstances. This may include offering  optional low cost or limited benefit plans. (It was suggested that IF we are going to explicitly offer "optional low cost or limited benefit plans" ... that we really should also offer the flip side of this ... i.e., optional high cost and expanded benefit plans ... for which employees must pay more, so that others do not have to subsidize this higher cost.
March 28, 2014

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EBAC Meeting – March 2014
5.  The program’s financials should be easy to project and budget and within agreed upon targets.
6.  Employees should share in the cost of their program elections in a way that  reflects the relative value and cost of their elections. (It was suggested that we drop the qualifier "If necessary" ... and use more plain language for the phrase "the cost of their program elections" (e.g., the cost of their particular health care plans, programs, or coverage options)
7.  Wellness and health initiatives should be supported and promoted 
March 28, 2014

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EBAC Meeting – March 2014
8.  There should be COMMUNICATION with the campus community about the value of the benefits program, the ADVISORY ROLE OF EBAC, AND THE DECISION-MAKING PROCESSES OF THE ADMINISTRATION of the cost and value of the benefits program.
9. Technology should be leveraged to improve efficiency and value to participants. (It should read more like the following: "ALL MEANS (e.g., social, administrative, technological, institutional, etc.) should be leveraged to contain costs and to improve efficiency and value to all participants.)
March 28, 2014

7. Wellness Discussion - EBAC Meeting – March 2014 10/16/2019

8. Behavior Drives Healthcare Utilization
“75% of all health care costs is for chronic care and 75% of that is behavior based modifiable risk.”
Center for Disease Control
80% of healthcare is modifiable.
Behavior clearly drives the majority of healthcare utilization.
Source: IFTC, Center for Disease Control and Prevention
Midwest Business Group on Health, 2003
Annals of Internal Medicine, 2002 8

9. The KEY is to Identify Future Risk
Who is Driving Cost?
The 5/50 Principle
Who Will Be The Next 5%? . 5% .
50% .
59% of last year’s healthy are this year’s high risk
75% of chronic diseases are preventable or reversible 9

10. Health & Performance 5 Phase Approach
Phase V: Measure & Evaluate
Develop Metrics
Collect Data
Review, Evaluate, and Adjust Strategy
Phase IV: Educate & Engage
Wellness Committee
Employee Education
Webinars and Newsletters
Targeted Communication
Plug & Play Resources
Phase III: Define & Design
Wellness Program Legal Review
Carrier Tool Education
Design Programs to Address Risk Factors
Environmental Assessment Action Plan
Best Practice Integration
Program Management
Phase II: Collect & Analyze
Environmental Assessment
Incentive Design
Biometric Screening and Health Assessments
Wellness Survey
Workers’ Compensation Analysis
Phase I: Strategy & Goals
Sr. Leadership Buy-In
Develop Framework
Analyze Data
Develop Vision, Mission and Branding

11. EBAC Meeting – March 2014 Phase I: Strategy & Goals
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EBAC Meeting – March 2014
Phase I: Strategy & Goals
Sr. Leadership Buy-In
Develop Framework
Analyze Data
Develop Vision, Mission and Branding
Phase II: Collect & Analyze
Environmental Assessment
Incentive Design
Biometric Screening and Health Assessments
Wellness Survey
Workers’ Compensation Analysis
March 28, 2014

12. Health Assessment
A simple questionnaire about your health and lifestyle
Not a medical questionnaire
Measures current health status
minutes to complete
On-line version
Assesses lifestyle behaviors
Identifies good health practices
Detects lifestyle health risks and provides information
to help avoid those risks
Once you’ve completed the health screening, you can proceed to the next step: the on-line health assessment.
The on-line health assessment is not a medical questionnaire. Instead it asks questions about your current health habits. Questions like:
On average, how many hours of sleep do you get each night?
How many servings of fruit do you eat each day?
Do you have your teeth cleaned every six months as recommended?
Simple stuff! You are encouraged to be honest with this questionnaire. You’ll see privacy and confidentiality later in this presentation but please feel confident your individual answers to these questions are not shared with ACTIVE. That’s the law! The report you receive at the end of this process is only as honest as you are willing to be.
The report you receive will assess your lifestyle behaviors, identify the areas where you’re doing well, highlight any risks, and provide information on how to help avoid these risks.
The next few slides are screen shots from your health assessment site.
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13. Onsite Biometric Screenings
Finger-stick blood test
Total cholesterol
LDL cholesterol (bad)
HDL cholesterol (good)
Triglycerides
Glucose
Blood pressure
Height and weight
Waist measurements
Body fat % (onsite screenings only)
Teachable moment
Alternatives for those not on site
The health screenings will include:
A finger-stick blood test. There won’t be a full blood draw from the arm. From the finger prick, Hooper Holmes will collect a few drops of blood to run tests on your total cholesterol, your LDL cholesterol (bad), your HDL cholesterol (good), your triglyceride count, and glucose levels.
You’ll have your blood pressure measured, your body fat percentage, and your height, weight, and waist measurements.
Once you receive the results of those tests, you’ll sit down with the lead nurse for a review of the results. This is your opportunity to discuss the results with a health educator in a private setting.
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14. Incenting Behavior Change
Option 1
Trinkets for participation
($5-$25 per
participant)
Option 2
Cash, coupons or merchandise for participation
($10-$125 per
participant )
Option 3
Use of “reward” points for participation
($50-$200 per participant)
Option 4
Medical Plan
Contribution Differential
($300-$1200 per
participant/year)
Option 5
Individual Outcomes are required for Contribution Differential
(Legal Limits apply) 0%
30%
50%
75%
90%
Participation Levels
Optimal incentives and resulting participation are significantly impacted by the culture of the organization, including leadership support
Sources: Larry Chapman, WebMD. National Wellness Institute
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15. Keys to Success/ Lessons Learned
Leadership Messaging Venues and Visibility
Diversity in Population and Culture
Privacy Concerns
Fear of Information Overload
Vendor Integration and Measurement
Programs cannot succeed without support of its leaders
Targeted approach yields best outcomes
Transparency is everything
Streamlining is key
Strong partnerships are critical
Use creative approach (Town Halls, Social Media, Webinars)
Communicate often
Have leadership including Executive Directors attend live meetings and events regularly
Have leadership demonstrate and enforce companies commitment to initiative
Understand the different groups/cultures/ ethnicities
Know the language barriers
Understand generational differences (GenY vs. GenX)
Understand gender differences
More information is always better
Post actual privacy guidelines/ standards for all to review
Give examples of how information will be used and why
Allow employees to express concerns and get answers to them directly
Ensure managers are informed an able to answer questions
Multifaceted approach- use multiple avenues of communication
Consider targeted campaigns for specific groups within the organization
Allow for enough lead time
Don’t underestimate the amount of information employees need and want
Create a strategy that allows for growth
Integrate all programs possible
Measure outcomes to build a case for sustainability of the program
Align vendors and measurement triggers with overall strategy
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16. EBAC Meeting – March 2014 Timeframe and Schedule for 2014 Process
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EBAC Meeting – March 2014
Timeframe and Schedule for 2014 Process
Frequency of EBAC Meetings
Monthly (Next meeting is tbd)
Public Forum Process
Need to schedule and organize
Leadership buy in
ALL of us must work to involve
Define deliverables and Goals
March 28, 2014

17. EBAC Meeting – January 2014 2014 EBAC Initiatives –
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EBAC Meeting – January 2014
2014 EBAC Initiatives –
Thank you for your participation !
Please forward all questions to Eduardo
March 28, 2014

18. 10/16/2019
EBAC Meeting – March 2014
March 28, 2014

19. EBAC Meeting – February 2014
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EBAC Meeting – February 2014
2014 EBAC Initiative:
A re-examination of what and how Saint Mary’s College provides their employees with employee benefits; the vendors, the offerings, the budget and the competitive needs of the community.
March 28, 2014

20. EBAC Meeting – February 2014
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EBAC Meeting – February 2014
2014 EBAC Initiative:
A re-examination of what and how Saint Mary’s College provides their employees with employee benefits; the vendors, the offerings, the budget and the competitive needs of the community.
March 28, 2014

21. EBAC Meeting – March 2014 Review of certain group insurance concepts
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EBAC Meeting – March 2014
Review of certain group insurance concepts
Risk vs Exposure vs Credibility
Defined Benefit vs Defined Contribution
Risk Sharing and Pooling
March 28, 2014

22. EBAC Meeting – March 2014 Risk vs Exposure vs Credibility
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EBAC Meeting – March 2014
Risk vs Exposure vs Credibility
Risk is the potential of an event, the probability of the event is likely
uncertain, but exists with various level of credibility.
Exposure is the projected cost of a risk, although not all exposures are monetary. Exposures are usually shared between various parties (insurer, insured, etc.)
Credibility is an actuarial term used to define the projected accuracy that
past outcomes have in predicting future results. More data yields higher credibility (greater certainty).
You have car insurance. The risk is in operating (crashing) the car, YOUR exposure is the deductible (and potential lost time and use of the vehicle). The credibility (likely hood that you will have an accident) comes from your driving record (past outcomes) and other historical data.
COST = (Risk x Exposure ) / Credibility
March 28, 2014

23. EBAC Meeting – March 2014 Risk vs Exposure vs Credibility
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EBAC Meeting – March 2014
Risk vs Exposure vs Credibility
For Saint Mary’s:
the ‘Risk’ is in offering a plan(s); morbidity of participants
the ‘Exposure’ is the cost of the plan (premiums in a fully insured scenario); which is a reflection of claims costs
the ‘Credibility’ is 100% for the total pool (600+ employees). Slices of the pool may have lower credibility
March 28, 2014

24. EBAC Meeting – March 2014 Defined Benefit vs Defined Contribution
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EBAC Meeting – March 2014
Defined Benefit vs Defined Contribution
Defined Benefit is the ‘promise’ of providing a certain level of benefit, regardless of cost.
Example: If you work here 5+ years we will provide a pension equal to 5% of your life time earnings starting at age 65 until you die
Defined Contribution is the promise to provide a certain level of funding for a benefit.
Example: If you work here a year we will contribute 5% of your earnings into a tax favored vehicle for your retirement.
March 28, 2014

25. EBAC Meeting – March 2014 Defined Benefit vs Defined Contribution
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EBAC Meeting – March 2014
Defined Benefit vs Defined Contribution
For Saint Mary’s the current structure is a hybrid.
The defined contribution part is that the college has a set budget per employee (pepm) for benefits. The employee can choose what they want to buy, although there is a cost share, and the specific value to the employee is not tied to the SMC contribution.
The defined benefit part is that the options available are limited and if an employee waives any part of the program they lose that part of the SMC contribution.
March 28, 2014

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EBAC Meeting – March 2014
Risk Sharing Discussion (originally presented to HIRC in 2009)
Absent delivery system differences the total cost of care for SMC participants (the ‘pool’) is a constant; cost differences between carriers is driven more by the relative health of the benefitted population than by the carrier chosen.
Kaiser’s costs are lower in large part because the participating population in Kaiser is healthier. Driving employees into Kaiser for the lower cost is a short term (1 year) solution.
Is it reasonable (fair) to charge employees more for being part of an older, sicker group?
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EBAC Meeting – March 2014
Risk Sharing Discussion (originally presented to HIRC in 2009)
For example, IF the overall morbidity of SMC = 1.0 (risk factor)
Then the relative risk factors would be:
Kaiser = .95 ; Non-Kaiser= 1.10
Should SMC support each plan equally or proportionally?
Equally: SMC contribution is the ‘same’ regardless of plan choice
Proportionally: SMC contributions are modified to pay more, on a relative basis, toward the higher risk group
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EBAC Meeting – March 2014
The total cost of the ‘pool’ is not impacted by contribution strategy or scheme except for:
> dis-enrollments (modify risk)
> cost shifting (sorta)
The issues around contribution modeling are more than the technical discussion above and are impacted by the values of the college and the total compensation strategy.
March 28, 2014

29. EBAC Meeting – March 2014 2014 EBAC Initiatives – Basic Tenets
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EBAC Meeting – March 2014
2014 EBAC Initiatives – Basic Tenets
Originally developed as part of the first HIRC process in 2006 for the 2007 plan year
Designed to articulate the values of the college and provide a framework for our decisions then and in the future
Addressed what was perceived as the most significant issue at the time; dependent affordability and college budget ability
March 28, 2014

30. EBAC Meeting – February 2014
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EBAC Meeting – February 2014
Basic Tenets - Contribution Strategy:
Employee choice of Kaiser / non-Kaiser
Maintain a ‘Low/no-cost’ plan
Reflect cost difference
Stay within the target budget
Ease of communication and administration
Support coverage for dependents
March 28, 2014

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EBAC Meeting – March 2014
PROPOSED New Tenets for 2014: Employee Work/Life Programs (employee benefits)
Employee Benefits are part of the college’s total compensation strategy and
must be considered as part of a holistic employee engagement
2. The employee benefits program(s) offered should align with Catholic and Lasallian principles
3. Programs offered will treat all members of the College community with fairness;
and support our families.
4. Where practical programs offered should contain choices for employees that match to their individual needs, beliefs and circumstances. This may include offering optional low cost or limited benefit plans.
March 28, 2014

32. 10/16/2019
EBAC Meeting – March 2014
PROPOSED New Tenets for 2014: Employee Work/Life Programs (employee benefits)
5. The program’s financials should be budgetable and within agreed upon targets.
6. If necessary, employees should share in the cost of their program elections in a way that reflects the relative value and cost of their elections.
7. Wellness and health initiatives should be supported and promoted
8. There should be a strategy to communicate with the campus community
the value of the benefits program, the decision process of the EBAC and administration
9. Where practical, technology should be leveraged to improve efficiency and value to participants.
March 28, 2014