1. Copyright © Health Behavior Innovations 2008 Accountability-Based Employer Wellness Programs Darrell Moon, CEO Health Behavior Innovations Developing Value-Based Programs to Enhance Employee Health Productivity and Outcomes

2. Copyright © Health Behavior Innovations 2008 Presentation Outline Program design Results Financial Impact & Return Model Federal guidelines Wellness at no-net cost to employer

3. Copyright © Health Behavior Innovations 2008 Program Design Measure Everyone’s Health Status Healthy Individuals Participate In Health Promotion Campaigns Those with Health Risks work with a coach Must adhere to program requirements to get incentive

4. Copyright © Health Behavior Innovations 2008 Fair to Each Person Create an Alternative Standard –Individualized –Unique to specific health condition –Designed by the person –Approved by the coach –Individual accepts ownership

5. Copyright © Health Behavior Innovations 2008 Accountability is Key Accountability to a health coach Accountability for tracking progress Accountability for goal success

6. Copyright © Health Behavior Innovations 2008 Individualized Support Support of a personal health coach Key to sustained participation

7. Copyright © Health Behavior Innovations 2008 Results Financial Employee Satisfaction Productivity Health Status

8. Copyright © Health Behavior Innovations 2008 Financial Case Study 1 Ken Garff Case Study 2 Utah County

9. Copyright © Health Behavior Innovations 2008 Case Study 1 Ken Garff: Multiple locations throughout Utah 730 Total Benefited Employees 453 Wellness Plan Participants 1 Year period: 2005 (Jan.-Dec.)

10. Analysis of claims to calculate actual savings Average Change in Annual Claims for Non-Participants Minus Average Change in Annual Claims for Participants who stayed involved $151.22 (outliers excluded for statistical validity )

11. 1 st Year Claims Savings From Employees Who Stayed Involved $151.22 X 334 Savings Per Participant Number of Participants Total Claims Savings

12. Financial Impact Costs versus Savings 1 st Year Saved Over 109% of Costs in 1 st Year $46,005 $50,507

13. Copyright © Health Behavior Innovations 2008 Case Study 2 Utah County: government entity 950 Total Benefited Employees 808 Wellness Plan Participants 420 Coached Participants 1 Year period: 2007 (Jan.-Dec.)

14. Prior to Intervention Copyright © Health Behavior Innovations 2008 Case Study 2

15. Copyright © Health Behavior Innovations 2008 Case Study 2

16. Copyright © Health Behavior Innovations 2008 Employee Satisfaction Happier Workforce

17. Customer Satisfaction Copyright © Health Behavior Innovations 2008

18. Customer Satisfaction Survey Questions: 1.Positive overall impression of the wellness program. 2.Insurance discount played a significant role. 3.Assessment process was helpful. 4.Coach took the time to learn about me and my health concerns. 5.Coach educated me about things I could do to improve my health. 6.Coach helped me develop goals I could own and am willing to do. 7.My goals are realistic and will stretch me but not overwhelm me. 8.Coach is knowledgeable and professional. 9.Coach is caring and compassionate. 10.Coach has been a motivation for me to improve my health. 11.Coach has helped me understand the wellness program. 12.Communicating with my coach has not been difficult. 13.I have made personal changes that will improve my health. 14.I have become healthier through my participation. 15.My participation has helped me increase my personal productivity. Copyright © Health Behavior Innovations 2008

19. Productivity More Productive Workforce

20. Copyright © Health Behavior Innovations 2008

21. Health Status Improvement HBI’s aggregate results: All at-risk participants = 70% Men = +6% Women = +9% All High-risk participants = 25% Men = +10% Women = +14%

22. Coach Intervention Copyright © Health Behavior Innovations 2008

23. Coach Intervention Copyright © Health Behavior Innovations 2008

24. Coach Intervention Copyright © Health Behavior Innovations 2008

25. Coach Intervention Copyright © Health Behavior Innovations 2008

26. Coach Intervention Copyright © Health Behavior Innovations 2008

27. Coach Intervention Copyright © Health Behavior Innovations 2008

28. Coach Intervention Copyright © Health Behavior Innovations 2008

30. Financial Impact & Return Model®

31. Copyright © Health Behavior Innovations 2008 Recent National Poll 91% of employers “Believe that they could reduce their health care costs by influencing employees to adopt healthier lifestyles” Source: Michelle M. Mello, J.D., Ph.D., and Meredith B. Rosenthal, Ph.D. “Wellness Programs and Lifestyle Discrimination – The Legal Limits”; The New England Journal of Medicine, Health Law, Ethics, and Human Rights; July 10, 2008; 359;2. www.nejm.org.

32. Copyright © Health Behavior Innovations 2008 Large Employers Reported in 2007 40% plan to pay employees -Health enhancing behaviors -Next 2-3 years 40% supported higher premiums -Obese persons -Declined participation weight management programs Source: Michelle M. Mello, J.D., Ph.D., and Meredith B. Rosenthal, Ph.D. “Wellness Programs and Lifestyle Discrimination – The Legal Limits”; The New England Journal of Medicine, Health Law, Ethics, and Human Rights; July 10, 2008; 359;2. www.nejm.org.

33. Copyright © Health Behavior Innovations 2008 Incentives Can employers treat employees differently based on their health status? Reward the healthy Engage the resistant majority

34. Employers can now use benefit design to engage employees in healthy behaviors Attorney Greg Matis Presentation Utah SHRM Conference 2007 Federal Wellness Guidelines

35. HIPPA – Amends –Internal Revenue Code –Employee Retirement Income Security Act (ERISA) –Public Health Service Act ADA – The Americans with Disabilities Act Attorney Greg Matis Presentation Utah SHRM Conference 2007 Federal Law

36. The Departments of Labor, Treasury and the Health and Human Services issued joint proposed regulations on nondiscrimination in wellness programs in 2001. Those regulations have now been finalized in regulations issued December 13, 2006. Attorney Greg Matis Presentation Utah SHRM Conference 2007 HIPAA

37. HIPAA bars discrimination on the basis of “health factors” with respect to employer health plan eligibility, benefits, premiums or contributions. Attorney Greg Matis Presentation Utah SHRM Conference 2007 HIPAA

38. But, HIPAA also states that plans and issuers may: “establish premium discounts or rebates or modify otherwise applicable co-pays or deductibles in return for adherence to programs of health promotion and disease prevention,” i.e. wellness programs. Attorney Greg Matis Presentation Utah SHRM Conference 2007 HIPAA

39. The regulations are aimed at providing guidance to those plans that do wish to provide a reward based on a health factor. Attorney Greg Matis Presentation Utah SHRM Conference 2007 Blood PressureBody Fat % Glucose Cholesterol Obesity HIPAA

40. 1. The total reward (for all features that contain a reward based on a health factor) must not exceed 20% of the total (unsubsidized) cost of employee only coverage. Attorney Greg Matis Presentation Utah SHRM Conference 2007 5 Requirements Final Guidelines added: 20% of Family coverage if other Family members are invited to participate.

41. 2. The wellness program must be reasonably designed to promote health or prevent disease. Attorney Greg Matis Presentation Utah SHRM Conference 2007 5 Requirements

42. 3. The wellness program must give eligible individuals the opportunity to qualify for the reward at least once per year. Attorney Greg Matis Presentation Utah SHRM Conference 2007 5 Requirements

43. 4. The reward must be available to all similarly situated individuals. Attorney Greg Matis Presentation Utah SHRM Conference 2007 5 Requirements

44. According to the DOL, this means the Wellness Program must provide reasonable alternative standards for those for whom, due to a medical condition, it is unreasonably difficult or it is medically inadvisable to attempt to satisfy the normal standard. Attorney Greg Matis Presentation Utah SHRM Conference 2007 5 Requirements

45. The regulations provide examples of reasonable alternative standards: –Instead of having a body mass index between 19 and 26, walking 20 minutes 3 times a week. Attorney Greg Matis Presentation Utah SHRM Conference 2007 5 Requirements

46. 5. The plan or issuer must disclose in all plan materials that describe the program the availability of reasonable alternative standard Attorney Greg Matis Presentation Utah SHRM Conference 2007 5 Requirements

47. The Americans with Disabilities Act (ADA) generally prohibits employment discrimination against disabled individuals and limits the circumstances in which an employer may require physical examinations or answers to medical inquiries. Attorney Greg Matis Presentation Utah SHRM Conference 2007 ADA

48. Q: Does this affect your wellness program? Attorney Greg Matis Presentation Utah SHRM Conference 2007 ADA

49. ADA The EEOC Technical Assistance Manual says that the ADA permits employers to: “conduct voluntary medical examinations and inquiries as part of an employee health program (such as medical screening for high blood pressure, weight control, and cancer detection), provided that: participation in the program is voluntary;”

50. “Limits an employer’s ability to collect employee health information” Use a third party provider for confidentiality ADA Source: Michelle M. Mello, J.D., Ph.D., and Meredith B. Rosenthal, Ph.D. “Wellness Programs and Lifestyle Discrimination – The Legal Limits”; The New England Journal of Medicine, Health Law, Ethics, and Human Rights; July 10, 2008; 359;2. www.nejm.org.

51. HIPAA & ADA Summary Nondiscrimination and Wellness Programs in Health Coverage in the Group Market, Federal Registry/Vol. 71, No. 239/Wednesday, December 13, 2006/ Rules and Regulations HIPAA prohibits discrimination in health coverage. HIPAA does make an exception: Wellness Programs that reward based on individuals satisfying a health standard or that meet specified requirements ADA – Make sure your program is voluntary & confidential. Copyright © Health Behavior Innovations 2008

52. Can employers afford big enough incentives? How many companies have hundreds of dollars to hand out to each employee each year to engage them in being healthy?

53. Copyright © Health Behavior Innovations 2008 Wellness with No Net-Cost Zero-based budgeting

54. Increase employee contribution then discount the increase to create a cash incentive that won’t cost anything. Employers Can Be Creative Copyright © Health Behavior Innovations 2008

55. Transfer program costs from Participants Non-participants Those who don’t participate pay for those who do How Do You Fund Program? Copyright © Health Behavior Innovations 2008

56. HIPAA Section III Economic Impact “Costs can be shifted to workers through increases in employee premium shares...” Nondiscrimination and Wellness Programs in Health Coverage in the Group Market, Federal Registry/Vol. 71, No. 239/Wednesday, December 13, 2006/ Rules and Regulations

57. Copyright © Health Behavior Innovations 2008 Financial Case for Wellness Traditional – ROI New Trend – Benefit Design-no cost

58. Copyright © Health Behavior Innovations 2007 Cost by Member Demand Management Supply Management

59. Copyright © Health Behavior Innovations 2008 Summary Accountability Based Design Multiple Results Financial Impact & Return Model Federal guidelines – HIPAA & ADA Wellness at no-net cost to employer