1. An Independent Licensee of the Blue Cross Blue Shield Association HRA Management Report 2005

2. 2 Agenda Context for the program Background on the HRA report Major findings Interpretation of results Update on coaching activity The challenge ahead What’s needed next?

3. 3 Health Cost Increases: The “Problem” Another year of double-digit health cost increases

4. 4 Health risks push costs up! Yet preventable through lifestyle change Average annual per capita excess health costs when risk is present. Goetzel, R et al. The Relationship Between Modifiable Health Risks and Health Care Expenditures, Journal of Occupational and Environmental Medicine. 1998;10:843-854

5. 5 Effect of single risk factors Source: Serxner, S., et al., (2001). The impact of behavioral health risks on worker absenteeism. JOEM, 43(4), 347-354 Percent higher sick leave absenteeism N = 35,451

6. 6 Effect of single risk factors Source: Musich, S., et. al., (2001, June). The Association of Health Risks with Workers’ Compensation Costs, JOEM,, p. 534-541. Percent higher Workers’ Comp cost N = 3,388 X 4 years

7. 7 Effect of multiple risk factors Number of Health Risks Multiples Source: Yen, Louis, et al., (1991, Sept/Oct). Associations between health risk appraisal scores and employee medical claims costs in a manufacturing co., AJHP, 6(1), p. 46-54. Multiples of Annual Health Plan Cost N = 1,838

8. 8 Preventable claims cost Group Level health care expenditures Source: Anderson, et. al., (2000, Sept/Oct). The Relationship Between Modifiable Health Risks and Group-Level Health Care Expenditures, AJHP, 15(1), p. 45-52. Depression Stress Blood Sugar Smoking Obesity Blood Pressure Sedentary Life N = 46,026 X 6 years

9. 9 Wellness has evolved ROI goals determine model

10. 10 Summex Health Management Strategic approach Control costs by reducing risks Maximize HRA participation Identify health risk cost drivers Reduce risks through coaching for behavior change Incent people for wellness Keep low risk low Measure outcomes Determine ROI

11. 11 University of Alaska The THAW Program 1. Tri-Fold brochure sent to participants homes 2. Mayo Clinic Self-Care Guide sent to participant homes 3. Deploy Online HRA 4. Paper HRAs sent to all non-participants 5. Incent HRA ($100 Benefit Credit) 6. HTML EMAIL Weekly Campaign 7. Enroll into IMPACT™ and IMPACT™ MR

12. 12 Participation –2,927 HRA Participants = 45.7% Participation Rate 58.4% of Participants were Female 41.6% of Participants were Male 26.3% of Participants were spouses 73.7% of Participants were employees 28% were paper 72% were online University Of Alaska HEALTH MONITOR ™ HRA

13. 13 Risk Status of HRA Completers N = 2,927 N = 6,399

14. 14 Risk status of HRA completers Total Eligible = 6,399 N = 2,927 <76.3 76.4 to 80.4 >80.5 (1,449) (764) (714)

15. 15 Are HRA participants healthier? Per Member Per Month (PMPM) Source: Premera, Knowledge Services * = 7/1/2004 to 6/30/2005

16. 16 Campus HRA Participation SW UAA UAF UAS

17. 17 University of Alaska Multiple Risk Factor Prevalence

18. 18 Cost of Multiple Risk Factors Multiple risks multiply costs Source: Yen, Louis, et al., (1991, Sept/Oct). Associations between health risk appraisal scores and employee medical claims costs in a manufacturing co., AJHP, 6(1), p. 46-54. Number of Risks Multiples

19. 19 Overall Wellness Score (OWS) Risk Factors Used in OWS Aerobic BP Weight Stress Fat Cholesterol Alcohol Lift DUI Seatbelt Speed Screen Self Care Depression Pre-Diabetes Tobacco Multi-CVD Multi-Stroke Multi-Psych

20. 20 Overall Wellness Score

21. 21 Overall Wellness Score Comparison of U o A with Summex database

22. 22 Identifying your “low hanging fruit” Intervention Opportunity Index (IOI) Located on page 27 & 28 of the management report “Low hanging fruit” The IOI ranks your organization’s top risk factors based on: Your risk prevalence Your excess costs Your readiness to change Your top “3” IOIs CVD prevention Physical inactivity Stress

23. 23 #1 IOI Target: Cardiovascular Disease Prevention

24. 24 Cardiovascular Disease Risks Participants with multiple risks

25. 25 #2 IOI Target: Inactivity

26. 26 University of Alaska Weight management

27. 27 #3 IOI Target: Stress management

28. 28 University of Alaska Readiness to change profile

29. 29 pre-contemplation contemplation preparation action maintenance Risky behavior Permanent behavior change IMPACT TM Stages of Change Pre-contemplation Contemplation Preparation Action Maintenance Termination termination High-risk individuals will change health behaviors given the right coaching at the right time.

30. 30 Engaging Lifestyle-focused Goal-oriented Personal Confidential Supportive I MPACT TM Personal health coaching “About 40% of high risk move out of high risk the first year of coaching.”

31. 31 Welcome Kit or Physician Letter Telephone & mail-based counseling  Impact: Up to 12 counseling sessions per year  Impact MR: Up to 6 counseling sessions per year  Stage-of-change protocol Personal health journal Integration of health resources: EAP, DM, worksite activities HEALTHSTAGES TM change guides Quarterly management reports I MPACT TM and IMPACT TM MR Personal health coaching

32. 32 IMPACT™ 1,189 enrolled (82.0%) IMPACT™ MR 440 enrolled (57.6%) As of February 1, 2006 Current I MPACT TM Program Personal health coaching

33. 33 What needs to happen now Statewide is not driving the site-based wellness activity, so… Each campus needs to organize for wellness and… Then focus on the IOIs –CVD prevention –Inactivity –Stress

34. 34 Virtual and site-based wellness: Options for University of Alaska Virtual Site-based + + + + + +  

35. 35 CVD prevention? –Cholesterol? –Blood pressure? –Weight management? –Tobacco use? –Nutrition? Inactivity? Stress? What can be done?

36. 36 Summary of Key Points Health risks drive a large proportion of your health costs. You have made an excellent start! (45.7%) The infrastructure for measurement and intervention with individuals is in place. Awareness and coaching are usually required for behavior change. There is much that can be done at each location. Each location must organize and conduct programming and help create healthy cultures. Volunteers are available. Site leadership is needed. Wellness produces benefits and value for everyone.

37. 37 Questions