1. 1 Building a Sustainable Infrastructure for EHM: A Vision for the Future Presented by Larry Chapman M.P.H. Chairman and Co-Founder Summex Health Management

2. © Summex Health Management 2 Agenda The mistake most employers make The key pieces of your program infrastructure Matching your infrastructure to your program model Resource implications A vision for the future

3. © Summex Health Management 3 The Mistake Most Employers Make They fail to build a sustainable EHM program infrastructure.

4. © Summex Health Management 4 “Sustainability” includes… Enterprise-wide Highly “actionable” Administratively efficient Strong metrics Simplifying in nature Well-integrated Strategic Viable over the long term

5. © Summex Health Management 5 Key Definitions Infrastructure- “The basic structure or features of a system or organization.” Structure- “The manner of construction of something and the arrangement of its parts.” System- “Instrumentality that combines interrelated and interacting artifacts designed to work as a coherent entity.” Program-“..an organized response to eliminate or reduce one or more problems where the response includes one or more objectives, performance of one or more activities, and the expenditure of resources.” -The Free Dictionary by Farlex

6. © Summex Health Management 6 Mission… Optimizing the productivity of your human capital

7. © Summex Health Management 7 Perspective… Health and Productivity Management (HPM) "The integrated management of health risks, chronic illness, and disability to reduce employees' total health- related costs including direct medical expenditures, unnecessary absence from work, and lost performance at work (i.e., presenteeism).” -IHPM

8. © Summex Health Management 8 Platform… For Health and Productivity Management (HPM) =

9. © Summex Health Management 9 Program Model Main Features Primary Focus Major Wellness Program Models

10. © Summex Health Management 10 Key Pieces of the Program Infrastructure HRA and personal report Telephonic coaching & referral network Self-directed change materials Annual program kit Medical self-care book Mailings and emails Wellness newsletter PCP oriented-summary Full-function E-Health source Wellness incentives

11. © Summex Health Management 11 Visual Diagram of the Infrastructure Referrals

12. © Summex Health Management 12 Core Program Infrastructure Plus…. Core Program Infrastructure Site-based Activity + +    

13. © Summex Health Management 13 Schematic of the Infrastructure

14. © Summex Health Management 14 Key HRA Features Identity & demographics Personal and family medical history Current symptoms and treatment status Preventive screening status PCP relationship Medical self-care book use Clinical and behavioral risks Readiness to change Self-efficacy levels Psycho-social indicators Injury risk issues (W,H,V & R) Health care utilization levels Health consumer skills level Presenteeism status Option for use of biometric values Overall Wellness Score (OWS) Report of past OWS scores

15. © Summex Health Management 15 Schematic of the Infrastructure

16. © Summex Health Management 16 Key Coaching Features Everyone gets a call (Opt-out) Call at home – then at-work “No reach” protocol Moderate risk 2-4 calls/yr High risk 5-12 calls/yr Strong use of SOC Strong use of motivational interviewing techniques Follow-up materials provided Referrals provided Everyone asked to have personal wellness objectives Incentive for coaching adherence

17. © Summex Health Management 17 Schematic of the Infrastructure

18. © Summex Health Management 18 Key E-Health Features SSO access from company website Personal health record HRA data linked Query with depth Symptom reference and advice Benefit decision support Health cost estimator (FSA, HSA, etc.) Provider decision support Treatment decision support Two-way communication system Incentives for use Integration with benefits and services Report generation on use patterns

19. © Summex Health Management 19 Schematic of the Infrastructure

20. © Summex Health Management 20 Key Incentive Features Use “play or pay” concept Require annual HRA Use $500 to $1,000 per year of value Use premium discount and/or debit card Use 4/5, 6/8 or 8/10 Wellness criteria Tighten and change criteria over time Everyone who “plays” gets a prize Provide a waiver opportunity Use “sentinel” features Connect it to open enrollment Consider a “zero base budget” approach

21. © Summex Health Management 21 4/5* Non-tobacco user BMI < 30 OWS > 85 Physical activity > 4 times per week Completion of 30 minute webinar on wellness and consumer health 6/8, 8/10* Non-tobacco user BMI < 30 OWS > 85 Physical activity > 4 times per week Completion of 30 minute webinar on wellness and consumer health Current on preventive screening (MD form) 100% seat belt use Have a PCP Use of your medical self-care book in previous 3 months No more than 3 sick leave in last 12 months * = All “HSRF” criteria would also have participation options Large employers could further customize the criteria Examples of Wellness Criteria

22. © Summex Health Management 22 Schematic of the Infrastructure

23. © Summex Health Management 23 Infrastructure Linked to Model

24. © Summex Health Management 24 Resource Implications Resources for Program Infrastructure No cost or very low cost (<$25/EE/yr) Moderate cost (Between $26 and $140/EE/yr) Major cost (Between $141 and $340/EE/yr)

25. © Summex Health Management 25 Program Infrastructure and Effects Type of Emphasis or Major Effects Option #1 QWL Program Model Option #2 Traditional Program Model Option #3 HPM Program Model Information+ + + ++ + Motivation++ + + + + + Behavior Change++ + + Economic Change++ + + + + + Cultural Change+ + + - Chapman, Planning Wellness, 2005

26. © Summex Health Management 26 Major Phases Introduction Experimentation Shakedown Refinements Realignment Expansion Partnership Optimal effectiveness

27. © Summex Health Management 27 How to Develop an Infrastructure Define needs Establish priorities Select metrics Define technical specifications Make or buy Evaluate regularly Refine specifications Redefine needs

28. © Summex Health Management 28 Summary of Key Points Few employers have sustainable program infrastructures Most Wellness activity is episodic and short term oriented There are standard components to program infrastructures The extent of your infrastructure depends on your model Your infrastructure is the “core” of your program Your program model will drive your infrastructure costs The three basic models result in different levels of effects Program infrastructure should be built in phases The process of building your infrastructure should be rational A sustainable infrastructure is key to long term success The quality of the infrastructure will have a major impact The program infrastructure must have an appropriate administrative infrastructure

29. © Summex Health Management 29 Your Questions?