MERCER’S NATIONAL SURVEY OF EMPLOYER-SPONSORED EMPLOYER -SPONSORED ...€¦ · Tobacco Free Living (Cessation and Workplace Policies) –Evaluation •63% of employees who took

H E A L T H W E A L T H C A R E E R

M E R C E R ’ S N A T I O N A L S U R V E Y O F E M P L O Y E R - S P O N S O R E D H E A L T H P L A N S 2 0 1 7

Presented to ABGOH

Stephanie Beach

May 4, 2018

M E R C E R ’ S

N AT I O N A L S U R V E Y O F

E M P L O Y E R - S P O N S O R E D

H E A LT H P L A N S 2 0 1 7

M E R C E R ’ S N A T I O N A L S U R V E Y O F E M P L O Y E R - S P O N S O R E D H E A L T H P L A N S 2 0 1 7

H E A L T H W E A L T H C A R E E R

About the survey

Oldest Marking 32 years of measuring health plan trends

Largest 2,481 employers participated in 2017

Most comprehensive Covers a broad range of health benefit issues and strategies

Statistically valid Based on a probability sample of private and public employers for reliable results

Includes employers of all sizes, industries, regions Results project to all US employers with 10 or more employees

6.1% 6.1% 6.1% 6.3%

5.5%

6.9%

6.1%

4.1%

2.1%

3.9% 3.8%

2.4% 2.6%

10.0% 9.8%

9.0%

7.9%8.3%

9.1%

9.8%

8.2%

7.4%

8.0%

7.1%

6.3% 6.3%

2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017

Employers are holding average health benefit cost growth to about 3% annually

MERCER’S NATIONAL SURVEY OF EMPLOYER-SPONSORED HEALTH PLANS

Expected change in health plan cost before changes to plan design

Annual change in total health benefit cost per employee

Employers rate importance of their strategies for the next five years

The top two address costs that aren’t “shoppable”

33%

40%

49%

70%

72%

77%

Focused strategy for creating a culture of health

1

2

MERCER’S NATIONAL SURVEY OF EMPLOYER-SPONSORED HEALTH PLANS / employers with 500+ employees

Monitoring/managing high-cost claimants

Focused action to manage cost for specialty pharmacy

Offering employees more plan/benefit options with decision-support tools

Point solutions – high-tech/high-touch support for physical/mental/financial health

ACO and other high-performance network strategies

3

Steps taken to build a “Culture of Health”

28%

60%

56%

60%

60%

68%

Healthy food choices

No smoking anywhere on campus

Onsite fitness facility

Healthy work/life balance policies

Mission statement supports healthy workplace culture

Modified work environment to promote physical activity

Fortune’s Best Companies to Work for

Employers with 500+ employees

MERCER’S NATIONAL SURVEY OF EMPLOYER-SPONSORED HEALTH PLANS

23%

23%

42%

43%

54%

59%

Strategy Impact Analysis: Cost TrendRespondents’ cost trends were analyzed based on their use of 24 best practice health program strategies

BASICS CULTURE OF HEALTH QUALITY AND VALUE

• Offer CDHP

• HSA sponsor makes a contribution to employees’ accounts

• Offer voluntary supplemental health insurance

• Use/planning to use bundled solution for health benefits (including private benefits exchange)

• Transparency tool provided by specialty vendor

• Mandatory generics or other Rx strategies

• Steer members to specialtypharmacy for specialty drugs

• Collective purchasing of Rx benefits

• Offer optional (paid) well-being programs through plan or vendor

• Company vision/mission statement supports a healthy workplace culture

• Offer technology-based well-being resources (apps, devices, web-based)

• Use incentives for well-being programs

• Well-being strategy includes focus on intrinsic motivation to improve health

• Spouses and/or children may participate in programs

• Smoker surcharge

• Have conducted analysis of employee behavioral health issues

• Provide stress management, resiliency, or mindfulness programs

• Offer health advocacy program

• Offer a Surgical Center of Excellence

• Offer a COE other than for surgical (oncology, orthopedics, cardiology, women’s health)

• Primary care on-site clinic

• Telemedicine utilization of 5% or higher

• Employees have incentives to use:

– Medical homes

– Accountable care organizations

– Other narrow network

• Reference-based pricing

Survey says: Hard work pays off!Increase in total health plan cost

4.3%

3.8%

4.8%

4.2%

3.7%

2.9%

3.8%

2.7%

2014 2015 2016 2017

Employers using the fewest best practicesEmployers using the most best practices

MERCER’S NATIONAL SURVEY OF EMPLOYER-SPONSORED HEALTH PLANS / employers with 500+ employees

Program Evaluation of Health & Wellbeing InitiativesP H I L I P H U A N G , M D M P H

H E A LT H A U T H O R I T Y/ M E D I C A L D I R E C TO R

A U S T I N P U B L I C H E A LT H

Source: CDC

Assessment & Data ReviewIDENTIFYING SOURCES OF INDIVIDUAL & ORGANIZATIONAL WELLNESS DATA

Identification of Data SourcesINDIVIDUAL DATA

SampleHealth Risk Assessment Survey Data

Note: All real values for this evaluation have been altered. Numbers presented are only examples.

SampleHealth Claims Data Comparing claims data between employees who use tobacco and employees who do not use tobacco


Health Claims Data – How do I use it?

1. What chronic diseases or conditions do staff have (high blood sugar, high blood pressure, stress) ?

2. What behavioral risk factors do staff have (smoking, lack of physical activity, high BMI)?


No individual data?

Survey staff • Individual needs and interests

for wellness programming

• Health risks, health behaviors, and health outcomes

• Privacy may be an issue when surveying staff for personal health information for small organizations

No individual data?

Use local data to look for health trends in your area

• 500 Cities Behavioral Risk Factor Surveillance System data

• Chronic Disease in Travis County Report

• Austin Travis County Critical Health Indicators Report 2017

Identification of Data SourcesORGANIZATIONAL DATA

CDC Worksite Health ScoreCard

❖ Online or PDF

❖ Provides benchmarks

❖ Online records to track progress over time

❖ Can export data to make reports

https://nccd.cdc.gov/DPH_WHSC/HealthScorecard/Home.aspx

https://nccd.cdc.gov/DPH_WHSC/HealthScorecard/Home.aspx

American Heart Association’s My Life Check

❖ 5-Step Assessment Process

❖ Online employee health assessment data (My Life Check) allows you to track employee health data

www.heart.org

http://www.heart.org/

CEO Cancer Gold Standard

❖ Online application

❖ 5 Pillars

❖ Checklist to get you prepared to apply

❖ Applicable to all organization sizes

www.cancergoldstandard.org

http://www.cancergoldstandard.org/

Putting it all together:1. What chronic diseases or conditions do staff have?

• Diabetes

• Stroke

• High blood pressure

• High cholesterol

2. What behavioral risk factors do staff have?• Smoking

• Lack of physical activity

• High BMI

3. How does the data compare to the previous year’s data?

Prioritize &Plan Health InitiativesGETTING READY TO IMPLEMENT

Prioritizing Health Initiatives

Considerations to prioritize health initiatives and plan for implementation:

1. Current health & wellness initiatives• Tobacco-free Living

• Nutrition (Healthy Meetings & Healthy Vending)

• Physical Activity

• Health Education & Preventive Services

2. Available resources (e.g. staff, funding, etc.)

3. Long-term organizational employee health and wellness goals

4. Timeline (e.g. leadership buy-in, employee readiness, concurrent initiatives)

❖ Use data findings to plan wellness programming

Implementation

Implementation ConsiderationsPlan to use feedback surveys after health & wellness activities

1. Outcome question examples:

• Did you learn something new by participating in this activity?

• Did you change a behavior by participating in this activity?

2. Process question examples:

• Did you like the activity?

• Was it at a good time/place?

• How would you improve it?

• What were the barriers to participating?

EvaluationTRACKING EFFECTIVENESS, PROGRESS & EMPLOYEE SATISFACTION

Options for Evaluation

• Use your worksite tool on an annual basis to assess organization progress

• Use your annual health claims data to assess changes in employee health

• Survey employees on satisfaction, knowledge & behavior change with health and wellness initiatives (e.g. feedback forms after a wellness activity)

• Use various survey formats so everyone has the opportunity to respond (e.g. hard copies, Survey Monkey, etc.)

Case StudyPROGRAM EVALUATION OF HEALTH & WELL-BEING INITIATIVES

CITY OF AUSTIN’S TOBACCO -FREE LIVING PROGRAM

Tobacco Free Living (Cessation and Workplace Policies) – Assessment

Health Claims & Human Resources Data:• Every year 6-10% of employees in COA reported using tobacco

• In 2012, 75% of employees using tobacco wanted to cut down or quit

• In 2016, 91% of employees using tobacco wanted to cut down or quit

• Employees using tobacco had more absenteeism (sick days)

• Employees using tobacco had an average of $1,000 more in tobacco-related health care claim costs (cancer, CVD, respiratory diseases)

Employee Survey Data:• 63% said they were exposed to second hand smoke in outside areas at their worksite in the

last month

• 68% were bothered by it

• 75% said it was important to work at a tobacco-free worksite

Tobacco Free Living (Cessation and Workplace Policies) – Planning & Implementation• Austin Public Health went tobacco-free in 2011, protecting 500 employees.

• City of Austin offers Tobacco Cessation 101 to all employees.

• Austin Public Health continues to advocate for and support worksites/departments in establishing tobacco-free work place policies:

✓ Policy drafting

✓ Policy and implementation timeline

✓ Signage design and placement

✓ Presentations to leadership and staff

✓ Cessation Resources

Tobacco Cessation Program Evaluation –Employee Behavior Change & Satisfaction Survey

Tobacco Free Living (Cessation and Workplace Policies) – Evaluation • 63% of employees who took

Tobacco Cessation 101 said they quit or reduced tobacco use after the class

• Percentage of employees who report tobacco use has decreased since 2011

• Since 2011, 12 other departments have gone tobacco-free, protecting over 6,000 employees

0

1000

2000

3000

4000

5000

6000

7000

2011 2012 2013 2014 2015 2016 2017

Employees Covered by Tobacco-Free Workplace Policy

AcknowledgementsSARAH SEIDEL, DRPH, RESEARCH ANALYST

CRISTINA GARCIA, RDN, LD, IBCLC, RLC, PROGRAM COORDINATOR

H E A LT H W E A LT H C A R E E R

MAY 4, 2018

Tre' McCalister, Ed. D

M E A S U R E M E N T A N D E V A L U A T I O N A P P R O A C H E S T O H E A L T H A N D W E L L - B E I N G I N I T I A T I V E S

R O I A N D V O I

2 Copyright © 2018 Mercer (US) Inc. All rights reserved.

R E T U R N O N A N D V A L U E O F I N V E S T M E N T

M E A S U R E M E N T O F H E A L T H A N D W E L L - B E I N G I M P A C T

VA L U E O F I N V E S T M E N T R E T U R N O N I N V E S T M E N T

• $1.5 to $2:$1 ROI over three years is

possible.1

• Stock price of firms with effective

health and safety programs

outperform the S&P 500 by 3%.2

• Employer of Choice — Attraction

and retention of top talent.

• Enhanced productivity and

performance.

• Improved employee engagement —

Enhanced quality of output.

1 Goetzel R.Z, et al. “Do Workplace Health Promotion (Wellness) Programs Work?” Journal of Occupational and Environmental Medicine, Volume

56, Issue 9 (2014), pp. 927–934. 2 Fabius R, et al. The Link Between Workforce Health and Safety and the Health of the Bottom Line. Journal of Occupational and Environmental

Medicine, Volume 55, Issue 9 (2013), pp. 993–1000.


R E T U R N O N A N D V A L U E O F I N V E S T M E N T

M E A S U R E M E N T O F H E A L T H A N D W E L L - B E I N G I M P A C T

• Linking Workplace Health Promotion Best Practices and Organizational Financial Performance: Tracking Market Performance of Companies With

Highest Scores on the HERO Scorecard. Grossmeier, J, Fabius, R, Flynn, JP, Noeldner, SP, Fabius, D, Goetzel, R, Anderson, DR JOEM 58 (1) 2016

• The Stock Performance of C. Everett Koop Award Winners Compared With the Standard & Poor’s 500 Index: Ron Z. Goetzel, PhD, Raymond Fabius,

MD, Dan Fabius, DO, Enid C. Roemer, PhD, Nicole Thornton, BA, Rebecca K. Kelly, PhD, RD, and Kenneth R. Pelletier, PhD, MD JOEM 58 (1) 2016

• Tracking the Market Performance of Companies that Integrate a Culture of Health and Safety. Raymond Fabius, MD, Ronald R. Loeppke, MD, MPH,

Todd Hohn, CSP, Dan Fabius, DO, Barry Eisenberg, CAE, Doris L. Konicki, MHS, and Paul Larson, MS JOEM 58 (1) 2016

325%

235%

345%

159%

-50

0

50

100

150

200

250

300

350

2001 2004 2007 2010 2013

% C

hange

Koop

HERO

CHAA

S&P 500

HERO Scorecard “High Scorer”, Koop Award Winners and Corporate Health Achievement

Award (CHAA) “High Scorer” Stock Performance Compared to S&P 500

From 2009-2014, stock

prices of HERO “High

Score” companies

appreciated 235%

compared to 159% for

the S&P 500 and out-

performed the S&P 500

in 16 of 24 quarters

during the study period.


W H Y E M P L O Y E R S I N V E S T I N H E A L T H A N D W E L L - B E I N G

9 1 % I N V E S T F O R R E A S O N S B E Y O N D M E D I C A L C O S T

Reduce health

care costs

Reduce employee

health risks

Productivity

Camaraderie

Job

satisfaction

Business

performance

metrics

Morale

Sick

days

Daily health

decisions

Attract

employees

Presenteeism

Safety

Energy

levels

Disability

claims

Source: OptumTM and NBGH 2014 Survey

CULTURE OF HEALTH


MEASURING VOI

WELLBEING PROGRAMS

CAN HELP EMPLOYEES

THRIVE – AND LOVE

WHERE THEY WORK


N AT I O N A L E M P L O Y E R S U R V E Y D AT A

W E L L - B E I N G I M P A C T A N A LY S I S : T U R N O V E R

Respondents’ turnover rates were analyzed based on their use of 10 best practices for

supporting well-being and a healthy workplace culture

CULTURE OF HEALTH

• Offer optional (paid) well-being programs through plan or vendor

• Company vision/mission statement supports a healthy workplace culture

• Offer technology-based well-being resources (apps, devices, web-based)

• Use incentives for well-being programs

• Well-being strategy includes focus on intrinsic motivation to improve health

• Spouses and/or children may participate in programs

• Smoker surcharge

• Smoke-free workplace

• Have conducted analysis of employee behavioral health issues

• Provide stress management, resiliency, or mindfulness programs


W E L L - B E I N G I M P A C T A N A LY S I S : T U R N O V E R ( C O N T ’ D . )

Turnover rate drops by over a third when comparing companies doing the most to help

employees thrive to those doing least

Average turnover rates in 2016:

6+ well-being

best practices

17%

4-5 well-being

best practices

21%

0-3 well-being

best practices

29%

MERCER’S NATIONAL SURVEY OF EMPLOYER-SPONSORED HEALTH PLANS /

employers with 500+ employees


W E L L - B E I N G I M P A C T A N A LY S I S : T U R N O V E R ( C O N T ’ D . )

Across industries, employees stay longer when the culture of health is stronger

Average turnover rate in 2016:

54%

29% 32%

17%

38%

17% 19%

15%

Wholesale/Retail Health Care Services High Tech

Employers using fewest best practices

Employers using most best practices

MERCER’S NATIONAL SURVEY OF EMPLOYER-SPONSORED HEALTH PLANS /

employers with 500+ employees


HOW DO YOU MEASURE

PROGRAM IMPACT?


M E A S U R E M E N T & E V A L U A T I O N

H E A L T H M A N A G E M E N T P R O G R A M R O I / V O I A N A LY S I S

Objectives

• Measure the return and value on investment – i.e., the total value creation – of company’s

health and well-being programs

Key Considerations

• Balancing the level of rigor vs. cost/complexity of data capture and analysis

• Weighing the value of analysis output vs. the amount of resources needed

• Ensuring analysis is credible and defensible to broader HR, senior management, and other

key stakeholders

• Estimating program impact on outcomes using Company data vs. proxy/projection

assumptions vs. controlling for other factors

• Ability to make program or intervention-specific attribution

Next Steps

• Identify Metrics

• Determine Measurement and Analytics Methods

• Determine Data Availability


Descriptive /

Association Descriptive / Comparative Cause & Effect

Primary question In total, is program having

an impact?

Does participation have an impact on

outcomes?

Are we allocating our resources towards

the right mix of programs?

Have our programs had an impact on

outcomes, controlling for other factors?

Purpose

Tracking engagement,

health status and/or

cost measures in

aggregate and by

subsets

Comparison of program participants and

non participation

Analysis controlling for program

selection bias and potentially,

program interactions

Intended to identify causal

relationships

Level of rigor Lower Higher

Question type Program monitoring Program monitoring

Some program evaluation Program evaluation

Ability to make program or

intervention-specific attribution None Low Moderate / High

Selection adjustments or control

groups None Low Moderate / High

Recommended timing Earlier in program 12 to 36 months after program initiation 36+ months after program initiation

M E A S U R E M E N T A N D E V A L U A T I O N A P P R O A C H

F I N D I N G T H E B E S T A P P R O A C H – A N S W E R I N G K E Y

Q U E S T I O N S W I T H T H E R I G H T L E V E L O F R I G O R


F I N AN C I AL S AV I N G S

M O D E L

M AT C H C O N T R O L HYBRID APPROACH

APPROACH • Evaluate changes in health

risks

• Monetize changes in health risks

based on external book-of-

business or published study

• Total estimated savings equals

changes in health risks X

additional cost of risk for each

health risk

• Compares “study “group (programs

participants) to a matched control

group (non-program participants) using

statistical approaches to ensure that they

are as comparable as possible

• The difference between the change

over time for the two groups is

calculated to estimate savings (i.e.,

difference-in-difference)

• Uses match control method to

determine the client specific

assumptions for additional cost

of risk

• Applies these assumptions to the

financial savings model

PROS • Less labor intensive to conduct

• Quicker turnaround of financial

reporting (no need for claims run-

out)

• Can provide more transparent

reporting of the value chain

without additional analysis

• Most rigorous process to determine

whether the savings achieved was a

result of the intervention

• Directly measures the impact of the

intervention

• Can analyze any outcomes included in

the dataset to establish the full value

chain (e.g., change in gap closure,

utilization, and cost)

• Makes the financial savings model

completely client specific

• Provide client specific cost of risk

assumptions that can be used for

future years to run additional

financial savings models

CONS • Highly dependent on the

assumptions of the model

• Difficult to establish that the

intervention caused the outcome

• Labor intensive analysis

• Relies on incurred claims data that

requires claims run-out

• Difficult to establish that the

intervention caused the outcome

• Labor intensive analysis

• Relies on incurred claims data

that requires claims run-out

R O I M E A S U R E M E N T A P P R O A C H E S


EXAMPLES



M E A S U R E M E N T A P P R O A C H – K E Y A S S U M P T I O N S

Number of

wellness

participants

x x = 5,000 1.5 days $400.00 $3,000,000

Absence/Disability/Lost Time

Estimated

reduction in

absentee days

for participants

Average

Daily Wage

Savings

Associated

with

Reduction in

Lost Time

ILLUSTRATIVE EXAMPLE


Number of

Wellness

participants

Participant

change in illness

burden score

Differential in

change in

score vs. non-

participant

Average

Med/Rx

spend

increase with

% shift in

score

Savings

Associated

with impact on

illness burden

score

x x x = 5,000 10% 10% $4,200 $210,000

Health Status – Lifestyle Risk

Number of

Wellness

participants

5,000 x x x

Net Movement in

health risk

Estimated %

savings in

reduction of

risk level

Average

Med/Rx

cost

Savings

Associated

with risk

reduction

Health Status – Illness Burden

+ 2% - 4% $700.00 =



$2,800



Number of

Wellness

participants

% Flu Incidence

Among

Unvaccinated

Working Adults

Estimated

reduction in

absentee days

for participants

Average

Daily Wage

Lost Time

Savings

Associated

with

Incremental

Flu Shots

x x x =

61% Higher Rates of Flu

Vaccinations with Onsite

Delivery

5,000 8% (x .68*)

*Flu Vaccine

Efficacy Rate is 68%

2.8 days**

** Study Results Company Weighted

Average Including

Benefits Load

$444.36 $338,425

Health Care Costs

Estimated

Incremental

Employee Flu

Shots

8% (x .68*) 800 x 2.8 days** x $444.36 x

Differential in

medical/Rx trend

Estimated Lost

Time Saved Per

Flu Case (Days)

Average

Daily Wage

Lost Time

Savings

Associated

with

Incremental

Flu Shots

$54,148

Workers Compensation Claims



=



Number of

wellness

participants

Percent of

voluntary attrition

Estimated projected

turnover in absence

of wellness program

Lost Time

Savings

Associated

with

Incremental

Flu Shots

x x x = 5,000 20% 8%**

** Study Results; benchmark data

$400.00 $32,000

Presenteeism

10% 12** x $444.36 x

Changed in

average health

risks

Estimated % of

lost

productivity

per risk factor

Average

Daily Wage

Savings due to

increased

presenteeism

for wellness

participants

$533 Retention / Attrition

Average

Daily Wage



=



QUESTIONS??T?


Documents

MERCER’S NATIONAL SURVEY OF EMPLOYER-SPONSORED EMPLOYER -SPONSORED ...€¦ · Tobacco Free Living (Cessation and Workplace Policies) –Evaluation •63% of employees who took