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©2009 Medical Mutual of Ohio
Medical Mutual Employee Wellness Program:
Implementation and Results
June 8, 2011
©2009 Medical Mutual of Ohio
22
Purpose and Mission
Fundamental purpose:
Improve the health and productivity of our population by modifying lifestyle behaviors that negatively impact well-being
Medical Mutual Program Mission:
“To provide the means and opportunities for employees to reach and maintain their best possible well-being”
©2009 Medical Mutual of Ohio
33
Medical Mutual’s Employee
Program
Makes a strong commitment to wellness ensuring that Medical Mutual
will meet and exceed strategic goals:
Keep our healthy employees healthy
Reduce the risks of the medium and high-risk employees
Positively impact healthcare cost/trend
Enliven and rejuvenate our corporate culture
©2009 Medical Mutual of Ohio
44
Employee Program Direction
Shift in Focus…
From: Basic Awareness and Program Participation
To: Concrete, Measurable Outcomes
– Reduction in employee health risk
– Economic Analysis
©2009 Medical Mutual of Ohio
5
Company Demographics
•Approx. 2700 employees •Years of Service: Less than 5= 32%
•75% Female; 25% Male Over 5= 68%
Over 10= 51%
Over 20= 25%
Employee Breakdown by Age
0%
5%
10%
15%
20%
25%
30%
35%
20-29 Year
Old
30-39 Years
Old
40-49 Years
Old
50-59 Years
Old
60-64 Years
Old
Over 65
Years Old
Employee Breakdown by Age
0%
5%
10%
15%
20%
25%
30%
35%
20-29 Year
Old
30-39 Years
Old
40-49 Years
Old
50-59 Years
Old
60-64 Years
Old
Over 65
Years Old
©2009 Medical Mutual of Ohio
66
Medical Mutual’s
Program Timeline
•Corporate Wellness
Proposal approved
by executive team
•Full implementation
of health promotion
practices into day-to-
day operations
•First Health
Assessment (HA)
•Walking for Wellness
•Weight Watchers
•Onsite Health
Screenings
•Onsite Immunizations
•Enhanced employee
preventive benefits
•Toledo Wellness
Center Opening
•Roll-out of
REWARDS program
•Lunch and Learn
Seminars
•Smoking Cessation
Program
•Annual employee
wellness survey
•Nurse Line
•Cleveland Cafeteria
Grand Opening –
healthy menu choices
•Web-based Healthy
Living Programs
•Cleveland Wellness
Center Opening
•Education Modules
•Health club
membership
reimbursement
•Recipient of NBGH
Platinum Award and
Local Healthy 50
Award
• Transition from
gift incentives to
healthcare premium
discount
2003 2004 2005 2006
©2009 Medical Mutual of Ohio
77
Medical Mutual’s
Program Timeline
•Onsite Mammography
Screening
•Pilot Program: Onsite
BP Machines
•Employee Assistance
Program Integration
•HA and HLPs Made
Available to Non-
Insured Employees
•Incentive Options
Added to REWARDS
Program
•HR Dept. Includes
Wellness Initiative in
Company Survey
•Continual
Programming
Analysis/Evaluation
•Weight Loss
Challenge
•Cooking
Demonstrations
•ROI Calculation
•Measurement of
Obesity in the
Population
•Rollout of Incentive
Tracking and
Fulfillment Program
•Expansion of
Employee Preventive
Benefits
•Incentives for
Preventive Care
•Implementation of New
Fitness Center
Management Team
•Implementation of
Telephonic/Online
Lifestyle Coaching
•Fresh Produce Home
Delivery Program
•Rollout of SuperWell for
Life Web site
•Analysis of Cafeteria
Food Purchases
•Benchmarking with
NBGH and HERO
20092007 2008 2010•SuperLoser Weight
Loss Challenge
•C. Everett Koop Award
•Amer. Heart Assoc. Fit
Company Award
•Rollout of Onsite
Hypertension Pilot
•Quarterly Fitness
Contests through
Wellness Centers
•SuperWell for Life Web
site Enhancements
•Program Evaluation
against Industry
Benchmarks
•Smoking Surcharge
Implemented
©2009 Medical Mutual of Ohio
8
Wellness Program Offerings
Health Promotion
Health Assessment-400
Onsite Health Screening-300
Goal Getter Program-300
Flu Immunization-100
Dental Visit-50
Preventive Care Visit-50
Quarterly BP/ Weight Clinics-75
Healthy Habits
Weight Watchers-120
QuitLine Program-120
Chiricosta SupeLoser Challenge-150
The Chef’s Garden Purchase-50
Lifestyle Coaching-100
Disease Management Program-100
Fitness
Join Company Fitness Center-50
Join Community Fitness Center-50
Company Fitness Center Check-in-120
Quarterly Fitness Center Contests-40
Fitness Evaluation-150
Physical Activity Cardio Log-120
Walking Program-160
Company Sponsored Fitness Walks-25
Community Fitness Event Participation-25
Education
Education Modules/Quiz-120
Virtual Health Guides-100
Lunch & Learn Seminars-240
Healthy Environment/Culture
Tobacco Free Campus
Healthy Cafeteria/Vending/Catering Options
Accessible Stairwells
Coordination with Employee Assistance Program
Wellness Integrated into Orientation Sessions
Visibility/ Accessibility of Wellness Team and Program
Comprehensive and Multi-Modal Communications
Executive Team Communications
Point System allows us to heavily weight programs that we feel are most
important for employees to utilize.
©2009 Medical Mutual of Ohio
9
Employee Wellness Site
©2009 Medical Mutual of Ohio
Participation Results
©2009 Medical Mutual of Ohio
11
Participation Analysis: Annual Growth
76 %8 1% 8 1%
8 7%
75%
8 6 %9 2 % 9 2 %
9 8 %
0
9 4 %9 1%
8 3 %
9 2 %
6 8 %
79 %73 %
8 2 %
6 1% 6 2 %6 9 %
4 9 %
57%
0 %
2 0 %
4 0 %
6 0 %
8 0 %
10 0 %
12 0 %
2005
(N=2,549)
2006
(N=2,577)
2007
(N=2,500)
2008
(N=2,928)
2009
(N=2,835)
2005-2009
(N=1,813)
Yearly Participation Cumulative Participation 2+ Time Participants
3+ Time Participants 4+ Time Participants
©2009 Medical Mutual of Ohio
12
Participation: Employee Healthcare Costs
By Rewards Points Earned
$ 4,520
$ 2,107
$ 4,177
$ 2,290
$ 4,565
$ 3,009
$ 4,592
$ 3,129
$1,000
$1,500
$2,000
$2,500
$3,000
$3,500
$4,000
$4,500
$5,000
2005 2006 2007 2008 2009
0-2000 (N=257)
2000-3999 (N=242)
4000-5999 (N=244)
6000 + (N=954)
Average Annual
Healthcare Costs Increase
$ %
$581 28%
$465 20%
$415 14%
$320 10%
•There is a strong correlation between participation intensity and averaged
annual healthcare cost increases
Cla
ims
Pa
yo
ut
Pe
r E
mp
loye
e
Points
©2009 Medical Mutual of Ohio
13
Participation: Average Lost Workdays by
Rewards Points Earned
2.24
1.36
3.09
0.95
1.88
1.38
2.28
1.7
0.0
0.5
1.0
1.5
2.0
2.5
3.0
2005 2006 2007 2008 2009
0-2000 (N=257)
2000-3999 (N=242)
4000-5999 (N=244)
6000 + (N=954)
Average Annual Lost
Workday Increases
Days %
0.26 19%
0.49 51%
0.17 13%
0.18 11%
• Fewer clean trends in lost workdays associated with program involvement.
• Those earning greater than 4,000 points show less lost workday increases
as compared with those earning less than 4,000 points.
Points
Lo
st
Wo
rkd
ays
©2009 Medical Mutual of Ohio
14
Wellness Points/T1, T2 Risk Status
Time One Risk Status
Time Two Risk Status
Wellness Rewards Points
(Cumulated 2005 ~ 2009)
N Average
0-2 0-2 871 8,801
3-4 112 8,037
5+ 15 7,659
3-4 0-2 188 8,953
3-4 223 8,503
5+ 39 7,023
5+ 0-2 20 7,442
3-4 78 8,684
5+ 86 6,905
Among two time HRA Participants (2005/2006 vs. 2007/2008), N=1,632
©2009 Medical Mutual of Ohio
15
Participation Analysis
• Program participation remains high, with a cumulative participation of 98%
• Repeat participation was especially high, with 94% of employees participating at least two years from 2005 through 2009.
• In 2009, 75% of employees took part in at least one program.
• Strong correlation between participation and averaged annual healthcare cost increases.
• Correlation between participation and remaining low risk or moving to lower risk from T1 to T2 HRA.
©2009 Medical Mutual of Ohio
Risk Analysis and Economic Results
©2009 Medical Mutual of Ohio
1717
Risk Analysis:
Shift in Risk Groups
Risk 2004/2005 2007/2008 2009/2010 % Change
Low Risk
(0-2)61.1% 66.1% 68% 6.9%
Medium Risk
(3-4)27.6% 25.3% 23.4% 4.2%
High Risk
(5+)11.3% 8.6% 8.6% 2.7%
©2009 Medical Mutual of Ohio
1818
Risk Analysis: Shift in Risk Measures
Time 1 High Risk %
Time 2 High Risk %
Net Change % Point*
Physical Activity 13.4% 8.7% -4.7%
Safety Belt Use 12.7% 10.4% -2.3%
Life Satisfaction 5.8% 3.8% -2.0%
Smoking 8.4% 6.6% -1.8%
Job Satisfaction 5.5% 4.4% -1.1%
Medication to Relax 0.9% 0.5% -0.4%
Alcohol 1.4% 1.1% -0.3%
Perceived Health 8.6% 8.3% -0.3%
Illness Days 3.4% 4.4% 0.9%
Existing Disease 12.9% 14.0% 1.1%
Cholesterol 5.4% 7.3% +1.9%
Blood Pressure 34.1% 36.5% +2.4%
Weight (BMI) 48.3% 51.3% +3.0%
•While improvement is evident in several measures, there is still a negative shift in cholesterol (+1.9%), blood pressure (+2.4%) and weight/BMI (+3.0%).
Targeted for Intervention
©2009 Medical Mutual of Ohio
19
Risk Analysis :
Impact of Risk Categories on Medical Cost
MED/HIGH RISK
Medical Costs
$6965
LOW RISK
Medical Costs
$2,879
MED/HIGH RISK
Medical Costs
$9180
+$2215 -$1522
LOW RISK
Medical Costs
$5543
MED/HIGH RISK
Medical Costs
$6314
LOW RISK
Medical Costs
$3502
+$3435 +$623
N=1,599; MMO Employees
2008 Healthcare
Costs
2009 Healthcare
Costs
©2009 Medical Mutual of Ohio
20
Excess Medical Cost Due to Excess
Risk Status
$ 3,489 $ 3,489 $ 3,489
$ 1,020
$ 9,090
$ 4,509
$ 6,994
$ 12,579
$ 3,489
$ 3,505
$ 0
$ 2,000
$ 4,000
$ 6,000
$ 8,000
$ 10,000
$ 12,000
$ 14,000
Lo w R isk
(0-2 R isks)
N o n P art icipants M edium R isk
(3-4 R isks)
H igh R isk
(5+ R isks)
Number of Risks
M
e
d
i
c
a
l
C
o
s
t
s
Excess C o st
B ase C o st
*2010 HRA and 2009 Medical Costs
©2009 Medical Mutual of Ohio
21
Excess Lost Work Days Due to
Excess Risk Status
1.8 1.8 1.8
1.7
4.33.5
4.6
6.1
1.8
2.9
0.0
1.0
2.0
3.0
4.0
5.0
6.0
7.0
8.0
9.0
10.0
Low Risk
(0-2 Risks)
Non Participants Medium Risk
(3-4 Risks)
High Risk
(5+ Risks)
Number of Risks
S
T
D
D
a
y
s
Base Cost Excess Cost
©2009 Medical Mutual of Ohio
22
Healthcare Cost/T1, T2 Risk Status
Time One
Risk Status
Time Two
Risk
Status
N
Average Annual Healthcare Paid
2005 2006 2007 2008 2009
Average
05-09
0-2
0-2 871 $2,070 $2,717 $2,558 $2,936 $3,687 $2,794
3-4 112 $2,348 $4,041 $4,566 $3,716 $4,467 $3,828
5+ 15 $6,495 $4,921 $6,696 $5,580 $5,309 $5,800
3-4
0-2 188 $2,956 $2,828 $3,080 $3,369 $3,721 $3,191
3-4 223 $3,777 $3,625 $4,046 $3,724 $5,132 $4,061
5+ 39 $2,900 $3,985 $6,276 $5,977 $5,728 $4,973
5+
0-2 20 $2,510 $2,734 $5,453 $2,869 $4,593 $3,632
3-4 78 $6,536 $7,560 $7,201 $7,520 $9,583 $7,680
5+ 86 $5,555 $6,958 $7,144 $8,455 $11,905 $8,003
Among two time HRA Participants (2005/2006 vs. 2007/2008), N=1,632
©2009 Medical Mutual of Ohio
23
Lost Work Days/T1,T2 Risk Status
Time One
Risk Status
Time Two
Risk Status N
Average Work Lost Days (STD)
2005 2006 2007 2008 2009
Average
05-09
0-2
0-2746 0.86 0.67 1.18 1.08 1.85 1.13
3-4103 0.54 2.24 3.17 2.54 2.50 2.20
5+ 13 8.85 0.00 1.37 0.00 3.20 2.68
3-4
0-2162 2.66 0.56 0.71 1.74 2.41 1.62
3-4194 2.20 0.88 2.36 2.15 2.94 2.11
5+ 36 0.00 0.89 3.87 4.86 3.92 2.71
5+
0-218 2.56 2.00 2.14 0.00 1.05 1.55
3-471 3.39 2.66 6.32 5.56 4.42 4.47
5+ 72 4.07 5.79 10.26 4.64 8.41 6.63
Among two time HRA Participants (2005/2006 vs. 2007/2008), excluding women with pregnancy claims N=1,415
©2009 Medical Mutual of Ohio
24
Excess Cost by Risk/Condition
Risk Factor/
Disease StatePrevalence
Adjusted* Mean
At RiskNot
at Risk
Excess
Cost
Hypertension 37.4% $3,733 $3,387 $346
Cholesterol >=240 6.4% $3,578 $3,523 $55
Obesity (BMI>=30) 37.1% $4,757 $3,511 $1,246
Diabetes 6.8% $10,115 $3,524 $6,591
Coronary Artery Disease 6.2% $6,087 $3,827 $2,260
Asthma 11.4% $4,516 $3,899 $617
Smoking 6.1% $3,517 $3,429 $88
Depression 11.7% $5,641 $3,755 $1,886
None of the listed risks 28.6% $2,633
*Adjusted for age, gender and all listed risks
Study population: N=2,047 (2009 HRA and 2009 Medical and Drug Paid Amount)
©2009 Medical Mutual of Ohio
25
Studying Relationships…
•BMI and Lost Workdays
•BMI and Healthcare Costs
Then Developing Strategic Initiatives
©2009 Medical Mutual of Ohio
26
1.56 1.49 1.17
2.18
3.16
4.5
0
1
2
3
4
5
<25
(N=355)
25-27.4
(N=216)
27.4-
29.9
(N=197)
30-34.5
(N=270)
35-39.9
(N=187)
40+
(N=144)
BMI
Day
s
Obese (BMI >30)
BMI vs. Lost Workdays
©2009 Medical Mutual of Ohio
27
$3,290 $3,227 $3,094
$4,113
$5,374
$6,871
$0
$1,0 0 0
$2 ,0 0 0
$3 ,0 0 0
$4 ,0 0 0
$5,0 0 0
$6 ,0 0 0
$7,0 0 0
$8 ,0 0 0
<25
(N=355)
25-27.4
(N=216)
27.4-
29.9
(N=197)
30-34.5
(N=270)
35-39.9
(N=187)
40+
(N=144)
B M I
Pai
d A
mo
un
t
Obese (BMI >30)
BMI vs. Healthcare Costs
©2009 Medical Mutual of Ohio
28
BMI Initiatives
Chiricosta Challenge
• Six-Month Weight Loss/Get Healthier Challenge
• CEO Endorsement and Ownership of Program
• CEO Blogs and Communications
• 1400 Participants
• 6500 Pounds Lost
©2009 Medical Mutual of Ohio
29
BMI Initiatives (cont’d)• Fitness Center Reimbursements
• Onsite Fitness Facility Check-in Points
• Onsite or Community Facility Membership Points
• Fitness Center Contests
• Cardio Log Entry Points
• Walking Program
• Company Sponsored Fitness Walks
• Lunch and Learn Seminars
• Education Modules
• Healthy Choices: Cafeteria, Vending, Catering, Company Meetings
• Cafeteria Promotions, Educational Displays
• Healthy Cooking Demos
©2009 Medical Mutual of Ohio
Benchmarking –
How are we doing against national standards?
©2009 Medical Mutual of Ohio
3131
Health Enhancement Research
Organization
HERO Scorecard Results
The scorecard is a tool designed to determine employee health management best practice. It can be used as an inventory, an indicator for program success and as a benchmarking tool.
"The greatest value of the Scorecard is in providing an inventory of EHM best practices for consideration; your scores provide an indication of where you can identify opportunities to enhance your program."
2008 2009
Medical Mutual of Ohio Score 147 162
Total possible points: 200
National Average: 96
©2009 Medical Mutual of Ohio
3232
National Business Group on Health
Wellness Impact Scorecard
The scorecard was developed to assist employers in understanding levels of achievement in improving health, the strengths and weaknesses of their programs and to help them benchmark against the programs of other employers.
Overall Progress
Total Potential
Points
MMO’s Score
2008 2009
Company’s Efforts to Improve Health (Level 1) 50 43 50
Employee Engagement (Level 2) 50 39 50
Outcomes and Analysis (Level 3) 100 75 87.5
Total 200 157 187.5
©2009 Medical Mutual of Ohio
3333
Cultural Analysis:
Impact of Wellness Program
Wellness Program Survey Results
– 94% of employees surveyed feel that the Wellness programs are making a positive impact on the culture at MMO.
– 90% of employees surveyed feel that the Wellness programs are making a positive impact on their health.
– 82% of employees responded that they are very satisfied or satisfied with the Wellness program.
©2009 Medical Mutual of Ohio
Executive Summary and Analysis
©2009 Medical Mutual of Ohio
3535
• Participation in the wellness program showed a positive impact on healthcare cost trends for three consecutive study periods.
• The low risk population continues to grow, a key achievement in our health management strategies.
• Employees who earned more reward points had smaller healthcare cost increases and smaller lost workday increases than those who earned less points.
• In general, an increased participation level (years of participation or number of wellness points) was associated with an increase in the percentage of individuals at low risk.
• The wellness program had the most impact on percent risk reduction for those employees with risk factors for: physical activity, safety belt use, life satisfaction and smoking.
• The number of employees at risk for weight (BMI), blood pressure, and elevated cholesterol increased over time and will remain a focus of programming and interventions.
Executive Summary and Analysis
©2009 Medical Mutual of Ohio
36
Future of Wellness/Next Practices…
1. Focus on the individual and how to impact:
Personal buy-in and personal significance of change in health status
Sustainable behavior
Health in the context of life
2. Moving the general public to healthier lifestyles
Employer involvement in community health
Role of the community in employee/family health
Health as a social trend; social “movement”
3. Standardization of program offerings, measurement, evaluation and performance metrics
4. Continued focus on the influence and impact of corporate culture