A Message from Our CEO Jerry Noyce

Welcome to the winter, 2013 edition of HERO on Health. This begins the second year of our quarterly newsletter. Our goal is to share information that can help move our field forward. We appreciate your comments on our efforts.  

The author of “Industry Voices” this quarter is Chris Behling, CEO of Mollen Immunization Clinics. He and Rebecca Kelly, Director of Health Promotion & Wellness at the University of Alabama, have co-chaired a joint study committee comprised of thought leading representatives from HERO, ACOEM, American Cancer Society, American Diabetes Association and American Heart Association whose purpose is to develop a guidance paper for employers on planning onsite biometric screening events for their workers as part of a comprehensive employee health management program. In his column, Chris shares an overview of this report to be released later this spring. The work of this Joint Screenings Committee will provide a follow up to the joint consensus document on outcomes-based incentives published in July. We thank the many members of this joint committee for their work on behalf of the industry.  

As you may be aware, the Departments of Health and Human Services, Labor and the Treasury have recently published proposed regulations pertaining to the legislation passed in the Affordable Care Act affecting worksite wellness programs. The departments have asked for comments on certain aspects of the proposed regulations. HERO has submitted our comments, which may be accessed here. 

HERO has been active in research as well. The most recent research study facilitated by HERO and led by Ray Merrill, PhD, Brigham Young University was published in January in JOEM. This study titled “Self-Rated Job Performance and Absenteeism According to Employee Engagement, Health Behaviors, and Physical Health” is a sister study to an earlier study on the same employee population, looking at presenteeism. Both studies are based on self-reported Well-Being Index data provided by Healthways. See the “Research Update” section of the newsletter for more details. 

In late January, we presented a webinar featuring members of a group of organizations in the state of Maine who created an employer-community collaborative model to provide comprehensive wellness programs to very small employers. This webinar, “Small Business Wellness, A Community-Based Approach”, was recorded and is available on our website, www.the-hero.org. This collaborative approach between employers and community health is an example of a growing number of initiatives nationwide Bringing together employers and the community to improve health of employees and the entire community population. We plan to share more examples of such innovative approaches in the future.  

Finally, thank you to Seth Serxner, Chief Wellness Officer for Optum Health for his enlightening commentary “Strategic Planning- a Path to Greater Health Impact” based on data from the HERO EHM Best Practice Scorecard in Collaboration with Mercer. Nearly 900 organizations have now completed a HERO Scorecard at least once which is helping us identify and share self-reported best practices in building program participation, improving employee health and reducing medical costs for companies large, medium and small. 

Industry Voices: Chris Behling

Screenings are not a Product and Health Fairs don’t Work!
It has only been within the past ten years that the biometric screening bandwagon left the station.  In the early days, screenings were often offered as a perceived employee benefit and implemented in association with health fairs.  The goal of these early screenings seemed to be to raise awareness of health concerns, educate employees about their health plan and other benefits, hand out tchotchkes, and demonstrate that the employer cares.  Generally screenings were a “one and done event’” disconnected from any discernible health management strategy.  These health fair screenings generated potentially valuable health data that often walked out the cafeteria door with the employee, rarely resulting in interventions to improve the health of the population.

Unfortunately, all too often, this is still the case.

Screenings are not a product.  They are not a stand-alone event.  They do not, (in and of themselves), improve the health of an employee population.  A health fair does not an employee health management program make.

Instead, screenings are an integral and potentially indispensable part of a comprehensive and integrated employee health management process.  When implemented as part of an overall health management program, biometric screenings allow employers to:

• Identify health risks both for individual employees and across the employee population
• Stratify a population to identify opportunities to improve health while addressing costs
• Structure benefit plan design to address identified risks
• Target health interventions to manage and mitigate identified risks
• Establish a baseline from which improvements can be measured (both individual and group)
• Tailor health management programs to individual employee needs
• Provide data to help motivate employees to take appropriate actions to improve their health
• Identify objective measures upon which incentive programs can be established

Screenings can provide invaluable data and insights that allow employers to implement intervention and incentive strategies to improve the health and well-being of their employees.  But the value of screenings is only unlocked when they are integrated into overall health management strategy.
For the past several months HERO has been leading the development of a Joint Consensus Statement on the appropriate and effective use and implementation of biometric screenings.  The resulting work is a comprehensive review of screening approaches and methods covering topics including what can be screened, appropriate screening methods, key operational and regulatory considerations and best practices for evaluation and incentives. 

HERO is leading the way in pulling (or pushing) the industry toward the appropriate use of screenings where they are positioned not as a standalone event offered in the cafeteria at the annual health fair, but as the start of an ongoing employee health management process that can meaningfully improve the health of employees while reducing overall healthcare costs.

About The Author
Chris Behling is the President of Mollen, a board member and Treasurer of The Care Continuum Alliance and an Executive in Residence at Albion College’s Healthcare Institute.  Chris is focused on transforming healthcare delivery through extending the reach of providers and expanding access to care by providing healthcare services in the most convenient and cost effective ways possible. 
Prior to joining Mollen, Chris was President of Hooper Holmes Health and Wellness. Chris founded the division and grew it to become the largest provider of onsite biometric screenings in the country.  Before entering healthcare services, Chris founded, grew and successfully sold LifeSource Executive Benefits and Insurance Services, a national brokerage agency. 
Chris received his Bachelor of Arts degree from Albion College and a Masters degree in Theological Studies from Harvard Divinity School.
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Scorecard Quarterly Commentary

Strategic Planning – A path to greater health impact

Overview

This brief discussion reviews findings regarding the role of strategic planning as a critical success factor in engaging employees, improving health, and achieving health care cost savings. The HERO Scorecard assesses six broad dimensions of employee health management (EHM) best practices: strategic planning, leadership engagement, program level management, programs, engagement methods and measurement and evaluation.  Each of these sections is scored individually. The highest possible score for all sections combined is 200; the average score for the 747 unique organizations currently in the Scorecard database is 94. A recent analysis of the HERO Scorecard database looked at both respondents’ section scores and individual best practices within each section to gauge their impact on engagement, health improvement, and healthcare savings.  These three measures (engagement, health improvement and healthcare savings) were then analyzed by best practice dimensions.

Strategic Planning Activity

The strategic planning section has 10 items that cover issues such as having a written plan, measures of success, approach for addressing different portions of the population, and whether the planning process is effective or not.  In one of the items 58% of the respondents (n=744) responded that they did not have a formal written strategic plan regarding EHM, about 25% have a multi-year plan and 18% take planning one year at a time.  These findings seem surprising given most business decisions involving significant human capital and financial investment occur within a strategic business planning context.  Why is it that investment in EHM would be any different?  This finding sets the context for another item that indicated that almost half (46%) of the respondents noted they do not think their strategic planning for EHM has been effective.  That may be easily understand in that most organizations indicated they don’t have a plan or they only plan a one year at a time. 

Impact of Strategic Planning on Engagement, Health and Cost Savings

While strategic planning may seem like an obvious element in successful program implementation and outcomes this analysis confirmed a direct relationship between the two. In fact, of the six best practice categories, strategic planning was among the top three factors driving improved health, engagement and healthcare savings.  Strategic planning had the greatest impact on health improvement of all the categories. Eighty-six percent of those who rated their organization as having very effective or effective Strategic Planning reported seeing health improvement, versus only 59% of those who rated their Strategic Planning as not very effective or did not have Strategic Planning at all.  

Additionally, strategic planning had the second strongest impact on engagement following only incentives as having the highest impact on engagement.  Finally, impact on savings is also closely linked to strategic planning with only communications and incentives having stronger relationships.  Overall, strategic planning which in many cases drives the overall strategy for communications, engagement (leadership and program), and programming as well as measures for success is clearly a critical best practice that can often be overlooked in an effort to “get started” and just implement a program.  This analysis supports the importance of the strategic planning process to increase the likelihood of achieving positive program outcomes

 

About the Author

Seth Serxner, PhD, MPH
Chief Health Officer and Senior Vice President of Population Health
OptumHealth Care Solutions. Seth’s deep knowledge of behavior change, population health and measurement allow him to visualize and deliver on program innovation. He has more than 25 years of experience in health and productivity management and has published more than 30 articles.

Seth came to OptumHealth from Mercer’s Total Health Management specialty, where he served as partner and senior consultant for nine years. During his tenure there he established himself as a national expert on behavior change, program design and measurement.

Program Spotlight: Prudential Financial

Interview participant: Andy Crighton, MD 

Link to 2011 Koop Award summary       

HERO:
What have been the keys to your success in creating an effective employee health management program?

Crighton:

There are two things that have given us clarity in our goals and employee health strategy at Prudential. First, we started with a data-driven analysis of not only our results, but of our needs. By using data, including HRA data and claims data, to identify our population’s health risks, we were able to secure leadership commitment and remain committed to driving a culture of health.  

We have also established a clear definition of health that goes beyond the medical side of things to include mental health, financial health, social support and spiritual health. This approach has really resonated with our employees. 

HERO: 

When you look back at your program outcomes, what results or outcomes do you feel are the most significant?  

Crighton: 

A few of the data-driven outcomes that I feel are significant include the risk profile of our population, which has improved significantly since 2008. When we started our health initiative, our low-risk population was only 55 percent of our workforce, last year 79 percent of employees were at low risk. On the back end, we’ve been able to demonstrate cost reductions from our health management program. This then engages the conversation with the leadership and feeds back to employees. 

At Prudential, the goal of our program is not cost reduction. It just happens in part because we talk about a shared responsibility and we tell employees that as they move to a lower risk category, they’ll have lower personal health care costs, lower needs and be able to retire healthier. And who doesn’t want that? 

One of our goals is to maximize performance for our employees, whether they’re at work or at home. This is where the work-life function becomes important. At Prudential, we’ve added HRA questions that get to the heart of how employees manage balance between their lives at work and at home. We look at participation from both an organizational level and a program level. Currently, 62 to 66 percent of employees take the HRA every year and 77 percent take it at least once in a three-year period. I’m also very pleased to say that we’re starting to look at business group outcomes in addition to individual outcomes so we can better understand how we’re affecting the health of the organization as a whole, not just at the individual level. 

HERO: 

What lessons have you learned over the years that you can share with other companies that have made a commitment to improving employee health? 

Crighton: 

There are four very simple things employers can do to improve their employee health outcomes. First, start by understanding your business and the culture of your organization. Make sure, over time that your health management program does not conflict with your values. Second, keep things as simple as possible, while still driving good results. For instance, don’t lead with a complicated incentive plan out of the gate when a more basic approach will accomplish your goals. Third, share your successes and be open and honest about your issues along the way. Employees will become more invested if they’re aware of the challenges you’re trying to address and are able to share in the company’s success. And finally, remember that improving employee health is not something you do to employees, but rather something that you do with them.

HERO Research

HERO Research Study: Health habits tied to absenteeism and job performance

The latest study from HERO indicates that everyday health habits, such as eating healthy and exercising can influence absenteeism and job performance. The study, “Self-Rated Job Performance and Absenteeism” 

According to Employee Engagement, Health Behaviors, and Physical Health,” was published in the January 2013 issue of Journal of Occupational and Environmental Medicine.  

The study was based on findings from self-reported survey data from 20,000 employees at three different companies. Analysis by members of the HERO Research Study Committee, Brigham Young University, and the Center for Health Research at Healthways found better job performance and lower absenteeism for those workers who ate healthily and exercised on a regular basis. In addition, absenteeism was 27 percent lower for those workers.

 

Findings from this study demonstrated that physical health and health risk are important determinants of absenteeism, while work environment is important in determining at-work performance. This study is important in identifying the link between employee health, performance and productivity, and it reinforces the business case for employers who provide a comprehensive, evidence-based health management program for their employees.

 

HERO Research Agenda Announced

Each year, HERO members meet to discuss the current state of health management evidence, the issues that are most important in employers’ minds, and how we can help bring the two together. From this meeting and an in-depth review by our HERO Research Advisory Group, an agenda of research priorities is created. The 2013 HERO Research Agenda is now available for your review  .

HERO Research Partners

Funding for HERO research projects can occur in a variety of ways. In some cases, individual organizations step forward to fund projects that are of particular interest to their company . Such has been the case with Healthways and Kaiser Permanente, who have provided financial support for HERO research.

Other companies who are interested in supporting quality research have joined the HERO Research Partners, which offers a collaborative approach to funding new research. One such study, which focuses on the comparison between organizations that score high on the HERO Scorecard with their actual experience in reducing medical costs and improving the health of their employees, is currently in process. We hope to be able to share the results of that study in our next newsletter . HERO has also begun to seek grant funding from both federal and private foundations.

If your company is interested in learning more about our work, please contact jerry.noyce@the-hero.org.

New Members of the HERO Think Tank

Central Michigan University
Central Michigan University was originally founded as a school for teacher and business education. Today, this doctoral research university is the fourth largest institution in Michigan and among the 100 largest public universities nationally. The University operates a network of CMU Learning Centers in more than 50 locations throughout the United States, Canada and Mexico. cmich.edu

Hennepin County Health Works
HealthWorks is a county work unit that connects employees, their dependents and retirees with wellness programs and services to help them maintain or improve their health. www.hennepin.us/healthworks
Marsh & McLennan Agency (MMA)
MMA  is a wholly owned subsidiary of Marsh, dedicated to serving the insurance needs of middle market companies in the United States. MMA provides public and privately held companies with risk management and employee benefit insight that helps enable them to flourish in the market.  marshmclennanagency.com/

State of Nebraska
The State of Nebraska has a total population of 17,000 employees working in all 93 counties.  The State of Nebraska is one of the first states in the country to provide an innovative health management solution that has produced a 2.70:1 ROI by linking wellness program participation with low premium and value-based medical plan coverage for an eligible population of 14,000 employees, cobra and retirees, in addition to 7,000 spouses.  The integration of our wellness program with a value based Wellness Health Plan has allowed the State to gain these results in a short period.  For further information, view www.wellnessoptions.nebraska.gov.

Schwan’s Food Company
From home to stores, restaurants and more, our products are everywhere you eat. The Schwan Food Company is a multibillion-dollar private company with approximately 15,000 subsidiary employees in the United States. Based out of Minnesota, Schwan’s sells fine, branded frozen food through home delivery, the foodservice industry and grocery stores in North America. www.schwans.com

VAL Health
VAL Health is a leading behavioral economics consulting firm. Val Health develops health-related incentive solutions to increase user engagement and improve health behavior, outcomes and the value of spending on health. www.valhealth.com

HERO Happenings

Winter Think Tank Roundtable: 
February12 -13, 2013, Westin Airport, Atlanta, GA
(For HERO Members Only)
Featured Discussion Leaders:
Behavior Modification, Dr. Kevin Volpp, VAL Health
Creating a High Performing Workplace, Josh Glynn, Google and Jack Groppel, Prevention & Wellness
Influencing Culture Through Organization Change,  John Riedel, Riedel & Associates
Legal and Political Landscape, Tami Simon, Buck Consulting

It is not too late to attend. Please contact the HERO Office (952) 835-4257 if you plan to join us.  
To reserve a room visit the Westin Reservation page

Fall Think Tank Roundtable:  September 23, 2013, Hilton at Walt Disney World, Lake Buena Vista, FL.

Recent additions to the HERO library:
Conversation with Bill Pierce. Review the slides from this members-only webinar. (Login required)
Become an Organization in Motion: Investigating the Organizational Impact of Strategic Movement throughout the Workday by Jack Groppel PhD and Joe Alexander. Read the full article (login required)

HERO Forum 13 for Employee Health Management Solutions:
September 24- 26, 2013, Hilton at Walt Disney World, Lake Buena Vista, FL

Scorecard News:
The HERO EHM Best Practices Scorecard in Collaboration with Mercer Preferred Provider program, piloted in 2010 and launched in 2011, helps extend the Scorecard's reach.  The Scorecard Preferred Provider companies have custom links on their websites through which their clients can enter their Scorecard responses. Those responses are then housed in the Preferred Provider’s module of the Scorecard database, allowing the Preferred Provider to do analysis on the responses of their group along with comparisons with the entire Scorecard database. Preferred Providers through their encouragement to their clients, has helped the HERO Scorecard grow in visibility and in size of its database.  The database now exceeds 800 employers with representation from large, midsize and small organizations.  The current members of the Scorecard Preferred Providers network are: Alere, Capital BlueCross, HealthyFit, Healthyroads, Kaiser Permanente, Mayo Clinic, Mercer, Noridian Mutual Insurance Company and StayWell Health Management.

Learn more about the Scorecard and Preferred Provider program in the HERO Scorecard 2012 Annual Report.