creating a culture of health – putting theory into practice joyce young, md, mph

© 2009 IBM Corporation

Creating a Culture of Health – Putting Theory into Practice

Joyce Young, MD, MPH

April 7, 2010


IBM Integrated Health Services

April 2010

Key Components of Strategy

Commitment to Quality & Prevention

Commitment to Quality & Prevention

Voice for Health Care Reform

Voice for Health Care Reform

Employee-centeredEmployee-centered

Foundation inPrevention & Primary

Care

Foundation inPrevention & Primary

Care

FOCUS ON PREVENTION AND VALUE IN MEDICAL CARE

FOCUS ON PREVENTION AND VALUE IN MEDICAL CARE

EMPLOYEE-CENTERED INVESTMENT

EMPLOYEE-CENTERED INVESTMENT

• One no-contribution medical and dental option

• “Per-person” pricing for dependents

• Preserve access and choice• “No coverage” cash back

• Free coverage for primary care and preventive care

• Aggressive support for chronic illness

• Personalized electronic health management tools, content, and Personal Health Record

INCENTIVES FOR HEALTHY LIVING PROGRAM

INCENTIVES FOR HEALTHY LIVING PROGRAM

HEALTH CARE REFORM

HEALTH CARE REFORM

Option to earn $300 in cash rebates for completing two programs:

• Personal vitality program• Physical activity or nutrition

program• Children’s healthy weight

program

• Building quality into medical plans/provider relationships

• Leader for Patient-Centered Primary Care & Medical Home

• HIT, clinical decision support and administrative efficiency



April 2010

The Wellness Program Continuum

Healthy Workplace

Environment

Integration Strategic Outcome Focused

Programming

Evaluation

Les

s C

om

pre

he

nsi

ve

Mo

re

Co

mp

reh

en

sive

Health Risk Assessment

Employee Education & Awareness



April 2010

Wellness for Life Center



April 2010

EVOLUTION OF THE IBM HEALTHY LIVING REBATE PROGRAMS

2003 / 2004 / 2005 2006 2007 2008 / 2009 2010

Non-Smokers Discount:

$11/mo. premium discount

Not smoking or smoking cessation program

Physical Activity Rebate:

$150 cash rebate 20 min. 3 days/wk for 10

out of 12 weeks Log activity on Virtual

Fitness Center

Smoke-Free Rebate:

$150 cash rebate

Preventive Care Rebate:

$150 cash rebate Complete online HRA Set action dates for

preventive screenings & risk reduction activities

Review hospital quality using Web-based resources

Physical Activity Rebate:

$150 cash rebate 30 min. 4 days/wk for 10 out

of 12 weeks Or, 30 min. 2 days/wk for 10

out of 12 weeks, plus Web-based coaching

Log activity on Virtual Fitness Center

New Hire Smoke-Free Rebate:

$150 cash rebate Not smoking or smoking

cessation program


$150 cash rebate Complete online HRA Confirm completion of

overdue screenings Begin or update online Personal Health Record

Physical Activity-Nutrition Rebate:

$150 cash rebate 12-wk online nutrition or weight

management on Virtual Food Pro

Or, logging-free physical activity program with self-tests and online interaction with fitness pro

Or, same physical activity logging options from 2006 on Virtual Fitness Center

New Hire Smoke-Free Rebate:

$150 cash rebate Not smoking or smoking

cessation program

Children’s Health Rebate:

$150 cash rebate Complete family inventory of

healthy weight behaviors Set family action goals Repeat family inventory at 12

weeks to identify successes


$150 cash rebate Complete online HRA Confirm completion of

overdue screenings Use online Health Optimizers

for individualized support


$150 cash rebate Complete a Personal

Outcomes Assessment 12-wk online nutrition or weight

management on Virtual Food Pro

Or, logging-free physical activity program with self- tests and online interaction with fitness pro

Or, 30 min. 3 days/wk for 10 out of 12 weeks logged on Virtual Fitness Center

New Hire Healthy Living Rebate:

$150 cash rebate Complete online HRA Begin use of online Personal

Health Record Register on Wellness for Life

Web site

Personal Vitality Rebate:

$150 cash rebate Personal Vitality

& Energy Assessment Complete 3 vitality-building

practices over 12 weeks Re-assess Personal

Vitality & Energy

Children’s Health Rebate:

$150 cash rebate Complete Family Meal Analysis,

create action plan, & choose action tools

Check-in-mid-way to adjust action plan

Evaluate achievements after 12 weeks


$150 cash rebate Complete a Personal Outcomes

Assessment 12-wk online nutrition or

weight management on Virtual Food Pro Or, logging-free physical activity

program with self-tests and online interaction with fitness pro

Or, 30 min. 3 days/wk for 10 out of 12 weeks logged

on Virtual Fitness Center

New Hire Healthy Living Rebate:

$150 cash rebate Complete online HRA Begin use of online

Personal Health Record Register on Wellness for Life

Web site Indicates yearly changes made to the programs

Healthy Living Rebate Evolution



April 2010

Virtual Fitness Center



April 2010

Virtual Fitness Center (continued)



April 2010

Virtual Food Pro



April 2010

Children’s Health Rebate



April 2010

Overview of Outcomes 2003 – 2008

Program Outcomes

Non-Smokers1 Up 2%

Adequate Physical Activity (3x/wk)

2 Up 28%

BMI < 27.52 Up 3%

Low Risk2 Up 23%

Health Care Costs3

Participants’ HC Cost Increases 19% Less than Non-

Participants’

Current Employee Population

Health Behaviors

% Non-Smokers1 90%

% Adequate Physical Activity (3x/wk)

2 76%

% BMI < 27.52 65%

% Low to Medium Stress2 76%

% Low Risk2 68%

1 Based on smoking status designations during annual benefits enrollment (2003-2005).

2 Based on 336K HRAs completed by 121K employees 2004-2008.

3 Based on UMich analysis of 2003-2005 health care claims for rebate program participants vs non-participants

(JOEM Nov 2008).



April 2010

IBM Population Risk Has Moved to Improved Health

2005 2006 2007 20084 Year Total

Est. savings between IBM health risk improvement &

expected cost increase with no risk improvement*

$12M $29M $38M $33M$112M Total

Wellness programs have had a dramatic impact on the health of our employees 2004 to 2008

High health risk population reduced 59% Low health risk population increased 23%

Reduction in health risks translates into savings in health claims costs compared to expected trends with no wellness interventions

$112M estimated savings for 2005 to 2008 period

2004 - 2008 Health Risk Assessment Participation

68.4%68.3%64.8%59.2%

55.4%

26.3%26.0%28.7%30.2%31.8%

5.3%6.5%10.6% 5.7%12.8%

0%

20%

40%

60%

80%

100%

2004 2005 2006 2007 2008

% o

f A

ll H

RA

Part

icip

an

ts

High Risk (4+ risks)

Medium Risk (2-3 risks)

Low Risk (0-1 risk)

Estimated Healthcare Savings 2005-2008from Improved Employee Health Risk Profile

$112M

$0

$20

$40

$60

$80

$100

$120

2004 2005 2006 2007 2008Cu

mu

lati

ve E

stim

ated

Sav

ing

s in

IBM

Med

& R

x P

aid

Cla

ims

($M

s)

*Expected risk increase with no intervention based on Edington (2001) AJHP 15(5):341-349.



April 2010

The New Face of Wellness

Reaping the Benefits Now



April 2010

The Personal Vitality Rebate

The new Personal Vitality Rebate is designed to help employees build energy, vitality, and optimal health by using simple techniques

that boost personal energy and enhance vitality.

Employee Actions

Build Personal Vitality and Energy Profile to understand current energy and vitality levels

Use 3 Energy Building Practices to optimize personal energy and vitality over 12 weeks

Rebuild Personal Vitality and Energy Profile after 12 weeks to assess achievements in energy management, and recognize impacts on personal health and vitality



April 2010

How do you build vitality?



April 2010

Personal Vitality Rebate: Dimensions



April 2010

Personal Vitality Rebate

Practice 1 (4 weeks)

Personal Vitality & Energy Assessment

(week 1)



Personal Vitality & Energy Re-Assessment

(week 12)

Evaluate current vitality & energy levels

Select techniques for optimizing energy & vitality

in the 4 dimensions

Reassess vitality & reflect on any changes to

personal energy & health

I usually wake up feeling refreshed.

PhysicalMental

EmotionalValues

I typically have the energy to do the things I want when I get home

from work.



April 2010

Personal Vitality Rebate: Energy Profile T1



April 2010

Personal Vitality Rebate: Practices



April 2010

Example Practice: Daily Oscillation



April 2010

Personal Vitality Rebate: Energy Profile T2



April 2010

The Wellness Program Continuum

Healthy Workplace

Environment

Integration Strategic Outcome Focused

Programming

Evaluation

Les

s C

om

pre

he

nsi

ve

Mo

re

Co

mp

reh

en

sive





April 2010

Good starting place Prepares employees for more impact-focused interventions Inexpensive

Makes Wellness intentions visible Sets an example Includes policies for tobacco, food and flex time supporting non-smoking,

weight management & physical activity

Raises personal awareness Identifies specific options for individual improvement Provides aggregated data that characterizes workforce health status May assist participants in making positive health behavior changes

Key Learnings


Healthy Workplace Environment




April 2010

Health plan interface Overall health benefit and employee well-being strategy

Define purpose and strategy Develop & implement effective program management Fund for meaningful impact Implement effective health risk reducing interventions

Evaluate for outcomes– Levels of:

• Participation• Behavior change• Risk reduction• Health cost impact• User satisfaction

Key Learnings (continued)

Integration

Strategic Outcome-Focused Programming

Evaluation



April 2010

• Provide proven wellness and prevention strategies that help employees:- maintain good health and resilience - reduce lifestyle related health risks - encourage utilization of valid clinical preventive health services- support the management of chronic conditions

• Facilitate workplace environments that are:- smoke free, safe and ergonomically sound - support physical activity and other healthy lifestyle practices - where food is provided, offer and promote options for healthy

food choices

• Incorporate methodology that generates data sufficient to determine outcomes and measure program performance

• Ensure protection of personal health information and support for IBM’s position on nondiscrimination in the workplace

• Leverage health information technology to facilitate: - behavior change

- health literacy - health consumerism

GLOBAL WELLNESS GUIDING PRINCIPLES



April 2010

Summary: The Experience of Early Adopters

Start with what you have & prepare for a long run

Use continuous improvement to advance program and increase impact

creating a culture of health – putting theory into practice joyce young, md, mph

Documents