Source: Chapman Institute

What is this about?

Employer health benefit costs are headed up again. Estimates range from 6% to 9% or higher annual increases for 2020 renewals.  For larger organizations, a health plan claims analysis of their employee wellness program is certainly desirable.  Yet few wellness professionals know much about how to request a valid health plan claims analysis.  In this edition of Connections, we provide a sample health plan claims analysis request. You can use this document to help prepare your own request. This sample request applies primarily to employers with several thousand employees that are concentrated in a few health plans and have a clear definition that separates “participants” from “non-participants.”

Why is this important?

This Solution Set document is designed to provide a template for your health plan claims request.  It is important because it establishes the technical parameters for the effort and helps contain the analysis to those issues that are relevant.  A critical issue in health plan claims analysis is how very large or catastrophic claims costs are handled.  This issue confounds most of the peer review articles that have been published in the field and creates non-random bias which unfairly prejudices these analyses.  It is not fair to expect a garden variety employee wellness program to have a significant effect on the rare and very large catastrophic claims of employees and family members.  The important econometric assumption recommended here is the use of the conventional attachment points associated with individual stop-loss reinsurance as a way of more fairly adjudicating what claims expense should be included in the analysis.  This becomes even more important when considering the highly skewed distribution of typical employer claims patterns. The analysis needs to be conducted in a reasonable business-based manner in order to appropriately guide business decision-makers.

What can you do with this document?

• First, look the document over to get a sense of how it positions the key technical issues of the health plan claims analysis.
• Next, decide if the proposed position on those technical issues is appropriate for the analytical expectations of your senior managers. (Note: This is where the use of a survey of senior managers such as the one included under Solution Set #1 – Quick Senior Management Survey on Wellness becomes critical.)
• Then, determine which of these technical issues needs to be modified for use in your request and then adapt it to the specifics of your own health plan situation.
• Also, remember that the sub-populations to be studied (“Participants” and “Non-Participants” should each have a minimum size of 1,000 individuals to assure the actuarial credibility of any analytic results. Some actuarial techniques can be used with smaller populations but are limited.
• When you have received the raw data from your health plan, go ahead and do the summary analysis of savings and costs and make the comparison with the total direct cost of your employee wellness program to derive ROI (Return-on-Investment).
• Don’t forget to conduct an analysis that answers the question of whether any other variable or factor could have accounted for the observed change in expected health plan claims cost between participants and non-participants. If no other alternative explanation is identified, then it is reasonable to propose that the attribution of the observed change is likely due to the effects of your employee wellness program.  It is also advisable to look for any intermediate results (i.e., participation, risk prevalence changes, screening results, morbidity changes, etc.) to help establish attribution and to help document the “cause and effect” relationship of your wellness program to employee health plan cost.

In summary, this sample request for a health plan claims analysis can be used to examine the effects of an employee wellness program on an employee’s health plan claims cost experience and is critical in establishing the primary economic effects of the program on a particular workforce

Click here to download this document

NOTE: You will need to have an active WellCert Membership in order to download this document.

I hope this tool helps you reach your wellness programming goals!  Drop me a note and let me know your thoughts and if you found it to be helpful: [email protected].

Source: Chapman Institute

What is this about?

Most of us know that better-integrated wellness programs achieve more results, both the lower and higher-order results from our Results Hierarchy Solution Set (S3). The challenge all employers face is knowing what elements in their wellness program need to be integrated.  This Solution Set document provides a complete list of integration points where your wellness program activity can be linked to other wellness activities and other related organizational activities.  They are divided into “program activities”, “policy positions” and “environmental aspects.” In addition, the most productive Google search string is provided to enable you to acquire actual examples of the integration steps or language involved.

Why is this important?

This Solution Set document is designed to determine how integrated your wellness and well-being programming is and how to improve its degree of integration. Integrating your wellness program usually involves some level of personalization, use of personal information to shape programming, provision of reminders, linkage of messaging, repetition of key messaging, creation of supportive environment including organizational policies and ease of use of programming.  Ultimately a major portion of the potential results of your wellness program will be determined by the degree of integration of your wellness activities.  By using the recommended search string, you can access examples of policies, approaches and messaging that can strengthen the integration of your wellness programming and its effectiveness.

What can you do with this document?

• First, look the document over to get a sense the span of issues that integration addresses
• Next, decide which of these points you feel are adequately addressed now and check the “OK” box.
• Then, determine which of the remaining items need attention and number them in the “OK” box as to how you are going to work on them. (Number “1” is first up, “2” is second-up. etc.)
• Then, slowly work through each one using the search string to get actual examples of each.
• Then, introduce the improvements you come up with.
• Then, perform a follow-up evaluation of the effectiveness of your wellness program on the key results you desire.
• Periodically write up that evaluation and distribute it to key stakeholders.

In summary, this fairly comprehensive listing of integration and linkage points can be used to enhance the overall effectiveness of your employee wellness efforts and provides a useful framework for better integrating your wellness programming efforts.

Click here to download this document

NOTE: You will need to have an active WellCert Membership in order to download this document.

I hope this tool helps you reach your wellness programming goals!  Drop me a note and let me know your thoughts and if you found it to be helpful: [email protected].

Source: Chapman Institute

What is this about?

Another major challenge facing all U.S. employers involves estimating the current organizational cost associated with employees who are at work but have an underlying health problem that impairs their productivity.  Whether it is the effects of cannabis addiction, poor sleep patterns, excessive screen time, a bout of mild depression or a pesky reflux condition, employers need to know how much lost productivity is occurring from health-related causes in their workforce.  Once they know how large the problem is then the opportunity to manage it logically arises. Recent research establishes that presenteeism losses typically amount to 1 to 3 times the cost of health plan coverage for individuals in a workforce.  This translates into between $17,000 and $51,000 per employee per year in lost value from the level of total compensation involved.

Why is this important?

This document is intended to be used to help you estimate the actual value of presenteeism losses associated with your employee’s health problems.  If worksite wellness is to be viewed seriously by senior managers, we need to credibly measure and ultimately reduce the significant economic drain that health problems create for all employers.  Without the ability to consistently track all worker health costs including presenteeism losses, management will likely under-value and under-fund employee wellness efforts.

What can you do with this document?

• First, read the document to get a sense of how presenteeism issues might be addressed.
• Next, decide your position on those issues for your organization.
• Then, determine what interventions you plan on taking and when you should implement them.
• Then, perform a baseline measurement to find out your presenteeism starting point.
• Then, implement your interventions or remedial action to reduce presenteeism losses.
• Then, perform a follow-up measurement to find out the effects of your interventions on your presenteeism losses.
• Periodically write up the evaluation of the effects on your organization and distribute it to key stakeholders.

In summary, this Q & A piece on addressing and measuring presenteeism in your organization provides a useful framework to help move your employee wellness activities to a more strategic and relevant position with your management team.

Click here to download this document

NOTE: You will need to have an active WellCert Membership in order to download this document.

I hope this tool helps you reach your wellness programming goals!  Drop me a note and let me know your thoughts and if you found it to be helpful: [email protected].

Source: Chapman Institute

What is this about?

A major challenge facing all U.S. employers is measuring the current status of their Health and Productivity Management (HPM) and the effects of their employee wellness/well-being intervention efforts over time. Without believable Return-on-Investment (ROI) evidence for their wellness efforts limited investment and priority will likely result.  These resulting “tactical” wellness activities have even been referred to by some as “minimalist” or “zombie” style wellness programs.  Repeating in a lock step manner the same few methodological steps (HRA, screening, lunch and learn events, etc.) resulting in minimal demonstrable effects or effectiveness.

If employee wellness is ever going to become “strategic” or vital to a work organization, it will need to have clear evidence of its positive effect on the organization’s HPM. Measuring employee HPM is how we document the economic evidence or ROI rationale for employee wellness.

The document in this edition of Connections newsletter contains a detailed set of instructions and a worksheet on how to measure current worker health and productivity-related costs of your workforce allowing you to document the Health and Productivity Management (HPM) status associated with your employee wellness/well-being initiative.

Why is this important?

This document is important because it provides a detailed methodology for measuring the economic and productivity effects of workplace wellness initiatives. If senior managers don’t understand or regularly quantify and track these economic metrics, they will usually not devote the resources, time and organizational priority to any activity like wellness programming.  That’s why at least three-quarters of current employer wellness/well-being activity currently conducted in the American workplace is under-funded, overly simplistic and relatively ineffective.  We believe that If we want to change that situation, work organizations will have to quantify their current HPM status and consistently track the effect that wellness activity has on their status.

HPM measurement should not have to adhere to an impossibly high academic standard of proof regarding attribution of causality for wellness but instead needs to meet a reasonable business standard for how we determine what activities benefit our work organizations.  Tracking basic trends over time and examining for plausible alternative explanations for the effects we observe makes much more sense than holding out for randomized controlled trial (RCTs) evidence.  The question is not…”do wellness programs work?” but rather..” how should we do wellness so that it does work for us?”  Also we need to consistently examine the widest possible set of relevant economic and productivity variables in our approach. This needs to include at a minimum, health plan cost, sick leave absenteeism, workers compensation costs, disability insurance costs and presenteeism costs.

We believe this measurement process is absolutely critical to the future of workplace wellness.

What can you do with this document?

• First, read the document to get a sense of what issues are to be measured.
• Next, decide which of those measurement issues are relevant for your organization.
• Then, determine what data sources and time periods you are going to use to derive the metrics.
• Then, perform your baseline measurement to find out your starting point for all the relevant metrics, either prior to the introduction of wellness programming or after its introduction.
• Then, begin a regular process of measurement for all the relevant HPM metrics and use the metrics to help refine the wellness programming that is planned and implemented in each annual cycle of activity.
• Periodically write up the evaluation of the effects of the observed changes in your organization and distribute it to key stakeholders.

In summary, this worksheet and set of instructions for measuring the HPM for your organization provides a pragmatic approach to help you move your employee wellness efforts from a minimalist or “tactical” position to one that considers the wellness initiative as a more “strategic” and organizationally relevant priority by your senior management team.

Click here to download this document

NOTE: You will need to have an active WellCert Membership in order to download this document.

I hope this tool helps you reach your wellness programming goals!  Drop me a note and let me know your thoughts and if you found it to be helpful: [email protected].

Source: Chapman Institute

What is this about?

A major challenge for all U.S. employers is implementing employee wellness programs without triggering any regulatory compliance problems.  Historically, the federal Equal Employment Opportunity Commission (EEOC) has been the main federal agency concerned about the potential for U.S. employers to use their wellness incentive features to discriminate unfairly against various groups of employees.  Much of this concern has turned out to be unfounded but was legitimately stimulated by a few over-zealous employers putting limitations on health benefits coverage for self-imposed health practices, such as smoking or not wearing seat belts or requiring unreasonable health outcomes to secure the incentive reward. The other major regulatory concern for U.S. employers in the wellness space has been the Health Insurance Portability and Accountability Act (HIPAA) and specifically the prevention of unauthorized disclosures of individual health information. Additionally, a few states have somewhat more detailed privacy and confidentiality provisions and a few have some tobacco use protections that apply to employees in their respective states. However, the incentive regulatory issues and the EEOC’s role have been the most problematic for U.S. employers.

The document in this edition of Connections newsletter contains a number of programming recommendations that are intended to completely prevent any potential incentive compliance problem with employee wellness initiatives. 

Why is this important?

This document is important because it provides programming strategies that are intended to virtually eliminate any potential for employee complaints and subsequent compliance problems associated with wellness incentive features.  This has the effect of removing an annoying and potentially risky unknown from the management of employee wellness programs while safeguarding the controversy-free operation of your program.

What can you do with this document?

• First, read it to get a sense of what it calls for from wellness program and incentive management.
• Next, determine which of the recommendations should be included in your program management strategy for the next programming cycle.
• Then, layout which additional recommendations should be incorporated into the wellness program incentive feature over the next couple of years.
• Periodically evaluate the effects of the changes in securing effective and efficient program operations.

In summary, this set of recommendations about wellness incentive design and operation are intended to provide a pragmatic approach to minimizing the potential for employee complaints regarding wellness incentives and significantly reducing the risk of compliance problems with the EEOC.

Click here to download this document

NOTE: You will need to have an active WellCert Membership in order to download this document.

I hope this tool helps you reach your wellness programming goals!  Drop me a note and let me know your thoughts and if you found it to be helpful: [email protected].

Source: American Journal of Health Promotion

What is this about?

A major challenge for all employers is understanding how other employers are approaching employee wellness. National data on employer wellness efforts has been spotty at best. This documents reports on the fifth national randomized, stratified sample of employer wellness efforts that was conducted primarily in 2017 through the federal Centers for Disease Control and Prevention (CDC). This survey reports on a wide range of issues around health promotion and wellness and occupational health in the American workplace and is stratified for employee size, industrial category and state. Additional comparisons are made with the previous national survey conducted in 2004.

Some interesting highlights contained in the survey results include:

• 35,584 employer organizations with 10 or more employees were contacted to complete the survey. (Initial sample)
• 2,843 employers completed the survey (10.1% of the final sample)
• 46% of respondent organizations had worksite wellness programs for employees.
• 72% of respondents had a designated employee managing the wellness program.
• 59% of respondents had an employee advisory committee for the wellness and/or safety program.
• 36% did not have a budget for the wellness program.
• 50% evaluated their wellness program with data.
• 26% of respondents have offered an HRA in the previous 12 months.
• 22% of respondents have offered health screening in the previous 12 months.
• 45% of respondents offer an EAP.
• 53% of respondents offer incentives for wellness.
• 28% used health plan premium discounts as incentives for wellness.
• 58% rated cost of programming as the major challenge to wellness programming.
• 17% of respondents have a “comprehensive health promotion” program according to these 5 elements.
  1. health education programs,
  2. supportive social and physical work organization,
  3. integration of the program into the organization’s structure,
  4. linkage to related programs such as employee assistance programs (EAPs) and
  5. health screening with appropriate follow-up and education. (From DHHS, Healthy People 2010)

Why is this important?

This document is important because it provides many in-depth insights into the current status of health promotion and wellness programming conducted by American employers. These insights provide valid reference and comparison points for employers interested in examining their own employee health improvement efforts. The validity of the survey methodology used in the study allows many useful implications to be drawn from its findings.

What can you do with this document?

• First, familiarize yourself with the issues that are reported from this survey.
• Next, for each of the relevant attributes draw a comparison with your own wellness program for senior management.
• Then, provide a set of recommendations for management about how your wellness program should evolve during the next 2 -3 years.

In summary, this survey can help bring perspective to employee wellness programming efforts by comparing your own efforts with national data on the characteristics of other employer wellness efforts.

Click here to download this document

NOTE: You will need to have an active WellCert Membership in order to download this document.

I hope this tool helps you reach your wellness programming goals!  Drop me a note and let me know your thoughts and if you found it to be helpful: [email protected].

Source: Chapman Institute

What is this about?

A major challenge for all employers is how to align their health plan design so that it supports wise personal health care choices and wellness behaviors.  Historically health plan design has been either agnostic with regard to wellness or in the worst situations, actively in conflict.  We know that rich or generous health plan design leads to higher cost and can undercut wellness and wise plan use choices of employees and their family members.  Issues such as plan type, out-of-pocket cost sharing levels and forms, utilization incentives, health cost management requirements, provider panels and preventive benefit design all have a significant impact on the health effects and cost of health benefit coverage.

The various health plan design features that are addressed in this Solution Set document include:

• Core health plan functions
• Plan Type
• Employee Premium Contribution Level
• Employee Share of Future Plan Increases
• Size of Individual Deductible
• Number of Family Deductibles/year
• Co-insurance rate
• Annual Maximum Out-of-Pocket (Individual) MIOP
• Annual Maximum Out-of-Pocket (Family) MFOP
• Emergency Room Co-pay
• Prescription Drug Cost Sharing (All drugs must be included in a formulary and unusually high-cost drugs must be used under case management oversight.)
• Preventive Medical Benefit Coverage
• Separate Employee Premium Contribution for Wellness Incentive
• Case Management Requirement
• Management and operating principles

Why is this important?

This document is important because it addresses the major elements of health plan design that lead to efficient and effective health care utilization and provide the strongest support for individual employees to engage in wise health consumer and wellness supporting behavior.  My experience with more than a thousand employer wellness programs and benefit re-design projects underscores that the best worksite wellness programs will only produce mediocre results if the health plan involved are not fully aligned and compatible with the wellness behaviors (and attitudes) that the employer wants to promulgate among employees and their family members.    This document is an important resource because it can help you get the most out of your worksite wellness efforts.

What can you do with this document?

• First, familiarize yourself with the issues that are addressed in this Solution Set.
• Next, assess for all these issues the current status of each recommendation for each health plan offered to employees.
• Then, provide a set of recommendations on how each health plan involved can be modified to enhance its alignment with wellness goals and objectives.
• Then, conduct after the modifications are in place for a minimum of 12 months, conduct an evaluation of the effects of the recommendations.

In summary, this Solution Set document can help bring greater effectiveness to employee wellness programming efforts by modifying and aligning health plan design to support the behaviors and attitudes that are embodied in our wellness programming efforts.

Click here to download this document

NOTE: You will need to have an active WellCert Membership in order to download this document.

I hope this tool helps you reach your wellness programming goals!  Drop me a note and let me know your thoughts and if you found it to be helpful: [email protected].