"Culture Makes a Difference" presented by Lindsey Magnus, Cigna, during Winter 2013 NCLGBA Conference.

1. CULTURE
MAKES A
DIFFERENCE
Creating a culture of well-being: A long term strategy for cost savings

2. panelist
Lindsey Mangus – Health Promotion Specialist for the
Carolinas of Cigna Health Services
Ben Buchanan – Product Manager, Corporate Health &
Wellness of Carolinas Health System
Christie Dean – Wellness Coordinator of Mecklenburg
County Government
Cheryl Walker – Health & Benefits Manager of the City
of Asheville, NC
2

3. why does better
health matter in
the workplace?
Healthier workforce
__
Lower benefit costs
__

employee retention

sick days
__ Better
__ Fewer

__ Higher productivity
Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2012 Cigna
3

4. cost savings of healthier individuals
• Fewer smokers
• Fewer heart attacks
Potential savings
per individual health
improvement
$1,623
$5,176
• Employees who reverse their
risk for metabolic syndrome
$3,200
• Employees bringing BMI to
a healthy range
2
$952
• Employees having
cardiovascular diseases
and bringing their stress
under control
1
$393
3
1
1
Organizations with highly effective Health and Well-Being programs.
1.Cigna Internal Analysis and Proof Points 2.Cardiovascular Even Average Monthly Cost: Milliman’s review of MedStat MarketScan TM Commercial Data 2004 Trended to 2006, Metabolic Syndrome
and Employer Sponsored Benefits, An Actuarial Analysis, Milliman, March 2006. 3. Metabolic Syndrom and Employer Sponsored Benefits, An Actuarial Analysis, Milliman, March, 2006
4.2009/2010 North American Staying @ Work Report: The Health and Productivity Advantage. Towers Watson. Link: http//www.towerswatson.com/research/648
Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2013 Cigna
4

5. what is a
culture of
well-being?
It’s more than just encouraging physical wellness.
It supports and fosters happier, healthier, more
productive employees. Built into your overall business
goals and a routine part of operations, it’s promoted
at all levels of your company through programs,
policies, benefits and the physical environment.
It motivates and inspires people to take action
to feel their best and perform their best
leading to lower total benefit costs.
culture influences engagement
Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2013 Cigna
5

6. key components
for a culture of
well-being
1
Strong
Leadership
2
3
Targeted
Solutions
4
Proper
Incentives
Ongoing
Communication
Optimal
Engagement
Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2013 Cigna
6

7. building a solution tailored to
your organization
Health
Awareness
Help people
“know their
numbers” and
understand their
health status and
potential risks
Education
Prevention
Lifestyle
Easy-tounderstand
resources to
help individuals
learn how to be
well for life
Helpful programs
aimed at
preventing
illness and
disease
Highly engaging
behavior-change
programs that
encourage your
employees to
practice healthy
habits for a
lifetime
Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2013 Cigna
Activity
Motivational
programs and
challenges to
inspire people
to actively
participate
in their health
Coaching
Expert guidance
and consultation
to support
organizations
and individuals
throughout
the process
7

8. certain
components
drive higher
engagement
key
engagement
influencers:
1 2 3 4 5
leadership
commitment
tailored
programs
long-term
wellness
strategy
Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2013 Cigna
easy to
access
programs
available
to all
employees
incentives
to motivate
8

9. engagement
boosting best
practices
Creating a culture of well-being
is more than providing programs
that promote health. It’s a
commitment to improving
health. And a plan to make it a
way of life.
set the tone
walk the talk
eye on the ball
recruit help
communicate
make it clear
you value
employee
health
model the
behavior
make health
improvement
a standard
agenda item
develop a wellness
committee to share
ideas, work on
promotions and
help execute plans
make goals clear,
address obstacles,
celebrate success
Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2013 Cigna
9

10. bottom line
develop
culture
of well-being
•Identifying participants’ health status, is a key first step in
motivating individuals to take the right actions to achieve meaningful
and lasting healthy behavior changes.
identify
employee
health risk
motivate and
influence
behavior
improved
health lower
cost
Maintain strong culture of well-being
Behavior
Service manager quits smoking, starts walking and
avoids stroke
$5,176/month1
Head of finance avoids chronic high blood pressure
through exercise, nutrition and stress management
1. Cardiovascular Event Average Monthly Cost: Millman's review of
MedStat MarketScan(TM) Commercial Data 2004 trended to 2006.
2. "An Unhealthy America: Economic Burden of Chronic Disease" 2010 Hypertension direct/indirect costs PPPY.
www.milkeninstitute.org
Savings
$1,116/year2
Ten people in sales department lose 25 lbs. each
and bring weight into a healthy range
$5,760/year1
Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2013 Cigna
10

11. “It’s clear that the cost of
doing nothing is greater than
the cost of doing something.
The natural flow of risks is to high risk.
The natural flow of costs is to high cost.”
– Dee Edington, PhD
Former Director,
Health Management Research Center,
University of Michigan
Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2013 Cigna
11

12. Carolinas HealthCare System:
“A Culture of Wellness”

13. Wellness…Historically

14. CHS LiveWELL – Guiding Principles
• Achieving optimal health and well-being…Through an
integrated and customized care experience.
– It is our goal to improve the total health and well-being of our
teammates so they can provide the best care to our patients
– We are committed to providing a comprehensive and optimal
health experience to our teammates and their families,
based on experience, research, analytics and communications
– We will use our integrated System resources to consistently
deliver a high-quality health experience throughout our
teammates’ life stages

15. 1. To Create a Culture of Wellness you must
choose your metrics accordingly.

16. Communication

17. 2. To Create a Culture of Wellness you must
use your data wisely.
• Data sources to leverage:
– Health risk assessment data
– Biometric data
– Claims data
• Use the data to help you choose the most appropriate
partners within your community for assistance.

18. Completing the 360º View
Consumer Data
provides sociogeographic
consumption trends
Personal
Health
Survey
Consumer
Data
Personal Health
Survey captures
health and lifestyle
risks not readily
available elsewhere
Clinical
Biometrics
Biometric and
Clinical Data
identify the
status of disease
not just its
presence
Person
Claims supply a
wealth of medical
and cost data at
the member level
Claims
18

19. 3. To Create a Culture of Wellness you must
Meet your Employees Where they are.
• A one-size fits all strategy
will not work for all three
population segments.
• Each group has it’s own
unique challenges, and
will need its own
resources to maintain or
improve their health
status.
• Focusing on high risk
members only, will only
return short term success.
High Risk
High Risk
Rising Risk
Rising Risk
Well
Well
19

20. “It is common sense to take a method and
try it. If it fails, admit it frankly and try
another. But above all, try something.”
-Franklin D. Roosevelt

22. •
Leverage
•
Executive Support
•
Departmental Support
•
Public Recognition
•
Activities that are educational and engaging
Although, we don’t yet have the ROI from our newly created enterprise wellness program, we
certainly have insight on what needs to happen first!
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23. Wellness Passport Program



Reward Based Wellness Program
Tracking Mechanism
Activities and Points Address the Risk Behaviors of
Population
Wellness Passport Activity Log
2011
Wellness
Wellness
Passport
myTotal Awards for Healthy
Passport
Behavior
myTotal Awards for Healthy
Behavior
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24. 
Wellness Kickoff
◦ Vendor Fair
◦ Biometric Screenings

10K Step Walking Program
◦ 8 Weeks

Wellness Seminars
◦ ICMA Webinar Sessions

Health Risk Assessment

De-stress and Relaxation Techniques

Flu Clinics

Wellness Boot Camp
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25. 331 Total Participants
Blood Pressure
Note:
Normal
Pre Hypertension
Hypertension
38%
55%
7%
62% of the participants are at risk or abnormal.
Total Cholesterol
Desirable
Borderline High 26%
High
65%
9%
Did You Know?
A 2001 University of Michigan study showed that for
every employee who reduces their cholesterol levels
from 240 to 190, employer’s save an average of $1,200
per year.
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26. 331 Total Participants
Body Mass Index
Below Recommended
Recommended
Overweight
Obese
Extreme Obesity
1%
25%
31%
34%
10%
Note:
75% of County employee participants that were
measured are in or above the Overweight category.
Waist Circumference
Desirable
Abnormal
60%
40%
Did You Know? Fat around the waistline is strongly associated
with coronary heart disease, diabetes and colon cancer.
26

27. 
Recognized by the American Heart Association as a
GOLD LEVEL recipient for fulfilling the following
parameters:
 Offer employees physical activity support
 Provide/increase healthy eating options at the worksite
 Promote a wellness culture
 Implement at least 9 criteria as outlined by the AHA in the areas
of physical activity, nutrition and culture.
27

28. ◦ Employees have had for years…
 Access to Mecklenburg County’s 11 fitness centers with
classes where employees may participate at a discounted
price.
 Mapped and Marked walking trails in a secure environment.
 No Smoking Policy (Implemented in the 1990’s).
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29. 
Established -Internal Wellness Program, myTotalHealth, supported by a Wellness
Team ; Wellness Ambassadors from different departments and divisions

Offered - Free tobacco cessation classes

Promoted a walking challenge, including pedometers, information on walking
distributed through e-mails, County websites, with prize incentives

Showcased - Artwork in the stairwells that encourages employees to take the stairs
rather than riding the elevator, with the County Manager leading by example

Sponsored - Numerous Healthy Cooking classes throughout various County
locations

Provided - On-Site Biometric screenings as part of our “Know Your Numbers”
campaign to educate and help employees with awareness

Support and commitment – From the County Manager, The Executive Team,
Dept. Directors, Managers and Front Line Supervisors.
29

30. “YOU can do a lot with healthy life style
changes”
30

31. City of Asheville
Employee Health & Wellness
December 2013
Cheryl Walker, SPHR

32. Employee Health & Wellness
•
The Asheville Project®
City of Asheville, North Carolina
•
•
On-site Medical Clinic
•
•
•
Overview
Overview
Coordination
Wellness Program
•
•
•
Design & Implementation
Coordination
Next Steps

33. Asheville’s Workforce
 1,100 Full Time Employees & 200
Retirees
 Self-Insured Health Program
 2,300 Covered Lives

34. The Asheville Project Disease
Management Program®
(1997 Inception)
The Foundation Principles
•
•
•
We want you to feel better;
We care about your health;
We will remove barriers to get you the treatment you
need

35. The Asheville Project®
Diabetes:
1997
106 participants
Asthma:
1998
51 participants
CV Health:
1999
229 participants
Depression:
2006
55 participants

36. Incentives
Removing the barriers to patient compliance:




Patient Education
Ongoing counseling with Pharmacist Care Managers
Disease-specific Lab tests
Disease-specific medication and supplies
ALL ARE PAID AT 100%

37. The Asheville Project: 2013
Patients
enrolled in 1
Program
Patients enrolled in
2+ (Co-morbidities)
Total
Enrollment
Diabetes
17
93
110
Asthma
28
32
60
Cardiovascular
135
131
266
Depression
24
50
74
Total participants: 340
15% of the covered lives on the city’s plan

38. Use of Incentives
• Modification of prescription drug
formulary
• Remove brand-name medications with
generic equivalents from copay waiver
program
• Removal of copay waiver for participants if
City not primary insurance (dependents or
retirees with Medicare)
•
•
Meeting with patients in on-site medical clinic to
enroll in disease management program and help in
maintaining compliance
Tying participation & compliance to Asheville
Balanced Choices

39. Wellness & On-site Medical Clinic

40. Wellness & On-site Medical Clinic
• Occupational Services: work-related injuries,
vaccinations, drug testing, MRO, Hearing testing
• Personal minor illness, flu vaccinations, allergy
shots, etc.
• Increase personal visits for employees
• Increasing access
• Staff – PA, nurses and non-medical staff
• Dependents may utilize clinic services

41. Asheville Balanced Choices Wellness

42. Phase 1: Designing our Wellness Program
Determining our goals –
What you want to achieve determines the behavior you reward
•
•
•
•
•
•
Design Wellness programs to reward healthy members (the other 85%)
and achieve financial goals
Coordination with On-site Health Clinic
Utilize all available data (medical claims, On-site Medical Clinic and
Health Risk Assessments) to:
•
•
identify members without annual wellness screenings
provide early warning diagnosis’
Encourage compliance through financial incentives
$600 per year per adult drives behavior
Continue to develop, track, and expand disease management

43. Asheville Balanced Choices Wellness Program
Phase 2: Implementation
•
•
All or nothing approach 89% participation
To participate you must agree to:
•
•
•
•
•
Complete Annual Health Risk Assessment (employee & spouse)
Annual health screenings
Be tobacco free or agree to participate in Tobacco Cessation program
Participate in 4 additional Wellness Activities (web-based, employer sponsored
activities and preventive care) each year
Tobacco Cessation Program
•
•
Combined group classes with medical supervised nicotine replacement aids
and/or prescription drugs at $5.00 copay
Accountability for 90 days following graduation and semi-annual updates

44. Asheville Balanced Choices Wellness Program
• Use Health Risk Assessments and Health Screenings to measure
current health of all adult participants.
• Include verifiable biometric data
• Use all future data to determine impact/effectiveness of Wellness program
offerings.
• Gradually change mindset of Wellness program before implementation of
Outcomes-based program.
• Use Employee Clinic to follow-up on biometric screening concerns and
identify participants for enrollment in disease management programs.
• Tobacco Cessation Programs -140 graduates
• Current quit rate for members still actively employed 12 months post graduation
58%

45. Next Steps
The Asheville Project®, On-site medical clinic, & Wellness Program
•
•
•
•
•
Expanding Provider Collaboration using electronic medical record systems
•
Determine high frequency services to add to employee health clinic that
accomplishes cost savings for City and employees
•
•
Designing Phase 3 of Wellness program to include outcomes-based requirements
Weight Management Program
Integration of The Asheville Project® & Wellness programs to ensure compliance
Care Manager Report Cards
Identification of participants not receiving recommended ‘wellness’ screenings or
procedures (eye exams, flu shots, annual physicals, etc.) and offering services
through on-site health clinic
Partnerships with community to consider new or unique approaches to Wellness to
accomplish Wellness objectives

46. Lindsey Mangus – Health Promotion Specialist for the
Carolinas of Cigna Health Services
Ben Buchanan – Product Manager, Corporate Health &
Wellness of Carolinas Health System
Christie Dean – Wellness Coordinator of Mecklenburg
County Government
Cheryl Walker – Health & Benefits Manager of the City
of Asheville, NC
46