2. The MCC Team
• Chase Eldredge, D’11
• Boyd Lever, D’10
• Tom Perry, TDI’11
• Anuradha Ramanath, TDI’11
• Jeff Wang, T’11
2
3. Project Overview
• Dartmouth College aims to improve the
health of its employees, retirees, and
dependents
• The college is interested in exploring
innovative health and wellness programs,
and how comparable institutions
effectively implement these programs
• Improved health and wellness among
beneficiaries may result in reduced
healthcare expenditures
3
4. Agenda
• A profile of Dartmouth College
• An implementation model for wellness at
Dartmouth College
• Case Studies: Wellness at other larger
employers
• Immediate opportunities at Dartmouth
• A path forward
4
5. Dartmouth College is a large employer, with 50%
of self-insured employees 40 years of age or older
5
Self-Insured Employees
At a Glance
No. of
Subscribers
3,892
No. of
Members
8,251
Avg.
Contract
Size
2.1
Male 48%
Female 52%
0.00%
5.00%
10.00%
15.00%
20.00%
25.00%
65+60-6450-5940-4930-3918-297-170-6
DistributionofMembersbyAgeGroup
40-49
705
40-49
845
50-59
776
50-59
914
60-64
321
60-64
339
65+
131
65+
82
0 500 1,000 1,500 2,000 2,500
Male
Female
MemberComposition,ByGender,>=40YearsOld
Source: Anthem 2009 Report, p. 5
6. The largest drivers of healthcare spending at Dartmouth
are the usual suspects troubling many employers
• Spending on Gastroenterology, Endocrinology, Behavioral Health, Cancer,
Cardiology, and Orthopedics account for 50% of total healthcare claims
paid in 2009
6
Inpatient Outpatient Professional Rx Total
Gastroenterolog
y
$ 291,515 $ 1,078,451 $ 554,219 $ 242,236 $2,166,421
Endocrinology
252,624
471,800 529,469 934,839 2,188,732
Behavioral
181,577
463,607 1,298,740 871,295 2,815,219
Cancer
119,572
2,133,295 614,837 92,409 2,960,113
Cardiology
1,470,075
1,193,760 658,028 282,074 3,603,937
Orthopedics
735,832
2,841,003 2,104,620 315,168 5,996,623
Sub-Total $19,731,045
Total Claims
Paid
$39,464,188
% of Total 50.0%
Source: Anthem 2009 Report, p. 7-8
7. There has been a high concentration of spending on
a small cohort of employees
• In 2009, claims paid on 83 employees accounted for $8.9 million,
more than 20% of total claims paid
• The top three conditions presented by these employees are:
7
Source: Anthem 2009 Report, p. 29
Condition Number of
Claimants
Expenditure Expenditure /
Claimant
Cancer 16 $1,997,787 $124,862
Cardiology 15 $1,889,802 $126,987
Orthopedics 18 $1,289,266 $71,626
• Not all of these high-cost employees may be susceptible to
intervention by a wellness program; 8 of these 83 employees were
terminated by year-end
• But if each of these conditions can be reduced by one claimant, the
potential cost saving could exceed $300,000
8. For each of the major cost drivers, we know many of
the contributing factors and what to do in response
8
Common Ailments Contributing Factors Potential Mitigation
Gastroenterology
(5.5% of total claims)
IBD, ulcers, heartburn
Poor diet, smoking,
alcohol
Improved diet,
tobacco and alcohol
cessation
Endocrinology
(5.5% of total claims)
Diabetes,
hyperlipidemia, thyroid
disorder
Obesity, sedentary
lifestyle, poor diet,
smoking
Exercise, improved
diet, tobacco cessation
Behavioral
(7.1% of total claims)
Depression, bipolar
disorder, anxiety,
substance abuse
Job stress, family
stress, inactive
lifestyle, trauma
Stress management,
exercise, counseling
Cancer
(7.5% of total claims)
Breast, lung, colon-
rectal, prostate, etc.
Many, including genetic
Screening, disease
management
Cardiology
(9.1% of total claims)
Heart disease,
hypertension,
circulatory, irregular
Obesity, smoking, poor
diet, inactive
lifestyle, stress
Exercise, tobacco
cessation, improved
diet, stress
Orthopedics
(15.2% of total claims)
Arthritis, back pain,
joint injury, fractures
Obesity, inactive
lifestyle, worker safety
Improved diet,
exercise, safety training
Source: Anthem 2009 Report, p. 23-28
9. What is necessary today is a strategy for
implementing a wellness program at Dartmouth
• A wellness program at Dartmouth College will
likely need to include the following:
– Exercise
– Tobacco cessation
– Improved diet
– Stress management
• In order to successfully implement a wellness
program, Dartmouth will need to have a clear way
forward that involves all constituents of the
College
• Our team has focused on creating an
implementation framework, as well as developing
action items that can be executed on immediately
9
10. Agenda
• A profile of Dartmouth College
• An implementation model for wellness at
Dartmouth College
• Case Studies: Wellness at other larger
employers
• Immediate opportunities at Dartmouth
• A path forward
10
11. EMPLOYEES
WELLNESS
LEADERSHIP
Commitment &
Establishment
• What do I need to
do to create
institutional buy-
in?
• What do I need to
succeed in
establishing a
wellness
program?
• How do I prepare
myself for
engaging with a
wellness
program?
Design &
Execution
• What role do I
play in
administering a
wellness program
across my
institution?
• How do I execute
an effective
wellness
program?
• How do I best
participate in my
wellness
benefits?
Tracking &
Modification
• How do I
continuously
manage a
wellness
program?
• How do I improve
the wellness
program over
time?
• How do I
continue to
improve my
health over time?
DARTMOUTH
COLLEGE
ADMINISTRATION
Implementing a wellness program must involve all
constituencies of the Dartmouth College community over time
12. EMPLOYEES
WELLNESS
LEADERSHIP
Commitment & Establishment
• - Understand the financial and cultural value of
employee health
• - Commit capital to employee wellness
• - Establish a culture of wellness as part of my
institutional’s identity
• - Wellness needs to be a significant portion of the scope
of my work
• - Assess the available wellness resources
• - Have access to decision-makers
• - Increase my self-awareness of my health and wellness
• - Tie wellness to what’s important to me (e.g., wealth,
life satisfaction)
• - Prioritize health and wellness more highly in making
lifestyle decisions
DARTMOUTH
COLLEGE
ADMINISTRATION
The Commitment and Establishment phase creates the
conditions that make a wellness program successful
13. EMPLOYEES
WELLNESS
LEADERSHIP
Design and Execution
• - Establish reporting structures for wellness
• - Set expenditure budgets for wellness
• - Adopt incentive structures for wellness
• - Create systems of accountability for wellness
• - Analyze wellness opportunities and challenges within the
population
• - Establish robust channels of communication with
constituents
• - Proactively engage employees and their health status
• - Promote participation in wellness using approved
incentive structures
• - Explore my benefits and wellness opportunities
• - Make rational health decisions based on incentives and
opportunities
• - Develop “health-based” relationships with colleagues
• - Bring healthy-living back home to my family members
DARTMOUTH
COLLEGE
ADMINISTRATION
The Design and Execution phase involves the day-to-day
activities and choices that result in improved wellness
14. EMPLOYEES
WELLNESS
LEADERSHIP
Tracking and Modification
• - Integrate employee health status as part of financial
reporting
• - Assess benefits provisions based on wellness outcomes
• - Include wellness results as part of employee development
• - Reinvest savings to further wellness promotion
• - Make periodic health assessments
• - Respond to employee feedback
• - Continue to innovate based on employee needs and
responses
• - Raise the bar to the next level
• - Provide feedback to wellness leadership and
administration
• - Self-assess my successes and failures
• - Enjoy my better health, and have more fun
• - Set new goals
DARTMOUTH
COLLEGE
ADMINISTRATION
The Tracking and Modification phase provides mechanisms
to continuously assess and improve the wellness program
15. Agenda
• A profile of Dartmouth College
• An implementation model for wellness at
Dartmouth College
• Case Studies: Wellness at other larger
employers
• Immediately opportunities at Dartmouth
• A path forward
15
16. Success Stories with Fitness
• MetLife:
– Challenge: Improving cardiovascular health
– Expended $550,000 per year on fitness center for employee access
– Saved $1.38 million per year by improving cardiovascular risk
profiles of 2,100 members in its fitness centers
• Aetna:
– Aetna measures ROI for its wellness programs using medical claims
data and productivity studies
– 2004 study of fitness center usage under the Healthy Lifestyles
program indicated:
• Lower combined medical and pharmacy costs for fitness-
center users
• Annualized savings of $340 per member per year for fitness
center users
• Comparison of participating members to non-participants
indicated an ROI of 3.4:1
16
Source: Business Roundtable. Doing Well through Wellness: 2006-2007 , p. 47-48
17. • General Motors
- Challenge: Educating a diverse employee
population on health and wellness
- Utilizes lifestyle-based wellness
education
- Example: Deer Hunting Module
- Proper deer lifting routines
- Nutritious venison recipes
- Each program provides:
- Topic information
- Skill building and group support
- Tracking of individual behaviors
and outcomes
• FedEx Express
- Challenge: Diabetes management
- Provides simple $50 cash-reward for
diabetes patients that comply to
regular screening (e.g., retinopathy
screening)
- Participation increased from 55% to
100%
- Diabetes-related ER visits dropped
13%
- Cost-per-episode for diabetes
patients dropped 75%
Source: Business Roundtable. Doing Well through Wellness: 2006-2007 , p. 13-16
Other Success Stories
18. Agenda
• A profile of Dartmouth College
• An implementation model for wellness at
Dartmouth College
• Case Studies: Wellness at other larger
employers
• Immediately opportunities at Dartmouth
• A path forward
18
19. What Dartmouth has today
19
Dartmouth Brown Cornell Yale Harvard Columbia Princeton U. Penn.
EAP ♦ ♦ ♦ ♦ ♦ ♦ ♦ ♦
Fitness ♦ ♦ ♦ ♦ ♦ ♦ ♦ ♦
Nutrition ♦ ♦ ♦ ♦ ♦ ♦ ♦ ♦
Stress Mgt ♦ ♦ ♦ ♦ ♦ ♦ ♦
Smoking
Cessation
♦ ♦ ♦ ♦ ♦ ♦ ♦
HRA ♦ ♦ ♦ ♦ ♦
Gym Cost $297-480 Free $175 $300 $184 $295 $212 $460
Source: Analysis performed by Carl Pratt
• A first glance, Dartmouth College seems to be competitive with the
other Ivy League institutions in providing wellness benefits to its
employees
• However, further study indicates that there are many opportunities
to improve Dartmouth’s wellness offerings
20. Improving Dartmouth’s Web Content
On Health and Wellness
• Example 1: Finding employee health information on website
– Click, scroll, click from Dartmouth.edu
• Example 2: Faculty/Employee Assistance Program
– Does not communicate well to employees seeking assistance
with stress management and other mental health needs
• Improving the website would prioritize
– Easy access to wellness content (1-click)
– Motivating employee participation
– Keeping employees informed on their wellness benefits
– Receiving employee feedback regarding their wellness needs
21. Improving Employee Access to Dartmouth’s
Fitness Center
Disadvantages to current offerings
• Gym membership cost is still second-highest
compared to other Ivy-League schools
- Cost at Dartmouth - $433
- Average of other Ivies - $232
- Brown’s fitness center is free for employees
• Employees have to pay a higher price than
students to access exercise and stress
management programs
• No programs designed specifically for employees
What employees can access today
• On-site fitness center available
• $349 membership discount from street prices
• For fee, 19 exercise programs and 6 stress
management programs are available
• Members who exercise 12 out of 20 weeks receive
$200 discount off of health premiums
22. Agenda
• A profile of Dartmouth College
• An implementation model for wellness at
Dartmouth College
• Case Studies: Wellness at other larger
employers
• Immediately opportunities at Dartmouth
• Next steps
22
23. Next Steps
• Start on the immediate-run items:
– Website
– Gym access
• Begin the implementation process:
– Commitment and Establishment:
• Dartmouth Administration
• Create a wellness leadership team
• Begin to engage employees on their health status
23
