1. WELLNESS AT DARTMOUTH COLLEGE
MEDICAL CARE AND THE CORPORATION
NOVEMBER 16, 2010
Chase Eldredge, D’11
Boyd Lever, D’10
Tom Perry, TDI’11
Anuradha Ramanath, TDI’11
Jeff Wang, T’11

2. Wellness at Dartmouth College !2
EXECUTIVE SUMMARY
INTRODUCTION
Dartmouth College aims to improve the health of their employees, retirees, and dependents, and hopes to
reduce the cost of health care for all beneficiaries. We researched various wellness programs and made
recommendations on what steps Dartmouth College needs to take in order to implement a program.
OVERVIEW
We identified the most costly afflictions amongst Dartmouth College employees, based on claims data
summarized by Anthem. Six conditions account for 50% of total health care spending by Dartmouth
College, or $19.7 million of $39.5 million spent in total: (1) Gastroenterology, (2) Endocrinology, (3)
Behavioral health, (4) Cancer, (5) Cardiology, and (6) Orthopedics.
FRAMEWORK
Based on the Anthem claims data, we identified the highest costing conditions that may be targeted
through a healthy living and wellness program. Based on the six cost-driving conditions, it is likely that a
wellness program at Dartmouth College should include the following activities: increased exercise,
tobacco cessation, improved diet, and stress management. Our framework aims to involve the three major
constituency groups that will be included in the wellness program, as well as to consider the three phases
of work associated with implementing a wellness program.
IMMEDIATE OPPORTUNITIES
Upon reviewing the current offerings available at Dartmouth College with regard to employee health, we
believe that the website and fitness center are two opportunities for immediate improvement.
CONCLUSION
Based on our research, employers that proactively engage with employee health often see benefits in
increased employee satisfaction and productivity, as well as benefits in health care savings. Dartmouth
College’s current offerings in health and wellness indicate ample room for improvement, and we have
suggested some near-term solutions that may yield some benefits. However, we believe that, in order to
create a successful and sustainable wellness program at Dartmouth College, a broad-based program that
involves all constituencies of the Dartmouth community over time will be necessary.

3. Wellness at Dartmouth College !3
INTRODUCTION
Dartmouth College is interested in exploring various types of innovative health care programs
and how other self-insured employers effectively implement these programs. Dartmouth College
aims to improve the health of their employees, retirees, and dependents, and hopes to reduce the
cost of health care for all beneficiaries. Dartmouth has engaged a consulting team comprised of
students from the “Medical Care and the Corporation” course at the Tuck School of Business to
investigate wellness programs being implemented by other employers, as well to consider how
wellness can be improved within the Dartmouth community.
Through the course of the project, we have conducted analyses through reviewing health care
claims filed by Dartmouth beneficiaries (as summarized by Anthem, Dartmouth’s third-party
administrator); interviewing Mr. Carl Pratt, who is a consultant to Dartmouth with regard to
wellness planning; and researching publically available literature with regard to employer-
sponsored wellness programs. The materials we considered included, but were not limited to:
(1) “Cost and Utilization Review” report, by Anthem, for the year 2009
(2) Research materials provided by Mr. Carl Pratt
(3) “Doing Well Through Wellness” report, by Business Roundtable, for years 2006-2007
(4) Online research of Ivy League universities along with other self-insured employers
DARTMOUTH COLLEGE POPULATION OVERVIEW
Through analysis of the 2009 Anthem report, we have identified key statistics that provide a
high-level snapshot of the Dartmouth population:

4. Wellness at Dartmouth College !4
As the statistics above indicate, approximately 50% of Dartmouth’s beneficiaries are over forty
years of age, and the majority of the beneficiaries are women. As older individuals tend to
consume health care more frequently – and often with more complex needs – Dartmouth’s
population is potentially more difficult to manage. Also, as women tend to consume health care
at higher rates, whether due to maternal needs or other factors, the gender mix among
Dartmouth’s population may also yield challenges.
We have also identified the most costly conditions presented by Dartmouth employees, based on
claims data summarized by Anthem. Six conditions account for 50% of total health care
spending by Dartmouth, or $19.7 million out of $39.5 million spent in total: (1)
Gastroenterology, (2) Endocrinology, (3) Behavioral health, (4) Cancer, (5) Cardiology, and (6)
Orthopedics. The following table illustrates the dollars spent by Dartmouth in 2009 as a result of
each of these conditions:
Figure 1: Darmouth College Self-InsuredPopulation - Summary Statistics
Number of Subscribers 3,892
Number of Members 8,251
Avg. Contract Size 2.1
Male 48%
Female 52%
Avg. Member Age 36.2
> 40 YO 50%
> 50 YO 31%
> 60 YO 11%
Figure 2: Dartmouth College Self-InsuredPopulation - Distribution by Age
Male Female Combined Male Female Combined
0-6 8.5% 8.0% 8% 337 343 680
7-17 16.6% 13.7% 15% 657 588 1,245
18-29 12.3% 11.9% 12% 487 511 998
30-39 13.8% 15.6% 15% 547 669 1,216
40-49 17.8% 19.7% 19% 705 845 1,550
50-59 19.6% 21.3% 20% 776 914 1,690
60-64 8.1% 7.9% 8% 321 339 660
65+ 3.3% 1.9% 3% 131 82 212
3,960 4,291 8,251

5. Wellness at Dartmouth College !5

6. Wellness at Dartmouth College !6
Figure 3: Top-Six Conditions By Total Claims Paid
We have also identified a small cohort of 83 employees that accounted for more than 20% of
total health care dollars spent by Dartmouth in 2009. The following table illustrates the three
most costly conditions associated with these high-cost employees:
Figure 4: Top-Three Conditions Among Highest-Cost Employees
IMPLEMENTATION FRAMEWORK
Based on the claims data as summarized by Anthem, we have identified the high-value targets in
terms of costly medical conditions that may be mitigated through healthy living and wellness
promotion. Based on the conditions aforementioned, it is likely that any wellness program that
Dartmouth considers should include the following activities:
Inpatient Outpatient Professional Rx Total
Gastroenterology $ 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 ClaimsPaid $39,464,188
%ofTotal 50.0%
Condition NumberofClaimants Expenditure
Expenditure /
Claimant
Cancer 16 $1,997,787 $124,862
Cardiology 15 $1,889,802 $126,987
Orthopedics 18 $1,289,266 $71,626

7. Wellness at Dartmouth College !7
- Increased exercise
- Tobacco cessation
- Improved diet
- Stress management
However, it is less clear how such a program should be implemented by Dartmouth. As such, we
have focused our efforts on creating an implementation framework that Dartmouth should
consider as it begins to create a wellness program.
Figure 5
The implementation framework above seeks to consider (a) the three major constituency groups
that will be involved in the wellness program (the college administration, “wellness leadership,”
and the employees), and (b) the three phases of work associated with implementing a wellness
EMPLOYEES
WELLNESS
LEADERSHIP
Commitment &
Establishment
What do I need to
do to create
institutional buy-
in?
What do I need to
succeedin
establishinga
wellnessprogram?
How do I prepare
myselfforengaging
with a wellness
program?
Design&
Execution
What role do I play
in administering a
wellnessprogram
acrossmy
institution?
HowdoIexecute
an effective
wellnessprogram?
How do I best
participate in my
wellnessbenefits?
Tracking&
Modification
How do I
continuously
manageawellness
program?
How do I improve
thewellness
programovertime?
How do I continue
to improve my
health over time?
DARTMOUTH
COLLEGE
ADMINISTRATION
Implementingawellnessprogrammustinvolveall
constituencies of the Dartmouth College community over time

8. Wellness at Dartmouth College !8
program. By order of the three phases of work, the following will summarize the key issues that
each constituency group will need to address (Figures 6-8 below):

9. Wellness at Dartmouth College !9
EMPLOYEES
WELLNESS
LEADERSHIP
Commitment&Establishment
- Understand the financial and cultural value of employee health
- Commitcapitaltoemployeewellness
- Establishacultureofwellnessaspartofmy institutional’s identity
- Wellnessneedstobeasignificantportionofthescopeofmywork
- Assesstheavailablewellnessresources
- Haveaccesstodecision-makers
- Increasemyself-awarenessofmyhealthandwellness
- Tie wellness to what’s important to me (e.g., wealth, life satisfaction)
- Prioritizehealthandwellnessmorehighlyinmakinglifestyledecisions
DARTMOUTH
COLLEGE
ADMINISTRATION
The CommitmentandEstablishment phasecreatesthe
conditionsthatmakeawellnessprogramsuccessful

10. Wellness at Dartmouth College !10
EMPLOYEES
WELLNESS
LEADERSHIP
DesignandExecution
- Establishreportingstructuresforwellness
- Setexpenditurebudgetsforwellness
- Adoptincentivestructuresforwellness
- Createsystemsofaccountabilityforwellness
- Analyze wellness opportunities and challenges within the population
- Establishrobustchannelsofcommunicationwithconstituents
- Proactivelyengageemployeesandtheirhealthstatus
- Promote participationinwellness usingapprovedincentive structures
- Exploremybenefitsandwellnessopportunities
- Make rational health decisions based on incentives and opportunities
- Develop “health-based”relationshipswithcolleagues
- Bringhealthy-livingbackhometomyfamilymembers
DARTMOUTH
COLLEGE
ADMINISTRATION
The DesignandExecution phaseinvolvestheday-to-day
activitiesandchoicesthatresultinimprovedwellness

11. Wellness at Dartmouth College !11
EMPLOYEES
WELLNESS
LEADERSHIP
TrackingandModification
- Integrate employee health status as part of financial reporting
- Assessbenefitsprovisionsbasedonwellnessoutcomes
- Include wellness results as part of employee development
- Reinvestsavingstofurtherwellnesspromotion
- Makeperiodichealthassessments
- Respondtoemployeefeedback
- Continuetoinnovatebasedonemployeeneedsandresponses
- Raise the bar to the next level
- Provide feedback to wellness leadership and administration
- Self-assessmysuccessesandfailures
- Enjoy my better health, and have more fun
- Setnewgoals
DARTMOUTH
COLLEGE
ADMINISTRATION
The TrackingandModification phaseprovidesmechanismsto
continuouslyassessandimprovethewellnessprogram

12. Wellness at Dartmouth College !12
IMMEDIATE OPPORTUNITIES
We understand that, based on the aforementioned implementation framework, creating a wellness
program at Dartmouth will likely require concerted efforts by different players across the
community, and will also require some time and capital. However, upon reviewing the current
offerings made by Dartmouth with regard to employee health, we believe that there are
immediate opportunities for improvement than can be seized while the larger program is being
implemented.
Website
We believe that there is much room for improvement in Dartmouth’s online communications to
employees with regard to health and wellness. To start, information on employee health is
difficult to locate on the Dartmouth website, requiring several clicks and searches from the
frontpage. Creating one-click access to wellness information from the frontpage would be a step
in the right direction. In addition, we have found inadequacies in the health information on the
face of the site. For example, on the Faculty/Employee Assistance Program page, the content
does not appeal to employees in need to stress relief, and the page also appears to have dead
links as well as vague images. In the case of FEAP, Dartmouth should consider presenting a
website that is easier to use and is more empathetic to employees dealing with stress.
Fitness Center
We also believe that Dartmouth can further leverage its fitness center in promoting employee
health. Currently, employees have access to the gym at a fee that is less than street-prices, but the
membership is still relatively expensive ($433 per year), especially when compared to other Ivy-
league institutions (average of $232 per year). Brown University, for instance, provides gym
access to its employees at no cost. In addition, while there are fitness programs within the gym
that employees can purchase in addition to their regular membership, these programs are not

13. Wellness at Dartmouth College !13
catered directly toward employee health needs, and often are designed for student-use.
Considering the significant health expenditures associated with sedentary lifestyles, improper
weight control, and stress, we believe that Dartmouth should consider offering fitness content
that is designed specifically for employee health needs.
CONCLUSION
Dartmouth College should be commended for their desire to improve employee health and
wellness. Based on our research, employers that proactively engage with employee health often
see benefits in increased employee satisfaction and productivity, as well as benefits in health care
savings. Dartmouth’s current offerings in health and wellness indicate ample room for
improvement, and we have suggested some near-term solutions that may yield some benefits.
However, we believe that, in order to create a successful and sustainable wellness program at
Dartmouth, a broad-based program that involves all constituencies of the Dartmouth community
over time will be necessary. We have proposed an implementation framework that we hope
Dartmouth will consider.