1. Building a Sustainable Infrastructure for EHM: A Vision for the Future Presented by Larry Chapman M.P.H. Chairman and Co-Founder Summex Health Management

2. Agenda • The mistake most employers make • The key pieces of your program infrastructure • Matching your infrastructure to your program model • Resource implications • A vision for the future

3. The Mistake Most Employers Make • They fail to build a sustainable EHM program infrastructure.

4. “Sustainability” includes… • Enterprise-wide • Highly “actionable” • Administratively efficient • Strong metrics • Simplifying in nature • Well-integrated • Strategic • Viable over the long term

5. Key Definitions • Infrastructure- “The basic structure or features of a system or organization.” • Structure- “The manner of construction of something and the arrangement of its parts.” • System- “Instrumentality that combines interrelated and interacting artifacts designed to work as a coherent entity.” • Program-“..an organized response to eliminate or reduce one or more problems where the response includes one or more objectives, performance of one or more activities, and the expenditure of resources.” -The Free Dictionary by Farlex

6. Mission… • Optimizing the productivity of your human capital

7. Health and Productivity Management (HPM) "The integrated management of health risks, chronic illness, and disability to reduce employees' total health-related costs including direct medical expenditures, unnecessary absence from work, and lost performance at work (i.e., presenteeism).” -IHPM Perspective…

8. Platform… For Health and Productivity Management (HPM) = Wellness

9. Major Wellness Program Models Program Model Main Features Primary Focus

10. Key Pieces of the Program Infrastructure • HRA and personal report • Telephonic coaching & referral network • Self-directed change materials • Annual program kit • Medical self-care book • Mailings and emails • Wellness newsletter • PCP oriented-summary • Full-function E-Health source • Wellness incentives

11. Visual Diagram of the Infrastructure Referrals

12. Core Program Infrastructure Plus…. Core Program Infrastructure    + +  Site-based Activity

13. Schematic of the Infrastructure

14. Key HRA Features • Identity & demographics • Personal and family medical history • Current symptoms and treatment status • Preventive screening status • PCP relationship • Medical self-care book use • Clinical and behavioral risks • Readiness to change • Self-efficacy levels • Psycho-social indicators • Injury risk issues (W,H,V & R) • Health care utilization levels • Health consumer skills level • Presenteeism status • Option for use of biometric values • Overall Wellness Score (OWS) • Report of past OWS scores

15. Schematic of the Infrastructure

16. Key Coaching Features • Everyone gets a call (Opt-out) • Call at home – then at-work • “No reach” protocol • Moderate risk 2-4 calls/yr • High risk 5-12 calls/yr • Strong use of SOC • Strong use of motivational interviewing techniques • Follow-up materials provided • Referrals provided • Everyone asked to have personal wellness objectives • Incentive for coaching adherence

17. Schematic of the Infrastructure

18. Key E-Health Features • SSO access from company website • Personal health record • HRA data linked • Query with depth • Symptom reference and advice • Benefit decision support • Health cost estimator (FSA, HSA, etc.) • Provider decision support • Treatment decision support • Two-way communication system • Incentives for use • Integration with benefits and services • Report generation on use patterns

19. Schematic of the Infrastructure

20. Key Incentive Features • Use “play or pay” concept • Require annual HRA • Use $500 to $1,000 per year of value • Use premium discount and/or debit card • Use 4/5, 6/8 or 8/10 Wellness criteria • Tighten and change criteria over time • Everyone who “plays” gets a prize • Provide a waiver opportunity • Use “sentinel” features • Connect it to open enrollment • Consider a “zero base budget” approach

21. 4/5* Non-tobacco user BMI < 30 OWS > 85 Physical activity > 4 times per week Completion of 30 minute webinar on wellness and consumer health 6/8, 8/10* Non-tobacco user BMI < 30 OWS > 85 Physical activity > 4 times per week Completion of 30 minute webinar on wellness and consumer health Current on preventive screening (MD form) 100% seat belt use Have a PCP Use of your medical self-care book in previous 3 months No more than 3 sick leave in last 12 months Examples of Wellness Criteria * = All “HSRF” criteria would also have participation options Large employers could further customize the criteria

22. Schematic of the Infrastructure

23. Infrastructure Linked to Model

24. Resource Implications Resources for Program Infrastructure • No cost or very low cost (<$25/EE/yr) • Moderate cost (Between $26 and $140/EE/yr) • Major cost (Between $141 and $340/EE/yr)

25. Program Infrastructure and Effects - Chapman, Planning Wellness, 2005

26. Major Phases • Introduction • Experimentation • Shakedown • Refinements • Realignment • Expansion • Partnership • Optimal effectiveness

27. How to Develop an Infrastructure • Define needs • Establish priorities • Select metrics • Define technical specifications • Make or buy • Evaluate regularly • Refine specifications • Redefine needs

28. Summary of Key Points • Few employers have sustainable program infrastructures • Most Wellness activity is episodic and short term oriented • There are standard components to program infrastructures • The extent of your infrastructure depends on your model • Your infrastructure is the “core” of your program • Your program model will drive your infrastructure costs • The three basic models result in different levels of effects • Program infrastructure should be built in phases • The process of building your infrastructure should be rational • A sustainable infrastructure is key to long term success • The quality of the infrastructure will have a major impact • The program infrastructure must have an appropriate administrative infrastructure

29. Your Questions?