Emerging Engagement Strategies for Employee Wellness �������������
Agenda • Trends : Highlights from Buck’s fourth annual survey WORKING WELL: A Global Survey of Health Promotion and Workplace Wellness Strategies • Compliance : Legal requirements that impact wellness programs and key actions taken in 2010 • Incentives : Effective incentives that focus on engaging members in their health and in their health care purchasing decisions • Communication : Emerging employer practices that focus on changing member behavior Questions are welcome throughout 2
Working Well: A Global Survey of Health Promotion and Workplace Wellness Strategies By: Sherri Bockhorst 3
2010 Fourth Annual Global Wellness Survey Objective: • Assess trends in employer-sponsored wellness strategies and practices Participants: • 1,248 participating employers (620 U.S.) • 47 countries (62% North America) • 13 million employees • All industry categories Reports: • Global survey report • Executive summary in 8 languages • Special country reports www.BuckSurveys.com 4
Globalization of Strategy Reasons For Not Having a Global Wellness Strategy Differing cultures, laws, and practices 60% across regions No global oversight for health care strategy 44 % 44% Lack of vendors who can meet our global 28% 41 % objectives Limited availability of language and culturally 23% 34 % adapted tools and solutions 16% 29 % Not a priority in our organization Other 22% 25 % STRATEGY IS GLOBAL (MULTINATIONAL EMPLOYERS) 16% No Yes 46% 54% 5
Prevalence of Incentive Rewards (or Penalties) Incentive rewards offered today Not offered today, but have plans to offer No plans to offer U.S. 62 % 25% 13% Asia 42 % 19% 39% Canada 41 % 30% 28% Africa/Mid East 34 % 24 % 41% Australia 29 % 24 % 47% Europe 25 % 11 % 63% Latin America 16% 38% 46% 0% 20% 40% 60% 80% 100 % 6
Employer Objectives Driving Wellness Strategy Africa/ Latin Mid East Asia Australia Canada Europe America U.S. Productivity/presenteeism 2 5 4 1 1 1 2 Morale/engagement 1 2 2 3 2 2 4 Absence 5 6 3 2 4 7 3 Workplace safety 2 4 1 6 6 3 6 Work ability 4 1 5 4 5 4 7 Org. values/mission 5 3 8 7 3 5 5 Attract and retain 8 8 7 8 7 8 8 Promote image/brand 7 7 6 9 10 10 9 Health care costs 11 11 10 5 11 11 1 Social responsibility 9 9 9 10 9 6 10 Comply with legislation 9 10 11 11 8 9 11 Supplement gov't care 12 12 12 12 12 12 12 7
Health Issues Driving Wellness Strategy Africa/ Latin Mid East Asia Australia Canada Europe America U.S. 1 1 1 1 1 2 Stress 6 3 3 3 2 1 1 Physical activity/exercise 4 1 3 2 Nutrition/healthy eating 4 7 5 5 2 3 2 3 Work/life issues 4 12 10 High blood pressure 4 10 10 8 10 4 5 2 3 Chronic disease 9 9 7 13 5 Workplace safety 9 4 6 6 4 6 11 Depression/anxiety 8 13 7 4 7 9 9 High cholesterol 12 11 11 9 12 7 7 Tobacco use/smoking 11 5 13 11 8 10 8 Psychosocial work envir. 10 8 14 12 6 8 15 Obesity 15 14 8 14 14 11 4 Sleep/fatigue 16 12 5 9 11 14 14 Personal safety 13 6 12 13 9 13 13 3 Infectious diseases (HIV) 17 16 17 18 16 17 Maternity/newborn health 18 15 18 16 16 15 12 Substance abuse 14 18 15 15 15 18 16 Public sanitation 17 16 17 18 17 17 18 8
Impact of Wellness Programs on Health Care Trend REDUCTION IN HEALTH CARE TREND RATE – U.S. EMPLOYERS Yes 18% Don't know 60% No 22% AVERAGE ANNUAL REDUCTION IN HEALTH CARE TREND RATE – U.S. EMPLOYERS More than 10 trend percentage points per year 2 % 6-10 trend percentage points per year 10 % 2-5 trend percentage points per year 61% 28 % 1 or fewer trend percentage points per year 9
Activities For Which Incentive Rewards Are Offered Offered today Plan to offer in next year Plan to offer in next 2-3 years Don't currently offer and no plans to offer Completing a health risk appraisal 57% 18% 10% 14% Participation in workplace health "challenges" 50% 16% 15% 19% Completing a biometric health screening 46% 21% 15% 18% Obtaining regular preventive care examinations 37% 15% 21% 26% Refraining from tobacco use 27% 37% 18% 18% Tracking regular healthy living activities 33% 18% 19% 30% Completing educational courses (live or online) 29% 15% 21% 34% Contacting a health coach or advisor 30% 14% 16% 39% Adherence to a disease management program 25% 15% 23% 37% Achieving or maintaining health status results 23% 17% 26% 33% Adherence to a therapeutic regimen 51% 13% 14% 22% 10
Types of Incentive Rewards Offered Offered today Plan to offer in next year Plan to offer in next 2-3 years INCENTIVES/REWARDS Don't currently offer and no plans to offer Gifts/merchandise 49% 11% 10% 30% Free or low-cost preventive health services 49% 8% 9% 34% Raffles/drawings 47% 10% 8% 35% Employer-subsidized gym membership 37% 6% 11% 46% Cash 35% 7% 6% 52% Reimbursement for wellness classes (nutrition, smoking) 32% 8% 15% 45% Health insurance premium reductions 29% 13% 17% 40% Contribution to health savings and/or spending accounts 15% 7% 14% 63% Vacation days/paid time off 12% 5% 10% 73% Reduced health copayments 8% 7% 18% 68% DETERRENTS/PENALTIES Health insurance premium increases 15% 8% 11% 66% Mandatory participation (such as health risk appraisal) 4% 5% 7% 84% in order to receive health insurance Increased health copayments 3% 4% 9% 83% Condition of employment (e.g., not hiring smokers) 3% 2% 4% 91% Benefit reduction 2% 4% 7% 87% Salary penalty 1% 1% 2% 96% 11
Compliance By: Dannae Delano & Alan Kandel 12
HIPAA Nondiscrimination • Do HIPAA nondiscrimination rules apply? – Yes, if a wellness program is part of a health plan – If yes, discrimination in eligibility or benefits based on health status is prohibited – Violation results in excise tax liability ($100 per day per affected individual) • Two types of wellness programs: – Participation only • Participation must be available to all similarly situated individuals – Standard based • If award is based on a standard, five conditions must be met 13
HIPAA Nondiscrimination – Standard Based 1. Limited value for award 2. Promote health or prevent disease 3. Annual qualification 4. Available to all similarly situated participants 5. Disclosure of reasonable alternative or waiver 14
GINA Compliance • Both Title I and Title II compliance required – Title I applies to group health plans and insurers – Title II applies to employers and non-group health plan wellness programs (not discussed) • Title I compliance: Three general prohibitions 1. Adjusting group premium or contribution amounts based on genetic information 2. Requesting or requiring a genetic test 3. Collecting genetic information before or in connection with enrollment, or at any time for underwriting purposes 15
GINA Compliance • Alternatives for health assessment compliance 1. No incentive for completion of health assessment 2. Incentive on health assessment with optional completion of genetic information 3. Incentive on completing health assessment with no genetic information requested 16
ADA Compliance • Prohibits discrimination in employment against qualified individuals with disabilities • Are mandatory physical examinations or medical inquiries considered discriminatory? – Permitted as part of an employee health plan if: • Participation is voluntary • Information obtained is maintained as confidential medical records • Information obtained is not used to discriminate against employee 17
ADA Compliance • What is voluntary participation? – ADA and EEOC regulations do not provide guidance – Informal EEOC guidance takes a strict interpretation • Health assessment is voluntary if employees are neither required to participate nor penalized for nonparticipation • Certain practices are considered involuntary – Voluntary addressed under GINA Title II regulations CAUTION: Compliance with HIPAA wellness program rules does not equal compliance with ADA 18
Impact of Health Care Reform • Codified HIPAA health status nondiscrimination rules – Increase maximum permissible award from 20% to 30% and HHS, Treasury and DOL may increase up to 50% – Effective for plan years beginning on or after January 1, 2014 • HHS, Treasury and DOL required to prepare congressional report on wellness programs • Grants for small businesses available to promote wellness programs • CDC assistance with wellness programs • Grants for state and local governments and community-based organizations for wellness programs • Preserving grandfather status 19
Other Compliance Issues • State laws – Insured plans may have to comply with state insurance law limits or restrictions on wellness programs – Non-group health plan wellness programs may need to comply with state laws prohibiting discrimination in the workplace • Tax implications – Cash or cash equivalent awards are taxable – Health benefit related awards are not taxable • May raise discrimination or comparability issues – Other non-cash awards • Taxable, unless nontaxable fringe benefit 20
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