2/21/2018. Chronic Conditions Health and Productivity Specialty Medications. Behavioral Health

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1 Employee Health, Engagement and Productivity: Moving Beyond the Traditional Approach Sarah Smith Senior Consultant, Lockton Health Risk Solutions Hot topics in population health management Behavioral Health On-site Clinics Condition-Specific Targeted Disease Management Second Medical Opinion Chronic Conditions Health and Productivity Specialty Medications Financial Wellness Executive Physicals Centers of Excellence Stress Management and Resilience 2 The drivers of medical cost High-risk claims ~20% of the total population drives 80% of the costs. High-risk claimants have chronic conditions (such as coronary artery disease, diabetes, hypertension, smokingrelated illness and obesity) but also include maternity, behavioral health and orthopedic conditions. High-cost claimants ~2% of the total population drives 50% of the costs. High-cost claimants are associated with specialty medicines, cancers, back conditions, trauma, premature births and complications of hospitalization and surgeries. Healthcare inflation is driven by price increases, not utilization (new medical and pharmacy technologies). Severity and frequency of catastrophic claims continue to increase. Specialty medications are the fastest growing driver of high cost. Source: Lockton Infolock. 3 1

2 Focused interventions Wellness Solutions Access to Care Solutions Targeted Care Solutions Wellness programs. Employee communications. Incentive design. Culture of health. Assistance for members to find the right provider. New ways of interacting with the right provider. Identification of high-risk, high-cost, high-complexity members. Interventions that improve the health outcomes of designated members. 4 Wellness solutions Wellness programs Health risk assessment. Employee communications Wellness portal. Incentive design Morale-based. Culture of health Mission and vision. Biometric screening. Program branding. Participation-based. Wellness committee. Condition management. Health coaching. Weight loss. Physical activity. Newsletters. Multiple channels. C-suite support. Progress-based. Outcomes-based. Tobacco cessation. ACA compliance. Corporate policies. Work environment enhancements. Middle management accountability. 5 Dimensions of well-being Sample Activities Physical Feeling Well Biometric screening/health assessment. Preventive exam and age-related screenings. Device-enabled step tracking. On-site fitness opportunities. Physical activity, nutrition and weight loss education. Targeted programs (diabetes, heart disease). Tobacco-free campus and tobacco cessation. Healthy food policies and program offerings. Meaning and Purpose Mental and Behavioral Community service and volunteer activities. Work-life balance initiatives. Stress management education and workshops. Resiliency and mindfulness programs. Meditation and yoga. Quiet rooms. Financial Effective Money Management Financial education workshops. 1:1 financial planning with advisor. Employer match for 401(k). 401(k) plan auto-enrollment and auto-increase. Social Quality Relationships Corporate and peer challenges. Employee appreciation (e.g., picnic, BBQ). Recognition among peers. Group-based classes and education. Relaxation areas at the worksite. 6 2

3 Behavioral health Employer interventions Conflict resolution assistance. Fitness-for-duty evaluations. Focus on diversity and inclusion. Formal processes for referral and employee evaluation. Return-to-work assessments. Sexual harassment/fmla awareness. Substance abuse awareness training. Workplace violence prevention training. Vendor-based offerings Career counseling. Drug- and alcohol-related services. Elder care resources. Mental health-related services. On-site EAP. Support for personal issues (i.e., divorce, parenting, finances, etc.). Work/life therapy. 7 Financial wellness: Why it matters Of employees who report experiencing financial stress: 53% are stressed about finances. 48% are distracted by finances at work. 35% cited health issues caused by financial stress. 47% say finance-related stress increased in the last 12 months. HR professionals report: Employers report: 61% felt employees financial health was fair, at best. 17% employees were not financially literate. 24% offered online educational programs. 27% offered 1:1 counseling. 22% Offered group or classroom educational opportunities. Source: PwC Employee Financial Wellness Survey, Stress in the workplace 37% of working adults report experiencing chronic stress at work. Top 5 factors contributing to work stress: 1. Low salaries. 2. Lack of opportunity for growth or advancement. 3. Too heavy of a workload. 4. Uncertain or undefined job expectations. 5. Unrealistic job expectations. Chronic stress leads to negative health outcomes: Anxiety and depression. Difficulty with memory and concentration. Digestive issues. Headaches. Heart disease. Sleep problems. Weight gain. Source: American Physiological Association Work and Well-being Survey,

4 Access to care solutions On-site health solutions Convenience. Cost control. Geographic concentration. Productivity improvement. Telemedicine Reduce ER overutilization. Offset urgent care expense. Efficiency for common ailments. Cost transparency Increase health engagement. Allow members to control their own costs. In tandem with HDHP and cost shifting. Patient advocacy Telephone assistance with navigating complexities of healthcare system. Quality of care transparency. 10 On-site health clinics Services offered at on-site health clinics for employers with one or more clinics Acute Care 62% Health Improvement Programs 56% 15% Occupational Health Primary Care 48% 51% 18% Chronic Care Management Pharmacy Onsite EAP 18% 24% 36% 20% 11% All Centers Some Centers Specialty Care Mental/Behavioral Health 15% 16% 11% Onsite Navigation/Concierge 10% 10% Why it matters/key considerations On-site clinics are often used to promote company wellness initiatives. Although results vary, many employers have been pleased with their ROI through reduced health risks and improved productivity. 54% of employers with 10,000+ employees have an on-site clinic. Services are typically provided at a reduced cost to employees to incent them to prevent and treat illness. Employers have the option of enlisting a third party to provide medical professionals and manage delivery of services, contract directly with outside medical professionals, or hire healthcare professionals as employees of the company to deliver services. Source: National Business Group on Health, Targeted care solutions Second opinion solutions High-cost claimants. High-risk claimants. High-complexity patients. High-uncertainty medical situations. Other targeted solutions Pharmacy demand management. Specialty Rx provider carveout. Narrow network. Centers of excellence. Value-based design. Disease management Asthma. Cardiac health. Diabetes. Mental health. Back disorders. Case management Catastrophic care management. Renal care/dialysis. Cancer care. Rehabilitation. Home-care solutions. 12 4

5 Second medical opinion Second medical opinion is a process by which a physician reviews clinical information to determine if a member has been correctly diagnosed or is receiving appropriate treatment. Provides personalized clinical support for employees facing a wide range of medical decisions. The healthcare system often fails members with complex illnesses. A second expert opinion can be a significant resource for employees. The marketplace of vendors is growing. A second opinion from leading experts helps ensure care is evidence-based and clinically appropriate. The process: Appropriate medical experts are assembled based on the member s clinical condition. Medical experts collect and review medical records, determine their expert opinion and provide a formal write-up of their findings. A case call with the treating physician may occur as part of the process. Increasingly employers have expressed interest in adding this as a carved-out solution: 45% of employers report having second opinion services in place, with 66% reporting they plan to offer it by Source: National Business Group on Health, Large Employer s Health Care Strategy and Plan Design Survey, Condition-specific disease management Specialty vendors have entered the wellness space with programs that address chronic conditions such as diabetes, heart disease and obesity. Technology and Programming Use apps, technology-based monitoring systems. Customized, real-time interventions. Education and 1:1 coaching to maintain or improve health status. Focus Areas Disease prevention and outreach to those with elevated risk to mitigate condition development. Targeted outreach to those with chronic conditions to manage gaps in care. Strategic Implementation Collaborate with Lockton to evaluate population risk data and intervention opportunities. Evaluate targeted DM vendors best aligned with population health risks. 14 Linking health and productivity Total Worker Health Wellness and risk prevention Identify and prevent injury and health conditions that impact the company s bottom line. Targeted Interventions Loss mitigation and risk management Coordinating solutions for employees with an injury or health condition to improve their outcome. Absence Management Leave policies and absence administration Policies and practices that measure, manage and reduce absences and control loss related to injuries or health conditions. 15 5

6 RISK MANAGEMENT EMPLOYEE BENEFITS RETIREMENT SERVICES Our Mission To be the worldwide value and service leader in insurance brokerage, risk management, employee benefits and retirement services LOCKTON.COM Our Goal To be the best place to do business and to work 6