1. Medical Mutual Employee Wellness Program:
Implementation and Results
June 8, 2011
©2009 Medical Mutual of Ohio

2. Purpose and Mission
Fundamental purpose:
Improve the health and productivity of our population by modifying
lifestyle behaviors that negatively impact well-being
Medical Mutual Program Mission:
“To provide the means and opportunities for employees to reach and
maintain their best possible well-being”
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©2009 Medical Mutual of Ohio

3. Medical Mutual’s Employee
Program
Makes a strong commitment to wellness ensuring that Medical Mutual
will meet and exceed strategic goals:
 Keep our healthy employees healthy
 Reduce the risks of the medium and high-risk employees
 Positively impact healthcare cost/trend
 Enliven and rejuvenate our corporate culture
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©2009 Medical Mutual of Ohio

4. Employee Program Direction
Shift in Focus…
From: Basic Awareness and Program Participation
To: Concrete, Measurable Outcomes
– Reduction in employee health risk
– Economic Analysis
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©2009 Medical Mutual of Ohio

5. Company Demographics
•Approx. 2700 employees •Years of Service: Less than 5= 32%
•75% Female; 25% Male Over 5= 68%
Over 10= 51%
Over 20= 25%
Employee Breakdown by Age
35%
30%
25%
20%
15%
10%
5%
0%
20-29 Year 30-39 Years 40-49 Years 50-59 Years 60-64 Years Over 65
Old Old Old Old Old Years Old
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©2009 Medical Mutual of Ohio

6. Medical Mutual’s
Program Timeline
2004 2006
2003 2005
•Toledo Wellness
•Web-based Healthy
Center Opening
•Corporate Wellness •Walking for Wellness Living Programs
Proposal approved •Roll-out of
by executive team •Weight Watchers •Cleveland Wellness
REWARDS program
Center Opening
•Full implementation •Onsite Health •Lunch and Learn
of health promotion Screenings •Education Modules
Seminars
practices into day-to-
day operations •Onsite Immunizations •Health club
•Smoking Cessation
membership
Program
•First Health •Enhanced employee reimbursement
Assessment (HA) preventive benefits •Annual employee
•Recipient of NBGH
wellness survey
Platinum Award and
Local Healthy 50
•Nurse Line
Award
•Cleveland Cafeteria
• Transition from
Grand Opening –
gift incentives to
healthy menu choices
healthcare premium
discount 6
©2009 Medical Mutual of Ohio

7. Medical Mutual’s
Program Timeline
2007 2008 2009 2010
•Onsite Mammography •Continual •Incentives for •SuperLoser Weight
Screening Programming Preventive Care Loss Challenge
Analysis/Evaluation •C. Everett Koop Award
•Implementation of New
•Pilot Program: Onsite •Weight Loss Fitness Center
BP Machines •Amer. Heart Assoc. Fit
Challenge Management Team Company Award
•Employee Assistance •Cooking •Implementation of •Rollout of Onsite
Program Integration Demonstrations Telephonic/Online Hypertension Pilot
•ROI Calculation Lifestyle Coaching
•HA and HLPs Made •Quarterly Fitness
•Measurement of •Fresh Produce Home Contests through
Available to Non- Delivery Program
Insured Employees Obesity in the Wellness Centers
Population •Rollout of SuperWell for •SuperWell for Life Web
•Incentive Options •Rollout of Incentive Life Web site site Enhancements
Added to REWARDS Tracking and •Analysis of Cafeteria
Program •Program Evaluation
Fulfillment Program Food Purchases against Industry
•HR Dept. Includes •Expansion of •Benchmarking with Benchmarks
Wellness Initiative in Employee Preventive NBGH and HERO •Smoking Surcharge
Company Survey Benefits Implemented
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©2009 Medical Mutual of Ohio

8. Wellness Program Offerings
Point System allows us to heavily weight programs that we feel are most
important for employees to utilize.
Health Promotion Healthy Habits
Education Weight Watchers-120
Health Assessment-400
Onsite Health Screening-300 Education Modules/Quiz-120 QuitLine Program-120
Goal Getter Program-300 Chiricosta SupeLoser Challenge-150
Virtual Health Guides-100 The Chef’s Garden Purchase-50
Flu Immunization-100
Dental Visit-50 Lunch & Learn Seminars-240 Lifestyle Coaching-100
Preventive Care Visit-50 Disease Management Program-100
Quarterly BP/ Weight Clinics-75
Fitness
Join Company Fitness Center-50 Healthy Environment/Culture
Join Community Fitness Center-50 Tobacco Free Campus
Company Fitness Center Check-in-120 Healthy Cafeteria/Vending/Catering Options
Quarterly Fitness Center Contests-40 Accessible Stairwells
Fitness Evaluation-150 Coordination with Employee Assistance Program
Physical Activity Cardio Log-120 Wellness Integrated into Orientation Sessions
Walking Program-160 Visibility/ Accessibility of Wellness Team and Program
Company Sponsored Fitness Walks-25 Comprehensive and Multi-Modal Communications
Community Fitness Event Participation-25 Executive Team Communications
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©2009 Medical Mutual of Ohio

9. Employee Wellness Site
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©2009 Medical Mutual of Ohio

10. Participation Results
©2009 Medical Mutual of Ohio

11. Participation Analysis: Annual Growth
Yearly Participation Cum ulative Participation 2+ Tim e Participants
3+ Tim e Participants 4+ Tim e Participants
12 0 %
92% 98%
10 0 % 92% 92% 9 4 %1%
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86% 8 7% 82%
8 1% 8 1% 79 % 83%
76 % 73 % 75%
80% 68% 69%
6 1% 62%
57%
60% 49%
40%
20%
0
0%
2005 2006 2007 2008 2009 2005-2009
(N=2,549) (N=2,577) (N=2,500) (N=2,928) (N=2,835) (N=1,813)
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©2009 Medical Mutual of Ohio

12. Participation: Employee Healthcare Costs
By Rewards Points Earned
•There is a strong correlation between participation intensity and averaged
annual healthcare cost increases
$5,000 $ 4,592
$ 4,565
Claims Payout Per Employee
$4,500 $ 4,520 Average Annual
$ 4,177 Healthcare Costs Increase
$4,000
Points $ %
$3,500 0-2000 (N=257) $581 28%
$ 3,129
$3,000 $ 3,009
2000-3999 (N=242) $465 20%
$2,500 $ 2,290
4000-5999 (N=244) $415 14%
$2,000 $ 2,107
6000 + (N=954) $320 10%
$1,500
$1,000
2005 2006 2007 2008 2009
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©2009 Medical Mutual of Ohio

13. Participation: Average Lost Workdays by
Rewards Points Earned
• Fewer clean trends in lost workdays associated with program involvement.
• Those earning greater than 4,000 points show less lost workday increases
as compared with those earning less than 4,000 points.
3.0 3.09
2.5 2.28 Average Annual Lost
2.24 Workday Increases
Lost Workdays
2.0 Days %
1.88 Points
1.7
1.5 0-2000 (N=257) 0.26 19%
1.38
1.36 2000-3999 (N=242) 0.49 51%
1.0
0.95 4000-5999 (N=244) 0.17 13%
0.5 6000 + (N=954) 0.18 11%
0.0
2005 2006 2007 2008 2009
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©2009 Medical Mutual of Ohio

14. Wellness Points/T1, T2 Risk Status
Wellness Rewards Points
(Cumulated 2005 ~ 2009)
Time One Risk Time Two Risk
Status Status N Average
0-2 0-2 871 8,801
3-4 112 8,037
5+ 15 7,659
3-4 0-2 188 8,953
3-4 223 8,503
5+ 39 7,023
5+ 0-2 20 7,442
3-4 78 8,684
5+ 86 6,905
Among two time HRA Participants (2005/2006 vs. 2007/2008), N=1,632 14
©2009 Medical Mutual of Ohio

15. Participation Analysis
• Program participation remains high, with a cumulative
participation of 98%
• Repeat participation was especially high, with 94% of
employees participating at least two years from 2005 through
2009.
• In 2009, 75% of employees took part in at least one program.
• Strong correlation between participation and averaged annual
healthcare cost increases.
• Correlation between participation and remaining low risk or
moving to lower risk from T1 to T2 HRA.
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©2009 Medical Mutual of Ohio

16. Risk Analysis and Economic Results
©2009 Medical Mutual of Ohio

17. Risk Analysis:
Shift in Risk Groups
Risk 2004/2005 2007/2008 2009/2010 % Change
Low Risk
61.1% 66.1% 68% 6.9%
(0-2)
Medium Risk
27.6% 25.3% 23.4% 4.2%
(3-4)
High Risk
11.3% 8.6% 8.6% 2.7%
(5+)
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©2009 Medical Mutual of Ohio

18. Risk Analysis: Shift in Risk Measures
•While improvement is evident in several measures, there is still a negative shift
in cholesterol (+1.9%), blood pressure (+2.4%) and weight/BMI (+3.0%).
Time 1 High Time 2 High Risk Net Change %
Risk % % Point*
Physical Activity 13.4% 8.7% -4.7%
Safety Belt Use 12.7% 10.4% -2.3%
Life Satisfaction 5.8% 3.8% -2.0%
Smoking 8.4% 6.6% -1.8%
Job Satisfaction 5.5% 4.4% -1.1%
Medication to Relax 0.9% 0.5% -0.4%
Alcohol 1.4% 1.1% -0.3%
Perceived Health 8.6% 8.3% -0.3%
Illness Days 3.4% 4.4% 0.9%
Existing Disease 12.9% 14.0% 1.1%
Cholesterol 5.4% 7.3% +1.9%
Targeted for Intervention
Blood Pressure 34.1% 36.5% +2.4%
Weight (BMI) 48.3% 51.3% +3.0%
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©2009 Medical Mutual of Ohio

19. Risk Analysis :
Impact of Risk Categories on Medical Cost
MED/HIGH RISK LOW RISK
Medical Costs 2008 Healthcare Medical Costs
$6965 Costs $2,879
+$2215 -$1522 +$3435 +$623
MED/HIGH RISK LOW RISK 2009 Healthcare MED/HIGH RISK LOW RISK
Medical Costs Medical Costs Costs Medical Costs Medical Costs
$9180 $5543 $6314 $3502
N=1,599; MMO Employees
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©2009 Medical Mutual of Ohio

20. Excess Medical Cost Due to Excess
Risk Status
$ 14 ,0 0 0
$ 12 ,5 7 9
M $ 12 ,0 0 0
e
d $ 10 ,0 0 0
i E xc e s s C o s t
c $ 8 ,0 0 0 B ase C o st $ 6 ,9 9 4 $ 9 ,0 9 0
a
$ 6 ,0 0 0
l $ 4 ,5 0 9 $ 3 ,5 0 5
$ 4 ,0 0 0 $ 1,0 2 0
C
o $ 2 ,0 0 0 $ 3 ,4 8 9 $ 3 ,4 8 9 $ 3 ,4 8 9 $ 3 ,4 8 9
s
t $0
s Lo w R is k N o n P a rt ic ipa nt s M e dium R is k H igh R is k
( 0 - 2 R is k s ) ( 3 - 4 R is k s ) ( 5 + R is k s )
Number of Risks
*2010 HRA and 2009 Medical Costs
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©2009 Medical Mutual of Ohio

21. Excess Lost Work Days Due to
Excess Risk Status
10.0
S 9.0
T 8.0
7.0 6.1
D
6.0 Base Cost Excess Cost 4.6
5.0
D 3.5
4.0 4.3
a 2.9
3.0 1.7
y
2.0
s 1.0 1.8 1.8 1.8 1.8
0.0
Low Risk Non Participants Medium Risk High Risk
(0-2 Risks) (3-4 Risks) (5+ Risks)
Number of Risks
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©2009 Medical Mutual of Ohio

22. Healthcare Cost/T1, T2 Risk Status
Average Annual Healthcare Paid
Time Two
Time One
Risk
Risk Status
Status Average
N 2005 2006 2007 2008 2009 05-09
0-2 871 $2,070 $2,717 $2,558 $2,936 $3,687 $2,794
0-2 3-4 112 $2,348 $4,041 $4,566 $3,716 $4,467 $3,828
5+ 15 $6,495 $4,921 $6,696 $5,580 $5,309 $5,800
0-2 188 $2,956 $2,828 $3,080 $3,369 $3,721 $3,191
3-4 3-4 223 $3,777 $3,625 $4,046 $3,724 $5,132 $4,061
5+ 39 $2,900 $3,985 $6,276 $5,977 $5,728 $4,973
0-2 20 $2,510 $2,734 $5,453 $2,869 $4,593 $3,632
5+ 3-4 78 $6,536 $7,560 $7,201 $7,520 $9,583 $7,680
5+ 86 $5,555 $6,958 $7,144 $8,455 $11,905 $8,003
Among two time HRA Participants (2005/2006 vs. 2007/2008), N=1,632 22
©2009 Medical Mutual of Ohio

23. Lost Work Days/T1,T2 Risk Status
Average Work Lost Days (STD)
Time One Time Two Average
Risk Status Risk Status N 2005 2006 2007 2008 2009 05-09
0-2 746 1.13
0.86 0.67 1.18 1.08 1.85
0-2 3-4 103 2.20
0.54 2.24 3.17 2.54 2.50
5+ 13 2.68
8.85 0.00 1.37 0.00 3.20
0-2 162 1.62
2.66 0.56 0.71 1.74 2.41
3-4 3-4 194 2.11
2.20 0.88 2.36 2.15 2.94
5+ 36 2.71
0.00 0.89 3.87 4.86 3.92
0-2 18 1.55
2.56 2.00 2.14 0.00 1.05
5+ 3-4 71 4.47
3.39 2.66 6.32 5.56 4.42
5+ 72 4.07 5.79 10.26 4.64 8.41 6.63
Among two time HRA Participants (2005/2006 vs. 2007/2008), excluding women with
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pregnancy claims N=1,415
©2009 Medical Mutual of Ohio

24. Excess Cost by Risk/Condition
Adjusted* Mean
Risk Factor/
Prevalence Not Excess
Disease State At Risk
at Risk Cost
Hypertension 37.4% $3,733 $3,387 $346
Cholesterol >=240 6.4% $3,578 $3,523 $55
Obesity (BMI>=30) 37.1% $4,757 $3,511 $1,246
Diabetes 6.8% $10,115 $3,524 $6,591
Coronary Artery Disease 6.2% $6,087 $3,827 $2,260
Asthma 11.4% $4,516 $3,899 $617
Smoking 6.1% $3,517 $3,429 $88
Depression 11.7% $5,641 $3,755 $1,886
None of the listed risks 28.6% $2,633
*Adjusted for age, gender and all listed risks
Study population: N=2,047 (2009 HRA and 2009 Medical and Drug Paid Amount)
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©2009 Medical Mutual of Ohio

25. Studying Relationships…
•BMI and Lost Workdays
•BMI and Healthcare Costs
Then Developing Strategic Initiatives
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©2009 Medical Mutual of Ohio

26. BMI vs. Lost Workdays
Obese (BMI >30)
5 4.5
4 3.16
3 2.18
1.56 1.49
Days
2 1.17
1
0
<25 25-27.4 27.4- 30-34.5 35-39.9 40+
(N=355) (N=216) 29.9 (N=270) (N=187) (N=144)
(N=197)
BMI
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©2009 Medical Mutual of Ohio

27. BMI vs. Healthcare Costs
Obese (BMI >30)
$8 ,0 0 0
$6,871
$7,0 0 0
$5,374
Paid Amount
$6 ,0 0 0
$5,0 0 0 $4,113
$4 ,0 0 0 $3,290 $3,227 $3,094
$3 ,0 0 0
$2 ,0 0 0
$1,0 0 0
$0
<25 25-27.4 27.4- 30-34.5 35-39.9 40+
(N=355) (N=216) 29.9 (N=270) (N=187) (N=144)
(N=197)
BM I
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©2009 Medical Mutual of Ohio

28. BMI Initiatives
Chiricosta Challenge
• Six-Month Weight Loss/Get Healthier
Challenge
• CEO Endorsement and Ownership of
Program
• CEO Blogs and Communications
• 1400 Participants
• 6500 Pounds Lost
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©2009 Medical Mutual of Ohio

29. BMI Initiatives (cont’d)
• Fitness Center Reimbursements
• Onsite Fitness Facility Check-in Points
• Onsite or Community Facility Membership Points
• Fitness Center Contests
• Cardio Log Entry Points
• Walking Program
• Company Sponsored Fitness Walks
• Lunch and Learn Seminars
• Education Modules
• Healthy Choices: Cafeteria, Vending, Catering, Company
Meetings
• Cafeteria Promotions, Educational Displays
• Healthy Cooking Demos
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©2009 Medical Mutual of Ohio

30. Benchmarking –
How are we doing against national standards?
©2009 Medical Mutual of Ohio

31. Health Enhancement Research
Organization
HERO Scorecard Results
The scorecard is a tool designed to determine employee health
management best practice. It can be used as an inventory, an
indicator for program success and as a benchmarking tool.
"The greatest value of the Scorecard is in providing an inventory
of EHM best practices for consideration; your scores provide an
indication of where you can identify opportunities to enhance your
program."
2008 2009
Medical Mutual of Ohio Score 147 162
Total possible points: 200
National Average: 96
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©2009 Medical Mutual of Ohio

32. National Business Group on Health
Wellness Impact Scorecard
The scorecard was developed to assist employers in
understanding levels of achievement in improving health,
the strengths and weaknesses of their programs and to
help them benchmark against the programs of other
employers.
Overall Progress
Total MMO’s Score
Potential
Points
2008 2009
Company’s Efforts to Improve Health (Level 1) 50 43 50
Employee Engagement (Level 2) 50 39 50
Outcomes and Analysis (Level 3) 100 75 87.5
Total 200 157 187.5
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©2009 Medical Mutual of Ohio

33. Cultural Analysis:
Impact of Wellness Program
Wellness Program Survey Results
– 94% of employees surveyed feel that the Wellness programs are
making a positive impact on the culture at MMO.
– 90% of employees surveyed feel that the Wellness programs are
making a positive impact on their health.
– 82% of employees responded that they are very satisfied or satisfied
with the Wellness program.
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©2009 Medical Mutual of Ohio

34. Executive Summary and Analysis
©2009 Medical Mutual of Ohio

35. Executive Summary and Analysis
• Participation in the wellness program showed a positive impact on
healthcare cost trends for three consecutive study periods.
• The low risk population continues to grow, a key achievement in our
health management strategies.
• Employees who earned more reward points had smaller healthcare
cost increases and smaller lost workday increases than those who
earned less points.
• In general, an increased participation level (years of participation or
number of wellness points) was associated with an increase in the
percentage of individuals at low risk.
• The wellness program had the most impact on percent risk reduction
for those employees with risk factors for: physical activity, safety
belt use, life satisfaction and smoking.
• The number of employees at risk for weight (BMI), blood pressure,
and elevated cholesterol increased over time and will remain a focus
of programming and interventions.
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©2009 Medical Mutual of Ohio

36. Future of Wellness/Next Practices…
1. Focus on the individual and how to impact:
 Personal buy-in and personal significance of change in health status
 Sustainable behavior
 Health in the context of life
2. Moving the general public to healthier lifestyles
 Employer involvement in community health
 Role of the community in employee/family health
 Health as a social trend; social “movement”
3. Standardization of program offerings, measurement,
evaluation and performance metrics
4. Continued focus on the influence and impact of corporate
culture
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©2009 Medical Mutual of Ohio