The document summarizes strategies to enhance the return on investment (ROI) of wellness programs. It discusses analyzing population health data, developing a strategic wellness framework with six components, implementing evidence-based wellness interventions, and measuring outcomes through scorecards. It also covers recent trends like onsite fitness centers and clinics, and critical success factors for wellness programs like determining opportunities using claims data and selecting partners willing to work within the employer's model.

1. Strategies to Enhance the ROI of Wellness Programs
Webinar
September 14, 2011

2. Agenda
• Introductions
• Current Landscape
• A Strategic Wellness Framework
• Wellness Interventions
• Total Health Management
• Recent Trends
– Onsite fitness
– Onsite clinics
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3. The Landscape: Medical Costs and Access
• Medical cost inflation continues rapidly (8-10%)
• 2011 health care spend estimated at $3 trillion
• Health reform bill mandates coverage and penalizes
employers to pay the costs, but does little to address the
rising cost of health costs, unhealthy behaviors, or the
current fee for service medical payment model
• The current bill increases access to care in a system that is
already at capacity- 32 million more patients will now
have access to the same number of physicians
• Reduction in Medicare and Medicaid reimbursement
schedules has hospitals and physicians looking to private
insurance to fill the gap
*Source: Segal, Kaiser, Aon studies 3

4. The Landscape: Health Continues to Decline
• Out of 100 U.S. adults….
– Only three are non-smokers, not overweight, are physically
active, and eat a healthy diet
• 60% of healthcare expenditures are attributable to
preventable illness or modifiable risks
• For every 100 employees….
– 20% of healthcare expenditures are attributable to preventable
illness
– 40% of healthcare expenditures are attributable to modifiable
risk
– 11,500 hours of productivity per year are lost due to health
conditions
• Inpatient hospital stays represent the largest portion of
medical inflation
*Source: CDC, Segal 2011 Study 4

5. What does this mean for the employer?
“It is not the strongest of the species that survives, nor the
most intelligent, but the one most responsive to
change.” Charles Darwin
•Employers have a unique ability to change the trend if
they are willing to adapt
•Requires a comprehensive strategy that addresses:
•Plan design that supports the population’s unique needs- driven
by analytics
•Access to high quality and high value care that is convenient
•Employee engagement: From participation to outcomes
•Coordination of clinical and various vendor resources
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6. Keys to Success
Employee
Engagement
Total Health
Consumerism
Management
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7. Outcomes and Quality
Assurance
Wellness
Framework: Six Engagement and Rewards
Components Benefit Plan Design and
Intervention
Data Analysis and Strategic
Plan
Sustainable Operating
Environment
Organizational
Commitment
© Copyright 2011 – CBIZ, Inc. NYSE listed: CBZ. All rights reserved
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8. Quality of Population
Traditional
Work/Life Health
Approach
Approach Management
Broader access to Broader range of evidence-
Fun activity focus education and on-line based, interactive programs
Create awareness programs Integration of providers to
Generate interest Assess population risk provide member centric
Educate with health risk focus on overall wellbeing
Voluntary assessment/biometrics High engagement strategies
No risk reduction Modest incentives for Behavioral coaching, disease
No high risk focus participation management, EAP utilization
No meaningful Tracking participation Strong risk reduction
incentives Wellness Committee Strong high risk focus
No link to benefit plans Modest evaluation Major use of external and
No three year strategic Modest risk reduction intrinsic motivators
plan Mostly health focus Required activity
No specific Voluntary Strongly personal
goals/scorecard Some personalization Developed three year strategic
No personalization Few spouses plan
No spouses included Modest (annual) planning Rigorous evaluation/scorecard
Modest goals Spouses and dependents served
Morale Participation Results
Oriented Oriented Oriented
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9. Strategic Plan for Population Health Management includes
the following broad objectives:
– Year One: Branding/Culture/Organizational Commitment
Define Vision and Strategy
Setting Expectations
Rewarding Participation
– Year Two: Rewarding Participation and Improvement
Expanding Engagement
Capturing Process and Impact
– Year Three: Rewarding Participation and Achievement
Reporting Outcomes
Return on Investment
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10. Intervention and Engagement Progression Flow
Greater
Improved
Awareness Participation Engagement Performance
Wellbeing,
and and External and Intrinsic and Positive
Vitality, and
Education Motivation Motivation Clinical
Energy
Impact
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11. Participation to Outcomes Achievement Matrix
Year One Year Two Year Three
• Goal: change over Participation Criteria term Participationbiometricsand
Employee
Meets Participation
Engagement
Criteria
Meets
the longYear One Meets specified Criteria
improves biometrics over
and
achieves
and Reward Saves $20 per month Saves $30 per month Saves $40 per month
– Organization working to maintain the change
Goal: 60% Goal: 30% Goal: 60%
– Individuals working $15 per month
to maintain theMeets$20 per monthCriteria
Meets Participation Criteria
Saves
change
Saves
Participation
Goal: 50% Goal: 30%
Non Participant pays Non Participant Non Participant
additional $20 per month Pays additional $30 per month Pays additional $40 per month
Employee •Biometric Screening •Biometric Screening •Biometric Screening
Participation •Health Risk Assessment •Health Risk Assessment •Health Risk Assessment
Criteria •Annual Physical/Medical •Annual Physical/Medical Home •Annual Physical/Medical Home
Home •Preventive Screening •Preventive Screening
•Preventive Screenings •Wellbeing Planning Session •2 Wellbeing Sessions
•Wellbeing Planning •Non tobacco user •Non tobacco user
Session •2 Intervention programs •3 Intervention programs
•Non tobacco user •DM if chronic condition •DM if chronic condition
•Pregnancy program if applicable •Pregnancy program if applicable
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12. Engagement Strategies to Enhance ROI
• Provide autonomy, employee decides their choices, creates accountability = Self-directed
• Enhance the employee’s belief that they can do something (exercise regularly, quit smoking),
and provide the opportunity to get incrementally better at something that matters to the
employee = Self-efficacy and Mastery
• Enhance the employee’s belief that a particular behavior will produce a desired consequence
(quitting smoking will help them breathe better when playing with kids) = Behavioral efficacy
• Provide opportunities that are part of or impact the employee’s personal purpose, meets their
unique needs and interests = Purpose. Provide a session for employees to create their
personal purpose that includes their passions, long-term goals and current priorities
• Create an environment that:
– makes people feel good about participating; positive marketing
– Little or no cost to employee (cost barrier removed)
– Is as open as possible: interventions are readily available and accommodating, they fit
into employee’s lifestyles and schedules (access and time barriers removed)
– Shows employees how to (not telling “what to do”) perform the actual behaviors they
should perform, how to integrate the behaviors into their lives and how to change their
environment outside of work so they can practice the behaviors (experiential learning)
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13. ROI Measurement: Scorecards and Dashboards Wellness Scorecard
[Date]
Measure Year One Year Two Year Three
Total Employee Count
Number of Employees Eligible for Medical Plan
Number of Total Members Enrolled in Medical Plan
Number of Employees Enrolled in Medical Plan
Number or percentage of members in a Consumer Driven Plan Design
Male Employee Population in Medical Plan 80.30%
Measure Year One Year Two Year Three
Female Employee Population in Medical Plan 19.70%
Screening Participation Total (ee's only)
Population Demographics
Employee Average Age 41.1
Biometric Screenings
At Risk and Obese BMI (BMI > 25)
Number of Dependents Enrolled in Medical Plan At Risk Waist Circumerence (male > 40, female > 35)
Child Dependents in Medical Plan Pre-Hypertension/High Blood Pressure (Stage 1 & 2)
Female Adult Dependents in Medical Plan High Cholesterol (> 200)
Male Adult Dependents in Medical Plan Pre-Diabetes (Fasting)
Member Demographics by Age Band High Glucose (Fasting and Non-Fasting)
<01 Members with Chronic Conditions (Diabetes, High BP, High Choles., Asthma)
01 - 19 Members with Chronic Conditions (Stress and Anxiety, Depression)
20 - 29
Prescription Classes
Top Number of Prescriptions (per 1,000) Year One Year Two Year Three
30 - 39 Antidepressants 603.1
40 - 49 Lipotropics 432.3
50 - 59
Diabetic therapy 298.9
Antiarthritics 230.0
60 - 64
Bronchial Dilators 222.2
65+ Anti-ulcer/gastrointestinal 188.8
Measure Year One Year Two Year Three
Qualifying Events Participation
Medication Adherence Rate
Health Risk Assessment 92 Measure (Benchmark is 80%) Year One Year Two Year Three
2011 Weight Loss Challenge (10% of body weight) Hypertension/Cardiac 84.4%
2011 Walking Challenge (150 miles) Diabetes 83.3%
Routine Annual Physical Exam
Cholesterol 91.9%
Preventive Screenng
Depression 86.3%
Biometric Screenings
Antipsychotics 88.5%
Non-Tobacco Waiver
Asthma 74.1%
Two organization-wide intervention programs engagement
Osteoporosis 87.2%
Measure Year One Year Two Year Three
HRA Participation Total (employees) 92 (4%)
HRA Participation Total (dependents) 0.0%
Male Population in HRA 42.0%
Female Population in HRA 58.0%
Average Age
Wellness Population Score
38.7
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Risk Stratification

14. • Low hanging ROI fruit:
– Annual Exam and Preventive Screenings
– Medical self-care
– Flu vaccinations
– Stress/resiliency programs
– Injury prevention: work, home, vehicular and recreational
– High risk pregnancy prevention program
– Tobacco cessation program with NRT
– Positive communication, communication, communication
6 – 18 month ROI
• A Way to Approach ROI:
– First focus on impacting risks and costs associated with the health plan
– Second, look closely at absence and sick leave costs and those than can be
affected by a wellness program
– Third, reduce workers compensation risks and costs
– Fourth, focus on reducing risks and costs associated with disability
– Finally, review the ‘harder to measure’ areas that can be positively impacted,
including work effectiveness, employee morale, productivity, decision-making
ability, improved service and increased revenue generation potential
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15. TOTAL HEALTH MANAGEMENT = VALUE
Plan Design
Value Based
Benefits
Wellness and
Absence
Condition
Management
Management
Consumerism Wellness
and employee Physical Activity
engagement Center
Safety and
Communication
Occupational
and Education
Medicine
High
Performance
Networks
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16. Sustainable Operating Environment Interventions – Onsite Fitness
Goals Typically Considered:
• Convenience, removes barriers to access, and medium for other wellness programming
• Cultural message in support of wellness
General Considerations:
• Space planning and construction, budgeting for equipment purchase and maintenance
• How will each individual get access to the fitness center?
• What will the hours of operation be? Will you have cameras or key cards?
• Will it be staffed by a fitness professional? Concern for an individual working out alone?
Policies and Procedures:
• Individual must complete a pre-activity screen
• If there are any cardiovascular risk factors they must have a signed physician release form
• Develop a written policy for cleaning and disinfecting equipment
• Apply appropriate signage that clearly indicates they are assuming personal responsibility for engaging in
the use of the facility without staff supervision, and that as a result, certain risks exist that they should be
prepared to deal with.
• Consider a formal orientation process
Risk:
• Consult with your property and casualty advisor regarding insuring equipment and risk
• Ensure legal counsel is supportive
• An automated external defibrillator should be placed in or near the facility
• Facility staff should be CPR and AED certified
• Safety/incident reporting and management process in place
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17. Trends in employer sponsored clinics
Trends
• Onsite Clinics
• Near-site or shared clinics
• Concierge physician relationships with local providers or health systems
• Part-time clinics (scalable model)
• Increased adoption of these services as cost saving measures in the public sector
• Outcomes based performance metrics
• Carrier Support
Why are employers evaluating these options?
• Improve access to quality care for their employees in light of healthcare reform
• Healthcare reform does not address the rising cost of healthcare, it addresses access
• Provide the necessary access to enable employees to be accountable for their health
• Creation of a predictable and fixed liability for services performed in these arrangements
• Cost savings through reduction of over-utilized and expensive services
• Improve employee recruitment and retention during tough economic times
• Improve access to preventative services
• Make consumer driven plans more palatable
• Improve the quality of the employee and provider relationship—personalize the approach
• Creation of a happy and healthier workforce
• Provide a consistent and trusted relationship to employees, improving the healthcare
experience 17

18. Scope of Services for Consideration
Urgent Care
• Colds and Sinus Infections
• Prescriptions
• Flu Shots
• Routine labs
Wellness
• Biometric Screenings
• Health Assessments
• Coaching and Education
Primary Care
• Communication with other providers
• Patient Centered Medical Home
• Physicals
• Specialty Referral Networks
• FMLA Certification
Ancillary Services: PT, Chiropractic, Radiology
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19. Scope of Services for Consideration
Occupational
• Safety Seminars
• Post-Employment
• DOT Physicals
• Functional Exams
• TB tests and Immunizations
• DOT Drug Screens
• Random Drug Screens
• Post employment physicals
• Roles and responsibilities definitions
• Supervisor training
Worker’s Compensation
• Occupational Medical Services
• Communication with other providers
• Coordination of light duty and return to work programs
• Record Management/DOT file maintenance
• First Report of Injury
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• Case Management

20. Onsite Clinic Profile and Considerations
Characteristics of Organizations implementing onsite clinics
• Organizations with or 450 or more benefit enrolled employees or a large percentage of retirees or
dependents who live within 7 miles of the proposed site location
• High prevalence of chronic conditions within the population
• Low utilization of primary care and preventative services
• ER and specialist visit utilization is high
• Occupational medicine costs are high or are not decreasing
• Health risk factors in the population are not decreasing, despite wellness programs
• Implement or are willing to consider consumer driven plans
• High absence or lost time replacement costs
• High pharmacy utilization, or low generic or therapeutic alternative utilization
• Smaller employers in close proximity with shared demographics
Onsite Clinic Considerations
• Feasibility Employer Sponsored Clinics
• Cost and Measuring Return on Investment
• Staffing Model
• Scope of Services to offer
• Who will have access to utilize the clinic
• Will you charge for use of the clinic
• What is your primary objective for opening a clinic
• Compliance and Regulatory issues
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• Funding arrangement

21. Critical Success Factors
• Determine opportunity using the client specific claims data
• Coordinate with current benefit programs
• Select partners, not vendors, based on their willingness to work within your model
• Develop scope of services based on your specific needs
• Communication is key- over communicate in a variety of medium
• Do not under-estimate time commitment
• Align plan design, incentives and scope of services
• Prioritize and phase in services based on demand
and greatest return on investment
• Set realistic expectations
• Provide and show executive level engagement
• Hire clinicians for cultural fit
• Integrate data and provide for coordinated care
• Engage employees early in the process
• Develop relationships with community-based providers
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22. • Thank you for attending!
• Questions?
• Contact Information:
– Polly Thomas, Director, Onsite Clinic Consulting,
pthomas@cbiz.com, (913) 234-1013
– Gina Payne, National Director of Wellness,
gina.payne@cbiz.com, (913) 234-1064
– www.cbiz.com
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