APHA Annual Meeting Washington DC Session 3332.0 Balancing Equity, Effectiveness and Efficiency in Health System Reform

1. Somerset Microwellness:A Healthy Community coalition creates a wellness pool for very small businesses as an add-on to coverage through exchanges Kala Ladenheim, MCDWilliam Primmerman, GSPHCAndrew Spaulding, MCD APHA Annual Meeting Washington DC Session 3332.0 Balancing Equity, Effectiveness and Efficiency in Health System Reform Monday, October 31, 2011, 2:30 PM-4:00 PM (C) Medical Care Development 2011

2. Presenter Disclosures Kala Ladenheim No relationships to disclose The following personal financial relationships with commercial interests relevant to this presentation existed during the past 12 months: Medical Care Development 2011

3. Somerset County • More than half of the businesses (55%) employed fewer than five • Poor county health statistics • High rates of obesity, poor eating habits, smoking… • Engaged community health partnership (HMP), health and business leadership • Strong ties among health providers, businesses (C) Medical Care Development 2011

4. Problem • Microbusinesses (<=5) are neglected by insurance and wellness market • Unpredictable-sometimes like individual and sometimes like group • No economies of scale • almost same work to serve as midsize group • one-time/fixed costs don’t get diluted • Little margin for workers, employer, resources • Many can’t afford insurance (C) Medical Care Development 2011

5. Opportunity • Exchange and state-level health reform offers a model for community-based grouping • Healthy Maine Partnerships (HMPs) doing community-based wellness • ACA stresses health, not just medical care • Businesses and brokers need a different option • Hospital wants to reduce avoidable illness (C) Medical Care Development 2011

6. What We Hope to Learn • Design challenges due to size. For example: • How to build community yet protect privacy • Group release of data and some activities • Small business perspective is central • What motivates change in a tiny organization? • Will a nominal incentive work? • What policy and environmental changes happen? • Will the public health/community model provide the needed support? • Can an HMP achieve viable economy of scale? • Will insurers step up? (C) Medical Care Development 2011

7. Unknown: Emerging Questions • Known unknowns • Maine policy actions—insurance and tax credit changes in 2011, implementation unknown • ACA implementation, demonstration funding • How many businesses even have insurance? (40% in demo—but 92% of employees) How many will in the future? • Unknown unknowns—Examples of new questions • Can we market to solo contractors who all work for a single operation? • Tax status of incentive (Maine enacted tax credit but did not fund yet)? (C) Medical Care Development 2011

8. Wellness: Best Practice Approach • Approach 1: Environmental Interventions That Support Healthy Lifestyles. • Approach 2: Policies And Financial Incentives That Support Healthy Lifestyles. • Approach 3: Frequent And Simple Prevention Messages. • Approach 4: Health Education Classes, Workshops, Medical Self-Care. • Approach 5: Screenings, Health Assessments And Referral Leading To Risk Factor Follow-Up Education And Counseling. • Reference: Matson Koffman D, Goetzel R, Anwuri V, Shore K, Orenstein D, LaPier T. Heart Healthy and Stroke Free: Successful Business Strategies to Prevent Cardiovascular Disease. Am J Prev Med 2005;29(5SI):113-121. (C) Medical Care Development 2011

9. adapted from Dee Edington, Ph.D., University of Michigan Health Management Research Center, “Health Management as a Serious Business Strategy” presentation . http://www.somersethearthealth.org https://wellsuite.com/somerset/ws/Default.aspx (C) Medical Care Development 2011

10. (C) Medical Care Development 2011

11. Activities • Define the activities required for insured group to earn the wellness rebate; • Wellness committee, scorecard • Describe and package the services that the HMP will offer to support earning the rebate; • HMP business wellness portfolio, brochure • Create an organizational workplan • Achieving the workplan is the criterion for the simulated credit • Identify policy changes needed to allow this model; • Incentive committee (C) Medical Care Development 2011

12. Design issues • Balancing who pays so incentive=opportunity • The practicalities, how much, how and when • Insurance rebate, tax credit, other rewards • Cut-off points—don’t make new gaps • Coordinate with medical home • Coordinate with public insurance (Mainecare, Dirigo) (C) Medical Care Development 2011

13. Activities (cont) • Market the product to different groups • Insuring and non-insuring micro businesses • Advisory committee • Defining messages • Wellness is good business and is about caring • Brochures, presentations and “free media” • Role of • Brokers • Businesses • HMP • Individuals • Community-based / health care providers • Care committee (C) Medical Care Development 2011

14. Activities (cont) • Test alternative pricing approaches • Prepaid comprehensive wellness contracts • Fee-for-service wellness activities • Evaluate acceptability and impact to demonstrate the value of the product; • Coordinate among clinical and community services to ensure a continuum of wellness. • Make sure this is integral part of medical home activity (C) Medical Care Development 2011

15. HERO Scorecard • Inventory of best practices in employee health management • 6 Categories: Strategic Planning, Leadership Engagement, Program Level Management, Programs, Engagement Methods, Measurement and Evaluation • Indicator of program success – Compares organization’s scores to aggregate scores in the entire database • Normative database for benchmarking and research – National database allowing for research on the relationship between program structure and individual and organizational outcomes Source: http://the-hero.org/scorecard_folder/scorecard.htm Medical Care Development 2011

16. Scorecard Adaptations • Convert from scoring tool to a set of criteria by which the very small businesses wellness program will be measured • Modify HERO Scorecard language to better match the communication style of small-businesses • Wellness program criteria identified as employer responsibility or provided by the community health agency • Program criteria will be used to… • Educate and communicate regarding the best practice approach • Inform program planning and setting of targets • Measure program attainment annually (C) Medical Care Development 2011

17. CDC Worksite Health InitiativeComprehensive Workplace Health Programs to Address Physical Activity, Nutrition, and Tobacco Use in the Employee Population • Funds will support the development of a core workplace health program in small and large worksites across 7 cohorts • Somerset County, ME is being considered as an employer cohort for this initiative • Provides excellent opportunity to demonstrate a new approach whereby local public health agencies can support worksite health promotion and disease prevention (C) Medical Care Development 2011

18. Acknowledgements and Information The microwellness project was funded in part by a generous grant from the Maine Health Access Foundation under their Advancing Cost Containment and Payment Reform Strategies in Support of the Affordable Care Act initiative. www.MeHAF.org The Microwellness project partners are • The Greater Somerset Public Health Collaborative www.somersethearthealth.org and • Medical Care Development www.mcd.org (C) Medical Care Development 2011