Wellness Programs, Wellness Centers, and Claims Reviews:

1. Wellness Programs, Wellness Centers, and Claims Reviews: How Employers and Employees Can Take a More Active Role in Managing Health Outcomes and Health Plan Costs

2. Today’s Panelists • LeighAnn Blackmore • Director of Labor Relations for Orange County Public Schools • LeighAnn.Blackmore@ocps.net • Chuck Breiner • Assistant Superintendent for Charlotte County Public Schools • chuck.breiner@yourcharlotteschools.net • Kevin Shibley – Pasco County Public Schools • Assistant Superintendent for Pasco County Public Schools • kshibley@pasco.k12.fl.us

3. Main Topics • Wellness Initiatives to Engage Your Employees • Operating Health and Wellness Centers to Manage Claims and Control Costs • Using Claims and Other Health Data to Make Data-Based Plan Decisions

4. Rules of the game • This presentation is meant to be active and meaningful for the audience participants. • The panelists have each brought some District specific information to start the discussion around each of the main topics. • Audience members are encouraged to stop us ay any time to ask questions! This Photo by Unknown Author is licensed under CC BY-NC

5. How Pasco is Using Wellness initiatives to engage employees • Step 1 - Offer District-Wide Screenings and Programs to Address Known Health Plan Cost Drivers • Step 2 – Incentivize Individual Employee Engagement in Health Risk Assessments and Follow-Up • Step 3 – Offer a variety of condition specific wellness education and action programs to address employee specific HRA results.

6. Step 1 - District-Wide Initiatives Based on Aggregate Data on cost drivers and lifestyle risks • Tobacco Use • Introduced Smoking Cessation Programs (Face-to-Face and Online) • Obesity/Overweight and Diabetic Employees • Introduced Healthy Eating Programs • Introduced Beginners Exercise Programs • Offered subsidized gym membership via Incentive Program • Cardiovascular • Strategically Placed Blood Pressure/Heart Monitor Machines • Partnered with American Heart Association for Traveling Heart Health Screening Bus • Cancer • Continued Cancer Screening Programs with Traveling Screening Bus for Mammograms • Promoted Prostate Cancer Screening Programs at Health and Wellness Centers

7. Step 2 – Incentivize Health risk assessments • Employees Offered $150 per year to complete a Health Risk Assessment and attend a follow-up appointment to review results. • Funds loaded quarterly onto a Bank of America Visa card. • Assessment consists of basic biometric readings as well as multi-panel blood draw and analysis. • No employee specific data is shared with the District, but data is aggregated for review and decision making. This Photo by Unknown Author is licensed under CC BY-SA-NC

8. Step 3 – Employee Specific Wellness PLans • Employees receive an additional $50 for each of two condition specific wellness programs they engage in over the course of the year. • Courses cover things like stress, weight management, healthy eating, building an exercise routine, managing cholesterol, managing hypertension, etc. • Employees with “healthy” HRAs still have options to choose from. • Employees can also choose to redirect their incentive funds to gym memberships and other healthy lifestyle programs. This Photo by Unknown Author is licensed under CC BY-NC-ND

9. Charlotte County’s Health And Wellness Center • Year of Start UP: 2010 • Location: Central Campus, District Offices: 1200 sq ft: SINGLE SITE: 21 Schools: No., Cen., W • Original Contract:HealthStat • Current Contract: Marathon Health: $1.1 Million • District Employees: 2150 (Enrolled:1380/2800 with Dependents) • Staff Breakdown: 3 Nurse-Practitioners; 3 Medical Assistants, 1 Behavioral Health Professional (Pilot) • Prescriptions: 300 Medications (District Expense: Free to Employee-Patients)

10. Details of Center Functions • Wellness Visits: FREE + $50 Per Month in Premium Reduction • Acute Care Visits: $25 Per Visit (Toward Deductible, per IRS Regs) • Focus: Reduction/Elimination of Risk Factors • Delivery: Counseling Model, Focused on Strategies for Healthful Living • Typical Appointment: 30 Minutes • Fill Rate: 95% • Patient Statistics: Average Patient Age is 43 and Average Employee Age is 51+

11. Unique Features and Services • EXCELLENT ANALYTICS: CATEGORIES OF RISKS; PROGRESS; FREQUENCY • SAVINGS: PER MONTH/PER EMPLOYEE (NOTE COMPARISON WITH PRIMARY CARE DRS.) • WELLNESS-VISIT FEQUENCY VS ACUTE CARE VISITS • APPOINTMENT FILL RATES • IMMUNIZATIONS (FLU SHOTS) • NEW EMPLOYEE PHYSICALS • DEPARTMENT OF TRANSPORTATION (D.O.T) PHYSICALS • LAB DRAWS • MENTAL HEALTH COUNSELING (PILOT): EMERGENT NEED • ANNUAL PARTNER CONFERENCE: BURLINGTON, VERMONT • EMPLOYEE-BENEFITS ADVISORY GROUP: MONTHLY: DATA REVIEW/ PRESENTATIONS • WELLNESS SUPERVISOR (LIAISON TO CLINIC)

12. Additional Factors Impacting the Wellness center • MOVE TO HIGH DEDUCTIBLE PLANS: 2018: 1500, 3000, 4500, 6650 • ADDITIONAL OPTION: TELEDOC: $45 FEE (COUNTS TOWARD DED.) • STRATEGY: FURTHER INCENTIVIZATION OF EMPLOYEE METRICS • STRATEGY: PETRI DISH CONCEPT: NAVIGATION OF ALL INSURANCE CARRIER COLLABORATION HAS BEGUN: ONE STOP SHOP • STRATEGY: TEACHING EMPLOYEES ABOUT INSURANCE USE • STATEGY: POSSIBLE FORMALIZATION OF PHARMACY IN CENTER • EMPLOYEE CONTRACT BARGAINING: EMPLOYEE ONLY: JULY 01 • FSA: $2000 AND $4000 FOR EMPLOYEES WHO DON’T ENROLL • HSA CONTRIBUTION: $2M IN 2018 AND 2019: PLAN MIGRATION

13. Orange County’s Claims review process This Photo by Unknown Author is licensed under CC BY-SA

14. Monthly Review • Includes • Medical Director - medical TPA • Pharmacist – PBM • Practice Leader- Behavioral Health TPA • Account Managers for all vendors • Benefits Consultants – Arthur J. Gallagher • Purpose • Review industry and District trends

15. Quarterly Claims Review • Includes • Each vendor/provider • Medical, Pharmacy, Behavioral Health, • Purpose • Review plan performance • Performance guarantees • Cost saving featuresand opportunities

16. Quarterly Financial & Claims Review • Present to both our Employee Benefit Trustees and bargaining teams • Comprehensive review of membership, financial performance and claims history compared to prior year • Reconcile and balance the funds in the Trust

17. Annual Audits • Outside contractors conduct audit of medical and pharmacy claims • Results • Discrepancies corrected in the claims’ systems • Incorrect claims reimbursed to District • Performance Guarantees paid to District for unachieved results

18. Recent Plan Redesign Elements • Telemedicine • $10 copay • Reduce unnecessary visits to urgent care center or emergency room Communicate with Board Certified physician via phone, Skype, Facetime, etc. for non-emergency situations • Omada • Designed to improve healthy habits of employees with emphasis on those identified as prediabetic • Interactive program with weekly lessons and access to a health coach

19. More Redesign Elements • Thrive – Diabetes Care Program • Designed for those employees diagnosed with Type 1 or Type 2 Diabetes • Goal to improve healthand reduce gaps in care while lowering costs • Offered through the AdventHealth Diabetes Institute • Year-long program to improve diabetes management • Healthy Babies Program • Well-Pregnancy Program • High Risk Pregnancy Support • Motivate Me • Rewards employees who complete a health assessment, annual physical and screenings

20. Questions This Photo by Unknown Author is licensed under CC BY-SA