ALC-Employee Benefits Division Oversight Subcommittee

The thing is we're still, we're still working on trying to get a zoom up, uh, so we may be a few minutes, but we have a few housekeeping, uh, things that we need to do, so we're gonna go ahead and get started on that. Just know we may have to stop for a few minutes, but, uh, I'm supposed to read this. As you can see, we have a, uh, a new system in front of you. And if you're, and some of you here yesterday, so I know you understand this, so this is for the ones that were not here. Uh, if you're a member of this committee, you're assigned, your assigned seat is designated by your name on the name plate, of course. The name nameplates reading Bureau of Legislative Research or unassigned and non-committee members, they may take that seat. As you can see, you have PIN numbers also that you're supposed to use to access the system. Uh, so to access the microscope microphone system, each member must input his or her four-digit PIN number on the screen. So this is the important part. 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Once you have signed in, you'll see several tabs on your screen, voting documents, agen agenda, and etc. These functions are not available at this time. As our vendors are still working on programming to fit the needs of the com. OK. Uh, Seal, do you want, y'all want to come forward and y'all can, uh, introduce yourselves? Good to have you all back. Good morning, uh, Patrick Klein with Siegel. Hello, Doctor Saad to be back here. All right, thank you. Uh, whenever you are, whenever you all are ready, you can begin. And everybody hear me OK. I love it. So today is. Background on wellness, a busy slide, but every bullet is. And we want to emphasize some things here. Historically Wellnessks While also improving, but always the program. Similarly, if you have an ailment. Smartphones with the apps caught on again, and especially with COVID-19 because we all became virtual related uh app. So while the engagement of these low touch digital programs, very sure that we get something with something that they understand the perceived benefits of why do I participate, and overall in the wellness program. It has to be. So there are tons of vendors, Of those healthy lifestyles. We kind of have uh some philosophy in that. And those are usually, you know, the biome important that has come recently to to everybody's attention is the financial wellness, and by that I don't mean you. Kind of people reward people financially. By financial wellness is making people aware of how to manage their finances. That is a huge component of somebody's wellbeing. If they know I can put my kid through college if they know I have enough savings to that will last me through retirement if they know what pension I'm going to get and then to complement that, how much am I going to save every month on a 401k or pension plan, that's kind of the financial wellness that we're talking about. That knowledge somehow or That education We were never used to providing as a health care provider, but it is an important component of health, and that's very important. So combination of knowledge and motivation and that improves the member engagement. So we were asked to provide some case studies in terms of does wellness actually save money? And let me just reiterate the fact that it's not going to save you money right up front, or there is no measurable ROI that I can tell you is going to yield you a result tomorrow, however. Indirectly. We know it improves people's health. And thereby. We know eventually that person is going to have less chronic illnesses in their lifetime, and that's something these case studies are about. So we did do do this, we actually I have a couple of studies here. Uh, this one is short. The next one is really long, so we compared the participation of a. Compared the participants who are in the wellness program versus those who are not. And those who consistently enroll for 24 months, 2 years of wellness program, and we kind of measured their uh. Behavior in terms of, uh, their hospital admissions and then there. Biometric, which is a cholesterol level, just two metrics. And we found that the, uh, and this was a risk adjusted, so you may say that a healthy person who is participating in a wellness program is not going to be admitted in the hospital for anything anyway, right? But. When we do these kinds of user versus non-user comparison or actuaries, uh, use a method called risk. Scoring and those risk scoring is adjusting for risk level of every participant. They have to be equally chronically morbid ill to be compared to each other. So we are not comparing a 26 year old healthy male to a 58 year old chronically ill, hypertensive, female. So we, that's not what we do. We, we kind of adjust them on a riskco and it's a very legitimate statistical methodology that's adopted over the years. So when we Compare that, we found that the wellness participants had less admissions over the years, as well as they dropped. After participating in the uh uh wellness program by 39%, whereas compared to that, a risk adjusted non user group. Increased their inpatient admission by 9%. And that itself yields some savings because you can apply, you know, 10,000 $15,000 per hospital admission and multiply that, you get your savings. Cholesterol level, same thing you can see that the desirable level that's less than 199, we actually increased those with healthy levels of cholesterol for those who participated in the program, but those who are borderline or high, they actually dropped in numbers, so we know we are having an impact in managing their cholesterol levels. That also itself. We have some studies that, um, and I don't have that here, but. For every percentage drop in cholesterol, we know in the future how many adverse events are being avoided, and thereby. Your healthcare costs are less and and so on and so forth. So every biometric design does have results like that. This study was quite in depth and the plan wanted to uh check if. Uh, what impact the wellness program is having, so, but then they had these outcome-based performance guarantees from vendors, and by outcome based meaning actually getting the people to reduce their cholesterol level, their blood pressure levels, their blood glucose levels, uh, and also then obviously enhance employee communication, wellness program, design, etc. So you can see in the bar chart at the lower right, year 4, all of the metrics that we studied were higher. Controlling blood glucose level A1C testing, colonoscopy, uh. incidents of people getting colonoscopy, physicals, annual physicals, and mammograms. So all of the screenings. As well as the biometrics were higher in the wellness screening people. Those who got screened, and that itself we know is a healthy behavior that will yield results. The same group was then studied on admissions, readmissions, and ER visits. These are some of the tangible. Uh, metrics and there was a decrease in those across the board. Every time there is a 1% decrease in a patient admission, we can tell you how much it saves to the plan, but again, that's something that you have to extrapolate from the metrics that we can measure. The program participants perform much better on costs and utilization for nearly all major diseases. The care gaps, care gaps is something that we can measure by, um, kind of through your medical and pharmacy data, meaning those who are who's ANC is higher? Are they on a diabetic medication, uh, those whose cholesterol is higher, are they on statin or anti-cholesterol, uh, medication, and those are the care gaps that we can measure and the percentage change was better for the control group. This was mainly because you started with The higher threshold, but overall it was directionally favorable for those who participated. This was interesting that the 2nd last bullet M PMPM decrease 3.3%, which is a huge deal compared to, you know, if you look at your big, uh, what your total expenditure is. But the um change uh from the prior year 2 to the participating group decrease of 0.5% whereas the control group had a 14.5% increase during the same period. So we can take some credit for the wellness program. What I get sometimes is a question about um. What, what makes you think that it's the wellness program that's driving these drop in costs, right? And I it's a very valid question because cost is a. Is uh. Function of many different things. You may have a high cost claimants coming into the uh into the pool for any other reason for, for like a motor vehicle accident for uh. Chemotherapy for some cancer treatments for uh uh neonatal. Intensive care unit, babies, NICU babies as we call it, those very expensive claims, and they can all distort your cost of the charts. A lot of times we take trouble of like limiting those meaning we kind of make sure that they are outside our measurement metrics, but then sometimes you, you, you will, you might get. Adversely affected by some incidental claims like that. And then it will reflect poorly on your wellness plan. So just like people will question why are you taking credit? Well, we are taking the blame also. So it's like a function of both of those things, um, the, uh, interesting thing was the risk score of the participating group increased 3.3% from year 1 to 2 compared to decrease of 4.3 to the non-participants. This confirms that the risk levels that the that the carrier was targeting members with the potential ROI. The risk scores of both groups increased similar percentage point from 1 to 2. It's a little technicality here, but we were overall happy with the results. Pharmacy PMPM on the other hand, increased 13.6% for this group, and that's understandably so because of those care gaps I talked about earlier. The care gap is making sure somebody with that high biometric, that high cholesterol, that high hypertension. Group is taking the medication or not, if the group, if the program makes them take the medication, that means. Your pharmacy costs are going to go higher. But that's a good thing because in return, your medical costs eventually will be down because that person is not gonna have a super adverse event for them to go to the emergency room or for inpatient admission. So those were some studies, uh, that, that we had done internally, uh, and then I'm going to talk about like best practices in wellness programs, which is really the. Well it should be something that everybody can participate in the principles of equity and wellness programs. There are a lot of and we I have a section on the legal compliance, but. Wellness program should be something that everybody should be eligible to participate in regardless of their health conditions. So it's kind of meeting the person where they are in terms of their health journey. So it should be accessible to everybody, it should include everybody. It should have diverse incentive structure which is providing a range of intense incentives, including non-monetary rewards. And then cultural sensitivity depends on your location and your cultural um. Influence, create the program that meets the requirement activity offerings could be physical, mental, social wellness activities, equal opportunity where all employees can participate regardless of their health status, and then obviously communication is a plays a huge role. And then we always get often, we often get asked about. What are the pros and cons of? Doing inhouse wellness versus outsourcing wellness. In-house meaning. Your benefits Committee administering a wellness program in house without hiring. An outside vendor. The cause of that is people may not trust, because it's my employer looking at my biometrics. I may not want that. Uh, we may not have a lot of expertise in wellness in house. It's a huge administrative burden on on part of the committee. So clearly, you know, the resources is a major problem and then consistent administration is a major problem. But the pros is you have total control of the program, you have, uh, you can kind of have the leadership, uh, show up in these events and that kind of energizes people to respond. Expertise in the culture, so you, you really understand your people and then understanding barriers and challenges, that's kind of uh something that in-house programs are better at. Outsourcing to an external vendor, there are many, many, many wellness vendors out there. That whole space has evolved quite a bit and just my 20 plus years in the industry, I can tell you there is so much um. New entrance exits, M&As, but wellness is still there. The outsourcing to some vendor will, you know, you might feel you're giving control to them, they may not know your employee population or your cultural faith. Uh, the costs might be higher of outsourcing. And then employees do not trust the that oh where is my data going to? So that's privacy is a concern on both ends, but the pros of outsourcing is really they are the experts. They are on top of. What's happening in the marketplace, how to use the most recent gadgets technology advances, all of that will be taken care of, less administrative burden on the committee, uh, innovations definitely are happening in that area. I sometimes I'm very pleasantly surprised with, oh, that's very interesting. We didn't think about that, so the wellness wonders, that's all they do for a living, let them do their job kind of thing. Um, ability to easily integrate with your carriers, they may, they may have that too because of the information systems and linkage and everything. And then you can try a variety of things. You can have multiple vendors for multiple conditions, and they will connect with each other and that's kind of the uh the hope because ultimately you do want that one person engagement, but it doesn't happen without incentives. It's something we have, we have learned over the years. Incentives are important in making sure people do Participate in wellness programs. We're going to talk about some sample incentives. I'm not saying you do one or the other or all or anything that's up to us for debate later, but incentives do work in getting people engaged into their health. So this is a simple example, uh, $400 incentive amount per year, you just give that, oh, this is something that behavioral scientists have found out that you give somebody an incentive at the beginning of the year, and then you take it away from them if they don't complete certain tasks, and that always increases participation. So hence we are, we are proposing something that you do that at the start of the plan here, you put $400 into either their HSA HRA account, or one of the Uh, 2 or a premium discount and they can select from a variety of activities that already exist within your plans and at the end of the year they must submit the proof of their participation. Otherwise, take the $400 away just like you put that in. It's a pretty easy transaction to do in payroll. So, but we have observed that that increases participation, as opposed to the other way around, where you say you finish this and you'll get $400 because people apparently behaviorally, believe in keeping something that they already have as opposed to. The value of the money later. So some of the sample activities that do exist in your plans today? Through your careers are these just the join the fitness your way, gym pass. There's a chronic care management program, special delivery maternity program, enroll in the retirement plan or other program participation. It could be a variety of those that we can enlist and people can participate in. Example 2, we increase the incentive by $100 is $500 now at this again, give it at the start of the year, uh, the requirement is participation per quarter, meaning every quarter they have to finish an activity to finish to to make sure that. Uh, that they get the, the reward. Or they get to keep the reward they have, let's put it that way, uh, distribution is again, they can earn $100 at annual exam $100 at health screening. Those two things anybody can do whether whether they have a health condition or not, right? Annual exam, the physical and the health screenings that you are applicable for or you are eligible for based on your age and sex. Uh, if identified with the condition, like the the diabetes or weight loss that we had discussed prior to this discussion, if we combine that with this program, if you are eligible for that, they get to keep the next $100 for 12 to 4, so next 1003 times, and if not identified with the condition, they can choose and remain engaged with those predefined lists that I talked about earlier and I have some, uh, more to show on that as well, and again they show the Proof of participation at the end of the year, uh, or remaining engaged and they get to keep the 500 that we already gave them. So these are the sample activities that we can give them a menu to choose from. The annual exam, the biometric screening that we talked about, if you have a condition like a chronic care management, uh, they can if the lab values are outside of the uh. Norms for biometric screening enroll in economic care program or work one on one with a health coach or a nurse to earn awards, and then the wellness activities, if you don't have any of the conditions, then you earn $100 in quarters 234 if you remain engaged in fitness fitness your way, gym pass, retirement plan, utilization of other programs, those programs already exist within your plans. So that's something creating incentives for people to participate. And then I have the last example, which is we up the incentive by $100 more dollars, $600. It was really $50 a month, OK, that's, that's kind of what it comes to, for $600 a year. $600 is somehow a number that's Um, yields the most participation in the incentive research that I have read over the years somehow that resonates with people now with inflation, that $600 may have gone up. My research dates about 10 years ago that somebody did on what level of incentive gets the most participation, where 600 was the number they came up with, which gets, and after that it becomes almost a plateau, then you don't get more people for more money. That's up to 600 is like again this is behavioral health science that giving this research. So we did the same thing again, an annual exam and health screening and then if eligible for weight and diabetes management, they can get the rest 400 and if you don't have those conditions, you participate in that menu of different services that we offer like the wellness activities, screenings, etc. etc. And if we combine that with the diabetes weight management program that we talked about in the previous sessions. They can monitor those those participants for you and tell them these people are eligible. So again, that's this is the wellness activities that somebody can participate in the top two, anybody and everybody can. The other wellness activities are those the ones that existed exist in your plan, the fitness your way, the gym pass, utilization of the EAP program, the employee assistance program, which is really the kind of a great mental health resource that is available to people where people just simply don't use it. And mostly because lack of awareness, it's they don't know what exactly does it provide? And then again, diabetes and weight management, if you are eligible for those programs, you get those additional rewards. If you're not eligible, you get it by participating in other activities. So we're trying to combine the two programs here, the diabetes, weight loss, and the wellness in general. So that everybody gets a chance to participate, and we're not just focusing on those with illness because we are all about equity and inclusivity, so everybody has an equal chance of participating. Now, because these things are a lot of times governed by some uh compliance laws. We have a section here. I'm not a lawyer. I'm a doctor. He's an actuary. He's not a lawyer either. So we are not going to go in depth about what every law means, but in your entire wellness program or your benefit design is usually governed by all of these laws that we have listed here. The ADA, the GIA, which is the uh the genetic testing, HIPA, which is the privacy, and then there Some reasonably designed standards, incentives, taxation, and confidentiality of medical information. So all of those. This chart is just a to talk about. Where where the program belongs, but this is a more important chart where Based on where you fall, certain laws do apply to you. So there is something about the wellness plan cannot discriminate people within a health plan, but you could have a different health plan set up based on certain plan designs, and that's kind of all it's talking about. And if we really need a legal expert, we can have one of our legal experts come and talk to us before, but I'm not going to talk very much in details about these. You can obviously provide all of the services I talked about. provided they are within the. Constraints of what the compliance laws allow us to do and which are the wellness vendors are very much aware of all of those as well as we have the expertise to, to, uh, To make that decision as well. So they always talk about disclosure of the program. We have to have the alternative standard under the ACA, HIPA and make sure that we are not violating any of those. EEOC again, like I said, it has to be inclusive, so this is the equal opportunity, uh, commission and everybody has the right to participate, and they can, everybody has the right and the means to participate, um. ACA has some uh laws governing that too, but that doesn't apply here. HA Cobra, state laws, everything and everything that we just have to make sure that we don't violate. So I went through all of that really fast, but kind of wanted to spend some time on this last slide in the recommendations and obviously we will take some Q&As. Um, Costs are a big deal. It does cost you up front. And I cannot tell you. That you're going to recover your money 3 to 1 ROI in year 2 or year 3, which is what the vendors do a lot of times, and I always tell my clients, do not believe anything that the vendors tell you. The ROI will come maybe eventually, because we are keeping these people healthy and we are keeping them out of the hospital and we are keeping them out of the air and that's your ROI eventually, but I cannot prove that to you, that your wellness program is going to give you any financial ROI. Yeah, so, you know, if, if this is a decision that you make and you want to put this in, it's really a benefit to your people. You're giving them these incentives. You're gonna see a slight offset on the claims, a slight reduction. It's not gonna. It's not gonna offset the incentive, so there's, you, you're gonna need a budget for putting this program in place that there's going to be a cost. So we just want to make that clear as we talk through it. Plus, in uh not everybody is going to take advantage of that, so I have a very strong feeling that some people are, uh. Going to not. Take advantage of that, so you're not going to be paying the $600 the $500 that you choose to 100% of your participants. So that's kind of. Uh Usually what happens. So we do recommend if you ask for recommendations, Seal does recommend that we go with either that option 2 or 3, which was that $500 or $600 incentive option. Because it does combine that wellness program with the diabetes and weight loss program because we really think that those two programs, diabetes, weight loss is actually. More relevant. For our purposes, uh, today, because there is a huge need for reducing obesity levels and reducing diabetes in our population, and that will yield results and to be equitable, we combine that with the wellness program that everybody can participate in even better. So $5160 that's the one that we think we should adopt, uh, it does. Address the issues about equitable, it does not penalize individuals for having a chronic condition, because usually people with chronic conditions say I cannot participate in the gym fitness classes or anything else you offer, well then you don't do that, you have other things to participate. Uh, the criteria for earning incentives is clear, transparent, and also it promotes preventive screenings. You saw that in my case study number 2, preventive screenings were across the board higher in the wellness program participants and primary screenings do yield results. Nobody can deny the benefit of women over a certain age group going for mammogram and men doing their cholesterol and um blood pressure test every year and things like that, those. are the risk factors that does give rise to chronic conditions, thereby increasing your chronic health costs eventually. Um, one other thing I would like to mention here is wellness programs does nothing to reduce your high cost claims in general. Just keep that in mind. Just because you have a wellness program in place. I'm not going to see suddenly less number of cancer cases or NICU babies or some of the very high cost claimants that we see at the top of the top 5 conditions in any population health, wellness does nothing for that, but at the same time, if we are talking about some. Chronic health disease like a heart disease that progresses into a kidney disease that progresses into kidney failure and then ESRD, which is, uh, you know, like the, like the end stage renal disease. That's something that a wellness program can avoid because somebody is adopting that healthy behavior earlier into the adulthood, so that all those things don't happen. So that's kind of a difference between looking at. What will happen or what can it do, but this is the best we can do because, you know, my biggest concern is the cost, but at the same time. We think it's a perk, it's an employee perk. That you get that incentive and then you get to do these activities, which eventually does help both them. And the employer, so that's why we kind of believe in, in, in wellness, and I think that's my last slide, yeah. So we can take some questions, I think I see some light. OK, thank you. Y'all may have to bear with me on trying to get. OK, thank you for that. uh I've got a list of people in the queue to speak, uh, representing Collins, it appears that you're first. Thank you. Um, so I, I, in some of those figures that you were showing as far as the effectiveness of different programs early in the slide deck. What's the statistical significance of those? What kind of sample size are we talking about, um, or is it more just kind of in this limited sample size you found this was a pretty large sample size, about 75,000 members live. One of, one of the studies was 75,000 members, so pretty large. So you feel like these all those figures have such significance over and above what you would need for it to be significant. OK, it was definitely st. Thank you. Thank you sir, Cinder Boyd. Thank you, Mr. Chair. And I, I have a few questions, so if you get tired of them, just cut me off and put me back in the queue. I'm tired of them. Well, I guess you can cut me off if you need to you're in control, you take as long as you need. Um, so first of all, it's just I'm trying to understand the behavioral component of this. So is this just, when you look at this studies, is it just a matter of people really don't know any better, they don't know that exercise helps cholesterol or eating. Products that are packed with sugar, or is it, there's actually some type of behavioral change associated with participation. So that's my first. Um, it, it's about how it's communicated to them about everybody likes the, the kinds of foods you just mentioned that that, you know, the fast food industry has created that big market for us and we kind of grew up on that. Um, people might be aware, but reluctant to change the behavior. So the behavioral scientists have worked different ways. How do you communicate the benefit and it's called I don't want to get into the details of that. It's intrinsic versus extrinsic. Extrinsic is you change the behavior for somebody else if if they instill fear in them about. You're not going to live to see your son's graduation. That's like a fear, and then you kind of change your behavior for that reason, and intrinsically is because I want to get better and I want to live a better, healthier, older myself, and that's something that the messaging works around and I'm not a communication expert, but this behavioral scientists have crafted messages in a way that appeals to different audiences differently, and they craft it differently. It's not the same message. To males, females, people in the same age group, different age groups. It's a different message. People, you know, with children, people who are older, different messages apply to different people and the behavioral scientists have worked on that, yeah. I think you know part of this would be a a screening to say. You haven't been going to your doctor, you haven't done one of these screenings, and then all of a sudden they find something, so that's gonna be a big wake up call. So that could be what drives, you know, behavior change, not just, oh, you know, I need to exercise, everybody knows that they should be exercising more. So something like that or if they do have one of those chronic conditions, they would be. We are incentivizing them to join a program where they would have one on one support, so it's more high touch, not just something that you would. You know, general knowledge, right? Um. All right. And I think that's a valid point. I know recently I had a lab value and I was like, oh, so that, that is, that resonates right there. Uh, prescription per member per month. I've got kind of got a couple questions here they're kind of linked but separate. I was a little surprised, so there's an increase in the pharmacy per member per month with people and so maybe it goes back to hey, we identified something, right, that we didn't have there before, um, The, so the, the real specific question related to this. My first question is, so in the control group, Did the cost go up because the cost went up in the control group too, but less. Was it just a factor of, hey, things did happen or was it like people weren't taking their medications or doing what they were supposed to do. And so, uh, a, a more expensive medication was prescribed. I mean, any, any insight into what was happening in the control group versus the, you know, the participatory group, I don't have details to that level, at least right now with me, but from the top of my head what I tell you is, it's more to do with. The compliance with medication, the medication compliance that people uh do with when they are in the program and that usually does go up and the control group it's possible that they were prescribed something that was just, yeah, in general, the pharmacy market we we're projecting, you know, 8 to 10%. trend on pharmacy costs, just in general, so for the control group, if there's no behavior change for that group as a whole, we would expect like 8 to 10% increase. Right, but it was more like 20 something or something like that, so there was an increase in the control group, just not as much. So, and then related to that, I mean, the other thing is if you're participating, you know, I'd think diet and exercise is somehow a component of what our major risk, you know, blood pressure, you know, diabetes and um high cholesterol and if you eat right, that's 3 drugs right there. If you then exercise, that's another 3 drugs. And so that was the other thing where I was a little surprised. You know, or we just going straight to medication and not working on long-term behavioral change. So medication comes first and then the long term behavioral change will come with that, but I think to give people that boost of. Of kind of controlling their cholesterol and controlling their uh diabetes right away, medications are definitely more useful uh immediate reward, and then you can get somebody on a sustained behavior change. A lot of times what we found is these health coaches when they get involved with somebody uh with a chronic disease, and they are prescribed the medication and we find out that they're not taking it. Uh, they're not taking it for gives them heartburns, it gives them some other uh conditions, so they stopped taking it. Your your doctor is not aware of the fact that you're not taking it. But our health coaches find that out based on the conversations they have with them and then they make sure that, well, if you have a heartburn, then take it at a certain time or take it with food and things like that, that, that, that's the advice that the health coaches give, that your doctor's office a lot of times fails to give when they are writing just the prescription. So those Advantages of some of the programs to get people compliant with their medication, and then maybe change the medication if that's the one that's not working, they can work with your doctor to change that as well. So there are a lot of things that play a role here in why certain costs increase in the, in the beginning of the wellness program, but overall directionally favorable outcomes is what kind of the message I have on that. Like I wouldn't worry about that pharma cost going up in the, in the beginning. Because eventually it will go down. Suggest to you your pharmacist know too if they're not taking the medications, uh, you don't have necessarily have to engage a health coach to, uh, do this. You already have a team if, if you use it the right way. Uh, the other thing is, so. I, I wrote this question down before we got to example 3 and before we got to page 23, but I still think I, I need a little bit more clarity, um. So why do we not really take this to an individualized level and, you know, say I have high blood pressure, and that's my highest risk. Why do we not go and individualize me and say, hey, you get the reward if you can get your blood pressure down to less than 130/80 or less than 120/80 or whatever or maybe an A1C is off the, you know, up there and, you know, I, I realized everybody's an individual and some people have exercise limitations or what have you. Why can we not take it to the next level? Is there a legal reason or it's just too expensive to measure? No, it's a legal reason. So what you're saying is exactly right, uh, I would love to do that, like get somebody to lower their biometric levels from bad level to a good level, and we had started doing that and there was a lawsuit and I'm not a lawyer again, they will tell you, but there was a lot of there was a lawsuit by somebody through a uh ADA, uh, sued the employer for doing something like that, saying it's a discrimination that I cannot lower my level because of my other conditions, and therefore I'm not getting the reward, and he won and ADA actually started governing these uh. Uh, programs do not do that, to not tie in the biometric as a overall metric of reducing your risk level. So hence we move from outcomes to participation. Meaning, you show that even if you cannot get your level lower, you're participating in the program. And again, uh, don't quote me on this because I'm not a lawyer, but I had heard about this one case that somebody won uh through the ADA. So, I mean, the one thing you can do, so obviously the wellness program, if they're aware of the person's conditions, they're going to steer them. They're gonna have a unique experience based on their conditions, right? So but as far as the incentive tying it to an outcome can't really do that anymore. Um. But what you can do, I guess, population wide when we're looking at some of those statistics, whoever you would hire, you could make that a performance guarantee and say, OK, population wise, we need a reduction of 5% for this metric, this metric, this metric at the end of the year. If we don't get that, whatever we're paying you, you know, we want 10% back. So, um, that's definitely a focus, right? We want to see the outcomes. Uh, it's just not going to be at an individual level. Thank you, Patrick. Yeah, that's a good point. population level we can measure those, yes, individually, we cannot. Thank you, Senator Boyd. Uh, Senator Irvin, I apologize. I think I cut you off and you're actually next and after you. Thank you, Mr. Chair. I appreciate your presentation. Can you describe the rollout? Like if we do this and I mean, clearly intermittent, positive reinforcement is what drives behavior change. We know that. The casinos have figured it out. We do not have to reinvent the wheel. Honestly, they know exactly it's intermittent, positive reinforcement. Which I think is so important that the incentive is broken into a quarterly basis, but I think the key and the success is interactivity and, and then launching it correctly. So, I've been to several companies that would invite me to come to their health fairs for their employees because they are very focused in trying to help their employees maintain or seek a healthier lifestyle. Are, do you have any examples where a state has done that with their vendor or I I don't think we have one here in Arkansas. We, we did a month of May, kind of, you know, women's Health Month, uh, event at the Capitol, but I, I don't think I've ever recalled like when I signed up for my health insurance. It was just here, the forms, fill it out. There's no interactivity. There's no personal touch. There's no launch. There's no, hey, we're going to roll this out. Let me work with you. Let me individualize this with you. Here's a Fitbit. Here's how you use it. Here's, here's how do you use your app that's on your phone. There's none of that. So to me, I think that is one of the huge components that needs to be talked about, needs to be discussed, needs to be well organized, well planned, well thought out, um, and strategic. And so, you know, can you monitor Self-monitor your cholesterol. Is there a device for that? Can you self monitor? Here's how you self-monitor your weight. Here's how you self monitor this or that, you know, uh, what exists out there. Or have you looked and can you look to, you know, successful programs and how they've done any of that. Do you have any information on that? Do you have examples of uh state plan, Patrick, I have examples of. Clis, but they're not state plans, OK, OK. So we have some clients who do a marvelous job but with the help of a vendor internally we simply don't have the resources or the expertise to do that. So if we have a vendor, uh, so like a Virgin Pulse is the vendor that comes to mind which they just changed their name, um, but these are like the, the. traditional wellness vendors in the space, they will arrange these health fairs or they can actually have a presence at a state health fair for a state fair, for example. There'll be a booth that says employer or the school district's name, the one I'm thinking about is the school district, and they actually did that for uh during the. State Fair at there for the state and then they had a booth for the school district and the vendor did everything that you just described, you know, get people energized, the education, the communication effort, but and but they actually do have resources, feet on the ground, that'll go into the community, disperse the message, and and do effective communication campaign. Absolutely, yes, it can be done with I think that goes to one of your pros and cons, uh, slides about trusting and so I think if you, they don't trust somebody. I don't trust somebody if they're, I don't, I can't put a face to them or they don't have somebody on the ground and so I, I just think if we go down this road, we need to be more intentional about how we roll this out and what to expect, you know, and to communicate with people. Listen, you have high cholesterol, um, and utilize, I think Senator Boyd had a good point too in utilizing the health team that already exists around that person. Sometimes I see that we add way too many, you know, extra people into the mix and it gets confusing and then honestly, that gets really frustrating sometimes for doctors because they're questioning, you know, what the doctor's doing and the doctor's like, I have been managing this person, seeing this person for. Umpteen years, you don't know what else are on, you're just like, you know, it's, it, it can get complicated, but I do think utilizing your, your team already that you have in place and affect more effectively, we don't do that, um, but I, I think the trust is a big one, but I, I would really want to know. I don't care if it's another state doing it. What's the best client doing it? What's the best company doing it? And how can the state of Arkansas emulate. What that best business practice is for our state, for our state employees, because it is a benefit for them like if we can get everybody going in the right direction. It's not that dag em What that best business practice is for our state, for our state employees, because it is a benefit for them like if we can get everybody going in the right direction. It's not that dag them hard, um, in my opinion, but I, I appreciate your presentation. Thank you, Mr. Chair. those are all great points and it's not just that we get more the word across, but it's also the name recognition of like let's say if we hire a vendor and Virgin Pulse comes to mind because something I dealt with last week and let's say if you, if the employee gets a newsletter from them and they're like, Virgin Pulse who? Like that's what happens if they are not even aware of what program we are administering here. So just to create that upfront awareness and go into the places where most of your people show up, that's like the best way of doing it, yeah. Supported by the plan, the legislation, you know, it can't just be a vendor that's reaching out because if it's not communicated right. OK, thank you. uh, Representative Wooton, you're up, sir. Thank you, Mr. Chairman. Thank you all for being here. First of all, are you the national medical director? I'm sorry, I didn't catch OK. I have 3 questions. First of all, And a father's law with Senator Irwin's question, um, have y'all interviewed and talked to the participants and the beneficiaries of the program in putting this information together relative to what they see as important for my wellness standpoint. Have you, have you had focus groups and interviewed them and let them have input, not here, but we have done that for some of our other clients in the past. When you say not here, do you mean not in the state of Arkansas in the state of Arkans, the employees here? I think that's a little out of the scope for what, what we do. I think if we were, yeah, what, what would, why would he be out of the scope. When it's you're working for us to, to provide important information and, and the information you've put together is very good, but we, we're I'm not concerned about the employees in Indiana. Uh, Wisconsin, I'm concerned about the employees in this state that they have the benefits that they feel are important to their wellness and their health. So totally agree, yeah, I think it would be a next step. Right now it's kind of big picture, we were asked to to put together a presentation on wellness programs as a whole for consideration if this is some, a road that we're going to go down, then we could definitely get more into the weeds before we finally design it. Representative Wooton if, if I may, we, uh, just, just so the committee kind of understands and I appreciate what you're saying. Maybe I needed to say this in the beginning. We had asked them to look at this and the reason, the reason was on this wellness is we had made a decision not to have the wellness program. You can say that I was as big a part of that as anything, and you can say that on page 26, The first recommendation where it says but not enough to offset incentives paid. The thing is, is, uh, as, as you all know, uh, our healthcare costs and the way we're doing things were out of control and we were literally putting. Millions upon hundreds of millions of extra dollars in and we had a special session to try to rein this in dissolve committees and do a bunch of special other things. And that's the reason this committee was even, uh, was developed. And again, I appreciate you doing this. I, I thought about doing this earlier, but so the thing is, is, is during our meetings, some of our members had said, can we have Seal, which we already had, can we have them to look into the wellness program. To see if it's gonna be beneficial. Now, I think we all know that we want everyone to be healthy, but we're gonna have to weigh this with what the cost, the additional cost will be and whether or not we did so. It could have been my own fault as a chair that I didn't ask him to, to go forward with that because I think that that our next step would be, we're going to have to make a decision whether or not we're even going to have this wellness program. And then possibly to look at maybe what example as one they provided or one that y'all commingle together or whatever we'd want to do. So I wanted, I want to do that because if there's any fault on that, that could possibly be on me, so that's fine, I understand what you're saying. The next question that was on uh page 11 was transparent communication and feedback and clearly it's where I got that on page 17, incentive dollars, 1010. 1, 10001, 300 on another, and then 100 based on the quarters involved. How much above that. Could the employee be faced with cost to cover that. Lab work. Uh, radiology, whatever they have to do and, and they get $100 incentive, what is the medical professional gonna charge them above that. So if it's a preventive service, it's cost 0 to the employee, if it is an annual physical and anything that goes the blood draw and the lab work that happens during the annual physical, the employee pays nothing. Your plan will pay that, but the employee pays nothing. My final question, Mr. Chairman, is on page 26, the last page under the recommendations. I want to be sure I understand this. The cost must be. considered when determining if investment is viable for Arkansas, improve health will help reduce long-term claims. That's the aim, I think, of a wellness program, but then you go on and say, but not enough to offset the incentives paid. So are you, are you telling us as a committee. That has to make the decision that the senator spoke of. Are you telling us it's gonna cost us more? With the wellness plan in place and the incentives, then we'll benefit from claims that are being filed. That's right. OK. Thank you. Thank you both. Thank you, Mr. Chairman, thank you, Mr. Representative Wooton. That was, uh, something we needed to have said and discussed and I appreciate you bringing that forward. Uh, Represented Beck, you're up next. And you should be a. Thank you, Mr. Chair, so my, my question is, and I know you said that you can't. Uh, quantify, you know, the return on investment and and all that, but there's, but then you, you, you kind of hedge your, your statement there by saying, but there'll be lower costs in the future that type of thing. So, you know, it kind of puts us in, you know, we gotta make a decision here and there's, I didn't see a number anywhere, right? And, and I understand that you can't give a hard fast number, but. If in fact the, the, I mean, are we talking about something in the ballpark, right? Are we, are we talking about that the wellness program is gonna cost you an additional. $100 million additional 1000 per participant, uh. Are, are we talking about $50 you know, that, that type of deal. There's gotta be some type of scale that, you know, we're noticing for a precise number but some type of, well, you know, this wellness is gonna help with the the the overall wellness of your population. It's going to cost you $50 per practitioner, something of that nature I guess I'm looking for a loose number here at least uh kind of hold on to. Yeah, I think I mean the cost piece would. Be pretty easy, so you're looking at $600 a year per participant and I think going back to when you had the program in place. Years ago. I want to say there was like a 60% participation. Don't hold me to that, but somewhere in that ballpark, um. So you can kind of get at the cost piece pretty easy. The the hard part is how much of that $600 are you going to offset through the program and, you know, in the first couple of years, I would say not much, uh, long term, hopefully that number grows and grows, um, and you know, once we get data and we could see if you have the outcome similar to one of the case studies, I think we could extrapolate and say, OK, we've got Chronic condition wise, we have this reduction here and that's gonna be. Worth X, um. Yeah, it's, it's, it's hard to say. I would say in the near term, I wouldn't expect much at all just to add on that, so I've done a lot of ROI studies in my, uh, life as a medical director uh in different health plans. We, it's hard to control for other factors that increase your healthcare costs that I talked about earlier, right? You might have some catastrophic cases coming in this and NICU babies and uh some uh motor vehicle accidents, transplants, those are Very, very expensive cases you have to control for that. Overall, your health care costs will still continue to go up, but that doesn't mean that the wellness program is not working. You see what I'm saying, so because of all those other conditions, the new GLP1 drugs coming up, the new gene therapy coming up. It will increase your healthcare costs going forward, no matter what, whether you do wellness or not, but for the wellness program, what Patrick is saying, why we need that very clean data of at least 5 years of a program in place, clean data, we take all those variables out and then we do this participant versus non-participant study, control them at a risk factor level. and then measure their outcomes, then I can tell you that the program is working. But whether it is going to move the needle on the healthcare cost? No, because the healthcare costs are a function of all of those other things that are always going to increase your healthcare costs. So that's something we always struggle with improving. And I guess the other thing is the $600 isn't going to an insurance company or somewhere like it is directed at. The teachers or the the employees, right? So, um, Yeah, like the plan as a whole, are you gonna see an RI? No, but the money that it's really an investment. It's another benefit for the people and then long term you're hoping that, you know, instead of a 6% trend, that's 5.5 or 5 or whatever it is. I almost look at that as a perk. It's a, it's a perk of the employee benefits. So, so one other question. So the, the money that the employee the, the 500 I think you suggested 500. The $500 that. That That's a discount off of their healthcare plan or how is that or is it a health savings account or, you know, you could find it to give it provided to the, uh, member and several different ways. So yeah, plans that have a high deductible plan and an HSA or an HRA they, they can fund it that way. It can be a discount off the employee contribution, the monthly contribution, it can be outside of that completely, you know, in terms of, uh, A gift card, uh, it could be. A reimbursement if they spend that $500 on something we deem as healthy, a gym membership, uh. Yeah, a new bike or something to do with their diet. So it can be. You know, funded through. A lot of different mechanisms. I, I, I have some experience with one that was, I, I hesitate to call it a health savings account because it was sort of a real loose health savings account. We, we did accumulate dollars in there for for participating in these programs and then you could use that to offset that, but you also could do like what you're saying, if you, a gym membership or something like that, that might not be covered under the health savings account, you could utilize that. And I think that was more of an incentive for the person to see that, hey, I'm doing these extra tasks. I'm feeling better. And hey, by the way, I've got this money sitting over here that, that I could be utilizing for something so you know just my input. thank you. All right, thank you, Representative Beck. Does anybody else have any questions? I've seen some mics come on, but they've went off. OK, uh, fair enough. Do y'all have anything else? Are you, are you finished up? No, this was the last slide. Thank you. All right, we really appreciate, uh, appreciate y'all's work and, uh, uh, But frankly, or frank frankness on some of that. I do appreciate that that myself. So, anyway, uh, are there any other questions? To come before this body. OK, with that, we'll be adjourned.