ALC-Employee Benefits Division Oversight Subcommittee

Call the meeting to order. I got echo. Alright. Yeah. As you all can hear we have feedback so let us get our team well my position for you to listen better. Yeah. Test. Yeah. Test. Test. Yeah. Test. Test test it sounds good that that sounds good you are. Our ads will get will get started we appreciate you are fixing the equipment okay we're going to go to be diabetes management program study for our welders problem if you want to come come forward. Yeah. And if you don't if you don't mind whenever you all sit down I think you know the drill if you just introduce yourselves and then you can begin. Spatric line with siegel. And sarage understand was signal great heavy august so again just if you want to would just jump right into the new york and just begin and then will take questions after that okay and sign up you and introduce yourself. Yeah. Okay sorry you couldn't be with this. We got a new room in a new new time site today a lot of changes so it's been a few months since we've we presented the last time we are here we are talking we wrapping up the diabetes portion and making a recommendations. During that meeting there is some discussion on the well wellness and wellness programs. So we're here to over the the next meeting or two or three go and take a deeper dive into wellness programs. And today's presentation is an introduction kind of setting the stage for the next two or three meetings we're going to cover even as history with wellness programs what other states are doing and lastly go for some examples of effective wellness programs. So what that being set out turned over to sarah. Great thank you I so will take this off by talking about the mean trend here which is a whole listing approach to wellness that we're seeing increasingly organizations and states are focusing on integrating their different programming together as part of a wellness program so that means that medical conditions meant or half an overall wellness are coming together for a more integrated approach now in the past months we've talked about your claims data a bit I showing that things like mental health has a profound impact on your medical conditions like diabetes what those outcomes are and how they affect overall well being I so like patrick said in this presentation we'll talk about what the students tried in the past the typical scope of wellness programs are in some ideas of what we've seen for best in class solutions. Yeah. Side of you you may have to get real close to your mike I hope you can hear me. Yep well not really again up it's not on our end either because we've already checked that I believe. Okay I can hear them just for that's better tremendous thank you. Yeah. Yeah. Okay so. We told about he said like how many twelve boxes on this line and it has a different components written on these boxes we'd have a lot about the the box on the top line which is management so i'm not going to believe that that point but we will link it back to how it does link back with wellness. What we see in the end as well as would be recommended comes off. Engaging in well less is really doing all of this and if you can read that it's it says mental health then and we talk a lot about mentally has saturday at his hour a specialist in a mental health and enhanced mental head programs and coming up with something that helps patience integrate them had programs other programs by moscow skinner which involves your back and giants and knees and hips and beat and everything interconnected that's a bigger less component because once he must california problem start it then get radisabling and it can really hurt your journey all the. Your help. Will be city read legacy top a lot about that for which all of the about that our programs that. Online there are well programs programs that allow your people to participate in programs who it's some incentives and also manage their chronic care and then there is some other things that we never talked about before in the were less industry like sleep. Savings a huge component of your head off your overall well being and holistic to a very small personal portion of the people it is important it affects them and all of them that can be incorporated in a very west well less program by teaching people about how to do all of these things use the help coaching to achieve the goal is they need to be talked a lot about that during the obviously day days programs as well and coaching please in a very important rule in managing that same with the clinic health coaching is writing to understand what's happening with you and how to prevent it and then financially when being that one peace is also a while they're missing comparing to when this programs were the last two decades of so i'd last five years especially since called we have started talking a lot about financial and there's because it does directly in back your mental well being and programs that allow you to do that as well. Next like it. So the top fight transit correct in bonus pregnancy if I have the big and choose five out of the twelve we talk about earlier we would pick these. So starting with. Mental health i've been also addressing some of these physical health so highly. Disabling all at the same time might lead to chronic and lessons which is back or bc and diabetes and in the financial well being we can leave at. Like as a fifth component also important like mostly what there is is a financial education and integrating that into the well as program I have said more about each of these. Yes and now I saw not on the last page mentioned sleep as one of the main components are wellness programs as we're seeing more encompassing on this programs I and coming back to what we saw related to mental health when we were speaking a few months ago if you recall this is actually a very big impact on diabetics. So those who had sleep wake disorders so that things like in samir I they had a monthly cost a medical cost one point eight times that of diabetics and didn't have the sleep weak disorders so that really goes to show why don't impact some of these more innovative holistic well that's pieces can have both on your members spend but also on outcomes and quality of life now these other areas like abu city diabetes are these are these chronic condition states that are we're seeing across the board are using our incorporating incentives increasingly I had to try to get folks involved in in wellness programming I to see what we can do to move the need off on some of these chronic conditions as well. Now we're going to switch in to some history that the plan has had with wellness programs so starting in twenty fifteen the state arkansas. Began their wellness program so the way was structured there was a annual physical and a health risk assessment that needed to read done by october thirty first. And then as time went on there is in addition to the program so tobacco session in general there is about a seventy five dollars monthly contribution spread for those who participated in the wildness met the requirements in those who didn't and twenty twenty that decreased down a fifty dollars and then in twenty twenty two the plan decided to terminate the well this program. And the status from twenty twenty two. The last year the program we saw wellness participation of around in the high seventies for both the ase and the psy plan. And depending on what the contribution differential was. At you know different points during the programs life at seventy five dollars that contribution differential was sixteen worth sixteen point nine million dollars for a thirty five point one million dollars for psy so that means the employee or the member would be paying that much less and total dollars in another way to think of that that's you know revenue that isn't being collected by the plan so when that got scaled down to fifty dollars the numbers were a little bit less eleven point three million for AC and. Pseud was twenty three point four. So I think that the point here is that you know wellness it's it's a big financial investment here so we need to keep that in mind as we talk about different options. Yeah. Now we're going to switch gears a little bit here and talk about a few client examples of state and other clients that see gold works with are and what they've done to create well in this programs and what their level of success has been. I so our first client that we're looking at here is a state in the northeast and this group was very focused on preventive care and also early intervention for a chronic condition so those chronic conditions are things like the diabetes white management card yet conditions things like that so their incentive was actually pretty high higher than average they were providing a lower monthly premium by a hundred dollars a month and also lowering the deductible as well for participants are and the last thing they did was waving copies for office visits and for medications that were for a chronic conditions so as a result of that we saw ninety eight percent participation so very close to a hundred percent participation so what did participants need to do in order to get those in our benefits I just described if you look at the left hand column here you'll see it but the summary is there was a whole laundry list of things that participants needed to do to check the box in order to get those discounts I described so it was things like submitting information on our proof of having dental screenings twice a year things like that so it was a lot for the participant to keep track of and submit and it was also a little bit of a burden for the administration piece of this to see who who did all these things and check all these boxes to make sure that folks had eligibility for those discounts that I described but with that said everything that was on that laundry list was you know good practice things like dennis and prevent of screenings out whatever cancer screenings the participant was due for now like I said we saw that great engagement by focusing on the preventive care but really in summary it it was a hefty program to administer here as you can imagine with all these components. Now our next example are is a client in the west I earns what similar to what we just talked about are like the first example this this client also required a lot of different pieces to be done meaning they needed a well most vendor rather than being able to do this and house to be able to track all these different components and see who met the criteria but there's a two key differences are here with this client number two compared to what we just looked at with the first in this scenario the way that this was handled was they had a pcp form so primary care provider form that needed to be completed so basically this was providing proof that there was an annual preventive visit and also that biometric screenings were done so those are the things like measuring your blood pressure your wastes or conference those things that are measures of wellness that got done as part of the preventive care visits. And then that for needed to be completed and returned to the wound this program to be able to get any of the incentive credits here I and there was really no way around this pieces annual visit and the pro biometric screening but then there was a second piece on top of this so if the participant was identified as having a chronic condition so that might be the diabetes low back pain OB city weight management concerns are if they had a condition like this they weren't finished with the wellness incentive program they actually needed to do coaching with a registered nurse in order to get the rest of their incentive structure payments. So the pcp form that first part of it turning in the form got a hundred percent participation which you can't get any better than that that was awesome but then as far as that chronic condition peace so the folks who were identified as having chronic conditions and needing the coaching that was only about half of people of the of the folks who were supposed to do that peace who had the current conditions only about half of them actually went through and did the coaching and come and got to the point where they were checked off for that so in summary how I would say this client number two experience were was removing some of the burden from the participant to figure out the complicated tracking piece is like submitting dental exam proof and engagement that that helped engagement that got us to a hundred percent engagement by making it a little more simple and easy for the participants. But having this secondary stap of the coaching it cut participation greatly you know this wasn't a light touch type of approach to wellness this is intensive coaching over a period of time and we did see half of the people who who needed that getting that which hey how half is better than a lot of what else we would see without this program in place but we weren't anywhere near a hundred percent of those people with that program. Yeah. Now I have wine more client example this is our last one here. And this is kind of similar to what we saw from what I just talked about client number two in that this is a two stat process for this wellness approach but a little different in that there was no preventive care requirement like we saw for the others this was only a requirement for the biometric screening so that meant that participants could go to a lab and get get some of these screenings done in participating labs without ever seeing their primary care doctor or having the follow up that comes with having the conversation or the lab tested down in a in a preventive care setting. Now that said though the incentive of the financial incentive was really high so you got four hundred dollars for doing a health risk assessment so that's that question area that asks you about your health behaviors and getting that biometric screening done and what we saw was about ninety three percent of participants did this piece that assessment and the biometric screenings are and then there was a second piece of this just like we saw for their second example client example where participants got to pick and choose so we see a list here of the requirements on that left side they got to pick and choose what they wanted to do to earn points I and so that a maximum amount of points are corresponded to seven hundred dollars additional I so but that plus the four hundred dollars for doing the first assessment I that adds up to over a thousand dollars a year eleven hundred a year for the wellness program so you'd think that's a lot of money that's a should see a lot of participation rate but what we saw I even though ninety three percent did that first piece the biometrics health risk assessment for the picking and choosing peace to get extra points that turns into money it was actually only about a quarter of people were actually doing those things to get that piece of money so are taken away here is when you have at like a two part two prompt program where you have this additional incentive on top of the core incentive peace you're not going to see huge amounts of engagement for that secondary piece even if it's a lot of money even if it's seven hundred dollars so all or nothing requirements for a financial incentive or something definitely worth considering when we're thinking about what is a good well on this program and what's a good structure to get people to participate and ultimately to affect their health outcomes. Now we'll change gears here a little bit now that we looked at some examples let's take a sat back and look at what states are doing overall in terms of wellness incentives. You this is a survey of all the states looking at twenty twenty three twenty twenty four plan data and we'll see some examples of what what plans are doing so we see that the most popular way of incentivising participants we see that direct payment has fourteen states using that as their method. Next is reducing the premium so the amount that participants are paying out of their paycheck every time that was the the second most popular third most popular is that non tobacco user discount and I will say that over time we're seeing this become less popular compared to say ten twenty years ago there's a little bit of a negative perception with having a tobacco surcharge or discount and there's some concern from a lot of states that this is something that people aren't necessarily representing themselves truthfully about so there's a little bit of question of the value of having a tobacco related user discounts but or take away here from this wellness incentive survey of the states is that it's pretty common to have financial incentives tight to wellness. Now we're going to build off what we just saw on this last page by going into a little more detail here. As you can see from most of these graphs here looking at the different types of the wellness incentives that largely there's no clear consensus between what's the amount that the different states are using as incentives within each type of incentive and i'll see the exception to that as we can see in the reduced premium on the upper left that chart there does seem to be a little bit of a consensus as more popular to do the reduced premium in the twenty one to fifty dollars range and that's per month I that's the most popular with five states are using that range there but across the types of incentives we're seeing arranged per year from less than a hundred dollars per year incentive to well over you know fifteen hundred I do keep in mind some states have more than one of these incentives going at the same time they might have you know tobacco discount at the same time as you know what we're caused sharing for certain of these programs. So really are take away here as we don't necessarily need to be you're holding to a certain standard among the states in terms of what the wellness instructive up incentive structure looks like but with that said do keep in mind that anecdotes and an experience shows that it does take at least several hundred dollars at least five hundred as a minimum a year to really get folks attention and get move the needle on participation. Yeah. All right. In the slide. So could you guys may have seen a bulletin this population I take it for ended because I don't mind it has been in population management so they may explain that about what we mean by that so population has management is really putting people stratifying people step setting up to make it three pockets and most of us are held the and technically I shouldn't use the world had the lately been told that I could use the word those who are not using any heads doesn't mean that they're healthy those who are not using so the long users and that's usually your most of the people most people are not going to the doctors even if they have a little problem here there you know need what another one where people go to even though they have little the test so technically they might have something but they're not going to be to the doctors the middle east is somebody in who knows that they have and then they're getting treated for that. And then the last one that is economically location you cannot shy away from these like microphones says like arkansas like II don't accidents in that because that's not something that we have here to address it comes off. Population management. What you can see is that our health promotion strategies so the first for those who right now. All right certain things are are owner the we need to keep them handy and then that I think this there is screenings cancer different seven thing of cancel eighty eight evolving point a bit of explanations for preventing certain infections diseases you have self gear that prevents in this is from getting what you know back the words like in addition to the manner then for their speaking we do recommend some kind of best self exam bag your doctor or your college indicator can be sure about and then obviously they displace management for mental hands keeping your sanity level at every step of the way and that's your responsibility and most stuff regionally used to be that that is eighty twenty really that means thirty percent of the people. And twenty percent of the people can zoo. Those twenty percent are in my night to buckets okay somehow in the middle of the pocket that could send might be meaning that number don't take it for the. Number anyway it could anyway between fifteen and twenty five percent but they are the maximum consumers and that's where some of the other folks come in which is really disease management programs meaning you identify somebody who is now they need to have a case but came back really helps them maintain back. There's a doctor component in that many pay you need to have a regular doctor and the collaboration between doctors office and you. The financial rewards to make sure that they are in the program and then pay open and that's the only about not just letting the patient be on their own but it's about that important it is about. Getting the patient better and inefficiently social that means sending the people who all. Adopt best at reading back that's another one that we kind of want with involvement we also telemedicine for that kindly excess as well. And in the last market which is an other serious as you know there is the evolution in place of management it's no longer disease most plans I can see had become a business is I personally know some plans that between the state was not the case before that's become a disease but david always been that right hand book where. They need to be monitor so then you could be how to pay care of their seller that they are monitoring and anything some nudges about going forward the opinion of my that's a utilization management case management of those coming centers of excellent there are some excellent cases of excellent people access from and you don't even have to travel out there technology has made it be available or canceled care to be delivered to the as well especially in comes off. Deciding where dogs need to be the wind and then they can be given a community community and system. That means somebody wasn't happy from the best in glass of my son of the interventions that are undertaken for that episode management also serious disease maintainers but the wellness the evolution of population had management and whether one is that my own the red round here which is really on the on the blue side where we need to empower people to get about how to stay fiction held the income so died new different exercise and then also somebody who has been diagnosed with a politically maintenance disease and how to make a lesson when listening play a usual in both of those. So then the next day talks about okay what do we do with all the information we have gathered so far because we did extensive park on diabetes and obviously in the last three sessions but I was in that so we need to prioritize the breathing needs and divides in the best thing news in the population because. That is a underlying cause of many other chronic illnesses that we talked about which is some panel I live opinion and other comic diseases and what so they can in the listing then I could go on it on about that so if you don't maintain the diabetes well secondly to dial consequences and that's the best thing me. The general way being program that we just talked about I was saying I was describing in terms of what other states are doing or the clients are doing focusing on exercise and it behavior change the help and coach is on that applies to everybody that doesn't just apply to people who divert is on these fact that does apply to everybody in the population and then that could include any kind of the other programs that we have listed below and a good realist program does. Address all of those things that I listen here such as lifestyle couching lifestyle devices to borrow their head medications if you need it if they have medications support would be which is a bit expensive but they are the best intelligent drugs for diabetes management because we. Yes miss me you know people the policy the same so it's well those where. Everybody needs help in turns out so we need to we as in your ask me to discuss it because some thanks. That is generally being where nobody has been everybody participated. But I think that is the last slide and reading. Open up. Thank for the presentation representative back you're recognized for a question. Thank you mister chairman. Might my question is would the numbers that you presented to get maybe a little bit more granular right we had a five year program by my calculations there are there any numbers out there that shells that yeah and i'm just there was you said about one point eight a percent i'll be stupid that medics are thanks use that that the increased costs of health care were there any do we have any grandlare and her data that shows that okay this program it costs you said seventy five hours of start but with one thing is like this group that diabetics overweight or whatever group you want to pick we've certainly got our bang for the buck with with those people as far as return on I had to say return investment but I guess it is that so in in and and on a broader scale then also looking at what you know these other programs did there should be some day that are shows hey now we had we have less participation in this program but those in this category who participated whose well worth the money because we we saw some results in there so I guess we can do it off line tell me whatever that yeah and so it's a great point that's one of the first things that I wanted to look back at when we were going to go to get deeper dive into a wellness program since you already had a wellness program in you had incentives we have eighty percent of the people that were participating can we look at those eighty percent and how is there behave your change before and after they join the program what were their cost relative to that twenty percent. In the data that we received they didn't tag the member as a participant or not so there's no way for us to go through the data and do. Bad analysis we can follow up with grant and see back then was there some reporting. Where those groups were were separated out and we could take a little deeper because yeah I think that's an excellent point to see come back was there any bank for your book I mean to use your phrase was there any return on investment with those people when you're given away. You have seventy five dollars month you'd like to say some change in behavior and some savings and costs follow. So but even if we can't get our data you know people are kind of the same rate across state lines they don't is a possible that we could take some most other programs and say they hate doing this as doing this in this program worked very well in another for another client and you know maybe a collage good outcome from those programs that we can incorporate into a well this program he can see those with you in it in fact the diabetes and obviously management there is no doubt that anybody who has managed to date will be seen well has you lived savings to the player and by the way it doesn't hurt to say that non investment that's what it is we we talk about that a lot so that is the correct of the knowledge of diabetes will be city I have no doubt that that is generally when this will be a we have seen it where the actually had been this is a applying but I know they had been people to disability the program was is done by recipient in the program and then you can match them on their risk levels you match their own their demographics so you don't imagine the one with them and go to participate in the well as program which is those who don't and you follow how the utilized health care in themselves emergency is how many specialists visit etc and then you want to find that and they have been studies when you see a relief that's positive so it has been done before for other times and I think it depends on the structure of the program what's being required if it's just. If this is going online and filling out a quick survey once a year. Yeah you know are you really going to get any behavior changed with that most likely not but you know there's. Some of the. Charges and just one quick and also that are they are but the thing is it seems to me like and i'll bet you that are certain segments out there or we get a huge return in you know to me it almost seems like instead of like a one size fits all we should meal maybe say hey this is an area where you will get huge returns and help help that person with the better quality of life and maybe we would push that initiative in not to others thank you. Yes and and adds kind of where our discussions will be going coming up next I tied together what we've talked about already for diabetes and obesity I understanding from your data that those are areas where we have a huge potential to impact that's really where we would like the focus to be are rather than abroad spectrum program I going back to what we were talking about a minute ago you know having everyone fill out a survey on their health behaviors we see that as a lower return on investment yeah everybody who is you know saying whether they use a seat bell to whether they use a harmer you know that that's a lower value type of program component than say getting folks involved in intensive coaching and support for something like diabetes. Yeah. Exactly. Representative brown your recognized question thank you mister chair i'm curious about a things it may not be addressed in this report have employers who have implemented a wellness program have his orbition in the analysis about employees being present on the jab sick days taken. Things like sort of those I guess you might call them in tangibles but I would think that they would that are wellness program would be reflected about the more robust work force. Absolutely yeah we see that and of course that's something that you can't measure through claims which is one of the main data sources that we have but there have been analysis done that i've showed there sometimes called soft savings but some of those are things like turnover our reduction in turnover present he is they're trying to track those things and arm I agreed that when you have something that's a wellness program that supports employees and make some feel like like they're supported that's where you tend to see some movement there and and we do see studies that that show that there is movement with with the more support of wellness program thank you representative collins you recognize. Thank you so in addition to what representative back to talking about which was some I was going to ask about as well completely agree that it would be helpful i'm kind of curious I mean assuming that the goal is to get people to change behavior as opposed to effectively making them pay less for being healthier which makes sense but I don't talk that's really the goal here is there any analysis of how these different models are wellness programs either just reward existing health or actually change behavior I mean I kind of looking at this third when it says you know if you're blood pressure is less than a hundred and forty year old or ninety you get some points. Do people just who happen to have low blood pressure to get those points or do people actually get healthier to get those points and that is one of the struggles with plan design in in that respect because the the folks who it's easy to get the points get the the incentives they're part of the participation but I wouldn't I one of these examples I think it was the second example where if you have a chronic condition then you have to do this extra step of the coaching we saw that that was about half of the level of participation compared to everybody who just needed that initial check the box piece goes to your point that I the the struggle and designing a program like this is how are you helping the people who need the help rather than just throwing money at people who are already healthy or where it's a small lift for them in order to meet the requirements because they don't have these extra hoops that they have to jump through which are in the case of the second example was chronic conditions and really those those are the folks that we white most of our resources to go to the the people with the chronic conditions you have a lot of areas for improvement in areas that we can support them and. If when you're getting that information for representative back if there's any analysis about that delta about you know people actually changing behavior during these incentives that would be great to have as well yeah and we can get that through the types of studies that look at people's behavior before and after you know single person as opposed to you otherwise you you run the risk of just looking at two cohorts the court that participated in the cohort that didn't and that's when you run the risk of some buyers of the people who were the go getters or the healthy people that are the ones who participate in the they bias the analysis. Yeah big points and there are some by the way compliance laws above what will be legally because it's been going by the confirming that the european scene way on the equally so everybody's in the benefits and then that's why that is really critical. And the benefits everybody's eligible participation so that's keep added mine. Any other questions from the committee up. The senator selfield you recognize. Cheer when you're doing the study do you consider any other factors outside of diabetes obesity factors such as stress and exactly. Absolutely. Yeah part of the whole listing well being as. And that something that we can see a lot of the times not all the time but through claims data looking at claims where people have a diagnosis of things like anxiety now we can't capture a hundred percent just because there are folks who might be experiencing that who aren't seeking help and we don't have a way of knowing about those unless we have additional data sources like you know a report you know suffer porter and assessment that someone takes that describe well to ask you that is you know i'm sure you you know this recently we had a professor harvard. Recommended that people get off their blood pressure medicine. And pay more attention to stress and the exactly in those situations that they allow themselves to get into. And it would do the much better than the the chemicals that were taking. The. It's possible it's also. That one being starting back and you would need. Well they speak to the value of having a more holistic program approach you know in the past in past decades if you have high blood pressure your solution was medicine or you know exercise more worrying that kind of thing not a holistic approach of what what's going on you want in your life that could be contributing to stress raising a blood pressure things like that and so that's in exciting time for us now in in well this program said it well it's in general just to try to hit those things more holistically and and have a program that's addressing stress or components that are addressing stress even if it's a medical chronic condition focus. Thank you mister center urban to recognize. Thank you slide on page eleven if you. I think you said that it was a combination. I have different types of financial and centers reaching about a total of five hundred dollars annually that light moves the needle for participation as that what you said yeah that's what we see ane totally yeah when it's less than that it it's not enough to motivate sometimes people are just great so also along that same thought process and i'm kind of looking more at the direct financial payment. Um. Graph their do people respond more when they get money back versus having to pay less in a premium that is a very good question and there have been different behavioral economics research projects dedicated to that I truthfully I think the evidence shows that are the eight the prospect of someone having to pay money back is a little more motivating but that said from an administration standpoint for something like a wellness program it would be a lot more complicated and i'm sure that there would be some legal issues that would be I a big component of thinking through a program like that but just in general in terms of behavioral economics the prospect of having to pay money back scares people motivates them a little more well I was talking about type of like a I was I was talking about returning money to them from the plan in other words instead of them paying a lower premium every month yeah and at the end of the thing that that's what I guess so I think that. Yeah go ahead yeah I i've seen their band and actually get exactly right instead of reduced premiums people like to really see the senders and an action of money so is the same amount of money that you will be charging with them of as a plan by people like save money as a person less opinion and I was talking about is that suffasinating economic scene what they do is I don't know they create it where let's say five hundred dollars for everybody in san diego a plan to see if it's the account in the beginning everybody gets five hundred dollars in the beginning of the year and the condition is monday providing they meet one do they are any of these activities that they're supposed to do as a windness participant and if they don't get in the year you take the five minute back and received a lot more participation from people in the wellness program so that is a second step i'll be on what you are asking whether people actually see money that's one and tourists they say money and then you've been saying such a way that you take the money back and that's even by day comes up keeping up people active in the participation but there are some legal this issue adaptable to me that happened okay and sent a direct financial payment what exactly how does that exactly work then. Understand the reduced premium understand the discount and the lower car sharing but what's the direct financial payment just what you are talking about that's where that could even it could even be gift cards it could be it like sigo we have a program where we get reimbursed for a gym membership or anything health related so it's basically outside of the insurance plan. Yep it's taxible and they're supposed to provide evidence of that we did this but I went to this okay okay. Okay yeah I think people would respond to that positively if if you're getting some dean in there in the mail versus a penalty or something like that so okay all right and then i'm sure like looking through this you know there there's gotta be a balance between the administrative burden and then what we're going to gain from it but the end of the day I mean. I think encouraging people to to take healthier. At staps and enter to work those kinds of things into I mean I like what you just said I think I think it's great I want people to be you know whether they have a home jim or whether they're go to a jim you know it's something to that nature I think would be great but so but I guess how do you do you take that and analyze it or build it particularly for each states are how how does that determine. To is that like a a suggestion that signal could give to us like this is what we think there must well constructed wellness plan would be for this plan for the state of arkansas or is that something that we as a committee what kind of have to go through and choose and aside. Now there's a lot of different types of programs as you can see and different financial months II don't know if there's like the perfect program for the state of arkansas but I think you know in the next meeting we'd like to. Show pros and cons with different types of programs I mean some even just some of the examples I thought if you are given a thousand dollars a year and there's a hundred percent or ninety eight percent participation. That's gonna have significant impact on your budget and your premiums and everything else so and that's pretty high touch and then there's other options where it's less money you lower touch so I think you know we'd want it present different options pros and cons and then hopefully I have a discussion in you what the committee what direction you guys want to take this art thank you. Rep representative back you're recognized. Thank you so you hit that something while ago I have we loated a private sector you know in plants and a private sector may be components that are in those by them the private sectors therefore profit so they see the bottom line of this thing and what works and what does it something they would be more focused on on their programs so have you got to reviewed any major corporation plans and said hey this is a component that's really working there and it would probably work in a state program yes and actually that third example that I gave is a corporate example and that was the wine where there was eleven hundred dollars everyone did the four hundred dollars peace of all ninety three percent of people dead and then only about a quarter of people went and did the pick and choose from the laundry list remaining item I so of course any across all sectors the design is really going to impact what kind of participation you get what kind of value you get you see that across sectors but you do see different willingness depending on how much money and organization has whether they're an employee or a state you see a variety that like we've seen of how much money is at stake but really I think where the important pieces is the design itself because if you can be smart with that in a way that you're inside of isn't people to do what really matters for their health as opposed to say like a health risk assessment that's not really changing behavior or helping anybody that's really where you can get some value. Representative johnson you recognize our search senator johnson so I hadn't heard this when then I have no idea on our stop laws if I go through all this crap and listen to the coach lose way and that lower my stop was. Or doctorable I mean. There are some there's something cute happens then. Then you'll you'll be out less money as a insured is that anywhere there so that's the cost of the lower car sharing. Bucket there so it could be yet reduced copays reduced deductibles like like you mentioned so that's an option that. The plants have one of the plans I work with they have a plan that's called their willness plan so he was requirements related to that and the contribution is about the same as the non wellness plan but it's lower deductibles there's all these additional benefits. So we have our state do we have a stop loss on on a like we have a heart attacker cancer whatever in our plan we have. So yet you you would have an out of pocket max so once you get a certain limit than the plans going to pick up the rest of the member no longer pays there's also deductible so when you reach to the deductible maybe you're only paying a portion of you know ten percent a coin on the rest of the dollars until you meet the outpocket max so those yeah those are common plan design components that that would that would that would be more over an inch and i've stick out five hundred dollars for me to inject me your view if I do the right things and a new lower master bloss to a hundred thousand dollars rather than a quarter of me and are five hundred thousand. Then as that's that's only measure more if something happens. And. And I think you're going to have more probably more participation based on the possibility of the old situation. I've got a question you know we're talking about the patient and the plan in the incentives but i'm confused to I mean obviously in a lot of communities and arkansas because we're so rule you've got one may be only two clinics in town that provider has a lot of trust with those members especially with the school employees i'm just kind of curious I mean is there anything if you all seen any wellness plans where there is an is for providers for getting there plan members who visit their facility to enroll and willness programs and to participate in to have exhorted participation I mean they're the kind of a key part of this whole ecosystem and we have really talks about them and also is curious if there's anything you can add to that. Oh yes sorry yeah so the but why does it is serious and there's from the health black. In which network and who's necklace they are and then you might be paying for that but there are ways of physicians doing these preventive services many people in the screenings and business and the white but not from you as the state employer that the way to see something yeah I was I was going to mention I work with another state that has an informal relationship between their providers it's a little bit of a different structure there's no actual performance guarantees or anything like that that goes you know and the antique don't that i'm referring to but the goal is developing these relationships and educating the providers of what's available so if there is say you know a diabetic program educating those providers so that the providers know when they have a diabetic you know state employee this is a program they can refer to and kind of get some of that buying from the providers because people tend to listen to what they're providers in respect with the providers are suggesting to them so i've seen that as an approach with some good effect. Gotcha yeah I just II imagine it's on these areas you know i'm beginned like in my district call hartman there's a school district over there there's only one clinic in that you know between those two towns and you know i'm sure most they were going there and if their providers telling them you need to be on this program they probably are gonna listen more to that provider than they're going to listen to me or any letter they get the mail or not fancy grant but you know you're so you've got a large enough population that you can do things like that whereas you know if it's a small employer. They only have five thousand lives but yep significant membership in the state so. Senator you're recognized. I thought that was a great question and I would agree one hundred percent with the chair on that point because i've said the story repeatedly that a lot of times there are lots of opportunities generally even through like our extension officers they have people on staff that we already pay for as tax as now it's taxpayers to provide programming on health and nutrition through our extension offices through the university of arkansas and so and those are located in every single county and so a lot of times my husband and so primary care provider will our physician you know well literally rodder prescription for them to go and take the nature and class or the walking class or whatever the the exercise class is that's for that's available to them for free through our extension officers and so those are the kinds of things that I just think it's about a coordinating understanding and can of making a road like making basically a a chart of what's already happening was already available where are these programs like the silver sneakers programs that and add up the blue cross and blue shield foundation supports where are the community centers connecting those people giving them the information and incentivising though they're where they get their health care at that those of the people they trust and southern those clinicians that are out there particularly in the rural areas but so it's it's I think if we could do a better job of just identifying available resources that we already pay for in a lot of these different areas and kind of connecting the dots for everybody and providing those opportunities and and making them aware of those like that's what I want to see and a lot of that you know could be just free though we are not from free to them. We're already paying in for a lot of that programming so though those are the kinds of things that II think i'm very interested in which shouldn't cost us a ton of money. But great point now I agree with the chair thank you. Thank you are there any other questions. Are no other questions appreciate your time in presentation and we'll move on to the next item on the agenda. Item see consideration to the adoption of the initial diabetes management program study report. You should all have a copy of their to tandel see if there's any questions. Let us know but if not we will need a motion to approve the report. Yeah. Yeah if if everybody will read like the last since on this now that this is what we require within the legislation but because of the wildness and everything the staff are drafted this so that we will continue this uh continue this problem through september. The. Excuse me december is when it'll be presented to the four legislative council so. To have a second. I was in favor say I all are supposed. Motion passes. All right committee is there any other business. If not we are journed thank you.