Optima Health: Managing the Wellness Gap

“We all know where the dollars in healthcare are going and it’s an unsustainable upward spiral. This program helps bend the rate of that rise. But the more important thing, on the clinical side, is that we’ve made improvements in health.”

Optima Health Vice President & Senior Medical Director George Heuser, MD

The Wellness Payoff

Sentara Healthcare and Optima Health demonstrate a five-year trend of bending the healthcare cost curve downward while improving employee health.

It sounds too good to be true – spending less on healthcare, paying employees up to $1,000 in rewards and getting better health outcomes. But it is true.

Five years ago Optima Health, in partnership with Sentara Healthcare, implemented an innovative incentive-based health and wellness program for its 11,200 benefits-eligible employees. In 2010, we reported that the program, called Mission: Health, saved Sentara Healthcare $3.4 million in healthcare costs -- $6 for every $1 invested in the program – in the first three years, while health indicators improved significantly.

Since then, the financial and clinical savings have just gotten better. Over the entire five-year period since Mission: Health’s conception, Optima Health can demonstrate a bending of the rate of rise in healthcare spending based on a data analysis of a 5,000 member subset of the original Mission: Health membership.

For 2011, Optima Health’s commercial population actual trend was 5.8 percent. In the same year, Sentara Healthcare’s total claims costs increased by only 4.5 percent. However, the costs dropped by 23 percent of what was expected. Expected healthcare costs were $23 million in 2011 and actual costs were $21 million.

In the study population, Sentara has saved more than $4 million dollars in medical costs and were able to sustain significant return on investment. For every dollar invested in the Mission: Health program, Sentara Healthcare has saved $2.70.

Eighty-seven percent of monitored participants have maintained or improved their critical health risks (blood pressure, body-mass index, cholesterol, tobacco use and level of exercise) all while aging five years. Keep in mind, health risk levels typically rise as we age.

Actuarially one year of age equals 2.5 percent of increase in claims cost. Optima Health did not see that with this subset of members. When we expected to see an increase in healthcare costs of approximately 12.5 percent attributed solely to this increase in average age, instead we saw a 10.5 percent decrease in medical expenditures for those participants over that time frame.

Today the Mission: Health program includes spouses and members who are pregnant and is used in some variation by seven other clients offering benefits to over 90,000 members. Employers can use Mission: Health as an effective wellness program model and partner with Optima Health to realize dramatic cost savings in their organizations.

The information on this site provides both the results from the 2010 study and the updated 2012 results. Use these resources to learn how to implement an incentive-based wellness program in either a large or small employer environment.

For more information about incentive-based wellness programs, email wellnesspayoff@sentara.com.

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