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Note: This case study refers to the use of INTERVENT in the US under Nationwide Better Health SM.

Challenge

In the mid-1990s the State of Oklahoma statutorily created the State Wellness Program, a program of the Employees Benefits Council (EBC) and a health and wellness program for all 37,000 state employees. The EBC recognized a need to implement a sustainable program for all employees due to the rising cost of health care, the increased cost to fund health benefits for state employees and their families, and the overall poor health status of state employees. More than 30% of state employees had been diagnosed with cardiovascular disease and/or diabetes, and another 30% were at risk for developing these conditions. As a result, Nancy Haller was hired to develop and implement the statewide employee health and wellness program.

For a decade, Haller and others traveled throughout Oklahoma screening state employees and providing self-care guides to program participants. It was then that Haller realized the program’s success required a new, automated screening process to avoid possible misreporting or loss of data. With state employees moving from agency to agency and choosing from a variety of health plans, a better, more efficient manner for tracking these employees’ health and behavior changes also had to be developed.

Solution

2002: The EBC and partner, INTERVENT USA, Inc., of Savannah, GA, (which was acquired by

Nationwide Better Health SM in 2007) developed and implemented a 12-month, scientifically proven, web-based program that included an online health history questionnaire, a risk stratification of participants, goals and action plans, an extensive tracking component, one-on-one telephone health mentoring (coaching), and educational kits on exercise, nutrition, stress management, diabetes management and smoking cessation.

2003: Haller piloted her newly modeled program to the Oklahoma Department of Human Services. Six months into the pilot, response was so great that Haller had to add three health educators to mentor more than 1,500 participants.

2006: Haller and her team rolled out the more comprehensive program, known as the “OK Health Mentoring Program,” to all 37,000 state employees. To make the program even more attractive, they began to offer cash incentives—a perk new to government agencies as a result of recently passed legislation. With the assistance of Administrator and Cabinet Secretary for Human Resources and Administration Oscar B. Jackson, Jr., and his staff, Haller and her team crafted rules around three types of incentives: participants can have one initial visit with their primary care provider and two labs (specific to the program) free of charge, receive a cash incentive paid by participating state agencies (gold $500, silver $300 and bronze $100) and receive discounts to fitness facilities throughout Oklahoma.

2006 to present: Since the OK Health Mentoring Program’s inception, the response from state employees has been overwhelming. In addition to the program’s features and benefits, Haller attributes the success—and the success of her mentors—to her Nationwide Better Health team, led by Dr. Neil Gordon, chief medical and science officer; Dr. Richard Salmon, director of IT applications; Billy Saxon, IT applications consultant; and Chip Faircloth, senior market planning consultant. This team also included the EBC’s new executive director, Philip K. Kraft, whose determination and resolve was key to making the program thrive. Kraft insisted on creating a “Healthy Vision Committee” article, dated 2013, that outlined how state employees in Oklahoma would become the healthiest in the nation. He cautioned state employees that the effort would be hard, but reminded them of President John F. Kennedy’s 1962 vision for sending American astronauts to the moon: “We choose to go … not because it is easy, but because it is hard, because that goal will serve to measure and organize the best of our energies and skills.”

As a result of this success, the staff was expanded to include 10 health mentors, an administrative assistant and an epidemiologist who analyzes medical and pharmacy claims data. Haller continues to work closely with Nationwide Better Health SM on biomedical analysis, streamlining the employee enrollment process and for technical assistance. She also oversees the State Wellness Program, which is made up of 124 agency wellness coordinators representing the 37,000 employees in Oklahoma. The State Wellness Program meets on a quarterly basis and is now in its 14th year. Information on the State Wellness Program and OK Health Mentoring Program can be found at www.ebc.state.ok.us.

Results

Although current program results are still in the early stage, more than 7,000 state employees have made inquiries about the program and more than 3,500 employees completed at least one year in the program. Those participants with actionable health outcomes have, on average:

  • Decreased total cholesterol by 25 mg/dl 0.6465 mmol/l
  • Decreased LDL by 25 mg/dl 0.6465 mmol/l
  • Increased HDL by 5 mg/dl 0.1293 mmol/l
  • Decreased blood sugar by 10 mg/dl 0.55556 mmol/l
  • Decreased triglycerides by 53 mg/dl 0.59837 mmol/l
  • Lost more than nine lbs (about four kilograms)


More recently, Haller has noticed some positive trends among program participants, including a 21% drop in medical claims use and an increase in pharmacy claims submitted. These “wins” are primarily due to more participants taking their prescribed medications as directed and taking accountability for their health while working with their personal mentor. The evaluation process also indicates that participants who have been enrolled in the program for at least one year feel better about themselves, are more productive during the day and are more motivated to remain in the program. Also, through better tracking, Haller has seen doctor visits, hospitalizations and emergency room encounters decrease by 34%, 9% and 3%, respectively.

State of Oklahoma Case Study