Survey Word Document

Appendix C

Prevention and Wellness Assessment Survey

Form Approved

OMB No. 0920-[XXXX]

Exp. Date [xx/xx/20xx]

Public reporting burden of this collection of information is estimated to an average of 30 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to CDC/ATSDR Information Collection Review Office, 1600 Clifton Road NE, MS D-74, Atlanta, Georgia 30333, ATTN: PRA [INCLUDE OMB No. 0920-XXXX].

Overview
Thank you for your participation in the Health Plan Prevention and Wellness Program Survey. America’s Health Insurance Plans (AHIP), in collaboration with the Centers for Disease Control and Prevention (CDC), is conducting this survey to examine approaches to promote clinical preventive services and wellness in the commercially insured population. This survey is organized into the following five sections:

   Section I. Health Plan Characteristics
   Section II. Overall Approaches to Prevention and Wellness
   Section III. Clinical Preventive Services
   Section IV. Wellness Programs

Section V. Community Partnerships in Prevention and Wellness

Scope

Please answer all the survey questions based on the prevention and wellness programs you offer in the COMMERCIAL MARKET for both fully insured and self-insured products. Prevention and wellness programs aimed at Medicaid and Medicare Advantage beneficiaries are outside the scope of this survey. Where feasible, please respond based on the most commonly implemented prevention and wellness approaches.

Definitions

Prevention Program

For the purpose of this survey, prevention activities refer to the delivery and promotion of clinical preventive services that help protect against disease or reduce the likelihood of disease, disability, and premature death.

Wellness Program

A wellness program refers to structured approaches such as tools, rewards, and/or interventions intended to improve and promote health and fitness. For example, rewards and interventions to reduce risk for cardiovascular disease are typically included in a wellness program. Disease management programs that aim to help individuals manage or control existing diseases or conditions are outside the scope of this survey and should not be included in your responses.

Instructions / Tips

Please note that questions may require information from other staff members or other departments within your organization. We recommend that you review the survey questionnaire in the Word format first and, if needed, collect this information prior to submitting your answers via the online web link.

We estimate it will take approximately 30 minutes to submit your responses.   

Please answer the survey questions on behalf of your organization including all of your subsidiary plans. If you would like to submit separate responses for your subsidiaries, please forward the survey link to appropriate staff and they will be able to submit a separate survey response.

Contact Information

If you have questions about the survey or are experiencing technical difficulties, please contact:

• German Veselovskiy at [email protected] or 202-778-8476.

• Merianne Spencer at [email protected] or 202-778-3299.
  
  

Section I. Health Plan Characteristics

1. What is the name of your health plan? _______________________________________

2. What is your health plan’s total Commercial (individual and group market) enrollment as of January 1, 2015?

Commercial individual and group market enrollment (including both fully-insured and self-insured)

3. Please estimate what percent of your commercial members are enrolled in grandfathered plans¹. (Note: Please do not include transitional plans in your estimate.)

(A slider would allow the respondent to choose a specific number between 0% and 100%)

4. What commercial markets does your health plan service? (Please check all that apply):

   1. Fully insured individual market

   2. Fully insured large group market (100+ employees)

   3. Fully insured small group market (< 100 employees)

   4. Self-insured (ERISA)

Section II. Prevention and Wellness

Approaches to Prevention and Wellness

Prevention Program

For the purpose of this survey, prevention activities refer to the delivery and promotion of clinical preventive services that help protect against disease or reduce the likelihood of disease, disability, and premature death.

Wellness Program

A wellness program refers to structured approaches such as tools, rewards, and/or interventions intended to improve and promote health and fitness. For example, rewards and interventions to reduce risk for cardiovascular disease are typically included in a wellness program. Disease management programs that aim to help individuals manage or control existing diseases or conditions are outside the scope of this survey and should not be included in your responses.

5. Please rank the objectives of your prevention and wellness programs:

Objectives of your Prevention and Wellness programs:	Primary Objective	Secondary Objective	This is not an objective specific to our prevention and wellness programs	Not applicable (N/A)
Promote health in covered population
Prevent onset of chronic disease
Reduce or mitigate health care costs
Improve workforce productivity
Improve overall quality of care
Other objective(s) (please specify) _______________________________

Section III – Clinical Preventive Services

Provider Engagement on Clinical Preventive Services

The purpose of this section is to understand how your health plan engages with providers to promote clinical preventive services². Please answer the questions below based on your experiences interacting and engaging with your providers.

6. In your experience, how useful are the following provider tools/resources at promoting clinical preventive services?

Tools & Resources Your Health Plan Makes Available To Providers	Very Useful	Somewhat Useful	Not Useful	Don't know	We haven’t implemented these approaches
Share with providers real-time patient data
Make available to providers clinical decision-support tools
Provide physicians with lists of individual patients requiring specific clinical preventive services based on claims data
Share performance reports with providers on preventive care quality measures
Provide physicians with patient education materials on clinical preventive services
Other (Please specify. If not applicable, please select the “We have not implemented these approaches” option for this row.)

7. What types of provider incentives does your health plan currently use to promote clinical preventive services? (Please check all that apply):

1. New payment models (excluding pay-for-performance) with a focus on primary care (e.g., shared savings/shared risk models, bundled payments, global payment)

2. Pay-for-performance (P4P) incentives for meeting specific targets on preventive measures (e.g. HEDIS measures)

3. Other (please specify) ______________________________________________

4. Our health plan does not use provider incentives. (Skip to question 10)

8. Are provider incentives currently tied to achievement of performance targets in specific areas? (Please check all that apply):

1. Cancer screenings

2. Immunizations

3. Tobacco cessation

4. Well visits

5. BMI assessment

6. Weight reduction

7. Other (please specify) _______________________________________________

8. No, incentives are not currently tied to performance targets

9. In your experience, what types of provider incentives are useful for promoting clinical preventive services?

	Very useful	Somewhat useful	Not useful	Don't know	We haven’t used these approaches
Risk-adjusted PMPM
Care Management Fee
Pay-for-performance incentives
Shared savings (upside)
Shared risk (downside)
Partial capitation
Recognition programs or awards
Other (Please specify. If not applicable, please select the “We haven’t used these approaches” option for this row.) _________________

Member Engagement on Clinical Preventive Services

The purpose of this section is to understand how you work and engage with your members to promote clinical preventive services. Please answer the questions below based on your experiences interacting and engaging with your members.

10. In your experience, which approaches are useful for increasing uptake in clinical preventive services?

Interventions Targeted at Members	Very useful	Somewhat useful	Not useful	Don't know	We haven’t used these approaches
Reminders provided to members for clinical preventive services
Member incentives (positive) for receiving specific clinical preventive services (i.e. financial or non-financial rewards)
Member disincentives for receiving specific clinical preventive services (i.e. financial or non-financial penalties)
Value-based insurance design for preventive services3
Provision of educational material
Other (please specify. If not applicable, please select the “We haven’t used these approaches” option for this row.) _________________

Section IV. Wellness Programs

Definition of a Wellness Program

Wellness Program

A wellness program refers to structured approaches such as tools, rewards, and/or interventions intended to improve and promote health and fitness. For example, rewards and interventions to reduce risk for cardiovascular disease are typically included in a wellness program. Disease management programs that aim to help individuals manage or control existing diseases or conditions are outside the scope of this survey and should not be included in your responses.

11. What are key components of wellness programs offered directly to your members? (Please check all that apply):

1. Identification and stratification of risk for illness

2. Targeted interventions to promote wellness

3. Monitoring and evaluation of programs

4. Providing feedback to employers/consumers

5. Partnering with providers to promote wellness

6. Other (please specify)___________________________________________________

12. What guidelines, standards or studies does your health plan use in designing your wellness programs (Please select all that apply)?

1. The Guide to Community Preventive Services (The Community Guide)

2. The Health Enhancement Research Organization (HERO)⁴

3. NCQA wellness and health promotion accreditation standards

4. Best practices from successful wellness programs of other health plans or employers

   • (Optional): Please describe some of the best practices you have identified from successful wellness programs:

_________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

5. Findings or recommendations from regional coalitions

   • (Optional): Please list specific findings or recommendations from regional coalitions that you have used:

__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

6. Peer-reviewed evidence-based studies

7. Behavioral and/or psychosocial theories (e.g. Stages of Change, trans-theoretical model, etc.)

8. Condition-specific guidelines (e.g. American College of Sports Medicine; American Dietetic Association, American Heart Association, National Cancer Institute; WELCOA; WebMD)

9. Federal studies or guidelines (e.g. CDC, NIOSH, NHLBI, WHO, U.S. Department of Agriculture)

10. Other (please specify)______________________________________________________

13. How does your health plan administer your wellness programs?

1. Design and administer programs in-house

2. Contract with a vendor to design and administer programs

3. Both in-house and outside vendor

4. Don’t know (explain) ______________________________________________

14. How does your health plan identify members who may benefit from wellness programs? (Please check all that apply):

1. Medical chart reviews

2. Patient self-report (e.g. HRA)

3. Prospective analysis/predictive modeling

4. Provider referrals

5. Retrospective data analysis

6. Biometric screening (i.e. weight, lipid profile etc.)

7. Other (please specify)__________________________

15. Do your members have access to programs that are designed to assist them in minimizing specific risk factors (Please check all that apply)?

Programs that target:	Yes, our fully-insured members have access	Yes, our self-insured members have access	No, we do not offer this program
Cardiovascular risk (e.g. elevated lipid levels, hypertension)
Mental health/ substance abuse
Pre-diabetes
Prenatal care for the eligible subpopulation
Stress
Tobacco use
Low physical activity
Other risk factor1 (Please describe. If not applicable, please select the “No, we do not offer this program” option for this row.) __________________
Other risk factor2 (Please describe. If not applicable, please select the “No, we do not offer this program” option for this row.) __________________
Other risk factor3 (Please describe. If not applicable, please select the “No, we do not offer this program” option for this row.) __________________

16. What intervention methods does your health plan use to target risk factors and promote member wellness?

Intervention Methods	We offer to all our members regardless of their risk level for disease	We offer only to members who are at high risk for disease	We do not offer this intervention method
Digital coaching
Educational material for patient self-management of health
In-person health coaching
Mobile health vans
Nurse call lines
Patient self-management tools (e.g., calorie counters)
Remote outbound telephonic coaching
Telehealth5
Other intervention method(s) (Please specify. If not applicable, please select the “We do not offer this intervention method” for this row.) ______________________________

17. In your experience which member-facing wellness interventions have been useful at promoting wellness?

	Very useful	Somewhat useful	Not Useful	Don't know	We haven’t used these approaches
Digital coaching
Educational material for patient self-management of health
In-person health coaching
Mobile health vans
Nurse call lines
Patient self-management tools (e.g., calorie counters)
Remote outbound telephonic coaching
Telehealth5
Other (Please specify. If not applicable, please select the “We haven’t used these approaches” option for this row.) __________________

18. What types of technology does your health plan use to promote wellness among your members? (Please check all that apply):

1. Smart phone apps

2. Social media (Facebook, Twitter)

3. Text messaging

4. Web-based tools (e.g., portal)

5. Employer-based web portal

6. Other (please specify)_______________________________________

7. Currently we do not use technology for this purpose

19. What kinds of member incentives are offered to promote member wellness? (Please check all that apply):

1. Merchandise or gift cards

2. Discounted gym or health club membership

3. Discounts for buying healthful foods

4. Cash payments

5. Lower insurance premium (or higher if penalties)

6. Recognition program for achieving certain goals

7. Other (please specify)_______________________________________

8. Currently, we do not offer member incentives (Skip to Q21)

20. If member incentives are part of your program, to what activities are they tied?

Incentives	Incentives can be tied to:	Incentives can NOT be tied to:	Not Applicable (N/A)
Completion of personal health risk assessments
Participation in biometric screenings
Enrollment in specific programs
Completion of specific programs
Achievement of specific health goals
Other activities/outcome(s) (please specify) ­­­­­­­­­­­­­­_______________________________________

21. How does your health plan engage providers in wellness programs? (Please select all that apply):

1. Participation of physicians in patient-centered medical homes

2. Via financial incentives

3. Sharing educational materials with providers

4. Sharing information on evidence-based wellness approaches

5. Decision support tools made available to providers

6. Other (please specify):_____________________________________________________

7. Currently, we do not engage providers in wellness.

22. What areas of your health plan wellness programs do you monitor?

1. Health risk improvements

2. Return on investment (ROI)

3. Member participation

4. Member satisfaction

5. Other (please specify)______________________________________________________

6. Currently, we do not monitor wellness programs.

23. Does your wellness program conduct evaluations using specific metrics?

1. Yes  If yes, proceed to Q24

2. No  If no, proceed to Q25

24. In evaluations of your wellness programs, what changes to outcomes have you observed?

Outcomes	In all of our wellness programs	In some of our wellness programs	In none of our wellness programs	We do not measure
Decrease in healthcare costs
Reduction in onset of chronic disease across members
Reduction of risk factors for chronic conditions across members
Improved workforce productivity
Other (Please specify. If not applicable, please select the “We do not measure” option for this row.) _________________________

25. What challenges has your health plan encountered in implementing wellness programs (Please select all that apply)?

1. Employee turnover

2. Employer commitment

3. Lack of provider engagement

4. Lack of member engagement

5. Other challenges (Please describe) ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

26. Please describe innovative prevention and wellness programs you have implemented in the past 1-2 years. Please include any results, if available.

________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Section V. Community Partnerships in Prevention and Wellness

Please respond to question(s) in Section V based on your health plan activities. When responding to this section, please do NOT include activities undertaken by your Foundation (if applicable).

27. Do you invest resources in community programs or participate in community partnerships? (Please check all that apply):

Area	We invest financial resources in community programs	We provide in-kind assistance to community partnerships	No, we do not provide financial or in-kind assistance
Prevention of overweight/obesity (child and adult)
Promotion of community health fairs/screenings (e.g. immunizations)
Promotion of fitness/physical activities (e.g. fitness trails)
Promotion of prenatal care
Reduction of risk for chronic conditions (e.g. cardiovascular disease, diabetes, metabolic syndrome)
Support for mental health/depression services (promote awareness, suicide prevention, support, etc.)
Child and adolescent health and safety (e.g. bullying, teen pregnancy)
Environmental health
Other (Please specify. If not applicable, please select the “No, we do not provide financial or in-kind assistance” option) _________________________________

Proceed to Q28 if at least one item of the first two columns is selected.

28. Please indicate the types of community organizations to whom your health plan provides financial or in-kind assistance. (Please select all that apply):

1. Churches and religious groups

2. Schools or school systems (e.g. universities)

3. Health departments (e.g. state, local, etc.)

4. Foundations

1. Business coalitions (e.g. National Business Group on Health)

2. Non-profit community support groups (e.g. YMCA, local racial/ethnic support communities and associations)

3. Federally qualified health centers (FQHC)

4. Free medical clinics

5. Disease-based organizations (e.g. American Cancer Society Cancer Action Network)

6. Other (please specify) _________________________________________________

Thank You!

Thank you for completing this survey. If you have any questions about the survey, please contact:

• German Veselovskiy at [email protected] or 202-778-8476

• Merianne Spencer at [email protected] or 202-778-3299

1 Grandfathered plans are group health plans or group/individual health insurance coverage that existed on March 23, 2010, which do not meet all the requirements of the Affordable Care Act.

2 Refers to services provided by clinicians. Examples include screening and counseling.

3 Value-Based Insurance Design (V-BID) is built on the principle of lowering or removing financial barriers to essential, high-value clinical services for members. V-BID aligns patients’ out-of-pocket costs, such as coinsurance, with the value of services.

4 Link to HERO website: http://www.the-hero.org

5 HRSA defines telehealth as the use of electronic information and telecommunications technologies to support long-distance clinical health care, patient and professional health-related education, public health and health administration. Technologies include videoconferencing, the internet, store-and-forward imaging, streaming media, and terrestrial and wireless communications.

Please respond to all survey questions based on your Commercial product.

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