Employers are at war with rising health care costs. But cost-inflation is not the enemy, Den Bishop, benefit broker and chairman of the board of the wellness vendor ACAP Health says. It’s disease that is the enemy — and benefit advisers are uniquely positioned to lead the charge against it, he says.

Bishop, who is also president of the national brokerage firm Holmes Murphy and Associates, formed ACAP Health as a Holmes Murphy subsidiary in 2006 with co-founder and CEO Wally Gomaa, who is also a broker and senior vice president at Holmes Murphy. As benefit advisers, they found most wellness programs at the time concentrated only on measuring employee participation. They chose to pave a different path, focusing their wellness approach on combatting disease.

Disease is what’s stealing money and years from people’s lives, says Bishop. “That’s something we forget as an industry. But, the insurance company is not the enemy. The hospital is not the enemy. The doctor is not the enemy and even the broker is not the enemy. If we all shift our focus on attacking the true enemy of disease and align everything else around that, we have a chance to reinvent the benefits industry,” he says.

Benefit advisers play a pivotal role, coordinating with all the necessary stakeholders to do just that, Bishop says.

“We’re the Rosetta Stone. The benefit adviser speaks multiple languages. We speak employer. We speak provider. We speak insurance company. All other stakeholders only speak their own language. Our job is to be the translator to an effective solution,” he says. “We, as benefit advisers, sell our cumulative knowledge and experience. We sell our ability to translate, communicate and cast a vision.”

The root cause
ACAP Health was born from one of those very visions. In 2005 and 2006, Bishop says, Holmes Murphy had a lot of clients moving into the wellness space, but with very little measurable impact. Bishop and Gomaa saw a need to create a wellness solution that showed quantifiable results.

“Most of the things being offered in the wellness space at the time were measuring participation,” Gomaa says. “But at the end of the day when you looked at lab values or the weight on the scale, we weren’t seeing that lab values were improving or that we were doing anything to impact obesity rates.”

Bishop and Gomaa decided their wellness solution would need to get specific about what health measures to target.

Companies at the time “lacked any clinical definitions” and had a very soft, broad vision for their wellness programs to “make our people healthier,” Bishop says.

“Our initial desire was to settle on a consistent clinical risk definition of wellness,” he says of the assessment that eventually bore ACAP, which stands for Accountable Care and Accountable Patients.

“We settled on the metabolic syndrome risk cluster as our measure,” he adds.
Metabolic syndrome is a group of risk factors that “raises your risk for heart disease and other health problems such as diabetes or stroke,” according to the National Institutes of Health.

Metabolic syndrome and its risk factors are also markers for high utilization and costs among patients receiving medical care, the NIH says. It’s that fact that prompted Bishop and Gomaa to concentrate their wellness efforts on combatting the syndrome.
The five risk measures identifying metabolic syndrome, include:
• Blood pressure
• Waist circumference
• Fasting glucose
• Triglycerides
• HDL cholesterol, also known as good cholesterol

“If you have three or more of the five then your likelihood of claim goes up drastically — whether it’s for cancer, diabetes, or heart disease,” Bishop says.

In fact, NIH found that overall medical costs per person increased an average of 24% per additional metabolic syndrome risk factor. Costs for individuals with diabetes plus weight risk, high cholesterol and high blood pressure were almost double the costs for individuals with pre-diabetes plus similar risk factors.

Additionally, the number of people being treated for diabetes jumped 159% between 1996 and 2011, according to the U.S. Department of Health and Human Services. With higher health care costs linked to diabetes and other metabolic syndrome risk factors, it’s easy to see how health care spending continues to rise, Bishop says. “The most effective diabetes cost-control program is no new diabetes,” he says.

With that in mind, Bishop and Gomaa designed ACAP’s flagship product, that they call their clinical wellness program, to target metabolic syndrome  with two major components — a healthy eating/weight-loss curriculum with proven results from partner Naturally Slim and a plan to create a culture of health within a company  to motivate employees to actually use the curriculum. Today the company offers two other products on top of wellness including one that assesses gaps in care for early detection of chronic diseases and a consumer advocacy program for low-cost, transparent care.

Reversing the risk
Their first task in creating their clinical wellness solution, Bishop says, was to find a curriculum that worked to “reverse the risk.”

“We experimented with several approaches and programs before committing to a deep partnership with Naturally Slim,” Bishop says about the company that’s also independently owned out of Dallas, Texas. Naturally Slim offers a 10-week behavioral program delivered on a technology platform that is available on-demand to the employee. The curriculum of the program consists of 10 45-minute videos that discuss a number of topics related to healthy eating, including learning some new techniques about how and when to eat — learning to eat in a natural, normal way versus when you think you should or when you aren’t hungry.

A 2009-2010 study of more than 3,000 Naturally Slim participants whose primary health risk factors — the same ones used to measure for metabolic syndrome — were considered at risk showed that 80% experienced a reduction in waist circumference, 69% experienced reduced triglyceride levels, 51% experienced increased HDL or good cholesterol, 59% experienced lower blood pressure and 57% experienced lower fasting glucose. Bishop says he, Gomaa and ACAP Health have used the Naturally Slim program with approximately 500 employer clients. 

One of those ACAP customers is Southwest Airlines, which implemented the program in the summer of 2013 and whose employees have since “experienced significant weight loss, as well as improvements on health measures such as blood pressure, glucose levels, and cholesterol levels,” according to the company’s health and wellness program manager Kembre Roberts.

She says the Naturally Slim program has contributed to more than 8,000 pounds lost at the company. The average weight loss is 10 lbs. for each participant in Southwest Airlines’ program. Some participants have lost as much as 35 lbs. and are still losing, she adds.

“Like many employers, Southwest was looking for a way to provide wellness opportunities that could enhance the quality of life for our employees and stop the progression of disease that is impacting overall health care spend,” Roberts says.

“The program is focused on behaviors and meeting people where they are in their weight loss journey. More than anything, the program seems to empower participants to live healthier — they get to own their journey,” she adds. “Weekly online modules provide a great benefit to our employees because participants can share the experience of being in Naturally Slim without having to be in the same physical location during the program.”

Leia Spoor, director of health and wellness for Baylor Health, an ACAP Health client since 2010, agrees, saying the web-based platform allows the company’s thousands of employees located across the country to participate in the program at any given time.  

Grassroots movement
The Naturally Slim curriculum, however, was just one piece of Bishop and Gomaa’s wellness vision. Bishop also wanted to find a new way to motivate employees to participate in the wellness program.

While wellness programs typically rely on rewards or premium surcharges to incentivize employees to participate in the wellness program, Bishop envisioned a different way — building a grassroots movement in the company’s culture.

Sustainable success for a wellness program does not come from some “magic curriculum,” Bishop says, nor does it come from “hefty incentives or appealing websites.”

“We discovered that sustainable success comes from creating a grassroots movement of positive momentum within a culture,” he says. “We tell an employer, ‘We need to create a grassroots movement where it’s actually cool inside the culture of the company to be healthy.’”

So how do you do that? Bishop began working with employers to roll out their wellness program in stages.

In a message to the employees, ACAP Health says, “We have this program and it’s worked well with other companies, but we’re not sure it’s going to work inside the culture of your company, so we have a limited number of spots available in the pilot program. If you would be interested and if you think you might be at risk, you can apply and you may or may not be accepted.”

Bishop says they’ve never had fewer applications than they have spots in an employer program. Employees don’t expect the insurance company to act that way, Bishop says — they expect the insurance company to say, “You’re sick. You need help. Sign up or we’re going to penalize you.”

“Well, that doesn’t work,” Bishop adds. “Because you haven’t connected with the person and the person isn’t motivated.”

Targeting the risk measures of metabolic syndrome, a percentage of those enrolled employees will see results in the program, either through the loss of weight or better laboratory results, sometimes in just the first ten weeks, Bishop says.

When it comes time to roll out the second phase, a limited number of spots is again offered to employees who have now seen their co-workers’ results.

“It sells out online immediately, virtually every time,” Bishop says, adding that people again are turned down when the spots are filled.

“They’re not used to that,” he says. “They think, ‘Wait I applied and I didn’t get in? I’ve got these risks and you’re not going to help me?’”

By dangling the program out to employees slowly, you create a demand inside of the culture, Bishops says. “You start a culture grass fire. Then when you roll the program out to everyone, you have enough people who know somebody that had success in the program, the employees think it’s a cool program. They know it helps you get healthy and lose weight.”

A lot of professionals in the benefits industry including brokers and advisers have “missed it,” Bishop says, about creating sustainability and employee motivation. “We take this ‘Mother may I?’ approach that says we and the insurance industry know better and you need to do as we say.’”

Employees don’t respond to that, he adds. “We have to be a little more creative as an industry in how we create real demand, rather than just telling people they’re sick.”

ACAP Health
With their vision in hand to target metabolic syndrome through the Naturally Slim curriculum and by creating a grassroots movement to motivate employee participation in the program, Bishop and Gomaa decided to found ACAP Health.

“We launched ACAP Health in order to make the investments to build out that program and infrastructure,” Gomaa says.

While maintaining a stake in the new venture, the benefit advisers decided to set up ACAP Health as a subsidiary of Holmes Murphy so that ACAP Health could own and have distribution rights to the intellectual property in the clinical wellness space. 

“We believed that our answers could bring value beyond Holmes Murphy’s traditional geographic boundaries. Therefore, we created ACAP to distribute the clinical wellness products, services and intellectual property through other agents, brokers and consultants in other parts of the country,” Bishop says.

Gomaa and Bishop have since liquidated their interest in ACAP so Holmes Murphy now owns 100%. The two continue their mission as benefit advisers bringing solutions to their clients through their roles at the brokerage and ACAP. But, “Holmes Murphy advisers evaluate ACAP products and services the same way that they assess options from any other vendor,” Bishop adds.

Bishop says ACAP Health measures the success of the program for their clients clinically, using metabolic syndrome as a consistent measure — going back to the root of what conjured up the idea to create the company in the first place.

“Many wellness programs measure success by improvement in risk numbers,” he says, adding that he and Gomaa set up ACAP Health to stand apart from those other programs by measuring success as the elimination of the risk.

For example, a person with fasting triglycerides may start a program with a level of 300. The metabolic syndrome definition considers any triglyceride level above 150 to be at risk. 

“Lowering the triglycerides from 300 to 250 might be a move in the right direction,” Bishop says. “But we wouldn’t consider it a success until the level dropped below the prescribed risk threshold of 150. This focus on risk elimination rather than simple directional improvement has set us apart in many sales situations.”
Based on the results he’s seen so far, he says, “We know that we can eliminate the presence of metabolic syndrome in close to 50% of the at-risk individuals within 10 weeks when the company’s core beliefs, communication, and curriculum come together.”

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