The Vitality Wellness Programme Experience from South Africa
Discovery Corporate Profile
7,000 employees $4.8 billion annual revenue 100%
100%
100%
Launched 2001
75%
UNITED KINGDOM
SOUTH AFRICA
Launched 1993
75%
Launched 2007
Launched 2004
Launched 2007
25%
100%
UNITED STATES
Launched 2008
Launched 2011
25%
CHINA
Launched 2010
“Why is Discovery, a South African firm, paying its customers to get healthy while most Western insurance giants do not?”
The Economist, 20 February 2010
3
1
Background to the Vitality Programme
Key drivers of morbidity and mortality
Probability P b bilit off 15 year survival i l without ith t coronary artery disease, stroke or diabetes
The Oxford Health Alliance’s 3-4-50 model
4 Diseases Cancers, Diabetes, Lung g disease, Heart disease
50% of deaths worldwide
100% 15 ye ear survival p probability
3 Behaviours Smoking No exercise Poor diet
90%
81%
80%
86%
71%
70% 60%
56%
50% 40% 30% 20% 10% 0% Male aged 50: overweight smoker
Step 1: quit smoking
Step 2:get active
Step 3: lose weight
Source: Lifestyle and 15-year survival free of heart attack, stroke, and diabetes in middleaged British men men. Archives of Internal Medicine (1998) (1998), SG Wannamethee et al al.
Key drivers of mortality in South Africa Non-communicable diseases As a % of total deaths
MEN
WOMEN
Cardiovascular diseases (CVD)*
14%
19%
Cancers
8%
8%
Oth chronic Other h i diseases di
7%
6%
Respiratory
5%
4%
Diabetes
2%
3%
Total chronic diseases
36%
40%
Problem definition and underlying behavioral causes Problem definition: Increasing prevalence of diseases of lifestyle
Root cause: Under-consumption Under consumption of preventative care
Distribution of healthcare costs
Problem of behavioural economics
Genetic and age related risks
Immediate price to wellness, hidden benefit
Access
Hyperbolic discounting places undue emphasis on the present
Behaviour
Over-optimism O ti i off ability bilit tto ttake k corrective action
Behaviour
Modifiable h lth risks health i k
Facilitated access and immediate benefits are required to address behavior tendencies and to motivate longterm health behaviour change Source: Wellness Councils of America and the Center for Health Care Economics
2
Philosophy and Structure of Vitality
Member experience of the Vitality programme Obtain a Personal Pathway Determine Vitality Age and set health goals
Assets and capabilities biliti
Online c capability
Complete a Personal Health Review
Clinical and scientific basis
Personal Pathway algorithms
Earn vitality points and achieve a status
Actuarial points allocation methodology
Enjoy incentives
Reward network Valuable
Wellness network incentives
Vitality Age: supported by 75 million years of data
Cancer Prevention Study Nurses Health Study Multiple Risk Factor Intervention Trial Norwagian Population Cohort Harvard Nurses’ Health Study and Health Professionals Follow-… Korean National Health Insurance Study Swedish Construction Workers United Stated National Institute of Health-AARP Diet and Health… General Practice Research databse Korea Medical Insurance Corporation Sweden Lung Cancer Canadian National Breast Screening Study Taiwan teachers and civil servants cohorts Japan Collaborative Cohort Study Physicians Health Study Singapore Health Study Health Professionals Follow-up p Study y Others 0
4,000,000
8,000,000
12,000,000
16,000,000
Evidence for body mass index & risk for all-cause mortality
Evidence for physical activity & risk for all-cause mortality
Relative risk fo or ACM VPA) (min/wk MV
1.5 Yu 2003 (Caerphilly men)
1.0
van Dam 2008 (NHS women) Lee 2004 (HAS men)
0.5
Bucksch 2005 (German men) Bucksch 2005 (German women) Haapenen 1996 (Finnish men)
00 0.0
Inoue 2008 (JPHC men) Inoue 2008 (JPHC women)
-0.5
Richardson 2004 (HRSmen&women) Kujala 1998 (Finnish Twins) Kushi 1997(Iowa women's study)
-1.0
Leon 1997 (MRFIT men)
0
100
200
300
Min/wk MVPA
400
500
Outcomes of the scientific research Male – age 45; Risk factors – overweight, smokes, elevated cholesterol
Relative mortality risk factors, derived from the meta-analysis, translated into years of life expectancy t llostt
Drivers of extra mortality risk BMI: 31 Smokes: 20 per day Cholesterol: 232 mg/dl 17%
years lost
Overweight
increased mortality risk
43% Smoking
40% Elevated Cholesterol
40
45 age
50
55
60 Vitality Age
65
Vitality Personal Pathways™
Vitality Personal Pathways™
Vitality Personal Pathways™
Complete an HRA
Risk assessment
Determine Vitality Age and set goals
Vitality Age
41
1. Target BP
Actual Age:
2. Target glucose
Vitality Age: 42
3. Target cholesterol
Goals 4. BMI < 25 1. Improve diet 5. Tobacco free 2. Increase exercise 6. Exercise 3x per week
Obtain a Personal Pathway
Earn Vitality Bucks and achieve a Vitality Status
Enjoy Vitality Rewards
Vitality Lottery
Vitality Personal Pathways™
Complete an HRA
Determine Vitality Age and set health goals
Obtain a Personal Pathway
Earn Vitality Bucks and y Status achieve a Vitality
Enjoy Vitality Rewards
Vitality Lottery Risk assessment
Vitality Age
37
1. BP high
Actual Age:
2. Glucose high
Vitality Age: 58
3. Cholesterol high
Goals 4. BMI > 30 5. Smoker 6. No exercise
1. Quit smoking 2. Lose weight 3. Start to exercise 4. Manage diabetes 5 Reduce cholesterol 5.
Broad Rewards Motivate Differing Aspirations: SA Vitality partner network
Travel
Va alue per use
Percentage discount tiered by Vitality status
10% discount on HealthyFoodTM for all members; 25% if Personal Health Review is completed
Integration with store card Additional benefits on partner store card tiered by status Cinema HealthyFoodTM Retail
Cash back on all purchases in retail network tiered by Vitality status
1/3 of retail price p available to all members
Frequency of use 18
Reward utilisation is high across the benefit spectrum
Participation p levels 600,000 500 000 500,000 400,000 300,000 200,000 100,000 0 Movie Club members
kulula.com flights
Gym benefit users
Activated HealthyFoods benefit
Clicks users
Vitality members shopping with a Discovery Credit Card
19
Overview of the Vitality rewards
Tangible rewards
Motivating factor
Example
Value
Nature of reward
Self-interest
Frequency of use
Charitable rewards
Noble cause
1. Earn money for a charity of your choice 2. Promotion through social networks
Lottery
Self-interest
1. Points convert into entries 2. Status gears number of entries
Equitable q Contribution Manager g 120
100
Contribution Manager
80
Loss aversion
60 ` 40 20
0 Non-engaged
Low engaged
Employer
Moderate engaged
High engaged
Employee
20
3
Clinical Impact of Vitality
The effect of engagement
1
D Does engagementt iin wellness ll reduce d healthcare h lth costs? t ?
2
Does Vitality induce wellness?
The effect of engagement
1
D Does engagementt iin wellness ll reduce d healthcare h lth costs? t ?
2
Does Vitality induce wellness?
Vitality studies conducted
VIP studies
• Cross-sectional study of 948 974 Discovery Health members from 2003 to 2007 • Determine the impact of engagement on medical claims experience and healthcare costs • Risk-adjusted Risk adjusted for covariates such as age, age gender chronic status and health plan • Done in conjunction with Harvard, University of Cape Town, University of the Witwatersrand
Vitality cross-sectional studies
VIP Study 1: Vitality engagement is correlated with lower healthcare costs Risk-adjusted hospital admission costs for engaged vs not engaged
Not Engaged benchmark
*
P < 0.001 for all categories (incl overall result) except cancer where P < 0.01 *Categorisation based on diagnosis-related groupers using ICD-10, CPT-4 and local procedural codes
VIP Study 2: Vitality engagement reduces the cost of managing chronic disease Risk-adjusted hospital cost for chronic members: engaged vs not engaged Hospital cost per non- engaged member
100% 90%
90
92
90
80% 70%
79 70
60% 50% 40% 30% 20% 10% 0%
Multiple metabolic conditions
Hypertension
Dyslipidaemia
Cancer
Mental illness
Beneficiaries with single conditions
P = 0.001 for multiple p metabolic conditions, all single g conditions are not statistically y significant g
VIP Study 3: Fitter people spend less time in hospital and incur lower healthcare costs 1. Admission per patient* • 9.6% 9 6% lower in highly active individuals vs inactive
1.60 1.55
1.57
1.57 1.52
1.50
1.49
1.45
1.42
1.40 NR
2. Length of stay in hospital • On average 0.57 days shorter for highly active individuals vs inactive
INACTIVE
LO
MED
HI
6.5 6.0
6.12
5.5
5.88 5 38 5.38
5.0 0
5.19
4.5
4.57
4.0
3. Cost per patient • Medical costs once hospitalised R5,052 lower for highly active individuals vs inactive
Thousands
NR 32 31 30 29 28 27 26 25
30
INACTIVE
LO
MED
31 30
30
26 NR
INACTIVE
LO
MED
Fit p people p make better patients p – admissions,, length g of stay y and costs are risk-adjusted j *Patients with at least one admission event
HI
HI
The case for wellness
1
D Does engagementt iin wellness ll reduce d healthcare h lth costs? t ?
2
Does Vitality induce wellness?
Data shows increasing engagement over time
Engagement levels amongst longitudinal study test participants over the investigation period 100 90
12%
20%
80
% of members
70
26% 28%
60 50
13% 22%
40 30
49% 9% 20
30%
10 0 Y Year 1
Y Year 5
High engaged
Low engaged
Medium engaged
Not engaged
Longitudinal Study of Fitness Engagement
•
A retrospective analysis of 304,000 adults over the period 2004 to 2008
•
The analysis was designed to test » For significant changes in engagement with fitness-related activities over time » Whether these changes were associated with changes in the probability and cost of hospitalisation
Increase in Fitness Engagement
31.1
31.8
4
5
27.0 % of m members using the gym beneffit g
24.8 21.1
1
2
3
Year
Outcomes associated with transitions between engagement levels
Year 1
Year 3
Hospital cost per member, Year 4 to 5
Inactive
Benchmark
Inactive Active
6%
Less active
A ti Active
Benchmark
A ti Active
8%
More Active
9% 90
92
94
96
98
100
Relationship between increasing activity and the odds of hospitalisation
1.00
Odds rratio for ho ospitalisattion in Years 4 to 5
3% 7% 10%
0 95 0.95
13%
0 90 0.90
0.85
0.80 0.5
1.0
1.5
Number of additional gym visits per week from Y Year 1 tto Y Year 3
2.0
4
Case study – the impact of HealthyFoodTM
HealthyFood™
25% saving on nutritional items purchased at Pick n Pay
36
HealthyFood™ structure
Fruitit and Fr vegetables 3,000 products Grains and cereals 1,425 products Lentils and legumes 373 products
Nutrient
WHO dietary recommendations
S Saturated fat f
10 en% %
Trans fat
1 en%
S di Sodium
1 2 /k l 1.2mg/kcal
Added sugar
10 en%
Di Dietary fib fibre
1 3 /k l 1.3mg/kcal
Chicken, fish and Chicken meat alternatives 479 products Vegetable oils and nuts 536 products Milk and dairy products 217 products
61,000 products assessed; 10,000 classified as HealthyFoodTM
HealthyFood™ mechanics
HealthyFood purchases HealthyFood™ marked on till slips
38
HealthyFood™ Marketing and Communication
39
HealthyFood™ Marketing and Communication
Proprietary and confidential: Not for use or disclosure outside The Vitality Group and its clients.
Adoption of the HealthyFood Benefit TM
Number of HealthyFood Store Vi it Visits
HealthyFood as % of cart 35.00%
12,000,000
30.00%
10 000 000 10,000,000
25.00% 8,000,000 20 00% 20.00% 6,000,000 15.00% 4,000,000 , , 10.00% 2,000,000
5.00%
Mar-11
Jan-11
Nov-10
Sep-10
Jul-10
May-10
Mar-10
Jan-10
Nov-09
Sep-09
Jul-09
May-09
Mar-09
-
0.00% pre-launch
2009
2010
2011
Result: Over 240,000 families have activated the HealthyFood™ benefit
5
Broader Health Promotion Initiatives
Healthy Active Kids Report Card 2010
Healthy Active Kids Report Card 2010
Physical Activity (Grade D): •
Less than 70% of high school learners report having regularly scheduled physical education education.
•
Less than 50% participate in enough physical y for it to be considered ‘health-enhancing’. g activity
Nutrition (Grade D): •
Just over 2 servings of fruits and vegetables per day, with less than 1 serving of fruit per day.
•
Over 50% drink sweetened cool drinks more than 4 times a week week.
•
Nearly 30% eat fast food between 2 and 3 times per week.
Healthy Active Kids Report Card 2010
Screen time (Grade F): •
Nearly y 1 in 3 adolescents watch more than 3 hours of television daily
Overweight, obesity (Grade C-) and stunting (Grade D-): •
20% are overweight and 5% are obese
•
13% of teens are stunted
Smoking (Grade D): •
29.5% of adolescents report having smoked
•
21% are current smokers
Vitality Schools Program
www.vitalityschools.co.za
Vitality Schools Program
www.vitalityschools.co.za
Developing healthy active kids
Developing healthy active kids
Developing healthy active kids
Vitality Schools Program
Vitality Schools Program
Vitality Wellness Centres
Vitality Fitness Convention
Vitality Wellness Network
Vitality Healthiest City
Vitality Healthiest City
% Difference in mortality risk, compared to Johannesburg
12.7
98 9.8
4.7 2.8
Durban
Pretoria
Port Elizabeth
Cape Town
Vitality Healthiest City High Blood Pressure
High Cholesterol
Unhealthy Weight3.9 3.4
31 3.1
29 2.9
1.2
0.9
1.3
1.5
1.4
Cape Town
Durban
Pretoria
-0.2
-2.5 -3.2 Durban
Pretoria
Port Elizabeth
Cape Town
Durban
Smoking
Pretoria
3.9
Port Elizabeth
Insufficient Physical Activity
2.6 1.7
1.8
Durban
Pretoria
2.0 1.2
0.0
-0.9
Durban
Pretoria
Port Elizabeth
Cape Town
Port Elizabeth
Cape Town
Port Elizabeth
Cape Town
Discovery Healthy Company Index
Discovery and the Vitality Programme
Over 3.7 million unique clients; representation in four countries
Scale
Research
“The outfit that seems to have more experience with these kinds of incentive programs than any on the planet is a South African company called Discovery.” New York Times, January 2011
Partnerships Largest, L t and d oldest, UK life assurer
4th-largest US health insurer
World’s W ld’ 2ndd-largest l t insurance company
World’s W ld’ premier i consumer health company
The Vitality Wellness Programme Experience from South Africa