Participation - Demographics January 1, 2017 - March 31, 2017 Age Ranges* 50% n = 139 42.4% Total 38% 25% 20.9% 20.1% 13% 12.9% 3.6% 0% 18-29 years 30-39 years 40-49 years 50-59 years 60+ * Age ranges based on HRA respondents only, not total number of participants Gender* Female Male 20.9% 79.1% n = 139 * Gender based on HRA response only Page 1 / 23
Participation - Usage Trends January 1, 2017 - March 31, 2017 Number of participants in program: 575 Tip: For the group selected, this number represents the total number of individual member participants in the BALANCE program since program launch (December 2015). Total participant logins (total number of user logins in the defined time period): 8,174 Tip: For the date range selected and group selected, this number represents the total number of member logins. Note this includes multiple logins by the same members. Total unique participant logins (total number of individual user logins in the defined time period): 575 Tip: For the date range selected and group selected, this number represents the total number of INDIVIDUAL member logins. Note this excludes multiple logins by the same members. New participant logins (newly registered users in the defined time period): 45 Tip: For the date range selected and group selected, this number represents the number of brand new members on the BALANCE program, i.e. the number of individual members who logged in to BALANCE for the first time. Average Number of logins per member: 14.22 Tip: For the date range selected and group selected, this number represents the average number of logins per members. Average time spent/visit: 6.53 Minutes Tip: For the date range selected and group selected, this number represents the average number of pages viewed for all member logins. Note this includes multiple logins by the same members. Average number of pages viewed/visit: 10.55 Tip: For the date range selected and group selected, this number represents the average number of pages viewed for all member logins. Note this includes multiple logins by the same members. Medication Adherence Number of participants who indicated they are currently taking medications: 57 Total number of participants who have signed up for Medication Reminders: 4 Surveys completed* n = 1,163 Answered Yes: 75.1% Answered No: 24.9% * number of responses to whether medication taken based on email reminders Page 2 / 23
Health Tracker Usage Total Health Tracker usage: 551 Number of your members who have used online health trackers at least once in the selected date range: Tracker Name Number Step Tracker 92 Weight Tracker 66 Fruit Tracker 60 Sleep Tracker 51 Stress Tracker 43 Mood Tracker 41 Track Your Pain Improvement 21 Blood Pressure 20 Asthma Tracker 18 COPD Tracker 13 Blood Sugar 9 Cholesterol 9 Gout Attack & Serum Uric Acid Tracker 5 Participation - Fitbit January 1, 2017 - March 31, 2017 Number of participants in program: 345 Steps 0 Steps average per day = 9.9% <1,000 steps average per day = 7.8% 1,000-2,000 steps average per day = 5.2% 2001-3000 steps average per day = 3.5% 3001 5000 steps average per day = 10.1% 5001 7000 steps average per day = 18.6% 7001 10000 steps average per day = 25.8% >10000 steps average per day = 19.1% Page 3 / 23
Health Risk Assessment - Overview January 1, 2017 - March 31, 2017 Total number of participants who completed the HRA: 139 Gender Average HRA score for all HRA (n=139) 56.8% 42.4% 44.8% 51.7% 60% 40% Age Ranges n = 139 100% 75% 50% 69% 50.8% 47.5% 42.9% 57.1% 38.9% 61.1% 80% High Risk Medium Risk Low Risk 31% 25% 20% 0% 0% 1.7% 0% 0% 0% 18-29 years 30-39 years 40-49 years 50-59 years 60+ Page 4 / 23
Health Risk Assessment Results - Modifiable Risk Factors (Alone) This section includes your members reported risk level (indicated by red light, yellow light and green light ) related to their modifiable risk factors, or lifestyle changes they can do something about. Diet 13.8% 47.5% 45.3% 37.9% 50% 44.5% 48.3% 52.5% of your employees have elevated risk related to Diet Sleep 59.7% 38.1% 55.2% 44.8% 60.9% 36.4% 40.3% of your employees have elevated risk related to Sleep Page 5 / 23
Stress 13.8% 56.1% 36.7% 48.3% 37.9% 58.2% 36.4% 43.9% of your employees have elevated risk related to Stress Financial Health 33.8% 31% 34.5% 51.8% 51.7% 51.8% 14.4% 17.2% 13.6% 48.2% of your employees have elevated risk related to Financial Health Medication 95.7% 96.6% 95.5% 4.3% of your employees have elevated risk related to poor Medication Adherence Page 6 / 23
Physical Activity 25.9% 37.9% 22.7% 12.2% 61.9% 51.7% 12.7% 64.5% 74.1% of your employees have elevated risk related to Physical Activity Alcohol 91.4% 96.6% 90% 8.6% of your employees have elevated risk related to Alcohol Smoking Status 93.5% 96.6% 92.7% 6.5% of your employees currently smoke Page 7 / 23
Multiple Modifiable Risk Factors Summary This section includes a summary of members with multiple BALANCE modifiable risk factors. Specifically, the total red zones and yellow zones as reported by members in the HRA habits related to diet, activity, smoking, financial health, stress, sleep, medication adherence and excessive alcohol use. Multiple Modifiable Risk Factors n = 139 0-1 Risk Factors 28.1% 2-4 Risk Factors 54.7% 5 or More Risk Factors 17.3% 0% 15% 30% 45% 60% Page 8 / 23
Health Condition Risk: Non-Modifiable Risk Factors PLUS Modifiable Risk Factors This section includes your members red light, yellow light and green light risks by health condition, including scoring consideration from both their reported modifiable risk factors (things they can change) and their non-modifiable risk factors (things they can t change, like family history, age, gender, etc.). Heart Health Red, yellow and green lights for Heart Health have been tabulated based on available Canadian clinical practice guidelines and participants HRA responses to questions about key risk factors, such as their family history, current lifestyle, age, ethnicity, blood pressure, cholesterol and/or heart disease, plus smoking status. 21.6% 24.1% 20.9% 43.9% 51.7% 41.8% 34.5% 24.1% 37.3% 56.1% of your employees have elevated risk related to Heart Health Diabetes & Kidneys Red, yellow and green lights for Diabetes & Kidneys have been tabulated based on available Canadian clinical practice guidelines and participants HRA responses to questions about key risk factors, such as family history, current lifestyle, and diagnosed or existing health conditions, e.g. diabetes or kidney disease. 40.3% 16.5% 31% 17.2% 42.7% 16.4% 43.2% 51.7% 40.9% 59.7% of your employees have elevated risk related to Diabetes & Kidneys Page 9 / 23
Mental Health Red, yellow and green lights for Mental Health have been tabulated based on available Canadian clinical practice guidelines and participants HRA responses to questions about key risk factors, such as family history, current lifestyle, stress levels, social support network and diagnosed/existing health conditions, e.g. anxiety, depression or bipolar disease. 15.8% 13.8% 16.4% 41.7% 42.4% 51.7% 34.5% 39.1% 44.5% 58.3% of your employees have elevated risk related to Mental Health Digestive Health Red, yellow and green lights for Digestive Health have been tabulated based on available Canadian clinical practice guidelines and participants HRA responses to questions about key risk factors, such as family history, current lifestyle, diet and diagnosed/existing health conditions, e.g. Irritable bowel syndrome, ulcers, chronic constipation/diarrhea or heartburn. 25.2% 24.1% 25.5% 73.4% 75.9% 72.7% 26.6% of your employees have elevated risk related to Digestive Health Page 10 / 23
Lung Health Red, yellow and green lights for Lung Health have been tabulated based on available Canadian clinical practice guidelines and participants HRA responses to questions about key risk factors, such as family history, current lifestyle, smoking status and diagnosed/existing health conditions, e.g. asthma or Chronic Obstructive Pulmonary Disorder (COPD). 14.4% 17.3% 84.9% 96.6% 81.8% 15.1% of your employees have elevated risk related to Lung Health Cancer Risk Red, yellow and green lights for Cancer Risk have been tabulated based on available Canadian clinical practice guidelines and participants HRA responses to questions about key risk factors, such as family history, current lifestyle, smoking status and diet. Note : participants are provided with recommendations/rewards within their personalized action plans for standard cancer screeners, e.g. prostate, mammogram, colorectal based on Canadian guidelines 20.1% 13.8% 21.8% 79.9% 86.2% 78.2% 20.1% of your employees have elevated risk related to Cancer Risk Page 11 / 23
Arthritis and Pain Red, yellow and green lights for Arthritis & Pain have been tabulated based on available Canadian clinical practice guidelines and participants HRA responses to questions about key risk factors, such as family history, current lifestyle, gender and diagnosed/existing health conditions, e.g. arthritis, chronic back pain or knee pain. 34.5% 51.8% 44.6% 65.5% 48.2% 47.3% 48.2% of your employees have elevated risk related to Arthritis and Pain Bone Health & Osteoporosis Red, yellow and green lights for Bone Health & Osteoporosis have been tabulated based on available Canadian clinical practice guidelines and participants HRA responses to questions about key risk factors, such as family history, current lifestyle, gender and diagnosed/existing health conditions, e.g. osteoporosis. 12.2% 17.2% 10.9% 46% 37.9% 48.2% 41.7% 44.8% 40.9% 54% of your employees have elevated risk related to Bone Health & Osteoporosis Page 12 / 23
Specific Lifestyle Measures (Modifiable Risk Factors) vs. National Averages This section provides an overview of your specific members self reported data (pulled directly from HRA responses to specific modifiable risk factor questions) compared with available Canadian national averages. Lifestyle Your Members National Averages Smoking Prevalence Excessive Alcohol 2.2% Inactivity 74.1% Overweight/Obese 61.2% High Stress 43.9% >5 Fruit and Veg 52.5% Sleep 40.3% 6.5% of your members currently smoke of your members report drinking excessive levels of alcohol regularly of your members do not complete the Health Canada recommended daily activity - 150 minutes of moderate to vigorous physical activity, each week of your members are overweight or obese based on their BMI of your members report moderate to extreme stress of your members eat 5 fruit and vegetable servings per day of your members report less than 7 hours per night 18.1% of Canadians currently smoke (Statistics Canada 2014) 17.4% of Canadians drink excessive levels of alcohol regularly, i.e. more than 10 drinks a week for women or more than 15 drinks a week for men (Statistics Canada 2012). 44.8% of Canadians do not complete the Health Canada recommended daily activity 150 minutes of moderate to vigorous physical activity, each week (Statistics Canada 2013) 53.6% of Canadians are overweight or obese, with a Body Mass Index (BMI) greater than 25 (Statistics Canada 2013). 23.0% of Canadians have moderate to extreme stress (Statistics Canada 2013) 40.8% of Canadians eat 5 fruit/vegetable servings per day (Statistics Canada 2013) Canadians sleep an average 8.3 hours per night (Statistics Canada 2013). The recommended amount of sleep for Canadian adults is 7-8 hours per night. Legend: The Specific Lifestyle Measures chart above has been colour coded (red, yellow, green) to reflect the prevalence of the risk factor with your specific population vs. the Canadian national averages. Red Your member population has a higher prevalence than the national average for this modifiable risk factor. Yellow Your member population is at the same level or slightly lower than the national average, but it still may present an opportunity to take action (since the prevalence for your members is still relatively high). Green Your member population is significantly lower than the national average. Great job! Note: the population health statistics shown here may have been gathered using different criteria than the information from the health risk assessment used to generate this report. Page 13 / 23
Health Risk Assessment Results - Medication Adherence This section summarizes the self-reported adherence levels reported by your members who have indicated they currently take medication. Reported adherence levels have been calculated based on the Morisky Medication Adherence Scale (MMAS-8), one of the most validated and widely used mechanisms to assess adherence. Total number of participants who completed the HRA: 139 Number of members who reported that they take medication: 64 Adherence Scale Very Adherent Somewhat Adherent Non-Adherent Total 0 48 16 Male 0 5 2 Female 0 43 14 Very adherent = always take medication as prescribed Somewhat adherent = sometimes forget to take their medication Non-adherent = often forgets to take medication Medication Adherence Total number of participants who have signed up for Medication Reminders: 4 Surveys completed* n = 1,163 Answered Yes:: 75.1% Answered No: 24.9% * number of responses to whether medication taken based on email reminders Health Risk Assessment Results - Health Behaviour Change Measures One would think that if we informed people of their risks they would rush home and, in the interests of good health, change behaviours that caused the risk. Some people do, but most do not. Syme, S.L. (2002). Promoting health and preventing disease: how will we meet the challenge of behavior change? Social Marketing Quarterly, VIII(4), 64-66. We live in an era in which chronic health issues are commonplace, and increasingly dominate our health care attention and resources with an estimated economic burden of over $80 billion each year. Presently, 59% of Canadians aged 45-64 live with at least one chronic condition, as do 88% of those 65 years and older, contributing to two-thirds of all deaths. To turn the tide, layered and coordinated initiatives at the population level are needed that to educate, motivate and support individuals to embrace healthy living. The Balance program combines principles from several gold standard, evidence based health behaviour change models, including the Prochaska Readiness for Change model and the Keller Conviction/Confidence model for members. These models generate information about members stage of health behaviour change, plus their motivation/confidence in their ability to take action towards health behaviour change. You may select date ranges above in the Balance reporting dashboard (found at the top of the page) to compare your baseline data for members vs. current state. This data may support and inform the focus for supplemental Health and Wellness programs, e.g. efforts toward creating a culture of health with the Excellence Canada Healthy Workplace Essentials program. The Healthy Page 14 / 23
Workplace Essentials Program available through the Balance program is an exclusive tool available to Alberta Blue Cross clients. It provides plan sponsors with step by step tools to foster a culture of workplace health and well being. The reporting dashboard will give you an indication (over time) where your health and wellness initiatives are having an impact. The Harvard Health Publication (June 2009) article Why it s hard to change unhealthy behavior and why you should keep trying provides an excellent summary of the Readiness for Change model. Access an excerpt of the article here. In BALANCE program, there are two points at which the plan members are asked to respond to questions regarding their readiness to make changes, and regarding their confidence in their ability to make changes. The first instance occurs in the Health Risk Assessment where members respond to general questions associated with the Readiness to Change model. Chart I: READINESS FOR CHANGE (GENERAL HEALTH BEHAVIOUR CHANGE) summarizes your member population in terms of their overall readiness to make (any) health behaviour change. The goal is to see movement amongst your members to more readiness to make change, i.e. moving from precontemplation to contemplation, preparation and action/maintenance. CHART I: READINESS FOR CHANGE (GENERAL HEALTH BEHAVIOUR CHANGE) That's not for me! Why should I? I wish I could! I'm doing it! Pre-contemplation Contemplation Preparation Action/Maintenance 3.8% 9.6% 21.7% 65% Following completion of the HRA, each member is provided a personalized action plan based on their responses. The personalized action plan lists key modifiable risk factors with links to health literacy educational modules, tracking and goal setting tools. The first time each member clicks each of the modifiable risk factor within their action plan, he/she will be prompted to respond to the (optional) conviction/confidence questions. Once triggered (following the initial response), the same conviction/confidence scale will be prompted every 30 days to monitor movement along the continuum from That s not for me to I m doing it! Chart II: CONVICTION/CONFIDENCE FOR EACH MODIFIABLE RISK FACTOR represents member s responses to questions about their confidence to make risk factor specific behaviour change for the time frame selected. Please note: this is an optional survey that opens only when members click the modifiable risk factors within their personalized action plans. The n= number in the left column represents the number of your members who have completed the survey in the time frame selected. Page 15 / 23
CHART II: CONVICTION/CONFIDENCE FOR EACH MODIFIABLE RISK FACTOR Conviction/Confidence Model Lack of knowledge and cynical Skeptics (e.g. have knowledge but unconvinced) Frustrated (e.g. want to make the change but struggling) Empowered(e.g. having success with changes made) Physical Activity n=49 4.1% 0% 18.4% 77.6% Financial Health n=40 12.5% 2.5% 12.5% 72.5% Diet n=33 9.1% 6.1% 9.1% 75.8% Sleep n=26 19.2% 3.8% 30.8% 46.2% Stress n=24 25% 0% 29.2% 45.8% Alcohol n=12 25% 0% 8.3% 66.7% Smoking Status n=8 62.5% 0% 0% 37.5% Medication n=7 14.3% 0% 0% 85.7% For additional information on the Conviction/Confidence model, please access the Journal of Clinical Outcomes Management (1997) special supplement, entitled Choices and Changes: A New Model for Influencing Patient Health Behavior, by its inventor Vaughn F. Keller, MFT, and Maysel Kemp White, PhD. Chart III: AREAS OF OPPORTUNITY specifically addresses key modifiable risk factors where a larger proportion of your members have been identified at higher risk. In addition, it ranks each modifiable risk factor based on the larger percentage of members who have identified themselves as frustrated (high conviction, i.e. they feel it s important to make a change, but they have low confidence, i.e. not sure how to accomplish it). Consider these areas as opportunities to drive the best return on investment for your organization since members have identified that they are very important (i.e. they are motivated), but they are not confident about how to make the change. The goal is to move members along the continuum from I wish I could to I m doing it! CHART III: AREAS OF OPPORTUNITY Lifestyle Risk Sleep 26 Stress 24 Physical Activity Financial Health 49 40 Diet 33 Alcohol 12 Smoking Status 8 Medication 7 Members at risk (# of members with red light and yellow light for risk) "I wish I could" (important but not confident about making change) 30.8% of red light and yellow light members are frustrated 29.2% of red light and yellow light members are frustrated 18.4% of red light and yellow light members are frustrated 12.5% of red light and yellow light members are frustrated 9.1% of red light and yellow light members are frustrated 8.3% of red light and yellow light members are frustrated 0% of red light and yellow light members are frustrated 0% of red light and yellow light members are frustrated Page 16 / 23
BALANCE Spotlight: Stress, Financial Health, Diet, Physical Activity & Weight Below provides some additional information related to the drivers behind key risk factors amongst your employees based on their responses to specific questions within the Health Risk Assessment (HRA). How would you rate your current stress level? Stress n = 139 No stress in my life 0.7% 6.5% 5.8% Total Female Male Mild stress in my life 9.4% 40.3% 49.6% Moderate stress 7.9% 28.8% 36.7% Severe stress 5% 2.9% 2.2% Extreme stress 2.2% 1.4% 0.7% 0% 15% 30% 45% 60% Page 17 / 23
Moderate or Greater: Causes of Stress For those who answered moderate or greater (n = 61, % = 43.9), Which of the following is causing your stress (check all that apply)?" n = 61 Total Work problems 16.7% 41.7% 58.3% Female Male Family problems 10% 30% 40% Relationships with friends 1.7% 5% 6.7% Financial problems 13.3% 46.7% 60% 0% 20% 40% 60% 80% Page 18 / 23
Financial Health The following represents who your members rate their current financial situation: n = 139 Significant stress/worried about future 5.8% 2.9% 2.9% Total Female Male Some stress/situation will improve 3.6% 28.1% 24.5% Worried/able to save for retirement 3.6% 10.8% 14.4% Comfortable/not enough for retirement 4.3% 23.7% 19.4% Very comfortable/retirement needs met 6.5% 21.6% 28.1% 0% 25% 50% 75% 100% Page 19 / 23
Diet The following represents what your members average day diet includes by answering yes to the following; n = 139 Eat out at least one meal Go back for second portions 8.6% 9.4% 17.3% 18.7% 25.9% 28.1% Total Female Male Report eating more than others 7.2% 15.2% 22.5% Drink soft drinks, specialty coffees, etc 6.5% 23.2% 29.7% Drink 4+ glasses of juice 3.6% 2.2% 1.4% Eat processed food 12.3% 35.5% 47.8% Add extra salt 2.9% 14.5% 11.6% 0% 15% 30% 45% 60% The following represents what your members average week includes by answering yes to the following n = 138 Eat fish once or twice weekly Eat nuts a couple times a week 13.8% 13% 31.9% 41.3% 45.7% 54.3% Total Female Male 7-10 servings of veg or fruit most days 8.7% 43.5% 52.2% Make extra effort to eat healthier 15.2% 70.3% 85.5% Eat breakfast 13.8% 70.3% 84.1% Drink 4-6 glasses of water per day 16.7% 62.3% 79% 0% 25% 50% 75% 100% Page 20 / 23
Physical Activity The following represents a summary of your members responses to the amount of physical activity they engage in ( at a level that makes your heart beat faster than normal ) in an average week: n = 139 0-20 minutes/week 21-50 minutes/week 4.3% 2.9% 10.1% 14.4% 14.4% 17.3% Total Female Male 51-75 minutes/week 2.2% 19.4% 17.3% 76-120 minutes/week 1.4% 10.8% 9.4% 121-149 minutes/week 2.2% 12.2% 10.1% More than 150 minutes/week 7.9% 18% 25.9% 0% 8% 15% 22% 30% Page 21 / 23
Healthy Weights The following represents an aggregate summary of Body Mass Index based on heights and weights entered in the HRA. n = 139 Underweight 3.6% 2.2% 1.4% Total Female Male Healthy weight 29.5% 35.3% 5.8% Overweight/Obese 13.7% 47.5% 61.2% 0% 20% 40% 60% 80% Underweight (BMI less than 18.5) Healthy weight (BMIs 18.5 to 24.9) Overweight (BMIs 25 to 29.9) Obese (BMI 30 and over) Page 22 / 23
Health Risk Assessment Results - Flu Shot The chart below represents the number of members who indicated they get their flu shot annually: n = 139 38.1% Total Female Male Flu Shot 40% 31% 30% 33% 36% 39% 42% Page 23 / 23