The city of Fort Smith, AR, under the guidance of Human Resources Director Richard Jones, M.A., strongly believes in a proactive approach to health care.
The organization has designed cutting-edge benefit strategies that focus on preventive care and motivating its employees to take an active interest in their health and wellness. City leaders have shown dedication to this objective, creating forward-looking, multiyear strategies to meet their goals. One example is the clinical health risk assessments (CHRA), coupled with disease management and health and wellness programs that the city introduced more than six years ago.
While participation rates in the CHRAs have been high, active participation among at-risk members identified by the CHRAs in the available care management programs was not at a level desired by city leadership. After careful thought and consideration, Jones and the city approached UMR, its third party administrator, with an incentive program built around five key biometric measurements: body mass index (BMI), blood pressure, glucose (diabetes), LDL (cholesterol), and a nicotine test (nonsmoking).
To encourage savvy consumerism and assist members in making a stronger connection between health and wellness, the city also introduced a health reimbursement account (HRA) program in place of a traditional PPO, which included a deductible potentially three times as high as the previous plan design level. The key to the program, however, was the potential for plan members to reduce their financial exposure (deductible) back to the previous level by earning incentive dollars surrounding each of the biometric measurements.
“The buy-in by senior leadership was easy. I explained that the only way you can begin to get your arms around the cost of health care is to change those behaviors that are detrimental to the health of our employees and their families,” Jones said. “Initial employee buy-in was accomplished by asking employees in a survey if they would participate in wellness for an incentive or would they prefer to pay more. Approximately 65% said they would participate for some financial incentive.”
For the initial program rollout, the health goals weren’t set so high as to seem unobtainable. For example, while a body mass index of 25 is considered overweight and 30 considered obese, the BMI goal was set at 32. A dispute process was also put in place whereby members could obtain a letter from their physician requesting a medical exception. Exceptions are also made for people with known, diagnosed disabilities. The program isn’t limited to employees, as spouses are required to provide lab work in order for a family to receive any dollars for their HRA. Even if a spouse or employee fails the biometric tests, the other adult member can still earn incentive dollars. If both meet the biometric standards, they have the further motivation of doubling their incentive dollars. Children are exempt and continue to receive full care at the previous lower deductible regardless of how their parents perform in the incentive program. New employees are also allowed to immediately participate in the program by submitting lab results from a physician they may have already visited.
- Organization: City of Fort Smith, Arkansas
- Headquarters: Fort Smith, AR
- Website: www.FortSmithAR.gov
- No. of employees: 860 with 1,808 enrolled members
- Nature of business: The city of Fort Smith provides a full range of municipal services including public safety, construction and maintenance of streets and other infrastructure, parks and recreation facilities, water and sewer services, solid waste collection and disposal, public transportation, and administrative services to more than 80,000 residents and a workforce of more than 150,000 by day.
Key executives:
- C. Ray Baker Jr., mayor
- Dennis Kelly, city administrator
- Ray Gosack, deputy city administrator
- Richard Jones, director of Human Resources
- Kevin Lindsey, police chief
- Mike Richards, fire chief
Key solution providers: 
- UMR, medical administration, dental administration, COBRA, utilization management, case management, health and wellness, disease management, stop loss, flexible spending account, health reimbursement account, retiree administration
- Employers Health Coalition, provider network
- Sparks Health System, health system
- IMWell Health, employer clinic
- Catalyst Rx, prescription benefits manager