Wellness Program Workshop

1. AMERICAN COUNCIL FOR INDEPENDENT LABORATORIES
WELLNESS PROGRAM
WORKSHOP
OCTOBER 8, 2012
N E W Y O R K C I T Y, N Y
P R E S E N T E D B Y: A R V I D R . “ D I C K ” T I L L M A R , TILLMAR CONNECT
LLC
Not just politically correct, developing a wellness program can save your laboratory real dollars with
studies showing that 80 percent of all health care spending is preventable and 50 percent of these
potential savings come from wellness, lifestyle and behavioral changes. This presentation will provide
a road map to launch a new wellness program or improve an already existing one, so join us to
improve your laboratory’s bottom line.

2. THE NEED FOR WELLNESS
 Prevention
 Why?
 Increase in illnesses

3. THE NEED FOR WELLNESS
3
The biggest threats facing the American work
force today are obesity, tobacco use, and
stress.
Together, these lifestyle factors contribute to lost
productivity and absenteeism, among other
problems, but a wellness program can work to
combat all three

4. BENEFITS OF WORKSITE
WELLNESS PROGRAMS
Source: National Business Group on Health,

5. THE NEED FOR WELLNESS
5

6. MILESTONES IN CONTEMPORARY AMERICA
Hostess introduces
Twinkies, 1953 Ray Kroc franchises the
McDonald Brothers, 1955
And then introduces
“supersizing,” 1993

7. INDIVIDUAL BEHAVIOR
 Awareness/education
 Motivation
 Tools, strategies
 Policy and environment
7

8. Individual

10. 10

11. 11

12. 12

13. 13
It’s All About
Behavior Change

14. 14
Individual Family

15. 15

16. 16
Individual Family Worksite

18. 18
Individual Family Worksite Community

19. 19

20. 20

21. 21

22. 22
Individual Family Worksite Community Nation/
World

23. 23
23

24. Constraining Medical Costs
BEHAVIOR & LIFESTYLE: WEIGHT GAIN
1986-2006
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
No Country Can
Fund All the
Consequences:
• Hypertension
• Type 2 Diabetes
• Osteoarthritis
• Stroke
• Coronary Heart
• Gallbladder
• Sleep Apnea
• Respiratory Issues
• Some Cancers
Obesity Trends Among U.S. Adults (BMI>30%)
No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%
 Centers for Disease Control & Prevention, 2006 Behavioral Risk Factors Surveillance
System

25. PERCENT OF OBESE (BMI>30) U.S. ADULTS

26. PERCENT OF OBESE (BMI>30) U.S. ADULTS

27. PERCENT OF OBESE (BMI>30) U.S. ADULTS

28. PERCENT OF OBESE (BMI>30) U.S. ADULTS

29. DIABETES TRENDS AMONG ADULTS IN THE U.S.
BRFSS 1990
29
No Data <4% 4%-6% 6%-8% 8%-10% >10%

30. DIABETES TRENDS AMONG ADULTS IN THE U.S.
BRFSS 1991-1992
30
No Data <4% 4%-6% 6%-8% 8%-10% >10%

31. DIABETES TRENDS AMONG ADULTS IN THE U.S.
BRFSS 1999-1994
31
No Data <4% 4%-6% 6%-8% 8%-10% >10%

32. DIABETES TRENDS AMONG ADULTS IN THE U.S.
BRFSS 1995-1996
32
No Data <4% 4%-6% 6%-8% 8%-10% >10%

33. DIABETES TRENDS AMONG ADULTS IN THE U.S.
BRFSS 1997
33
No Data <4% 4%-6% 6%-8% 8%-10% >10%

34. DIABETES TRENDS AMONG ADULTS IN THE U.S.
BRFSS 1998
34
No Data <4% 4%-6% 6%-8% 8%-10% >10%

35. DIABETES TRENDS AMONG ADULTS IN THE U.S.
BRFSS 1999
35
No Data <4% 4%-6% 6%-8% 8%-10% >10%

36. DIABETES TRENDS AMONG ADULTS IN THE U.S.
BRFSS 2000
36
No Data <4% 4%-6% 6%-8% 8%-10% >10%

37. DIABETES TRENDS AMONG ADULTS IN THE U.S.
BRFSS 1995-1996
37
No Data <4% 4%-6% 6%-8% 8%-10% >10%

38. A WEIGHTY TOLL ON EMPLOYERS
38
 Obesity costs U.S.
companies $13
billion annually
 These workers have
36% higher medical
costs than fit
employees

39. THE HIGH COST OF SMOKING
39
 A smoker costs the employer $3856/yr in added healthcare costs
and lost productivity
 The overall prevalence of tobacco use is about 25% of the
population, which can be generalized to any workplace
population
 Calculating the cost of smoking:
 Assume a workplace with 100 employees
 Assume 25 employees use tobacco
 Result = $96,400/yr in business borne costs associated with smoking
 Because of this high cost, it is estimated more than 6,000 companies now refuse
to hire smokers
 Alaska Airlines requires a nicotine test before hiring people
 Kalamazoo Valley Community College stopped hiring smokers for full-time
positions
 Union Pacific won’t hire smokers

40. THE COST OF POOR HEALTH
40
 Lost productivity
related to absence
Presenteeism Medical
& presenteeism Lost Costs
compared to Productivity 25%
34% STD/LTD/WC
medical & 5%
pharmacy costs Absenteeism
Lost
Productivity
36%
IBI Research Insights - Single employer example

41. TOP 10 MOST COSTLY HEALTH CONDITIONS
41
Chronic disease has $1 TRILLION impact on U.S. lost productivity each
year.
Goetzl, R; JOEM 45(1) 5-14 2003

42. EXPENSE DRIVERS
42
 Health Care System 10%
 Environment 20%
 Genetics 20%
 Lifestyle 50%

43. PREVENTABLE CAUSES OF DEATH IN WISCONSIN
43
 Tobacco: 8,100 +/- deaths per year in Wisconsin
 Poor diet: Physical inactivity: 6,900 +/- deaths per year in Wisconsin
 Microbial agents: 1,700 +/- deaths per year in Wisconsin
 Alcohol: 1,600 +/- deaths per year in Wisconsin
 Toxic agents: 1,000 +/- deaths per year in Wisconsin
 Medical errors: 1,300 +/- deaths per year in Wisconsin
 Motor Vehicles: 800 +/- deaths per year in Wisconsin
 Firearms: 400 +/- deaths per year in Wisconsin
 Sexual behavior: 400 +/- deaths per year in Wisconsin
 Uninsurance: 300 +/- deaths per year in Wisconsin
 Illicit drug use: 300 +/- deaths per year in Wisconsin
TOTAL: 22,800

44. Six Unhealthy Truths Tell the Story of the Rise of Chronic
Disease and It’s Impact on Health and Health Care
44
Truth #1: Chronic Diseases are the #1 cause of death and
disability in the U.S.
Truth #2: Chronic diseases account for 75% of the nation’s
health care spending.
Truth #3: About two-thirds of the rise in health care spending is
due to the rise in the prevalence of treated chronic disease.
Truth #4: The doubling of obesity between 1987 and today
accounts for nearly 30% of the rise in health care spending.
Truth #5: The vast majority of cases of chronic disease could
be better prevented or managed.
Truth #6: Many Americans (five in six) are unaware of the
extent to which chronic disease harms their health – and their
wallets. www.fightchronicdisease.org

45. IMPACT OF HEALTH RISK FACTORS ON PRODUCTIVITY
45
Risk Factors considered in study
include:
30%
Tobacco Use
25.9%
BMI <18.5 or >24.9 25%
Presenteeism
Physical inactivity Absenteeism
Mean Lost Productivity
20%
Lack of emotional fulfillment,
15%
High stress
10%
High blood pressure
6.3%
High cholesterol 5%
0.0%
Alcohol use
0%
Overdue preventive visits 0 risks 1 risk 2 risks 3 risks 4 risks 5 risks 6 risks 7 risks 8 risks
Diabetes
Boles M, Pelletier B, Lynch W. The Relationship Between Health Risks and Work Productivity.

46. AS HEALTH RISKS INCREASE, SO DO EXCESSIVE COSTS
46
$6,000 Average Annual Medical Cost
Excess Costs
$5,000 Base Cost
$4,000 $3,321
$3,000
$1,261
$840
$2,000
$1,000
These represent
the maximum
$0
Low Risk (0-2 HRA Non- Medium Risk (3-4 High Risk (5+ Risks) savings
Risks) Participant Risks)
opportunity if you
$1,500
Average Annual Disability Cost moved people
Excess Costs
Base Cost
from
High (6+ risks) to
$1,000
$757 Low (0-2 risks)
$292
$175
$500
$0
Low Risk (0-2 HRA Non- Medium Risk (3-4 High Risk (5+ Risks)
Risks) N=685 Participant N=4,649 Risks) N=520 N=366
Chart Sources: Medical Edition: Edington. AJHP. 15(5):341-349, 2001; Disability: Wright, Beard, Edington. JOEM. 44(12): 1126-1134, 2002

47. AS HEALTH RISKS INCREASE, SO DO EXCESSIVE COSTS
47
Sample XYZ Company Summary Report - Percentage of employees
who:
Have at least 1 coronary risk factor 75%
Were rated poor for nutrition practices 70%
Have high blood pressure 60%
Smoke 57%
Are 20% over their ideal body weight 40%
Exercise Regularly 20%
-There were 3 complicated pregnancies last year that cost the company $300,000
-The interest survey indicated that the majority of employees would like to participate in programs with their families, would like
aerobics classes during the day and would like a weight control class at work. A few employees indicated they wish to quit
smoking.
-An additional survey showed that almost all managers were supportive of the proposed wellness program. It further indicated that
managers would participate and encourage others to as well.

48. IMAGINE IF YOU COULD SAVE 25% OFF YOUR RISING
HEALTH CARE COSTS
48
25% savings off of Rising Health Care Costs
health care cost per
$10,000
Annual employer
$7,379 $7,832
$8,000 $6,348 $6,918
employee
$5,758 $1,958
$6,000 $4,604
$5,162 $1,587 $1,730 $1,845
$4,320 $1,440
$4,000 $1,151 $1,291
$1,080
$2,000
$0
1999 2000 2001 2002 2003 2004 2005 2006
Year

49. WELLNESS PROGRAMS
49
EFFICACY &
CASE STUDIES

50. NUMEROUS STUDIES DOCUMENT STRONG ROI
50
 A multitude of studies show ROI averages of $3 for every
$1 invested
 One recent study had the return as high as 10 to 1
 Companies must be patient. “Worksites typically don’t
realize returns until about three years into the program. If
an organization is willing to wait two or three years, it will
be capable of achieving this magnitude (3 to 1) of ROI.”
 A review of 32 studies found claims costs were reduced by
27.8%, physician visits by 16.5%, hospital admissions by
62.5%, disability costs by 34.4% and incidence of injury by
24.7%

51. WELLNESS WORKS, ACCORDING TO ROI STUDIES
51
 From a review of 73 published studies of worksite wellness
programs
 Average $3.50-to-$1 savings-to-cost ratio in reduced absenteeism
and health care costs
 From a meta-review of 42 published studies of worksite
wellness programs
 Average 28% reduction in sick leave absenteeism
 Average 26% reduction in health care costs
 Average 30% reduction in workers’ compensation and disability
management claims costs
 Average $5.93-to-$1 savings-to-cost ratio
 A comprehensive health management program at Citibank
 $4.56-$4.73-to-$1 savings-to-cost ration in reduced total health care
costs

52. WELLNESS PROGRAMS
BUSINESS CASE
52
&
IMPLEMENTATIO
N

53. DEFINING HEALTH RISKS & RISK LEVELS
53
Health Risk Measure High Risk Criteria
Alcohol > 14 drinks per week
Blood Pressure Systolic >139 mmHG/Diastolic >89
mmHG
Body Weight BMI =/>27.5
Cholesterol >239 mg/dl
Existing Medical Heart, Cancer, Diabetes, Stroke
Problem
HDL <335 mg/dl
Illness Days >5 days last yr
Life Satisfaction Partly or not satisfied
Perception of Health Fair or Poor
Physical Activity <1 time per week
Safety Belt Usage Using safety belts <100% of time
Smoking Current smoker
Stress High
Overall Risk Levels
Low Risk 0 to 2 high risks
Medium Risk 3 to 4 high risks
High Risk 5 or more high risks

54. GET WELL OR PAY NOT TO
54
 Consumers may be able to improve their health and bottom line by
participating in company sponsored wellness programs.
 More employers are offering cash, discounts and even lower health
insurance premiums to entice workers to participate in a variety of programs.
 Starting next year, employees could have further incentives to get healthy as
more companies add penalties to insurance premiums for workers who don’t
partake.
 “It’s an opportunity to get cash for doing what’s right for you.
 Despite cutbacks amid the recession, 58% of large U.S. companies now offer
lifestyle-improvement programs, up from 43% in 2007, according to a Watson
Wyatt Study. And 56% provide health coaches, compared with 44% in 2007.
Health-risk appraisals are offered at 80% of companies, up from 72% in 2007.

55. DISCOUNTS AND FREEBIES
55
 Employees may be able to get $200 to $300 for
participating in health-risk appraisals, smoking-
cessation, weight management and preventive
care classes.
 Other offerings include heavily discounted
weight loss programs and free or discounted gym
memberships. At some companies, employees
who participate are rewarded with gift cards or
lower insurance premiums.

56. WELLNESS PROGRAMS
56
EMPLOYERS’
EXPERIENCES
WITH ROI

57. HISTORICAL PERSPECITIVE ON SAVINGS
57
 Johnson & Johnson
 Started in 1979
 Invested $30M, 94% participation rate
 Cholesterol, activity and smoking
 Results of $224 per year savings per employee ($8.5M annually)
 Pitney Bowes
 Analysis 1991; Health Care University started in 1993
 2.8:1 ROI for participants in HCU
 Increased productivity, less absenteeism for gym members
 Ergonomics showed a 5.1 ROI
Union Pacific
 Winner of C. Everett Koop Award 1994, 1997, 2001
 Smoking down from 40% to 28% over 10 years
 10% decrease in lifestyle related healthcare costs equating to $53.6M dollar difference in 2001

58. ... AND TODAY’S EXPERIENCE
58
2008 PRICEWATERHOUSE COOPER’S HEALTH
AND WELLNESS TOUCHSTONE SURVEY
RESULTS:
 69% of 561 companies have a wellness program
 Less than 30% of members participate: the use of incentives increases
participation
 52% of respondents don’t believe wellness programs are effective at
mitigating healthcare costs, improving performance/productivity, or
enhancing employee engagement/loyalty.
They do believe they are effective at reinforcing corporate responsibility and
image
 Only 37% of respondents integrate occupational health with their wellness

59. ASSOCIATION OF RISK LEVELS WITH SEVERAL
CORPORATE COST MEASURES
59
Research conducted at the University of Michigan has shown that the low risk
employees (1-2 risk factors) have lower cost for short term disability, workers’ comp,
absence and health care costs whereas high risk employees (5+risk factors) have higher
costs.
Source: Wright, Beard, Edington, JOEM 44 (12): 1126-1134

60. WELLNSS PROGRAM SAVINGS

61. WELLNSS PROGRAMS
So, how do
you do it?

62. WELCOA’s 7 BENCHMARKS
 Benchmark #1 - Capturing CEO Support
 Benchmark #2 - Creating Cohesive Wellness Teams
 Benchmark #3 - Collecting Data To Drive Health Efforts
 Benchmark #4 - Carefully Crafting An Operating Plan
 Benchmark #5 - Choosing Appropriate Interventions
 Benchmark #6 - Creating A Supportive Environment
 Benchmark #7 - Carefully Evaluating Outcomes

63. WHAT DOESN’T WORK
ONE SIZE DOES NOT FIT ALL!
 Health Assessments alone
 Low budget, low intensity, low participation rates
 Programs that focus on what’s in it for the organization,
not the individual participant
 “Under the radar” initiatives
 NIH (not invented here) philosophy
 Huge incentives that would be better used for
programming HERO Panel: EHM – What Really Works? HERO Forum for Employee Health Management Solutions
New Orleans, Louisiana -- October 2007 Ron Z. Goetzel, Ph.D.
Cornell University and Thomson Medstat

64. BEST CRITERIA FOR WELLNESS PROGRAMS
 Employ features and incentives that are consistent with the
organization’s core mission, goals, operations, and administrative
structures;
 Operate at multiple levels, simultaneously addressing individual,
environmental, policy, and cultural factors in the organization;
 Target the most important health care issues among the employee
population;
 Engage and tailor diverse components to the unique needs and
concerns of individuals;
 Achieve high rates of engagement and participation, both in the short
and long term;
 Achieve successful health outcomes, cost savings, and additional org.
objectives;
 Are evaluated based upon clear definitions of success, as reflected in

65. DR. ROBERT LUSTIG
Robert H. Lustig, MD, UCSF Professor of Pediatrics in the Division of
Endocrinology, explores the damage caused by sugary foods. He argues that
fructose (too much) and fiber (not enough) appear to be cornerstones of the
obesity epidemic through their effects on insulin. Series: UCSF Mini Medical
School for the Public [7/2009] [Health and Medicine] [Show ID: 16717]
http://www.youtube.com/watch?v=dBnniua6-oM

66. WELL WORKPLACE
 Sample Comprehensive Report
 Sample Executive Summary

67. (double click on documents to bring up full PDF versions)
http://www.welcoa.org/wwpcheckli
st/

68. ESSENTIAL ELEMENTS: WELLNESS PROGRAMS
1. A Vision/Mission Statement for
The Wellness Program
2. Specific Goals and Measurable
Objectives
3. Timelines For Implementation
4. Roles And Responsibilities
5. Itemized Budget
6. Appropriate Marketing
Strategies
7. Evaluation Procedures

69. THE EFFECTS OF AN EFFECTIVE WELLNESS PROGRAM
Click image below to read full article

70. THE USE OF INCENTIVES
 Companies are now using incentives to drive participation in health
programs
 Of nearly 2,000 U.S. surveyed employers, 84% offer employees
incentives to participate in a health risk questionnaire (HRQ) and
64% of those offer an incentive for participation screening.
 51% provide incentives to employees who participate in health
improvement and wellness programs.
 The use of monetary incentives, in particular, has increased
dramatically in 2012.
 A growing number of employers are beginning to link incentives to
a result.

71. SMART GOALS & OBJECTIVES
The need to have SMART goals & objectives for your Wellness Programs:

72. WHO’S TO BLAME IF YOU’RE FAT?

73. WHO’S TO BLAME IF YOU’RE FAT?
Click image below to read full article

74. REFERENCE GUIDES
 Emphasis of Preventative Care in the
Affordable Care Act
http://www.healthcare.gov/news/factsheets/2010/07/preventive-services-list.html
 Well City Milwaukee
www.wellcitymilwaukee.org

75. RETHINK YOUR DRINK
75
48 Teaspoons Sugar
52 oz 64 oz
44 oz
32 oz
16 oz

76. A YEAR OF SODA: 44.7 GALLONS
Here’s what carbonated soft drink
consumption – sugared and diet sodas –
looked like in 2010. Average American
chugged the equivalent of 48 two-liter
bottles and 206 12 – ounce cans of soft
drinks in one year.
Teaspoon of Sugar
1. 4.2 grams of sugar = 1 teaspoon of
sugar
2. Before you order a drink, ask how
much sugar is in the beverage – it
is listed in grams on the ingredients
list
3. After you do the math, simply
divide the number of grams of
sugar by 4 – and ask yourself if
almost 10 or more teaspoons of
sugar is really what you want.

77. QUESTIONS & ANSWERS

78. THANK YOU!
Arvid R. “Dick” Tillmar
Health Advocate
8820 West Cleveland Ave
West Allis, Wisconsin 53227
(414) 690-2232
Web: http://www.tillmarconnect.com/
Email: tillmar@tillmarconnect.com
LinkedIn: www.linkedin.com/in/dicktillmar

79. ALBERT EINSTEIN
“INTELLECTUALS SOLVE
PROBLEMS, GENIUSES
PREVENT THEM.”