Carine Sakr, Wellness at Work Conference, June 14, 2010

DELAWARE STATE CHAMBER OF COMMERCE WELLNESS @ WORK Conference Carine Sakr, MD, MPH Clinical Director Christiana Care Occupational Health & Wellness June 14, 2010

Outline Current situation Work-related mortality and morbidity Non work-related risk factors Poor health and work Wellness programs Health care reform Take home messages

Work-Related Mortality and Morbidity Fatal Occupational Injuries Non-Fatal Occupational Injuries and Illnesses 6 D e a th s p e r 1 0 0 ,0 0 0 e m p lo y e d w o rk e rs 5 3 Cases p er 100 fu ll- 4 2.5 tim e w o rkers 2 3 1.5 2 1 1 0.5 0 0 1995 2000 2001 2004 2005 2006 2007 2003 2005 2006 2007 Year Year 3

Health Risk Factors Obesity Trends* Among U.S. Adults 1994 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 4 Behavioral Risk Factor Surveillance System

Health Risk Factors Obesity Trends* Among U.S. Adults 2008 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30% 5 Behavioral Risk Factor Surveillance System

Health Consequences of Overweight and Obesity Cardiovascular disease High blood pressure Abnormal lipids Type 2 diabetes Osteoporosis Constipation Diverticular disease Iron deficiency anemia Oral disease Malnutrition Some cancers 6

Health Risk Factors Diabetes 11 % Persons 20 years of 10 Cigarette Smoking Adults age and over 9 8 US (2007) 7 6 70 1988-1994 1999-2000 2001-2002 2003-2004 2005-2006 60 Percentage 50 Year 40 Men 30 Women 20 Hypertension 10 0 35 Never Former Current % Persons 20 years of Smoker Smoker Smoker age and over 30 25 20 1988-1994 1999-2000 2001-2002 2003-2004 2005-2006 7 Year

Consequences for Employers Unhealthy workforce Increased medical cost Decreased productivity Absenteism + Presenteism Non- Former Current smoker Smoker Smoker Mean days missed from work due to health conditions per year 4.4 4.9 6.7 Total cost of productivity due to health per employee per year $2,623 $3,246 $4,430 8 *Bunn et al. Effect of Smoking Status on Productivity Loss. J Occup Environ Med. 2006;48:1099-1108

Wellness Programs % of METHOD OF DELIVERY Firms Health Risk Assessment 81 Self-Help Education Materials 42 Health Risk Assessment: Individual Counseling 39 Survey gathers baseline self- Classes, seminars, group activities 36 reported health data from the Added Incentives for Participation 31 employee which are in turn used by employer to tailor subsequent interventions FOCUS OF INTERVENTION Weight Loss and Fitness 66 Smoking Cessation 50 Multiple Risk Factors 75 9 *Baicker et al. Workplace Wellness Programs Can Generate Savings. Health Affairs. 2010;29

Wellness Programs Work! Average STUDY FOCUS ROI Health Care Costs 3.27 Absenteeism 2.73 Medical costs fall by ~ $3.27 for every dollar spent on wellness programs and absenteeism costs fall by ~ $2.73 10 *Baicker et al. Workplace Wellness Programs Can Generate Savings. Health Affairs. 2010;29

HRA Example: Christiana Care Program Overview 2010 2008 Eligible 7,957 8,241 Participated 6,217 6,403 % Participated 78% 78% Spouses eligible 2,869 N/A Spouses 1,925 N/A Participated % Participated 67% N/A 11

HRA Example: Christiana Care Modifiable Risks 2010 Modifiable 2010 *National Risks % Norms % Very Obese, very 18% 12% high risk (BMI >35) Obese BMI >30 37% 32% High levels of stress 13% 3% at home High levels of stress 23% 4% at work Low physical 68% 56% activity(1-4 days/wk) * National Center for Health Statistics. Health, United States, 2007. Centers for Disease Control and Prevention. Accessed January 25, 2008. 12

HRA Example: Christiana Care Number of Health Risk Comparison 30% 25% 20% 15% 2008 10% 2010 5% 0% 0 Risk 1 Risk 2 Risk 3 Risk 4 Risk 5 Risk 6 Risk 7 or more 13

HRA Example: Christiana Care HRA/Biometric Program Highlights 0 Risk category went up by 4% 3, 4, and 5 risk categories went down by a total of 5% equating to a savings of $3,699,062! Our savings between 2008 and 2010 is $228/employee or a total of $4,900,919! *Wright et al. Comparing excess costs across multiple corporate populations. J Occup Environ Med. 14 2004;46:937-945

Smoking Cessation Financial Incentives for Smoking Cessation Randomly assigned 878 employees of a multinational company based in the US 442 employees: information about smoking-cessation programs 436 employees: information about programs plus financial incentives Financial incentives: $100 for completion of a smoking-cessation program $250 for cessation of smoking within 6 months after study enrollment (confirmed by a biochemical test) $400 for abstinence for an additional 6 months after the initial cessation (confirmed by a biochemical test) *Volpp et al. A randomized, controlled trial of financial incentives for smoking cessation. N Engl J Med. 15 2009;360:699-709.

Smoking Cessation Financial Incentives for Smoking Cessation Smoking Incentive Information Cessation Group Group 9-12 Months 14.7% 5% 15-18 Months 9.4% 3.6% *Volpp et al. A randomized, controlled trial of financial incentives for smoking cessation. N Engl J Med. 16 2009;360:699-709.

Provisions in the Patient Protection and Affordable Care Act Bring value of Primary, Secondary, and Tertiary prevention to workplace beyond traditional wellness programs Provide culture of health to workplace as a complement to the culture of safety: Increased Productivity (less abs; less pres) Decrease cost to employers 17

Provisions in the Patient Protection and Affordable Care Act Workplace Wellness and Productivity Grants for Small Businesses to provide Comprehensive Workplace Wellness Programs Employer-Based Wellness Programs: Directs CDC to providing services in areas of employer-based wellness programs 18

Wellness at Work Take Home Messages Health risk factors are increasing in the US A healthy workforce is more productive Wellness programs work!

Carine Sakr, Wellness at Work Conference, June 14, 2010

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Carine Sakr, Wellness at Work Conference, June 14, 2010 Presentation Transcript