ROI Wellness Calculator Presentation (National Wellness Institute)


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Why Bother Waiting? Do it Now! ROI Estimation Versus ROI Studies? (Dr. Joel Bennett presentation; July, 2009)--folks have asked for this presentation so here it is

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ROI Wellness Calculator Presentation (National Wellness Institute)

  1. 1. Dr. Joel Bennett (817-921-4260) 8/12/2009 Why Bother Waiting? Do it Now! ROI Estimation Versus ROI Studies? ADVANCED WORKSITE ACADEMY MONDAY, JULY 20, 2009 NATIONAL WELLNESS INSTITUTE Joel B. Bennett, PhD Organizational Wellness & Learning Systems Overview • Return on Investment (ROI) estimation models can offer a lower-cost alternative to expensive analysis of financial data. • Helpful to know online ROI and health-cost estimation tools that can estimate potential employer costs of various health conditions. • Then show the potential savings from reducing those costs with well-developed health promotion strategies. 1
  2. 2. Dr. Joel Bennett (817-921-4260) 8/12/2009 Objectives • Participants will know which tools are available and how to find them • Participants will experience the logic and mathematical aspects of conducting a simple ROI • Participants will work through a simulation of a cost or ROI tool PARTS • PART 1: Perspective and Caveats • PART 2: Recent Estimation Studies • PART 3: Logic and Math • PART 4: Review of online calculators (most just at cost) 2
  3. 3. Dr. Joel Bennett (817-921-4260) 8/12/2009 PERSPECTIVE Adapted From Ken Wilber (All Quadrants, All Levels) PERSPECTIVE The Bean Counter Adapted From Ken Wilber (All Quadrants, All Levels) 3
  4. 4. Dr. Joel Bennett (817-921-4260) 8/12/2009 PERSPECTIVE What is your Philosophy of ROI? Is it really just about numbers? • Is wellness only a commodity? – Create stock markets for reduction of particular diseases? (e.g., by stock for Get em to STRESS, OBESITY, ALCOHOL reduction) stop the risk • Is it only about changing life-style behavior (behavior)? – When all you have is a hammer everything else looks like nail Its all about the bottom- bottom- • Should we neglect the Interior? line – INDIVIDUAL: Holistic health, Mind-body therapy, complementary & alternative medicine, spiritual health, YOU – COLLECTIVE: Research on work culture, peer-to-peer, mentoring, social networking, leadership, social health, community interventions, YOUR TEAM Caveats • In reviewing ROI estimates remember to not mistake the numbers for the reality • The thing measured is not the thing itself • Always think “what do the numbers really represent?” • What do the numbers NOT capture? • Do not place any more credence in the $ than you should 4
  5. 5. Dr. Joel Bennett (817-921-4260) 8/12/2009 PARTS • PART 1: Perspective and Caveats • PART 2: Recent Estimation Studies • PART 3: Logic and Math • PART 4: Review of online calculators (most just at cost) Two Key References (Obesity ROI) (JOEM) Journal of Occupational and Environment Medicine • Using a Return-On-Investment Estimation Model to Evaluate Outcomes From an Obesity Management Worksite Health Promotion Program (Baker, Goetzel, et al.) • VOLUME 50, Number 9, September 2008, 981-990 • American Specialty Health, HealthyRoads Obesity Management 5
  6. 6. Dr. Joel Bennett (817-921-4260) 8/12/2009 6
  7. 7. Dr. Joel Bennett (817-921-4260) 8/12/2009 (JOEM) Journal of Occupational and Environment Medicine •A Return-On-Investment Simulation Model of Workplace Obesity Interventions Volume 51(7):751-8, July 2009 Trogdon J, Finkelstein EA, Reyes M, Dietz WH. General Simulation Model Application of Model to Different Interventions for Weight Loss Representative Published Potential Savings based on Interventions estimator CDC Community Guide STUDY 1: If can reach and sustain (included nutrition 5 lb loss than savings likely. education, financial incentives, and on-site STUDY 2: Weight loss exercise facilities) competitions can save if sustained Weight Watchers Not profitable for employers to cover full cost (but subsidize for 3- 5% weight loss saves) Prescription Drug Coverage Does not have a positive ROI 7
  8. 8. Dr. Joel Bennett (817-921-4260) 8/12/2009 Conclusions • Positive ROI is a high threshold for interventions to meet. Medical interventions improve health but increase costs. • Even moderately effective workplace interventions would need to be relatively inexpensive to generate a positive ROI. PARTS • PART 1: Perspective and Caveats • PART 2: Recent Estimation Studies • PART 3: Logic and Math • PART 4: Review of online calculators (most just at cost) 8
  9. 9. Dr. Joel Bennett (817-921-4260) 8/12/2009 THE BASICS SAMPLE ESTIMATION Logic and Math GUIDED ESTIMATION (BASE FORMULA) (Prevalence X Cost of Disease – (Reduction in Disease Prevalence Disease) Reduction Disease) Cost of Program • DISEASE/RISK PREVALENCE: What is the estimated prevalence of the disease in the worksite? • COST OF DISEASE (RISK) BURDEN: What is the expected cost of the disease (per employee)? • REDUCTION OF DISEASE (SAVINGS): What is the expected reduction in disease prevalence, reasonably obtained? • COST OF PROGRAM: What is the expected cost of delivering the program (per employee or per group)? Note. These questions ignore various parameters that can significantly influence the outcomes of estimation: gender, age, employee migration (turnover), comorbidity, time to intervene, time to follow-up, failures to take into consideration hidden costs and hidden benefits, and a host of contextual factors (e.g., leadership support, work culture, unknown incentive costs—THE WE AND THE I) 9
  10. 10. Dr. Joel Bennett (817-921-4260) 8/12/2009 Pause The answers to the following questions are WITHIN you Personal Coaching Queries 1=N-Not at all 2=L-A little 3=S-Some 4=GD-A good deal 5=VM-very much DISEASE/RISK COST OF DISEASE REDUCTION OF COST OF PREVALENCE (RISK) BURDEN DISEASE (SAVINGS) PROGRAM I know how many I know how many I workers may I know how much it will be able to I know how much I develop the disease costs for any reach who will am going to spend or risk if NOTHING employee to have benefit from the delivering the is done the DISEASE or RISK program program N L S GD VM N L S GD VM N L S GD VM N L S GD VM 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5 10
  11. 11. Dr. Joel Bennett (817-921-4260) 8/12/2009 1 2 3 $ Medical 10 $ Productivity X $4000 $ Absenteeism $40,000 N = 10 $4000 (year) 5 6 7 60% 11
  12. 12. Dr. Joel Bennett (817-921-4260) 8/12/2009 (Prevalence X Cost of Disease) – (Reduction in Disease) Cost of Program 10 X $4000 60% $40,000 (10 X $4000) – ($16,000) $13,000 12
  13. 13. Dr. Joel Bennett (817-921-4260) 8/12/2009 13
  14. 14. Dr. Joel Bennett (817-921-4260) 8/12/2009 Maximizing ROI Prevalence (Prevalence X Cost of Disease) – (Reduction in Disease) Reduction Disease Cost of Program Cost To increase ROI: • Lower the Denominator (lower cost) • Increase the Numerator (increase reduction) • Find PREVALENT diseases that COST a lot • Selected, Indicated, Universal • Find programs that are highly impactful in REDUCING • Evidence-based (confident they work) • Change Paradigm (context, culture I & WE (not just ITS) 14
  15. 15. Dr. Joel Bennett (817-921-4260) 8/12/2009 Lower the Denominator? (Prevalence X Cost of Disease) – (Reduction in Disease) Cost of Program Employee Assistance Programs Good Example • Recent national survey shows that most employers spend $7,983 per employee (total health benefit) • Cost of EAPs have gone down to $12-$40 (<.003% of overall benefit) • YET, the literature consistently shows positive effects of EAPs (presenteeism, absence, conflict, turnover, etc.) Attridge, M., Amaral, T., Bjornson, T., Goplerud, E., Herlihy, P., McPherson, T., Paul R., Routledge, S., Sharar, D., Stephenson, D., & Teems, L. (2009). EAP effectiveness and ROI. EASNA Research Notes, Vol. 1, No. 3. Available online from Increase the Numerator? Part 1. Strategically focus on right disease or right population (Prevalence X Cost of Disease) – (Reduction in Disease) Cost of Program What are the highest cost diseases? • Stress, depression, obesity, ?? But these vary ACROSS and WITHIN workplaces? • Makes sense to be selective (e.g., go for moderate risk who may be progressing to high?) • Makes sense to be universal (e.g., vaccinations) • But what if everyone in a work group is already moderately healthy (may not even need an HRA) 15
  16. 16. Dr. Joel Bennett (817-921-4260) 8/12/2009 Increase the Numerator? Part 2. Strategically focus on right intervention (Prevalence X Cost of Disease) - (Reduction in Disease) Cost of Program What programs are most effective? (“preference” logic) • The ones we like? • The ones that cost the least? • The ones our insurer is pushing? What programs are most effective (“science” logic) • The ones shown to be effective (evidence-based) • The ones that FIT within our culture • The ones that can be sustained over time Change the Paradigm? Consider the whole context (Prevalence X Cost of Disease) - [Reduction in Disease + I AND WE) Cost of Program 16
  17. 17. Dr. Joel Bennett (817-921-4260) 8/12/2009 PARTS • PART 1: Perspective and Caveats • PART 2: Recent Estimation Studies • PART 3: Logic and Math • PART 4: Review of online calculators Sample of Disease Cost Estimation (ROI) Websites 17
  18. 18. Dr. Joel Bennett (817-921-4260) 8/12/2009 Blue Print •Takes into account your: • Average salary The HHC Foundation; Cheyenne, WY • Gender • Marital status • Percent exempt • Age •Generates medical and personnel costs: • Insomnia • Obesity • Diabetes • Hypertension • High Cholesterol • Focus on productivity loss • Estimates cost of absences and work impairment • includes turnover in estimates •Does not generate a true ROI in terms of a ratio (only cost savings) Optimal Office • Based on a combination of costs related to stress, results of the Logisens Corp.; Ft Collins, CO Optimal Office pilot studies, and meta-analysis studies published by government/industry sources. • Accounts for number of employees and average salary Incorporates : • Turnover • Absenteeism • Healthcare cost • Workers compensation cost • Productivity affected by stress • Generates percent improvement and yearly savings (in dollars) per employee in each of the health and productivity components based on improvements in work stress • No ratio generated 18
  19. 19. Dr. Joel Bennett (817-921-4260) 8/12/2009 Ensuring Solutions Based on to Alcohol Problems • National Survey on Drug Use The George Washington University Medical Center and Health (n=70K) and Washington, DC • National Comorbidity Study (n= 8K) • Screening & Brief Intervention (SBIRT) Alcohol Cost Calculator for: • Business • Kids • Health Plans • ROI • Savings and Costs of Alcohol Treatment Based on Proportion of Identified and Treated Employees • No ratio generated Productivity Impact Model The HSM Group; Scottsdale, AZ • Accounts for Size of workforce and industry, region, age, gender, prevalence of depression and affected employees, type of care provided • Gives detail of how impact is estimated, based on absenteeism and medical costs • Provides three-year estimates of savings by treating depression in diagnosed employees • Requires knowledge or access to diagnosis of depression among employees, rates of absenteeism, and medical costs, which may be difficult to obtain. 19
  20. 20. Dr. Joel Bennett (817-921-4260) 8/12/2009 America’s Health • Use information about your population to estimate Insurance Plans (AHIP) service delivery costs and future financial savings of or/calcintro.aspx several smoking cessation AHIP; Washington, DC interventions 1. "5A's" (Ask, Advise, Assess, Assist, and Arrange) Program with: 2. Medication 3. Telephone counseling 4. Both Medication and telephone counseling • Generates intervention use and cost and medical savings for organization and per employee • Generates Graphs and Tables for ROI Centers for Disease Control and Prevention mpanyprofile.aspx Centers for Disease Control and Prevention Atlanta, GA •Accounts for BMI by: •Gender •Age group (18-44, 45+) •State •Industry •Ages •Benefits •Generates total annual medical costs AND total annual work loss costs attributable to employees with high BMIs (workplace obesity) •Allows the user to enter generate savings by including information on interventions aimed at reducing BMI •No ratio generated 20
  21. 21. Dr. Joel Bennett (817-921-4260) 8/12/2009 Center for Health Care Strategies ntion.aspx Center for Health Care Strategies, Inc. Hamilton, NJ • Designed for Medicaid stakeholders to assess and demonstrate a ROI from projects to improve quality in health care • Users enters intervention specifics: • Strategies / Timeframe • Target population • Disease prevalence • Expected enrollment rate • Utilization / Program costs • Cost to the organization • Requires access to above info • Stores forecasts for you • Allows you to stratify risks • Intervention ROI is not disease specific Review • Perspective and Caveats • Recent Studies in JOEM • Logic and Math of Calculation • Maximize ROI • Websites Joel B. Bennett Organizational Wellness & Learning Systems Fort Worth, Texas 21