1. Successful Engagement Strategies
and Return on Investment
Improving Worksite Health
Ron Z. Goetzel, Ph.D. Emory University & Truven Health Analytics
Maryam J. Tabrizi, M.S. Truven Health Analytics

2. LEARNING OBJECTIVES
• Describe the main findings from the HERO II study recently published in
Health Affairs examining the relationships between ten modifiable health
risk factors and medical cost
• Demonstrate an understanding on how increasing engagement can
improve return on investment (ROI)
• Describe ways to increase engagement in worksite health promotion
programs
2

3. BACKGROUND
Truven Health Analytics, in partnership with the Emory University Institute
for Health and Productivity Studies (IHPS), conducts empirical research on
the relationship between employee health and work-related productivity,
our research helps inform public and private decision makers on issues
related to health and productivity management (HPM)
OUR MISSION: To bridge the gap between academia, the business
community, and healthcare policy world by bringing academic resources
into policy debates and day-to-day business decisions, and bringing health
and productivity management issues into academia
3

4. THINK ABOUT IT…BEFORE GOING BANKRUPT…
WHAT DID KODAK THINK AMERICANS WANTED?
Ref: Asch and Volpp, NEJM, 367:10, Sep. 6, 2012, 888
4

5. WHAT DID AMERICANS REALLY WANT?
5

6. WHAT DOES THE HEALTHCARE INDUSTRY THINK
AMERICANS WANT—MORE HEALTH CARE?
6

7. OR MORE HEALTH?
7

8. WHERE IS THE VALUE IN HEALTH CARE?
8

9. WHAT ARE WE GETTING FOR OUR MONEY
9

10. WHAT PROBLEM ARE WE ATTEMPTING TO SOLVE?
WE’RE SPENDING A BOATLOAD OF MONEY ON SICK CARE
• The United States spent $2.59 trillion in
healthcare in 2010, or $8,402 for every man,
woman and child.
• Government paid $1.2 trillion (45% of total),
private businesses financed $534 billion (21%).
Employers contributed 77% to health insurance
premiums.
• Health expenditures as percent of GDP:
7.2 % in 1970
17.9 in 2010
19.3% in 2019 (est)
Source: Martin et al., Health Affairs, 31:1, January 10, 2012, 208
10

11. IT’S NOT JUST THE EMPLOYER’S PROBLEM
EMPLOYERS’ AND EMPLOYEES’ COSTS ARE RISING
RAPIDLY
Average Annual Health Insurance Premiums and
Worker Contributions for Family Coverage, 2005-2010
Percent
2005 2010
Increase
Worker Contribution $2,713 $3,997 47%
Employer Contribution $8,167 $9,773 20%
Total $10,880 $13,770 27%
Source: Kaiser/HRET Survey of Employer-Sponsored Health Benefits, 2005-2010. http://ehbs.kff.org/
11

12. IT SEEMS SO LOGICAL…
If you improve the health and well being of your employees…
…quality of life improves
…health care utilization is reduced
…disability is controlled
…productivity is enhanced
12

13. SEEMS LIKE A NO BRAINER – RIGHT?
13

14. WHAT IS THE EVIDENCE BASE?
• A large proportion of diseases and disorders is preventable. Modifiable health risk
factors are precursors to a large number of diseases and disorders and to
premature death (Healthy People 2000, 2010, Amler & Dull, 1987, Breslow, 1993,
McGinnis & Foege, 1993, Mokdad et al., 2004)
• Many modifiable health risks are associated with increased health care costs
within a relatively short time window (Milliman & Robinson, 1987, Yen et al., 1992,
Goetzel, et al., 1998, Anderson et al., 2000, Bertera, 1991, Pronk, 1999)
• Modifiable health risks can be improved through workplace sponsored health
promotion and disease prevention programs (Wilson et al., 1996, Heaney &
Goetzel, 1997, Pelletier, 1991, 1993, 1996, 1999, 2001, 2005, 2009, 2011)
• Improvements in the health risk profile of a population can lead to reductions in
health costs (Edington et al., 2001, Goetzel et al., 1999)
• Worksite health promotion and disease prevention programs save companies
money in health care expenditures and produce a positive ROI (Johnson &
Johnson 2002, Citibank 1999-2000, Procter and Gamble 1998, Chevron 1998,
California Public Retirement System 1994, Bank of America 1993, Dupont 1990,
Highmark, 2008, Johnson & Johnson, 2011)
14

15. LEADING A HEALTHY AND PRODUCTIVE LIFE – NOT EASY
15

16. GOOD NEWS – WORKSITE HEALTH PROMOTION WORKS!
16

17. CDC COMMUNITY GUIDE TO PREVENTIVE
SERVICES REVIEW – AJPM, FEBRUARY 2010
17

18. SUMMARY RESULTS AND TEAM CONSENSUS
Body of Consistent Magnitude of
Outcome Evidence Results Effect Finding
Alcohol Use 9 Yes Variable Sufficient
Fruits & Vegetables 9 No 0.09 serving Insufficient
% Fat Intake 13 Yes -5.4% Strong
% Change in Those 18 Yes +15.3 pct pt Sufficient
Physically Active
Tobacco Use Strong
Prevalence 23 Yes –2.3 pct pt
11
Cessation Yes +3.8 pct pt
Seat Belt Non-Use 10 Yes –27.6 pct pt Sufficient
18

19. SUMMARY RESULTS AND TEAM CONSENSUS
Body of Consistent
Outcome Evidence Results Magnitude of Effect Finding
Diastolic blood pressure 17 Yes Diastolic:–1.8 mm Hq Strong
19
Systolic blood pressure Yes Systolic:–2.6 mm Hg
12
Risk prevalence Yes –4.5 pct pt
BMI 6 Yes –0.5 pt BMI
12
Weight No –0.56 pounds Insufficient
5
% body fat 5 Yes –2.2% body fat
Risk prevalence No –2.2% at risk
Total Cholesterol 19 Yes –4.8 mg/dL (total) Strong
8
HDL Cholesterol No +.94 mg/dL
11
Risk prevalence Yes –6.6 pct pt
Fitness 5 Yes Small Insufficient
19

20. SUMMARY RESULTS AND TEAM CONSENSUS
Body of Consistent Magnitude of
Outcome Evidence Results Effect Finding
Estimated Risk 15 Yes Moderate Sufficient
Healthcare Use 6 Yes Moderate Sufficient
Worker Productivity 10 Yes Moderate Strong
20

21. WHAT ABOUT ROI?
CRITICAL STEPS TO SUCCESS
Financial ROI
Reduced Utilization
Risk Reduction
Behavior Change
Improved Attitudes
Increased Knowledge
Participation
Awareness
21

22. HEALTH AFFAIRS ROI LITERATURE REVIEW
Baicker K, Cutler D, Song Z. Workplace Wellness Programs Can Generate
Savings. Health Aff (Millwood). 2010; 29(2). Published online 14 January 2010.
22

23. RESULTS - MEDICAL CARE COST SAVINGS
Description N Average ROI
Studies reporting costs and 15 $3.37
savings
Studies reporting savings only 7 Not Available
Studies with randomized or 9 $3.36
matched control group
Studies with non-randomized or 6 $2.38
matched control group
All studies examining medical 22 $3.27
care savings
23

24. RESULTS – ABSENTEEISM SAVINGS
Description N Average ROI
Studies reporting costs and 12 $3.27
savings
All studies examining 22 $2.73
absenteeism savings
24

25. J&J STUDY – HEALTH AFFAIRS, MARCH 2011
25

26. HEALTH RISKS – BIOMETRIC MEASURES -- ADJUSTED
Results adjusted for age, sex, region * p<0.05 ** p<0.01
26

27. HEALTH RISKS – HEALTH BEHAVIORS -- ADJUSTED
Results adjusted for age, sex, region * p<0.05 ** p<0.01
27

28. HEALTH RISKS – PSYCHOSOCIAL -- ADJUSTED
Results adjusted for age, sex, region * p<0.05 ** p<0.01
28

29. ADJUSTED MEDICAL AND DRUG COSTS VS. EXPECTED
COSTS FROM COMPARISON GROUP
Average Savings 2002-2008 = $565/employee/year
Estimated ROI: $1.88 29 $3.92 to $1.00
-

30. HERO STUDY – FIRST PUBLISHED IN 1998
30

31. UPDATED STUDY PUBLISHED IN 2012
31

32. HERO STUDY UPDATE: November 2012
1998 2012
Data collection period 1990-1995 2005-2009
Claims data (MarketScan®) Medical Medical and Pharmacy
Enrollment Health Plan Health Plan
HRA StayWell StayWell
“N” Employees 46,026 92,486
Person Years 113,963 272,834
Methods Truven Health/HERO Truven Health/HERO (enhanced)
Publication JOEM Health Affairs
Sponsor HERO ASH/HealthyRoads
32

33. VARIABLES
• Outcome Variables
– Annualized medical utilization and expenditures
• Total allowed charges (inpatient, outpatient, and pharmaceutical),
including both the employer and employee shares of costs
• Costs were inflation-adjusted to 2009 U.S. dollars using the
general Consumer Price Index from the Bureau of Labor
Statistics
• Predictors- Health Risks
Alcohol use Body weight, height, BMI
Tobacco use Diet/nutrition
Stress level Physical activity
Depression Blood glucose
Blood pressure (systolic and diastolic)
Total Cholesterol
33

34. DESCRIPTIVE RESULTS SUMMARY
High Risk Category Prevalence: HERO I Prevalence: HERO II
Poor Exercise Habits 32% 36%
Obesity 20% 32%
Poor Nutritional Habits 20% 64%
High Stress 19% 17%
Current Tobacco User 19% 22%
High Cholesterol 19% 10%
High Blood Glucose 5% 10%
High Alcohol Use 4% 5%
High Blood Pressure 4% 8%
Depression 2% 11%
34

35. RISK-COST IMPACTS- HERO II
EXHIBIT 1 Average Unadjusted And Adjusted Medical Expenditures, In 2009 Dollars, By Risk
Levels
Unadjusted
Risk Unadjusted Adjusted difference Adjusted difference
Risk measure level means ($) means ($) (%) (% )
Depression High 6,207 6,738 59.1 48.0
Lower 3,902 4,553
Blood glucose High 6,532 6,849 70.0 31.8
Lower 3,842 5,196
Blood pressure High 5,264 5,734 27.4 31.6
Lower 4,132 4,356
Body weight High 4,956 5,078 41.7 27.4
Lower 3,498 3,988
Tobacco use High 4,192 4,184 10.8 16.3
Lower 3,784 3,597
Physical inactivity High 4,477 4,582 26.6 15.3
Lower 3,537 3,976
Stress High 5,024 5,249 13.0 8.6
Lower 4,444 4,836
Cholesterol High 4,780 4,913 2.0 -2.5
Lower 4,688 5,037
Nutrition and eating -23.2 -5.2
habits High 3,245 3,261
Lower 4,226 3,440
Alcohol consumption High 3,857 3,843 -3.94 -9.48
Lower 4,015 4,246
35

36. COST IMPACTS: HERO I VS. HERO II
Difference in Medical Expenditures:
High-Risk vs. Lower-Risk Employees
100
80
60 HERO
Percent
40 HERO II
20
0
-20
36

37. HERO II: IMPACT OF COEXISTING MULTIPLE RISK FACTORS
ON COST
with multiple risk Without any of the risk
factors factors %differerence
High risk for heart disease $10,134 $3,232 213.57%
High risk for stroke $6,137 $3,786 62.09%
High risk for psychosocial
problems $6,165 $3,838 60.62%
Risk-free individual is estimated to have medical expenditures of $3,207
Risks for heart disease include: tobacco use, high blood pressure, high blood glucose, high cholesterol, lack of exercise, obesity and
stress
Risks for stroke include: tobacco use, high blood pressure, high cholesterol, and stress
Risks for psychosocial problems include: stress and depression
37

38. HERO II: ESTIMATED EFFECT OF EACH RISK CATEGORY ON ANNUAL MEDICAL
EXPENDITURES
Estimated Effect of Each Risk Category on Annual Medical Expenditures, Independent of All other Risk Categories and Controlling
for Covariate Factors*
High-Risk
Group Annual
Effect (Effect
Estimated Prevalence: Per High_Risk High-Risk Group Annual High_risk Group Annual Effect
Annual Effect Per Number of Person x Effect as Percent of on a Per Capita Basis (High-Risk
High Risk Person People at High Prevalence) Annual Total Group Annual Effect/ 92486
Risk Category ($) Risk ($) Expenditures Sample Size) ($)
Stress Level 413 8582 3,544,366 0.97% 38.32
Current Tobacco Use 587 16735 9,823,445 2.68% 106.22
Body Weight 1091 29416 32,092,856 8.76% 347.00
Exercise Habits 606 27251 16,514,106 4.51% 178.56
Blood Glucose Level 1653 5823 9,625,419 2.63% 104.07
Depression 2184 5427 11,852,568 3.24% 128.16
Blood Pressure 1378 5423 7,472,894 2.04% 80.80
Excessive Alsohol Use -402 3213 -1,291,626 -0.35% -13.97
Cholesterol -124 4734 -587,016 -0.16% -6.35
Nutritional Habits -179 38964 -6,974,556 -1.90% -75.41
Total expenditure attributable to high risk 82,072,456 22.40% 887.40
*The annual effect figures, both per capita and overall, are the effect of each of the risk categories, independent of all other risk categories and
coveriate factors. Expenditures are expressed in constant 2009 dollar figures. Total annual expenditures for the ASH
study sample were $366,373,301.
38

39. Identifying “Best Practices” in Workplace Health
Promotion: What Works?
Source: Goetzel RZ, Shechter D, Ozminkowski RJ, Reyes M, Marmet PF, Tabrizi M, Chung
Roemer E. Critical success factors to employer health and productivity management efforts:
Findings from a benchmarking study. Journal of Occupational and Environmental Medicine.
(2007) February; 49:2, 111-130.

40. Health Promotion Programs — What Works?
Leadership Commitment
• Leading by example – with buy-in
by middle managers
• “Healthy company” norm/culture
• Explicit connection to the core
principles of the organization
• Employee-driven advisory board
• Specific program goals and
objectives – with realistic
expectations
• Alignment of organizational, HR
and health promotion
policies/practices
• Sustainability – future orientation
40

41. Health Promotion Programs — What Works?
Incentives
• Incentives to participate (not
change biometrics)
• Accountability at all levels –
linked to rewards
• Effective marketing and
communication (multi-
channel)
41

42. Health Promotion Programs — What Works?
Effective Screening and Triage
• Casting a wide net to identify
the highest risk individuals
• Providing “public health”
interventions to keep people at
low risk
• Triaging individuals into
programs that produce greatest
impact/payoff
• Protecting confidentiality
• Coordinating with providers and
community resources
42

43. Health Promotion Programs — What Works?
State-of-the-Art
Intervention Programs
• Theory and evidence-based
(e.g., Bandura, Prochaska,
Lorig, Strecher, Glasgow)
• Tailored and individualized
interventions
• Balancing high touch with high
tech
• Individual and
Environmental/ecological
interventions
• Effective, reliable, valid tools
43

44. Health Promotion Programs — What Works?
Effective Implementation
• Integrate programs – insure vendor
(stakeholder) engagement
• Accessible/attractive programs
• Start simple – pilot – grow on success
• Multi-component -- variety of topics
and engagement modalities
• Integrate staff into the fabric of the
organization
• Spend the right amount of money to
achieve a desired ROI
44

45. Health Promotion Programs — What Works?
Measure,
manage, and
measure
Rigorous again
Regular
methods that communication
stand up to
peer review of results
Explicit
Integrated
connection of
Data
results to core
Systems
values
Excellent Evaluation
45

46. ENGAGEMENT – DOES IT REALLY MATTER?
Home Page
Health and Productivity Management Return on Investment Tool
PURPOSE OF THE MODEL
This tool will help you forecast the return on investment (ROI) you can expect by investing in programs that improve the health of
your employees. The tool is based on research showing an association between employees’ health risks and health care costs and
Home
worker productivity. By reducing these risks, you can thereby expect to see cost reductions. But you also need to consider how
much money you invest in order to achieve these reductions.
Health Promotion Program
HOW TO USE THE MODEL
Employee Characteristics The model opens with pages that specify demographic and health risk characteristics of an employee population then presents
pages of results, which are described below. Each of the pages can be viewed by pressing the navigation buttons on the left.
Baseline Risk & Annual Change
These cells contain model inputs that can be changed (click in the cell and type a new value).
Annual Rate of Productivity Loss These cells contain values calculated from the model inputs and cannot be changed.
Summary of Results
These cells contain values that are fixed and cannot be changed.
Description of Model Input Pages:
Predicted Medical Expenditure
Health Promotion Program Specify basic model settings including program cost and employee participation rate.
Projected Productivity Loss Employee Characteristics Specify demographic characteristics of the employee population.
Risk Profile with No Program Baseline Risk & Annual Change Specify the baseline risk level and annual rate of change.
Annual Rate of Productivity Loss Productive hours lost by risk factor from literature review.
Risk Profile with Health Promotion
Description of Model Result Pages:
Savings by Risk Factor
Summary of Results Total medical & productivity savings and program cost with ROI (return on investment).
Total Savings by Risk Factor Predicted Medical Expenditure Medical cost savings per participant tabulated by risk factor and year of program operation.
Scenario Simulation Projected Productivity Loss Savings from improved productivity per participant tabulated by risk factor and year.
Risk Profile with No Program Percentage of employees at risk tabulated by risk factor & year with No Program.
Appendix
Risk Profile with Health Promotion Percentage of employees at risk tabulated by risk factor & year with Health Promotion Program.
Input Sheet Simulation
Savings by Risk Factor Cumulative medical and productivity savings per participant tabulated by risk factor.
Total Savings by Risk Factor Cumulative medical and productivity savings for all employees tabulated by risk factor.
Description of Simulation Tool & Appendix:
Scenario Simulation Specify 1- 5 scenarios by changing the model inputs and run them all automatically.
Appendix Supplemental information including default values, regression model, and risk definitions.
Truven Health Analytics Proprietary Information - Subject to Section 6 (Ownership and Confidentiality) of the Services Agreement
between Truven Health Analytics Inc. and StayWell Health Management, LLC dated December 22, 2011.
Questions about the ROI model: If you have questions about the use of this model, please contact Dr. Ron Z. Goetzel, Vice
President, Consulting and Applied Research, Truven Health Analytics, at ron.goetzel@truvenhealth.com.
46

47. DATA INPUTS
0.62 Health and Productivity Management Return on Investment Tool
Specify the basic model settings
Home Number of employees in the base year? 10,000 Press a button to restore default values
Health Promotion Program Restore Defaults from the HERO 2 Study
Annual % point change in number of employees? 0.0%
Employee Characteristics Restore Defaults from Credible National Sources
Baseline Risk & Annual Change Medical payment per employee in the base year? $4,692
Annual Rate of Productivity Loss
Please specify an average daily wage. $190.17
Summary of Results
Predicted Medical Expenditure Participation rate of employees in the program? 62.0%
Projected Productivity Loss
Annual program cost per employee? $156.00
Risk Profile with No Program
Risk Profile with Health Promotion Time horizon (1 to 10 years)? 5
Savings by Risk Factor
Number of years until program levels off? 5
Total Savings by Risk Factor
Scenario Simulation Discount rate applied for ROI calculation? 3.0%
Appendix
Choose the type of analysis: TRUE
Input Sheet Simulation
47

48. Employee Characteristics
48

49. CHANGES IN THE RISK PROFILE
Health and Productivity Management Return on Investment Tool
Specify the baseline risk level and annual rate of change with and without a health promotion program
Baseline Annual Change (% points) Change in
Home
Risk No Program With Program Impact(%)
Health Promotion Program Obesity 31.8% 0.7% -0.5% 100.0%
(i.e., annual change with program in year x+1 / year x)
Employee Characteristics
High Blood Pressure 7.6% -0.3% -2.8%
Baseline Risk & Annual Change Biometric
High Total Cholesterol 9.9% -0.5% -1.0% Press a button to restore default values for Baseline Risk
Annual Rate of Productivity Loss
Restore Baseline Risk from the HERO 2 Study
Summary of Results
High Blood Glucose 9.5% 0.3% -3.0%
Restore Baseline Risk from Credible National Sources
Poor Nutrition/Eating Habits 64.1% -0.1% -6.6%
Predicted Medical Expenditure
Press a button to restore defaults for Annual Change
Projected Productivity Loss Physical Inactivity 36.4% -0.6% -3.7% No health promotion program
Behavioral Restore Change with No Program to 0.0%
Risk Profile with No Program
Tobacco Use 21.5% -0.7% -1.2%
Restore Change with No Program from National Sources
Risk Profile with Health Promotion
High Alcohol Consumption 4.9% -0.1% -2.0% After implementation of a health promotion program
Savings by Risk Factor
Restore Change with Program from CDC Community Guide
High Stress 17.4% 0.2% -3.4%
Total Savings by Risk Factor
Psychosocial Restore Change with Program from Recent Published Studies
Scenario Simulation Depression 10.9% 0.2% -2.0%
A blank cell indicates there are no estimates from the literature that are statistically significant.
Appendix
Input Sheet Simulation
49

50. RESULTS – 62% PARTICIPATION RATE
MEDICAL ROI = $1.74 TO $1.00
Health and Productivity Management Return on Investment Tool
Summary of results
With the current model settings the ROI is $1.74 for the cost of medical care and $3.21 for increased productivity.
Home Current annual rate No With a Break
Cumulative savings, program cost, and ROI (all discounted): of change in risk: Program Program Even*
Health Promotion Program Cumulative medical cost, no program $215,360,798 Obesity 0.7% -0.5% -1.1%
Employee Characteristics
Cumulative medical savings, with program $12,444,468 High Blood Pressure -0.3% -2.8% -1.1%
Cumulative productivity savings, with program $22,967,121 High Total Cholesterol -0.5% -1.0% -1.1%
Baseline Risk & Annual Change
Cumulative program cost $7,144,343 High Blood Glucose 0.3% -3.0% -1.1%
Annual Rate of Productivity Loss Net Present Value (NPV), medical care $5,300,125 Poor Nutrition/Eating Habits -0.1% -6.6% -1.1%
Summary of Results NPV, medical + productivity $28,267,246 Physical Inactivity -0.6% -3.7% -1.1%
Return on Investment (ROI), medical care $1.74 Tobacco Use -0.7% -1.2% -1.1%
Predicted Medical Expenditure
ROI, workplace productivity $3.21 High Alcohol Consumption -0.1% -2.0% -1.1%
Projected Productivity Loss
ROI, medical care + workplace productivity $4.96 High Stress 0.2% -3.4% -1.1%
Risk Profile with No Program Break even program cost, medical care only $271.73 Depression 0.2% -2.0% -1.1%
Risk Profile with Health Promotion Break even program cost, productivity only $501.50 * Annual change in risk that achieves ROI=$1.00 for medical care.
Break even program cost, medical + productivity $773.23 Click to calculate break-even risk reduction
Savings by Risk Factor
Current model settings: Save a Copy of the Model
Total Savings by Risk Factor
Total employees at baseline 10,000
Save a PDF Copy of the Results
Scenario Simulation Annual medical cost/employee, baseline $4,692
Annual program cost/employee, baseline $156.00
Appendix
Employee participation rate 62.0%
Input Sheet Simulation
Time horizon (yrs) 5
Program levels off (yrs) 5
Discount rate 3.0%
50

51. RESULTS – 35% PARTICIPATION RATE –
MEDICAL ROI = $0.98 TO $1.00
Health and Productivity Management Return on Investment Tool
Summary of results
With the current model settings the ROI is $0.98 for the cost of medical care and $1.81 for increased productivity.
Home Current annual rate No With a Break
Cumulative savings, program cost, and ROI (all discounted): of change in risk: Program Program Even*
Health Promotion Program Cumulative medical cost, no program $215,360,798 Obesity 0.7% -0.5% -1.1%
Employee Characteristics
Cumulative medical savings, with program $7,025,103 High Blood Pressure -0.3% -2.8% -1.1%
Cumulative productivity savings, with program $12,965,310 High Total Cholesterol -0.5% -1.0% -1.1%
Baseline Risk & Annual Change
Cumulative program cost $7,144,343 High Blood Glucose 0.3% -3.0% -1.1%
Annual Rate of Productivity Loss Net Present Value (NPV), medical care -$119,240 Poor Nutrition/Eating Habits -0.1% -6.6% -1.1%
Summary of Results NPV, medical + productivity $12,846,070 Physical Inactivity -0.6% -3.7% -1.1%
Return on Investment (ROI), medical care $0.98 Tobacco Use -0.7% -1.2% -1.1%
Predicted Medical Expenditure
ROI, workplace productivity $1.81 High Alcohol Consumption -0.1% -2.0% -1.1%
Projected Productivity Loss
ROI, medical care + workplace productivity $2.80 High Stress 0.2% -3.4% -1.1%
Risk Profile with No Program Break even program cost, medical care only $153.40 Depression 0.2% -2.0% -1.1%
Risk Profile with Health Promotion Break even program cost, productivity only $283.10 * Annual change in risk that achieves ROI=$1.00 for medical care.
Break even program cost, medical + productivity $436.50 Click to calculate break-even risk reduction
Savings by Risk Factor
Current model settings: Save a Copy of the Model
Total Savings by Risk Factor
Total employees at baseline 10,000
Save a PDF Copy of the Results
Scenario Simulation Annual medical cost/employee, baseline $4,692
Annual program cost/employee, baseline $156.00
Appendix
Employee participation rate 35.0%
Input Sheet Simulation
Time horizon (yrs) 5
Program levels off (yrs) 5
Discount rate 3.0%
51

52. INCREASING ENGAGEMENT–
ENLIST SENIOR/MIDDLE LEADERSHIP SUPPORT
• Get out the message – you have my permission to lead a healthy
lifestyle -- e.g., billing codes on time sheets
• Hold managers accountable – through feedback, report cards,
health index scores (Dow, PepsiCo, PPG, Novartis)
• Recognize best practices, and best practitioners, with tangible and
intangible rewards
• Train the boss – provide a “how to” guide and hand hold
• For leaders, walk the talk – participate in programs and be visible
• Look and act the part -- be a role model for others to emulate
• Communicate, market, advertize, brand, and “sell” health
• Treat health as you would any other business investment – with a
plan, goals, benchmarks, and budget
52

53. INCREASING ENGAGEMENT–
CREATE A SUPPORTIVE ENVIRONMENT AND CULTURE
• Indoor/campus-wide smoking bans
• Vending machines – containing a preponderance of healthy foods,
with subsidies for healthy items
• Hide the unhealthy stuff – highlight the good stuff
• Insist on healthy foods at company-sponsored events
• Create marked walking trails
• Provide fitness centers/rooms
• Build bike racks/storage areas
• Make available shower facilities
• Provide stairwell signs/posters—point of decision prompts
• Offer walking desks (scheduled via Outlook)
• Create a work environment that encourages health
53

54. INCREASING ENGAGEMENT–
WORK FLEXIBILITY, SOCIAL NORMS, AND INCENTIVES
• Allow for flexible work schedules and telecommuting
• Make available health improvement programs during odd shifts
• Publish statistics on prevalence of healthy lifestyles – assuming
more than 50% practice them
• Make health social – create affinity groups, competitions, enlist
mavens, influencers, and persuaders
• Recruit health ambassadors (champions/advocates) – reward and
recognize them
• Incent behaviors, movement toward goal achievement, and
outcomes (carefully)
• Connect health and safety
54

55. INCREASING ENGAGEMENT–
LEVERAGE BEHAVIORAL ECONOMICS
• Healthy snacks as the default
• Exercise commitment contracts
• Forcing active choices – pre-commitment
– planning future menus – I will choose fruit
instead of a donut, tomorrow
– I will get my flu shot on November 15
• Encourage competitions and games – make health
fun
55

56. SO, WHAT CAN YOU DO TO INCREASE ENGAGEMENT?
Promote physical activity
• Walking trails, open stairwells, slow down the elevator, promote public transport,
subsidize gym membership, provide pedometers, sponsor competitions, work with your
local schools
Promote access to healthy foods
• Make the healthy choices the easy choices, label “healthy” choices, only allow healthy
food at company-sponsored events, change vending machine contractors, sell half
portions in the cafeteria, give people smaller plates, provide free water, make people
wait for unhealthy food, promote and subsidize nutritious food, provide healthy
cupboards, pay for microwaves and refrigerators, educate
Advocate for legislation that supports healthy lifestyles
• Soda taxes, physical activity in schools, ensure food advertizing to children is
responsible, support outdoor facilities and parks, end subsidies for unhealthy foods and
increase subsidies for healthy foods, build bike and walking trails
Build a healthy company culture
• Change the norms of the organization, reward employees and managers for healthy
lifestyles, provide social support for employees who want to lose weight, make the
workplace fun
56

57. YOOHOO!! Focusing on improving the health and
quality of people’s lives will improve the
productivity and competitiveness of our
workers and citizens.
A growing body of scientific literature
suggests that well-designed, evidence-
based health promotion and disease
prevention programs can:
• Improve the health of workers and lower their
risk for disease;
• Save businesses money by reducing health-
related medical losses and limiting absence
and disability;
• Heighten worker morale and work relations;
• Improve worker productivity; and
• Improve the financial performance of
organizations instituting these programs.
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