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Worksite Wellness Evaluation: Basic Strategies for Worksites of All Sizes w David Chenoweth
 

Worksite Wellness Evaluation: Basic Strategies for Worksites of All Sizes w David Chenoweth

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    Worksite Wellness Evaluation: Basic Strategies for Worksites of All Sizes w David Chenoweth Worksite Wellness Evaluation: Basic Strategies for Worksites of All Sizes w David Chenoweth Presentation Transcript

    • Worksite  Wellness  Evalua0on:  Basic  Strategies  for  Worksites  of  All  Sizes   David  Chenoweth,  Ph.D.,  FAWHP   HPlive.org   Webinar   March  15,  2013  
    • Well-­‐planned  Evalua0ons  Can  be  a  Decisive   and  Strategic  Advantage        Assess  quality  of  resources  (personnel,            equipment,  facili>es,  etc.)      Determine  level  of  impact        Allocate  your  budget  propor>onately      Establish  external  benchmarking      Guide  strategic  planning  
    • A  growing  impetus  for  evalua0on…   Alcohol Health & Benefits Abuse Structured “Wellness” Productivity Recreational Enhancement Treatment Safety Exercise Programming ManagementHorseback rides, Occupational “Business Strategy” Employeegyms, swimming, • Hershey Assistance Safety & Health •PepsiCo • Quaker Oatsetc. Foods Programs Act •NASA • Union Pacific•Pullman • Kimberly-Clark • Steelcase • Sentry Ins. • First Chicago Bank•NCR 1890 1930 1950 1970 1980 1990 2000 2015
    • Purpose  of  Evalua.on…        “Evalua>on  is  not  research;    it  is  not  done  to  prove  or  disprove  anything;     it  is  done  to  improve  something...”   Research   Evalua>on   “Careful  or  diligent  search”   “Determine  or  affix  the  value  of”   “Studious  inquiry  or  examina9on”   “Determine  the  significance,   worth,  or  condi9on…”  
    • The  Seven  Benchmarks  1.  Capturing  Senior  Level  Support  2.  Crea>ng  Cohesive  Teams  3.  Collec0ng  Data  4.  CraRing  an  Opera>ng  Plan  5.  Choosing  Appropriate   Interven>ons  6.  Crea>ng  Suppor>ve   Environments  7.  Carefully  Evalua0ng  Outcomes   Courtesy  of  Wellness  Council  of  America  (WELCOA).  
    •  Perceived  Values  vs.  Actual  Performance…   WELCOA  Faculty  &   Well  Workplace  Checklist   Ranked  Diff.   %  Criteria  @  B-­‐ Webinar    Part.  (480+)   (3,800+)   Benchmarks  vs.   mark  Status   Rank   “Benchmarks”   “Norms”   Norms    (>4  of  5)   1st   Wellness  Opera>ng  Plan   Choosing  App  Inter.   +5   85%   2nd   Sr.  Level  Support   Wellness  Teams   +1   88%   3rd   Evalua0ng  Outcomes   Sr.  Level  Support   +4   100%   4th   Crea>ng  Wellness  Team   Healthy  Environ.   -­‐2   50%   5th   Choosing  Appropriate   Collec>ng  Data   -­‐4   58%   Interven>ons   6th   Crea>ng  Healthy   Well.  Opert’g  Plan   -­‐2   55%   Environment   7th   Collec0ng  Data   Evalua0ng  Outcomes   -­‐2   38%  Source:  Chenoweth,  D.  and  HunnicuM,  D.  WELCOA’s  Benchmark  Survey,  2013.  
    • Crea.ng  a  data-­‐driven  evalua.on…   1.  Capturing  Senior  Level  Support   2.  Crea>ng  Cohesive  Teams   3.  Collec0ng  Data   4.  CraRing  an  Opera>ng  Plan   5.  Choosing  Appropriate  Interven>ons   6.  Crea>ng  Suppor>ve  Environments   7.  Carefully  Evalua0ng  Outcomes  
    • Building  a  prac0cal,  results-­‐oriented  [3-­‐0ered]  evalua0on…   Health   Management   “Financial   Outcome”   “Impact”   “Process”   8  
    • Insert  slide  of  Eval’n  book   Financial   Process   Impact   outcome   Chenoweth  &  Associates,  Inc.   9  
    • Transi.oning….from  Process  to  Impact  to  Outcome…  is  a  JOURNEY….that  takes  .me…  
    • The  essence  of  “tailoring”  an  evalua.on  around  your   wellness  interven.on…   Process   Impact   $  Outcome  
    • “Financial     Outcome”   “Impact”   Appraising  the      Risk  factor  status   monetary  value  to        Behavior     wellness-­‐generated   “Process”      Health  care  usage   impacts    Produc>vity     Assessing  par9cipant   sa9sfac9on  with  instructor/coach,   facility,  program  quality,  etc.  Jan.                                                  July                                            December                    July      
    • “Financial     Outcome”   “Impact”   “Process”   Business     Quan0ty   Performance     -­‐ -­‐  -­‐  -­‐  -­‐  -­‐  -­‐  -­‐  -­‐  -­‐   Financial     Quality     Accountability  Jan.                                                                      July                                                                December                  July          
    • “Process”   Do  employees  like  and  respect   the  wellness  program,  etc.?     Par>cipa>on     Par>cipants’  sa>sfac>on  with:    -­‐  program  content    -­‐  delivery    -­‐  feedback  Jan.                                                                              July                                          December                              July        
    • “Process”  Evalua.on   [Qualita.ve]   •    Employees’  sa.sfac.on  with  program  content,  delivery,   availability,  facili.es,  instructors,  policies,  etc.   When  using  HRA  and  self-­‐report    tools,  use  non-­‐biased  statements    and  a   quan9ta9ve  index   Please  indicate  your  opinion     with  a  check  mark  on  the  following  scale:     “Level  of  customer  service  provided  by  wellness  staff”   [  -­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐]   Very                          High                    Moderate                  Low                          Very   High                                                                                                                                                              Low   (5)                          (4)                              (3)                    (2)            (1)  
    • “Impact”      Risk  factor  status      Behaviors      Health  care  usage      Produc>vity     “Process”  Jan.                                                                                          July                                                                                    December                          
    • Tools/techniques  for  assessing  IMPACT…     Employee  health  records     Environmental  audit     Culture  audit     Employee  focus  groups     Health  risk  assessment  (HRA)     Biometric  screening     Produc0vity  survey     Medical  care  claim-­‐cost  data     Visual  observa0on   CAUTION:  No  single  technique  is  a  sufficient  stand-­‐alone  diagnos0c  tool   17  
    • Conduc.ng  an  IMPACT  evalua.on…   1)  Select  key  variables  to  measure  (i.e.,   par9cipa9on,  risk  factor  status,  health  care   usage,  worksite  accidents,  etc.)   2)  Iden9fy  your  target  popula9on   3)  Prepare  a  format  to  record  and  format  data   4)  Collect  data  via  screening,  health  risk   appraisal,  etc.   5)  Analyze  data  at  designated  intervals  
    • Preparing  a  format  to  record  and  analyze  IMPACTS…   “IMPACT” " Baseline 02" 03 " 04 " 0 5" Variable" 01 " March" July" Oct.! Dec." Jan."Blood"pressure"Absences" Visits to OHN"Low backinjuries"Productivity"
    • Recording and analyzing impact data…   Impact" Baseline 02" 01 to 02" 03 " 01 to 03 " Variable " 01 [Jan.] " [March] " % Change " [Oct.] % Change" !Blood" 134/90 " 130/89 " -2.3"pressure"Absences" 5/100" 4.8" -4.0%" 4.5" -10%"On-site 348" 346" -1%" 321" -7.8%"clinic visits"Low back 3/100" 2.9" -3.5%" 2.8" -6.7%"injuries"Productivity" 78" 79" +1.3%" 83" 6.4%"
    • A  sample  IMPACT  variable…    “Rate  the  availability  of  healthy  vending  machine  items:”    Very  Good                      Good                  Neutral                                  Poor                                Very  Poor                5                4                3            2            1    
    • “Financial     Outcome”   Appraising  the     “Impact”   monetary  value  of     wellness-­‐generated   impacts  Jan.                                                                          July                                                              December                                        July      
    • …the  real  value  proposi0on…  conver0ng  human  [health  capital  into  business  capital…      Work  performance      Revenue  genera0on      Compe00ve  edge   23  
    • Transi0oning  from  IMPACT  to  $  OUTCOME…   Impact  (Non-­‐financial)  Values   $  Financial  Outcomes      BMI  decrease      Blood  pressure  decrease      Physical  ac>vity  increased      Self-­‐confidence  improved      Perceived  performance  higher      Fewer  workers’  comp  claims      Fewer  Rx  drug  claims      Fewer  medical  claims   2 4
    • Ostbye,  T.  et  al.  Arch  Intern  Med  2007;167:766-­‐773.   25  
    • When possible, build on today’s standards…(e.g., specificity)… Source:  Chenoweth  &  Associates,  Inc.;  North  Carolina  League  of  Municipali9es,  Raleigh,  NC,  2010.  
    • Medical  care  cost  per  risk  factor    Source:  Chenoweth,  D.  Promo.ng  Employee  Well-­‐Being:  Wellness  Strategies  to  Improve  Health,  Performance  and  the  Bo_om  Line.  SHRM  Founda9on’s  Effec9ve  Prac9ce  Guidelines  Series.  June  2011.  [www.shrm.org/founda9on]  
    • Risk Condition Absenteeism Presenteeism TotalDiabetes mellitus 4.94% 18.26% 23.20%Depression 2.61% 14.51% 17.12%Alcohol abuse 5.00% 4.78% 9.78%Obesity 1.40% 8.30% 9.70%High cholesterol 3.14% 4.91% 8.05%Smoking 2.84% 4.78% 7.62%High stress 3.08% 4.45% 7.53%Arthritis 2.36% 4.90% 7.26%High blood pressure 0.37% 5.70% 6.07%Asthma 4.80% 1.20% 6.00%Migraine 3.96% 1.99% 5.95%Physical inactivity .28% 4.59% 4.87% 28  Source:  Chenoweth,  D.  2011.  Ibid.  
    • Recommended  resource…   Full  Report:   www.shrm.org/founda9on/ products/documents/ 6-­‐11%20Promo9ng %20well%20being%20EPG-­‐ %20Finalpdf   Execu9ve  Summary:   www.shrm.org/about/ founda9on/products/ documents/wellness/%20Exec %20Briefing-­‐Final.pdf   Chenoweth  &  Associates,  Inc.   29  
    • Calcula0ng  the  Cost  of  Lost  Produc0vity  Per  Risk  Factor     “A”    mul9plied  by    “D”  [BxC]    mul9plied  by  “  E  “      =        “F”   Risk  Factor   (A)  %   (B)  #   (C)   (D)  #  At-­‐risk   (E)  Median   (F)  Lost   Workload   Employees   Prevalence   employees   Annual   prod.  cost   Lost   Compens’n   Alcohol  abuse   Arthri0s   .0726   500   .26   130   $50,000   $471,900   Asthma   Depression   Diabetes   High  cholest.   Hypertension   Migraine   Obesity   Phy.  inac>vity   Stress   30  
    • Building  a  credible  evalua0on  approach  …   Process   Impact   $  Financial   Outcome   Chenoweth  &  Associates,  Inc.   31  
    • CAUTION!  What  are  the  key  prerequisites  for   construc0ng  a  credible  evalua0on?     Suitable  and  suppor0ve  poli0cal  environment     Programs  –  well  established     Sufficient  par0cipa0on     Data  tracking:  pre  vs.  post     Evaluator’s  competence  and  objec0vity   Chenoweth  &  Associates,  Inc.   32  
    • Enhancing  the  quality  of  evalua.on   by  establishing  goals  that  are…     compa0ble  with  stakeholders’  needs  and  values     measurable:  variables  that  can  physically  be  measured     quan0fiable:  a  value  (#,  %,  $)  can  be  assigned  to  a  variable     focused  on  an  interven>on  that  has  been  opera0ng  long                  enough  to  legi>mately  generate  an  impact     realis0cally  achievable  (e.g.,  wellness  interven>on  is  likely  to                          make  a  posi>ve  impact)   Chenoweth  &  Associates,  Inc.   33  
    • Wellness  Strategies  and  Impact  Timeframes   Impact  on   Impact  on  Employee   Impact  on  Employee   Organiza>on’s  Health  Wellness  Interven>on   Health  Status   Produc>vity   Costs  Biometric  Screening   12-­‐18  months   Not  well  established   NWE   (NWE)  Condi0on  mgmt   6-­‐12  months   6-­‐12  months   12-­‐18  months  (asthma,  arthri0s,  diabetes,  etc.)  Drug-­‐tes0ng     3-­‐6  months   3-­‐6  months   6-­‐12  months  EAP     12-­‐18  months   12-­‐18  months   >24  months  Ergonomics   3-­‐6  months   3-­‐6  months   NWE  Financial  incen0ves   6-­‐12  months   NWE   NWE  Flex-­‐0me  work   3-­‐6  months   3-­‐6  months   6-­‐12  months  schedule  Health  Risk   NWE   NWE   NWE  Assessment  (HRA)  Low  back  health   6-­‐12  months  Chenoweth  &  Associates,  onths   6-­‐12  m Inc.   12-­‐18  months   34  
    • Wellness  Strategies  and  Impact  Timeframes   Impact  on   Impact  on  Employee   Impact  on  Employee   Organiza>on’s  Health  Wellness  Interven>on   Health  Status   Produc>vity   Costs  Medical  self-­‐care   3-­‐6  months   6-­‐12  months   12-­‐18  months  Mental  health/ 3-­‐6  months   3-­‐6    months   12-­‐18  months  depression  mgmt.  Non-­‐financial   NWE   NWE   NWE  incen0ves    Nutri0on     3-­‐6  months   6-­‐12  months   12-­‐18  months  Physical  ac0vity   3-­‐6  months   6-­‐12  months   12-­‐18  months  Smoking  cessa0on   3-­‐6  months   6-­‐12  months   36-­‐48  months  Stress  management   3-­‐6  months   3-­‐6  months   6-­‐12  months  Tobacco  free  worksite   3-­‐6  months   3-­‐6  months   6-­‐12  months  Weight  management   6-­‐12  months   12-­‐18  months   NWE   Chenoweth  &  Associates,  Inc.   35  
    • Identifying and acquiring key data for evaluation… Occupational Health andWork/life Safety (Accidents/ Demographics Productivity Injuries) Management Medical Ergonomics claims Health risk status Absenteeism/presenteeism (HRA/Screening) 36  
    • Designing  a  prac.cal  plan  for  evalua.ng…   Scope  &   Evalua>on   Evalua>on   Evalua>on   Timeframe   Specificity   Goals   Design   Resources  What   -­‐  are  we   -­‐  do  we  want  to   -­‐  design  is   -­‐  types  of   -­‐  Is    an   evalua9ng:   generate:   appropriate:   resources  are   appropriate      program?      internal      non-­‐exp?   needed?   9meframe?      policy?   assessment?      quasi  exp?      benchmark?      incen9ve?      proposal  for   expanding?  Why   -­‐  are  we   evalua9ng?  How   -­‐  can  we  best   use  each   resource?  Who   -­‐  is  the  target   -­‐  is  most   popula9on?   qualified  to  use   each  resource?  Where   -­‐  is  the  evalua9on   -­‐  can  we  obtain   conducted?   resources?  When   -­‐  is  the  best  9me?   Chenoweth  &  Associates,  Inc.   37  
    • Iden0fying  WHAT  you  are  going  to  evaluate…   Wellness   Enviro-­‐   Program   Health  Plan   Policies   Cultural   Incen>ves  Health  coaching   CDHP  focus   Smoke  free,  drug   Healthy  work   Health  insurance   with  incen>ves   free,  safety   semng/clean/safe   premium  discount   Fitness  center   Waived  co-­‐pays   Healthy  food   Accessible,   Fitness  center  subsidy   for  main.  Rx   op>ons   aorac>ve  stairways   drugs  Women’s  weekly   Medical  self-­‐ Lacta>on   Healthy  food   Flexible  spending   health  series   care  included   op>ons   account  (FSA)     Lunch  ‘n  Learn   Flex-­‐>me  and   Ergonomically-­‐   Health  reimbursement   telecommu>ng   enhanced   account  (HRA)     worksta>on   Walking  club   38  
    • Programs,  policies,  and  incen0ve  op0ons…   Physical  Ac>vity   Nutri>on   Informa>on/Educa>on   Other  Stairway  signage   Lunch  ‘n  learns   E-­‐mail  daily  >ps   On-­‐site  medical  clinic  Low  impact  walking   On-­‐line  webinars   Bull.  Boards  in  high   Health  Kiosk  with  b.p.   density  areas   cuff,  scales,  etc.  Walking  trails     Color-­‐coded  healthy   Medical  self-­‐care   Quiet  room   vending  items   booklets  Exercise  equip.  in  break   Healthy  potluck  with   On-­‐site  library   5  minute  on-­‐>me  area   recipe  exchange   stretching  Stretch  breaks   Gradually  phase  in   Hlth  mags  in  bathroom   Days  off  for  excellent   healthy  vend.  items   stalls   aoendance    Fit  ctr.  $  subsidies   Fruits/veggies  @  mtgs.   Health  column  in  co.   Establish  smoke-­‐free   newsleoer   worksite  At-­‐work  showers  and   Subsidize  healthier   Lacta>on  suites  for  lockers   cafeteria  food   nursing  employees  Dept.  compe>>ons    “Nutri-­‐>ps”  on  café/ break  tables   39  
    • Environmental  enhancements  to  boost  more   physical  ac0vity…   Before   ARer  
    • Environmental  [physical  environment]   enhancements…   –  Vending  op9ons   –  Workout/fitness  space   –  Cafeteria   –  Hea9ng/cooling/ven9la9on   –  Ergonomic/Safety   –  Well  lit  areas   –  Smoke-­‐free  
    • Tailoring  the  scope  of  an  evalua0on…      Process            -­‐  par>cipa>on            -­‐  like/dislike  change      Impact              -­‐  #  of  steps/day              -­‐  #  mins.  exercise/day              -­‐  body  mass  index  (BMI)              -­‐  #  of  health  care  claims              -­‐  perceived  produc>vity      Financial  outcome              -­‐  Health  care  cost$  
    • In  a  small  worksite…   PCL  Construc>on  –  Denver,  CO   “Keys  to  Wellness”      Provides  healthy  snacks  in  vending  machines      Fitness  center  subsidies      “Ping-­‐pong”  tables      Local  5K  runs      H1N1  and  flu  vaccina>ons      Annual  on-­‐site  health  screenings      Doesn’t  use  “program”  as  this  creates  a  percep>on            that  healthy  ac>vi>es  are  separate  from  the            company’s  normal  business  prac>ces.     Courtesy  of  PCL  Construc9on,  Inc.   43  
    • Aligning  wellness  (programs,  policies,  and  incen0ves)  within    a  feasible  evalua0on  plan…   PCL  Construc>on  –  Denver,  CO   “Keys  to  Wellness”   Strategy   “Process”   “Impact”   “$  Outcome”   Healthy  vending  snacks   √   √   Fitness  center  subsidy   √   √   √√   “Ping  Pong”   √   H1N1  vaccina9ons   √   √   √√   On-­‐site  hlth  screenings   √   √  √√  Compare  medical  care  claims  and  cost  among  par.cipants  vs.  non-­‐par.cipants.   44  
    • Sample  tools/techniques  used  for  evalua0on…   Strategy   “Process”   “Impact”   “Financial   (volume  indicators)   (changes)   Outcome”  Healthy  vending  snacks   √   √   (Item  counts)   (HRA,  BMI   scr’g)    Fitness  center  subsidy   √   √   √√   (Par>cipa>on)   (HRA,  biometric   (Annual  claims   scr’g)   data)  H1N1  vaccina9ons   √   √   √√   (Par>cipa>on)   (Aoendance,   (Annual  influenza   flu  claims)   claim  &  cost  data)  On-­‐site  hlth  screenings   √   √   (Par>cipa>on)   (HRA  health   status)  √√  Compare  medical  care  claims  and  cost  among  par.cipants  vs.  non-­‐par.cipants.   45  
    • In  a  mid-­‐size  worksite…   Syngenta  Crop  Protec0on      Healthy  snacks  in  vending  machines      Fitness  center  subsidy      On-­‐site  Medical  Clinic      Weight  Watchers™  on-­‐site  program      Annual  on-­‐site  health  screenings   Courtesy  of  Judy  Garreo,  COHN.  Syngenta  Crop  Protec>on,  Greensboro,  NC   46  
    • Syngenta  Crop  Protec.on   Strategy   “Process”   “Impact”   “Financial   (volume  indicators)   (change)   Outcome”  Healthy  vending  snacks   √   √   (Item  counts)   (HRA,  BMI  scr’g)  Fitness  center  subsidy   √   √   √√   (Par>cipa>on)   (HRA,  biometric  scr’g)  On-­‐site  Medical  Clinic   √   √   √√   (U>liza>on)   (HRA,  health  records,   (Annual  claim   #  of  medical  claims)   costs)  Weight  Watchers™   √   √   √√   (Par>cipa>on)   (HRA,  biometric  scr’g)    (Pre  vs.  Post   claim  costs)  On-­‐site  health  scr’ning   √   √   (Par>cipa>on)   (HRA  health  status)  √√  Compare  medical  care  claims  and  cost  among  par.cipants  vs.  non-­‐par.cipants.   47  
    • In  a  large  worksite…   Bap0st  Health  South  Florida…     “Wellness  Advantage”  award-­‐winning  program     Eight  on-­‐site  fitness  centers  with              2x  annual  open  houses     Classes:  boot  camp,  urban  training,  walking  and      circuit  training     Bi-­‐annual  wellness  fairs  with  free  screenings     $3  Wellness  Meals  (<600  calories  &  <30%  fat)                -­‐    the  fastest-­‐selling  items!  >  Disease  management  program  =  posi>ve  ROI   Courtesy  of  Bap0st  Health  South  Florida   48  
    • “Process”   “Impact”   Strategy   (volume  indicators)   (changes)   “$  Outcome”  On-­‐site  fitness  centers   √   √   √√   (Par0cipa0on)   (HRA  status  &   (Annual  medical   biometric  scr’g)   claim  costs)  Classes   √   √   (Par0cipa0on)   (HRA  status)  Wellness  Fair   √   (Par0cipa0on)  Wellness  Meals   √   √   (#  Meals  sold)   (HRA  health   status  indicators)  Disability  management   √   √   √+   (Par0cipa0on)     (RTW,   (Disability-­‐ Produc0vity   specific  claim   indicators)   costs)  √√  Compare  medical  care  claims  and  cost  among  par.cipants  vs.  non-­‐par.cipants.  √+  Track  medical  care  and  Rx  drug  use  and  costs  at  quarterly  intervals.   49  
    • Tips  for  Enhancing  your  Evalua.on…      Establish  a  clearly  delineated  goal  or  vision  for                  doing  an  evalua>on      Allocate  at  least  5%  -­‐  10%  of  your  budget  for  evalua>on      Iden>fy  key  stakeholders  and  tailor  the  evalua0on                  to  their  needs  and  values      Have  a  realis0c  expecta0on  of  what  an  evalua>on  can  produce      Select  only  variables  that  you  can  reasonably  track      Assess  data  sources  and  types  of  data  that  are  available                    before  pumng  an  evalua>on  into  ac>on      Give  the  interven>on  >me  to  make  a  genuine  impact      Once    essen>al  resources  (e.g.,  personnel,  equipment,                    facili>es,  etc.)  are  iden>fied,  conduct  a  beta  trial  (test  run)                  to  iden>fy/resolve  any  barriers    Source:  Chenoweth,  D.  “Decision  Points  Around  Evalua9on.”  AWHP’s  Worksite  Health,    Summer  2001,  8-­‐14.   50  
    • Crea0ng  synergism  for  building  successful  evalua0ons  today…tomorrow…and  the  future…   PROCESS   Environment   Programs   Evalua0on   IMPACT  Worksite  Infrastructure   Policies   $  OUTCOME   Incen0ves   51  
    • Thank  You!   David  Chenoweth,  Ph.D.   Chenoweth  &  Associates,  Inc.   128  St.  Andrews  Circle   New  Bern,  NC    28562-­‐2907   252-­‐636-­‐3241  EconohealthROI™   www.chenoassociates.com   dave@chenoassociates.com   PRFCA™   CorpWellROI™   52