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uestions & nswers
if your message is a
if your message is a
– Include presenters so your question
will be directed toward ...
Al Lewis Agenda
• Qualifications
• Brief Response to August 29 Goetzel/Aldana
Attack
– Review the Wellsteps/Aldana “scienc...
My Own Metrics Qualifications
• Outcomes evaluation and procurement consulting for DM and wellness,
and now litigation sup...
Most Importantly, I’ve Written award-winning
trade bestsellers on Wellness Outcomes
Honest vendors and consultants will re...
Today We Will Test This Line…
• “In wellness, you don’t have to challenge the data to
invalidate it. You simply have to re...
Al Lewis Agenda
• Qualifications
• Brief Response to August 29 Goetzel/Aldana
Attack
– Review the Wellsteps science …and m...
Oops—Spending Goes Below Zero
The Bialystock Rule
1. You cannot reduce a number by more than 100% no matter how hard you
try
2. This is not one of those...
Let’s Use More Reasonable Assumptions
Another way to save money is to
INCREASE smokers and obesity
No “confusion” being created here…
Next Steps for Dr. Aldana
• The “open mike” gives you a chance to
apologize for pretending to offer a model
• This lack of...
…More Bialystock Rule violations
In Childrens’ Admissions for North Carolina,
Milliman “validated” savings for 2007-2010 > amount spent in 2006
Aggregate c...
Mercer/Staywell can reduce BP’s events by more than
100%...and get 100x the savings Staywell says is possible
Al Lewis Agenda
• Qualifications
• Brief Response to August 29 Goetzel/Aldana
Attack
– Review the Wellsteps “science” …and...
Lots of Ironies in 8/29 Presentation…he
presented this slide—and did exactly that
Example #1: “Selective Citation of Literature”
Failed to Mention the Author Walked It Back
4 years ago: “Workplace Wellness Can Generate Savings” of 3.27-to-1
July 2013:...
Selective Citation #2: Nebraska
• Claimed $4.2-million in savings even though risk
factors only declined for 186 participa...
But People Are Becoming Aware that the Koop
Committee Didn’t Notice or Care
514 Cancer Cases Were Made Up to Win
an Award named for C. Everett Koop
• 2012 Claim: Nebraska/HFC program made “life
savi...
Selective Omission #3: Penn State
(See Harvard Business Review)
Highmark-Penn State-Goetzel Program:
The Worst Wellness Program Ever?
• Rep. Louise Slaughter: “What happened at
Penn Stat...
Lots of Ironies in 8/29 Presentation…he
presented this slide—and did exactly that
You Can’t Match Participants to Non-Participants
• You can “match” demographics all you want but you
can’t compare the min...
The Most Eloquent Participants-vs.-
Non-Participants Smackdown
• “Self-improvers are likely to be drawn to self-
improveme...
Costs fall before the program starts just by separating participants from non-participants
What have we learned so far?
• Wellness vendor/consultant data indeed
invalidates itself
What have we learned so far?
• Wellness data indeed invalidates itself
• We also learned why I am not very popular in some...
How Cool is Being on the Enemies List?
Al Lewis Agenda
• Brief Response to August 29 Goetzel/Aldana
Attack
– Review the “qualifications” of Wellsteps’ Steve
Alda...
Cigna Guarantees that 30% of High and Medium Risk will decline
in risk:
37 (c) 2013 DMPC www.dismgmt.com
What about people whose risk factors should go up? Shouldn’t
they be counted too?
38 (c) 2013 DMPC www.dismgmt.com
Should Cigna have drawn the 670-person low-risk segment larger
than the 200 and 130?
39 (c) 2013 DMPC www.dismgmt.com
Example from Wellness using Cigna
methodology: Smoking Cessation
40 (c) 2013 DMPC www.dismgmt.com
Smoking hypothetical
• Suppose everyone in your organization
smokes and quits in alternate years, and that
smoking is the ...
Smoking hypothetical
• Suppose everyone in your organization smokes and quits in
alternate years, and that smoking is the ...
43 (c) 2013 DMPC www.dismgmt.com
Significance of Cigna Example
• Shows how little respect vendors and health plans
have for your advisors’ ability – or wil...
So What Do You Do Instead?
• Use honest vendors and consultants
– They will ask the question: “What should improve
as a re...
What is this group and
How does Release 1.0 work?
• Inter-corporate committee developed list of
medical events most likely...
Screen Shot of Release 1.0 and
Instructions
Example of Output:
ER and IP Event Rates per 1000 covered people
0
0.5
1
1.5
2
2.5
3
3.5
4
4.5
2002 2003 2004 2005 2006 20...
CAD vs. national averages (events per
1000 commercial members)
0.0
0.5
1.0
1.5
2.0
2.5
3.0
3.5
4.0
4.5
Employer A
National...
Here’s what you can learn
• Whether you are reducing wellness-sensitive
medical events through your wellness
program
• Whe...
Take-Aways
• Test models – they usually don’t work
• Track records (Nebraska, Penn State) aren’t
always disclosed but are ...
The Key Difference between What You Saw in
August and Today
“Who are you gonna believe, me or your own eyes?”
53 (c) 2013 ...
How wellness subverts essential medical principles
and drives hyper-diagnosis by giving us what we’ve
already had
Vik Khan...
10/02/2013 Wellness as managed care; No use without permission and attribution 55
Wellness as managed care; No use without permission and attribution 56
http://www.imdb.com/title/tt010
7048/
10/02/2013
Wellness as managed care; No use without permission and attribution 57
• Overdiagnosis
• Encouragement
of the sick role
In...
Control
of the
individual
“Incentives”
“Comprehensive
solutions”
“Cost containment”
Wellness as managed care; No use witho...
2.40 2.50
2.89 3.00
1.73
1.65
1.48 1.14
0.00
0.20
0.40
0.60
0.80
1.00
1.20
1.40
1.60
1.80
2.00
0.00
0.50
1.00
1.50
2.00
2....
Wellness as managed care; No use without permission and attribution 6010/02/2013
Fortune 1000 Company
State 1 State 2
Younger population
75% greater ED use
50% higher hosp
admit rate
10% higher per capita
med care spending
L...
Colorado Mississippi
Younger population
75% greater ED use
50% higher hosp
admit rate
10% higher per capita
med care spend...
Uwe Reinhardt,
commenting atThe Health
Care Blog
• “I have deplored this
Nurse Ratched intrusion
[corporate wellness] for ...
10/02/2013 Wellness as managed care; No use without permission and attribution 64
Health economists don’t even use the wor...
RE-FRAMING THE WELL-BEING VALUE
PROPOSITION
HP Live
Rosie Ward, Ph.D., MPH, MCHES, BCC, Certified Intrinsic Coach®
Health ...
MARSH & McLENNAN AGENCY LLC
WHO IS THIS CHIC???
• 20 Years in the Health & Wellness Industry
– B.S. in Kinesiology
– MPH i...
MARSH & McLENNAN AGENCY LLC 67October 2, 2013
MARSH & McLENNAN AGENCY LLC
Section 1
CHANGING THE PARADIGM
From Health Risk Reduction to Total Well-
Being
MARSH & McLENNAN AGENCY LLC
INDIVIDUAL WELL-BEING
5 Universal, Interconnected
Elements:
• Career Well-Being
• Social Well-...
MARSH & McLENNAN AGENCY LLC
ENGAGEMENT & PHYSICAL
HEALTH
Source: Crabtree, Gallup Management Journal (2005)
22
%54
%
23
%
...
MARSH & McLENNAN AGENCY LLC
DISENGAGEMENT & MENTAL WELL-
BEING
4.6%
6.4% 6%
7.6%
8.8%
10.4%
Engaged Not Engaged Actively D...
MARSH & McLENNAN AGENCY LLC
THE REALITIES OF WORKPLACE
STRESS IN AMERICA
• 69% of adults with high stress report increased...
MARSH & McLENNAN AGENCY LLC
WORKPLACE OVERLOAD
Indicators of Poor Career Well-Being
73October 2, 2013
MARSH & McLENNAN AGENCY LLC
Section 3
WHY CULTURE MATTERS
The Link to Well-Being & Sustainability
MARSH & McLENNAN AGENCY LLC
ORGANIZATIONAL CULTURE
MARSH & McLENNAN AGENCY LLC
A HIGH-PERFORMING CULTURE:
Beyond Engagement
76
Engaged
Enabled
Energized
A work
environment
t...
MARSH & McLENNAN AGENCY LLC
COMPETITIVE ADVANTAGE OF E + E +
E
9.9%
14.3%
27.4%
Companies
with Low
Engagement
Companies
wi...
MARSH & McLENNAN AGENCY LLC
LEADERSHIP CREATES CULTURE
50-70% of employee’s
perception of the
organization’s climate
can b...
MARSH & McLENNAN AGENCY LLC
79
LEADERS’ ROLE IN WELL-BEING
• Leaders shouldn’t ignore well-being as if it’s
beyond the sco...
MARSH & McLENNAN AGENCY LLC
SHIFTING FROM BEHAVIOR
CHANGE TO CULTURE
“Behavior change is really the mantra of wellness,
bu...
MARSH & McLENNAN AGENCY LLC
IF YOU DON’T MANAGE CULTURE,
IT WILL MANAGE YOU
81
MARSH & McLENNAN AGENCY LLC
WELL-BEING VALUE PROPOSITION
6 Components to Effective Well-Being
1. Data Collection / Analysi...
MARSH & McLENNAN AGENCY LLC
CONTACT INFORMATION
Rosie Ward, Ph.D., MPH, MCHES, BCC
Certified Intrinsic Coach®, Certified V...
on Robison holds a doctorate in health education/exercise physiology and a mas
science in human nutrition from Michigan St...
EVIDENCE BELIEF
Worksite Wellness
At a Crossroads
Evidence vs. Belief
Evidence-Based
“Evidence-Based
Medicine”
“The integration of best research
evidence with clinical expertise and
patient values.”
Sackett ...
“Evidence-Based”
Worksite Wellness?
Programming
Process
Weight Loss
Motivation
Weight Loss at The
Workplace
Types of Wellness Coaching Offered:
Exercise 85%
Weight 83%
Nutrition 81%
Stress 78%
Heart He...
The Legacy of Failure
Medicare’s Search for
Effective Obesity Treatments
“In sum, there is little support for
the notion t...
The Legacy of Failure
At The Workplace
17 worksites - 2,407 employees
Year-long, incentive programs
Weight loss – 1.4 to 3...
The Legacy of Failure
At The Workplace
“Weight loss money is money down the toilet.
Every diet program gets results, but n...
1.2 lbs.
.31 lbs.
5 oz.
To Reward?... Or Not To Reward?:
Questioning the Wisdom of Using
External Reinforcement in Health
Promotion Programs
Jonat...
Motivation
doing something due to
pressure or tangible rewards rather than
for the fun or interest of it - because
someone...
Incentives: Evidence-Base ??
Curry, Wagner., J.Consult Clin Psych. 1991;59(2):318-323)
Windsor, 1988, J.Behav.Medicine;11:...
Extrinsic Motivation
Does not produce long-term behavior change
Can diminish performance
Can diminish creativity
Can foste...
Motivation
“There are literally hundreds and hundreds
and hundreds now of scientific
investigations that have shown when y...
Motivation
your performance will be better
particularly at heuristic activities, and
your emotions will be much more posit...
The Safeway Debacle
or…
“We all drank
the Kool-Aid”
The “Safeway Amendment”
“Safeway designed such a plan in 2005
and has made continuous improvement
each year.
The results h...
The “Safeway
Amendment”
“Safeway designed such a plan in
2005 and has made continuous
improvement each year.
The results h...
The “Safeway Amendment”
“Safeway figured out how to incentivize
people to take better care of themselves,
and they have fl...
The “Safeway Amendment”
“You know, there’s a guy who has become
pretty famous lately, and he’s the CEO of
Safeway… Safeway...
The “Safeway Amendment”
“It’s a program that has helped Safeway
cut health-care spending by 13 percent
and workers save ov...
David S. Hilzenrath, Washington Post
“Misleading claims about Safeway
wellness incentives
shape health-care bill”
Washingt...
The “Safeway Amendment”
The Reality
Costs declined by 12.5 % in 2006
Program was not implemented until 2009
(only 11,000 o...
The “Safeway Amendment”
The Reality
“Although it may seem obvious that charging
higher premiums for smoking (body mass ind...
The “Safeway Amendment”
The Reality
“We also have a pretty good idea of what doesn’t
work, and heading the list are strate...
The “Safeway Amendment”
Why Not?
Workplace wellness regulations:First do no harm.The Prevention Institute, The Greenlining...
Take Home
The field has been riding the behavioral
change horse for 40 years with little to
show for it…
Paying individual...
Take Home
“Don’t ask how you can motivate others.
That’s the wrong question.”
Ask how you can create the conditions
within...
Take Home
Addressing the issues that have the
greatest impact on employee health ?
Addressing the issues that have the
gre...
EVIDENCE BELIEF
Worksite Wellness
At a Crossroads
How successful do we want to be ?
How seriously do we want to be take
uestions & nswers
if your message is a
if your message is a
– Include presenters so your
question will be directed toward ...
When Wellness Worlds Collide:  Wellness Critics Respond to Attacks
When Wellness Worlds Collide:  Wellness Critics Respond to Attacks
When Wellness Worlds Collide:  Wellness Critics Respond to Attacks
When Wellness Worlds Collide:  Wellness Critics Respond to Attacks
When Wellness Worlds Collide:  Wellness Critics Respond to Attacks
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When Wellness Worlds Collide: Wellness Critics Respond to Attacks

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Transcript of "When Wellness Worlds Collide: Wellness Critics Respond to Attacks"

  1. 1. uestions & nswers if your message is a if your message is a – Include presenters so your question will be directed toward the appropriate person ( )
  2. 2. Al Lewis Agenda • Qualifications • Brief Response to August 29 Goetzel/Aldana Attack – Review the Wellsteps/Aldana “science” …and make him an offer – Fill in some “blanks” Mr. Goetzel might have left out • How to Measure Outcomes
  3. 3. My Own Metrics Qualifications • Outcomes evaluation and procurement consulting for DM and wellness, and now litigation support (JD from Harvard Law School) • The popular course/certification in Critical Outcomes Report Analysis so you don’t have to rely on vendor/consultant ROIs • “Unsung Hero Changing Healthcare Forever,” Leah Binder, Forbes 6
  4. 4. Most Importantly, I’ve Written award-winning trade bestsellers on Wellness Outcomes Honest vendors and consultants will recommend these very well-reviewed books even if don’t agree with everything in them
  5. 5. Today We Will Test This Line… • “In wellness, you don’t have to challenge the data to invalidate it. You simply have to read the data. It will invalidate itself” – Cracking Health Costs
  6. 6. Al Lewis Agenda • Qualifications • Brief Response to August 29 Goetzel/Aldana Attack – Review the Wellsteps science …and make them an offer – Fill in some “blanks” Mr. Goetzel might have left out • How to Measure Outcomes
  7. 7. Oops—Spending Goes Below Zero
  8. 8. The Bialystock Rule 1. You cannot reduce a number by more than 100% no matter how hard you try 2. This is not one of those things that’s the opposite in the Southern hemisphere 11 (c) 2013 DMPC www.dismgmt.com
  9. 9. Let’s Use More Reasonable Assumptions
  10. 10. Another way to save money is to INCREASE smokers and obesity
  11. 11. No “confusion” being created here…
  12. 12. Next Steps for Dr. Aldana • The “open mike” gives you a chance to apologize for pretending to offer a model • This lack of regard for facts, data and simple arithmetic is typical in this field, especially the Bialystock Rule
  13. 13. …More Bialystock Rule violations
  14. 14. In Childrens’ Admissions for North Carolina, Milliman “validated” savings for 2007-2010 > amount spent in 2006 Aggregate costs of discharges Medicare Medicaid Total number of discharges 1,106,005 423,602 226,190 ######## ######## ######## Age group <1 136,849 19 69,019 390,703,783 68,228 227,790,451 1-17 44,546 117 22,394 250,617,666 1,365,939 114,620,426 18-44 289,755 21,669 97,859 ######## 178,553,996 487,584,960 45-64 265,992 72,447 36,442 ######## 729,137,435 369,788,731 65-84 299,251 264,785 429 ######## ######## 4,874,779 85+ 69,595 64,563 39 531,179,285 495,677,349 335,288 2006 baseline spending (c) 2013 DMPC www.dismgmt.com17
  15. 15. Mercer/Staywell can reduce BP’s events by more than 100%...and get 100x the savings Staywell says is possible
  16. 16. Al Lewis Agenda • Qualifications • Brief Response to August 29 Goetzel/Aldana Attack – Review the Wellsteps “science” …and make them an offer – Fill in some “blanks” Mr. Goetzel might have left out • How to Measure Outcomes
  17. 17. Lots of Ironies in 8/29 Presentation…he presented this slide—and did exactly that
  18. 18. Example #1: “Selective Citation of Literature”
  19. 19. Failed to Mention the Author Walked It Back 4 years ago: “Workplace Wellness Can Generate Savings” of 3.27-to-1 July 2013: “It’s too early to tell” whether these programs save money
  20. 20. Selective Citation #2: Nebraska • Claimed $4.2-million in savings even though risk factors only declined for 186 participants and other costs “spiked” • Claimed 40% of screened people were diagnosed with cardiometabolic disorders – but drug use for cardiometabolic disorders declined 3% • Claimed cancer rates 40-60x that of Love Canal (514 cases) Goetzel’s Koop Committee Did Not Notice and/or Care about Any of This
  21. 21. But People Are Becoming Aware that the Koop Committee Didn’t Notice or Care
  22. 22. 514 Cancer Cases Were Made Up to Win an Award named for C. Everett Koop • 2012 Claim: Nebraska/HFC program made “life saving, cost saving catches [of ] 514 early-stage cancer cases” • 2013 Admission of Guilt: HFC’s Dr. Richling admitted that these 514 cases “technically were not cancer” • Goetzel Committee lets HFC cronies keep their Koop Award despite admitted lies • LinkedIn groups and blogosphere: What would Koop say?
  23. 23. Selective Omission #3: Penn State (See Harvard Business Review)
  24. 24. Highmark-Penn State-Goetzel Program: The Worst Wellness Program Ever? • Rep. Louise Slaughter: “What happened at Penn State was appalling”
  25. 25. Lots of Ironies in 8/29 Presentation…he presented this slide—and did exactly that
  26. 26. You Can’t Match Participants to Non-Participants • You can “match” demographics all you want but you can’t compare the mindset of participants and non- participants • “Match” 50 smokers who want to quit against 50 other smokers with identical demographics who don’t want to quit – and the quit rate will be higher among the people who want to quit, program or no program.
  27. 27. The Most Eloquent Participants-vs.- Non-Participants Smackdown • “Self-improvers are likely to be drawn to self- improvement programs, and self-improvers are more likely to improve.” – Henry Albrecht, Limeade
  28. 28. Costs fall before the program starts just by separating participants from non-participants
  29. 29. What have we learned so far? • Wellness vendor/consultant data indeed invalidates itself
  30. 30. What have we learned so far? • Wellness data indeed invalidates itself • We also learned why I am not very popular in some circles… “My greatest achievement is being on Nixon’s enemies list”
  31. 31. How Cool is Being on the Enemies List?
  32. 32. Al Lewis Agenda • Brief Response to August 29 Goetzel/Aldana Attack – Review the “qualifications” of Wellsteps’ Steve Aldana …and make him an offer – Fill in some “blanks” Truven’s Mr. Goetzel might have left out • How to Measure Outcomes: Caveat Emptor and do-it-yourself opportunities • Example: Cigna
  33. 33. Cigna Guarantees that 30% of High and Medium Risk will decline in risk: 37 (c) 2013 DMPC www.dismgmt.com
  34. 34. What about people whose risk factors should go up? Shouldn’t they be counted too? 38 (c) 2013 DMPC www.dismgmt.com
  35. 35. Should Cigna have drawn the 670-person low-risk segment larger than the 200 and 130? 39 (c) 2013 DMPC www.dismgmt.com
  36. 36. Example from Wellness using Cigna methodology: Smoking Cessation 40 (c) 2013 DMPC www.dismgmt.com
  37. 37. Smoking hypothetical • Suppose everyone in your organization smokes and quits in alternate years, and that smoking is the only risk factor • So the 50% of the workforce smokes every year but it’s a different 50% each year 41 (c) 2013 DMPC www.dismgmt.com
  38. 38. Smoking hypothetical • Suppose everyone in your organization smokes and quits in alternate years, and that smoking is the only risk factor – Only smokers are high-risk • So the 50% of the workforce smokes every year but it’s different 50% This methodology would find a 100% reduction Every year even though the smoking rate remains unchanged There is, however, one undeniably true statement in Cigna’s brochure… 42 (c) 2013 DMPC www.dismgmt.com
  39. 39. 43 (c) 2013 DMPC www.dismgmt.com
  40. 40. Significance of Cigna Example • Shows how little respect vendors and health plans have for your advisors’ ability – or willingness -- to find fallacies – Many advisors to HR departments are also getting directly or indirectly paid by vendors (from Wellnet website)
  41. 41. So What Do You Do Instead? • Use honest vendors and consultants – They will ask the question: “What should improve as a result of wellness?” by saying “Wellness – sensitive medical events” • Do It Yourself – The “Wellness-Sensitive Medical Event Committee” is making its work product available to self-insured employers, Leapfrog Group and IHPM members free from www.dismgmt.com
  42. 42. What is this group and How does Release 1.0 work? • Inter-corporate committee developed list of medical events most likely to be avoided through wellness • There will be other things that go up (MD visits) and maybe other events that decline but this is a “plausibility test” • We will be expanding the list in future releases of other impacts • You can ask to join the committee
  43. 43. Screen Shot of Release 1.0 and Instructions
  44. 44. Example of Output: ER and IP Event Rates per 1000 covered people 0 0.5 1 1.5 2 2.5 3 3.5 4 4.5 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 asthma cad chf copd diabetes 49
  45. 45. CAD vs. national averages (events per 1000 commercial members) 0.0 0.5 1.0 1.5 2.0 2.5 3.0 3.5 4.0 4.5 Employer A National Averages 50
  46. 46. Here’s what you can learn • Whether you are reducing wellness-sensitive medical events through your wellness program • Whether your wellness-sensitive medical event rate is higher or lower than average for the US (or your segment), and whether it is decreasing faster or slower than average • With the real ROI calculator (not free) you can see if you saved money.
  47. 47. Take-Aways • Test models – they usually don’t work • Track records (Nebraska, Penn State) aren’t always disclosed but are relevant • Vendors and consultants fabricate numbers and selectively cite literature • Measure wellness-sensitive medical events to see if your wellness program “moves the needle”
  48. 48. The Key Difference between What You Saw in August and Today “Who are you gonna believe, me or your own eyes?” 53 (c) 2013 DMPC www.dismgmt.com You decide which you’d like to do
  49. 49. How wellness subverts essential medical principles and drives hyper-diagnosis by giving us what we’ve already had Vik Khanna Vikram Khanna Health Consulting Chesterfield, MO October 2013
  50. 50. 10/02/2013 Wellness as managed care; No use without permission and attribution 55
  51. 51. Wellness as managed care; No use without permission and attribution 56 http://www.imdb.com/title/tt010 7048/ 10/02/2013
  52. 52. Wellness as managed care; No use without permission and attribution 57 • Overdiagnosis • Encouragement of the sick role Intentional • Reliance on discrete data points Inaccurate • Belief in the clinic as the locus of health Deceptive 10/02/2013
  53. 53. Control of the individual “Incentives” “Comprehensive solutions” “Cost containment” Wellness as managed care; No use without permission and attribution 5810/02/2013
  54. 54. 2.40 2.50 2.89 3.00 1.73 1.65 1.48 1.14 0.00 0.20 0.40 0.60 0.80 1.00 1.20 1.40 1.60 1.80 2.00 0.00 0.50 1.00 1.50 2.00 2.50 3.00 3.50 1994 1997 2003 2009 Miles driven (trillion) Death rate (per 100M miles driven) Source: http://www- fars.nhtsa.dot.gov/Main/index.aspx Wellness as managed care; No use without permission and attribution 5910/02/2013
  55. 55. Wellness as managed care; No use without permission and attribution 6010/02/2013 Fortune 1000 Company
  56. 56. State 1 State 2 Younger population 75% greater ED use 50% higher hosp admit rate 10% higher per capita med care spending Longer lifespan 30% lower death rate 55% higher rate of vigorous exercise 44% higher rate of fruit/veg consumption 10/02/2013 Wellness as managed care; No use without permission and attribution 61 Source: Kaiser Family Foundation, State Health Facts
  57. 57. Colorado Mississippi Younger population 75% greater ED use 50% higher hosp admit rate 10% higher per capita med care spending Longer lifespan 30% lower death rate 55% higher rate of vigorous exercise 44% higher rate of fruit/veg consumption 10/02/2013 Wellness as managed care; No use without permission and attribution 62 Source: Kaiser Family Foundation, State Health Facts
  58. 58. Uwe Reinhardt, commenting atThe Health Care Blog • “I have deplored this Nurse Ratched intrusion [corporate wellness] for a long time as well.” Donald Lloyd-Jones, MD, Chair of Preventive Medicine, Northwestern University • “Treatment can never restore you to the baseline risk factors of someone who has never had them.” 10/02/2013 Wellness as managed care; No use without permission and attribution 63
  59. 59. 10/02/2013 Wellness as managed care; No use without permission and attribution 64 Health economists don’t even use the word “wellness” when talking about the slowing rate of growth in medical care spending, which is nearly all due to macro-economic trends that conventional wellness vendors don’t even understand let alone affect.
  60. 60. RE-FRAMING THE WELL-BEING VALUE PROPOSITION HP Live Rosie Ward, Ph.D., MPH, MCHES, BCC, Certified Intrinsic Coach® Health Management Services Manager Marsh & McLennan Agency Minneapolis, MN October 2, 2013
  61. 61. MARSH & McLENNAN AGENCY LLC WHO IS THIS CHIC??? • 20 Years in the Health & Wellness Industry – B.S. in Kinesiology – MPH in Community Health Education • 2001: realization that published “best practices” weren’t reality for us in the field; disheartened with worksite wellness but still a believer… • 2003-2004: Light Bulb moment – Broadened scope and earned Ph.D. in Organization and Management • 2004 – Present: Trying to change the world and elevate well-being to a different level of understanding and focus within organizations and our field 66October 2, 2013
  62. 62. MARSH & McLENNAN AGENCY LLC 67October 2, 2013
  63. 63. MARSH & McLENNAN AGENCY LLC Section 1 CHANGING THE PARADIGM From Health Risk Reduction to Total Well- Being
  64. 64. MARSH & McLENNAN AGENCY LLC INDIVIDUAL WELL-BEING 5 Universal, Interconnected Elements: • Career Well-Being • Social Well-Being • Financial Well-Being • Physical Well-Being • Community Well-Being
  65. 65. MARSH & McLENNAN AGENCY LLC ENGAGEMENT & PHYSICAL HEALTH Source: Crabtree, Gallup Management Journal (2005) 22 %54 % 23 % Engaged Not Engaged Actively Disengaged 39 % 30 % 30 % 62 % 12 % 25 % 2% 1% 1% Effect of Work Life on Health ENGAGEMENT & PHYSICAL HEALTH
  66. 66. MARSH & McLENNAN AGENCY LLC DISENGAGEMENT & MENTAL WELL- BEING 4.6% 6.4% 6% 7.6% 8.8% 10.4% Engaged Not Engaged Actively Disengaged % Dx with Depression Over the Next Year % Dx with Anxiety Over the Next Year Source: Robison, Gallup Management Journal (2010) 1.7x Increase for Disengaged EEs compared to Engaged EEs
  67. 67. MARSH & McLENNAN AGENCY LLC THE REALITIES OF WORKPLACE STRESS IN AMERICA • 69% of adults with high stress report increased stress over past year; 35% report increased stress overall. (APA, Feb. 2013) - Main sources of stress: Money (69%) , Work (65%) • 80% of workers feel stress on the job. (American Institute of Stress, 2011) • Workplace stress is as bad for the heart as smoking & high cholesterol. (JAMA, Oct. 2007) • 90% of all visits to primary care doctors are related to stress. (JOEM, Oct. 1998) 72
  68. 68. MARSH & McLENNAN AGENCY LLC WORKPLACE OVERLOAD Indicators of Poor Career Well-Being 73October 2, 2013
  69. 69. MARSH & McLENNAN AGENCY LLC Section 3 WHY CULTURE MATTERS The Link to Well-Being & Sustainability
  70. 70. MARSH & McLENNAN AGENCY LLC ORGANIZATIONAL CULTURE
  71. 71. MARSH & McLENNAN AGENCY LLC A HIGH-PERFORMING CULTURE: Beyond Engagement 76 Engaged Enabled Energized A work environment that supports productivity & performance Attachment to the company & willingness to give extra effort Individual physical, social & emotional well-being at work Source: Adrian Gostick & Chester Elton, All In: How the Best Managers Create a Culture of Belief and Drive Big Results (2012)
  72. 72. MARSH & McLENNAN AGENCY LLC COMPETITIVE ADVANTAGE OF E + E + E 9.9% 14.3% 27.4% Companies with Low Engagement Companies with High Engagement Companies with High Levels of E+E+E Operating Margin 77 Source: Adrian Gostick & Chester Elton, All In: How the Best Managers Create a Culture of Belief and Drive Big Results (2012) 3x Higher
  73. 73. MARSH & McLENNAN AGENCY LLC LEADERSHIP CREATES CULTURE 50-70% of employee’s perception of the organization’s climate can be traced to the actions of the leaders. 78 Sources: Consortium for Research on Emotional Intelligence in Organizations (2001); Adrian Gostick & Chester Elton, All In: How the Best Managers Create a Culture of Belief and Drive Big Results (2012)
  74. 74. MARSH & McLENNAN AGENCY LLC 79 LEADERS’ ROLE IN WELL-BEING • Leaders shouldn’t ignore well-being as if it’s beyond the scope of their jobs. • People who agree their manager cares about them as a person: – Are more likely to be top performers – Produce higher quality work – Are less likely to be sick – Are less likely to change jobs – Are less likely to get injured on the job Source: Rath & Harter (2010), Wellbeing: The Five Essential Elements
  75. 75. MARSH & McLENNAN AGENCY LLC SHIFTING FROM BEHAVIOR CHANGE TO CULTURE “Behavior change is really the mantra of wellness, but if a person achieves a lifestyle behavior change, only to return to the same unhealthy environment, what can we expect will happen? We set up wellness for failure if we don’t work on improving the environment and culture before we work on individual behavior change.” (Dee Edington, Ph.D., The Art of Health Promotion, Sept./Oct. 2012) 80
  76. 76. MARSH & McLENNAN AGENCY LLC IF YOU DON’T MANAGE CULTURE, IT WILL MANAGE YOU 81
  77. 77. MARSH & McLENNAN AGENCY LLC WELL-BEING VALUE PROPOSITION 6 Components to Effective Well-Being 1. Data Collection / Analysis 2. Strategic and Annual Planning 3. Establish Foundation for Ongoing Support 4. Quality Coaching and Support 5. Environmental Support 6. Resource Allocation 82October 2, 2013
  78. 78. MARSH & McLENNAN AGENCY LLC CONTACT INFORMATION Rosie Ward, Ph.D., MPH, MCHES, BCC Certified Intrinsic Coach®, Certified Valuations Specialist Health Management Services Manager Marsh & McLennan Agency wardr@rjfagencies.com, (763) 548-8861 www.rjfagencies.com www.DrRosieWard.com © Copyright 2013. RJF, a Marsh & McLennan Agency LLC company. All Rights Reserved. The content provided in this presentation is proprietary and confidential and not for distribution without written consent from MMA.
  79. 79. on Robison holds a doctorate in health education/exercise physiology and a mas science in human nutrition from Michigan State University where he has been aching for 20 years in the Nutrition and Physiology Departments as an Adjunc ssistant Professor. Dr. Robison is also adjunct Associate Professor at Western ichigan University where he teaches in the Holistic Health Care Program. He h thored numerous articles and book chapters and is a frequent presenter at nferences throughout North America. Dr. Robison specializes in health promotion and human behavior, with a particu terest in why people do what they do and don’t do what they don’t do. His book he Spirit and Science of Holistic Health More than broccoli, jogging and bottled water More than yoga, herbs and meditation esents a radically new direction for health education and promotion. Dr. Robis ork served as the foundation for the award-winning KAILO - one of the first t listic employee-wellness programs in North America. He continues to work wit ganizations to help promote non-coercive, relationship-based personal and ganizational health. Dr. Robison has served as co-editor of the journal Health At Every SizeTM – a one of the featured health professionals in the powerful Documentary - Amer e Beautiful II - The Thin Commandments. Aside from his work, Dr. Robison’s passions include his wife Jerilyn, music, hu d arranging sports schedules for his 18-year old son, Joshua.
  80. 80. EVIDENCE BELIEF Worksite Wellness At a Crossroads
  81. 81. Evidence vs. Belief
  82. 82. Evidence-Based
  83. 83. “Evidence-Based Medicine” “The integration of best research evidence with clinical expertise and patient values.” Sackett D et al. Evidence-Based Medicine: How to Practice and Teach EBM, 2nd edition. 2000, p.1
  84. 84. “Evidence-Based” Worksite Wellness? Programming Process Weight Loss Motivation
  85. 85. Weight Loss at The Workplace Types of Wellness Coaching Offered: Exercise 85% Weight 83% Nutrition 81% Stress 78% Heart Health 73% Diabetes Health 65% Pregnancy 38% Sleep Management 29% WellnessintheWorkplace2012:AnOptum®ResearchUpdate–N=156
  86. 86. The Legacy of Failure Medicare’s Search for Effective Obesity Treatments “In sum, there is little support for the notion that diets lead to lasting weight loss or health benefits.” American Psychologist, April, 2007
  87. 87. The Legacy of Failure At The Workplace 17 worksites - 2,407 employees Year-long, incentive programs Weight loss – 1.4 to 3.6 pounds Dropout – as high as 76.4% Cawley, National Bureau Of Economic Research, Inc. Working Papers, No. 14987, 2009
  88. 88. The Legacy of Failure At The Workplace “Weight loss money is money down the toilet. Every diet program gets results, but none works beyond two years.” Dee Eddington, HR Magazine, Countering a Weight Crisis, March 1 Sound Business Investment ?
  89. 89. 1.2 lbs. .31 lbs. 5 oz.
  90. 90. To Reward?... Or Not To Reward?: Questioning the Wisdom of Using External Reinforcement in Health Promotion Programs Jonathan I. Robison American Journal of Health Promotion: September/October 1998 Vol. 13, No. 1, pp. 1-3.
  91. 91. Motivation doing something due to pressure or tangible rewards rather than for the fun or interest of it - because someone is trying to get you to do it. doing something because it provides spontaneous satisfaction - doing it because you want to do it. Gagne & Deci, Self-determination Theory & Work Motivation, J.Org.Beh.2005;26:331-362 Extrinsic- Intrinsic-
  92. 92. Incentives: Evidence-Base ?? Curry, Wagner., J.Consult Clin Psych. 1991;59(2):318-323) Windsor, 1988, J.Behav.Medicine;11:407-21 Matson et al., AJHP 1993;7(4):270-80, 295 Koffman DM , et al., AJHP 1998;13:105-111 Redmond et al., Center on Budget and Priority Policies, June 2007 Cochrane Database of Reviews,Cahill & Perera, 2008, Issue 3 Kevin Volpp et al., Randomized Controlled Trial of Financial Incentives, JAMA 2009;360:699-709 Kramer et al., Behavior Therapy 1986:295-301 Obesity Reviews 2007;9, 355-367 Volpp, Financial Incentive-Based Approaches for Weight Loss, JAMA 2008;300, 2631 Geller, Rudd, et. al. Journal of Safety Research 1987;18:1-17. Gingerich SB, et al. Impact of financial incentives on behavior change participation and risk reduction in worksite health promotion, American Journal of Health Promotion 2012;27(2) 25 years of workplace research: Top 13 Reasons Not To Use Incentives Competitions & Incentives for Smoking Cessation, Kate Cahill and Rafael Perera - April, 2011
  93. 93. Extrinsic Motivation Does not produce long-term behavior change Can diminish performance Can diminish creativity Can foster short-term thinking Can encourage cheating, shortcuts, etc. Can become habit forming Can reduce or extinguish intrinsic motivation
  94. 94. Motivation “There are literally hundreds and hundreds and hundreds now of scientific investigations that have shown when you’re autonomously motivated you’re behavior will be more creative, you’ll be a better problem solver, when you encounter obstacles you’ll be able to think outside the box and figure out what to do about them. Dr. Edward Deci - http://www.youtube.com/watch?v=VGrcets0E6I
  95. 95. Motivation your performance will be better particularly at heuristic activities, and your emotions will be much more positive. And very importantly, autonomous motivation is associated with both physical and psychological health.” Dr. Edward Deci - http://www.youtube.com/watch?v=VGrcets0E6I
  96. 96. The Safeway Debacle or… “We all drank the Kool-Aid”
  97. 97. The “Safeway Amendment” “Safeway designed such a plan in 2005 and has made continuous improvement each year. The results have been remarkable, our health care costs for four years have been held constant.” The Rhetoric Steven A Burd, Safeway CEO, Wall Street Journal, June 12, 2009
  98. 98. The “Safeway Amendment” “Safeway designed such a plan in 2005 and has made continuous improvement each year. The results have been remarkable, our health care costs for four years have been held constant.” The Rhetoric Steven A Burd, Safeway CEO, Wall Street Journal, June
  99. 99. The “Safeway Amendment” “Safeway figured out how to incentivize people to take better care of themselves, and they have flat-lined their health care costs for 200,000 employees in the last four years.” The Rhetoric Sen. Thomas R. Carper, Democrat, Delaware, Senate Finance Committee, September, 2009
  100. 100. The “Safeway Amendment” “You know, there’s a guy who has become pretty famous lately, and he’s the CEO of Safeway… Safeway’s health-care costs have gone down. Why can’t we adopt that on a national scale.” The Rhetoric Sen. John McCain, Republican, Arizona, Town Hall Meeting, August, 2009
  101. 101. The “Safeway Amendment” “It’s a program that has helped Safeway cut health-care spending by 13 percent and workers save over 20 percent on their premiums... And we’re open to help employers adopt and expand programs like these.” The Rhetoric President Barack Obama – June – American Medical Association speech
  102. 102. David S. Hilzenrath, Washington Post “Misleading claims about Safeway wellness incentives shape health-care bill” Washington Post Sunday, January 17, 2010
  103. 103. The “Safeway Amendment” The Reality Costs declined by 12.5 % in 2006 Program was not implemented until 2009 (only 11,000 out of 200,000 employees eligible) http://ilovebenefits.healthcarebenefitsnetwork.com/?p=3284
  104. 104. The “Safeway Amendment” The Reality “Although it may seem obvious that charging higher premiums for smoking (body mass index, cholesterol, or blood pressure) would encourage people to modify their habits to lower their premiums, evidence that differential premiums change health-related behavior is scant. Indeed, we’re unaware of any insurance data that convincingly demonstrate such effects.” Volpp, et. Al, Redesigning Employee Health Incentives, NEJM 2011;365:388-390
  105. 105. The “Safeway Amendment” The Reality “We also have a pretty good idea of what doesn’t work, and heading the list are strategies that tie individual employees’ share of health insurance premiums to health-related behaviors and/or meeting benchmarks.” Workplace wellness regulations:First do no harm.The Prevention Institute, The Greenlining Institute, 2013
  106. 106. The “Safeway Amendment” Why Not? Workplace wellness regulations:First do no harm.The Prevention Institute, The Greenlining Institute, 2013 Punitive measures have not been linked to improved health outcomes May instill resentment in employees Shift health costs to the least healthy Most damaging effect on people of color and low-income workers
  107. 107. Take Home The field has been riding the behavioral change horse for 40 years with little to show for it… Paying individuals for forced participation is a step in the wrong direction Motivation Dr. Dee Edington – August 21, 2013 – Edington Associates
  108. 108. Take Home “Don’t ask how you can motivate others. That’s the wrong question.” Ask how you can create the conditions within which others will motivate themselves.” Motivation Dr. Edward Deci - http://www.youtube.com/watch?v=VGrcets0E6I
  109. 109. Take Home Addressing the issues that have the greatest impact on employee health ? Addressing the issues that have the greatest impact on organizational health ? Promoting engagement? Inhibiting it ? Are Our Programs:
  110. 110. EVIDENCE BELIEF Worksite Wellness At a Crossroads How successful do we want to be ? How seriously do we want to be take
  111. 111. uestions & nswers if your message is a if your message is a – Include presenters so your question will be directed toward the appropriate person ( )
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