Work Site Health Promotion Return on Investment

Maximizing the ROI of Worksite Wellness Programs Larry S. Chapman MPH President and CEO Chapman Institute Seattle, WA 98155 (206) 364‐3448 LChapman@ChapmanInstitute.net 1

Agenda• Potential ROI of worksite health promotion efforts• Measuring ROI to meet management expectations• Model of health care utilization• Major pathways for health cost savings• Strategies for maximizing ROI• Objections to WW and counter-arguments• Summary of main points 2 © Chapman Institute, 2010. All rights reserved.

Key TermsEconomic Return: The monetary benefit (savings) associated with a program.Return-on-investment (ROI): The monetary benefit (savings) associated with a program divided by the cost of that program expressed as a percent.Cost/Benefit (C/B) Ratio: The monetary benefit(savings) associated with a program divided by the cost of that program expressed as an integer and/or a decimal.Net Present Value: A commonly accepted way of estimating the time adjusted net monetary benefit(savings) associated with a program expressed as a dollar amount. 4 © Chapman Institute, 2010. All rights reserved.

New Meta-Analysis… Source: Katherine Baicker, David Cutler, and Zirui Song, Workplace Wellness Programs Can Generate Savings, HEALTH AFFAIRS February,2010, 29(2) 1-8. C/B = 1:6.0 5 © Chapman Institute, 2010. All rights reserved.

ROI Studies of Wellness Programs C/B = 1:5.8• Bank of America• Blue Shield of CA• Duke University Traditional• Citibank Newer Programs• City of Birmingham• Coors Outliers• DuPont C/B Ratio• General Foods• General Motors• GlaxoSmithKline• Indiana BCBS• Johnson & Johnson• Life Assurance• Nortel• Prudential• Travelers• Union Pacific• Washoe County Study Number Source: Proof Positive: An Analysis of the Cost-Effectiveness of Worksite Wellness, Chapman Institute, Sixth Edition, 2007. 6 © Chapman Institute, 2010. All rights reserved.

Other Factors• Limited economic scope of studies• Few programs use VBD approaches• Few direct healthcare utilization interventions• Few use “best practice” incentives• Few invest in good evaluation techniques 7 © Chapman Institute, 2010. All rights reserved.

Changing Management Expectations • Platform for integration • Connect to benefits • Becoming aware of the “stakes” • Expect higher ROI • Expect measurement validity • Expect dashboard 9 © Chapman Institute, 2010. All rights reserved.

Tips for Measuring ROI #1 Define economic measures #2 Compare on “direct” only #3 Plan on “multiple” time series #4 Focus on growth rate trends #5 Use same framework each year #6 Look for other explanations #7 Match methods to expectations #8 Evaluate annually #9 Compose annual evaluation report #10 Ask for suggestions for improvement 10 © Chapman Institute, 2010. All rights reserved.

Model will Affect Outcomes PopulationProgram Model Quality of Work Traditional Health Life Approach Approach Management • Fun activity focus • Mostly health focus • Add productivity • No risk reduction • Some risk reduction • Strong risk reduction • No high risk focus • Little high risk focus • Strong high risk focus • Not HCM oriented • Limited HCM oriented • Strong HCM orientedMain Features • All voluntary • All voluntary • Some required activity • Site-based only • Site-based only • Site and virtual both • No personalization • Weak personalization • Strongly personal • Minimal Incentives • Modest Incentives • Major Incentives • No spouses served • Few spouses served • Many spouses served • No evaluation • Weak evaluation • Rigorous evaluationPrimary Focus Morale-Oriented Activity-Oriented Results-Oriented Source: Chapman, Planning Wellness, Chapman Institute, 2008, p. 213. (available on Amazon.com) 11 © Chapman Institute, 2010. All rights reserved.

Reasonable Expectations?Usual Outcomes:• 45% to 95% participation• 10% to 35% increase in behavior change• 2% to 12% reduction in risk prevalence• 17% - 28% reduction in sick leave• 0% to 47% reduction in per capita health costs• 15% to 25% reduction in per capita health cost trends• ROI = 1:1.7 to 1:7.4 12 © Chapman Institute, 2010. All rights reserved.

Factors that Healthcare Utilization Demand-Side Factors Supply-Side FactorsSupply-Side Factors (inside the individual) (outside the individual) (outside the individual) Age* Regional or local Extent and scope of Gender practice patterns insurance coverage* Provider incentives Point-of-use cost Sense of affecting diagnosis Personal sharing* responsibility health and treatment for personal behavior* decisions* Geographic access health* to services Clinical risk Attitudes factors* about Current personal morbidity* health and* = Potentially modifiable. health Self-efficacy* care use* Source: L. Chapman, 2008 14 © Chapman Institute, 2010. All rights reserved.

Pathways to Health Cost Savings• High risk intervention• Medical self-care• Consumer health skills• Early detection• Risk reduction• Targeted follow-up• Disease/condition management• Injury prevention• Treatment decision support• Point-of-use cost sharing• Comparative price information• Comparative provider information• Avoiding iatrogenic risk 16 © Chapman Institute, 2010. All rights reserved.

Key Strategies for Increasing ROI#1 Expand economic measures#2 Enhance risk reduction/mitigation#3 Move to PHM program model#4 Include spouses#5 Require an annual HRA#6 Target benefit communications#7 Provide medical self-care and Consumer health education#8 Address injury prevention#9 Use coaching intervention#10 Use multiple Wellness criteria Source: Chapman, L., Health Cost Management Strategies for Health Promotion Programs, TAHP, 2002, Jan/Feb 5(6), p. 12. 18 © Chapman Institute, 2010. All rights reserved.

Key Strategies for Program Effectiveness • Ongoing methods for raising awareness • Ability to enhance motivation • Opportunity to learn new skills associated with new behavior • Opportunity to practice those new behavioral skillsSource: O’Donnell, M., A Simple Framework to Describe What Works Best: Improving Awareness, Enhancing Motivation, Building Skills andProviding Opportunity, The Art of Health Promotion, American Journal of Health Promotion, September/October, 2005, 20(1):1-12 19 © Chapman Institute, 2010. All rights reserved.

Issues Effecting Wellness Program ROI “Situation-related” Issues “Implementation-related” Issues• High risk prevalence • Behavioral targets selected• Older work force • Program interventions used• Turnover profile • Number of “touches”• Greater occupational risks • Quality of implementation efforts• Measurement methods used • Plan design compatibility• Economic variables measured • Degree of HCM focus• Quality of baseline • Incentives used• Intensity of intervention • Senior management support• “Generosity” of health plan • Degree of integration• Years of operation• Attitudes of employees• Extent of reach to spouses• Capital investment level• Balance of virtual vs. site-based © Chapman Institute, 2010. All rights reserved.

Wellness Should be Well IntegratedManagement Strategies Periodic Unified Regular Staff Prospective Function and Integration Administrative Planning Integration Operational Focused Review Structure Meetings Points Review Before After 22 © Chapman Institute, 2010. All rights reserved.

Worksite Wellness “Objections” “Counters”• Too much work • Depends…• Don’t have the money • How much are you spending? • How much will you be pending? • PL 111-148?• ROI not guaranteed • What is? • Do nothing and it will get worse!• Its not our core • Aren’t people part of your core business business?• We are too busy • Are your competitors too busy? 24 © Chapman Institute, 2010. All rights reserved.

Summary of Key Points• Wellness is not “rocket science!”• Wellness just needs the same level of attention that anything else of value deserves• You need to spend money to make money• There are a variety of ways that the economic return from Wellness programs can be increased• Determine what you want from Wellness and then do your homework• Get ready to have fun! 26 © Chapman Institute, 2010. All rights reserved.

Work Site Health Promotion Return on Investment

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