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Successful Engagement Strategies and Return on Investment with Maryam J. Tabrizi, MS, CHES and Ron Goetzel, PhD.

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Successful Engagement Strategies and Return on Investment with Maryam J. Tabrizi, MS, CHES and Ron Goetzel, PhD.

  1. 1. Successful Engagement Strategies and Return on Investment Improving Worksite HealthRon Z. Goetzel, Ph.D. Emory University & Truven Health AnalyticsMaryam J. Tabrizi, M.S. Truven Health Analytics
  2. 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. 3. BACKGROUNDTruven Health Analytics, in partnership with the Emory University Institutefor Health and Productivity Studies (IHPS), conducts empirical research onthe relationship between employee health and work-related productivity,our research helps inform public and private decision makers on issuesrelated to health and productivity management (HPM)OUR MISSION: To bridge the gap between academia, the businesscommunity, and healthcare policy world by bringing academic resourcesinto policy debates and day-to-day business decisions, and bringing healthand productivity management issues into academia 3
  4. 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. 5. WHAT DID AMERICANS REALLY WANT? 5
  6. 6. WHAT DOES THE HEALTHCARE INDUSTRY THINKAMERICANS WANT—MORE HEALTH CARE? 6
  7. 7. OR MORE HEALTH? 7
  8. 8. WHERE IS THE VALUE IN HEALTH CARE? 8
  9. 9. WHAT ARE WE GETTING FOR OUR MONEY 9
  10. 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. 11. IT’S NOT JUST THE EMPLOYER’S PROBLEMEMPLOYERS’ AND EMPLOYEES’ COSTS ARE RISINGRAPIDLYAverage Annual Health Insurance Premiums andWorker 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. 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. 13. SEEMS LIKE A NO BRAINER – RIGHT? 13
  14. 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. 15. LEADING A HEALTHY AND PRODUCTIVE LIFE – NOT EASY 15
  16. 16. GOOD NEWS – WORKSITE HEALTH PROMOTION WORKS! 16
  17. 17. CDC COMMUNITY GUIDE TO PREVENTIVESERVICES REVIEW – AJPM, FEBRUARY 2010 17
  18. 18. SUMMARY RESULTS AND TEAM CONSENSUS Body of Consistent Magnitude of Outcome Evidence Results Effect Finding Alcohol Use 9 Yes Variable SufficientFruits & 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. 19. SUMMARY RESULTS AND TEAM CONSENSUS Body of Consistent Outcome Evidence Results Magnitude of Effect FindingDiastolic blood pressure 17 Yes Diastolic:–1.8 mm Hq Strong 19Systolic 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. 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 SufficientWorker Productivity 10 Yes Moderate Strong 20
  21. 21. WHAT ABOUT ROI?CRITICAL STEPS TO SUCCESS Financial ROI Reduced Utilization Risk Reduction Behavior Change Improved Attitudes Increased Knowledge Participation Awareness 21
  22. 22. HEALTH AFFAIRS ROI LITERATURE REVIEWBaicker K, Cutler D, Song Z. Workplace Wellness Programs Can GenerateSavings. Health Aff (Millwood). 2010; 29(2). Published online 14 January 2010. 22
  23. 23. RESULTS - MEDICAL CARE COST SAVINGSDescription N Average ROIStudies reporting costs and 15 $3.37savingsStudies reporting savings only 7 Not AvailableStudies with randomized or 9 $3.36matched control groupStudies with non-randomized or 6 $2.38matched control groupAll studies examining medical 22 $3.27care savings 23
  24. 24. RESULTS – ABSENTEEISM SAVINGSDescription N Average ROIStudies reporting costs and 12 $3.27savingsAll studies examining 22 $2.73absenteeism savings 24
  25. 25. J&J STUDY – HEALTH AFFAIRS, MARCH 2011 25
  26. 26. HEALTH RISKS – BIOMETRIC MEASURES -- ADJUSTED Results adjusted for age, sex, region * p<0.05 ** p<0.01 26
  27. 27. HEALTH RISKS – HEALTH BEHAVIORS -- ADJUSTED Results adjusted for age, sex, region * p<0.05 ** p<0.01 27
  28. 28. HEALTH RISKS – PSYCHOSOCIAL -- ADJUSTED Results adjusted for age, sex, region * p<0.05 ** p<0.01 28
  29. 29. ADJUSTED MEDICAL AND DRUG COSTS VS. EXPECTEDCOSTS FROM COMPARISON GROUP Average Savings 2002-2008 = $565/employee/year Estimated ROI: $1.88 29 $3.92 to $1.00 -
  30. 30. HERO STUDY – FIRST PUBLISHED IN 1998 30
  31. 31. UPDATED STUDY PUBLISHED IN 2012 31
  32. 32. HERO STUDY UPDATE: November 2012 1998 2012Data collection period 1990-1995 2005-2009Claims data (MarketScan®) Medical Medical and PharmacyEnrollment Health Plan Health PlanHRA StayWell StayWell“N” Employees 46,026 92,486Person Years 113,963 272,834Methods Truven Health/HERO Truven Health/HERO (enhanced)Publication JOEM Health AffairsSponsor HERO ASH/HealthyRoads 32
  33. 33. VARIABLES• Outcome Variables – Annualized medical utilization and expenditures • Total allowed charges (inpatient, outpatient, and pharmaceutical), including both the employer and employee shares of costs • Costs were inflation-adjusted to 2009 U.S. dollars using the general Consumer Price Index from the Bureau of Labor Statistics• Predictors- Health Risks Alcohol use Body weight, height, BMI Tobacco use Diet/nutrition Stress level Physical activity Depression Blood glucose Blood pressure (systolic and diastolic) Total Cholesterol 33
  34. 34. DESCRIPTIVE RESULTS SUMMARYHigh Risk Category Prevalence: HERO I Prevalence: HERO IIPoor Exercise Habits 32% 36%Obesity 20% 32%Poor Nutritional Habits 20% 64%High Stress 19% 17%Current Tobacco User 19% 22%High Cholesterol 19% 10%High Blood Glucose 5% 10%High Alcohol Use 4% 5%High Blood Pressure 4% 8%Depression 2% 11% 34
  35. 35. RISK-COST IMPACTS- HERO II EXHIBIT 1 Average Unadjusted And Adjusted Medical Expenditures, In 2009 Dollars, By Risk Levels Unadjusted Risk Unadjusted Adjusted difference Adjusted difference Risk measure level means ($) 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. 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. 37. HERO II: IMPACT OF COEXISTING MULTIPLE RISK FACTORS ON COST with multiple risk Without any of the risk factors factors %differerenceHigh risk for heart disease $10,134 $3,232 213.57%High risk for stroke $6,137 $3,786 62.09%High risk for psychosocialproblems $6,165 $3,838 60.62%Risk-free individual is estimated to have medical expenditures of $3,207Risks for heart disease include: tobacco use, high blood pressure, high blood glucose, high cholesterol, lack of exercise, obesity andstressRisks for stroke include: tobacco use, high blood pressure, high cholesterol, and stressRisks for psychosocial problems include: stress and depression 37
  38. 38. HERO II: ESTIMATED EFFECT OF EACH RISK CATEGORY ON ANNUAL MEDICALEXPENDITURES Estimated Effect of Each Risk Category on Annual Medical Expenditures, Independent of All other Risk Categories and Controlling for Covariate Factors* High-Risk Group Annual Effect (Effect Estimated Prevalence: Per High_Risk High-Risk Group Annual High_risk Group Annual Effect Annual Effect Per Number of Person x Effect as Percent of on a Per Capita Basis (High-Risk High Risk Person People at High Prevalence) Annual Total Group Annual Effect/ 92486 Risk Category ($) 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. 39. Identifying “Best Practices” in Workplace HealthPromotion: What Works?Source: Goetzel RZ, Shechter D, Ozminkowski RJ, Reyes M, Marmet PF, Tabrizi M, ChungRoemer 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. 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. 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. 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. 43. Health Promotion Programs — What Works?State-of-the-ArtIntervention 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. 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. 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. 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. 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. 48. Employee Characteristics 48
  49. 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 SourcesRisk 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. 50. RESULTS – 62% PARTICIPATION RATEMEDICAL 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. 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. 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. 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. 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. 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. 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 schoolsPromote 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, educateAdvocate 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 trailsBuild 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. 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. 57

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