Next Practices and Best Places to Work with Dee Edington
HPCareer.net ---Health Promotion Live Health Management as a Serious Business Strategy Achieving Zero Cost Trends and A BestCompany to Work forTHE UNIVERSITY OF MICHIGAN HEALTH MANAGEMENT RESEARCH CENTER Dee W. Edington
What if you worked for the bestcompany you could imagine.A company that was a highperforming company and a bestcompany to work for.What words would you use todescribe the workplace and howwould you describe the workforce?
Business ProblemCurrently, most costs associated withworkplace and workforce performanceare growing at an unsustainable rateHow are we going to be successful inthis increasingly competitive worldwithout a healthy and high performingworkplace and workforce? How can we turn costs into an investment?
UM-HMRC Corporate Consortium Ford Steelcase (H) Delphi Progressive (H) Kellogg JPMorgan Chase (H) We Energies Affinity Health System (H) General Motors SW MI Healthcare Coalition (H) Crown Equipment Delphi Automotive *The consortium Southern Company members provide University of Missouri health care insurance Medical Mutual of Ohio for over two million Florida Power and Light individuals. Data are St Luke’s Health System available from three to St Joseph Health System 20 years. Allegiance Health System Meets on First Cuyahoga Community College Wednesday of each United Auto Workers-General Motors December in Ann Arbor. American Construction Benefits Group Wisconsin Education Association Trust Australian Health Management Corporation
HPCareer.net ---Health Promotion LiveHealth as a Serious Business and Economic Strategy February 25, 2011Natural Flow of a Population High Risks and High Costs Health as a Serious Business andBusiness Case Economic Strategy Change the Economic Assumptions from TreatingMission Disease to the 21st Century Assumptions about Creating and Maintaining Healthy Populations Engage Champion Companies in Systematic, SystemicSolution and Sustainable Five Pillars which Promote a Healthy and High Performing Workplace and Workforce
Section IThe Current Healthcare Strategy Natural FlowWait for Disease and then Treat(…in Quality terms this strategy translates into “wait for defects and then fix the defects” …)
Estimated Health RisksHealth Risk Measure High RiskBody Weight 41.8%Stress 31.8% From the UM-HMRC MedicalSafety Belt Usage 28.6% Economics ReportPhysical Activity 23.3% Estimates based on the age-Blood Pressure 22.8% gender distribution of a specificLife Satisfaction 22.4% corporate employee populationSmoking 14.4%Perception of Health 13.7%Illness Days 10.9% OVERALL RISK LEVELSExisting Medical Problem 9.2% Low Risk 0-2 risksCholesterol 8.3% Medium Risk 3-4 risksAlcohol 2.9% High Risk 5 or moreZero Risk 14.0%
Risk Transitions (Natural Flow) High Risk 2,373 (50.6%) Time 1 – Time 2 (>4 risks) 4,691 (10.8%) 1,961 Medium Risk (18.4%) 5,226 (12.1%) (3 - 4 risks) 892 4,546 10,670 (24.6%) 1640 (35.0%) (3.2%)(42.6%) 678 11,495 (26.5%) (14.4%) 5,309 (19.0%) 4,163 (39.0%) 27,951 (64.5%) Average of three years Low Risk 26,591 (61.4%) between measures (0 - 2 risks) 21,750 (77.8%)Modified from Edington, AJHP. 15(5):341-349, 2001
Total Medical and Pharmacy Costs Paid by Quarter for Three Groups 9000 Serious Cost The 20-80 rule is 8000 Medium Cost always true but 7000 Low Cost terrifically flawed as a strategy 6000 5000 4000 3000 2000 1000 0 Q_12 Q_10 Q_8 Q_6 Q_4 Q_2 Q0 Q2 Q4 Q6 Q8 Q10 Q12Musich,Schultz, Burton, Edington. DM&HO. 12(5):299-326,2004
Costs Associated with Risks Medical Paid Amount x Age x Risk Annual Medical $11,909 $11,965 Costs $10,785 $7,991$12,000 $5,710 $8,927 $5,114 $7,989 $9,000 $6,625 $8,110 $6,636 $4,620 $6,000 $3,353 $5,212 $2,565 $3,800 $2,944 $5,756 High $3,000 $1,414 $4,613 $3,734 Med Risk $2,193 $2,740 Non-Participant $1,776 $0 Low 19-34 35-44 45-54 55-64 65-74 75+ Age RangeEdington. AJHP. 15(5):341-349, 2001
Section II Build the Business Case for the Health as a Serious Economic Strategy (200+ Publications)Engage the Total Population to get to the Total Value of Health Complex Systems (Synergy & Emergence) versus Reductionism (Etiology)
Excess Diseases Associated with Excess Risks (Heart, Diabetes, Cancer, Bronchitis, Emphysema Percent with Disease 100.0% 80.00% 80.0% 56.40% 61.40% 60.0% 25.30% 40.0% 32.00% High 20.0% 9.50% 18.60% Med Risk 3.00% 10.50% 0.0% Low Risk Less than 45 45 to 64 Greater than 65 Age RangeMusich, McDonald, Hirschland, Edington. DiseaseManagement & Health Outcomes 10(4):251-258, 2002.
Excess Medical Costs due to Excess Risks $6,000 $5,520 Excess Costs $5,000 Base Cost $4,000 $3,321 $3,460 $3,039 $3,000 $1,261 $840 $2,199 $2,000 $1,000 $0 Low Risk (0-2 HRA Non- Medium Risk (3- High Risk (5+ Risks) Participant 4 Risks) Risks)Edington, AJHP. 15(5):341-349, 2001
Change in Costs follow Change in Risks Cost increased $600 $400 $200 $0 Cost reduced -$200 -$400 -$600 3 2 1 0 1 2 3 Risks Reduced Risks IncreasedOverall: Cost per risk reduced: $215; Cost per risk avoided: $304 Actives:Cost per risk reduced: $231; Cost per risk avoided: $320 Retirees<65: Costper risk reduced: $192; Cost per risk avoided: $621 Retirees>65: Cost per riskreduced: $214; Cost per risk avoided: $264Updated from Edington, AJHP. 15(5):341-349, 2001.
Medical and Drug Cost (Paid)* $4,000 Slopes differ P=0.0132 $3,500 $3,000 Paid Non-Impr Improved $2,500 $2,000 Impr slope=$117/yr Nimpr slope=$614/yr $1,500 2001 2002 2003 2004 YearImproved=Same or lowered risks
Business Case Zero Trends follow “Don’t Get Worse” and“Help the Healthy People Stay Healthy”
The Economics of Total Population Engagement and Total Value of Health Total Value of Health Medical/Hospital Drug Low or Health Disease AbsenceNo Risks Risks Disability Worker’s Comp increase Effective on Job increase Recruitment decrease Retention MoraleWhere does cost turn intoan investment?
Health and Wellness Programs Healthier Better Gains for The Person Employee Organization 1. Health Status 2. Life Expectancy 3. Disease Care Costs Lifestyle 4. Health Care Costs Change 5. Productivity a. Absence b. Disability c. Worker’s Compensation d. Presenteeism Health e. Quality Multiplier Management 6. Recruitment/Retention Programs 7. Company Visibility1981, 1995, 2000, 2006, 2008 D.W. Edington 8. Social Responsibility
In December of 2006 we celebrated the first 30 years of our work: the BusinessCase was solid, although not yet perfect. Congratulations! However, nothing has changed in the population No more people doing physical activity No fewer people weighing less No fewer people with diabetesWhy the disconnect between the business case and the intervention outcomes?
The world we have made as a result of the level of thinking we have done thus far creates problems we cannot solve at the same level of thinking at which we created them. - Albert Einstein
Where do we go next?TO A NEW LEVEL OF THINKING…
… to a Transformation from the Tired Old20th Century Assumptions About Disease to the New 21st Century Assumptions About Healthy and High Performing Populations From Health as the Absence of Disease to Disease as the Absence of Health From the Cost of Disease to the Total Investment and Value of Health From Individual Participation to Total Population Engagement From Behavior Change to Integration of Health into the Culture
Section III The Evidence-Based Solution: Zero Trends Integrate Health into the Environment and the Culture(…in Quality terms this strategy translates into “…fix the systems that lead to the defects” …)
Vision for Zero Trends Zero Trends was written to be a transformational approach to the wayorganizations ensure a continuous healthy and high performing workplace and workforce Based upon 175Research Publications
Integrate Health into Core Business Healthier Better Gains for The Person Employee Organization 1. Health Status 2. Life Expectancy 3. Disease Care Costs Lifestyle 4. Health Care Costs Change Company Culture 5. Productivity and Environment a. Absence Senior Leadership b. Disability Operations Leadership c. Worker’s Compensation Self-Leadership Wellness Reward Positive Actions d. Presenteeism e. Quality Multiplier Programs Quality Assurance 6. Recruitment/Retention 7. Company Visibility1981, 1995, 2000, 2006, 2008 D.W. Edington 8. Social Responsibility
Characteristic of a Champion Company Systematic StrategiesMake the Solutions Systemic Make it Sustainable
Senior Leadership Create the Vision •Commitment to healthy culture •Connect vision to business strategy •Engage all leadership in vision“Establish the value of a healthy and high performingorganization and workplace as a world-wide competitiveadvantage”
Operations Leadership Align Workplace with the Vision •Brand health management strategies •Integrate policies into health culture •Engage everyone“You can’t put a changed person back into the sameenvironment and expect the change to hold”
Population Health Benefit Strategy Sickness Management --reduce errors --coordinate services Disease Management Health Management --stay on protocol --healthy stay healthy --don’t get worse --don’t get worseWhere is the economic strategy?
Integrate all of the outsourced partners Integrate all of the internal resources Coordinate all of the resources towards a healthy and highperforming environment and culture (follow the safety and quality strategies)
Promote Self Leadership Create Winners •Help employees not get worse •Help healthy people stay healthy •Provide improvement and maintenance strategies“Create winners, one step at a time and the first stepis don’t get worse’
Population-Based ResourcesWeight Management Business Specific ModulesPhysical Activity Career developmentStress Management CommunicationsSafety Belt Use Financial ManagementSmoking cessation Social/Information NetworksNutrition EducationDisease Management Clinic or Medical CenterOn-Line Information ErgonomicsNurse LineNewsletters Vision DentalBehavioral Health & EAP HearingPharmacy Management Chiropractic Complementary CareCase Management Integrative MedicineAbsence Management Physical TherapyDisability Management
Recognize Positive Actions Reinforce the Culture of Health •Reward champions •Set incentives for healthy choices •Reinforce at every touch point“What is rewarded is what is sustained”
Positive Re-Enforcement Culture reminders (Managers, Leaders,…) Cash, debit cards ($25 to $200) Benefit Design (HSA contributions) Hats and T-Shirts Population programs Surprise events Decorate stairwells Special cafeteria/vending offerings Organizational rewards (Departments…)
Quality Assurance Outcomes Drive the Strategies •Integrate all resources •Measure outcomes •Make it sustainable“Metrics to measure progress towards the vision,culture, self-leaders, actions, economic outcomes”
Overall Business Strategy Pillar 2: Operations LeadershipWhat is your vision? Recognize Senior Operational Self- Positive Quality Leadership Leadership Leadership Actions Assurance Vision Healthy Everyone Recognize Progress Champion from System & a Self- Positive in All Leaders Culture Leader Actions Areas Speech Reduce Change in Reduction Reward Risk & Comprehensive from Health in Risks Achievement Sick Costs Leader Risks Programs Health Inform Targeting Reward Change in Traditional Risk Leader Risks Enrollment Risks Awareness Do Nothing Status Quo Status Quo Status Quo Status Quo Status Quo
New Tools for the TransformationNext Generation Health Risk Assessments Corporate Culture and Environmental Audit and Gap Analyses Where do Employees go after Work? Community and Home From Best Practices to Next Practices
Characteristic of a Champion Company Systematic StrategiesMake the Solutions Systemic Make it Sustainable
Thank you for your attention. Please contact us if you have any questions.Phone: (734) 763 – 2462Fax: (734) 763 – 2206Email: email@example.comWebsite: www.hmrc.umich.eduDee W. Edington, Ph.D. , DirectorHealth Management Research CenterSchool of KinesiologyUniversity of Michigan1015 E. Huron StreetAnn Arbor MI 48104-1689