What are the health issues among operators/drivers and how do they impact your company’s safety? Have you adequately addressed your employees’ needs to adapt to their unique lifestyle challenges? From the company perspective, is the cost and productivity opportunity of developing a program and culture of organi Piedmont Wealth Advisory and a representative from Blackrock Investments. Learn how to develop and implement a successful health and wellness program. Mr. Johnson will provide the latest results from CMV operator studies on obesity, depression and sleep apnea and provide tips and tools to integrate technology into your employees’ wellness program to engage and motivate your employees. Speaker: Randall Johnson, Vice President, Hays Companies

1. Enterprise Cost Containment –
A Workforce Health Perspective
November 8, 2017
Randall M Johnson
Vice President
Employer Benefits and Workforce Health Advisor

2. Workforce Health: Agenda
2
A common ground
Impact on profits
Impact on organizational engagement
The broad approach of integrating health messaging
Using data
Closing comments: high cost claimants & personal
choice

3. Managing Human Capital and Risk
Organizational Health Culture…
Workforce Health and Wellbeing…

4. Organization Health and Workforce
Wellbeing:Affordable Workforce
4
Organizational Costs
1. Medical
2. Workers Compensation
3. Recruitment/Retention
4. Productivity
5. CMV – License Status

5. WHY IS WORKFORCE HEALTH SO
IMPORTANT?
5

6. Why Is YOUR Organization in Business?
And What is It’s Primary Objective? 6

7. Ultimately – Don’t ALL Organizations Share
One Common Objective?
7

8. So Does Health Really Impact the Bottom
Line?
8
“A portfolio of companies
recognized as award winning for
their approach to the health and
safety of their workforce
outperformed the
market.…
Nevertheless, the literature
increasingly links the health
of a workforce to its safety
and performance…
…the evidence seems to be
building that healthy
workforces provide a
competitive financial
advantage in the
marketplace.”
The Link Between Workforce Health & Safety
and the Health of the Bottom Line, Fabius,
Thayer et al, JOEM, Vol 55, No 9, September
2013

9. Workforce Health: The Value Proposition
9
9
A well-managed health and safety
program
A positive and caring image
Improved staff morale
Reduced staff turnover
Reduced absenteeism
Increased productivity
Reduced health care/insurance costs
Reduced risk of fines and litigation
TO THE
ORGANIZATION
TO THE
EMPLOYEE
A safe and healthy work environment
Enhanced self-esteem
Reduced stress
Improved morale
Increased job satisfaction
Increased skills for health protection
Improved health
Improved sense of well-being
http://www.who.int/occupational_health/topics/workplace/en/index1.htmlhttp://www.who.int/occupational_health/topics/workplace/en/index1.html

10. Workforce Health: The Financial Impact
10

11. Workforce Health: The Productivity Impact
11

12. National Surface Transportation Safety Center for Excellence
 86% of CMV drivers are overweight and 69% are obese
(BMI over 25)
– 68% of U.S. are overweight
– 34% of U.S. are obese
– 61% of CMV drivers reported two or more risk factors for
cardiovascular disease
 High blood pressure
 Obesity
 Smoking,
 High cholesterol
 No physical activity
 Sleep deprivation
12
Ellin, Abby (2011-11-21). “A Hard Turn: Better Health on the Highway”. The New York Times. Retrieved 2012-03-14.
Sieber WK, Robinson CF, Birdsey J, Chen GX, Hitchcock EM, Lincoln JE, Nakata A, Sweeney MH (June 2014). "Obesity and other risk factors: the national survey of
U.S. long-haul truck driver health and injury". American Journal of Industrial Medicine 57 (6): 615–26.

13. Chronic Disease - Obesity & Health Care Cost
13
A
B
C

14. Health Related Conditions
 Increased risk for:
– Hypertension
– Dyslipidemia
– Sleep apnea
– Type 2 diabetes
– Coronary heart disease
– Stroke
– Gallbladder disease
– Osteoarthritis
14

15. Short-Poor Sleep Habits
 Transportation Industry has a fragmented work
schedule
– Short Sleep Periods
– Poor Quality of Sleep
– Wake time Fatigue
– Certain Transportation Segments
 Average only 3.8 to 5.2 hours of Sleep
– Sleep impaired driving attributed to commercial vehicle accidents
 7% of CVM crashes (NTSB)
– Obstructive sleep apnea (OSA) one of the most common sleep
disorders
 Estimated 1 in 4 CMV drivers has OSA in the U.S.
15

16. Federal Law
 H.R.3095 - To ensure that any new or revised requirement
providing for the screening, testing, or treatment of individuals
operating commercial motor vehicles for sleep disorders.
– 391.41(b) - Federal Motor Carrier Safety Administration - A person is
physically qualified to drive a commercial motor vehicle if that person:
 Has no established medical history or clinical diagnosis of diabetes mellitus currently
requiring insulin for control
 Has no current clinical diagnosis of myocardial infarction, angina pectoris, coronary
insufficiency, thrombosis,
 Any other cardiovascular disease of a variety known to be accompanied by syncope,
dyspnea, collapse, or congestive cardiac failure,
 Has no established medical history or clinical diagnosis of a respiratory dysfunction
likely to interfere with his/her ability to control and drive a commercial motor vehicle
safely.
 Has no current clinical diagnosis of high blood pressure likely to interfere with his/her
ability to operate a commercial motor vehicle safely
 Has no established medical history or clinical diagnosis of a rheumatic, arthritic,
orthopedic, muscular, neuromuscular or vascular disease which interferes with
his/her ability to control and operate a commercial motor vehicle safely
16

17. Health Related Conditions of OSA
 Obesity
 Cardiovascular Disease
– High Blood Pressure
– Coronary Heart Disease
– Stroke
– Abnormal Heart Rhythm
 Metabolic Disease
– Diabetes and insulin resistance
 Depression
 Cognitive Impairment
17

18. CMV- Transportation Emotional Related Stress
 Social Isolation
 Dangerous – High Risk
 Lack of Job Satisfaction- Control
 Chronic Fatigue
 Relationship Impact
– Mental Health – Depression
 Motivation for Health and Lifestyle
– Poor Eating and Nutritional Habits
– Lack of Exercise
 High Tobacco usage > than 50% of CMV drivers
18

19. Type 2 Diabetes
 CVM Prevalence vs. US Population:
– 16% vs 9.4%
 Controlled Diabetes
– Lifestyle (Nutrition and Exercise)
– Medications
 Uncontrolled Diabetes
– Neuropathy
– Impaired Vision
– Heart Disease/Stroke
– Kidney Failure
19

20. Diabetics and Healthcare Costs
20
XYZ Incorporated
Chronic Disease - Combined
Chronic Disease - Combined Mbrs % Mbrs Plan Paid % Paid Paid/Mbr
Total 22,381 100.00% $93,069,202 100.00% $4,158
Chronic Disease Members 8,449 37.75% $63,978,460 68.74% $7,572
High Blood Pressure Patients 5,032 22.48% $46,781,296 50.27% $9,297
Depression-related Disorder Patients 2,594 11.59% $25,742,416 27.66% $9,924
Diabetics 2,008 8.97% $16,941,130 18.20% $8,437
Asthmatics 1,938 8.66% $14,389,578 15.46% $7,425
Coronary Heart Disease Patients 502 2.24% $12,652,309 13.59% $25,204
Obesity Patients 277 1.24% $2,571,060 2.76% $9,282
Non-Chronic Members 13,470 60.18% $25,972,580 27.91% $1,928
XYZ Incorporated
Chronic Disease - Diabetic Patients - Additional Conditions
Chronic Disease - Combined Mbrs % Mbrs Plan Paid % Paid Paid/Mbr
Diabetics 2,008 100.00% $16,941,130.02 100.00% $8,437
High Blood Pressure Patients 1,387 69.07% $13,837,840.94 81.68% $9,977
Depression-related Disorder Patients 391 19.47% $5,486,595.80 32.39% $14,032
Coronary Heart Disease Patients 174 8.67% $4,819,261.30 28.45% $27,697
Asthmatics 215 10.71% $3,706,816.09 21.88% $17,241
Obesity Patients 56 2.79% $725,992.67 4.29% $12,964

21. Workforce Health: Impact on Work Comp
Chart data as reported in a 2010 Study Conducted by CHCWS on
the impact of comorbid conditions on WC medical costs
21

22. Obesity – Medical/Workers Comp Costs
22

23. The Right Metrics to Measure Impact
23

24. BUT WAIT…THERE’S ALSO THE IMPACT
ON EMPLOYEE ENGAGEMENT
24

25. Engagement Matters
25

26. Yet Engagement Levels Aren’t that Good
How does your workforce measure up?
26

27. Engagement: Beyond the Organizational Level
27

28. Correlating Engagement with Health Status
28
Engaged employees are 63% more likely
to report excellent health

29. Further Correlation with Engagement & Health
29

30. Workforce Characteristics
30

31. TAKING A BROADER APPROACH TO
BUILDING AN INTEGRATED, HEALTH
CENTRIC CULTURE
31

32. Internal Competition for Employee Time &
Attention
• Expectations
• Culture
• Sales
• Customer Service
• Revenue
• Multiple levels of leadership
• Carriers/vendors/partners
• Emails
• Text messages
• Policies
• Non-verbal
• Safety/Quality Control
• Wellness
• Health benefits
• Continuing Education
• Worksite based
Communications
Offered
Programs
Leadership
32

33. Safety – How It Connects to Health
A great example of a program that has 100%
engagement
 Who doesn’t know about the Safety Program?
 What can we learn from them in terms of
creating a focused culture?
 What can we learn from them in terms of
onboarding?
 What can we learn from them in terms of
communication?
 What can we learn from them in terms of
incentives?
 And most importantly, how can
we connect & build the business
case for well-being by
integrating programs?
33

34. Going Green
Environmental initiatives have a natural
connection to wellness!
 How many opportunities to connect with these
initiatives exist? UNLIMITED!
 Nutrition
 Buy/Eat locally
 Physical activity
 Walking/biking versus driving
 Gardening/compositing
34

35. Acquisitions
Can wellness programs help assimilate cultures
and workers?
 Can help establish commonality between
different locations/populations
 Establishes shared goals and communications
 Can use as a motivator in onsite challenges, for
example, walking or other tracking-type
challenges
35

36. Customer Service
Better health. Better customer service.
 Engagement & good health critical to good
performance
 Call centers, especially, present a unique set of
health risks
− Musculoskeletal (ergonomic opportunity)
− Mental health (stress)
 Does your program customize
options and solutions for your
customer service personnel?
36

37. Production/Productivity
Productivity is not just about
manufacturing!
 It’s not just absenteeism – it’s also presenteeism
 Is a natural link between workforce health and
the organization’s goals
 But how many American
employers are using productivity
measures to evaluate their
workforce health efforts?
37

38. Cost Containment
It just makes cents
 Cost containment occurs at every level within
your organization
 It is also an issue faced by most individuals
 What drives costs in your organization?
− Materials
− Human capital
− Turnover
− Poor quality
 How can your workforce health
efforts connect to these cost
drivers?
38

39. It All Leads to One End Point
39

40. LASTLY, DATA DRIVES DECISIONS
HOW DO YOU VIEW & USE YOUR DATA WHEN
MANAGING YOUR WORKFORCE? 40

41. Financial and Clinical Data
 Benchmark
– Metrics
– Goals
 Measure
– Strategy
– Resources
– Change
41

42. 42
The Continuum of Prevalence and Cost – Employer A
Healthy
58% Prevalence
6% of Cost
Employer A
62.59% Prevalence
23.34% of Cost
At Risk
22% Prevalence
10% of Cost
Employer A
33.41% Prevalence
40.30% of Cost
Chronic
17% Prevalence
29% of Cost
Employer A
3.29% Prevalence
14.8% of Cost
Acute
3% Prevalence
55% of Cost
Employer A
.71% Prevalence
21.56% of Cost
Acute/Catastrophic.
• Disease Management
• Case Management
Poly-Chronic
• Case Management
• Disease Management
• Pregnancy Management
Early Chronic
• Care Coordination
• Pre-disease Education
• Health Coach
• Physician Collaboration
Population Health
• Health Engagement
• Prevention
• Health Risk Assessment
• Health Promotion
Accelerated risk progression
CRITICAL ISSUE
Individual Engagement

43. Relationship Between Lifestyle Risks & RX
Solutions
43
Next Steps: Understanding the organization’s
position on encouraging medication usage
over making lifestyle changes
Statins are a class of drugs often prescribed by doctors to help lower cholesterol levels in the
blood. By lowering the levels, they help prevent heart attacks and stroke. Statins have been shown
to reduce the risk of heart attack, stroke, and even death from heart disease by 25% to 35%

44. Male Employee Risk Factors by Cost
44
BMI Underweight (18.5 or less)
BMI Normal (18.5 – 24.99)
BMI Overweight ( 25 to- 29.99)
BMI Obese Class I (30 – 34.9)
BMI Obese Class II (35-39.9)
BMI Obese Class III (40 or greater)
B.P. Normal (systolic <120 and diastolic <80)
B.P. PreHTN (systolic 120-139 or diastolic 80-89)
B.P. Stg 1 (systolic 140-159 or diastolic 90-99)
B.P. Stg 2 (systolic >160 or diastolic >100)
In terms of costs, the highest risk categories are
age (over 60), stage 1 hypertension and weight
(Obese Class II and III).

45. Lifestyle Risk Factors for WC Claimants
45
Next Steps: Modify wellness
offerings/focus, change messaging,
evaluate shift policies, etc.

46. Traditional Continuum of Costs
46

47. Wellness Score Card Target
1) Total Employee Count ---
2) Covered Employees ---
3) Covered Spouses ---
4) Screening Participation
Health Measure Outcomes
5) Prehypertension and Hypertension 62.1%
6) High Cholesterol 25.3%
7) LDL<= 130 16.6%
8) At Risk BMI 75.5%
9) Pre-diabetes and Diabetics Not offered
10) A1c Not Controled 16.9%
Claim Experience (ee / sp)
#
Members
%
Members
Plan
Paid
Paid /
Member
#
Members
%
Members
Plan
Paid
Paid /
Member
#
Members
%
Members
Plan
Paid
Paid /
Member
11) Alcohol Related Disorders 7 0.6% $113,398 $16,200 9 0.7% $194,944 $21,660 10 0.7% $282,956 $28,296
12) Asthma (1) 29 1.6% $485,928 $16,756 28 1.3% $248,895 $8,889 48 2.0% $463,497 $9,656
13) Certain Types of Cancer (2)
30 2.7% $133,496 $44,450 47 3.4% $893,578 $19,012 46 3.0% $923,991 $20,087
14) Coronary Heart Disease 17 1.5% $123,184 $7,267 25 1.8% $523,227 $21,409 28 2.5% $421,433 $11,090
15) Diabetes 72 6.6% $1,092,829 $8,179 96 7.1% $1,019,520 $10,620 131 8.6% $1,471,618 $11,234
16) Diabetes, A1c test 52 85.3% --- --- 55 58.5% --- --- 75 57.3% --- --- 100%
17) High Blood Pressure 104 9.4% $1,130,311 $10,868 150 11.0% $799,588 $5,331 195 12.8% $1,902,870 $9,758
18) High Cholesterol 17 1.5% $90,540 $5,326 26 1.9% $90,654 $3,487 28 1.8% $139,514 $4,983
19) Mental Health (3)
50 4.7% $526,808 $10,536 55 4.2% $315,244 $5,732 72 4.7% $338,098 $4,696
20) Neck / Back Problems 119 18.0% $1,421,803 $7,444 223 17.0% $2,166,098 $9,713 225 16.7% $1,970,367 $7,727
21) Obesity 2 0.2% $35,293 $17,646 3 0.2% $2,964 $988 9 0.6% $74,443 $8,271
22) Smoking-related disorders 24 2.2% $430,911 $17,955 37 2.7% $253,750 $6,858 48 3.1% $378,316 $7,882
23) Stroke 8 0.7% $280,469 $35,059 12 0.9% $327,377 $27,281 12 1.3% $667,853 $33,393
Preventive / Wellness (ee / sp)
24) Visits 100%
25) Cholesterol Screening 50%
26) Colonoscopy >40 years 10%
27) Mammograpy >40 years 35 - 40%
28) PSA no longer recommended
29) Pap Smear 35 - 40%
Impact
30) Prescription Drug PEPM
31) Paid Claims PMPM
no longer recommended
78.3%
14.0%
4.8%
15.0%
36.2% 37.5%
14.2%
no longer recommended
2015
1175
2013 2014
1153905
18.3%
4.3%
17.1%
7.3%
863 or 75%
18.7%
4.1%
75.5%
58.2%
28.0%
19.5%
71.8%
28.3%
20.2%
$240 $218 $224
673 or 74%
25.0%
$72 $91 $97
20.1%
no longer recommended
36.2%
0.2%
18.9%
873
20.7%20.7%

48. Turning Static Data Points into Actionable
Initiatives
48
Targeted,
Patient Centric
Decision
Making
Program
Participation
HRA-
Biometric
Pharmacy
Claims
Health Plan
Utilization
Claims
Risk-WC
Claims
Safety
 Plan Design
 Targeted
Outreach
 Incentive Design
 Program choices
 Opportunity
Analysis
 Communications
 Risk Stratification
 Partner
Collaboration
 Impact Analysis
 Value Based
Benefits

49. Organizational Health Structure
49

50. Example: Turn-key Wellness Program
50
Focused Health and Wellbeing
Five Pillars of Health

51. Engagement Technology
51

52. Care Path Management
52
Assessment Biometrics Clinical Review Claims Data Vitual Coaching Reporting

53. Employee – Spouse Biometric and Blood Profile
53
Health Screening Intake Review blood panel
 Review biometrics
Other:
 Review Family History
 Review Smoking Habits
 Review Nutrition Habits
 Review Physical Activity
 Review overall health and general mental health
wellbeing, behaviors and attitudes.
 Make recommendations for patient follow up and
referrals to other specialists.

54. Annual Preventative Care Counseling
54
• Age and gender-appropriate review of physical condition, including vital signs such as blood pressure,
height/weight/BMI calculation (utilized to screen for obesity)
• Counseling regarding obesity, weight loss, healthy diet and exercise
• Review of family and personal health risks
• Guidance and counseling regarding substance abuse, alcohol misuse, tobacco
• use, obesity, exercise and healthy diet/nutritional counseling as indicated
• Screening for depression in adolescents and adults
• Behavioral dietary counseling for adults with hyperlipidemia and other known risk factors for
cardiovascular and diet-related disease
• Review of laboratory test results available at the time of the encounter
• Screenings -Cholesterol screening (dyslipidemia) in adults, Screening for glucose levels and tobacco
use

55. Virtual Health Advocate Coaching Engagement
55

56. Populations Health Status Reporting
56

57. Health Gaps in Care Reporting
57

58. Virtual Patient Monitoring –
Primary Care Provider and Coaches
58

59. No
Direct
Cost
Biometric
Screening
Health Risk
Assessment
Clinical
Review
Challenge
Tracking
Software Wellness
Coach and
Consultant
Financial
Wellness
Seminars
Measurable
Analytics
59
A Turn-Key Wellness Program

60. Telehealth - Remote Driver Monitoring
60
1. Polysomnography (PSG) – Sleep Study
2. Home-based sleep testing
3. Continuous positive air pressure
(CPAP)
4. Sleep Oral appliances, and other
effective alternative treatments
5. Pulse oximeter
6. Heart
7. Weight - BMI

61. Workplace Health is an Essential Business Strategy!
61
Employers can impact an Individual in a very Personal Way