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1. Practical Application in Business
John Harris Katie Bell
Chief Wellness Officer Partner
Vice President Innovations Global Wellbeing
Healthways, Inc. Gallup

2. How Poor Health Costs the United States:
$147 billion annual healthcare cost of obesity in the United States
75% of national health expenditures are due to chronic disease
$6,032 the average annual healthcare coverage cost for people with
a chronic condition; five times higher than for those without
$1.3 trillion direct health costs of chronic disease (2006)

3. American Prevention Success Story:

4. Leaders Have The Ability to Correct Public Health:

5. Indirectly responsible
Directly responsible
• How would you describe your personal role
as it pertains to wellness and well-being?
• Not responsible.
• Indirectly responsible
• Directly responsible
www.healthways.com 5

6. Measuring Well-Being
• 25-year commitment, initiated January 2, 2008
Six Domains:
• 1,000 completed surveys per day/7 days/week
1. Life Evaluation
• 1,000,000 completed surveys October 23, 2010
• For results based on this sample of respondents,
2. Emotional Health
the maximum 95% margin of sampling error is 3. Physical Health
±0.3 percentage points
• Science-based design, support and oversight: 4. Healthy Behavior
• Behavioral economists 5. Work Environment
• Psychologists 6. Basic Access
• Experts in psychometric statistical analysis
6

7. Well-Being at the National Level
Well-Being Life Evaluation, U.S. Residents, 2009
Thriving Struggling Suffering
60
50
40
30
20
10
0
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan
2009 2010
Source: Gallup-Healthways Well-Being Index Community Survey 2009, n=353,849

8. Our Nation’s Well-Being by State - 2009
Ranking: Top Quintile Second Quintile Third Quintile Fourth Quintile Bottom Quintile
Source: Gallup-Healthways Well-Being Index Community Survey 2009, n=353,849
8

9. 2009 Congressional District Rankings
Ranking: Top Quintile Second Quintile Third Quintile Fourth Quintile Bottom Quintile
Source: Gallup-Healthways Well-Being Index Community Survey 2009, n=353,849 9

10. 2009 MSA Rankings
Ranking: Top Quintile Second Quintile Third Quintile Fourth Quintile Bottom Quintile
Source: Gallup-Healthways Well-Being Index Community Survey 2009, n=353,849 10

11. • Do you believe an index of this magnitude
can bring value to your business planning:
• No
• Yes, but only indirectly
• Yes, significant value
• This index provides essential information for our
planning
www.healthways.com 11

12. Harvesting the Value of
Well-Being

13. Making the Jump from Health to
Well-Being
www.healthways.com 13

14. Why It Matters:
The Economic Case for Well-Being
Well-Being Total Medical Performance Total Economic
Improves Cost Decreases Increases Value Increases
• Help healthy people • Hospitalizations • Engagement • Public Payers
stay healthy
• Event Rates • Absence • Private Payers
• Mitigate health-related
risk from lifestyle • Disease Rates • Work Impairment • Employers
behaviors
• Lifestyle Risks • Productivity • Communities
• Optimize care for those
with health conditions • States
14

15. Impact of social time on daily affect for
different income levels
Positive affect: happiness, enjoyment, smiling/laughter
Gallup-Healthways Well-Being Index Jan-Dec 2009, controlling for demographics
15

16. BMI and Physical Pain
n = 254,987; after controlling for gender, education, and age
16

17. Real World Examples of
Opportunity

18. Example: Life Evaluation
“Please imagine a ladder with steps numbered from zero at the bottom to
ten at the top. The top of the ladder represents the best possible life for you
and the bottom of the ladder represents the worst possible life for you.
On which step of the ladder would you say you personally feel you stand at this
time?”
Thriving
Average 20% Lower
Six well-being Medical Costs
domains
1. Life Evaluation 7.0
2. Work Quality
3. Basic Access Struggling
4. Healthy
Behavior
4.0
5. Physical Health
Suffering
6. Emotional Average 50% Higher
Health Medical Cost
Source: Gallup-Healthways Well-Being Index Community Survey and
Wellmark Corporate Survey 2008

19. Health Risk By Life Evaluation
Risk Category by Life Evaluation
80%
60% 0-1 risks
2-3 risks
40% 4-5 risks
6-9 risks
20%
0%
Suffering Struggling Thriving
Toward Integration to Enhance Health and Well-Being by Evers, KE, Prochaska, JO, Castle, P. & Prochaska, JM. 2009 (under review)
20

20. Work Impact By Life Evaluation
Activity Impairment, Work Presenteeism and
Work Productivity Loss by Life Evaluation
25%
20%
15%
10%
5%
0%
Toward Integration to Enhance Health and Well-Being by Evers, KE, Prochaska, JO, Castle, P. & Prochaska, JM. 2009 (under review)
21

21. Anger in the Workplace:
Wellness Inhibitor?
“Did you experience the following feelings during A LOT OF THE DAY yesterday: Anger?”
100%
80%
79% 88% 86% No
60%
U.S. Counties
40% Poorest 100
20% Richest 100
31%
12% 14% Yes
0%
Poor Work Quality Work
Nation
Environment Environment
Source: Gallup World Poll, Gallup-Healthways Well-Being Index Community Survey 2008

22. Work Environment Affects Health and
Engagement of a Workforce
Impact of Negative Work Environment
Higher Disengaged Employees / Higher Productivity Losses
80%
Negative Positive or Neutral
70%
60%
50%
40%
30%
20%
10%
0%
Job Impacts Disengaged
Health
Service Mark SM 2008 Gallup-Healthways Well-Being Index. All rights reserved. Copyright © 2008 Gallup, Inc. All rights reserved. Copyright © 2008 Healthways. All rights reserved.

23. Work Environment Impact on Employees With
Chronic Conditions
Days Unable to Carry Out Usual Activities Per Year
16.2 Days/Year
6.6 Days/Year

24. Well-Being Disparities:
Work Environment
Variance from National Score (points) for Congressional Districts of Work Environment:
Top 25 Company Locations (ordered by # team members) Examples
6.3 Job satisfaction and
engagement
Work 4.6
• Satisfaction with
Environ- 3.2
3.6
community
ment 2.8
2.1 2.3 2.1 1.7 • Are you satisfied
Score 1.3 1.3 1.4 or dissatisfied with
(2008) = 0.3 0.1 0.1 0.5 your job or the
work you do?
51.4
• At work, do you
-0.6 -0.9
-1.3 -1 get to use your
-2 strengths to do
what you do best
-3.7 every day?
-4.6 • Does your
supervisor at work
-7.1
Plans with worst work treat you more like
he or she is your
environments were also the boss or your
partner?
worst performers • Does your
supervisor always
-13.4 create an
environment that
is trusting and
Plant 1
Plant 2
Plant 3
Plant 5
Plant 6
Plant 7
Plant 9
Plant 11
Plant 12
Plant 13
Plant 14
Plant 15
Plant 16
Plant 17
Plant 17
Plant 19
Plant 20
Plant 21
Plant 22
Office 1
Office 2
Office 3
Office 4
Office 5
Office 1a
open?
Source: Gallup-Healthways Well-Being Index Community Survey 2008, n= 355,334
Based on congressional district in which Tyson Foods location is based

25. Commute Time and Well-Being
% Reporting Stress
15 Minutes or less 39%
16-30 Minutes 42%
31-45 Minutes 43%
46-60 Minutes 43%
Over 60 Minutes 44%
36% 37% 38% 39% 40% 41% 42% 43% 44% 45%

26. The Impact of Care-Giving
Caregiver Non-Caregiver
Non-Caregiver
Caregiver Caregiver Non- Non-Caregiver Non-
Employed Employed Employed Employed
Composite Score 64.39 57.15 68.00 62.14
Life Evaluation
Index 39.50 25.26 47.29 32.77
Emotional Health
Index 77.35 67.24 81.00 72.62
Physical Health
Index 76.74 61.16 82.26 67.92
Healthy Behavior
Index 62.43 60.38 61.34 60.77
Work
Environment
Index 49.47 n/a 51.19 n/a
Basic Access
Index 80.83 71.71 84.95 76.62

27. Life Evaluation
Smokers vs. Non-Smokers
“Please imagine a ladder with steps numbered from zero at the bottom to
ten at the top. The top of the ladder represents the best possible life for you
and the bottom of the ladder represents the worst possible life for you.
On which step of the ladder would you say you personally feel you stand at this time?”
Smokers Non-Smokers
55%
52%
45%
39%
6%
3%
Thriving Struggling Suffering
Source: Gallup-Healthways Well-Being Index Community Survey 2009, n=353,849
28

28. Emotional Health
Smokers vs. Non-Smokers
“Did you experience the following feelings during A LOT OF THE DAY yesterday?”
% of Respondents Who Answered “Yes”
Smokers Non-Smokers
50%
43%
37%
31%
26% 27%
21%
17%
15%
13%
Worry Stress Anger Sadness Depression
Source: Gallup-Healthways Well-Being Index Community Survey 2009, n=353,849
29

29. Drivers of BMI Risk
Healthy Eating
Energy Level
Exercise Height Weight
Number of
Health Risks
Physical
Coping With Health
Stress BMI Risk
Negative Affect
Personal Emotional
Sources of Health
Presenteeism
Recognition at
Financial Stress
Days of Best Work
Work
The only things we focused on in the “old days”

30. • What best describes your view of focusing
on the broader value proposition of well-
being?
• It does not change my view – well-being is only
semantics
• I can see some value in taking a broader view
• I see significant value in taking a broader view
• I believe a broader view will redefine the value
proposition, making it both measureable and
more substantial
www.healthways.com 31

31. What Innovations Will Emerge?

32. Strategic Process To Drive Sustainable
Engagement
Environment
Measurable Outcomes Business Objectives
Appropriate Interventions Consumer Insights
Sustainable
Engagement
Relevant Incentives Effective Communications
Environment
33

33. Improved Use of Behavior Change Sciences
Putting Science into Practice
Prochaska’s Transtheoretical Model
Decision • Rational decision-making through stages of change
Making • Pro-Change Embedded in Healthways Core Products
Dynamic Intermittent Reinforcement
Behavioral • Predictably irrational decision making in humans
Economics HEALTHHONORS®
• Already in use for medication adherence
Mindfulness and Neuro-plasticity
Emotional and • Paying attention in a particular way: on purpose, in
Social Health the present moment, and non-judgmentally LifeMatters®
• The changing of neurons via new experiences
Social Networks
Social • A social structure of “nodes” which are connected by
Connectivity one or more specific types of interdependency, such as
friendship, kinship, common interest, knowledge, etc.
Gaming theory
Gamification • Fun vs. fulfillment
• Explorer, achiever, socializer, competitor
34

34. New Approaches to Drive Physical, Emotional and
Social Well-Being Improvement
Innovative and integrated …contributes to different …which results in an
methodology… approach to coaching engaging user experience
Mindfulness-based tools New Coaching vs. Traditional
Coaching
Emotional/social Physical Health
health approach
Coaches with Physical health
behavioral health background
background
Experiential Traditional
coach training training
Research Outcomes
questions
Personality N/A
profiling
Ntrinsx Well-Being HRA
Survey
Work & personal Health Home
homes
Multiple brief Three calls
coaching touches
New integrated Traditional
platform
Multiple Telephonic
modalities
35

35. Leveraging Social Networks and Mobile
Applications
Product Starting
Points

36. Transformational Community Initiatives to
Support Well-Being Improvement
Engage and transform … through a compelling value … that leverages our
communities … proposition … strategic relationships
Our Goal: Create a Movement
• Create “Vitality Cities” through IMPROVED VITALITY
Reduced Medical Trend AND Improved Productivity
sustainable changes that
encourage people to practice
healthy behaviors so that they
can live well – longer IMPROVED WELL-BEING
(measurement)
Our Plan:
• 2010- select 1st Vitality City
• 2011- scale the Vitality City
concept to cities across POWER 9 PRINCIPLES
America while creating a (become norm)
national movement
• Use WBI to measure progress CULTURE
Focused Investment Areas
Promote / Support Power 9
Participation
Leadership
Commun-
ications
Policy
Etc.
37

37. Health Care Reform – Leveraging the Medical
Home and Accountable Care Concepts
Leverage Healthways’ expertise in population analysis, Build collegial and trusted relationships with physician practices. Use care
identification and analytics plans and care coordination to improve health one patient at a time.
Claims Data
Pharmacy Data
HRA Gaps in Care, Psychosocial
Biometrics/Lab Educational, Environmental
needs assessed
EMR/PHR Care Plan Generated
Self reporting
Predictive
Registry Care Coordinator
Modeling Care coordinator assures
documents progress on the
Care Team Reviews and
Care Plan.
Agrees with Care Plan
Provides Feedback to MD
Medical
Problem Diagnosis/
Treatment
Care Plan is implemented.
Care Coordinator engages
MD engages with patient,
specific
using care plan
Quality Care Healthways and
Improvement Coordination community resources
Care Coordinator engages
as appropriate
w/ patient using care plan
Analytic Support
Reporting Lifestyle Management
Disease Management
Case Management
Social Network
Cognitive Behavioral Therapy
Patient Compliance Programs
Transitions of Care management
38

38. • I believe these new well-being innovations
will be:
• Of only minimal value over the traditional
approaches used today
• Will better position the field to capture a broader
value proposition
• Will be instrumental in taking the health
promotion programs to an all new level
• Will revolutionize health promotion
39

39. Closing Thoughts

40. Organizations With Higher Well-Being =
• Measurably healthier and happier people
• Longer life expectancy and productive life
Health
years
• Higher workforce productivity (employed) Health Costs
• Increased independence rate (seniors) Productivity
• National recognition as an employer of
choice Turnover
• Measurable accountability to shareholders Economic
Vitality
• Improved sense of purpose and corporate
pride Corporate
• And hence, improved business performance Pride
and social vitality Business
Performance

41. For More Information
www.well-beingindex.com
42

42. Questions/Discussion