This document discusses approaches to measuring and improving well-being at both the individual and societal level. It describes two major indices for measuring well-being - the OECD Better Life Index which covers 11 topics across 2 domains for 34 countries, and the Gallup-Healthways Global Well-Being Index which measures 5 elements of well-being in 135 countries using standardized questions. The document also presents evidence that higher individual and population well-being leads to lower healthcare costs and higher work performance, and describes tools and strategies for actively improving well-being through engagement, leveraging evidence-based interventions, and understanding an individual's stage of change.

1. Copyright © 2014 Healthways, Inc. All rights reserved.
Friday, 7 November 2014 Peter Choueiri, President Healthways International
Time to act!
From Well–Being Measurement to Well– Being Improvement
Practitioner Keynote: Managing for Well-Being

2. Our approach to Well-Being measurement

3. Fellow travellers in well-being measurement
Gallup-Healthways Global Well-Being Index, OECD Better Life Index
3
• Builds on >10 years of OECD interest in measuring
societal performance more broadly than simply
economics
• Covers 34 countries (OECD members, plus Brazil
and Russia)
• Two areas, comprising 11 topics the OECD has
identified as essential to well-being:
1. Material living conditions (housing, income,
jobs), and
2. Quality of life (community, education,
environment, governance, health, life
satisfaction, safety and work-life balance)
• Builds on Gallup-Healthways partnership for well-being
measurement and improvement launched
2008, and US well-being index reports since 2008
• Now covers 135 countries worldwide
• Five elements of well-being measured everywhere
using 10 standard questions (culturally translated
for each language)
1. Purpose
2. Social
3. Community
4. Financial
5. Physical
• http://info.healthways.com/wellbeingindex

4. Comparison of methodologies
General form of a Subjective Well-Being Equation Subjective Well-Being = Function1 x Variable1 + … Functionn x Variablen
Two measures
Two domains, nine objective dimensions
Ten questions across five elements
OECD Better Life Index
Gallup-Healthways Well-Being Index
Prioritisation of well-being domains for intervention can be based initially on either report
Highly complementary methodologies
4

5. Gallup-Healthways’ definition of Well-Being
− Purpose: Liking what you do each day
and being motivated to achieve goals
− Social: Having supportive relationships
and love in your life
− Financial: Managing your economic life
to reduce stress and increase security
− Community: Liking where you live,
feeling safe, and having pride in your
community
− Physical: Having good health and enough
energy to get things done daily
PURPOSE
SOCIAL
FINANCIAL
COMMUNITY
PHYSICAL
Well-being is comprised of five elements – and all five are interrelated
and interdependent.
5

6. Denmark
40%
Austria
39%
Sweden
36%
Netherlands
33%
Malta
28%
United Kingdom
28%
Ireland
27%
Germany
27%
Iceland
26%
Spain
24%
Kosovo
24%
Belgium
23%
Finland
23%
Luxembourg
21%
North Cyprus
21%
Portugal
20%
France
19%
Slovenia
18%
Hungary
18%
Poland
17%
Slovakia
16%
Cyprus
15%
Macedonia
14%
Romania
14%
Czech Republic
13%
Bulgaria
12%
Montenegro
10%
Serbia
10%
Greece
10%
Bosnia Herzegovina
10%
Albania
8%
Italy
8%
Croatia
7%
Significant variations in Well-Being by country % country residents thriving in at least 3 of 5 elements
Denmark leads Europe; UK, Germany, and Spain in Top 10; France in the middle
6

7. Within countries, significant variation between organisations
100
0
High
Low
Low-Mid
Mid
Mid-High
Well-Being Score
Distribution of Individual Well-Being Scores
% of population with given score
Black line is average of national nightly survey
Colored lines represent six example companies
7

8. Well-Being Drives Business Performance
8
Well-Being Assessment Results by Business Unit
Overall
Life
Evaluation
Emotional Health
Physical
Health
Healthy Behavior
Work Environment
Basic
Access
% at Optimal Income
68.4
60.9
76.4
78.1
62.6
46.9
85.5
41.7%
73.5
73.1
80.6
80.2
65.1
53.7
88.1
66.7%
72.4
70.4
79.7
82.4
66.3
49.5
86.0
64.5%
72.0
71.4
73.8
81.1
67.0
51.2
85.9
59.6%
72.0
69.6
78.6
78.1
65.6
52.6
88.6
39.2%
71.9
66.5
78.4
78.6
66.5
54.9
86.7
50.3%
71.8
64.5
79.1
81.5
64.9
53.9
86.9
69.2%
71.4
68.6
78.0
78.5
67.5
49.3
86.7
47.9%
71.2
67.7
80.0
81.7
64.4
49.1
84.5
51.4%
70.6
60.7
76.5
80.2
66.5
51.9
85.4
44.9%
70.6
65.8
79.6
77.6
62.6
54.4
86.0
41.6%
70.0
63.9
76.2
80.3
63.6
48.5
87.4
55.6%
69.7
58.0
76.5
78.4
68.4
53.2
83.6
63.6%
69.6
62.5
75.0
79.0
65.0
50.0
86.0
56.2%
69.2
64.7
77.5
76.8
62.6
46.0
87.9
51.8%
69.1
60.8
76.8
78.1
61.9
52.2
85.0
39.3%
68.6
61.6
75.5
76.8
65.2
46.4
86.2
51.8%
68.6
59.6
76.3
80.3
66.4
44.4
84.8
41.6%
68.1
59.9
77.9
78.9
61.5
45.3
85.0
40.8%
67.8
58.0
75.7
78.1
63.9
43.4
87.7
57.2%
66.3
58.3
74.7
76.4
59.2
46.0
83.3
31.7%
66.2
52.4
75.0
76.9
61.1
45.4
86.5
37.9%
65.8
59.1
76.4
75.8
53.4
45.6
84.2
28.4%
65.7
57.3
73.9
76.8
61.7
40.1
84.2
36.6%
65.5
56.8
76.3
76.7
56.8
43.2
83.4
28.3%
64.5
52.5
73.0
75.3
60.2
42.4
83.8
26.8%
Top Quintile
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile
Well-Being Scores
Internal Corporate Measure: Percent at Optimal Income
Ranking 25 Business Units by Well-Being Score

9. The Right View Leads to The Right Intervention
9
OLIVER HARRISON
•Overall score (out of 100)
•Gap analysis for each of the five elements
•Analysis of underlying risks and/or behaviours
•Specific recommendations for action overall and within each element
•Proven “launch pad” for engaging individuals to create their own Well- Being Improvement Plan

10. Why Well-Being improvement matters

11. People with higher Well-Being cost less
and are
more productive
Basic Premise

12. Our Simulation Model
12
•An epidemiology-based model that simulates the complex relationships that exist between chronic conditions and modifiable behaviors
•No claims data needed; built on national datasets
•Projects ten years of medical and productivity savings by condition and modifiable behavior.
•Simulates the incidence and progression of diseases over time.
Simulation model developed by Healthways and BCG, with support of WEF
Goals
1.To suggest to senior executives and managers ways of thinking about well-being as a corporate strategic topic
2.To assess the healthcare and productivity costs associated with the highest lifestyle risks and most costly chronic conditions
3.To show how the presence of a comprehensive well-being program would affect healthcare costs and productivity

13. Building the Epidemiology Engine http://wellness.weforum.org
www.healthways.com
Demographic Segmentation
Initial Participant Characteristics
•Modifiable Behaviors
•Conditions
•Participation
Modifiable Behaviors
Chronic Conditions
Value Creation
•Baseline
•HWAY Impact
Medical Cost
Productivity
Intervention
Impact
Customizable Inputs
Assumptions Based Epidemiological Engine
Assign Initial Member Level Characteristics
Assign Cost to Severity of Existing Conditions
Managing principal, leading actuarial and healthcare research company, Healthcare economic expert, Harvard University
Epidemiologist, Harvard School of Public Health
Health Policy expert, Harvard Medical School
Health management expert, Johns Hopkins Bloomberg School of Public Health
Clinical and health psychologist, University of Rhode Island CEO, leading behavior change company
Economist, Cornell University
Health policy expert, Harvard Medical School
Productivity expert, Cornell University
External Experts Had Significant Input on Model Development
13
Copyright © 2014 Healthways, Inc. All rights reserved.

14. Opportunity of doing something: Economic savings Australia
8
7
7
6
7
7
6
7
56
8
8
7
7
8
8
7
8
61
Inactivity
Diet
Smoking
Alcohol
Poor Std of Care
Stress
Sleep
Screening
All Interventions
Source Healthways, World Economic Forum Simulation Model (2012)
Productivity savings
Medical savings
10-year cumulative savings from well-being improvement
€ Billion

15. Opportunity of doing something: Economic savings United Kingdom
22
21
20
20
21
21
20
21
166
16
14
14
13
16
15
13
14
114
Inactivity
Diet
Smoking
Alcohol
Poor Std of Care
Stress
Sleep
Screening
All Interventions
Source Healthways, World Economic Forum Simulation Model (2012)
10-year cumulative savings from well-being improvement € Billion
Productivity savings
Medical savings

16. Opportunity of doing something: Economic savings Germany
20
18
17
16
19
18
17
18
143
22
20
19
18
21
21
19
20
160
Inactivity
Diet
Smoking
Alcohol
Poor Std of Care
Stress
Sleep
Screening
All Interventions
Source Healthways, World Economic Forum Simulation Model (2012)
10-year cumulative savings from well-being improvement € Billion
Productivity savings
Medical savings

17. 17
19%
39%
26%
16%
Compounding Financial & Social Well-Being Risk
Well-Being Risks Interact to Drive Up Cost
Health Cost for Individuals with Chronic Disease
44%
39%
14%
3%
No Compounding
Well-Being Risks
28%
40%
21%
11%
Compounding Health Well-Being Risks
Low (<$1500)
Medium (<=$6000)
High (<=18000)
Very High (>$18000)
Health Plan 2012

18. Conclusions on value
18
High Costs of Doing Nothing
•Both medical and productivity costs impose heavy financial burdens on countries, communities and companies
•Without interventions, these costs can be expected to grow and compound
The Primary Sources of These Costs are Known
•Chronic conditions cause people to seek care (medical costs) and reduce their ability to work (productivity)
•While behaviors do not have costs associated with them, the conditions they create and exacerbate can have substantial costs
Intervening in Modifiable Behaviors Reduces Costs
•Curtailing or eliminating behavioral risks can reduce costly chronic conditions
•Addressing risks before they become conditions will be a significant source of savings
We have the tools to improve Well-Weing. Now we need to make it a priority.

19. Can Well-Being be actively improved?

20. Higher Well-Being means lowers medical costs
Higher Well-Being = Lower cost
Higher Well-Being = Lower utilisation
10.1%
18.4%
10.0%
14.2%
5.3%
9.6%
Individual Well-Being score
% Respondents with hospital utilisation in 12 months after WBA
Medium: >50-75
High: >75-100
Low: 0-50
Hospital admissions
$5,172
$3,765
$1,048
$3,399
$2,605
$771
$1,885
$1,507
$344
Individual Well-Being score
Medium: >50-75
High: >75-100
Low: 0-50
Median costs in 12 months after WBA
Source Science and Value Team, Healthways
ILLUSTRATIVE
Lower costs
Lower costs
ER visits
Total cost
Medical cost
Prescription cost
20

21. 21
21
Fortune 50 and Fortune 100 Case Studies
Fortune 50 Case Study
A pilot study program including:
•Well-Being Assessment
•Health Risk Coaching
•Disease Management
Well-Being Improved Significantly in Matched Respondents
Fortune 100 Case Study A comprehensive program including:
•Well-Being Assessment
•Bio-metric Screening
•Health Risk Coaching
•QuitNet
•Daily Challenge

22. Cost Goes Down When Well-Being Goes Up
Source: “Evaluation of the Relationship Between Individual Well-Being and Future Health Care Utilization and Cost” Population Health Management, Volume 15, Number 00 2012. Patricia L. Harrison, MPH, James E. Pope, MD, Carter R. Coberley, PhD, and Elizabeth Y. Rula, PhD
1
Point =
2.2%
likelihood of hospital admission
1.7%
likelihood of ER visit
1.0%
likelihood of incurring healthcare costs
Population Well-Being

23. Performance Goes Up When Well-Being Goes Up
10
%
Workforce Well-Being
5% fewer unscheduled absences
24%
lower presenteeism
5%
higher reported job performance
6%
more days of
‘best work’ in 28-day period
Source: “Evaluation of the Relationship Between Individual Well-Being and Future Health Care Utilization and Cost” Population Health Management, Volume 15, Number 00 2012. Patricia L. Harrison, MPH, James E. Pope, MD, Carter R. Coberley, PhD, and Elizabeth Y. Rula, PhD

24. Practical Advice for Well-Being Improvement

25. •10,000s of small decisions every day, every year
•Frequent gap between how people would like to act and how they really act
•Key question is: How can we support everyday decision making to improve health and well-being outcomes?
Today global disease burden is dominated by chronic diseases which accumulate over many years
High
Low
Medium
25

26. 26
“99% decisions are made by your auto- pilot which has a mind of its own” Daniel Kahneman

27. 1. Engagement – finding people where they are… (…not where we want them to be)
27
Mobile Apps
Web
Telephone
Social media
Face-to-face
Daily routine,
e.g. supermarket check-out

28. 2.Leverage evidence-based tools – don’t reinvent the wheel
1.Exercise
2.Healthy eating
3.Stress management
4.Weight management
5.Tobacco cessation
6.Appointment adherence
7.Medication adherence
8.Depression prevention
9.Self-care
10.Etc.
28
Health coaching and online health management with proven outcomes: Enable to set personal targets and identify steps to achieve those targets

29. Pre-awareness
Awareness
Contem- plation
Trial
Loyalty
3. Behaviour change requires understanding individuals’ dynamic “readiness for change”
Transtheoretical Model: Assessing readiness for change
When is someone ready to change their behaviour?
Given someone’s state of change what’s the most effective approach?
29

30. Item
Principle
Messenger
We are heavily influenced by who communicates information
Incentives
Our responses to incentives are shaped by predictable mental shortcuts, such as strongly avoiding losses
Norms
We are strongly influenced by what others do
Defaults
We ‘go with the flow’ of pre-set options
Salience
Our attention is drawn to what is novel and seems relevant to us
Priming
Our acts are often influenced by sub-conscious cues
Affect
Our emotional associations can powerfully shape our actions
Commitments
We seek to be consistent with our public promises, and reciprocate acts
Ego
We act in ways that make us feel better about ourselves
4. Use new, proven tools for behaviour change MINDSPACE, UK Government 2010
MINDSPACE: Designing effective behaviour change programmes
30

31. Many Asian cultures have distinct conceptions of individuality that insist on the fundamental relatedness of individuals to each other. The emphasis is on attending to others, fitting in, and harmonious interdependence with them.
American culture neither assumes nor values overt connectedness among individuals. Individuals seek to maintain their independence from others by attending to the self and by discovering and expressing their unique inner attributes.
Source Markus,HR, Kitayama S (1991). Culture and the self: Implications for cognition, emotion, and motivation. Psychological Review, Vol 98(2), Apr 1991, 224-253
31
5. Don’t forget the cultural aspect!

32. 6. And all of it needs to be based on data: the world’s largest well-being database: >1.4 PB
Our approach
1.Securely collect real-world data on
a.Health-related behaviour, and
b.Behaviour change interventions
2.Analyse data to
a.Identify risks, and
b.Find the most effective approaches
3.Incorporate these insights to drive continuous programme improvement
4.Scale-up programmes to drive population well-being improvement

33. Combining science and engineering for impact
From cutting- edge science…
through solutions engineered for impact…
to individual well-being improvement.
33

34. Examples
Case examples

35. Case Study: Healthways
Well-Being Improvement
Well-Being Segment Upward Shift
Performance Improvements
Elements of Well-Being Improved

36. France: Multiyear contract with CNAMTS Largest disease management programme in Europe
•CNAMTS is the biggest health insurer in France (86% of the population ~ 50 m members)
•In 2011, Healthways signed Disease Management contract “Sophia”, focus on Diabetes initially
•450,000 enrolled patients so far
•By 2015 program will cover 500,000 persons
•Expansion to other chronic diseases, e.g. Asthma and Chronic Heart Failure
36

37. Germany: 12 month outcomes
Significant reduction in admissions for chronic conditions
-20%
-15%
-10%
-5%
0%
5%
10%
15%
20%
25%
30%
35%
Overall Low
Severity
Med
Severity
High
Severity
Percent Change in Admission Rate
Comparison
Intervention
37

38. Telephonic Follow-Up to Reduce Hospital Readmissions
• The study tested whether telephonic
outreach from a nurse to ensuring
understanding of and adherence to
discharge orders reduced 30-day
readmissions
• Patients who received a call from a
Healthways nurse within 14 days after
discharge from the hospital were 23.1% less
likely than the comparison group to have a
30-day readmission
• Timely telephonic follow up after hospital
discharge provides an effective way to
improve quality measures and reduce the
burden of readmissions
23.1% reduction in hospital readmission
through timely intervention
38

39. 39
Australia: 12, 18 month outcomes
39

40. 40
Fortune 50 and Fortune 100 Case Studies
Performance
Unplanned Absence
Unintended Turnover
Value Beyond Reduced Medical Spend
Fortune 50 Case Study
Fortune 100 Case Study
Longitudinal Well-Being Improvement Net Positive Shift in Well-Being
=

41. Science and Outcomes
•Foundation for the ongoing development and continuous improvement of all our solutions
•Focused on 3 core areas
1.Health outcomes
2.Translation
3.Advanced analytics
Assets
•23-member team, including 11 doctoral degrees
•World’s largest health and well-being database 1.4 petabytes
•Published >130 studies/articles, including >50 external publications
•Summary of peer-reviewed literature available online at www.healthways.com/success/library.aspx
Our enduring focus on evidence based practice
41

42. © 2014 Healthways, Inc. All rights reserved.
Conclusion
1.Well-Being is a comprehensive reflection of the health status of a nation, an organisation and an individual.
2.Well-Being goes beyond the physical dimension of health includes dimensions like social, purpose, financial and community.
3.The impact of Well-Being on medical and productivity related cost is proven, measurable and can be influenced.
4.Well-Being improvement helps to reduce existing cost and avoid future cost.
5.There are proven interventions to improve Well-Being.
6.The selection of the right partner can help you to get there faster and more successfully.
42