Worksite Wellness Best Practice Strategies Tim Butler MS

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Worksite Wellness Best Practice Strategies Tim Butler, MS, MCHES Select. Health tim. butler@selecthealth. org

Worksite Wellness Best Practice Strategies Tim Butler, MS, MCHES Select. Health tim. [email protected] org 801 -442 -7397 Utah League of Cities and Towns Sheraton City Centre, Salt Lake City September 12, 2014

Learning Objectives • This presentation will explore the current state-of-the-art in the discipline of

Learning Objectives • This presentation will explore the current state-of-the-art in the discipline of worksite health promotion and examine the expanded role it is likely to play in light of the health care cost crisis, health reform legislation, an aging population and an increasing burden of chronic illness related to modifiable high-risk health behaviors. • Learning objectives include: – Understanding the value of integrating health promotion seamlessly into occupational health and safety strategies – Learn key success factors in best practice programs – Recognize the critical role of organizational culture as a factor in determining program engagement, effectiveness and sustainability

G y National Health Expenditures as a Share of GDP, 1960 -2021 NOTE: The

G y National Health Expenditures as a Share of GDP, 1960 -2021 NOTE: The U. S. population increased by 71% from ~180, 000 in 1960 to ~306, 000 in 2009

Healthcare Cost Inflation vs. Wages & CPI American families who are insured through their

Healthcare Cost Inflation vs. Wages & CPI American families who are insured through their jobs have health care costs of $19, 393 this year, up 7. 3%, or $1, 319 from last year ( Milliman Medical Index). More significantly, Workers are paying a bigger share of total health care expenses. Workers' out-of-pocket costs this year rose 9. 2% from 6. 6% last year and their payroll deductions for insurance coverage jumped to 9. 3% from 8% in 2010. (CNNMoney, May 11, 2011)

Healthcare Cost Trends • Annual premiums for worker-only coverage stand at $6, 025 this

Healthcare Cost Trends • Annual premiums for worker-only coverage stand at $6, 025 this year. Workers on average contribute $1, 081. • • Average annual family premiums stand at $16, 834, with workers contributing $4, 823. • Workers now pay deductibles averaging $1, 217, up 47% since 2009. This year's increase is similar to the year-to-year rise in worker's wages (2. 3%) and general inflation (2%). http: //www. nytimes. com/2014/09/11/upshot/latest-good-news-in-health-spending-employer-premiums. html

Premiums, Wages and CPI Trends In Employer Health Insurance Costs, Stability Is the New

Premiums, Wages and CPI Trends In Employer Health Insurance Costs, Stability Is the New Normal September 12, 2014, WSJ, By Drew Altman http: //blogs. wsj. com/washwire/2014/09/12/in-employer-health-insurance-costs-stability-is-the-newnormal/

Health Care Reform The Triple Aim “Quality controls costs. ” -Brent James, M. D.

Health Care Reform The Triple Aim “Quality controls costs. ” -Brent James, M. D. , M. Stat. ACOs, Pay for Performance and Shared Accountability • Improve Care - based on evidence-based guidelines and continuous quality improvement • Lower Costs – Deliver the care that should be delivered in the most cost effective way • Manage Population Health – primary and secondary prevention, including clinical preventive care The Triple Aim: Care, Health, And Cost D. M. Berwick, T. W. Nolan and J. Whittington. Health Affairs, 27, no. 3 (2008): 759 -769

Leading vs. Actual Causes of Death

Leading vs. Actual Causes of Death

U. S. Diabetes Prevalence 1980 -2008 http: //www. stateoftheusa. org/content/diabetes-on-the-rise. php

U. S. Diabetes Prevalence 1980 -2008 http: //www. stateoftheusa. org/content/diabetes-on-the-rise. php

Diabetes “Epidemic” Unabated • The prevalence of type 2 diabetes has tripled in the

Diabetes “Epidemic” Unabated • The prevalence of type 2 diabetes has tripled in the last 30 years. • 30 million children and adults in the United States— 8. 3% of the population—have diabetes. 18. 8 million people diagnosed, 7 M undiagnosed • Among diagnosed, 50% are at recommended control levels • Another 80 million adults are “pre-diabetics” • Alarming rise in incidence of Type 2 among children: ~50% new cases • 2 million new cases diagnosed annually • Leading cause of blindness, kidney failure, amputations and heart disease; diabetes contributes to 250, 000 deaths annually. • If current trends are not reversed, more than 33% of whites, 40% of blacks and 50% of Hispanic people in this country will develop diabetes. Source : CDC, American Diabetes Association, CDC

The Major Determinants of Health We will need to integrate strategies in all 5

The Major Determinants of Health We will need to integrate strategies in all 5 areas We spend ~97% of all health care dollars on treatment and diagnosis and ~ 3% on prevention and health promotion. Source: Mc. Ginnis et al. , Health Affairs 21(2): 78 -93 (2002)

Healthy Lifestyle is the Best Medicine “Healthy lifestyle”: (1) physical activity, (2) healthy diet,

Healthy Lifestyle is the Best Medicine “Healthy lifestyle”: (1) physical activity, (2) healthy diet, (3) healthy weight, (4) good sleep, (5) eliminate tobacco (6) clinical preventive care.

“Most Americans Don't Eat Smart And Exercise” • The CDC tracked the percentage of

“Most Americans Don't Eat Smart And Exercise” • The CDC tracked the percentage of Americans who – Eat at least five servings of fruits and vegetables daily and – Engage in moderately intense exercise for at least 30 minutes five days per week or vigorous exercise for at least 20 minutes three days per week • 356, 112 Americans provided self-reported data during a 2005 telephone survey • Only 14. 6%, one in seven Americans, exercises enough and eats enough fruits and vegetables, and men are worse than women report. • 12. 4% of men and 16. 6 % of women. Apr 5, 2007, By Will Dunham, WASHINGTON (Reuters)

The Graying of America • In 1950 there were 12 million Americans over 65;

The Graying of America • In 1950 there were 12 million Americans over 65; 8% of the population. • In 2010 there were >40 million people over age 65; 13% of population. • By 2030, ~1 out of every 5 Americans — some 72 million people — will be 65 years or older. • The age group 85 and older is now the fastest growing segment of the U. S. population. • The over 85 group is expected to increase by 475% between 2000 and 2025. http: //www. nih. gov

Our Aging Workforce http: //www. bls. gov/spotlight/2008/older_workers/

Our Aging Workforce http: //www. bls. gov/spotlight/2008/older_workers/

Will You Live to be 100? ? ? • • 71, 000 in the

Will You Live to be 100? ? ? • • 71, 000 in the U. S. as of 2010 Projected to grow to 500, 000 by 2050 570% increase in the rate of centenarians

http: //www. healthandage. com/html/min/new_england/imgs/graph. gif

http: //www. healthandage. com/html/min/new_england/imgs/graph. gif

Aging Impacts Health Care Costs • The population 65 and older in the United

Aging Impacts Health Care Costs • The population 65 and older in the United States is expected to more than double from 35 M in 2000 to 72 M in 2030. • ~80% of seniors have a chronic illness, and 50% have two or more. http: //www. forbes. com/sites/danmunro/2012/12/30/2012 -the-year-in-healthcare-charts/ Dan Munro, Forbes Contributor, 12/30/2012, “ 2012 - The Year In Healthcare Charts”

Medical Costs by Health Risk Levels and Age 1997 -1999 Average Annual Paid Amounts

Medical Costs by Health Risk Levels and Age 1997 -1999 Average Annual Paid Amounts Costs of high-risk group average 271% higher than low-risk group. Costs of 65+ age group average 346% higher than <35 age group. Source: Stay. Well data analyzed by U of Michigan (N = 43, 687)

Direct Health Care Cost Indirect Health Related Costs • Presenteeism • Absenteeism • WC

Direct Health Care Cost Indirect Health Related Costs • Presenteeism • Absenteeism • WC & Disability • Inefficiency • Worker replacement • Worker retraining “Poor health’s indirect costs (e. g. , absenteeism, presenteeism) are often more than double the cost of direct medical care. In fact, productivity losses related to personal and family health problems cost U. S. employers $1, 685 per employee per year, or $225. 8 billion annually. ” Source: U. S. Chamber of Commerce

Why Worksite Health Promotion • About 160 million Americans go to work every day

Why Worksite Health Promotion • About 160 million Americans go to work every day and spend more time at work than in any other single activity. • We have an aging workforce that would benefit tremendously from workplace health promotion programs since those over age 45 have the highest risk for chronic disease. • Impact on the national financial crisis: – Aging Americans will bring their unhealthy habits into Medicare and other federally funded health insurance programs that support the aging population. A recent report produced by the Centers for Health Research at Healthways showed that by increasing the proportion of low risk individuals at age 65 from 54% (the current proportion) to 65% and preventing a 10% upward risk transitions that would otherwise occur during the years people are in Medicare would save the government $65. 2 billion annually, or $652 billion in 10 years. R. Goetzle, Ph. D, ROI for Worksite Wellness, WELCOA News and Views, 2010. www. welcoa. org

Wellness Workplace Wellness Programs Can Generate Savings. By Katherine Baicker, David Cutler, and Zirui

Wellness Workplace Wellness Programs Can Generate Savings. By Katherine Baicker, David Cutler, and Zirui Song. HEALTH AFFAIRS 29, NO. 2 (2010). Amid soaring health spending, there is growing interest in workplace disease prevention and wellness programs to improve health and lower costs. In a critical meta-analysis of the literature on costs and savings associated with such programs, we found that medical costs fall by about $3. 27 for every dollar spent on wellness programs and that absenteeism costs fall by about $2. 73 for every dollar spent. Although further exploration of the mechanisms at work and broader applicability of the findings is needed, this return on investment suggests that the wider adoption of such programs could prove beneficial for budgets and productivity as well as health outcomes.

Wellness Workplace Wellness Programs Can Generate Savings. By Katherine Baicker, David Cutler, and Zirui

Wellness Workplace Wellness Programs Can Generate Savings. By Katherine Baicker, David Cutler, and Zirui Song. HEALTH AFFAIRS 29, NO. 2 (2010). • Amid soaring health spending, there is growing interest in workplace disease prevention and wellness programs to improve health and lower costs. • In a critical meta-analysis of the literature on costs and savings associated with such programs, we found that medical costs fall by about $3. 27 for every dollar spent on wellness programs and that absenteeism costs fall by about $2. 73 for every dollar spent. • Although further exploration of the mechanisms at work and broader applicability of the findings is needed, this return on investment suggests that the wider adoption of such programs could prove beneficial for budgets and productivity as well as health outcomes.

WELCOA’s 7 Benchmarks for EHM Success • Benchmark #1: Capturing CEO Support • Benchmark

WELCOA’s 7 Benchmarks for EHM Success • Benchmark #1: Capturing CEO Support • Benchmark #2: Creating Cohesive Wellness Teams • Benchmark #3: Collecting Data To Drive Health Efforts • Benchmark #4: Carefully Crafting An Operating Plan • Benchmark #5: Choosing Appropriate Interventions • Benchmark #6: Creating A Supportive Environment • Benchmark #7: Carefully Evaluating Outcomes All of these steps work together to build and sustain an organizational culture that values, supports, protects and promotes health. The Wellness Councils of America, http: //www. welcoa. org/

“Employer Health Asset Management Roadmap” Institute of Health and Productivity Management report: • The

“Employer Health Asset Management Roadmap” Institute of Health and Productivity Management report: • The challenge for leaders today is to “create an organizational culture that promotes a high-performing workforce in a high-performance workplace. ” No organization can be competitive without healthy and productive employees. • While employer-sponsored health insurance plays a part in maintaining employee health, Any approach that relies primarily on providing medical services after employees get sick is a failed strategy. • The total costs of an unhealthy workforce are growing at an unsustainable pace. • To meet escalating costs, federal and state policymakers continue to look at raising healthcare taxes, while employers further reduce coverage and shift costs to employees. Cost shifting, however, is not a sustainable solution. More than another adjustment of “who pays, ” we need new approaches for improving employee health in America. • Employers could take a major step in the right direction by elevating health to an integral part of their “human capital asset management” strategy. http: //www. ihpm. org/pdf/Employer. Health. Asset. Management. Roadmap. pdf

The “Full Value Proposition” for EHM • • Reduce population health risks Contribute to

The “Full Value Proposition” for EHM • • Reduce population health risks Contribute to control of medical expense and other health related costs Promote healing, speed recovery and return to work Deliver peak performance and productivity Achieve work/life balance, less burnout and better quality of life Enhance team work, creativity, innovation and morale Enhance public image Attract, retain and develop a talented, high quality workforce; be an “employer of choice” A recent study of the U. S. auto industry by the Integrated Benefits Institute showed: Health-related lost time and lost productivity for industry employers amount to 233% more than medical and pharmaceutical costs. Economic Recovery, Health and the Bottom Line - An Example from U. S. Automakers. http: //ibiweb. org/quickstudy_feb 2011

Human Capital Management HUMAN CAPITAL • Value of the organization’s human assets • Knowledge/Skills/Education

Human Capital Management HUMAN CAPITAL • Value of the organization’s human assets • Knowledge/Skills/Education • Attitude/Effort/Motivation • Tools/Equipment/Technology • Functional health status: • Multiplies value of the other components • Employees willing and able to complete a task with a desired outcome or result • Functional health is critical to optimize the application of human assets to organizational objectives. Adapted from: http: //www. ihpm. org/pdf/VBH_Presentation%20(update%202010). pdf

Health is Human Capital • Employee health is not peripheral to business success. It

Health is Human Capital • Employee health is not peripheral to business success. It is essential and foundational. Employee health is a valuable human capital asset – not just a “cost” of doing business. People, (employees) are the core, the engine, the heart and soul that drives any organizations success. • Each individual employee owns their own human capital … Wendy Lynch, Ph. D, VP at Human Capital Management Services • “. . . Health – a vital element of functionality and capacity to work – has remained the neglected “multiplier” of all the other components, without which they cannot realize their full value. Human capital is the key to productivity in this new economy where ideas are replacing “things” as the key economic output. . . The value of this capital must be improved systematically to increase its productivity. . . And improving employee health will increase the total value of everything else! • -- Sean Sullivan, President and CEO, IHPM • People have an innate desire and preference to be healthy and enjoy good health’s many priceless benefits. Managing the culture and the environment can enable people to be at their best, contribute their best and enjoy a high quality life at work and home.

The Workplace as a Social System • Every business is social system that interacts

The Workplace as a Social System • Every business is social system that interacts with the characteristics of the employee to influence motivation, individual performance, collective productivity and economic outcomes. • “Health affects work and work affects health” –Wendy Lynch, Ph. D • Culture is an independent influence, an enabler and amplifier. Its influence can be positive or negative. • The word “culture” originates from the concept of cultivation. With regard to wellness it means creating the psychological, social and physical environment that makes the healthiest choice the preferred and convenient choice.

Individualism vs. Culture Why has it seemed so difficult to shift the paradigm, like

Individualism vs. Culture Why has it seemed so difficult to shift the paradigm, like swimming upstream? • Traditionally, organizational culture is the last thing we think about when planning, designing and evaluating EHM programs. – EHM grew out of the medical model where psychosocial/environmental cultural factors take a back seat to the clinical biological variables that can be more quickly and definitively seen, measured, and in some cases manipulated. – The American tradition of rugged individualism encourages a focus on personal choice, behavior and responsibility in a climate of competition.

Individualistic vs. Culture-based Solutions • Health promotion programs that focus primarily on individual change

Individualistic vs. Culture-based Solutions • Health promotion programs that focus primarily on individual change help only a small fraction of those in need. Low participation, program attrition and low success rate limit impact and generate limited momentum within the culture. • Few individuals succeed at maintaining health behavior change without social support. • Interventions focused on the individual do little to prevent new behavior problems from developing. In an unsupportive and unmanaged culture people will migrate to new risks. Keeping healthy people at low risk has proven to be central to effective population health management. • Individualistic approaches can also undermines the enthusiasm for the cooperation, collaboration and mutual support essential for optimal success. • Traditional individualistic models tend to rely on extrinsic rewards while intrinsic rewards have proven much more cost effective.

Health Behaviors are Contagious

Health Behaviors are Contagious

Creating a Culture of Health Norms Shared Values Peer Support Touch Points Behavior Choices

Creating a Culture of Health Norms Shared Values Peer Support Touch Points Behavior Choices Work Climate Adapted from: Achieving a Healthy and Productive Workplace Culture by Judd Allen and Joseph Leutzinger. Health and Productivity Management, Spring 2009

Burnout: Smoking at work was considered cool in the 1950 s and ’ 60

Burnout: Smoking at work was considered cool in the 1950 s and ’ 60 s but now many bosses urge quitting Getty Images http: //www. brw. com. au/p/sections/health/bosses_smoke_out_office_tensions_5 akjf 1 K 36 QTBzi. K 57 LESu. O

Start at the Top • Senior leaders have the authority and leverage to create

Start at the Top • Senior leaders have the authority and leverage to create the vision and the comprehensive integrated strategy necessary to bring about fundamental change in “how we do business here”. • Though it starts at the top culture change must flow throughout the organization, especially through all layers of management, then to employees and their families. • Effective culture change is always home grown; an inside job, instigated and enthusiastically supported by enlightened leaders and widely supported throughout the organization. http: //www. ihpm. org/pdf/Employer. Health. Asset. Management. Roadmap. pdf

What Leaders Can Do • Articulate a vision of EHM its relationship to core

What Leaders Can Do • Articulate a vision of EHM its relationship to core business objectives and why and how to participate. • Encourage integration and collaboration that promotes a coherent strategy and synergistic execution; break down the silos so all functions related to workforce health are involved. • Serve as effective role models through active visible participation. • Align incentives, compensation and policies to enhance motivation for peak performance and self-responsibility for health management. (See the work of Lynch and Gardner at http: //www. hcmsgroup. com/hhcf/) • Monitor and celebrate success, both individual and collective.

Future Trends in EHM • More completely integrated focus within the organization • Broad

Future Trends in EHM • More completely integrated focus within the organization • Broad emphasis on “creating a culture of health” that supports full engagement, productivity, creativity and innovation • Increasingly holistic, not just emphasis on traditional medical model risk factors. More recognition of the critical importance of psychosocial factors, culture, environment and policies (see the APA’s Psychologically Healthy Workplace program) • Worksite health and safety programs will be increasingly synergistic with clinical care. Better integration with the evolving medical model (Medical Home/ACOs). • Evidence-based medicine converging with evidence-based EHM • Increased emphasis on personal engagement/empowerment/responsibility • Leveraging digital and mobile technologies and social media

Summary • Population health management is an integral component of healthcare cost control. •

Summary • Population health management is an integral component of healthcare cost control. • The workplace is the most promising venue we have to promote good health throughout the nation and the local community. • Human capital management is critical to organizational success and employee health is critical to optimizing the value of human capital assets as well as controlling all health related costs. • Culture and intrinsic motivation drives participation and program effectiveness more economically and sustainably than extrinsic economic incentives. However, extrinsic incentives are useful as “kindling” and “triggers” to promote behavior change. Finding the balance is the challenge. • What ever you are doing, you are creating an organizational culture. Is it a culture that will support the results you prefer?