The Confusion. Work? (Wellness) Programs Do They Really. Workplace Health Promotion. A Wellness Program Works? What Do We Mean When We Say:

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1 AGENDA Workplace Health Promotion (Wellness) Programs Do They Really Work? Webinar Series May 2016 Do Workplace Wellness Programs Work? Literature Reviews Wall Street Studies Dissemination of Best/Promising Practices Ron Z. Goetzel, Ph.D. Johns Hopkins University and Truven Health Analytics, an IBM Company Do Health Promotion Programs Work? The Confusion 3 What Do We Mean When We Say: A Wellness Program Works? Make workers aware of their health and how it improves quality of life. High participation and engagement. Lose weight, stop smoking, exercise more. Medical claims costs should go down. Less absenteeism, fewer safety incidents. Attract the best talent. Happier workers with more energy. Create a culture of health. 5 6

2 What Do We Mean When We Say: A Wellness Program Works? (con t) Produce a positive return on investment (ROI)? 7 8 Employer Per Capita Spending on Healthcare Employer Annual Per Capita Spending On Wellness - $156 (Source HERO) 9 Convince me Why should I invest in the health and well-being of my workers? It Seems So Logical If you improve the health and well being of your employees quality of life improves health care utilization is reduced absenteeism is controlled productivity is enhanced 11 12

3 Seems Like A No Brainer Right? What Is The Evidence Base? A large proportion of diseases and disorders is preventable. Modifiable health risk factors are precursors to a large number of diseases and disorders and to premature death (Healthy People 2000, 2010, Amler & Dull, 1987, Breslow, 1993, McGinnis & Foege, 1993, Mokdad et al., 2004) Many modifiable health risks are associated with increased health care costs within a relatively short time window (Milliman & Robinson, 1987, Yen et al., 1992, Goetzel, et al., 1998, Anderson et al., 2000, Bertera, 1991, Pronk, 1999, Goetzel 2012) Modifiable health risks can be improved through workplace sponsored health promotion and disease prevention programs (Wilson et al., 1996, Heaney & Goetzel, 1997, Pelletier, , Soler et al. 2010) Improvements in the health risk profile of a population can lead to reductions in health costs (Edington et al., 2001, Goetzel et al., 1999, Carls et al., 2011) Worksite health promotion and disease prevention programs save companies money in health care expenditures and produce a positive ROI (Citibank , Procter and Gamble 1998, Highmark, 2008, Johnson & Johnson, 2011, Dell 2015, Duke University 2015) Diseases Caused (At Least Partially) by Lifestyle Obesity: Cholesystitis/Cholelithiasis, Coronary Artery Disease, Diabetes, Hypertension, Lipid Metabolism Disorders, Osteoarthritis, Sleep Apnea, Venous Embolism/Thrombosis, Cancers (Breast, Cervix, Colorectal, Gallbladder, Biliary Tract, Ovary, Prostate) Tobacco Use: Cerebrovascular Disease, Coronary Artery Disease, Osteoporosis, Peripheral Vascular Disease, Asthma, Acute Bronchitis, COPD, Pneumonia, Cancers (Bladder, Kidney, Urinary, Larynx, Lip, Oral Cavity, Pharynx, Pancreas, Trachea, Bronchus, Lung) 1994 Lack of Exercise: Coronary Artery Disease, Diabetes, Hypertension, Obesity, Osteoporosis Poor Nutrition: Cerebrovascular Disease, Coronary Artery Disease, Diabetes, Diverticular Disease, Hypertension, Oral Disease, Osteoporosis, Cancers (Breast, Colorectal, Prostate) Alcohol Use: Liver Damage, Alcohol Psychosis, Pancreatitis, Hypertension, Cerebrovascular Disease, Cancers (Breast, Esophagus, Larynx, Liver) Stress, Anxiety, Depression: Coronary Artery Disease, Hypertension Uncontrolled Hypertension: Coronary Artery Disease, Cerebrovascular Disease, Peripheral Vascular Disease Uncontrolled Lipids: Coronary Artery Disease, Lipid Metabolism Disorders, Pancreatitis, Peripheral Vascular Disease

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6 Number and Percentage of U.S. Population with Diagnosed Diabetes, Good News Worksite Health Promotion Works! 34 CDC Community Guide To Preventive Services Review AJPM, February Studies Reviewed Summary Results and Team Consensus Outcome Body of Evidence Consistent Results Magnitude of Effect Finding Alcohol Use 9 Variable Sufficient Fruits & Vegetables 9 No 0.09 serving Insufficient % Fat Intake % Strong % Change in Those Physically Active Tobacco Use pct pt Sufficient Strong Prevalence Cessation pct pt +3.8 pct pt Seat Belt Non-Use pct pt Sufficient 36

7 Summary Results and Team Consensus Summary Results and Team Consensus Outcome Body of Evidence Consistent Results Magnitude of Effect Finding Diastolic blood pressure Systolic blood pressure Diastolic: 1.8 mm Hq Systolic: 2.6 mm Hg Strong Outcome Body of Evidence Consistent Results Magnitude of Effect Finding Risk prevalence 4.5 pct pt Estimated Risk 15 Moderate Sufficient BMI Weight % body fat No 0.5 pt BMI 0.56 pounds 2.2% body fat Insufficient Healthcare Use 6 Moderate Sufficient Worker Productivity 10 Moderate Strong Risk prevalence No 2.2% at risk Total Cholesterol HDL Cholesterol No 4.8 mg/dl (total) +.94 mg/dl Strong Risk prevalence 6.6 pct pt Fitness 5 Small Insufficient What About ROI? Critical Steps To Success Health Affairs ROI Literature Review Baicker K, Cutler D, Song Z. Workplace Wellness Programs Can Generate Savings. Health Aff (Millwood). 2010; 29(2). Published online 14 January Financial ROI Reduced Utilization Risk Reduction Behavior Change Improved Attitudes Awareness Participation Increased Knowledge Results - Medical Care Cost Savings Description N Average ROI Results Absenteeism Savings Description N Average ROI Studies reporting costs and savings 15 $3.37 Studies reporting savings only 7 Not Available Studies reporting costs and savings 12 $3.27 Studies with randomized or matched control group 9 $3.36 All studies examining absenteeism savings 22 $2.73 Studies with non-randomized or matched control group 6 $2.38 All studies examining medical care savings 22 $

8 Asthma Any Cancer Depression/Sadness/Mental Illness Diabetes Heart Disease Hypertension Migraine/Headache Respiratory Infections Arthritis Allergy* 2008 Thomson Reuters 2008 Thomson Reuters 2008 Thomson Reuters 2008 Thomson Reuters Goetzel s rule: An ROI of 1:1 is good enough if you can demonstrate health improvement! Poor Health Costs Money Top 10 Most Costly Physical Health Conditions Medical, Drug, Absence, STD Expenditures (1999 annual $ per eligible), by Component Drill Down Medical Absence/work loss Presenteeism Risk factors Source: Goetzel, Hawkins, Ozminkowski, Wang, JOEM 45:1, 5 14, January $450 $400 $350 $300 $250 $200 $150 Presenteeism STD Absence RX ER Outpatient Inpatient $100 $50 $- Annual Costs The Big Picture: Overall Burden of Illness by Condition Using Average Impairment and Prevalence Rates for Presenteeism ($23.15/hour wage estimate) Source: Goetzel, Long, Ozminkowski, et al. JOEM 46:4, April, 2004) 48

9 Higher Healthcare Utilization and Cost HERO II Study Risk-Cost Impacts HERO II EXHIBIT 1 Average Unadjusted And Adjusted Medical Expenditures, In 2009 Dollars, By Risk Levels Unadjusted difference Adjusted difference (%) (% ) Risk Unadjusted Adjusted Risk measure level means ($) means ($) Depression High 6,207 6, Lower 3,902 4,553 Blood glucose High 6,532 6, Lower 3,842 5,196 Blood pressure High 5,264 5, Lower 4,132 4,356 Body weight High 4,956 5, Lower 3,498 3,988 Tobacco use High 4,192 4, Lower 3,784 3,597 Physical inactivity High 4,477 4, Lower 3,537 3,976 Stress High 5,024 5, Lower 4,444 4,836 Cholesterol High 4,780 4, Lower 4,688 5,037 Nutrition and eating habits High 3,245 3, Lower 4,226 3,440 Alcohol consumption High 3,857 3, Lower 4,015 4, Individual vs. Population-Based Costs 52 Cost Per Capita of Risk Factors Research on Risk-Cost Relationships - Novartis

10 Risk Factors and Presenteeism (N = 5,875) Risk-Cost Relationships at PepsiCo % 80% 70% 60% 50% 40% 30% 20% 10% 0% 10% 16% 4% 15% 15% 5% 23% 77% 18% Percentage Sample with High Risk Health Risk Prevalence BMI Breakdown by Category 50% 45% 40% 35% 30% 25% 20% 15% 10% 5% 25% 44% 22% 7% 3% 0% Biometric Risks Health Behavior Risks Psychosocial Risks Normal BMI < 25 Overweight BMI Class I BMI Class II BMI Class III BMI PepsiCo Overweight / Obese Analysis (N=11,217) NHLBI Multi-Center Study: Estimated Annual Costs of Healthcare Utilization, Absenteeism, and Presenteeism by BMI Category *At least one difference significant at the 0.05 level Doctor Visits $178 $182 $229 * Normal Overweight Obese Diff = 29%, $613* Diff = 25%, $987 Emergency Room Visits Hospital Admissions $149 $155 $219 * $1,535 $1,544 $2,034 Diff = 58%, $111* Diff = 26%, $186* Diff = 7%, $49 Diff = 10%, $28 Absenteeism Days $872 $918 $1,180 * 74% of the sample is overweight or obese Presenteeism $1,200 $1,402* $1,416 * $0 $500 $1,000 $1,500 $2,000 $2,500 * P <.05 Difference between combined overweight/obese categories and normal weight is displayed Source: Henke RM, Carls GS, Short ME, Pei X, Wang S, Moley S, Sullivan M, Goetzel RZ. The Relationship between Health Risks and Health and Productivity Costs among Employees at Pepsi Bottling Group. J Occup Environ Med. 52, 5, May Source: Goetzel RZ, Gibson TB, Short ME, Chu BC, Waddell J, Bowen J, Lemon SC, Fernandez ID, Ozminkowski RJ, Wilson MG, DeJoy DM. A multi-worksite analysis of the relationships among body mass index, medical utilization, and worker productivity. J Occup Environ Med Jan;52 Suppl 1:S Percentage Sample In Each BMI Category

11 J&J Study Health Affairs, March 2011 Health Risks Biometric Measures -- Adjusted Results adjusted for age, sex, region * p<0.05 ** p< Health Risks Health Behaviors -- Adjusted Health Risks Psychosocial -- Adjusted Results adjusted for age, sex, region * p<0.05 ** p< Results adjusted for age, sex, region * p<0.05 ** p< Propensity Score Matching Results Adjusted Medical and Drug Costs vs. Expected Costs from Comparison Group 65 Average Savings = $565/employee/year Estimated ROI: $ $3.92 to $

12 Vanderbilt 8-Year Study Obesity and Diabetes Wall Street Studies Ray Fabius 2013 study AECOM CHAA Winners ACOEM Winners vs. S&P 500

13 HERO Study: Connecting Corporate Health and Wellness Best Practices to Superior Market Performance HERO Scorecard Study Average Change In Medical Expenditures Average Percent Change in Medical Expenditures Over Three Years for the Study Sample (Adjusted to 2012 Dollars Not Adjusted for Confounders) % -8.0% -6.0% -4.0% -2.0% 0.0% 2.0% 4.0% 6.0% 8.0% Average Percent Change in Medical Expenditures from Total Hero Scorecard Score Predicted Average Annual Per Member Healthcare Expenditures (Adjusted to 2012 dollars) for Organizations with High and Low HERO Scores Comparison of Expenditures by HERO Score, Adjusted for Confounders $3,100 $3,050 $3,000 $2,950 $2,900 $2,850 $2, (% Change from 2009) 2011 (% Change from 2010) LOW $3,048 $3,050 (0.05%) $3,051 (0.05%) HIGH $2,948 $2,901 (-1.6%) $2,855 (-1.6%) HERO Score Grossmeier et al., HERO S&P Study HERO Study Results Adjusted Annual Cost

14 Koop Award Winners and S&P 500 Index Goetzel et al., Koop S&P Study Koop Winners: BP America BP 2014 Eastman Chemical EMN 2011 Prudential Financial PRU 2011 Pfizer, Inc. PFE 2010 The Volvo Group VOLVF 2010 Alliance Data Systems Corp ADS 2009 Dow Chemical Company DOW 2008 International Business Machines IBM 2008 Pepsi Bottling Group PBG 2007 WE Energies WEC 2007 Union Pacific Railroad UNP 2005 UAW-GM GM 2004 Johnson & Johnson Services, Inc JNJ 2003 FedEx Corp. FDX 2002 Motorola Solutions Inc. MSI 2002 Citibank C 2001 Union Pacific Railroad UNP 2001 Northeast Utilities NU 2001 Caterpillar Inc. CAT 2000 Cigna Corp. CI 2000 DaimlerChrysler Corporation DDAIF 2000 Fannie Mae FNMA 2000 Aetna AET 1999 Pfizer, Inc. PFE 1999 Glaxo Wellcome GSK 1999 UNUM/ Provident UNM 1999 Getting the Word Out on Best and Promising Practices in Workplace Health Promotion Best/Promising Practice Dissemination Robert Wood Johnson Foundation Promoting Healthy Workplaces Transamerica Center for Health Studies Employer Guide to Workplace Health Promotion American Heart Association -- Developing a Culture of Health Playbook Centers for Disease Control and Prevention Workplace Health Research Network Centers for Disease Control and Prevention Information Clearinghouse

15 JOEM Study

16 The Secret Sauce 2008 Thomson Reuters 1. Culture of Health More than just a wellness program It s a way of life Ingrained in every part of the organization Business Mission Built Environment Performance Metrics Programs, Policies, Health Benefits 2. Leadership Commitment CEO Driven Lead by Example Middle Management Support Budget/business plan Empowered workers/unions 3. Specific Goals and Expectations Think big, start small, act fast -- one step at a time Set short and long term objectives Be realistic about what can be achieved in 1, 3, 5, 10+ years Accountability leaders and employees are accountable for doing their part to support a culture of health

17 4. Strategic Communications Relentless Surround Sound Messages need to be: Consistent Constant Engaging Targeted Two-way dialogue using a variety of channels Wellness champions 5. Employee Engagement in Program Design/Implementation Wellness Committees Employee Feedback Surveys Participatory Based Program Design Focus Groups 6. Best Practice Interventions 7. Effective Screening and Triage Convenience, removing barriers Many choices Making the healthy choice the easy choice Health Risk Assessments with Follow-up -- PLUS Biometric Screenings (USPSTF Guidelines) On-site Clinics and Counselors Applying behavior change theory/practice 8. Smart Incentives Tailoring, and providing alternative paths to motivate, reward, and help employees achieve their goals Tiered Incentive Programs Non-Monetary Incentives Carrots, Not Sticks 9. Effective Implementation Tailored to the company s culture Integrated solutions Flexibility Fresh ideas Fun Voluntary reasonable dollar amounts

18 10. Measurement and Evaluation This Is Hard! Structure: HEALTH, SAFETY, AND PRODUCTIVITY MANAGEMENT Process: Outcomes: Employees Modified Worksite Health Promotion (Assessment of Health Risk with Follow-Up) Logic Model adopted by the CDC Community Guide Task Force Workplace Health Promotion (Wellness) Works If You Do it Right! Another Benefit: Engaged Workers Who Love Their job! Financial Outcomes Health Outcomes QOL and Productivity Outcomes Cost savings, return on investment (ROI) and net present value (NPV). Where to find savings: Medical costs Absenteeism Short term disability (STD) Safety/Workers Comp Presenteeism Adherence to evidence based medicine. Behavior change, risk reduction, health improvement. Improved functioning and productivity Attraction/retention employer of choice Employee engagement Corporate social responsibility (CSR) Balanced scorecard Where We Need to Go.. Learn More at. Old Paradigm Bad behavior (poor diet) leads to High risk condition (obesity) leads to Disease (diabetes) leads to Death New Paradigm Good health (physical, mental, emotional, social, financial, spiritual) leads to Well-being (energy) leads to Purposeful life AND HIGH VALUE