A Sustainable Model for Worksite Wellness National Wellness Conference June 27, 2016 Mari Ryan, MBA, MHP, CWP

A Sustainable Model for Worksite Wellness National Wellness Conference June 27, 2016 Mari Ryan, MBA, MHP, CWP

Mari Ryan, MBA, MHP, CWP CEO/Founder, AdvancingWellness Co-Chair/Founder, Worksite Wellness Council of Massachusetts Member, Board of Directors and Grassroots Advocacy Chair, Health Promotion Advocates Adventurous soul: pilgrim, mountain climber, race car driver, sculler, photographer advwellness.com 2

Learning Objectives Following this session, you will be able to: Identify the benefits of a teach to fish model of building worksite wellness capabilities Identify the relationship between worker s compensation claims and health risks Outline the outcomes associated with a teach to fish program model. advwellness.com 3

Who are You? 1. Health Promotion Professional Corporate 2. Health Promotion Professional Education 3. Health Promotion Professional Non-Profit 4. Health Promotion Service Provider 5. Human Resources Professional 6. Safety/Worker s Compensation/Total Worker Health 7. Other advwellness.com 4

advwellness.com 5

Wisdom of the ages Give a man a fish and you feed him for a day. Teach a man to fish and you feed him for a lifetime. Proverb origins contested advwellness.com 6

Traditional Approaches to Wellness BUILD BUY advwellness.com 7

To Fish or Not to Fish Exercise Assignments to your designated group: To Fish Not to Fish advwellness.com 8

Fish or Not to Fish Exercise Working in pairs, your job is to sell your fishing partner on why your organization: should use a teach to fish model for developing a wellness program should not use a teach to fish model for developing a wellness program Keep notes for sharing advwellness.com 9

Why Teach to Fish? Provides skills and knowledge at the leadership, manager and employee level in the organization Instills the value and benefits of creating a program plan Provides professional coaching/expertise to support the learning process Establishes the internal skills and knowledge as a foundation for program sustainability advwellness.com 10

Got a Plan?

Got a Plan? Group A Group B Group C 57% 26% 17% No formal, written strategic plan Multi-year plan Annual plan The HERO Employee Health Management Best Practice 12 Scorecard, Annual Report 2010 12

MA DPH 2014 Benchmarking Survey Of over 600 Massachusetts businesses that responded to Group the survey: A 90% No formal, written strategic plan 13

Source: Ryan,MR Chapman, LS. Planning Worksite Health Promotion Programs: Models, Methods, and Design Implications. American Journal of Health Promotion, July/Aug 2008 14

Teach to Fish Model Application Massachusetts Department of Public Health Working on Wellness V1 2008 2013 62 Massachusetts employers Touched over 50,000 Massachusetts employees Working on Wellness V2 2015 2017 Target: 350 Massachusetts employers Currently enrolled: over 100 employers Worker s Compensation Insurance Company advwellness.com 15

Health Risks & WC Claims

What s the Issue? 42 Year Old Man Light job class Diagnosed with low-back pain No co-morbidities = 29 days of disability Tobacco users = 46 days of disability advwellness.com Source: Stepping Up To Wellness, Workcomp Central, May 15, 20126 17

What does the research show? Employee Health and Frequency of Workers' Compensation and Disability Claims Kuhen,AE et al High risk participants had higher odds of filing a WC claim, when compared with low risk participants Sept 2009 Medium risk participants had 1.5 times higher odds when compared with low risk participants for STD advwellness.com 18

What does the research show? Obesity and Workers Compensation: Results from the Duke Health and Safety Surveillance System Ostby, T. et al April 2007 Clear linear relationship between BMI and rate of WC claims Claims associated with BMI: Lower extremity Wrist/hand/back Pain/inflammation/strain/sprain Slips/falls, lifting/exertion advwellness.com 19

What does the research show? June 2001 The Association of Health Risks with Workers Compensation Costs Musich, S et al WC costs increased with increasing health risk status (low-risk to medium-risk to high-risk). 85% of WC costs can be attributed to excess risks (medium- or high-risk) advwellness.com 20

ACOEM Guidance Statement Workplace Health Protection and Promotion: A new Pathway for a Healthier and Safer - Workforce Hymel PA. et al June 2011 Problem: health protection programs (safety, and work environment) are separate from workplace health promotion programs (wellness and disease management) Making the case for integration of these functions advwellness.com 21

Case Study

Program Format Ten policyholders recruited to participate in each cohort Twelve month program Well-being Assessment administered three times per cohort (Y1, Y2, Y3) Three cohorts to be run over three years advwellness.com 23

AIM Mutual Innovative Approaches Massachusetts-based Worker s Compensation carrier advwellness.com 24

AIM Mutual Step 1 Redesigned traditional loss control model in 2013 Renamed Injury Prevention and Worksite Wellness Department A.M. Best gave Innovation Showcase Award for this approach Partnered with Best Doctors Occupational Health Institute to address post-injury Gave injured workers access to medical specialists and managing the key risks factors likely to impact recovery advwellness.com 25

AIM Mutual Step 2 Recognizing that managing risks factors and encouraging focus on general well-being was necessary Invited select group of policyholders to participate in a year-long program to learn to build a worksite wellness program advwellness.com 26

AIM Mutual Step 2 Program Elements Standardized curriculum In-person training four sessions, one per quarter Scheduled telephonic technical assistance/coaching Expert webinars four sessions Well-being Assessment T1 Month 2 of program T2 One year later T3 Two years later advwellness.com 27

Wellness Program Timeline Steps 1-3 January February March Training Session #1 Program Overview Values and Benefits Mandate from Management Wellness Sponsor Compose Wellness Team Wellness Champion Wellness Committee Research & Discovery Identify Needs Custom Well-being Assessment Technical Assistance SME Webinar ( : advwellness.com 28

Wellness Program Timeline Steps 4-6 April May June Training Session #2 Review of WBA Goals/Objectives Plan Development Develop Intervention Plans Technical Assistance ( Plan Approval SME Webinar : advwellness.com 29

Wellness Program Timeline Step 7 - Implementation July August September Training Session #3 Review of Challenges/ Opportunities Intervention Implementation Technical Assistance ( Intervention Implementation SME Webinar : advwellness.com 30

Wellness Program Timeline Step 7 - Implementation October November December Training Session #4 Success Stories Sustainability Intervention Implementation SME Webinar : Intervention Implementation advwellness.com 31

Planning Development Cycle Implement Plan Obtain Mandate for Wellness Initiative Compose Wellness Team Plan Approval Research & Discovery/ Identify Needs Plan Development Formulate Goals advwellness.com 32

Cohort 1 Results

Company Size/Industry Industries: 7 manufacturing, 1 insurance, 1 health care 400 376 350 300 250 200 150 100 50 0 165 117 insurance 81 86 37 Co 1 Co 2 Co 3 Co 4 Co 5 Co 6 Co 7 Co 8 Co 9 100 health care 75 30 34

Data Collection Well-being Assessment custom survey Well-being Questions Workplace Support for Well-being Financial Well-being Purpose, Connection and Social Support Health Risks Traditional HRA Questions (ten risks) Demographics Technology Commuting advwellness.com 35

Assessment Participation By Company 100% 90% 98% 100% Time 1 Target = 50% participation rate 80% 70% 69% 60% 50% 40% 30% 53% 52% 47% 46% 39% 57% 20% 10% 0% Co 1 Co 2 Co 3 Co 4 Co 5 Co 6 Co 7 Co 8 Co 9 36

Top Risks Identified Time 1 High/Low Ranges Weight Mgmt T1 59% 83% Sleep T1 47% 81% Lack of Physical Activity T1 41% 78% High Blood Pressure T1 19% 46% Tobacco Use T1 1% 44% High Cholesterol T1 12% 43% Binge Drinking T1 14% 40% Relaxation Drugs T1 12% 27% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 37

Health Risk Status Time 1 60% 56% 58% 50% 49% 52% 49% 52% 51% 49% 47% 41% 41% 40% 30% 34% 32% 32% 30% 33% 32% 32% 20% 10% 10% 19% 7% 19% 13% 15% 17% 19% 12% 0% Co1 Co 2 Co 3 Co 4 Co 5 Co 6 Co 7 Co 8 Co 9 Low Medium High University of Michigan HMRC = target 70% advwellness.com 38

Assessment Participation By Company Time 1 versus Time 2 100% 90% 80% 70% 98% 91% 100% 72% 69% 82% 60% 50% 40% 56% 53% 52% 47% 46% 41% 39% 57% 52% 30% 20% 22% 17% 10% 0% Co 1 Co 2 Co 3 Co 4 Co 5 Co 6 Co 7 Co 8 Co 9 3% 39

Top Risks Identified T1 vs. T2 High/Low Ranges Weight Mgmt T1 Weight Mgmt T2 Sleep T1 Sleep T2 Lack of Physical Activity T1 Lack of Physical Activity T2 High Blood Pressure T1 High Blood Pressure T2 Tobacco Use T1 Tobacco Use T2 High Cholesterol T1 High Cholesterol T2 Binge Drinking T1 Binge Drinking T2 Relaxation Drugs T1 Relaxation Drugs T2 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 40

Health Risk Status Time 2 80% 73% 70% 64% 60% 50% 40% 30% 55% 37% 50% 50% 45% 39% 56% 52% 34% 33% 26% 43% 30% 40% 45% 20% 21% 15% 14% 15% 15% 20% 10% 9% 9% 7% 0% 0% Co1 Co2 Co3 Co4 Co5 Co6 Co7 Co8 Co9 High Med Low 41

Participation Barriers Time! 70% 63% 60% 50% 50% 53% 40% 30% 20% 10% 31% 17% 15% 40% 31% 25% 13% 14% 13% 15% 8% 9% 33% 34% 30% 23% 20% 20% 20% 17% 11% 30% 7% 0% Co1 Co2 Co3 Co4 Co5 Co6 Co7 Co8 Co9 Time Work Remotely Personal/Family No barriers No on my shift Motivation Lack of interest 42

Awareness of Programs 100% 93% 90% 80% 70% 79% 75% 71% 73% 70% 72% 60% 58% 50% 40% 30% 20% 10% 0% 37% 38% 35% 28% 28% 25% 23% 20% 20% 14% 14% 10% 7% 3% 4% 1% Co 1 Co 2 Co 3 Co 4 Co 5 Co 6 Co 7 Co 8 Co 9 Very Well Informed Know some but not all Unaware advwellness.com 43

Participation in Programs 80% 80% 70% 60% 68% 63% 62% 69% 60% 58% 67% 50% 45% 42% 40% 30% 20% 25% 26% 18% 14% 13% 12% 31% 13% 22% 23% 20% 18% 19% 27% 10% 7% 0% Co 1 Co 2 Co 3 Co 4 Co 5 Co 6 Co 7 Co 8 Co 9 Fully utilizing Using some Not using advwellness.com 44

Program Interests Time 2 #1 #2 #3 Co1 Stress mgmt Health fair Getting more PA Co2 Back care Financial wellness Walking event Co3 Getting more PA Weight mgmt Eating behavior Co4 Yoga Active parenting Getting more PA Co5 Fitness or wellness challenge Weight mgmt Financial wellness Co6 Walking club or event Getting more PA Weight mgmt Co7 Yoga Aerobic ex class Back to nature Co8 Health fair Fitness or wellness challenge Walking club or event Co9 Monthly info seminar Nutritional session Getting more PA 45

Cohort Analysis - One Company

Cohort Risk Status Change 45% 41% 40% 35% 30% 25% 23% 25% 20% 15% 10% 5% 4% 6% 1% 1% 0% -2-1 0 1 2 3 4 N=122 individuals that took T1 and T2 surveys 76% of T1 respondents 47

Cohort Key Risk Summary 2016 2015 US Overweight (BMI 25-29.9) 36% 34% 37% Obese (BMI >30) 30% 35% 36% Diabetes 3% 3% 9% Lack of Physical Activity 57% 57% 49% High Blood Pressure 42% 42% 29% High Cholesterol 20% 25% 13% Tobacco Use 4% 5% 17% Mental Health Relaxation medication and drugs 18% 15% Binge drinking 11% 15% Sleep Get 7 or less hours most nights 53% 53% 48

Screenings Primary Care Visit Flu Shot 70% 60% 50% 61% 50% 70% 60% 61% 65% 40% 30% 20% 21% 29% 19% 15% 50% 40% 30% 39% 35% 10% 3% 2% 20% 0% In the last six months Between six months and 1 year Between 1 year and 2 years 2015 2016 More than 2 years ago 10% 0% 2015 2016 Yes No 49

Successes & Challenges

Successes Incentives drive participation (for some organizations) Wellness Committees committed to their work Once programs get going, employees asking for more Creative solutions HR Managers saw increases in 401K loans, implemented financial well-being portal Research by IT staff uncovered a wearable PA tracker for $12/ee Management commitment to program Shutting down manufacturing so all employees can attend health fair/event Change to shift hours no shifts that start before 5am (used to start at 3am), driven by high lack of sleep numbers advwellness.com 51

Challenges Teaching how to write goals/objectives Year 2 Well-being assessment participation was low Wellness Committees running out of fuel/fatigued Turnover in Committee, finding replacements Relapse to unhealthy behaviors Wellness Committee member who was very vocal about her success in quitting smoking, relapsed Keeping the momentum of the program advwellness.com 52

Cohort 2

Company Size/Industry 400 Industries: 4 manufacturing, 2 long-term care, automotive, 2 industrial services, trades show services 397 350 332 300 250 210 200 150 100 50 120 104 58 38 81 112 59 0 Co 1 Co 2 Co 3 Co 4 Co 5 Co 6 Co 7 Co 8 Co 9 Co 10 54

Assessment Participation By Company Cohort 2 Time 1 Target = 50 % participation rate 100% 95% 95% 90% 87% 80% 70% 71% 71% 68% 66% 60% 50% 40% 42% 36% 46% 30% 20% 10% 0% Co 1 Co 2 Co 3 Co 4 Co 5 Co 6 Co 7 Co 8 Co 9 Co 10 55

Top Risks Identified Cohort 2 Time 1 High/Low Ranges Weight Mgmt 53% 88% Sleep 45% 78% Lack of Physical Activity 48% 70% Binge Drinking 8% 48% Tobacco Use 4% 30% High Cholesterol 14% 36% High Blood Pressure 19% 44% Relaxation Drugs 11% 27% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 56

Health Risk Status Cohort 2 Time 1 60% 54% 55% 58% 55% 50% 45% 43% 44% 44% 44% 46% 46% 40% 30% 20% 10% 35% 11% 12% 13% 33% 24% 35% 19% 30% 27% 15% 15% 32% 22% 35% 9% 39% 36% 25% 0% Co 1 Co 2 Co 3 Co 4 Co 5 Co 6 Co 7 Co 8 Co 9 Co 10 Low Medium High advwellness.com 57 University of Michigan HMRC = target 70%

Program Interests Cohort 2 #1 #2 #3 Co1 Stress management Low impact PA Getting more PA Co2 Yoga Getting more PA Walking event or club Co3 Getting more PA Stress Fitness or wellness challenge Co4 Getting more PA Fitness or wellness challenge Intramural sports Co5 Walking event or club Getting more PA Yoga Co6 Getting more PA Yoga Meditation Co7 Getting more PA Walking club or event Weight management Co8 Getting more PA Fitness or wellness challenge Walking event or club Co9 Financial wellness Intramural sports Eating behaviors/diet Co10 Yoga Back care Eating behaviors/diet 58

Summary Challenges and limitations Participants have limited experience in writing goals and objectives, especially in the context of health promotion programs Need lots of coaching from experienced worksite wellness professional Tools need to be very specific and provide examples, or give them the answer Small sizes of organizations limit cohort analysis Length of time required for behavior change limits seeing immediate impact on WC claims advwellness.com 59

References Primary data from program administration and well-being assessment conducted in March, 2015 and February 2016. A.I.M. Works program Burton,W. The Association of Health Risks With On the Job Productivity, JOEM Volume 47 Number 8 August 2005 pp 769-777 Ostbye,T. et al, Obesity and Workers Compensation Results From the Duke Health and Safety Surveillance System, Arch Intern Med 2007, 167, pp 766-773 Kuhnen A. et al, Employee Health and Frequency of Workers Compensation and Disability Claims, JOEM September 2009 Volume 51 Issue 9 pp 1041-1048 Hymel, P. Workplace Health Protection and Promotion A New Pathway for a Healthier and Safer Workforce JOEM June 2011 Volume 53 Issue 6 pp 695-702 Ryan,MR Chapman, LS. Planning Worksite Health Promotion Programs: Models, Methods, and Design Implications. American Journal of Health Promotion, July/Aug 2008 advwellness.com 60

Contact Info Mari Ryan, MBA, MHP, CWP Email: mari@advwellness.com Phone: 617-621-0784 Web: advwellness.com advwellness.com 61