“A Workplace Culture of Health” Population Health & Disease Management Colloquium Ray Fabius MD
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Transcript of “A Workplace Culture of Health” Population Health & Disease Management Colloquium Ray Fabius MD
“A Workplace Culture of Health”
Population Health & Disease Management Colloquium
Ray Fabius MDStrategic Adviser to the President - Walgreens Health & Wellness
March 3rd, 2009
Date
Let’s Start with the Employer View
• Runaway health care costs without controls• Threatens company viability• Misuse, overuse, and underuse• Need for Transparency• Apply TQM, Six Sigma, TPS, Lean to Health care• Consumerism• Purchase & Perceive Care in Silo’s• Human Resources Leaders are Risk Advice • Often Depend on Payers and Consultants for next answer• Data deficient• Workplace Safety• Work Environment• Workplace Health
Today’s Agenda
• The Success of Occupational Health & Workplace Safety
• Translating that Success to Healthcare• How can you create a Culture of Health inside a
company?• What would the value be in creating a Culture of
Health?• Examples of Successful Efforts to Create a Culture
of Health
Occupational & Motor Vehicle Safety Improvements
• .US Vehicle & Workplace Death
Rates
01020304050
Motor VehicleWorkplace
Viewpoint on Public Issues, Mackinac Center for Public Policy, 3/1/99; No. 99-11
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One Glaring Exception: The Healthcare Environment is Becoming More Hazardous
Effectiveness Pathway to Workplace SafetyIdentify Opportunities
Measure Baseline
Establish Interventions
Implement Action Plan
Re Measure Data
Analyze for Effectiveness
Prevention of Errors in Workplace Safety
• Technology– Automated Processes– Decrease Complexity– Worker Removed from Process– Operator Monitors Automated System for
Abnormal Events• Prepared to handle response or solution
– Standardization
Tipping the Scale
Safety
Errors
LeadershipResourcesAwarenessGuidelinesCollaborationStandardizationSimplification
DocumentationNon-PunitiveActive LearningChange AgentTechnologyTrainingFeedback
Healthcare Delivery
Conditions that Prevent Workplace Errors
• Good Managerial Decisions• Right Equipment• Maintenance of Equipment• Skilled & Knowledgeable Workforce• Reasonable Workload & Schedule• Well-Designed Jobs• Clear Guidance on Desired & Undesired
Performance
Lessons Learned in Workplace SafetyPotential Application to Workplace Health
• Growing Awareness • Comprehensive Strategies• Intolerance with Errors• National Focal Point for Leadership• Dissemination of Information• Regulatory Responsibility• Research• Expanding Knowledge Base• Substantial Resources
What About the White Collar World?
• Executive Health• Ergonomics• Stress Management• Resiliency• Work Accommodation• Ex pat Services• Work / Life Balance
Building a Culture of Health
STEP 1
STEP 2
STEP 3
STEP 4
STEP 5
COMPANY ASSESSMENT
DATA AND METRICS
OPERATIONAL PLAN
INTERVENTIONS
EVALUATION & REFINEMENTS
Changes Required to Create a Culture of Health
• Create Awareness• Identify Gap from Benchmark• Study Intervention Options• “Operationalize” Best Efforts• Training and Education• Establish Accountabilities• Celebrate Success
How can you create a Culture of Health inside your company?• Branding• Champions• Rack & Stack• Incentives • Mandates• An environment of health• Fitness• Risk Assessment• Risk Reduction• Disease Management• Proof of Concept• Mainstream success
Resources to Effect Change
• Leadership• Attention• Investment
How do Health & Wellness effect productivity?
• Health care – self-insured• Workers Compensation• Disability• Absence• Presenteeism• Poor performance
The Skill & The WillBut What About Not Being Ill!
Total Employee Health Related Costs
Medical 22%
Disability 4%
Productivity Loss 74%
Workers’ comp, sick leave & other wage replacement
Lost ProductivityLost Productivity
AbsenteeismAbsenteeism
Subpar QualitySubpar Quality
Employee and Customer DissatisfactionEmployee and Customer DissatisfactionPresenteeismPresenteeismTurnoverTurnover
Adverse Bottom Line ImpactAdverse Bottom Line Impact
DIR
ECT
OTH
ER C
OST
S
Temporary StaffingTemporary Staffing
Replacement TrainingReplacement Training AdministrativeAdministrative
Health Care CostsMedical CareHospitalizationPharmacyDiagnostic TestingBehavioral HealthPhysical Therapy
Illness & InjuryIllness & InjuryTravel to Off-site MDTravel to Off-site MD
Source: Integrated Benefits Institute, 2000
Overtime PayOvertime Pay
Missed DeadlinesMissed Deadlines
The Connection Between Health & Human Capital is Significant
• Over 22% of working age adults report health-related work impairment in the past 30 days from chronic illness. Those with impairment average 6.7 lost days. Equivalent to 2.5 billion impaired days/year. -Kessler
• American Productivity Audit: Top 5 reasons for productivity loss result in $180 billion in lost time. -Stewart
• Illness and disability reduced total work hours by approximately 8.6%. Nearly 8.7 million Americans were completely unable to work. The loss to the U.S. economy represented about $468 billion. -Berger
Leading by Example
• “Investment in health delivery is consistent with a long-term view of maximizing return on human capital.” Michael Critelli—CEO, Pitney-Bowes
• “A healthy, engaged, and productive workforce is critical to maximizing business performance and driving sustainable growth.” Dean Oestreich—President, Pioneer Hi-Bred International, Inc.
• “Our profit potential is inextricably linked to the capability and performance of our employees.” Andrew Liveris—President and CEO, The Dow Chemical Company
Factors Affecting Health & Productivity
Health-related factorsPhysical health issues
Chronic diseaseAcute illness
Lifestyle issuesHealth risksPreventive care compliance
Behavioral healthOther factors: Demographics Caregiving Work/life imbalance
Financial concernsEmployer health benefits
Productivity-related factorsAbsenteeism
STD and LTD programsFMLA policiesSick leave policyEffect on team moraleValue of time in production
Workers’ CompensationPresenteeism
Work relationshipsJob security and controlHealth issues
Work issuesErgonomic issuesSafety concerns
Integrated Data to Evaluate Health & Productivity Costs
Lost time data• STD• LTD• FMLA• PTO/sick leave
WC/Safety data• OSHA, accident reporting• drug testing• WC claims data
HR/payroll• employee demographics• time reporting• employee surveys• turnover/overtime data• performance appraisals
Medical data• group health• pharmacy• mental health• health risk appraisals• disease prevalence• EAP utilization
Productivity metrics• staffing/overtime• per employee costs and revenues• self-reported presenteeism
Business data• customer satisfaction• production data• quality data• operational data• net income• gross revenue• human capital costs
Integrated data analysis
IHPM Journal, 2003
Top 15 Drivers of Lost Work Time
0
50
100
150
200
250
300
350
400
450
500
Sleep disorders
Depression
FatigueBack/neck
AnxietyHypertension
Other emotional
ArthritisObesity
Chronic pain
Headache
Irritable bowel
High cholesterol
Heart disease
Allergy
Los
t wor
kday
s/100
FT
Es Absence Presenteeism
Source: Kessler’s HPQ – Adjusted to Workforce
$0
$50
$100
$150
$200
$250
$300
$350
$400
Ann
ual c
ost p
er e
mpl
oyee
(PEP
Y)
presenteeismabsenteeismST disabilityinpatientoutpatientERmedications
The Total Cost of IllnessGoetzel, et al. JOEM 2004
allergyarthritis
depressiondiabetes
migraine
Health Risks: Associated with Productivity Loss
0
2
4
6
8
10
12
14
0 1 2 3 4+Number of Risk Factors
Ave
rage
Day
s A
bsen
t per
Yea
r
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
50%
0 1 2 3 4 5 6+
Total Number of Medical Conditions
Perc
ent R
epor
ting
Lim
itatio
ns
TimePhysical
0
2
4
6
8
10
12
Risk Parameter
Avg
Hou
rs L
ost p
er W
eek
(mea
n)
Illness Absence STD Absence Productivity Loss
The More Health Risks the Greater the Absence The More Health Risks the Greater the Limitations
Some Health Risks Cause Greater Lost Work Hours
Poor Health Impact – Continuum of Employee Performance Outcomes
Lost to the workforce
Not at work
Not doing work on work time
Not doing wellwhile working
permanent disabilityearly retirement due to health issuespremature death spousal illness
unscheduled absencedisabilityworkers’ compreplacement workers
unscheduled breaksunfocused time
health exams on work timeinformation gathering
errorscomplaints
delaysteam breakdown
HHS - The Workplace is a great location for preventive programs
“Employers are becoming more awarethat obesity, lack of physical activity, andtobacco use are adversely affecting thehealth and productivity of theiremployees and ultimately, the businesses’bottom line.”As a result:• Innovative employers are providing a
variety of work-site-based health promotion & disease prevention programs
• Significant return on investment for the employer (median ROI of $3.14)
Health by Numbers
Smoking 0 Tobacco (None)
Diabetes / Heart Disease 5 Diet (5 Fruits/Vegetables A Day)
Lack of Exercise 10 Exercise (10,000 Steps A Day)
Overweight / Obesity 25 Weight (Body Mass Index, weight to height ratio, less than 25 = healthy)
Driving Healthy Lifestyles
Message: Don’t Smoke
Message: Eat healthy
Message: Be active
Message: Maintain a healthy weight
Rewards (intrinsic / extrinsic) vs. Competitions (rack & stack)
A High Performance Network can reduce an employee community’s random access of care
Studies show: • half or more employees believe all doctors and hospitals provide the same care
• half or more employees are not aware of guidelines of care
• physicians referral patterns are based on consanguinity, friendship, financial ties and proximity.
However the majority of an employee community seek validation from their trusted clinician before proceeding
with a treatment decision.
%Using Best Hospitals 2006 vs 2007 %Using Best Specialists 2006 vs 2007
Identifying best specialists & hospitals & directing employees to them
2007 ActualBilled Charges
Paid January thru June
2007 ActualBilled Charges
Paid January thru June
The TFHC specialty referral rate is 2/3 lower than the community referral rate.
9.4% 8.7%
28.3%* 28.3%*
Toyota presentation to IHPM
On-site health center provides the framework and technological infrastructurefor the delivery of effective H&P programs
Occupational Health Health and Wellness
Keeping EmployeesSafe and at Work
Keeping EmployeesHealthy
Employer’s Health, Safety and Productivity Programs
Philosophical Approach to Onsite Health Services
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Clinical Outcomes for Health Center Users with Diabetes
Process Indicators Correlate with Outcomes LAB Value 2003
Year 12005
Year 3Variance
HbA1C 9.1 7.8 -14.0%HDL Cholesterol 43 47 +9.3%LDL Cholesterol 138 108 -21.7%Triglycerides 288 201 -30.0%Systolic PB 131 126 -3.8%
(2003 to 2005) N=336
Projecting Long-Term Economic Impact (Diabetes Care Improvement)
Analysis of risk factorspredictive modeling indicate asignificant reduction in risk ofdiabetes complications overthe 2003-2005 period fordiabetics under carePotential future economicimpact - reduced patientmorbidity has been estimatedat an average of $1,800 ofavoided medical costs perpatient per year (beforeinflation adjustment)Economic impact does notinclude impact onproductivity or disabilityoutcomes
Projected Cases Per 336 Patients
with Diabetes(10 Year Period)
Avoided Costs
(10 Years)
Risk Year 1
Risk Year 3
Lower extremity amputation
10.7 7.0 $156,600
Blindness 4.7 3.0 $54,400End stage renal disease
7.0 1.3 $4,934,200
MI or stroke 84 40 $1,094,000$6,238,600
Drivers Results
Population Health Excellence ™Toolkit & Requirements – Building Blocks
Community Prosperity
Extrinsic to Intrinsic
Self-Efficacy
Learning StylesHealth LiteracyDiversityAccessConvenienceEase of Use
Proven Efficacy
FlexibilityIntegration
Community of Health
Motivation
Participation
Multi-Modal
Spectrum of Care
Informatics
Platform
Health & Productivity Outcomes
Health & Productivity Outcomes
Behavioral Health
Behavioral Health
Incentives Rewards
Incentives Rewards
RecruitRecruit EngageEngage RetainRetain
Media Print, Audio,Video
Media Print, Audio,Video Web-BasedWeb-Based TelephonicTelephonic Face to FaceFace to Face
Health Promotion
Health Promotion
Lifestyle Risk
Management
Lifestyle Risk
ManagementHealth Risk
ManagementHealth Risk
ManagementHealth
AdvocacyHealth
Advocacy
Research & DevelopmentResearch &
DevelopmentScorecard DashboardScorecard Dashboard
Data Analysis
Data Analysis
Data Warehouse
Data Warehouse
Predictive Modeling
Predictive Modeling
Risk Management
Risk Management
Information TechnologyInformation Technology
Finance Contracting
Finance Contracting
Account Management
Account Management
Provider RelationsProvider Relations
Clinical IntensityClinical Intensity
Disease Management
Disease Management
Outcomes ManagementOutcomes
Management
Marketing Communications
Marketing Communications
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GE Global Medical Network: 230 On-Site Clinics & 600 Doctors & Nurses
US: 97
GE Medical Clinics February, 2004
Rev. 4/29/02
226 Clinics1.5 MM Patient Visits Annually
Canada: 11 ClinicsEurope: 46 Clinics
China: 7 Clinics
India: 9 Clinics
Mexico: 24 Clinics
South America: 11 Clinics
Puerto Rico:11 clinics
Other Asia: 6 Clinics
The issue of benefits extends beyond our country's borders
Summary
• The Success of Occupational Health & Workplace Safety
• Translating that Success to Healthcare• How can you create a Culture of Health inside a
company?• What would the value be in creating a Culture of
Health?• Examples of Successful Efforts to Create a Culture
of Health