May, 2007

Moving to a Health Agendawith High Return on Investment (ROI) High Reach / Low

Cost Interventions

Jim Grizzell, MBA, MA, CHES, HFI, FACHA

Policies

Health Communication, Ecological / Environmental Approach, Social Marketing

Activities no feedback

Health SystemsActivities w/ Health Education

SpecialtyCare

Community &Neighborhood Collaboration

Primary Care

Moving to a Health Agenda with High ROI High Reach / Low Cost Interventions 2

Moving to a Health Agenda Intervention Pyramid (slide 3)

High Reach / Low Cost vs Low Reach / High Cost Creating a Health Agenda (slides 4 – 7)

Historical Trend (slide 8)

Evolution of Wellness Programs (slide 9)

Cost-Effectiveness & Return on Investment Program and Intervention Levels of Interventions

and Return on Investment (ROI) Chart (slide 10)

Example (slide 11)

Population-Based Social Marketing Media Campaign vs

Willing Volunteer (People voluntarily attend classes)

Moving to a Health Agenda with High ROI High Reach / Low Cost Interventions 3

There is cost-effective health at the bottom of the pyramid

Think High Reach / Low Cost

High

Low

Cost

High

Low

Reach

Policies

Health Communication, Ecological / Environmental Approach, Social Marketing

Activities no feedbackHealth Systems

Activities w/ Health Education

SpecialtyCare

Community &Neighborhood Collaboration

Primary Care

Moving to a Health Agenda with High ROI High Reach / Low Cost Interventions 4

Recommendation to Create a Health Agenda

Two Key Elements1. Health promotion leaders must inform and

motivate the public, the people who benefit from

prevention, and policymakers

about the power of prevention and health promotion to increase longevity and improve quality of life.

McGinnis, J., Williams-Russo, P. and Knickman, J. The case for more active policy attention to health promotion. Health Affairs. 2002;21:2. 78-93.

Moving to a Health Agenda with High ROI High Reach / Low Cost Interventions 5

Recommendation to Create a Health Agenda

Two Key Elements2. We must create regulatory strategies and

financial incentives to facilitate social, behavioral and environmental change. Examples

taxes on high fat and sugar foods grants-in-aid to encourage communities to

develop bike paths (ecological approach) social marketing direct regulation (policy) indirect regulation through the legal system (i.e.,

law suits against false advertising)

McGinnis, J., Williams-Russo, P. and Knickman, J. The case for more active policy attention to health promotion. Health Affairs. 2002;21:2. 78-93.

Moving to a Health Agenda with High ROI High Reach / Low Cost Interventions 6

Recommendation to Create a Health Agenda Two Recommendations from the Institutes of Medicine

1. “A better balance is needed between the clinical approach to disease, presently the

dominant public health model for most risk factors, and

research and intervention efforts that address generic social and behavioral determinants of disease, injury and disability.”

2. Focus interventions on social and behavioral factors should link multiple levels of influence (i.e., individual, interpersonal, institutional, community, and policy levels)

Rather than focusing interventions on a single or limited number of health determinants

Smedley, B. and Syme, S. Promoting health: intervention strategies from social and behavioral research. 2000. Washington: National Academy Press. Available at http://www.nap.edu/books/0309071755/html/ Accessed May 20, 2004.

Moving to a Health Agenda with High ROI High Reach / Low Cost Interventions 7

Recommendation to Create a Health Agenda

Link to College Health

“Nationally, there is an imbalance of investments in medical care compared to health promotion and disease prevention activities This imbalance is true for most college health

programs The fact that the top health impediments to

successful academic performance are driven by conditions that are preventable ought to draw attention to policy opportunities for promoting health in the student population.”

Grizzell, J., The university learning mission, college health and the health agenda. NASPA NetResults, Research. March 25, 2005. Accessed on April, 10, 2007 at www.naspa.org/membership/mem/nr/article.cfm?id=1486, www.csupomona.edu/jvgrizzell/hppolicy/think_health_agenda.pdf

Moving to a Health Agenda with High ROI High Reach / Low Cost Interventions 8

Historical Snapshot: Think Health Agenda & Business Case

Corporate & College Health & Wellness

1850s 1970s 1980s ~1995 2010

Recreation Fitness Health Promotion HPM*

1st Generation 2nd Generation 3rd Generation 4th Generation

Instruction, Treatment, Exercise Health Education > Promotion HAPM*

1st Generation 2nd Generation 3rd Generation

* Health & Productivity Management, Health & Academic Performance Management

Moving to a Health Agenda with High ROI High Reach / Low Cost Interventions 9

Business Case

Evolution of Health & Wellness

Results / Outcome Oriented

Health and Academic

Performance Management

* = Health Cost Management, NOTE: chart adapted from Chapman, see notes section for reference.

Add focus on student learningStrong risk reductionStrong high risk focusSome required activitySite and virtualStrongly personal (individual, group)Major incentivesSig. others servedRigorous assess/eval

Traditional Medical and

Health Promotion

Traditional Medical Model

and Health Education

Mostly health focusSome risk reductionLittle risk reductionLimited HCM orientedAll voluntarySite-based onlyWeak personalizationModest incentivesFew sig. others servedWeak assess/eval

Fun activity focusNo risk reductionNo high risk focusNot HCM* orientedAll voluntarySite-based onlyNo personalizationMinimal incentivesNo sig. others servedNo assessment/eval

Activity OrientedMorale Oriented

Name of Model

Main Features

Primary Focus

Moving to a Health Agenda with High ROI High Reach / Low Cost Interventions 10

Business Case

Levels of Interventions & Wellness Program ROIs

Program Levels

Intervention Levels

Quality of Life

TraditionalHealth &

Productivity

I. Awareness Information, no feedback

<1:1

IIa. Behavior Change Health education w follow-up

3:1

IIb. Behavior Change Targeted priority health

issues with Social Marketing

6:1 to >15:1

III. Supportive Environment Ecological Approach, Policies

>15:1

Moving to a Health Agenda with High ROI High Reach / Low Cost Interventions 11

Business Case

High Reach / Low Cost vs Low Reach / High Cost

Population-Based Environmental Support Program Social Marketing Mass Media Campaign $294* x 4,500** = $1,323,000 Return on Investment = 4.4:1 (cost is less than benefit)

Willing Volunteer Behavior Change Program People voluntarily attend classes $294* x 250 = $73,500 Return on Investment = 0.73:1 (cost is greater than benefit)

* Johnson & Johnson health care costs avoided for each employee that gets regularly physically active

** WHEELING WALKS: a media-based intervention to increase walking. Bill Reger-Nash, EdD, www.americawalks.org/PDF_PAPE/Reger.pdf

Moving to a Health Agenda with High ROI High Reach / Low Cost Interventions 12

Questions?

High

Low

Cost

High

Low

Reach

Policies

Health Communication, Ecological / Environmental Approach, Social Marketing

Activities no feedbackHealth Systems

Activities w/ Health Education

SpecialtyCare

Community &Neighborhood Collaboration

Primary Care

Moving to a Health Agenda with High ROI High Reach / Low Cost Interventions 13

Employee Wellness Business Case

Six Core Program Cost (Percent) Areas

Medical$4,670 (37%) Turnover

$3,700 (29%) UnscheduledAbsence$810 (6%)

Non-occupational

Disability$513 (4%)

Presenteeism$2,590 (21%)

Worker’s Compensation

$310 (3%)

Moving to a Health Agenda with High ROI High Reach / Low Cost Interventions 14

Employee Wellness Business Case

A Seventh Core Program Cost Area

Health, Productivity & Absenteeism Management Health and Occupational Risk/Needs Assessment Health Promotion and Disease Prevention

Program Smoking cessation Stress/depression/mental health Heart and diabetes disease management

Employee assistance program Environmental health and safety

Cost $70 - $150 per employee

Benefit =/> $210 - $450 per employee

Moving to a Health Agenda with High ROI High Reach / Low Cost Interventions 15

Positive ROI (=/>$3:$1)

Increased productivity Reduced health care costs

Risk reduction (employees with fewer

risks) Improved attitudes & behaviors Teams & Participation (80% of employees)

Commitment (set organization & individual goals)

Awareness (HRAs, Group & Individual Reports, ≈80% of employees)

Increased knowledge (educate managers & employees) Teams and Program CoordinatorSenior Management Support

Sequence of Critical Success Factors

Moving to a Health Agenda with High ROI High Reach / Low Cost Interventions 16

Positive outcomes and ROI

Reduced utilization

Reinforcement Management: Finding intrinsic and extrinsic rewards for new ways of working;

Environmental Reevaluation: Appreciating that the change will have a positive impact on the social and work environment;

Self-Liberation: Believing that a change can succeed and making a firm commitment to the change

Self-Reevaluation: Appreciating that the change is important to one’s identity, happiness, and success

Dramatic Relief: Emotional arousal, such as fear about failures to

change and inspiration for successful change

Consciousness Raising: Becoming more aware of a problem and potential solutions

Processes of Change