The Business Case for Worksite Wellness Source: WellCert sm Program, Chapman Institute © Chapman...

The Business Case for Worksite WellnessSource: WellCertsm Program, Chapman Institute

© Chapman Institute. All rights reserved.

1

Definitions of Wellness

2

Many Perspectives on Wellness

• Physical– Fitness, nutrition, medical self-

care, control of substance abuse• Emotional

– Care for emotional crisis, stress management

• Social– Communities, families, friends

• Intellectual– Educational, achievement,

career development• Spiritual

– Love, hope, charity

Source: American Journal of Health Promotion (AJHP) & National Wellness Institute (NWI)

Emotional Social

Physical Intellectual

Spiritual

NWI

AJHP


3

Key Definitions

Wellness — “An intentional choice of a lifestyle characterized by personal responsibility, moderation, and maximum personal enhancement of physical, mental, emotional and spiritual health.”

Worksite Wellness Program — “An organized program in the worksite that is intended to assist employees and their family members (and/or retirees) in making voluntary behavior changes which reduce their health and injury risks, improve their health consumer skills and enhance their individual productivity and well-being.”

p. 2


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Relevance of Worksite Wellness

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Most of Us are Connected to a Worksite

82% of U.S. population has employer connection

Source: The National Data Book, 2012.


6

Top Ten Causes of Death: U.S. 1900 and 2010

1900

1. Pneumonia (all forms) and influenza

2. Tuberculosis (all forms)

3. Diarrhea, enteritis, and ulceration of the intestines

4. Diseases of the heart

5. Intracranial lesions of vascular origin

6. Nephritis (all forms)

7. All accidents

8. Cancer and other malignant tumors

9. Senility

10. Diphtheria

2010

1. Heart disease

2. Cancer

3. Respiratory disease

4. Stroke

5. All accidents

6. Alzheimer’s disease

7. Diabetes

8. Nephritis

9. Pneumonia (all forms) and influenza

10. Suicide

Source: CDC, 2013.


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Top Ten Causes of Death By Age Group: U.S. 2010


8

2000

Obesity Trends* Among U.S. Adults BRFSS, 1990, 2000, 2010

(*BMI 30, or about 30 lbs. overweight for 5’4” person)

2010

1990

No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%


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Economics of Worksite Wellness

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Health Benefit Cost Trends Affect Wellness


Majo

rM

inor

Future Direction of Healthcare Cost Growth?

Enhancing Cost• Aging• Technology• Risk factors increasing• Cost shifting increasing• Market imperfections

• Managed care limits• Defensive medicine• Collective bargaining pressures• Entitlement mentality• Margin/profitability erosion• Complexity of human health• Quality artifacts• Costs of privacy/confidentiality• Confusion about health & healthcare

Restraining Cost• Employee cost sharing• DC approach• Selected technological

developments• Improved price competition• Prevention improvements• Enlarged public role• EDI applications• Selected alternative

therapies


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Health Spending is Not Normally Distributed

A Small Percentage of Employees Account for a Large Percentage of Claims Cost

$150/personGenerally well with episodicneed for services

Chronically ill requiring systematic management: e.g. diabetes, hypertension

% of Employees% of Claims

$20,000/personComplex, multiple problems requiring aggressive, unique case management: e.g. Alzheimer's


Factors that Determine the Amount of Healthcare You Use

Supply-Side Factors (outside the individual)

Extent and scope of insurance coverage*

Point-of-use cost sharing*

Geographic access to services

Supply-Side Factors (outside the individual)

Regional or local practice patterns

Provider incentives affecting diagnosis and treatment decisions*

Demand-Side Factors (inside the individual)

Age*

Sense of responsibility for personal

health*

Clinical risk factors*

Current morbidity*

Self-efficacy*

Gender

Personal health

behavior*

Attitudes about personal health and health care

use*

* =Potentially modifiable. Source: L. Chapman, 2010


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Important Quote….

…….almost two thirds of the growth in national health spending over the past 20 years can be attributed to Americans’ worsening lifestyle habits and, in particular, the epidemic rise in obesity rates.”

Source: Goetzel, R.Z., Pickens, G.T., Kowlessar, N.M., The Workforce Wellness Index: A Method for Valuing U.S. Workers’ Health, J Occup Environ Med, Feb 2013, 55(2):1-8.


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Source: Goetzel RZ, et. al. (1998, October). The relationship between modifiable health risks and health care expenditures: An analysis of the multi-employer HERO health risk and cost database. JOEM, 40(10):843-54.

Percent Higher Annual Health Plan Costs

Health Risks Increase Health Costs (Original HERO Study)

N = 46,000+ X 3 yrs


Health Risk Factor Definitions

Risk Factors High-Risk Definitions

Body mass index BMI ≥30

Blood pressure Systolic ≥140 mmHg or diastolic ≥90 mmHg

Cholesterol Total cholesterol ≥240 mg/dL

Blood glucose Total blood glucose ≥126 mg/dL

Tobacco Currently smokes cigarettes or uses tobacco

Alcohol More than two drinks per day

Stress Often feels stressed and has trouble coping

Exercise Fewer than 2 days per week of at least 20 minutes of exercise or self-reported

non-exerciser/light exerciser in the previous month

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Source: Goetzel, R.Z., Pickens, G.T., Kowlessar, N.M., The Workforce Wellness Index: A Method for Valuing U.S. Workers’ Health, J Occup Environ Med, Feb 2013, 55(2):1-8.


Percent Higher Cost of Key Health Risk Factors (Updated HERO)


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Prevalence of Key Health Risk Factors (Frequency)


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Association Between Changes in Health Risk Status and Changes in Future Health Care Costs

20

Se-ries1

-$150

-$100

-$50

$0

$50

$100

$150

$200

$250

-$129

$210

Source: Steven Nyce, Jessica Grossmeier, David Anderson, Paul Terry and Bruce Kelley, Association Between Changes in Health Risk Status and Changes in Future Health Care Costs: A Multiemployer Study, JOEM, November, 2012, 54(11): 1364 – 1373.

N = 22,723

Add a Health Risk Factor

Reduce a Health Risk Factor Annual M

edic

al Pla

n

Cost


Relationship of Risk Factors to Medical Conditions

Source: Bolnick, H., Millard, F., and Dugas, J., Medical Care Savings from Workplace Wellness Programs, JOEM 2012, Jan, 55(1): 4-9.


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Percent of Total Medical Care Expenses Due to Risk Factors

Source: Bolnick, H., Millard, F., and Dugas, J., Medical Care Savings from Workplace Wellness Programs, JOEM 2012, Jan, 55(1): 4-9. Uses WHO Global Burden of Disease and Risk Factors Study and The Medical Expenditure Panel Surveys of the NCHS.

Age Groups


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Percent of Total Medical Care Expenses Potentially Preventable

Source: Bolnick, H., Millard, F., and Dugas, J., Medical Care Savings from Workplace Wellness Programs, JOEM 2012, Jan, 55(1): 4-9. Uses WHO Global Burden of Disease and Risk Factors Study and The Medical Expenditure Panel Surveys of the NCHS. If theoretical minimums are reached.

Age Groups


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Lifetime Health Costs

$0

$50,000

$100,000

$150,000

$200,000

$250,000

$300,000

$350,000

$400,000

Total Female Male

Vision/Hearing

Dental

Rx

Professional

Nursing Home

Hospital

$316,579

$361,192

$268,679

Source: Alemayehu, B., Warner, K.E., The Lifetime Distribution of Health Care Costs, Health Services Research, (June, 2004), 39:3, p. 627 – 642.


N = 3.7 million

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Average Annual Health Cost Growth

4.1%

0%

1%

2%

3%

4%

5%

6%

7%

8%

9%

10%

One Year of AgeSource: Alemayehu, B., Warner, K.E., The Lifetime Distribution of Health Care Costs, Health Services Research, (June, 2004), 39:3, p. 627 – 642.


The average amount of increase in health care costs with one more year

of age.

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Source: Musich, S., Schultz,A., Burton, W., Edington, D., Overview of Disease Management Approaches: Implications for Corporate-Sponsored Programs. Disease Management & Health Outcomes. 2004, 12(5):299-326.

Healthcare Spending Doesn’t Stay High Over Time

Quarters

N = 29,472

Dolla

rs p

er

Qtr


Financial Impact of Selected Health Risk Factors

Source: Kowlessar NM, Goetzel RZ, Carls GS, Tabrizi MJ, Guindon A., The relationship between 11 health risks and medical and productivity costs for a large employer. J Occup Environ Med. 2011 May;53(5):468-77. N = 63,013.

Cost

Per

Year

N = 63,013


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Financial Impact of Selected Health Risk Factors

Source: Kowlessar NM, Goetzel RZ, Carls GS, Tabrizi MJ, Guindon A., The relationship between 11 health risks and medical and productivity costs for a large employer. J Occup Environ Med. 2011 May;53(5):468-77. N = 63,013.

Cost

Per

Year

N = 63,013


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Source: Serxner, S., et al., (2001). The impact of behavioral health risks on worker absenteeism. JOEM, 43(4), 347-354

Percent Higher Absenteeism

Health Risks Increase Sick Leave Use (Early Study)

N = 35,451 X 1 yr


Source: Musich, S., et. al., (2001, June). The Association of Health Risks with Workers’ Compensation Costs, JOEM,, p. 534-541.

Percent Higher Annual WC Costs

Health Risks Increase Workers’ Comp Cost (Early Study)

N = 3,388 X 4 yrs


Source: Yen, Louis, et al., (2004, Sept/Oct). Associations between health risk appraisal scores and employee medical claims costs in a manufacturing co., AJHP, 11(1), p. 46-54.

Multiple Health Risks Multiply Cost (Early Study)

Multiples of annualhealthcare costscompared tosomeone with nohealth risks

Number of Risks

Mu

ltip

les N = 1,838


Source: Musich, S., et. al., (2001, June). The Association of Health Risks with Workers’ Compensation Costs, JOEM, p. 534-541.

Multiple Health Risks Multiply WC Cost (Early Study)

N = 3,338

(0 – 1) (2 – 3) (4+)

Health Risk Factors


Health Costs are Potentially Preventable (Early Study)

25%

75%

Preventable•Depression•Stress•Blood Sugar•Smoking•Obesity•Blood Pressure•Sedentary Life

Not Related

Source: Anderson, et. al., (2000, Sept/Oct). The Relationship Between Modifiable Health Risks and Group-Level Health Care Expenditures, AJHP, 15(1), p. 45-52.

N = 46,026 X 6 Yrs


Lifetime Health Costs Perspective

Source: WellCert Program

Birth

$ A

nn

ual H

ealt

h

Costs

Without Wellness

With Wellness 65

“Compression of Morbidity”

Death


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Presenteeism is a Major Cost for Employers

Dow Chemical0.0%

2.0%

4.0%

6.0%

8.0%

10.0%

12.0%

6.8%

1.5%

2.4%

Health Plan

Other Health Costs

Presenteeism

Per

cent

of

tota

l lab

or c

osts

Source: Collins, J., Baase, C., Sharda, C., Ozminkowski, R., Billoti, G., Turpin, R., Olson, M., and Berger, M., The assessment of chronic health conditions on work performance, absence and total economic impact for employers, J Occup Environ Med., 2005, Jun: 47(6): 547-557.

10.7%

Enterprise-wide Health Costs


N = 56,000+

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Economic Rationale for Worksite Wellness

Source: Goetzel, JOEM, (2004) data adjusted to 2010 by Mercer Employer Survey Results and by Collins Presenteeism study (2005) of Dow Chemical that was used for determining the Presenteeism cost.

Total = $28,541*


* = 2010 Dollars

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Contents of Worksite Wellness

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National Worksite Wellness Survey Results

Type of Programs Offered

1985 Survey

1992

Survey

1999

Survey

2004

Survey Exercise/Physical Fitness 27% 41% 36% 20% Smoking Control 36% 40% 34% 19% Stress Management 27% 37% 35% 25% Back Care 29% 32% 53% 45% Nutrition 17% 31% 23% 23% High Blood Pressure 16% 29% 7% 36% Weight Management 15% 24% 15% 21% Off-the-job Accidents 20% 18% na na Job Hazards/Injury Prevention na 64% na na Substance Abuse na 36% 28% na HIV/AIDS Education na 28% 25% 15% Cholesterol na 27% 23% 20% Mental Health na 25% 12% na Cancer Detection/Prevention na 23% 4% 22% Medical Self-Care/CHE na 18% 14% 22% STDs (Sexually Transmted Dis) na 10% 25% na Prenatal Education na 9% 12% 19% Employer Participants N=1358 N=1507 N=1544 N = 730

Sources: Office of Disease Prevention and Health Promotion, U.S.P.H.S. National Survey of Worksite Health Promotion Activities: A Summary. Summer 1987, p. 51., Office of Disease Prevention and Health Promotion, U.S.P.H.S. National Survey of Worksite Health Promotion Activities: A Summary. Spring 1993, p. 30., Association for Worksite Health Promotion, US Department of Health and Human Services, Office of Disease Prevention and Health Promotion, 1999 National Worksite Health Promotion Survey: Report of Findings. Linnan, L., et.al., Results of the 2004 National Worksite Health Promotion Survey, Am J Public Health. 2008;98:1503–1509.


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Six Step to Designing Your Wellness Program

Scope the Program

Plan Infrastructure

Plan Communications

Plan Health Management Process

Plan Group Activities

Plan Supportive Environment

Step #1

Step #2

Step #3

Step #4

Step #5

Step #6

“Program” Infrastructure

“Administrative” Infrastructure

Source: Chapman, L., Planning Wellness: Getting Off to a Good Start, 2013, p. 227.


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There Are Several Ways to Do “Wellness”

Quality of Work Life

Program Model

• Fun activity focus• No risk reduction• No high risk focus• Not HCM oriented• All voluntary• Site-based only• No personalization• Minimal Incentives• No spouses served• No evaluation

Morale-Oriented

Main Features

Primary Focus

Traditional Approach

• Mostly health focus• Some risk reduction• Little high risk focus• Limited HCM

oriented• All voluntary• Site-based only• Weak personalization• Modest Incentives• Few spouses served• Weak evaluation

Activity-Oriented

Population Health

Management

• Add productivity• Strong risk reduction• Strong high risk

focus• Strong HCM oriented• Some required

activity• Site and virtual both• Strongly personal• Major Incentives• Many spouses

served• Rigorous evaluation

Results-Oriented


Source: Chapman, L., Planning Wellness: Getting Off to a Good Start, 2013, p. 227.

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The Overall Relationship of Risks to Health Costs

Source: 2012 Health Care Survey, Aon Hewitt, 2012, p. 62. www.aonhewitt.com


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Aon Hewitt 2012 Health Care Survey: PHM Intentions

Source: 2012 Health Care Survey, AonHewitt, 2012, p. 62. www.aonhewitt.com N = 1,800+ employers


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http://www.aonhewitt.com/

Source: 2012 Health Care Survey, AonHewitt, 2012, p. 62.

www.aonhewitt.com

Aon Hewitt 2012 Health Care Survey: PHM Interventions

N = 1,800+ employers


43


Source: 2012 Health Care Survey, AonHewitt, 2012, p. 62. www.aonhewitt.com

Aon Hewitt 2012 Health Care Survey: PHM Intentions

N = 1,800+ employers


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Worksite Wellness Standards & Recognition Programs

WELCOA: welcoa.org

Wellness Council of America is one of the nation’s most-respected resources for building high-performing, healthy workplaces. 25+ year history

Well Workplace Checklist & Guide

Well Workplace Awards

Well Workplace Training

The American Heart Association: heart.org

Worksite Wellness Resources

Fit Friendly Worksite Award

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ROI Evidence of Worksite Wellness

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Psychologically Healthy Companies have Lower Turnover, Stress and Higher Satisfaction

Source: American Psychological Association, 2013.


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Source: Proof Positive: An Analysis of the Cost-Effectiveness of Worksite Wellness, Chapman Institute, Seventh Edition, 2013.

Summary of C/B Results

• Bank of America• Blue Shield of CA• Duke University• Citibank• City of Birmingham• Coors• DuPont• General Foods• General Motors• GlaxoSmithKline• Indiana BCBS• Johnson & Johnson• Life Assurance• Nortel• Prudential• Travelers• Union Pacific• Washoe County

Traditional

Newer Programs

Outliers

C/B

Rati

o

Study Number


48

2012 Meta-Evaluation Findings: Overview

Study Parameter Averages & Totals(N=62)

Average Study Years 3.83Observational Years 241.3Year Reported (Median) 1996# of Study Subjects 546,971# of Control Subjects 213,291Average # of Program Targets 5.2% Change in Sick Leave -25.1% (26)% Change in HCs -24.5% (32)% Change in Workers’ Comp -40.4% (4)% Change in Disability Mang. -24.2% (3)C/B Ratio 1:5.56 (25)


Source: Chapman, L. Meta-Evaluation of Economic Return Studies of Worksite Health Promotion Programs:2012 Update, America Journal of Health Promotion, March/April, 2012, 26(4): 1-12.

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Study Number

C/B

Rati

o

Source: Chapman, L. Meta-Evaluation of Economic Return Studies of Worksite Health Promotion Programs, America Journal of Health Promotion, March/April, 2012, 26(4): 1-12.

Average C/B Ratio = 1:5.56


2012 Meta-Evaluation Findings: Summary of C/B Ratios

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• Blue Shield of CA• Kansas BCBS• Indiana BCBS• Highmark BCBS

• Prudential• Life Assurance (Canada)

• City of Birmingham, AL • Washoe County, NV• Salt Lake County, UT• Swedish IRS

• Citibank• Bank of America

• Unilever• Coors• DuPont• General Foods• General Motors• Johnson & Johnson• GlaxoSmithKline

• Nortel• DirectTV• Duke University • Union Pacific• Regional Hospital


Source: Chapman, L. Meta-Evaluation of Economic Return Studies of Worksite Health Promotion Programs, America Journal of Health Promotion, March/April, 2012, 26(4): 1-12.

2012 Meta-Evaluation Findings: Organizational Sites

51

Even More Authoritative Meta-Analysis…

Source: Katherine Baicker, David Cutler, and Zirui Song, Workplace Wellness Programs Can Generate Savings, HEALTH AFFAIRS February,2010, 29(2) 1-8.

C/B = 1:6.0


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The Chapman Institute

Five (5) levels of professional certification for worksite wellness practitioners. Both Online and Onsite:

- CWPC (Level 1)- CWPM (Level 2)- CWPD (Level 3)- CWWPC (Level 4)- CWWP (Level 5)

30+ recertification online modules eBooks“New Research Findings”“Excellent National Wellness Resources”

Visit www.chapmaninstitute.net

WellCertsm Program: “The premier practitioner certification program for the

Worksite Wellness field.”


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The Business Case for Worksite Wellness Source: WellCert sm Program, Chapman Institute © Chapman...

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