David A. Alter, M.D., Ph.D., F.R.C.P.C

Employee health and wellness metrics, measurements, and evaluation - -

the building blocks for ROI

David A. Alter, M.D., Ph.D., F.R.C.P.CSenior Scientist, Institute for Clinical Evaluative Sciences

Division of Cardiology, The Li Ka Shing Knowledge institute of St. Michael’s Hospital Division of Cardiology,

Cardiac and secondary prevention program, The Toronto Rehabilitation Institute

Associated Professor of Medicine, University of Toronto

Disclosures

• Chief Scientific Officer, INTERxVENT Canada

“Ticking Clock” Hypothesis

Haffner SM et al. JAMA. 1990;263:2893-2898.

NGT IGT Hyperglycemia

MacrovascularDisease

MicrovascularDisease

Deferred Gratification



















How much?How long?

At what costs?

Metrics, measurement, and evaluation

Building blocks for ROI evaluation

• Choosing the appropriate question

• Selecting the appropriate population

• Designing the appropriate intervention

• Appropriate knowledge translation

• Determining the appropriate context

Asking the appropriate question

Benefits & payers

Pharmaceuticals

Appropriate use of meds

Efficient use of meds

Health Service ConsumptionAvoidable HospitalizationsEmergency Room Visits

Physician Visits ProductivityAbsenteeism

DisabilityImpairmentEngagement

Building blocksMetrics

MeasurementEvaluation

Government

EmployersPharmacy/Pharma

The evidence

-28.3

-26.1

-30.1

-40 -30 -20 -10 0 10 20

% change in disability management costs

% change in health care costs

% change in absenteeism

Chapman et al; The American Journal of Health Promotion 2003

Test case example

42.0%

-30.6%-50%

-30%

-10%

10%

30%

50%

70%

% C

han

ge

INTERxVENT Participants

Notes: INTERxVENT Program was implemented in January 2003. Participants enrolled in the INTER xVENT Program in 2003 and completed a full year of service and evaluations. Analysis performed by Milliman Consultants and Actuaries.

Notes: INTERxVENT Program was implemented in January 2003. Participants enrolled in the INTER xVENT Program in 2003 and completed a full year of service and evaluations. Analysis performed by Milliman Consultants and Actuaries.

Non-INTERxVENT Participants

Healthcare payer% Change in Average Health Care Claims Per Employee

(Oklahoma Employer): 2002 vs. 2003

Selecting the appropriate population

Early dividends

• Absolute risk reduction; population impact driven by baseline risk

Impact of interventions (ARR)

Baseline risk

Number of Health Risks and Productivity Loss

0

5

10

15

20

25

30

0 1 2 3 4 5 6 7

Pro

du

cti

vit

y L

oss

(%

)

Number of Health Risks

The average employee has 2.2 health risks, resulting in productivity losses of about $2,000/year.

Excess Productivity Loss

BaseCost

Journal of Occupational and Environmental Medicine 2005;47:769-77

n = 28,375

-6%-5%-4%-3%-2%-1%0%1%2%

Ch

ang

e in

pro

du

ctiv

ity

loss

-2 ormore

-1 0 1 +2 ormore

Change in Number of Health Risks

Adjusted for age, gender, medical conditions, other baseline risks, and each individual’s productivity loss at baseline.

Burton et al, J Occup Environ Med, 2006; 48:252-63

Designing the appropriate intervention

Organizational InterventionGlobal Health Risk Assessment:Global Health Risk Assessment:

Action Plan & ReportsAction Plan & Reports

Average or Low-riskAverage or Low-risk High-risk(e.g. Multiple risk factors, heart disease, depression, behaviors)

High-risk(e.g. Multiple risk factors, heart disease, depression, behaviors)

Self-Help ProgramExercise, diet, weight management, stress management, tobacco, smoking cessation,

cardiovascular risk reduction



Mentored Program Step-by-step guidance on exercise, diet,

weight management, stress management, tobacco, smoking cessation, cardiovascular risk reduction, drug safety & compliance.



Personalized













Personalized

Goal: reducing the Goal: reducing the prevalence of high-risk prevalence of high-risk

populationspopulations













Personalized

Goal: reducing the Goal: reducing the prevalence of high-risk prevalence of high-risk

populationspopulations

Variations in Variations in stratification stratification algorithmsalgorithms

ControlsControls

CultureCulture

Attributing productivity-impairment to costs =

Knowledge-Translation

Positioning Health & Wellness/Disease-management programs into their appropriate

context

http://www.scotland.gov.uk/Publications/2007/


To what extent is employee-To what extent is employee-engagement impacted by health engagement impacted by health

and wellness interventions?and wellness interventions?


Test case example

Presenteeism – health metrics of employee engagement

Presenteeism – health metrics of employee engagement

Summary

• Building blocks for ROI– Appropriate questions– Appropriate population– Appropriate intervention– Appropriate knowledge translation– Appropriate context – employee-engagement

• Measurement, metrics, and evaluation– Quantification of both deferred gratification

and earlier dividends

Selecting appropriate programs

Building blocks of the program

Therapeutic life-style and disease-management

Population Population screeningscreening

Self-management & Self-management & EducationEducation

Behavioral Behavioral learning theorieslearning theories

Evidence-based Evidence-based carecare

Information & Information & monitoring systemmonitoring system

Reporting & Reporting & feedback-loopsfeedback-loops

Personalized Personalized interventionsinterventions

33

INTERxVENT

% o

f C

han

ge

4.3%Percent Change in

10-Year Framingham CHD Risk Score in

Higher-Risk Employees (1-Yr Follow-Up; p<0.05 for

NBH vs Comparison Program )

-22.6%

INTERxVENT’s Health Lifestyle Health Coaching Program Versus Program Offered By a Leading Academic Institution/Healthcare System (Comparison Program):

Selecting a program

-20%

-15%

-10%

-5%

0%

5%

10%

-25%

Source: Abstract #62 May 2005 – AHA, CVD Epidemiology & Prevention Conference – Washington DC, Maron, David P, et al

Comparison program

34

Selecting a program

Metrics, Metrics, measurement, measurement, and evaluationand evaluation

Documents

David A. Alter, M.D., Ph.D., F.R.C.P.C