Engaging Employees in Wellness: The Disney Experience

Today’s Speakers

•Karen R. Roberts•Senior Vice President•Aon Consulting•National speaker and author on wellness•National speaker and author on wellness

strategies and implementation

S Ski•Susan Skinner•Manager, Benefits Services•Disney Worldwide Services, Inc., Orlando, FLy , , ,

What We’ll Talk About Today

•The Problems•They’re moving faster than we are!

•Reasons to Stay In The Game•Reasons to Stay In The Game•There are real solutions.

•Disney’s Engagement Strategy•Creating a Culture of Health•ProgramsPrograms•Results•Lessons learned

The Problems in US HealthcareThe Problems in US Healthcare

Th ’ i f t th !They’re moving faster than we are!

Determinants of Health Status

50%

40%

45%

50%

25%

30%

35%

20% 20%15%

20%

25%

10%

0%

5%

10%

Access To Care Genetics Environmental Behavior

Source: Center for Disease Control and Prevention

Health Choices Drive Health Costs

=

Lifestyle Triggers

50% of all disease, injury and premature death is preventablepremature death is preventable

Excess risk factors:A t f 25% f di l t•Account for 25% of medical costs

•Lead to higher absenteeism/lower productivity

Lifestyle triggers of preventable disease:Lifestyle triggers of preventable disease:•Tobacco•Poor diet•Obesity•Stress•Lack of exercise•Lack of exercise

Lifestyle Costs

Source: Journal of Occupational & Environmental Medicine. 47.5:523-32, May2005

Reality of Presenteeism

This job is giving me migraines highThis job is giving me migraines, high blood pressure, chest pains, and bleeding ulcers. I’d quit, but I like g q ,

their health plan.

Our Future Workforce

2002-2005 Trends in the Prevalence of Anti-Diabetic Drugs in Children: 5 to 19 Years

100.00%

120.00%

60.00%

80.00%

%

Type 1

20.00%

40.00%Type 2

TOTAL

0.00%5-9

Years10-14Years

15-19Years

Express Scripts study, "2002-2005 Trends in the Prevalence of Use of Antidiabetic Agents in Children: 5 to 19 Years,“

Focus on Cost Drivers% of POPULATION

100%

% of COST

90%

80%

70%

Healthy

Acute70%

60%

50%Chronic

Account for 85% of the

Healthy

40%

30%

20%

Chronic

Complex

of the cost!

Acute 27% of the population

10%Chronic populationComplex

50% to 60% hospital admissions due to chronic conditions50% to 60% osp ta ad ss o s due to c o c co d t o s

Focus on Cost Avoidance

Cost Management RealitiesCost Management Realities

•No end in sight to rapid cost increases•Employee relations harmed by cost shifting•Market replete with underperforming vendors•Broad-based cost management essential•Holistic, comprehensive, integrated approach required

Reasons to Stay in the GameReasons to Stay in the Game

Th l l tiThere are real solutions.

Reasons to Stay in The Health Care Game

Effective cost Employers can Productivitymanagement

programslimit employer

and

Employers can directly impact

workforce health and

d ti it

Productivity affects

organizational performance and

and employee

expenditures

productivity competitiveness

Effects on Survival: Stopping Smoking Cigarettesg g

Copyright ©2004 BMJ Publishing Group Ltd.

Doll, R. et al. BMJ 2004;328:1519

Reasons to Stay in The Game

“All studies document positive effects”

Reasons to Stay in The Game

“What other options do you have?”

Integrated Approach Can Reduce Trend by 50%

Corporate Culture

y

p& Support

Benefits Tools Environment

Plan design (w/emphasis on preventive care)

Web content/educationHealth Risk Assessment

Healthy food (vending, cafeteria)Seminars, lunch & learns

Appropriate disease management programsParticipation incentives

(HRA)Personalized feedback reportLifestyle modulesCoaching (virtual, telephonic)Biometric screenings

Walking path, pedometersDisease awareness weeksWorksite classes (weight mgt, smoking cessation)Health FairsBiometric screenings Health FairsDiscounts ( health clubs)

Engaged Consumers

“What’s best for me?”

personalized condition and treatment analysis based on medical history, current prescription drugs symptomsdrugs, symptoms

“Push” technology“Don’t make me look for it!”

Goals and follow throughhealth coaches attainable goalshealth coaches, attainable goals, rewards and recognition

Outreach

AIM HIGHTarget:

Actionable

Impactable

Members

Health Risk Appraisals

Self-reported info not found in claims data– Smoker, sedentary lifestyle, overweight, high-stress

workplace

Only HRA can identify readiness to changeOnly HRA can identify readiness to change– Prochaska factor

– 5 stages of change: pre-contemplation / contemplation / preparation / action / maintenance

Only HRA can identify pre-chronic cases for cost avoidancecost avoidance

– Self-identification of high-risk family histories, high BMIs, borderline diabetic or high blood pressure

Health Risk Appraisals

Very Important Study

$607$543

$625$600

$700No ActivitiesActivitiesP-

NP

$344$391

$400

$500P = 13,048

NP 13 363al S

avin

gs

$83

$173$200

$300NP = 13,363

age

Annu

a

$0

$83

$0

$100

0 1 2 3+

Aver

a

0 1 2 3+Number of HRAs in 6 Years (1992-1997)

Source: Serxner, et.al., The Relationship Between Health promotion Program Participation and Medical Costs: A Dose Response, JOEM, 45(11), November, 1196-1200.

Integrated Health Promotion and Health Coaching

• Financial incentives improve results

g

– 3:1 ROI possible with 80% participation– Dollars, points, etc.

• Incentives can apply toIncentives can apply to– Health assessment completion– Biometric screening– Non-smoking– Health coaching participation

Source: Dee Edington, PhD, University of Michigan

Incentives

Most incentives are financialReduced health plan contributions

Other financial (e.g., cash, FSA/HRA contributions flex credits)contributions, flex credits)

Health incentives (e.g., wellness credits, pedometers, fitness program reimbursement)

Reduced deductibles, copays or coinsurance

Gifts (e.g., prizes, lottery drawing, company promotional items gift certificates)promotional items, gift certificates)

Lessons Learned

• “The” Key is engagement - or participationp p

• Higher the participation level - the greater the ROI

• Greater the intensity of intervention• Greater the intensity of intervention -greater the ROI

• Works in any work setting – anywhere• More Health Promotion oriented – the

higher the level of return

Lessons Learned

• Superficial, education-based programs have little impact; short-term interventions don’t workinterventions don t work

• Well designed programs improve– health knowledge,

health behaviors and– health behaviors, and – underlying health conditions related to

• stress, • smoking, • weight, • fitness, • nutrition and • wise use of the medical system

• Well designed programs save more than they cost through medical cost containment and increasedproductivity.

(378 peer-reviewed studies).

Proven ROI

Source: Journal of Occupational & Environmental Medicine. 47.5:523-32, May2005

The DISNEY ExperienceThe DISNEY Experience

C ti V l th h C lt f H lthCreating Value through a Culture of Health

Strategies and Tactics to Drive a Corporate Culture of Health Improvement

Integrated Wellness Program Design and Communications

Building A Bridge to Improve Health

“If we do nothing, if we just follow the same pattern and treat one disease after another, we’ll continue to pay and pay and pay. So instead of focusing on pulling people out of the water, let’s go up and see why they are falling in the water in the first place and see if we can fix those bridges across the stream, so they don’t fall in.”Dr. Dee Edington, Director, Health Management Research Center, University of Michigan

THE FOUNDATION OF STRENGTH

Sustainable Behavior Change Through

Diff ti t d

Actionable Insights and Guaranteed

Earlier and More Effective Risk Differentiated

Coaching ResultsIdentification

IMPROVED HIGHER LOWER HEALTH PRODUCTIVITY COST

Disney at a Glance

• 130,000 Cast Members and employeesp y– Largest concentrations in Florida, California, New York and

Connecticut– Diverse workforce – from Guest-facing Cast Members to

executives and Studio/Media talent• Four major business segments:

– Studio Entertainment – Walt Disney Pictures, Pixar, yMiramax, Disney Home Entertainment, Disney Theatrical Group, Hollywood Records, etc.

– Parks and Resorts – Parks in Anaheim, Orlando, Paris, T k d H K Di C i Li ESPN ZTokyo and Hong Kong, Disney Cruise Line, ESPN Zone restaurants, Disney Vacation Club, etc.

– Consumer Products – Baby Einstein, Disney Publishing, Disney Interactive Studios Disney Stores Europe etcDisney Interactive Studios, Disney Stores Europe, etc.

– Media Networks – ABC, Disney Channel, ESPN, etc.

Health and Wellness at Disney

Disney’s goal is to provide meaningful health and y g p gwellness benefits, tools and resources that:

• Address the diverse needs and preferences of our Cast/employeesCast/employees

• Are market-competitive• Help keep Cast/employees healthy and productive

E C t/ l d th i f ili i ki• Engage Cast/employees and their families in making informed benefit decisions and healthy lifestyle choices

• Help manage health care costs for both Cast/employees d th Cand the Company

The Road Traveled . . . So Far

During 2004-07, Disney addressed rising health care costs in a variety of ways:

• Implemented new strategy for payroll contribution cost to participants, especially for spouse/partner coveragep p , p y p p g

• Increased required hours for hourly Cast/employee eligibility• Adjusted plan design – deductibles, copays, coinsurance – to

incent participants to use network providers generic drugsincent participants to use network providers, generic drugs• Introduced voluntary disease management programs for

targeted high cost illnesses and conditions• Adopted new “affordable” HealthValue and Med/70 options• Adopted new affordable HealthValue and Med/70 options• Reduced barriers to preventive care services• Established health promotion programs but not as part of an

t i id i t t d t tenterprise-wide, integrated strategy

Refining Our Wellness Strategy

• Focus of our health care program is wellness and personal health improvement

– Why? Plan design and cost-sharing only go so far in controlling health care costs without negatively impacting g g y p gthe competitiveness of our benefits offerings.

• Vision is to build a “culture of wellness” in which benefit programs align with other elements ofbenefit programs align with other elements of workplace environment in order to:

– Improve the health status of our cast/employees and their f ili l d d f i i dfamilies; lower demand for expensive services; reduce our health care trend

– Improve productivity; reduce absenteeism– Build a health conscious and engaged workforce

Aligning with Other Parts of the Business

• Healthier food options in the Parks and Resorts• Branded consumer products offering healthier food

and beverage options to children and their familiesN ki d i t d i Di i• No smoking depicted in Disney movies

• Characters in Disney Channel programs exhibiting good lifestyle behaviorsgood es y e be a o s

Making better health part of our g pbusiness strategy

Desired Outcomes for Wellness Strategygy

For the Company…R d th t d f h lth t i• Reduce the trend of health care cost increases

• Improve workplace environment and reduce indirect costs, such as absenteeism

• Address continued pressure from our businesses, especially our labor-intensive segments, to control health care costs

For the Community…• Obtain synergies with the external commitment the Company is making to• Obtain synergies with the external commitment the Company is making to

promote healthier lifestyles for our Guests and consumers• Mirror our customer focus on family values

F th C t/E lFor the Cast/Employees…• Support “best place to work” status by making wellness a key component of our

employment value proposition• Make Cast/employees more aware of their personal health risk factors and their p y p

responsibility to take action, and provides support for their actions to improve their health

Key Components to Execute on Wellness

1. Needs Assessment

• Health risk assessment identifies Disney populations with specific health/lifestyle conditions at risk of incurring high costs in the future (real time data, predictive model)

• Assessment provides roadmap for program development and informs all downstream wellness and employee engagement

2 Engagement2. Engagement

• Engagement is key: no participation, no return. Typically less than 10% enroll in wellness programs with no incentives; up to 70% with financial incentives.

• Financial incentives encourage participation. $100 gives us acceptable participation levels.• Endorses the concept of shared responsibility for health: be active and be rewarded

3. Execute

• Develop specific health promotion programs to maintain low health risk status and health• Develop specific health promotion programs to maintain low health risk status and health management programs to reduce new illness and enable employee to self-manage acute or chronic conditions

• Build rewards into benefit plan design (e.g., premium reduction for preventive services)• Continue to focus on individuals that will respond positively to targeted incentives toContinue to focus on individuals that will respond positively to targeted incentives to

improve their health and lower utilization and costs (e.g., extending to spouse/partners)

New Strategy Introduced in October 2007

An innovative collection of health care programs, tools and resources that Disney Cast/employees and their families can

use to make good health care choices, use their benefits wisely and take steps to improve their health – no matter

where they are on the road to better health.

Communications Theme – “One Simple Change”p g

• Help Cast/employees d d h ll i

e-Newsletter

understand why wellness is important and how it benefits them and the Company

• Motivate and encourage• Motivate and encourage Cast/employees to make positive strides to health improvement – no matter what their current status

• Make it personal – benefits selection and usage as changes toward better health

Print materials mailed to homes

changes toward better health decisions

• Use a variety of media to reach Disney’s diversereach Disney s diverse Cast/employee population

e-Postcard reminder

Key Messages – Why Wellness is Importantp

• Adopting healthy lifestyle habits today can positively p g y y y p yaffect health tomorrow

• Many health issues, such as heart disease and di b t b id d iti l d bdiabetes, can be avoided or positively managed by the choices we make every day

• Making changes for better health means differentMaking changes for better health means different things to different people

• Getting healthy is about making simple changes, t ti th t dd t h lth ltone at a time, that add up to healthy results

Disney is committed to helping our Cast/employees and their families live healthier lives.

Rollout of Disney Healthy Pursuits in 2008

• Re-launch of Personal Health Assessment with financial incentive for completion of assessmentincentive for completion of assessment

• Expanded wellness portal for on-line tools and services through WebMD

• Individualized lifestyle coaching programs• Individualized lifestyle coaching programs• Coordinated on-site health screenings• Promotion of screenings and immunizations

through preventive care benefit• Health and wellness branding campaigns,

including communications to homes• Evaluation of existing wellness programs and services for

potential expansion or consolidation• Opening of Orlando Health and Wellness Center• Opening or expansion of on-site fitness centers

Timeline for 2008 Activities

Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec

Communication/Communication/ Leader Engagement

Personal Health AssessmentAssessment

Individual Health Coaching

Financial Incentives

Analysis of Data for Program Design

Review Existing Programs; Pilot New Programs

Program Evaluation

Further Considerations for Action in 2009 and Beyondy

• Piloting of targeted wellness programs and services at selected locations addressing diversity of populationlocations, addressing diversity of population

• Financial incentive tied to completion of lifestyle coaching program or other wellness program in addition to completion of Personal Health AssessmentPersonal Health Assessment

• Expansion of scope of incentive to enrolled spouses/partners and childrenI t ti f P l H lth A t d t ith H lth C• Integration of Personal Health Assessment data with Health Care Plan claims/clinical data to identify intervention opportunities

• Benefit plan design changes based on prevention (e.g., "free" d f bl d t l h l t l t )drugs for blood pressure control, cholesterol, etc.)

• Integration of occupational and non-occupational health programs

• Mandatory participation in disease and care management programs

Behavioral Engagement Drives Sustainable Changeg

Mi dPhysical illness and

The Impact of the Mind-Body Link: A Holistic Approach

Mind

Body

Behavioral disorders and stressful environments

physically impact the

injury have social and psychological

consequences

Body physically impact the body

Behavior is a fundamental driver of health outcomesBehavior is a fundamental driver of health outcomes, workplace productivity and health costs

Coaching That Nurtures Behavioral EngagementBehavioral Engagement

Questions?

Contact Info

Barbara WachsmanDi W ld id S i IDisney Worldwide Services, Inc. Director of Worldwide Strategy and Program Development500 S. Buena Vista St.Burbank, CA 91521-7491 (818) 558-2084barbara.wachsman@disney.com

Karen RobertsKaren RobertsAon ConsultingSenior Vice President7650 W. Courtney Campbell CausewayT FL 33602Tampa, FL 33602(813) 636-3088karen_roberts@aon.com