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WellCertsm Business Case Slides: 2013
Scripted by Larry S. Chapman MPHPresident and CEOChapman InstituteSeattle, WA 98155
(206) [email protected]
© Chapman Institute. All rights reserved.
1
Purpose of this Slide Deck….
“The purpose of this slide deck is to provide WellCertsm graduates with a set of slides to make the best possible case for worksite wellness funding and programming. I have scripted each slide in the ‘Notes Page view’ with what I would say if I were presenting that slide to senior managers. Good luck with your own wellness advocacy efforts!”
-LSC © Chapman Institute. All rights reserved.
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
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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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4
Most of Us are Connected to a Worksite
82% of U.S. population has employer connection
Source: The National Data Book, 2012.
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5
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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6
Top Ten Causes of Death By Age Group: U.S. 2010
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7
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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8
Health Benefit Cost Trends Affect Wellness
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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
© Chapman Institute. All rights reserved.
10
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
© Chapman Institute. All rights reserved.
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
© Chapman Institute. All rights reserved.
12
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.
© Chapman Institute. All rights reserved.
13
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
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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
15
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.
© Chapman Institute. All rights reserved.
Percent Higher Cost of Key Health Risk Factors (Updated HERO)
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16
Prevalence of Key Health Risk Factors (Frequency)
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17
Association Between Changes in Health Risk Status and Changes in Future Health Care Costs
18
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
© Chapman Institute. All rights reserved.
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.
© Chapman Institute. All rights reserved.
19
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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20
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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21
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.
© Chapman Institute. All rights reserved.
N = 3.7 million
22
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.
© Chapman Institute. All rights reserved.
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
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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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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
© Chapman Institute. All rights reserved.
26
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
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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
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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
© Chapman Institute. All rights reserved.
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
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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
© Chapman Institute. All rights reserved.
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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32
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
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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*
© Chapman Institute. All rights reserved.
* = 2010 Dollars
34
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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35
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.
© Chapman Institute. All rights reserved.
36
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
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Source: Chapman, L., Planning Wellness: Getting Off to a Good Start, 2013, p. 227.
37
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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38
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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Source: 2012 Health Care Survey, AonHewitt, 2012, p. 62.
www.aonhewitt.com
Aon Hewitt 2012 Health Care Survey: PHM Interventions
N = 1,800+ employers
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40
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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41
Psychologically Healthy Companies have Lower Turnover, Stress and Higher Satisfaction
Source: American Psychological Association, 2013.
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42
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
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43
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)
© Chapman Institute. All rights reserved.
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.
44
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
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2012 Meta-Evaluation Findings: Summary of C/B Ratios
45
• 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
© Chapman Institute. All rights reserved.
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
46
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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47
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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48