2017 Financial & Risk Management Forum: Achieving Wellness in the Workplace

Enterprise Cost Containment –A Workforce Health Perspective

November 8, 2017Randall M JohnsonVice PresidentEmployer Benefits and Workforce Health Advisor

Workforce Health: Agenda

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A common ground Impact on profits Impact on organizational engagement The broad approach of integrating health messagingUsing data Closing comments: high cost claimants & personal

choice

Managing Human Capital and Risk

Organizational Health Culture…

Workforce Health and Wellbeing…

Organization Health and Workforce Wellbeing:Affordable Workforce

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Organizational Costs1. Medical 2. Workers Compensation3. Recruitment/Retention4. Productivity5. CMV – License Status

WHY IS WORKFORCE HEALTH SO IMPORTANT?

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Why Is YOUR Organization in Business?

And What is It’s Primary Objective? 6

Ultimately – Don’t ALL Organizations Share One Common Objective?

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So Does Health Really Impact the Bottom Line?

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“A portfolio of companies recognized as award winning for their approach to the health and safety of their workforce outperformed the market.…

Nevertheless, the literature increasingly links the health of a workforce to its safety and performance…

…the evidence seems to be building that healthy workforces provide a competitive financial advantage in the marketplace.” The Link Between Workforce Health & Safety and the Health of the Bottom Line, Fabius, Thayer et al, JOEM, Vol 55, No 9, September 2013

Workforce Health: The Value Proposition

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A well-managed health and safety program

A positive and caring image

Improved staff morale

Reduced staff turnover

Reduced absenteeism

Increased productivity

Reduced health care/insurance costs

Reduced risk of fines and litigation

TO THE ORGANIZATION

TO THE EMPLOYEE

A safe and healthy work environment

Enhanced self-esteem

Reduced stress

Improved morale

Increased job satisfaction

Increased skills for health protection

Improved health

Improved sense of well-being

http://www.who.int/occupational_health/topics/workplace/en/index1.htmlhttp://www.who.int/occupational_health/topics/workplace/en/index1.html

Workforce Health: The Financial Impact

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Workforce Health: The Productivity Impact

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National Surface Transportation Safety Center for Excellence

86% of CMV drivers are overweight and 69% are obese

(BMI over 25)

– 68% of U.S. are overweight

– 34% of U.S. are obese

– 61% of CMV drivers reported two or more risk factors for

cardiovascular disease

High blood pressure

Obesity

Smoking,

High cholesterol

No physical activity

Sleep deprivation

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Ellin, Abby (2011-11-21). “A Hard Turn: Better Health on the Highway”. The New York Times. Retrieved 2012-03-14.

Sieber WK, Robinson CF, Birdsey J, Chen GX, Hitchcock EM, Lincoln JE, Nakata A, Sweeney MH (June 2014). "Obesity and other risk factors: the national survey of

U.S. long-haul truck driver health and injury". American Journal of Industrial Medicine 57 (6): 615–26.

Chronic Disease - Obesity & Health Care Cost

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A

B

C

Health Related Conditions

Increased risk for:

– Hypertension

– Dyslipidemia

– Sleep apnea

– Type 2 diabetes

– Coronary heart disease

– Stroke

– Gallbladder disease

– Osteoarthritis

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Short-Poor Sleep Habits

Transportation Industry has a fragmented work

schedule– Short Sleep Periods

– Poor Quality of Sleep

– Wake time Fatigue

– Certain Transportation Segments

Average only 3.8 to 5.2 hours of Sleep

– Sleep impaired driving attributed to commercial vehicle accidents

7% of CVM crashes (NTSB)

– Obstructive sleep apnea (OSA) one of the most common sleep

disorders

Estimated 1 in 4 CMV drivers has OSA in the U.S.

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Federal Law

H.R.3095 - To ensure that any new or revised requirement providing for the screening, testing, or treatment of individuals operating commercial motor vehicles for sleep disorders.– 391.41(b) - Federal Motor Carrier Safety Administration - A person is

physically qualified to drive a commercial motor vehicle if that person:

Has no established medical history or clinical diagnosis of diabetes mellitus currently requiring insulin for control

Has no current clinical diagnosis of myocardial infarction, angina pectoris, coronary insufficiency, thrombosis,

Any other cardiovascular disease of a variety known to be accompanied by syncope, dyspnea, collapse, or congestive cardiac failure,

Has no established medical history or clinical diagnosis of a respiratory dysfunction likely to interfere with his/her ability to control and drive a commercial motor vehicle safely.

Has no current clinical diagnosis of high blood pressure likely to interfere with his/her ability to operate a commercial motor vehicle safely

Has no established medical history or clinical diagnosis of a rheumatic, arthritic, orthopedic, muscular, neuromuscular or vascular disease which interferes with his/her ability to control and operate a commercial motor vehicle safely

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Health Related Conditions of OSA

Obesity

Cardiovascular Disease

– High Blood Pressure

– Coronary Heart Disease

– Stroke

– Abnormal Heart Rhythm

Metabolic Disease

– Diabetes and insulin resistance

Depression

Cognitive Impairment

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CMV- Transportation Emotional Related Stress

Social Isolation

Dangerous – High Risk

Lack of Job Satisfaction- Control

Chronic Fatigue

Relationship Impact– Mental Health – Depression

Motivation for Health and Lifestyle– Poor Eating and Nutritional Habits

– Lack of Exercise

High Tobacco usage > than 50% of CMV drivers

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Type 2 Diabetes

CVM Prevalence vs. US Population:– 16% vs 9.4%

Controlled Diabetes– Lifestyle (Nutrition and Exercise)

– Medications

Uncontrolled Diabetes– Neuropathy

– Impaired Vision

– Heart Disease/Stroke

– Kidney Failure

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Diabetics and Healthcare Costs

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XYZ Incorporated

Chronic Disease - Combined

Chronic Disease - Combined Mbrs % Mbrs Plan Paid % Paid Paid/Mbr

Total 22,381 100.00% $93,069,202 100.00% $4,158

Chronic Disease Members 8,449 37.75% $63,978,460 68.74% $7,572

High Blood Pressure Patients 5,032 22.48% $46,781,296 50.27% $9,297

Depression-related Disorder Patients 2,594 11.59% $25,742,416 27.66% $9,924

Diabetics 2,008 8.97% $16,941,130 18.20% $8,437

Asthmatics 1,938 8.66% $14,389,578 15.46% $7,425

Coronary Heart Disease Patients 502 2.24% $12,652,309 13.59% $25,204

Obesity Patients 277 1.24% $2,571,060 2.76% $9,282

Non-Chronic Members 13,470 60.18% $25,972,580 27.91% $1,928

XYZ Incorporated

Chronic Disease - Diabetic Patients - Additional Conditions

Chronic Disease - Combined Mbrs % Mbrs Plan Paid % Paid Paid/Mbr

Diabetics 2,008 100.00% $16,941,130.02 100.00% $8,437

High Blood Pressure Patients 1,387 69.07% $13,837,840.94 81.68% $9,977

Depression-related Disorder Patients 391 19.47% $5,486,595.80 32.39% $14,032

Coronary Heart Disease Patients 174 8.67% $4,819,261.30 28.45% $27,697

Asthmatics 215 10.71% $3,706,816.09 21.88% $17,241

Obesity Patients 56 2.79% $725,992.67 4.29% $12,964

Workforce Health: Impact on Work Comp

Chart data as reported in a 2010 Study Conducted by CHCWS on the impact of comorbid conditions on WC medical costs

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Obesity – Medical/Workers Comp Costs

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The Right Metrics to Measure Impact

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BUT WAIT…THERE’S ALSO THE IMPACT ON EMPLOYEE ENGAGEMENT

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Engagement Matters

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Yet Engagement Levels Aren’t that Good

How does your workforce measure up?

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Engagement: Beyond the Organizational Level

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Correlating Engagement with Health Status

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Engaged employees are 63% more likely to report excellent health

Further Correlation with Engagement & Health

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Workforce Characteristics

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TAKING A BROADER APPROACH TO BUILDING AN INTEGRATED, HEALTH CENTRIC CULTURE

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Internal Competition for Employee Time & Attention

• Expectations• Culture• Sales • Customer Service• Revenue

• Multiple levels of leadership • Carriers/vendors/partners• Emails• Text messages• Policies• Non-verbal

• Safety/Quality Control• Wellness• Health benefits• Continuing Education• Worksite based

Communications

OfferedPrograms

Leadership

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Safety – How It Connects to Health

A great example of a program that has 100% engagement

Who doesn’t know about the Safety Program? What can we learn from them in terms of

creating a focused culture? What can we learn from them in terms of

onboarding? What can we learn from them in terms of

communication? What can we learn from them in terms of

incentives?

And most importantly, how can we connect & build the business case for well-being by integrating programs?

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Going Green

Environmental initiatives have a natural connection to wellness!

How many opportunities to connect with these initiatives exist? UNLIMITED! Nutrition Buy/Eat locally Physical activity Walking/biking versus driving Gardening/compositing

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Acquisitions

Can wellness programs help assimilate cultures and workers?

Can help establish commonality between different locations/populations

Establishes shared goals and communications Can use as a motivator in onsite challenges, for

example, walking or other tracking-type challenges

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Customer Service

Better health. Better customer service.

Engagement & good health critical to good performance

Call centers, especially, present a unique set of health risks

− Musculoskeletal (ergonomic opportunity)− Mental health (stress)

Does your program customize options and solutions for your customer service personnel?

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Production/Productivity

Productivity is not just about manufacturing!

It’s not just absenteeism – it’s also presenteeism Is a natural link between workforce health and

the organization’s goals

But how many American employers are using productivity measures to evaluate their workforce health efforts?

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Cost Containment

It just makes cents

Cost containment occurs at every level within your organization

It is also an issue faced by most individuals What drives costs in your organization?

− Materials− Human capital− Turnover− Poor quality

How can your workforce health efforts connect to these cost drivers?

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It All Leads to One End Point

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LASTLY, DATA DRIVES DECISIONSHOW DO YOU VIEW & USE YOUR DATA WHEN

MANAGING YOUR WORKFORCE?40

Financial and Clinical Data

Benchmark

– Metrics

– Goals

Measure

– Strategy

– Resources

– Change

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The Continuum of Prevalence and Cost – Employer A

Healthy 58% Prevalence

6% of Cost

Employer A62.59% Prevalence

23.34% of Cost

At Risk 22% Prevalence

10% of Cost


40.30% of Cost

Chronic 17% Prevalence

29% of Cost


14.8% of Cost

Acute 3% Prevalence

55% of Cost

Employer A.71% Prevalence21.56% of Cost

Acute/Catastrophic. • Disease Management

• Case Management

Poly-Chronic• Case Management

• Disease Management

• Pregnancy Management

Early Chronic• Care Coordination

• Pre-disease Education

• Health Coach

• Physician Collaboration

Population Health• Health Engagement

• Prevention

• Health Risk Assessment

• Health Promotion

Accelerated risk progression

CRITICAL ISSUE

Individual Engagement

Relationship Between Lifestyle Risks & RX Solutions

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Next Steps: Understanding the organization’s position on encouraging medication usage over making lifestyle changes

Statins are a class of drugs often prescribed by doctors to help lower cholesterol levels in the

blood. By lowering the levels, they help prevent heart attacks and stroke. Statins have been shown to reduce the risk of heart attack, stroke, and even death from heart disease by 25% to 35%

Male Employee Risk Factors by Cost

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BMI Underweight (18.5 or less)BMI Normal (18.5 – 24.99)BMI Overweight ( 25 to- 29.99)BMI Obese Class I (30 – 34.9)BMI Obese Class II (35-39.9)BMI Obese Class III (40 or greater)

B.P. Normal (systolic <120 and diastolic <80)B.P. PreHTN (systolic 120-139 or diastolic 80-89)B.P. Stg 1 (systolic 140-159 or diastolic 90-99)

B.P. Stg 2 (systolic >160 or diastolic >100)

In terms of costs, the highest risk categories are age (over 60), stage 1 hypertension and weight (Obese Class II and III).

Lifestyle Risk Factors for WC Claimants

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Next Steps: Modify wellness offerings/focus, change messaging, evaluate shift policies, etc.

Traditional Continuum of Costs

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Wellness Score Card Target

1) Total Employee Count ---

2) Covered Employees ---

3) Covered Spouses ---

4) Screening Participation

Health Measure Outcomes

5) Prehypertension and Hypertension 62.1%

6) High Cholesterol 25.3%

7) LDL<= 130 16.6%

8) At Risk BMI 75.5%

9) Pre-diabetes and Diabetics Not offered

10) A1c Not Controled 16.9%

Claim Experience (ee / sp) #

Members

%

Members

Plan

Paid

Paid /

Member

#

Members

%

Members

Plan

Paid

Paid /

Member

#

Members

%

Members

Plan

Paid

Paid /

Member

11) Alcohol Related Disorders 7 0.6% $113,398 $16,200 9 0.7% $194,944 $21,660 10 0.7% $282,956 $28,296

12) Asthma (1) 29 1.6% $485,928 $16,756 28 1.3% $248,895 $8,889 48 2.0% $463,497 $9,656

13) Certain Types of Cancer (2) 30 2.7% $133,496 $44,450 47 3.4% $893,578 $19,012 46 3.0% $923,991 $20,087

14) Coronary Heart Disease 17 1.5% $123,184 $7,267 25 1.8% $523,227 $21,409 28 2.5% $421,433 $11,090

15) Diabetes 72 6.6% $1,092,829 $8,179 96 7.1% $1,019,520 $10,620 131 8.6% $1,471,618 $11,234

16) Diabetes, A1c test 52 85.3% --- --- 55 58.5% --- --- 75 57.3% --- --- 100%

17) High Blood Pressure 104 9.4% $1,130,311 $10,868 150 11.0% $799,588 $5,331 195 12.8% $1,902,870 $9,758

18) High Cholesterol 17 1.5% $90,540 $5,326 26 1.9% $90,654 $3,487 28 1.8% $139,514 $4,983

19) Mental Health (3) 50 4.7% $526,808 $10,536 55 4.2% $315,244 $5,732 72 4.7% $338,098 $4,696

20) Neck / Back Problems 119 18.0% $1,421,803 $7,444 223 17.0% $2,166,098 $9,713 225 16.7% $1,970,367 $7,727

21) Obesity 2 0.2% $35,293 $17,646 3 0.2% $2,964 $988 9 0.6% $74,443 $8,271

22) Smoking-related disorders 24 2.2% $430,911 $17,955 37 2.7% $253,750 $6,858 48 3.1% $378,316 $7,882

23) Stroke 8 0.7% $280,469 $35,059 12 0.9% $327,377 $27,281 12 1.3% $667,853 $33,393

Preventive / Wellness (ee / sp)

24) Visits 100%

25) Cholesterol Screening 50%

26) Colonoscopy >40 years 10%

27) Mammograpy >40 years 35 - 40%

28) PSA no longer recommended

29) Pap Smear 35 - 40%

Impact

30) Prescription Drug PEPM

31) Paid Claims PMPM

no longer recommended

78.3%

14.0%

4.8%

15.0%

36.2% 37.5%

14.2%


2015

1175

2013 2014

1153905

18.3%

4.3%

17.1%

7.3%

863 or 75%

18.7%

4.1%

75.5%

58.2%

28.0%

19.5%

71.8%

28.3%

20.2%

$240 $218 $224

673 or 74%

25.0%

$72 $91 $97

20.1%


36.2%

0.2%

18.9%

873

20.7%20.7%

Turning Static Data Points into Actionable Initiatives

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Targeted, Patient Centric

Decision Making

Program Participation

HRA-Biometric

Pharmacy Claims

Health Plan Utilization

Claims

Risk-WC Claims

Safety

Plan Design Targeted

Outreach Incentive Design Program choices Opportunity

Analysis Communications Risk Stratification Partner

Collaboration Impact Analysis Value Based

Benefits

Organizational Health Structure

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Example: Turn-key Wellness Program

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Focused Health and Wellbeing

Five Pillars of Health

Engagement Technology

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Care Path Management

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Assessment Biometrics Clinical Review Claims Data Vitual Coaching Reporting

Employee – Spouse Biometric and Blood Profile

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Health Screening Intake Review blood panel

Review biometrics

Other:

Review Family History

Review Smoking Habits

Review Nutrition Habits

Review Physical Activity

Review overall health and general mental health

wellbeing, behaviors and attitudes.

Make recommendations for patient follow up and

referrals to other specialists.

Annual Preventative Care Counseling

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• Age and gender-appropriate review of physical condition, including vital signs such as blood pressure,

height/weight/BMI calculation (utilized to screen for obesity)

• Counseling regarding obesity, weight loss, healthy diet and exercise

• Review of family and personal health risks

• Guidance and counseling regarding substance abuse, alcohol misuse, tobacco

• use, obesity, exercise and healthy diet/nutritional counseling as indicated

• Screening for depression in adolescents and adults

• Behavioral dietary counseling for adults with hyperlipidemia and other known risk factors for

cardiovascular and diet-related disease

• Review of laboratory test results available at the time of the encounter

• Screenings -Cholesterol screening (dyslipidemia) in adults, Screening for glucose levels and tobacco

use

Virtual Health Advocate Coaching Engagement

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Populations Health Status Reporting

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Health Gaps in Care Reporting

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Virtual Patient Monitoring –Primary Care Provider and Coaches

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No Direct Cost

Biometric Screening

Health Risk Assessment

Clinical Review

Challenge Tracking Software Wellness

Coach and Consultant

Financial Wellness Seminars

Measurable Analytics

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A Turn-Key Wellness Program

Telehealth - Remote Driver Monitoring

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1. Polysomnography (PSG) – Sleep Study 2. Home-based sleep testing 3. Continuous positive air pressure

(CPAP)4. Sleep Oral appliances, and other

effective alternative treatments 5. Pulse oximeter6. Heart7. Weight - BMI

Workplace Health is an Essential Business Strategy!

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Employers can impact an Individual in a very Personal Way