“Wellness” for 21 st Century Miners: Integrating “Safety” & “Health” To Drive Employee, Family and Business Perfo

1. “Wellness” for 21st Century Miners:Integrating “Safety” & “Health”To Drive Employee, Family and Business Performance Michael D Parkinson, MD, MPH, FACPM NSSGA Convention March 2014

2. Objectives • Definition of 21st century “wellness” for industry, employers and employees in globally competitive economy • Military, NASA and private sector applications • Integration of “Safety”, “Health Protection” and “Health Promotion” • NIOSH Total Worker Health™ initiative • Employer Health & Productivity Roadmap • Implications for 21st century mining industry, employers, miners and their families

3. My Perspective: Always Achieving the Mission • Air Force flight surgeon • Mission achievement worldwide thru “whole person” orientation to worklife, professional and personal integration for hi-risk aircrew and families • Chief, US Air Force Preventive Medicine • Optimizing preventive medical care programs for Air Force and DOD pre-, during and post- Persian Gulf operations • Study and medical surveillance of occupational and environmental health risks • Deputy Director, Air Force Medical Operations and MHS leadership • Deliver or “buy” care from private sector for 2M beneficiaries • What functions are “mission-essential” for health, safety, performance? • President, American College of Preventive Medicine • Physicians in public health, preventive care and occupational medicine • Institute of Medicine NASA “Integrating Employee Health” 2 yr study • Consumer-directed health care – prevention paid 100% • NIOSH Total Worker Health Advisor U of Iowa

5. $2.6 T: 75% Behaviors, 30% WasteWhat are We Trying To Do Anyway?

6. 21st Century Mining and Related Industry • Global scope and competition • 24-7 high risk, high impact industry • Critical growth path and opportunities • Increasingly short “cycle time” to react and change • Safety and quality paramount • Mission critical personnel with time, attention, physical and mental health demands • Health and performance – similarly critical to global success and company growth

7. How Many Americans Can Just Say “Yes” to All 5? I am within 5 pounds of my ideal body weight I exercise 30 minutes or more most days of week I eat a healthy diet with 5 fruits/vegetables most days I don’t use tobacco products I have 2 or fewer alcoholic drinks per day

8. “Health Promotion” or “Health Protection” . .“Occupational” or “Non-Occupational” . . A Picture Worth . . .

9. Mediterranean (or Asian) Diet + Nonsmoker + Daily Activity + Moderate Alcohol Use* * Knoops et al and **Rimm, Stampfer, JAMA 2004;292:1433-1439

10. Determinants of “Health” and “Disease” Where & How We Live, Learn, Work and Play Social Environment Physical Environment Genetic Environment Individual Response --Behavior --Biology Health & Function Disease Health Care Well-Being Prosperity Evans, R. G., Barer, M. L., & Marmor, T. R. (1994) Why Are Some People Healthy and Others Not?. New York: Aldine De Gruyter

11. F100 Engine Performance ThreatsFlight Hour Periodic Maintenance Schedule 4th Stage Compressor Blade 3rd / 4th LPT Disk / Blade 3rd Fan Disk / Blade #5 Bearing Compartment HPT Distress Compressor Stalls Fuel Manifold Pigtails/Flex Hoses/Nozzles

12. Human System Performance Threat Mission-essential Preventive Maintenance? Human System Performance Threats Atherosclerosis Environmental Toxin Exposure Stress-Induced Disorders Back Injury Suicide Operational Demands Accidental Injury Injury/Illness From Hostile Attack Hearing Loss Infectious Disease Hypertension

13. Committee to Assess Worksite Preventive Health Program Needs of NASA EmployeesThe National Academies Institute of Medicine Food and Nutrition Board http://www.iom.edu/CMS/3788/18021/26995.aspx

14. HEALTHY Demonstrating optimal health status as defined by positive health behaviors; minimal modifiable risk factors; and minimal illnesses, diseases, and injuries PRODUCTIVE Functioning to produce the maximum contribution to achievement of personal goals and the organizational mission READY Possessing an ability to respond to changing demands given the increasing pace and unpredictable nature of work RESILIENT Adjusting to setbacks, increased demands, or unusual challenges by bouncing back to optimal “well-being” and performance without incurring severe functional decrement. Institute of Medicine: What Does A Healthy Workforce Look Like?* IOM: Integrating Employee Health: A Report for NASA 2007

15. Behaviors Drive Medical, Disability, Absenteeism, Worker’s Comp, &Total Employer Costs High Risk Medium Risk Non-Participant Low risk Edington. Am J Health Promotion 15(5):341-349, 2001

16. Strategy To Address Rising Medical Costs and Improve Workforce Health & Productivity Poorly Managed Well Managed High Risk Moderate Risk Low Risk 2% 8% 62% 12% 26% IMPROVE MAINTAIN MANAGE • 20% drive 80% of cost – but not the same 20%. 50% of those are new each year. • Average employee has 2.2 health risks, resulting in $2,000/yr in productivity losses. (JOEM, 2005) • 36% of absence– including STD and Workers’ Comp – is due to excess riskfactors (JOEM, 2002)

17. When Done Right: Positive ROI for Both Direct Medical and “Indirect” Total Costs • Medical costs fall by about $3.27 for every dollar spent on effective wellness programs • Absenteeism costs fall by about $2.73 for every dollar spent Source: Katherine Baicker, David Cutler, and Zirui Song, Health Affairs, February, 2010

18. The success and sustainability of an integrated health process must first and foremost begin with a clear understanding of the organization’s mission. The Committee recommends that the administrator of NASA adopt a new vision for worker health, readiness, and resilience that directly links to NASA’s mission and includes health as a core NASA valuethat is implemented through an integrated health and systems approach. NASA Recommendation “Job 1”: A New Vision

19. A mission-driven vision for health should articulate why investment in health and employee-integrated health helps NASA achieve its core mission on time, under budget, and better than expected. NASA #2: Link Health and Performance to Bottom Line and Mission

20. Develop a data-based approach to policy, planning, programming, budgeting, implementation, operations, evaluation, and management. Create a standardized “health and performance” full-cost accounting framework to define, standardize, prioritize, fund, and evaluate resource allocation for human-related mission performance and workplace safety, health, and productivity. Incorporate mission-essential elements of integrated health programs in contracting requirements. NASA #3: Visible Organizational Commitment

21. NASA should provide education and training to first-line managers and supervisors that focuses on the relationship between health and productivity NASA #4: Manager Educationand Ownership

22. NIOSH Total Worker Health™: Integrating Health, Prevention, Safety and Occupational Medicine • Total Worker Health™ is a strategy integrating occupational safety and health protection with health promotion to prevent worker injury and illness and to advance health and well-being. • “Most diseases, injuries, and other health conditions experienced by working people are multifactorial, especially as the workforce ages. Evidence supporting the role of work and personal risk factors in the health of working people is frequently underused in developing interventions. Achieving a longer, healthy working life requires a comprehensive preventive approach. To help develop such an approach, we evaluated the influence of both occupational and personal risk factors on workforce health.” • Interaction of Occupational and Personal Risk Factors in Workforce Health and Safety, AJPM Mar 2012 Schulte et al

23. Employer Health & Productivity Road Map™ *“Understand, Improve, and Partner With Your Doctor” Increase Healthy Behaviors Minimize Acute Care Optimize Chronic Care Reduce Excessive Surgery Speed Transitions Care-Home-Work Optimize Environment Incentivized Health Management Program or Consumer-Directed Health Plan *Parkinson MD. Employer Health and Productivity Roadmap™ J Occup Environ Med 2013;55 (12): Total Worker Health Supp S46-51.

24. Employer Health & Productivity Road Map “Understand, Improve & Partner With Your Doctor” Increase Healthy Behaviors Minimize Acute Care Optimize Chronic Care Reduce Excessive Surgery Speed Transitions Care-Home-Work Optimize Environment • Health and Productivity Alignment Assessment Report and Gap Analysis • Health & Performance Total Economic Opportunity • Ergonomic evaluation and support • Wellness Course Participation

25. Health and Productivity Performance Index Assessment Health and Productivity Performance Index (HAPPI) Leadership/Culture Communications Incentives Rewards Alignment Programs & Services The HAPPI assessment was developed from Best in Class tools to help employers identify areas for improvement and health related cost savings. Physical Environment Ergonomics, Facilities & Safety Fit-Friendly Worksites

26. Employer Health & Productivity Road Map “Understand, Improve & Partner With Your Doctor” Increase Healthy Behaviors Minimize Acute Care Optimize Chronic Care Reduce Excessive Surgery Speed Transitions Care-Home-Work Optimize Environment • “Champion Index” - % in optimal health • Population risk profile & movement • Biometric changes over time • Clinical preventive services • Lifestyle coaching enrollment & graduation

27. Understand Your Health and “Know Your Numbers” Provided in partnership with

28. Coaching & Competitions Work

29. Employer Health & Productivity Road Map“Understand, Improve & Partner With Your Doctor” Increase Healthy Behaviors Minimize Acute Care Optimize Chronic Care Reduce Excessive Surgery Speed Transitions Care-Home-Work Optimize Environment • Visits/1000 by site of traditional and alternative care • Video and e-visits • Lower cost and onsite care options • Prevalence of impactableacute visits

30. Norman Rockwell Had It Right! “Medical Home” Re-visited

31. I Still Want “My Rockwell” But My Way, My Time, For Less $$

32. Move “Care Forward”: Where Its Most Needed – Not Where Most Comfortable

33. Employer Health & Productivity Road Map “Understand, Improve & Partner With Your Doctor” Increase Healthy Behaviors Minimize Acute Care Optimize Chronic Care Reduce Excessive Surgery Speed Transitions Care-Home-Work Optimize Environment • Condition prevalence • Identification & referral process • % “active” self-identification • % ”passive” outreach • Disease Management Coaching: • enrollment & graduation

34. “Prescribe Engagement” – and We “Fill the Prescription”Health Coaching for Lifestyle, Disease and Shared Decision-making Chronic Condition Management Asthma COPD Diabetes Depression Cardiac conditions Low Back Pain Surgery SDM for back, hip, knee new • Evidence- & curriculum-based program/services • Individual and tele-group coaching • Coach supported self-study (online & workbook options) • Coach-on-Call e-mail & video • Onsite Health Coaching Lifestyle Improvement MyHealth Eating Well™ MyHealth Ready to Quit™ MyHealth Weigh to Wellness™ MyHealth Less Stress™ MyHealth Step Up to Wellness™ MyHealth Selections™

35. Employer Health & Productivity Road Map “Understand, Improve & Partner With Your Doctor” Increase Healthy Behaviors Minimize Acute Care Optimize Chronic Care Reduce Excessive Surgery Speed Transitions Care-Home-Work Optimize Environment • Shared decision-making before surgery with interactive online tool • Best practice step therapy pathway for low back pain • Reduce: • Number of low back surgeries • Advanced imaging rate • Expand to more preference-sensitive discretionary surgeries and conditions

36. Primary Care Physicians’ Opinions of Patients’ Need To Be Informed vs Actual Proportion Informed by Medical Service Type* *Foundation for Informed Medical Decision Making survey, 2009 (n=462)

37. National Priorities for Shared Decision Making: • Reduce unwarranted procedures, targeting: • Spine surgery • PTCA/Stent • Knee replacement • Hip replacement • Lumbar spine MRI prior to conservative therapy, without red flags • Bone or joint x-ray prior to conservative therapy, without red flags • Coronary artery bypass graft (CABG) • Hysterectomy • Prostatectomy • Cesarean section • Endoscopy • Others

38. Employer Health & Productivity Road Map“Understand, Improve & Partner With Your Doctor” Increase Healthy Behaviors Minimize Acute Care Optimize Chronic Care Reduce Excessive Surgery Speed Transitions Care-Home-Work Optimize Environment • Top 4-5 conditions that drive Time Away From Work • Absence changes over time • Leave management

39. Coordination of “Stove-piped” Programs Decreases Absenteeism, Lowers Total Costs & Improves Productivity Partners Program (Medical Home) Employee Assistance Program Incentive Driven Wellness Program(s) Worksite Health Clinics • Health Management • Coaching • Lifestyle/Wellness • Physical Condition Management • Behavior Condition Management • Complex Case Management Improve Health Manage Health Member Services Central Leave Management/FMLA 24/7 Nurse Line Short-Term Disability Pharmacy Outreach Maintain Health Workers’ Compensation

40. Employer Health & Productivity Road Map™ *“Understand, Improve, and Partner With Your Doctor” Increase Healthy Behaviors Minimize Acute Care Optimize Chronic Care Reduce Excessive Surgery Speed Transitions Care-Home-Work Optimize Environment Incentivized Health Management Program or Consumer-Directed Health Plan *Parkinson MD. Employer Health and Productivity Roadmap™ J Occup Environ Med 2013;55 (12): Total Worker Health Supp S46-51.

41. Powering the Health & Productivity Road Map: Moving to Maximally Effective Health and Cost Savings Increasing Consumer and Patient Engagement HSA only – full replacement HRA/HSA – full replacement HRA only – full replacement Financial Efficiency $$ HRA/HSA/Hybrid – optional HSA only – optional HRA only – optional PPO with Incentivized Comprehensive Health Management PPO with or without “Wellness Program” Migration Toward Consumer-Driven Health Care 41

42. Partner • Understand Rewarding Healthy Choices & Better Care Decisions • Improve UPMC Health Plan incentivizes the member $ Consumer Engages in Health and Care Activities

43. “Understand, Improve and Partner” Incentivized Strategy to Optimize Engagement • Health Risk Assessment • Biometric Screening • Flu Shot • Lifestyle & disease management • coaching • Preventive Screenings • Partner with your Doctor • Shared decision-making • Care delivery innovations – connectivity and eVisits • Earn up to $500/$1000 to use • toward your Deductible and • Coinsurance

44. Wellness, Health, Safety: Integration Saves Lives & Costs

45. Take Homes For 21st Century Mining “Performance” • Integrated health, safety, performance, bottom line savings and top line growth all tied to productive employees • Define what hi-performing mining workforce “looks like” using IOM 4 key elements – then shoot for goal • Preventive care should be standardized, emphasized, assured and measured as key component of “human performance” and achievement of corporate mission • The field, federal government and leading employers understand emphasis on “total worker health” paradigm Health/wellness AND safety/occupational health – one and same • To maximize company and industry productivity – maximize personal and family health, fitness and performance