The Value of Worksite Health

1. Nico Pronk, Ph.D., FACSM, FAWHP HealthPartners HealthPartners Institute for Education and Research Harvard School of Public Health The Value of Worksite Health IAWHP Global Symposium Atlanta, GA April 1, 2014

2. Agenda • The employers’ perspective • The workplace setting • Finding value in health • Best practices • Multiple levels of programming • Capturing the value of WHP

3. What About the Employers’ Perspective? • Non-clinical, community-based prevention policies and wellness programs appeal to employers • Importance of family inclusion • Importance of community connection • Company recognition as a leader for health improvement and economic vitality • Recognition that companies and organizations are complex social systems

4. Unsustainable Cost Pressure Source: 2011 Milliman Medical Index

5. Or to look at it another way… Source: Alliance of Community Health Plans

6. Or to look at it another way… Income: $59,858 Source: Alliance of Community Health Plans

7. Drivers of health Where money spent Facing the challenges in health care Medicalservices 20% Where do U.S. health care dollars actually go? Medical services 88% Social and economic factors 40% 4% Healthy behaviors Healthy behaviors 8% Other 30% Physical environment 10%

8. The Worksite Setting • Population access • Significant reach into the population • Significant frequency to intervention exposure • Significant access to tools, vehicles, resources, etc. that may be mobilized to increase awareness and PA behavior change • Worksites can identify the population of interest • Employees • Employees and dependents • Targeted subgroups of interest • Interventions can be designed at various levels that interact with the individuals receiving the intervention • Individual • Inter-personal • Organizational • Environmental

9. The Worksite Setting • Work matters for health • Unemployment is a major determinant of health • Worker health may be affected by the organization of work, the policies at work, the relationships at work, etc. • Health matters for work • Chronic conditions may be exclusion criteria for job fit • Fitness for duty tests as indicators of inclusion criteria • Healthy workers and a healthy culture appear to be a good business strategy • Worksite health promotion also is a sound public health strategy and fosters economic growth in the community

10. Broader context Employers recognize the need to: • Reduce healthcare spending • Reduce illness burden • Reduce the likelihood of becoming ill • Make healthy choices easy choices • Maintain or improve economic vitality • Reduce waste • Increase longevity • Enhance national security • Prepare communities for the workforce

11. Workplace Health Works! • AHRF includes both health assessments and biometric screenings • The Task Force finds insufficient evidence to determine the effectiveness of AHRF when implemented alone • The Task Force recommends the use of assessments of health risks with feedback when combined with health education programs, with or without additional interventions, on the basis of strong evidence of effectiveness in improving one or more health behaviors or conditions in populations of workers

12. The value of health ROI Literature ReviewSystematic review and meta-analysisConclusion:Worksite Health Promotion programs can generate positive ROI for medical- and absenteeism-related savings: Medical: 3.27 : 1Absenteeism: 2.73 : 1

13. The value of health Impact of obesity on work limitations is akin to 20 years of aging Source: Hertz, et al. JOEM 2004; 46:1196-1203.

14. Value through design Companies across a variety of industries report benefits: • Lower health care costs • Greater productivity • Higher morale ROI can be as high as 6:1 Six Essential Pillars for Successful Programs: • Engaged leadership at multiple levels • Strategic alignment with the company’s identity and aspirations • A design that is broad in scope and high in relevance and quality • Broad accessibility • Internal and external partnerships • Effective communications

15. Best Practice Design Principles 9 Best Practice Dimensions • Leadership • Relevance • Partnership • Comprehensiveness • Implementation • Engagement • Communications • Data-Driven • Compliance

16. Why then, such confusion? • Confusion over the definition of a worksite health/wellness program • Population-based • Even people with diagnosed disease retain access to lifestyle behavior change programs • Disease and lifestyle management programs are artificially segregated into siloes • Value of worksite health programs goes far beyond medical care cost savings • Even this article showed a positive ROI for the whole program ($1.46:1)

17. Environment shapes behavior Abnormal reaction to a normal environment? A normal reaction to an abnormal environment?

18. Individual decision do matter!

19. Cardiovascular disease, diabetes, cancers, lung disease…Preventable deaths Choices for interventions Obesity, lack of fitness, high blood pressure, high cholesterol, high blood sugar Tobacco use, poor diet, lack of physical activity, excessive alcohol use Environments – physical, psychosocial (culture), socioeconomic Social policy, community mobilization

20. Making healthy choices easy choices Individual Effort Health Potential Environmental (physical, psychosocial) and Policy Interventions (Public, organizational, etc) Source: Pronk NP, Kottke TE. Health Promotion in Health Systems. In: Rippe, J. Lifestyle Medicine, 2013.

21. Moving Beyond Available Evidence • Evidence of what works needs to be applied in the context of the workplace environment • Inflexible focus on program fidelity may limit adoption of programs with sustained success • Practice-based evidence can only be generated if solutions are successfully implemented • Worksite health programs will only deliver on their promise when supported as a business strategy with leadership support and accountability

22. Comprehensive, Multi-Level, Multi-Component Programming Make Being Healthy and Productive… Exceptional Customer and User Experience Levels of Influence Outcomes Health Productivity Financial / ROI Source: Pronk, NP. Journal of Physical Activity and Health, 2009, 6 (Suppl. 2), S220-S235.

23. Valuing Workplace Health i.e., Worksite Valuing – What should be counted? Comprehensive assessment Health Benefits ------------ Harms QALYs or HALE Community Well-Being Benefits ------------ Harms Community Well-Being Indicator Community Benefit Benefits and Harms Community Process Benefits ------------ Harms Community Process Indicator Value The value of an intervention considers its benefits, harms, and costs. Comprehensive assessment Valuing – What should be counted? • Identification of Investments and Resources Community Cost Savings ----------- Costs Monetary Units (USD) Resources Used i.e., Worksite

24. What Does “Success” Look Like?

25. Soource Risk transitions based on HA-derived risk levels among employees over 2 years (N=1,087) 21% 66% 13% Got Worse Got Better Stayed the Same Baseline 44% Low Risk Doing nothing may reduce the population’s health by as much as 7% per year 36.3% 14.4% Baseline 24% Moderate Risk 13.2% 15.1% 33.5% 2.5% 0.2% Baseline 24% High Risk Net population health improvement of 8%. 87% did not get worse 0.8% 4.5% Baseline 7% Disease: Well Managed This 2-year health and well-being program was associated with a ROI of 2.9:1 25.0% 1.3% Baseline 1% Disease: Poorly Managed Source: HealthPartners Health Assessment Database, 2011

26. Conclusions • When workplace health and wellness programs are implemented according to best practice principles of design, significant value may be generated • Valuation models should go beyond traditional ROI and capture those “values” that are relevant to the company Thank You!