“A Workplace Culture of Health” Population Health & Disease Management Colloquium Ray Fabius MD

1. “A Workplace Culture of Health” Population Health & Disease Management Colloquium Ray Fabius MD Strategic Adviser to the President - Walgreens Health & Wellness March 3rd, 2009 Date

2. Let’s Start with the Employer View • Runaway health care costs without controls • Threatens company viability • Misuse, overuse, and underuse • Need for Transparency • Apply TQM, Six Sigma, TPS, Lean to Health care • Consumerism • Purchase & Perceive Care in Silo’s • Human Resources Leaders are Risk Advice • Often Depend on Payers and Consultants for next answer • Data deficient • Workplace Safety • Work Environment • Workplace Health

3. Today’s Agenda • The Success of Occupational Health & Workplace Safety • Translating that Success to Healthcare • How can you create a Culture of Health inside a company? • What would the value be in creating a Culture of Health? • Examples of Successful Efforts to Create a Culture of Health

4. Occupational & Motor Vehicle Safety Improvements • .

5. One Glaring Exception: The Healthcare Environment is Becoming More Hazardous

6. Effectiveness Pathway to Workplace Safety Identify Opportunities Measure Baseline Establish Interventions Implement Action Plan Re Measure Data Analyze for Effectiveness

7. Prevention of Errors in Workplace Safety • Technology • Automated Processes • Decrease Complexity • Worker Removed from Process • Operator Monitors Automated System for Abnormal Events • Prepared to handle response or solution • Standardization

8. Tipping the Scale Leadership Resources Awareness Guidelines Collaboration Standardization Simplification Documentation Non-Punitive Active Learning Change Agent Technology Training Feedback Errors Safety Healthcare Delivery

9. Conditions that Prevent Workplace Errors • Good Managerial Decisions • Right Equipment • Maintenance of Equipment • Skilled & Knowledgeable Workforce • Reasonable Workload & Schedule • Well-Designed Jobs • Clear Guidance on Desired & Undesired Performance

10. Lessons Learned in Workplace SafetyPotential Application to Workplace Health • Growing Awareness • Comprehensive Strategies • Intolerance with Errors • National Focal Point for Leadership • Dissemination of Information • Regulatory Responsibility • Research • Expanding Knowledge Base • Substantial Resources

11. What About the White Collar World? • Executive Health • Ergonomics • Stress Management • Resiliency • Work Accommodation • Ex pat Services • Work / Life Balance

12. Building a Culture of Health STEP 1 COMPANY ASSESSMENT STEP 2 DATA AND METRICS STEP 3 OPERATIONAL PLAN INTERVENTIONS STEP 4 STEP 5 EVALUATION & REFINEMENTS

13. Changes Required to Create a Culture of Health • Create Awareness • Identify Gap from Benchmark • Study Intervention Options • “Operationalize” Best Efforts • Training and Education • Establish Accountabilities • Celebrate Success

14. How can you create a Culture of Health inside your company? • Branding • Champions • Rack & Stack • Incentives • Mandates • An environment of health • Fitness • Risk Assessment • Risk Reduction • Disease Management • Proof of Concept • Mainstream success

15. Resources to Effect Change • Leadership • Attention • Investment

16. How do Health & Wellness effect productivity? • Health care – self-insured • Workers Compensation • Disability • Absence • Presenteeism • Poor performance

17. The Skill & The WillBut What About Not Being Ill!

18. Workers’ comp, sick leave & other wage replacement Total Employee Health Related Costs Health Care Costs Medical Care Hospitalization Pharmacy Diagnostic Testing Behavioral Health Physical Therapy DIRECT Medical 22% Disability 4% Productivity Loss 74% Overtime Pay Lost Productivity Illness & Injury Travel to Off-site MD Subpar Quality OTHER COSTS Temporary Staffing Absenteeism Employee and Customer Dissatisfaction Presenteeism Turnover Replacement Training Administrative Source:Integrated Benefits Institute, 2000 Missed Deadlines Adverse Bottom Line Impact

19. The Connection Between Health & Human Capital is Significant • Over 22% of working age adults report health-related work impairment in the past 30 days from chronic illness. Those with impairment average 6.7 lost days. Equivalent to 2.5 billion impaired days/year. -Kessler • American Productivity Audit: Top 5 reasons for productivity loss result in $180 billion in lost time. -Stewart • Illness and disability reduced total work hours by approximately 8.6%. Nearly 8.7 million Americans were completely unable to work. The loss to the U.S. economy represented about $468 billion. -Berger

20. Leading by Example • “Investment in health delivery is consistent with a long-term view of maximizing return on human capital.” Michael Critelli—CEO, Pitney-Bowes • “A healthy, engaged, and productive workforce is critical to maximizing business performance and driving sustainable growth.” Dean Oestreich—President, Pioneer Hi-Bred International, Inc. • “Our profit potential is inextricably linked to the capability and performance of our employees.” Andrew Liveris—President and CEO, The Dow Chemical Company

21. Factors Affecting Health & Productivity Health-related factors Physical health issues Chronic disease Acute illness Lifestyle issues Health risks Preventive care compliance Behavioral health Other factors: Demographics Caregiving Work/life imbalance Financial concerns Employer health benefits Productivity-related factors Absenteeism STD and LTD programs FMLA policies Sick leave policy Effect on team morale Value of time in production Workers’ Compensation Presenteeism Work relationships Job security and control Health issues Work issues Ergonomic issues Safety concerns

22. Integrated Data to Evaluate Health & Productivity Costs IHPM Journal, 2003 • HR/payroll • employee demographics • time reporting • employee surveys • turnover/overtime data • performance appraisals • Lost time data • STD • LTD • FMLA • PTO/sick leave • Medical data • group health • pharmacy • mental health • health risk appraisals • disease prevalence • EAP utilization Integrated data analysis • Business data • customer satisfaction • production data • quality data • operational data • net income • gross revenue • human capital costs • WC/Safety data • OSHA, accident • reporting • drug testing • WC claims data • Productivity metrics • staffing/overtime • per employee costs • and revenues • self-reported presenteeism

23. Top 15 Drivers of Lost Work Time Source: Kessler’s HPQ – Adjusted to Workforce

24. The Total Cost of Illness Goetzel, et al. JOEM 2004 arthritis diabetes allergy depression migraine

25. Health Risks: Associated with Productivity Loss The More Health Risks the Greater the Absence The More Health Risks the Greater the Limitations Some Health Risks Cause Greater Lost Work Hours

26. Poor Health Impact – Continuum of Employee Performance Outcomes Not doing well while working errors complaints delays team breakdown Not doing work on work time unscheduled breaks unfocused time health exams on work time information gathering Not at work unscheduled absence disability workers’ comp replacement workers Lost to the workforce permanent disability early retirement due to health issues premature death spousal illness

27. HHS - The Workplace is a great location for preventive programs “Employers are becoming more aware that obesity, lack of physical activity, and tobacco use are adversely affecting the health and productivity of their employees and ultimately, the businesses’ bottom line.” As a result: • Innovative employers are providing a variety of work-site-based health promotion & disease prevention programs • Significant return on investment for the employer (median ROI of $3.14)

28. Health by Numbers Driving Healthy Lifestyles Smoking 0 Tobacco (None) Diabetes / Heart Disease 5 Diet (5 Fruits/Vegetables A Day) Lack of Exercise 10 Exercise (10,000 Steps A Day) Overweight / Obesity 25 Weight (Body Mass Index, weight to height ratio, less than 25 = healthy) Message: Don’t Smoke Message: Eat healthy Message: Be active Message: Maintain a healthy weight Rewards (intrinsic / extrinsic) vs. Competitions (rack & stack)

29. A High Performance Network can reduce an employee community’s random access of care Studies show: • half or more employees believe all doctors and hospitals provide the same care • half or more employees are not aware of guidelines of care • physicians referral patterns are based on consanguinity, friendship, financial ties and proximity. However the majority of an employee community seek validation from their trusted clinician before proceeding with a treatment decision.

30. Identifying best specialists & hospitals & directing employees to them The TFHC specialty referral rate is 2/3 lower than the community referral rate. 28.3%* 28.3%* 2007 Actual Billed Charges Paid January thru June 2007 Actual Billed Charges Paid January thru June 9.4% 8.7% %Using Best Hospitals 2006 vs 2007 Toyota presentation to IHPM %Using Best Specialists 2006 vs 2007

31. Philosophical Approach to Onsite Health Services Employer’s Health, Safety and Productivity Programs Occupational Health Health and Wellness Keeping Employees Safe and at Work Keeping Employees Healthy On-site health center provides the framework and technological infrastructure for the delivery of effective H&P programs

32. Clinical Outcomes for Health Center Users with Diabetes (2003 to 2005) N=336

33. Projecting Long-Term Economic Impact (Diabetes Care Improvement) Analysis of risk factors predictive modeling indicate a significant reduction in risk of diabetes complications over the 2003-2005 period for diabetics under care Potential future economic impact - reduced patient morbidity has been estimated at an average of $1,800 of avoided medical costs per patient per year (before inflation adjustment) Economic impact does not include impact on productivity or disability outcomes

34. Population Health Excellence ™ • Toolkit & Requirements – Building Blocks Drivers Results Community of Health • Community Prosperity Motivation • Extrinsic to Intrinsic Participation • Self-Efficacy Multi-Modal • Learning Styles • Health Literacy • Diversity Spectrum of Care • Access • Convenience • Ease of Use Informatics • Proven Efficacy Platform • Flexibility • Integration

35. GE Global Medical Network: 230 On-Site Clinics & 600 Doctors & Nurses The issue of benefits extends beyond our country's borders

36. Summary • The Success of Occupational Health & Workplace Safety • Translating that Success to Healthcare • How can you create a Culture of Health inside a company? • What would the value be in creating a Culture of Health? • Examples of Successful Efforts to Create a Culture of Health