Managing Total Risk & Total Cost: Workers Compensation & Employee Benefits

1. Managing Total Risk & Total Cost: Workers Compensation & Employee Benefits Why Wellness, Why Now? May 17, 2011 Joe Picone, Chief Claim Officer, Willis

2. Agenda • Cost of Workers Compensation and Employee Benefits • Today’s Workforce • Employee Benefits vs. Workers Compensation vs. Wellness • The Wellness Solution

3. WC Lost Time Claims: Indemnity NCCI, WC Symposium 2010

4. WC Lost Time Claims: Medical NCCI, WC Symposium 2010

5. WC Medical Costs Rising NCCI, WC Symposium 2010

6. “Presenteeism” • The measurable extent to which health symptoms, conditions and diseases adversely affect the productivity of individuals who choose to remain at work.

7. Why is Health Care So Expensive? (Employee Benefits Version) • Rise in spending for treated diseases (37%) • Innovations / advances in technology • New / better medicines • New treatments • Delivery costs of newborns have increased 5X (1987-2002) • Rise in prevalence of disease (63%) • ¾ of all spending in US focused on patients who have one or more chronic conditions. • Chronically ill patients receive only 56% of clinically recommended preventive health services. • 27% of the rise in health care costs is associated with increased rates of obesity.

8. Why is Health Care So Expensive? (Workers Compensation Version) • Increasing Severity – Decreasing Frequency • Attempts to maximize income by some • Failure to properly manage utilization • Wrong measures: savings vs. paid • Trends in our society: • Obesity • Age • Cultural • Mental Health

9. Time and Effort You Invest When Buying • A Car? • A House? • A College?

10. How much time do we take to research our own health decisions? Source: NBGH online survey, September 2007 N=1,558

11. Today’s Workforce

12. Some Facts About Today’s Workforce: Current Americans *US CENSUS 2006

13. More Facts About Today’s Workforce: Current Workforce

14. Why It’s Important to Understand Generational Differences • Boomers are larger than two previous generations • One out of every three adults over 21 is a boomer • Boomers have tremendous work ethic • 10,000 Boomers per day are turning 50 • 13,000 people will reach the age of 60 every day for the next 20 years • Boomers will work longer than in past • By 2050, the median age worldwide will be 38, up from 28 in 2000 and 24 in 1950. • In the US, the median age in 2050 will be 41, in Italy it will be 53!

15. The Workers: What are they like?

16. Fact: We have an aging workforce that: • Likes to work hard - motivated • Independent • Will retire later • Will be dependent on dual incomes • Are entitlement dependent • Are generally optimistic about how long they will live and how they will live • Have been hit hard by recent recession in home values and savings for retirement

17. What We Anticipate Will Happen To Our Workforce • Low claim frequency • High claim severity • Increased falls • Longer healing times • More severe musculoskeletal disorders • Certain claim types will increase

18. Common Age-Related Injuries

19. The years ahead could be the best for your workers… • Laura Ingalls Wilder wrote her first book at the age of 65. • Colonel Sanders took to franchising Kentucky Fried Chicken Restaurants, starting at age 65. • Orville Redenbacher launched famous popcorn at age of 63. • Ronald Wilson Reagan became President of United States at age of 70.

20. Can we agree on one major point? • Our Workforce is Getting Older!

21. Cost of Obesity: Duke University Medical Center Study Obese workers filed 2X the number of workers' compensation claims Obese workers had 7X higher medical costs Obese workers lost 13X more days of work from work injury or work illness than did non-obese workers. The average medical claim costs per 100 employees were $51,019 for the obese and $7,503 for the non-obese. John Hopkins and NCCI released similar studies 20

22. Obesity & Workers Compensation Duke Study Claims Per 100 FTEs Lost Work Days per 100 FTEs Truls Østbye, MD, PhD; John M. Dement, PhD & Katrina M. Krause, MA (2007). Obesity and Workers' Compensation Results From the Duke Health and Safety Surveillance System, Arch Intern Med.167:766-773.

23. Obesity & Workers Comp • Claims most strongly affected by Body Mass Index (BMI): • Lower extremity • Wrist or hand • Back • Pain/inflammation • Sprain/strain • Contusion/bruise • Falls/slips • Lifting • Exertion Truls Østbye, MD, PhD; John M. Dement, PhD & Katrina M. Krause, MA (2007). Obesity and Workers' Compensation Results From the Duke Health and Safety Surveillance System, Arch Intern Med.167:766-773.

24. 2001-What shape were we in?

25. 2002 - What shape were we in?

26. 2003 - What shape were we in?

27. 2004 - What shape were we in?

28. 2005 - What shape were we in?

29. 2006 - What shape were we in?

30. 2007 - What shape were we in?

31. 2008 - What shape were we in?

32. 2009 - What shape were we in?

33. Can we agree on two major points? • Our current workforce is (1) older and, (2) more obese when compared to past years.

34. Non-English Languages Spoken at Home “Ljestve moraju biti ispravno osiguran prije….” That was an important safety message but did you understand it? 33

35. Can we now agree on three major points? • Our current workforce is (1) older (2) more obese and (3) is experiencing an increase in cultural (fear) barriers.

36. What has the “Employee Benefits” Side Identified as the Top 2 Drivers of Overall Health Care Costs? Stress Mental Health More workers are absent from work because of stress & anxiety than because of physical illness or injury

37. Work-related Stress is a Growing Health Concern • 33% of the 40.2 million workdays lost by illness and injury are from stress, anxiety, and depression. • Stress can be a hidden trigger behind cardiovascular problems, musculoskeletal disorders, obesity, depression, and violence. National Safety Council - News Release September 21, 2005

38. Impact of Mental Illness • Recent economic trends have affected stress levels • Recession • Layoffs, foreclosures, loss of investments & savings • Impact on disposable income • Increased risk of stress-induced health concerns • Depression • Anxiety • Compulsive behaviors (over-eating, excessive gambling, spending) • Substance abuse Substance Abuse and Mental Health Services Administration, April 2009

39. Mental Health Back Pain Stressed No Exercise Obesity 0% 50% 100% 150% Effect of Single Risk Factors on Sick Leave Absenteeism 150% 140% 131% 118% 116% N = 35,451 Source: Serxner, S., et al., (2001). The impact of behavioral health risks on worker absenteeism. JOEM, 43(4), 347-354

40. Can we agree on four major points? • Our workforce is (1) older (2) more obese (3) more chance of encountering a language barrier and, (4) has more mental health issues.

41. Why Wellness and WC Have Not Mixed • Many employers haven’t seen correlation • Wellness typically focuses on Employee Benefits only • Some companies keep WC in Risk Management and Employee Benefits with HR…Wellness Message Not Shared • Carriers slow to make correlation

42. Strongest Force in Universe – Resistance to Change • Why don’t people change? • Think of one “risk” factor you could eliminate: • Why don’t you eliminate it? • What are cons of not making change? • What are pros of making change? • What support can you get?

43. Why don’t people change?

44. Rate Your Driving Skills • Excellent • Above Average • Average • Below Average • Poor

45. Optimistic Bias • “An earthquake of 9.2 won’t hit here?” • “The Titanic is the greatest ship ever made, it’s unsinkable.” • “I’ll quit tomorrow or soon.” • “I don’t have the time to exercise.” • “It’s so hard to eat good when you’re traveling.”

46. Low OWS Smoking Poor Health No Exercise Low Life Satisfaction Health Risks & WC Costs 1989% 1243% 836% 556% 255% 0% 500% 1000% 1500% 2000% Source: Musich, S., et al., (2001, June). The Association of Health Risks with Workers’ Compensation Costs, JOEM, P. 534-541 N = 3,388 X 4 Years

47. Analysis of Risks, Age and Cost Surviving the Perfect Storm; D.R. Anderson, PhD Source: StayWell Data analyzed by University of MichiganN=43,687

48. The Wellness Solution Converging healthcare trends affecting employers: • Ballooning costs – demand for new solutions • Increased focus on productivity • Talent retention / competition • Consumerism, cost sharing • Aging workforce Shifting costs does not always lead to lower costs or help address the problems causing increasing costs

49. ROI in Worksite Health Promotion

50. Why Now? • "There's no question that workplace wellness is worth it.  The only question is whether you're going to do it today or tomorrow.  If you keep saying you are going to do it tomorrow, you'll never do it.  You have to get on it today." • - Warren Buffett • Focus on productivity – doing more with less • Proactive cost-containment approach • Investment in human capital • Increased stress levels due to economic climate