The Value of Worksite Health

IAWHP Global SymposiumAtlanta, GA

April 1, 2014

Nico Pronk, Ph.D., FACSM, FAWHPHealthPartners

HealthPartners Institute for Education and ResearchHarvard School of Public Health

Agenda

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

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

Unsustainable Cost Pressure

$9,235(2002)

$10,168 $11,192

$12,214 $13,382

$14,500 $15,609

$16,771 $18,074

$19,393(2011)

$20,944 $22,620

$24,430 $26,384

$28,496 $30,774

$33,236

$35,895

$38,767

$41,868(2021)

2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021

Health care expenses for U.S. families:2002-2021 (projected at present growth rate)

Source: 2011 Milliman Medical Index

Or to look at it another way…

Source: Alliance of Community Health Plans

Income: $59,858

Source: Alliance of Community Health Plans

Or to look at it another way…

Where do U.S. health care dollars actually go?

Facing the challenges in health

care

Social and economic

factors

Physical environment

Healthy behaviors30%

10%

40%

Medicalservices20%

Medical services

8% Other

4% Healthy behaviors

88%

Where money spentDrivers of health

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

• 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

The Worksite Setting

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

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

The value of health

ROI Literature Review

Systematic review and meta-analysis

Conclusion:Worksite Health Promotion programs can generate positive ROI for medical- and absenteeism-related savings:Medical: 3.27 : 1Absenteeism: 2.73 : 1

Source: Hertz, et al. JOEM 2004; 46:1196-1203.

0

2

4

6

8

10

12

14

16

Normal Weight 1.9 3.6 8.4

Overweight 2 3.6 8.1

Obese 4.1 8 14.5

20-39 40-59 60+

Impact of obesity on work limitations is akin

to 20 years of aging

The value of health

Value through designCompanies 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:1. Engaged leadership at multiple levels2. Strategic alignment with the company’s identity and

aspirations3. A design that is broad in scope and high in relevance and

quality4. Broad accessibility5. Internal and external partnerships6. Effective communications

Best Practice Design Principles

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

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)

Environment shapes behavior

Abnormal reaction to a normal environment?

A normal reaction to an abnormal environment?

Individual decision do matter!

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

Making healthy choices easy choices

IndividualEffort

Environmental (physical, psychosocial) and

Policy Interventions(Public, organizational, etc)

HealthPotential

Source: Pronk NP, Kottke TE. Health Promotion in Health Systems. In: Rippe, J. Lifestyle Medicine, 2013.

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

Possible Simple Socially rewarding

Financially rewarding

Personally relevant

Organizationallyrelevant

Community connected

Individual

Inter-individual

Organizational

EnvironmentalLeve

ls o

f Infl

uenc

e

Make Being Healthy and Productive…

Exceptional Customer and User Experience

Outcomes

Comprehensive, Multi-Level, Multi-Component Programming

Source: Pronk, NP. Journal of Physical Activity and Health, 2009, 6 (Suppl. 2), S220-S235.

HealthProductivityFinancial / ROI

Valuing Workplace Health

Health

Community Well-Being

Community Process

Benefits------------

Harms

Benefits------------

Harms

Benefits------------

Harms

Valuing – What should be counted?

Bene

fits

and

Har

ms

Reso

urce

s U

sed

Savings-----------

Costs

Valuing – What should be counted?

Identification of

Investments and

Resources

Value The value of an

intervention considers its

benefits, harms, and costs.

QALYs or HALE

Community Well-Being Indicator

Community Process Indicator

Monetary Units (USD)

Community Benefit

Community Cost

i.e., Worksite

i.e., Worksite

Comprehensive assessment

Comprehensive assessment

What Does “Success” Look Like?

Soource

Low Risk

ModerateRisk

High Risk

Disease:Well

Managed

Disease:Poorly

Managed

Baseline 44%

Baseline 24%

Baseline 24%

Baseline 7%

Baseline 1%

15.1%

0.8%

4.5%

1.3%

14.4%

2.5% 0.2%

36.3%

33.5%

13.2%

25.0%

Risk transitions based on HA-derived risk levels among employees over 2

years(N=1,087)

21% 66% 13%

Net population health improvement of 8%.

87% did not get worse

GotBetter

Stayed theSame

Got Worse

Doing nothing may reduce the population’s

health by as much as 7% per year

This 2-year health and well-being program was associated with a ROI of

2.9:1

Source: HealthPartners Health Assessment Database, 2011

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!