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Building a Business Case for Worksite Health Promotion
Global Workplace Health Awards
Florianopolis, Brazil May 18-19, 2015
Nico Pronk, Ph.D. HealthPartners
HealthPartners Institute for Education and Research Harvard T.H. Chan School of Public Health
Agenda
• The worksite setting
• The workplace is changing
• A business case for worksite health promotion programs
• Do workplace health programs work?
• Value through design
• Workplace culture of health and business performance
• Conclusions
…A vote:
• Do you think employee health and well-being programs can improve health and generate savings?
…What Do You Think?
Yes No
The Worksite Setting
• Population access
– Significant reach into the population
– Significant frequency of program implementation (exposure)
– Significant access to tools, vehicles, resources, etc. that may be mobilized to increase awareness, behavior change, and supportive environments
– 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
The Worksite Setting—the Prevention Gap
• Obstacles to effective use of workplace disease prevention programs: – Limited leadership and advocacy
– Poor alignment between financial incentives and disease prevention (those who invest do not receive the full long-term benefits)
– Limitations in research quality and investment
– Regulation that does not support evidence-based practice (e.g., “reasonable design” vs. evidence-based/informed clause in ACA)
– Very few partnerships between communities and employers
Source: Tryon, et al. J Occup Environ Med 2014;56(11):11-37-1144
The Workplace is Changing
On-the-job energy expenditure has reduced over the past 50 years by ~100 kcal/day (Church, et al. PLoS ONE, 2011)
The Workplace is Changing
Obesity levels of the U.S. workforce have ~doubled over the past 30 years
Pronk. Ann Rev Public Health, 2015
What is a “Business Case”?
“A justification for a proposed project or undertaking on the basis of its expected commercial benefit.”
• Key components: – Effective “project or undertaking”
– Measured, meaningful outcomes
– Realization of value
Markets $
Goods / Services
EDUCATION INFRASTRUCTURE SOCIETAL
PRIORITIES
Critical to Business Success
HEALTHCARE
Essential to the Creation of Health
$
Business (Generates $)
Employee Wages
Common Resource Pool Gross Domestic Product
Adapted from: C. Baase, M.D. The Dow Chemical Company and Pronk, Baase, Noyce et al, JOEM 2015.
Why Business Matters to Health and Health Matters to Business
Positive Health Outcomes
• Workplace performance and productivity
• Employee engagement, job satisfaction, and safety
• Attraction and retention of talent
• Community partner/employer of choice
Social Determinants of health
Where do U.S. health care dollars actually go?
What drives
health and where do we spend
the money?
Social and economic
factors
Physical environment
Healthy behaviors
30%
10%
40%
Medical services
20%
Medical services
8% Other
4% Healthy behaviors
88%
Where money spent Drivers of health
A 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
Source: Hertz, et al. JOEM 2004; 46:1196-1203.
% W
ork
Lim
itat
ion
s
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
Evidence-Based Workplace Health
• Assessment of Health Risk with Feedback (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 : 1 Absenteeism: 2.73 : 1
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: 1.Engaged leadership at multiple levels
2.Strategic alignment with the company’s identity and aspirations
3.A design that is broad in scope and high in relevance and quality
4.Broad accessibility
5.Internal and external partnerships
6.Effective communications
Identification of Best Practice Design Principles
• Review of 28 scientific and “grey” literature, industry reports, and consensus statements
• Generated 44 best practices, such as:
– Organizational commitment to a healthy culture
– Adequate resourcing
– Meaningful and relevant incentives
– Wellness champion network
• Some are tactics, some are approaches, some are strategies…
• They have to work in context of the workplace—a complex social system
• What are the design principles we should pay attention to?
16
Best Practice Program Design Principles
• Design for success
1. Leadership
2. Relevance
3. Partnership
4. Comprehensiveness
5. Implementation
6. Engagement
7. Communications
8. Data-driven
9. Compliance
Based on 44 Best
practices
Pronk, NP. Best practice design principles of worksite health and wellness programs. ACSM’s Health & Fitness Journal 2014;18(1):42-46. 17
…Do you think employee health and well-being programs can improve health and generate savings?
…What Do You Think?
Yes No
It depends…good ones do!
Workplace culture and business performance
Marketplace rewards companies who
achieve cultures of health:
•ACOEM Corporate Health Achievement
Award (CHAA) culture of health award
winners as a stock portfolio
•Portfolio of approximately twenty publicly
traded award winners; over nearly two
decades
•The portfolio outperformed the market
significantly; in all four test scenarios
Individual Effort
Environmental (physical, psychosocial) and
Policy Interventions (Public, organizational, etc)
Health Potential
Source: Pronk NP, Kottke TE. Health Promotion in Health Systems. In: Rippe, J. Lifestyle Medicine, 2013.
Making Healthy Choices the Easiest Choices
The Use of Best Practice Design Principles at TURCK, Inc.
Sustainable Health, Growth
Pronk, et al. ACSM’s Health & Fitness Journal, 2015
“strong and sustained financial performance of the platform has moved from a break-even trend between 2003 and 2008 to approximately 7% to 8% income from operations during each of the past 5 years.”
--Dave Lagerstrom, CEO
Conclusions
• A strong business case for worksite health promotion (WHP) exists
• WHP programs can generate health improvement and financial savings
• Best practice design principles outline a path towards successful WHP programs
• Case studies that present the “why, what, and how” of WHP programs need to be communicated broadly
