measuring and acting upon well-being: the learnings, the application and the impact. with john...

1

Copyright ® 2011 Gallup-Healthways Well-Being Index. All rights reserved.

Copyright © 2011 Gallup, Inc. All rights reserved.

Copyright © 2011 Healthways, Inc. All rights reserved.

Measuring and Acting upon Well-Being:

The Learnings, the Application

and the Impact

John Harris Katie BellChief Well-Being Officer Partner

Vice President, Innovations Global Wellbeing

Healthways, Inc. Gallup, Inc.

2



Copyright © 2011 Healthways, Inc. All rights reserved. 2

3




GDP Doesn’t Help us Understand

How People will Behave

3

Egypt: Recent Trends in Percentage “Thriving” and GDP per Capita (PPP)

2005-2010 GDP Per capita (PPP) estimates are from the International Monetary Fund’s

World Economic Outlook database.


4




Leaders Have Corrected Public Health

5




Obesity Rates Trending up Globally

6




Reducing Obesity Saves Money

7




Americans’ Health Habits Are Getting Worse

Fewer Americans

are exercising.

Fewer Americans are

eating healthy.

8




Obesity and Related Chronic Conditions Are

on the Rise:

More Americans

are obese.

More Americans

have high blood

pressure.

More Americans

have high

cholesterol.

More Americans

have diabetes.

9




Americans’ Job Satisfaction Is Decreasing and Future Outlook for

Their Community Is Still Recovering From the Recession:

Fewer Americans

are satisfied with their jobs.

Americans’ optimism about the

future of their community has yet

to recover from the recession.

10




Well-Being Index Measures

Global Wellbeing

Objective Subjective

Evaluative ExperiencedGDP

Health

Employment

Literacy

Poverty

How one rates his or her life

What one experiences in daily life

10

11




11

• 25-year commitment, initiated January 2, 2008

• Telephonic-based for “community” survey

• 1,000 completed surveys per day/7 days/week

• 1,310,000+ surveys completed as of October 15,

2011

• The maximum 95% margin of sampling error is ±0.1

percentage points

• Science-based design, support and oversight:

• Behavioral economists

• Psychologists

• Experts in psychometric statistical analysis

• Largest and most comprehensive well-being survey

of its kind

Six Domains:

1. Life Evaluation

2. Emotional Health

3. Physical Health

4. Healthy Behavior

5. Work Environment

6. Basic Access

The Gallup-Healthways Well-Being Index

12




Life Evaluation on a Scale From 0 to 10: The

Cantril Ladder

Cantril Self-Anchoring Striving Scale:

“Please imagine a ladder. . . . On which step of the ladder would you say you personally feel

you stand at this time? On which step do you think you will stand about five years from now?”

Thriving 7/8

Struggling

Suffering 4/4

13




Germany

(n=4.811)

U.K.

(n=7.843)

U.S.

(n=208.013)

Well-Being Index Composite ScoreAverage of six sub-indexes

67.9 67.0 66.4

Life Evaluation Ranking one’s life today and in the future

35.3 48.0 49.4

Emotional HealthDaily feelings; clinical depression

80.1 80.8 79.3

Physical HealthChronic conditions, obesity, physical pain, cold/flu

77.3 80.4 76.9

Healthy Behavior Smoking, healthy eating, exercise

70.2 66.8 64.0

Work Environment Using strengths, supervisor relationships

54.8* 39.5* 47.1*

Basic Access Healthcare, community satisfaction, money for basics

89.8 86.7 82.0

Germans Rate Their Lives Lower Despite Superior

Results in Health, Work, and Basic Access

*WEI sample includes only respondents employed by an employer.

14




Germans Rate Their Lives Lower Than

Americans and Britons

15




Germans More Likely to Exercise and Express

Satisfaction With Cities

16




16

Noteworthy Trends from U.S.

2010 WBI Data

17




2010 Well-Being Index Findings

• Work Environment down 2.7 points since 2008

• Healthy Behavior score improved slightly in 2010

• Life Evaluation up 9.8 points since 2008

• Hawaii: highest state well-being score

• Boulder, CO: highest city well-being score

18




200820092010Well-Being in America

Fourth QuintileThird QuintileSecond Quintile Top Quintile Ranking: Bottom Quintile

19




2009 2010 2009 2010

Well-Being Overall 67.0 66.7 12 21

Life Evaluation 49.7 50.5 5 15

Emotional Health 79.3 79.0 15 22

Physical Health 77.4 77.0 16 22

Healthy Behavior 63.1 63.6 22 24

Work Environment 48.7 47.7 29 28

Basic Access 83.7 82.8 16 21

Result Rank

19

Well-Being in Virginia

TOP QUINTILE 2ND QUINTILE 3rd QUINTILE 4TH QUINTILE 5TH QUINTILE

20




20

Well-Being in Virginia Cities

TOP QUINTILE 2ND QUINTILE 3rd QUINTILE 4TH QUINTILE 5TH QUINTILE

Washington-Arlington-Alexandria, DC-VA-MD-WVCharlottesville, VAVirginia Beach-Norfolk-Newport News, VA-NCRichmond, VA Kingsport-Bristol-Bristol, TN-VA

Washington

DC Charlottesville Virginia Beach Richmond Kingsport

5,358,130 192,779 1,658,292 1,225,626 303,686

Overall Rank 2010 10 39 55 73 168 212009 8 #N/A 35 106 179 12

Life Evaluation 2010 6 16 28 87 166 152009 6 #N/A 15 104 185 5

Emotional Health 2010 18 67 27 42 175 222009 20 #N/A 24 69 172 15

Physical Health 2010 12 25 57 38 187 222009 12 #N/A 20 59 186 16

Healthy Behavior 2010 37 38 103 133 119 242009 51 #N/A 76 136 69 22

Work Environment 2010 81 168 141 84 74 282009 106 #N/A 142 132 116 29

Basic Access 2010 32 47 59 91 100 212009 31 #N/A 53 84 108 16

STATE

21




21

Life EvaluationLife Perception & Correlation to Healthcare Costs

“Please imagine a ladder with steps numbered from zero at the bottom toten at the top. The top of the ladder represents the best possible life for you and the

bottom of the ladder represents the worst possible life for you.

On which step of the ladder would you say you personally feel you stand at this time?”

2 2 2 3 5 3

37 41 42 44 4742

61 58 56 53 48 55

Suffering Struggling Thriving

22




The Residents of the Top 10 Wellbeing

Cities in America…

1. Learn new and interesting things each day.

2. Have very low rates of clinical depression.

3. Have supervisors at work that treat them like partners, not bosses.

4. Have a lot of energy each day.

5. Have low rates of chronic conditions such as high blood pressure,

high cholesterol and diabetes.

6. Have low rates of obesity.

7. Have very few smokers.

8. Find it easy to get clean and safe water.

9. Have safe places to exercise.

10. Have enough money to buy food at all times.

11. Visit the dentist each year.

22

23



Copyright © 2011 Healthways, Inc. All rights reserved. 23

A New Orleans Super Bowl Wellbeing Bounce?

24




U.S. vs. New Orleans:

% “Thriving” Trended Over Time

50.8

52.0 53.1 53.0 53.4 53.4

46.0

53.054.7 54.1

61.9 62.9

30

40

50

60

70

June-July 09 August-Sept 09

Oct-Nov 09 Dec 09-Jan 10 Feb-March 10 10-Apr

U.S. New Orleans

Saints Win Super Bowl!

February 7, 2010

24

25




25

Compelling Findings Since Inception

26




Thriving

Average 20% Lower

Medical Costs

Suffering

Average 50% Higher

Medical Cost

4.0

7.0

Struggling

“Please imagine a ladder with steps numbered from zero at the bottom toten at the top. The top of the ladder represents the best possible life for you and the bottom of the ladder represents the worst possible life for you.

On which step of the ladder would you say you personally feel you stand at this time?”

Source: Gallup-Healthways Well-Being Index Community Survey and Wellmark Corporate Survey 2008

Six well-being

domains

1. Life Evaluation

2. Work Quality

3. Basic Access

4. Healthy Behavior

5. Physical Health

6. Emotional Health

Cost Disparity of Life Evaluation

26

27




Risk Disparity By Life Evaluation

0%

20%

40%

60%

80%


0-1 risks

2-3 risks

4-5 risks

6-9 risks

Risk Category by Life Evaluation

Toward Integration to Enhance Health and Well-Being by Evers, KE, Prochaska, JO, Castle, P. & Prochaska, JM. 2009 (under review)

27

28




Life Evaluation

33%

61%

80%

0% 20% 40% 60% 80% 100%

Thriving

Struggling

Suffering

% With Significant Stress

82%

57%

30%

0% 20% 40% 60% 80% 100%

Thriving

Struggling

Suffering

% Feeling Well Rested

95%

79%

50%

0% 20% 40% 60% 80% 100%

Thriving

Struggling

Suffering

% With Sufficient Energy

91%

74%

50%

0% 20% 40% 60% 80% 100%

Thriving

Struggling

Suffering

% Satisfied with Job

29




Life Evaluation & Presenteeism Drivers

24% 21%11%

54%49%

24%

69% 65%

33%

0%

10%

20%

30%

40%

50%

60%

70%

80%

% With Personal Problems

% With Financial Stress or Concerns

% With Caregiver Responsibilities

Thriving Struggling Suffering

During the past four weeks (28 days), how often have you been at work but had trouble concentrating or

doing your best because of:

10% 11%4%

35%30%

7%

60%

48%

15%

0%

10%

20%

30%

40%

50%

60%

70%

Depression/Anxiety Health and Physical Condition

Regulatory/Legal Issue


53%

13%

30%

65%

23%

39%

70%

33%

45%

0%

10%

20%

30%

40%

50%

60%

70%

80%

Job Overload Co-Worker Issues

Technology Issues


9% 11%

19%18% 20%

32%32%30%

42%

0%5%

10%15%20%25%30%35%40%45%

Supervisor Issues Insufficient Training

Lack of Resources to Effectively do

Work


30




Risk Disparity By Life Evaluation

0%

20%

40%

60%

80%


0-1 risks

2-3 risks

4-5 risks

6-9 risks

Risk Category by Life Evaluation

Toward Integration to Enhance Health and Well-Being by Evers, KE, Prochaska, JO, Castle, P. & Prochaska, JM. 2009 (under review)

30

31




Productivity Impairment Disparity by

Life Evaluation

0%

5%

10%

15%

20%

25%


Activity Impairment

Work Presenteeism

Work Productivity Loss

Source: Toward Integration to Enhance Health and Well-Being by Evers, KE, Prochaska, JO, Castle, P. & Prochaska, JM. 2009 (under review)

Activity Impairment, Work Presenteeism and Work Productivity Loss by Life Evaluation

Pro

du

cti

vit

y I

mp

air

men

t

31

32




Commute Time and Well-Being

17%

15%

14%

14%

13%

0% 2% 4% 6% 8% 10% 12% 14% 16% 18%

Over 60 Minutes

46-60 Minutes

31-45 Minutes

16-30 Minutes

1-15 Minutes

% Reporting Anger

64%

66%

67%

69%

71%

60% 62% 64% 66% 68% 70% 72%

Over 60 Minutes

46-60 Minutes

31-45 Minutes

16-30 Minutes

15 Minutes or Less

% Feeling Well Rested

50%

50%

52%

56%

58%

46% 48% 50% 52% 54% 56% 58% 60%

Over 60 minutes

46-60 minutes

31-45 minutes

16-30 minutes

15 minutes or less

% Exercising

63%

63%

65%

67%

67%

61% 62% 63% 64% 65% 66% 67% 68%

Over 60 minutes

46-60 minutes

31-45 minutes

16-30 minutes

15 minutes or less

% Eating Healthy

36%

34%

32%

29%

28%

0% 5% 10% 15% 20% 25% 30% 35% 40%

Over 60 minutes

46-60 minutes

31-45 minutes

16-30 minutes

15 minutes or less

% Obese

33




Work Environment Affects Health and

Engagement of a Workforce

Service Mark SM 2008 Gallup-Healthways Well-Being Index. All rights reserved. Copyright © 2008 Gallup, Inc. All rights reserved. Copyright © 2008 Healthways. All rights reserved.

0%

10%

20%

30%

40%

50%

60%

70%

80%

Job ImpactsHealth

Disengaged

Negative Positive or Neutral

Impact of Negative Work Environment

More Disengaged Employees / Higher Productivity Losses

33

34




Work Environment Impact on

Employees With Chronic Conditions

6.6 Days/Year

16.2 Days/Year

Days Unable to Carry Out Usual Activities Per Year

34

35




35

Well-Being Index Composite Score = 66.8

2010 U.S. Well-Being DisparitiesAge

Source: Gallup-Healthways Well-Being Index Community Survey 2010, n= 352,840

Life Evaluation Score = 49.8 Physical Health Score = 76.9

Emotional Health Score = 79.3Healthy Behavior Score = 64.1 Work Environment Score = 48.2

36




The Interconnectedness of All Domains

BMI Risk

Healthy Eating

Exercise

Height WeightEnergy Level

# of Health Risks

Coping with Stress

Negative Affect

Personal Sources

of Presenteeism

Days of Best Work

Physical Health

Emotional Health

Recognition at

WorkFinancial Stress

traditional approach current approach future areas of exploration

Drivers of BMI Risks: Example of New Insight

36

37




37

Cost and Performance Impact

38




38

Well-Being Relationship to Total Medical Costs

0-50

(n=109)

>50-60

(n=151)

>80-90

(n=683)

>70-80

(n=582)

>60-70

(n=347)

>90-100

(n=363)

Annual Costs

(Indexed)

ANNUAL MEDICAL AND RX CLAIMS COST | Low:High Well-Being = ~3.5x more cost

Source: Wellmark Data, Healthways Center for Health Research Analysis (n=2,235)

4.0

1.0

2.0

3.0

Well-Being Score (Composite)Low High

39




Well-Being and Productivity

HIGHER IS ASSOCIATED WITH HIGHER OVERALL WELL-BEING PERFORMANCE & PRODUCTIVITY

39

Well-Being and Performance Well-Being and Absenteeism

40




41




Expanded Value Proposition

414141

Improve

Well-Being

Adopt or maintain

healthy behaviors

Reduce health-related

risks

Optimize care for health

conditions and disease

Increase

Performance

• Productivity

• Engagement

• Absence

• Work Impairment

Reduce Total

Medical Cost

• Hospitalizations

• Event Rates

• Disease Rates

• Lifestyle Risks

Increase Total

Economic Value

• States

• Communities

• Sponsors

• Individuals

Prevent or delay next new case of disease or condition

Prevent or reduce impact of the next new episode of care

Enhance one’s ability to actively manage their well-being

Economic Drivers

42




42

What Can We Do About It?

43




We Can’t Rely on the Status Quo

• Worksite health programs have been in existence for about 40 years

• There is evidence that these programs can generate an ROI

• However, penetration and sustained engagement have been lacking

43

Insanity: doing the same thing over and over again and expecting different results

- Albert Einstein

44




Individuals ● Experts ● Social Connections ● Environment ●Policy

Making the Transition from Health to

Well-Being

Social

Financial

Community

Physical

Emotional

Career

Well-being is bigger

than Physical Health

44

45




4545

The Best Science Behavioral Change

Social Networks• A social structure of “nodes” which are connected by

one or more specific types of interdependency, such as

friendship, kinship, common interest, knowledge, etc.

Decision

Making

Behavioral

Economics

Emotional and

Social Health

Social

Connectivity

Prochaska’s Transtheoretical Model• Rational decision-making through stages of change

• Pro-Change Embedded in Healthways Core Products

Mindfulness and Neuro-plasticity• Paying attention in a particular way: on purpose, in the

present moment, and non-judgmentally

• The changing of neurons via new experiences

Dynamic Intermittent Reinforcement• Predictably irrational decision making in humans

• Already in use for medication adherence HEALTHHONORS®

LifeMatters®

Gamification Gaming Theory• Fun vs. fulfillment

• Appealing to all…Explorer, achiever, socializer, competitor

Community, Work, School, Home and Play• Permanent and semi-permanent environmental changes

• Silver “Buckshot” versus the Silver “Bullet”

Environment

http://www.google.com/imgres?imgurl=http://neuronarrative.files.wordpress.com/2009/03/brain_000005809739xsmall.jpg&imgrefurl=http://neuronarrative.wordpress.com/2009/03/16/for-the-brain-keeping-it-real-means-keeping-it-relevant/&usg=__Ns9ja7Z1qXr18hgvYT1D2MufQ18=&h=346&w=347&sz=152&hl=en&start=23&itbs=1&tbnid=6fU8iq3_eg4DjM:&tbnh=120&tbnw=120&prev=/images?q=brain&start=20&hl=en&sa=N&gbv=2&ndsp=20&tbs=isch:1

http://www.google.com/imgres?imgurl=http://neuronarrative.files.wordpress.com/2009/03/brain_000005809739xsmall.jpg&imgrefurl=http://neuronarrative.wordpress.com/2009/03/16/for-the-brain-keeping-it-real-means-keeping-it-relevant/&usg=__Ns9ja7Z1qXr18hgvYT1D2MufQ18=&h=346&w=347&sz=152&hl=en&start=23&itbs=1&tbnid=6fU8iq3_eg4DjM:&tbnh=120&tbnw=120&prev=/images?q=brain&start=20&hl=en&sa=N&gbv=2&ndsp=20&tbs=isch:1

http://www.meyouhealth.com/

46




Leveraging Emotional and Social HealthTo Impact Physical Health

46

47




Think Differently

Often on-line wellness programs don’t work because they are:

UNREALISTIC MISALIGNED

INCONVENIENT DISINGENUOUS

The solution is a light-weight, self-directed, social well-being

product that is realistic, immediate, convenient, and genuine...

…deployed for the typically unengaged.

48




Health is More Like a Game

49




Stop Being Sloppy About Behavior Change

Source: BJ Fogg, Stanford University

50




Make it Fulfilling – “Gamification”

adapted from Dr. Richard Bartle

51




One Small Daily Action…

51

The likely impact of one person reducing their soft drink consumption over time?

•They lose weight

•Their overweight friends may lose weight

•Their normal weight friends will be less likely to gain weight

Now, imagine if 100,000 people do it?

52




Small daily actions | Conversations | Assessment | Social Engagement

3. Assess & track well-being1. Complete Daily Challenges

2. Share, discuss, celebrate 4. Social support & comparison

Daily Challenge: Take Small Steps

in All Six Well-Being Domains

53




Make it Social

53

54




Keep it Dynamic

We are connected Health solutions aren’t medical, they’re social

Pixel Tracking System

660,000+ 2,000 new added per dayUnique individuals

3 MM Events and social connections

Facebook Data Extraction

88,000 Individuals retrieved

20 MM Friends mapped

300 MMFriend connections mapped

Avg 280 friends per person

Each person shares 4,400 connections

Harness the understanding of the

network, to help participants build

more effective social systems that

drive engagement and

effectiveness.

55




5555

Create the Ability to Go Deep

• Tracks are unlocked by using keys.

• Keys are bought with a credit card, by exchanging tokens, or given to you by a sponsor.

Earn points participating

In the daily challenge

Every 1000 points gets

you one (1) token

Balance & Flexibility

Stress

Family Health

Healthy Eating

Each track is unlocked

for 30 days or more

A sponsor (employer, payer,

or other participant) can

give/purchase keys

Participant purchased

keys with a credit card

Acquire keys to

Unlock tracks

56




Make it Mobile

• Mobile apps

• Interactive SMS messaging being

57




5757

Make it Easy to Track

Build a “well-being sensor” that adds movement to our lives.

Realistic about who will wear it…

Convenient enough to use regularly…

Immediate feedback and sense of daily value…

Genuine care for your personal challenges and goals…

58




Optimizing the Community – Beyond Virtual

Blue Zones

Power 9 Principles

The Prototype Community

Albert Lea, Minnesota

2008-2009

Healthways| Blue Zones

Vitality Cities 2010

Community Framework

58

http://bluezones.com/

59




Confidential and Proprietary 59

Final Thoughts

measuring and acting upon well-being: the learnings, the application and the impact. with john...

Education