worksite health promotion /...
TRANSCRIPT
William B. Baun, EPD, FAWHP
Ph: 713-745-6927; Email: [email protected]
Worksite Health Promotion / Wellness
Worksite Health PromotionHistorical Snapshot
1800s 1970s 1980s 1995s
Recreation
Programs
1st Generation 2nd Generation 3rd Generation 4th Generation
Fitness
Programs
HP
Programs
HPM
Programs
ACSM’s Worksite
HP Manual, 2003
Why Should Employers Get
Involved in Wellness Issues?
Lifestyle Risk Factors
•Physical activity
•Stress
•Smoking
•Nutrition
•Seat Belts
•Multiple Health Risk
Clinical Risk Factors
•Obesity
•Blood pressure
•Cholesterol
•Blood sugar
•Musculoskeletal
Direct Health Impact
•Medical problems
•Health status
Indirect Outcome
•Health care utilization
•Health care cost
•Absenteeism
•Employee productivity
•Job/life satisfaction
•Other
*Anderson, D.R. (AJHP, 2004)
Causes of Death: 1999
10 Leading Causes of Death*
• Heart Disease 725,192
• Cancer 549,838
• Cerebrovascular disease 167,366
• Chronic lung disease 124,181
• Unintentional injury 97,860
• Diabetes 68,860
• Influenza & Pneumonia 63,730
• Alzheimer’s 44,536
• Chronic liver disease 35,525
• Blood poisoning 30,680
Total 1,907,768
Actual Causes of Death**• Tobacco 400,000• Diet/Inactivity patterns 300,000• Alcohol 100,000• Certain Infections 90,000• Toxic agents 60,000• Firearms 35,000• Sexual behavior 30,000• Motor vehicles 25,000• Drug use 20,000
Total 1,060,000
*Source: National Center for Health Statistics. “Advance Report on Final Mortality Statistics. 2002”
Traditional Model
Building a “Results Oriented” Program
• Senior management support
• Cohesive HP team
• Operating plan
• Appropriate interventions
• Supportive environment
• Data to drive your efforts
• Careful evaluation of program
outcomes & impact
WELCOA, 1992, 1999
Health Promotion – Art and a ScienceBehavior / Psychological Theories by Intervention Level
Individual
Small Group
Organization
Community
Planned Behavior
Transtheoretical Model
Goal-Setting Theory
Attribution Theory
Health Belief Model
Self-Regulatory
Theories
Social Cognitive Theory
Diffusion of Innovation
Social Network & Social
Support
Stage Theory of
Organizational
Change
Organizational
Development
Interorganizational
Relationship Theory
Conscientization
Community
Organization
Agenda Building
Policy Window
Theory
Bartholomew (2001) Intervention Mapping
Types of Programs Offered
National Survey 1985, 1992, 1999Program 1985 1992 1999
Exercise 27% 41% 36%
Smoking 36% 40% 34%
Stress Mgt 27% 40% 34%
Nutrition 17% 31% 23%
Weight Mgt 15% 24% 15%
HB Pressure 16% 29% 7%
Back Care 29% 32% 53%
CHO NA 27% 23%
Self Care NA 18% 14%
Prenatal Ed. NA 9% 12%
Substance Abuse NA 36% 28%
Cancer Prevention NA 23% 4%
AJHP, March / April 2004
Worksite Program Continuum
Facility vs. Non-Facility Program Models
Worksite Programs
Typical Participation Rates
Program Component Participation Range
Newsletter – readership 65- 95%
Printed information 10 – 80%
Health Fair/Awareness 5 – 65%
HRA – screening 30 – 60%
HRA – $ incentive 30 – 95%
Individually tracked activities 40 – 70%
Mail / email based intervention 20 – 40%
Phone based intervention 15 – 35%
Action campaign – incentive 10 – 25%
HRA – no screening 15 – 25%
On-site workshops 2 – 10
Telephonic help line 2 – 5%
AJHP, March / Apr 2004
Worksite Wellness Best Practices
• Program’s alignment to
business strategy
• Interdisciplinary team focus
• Management champions
and professional staff
• Effective communications
and incentives
• Learning and support
environments
• FUN!WELCOA
Fitness
Management
*Benchmarking Best Practices, American
Productivity and Quality Center 1997 & 1998;
ACSM Worksite Program Manual, 2003
Best Practices
• Alignment to business
strategy
• Interdisciplinary team
focus
• Program champions
• Involvement of
professional staff
• Learning environment
• FUN!
• Programs linked to
business objectives
• Effective communications
• Effective incentives
• Evaluation
• Support environment
• Management support
O’Donnell - 1997 Goetzel - 1998
O’Donnell, (1997) Benchmarking best
practices in workplace HP
Goetzel, (2001) Health and productivity management:
establishing key performance measures, benchmarks,
and best practices
HealthManagement
DemandManagement
DiseaseManagement
Primary
Prevention
Secondary
Prevention
Tertiary
Prevention
Health, Demand and Disease ManagementProgram Matrix
Dealing with precursors to chronic
illness & injury, tobacco, weight mgt
interventions
Early detection, testing,
hazard surveillance
Working with disease conditions, unproductive
attitudes & injuries
Health Productivity Management
“The integrated management of health and injury risks,
chronic disease illness, and disability to reduce employees’
total health-related costs including direct medical
expenditures, unnecessary absence from work, and lost
performance at work (i.e., presenteeism).”
Institute for Health and Productivity
Management
…lots of new hoops to jump
through…
Health Productivity Management
Wellness Model
1. Human capital is an essential business asset
*knowledge, skills/talents, behaviors
2. Health is a primary factor in human capital efficiency and
effectiveness
3. In general, population health is deteriorating due to age and
health behaviors that cause disease and disability
4. Strategic intervention can reduce health risk and improve how
employees manage their disease and reduce employee absence
and disability
5. HPM can yield comparatively higher human capital value and
a sustainable competitive advantageReynolds, Employer Health
Management News, 2002
HPM Serves as a Bridge“Between Key Health & Productivity Measures”
Medical Chest/back pain, heart disease, GI
disorders, headaches, dizziness,
weakness, repetitive motion injuries
Psychological Anxiety, aggression, irritability, apathy,
boredom, depression, loneliness, fatigue,
moodiness, insomnia
Behavioral Accidents, drug/alcohol abuse, eating
disorders, smoking, tardiness,
“exaggerated” diseases
Organizational Absence, work relations, turnover,
morale, job satisfaction, productivity
New Role for the Health Promotion /
Wellness Professional
Goetzel & Ozminkowski, AJHP M/A 2000
“HP professionals need to become the drivers &
champions of an HPM philosophy within the
organization. They need to become the catalyst -
the change agents for HPM. They need to
galvanize various organizational functions so
that they become complementary to one another
rather than competitive. And they need to be the
experts in documenting a direct link between
their work & improved business results.”
Driver
Catalyst
Galvanize
Expert
Health Promotion Programming is
getting more Complicated/Sophisticated!
Health Insurance
Organizational Development
Wellness
HP Managers role in Managing the “P’s”
is MORE IMPORTANT
Big “P” - Program Continuum
Little “p” - Programming Process
Program Continuum – Big P
Startup
Integration &
Cross Promotion
Maintenance
Growth
Programming Process – Little p
• Needs & interest assessment
• Goal setting
• Planning
• Implementation:
- promotion & marketing
- delivery
• Feedback debriefing,
evaluation, refinement
21st Century Program Delivery
Challenge
High
Tech
High
Touch
Healthy Workforce 2010
Elements of a Comprehensive
Worksite Health Promotion Program
1. Health education focused on skill development, lifestyle change, awareness building and
tailored to meet employee needs and interest.
2. Supportive social and physical environments that mirror an organization’s expectations
regarding healthy behaviors, using policies that promote health and reduce disease.
3. Integrate the program into the organization’s structure.
4. Linkage to related programs like EAP and programs that help employees balance work and
family.
5. Screening programs, ideally linked to medical care to ensure follow-up and appropriate
treatment as necessary.
6. Process for supporting individual behaviors change with follow-up interventions.
7. An evaluation and improvement process to help enhance the program’s effectiveness and
efficiency.
“Building public / private partnerships is the foundation of Health
People’s success. We enter the new millennium as a team
working together. Through prevention we can improve the health
of all Americans.”
Dr. David Satcher, Surgeon General
HPM Model Establishes the Link
Between People, Health & Productivity
Today’s Business Climate People / Operational
Challenge
Impact on Health &
Productivity
Making the Business Case for “Wellness”
• Modifiable health risk factors are precursors to a large number of diseases and disorders incurred by employees and to premature death
• Many modifiable health risks are associated with increased health care costs within a relatively short time window
• A large proportion of disease and disorders from which employees suffer is preventable
• Modifiable health risks can be improved through health promotion and disease prevention programs
• Improvements in the health risk profile of a population can lead to reductions in health costs
• Health promotion and disease prevention programs can save companies money
• Well-designed and well-implemented programs can even be cost/beneficial – they can save more money than they cost, thus producing a positive return on investment (ROI).
Bottom-Line Benefits of Worksite
Wellness Programs• Does program participation have value? YES
Participation has a significant impact on health risk for low and high risk employees (GM Lifestep, AJHP, 2001; J&J Pathways to Change, J Occup. Environ. Med., 2002)
• What happens when risk status changes? HEALTH CARE COSTS CHANGELargest increases in average cost occur when employees move from low to high risk, greatest reductions in average cost occur when employees move from high to low risk status (J Occup Med., 1997)
• Does participation affect disability days and absenteeism? YESThe more active participation, the greater the decrease in disability days (Dupont, AJHP, 2001) and absenteeism (HWP, AJHP, 2001)
• Does program participation affect productivity? YESLow cost diagnoses like asthma, allergies, irritable bowel syndrome, etc. are associated with high cost losses of productivity, but disease management programs have been shown to influence these costs (Bank One, J Occup Med., 2001)
• Does a worksite program affect employee recruitment/retention (employer of choice)? YESFortune and Working Mothers magazines’ Best Companies to Work For report work/life balance and wellness programs as important in becoming an employer of choice (2003)
The Rate of Return is Driven by the
Participation Rate
50% 100%
$1 : $3
Cost/Benefit Ratio
Participation Rate
25%
Bottom-Line Benefits of Worksite
Wellness Programs• Does program participation have value? YES
Participation has a significant impact on health risk for low and high risk employees (GM Lifestep, AJHP, 2001; J&J Pathways to Change, J Occup. Environ. Med., 2002)
• What happens when risk status changes? HEALTH CARE COSTS CHANGELargest increases in average cost occur when employees move from low to high risk, greatest reductions in average cost occur when employees move from high to low risk status (J Occup Med., 1997)
• Does participation affect disability days and absenteeism? YESThe more active participation, the greater the decrease in disability days (Dupont, AJHP, 2001) and absenteeism (HWP, AJHP, 2001)
• Does program participation affect productivity? YESLow cost diagnoses like asthma, allergies, irritable bowel syndrome, etc. are associated with high cost losses of productivity, but disease management programs have been shown to influence these costs (Bank One, J Occup Med., 2001)
• Does a worksite program affect employee recruitment/retention (employer of choice)? YESFortune and Working Mothers magazines’ Best Companies to Work For report work/life balance and wellness programs as important in becoming an employer of choice (2003)
Bottom-Line Benefits of Worksite
Wellness Programs• Does program participation have value? YES
Participation has a significant impact on health risk for low and high risk employees (GM Lifestep, AJHP, 2001; J&J Pathways to Change, J Occup. Environ. Med., 2002)
• What happens when risk status changes? HEALTH CARE COSTS CHANGELargest increases in average cost occur when employees move from low to high risk, greatest reductions in average cost occur when employees move from high to low risk status (J Occup Med., 1997)
• Does participation affect disability days and absenteeism? YESThe more active participation, the greater the decrease in disability days (Dupont, AJHP, 2001) and absenteeism (HWP, AJHP, 2001)
• Does program participation affect productivity? YESLow cost diagnoses like asthma, allergies, irritable bowel syndrome, etc. are associated with high cost losses of productivity, but disease management programs have been shown to influence these costs (Bank One, J Occup Med., 2001)
• Does a worksite program affect employee recruitment/retention (employer of choice)? YESFortune and Working Mothers magazines’ Best Companies to Work For report work/life balance and wellness programs as important in becoming an employer of choice (2003)
Bottom-Line Benefits of Worksite
Wellness Programs• Does program participation have value? YES
Participation has a significant impact on health risk for low and high risk employees (GM Lifestep, AJHP, 2001; J&J Pathways to Change, J Occup. Environ. Med., 2002)
• What happens when risk status changes? HEALTH CARE COSTS CHANGELargest increases in average cost occur when employees move from low to high risk, greatest reductions in average cost occur when employees move from high to low risk status (J Occup Med., 1997)
• Does participation affect disability days and absenteeism? YESThe more active participation, the greater the decrease in disability days (Dupont, AJHP, 2001) and absenteeism (HWP, AJHP, 2001)
• Does program participation affect productivity? YESLow cost diagnoses like asthma, allergies, irritable bowel syndrome, etc. are associated with high cost losses of productivity, but disease management programs have been shown to influence these costs (Bank One, J Occup Med., 2001)
• Does a worksite program affect employee recruitment/retention (employer of choice)? YESFortune and Working Mothers magazines’ Best Companies to Work For report work/life balance and wellness programs as important in becoming an employer of choice (2003)
Employee Health & Productivity Costs
$4,666
$3,693
$810
$513
$310
Health Plan
Turnover
Absenteeism
Disability
WC
1998 Median Health Productivity Mgt
Cost/Employee
Source: Goetzel, JOEM, Jan, 2001.
N = 43 Employers with 950,000+ employees
Bottom-Line Benefits of Worksite
Wellness Programs• Does program participation have value? YES
Participation has a significant impact on health risk for low and high risk employees (GM Lifestep, AJHP, 2001; J&J Pathways to Change, J Occup. Environ. Med., 2002)
• What happens when risk status changes? HEALTH CARE COSTS CHANGELargest increases in average cost occur when employees move from low to high risk, greatest reductions in average cost occur when employees move from high to low risk status (J Occup Med., 1997)
• Does participation affect disability days and absenteeism? YESThe more active participation, the greater the decrease in disability days (Dupont, AJHP, 2001) and absenteeism (HWP, AJHP, 2001)
• Does program participation affect productivity? YESLow cost diagnoses like asthma, allergies, irritable bowel syndrome, etc. are associated with high cost losses of productivity, but disease management programs have been shown to influence these costs (Bank One, J Occup Med., 2001)
• Does a worksite program affect employee recruitment/retention (employer of choice)? YESFortune and Working Mothers magazines’ Best Companies to Work For report work/life balance and wellness programs as important in becoming an employer of choice (2003)
*Well-designed and well-implemented health
promotion - disease prevention programs can
even be cost/beneficial…
*They can save more money than they cost
thus producing a positive return on
investment (ROI)
Should we be Thinking – ROI?
Health Management Program Studies
ROI studies of health management programs have been conducted for:
– Canada and North American Life
– Chevron Corporation– City of Mesa, Arizona– General Mills– General Motors– Johnson & Johnson– Pacific Bell– Procter and Gamble– Tenneco
ROI estimates in these nine
studies ranged from $1.40 -
$4.90 in savings per dollar
spent on these programs.
Median ROI was $3 in
benefits per dollar spent on
program.
Sample sizes ranged from 500
- 50,000 subjects in these
studies.
Demand Management Program Studies
ROI studies of demand
management programs were
conducted for:
– Blue Cross of California
– Five California counties
– Group Health Inc.
– Rhode Island Group
Health Association (2
studies)
– United Healthcare
ROI estimates in these six
studies ranged from $2.20 -
$13.00 in savings per dollar
spent on these programs.
Median ROI was about $4.50
in benefits per dollar spent.
Sample sizes ranged from 460
- 5,647 subjects in these
studies.
Disease Management Program Studies
ROI studies of disease
management programs were
conducted for:
– Henry Ford Hospital
(asthma)
– Spohn Memorial Hospital
(diabetes)
– United Behavioral Health
(mental health)
ROI estimates in these
three studies ranged from
$7.30 to $10.40 in benefits
per dollar spent on these
programs.
Median ROI was $9.00 in
benefits per dollar spent.
Sample sizes ranged from
176 - 1,671 subjects in
these studies.
Multiple Component Program Studies
ROI studies of multiple-
component programs were
conducted for:
– The Bank of America
– California Public
Employee Retirement
System
– Citibank, N.A.
ROI estimates in these three studies ranged from $5.50 - $6.50 in savings per dollar spent on these programs.
Median ROI was $6.00 in savings per dollar spent.
ROI for Citibank study dropped from $6.50 to $4.70 per dollar spent when subjects who died during study period were excluded from analyses.
Sample sizes ranged from 4,700 -21,700 subjects in these studies.
ROI Summary
ROI estimates ranged from $1.40 - $13.00 in savings per dollar
spent on these health, demand, and disease management
programs.
Wide range of ROI estimates may be due to variety in program
design features.
Maximum health impact may come from programs directed at
improving organizational health, employee absence patterns,
worker disability, and safety.
Literature Supporting Worksite Programming
-Berger, Investing in healthy human capital. JOEM 2003
-Brown, Exploring variables among medical center employees with injuries… AAOHN 2003
-Ozminkowski, A validity analysis of the Work Productivity Short Inventory… JOEM 2003
-Inadomi, Systematic review: economic impact of irritable bowel syndrome. Aliment Pharmacol Ther. 2003
-Allen, An intervention to promote appropriate management of allergie… JOEM, 2003
-Fragala, Addressing occupational strains & sprains… AAOHN 2003
-Panter, Issues of work intensity, pace and sustainability…nutritional status. AJHB 2003
-Georgiou, The impact of a large-scale population-based asthma… Ann Allergy Asthma Immunol. 2003
-Birnbaun, The economics of women & depression… J Affect disord. 2003
-Hogan, Economics cost of diabetes… Diabetes Care 2003
-Goetzel, The health and productivity cost burden of the top 10 physical and mental health conditions… JOEM 2003
Literature Supporting Worksite Programming
-Goetzel, The long term impact of J&J health and wellness… JOEM 2002
-Goetzel, The financial impact of HP and disease prevention programs…AJHP 2001
-Anderson, HERO study. AJHP 2000
-Leutzinger, Projecting future medical care cost… AJHP 2000
-Wasserman, Gender-specific effects of modifiable health risk factors… JOEM 2000
-Crystal-Peters, The cost of productivity losses associated with allergic rhinitis. AJMC 2000
-Goetzel, Health and productivity management: emerging opportunities… AJHP 2000
-Ozminkowski, The impact of Citibank, health management program… JOEM 2000
-Ozminkowski, A return on investment evaluation of the Citibank… AJHP 1999
-Goetzel, Health care cost of worksite HP participants and non-participants. JOEM 1998
-Anderson, Understanding the relationship between health risk and health related costs. AJHP 2004
-Serxner, The relationship between HP program participation and medical costs: dose response. JOEM 2003
-Whitmer, A wake-up call for corporate America. JOEM 2003
-Koopman, Stanford presenteeism scale: health status & employee productivity. JOEM 2002
Implementing a “Wellness Culture” at
M. D. Anderson Cancer Center
Institutional Values: Caring, Integrity, Discovery
Organizational Chart
EMPLOYEE ASSISTANCEPROGRAM
OCCUPATIONAL HEALTH EMPLOYEE WELLNESS
EMPLOYEE HEALTH & WELL-BEING
Vision: We will provide accessible and innovative
solutions to enhance health and to balance work and
family.
Mission: We will improve the overall health and well-
being of our employees and UT M. D. Anderson Cancer
Center.
M. D. Anderson Employee Wellness
Strategic Foundations• Design specific programs for senior
and middle management sponsorship
• Initiate policies and environmental systems that support work-life balance
• Implement a comprehensive program through a integrated team fully aligned with companies business strategy
• Brand the program as a key “employer of choice” benefit and health as a company value
• Ensure program access 24/7
• Develop and track program metrics
M. D. Anderson Wellness Key Strategy - Comprehensive Program Model
Individuals
Customized
Div/ Dept
Interventions
Cultural and Environmental Focus
MDACC Strategic Channels
Individuals
• Individual coach / counseling
• Wellness on Wheels
• Weight Watchers
• Exercise & yoga classes
• Elliptical & stretch trainers
• ASAP Wellness
• Quarterly programming challenges
10,000 Steps, 11,000 Mile Challenge, Colorful Choices, Passport Challenge, Holiday Bingo, Health Report Card, Weight4Me, etc.
MDACC Strategic Channels
Target Groups
• Lactation rooms
• Healthy Kids Club
• Bike club
• Running club
• Smoking cessation
• Cholesterol
• Diabetes
• *Upper respiratory conditions
• *High blood pressure
MDACC Strategic ChannelsDivisional & Department Programming
• Group self-care experiences
• Online program options
• Interest & support groups
• Targeted awareness & communication pieces
• Targeted Interventions
• Wellness on wheels
* Resource center
Customized:
Interventions Focused on
Adding Value
• Operating Room - workers compensation challenge
• Gynecological Oncology – moving & teaming
• Development Office – energy & release creativity
• Contract & Grants Office – stress & healthy backs
• Palliative Care – wellness culture & stress
• Enterprise Services – workcare
• MDACC Volunteers – teaming & self care
• Anderson Network – team energy
• Infusion Therapy – energy & self-care
• Night Nurses – stress management
• Bone Marrow Transplant – stress resistant culture
M. D. Anderson Wellness
Key Program Goals
• Build and promote a
supportive infrastructure
• Maximize the balance
between high tech and
high touch programming
• Strengthen internal and
external partnerships
• Design programs that are
accessible and add value
Accessible Programs - “Adding Value”
• Awareness programming developed through communication links and leverage (water cooler, KidsHealth, wellness tips, etc.)
• Behavior change programming providing challenge and support (WorkCare, Step Up to Health, Health Kids Club etc.)
• Environmental support programming creating a “wellness culture” (Working Mother’s Room, Exercise Room, elliptical and stretch trainers, Yoga, etc.)
Core Program Mix: Stress Management, Physical Activity,
Nutrition, Parenting, Smoking Cessation
Worksite HP/Wellness VisionBuild a Network of UT Health Promotion Programs
that can share the challenge of:
• Continuous job of educating stakeholders
• Building infrastructure / ownership
• Ensuring that the HPM “glue” is holding the pieces together –integration
• Effective/efficient measuring processes
• Strategic priority of programming
• Maintaining high program standards
• Managing program startup, cross promotion, maintenance & growth