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Copyright © 2014 Healthways, Inc. All rights reserved.
Friday, 7 November 2014
Peter Choueiri, President Healthways International
Time to act! From Well–Being Measurement to Well–Being Improvement
Practitioner Keynote: Managing for Well-Being
Our approach to Well-Being measurement
Fellow travellers in well-being measurement Gallup-Healthways Global Well-Being Index, OECD Better Life Index
3
• Builds on >10 years of OECD interest in measuring societal performance more broadly than simply economics
• Covers 34 countries (OECD members, plus Brazil and Russia)
• Two areas, comprising 11 topics the OECD has identified as essential to well-being:
1. Material living conditions (housing, income, jobs), and
2. Quality of life (community, education, environment, governance, health, life satisfaction, safety and work-life balance)
• Builds on Gallup-Healthways partnership for well-being measurement and improvement launched 2008, and US well-being index reports since 2008
• Now covers 135 countries worldwide
• Five elements of well-being measured everywhere using 10 standard questions (culturally translated for each language)
1. Purpose
2. Social
3. Community
4. Financial
5. Physical
• http://info.healthways.com/wellbeingindex
Comparison of methodologies
General form of a Subjective Well-Being Equation Subjective Well-Being = Function1 x Variable1 + … Functionn x Variablen
Two measures Two domains, nine
objective dimensions
Ten questions across five elements
OECD Better Life Index
Gallup-Healthways Well-Being Index
Prioritisation of well-being domains for intervention can be based initially on either report
Highly complementary methodologies
4
Gallup-Healthways’ definition of Well-Being
− Purpose: Liking what you do each day and being motivated to achieve goals
− Social: Having supportive relationships and love in your life
− Financial: Managing your economic life to reduce stress and increase security
− Community: Liking where you live, feeling safe, and having pride in your community
− Physical: Having good health and enough energy to get things done daily
PURPOSE
SOCIAL
FINANCIAL
COMMUNITY
PHYSICAL
Well-being is comprised of five elements – and all five are interrelated and interdependent.
5
Denmark 40%
Austria 39%
Sweden 36%
Netherlands 33%
Malta 28%
United Kingdom 28%
Ireland 27%
Germany 27%
Iceland 26%
Spain 24%
Kosovo 24%
Belgium 23%
Finland 23%
Luxembourg 21%
North Cyprus 21%
Portugal 20%
France 19%
Slovenia 18%
Hungary 18%
Poland 17%
Slovakia 16%
Cyprus 15%
Macedonia 14%
Romania 14%
Czech Republic 13%
Bulgaria 12%
Montenegro 10%
Serbia 10%
Greece 10%
Bosnia
Herzegovina 10%
Albania 8%
Italy 8%
Croatia 7%
Significant variations in Well-Being by country % country residents thriving in at least 3 of 5 elements
Denmark leads Europe; UK, Germany, and Spain in Top 10; France in the middle
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Within countries, significant variation between organisations
100 0 High Low Low-Mid Mid Mid-High
Well-Being Score
Distribution of Individual Well-Being Scores % of population with given score
Black line is average of national nightly survey
Colored lines represent six
example companies
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Well-Being Drives Business Performance
8
Well-Being Assessment Results by Business Unit
Overall Life
Evaluation
Emotional
Health
Physical
Health
Healthy
Behavior
Work
Environment
Basic
Access
% at Optimal
Income
68.4 60.9 76.4 78.1 62.6 46.9 85.5 41.7%
73.5 73.1 80.6 80.2 65.1 53.7 88.1 66.7%
72.4 70.4 79.7 82.4 66.3 49.5 86.0 64.5%
72.0 71.4 73.8 81.1 67.0 51.2 85.9 59.6%
72.0 69.6 78.6 78.1 65.6 52.6 88.6 39.2%
71.9 66.5 78.4 78.6 66.5 54.9 86.7 50.3%
71.8 64.5 79.1 81.5 64.9 53.9 86.9 69.2%
71.4 68.6 78.0 78.5 67.5 49.3 86.7 47.9%
71.2 67.7 80.0 81.7 64.4 49.1 84.5 51.4%
70.6 60.7 76.5 80.2 66.5 51.9 85.4 44.9%
70.6 65.8 79.6 77.6 62.6 54.4 86.0 41.6%
70.0 63.9 76.2 80.3 63.6 48.5 87.4 55.6%
69.7 58.0 76.5 78.4 68.4 53.2 83.6 63.6%
69.6 62.5 75.0 79.0 65.0 50.0 86.0 56.2%
69.2 64.7 77.5 76.8 62.6 46.0 87.9 51.8%
69.1 60.8 76.8 78.1 61.9 52.2 85.0 39.3%
68.6 61.6 75.5 76.8 65.2 46.4 86.2 51.8%
68.6 59.6 76.3 80.3 66.4 44.4 84.8 41.6%
68.1 59.9 77.9 78.9 61.5 45.3 85.0 40.8%
67.8 58.0 75.7 78.1 63.9 43.4 87.7 57.2%
66.3 58.3 74.7 76.4 59.2 46.0 83.3 31.7%
66.2 52.4 75.0 76.9 61.1 45.4 86.5 37.9%
65.8 59.1 76.4 75.8 53.4 45.6 84.2 28.4%
65.7 57.3 73.9 76.8 61.7 40.1 84.2 36.6%
65.5 56.8 76.3 76.7 56.8 43.2 83.4 28.3%
64.5 52.5 73.0 75.3 60.2 42.4 83.8 26.8%
Top Quintile
2nd Quintile
3rd Quintile
4th Quintile
5th Quintile
Well-Being Scores
Internal Corporate Measure:
Percent at Optimal Income
Ranking 25 Business Units by Well-Being Score
The Right View Leads to The Right Intervention
9
OLIVER HARRISON
• Overall score (out of 100)
• Gap analysis for each of the five
elements
• Analysis of underlying risks and/or
behaviours
• Specific recommendations for action
overall and within each element
• Proven “launch pad” for engaging
individuals to create their own Well-
Being Improvement Plan
Why Well-Being improvement matters
People with higher Well-Being cost less and are
more productive
Basic Premise
Our Simulation Model
12
• An epidemiology-based model that simulates the complex relationships that exist between chronic conditions and modifiable behaviors
• No claims data needed; built on national datasets • Projects ten years of medical and productivity savings by condition and
modifiable behavior. • Simulates the incidence and progression of diseases over time.
Simulation model developed by Healthways and BCG, with support of WEF
Goals 1. To suggest to senior executives and managers ways of
thinking about well-being as a corporate strategic topic 2. To assess the healthcare and productivity costs associated
with the highest lifestyle risks and most costly chronic conditions
3. To show how the presence of a comprehensive well-being program would affect healthcare costs and productivity
Building the Epidemiology Engine http://wellness.weforum.org
www.healthways.com
Demographic Segmentation
Initial Participant Characteristics
• Modifiable Behaviors
• Conditions • Participation
Modifiable Behaviors
Chronic Conditions
Value Creation • Baseline • HWAY Impact
Medical Cost
Productivity
Intervention Impact
Customizable Inputs
Assumptions Based Epidemiological Engine
Assign Initial Member Level Characteristics
Assign Cost to Severity of Existing
Conditions
Managing principal, leading actuarial and healthcare
research company, Healthcare economic expert,
Harvard University
Epidemiologist, Harvard School of Public Health
Health Policy expert, Harvard Medical School
Health management expert, Johns Hopkins Bloomberg School of Public
Health
Clinical and health psychologist, University of Rhode Island
CEO, leading behavior change company Economist, Cornell University
Health policy expert, Harvard Medical School
Productivity expert, Cornell University
External Experts Had Significant Input on Model Development
13 Copyright © 2014 Healthways, Inc. All rights reserved.
Opportunity of doing something: Economic savings Australia
8
7
7
6
7
7
6
7
56
8
8
7
7
8
8
7
8
61
Inactivity Diet Smoking Alcohol Poor Std of
Care
Stress Sleep Screening All
Interventions
Source Healthways, World Economic Forum Simulation Model (2012)
Productivity savings
Medical savings
10-year cumulative savings from well-being improvement
€ Billion
Opportunity of doing something: Economic savings United Kingdom
22
21
20
20
21
21
20
21
166
16
14
14
13
16
15
13
14
114
Inactivity Diet Smoking Alcohol Poor Std of
Care
Stress Sleep Screening All
Interventions
Source Healthways, World Economic Forum Simulation Model (2012)
10-year cumulative savings from well-being improvement
€ Billion
Productivity savings
Medical savings
Opportunity of doing something: Economic savings Germany
20
18
17
16
19
18
17
18
143
22
20
19
18
21
21
19
20
160
Inactivity Diet Smoking Alcohol Poor Std of
Care
Stress Sleep Screening All
Interventions
Source Healthways, World Economic Forum Simulation Model (2012)
10-year cumulative savings from well-being improvement
€ Billion
Productivity savings
Medical savings
17
19%
39%
26%
16%
Compounding Financial & Social Well-Being Risk
Well-Being Risks Interact to Drive Up Cost
Health Cost for Individuals with Chronic Disease
44%
39%
14%
3%
No Compounding Well-Being Risks
28%
40%
21%
11%
Compounding Health Well-Being Risks
Low (<$1500)
Medium (<=$6000)
High (<=18000)
Very High (>$18000)
Health Plan 2012
Conclusions on value
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High Costs of Doing Nothing
• Both medical and productivity costs impose heavy financial burdens on
countries, communities and companies
• Without interventions, these costs can be expected to grow and compound
The Primary Sources of These Costs are Known
• Chronic conditions cause people to seek care (medical costs) and reduce their
ability to work (productivity)
• While behaviors do not have costs associated with them, the conditions they
create and exacerbate can have substantial costs
Intervening in Modifiable Behaviors Reduces Costs
• Curtailing or eliminating behavioral risks can reduce costly chronic conditions
• Addressing risks before they become conditions will be a significant source of
savings
We have the tools to improve Well-Weing. Now we need to make it a priority.
Can Well-Being be actively improved?
Higher Well-Being means lowers medical costs
Higher Well-Being = Lower cost Higher Well-Being = Lower utilisation
10.1%
18.4%
10.0%
14.2%
5.3%
9.6%
Individual Well-Being score
% Respondents with hospital utilisation in 12 months after WBA
Medium: >50-75 High: >75-100 Low: 0-50
Hospital admissions $5,172
$3,765
$1,048
$3,399
$2,605
$771
$1,885
$1,507
$344
Individual Well-Being score
Medium: >50-75 High: >75-100 Low: 0-50
Median costs in 12 months after WBA
Source Science and Value Team, Healthways
ILLUSTRATIVE
Lower costs Lower costs
ER visits
Total cost Medical cost Prescription cost
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Chart colors
Table colors
21 21
Fortune 50 and Fortune 100 Case Studies
Fortune 50 Case Study
A pilot study program including:
• Well-Being Assessment
• Health Risk Coaching
• Disease Management
Well-Being Improved Significantly in Matched Respondents
Fortune 100 Case Study
A comprehensive program including:
• Well-Being Assessment
• Bio-metric Screening
• Health Risk Coaching
• QuitNet
• Daily Challenge
Cost Goes Down When Well-Being Goes Up
Source: “Evaluation of the Relationship Between Individual Well-Being and Future Health Care
Utilization and Cost” Population Health Management, Volume 15, Number 00 2012. Patricia L.
Harrison, MPH, James E. Pope, MD, Carter R. Coberley, PhD, and Elizabeth Y. Rula, PhD
1 Point =
2.2% likelihood of hospital admission
1.7% likelihood of ER visit
1.0% likelihood of incurring healthcare costs
Population Well-Being
Performance Goes Up When Well-Being Goes Up
10 %
Workforce Well-Being
5% fewer unscheduled absences
24% lower presenteeism
5% higher reported job performance
6% more days of ‘best work’ in 28-day period
Source: “Evaluation of the Relationship Between Individual Well-Being and Future Health Care
Utilization and Cost” Population Health Management, Volume 15, Number 00 2012. Patricia L.
Harrison, MPH, James E. Pope, MD, Carter R. Coberley, PhD, and Elizabeth Y. Rula, PhD
Practical Advice for Well-Being Improvement
• 10,000s of small decisions every day, every year
• Frequent gap between how people would like to act and how they really act
• Key question is: How can we support everyday decision making to improve health and well-being outcomes?
Today global disease burden is dominated by chronic diseases which accumulate over many years
High
Low
Medium
25
26
“99% decisions are
made by your auto-
pilot which has a
mind of its own” Daniel Kahneman
1. Engagement – finding people where they are… (…not where we want them to be)
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Mobile Apps
Web Telephone
Social media
Face-to-face
Daily routine,
e.g. supermarket check-out
2. Leverage evidence-based tools – don’t reinvent the wheel
1. Exercise
2. Healthy eating
3. Stress management
4. Weight management
5. Tobacco cessation
6. Appointment adherence
7. Medication adherence
8. Depression prevention
9. Self-care
10.Etc.
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Health coaching and online health management with proven outcomes: Enable to set personal targets and identify steps to achieve those targets
Pre-awareness
Awareness
Contem-plation
Trial
Loyalty
3. Behaviour change requires understanding individuals’ dynamic “readiness for change”
Transtheoretical Model: Assessing readiness for change
When is someone ready to change their
behaviour?
Given someone’s state of change what’s the most
effective approach?
29
Item Principle
Messenger We are heavily influenced by who communicates information
Incentives Our responses to incentives are shaped by predictable mental
shortcuts, such as strongly avoiding losses
Norms We are strongly influenced by what others do
Defaults We ‘go with the flow’ of pre-set options
Salience Our attention is drawn to what is novel and seems relevant to
us
Priming Our acts are often influenced by sub-conscious cues
Affect Our emotional associations can powerfully shape our actions
Commitment
s
We seek to be consistent with our public promises, and
reciprocate acts
Ego We act in ways that make us feel better about ourselves
4. Use new, proven tools for behaviour change MINDSPACE, UK Government 2010
MINDSPACE: Designing effective behaviour change programmes
30
Many Asian cultures have distinct conceptions of individuality that insist on the fundamental relatedness of individuals to each other. The emphasis is on attending to others, fitting in, and harmonious interdependence with them.
American culture neither assumes nor values overt connectedness among individuals. Individuals seek to maintain their independence from others by attending to the self and by discovering and expressing their unique inner attributes.
Source Markus,HR, Kitayama S (1991). Culture and the self: Implications for cognition, emotion, and motivation.
Psychological Review, Vol 98(2), Apr 1991, 224-253
31
5. Don’t forget the cultural aspect!
6. And all of it needs to be based on data: the world’s largest well-being database: >1.4 PB
Our approach 1. Securely collect real-world data on
a. Health-related behaviour, and b. Behaviour change interventions
2. Analyse data to a. Identify risks, and b. Find the most effective approaches
3. Incorporate these insights to drive continuous programme improvement
4. Scale-up programmes to drive population well-being improvement
Combining science and engineering for impact
From cutting-edge science…
through solutions engineered for impact…
to individual well-being improvement.
33
Examples Case examples
Case Study: Healthways
Well-Being Improvement
Well-Being Segment Upward Shift
Performance Improvements
Elements of Well-Being Improved
France: Multiyear contract with CNAMTS Largest disease management programme in Europe
• CNAMTS is the biggest health insurer in France (86% of the population ~ 50 m members)
• In 2011, Healthways signed Disease Management contract “Sophia”, focus on Diabetes initially
• 450,000 enrolled patients so far • By 2015 program will cover 500,000
persons
• Expansion to other chronic diseases, e.g. Asthma and Chronic Heart Failure
36
Germany: 12 month outcomes Significant reduction in admissions for chronic conditions
-20%
-15%
-10%
-5%
0%
5%
10%
15%
20%
25%
30%
35%
Overall Low Severity
Med Severity
High Severity
Pe
rce
nt C
ha
ng
e in
Ad
mis
sio
n R
ate
Comparison
Intervention
37
Telephonic Follow-Up to Reduce Hospital Readmissions
• The study tested whether telephonic outreach from a nurse to ensuring understanding of and adherence to discharge orders reduced 30-day readmissions
• Patients who received a call from a Healthways nurse within 14 days after discharge from the hospital were 23.1% less likely than the comparison group to have a 30-day readmission
• Timely telephonic follow up after hospital discharge provides an effective way to improve quality measures and reduce the burden of readmissions
23.1% reduction in hospital readmission through timely intervention
38
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Australia: 12, 18 month outcomes
39
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Fortune 50 and Fortune 100 Case Studies
Performance
Unplanned Absence
Unintended Turnover
Value Beyond Reduced Medical Spend
Fortune 50 Case Study Fortune 100 Case Study
Longitudinal Well-Being Improvement
Net Positive Shift in Well-Being =
Science and Outcomes • Foundation for the ongoing development and
continuous improvement of all our solutions • Focused on 3 core areas
1. Health outcomes 2. Translation 3. Advanced analytics
Assets • 23-member team, including 11 doctoral degrees • World’s largest health and well-being database 1.4
petabytes • Published >130 studies/articles, including >50
external publications • Summary of peer-reviewed literature available online
at www.healthways.com/success/library.aspx
Our enduring focus on evidence based practice
41
© 2014 Healthways, Inc. All rights reserved.
Conclusion
1. Well-Being is a comprehensive reflection of the health status of a
nation, an organisation and an individual.
2. Well-Being goes beyond the physical dimension of health includes
dimensions like social, purpose, financial and community.
3. The impact of Well-Being on medical and productivity related cost is
proven, measurable and can be influenced.
4. Well-Being improvement helps to reduce existing cost and avoid future
cost.
5. There are proven interventions to improve Well-Being.
6. The selection of the right partner can help you to get there faster and
more successfully.
42
