Activating Your Communityfor Well-Being
Ben Leedle, Chief Executive Officer, Healthways Inc.Ben Leedle, Chief Executive Officer, Healthways Inc.
The Problem… and a Solution
Source: Centers for Diseases Control and Prevention, University of California at San Francisco, Institute for the Future. Reprinted from Advances, Robert Wood Johnson Quarterly Newsletter, 2000; 1:1
Influencers of Health
Access to Care
Environment Genetics Health Behaviors
Health Behaviors
U.S. Healthcare Expenditures 88%
OtherAccess to Care (treatment)
4%8%
10% 20%20% 50%
2222
3
Discussion Topics
• Progress towards Improved Well-Being
• Evolution of the science
• Implications and action steps you can take
Intent is to frame a broad and deep set of discussions today into a pragmatic set of action steps and take-aways
Progress towards Improved Well-Being
5
Individuals ● Experts ● Environments ● Relationships
Improve Well-Being
6
• 25-year commitment, initiated January 2, 2008
• Telephonic-based for “community” survey
• 1,000 completed surveys per day/7 days/week
• Almost one million completed surveys to date
• For results based on this sample of respondents, the maximum 95% margin of sampling error is ±0.3 percentage points
• Science-based design, support and oversight
• Healthways Well-Being AssessmentTM:
• Hybrid of HRA and WBI; Independently validated
• Web-based (businesses and individuals)
• Over 600,000 WBA’s completed
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
7
Well-Being at the National Level
Source: Gallup-Healthways Well-Being Index Community Survey 2009, n=353,849
Fourth QuintileThird QuintileSecond Quintile Top Quintile Ranking: Bottom Quintile
20092008
8
Well-Being at the Regional Level
199
200
173
174Des Moines
Cedar Rapids
Mason City
Davenport
Pierre
Sioux Falls
Rapid City
Fourth QuintileThird QuintileSecond Quintile Top Quintile Ranking: Bottom Quintile
295
241
South Dakota
Iowa
2008
Congressional District Ranking by Well-Being Index (out of 436 Districts)
Source: Gallup-Healthways Well-Being Index Community Survey 2008, n=352,549
9
Well-Being at the Regional Level
40
50
133
66Des Moines
Cedar Rapids
Mason City
Davenport
Pierre
Sioux Falls
Rapid City
Fourth QuintileThird QuintileSecond Quintile Top Quintile Ranking: Bottom Quintile
156
194
2009
Congressional District Ranking by Well-Being Index (out of 436 Districts)
South Dakota
Iowa
Improvement by one quintile from 2008 to 2009
Source: Gallup-Healthways Well-Being Index Community Survey 2009, n=353,849
10
Cedar Rapids, Iowa, June 15 2008
11
The Transformational Recovery (I)Impact of 2008 Floods on Cedar Rapids and Surrounding Regions
Cedar Rapids
FEMA Public Asssistance and Hazard Mitigation Paymentsand DOT Payments Per Capita (2008)
Overlaid on Congressional District Quintiles by Well-Being Index (2009)
Very High
High
Moderate
Low
6
4
12
77
77%
7%
9%
8%
74%
5%
9%
11%
93%
1%
4%
2%
CountyImpact
Number ofCounties
Household Losses
Public SectorLosses
BusinessLosses
LossIntensity Ratio
2.0 +
1.0 – 2.0
0.5 – 1.0
< 0.5
Source: FEMA Individuals and Households Program, Small Business Administration’s Disaster Loan Program, Uninsured Losses Declared by Iowa State income tax filers (2008), FEMA Public Assistance Program, FEMA Hazard Mitigation Program, U.S. Department of Transportation Repairs to transportation infrastructure per capita, Small Business Administration’s Disaster Loan program per capita, agriculture crop peril payments per square mile; Evaluating Direct and Indirect Economic Outcomes of the 2008 Iowa Weather-Related Disasters, Swanson et al., Iowa State University Staff Report, August 2010; Gallup-Healthways Well-Being Index Community Survey 2009, n=353,849
Weather Related Loss Estimates
Housing and business structures
Infrastructure
Educational facilities
Cultural and historic landmarks
Agriculture and the environment
Total estimated losses
$1.33B
0.66
0.30
0.28
0.93
$3.50B
12
The Transformational Recovery (II)Well-Being at the Local Level
Overall Rank 150 12
Life Evaluation 121 42
Emotional Health 170 1
Physical Health 64 5
Healthy Behavior 182 46
Work Environment 144 144
Basic Access 39 4
2008 2009
Metropolitan Statistical Area (MSA) Ranking by Well-Being Index and Composite Sub-Indices (out of 187 MSAs)
Fourth Quintile
Third QuintileSecond Quintile Top Quintile
Bottom Quintile
Cedar Rapids
63.2
I learned or did somethinginteresting yesterday
2009
66.5
I did not experience sadness yesterday
2009
Examples of Emotional Health Geographic DisparitiesRelative to National Composite Score for MSAs
+8.6+7.9
66.5
80.2
Examples of Healthy Behavior Geographic DisparitiesRelative to National Composite Score for MSAs
I ate healthy all day yesterday % who don’t smoke
2009 2009
+6.0
+2.5
Source: Gallup-Healthways Well-Being Index Community Survey 2009, n=353,849
13
The Transformational Recovery (II)Well-Being at the Local Level
Overall Rank 150 12
Life Evaluation 121 42
Emotional Health 170 1
Physical Health 64 5
Healthy Behavior 182 46
Work Environment 144 144
Basic Access 39 4
2008 2009
etropolitan Statistical Area (MSA) Ranking by Well-Being Index and Composite Sub-Indices (out of 187 MSAs)
Fourth Quintile
Third QuintileSecond Quintile Top Quintile
Bottom Quintile
Cedar Rapids
Source: Gallup-Healthways Well-Being Index Community Survey 2009, n=353,849
57.4
My supervisor treats me like he/she is my partner
2009
Examples of Work Environemnt Geographic DisparitiesRelative to National Composite Score for MSAs
-1.5
14
The Transformational Recovery (III)Families Retained, Some Employment Losses but Well Managed
41%47%
13%
35%
49%
16%
High ImpactCounties
Medium ImpactCounties
Low ImpactCounties
2007-8 2008-9
Shares of Statewide Population Gains
K-12 Public School Enrollment(Baselined to October 2005)
2.3% 1.8%
-2.7%
0.5%
-9.6%
-13.5%
One Year Before Year of Occurance One Year After
Cedar Rapids New Orleans102%
101%
98%
96%
100%
2005 2006 2007 2008 2009
2007 2008 2009
+3%
+2%
+1%
0%
-1%
-2%
-3%
-4%
Employment Changes 2007-2009High Impact Counties
Nonfarm Job Changes: Cedar Rapids vs. New Orleans
Source: Evaluating Direct and Indirect Economic Outcomes of the 2008 Iowa Weather-Related Disasters, Swanson et al., Iowa State University Staff Report, August 2010
Evolution of the Science
1616
Chronic Disease Productivity Impact:~3x Health Care Cost Impact
Chronic Disease Economic Impact in the U.S. 2003 (Annual Costs)
Total Cost
$1.3 Trillion
Treatment Expenditures 21%
Lost Productivity Cost 79%
$0.3 Trillion
$1.0 Trillion
Source: Milken Institute 2007
17
Science Linkages Confirming the Value Examples of Recent Publications on Risk Reduction
10 — 25% Risk Reduction
$0.4T — $1.1T
10 Year Impact
10 — 50% Risk Reduction
$0.6T — $1.4 T
10 Year Impact
18
Emerging Science (I)
Well-Being Relationship to Medical Events
0-50 (n=109)
>50-60 (n=151)
>80-90 (n=683)
>70-80 (n=582)
>60-70 (n=347)
>90-100 (n=363)
Admission ER Visit
Percent
Well-Being Score (Composite)Low High
Impact of Well-Being on Event Frequency
-83%
-49%
Source: Wellmark Data, Healthways Center for Health Research Analysis (n=2,235)
0
5
10
15
20
19
Well-Being Relationship to Medical Costs
0-50 (n=109)
>50-60 (n=151)
>80-90 (n=683)
>70-80 (n=582)
>60-70 (n=347)
>90-100 (n=363)
Annual Costs($)
Well-Being Score (Composite)Low High
Impact of Well-Being on Claims and Rx Costs
Claims Rx Total
Source: Wellmark Data, Healthways Center for Health Research Analysis (n=2,235)
0
500
1,000
1,500
2,000
2,500
3,000
3,500
4,000
20
Emerging Science (II)
Well-Being Relationship to Performance
Productivity Loss by Emotional Health
10 9 8 7 6 5 4 3 2 1 0
LowHigh
0
5
10
15
20
25
30
35
40
Productivity Loss(%)
Emotional Health
Source: Effects on Well-Being of Healthways Effective LifeStyle Programs Phase II, Evers, KE, Prochaska, JO, Castle, P. & Prochaska, JM. 2010 (under review), n=4100
21
Well-Being Relationship to Performance Continued
Productivity Loss by Physical Health
0
5
10
15
20
25
30
35
40
Productivity Loss(%)
10 9 8 7 6 5 4 3 2 1 0
Physical HealthLowHigh
Source: Effects on Well-Being of Healthways Effective LifeStyle Programs Phase II, Evers, KE, Prochaska, JO, Castle, P. & Prochaska, JM. 2010 (under review), n=4100
22
Emerging Science (III)
Market Research About Well-Being
• Mixture of family situations/living arrangements
• Preliminary segmentation:
― Influencer, Someday, Start/Stopper, Caretaker
• Range of motivational levels
• Two hours or more per week online
Source: Healthways MeYou Health, Essential Research March 2010Source: Healthways MeYou Health, Essential Research March 2010
23
They Were Asked . . . “What are Your Goals?”
fitness
nutrition
job/career
relationships
big dreamsemotional
mental health
life events
hobby/skill development
financial
physical health
time management
weight loss
school
spiritualstress
personal time
environment
goal for others
quitting
learning
People reported a surprisingly complex tapestry of connected topics
Source: Healthways MeYou Health, Essential Research March 2010Source: Healthways MeYou Health, Essential Research March 2010
24
Physical• exercise, rest/sleep• “staying young” • diet (self & others)
Emotional• relationships: work & home • socializing , having friends• helping others • dinner with family
Intellectual• going back to school• learning something new• dean’s list • travel, culture
Spiritual• “thanking whoever is up
there for this day,” faith • meditation • “getting out of my head”
Holistic
Deeply held views surfaced, mapping to the Gallup-Healthways Well-Being Index:
“What Does Well-Being Mean to You?”
24Source: Healthways MeYou Health, Essential Research March 2010Source: Healthways MeYou Health, Essential Research March 2010
25
Different Well-Being “Personas” Emerged
• Fresh, diverse content
• New challenges, self-assigned goals (more rigorous)
• Options to coach others
• Social outlet
• Guilt free
• Valuable use of time
• Provide benefits for dependants
• Numbers, metrics
• Standards for personal comparison
• Reason for challenges
• Challenges they don’t do already
• Knowledge and inspiration
• Not interested in points
• Challenges must be fail-proof
• Extrinsic motivation to return
• Do with partner or group
• Anonymity and privacy—to eliminate shame
• Social groups based on same life situation
• Light-hearted approach
• Goals are “wants”
• Fast results
• Ability to have a personal coach or sponsor keep tabs on them
Excuse MakerMe-Time
Impoverished Idle EnabledAware and Achieving
Enlightened & Discovering
External Validation
Seeker
Source: Healthways MeYou Health, Essential Research March 2010Source: Healthways MeYou Health, Essential Research March 2010
26
Putting Science into Practice (I)
Healthways Behavioral Change Science
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 adherenceHEALTHHONORS®HEALTHHONORS®
LifeMatters®
GamificationGaming theory
• Fun vs. fulfillment• Explorer, achiever, socializer, competitor
27
Putting Science into Practice (II)
Modeling Behavior-Condition Relationships
A complex relationship between behavior – condition drives development and severity of health conditions
To understand what will happen to a population, a Monte Carlo Simulation Model is employed
Once a population is profiled, repeated random interactions weighted to epidemiologic probabilities are used to “age” a population five years
Effects of behavior change initiatives can be assessed by adding in probabilities that a program will have an effect along with the probability of recidivism
28
Putting Science into Practice (III)
Vitality Simulation App
• Simplified version of the Simulation Model available for you today• Demonstrates application of the model to create awareness and
facilitate action by business leaders• Allows high-level overview of the process
Data inputs
• Input basic demographics
• Assess current health and risk status of population
Project future cost trend
• View projected 5-year medical and productivity cost trends
• View the most costly contributing conditions
Investigate interventions
• Use as a planning tool by selecting various intervention configurations
• View the potential impact on your cost trends
1 2 3
Intellectual Property +
Implications and action steps you can take
30
Blue Zones Principles – Applying to an Employer Community
Move Naturally
Right Outlook - Purpose Now - Downshift
Eat Wisely - 80% Rule - Plant Slant - Wine@5
Belong - Right Tribe - Community - Loved Ones First
Move Naturally
Right Outlook - Purpose Now - Downshift
Eat Wisely - 80% Rule - Plant Slant - Wine@5
Belong - Right Tribe - Community - Loved Ones First
THE POWER 9THE POWER 9
31
What Does it Mean to be a Healthways Blue Zone?
An employer community with high well-being . . . .
• Has high engagement, energy and vigor where it all seems to work because leadership and employees share a bond of great purpose and
• A work environment that promotes innovation and collaboration and
• Becomes a “best place to work” which in turns generates deep seeded pride and drives overall economic and social progress and
• Has measurably improved business performance and
• Has gained national recognition and positive media because of its game changing commitment to the vitality of its people
32
Healthier People Cost Less and Perform Better
ImproveWell-Being
Adopt or maintainhealthy behaviors
Mitigate health-related risks
Optimize care for health conditions
Performance Increases
• Productivity
• Engagement
• Absence
• Work Impairment
Total Medical Cost Decreases
• Hospitalizations
• Event Rates
• Disease Rates
• Lifestyle Risks
Total Economic Value Increases
• States
• Communities
• Employers
• Individuals
Eliminate / delay next new case of disease / condition
Eliminate / reduce impact of the next new episode
Enhanced well-being
Economic Drivers
33
How Do You Make it Real in 12 — 24 Months?
Improve Well-Being EXECUTIONEXECUTION
Improved Business Performance RESULTSRESULTS
Adopt Well-Being Principles, Power 9CULTURECULTURE
Leadership Policy Communi-cations
Participation(Social
Network)
AUDIT & BLUEPRINTAUDIT & BLUEPRINT
Environment
34
Recommended Approach
Certification
Implement
Track Progress
Outcomes
Well-Being
Productivity
Business Performance
Well-Being Assessment
Vitality Coach and Compass
Vitality Simulation Model
Environmental Assessment
Assessments
Communications
Leadership
Environment and Policy
Participation
Blueprint
35
What’s in the Healthways Blue Zone Toolkit
Well-Being Assessment: baseline & annual,
individual & organization
• Detailed blueprint focusing on communications, leadership, policies, physical site and participation
• Creation of multi-year strategy to improve Well-Being
• Identification of available resources, both Healthways provided and third party
• Customized communication packages
• Detailed blueprint focusing on communications, leadership, policies, physical site and participation
• Creation of multi-year strategy to improve Well-Being
• Identification of available resources, both Healthways provided and third party
• Customized communication packages
Blueprint Design
• Implementation and ongoing support onsite• Well-being leadership and people manager training & tools• Progress tracking
• Implementation and ongoing support onsite• Well-being leadership and people manager training & tools• Progress tracking
Implementation Support
Certification
“Healthways Blue Zone Under Construction” designation
Outcomes validation:
• Well-Being
• Productivity
• Business performance
“Healthways Blue Zone” certification and annual renewal
Healthways Blue Zone CEO round tables
Marketing Support
“Healthways Blue Zone Under Construction” designation
Outcomes validation:
• Well-Being
• Productivity
• Business performance
“Healthways Blue Zone” certification and annual renewal
Healthways Blue Zone CEO round tables
Marketing Support
Assessments and tools
e.g., Vitality Simulation Appto size opportunity
and engage your leaderse.g., Vitality Compassand Coach
Environmental Assessment:community & organization
36
What “You Can Do Right Now”Seven Steps to Improved Company Well-Being
Assemble Back of theEnvelope Data
# Employees
Gender %
Male Female
Age %
65+55-6445-5435-4418-34
Employees’ Current State of Health
Average WellPoor
Employees Lifestyle Behaviors
AverageHigh Risk Low Risk
Average Medical Costs Per Employee(estimate all-in for current year including Rx, Copays etc.)
$
X 0.3 =
Employee share
Costs of Absenteeism
Costs of Presenteeism
$
Company cost
$
Total costs PEPY
Multiply total medical costs by 0.3$
$Multiply absenteeism costs by 7.7
X 7.7 =
Assess your readinessto change
1 2 Pick 3 behaviors to targetbeyond current programs
Physical Activity
Diet
Non-smoking
Desirable alcohol use
Standard of care compliance
Stress management
Sufficient sleep
Health screenings
4
Write down the opportunityas sized by the simulation
5
$$
Healthcaresavings by 2015
$
Productivitysavings by 2015
Totalsavings by 2015
Let off some steam with agame of Community Clash
6
http://www.meyouhealth.com/clash/
Improved performance through improved employee well-being is or will be a top five CEO agenda item for next fiscal year
I personally plan to devote at least 15% of my time to this opportunity
I am dissatisfied with my current set of initiatives and plans around health
Improving the vitality of the communities in which my employees, customers and business partners work is aligned with my stated company goals, as well as being just the right thing to do
I recognize the community levers we can pull in the 30 mile home radius around each of my locations
http://wellness.weforum.org/
Simulate the costof doing nothing
3
I can personally mobilize visible and committed leadership to this effort
Investigate becoming a certified Healthways Blue Zone7
http://healthwaysbluezones.com
and share the results with a friend
Source: Healthways Blue Zone Toolkit 2010; all rights reservedSource: Healthways Blue Zone Toolkit 2010; all rights reserved
Activating Your Communityfor Well-Being
Ben Leedle, Chief Executive Officer, Healthways Inc.Ben Leedle, Chief Executive Officer, Healthways Inc.