The Value of Worksite Health
IAWHP Global SymposiumAtlanta, GA
April 1, 2014
Nico Pronk, Ph.D., FACSM, FAWHPHealthPartners
HealthPartners Institute for Education and ResearchHarvard School of Public Health
Agenda
• The employers’ perspective• The workplace setting• Finding value in health• Best practices• Multiple levels of programming• Capturing the value of WHP
What About the Employers’ Perspective?
• Non-clinical, community-based prevention policies and wellness programs appeal to employers
• Importance of family inclusion• Importance of community
connection• Company recognition as a leader
for health improvement and economic vitality
• Recognition that companies and organizations are complex social systems
Unsustainable Cost Pressure
$9,235(2002)
$10,168 $11,192
$12,214 $13,382
$14,500 $15,609
$16,771 $18,074
$19,393(2011)
$20,944 $22,620
$24,430 $26,384
$28,496 $30,774
$33,236
$35,895
$38,767
$41,868(2021)
2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021
Health care expenses for U.S. families:2002-2021 (projected at present growth rate)
Source: 2011 Milliman Medical Index
Or to look at it another way…
Source: Alliance of Community Health Plans
Income: $59,858
Source: Alliance of Community Health Plans
Or to look at it another way…
Where do U.S. health care dollars actually go?
Facing the challenges in health
care
Social and economic
factors
Physical environment
Healthy behaviors30%
10%
40%
Medicalservices20%
Medical services
8% Other
4% Healthy behaviors
88%
Where money spentDrivers of health
The Worksite Setting• Population access
– Significant reach into the population– Significant frequency to intervention exposure– Significant access to tools, vehicles, resources, etc. that may be
mobilized to increase awareness and PA behavior change– 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
• Work matters for health – Unemployment is a major determinant of health– Worker health may be affected by the organization of work, the
policies at work, the relationships at work, etc.• Health matters for work
– Chronic conditions may be exclusion criteria for job fit– Fitness for duty tests as indicators of inclusion criteria
• Healthy workers and a healthy culture appear to be a good business strategy
• Worksite health promotion also is a sound public health strategy and fosters economic growth in the community
The Worksite Setting
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
Workplace Health Works!
• 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 : 1Absenteeism: 2.73 : 1
Source: Hertz, et al. JOEM 2004; 46:1196-1203.
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
Value through designCompanies 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 levels2. Strategic alignment with the company’s identity and
aspirations3. A design that is broad in scope and high in relevance and
quality4. Broad accessibility5. Internal and external partnerships6. Effective communications
Best Practice Design Principles
9 Best Practice Dimensions• Leadership• Relevance• Partnership• Comprehensiveness• Implementation• Engagement• Communications• Data-Driven• Compliance
Why then, such confusion?
• Confusion over the definition of a worksite health/wellness program– Population-based
• Even people with diagnosed disease retain access to lifestyle behavior change programs
• Disease and lifestyle management programs are artificially segregated into siloes
• Value of worksite health programs goes far beyond medical care cost savings
• Even this article showed a positive ROI for the whole program ($1.46:1)
Environment shapes behavior
Abnormal reaction to a normal environment?
A normal reaction to an abnormal environment?
Individual decision do matter!
Cardiovascular disease, diabetes, cancers, lung disease…Preventable deaths
Choices for interventions
Obesity, lack of fitness, high blood pressure, high cholesterol, high blood sugar
Tobacco use, poor diet, lack of physical activity, excessive alcohol use
Environments – physical, psychosocial (culture), socioeconomic
Social policy, community mobilization
Making healthy choices easy choices
IndividualEffort
Environmental (physical, psychosocial) and
Policy Interventions(Public, organizational, etc)
HealthPotential
Source: Pronk NP, Kottke TE. Health Promotion in Health Systems. In: Rippe, J. Lifestyle Medicine, 2013.
Moving Beyond Available Evidence
• Evidence of what works needs to be applied in the context of the workplace environment
• Inflexible focus on program fidelity may limit adoption of programs with sustained success
• Practice-based evidence can only be generated if solutions are successfully implemented
• Worksite health programs will only deliver on their promise when supported as a business strategy with leadership support and accountability
Possible Simple Socially rewarding
Financially rewarding
Personally relevant
Organizationallyrelevant
Community connected
Individual
Inter-individual
Organizational
EnvironmentalLeve
ls of
Influ
ence
Make Being Healthy and Productive…
Exceptional Customer and User Experience
Outcomes
Comprehensive, Multi-Level, Multi-Component Programming
Source: Pronk, NP. Journal of Physical Activity and Health, 2009, 6 (Suppl. 2), S220-S235.
HealthProductivityFinancial / ROI
Valuing Workplace Health
Health
Community Well-Being
Community Process
Benefits------------
Harms
Benefits------------
Harms
Benefits------------
Harms
Valuing – What should be counted?
Bene
fits a
nd H
arm
sRe
sour
ces U
sed
Savings-----------
Costs
Valuing – What should be counted?
Identification of
Investments and
Resources
Value The value of an
intervention considers its
benefits, harms, and costs.
QALYs or HALE
Community Well-Being Indicator
Community Process Indicator
Monetary Units (USD)
Community Benefit
Community Cost
i.e., Worksite
i.e., Worksite
Comprehensive assessment
Comprehensive assessment
What Does “Success” Look Like?
Soource
Low Risk
ModerateRisk
High Risk
Disease:Well
Managed
Disease:Poorly
Managed
Baseline 44%
Baseline 24%
Baseline 24%
Baseline 7%
Baseline 1%
15.1%
0.8%
4.5%
1.3%
14.4%
2.5% 0.2%
36.3%
33.5%
13.2%
25.0%
Risk transitions based on HA-derived risk levels among employees over 2
years(N=1,087)
21% 66% 13%
Net population health improvement of 8%.
87% did not get worse
GotBetter
Stayed theSame
Got Worse
Doing nothing may reduce the population’s
health by as much as 7% per year
This 2-year health and well-being program was associated with a ROI of
2.9:1
Source: HealthPartners Health Assessment Database, 2011
Conclusions
• When workplace health and wellness programs are implemented according to best practice principles of design, significant value may be generated
• Valuation models should go beyond traditional ROI and capture those “values” that are relevant to the company
Thank You!