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The Health Project: The C. Everett Koop National Health Awards – 2014 UpdateRon Z. Goetzel, Ph.D., Johns Hopkins University and Truven Health Analytics

HPCareer.net -- Health Promotion Live – April 24, 2014

Agenda

• Introduction to The Health Project and C. Everett Koop Award

• How to Apply for the Award

• Frequently Asked Questions

• Applied Research Methods – Documenting Health Improvement and Cost Savings

• Summary and Q&A

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We Honor

Dr. C. Everett Koop Former U.S. Surgeon General, 1916 - 2013

Dr. C. Everett Koop• Born in 1916 in Brooklyn, NY

• Served as the 13th Surgeon General of the US under President Reagan from 1982 to 1989

• In the 1940s and 1950s, became Professor of Pediatrics at the University of Pennsylvania School of Medicine

• As a surgeon in Philadelphia, performed groundbreaking surgical procedures on conjoined twins, invented techniques today commonly used for infant surgery, and saved the lives of countless children

• Remembered for his stance on

– Abortion

– Tobacco use

– HIV/AIDS

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Dr. Koop With President Reagan

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The Health Project C. Everett Koop National Health Award

• Non-profit, public-private partnership, that recognizes organizations that have demonstrated health improvements and cost savings from health promotion and disease prevention programs.

• At its launch in 1994, The Health Project recognized the following organizations: Johnson & Johnson, Aetna, Dow Chemical Company, L.L. Bean, Inc., Quaker Oats Company, Steelcase, Inc., and Union Pacific Railroad.

• The Health Project is dedicated to improving Americans’ health and reducing the need and demand for medical services through good health practices.

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The Health Project Board of Directors

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• Chairman and Co-Founder: Carson E. Beadle

• President and CEO: Ron Z. Goetzel, PhD

– Johns Hopkins University, Institute for Health and Productivity Studies and Truven Health Analytics

• Vice President: Seth Serxner, Ph.D., Optum

• Chief Science Officer : James F. Fries, MD

– Stanford University School of Medicine

• Secretary/Treasurer: James Wiehl, JD

– Fulbright & Jaworski

The Health Project Board Members• Steve Aldana, PhD WellSteps

• David R. Anderson, PhD StayWell Health Management

• David Ballard, PsyD, MBA American Psychological Association

• Dan Gold, PhD Mercer

• Michelle Hatzis, PhD. Google

• Rebecca Kelly, RD, CDE, PhD University of Alabama

• Debra Lerner, MS, PhD Tufts Medical Center

• Joseph A. Leutzinger, PhD Health Improvement Solutions, Inc.

• Wendy Lynch, PhD Altarum Institute

• Michael O’Donnell, PhD American Journal of Health Promotion

• Ken Pelletier, PhD, MD (hc) University of Arizona and UCSF Schools of Medicine

• Bruce Pyenson, FSA, MAAA Milliman

• Seth Serxner, PhD, MPH Optum

• Stewart Sill, MS IBM Integrated Health Services

• John F. Troy, JD Public Policy Consulting

Ex Officio:

• Jason Lang, MPH Centers for Disease Control and Prevention (CDC)

• Ellen Exum IBM

• Tre McCalister Mercer

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Friends and Supporters

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Our Website -- http://www.thehealthproject.com

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Koop Award Application – Available at: www.thehealthproject.com

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Winner of the 2013 Koop Award

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2013 Honorable Mentions

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Recent Winners

• Alcon Laboratories, Alcon’s Vitality Program

• Alliance Data, healthyAlliance

• Eastman Chemical Company, HealthE Connections

• L.L. Bean, Inc., Healthy Bean

• Nationwide Mutual Insurance Company, My life. My choice. My health

• Prudential Financial, HealthSolutions

• State of Nebraska, wellnessoptions

• The Dow Chemical Company, LightenUp Program

• Energy Corporation of America (“ECA”), ECA Platinum Wellness

• International Business Machines (IBM), Wellness for Life

• Lincoln Industries, Wellness – go! Platinum

• Vanderbilt University, Go for the Gold Wellness Program

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Dr. Koop with Winner -- IBM

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Dr. Koop with Winner – Vanderbilt University

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Dr. Koop with Winner – Dow Chemical

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Dr. Koop With Winner Lincoln Industries

Dr. Koop With Winner Energy Corporation Of America

The Health Project – C. Everett Koop National Health Award

• To receive the Koop Award, there are three considerations:

– 1) The program must meet The Health Project’s goal of reducing the need and demand for medical services,

– 2) Share the objectives of the Healthy People health promotion targets, and

– 3) Prove net health care and/or productivity cost reductions while improving population health.

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Frequently Asked Questions (1)• Are there minimum requirements for application?

– No specific requirements are set regarding participation rates, risk reduction, and cost outcomes because of unique challenges that may face any given applicant. However, it would benefit the applicant to demonstrate high participation in a program, which is comprehensive in nature (not single focus), net risk reduction, and cost savings that exceed program expenses. Longer term programs (3+ years) are generally higher rated than those in their beginning stages.

• What are programs evaluated on?

– Adherence to evidence-based practices, comprehensiveness, participation rates, health improvement/risk reduction, and net cost savings.

• Are requirements different for small and large organizations?

– Smaller organizations are not expected to do a sophisticated claims analysis. If they can document cost stabilization over 3-5 years (without significant benefit plan design changes or other utilization management measures), that is often considered sufficient in terms of demonstrating cost savings.

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Frequently Asked Questions (2)• Does a published article serve as a gold standard?

– Yes, if it informative of evaluation results demonstrating health improvement and cost savings. But, it is not a requirement.

• Is financial impact required or is change in risk status and utilization sufficient?

– Health behavior change/risk reduction plus cost savings are required. If the organization claims a positive return-on-investment (ROI), then both savings and program costs need to be documented. Reduced utilization translated into financial impact may be considered as long as this is not achieved through benefit plan design, rationing, outsourcing, or utilization review.  There needs to be a link to health improvement and risk reduction.

•  Are vendor reports as good as independent third party analyses?

– Independent analyses wield greater influence, but vendor reports are acceptable if they have well-documented methodology and are credible.

• What supporting materials are required?

– N’s, tables/graphs with clear annotation, statistics.

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Frequently Asked Questions (3)

• How are Winners determined?

– Applications are independently reviewed and scored by Board members. Reviewing Board Members rate applications on a 100-500 scale, where a score of 100 represents a superior program. Reviewers score applications using their best judgment, and specific criteria, with greater emphasis placed on program evaluation and results. Scores of 300 or above indicate that the reviewer considers the application to be non-competitive for a Koop Award.

– Scores from all reviewers are averaged with and without outliers (i.e., before and after dropping the lowest and highest values). Applicants with average scores below 300 are considered for the Koop Award. Applications with scores greater than 300 remain eligible for an Honorable Mention Award as determined by the reviewers’ discussions.

– Final determination of Winners and Honorable Mentions are made at a Board meeting that follows an independent review of applications.

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Convince Me…

Did your organization improve health and save money?

Setting A High Bar For Winning The Koop Award

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Research Methods -- Study Design 101

• Pre-experimental

• Quasi-experimental

• True experimental

Validity of results increases as you move down this list

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Notation In Study Design

• X=Intervention or program

• O=observation (data collection point)

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Research Design: Non-experimental (Pre-experimental)

One group posttest only

X 02

One group before and after (pre-test/posttest)

01 X 02

Non-experimental Design -- (Pre-experimental)

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Program start

General Trend Or Program Effect?

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Program start

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Research Designs: Quasi-experimental

Pretest posttest with comparison group

01 X 02 Intervention Group

--------------------------

01 02 Comparison Group

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Research Design: Experimental

TRUE EXPERIMENTAL – RANDOMIZED CLINICAL TRIAL (RCT)

01 X 02 EXPERIMENTAL GROUP

(R) -------------------

01 02 CONTROL GROUP

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Adjusted Risk Factor Status -- Change In Percent Prevalence

% High Risk (Number of Respondents)% Change^

Risk Factor T1 T3

All Respondents

Poor nutrition 79.0% (4711) 80.3% (3125) 1.3%*

Poor physical activity/exercise 39.6% (4742) 34.7% (3140) -4.9%*

Obesity 26.6% (4630) 27.0% (3079) 0.4%

High blood pressure 5.0% (4244) 4.2% (2810) -0.8%*

High cholesterol 6.1% (2995) 3.8% (2001) -2.3%*

High blood glucose (sugar) 5.2% (2392) 3.9% (1633) -1.3%*

Poor emotional health 21.6% (4626) 18.6% (3072) -2.9%*

Poor safety behaviors 21.4% (4544) 18.4% (2989) -3.0%*

Smoking & tobacco 13.8% (4747) 12.7% (3135) -1.1%*

High alcohol use 11.7% (4642) 9.6% (3045) -2.0%*

Lack of preventive screenings (Age 50+) 40.4% (1537) 39.3% (1015) -1.1%*

High stress 3.6% (4716) 2.8% (3132) -0.8%*

* denotes significance at the 0.05 level^ Negative numbers indicate greater program impactFor each time, the first column displays the prevalence of high risk respondents, the second column shows the number of respondents providing valid answers to the corresponding HRA question.

Intervention Sites N= 1,142 Control Sites N= 374

T1 T3Change

T1 T3Change

Difference-in-

DifferenceMean SD Mean SD Mean SD Mean SD

Weight (lbs)189.4 42.5 189.0 41.3 -0.3 187.9 38.5 189.2 39.9 1.3** -1.6**

BMI (kg/m2)28.3 5.3 28.2 5.2 -0.1 28.0 4.6 28.2 5.0 0.2** -0.3**

Systolic BP (mm Hg) 124.4 14.1 122.3 13.3 -2.1*** 123.1 12.2 128.1 12.6 4.9*** -7.0***

Diastolic BP (mm Hg) 80.3 9.1 78.2 8.8 -2.1*** 79.6 8.5 79.1 8.9 -0.5 -1.6**

Cholesterol (mg/dL) 196.1 35.5 192.8 34.6 -3.2*** 193.3 36.4 193.7 37.8 0.4 -3.6*

Blood glucose (mg/dL) 94.3 18.3 96.2 18.5 1.9*** 95.1 13.6 95.8 21.4 0.7 1.2

Biometric Values: (T1 – T3)

Statistically significant *p<0.05, **p<0.01 ***p<0.001

Cohort Data

J&J Study – Health Affairs, March 2011

Health Risks – Biometric Measures -- Adjusted

Results adjusted for age, sex, region * p<0.05 ** p<0.01

Health Risks – Health Behaviors -- Adjusted

Results adjusted for age, sex, region * p<0.05 ** p<0.01

Health Risks – Psychosocial -- Adjusted

Results adjusted for age, sex, region * p<0.05 ** p<0.01

Propensity Score Matching Results

Adjusted Medical and Drug Costs Vs. Expected Costs From Comparison Group

Average Savings 2002-2008 = $565/employee/year

Estimated ROI: $1.88 - $3.92 to $1.00

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Summary

The Health Project aims to recognize organizations that have documented health improvements AND cost savings.

Size is not important – results are!

A growing body of scientific literature, and real-world examples, suggest that well-designed, evidence-based health promotion programs can:

• Improve the health of workers and lower their risk for disease;

• Save businesses money by reducing health-related losses and limiting absence and disability;

• Heighten worker morale and work relations;

• Improve worker productivity; and

• Improve the financial performance of organizations instituting these programs.