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Is There a Link Between Stock Market Price and Having a Great Workplace Health Promotion (Wellness) Program?
Ron Z. Goetzel Ph.D. , Johns Hopkins University - Truven Health Analytics
Health Promotion Live Webinar – February 25, 2016
AGENDA
• Revisiting the Controversy: Do Workplace Wellness
Programs Work?
• Wall Street Studies
• Best and Promising Practices
• Q&A
Do Health Promotion Programs Work?
3
The Confusion
The Latest from Sharon Begley
What Do We Mean When We Say:A Wellness Program Works?
• “Make workers aware of their health and how it
improves quality of life.”
• “High participation and engagement.”
• “Lose weight, stop smoking, exercise more.”
• “Medical claims costs should go down.”
• “Less absenteeism, fewer safety incidents.”
• “Attract the best talent.”
• “Happier workers with more energy.”
• “Create a culture of health.”
6
7
What Do We Mean When We Say:A Wellness Program Works? (con’t)
“Produce a positive return on investment (ROI)?”
8
9
Baxter et al., Review
AJHP, July/August 2014.
Baxter et al. Literature Review
• Fifty-one studies (61 intervention arms) published between 1984 and
2012 included 261,901 participants and 122,242 controls from nine
industry types across 12 countries.
• Overall weighted ROI was 1.38 : 1.00, which indicated a 138% return
on investment.
• When accounting for methodological quality, an inverse relationship
to ROI was found.
• Randomized control trials (RCTs) (n = 12) exhibited negative ROI,
−0.22 ± 2.41(−.27 to −.16).
• Conclusion. Overall, mean weighted ROI in workplace health
promotion demonstrated a positive ROI.
RCT Studies Intervention
Period
Sample SizeIntervention
Type
Vaccine Interventions
Quasi-Experimental and Modeling Studies
Johnson & Johnson Study
Johnson & Johnson – “Low Quality Study”
Dell Inc. Research – AJHP, Jan/Feb 2015
ROI Analysis – 2.48:1.00
Duke University Study
ROI Estimate: 2.53:1.00
Michael O’Donnell Analysis of Baxter et al. ROI Review–AJHP, Jan/Feb 2015, 29:3, v-viii
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Goetzel’s New Rule: An ROI of 1:1 is good enough…
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…if you can demonstrate health improvement!
But…what about the Value-on-Investment (VOI)?
It all started with Ray Fabius’ 2013 study
AECOM CHAA Winners – 1996 - 2013
ACOEM Winners vs. S&P 500
HERO Study: Connecting Corporate Health and Wellness Best Practices to Superior Market Performance
HERO Scorecard Study
Average Change In Medical Expenditures
28
Average Percent Change in Medical Expenditures Over Three Years for the Study
Sample (Adjusted to 2012 Dollars – Not Adjusted for Confounders)
0
20
40
60
80
100
120
140
160
180
200
-10.0% -8.0% -6.0% -4.0% -2.0% 0.0% 2.0% 4.0% 6.0% 8.0%
To
tal H
ero
Sc
ore
ca
rd S
co
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Average Percent Change in Medical Expenditures from 2009 - 2011
Comparison of Expenditures by HERO Score, Adjusted for Confounders
Predicted Average Annual Per Member Healthcare Expenditures (Adjusted to 2012
dollars) for Organizations with High and Low HERO Scores
2009 2010 (% Change from 2009) 2011 (% Change from 2010)
LOW $3,048 $3,050 $3,051
HIGH $2,948 $2,901 $2,855
$2,800
$2,850
$2,900
$2,950
$3,000
$3,050
$3,100
Ad
jus
ted
An
nu
al
Co
st
HERO Score
(0.05%) (0.05%)
(-1.6%) (-1.6%)
Grossmeier et al., HERO S&P Study
HERO Study Results
Fabius et al. ACOEM II Study
High Health Promotion Scores vs. S&P 500
High Safety Scores vs. S&P 500
High Health and Safety Scores vs. S&P 500
Koop Award Winners and S&P 500 Index
Koop Winners: 1999-2014BP America BP 2014
Eastman Chemical EMN 2011
Prudential Financial PRU 2011
Pfizer, Inc. PFE 2010
The Volvo Group VOLVF 2010
Alliance Data Systems Corp ADS 2009
Dow Chemical Company DOW 2008
International Business Machines IBM 2008
Pepsi Bottling Group PBG 2007
WE Energies WEC 2007
Union Pacific Railroad UNP 2005
UAW-GM GM 2004
Johnson & Johnson Services, Inc JNJ 2003
FedEx Corp. FDX 2002
Motorola Solutions Inc. MSI 2002
Citibank C 2001
Union Pacific Railroad UNP 2001
Northeast Utilities NU 2001
Caterpillar Inc. CAT 2000
Cigna Corp. CI 2000
DaimlerChrysler Corporation DDAIF 2000
Fannie Mae FNMA 2000
Aetna AET 1999
Pfizer, Inc. PFE 1999
Glaxo Wellcome GSK 1999
UNUM/ Provident UNM 1999
Goetzel et al., Koop S&P Study
Getting the Word Out on Best and Promising Practices in Workplace Health Promotion
Best/Promising Practice Dissemination
• Robert Wood Johnson Foundation – Promoting Healthy
Workplaces
• Transamerica Center for Health Studies – Employer
Guide to Workplace Health Promotion
• American Heart Association -- Developing a Culture of
Health “Playbook”
• Centers for Disease Control and Prevention – Workplace
Health Research Network
• Centers for Disease Control and Prevention – Workplace
Health Promotion Resource Center (coming soon)
Kent et al. JOEM Study
Transamerica Center for Health Studies
American Heart Association
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The Secret Sauce
1. Culture of Health• More than just a wellness
program – It’s a way of life
• Ingrained in every part of the organization• Business Mission• Built Environment• Performance Metrics• Programs, Policies,
Health Benefits
2. Leadership Commitment
• CEO Driven
• Lead by Example
• Middle Management Support
• Budget/business plan
• Empowered workers/unions
3. Specific Goals and Expectations
• Think big, start small, act fast -- one step at a time
• Set short and long term objectives
• Be realistic about what can be achieved in 1, 3, 5, 10+ years
• Accountability – leaders and employees are accountable for doing their part to support a culture of health
4. Strategic Communications
• Messages need to be:
• Consistent
• Constant
• Engaging
• Targeted
• Two-way dialogue using a variety of channels
• Wellness champions
Relentless Surround Sound
5. Employee Engagement in Program Design/Implementation
• Wellness Committees
• Employee Feedback Surveys
• Participatory Based Program Design
• Focus Groups
6. Best Practice Interventions
• Convenience, removing barriers
• Many choices
• Making the healthy choice the easy choice
• Applying behavior change theory/practice
7. Effective Screening and Triage
• Health Risk Assessments with Follow-up -- PLUS
• Biometric Screenings (USPSTF Guidelines)
• On-site Clinics and Counselors
8. Smart Incentives
• Tailoring, and providing alternative paths to motivate, reward, and help employees achieve their goals
• Tiered Incentive Programs
• Non-Monetary Incentives
• Carrots, Not Sticks
• Voluntary – reasonable dollar amounts
• Long-term view - retirement
9. Effective Implementation
• Tailored to the company’s culture
• Integrated solutions
• Flexibility
• Fresh ideas
• Fun
Structure:
Process:
Outcomes:
10. Measurement and Evaluation
Modified Worksite Health Promotion (Assessment of Health Risk with Follow-Up) Logic Model adopted by the CDC Community Guide Task Force
HEALTH, SAFETY, AND PRODUCTIVITY MANAGEMENT
Employees
This Is Hard!
Workplace Health Promotion (Wellness) Works– If You Do it Right!
Financial Outcomes
Health Outcomes
QOL and Productivity Outcomes
Cost savings, return on investment (ROI) and net present value (NPV).Where to find savings:
Medical costs
Absenteeism
Short term disability (STD)
Safety/Workers’ Comp
Presenteeism
Adherence to evidence based medicine.
Behavior change, risk reduction, health improvement.
Improved “functioning” and productivity
Attraction/retention –employer of choice
Employee engagement Corporate social
responsibility (CSR) Balanced scorecard
Another Benefit: Engaged Workers Who Love Their job!
Learn More at….
http://www.jhsph.edu/promoting-healthy-workplaces