What Makes for a Healthy Workplace

What Makes For a Healthy

Workplace?

Ron Z. Goetzel, PhD

Institute for Health and Productivity Studies

Johns Hopkins University and Truven Health Analytics

HPCareerNet – HP Live Webinar

June 12, 2015

© 2014, Johns Hopkins University. All rights reserved.

The Problem

Poor Health Costs Money

• Medical

• Absence/work loss

• Safety/workers’ comp

• Presenteeism

• Risk factors


Top 10 Most Costly Physical Health

Conditions

Medical, Drug, Absence, STD Expenditures (1999 annual $ per eligible), by Component

Source: Goetzel, Hawkins, Ozminkowski, Wang, JOEM 45:1, 5–14, January 2003.


Diseases Caused (At Least Partially) by

Lifestyle

Obesity: Cholesystitis/Cholelithiasis, Coronary Artery Disease, Diabetes, Hypertension, Lipid Metabolism Disorders, Osteoarthritis, Sleep Apnea, Venous Embolism/Thrombosis, Cancers (Breast, Cervix, Colorectal, Gallbladder, Biliary Tract, Ovary, Prostate)

Tobacco Use: Cerebrovascular Disease, Coronary Artery Disease, Osteoporosis, Peripheral Vascular Disease, Asthma, Acute Bronchitis, COPD, Pneumonia, Cancers (Bladder, Kidney, Urinary, Larynx, Lip, Oral Cavity, Pharynx, Pancreas, Trachea, Bronchus, Lung)

Lack of Exercise: Coronary Artery Disease, Diabetes, Hypertension, Obesity, Osteoporosis

Poor Nutrition: Cerebrovascular Disease, Coronary Artery Disease, Diabetes, Diverticular Disease, Hypertension, Oral Disease, Osteoporosis, Cancers (Breast, Colorectal, Prostate)

Alcohol Use: Liver Damage, Alcohol Psychosis, Pancreatitis, Hypertension, Cerebrovascular Disease, Cancers (Breast, Esophagus, Larynx, Liver)

Stress, Anxiety, Depression: Coronary Artery Disease, Hypertension Uncontrolled Hypertension: Coronary Artery Disease, Cerebrovascular

Disease, Peripheral Vascular Disease Uncontrolled Lipids: Coronary Artery Disease, Lipid Metabolism

Disorders, Pancreatitis, Peripheral Vascular Disease


The Big Picture: Overall Burden of

Illness by Condition

Using Average Impairment and Prevalence Rates for Presenteeism ($23.15/hour wage estimate)

$-

$50

$100

$150

$200

$250

$300

$350

$400

$450

Allerg

y*

Arthrit

is

Asthm

a

Any Cance

r

Depress

ion/S

adness/M

ental I

llness

Diabete

s

Heart Dise

ase

Hyperte

nsion

Mig

rain

e/Headach

e

Respira

tory

Infe

ctio

ns

An

nu

al C

ost

s

Presenteeism

STD

Absence

RX

ER

Outpatient

Inpatient

Source: Goetzel, Long, Ozminkowski, et al. JOEM 46:4, April, 2004)


Mayo Clinic Study


Health Risks and Costs (N = 32,298 – 158,541)


Risk-Cost Relationships At PepsiCo


PepsiCo – Overweight / Obese Analysis (N=11,217)

*At least one difference significant at the 0.05 level

Diff = 29%,

$613*

Diff = 58%,

$111*

Diff = 25%, $987

Diff = 10%, $28

Diff = 7%, $49

Diff = 26%,

$186*

Difference between combined overweight/obese categories and normal weight is displayed

Source: Henke RM, Carls GS, Short ME, Pei X, Wang S, Moley S, Sullivan M, Goetzel RZ. The Relationship between Health Risks and Health and Productivity Costs among Employees at Pepsi Bottling Group. J Occup Environ Med. 52, 5, May 2010.

• 74% of the sample is overweight or obese


Header/Full Bleed Image

Name/Subject Subhead

Title/caption

Title/caption

No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

Prevalence of Obesity

1990 1996 2006

Prevalence of Diabetes (Among US adults; BRFSS)

No Data <4% 4%–6% 6%–8% 8%–10% >10%


Vanderbilt – 8-Year Study

11


Vanderbilt: Obesity and Diabetes

12


Increased Health & Productivity Risks

MEDICAL

Chest/back pain, heart disease, GI disorders, headaches,

dizziness, weakness, repetitive motion injuries.

PSYCHOLOGICAL

Anxiety, aggression, irritability, apathy, boredom, depression, loneliness, fatigue, moodiness, insomnia.

BEHAVIORAL

Accidents, drug/alcohol abuse, eating disorders, smoking, tardiness, “exaggerated” diseases.

ORGANIZATIONAL

Absence, work relations, turnover, morale, job satisfaction, productivity.


The Vast Majority of Chronic Diseases Can Be

Prevented or Better Managed

The Centers for Disease Control and Prevention (CDC) estimates…

• 80% of heart disease and stroke

• 80% of type 2 diabetes

• 40% of cancer

…could be prevented if only Americans were to do three things:

• Stop smoking

• Start eating healthy

• Get in shape


What We Know

• Work = where you spend most of your waking hours

• Unique opportunities for employers to improve population health

• Benefits of workplace health promotion

• Improve employee health and well-being

• Decrease healthcare costs

• Increase worker productivity/performance


The Challenge

• Employers are…

• Not convinced of the

health and economic

benefits.

• Unsure about where or

how to begin.

• Unable to discern what

works or doesn’t work.

• Bombarded with

negative press

information.


The Confusion


Do Wellness Programs Work or Not?

Yes, if you do it right…

Leaders Managers Champions Employees


What is the Evidence Base?

A large proportion of diseases and disorders is preventable. Modifiable health risk

factors are precursors to a large number of diseases and disorders and to

premature death (Healthy People 2000, 2010, Amler & Dull, 1987, Breslow, 1993,

McGinnis & Foege, 1993, Mokdad et al., 2004)

Many modifiable health risks are associated with increased health care costs within

a relatively short time window (Milliman & Robinson, 1987, Yen et al., 1992, Goetzel, et

al., 1998, Anderson et al., 2000, Bertera, 1991, Pronk, 1999, Goetzel et al. 2012)

Modifiable health risks can be improved through workplace sponsored health

promotion and disease prevention programs (Wilson et al., 1996, Heaney & Goetzel,

1997, Pelletier, 1991, 1993, 1996, 1999, 2001, 2005, 2009, 2011, Soler et al., 2010)

Improvements in the health risk profile of a population can lead to reductions in

health costs (Edington et al., 2001, Goetzel et al., 1999, Carls et al., 2011)

Worksite health promotion and disease prevention programs save companies

money in health care expenditures and produce a positive ROI (Johnson & Johnson

2002, Citibank 1999-2000, Procter and Gamble 1998, Chevron 1998, California Public

Retirement System 1994, Bank of America 1993, Dupont 1990, Highmark 2008, Johnson &

Johnson 2011, Dell 2015)


Worksite Health Promotion Works!


CDC Community Guide to Preventive

Services Review – AJPM, February 2010 86 Studies Reviewed

21


Health Affairs ROI Literature Review

Baicker K, Cutler D, Song Z. Workplace Wellness Programs Can Generate Savings. Health Aff (Millwood). 2010; 29(2). Published online 14 January 2010.

A Review of the Evidence:




Title/caption

Title/caption




Title/caption

Title/caption




Title/caption

Title/caption

ACOEM Winners vs. S&P 500

And the Answer is…


Promoting Healthy Workplaces


Project Aims and Objectives

• Fill in the knowledge gap about what constitutes an effective health promotion (wellness) program.

• Identify how organizations are succeeding when implementing workplace programs.

• Share the ingredients of their “secret sauce” with the business community.

• Tell “stories with substance” to inspire more companies to start or improve health promotion programs at their worksites.


Approach

• Updated Literature Review

• Expert Roundtable Discussions

• Organizational structure

• Program implementation

• Measurement and evaluation

• Site Visits to nine Companies

• C. Everett Koop Award Winners/Honorable Mentions

• Recommendations


Expert Panel David Anderson, Ph.D.

David Ballard, Psy.D., M.B.A.

John Harris, M.Ed.

Rebecca Kelly, Ph.D., R.D.

Craig Nelson, M.S., D.C.

George Pfeiffer, M.S.E.

Bill Baun, EPD, CWP, FAWHP

David Hunnicutt

David DeJoy, Ph.D.

Kate Lorig, R.N., Dr.P.H.

Steve Aldana, Ph.D.

Tre McCallister, EdD, MA

Michael O’Donnell, Ph.D.

Dan Gold, Ph.D.

Kenneth R. Pelletier, Ph.D., MD

Bruce Pyenson, FSA, MAAA

Debra Lerner, Ph.D.

Seth Serxner, Ph.D.


Case Studies – Companies That Do It

“Right”

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


10. Measurement and Evaluation

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.”


What Does Not Work

•HRAs alone

•Health outcome incentive based models disconnected from a comprehensive health promotion program

•“Under the radar” stuff (provided by health plans)

•Short term campaigns – “biggest loser”

•Asking vendor to “fix the unhealthy people”

•Lots of biometric testing, with little else

•Poor marketing/communications – no customer input


Culture of Health = Value on Investment

• “It’s the right thing to do; not everything has to have an ROI”

• “Our people and their unique individual talents are valued”

• “Happy people, healthy people”

• Present, engaged, energized,

active, productive, satisfied

• Low turnover

• “Win as a team, lose as a team”

• “It’s who we are”




Title/caption

Title/caption

Workplace Health Promotion 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


Where We Need to Go…..

• Old Paradigm

• Bad behavior (poor diet)…leads to

• High risk condition (obesity)…leads to

• Disease (diabetes)…leads to

• Death

• New Paradigm

• Good health (physical, mental, emotional, social,

financial, spiritual)…leads to

• Well-being (energy)…leads to

• Purposeful life

AND HIGH VALUE


Learn More at….

http://www.jhsph.edu/promoting-healthy-workplaces







Thank You www.jhsph.edu/health-and-productivity-studies

Follow us on Twitter: @jhu_ihps

Connect with us on LinkedIn: https://www.linkedin.com/pub/institute-

for-health-and-productivity-studies/a0/651/717

http://www.jhsph.edu/health-and-productivity-studies







Health & Medicine

What Makes for a Healthy Workplace