Worksite Wellness:

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Worksite Wellness

• The Need, The Theory, and The Plan
• James L. Early, MD
• University of Kansas School of Medicine-Wichita

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Looking Back at America and American Healthcare
Over the Past 50 Years
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Lack of leisure-time physical activity among US
adults
Source Healthy People 2010. JE Manson et al.
Arch Int Med 2004 Feb 9 vol 164
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Now
Then
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Genetics loads the gun the environment pulls
the trigger. George Bray
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Leading Causes of Death for All Males and
FemalesUnited States 2001
500
Males
400
Females
300
Deaths in Thousands
200
100
0
A
B
C
D
E
A
B
D
E
F
A Total CVD D Chronic lower respiratory disease B
Cancer E Diabetes mellitus C Accidents F
Alzheimers disease
CVD, cardiovascular disease. Heart Disease and
Stroke Statistical 2004 Update. American Heart
Association.
11
The Economic Burden of CVD
368
350
Billions
300
250
239
200
133
150
100
54
56
29
50
0
Heart disease
CAD
Stroke
HTN
CHF
Total CVD
CAD, coronary artery disease CHF, congestive
heart failure CVD, cardiovascular disease HTN,
hypertension. Heart Disease and Stroke
Statistical 2004 Update. American Heart
Association.
12
Obesity Trends Among U.S. AdultsBRFSS, 1991,
1996, 2003
(BMI ?30, or about 30 lbs overweight for 54
person)
1996
2003
No Data 1519 2024 25
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Economic Cost of Obesity

• Economic causes and costs of obesity study
  presented at 14th European Congress on Obesity
• 96.7 billion was spent on obesity in 2003 in the
  U.S.
• Figures are comparable in western countries with
  rising rates of obesity

Wolf, AM. Health Economics of Obesity Economics -
New Insights presented at the 14th European
Congress on Obesity
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Prevalence of Diagnosed Diabetes Among US
Adults,1991-2001
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Cost of diabetes in the US, 2002

• Total (direct and indirect) 
• 132 billion
• Direct medical costs 92 billion
• Indirect costs 
• 40 billion (disability, work loss, premature
  mortality)

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Waist/Hip RatioAn Index of Abdominal Versus
Peripheral Obesity
High WHR (? 0.95 in men) (? 0.80 in women)
Low WHR (? 0.95 in men) (? 0.80 in women)
American Diabetes Association
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Visceral Fat DistributionNormal vs Type 2
Diabetes
Normal
Type 2 Diabetes
Courtesy of Wilfred Y. Fujimoto, MD.
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The Presence of 3 or More Risk Factors
Correlates With the Metabolic Syndrome (ATP III)
Third Report of the National Cholesterol
Education Program Expert Panel. Executive
Summary. NIH Publication No. 01-3670. May 2001.
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Metabolic Syndrome In Action
Insulin Resistance
HYPERINSULINEMIA
Hyperglycemia
IGT
Hyperinsulinemia
Early DM
Late DM
Hypertension
IFG
Weight Gain
Genetics
Cardiovascular Disease
Advancing Age
Source Dr. LaSalle
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Prevalence of the Metabolic Syndrome in the US
Ford ES, et al. JAMA 2002287356-9
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?
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Metabolic Syndrome Costs
IGT
Early DM
Hypertension
IFG
Late DM
Environment
Genetics
Obesity
Diuretics Ace inhibitors Beta blockers Alpha
agonists ARBs Other
Fluoride Pesticides Antibiotics Fertilizers Sunblo
cks Antireflux
Fertility drugs Aspirin
Herbal supplements OTC Phentermine Orlistat Sibutr
amine
Resins Fibrates Statins Niacin OTC Ezetimibe
Insulin Glitizones Sulfonylureas Biguanides Others

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IGT
Early DM
Hypertension
IFG
Late DM
Genetics
Obesity
Environment
Fertility drugs Aspirin
Fluoride Pesticides Antibiotics Fertilizers Sunblo
cks Antireflux
Herbal supplements OTC Phentermine Orlistat Sibutr
amine
Resins Fibrates Statins Niacin OTC Ezetimibe
Diuretics Ace inhibitors Beta blockers Alpha
agonists ARBs Other
Insulin Glitizones Sulfonylureas Biguanides Others

3.99 80.00 29.99 138.29 9.99
61.99 79.95 89.79
493.99 per month
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Total Yearly Cost for Our Sample Patient

• 5,927.88

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The average yearly pharmacy cost of treating
adult patients over age 20 with metabolic
syndrome exceeds 4,000, which is more than 4
times the average annual drug cost for all other
patients.
Medical Research News. May 9, 2005
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Trends in Age-Standardized Death Rates for the 6
Leading Causes of Death in theUnited States,
1970-2002
Rates are age-adjusted to the 2000 US standard
population.
Jemal A, Ward E, Hao Y, Thun, M. JAMA
20052941255-1259.Trends in the Leading Causes
of Death in the United States, 1970-2002.
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Corporate Cost of Healthcare
Employer Share
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Corporate Cost of Healthcare
Double Digit Yearly Cost Increase
Employer Share
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Increasing Cost of Coverage
Billions of dollars spent on health care coverage

• General Motors Corp. health care costs now
  account for 1,400 per vehicle

5.1 billion
4.5 billion
3 billion
The Detroit News, March 11, 2004, Ed Garsten
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Corporate Cost of Healthcare
Double Digit Yearly Cost Increase
Increasing Employee Premium/Co-pay/ Deductible
Employee Share
Employer Share
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Source KFF/HRET Survey of Employer-Sponsored
Health Benefits, 19992005.
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Corporate Cost of Healthcare
Double Digit Yearly Cost Increase
Increasing Employee Premium/Co-pay/ Deductible
Employee Share
Employer Share
Employers decreasing health coverage quantity
and/or quality
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Corporate Cost of Healthcare
Double Digit Yearly Cost Increase
Increasing Employee Premium/Co-pay/ Deductible
Employee Share
Employer Share
Employees opting out of Insurance coverage
Employers decreasing health coverage quantity
and/or quality
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The Rising Cost of Coverage

• In the past 4 years, the of employers offering
  health benefits has fallen from 69-60
• Health insurance premiums for a family of four
  now average almost 11,000 a year, with almost
  3,000 contributed by the employee

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Corporate Cost of Healthcare
Double Digit Yearly Cost Increase
Increasing Employee Premium/Co-pay/ Deductible
Employee Share
Employer Share
Employees opting out of Insurance coverage
Employers decreasing health coverage quantity
and/or quality
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Indirect Costs

• Absenteeism
• Presenteeism
• Low Worker Retention

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What are our options?
?
Employee Share
Employer Share
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What are our options?
?
Employee Share
Employer Share
Low Bid Mentality
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What are our options?
?
Employee Share
Employer Share
Low Bid Mentality
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What are our options?
?
Employee Share
Employer Share
Low Bid Mentality
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What are our options?
National or State run health care program
?
Employee Share
Employer Share
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20,673
10,373
Eisenberg, MJ, et al. Outcomes and Cost of
Coronary Artery Bypass Graft Surgery in the
United States and Canada. Archives of Internal
Medicine 20051651506-1513.
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What are the elements of a successful plan?

• A successful plan
• Must reflect the long-term goals of the
  individual and the company during the ups and
  downs of economic cycles
• Must be grounded on the passionate beliefs and
  priorities of not only the individual employee,
  but the entire company

ODonnell, M. A Simple Framework to Describe What
Works Best Improving Awareness, Enhancing
Motivation, Building Skills, and Providing
Opportunity, American Journal of Health
Promotion, 200520(1)1-6.
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What are the elements of a successful plan?

• Must take into consideration the current and
  pressing priorities of employees and the
  demonstrated priorities reflected in the
  companys healthcare experience.

ODonnell, M. A Simple Framework to Describe What
Works Best Improving Awareness, Enhancing
Motivation, Building Skills, and Providing
Opportunity, American Journal of Health
Promotion, 200520(1)1-6.
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Environment
SE
K
T
A
B
Baranowski T, Cullen KW, Nicklas T, Thompson D,
Baranowski J. Are Current Health Behavioral
Change Models Helpful in Guiding Prevention of
Weight Gain Efforts? Obes Res 2003 October
111(90001)23S-43.
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DELPHI Center

• Dedicated to the Enhancement of and Leadership in
  Population Health Improvement

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Community Partners
Community as a Whole
KU School of Medicine-Wichita Department of
Preventive Medicine and Public Health
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Love Box Company Long Term Approach

• A long term vision of wellness and preventive
  care
• A decade long passionate dedication to wellness
  and prevention
• A careful examination of the employees priorities
  and the companys health care experience

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Love Box Company Long Term Approach

• An organizational plan targeting 6-8 specific
  health behaviors or modifiable health risks
  associated with specific health outcomes
• Each risk/behavior will be the target of a
  3-month campaign.
• Each risk factor/behavior will recycle on an
  every two year basis.
• Each campaign will include elements of attitude,
  knowledge, skill-development, environmental
  change and self-care covenant.

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Potential Focus Area Targets

• Modifiable risk factors
• Normal Blood Pressure
• Normal Blood Sugars
• Normal Cholesterol
• Healthy Weight

• Health Behaviors
• Being a non smoker
• Being physically active
• Being emotionally healthy
• Eating a healthy diet

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Healthy Congregations in Action Initiative

• To engage members of the United Methodist
  Churches of Kansas in the development adoption
  of a comprehensive plan to improve the health and
  fitness of the clergy, staff congregants of
  their statewide denomination

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Strategies to Model Promote Healthy Lifestyles

• Self-Care Covenant
• Environmental changes directed through
  congregational self-assessments
• Social support opportunities
• Policies

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Strategies to Create Healthy Environments

• Modifications to meal, snack vending choices
• Physical activity opportunities
• Environments for self-reflection and meditation
• Safe environments for mental/emotional health
  resources
• Supportive social groups

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What if we do nothing?
Employee Share
Employer Share
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What if We Do Nothing?
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What if we get it right?
Employee Share
Employer Share
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Health
Insurance Cost
10 Years
20 Years