Total Health Management: Piecing the Puzzle Together Presented by: Stephanie A. LaPlant, MA Wellness

1
Total Health Management Piecing the Puzzle
TogetherPresented by Stephanie A. LaPlant,
MAWellness Coordinator
2
Learning Objectives

• Discuss the Total Health Management puzzle.
• Assess current puzzle pieces.
• Establish a plan for creating a complete puzzle.

3
A Primary Shift in Paradigm

• Yesterdays assumption Health is a cost driver.
  
• Initiatives to improve employee health are
  primarily a strategy for controlling a top-line
  expense.
• Todays reality Healthy employees are a
  performance driver.
• Investing in health not only controls expenses,
  but also protects, supports, and enhances human
  capital.
• It is fundamental to a healthier bottom line.

4
EAP
Health Promotion
Demand Disease Mgmt.
Common Approach Individual Program Management
Environmental Safety Health
Group Health
Workers Comp.
Compensation Programs
Absence Disability
5
Integrated Health, Safety and Productivity
Management Putting the Pieces Together
Demand Disease Mgmt.
Group Health
Health Promotion
EAP
Compensation Programs
Absence Disability
Environmental Safety Health
Workers Comp.
6

• The Problem with our Puzzle

7
The Problem

• 60 of Business Roundtable CEOs cited healthcare
  costs as their number one cost pressure for the
  second year in a row.
• Productivity losses related to health problems
  cost U.S. employers an estimated 225.8 billion
  annually.
• Almost half of 1,400 CFOs surveyed said they
  expected healthcare costs to account for the
  biggest increase in the costs of doing business
  in the next 12 months.
• An overweight employee annually costs their
  employer an additional 450 to 2,500 in medical
  expenses and absences.

8
Pressures on Corporate America

• We now work 164 more hours per year than 20
  years ago.
• Less active due to technology.
• The average annual healthcare cost per person in
  the U.S. exceeds 3,000.
• It does not have to be this way
• Preventable illnesses make up approximately 70
  of the entire burden of illness and associated
  costs in the U.S.
• At least 25 of healthcare costs incurred by
  working adults are attributed to modifiable
  health risks such as diet exercise.

9
(No Transcript)
10
(No Transcript)
11
(No Transcript)
12
(No Transcript)
13
(No Transcript)
14
(No Transcript)
15
(No Transcript)
16
Current Status Is it a balancing act?

• Business case for increased employer investment
  in health, safety productivity management
  programs.
• Healthy fit employees
• Consume fewer health care resources,
• Are absent from work less frequently,
• Have fewer accidents,
• Are more productive, and
• Contribute more effectively to the workplace.
• But employers are still hesitant to offer
  sufficiently intensive and comprehensive health,
  safety and productivity management programs.

17
Why the hesitation?

• Does health, safety, productivity management
  improve health achieve bottom line impact?
• While some employers may believe that health
  promotion programs exert a positive effect, they
  may not know which elements of this programs are
  more effective and which are less so.
• Employers may feel at a loss when attempting to
  identify and implement effective programs on
  their own.

18
The Challenge!

• Not only are companys more complex, so are
  employees as it relates to their health
  productivity
• Medical
• Psychological
• Behavioral
• Organizational

19

• The Solution to Putting our Puzzle Together

20
Employers Need to Consider a Total Health
Strategy

• Workers health and safety impacts their
  productivity
• -and productivity impacts organization
  performance and competitiveness.
• Bottom line
• -Employers have an important role to play in
  managing employee health, safety and productivity.

21
Adapted from American Journal of Health
Promotion, Volume 19(4).March/April 2005.3,
Article retrieved May 24, 2007.
22
Case for Total Health Management

• A 3.50-to-1 savings in reduced absenteeism and
  healthcare costs.
• Reducing just one health risk increases
  productivity on the job by 9 and reduces
  absenteeism by 2.
• An employee at low risk saves a company about
  350 per year.
• Number of working Americans who get no exercise
  is 2 times higher among those who have no access
  to workplace fitness programs.

23
In Review

• Poor health is responsible for unnecessary and
  avoidable medical claims, safety and productivity
  losses
• Providing health benefits alone is not enough
• Coordination is needed across health benefits,
  health promotion, workers compensation,
  non-occupational disability, occupational health
  and safety, behavioral health, organizational
  development to maximize the impact of a package
  of human resources programs
• Successful health, safety, and productivity
  management programs can save more money than they
  cost and thus achieve a significant and positive
  ROI for the organization.

24
Integrated Health, Safety and Productivity
Management Putting the Pieces Together
Demand Disease Mgmt.
Group Health
Health Promotion
EAP
Compensation Programs
Absence Disability
Environmental Safety Health
Workers Comp.
25

• How do we put the puzzle together?

26
Vision of Integration
Phase I Identify Problem Collect Data
Phase IV Measurement Evaluation
Phase III Intervention
Phase II Strategic and Tactical Planning
27
EAP Employee Assistant Program

• Maximizes employee Potential
• Conflict resolution
• Work-life services
• Mental health services
• Critical incident response
• Management/employee training
• Review quarterly report
• Educate employees on services offered by EAP.

28
Group Health

• Analyze insurance data
• Demographic breakdown, including dependents.
• Top chronic health conditions.
• Top pharmaceuticals.
• Top diagnostic groups based on claims paid.
• Quality risk measures for a condition

29
Health Promotion

• As defined by the World Health Organization, is
  the process of enabling people to increase
  control over, and to improve, their health.
• Health Risk Assessment
• Programs
• Media
• Challenges events

30
Health Risk Assessment

• Employee health behaviors and risk factors.
• Key component effective communication about the
  purpose and process.
• Aggregate report to target wellness program
  what employees want and what health risks are
  prevalent.
• Consider incentives to increase participation

31
Demand Disease Management

• Demand Healthcare
• Takes a patient-centered approach to providing
  care.
• May lower costs by reducing the use of
  unnecessary or redundant services.
• Patients may suffer from one or more chronic
  disease, making coordination of services
  essential.

32
Compensation Programs

• Needs to consistently recognize employee and
  compensate for superior performance.
• Should direct individual behavior towards
  achieving common company goals.
• Should be designed to affect favorable change in
  the organization.
• Results oriented, not action oriented.
• Flexibility, to meet the unique needs of a
  company.

33
Environmental Safety Health

• OSHA
• General Duty Clause
• Recognition of Hazards
• Job Analysis
• Prevention control measures
• Training
• Inclusion of employees in safety health
  decisions.

34
Workers Compensation

• Review demographic data
• Review OSHA logs
• Look for trends with certain job
  descriptions/movements
• Look for correlations between sick hours, total
  hours worked, accident hours

35
Absence Disability

• An area to reduce costs without reducing
  benefits.
• Review of data to know absent/sick rate.
• Case management when related to injury.
• Program design

36
Before interveningdefine the problem.

• Areas of focus
• Medical
• Absence/Disability
• Diagnostic tools
• Medical claims analysis
• Review of absence disability records
• Analysis of HRA and presenteeism survey data.

37

• Tools to help you
• put the pieces together.

38
Measuring Results

• Primary Outcome Measures
• -Medical cost savings change in trend.
• -Productivity Workers compensation, scattered
  absent and short term disability, change in
  trend.
• Secondary Outcome Measures
• -Risk reduction
• -Risk avoidance
• -Disease control management
• -Participation
• Pre-Outcome Measures
• -Health status
• -Exercise minutes per day
• -High fiber and low fat diet
• -Eight glasses of water
• -Stages of change

39
Return-on-Investment (ROI)

• What is it?
• A form of cost-benefit analysis that measures the
  costs of a program (i.e., the investment) versus
  the financial return realized by that program.
• Can be used to evaluate the impact of an existing
  program, but is more often used to determine
  whether a program should be implemented.
• ROINet Benefits/Net Costs x 100

40
ROI Example

• Company X Worksite Wellness Program Projected
  Costs

41
ROI example continued
The projected ROI for the program is projected to
be 4.0. A savings/cost ratio of 4 for every 1
spent on the program. The overall savings of
the program was 300,000.
42
Challenges of ROI

• Adequate data to measure costs/benefits.
• Employer size affecting data collection.
• Inflation discount adjustments.
• Quantifying non-tangible benefits costs.

43
Measures for ROI

• Employee productivity
• Short- Long-term disability
• Workers compensation
• Absenteeism
• Pensions
• Life insurance
• Recruitment retention
• Although, getting data can be a challenge.

44
How do you increase ROI?

• 1. Manage three populations (champions, grass
  roots, employees).
• 2. Conduct regular needs assessments.
• 3. Nurture a culture of safety health.
• 4. Position your program (THM) powerfully.
• 5. Target your communications.
• 6. Reach out touch them!
• 7. Offer a menu of intervention options (to
  management employees).
• 8. Use incentives, but use them wisely.
• 9. Measure meaningful aspects of participation.
• 10. Establish specific goals and objectivesand
  manage them.

45
Lower-cost policies and environmental
interventions

• Consistent and frequent prevention messages.
• Accessible blood pressure monitors and AEDs.
• Heart-healthy and low-cost cafeteria and vending
  machine choices.
• Smoke-free policies (campus, vehicles).
• Clearly marked walking paths and places to
  exercise.
• Signage to encourage stair use.
• Mentoring programs with employees (successes).
• Partnerships with larger wellness programs in the
  community.

46
Collect Data

• Three examples of essential measuring tools
• Employee Health Risk Assessments (HRA)
• Company-wide Health Culture Audit
• Employee Interest Survey

47
Company-wide Health Culture Audit

• Assess companys health norms, employees
  individual attitudes about health, and the
  personal perceptions that exist concerning health
  and well-being.
• Gives an idea of how employees are perceiving a
  safety health initiative.
• www.healthyculture.com

48
Individual Interest Survey

• Health interests
• Are the programs interventions important to
  employees?
• Make employees feel part of the process they
  have a buy-in to the program.
• Will increase participation in programs if
  designed understanding what employees interests,
  formats, etc. are.

49
Case Studies
50
Union Pacific Railroad Company

• 47,000 employees
• 95 male with an avg. age of 46 years.
• In 1990, 29 of its total health care costs were
  related to lifestyle factors, such as smokingby
  2001, there percentage was reduced to 18.8.
• 4-tiered feedback process.
• On-site occupational nurses implemented at sites.

51
Union Pacific Strategy

• Determine most effective intervention strategy
  for employees to reach and maintain their optimum
  weight.
• Investigate how stage-based messaging can be used
  to help employees manage their weight (grant from
  NHLB).
• Quantify the loss of productivity costs
  associated with various lifestyle risk factors
  and chronic health conditions (partner with
  Harvard Medical School).
• Design an outreach model to influence community
  health policies and procedures in order to
  promote employee health in a more comprehensive
  setting.

52
Highsmith Company Fort Atkinson, WI

• 225 employees
• Total Commitment to Developing Human
  PotentialAccess to Learning OpportunitiesGrowth
  as an Individual and as a Company
• On-site health educators
• Health screenings
• Review annual claims, workers comp. information
  and health screening aggregate information.

53
Highsmith Outcomes

• 53 decrease total cholesterol high risk
  employees.
• 60 decrease high-risk LDL employees.
• 52 decrease high blood pressure.
• Health care premiums have risen by an average of
  only 4.9/yr.
• Decreased turnover workers compensation for
  participants.

54
Case Study 1 Local Publishing Company

• No. of employees 400
• History of service
• Mid. 1990s placement of on-site services.
• RN, NP, Therapy
• Puzzle pieces

Environmental Safety Health
Workers Compensation
Demand Disease Mgmt.
55
Case Study 1
56
On-site RN Activity Report
57
Case Study 1
58
Case Study 1
59
Case Study 2 Local Manufacturing Company

• No. of employees 466
• Wisconsin site for global company
• History of service
• 12 years of on-site providers
• RN, NP, Therapy
• Puzzle pieces

Environmental Safety Health
Workers Compensation
Health Promotion
60
Case Study 2
61
Case Study 2
62
Goal of Early Intervention
63
Case Study 3 Local Paper Mill

• No. of employees 215
• History of service 3 years
• RN, Therapy
• Puzzle pieces

Absence Disability
Health Promotion
Environmental Safety Health
64
Case Study 3
65
OHN Monthly Report - June 2007
66
Case Study 4 Manufacturing Company

• No. of employees 120
• Service Health data management consultation
• Puzzle pieces

EAP
Group Health
67
Insurance Data Review Manufacturing Company

• Top 3s
• Analyzed insurance data, 2 topics used to help
  define proposal.
• Top 3 Pharmaceuticals Antidepressants,
  Tranquilizers/Antipsychotics, Insulins
• Top 3 Chronic Conditions (cost, frequency) Back
  Pain, Depression, Headache
• Suggested Areas of focus
• Mental Health
• Womens Health
• Diabetes

68
Case Study 5 Local Retail Company

• No. of employees 400
• History of service 1.5 years
• Health education, on-site services
• Puzzle piece

Demand Disease Mgmt.
EAP
Health Promotion
Workers Compensation
69
Case Study 5

• On-site Therapy
• Wellness program Healthy Rewards
• HRA, Coaching follow-up
• Case Management

70
Case Study 5
71
Case Study 6 Utility Company

• No. of employees 400
• History of Service on-site RN 1.5 years
• Puzzle piece

Health Promotion
Environmental Safety Health
72
Case Study 6
73
Case Study 6
74
Case Study 7 - Local Produce Farm

• No. of employees 200
• History of Service Wellness programming for 1 ½
  years.
• Puzzle piece

Health Promotion
75
Case Study 7

• Get Moving program
• Total team weight loss 434 lbs.!
• The biggest loser lost 43 lbs. and stopped
  taking hypertension and diabetes medication.

76
Final Comments

• Goal Create a puzzle that is integrated to
  strengthen the effectiveness of each puzzle
  piece.

77
Thank YouQuestion/Answer
78
References

• American College of Occupational and
  Environmental Medicine Health Wellness in the
  Workplace Lessons and Best Practices from the
  Corporate Health Achievement Award
  www.chaa.org.
• American Heart Association Start! Presentation
  www.americanheart.org.
• American Journal of Health Promotion, Volume
  19(4). March/April 2005.3, Article retrieved May
  24, 2007.
• Anderson, David, PhD. Participation Builders to
  Increase ROI WELCOA www.welcoa.org.
• Cavallo, David, M.P.H. Health Promotion
  Economics, Using Return on Investment Analysis to
  Evaluate Health Promotion Programs Challenges
  and Opportunities RTI-UNC Center of Excellence
  in Health Promotion Economics November 2006,
  vol. 1, issue 3.
• Goetzel, PhD., Ron Z. Examining the Value of
  Integrating Occupational Health, Safety
  Productivity Presentation at CDC-NIOSH Steps to
  a Healthier U.S. Workforce Symposium Healthy
  Protection Promotion Policy and Practice
  Working Group.

79
References continued

• Hunnicut, David, PhD. By the Numbers, WELCOA,
  2007. www.welcoa.org.
• Matson Koffman DM, Molloy M, Agin L, Sokler L.
  Reducing the Risk of Heart Disease and Stroke A
  Six-Step Guide for Employers Centers for Disease
  Control http//www.cdc.gov/dhdsp/library/toolkit/
  pdfs/six_step_guide.pdf.
• Occupational Safety Health Administration
  www.osha.gov.
• The University of Michigan Health Management
  Research Center Health Management as a Serious
  Business Strategy www.hmrc.umich.edu.
• Partnership for Prevention. Leading by Example
  Improving the Bottom Line Through a High
  Performance, Less Costly Workforce CEOs on the
  Business Case for Worksite Health Promotion,
  www.prevent.org.
• Vocino, Joe HR Compensation Continues to Rise
  Rising Compensation Reflects an Improving Economy
  and HRs Role in Corporate Growth HR Magazine
  November, 2004.
• Wellness Councils of America Well Workplace
  Award Executive Summary Highsmith Inc.,
  Wisconsin www.welcoa.org.