Extreme Makeover Corporate Edition Reality TV Meets OEM, Showing You Hot Health and Productivity Man

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Extreme Makeover Corporate EditionReality TV
Meets OEM,Showing You Hot Health and
Productivity Management (HPM) Design Tips!

• Brian D. Harrison MD, FACOEM
• Medical Director, Affinity Health and
  Productivity Management
• 9/16/05 WAHU Conference

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The following slides are the Handout Version
of Dr. Harrisons talk. Together with the
bibliography, they contain all the information in
the presentation, minus the pictures. But you
may get lost if you try to follow this handout
during the talk. Instead, sit back and watch the
show!
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Now Lets Hear From Our Team of Designers
(They Know a LOT) What Corporate Health Ideas
Are Really RED HOT?
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Unlike Home Designers on THE LEARNING
CHANNELWe Use Corporate Execs for Our Expert
Panel
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WBGH/Watson Wyatt 2003 Survey of Corporate Execs
What do you do about those huge premium checks?

• Without competitive bidding wed be lost!
• Require your employees to share that cost!
• Make the health plans show quality believe me I
  know!
• Clinical case management will surely help the
  cash grow (and this wallpaper is killing me one
  of us has to go!)

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More Thoughts as Our Team Flies into Action

• How do you improve employee satisfaction?
• Flexible work arrangements work for me!
• You cant beat a good corporate EAP!
• Work and family programs are a big winner!
• To really make em happy give em a fitness
  center!

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What else do our experts advise? (WBGH/Watson
Wyatt 2003 Survey)

• How can you help employees live healthier lives?
• Again, you need that fitness center!
• But Health Promotion Programs are really better!
• Do you have an on-site medical clinic? Its a
  must!
• Duh? Without disease management your programs a
  bust!
• Im a traditionalist! Modernism be cursed
  Safety First, Safety First!

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OK Experts, With Your Powers of Deduction

• Now theyre happy, now theyre healthy What
  helps their production?
• A must-have, its true - EAP I say to you!
• Theyre not productive if never at work RTW
  initiatives, RTW program, RTW supervisor training
  a triple whammy will do!
• Another reason an on-site medical clinic will
  click!
• ALL THOSE THINGS will! Why, its automatic!
• (if theyre healthy and happy, production is
  never crappy)

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DESIGNERS HAVE BUT, THEIR HEADS IN THE CLOUDS AND
BUDGETS THAT ARE BLING! WHAT CAN WE DO, WITH OUR
OWN HPM THING?
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WE WANT A MAKEOVERNOT LIFESTYLES OF THE RICH AND
FAMOUS!WE JUST NEED SOMETHING THATS CHEAP!(BUT
THAT STILL WONT SHAME US!)
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Were Hurtin for Certain!

• The average employer in ACOEM survey only does 6
  out of 32 possible Value-Focused Activities in
  employee health
• The main difference between those that do more
  and those that do less available data and
  benchmarking not just dollars!

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What is it you like the LEAST when you look into
the mirror?Our makeover team will bring your
corporate health dreams nearer!
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We Do an Annual HRA, But I Am Ashamed to Say

• Participation is low! My popularity is LOST!
• Management wants to know what they got for the
  cost!
• We got the corporate report and here it will
  sit!
• Employees want to know whats next Is this it?

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Lets Start With That Embarrassing Participation
Rate!You know, its what determines your
programs fate!
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Youre Smart to Care About Your Participation
Rate Youve Got to Getem to Cooperate!

• The rate of return is driven by the participation
  rate greater than 3 to 1 if participation rate
  goes over 50 (Summex, 2001).
• Positive ROI can be achieved just with HRA
  participation, even if follow-up participation is
  low (Citibank 51 participation in HRA, 5
  completion of follow-up, yet ROI almost 51).
• High HRA participation is needed to change
  company culture.

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Whats on Their MindAll the Time?

• What do employees care about? (per Summex 2001)
• Improved compensation, security, financial
  protection no doubt
• Privacy and confidentiality they dont want to
  lose
• Few constraints, freedom to choose
• Self-service ( but with support of course!)

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They Want the Same Things As You!

• Shifting costs now means they pay too
• 83 of execs say cost shifting is what they do
• Employee share is up 50 in 5 years - thats
  whats new
• Youve been Trading Spaces (TLC Sat. 9PM EST),
  they and you!

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Home Builder, Bill Duggan, (Curb Appeal, HGTV
Wednesdays) hes no clodJust Repainting the
Front Door Can Transform Your Homes Facade!
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Change the HRA Front Door!

• Cash incentive just a little bit more
• For 25, fifty percent would
• If 100 then 90 could
• But paying 100 is all you should (StayWell
  Corporation)
• Cash isnt the only thing that brings this about
  -
• Pitney Bowes adds to a health spending account
• Sometimes even a pedometer gets them out.

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Wondering What Not To Wear?(TLC, Fri. 8PM
EST)How About Making Employees Go Bare?

• No HRA means no health plan
• if you work for Birmingham!
• Incentives versus disincentives
• City of Birmingham, Alabama Annual
  participation HRA required to receive healthcare
  coverage. Participation rate 97.5, healthcare
  costs nearly flat over five years (SHOCKING yes,
  but it does work!)

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ConfidentialityPerception is Reality!

• Without it, your program is badly broken!
• It is not like Clean Sweep (TLC, Saturdays)
  -dont haul junk into the open!
• Besides, info that is aggregated is the only
  kind thats management-related
• Consider out-sourcing for just that reason
• HIPAA statement on the HRA is very eye-pleasing

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We Cant Get em to Come to the InterventionThe
Numbers are Too Small to Even Mention

• Target the interventions The right individual
  should be identified and recruited (by the HRA
  vendor).
• Heaney and Goetzel (1997) 48 studies of
  multi-component programs, effective programs
  target those at risk for individual counseling.
• Erfurt and Foote (1993) Participation in
  interventions increased 500 by targeting.

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No BLING? Have to Design on a Dime?(HGTV
Mondays, 10PM EST)Then do just one thing on your
first time

• Like BP, Depression, Smoking
• Single Risks as Index to Other Problems
• Edington Likelihood of association with other
  risks (e.g. - if in the high risk BP category,
  how likely to be at high risk overall?)
• Diastolic BP risk group 48 have 4 or more
  risks
• Systolic BP group 43
• Smokers 38
• n16,879
• Austin Kostecki Depressed employees are 8.5
  of workforce but account for 18 of STD

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Because One Thing Will Lead to AnotherCertain
Risks are Key, You Will Discover!

• Find the hypertensives (hint check their BP)
• Find the smokers (hint they go outside on
  break)
• Find depressed employees (hint screening tools
  like Beck, Prime MD)

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Let the Employees do Some of the Choosing There
are Popular Ones to Consider Using

• HRA asks areas of interest.
• Offer a variety of simple programs (Quality of
  Work Life Programs, per Chapman) for goodwill and
  fun let them pick.
• This gets them ready for more important HPM
  programs (disease management, risk management)
  services for which they are individually invited

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So What if its Popular With Employees -Its
Those Management Tight Wads I Have to Please!
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The Sell This House TV Crew (A E
Sundays)Comes to Your Budgetary Rescue!

• They get three days to make a contestants house
  show well to potential buyers.
• They remove clutter and outdated décor! They play
  up the good points!
• And they know this is not your fathers
  corporate wellness program!

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IN GOD WE TRUST

• All else MUST show data!

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EMPLOYER HEALTH CARE SPENDING -WHICH IS IT?

• Benefit a gift you buy to make someone happy a
  purchase from surplus
• Commodity a necessity you buy from the lowest
  bidder, only as much as you must have an expense
  against the middle line
• Investment - considered purchase based on ROI,
  including risk and return. If its good, BUY ALL
  YOU CAN GET! It will be a credit to the top line!
  

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The Corporate HRA Report Doesnt Get a Second
Glance!(What do you want, it should sing and
dance?)

• Use it to show present and future costs (well
  show you how)
• Repeat HRA to set the stage for ROI calculation
• Make it the linchpin to all your other programs
• Risk stratify your population.
• Identify top risk categories and chronic
  diseases, prioritize interventions accordingly

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Your Corporate HRA Reports Show Money At Risk
to Tight Wad Sorts

• Monetize the annual lost productivity costs,
  using (from the HRA report)
• Disease prevalence (With Benchmarks).
• Self reported productivity losses
• By disease category.
• Mean per affected employee, compared to
  unaffected.
• Total excess disease-associated productivity
  loss.
• Self reported aggregate losses compared to
  literature benchmarks
• This was the cost of doing nothing!

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Design on a Dime (HGTV Mondays, 10PM EST)Tips
to use if you havent got time!

• Goetzel (JOEM 04/04) estimated distributed annual
  costs per employee (not just affected employees),
  medical productivity
• Hypertension 392
• Depression/mental illness 348
• Arthritis 327
• Heart disease (368) had the highest
  proportionate medical cost (81).
• Migraine Headache (213) had the highest
  proportionate presenteeism cost (89).

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But watch out for these design traps!

• Guessing prevalence is like shooting craps!
• Allergy 9 41
• Arthritis 3.5 - 20
• Asthma 4 - 8.5
• Depression 3 - 20
• Diabetes 2 - 6
• Heart Disease 1 16.9
• Hypertension 8.5 19
• Migraine 8 - 26
• Smoking 12 - 31

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Attention All Benefits Management Boys and
GirlsAccessorize Your Claims Data Base With
HRA Pearls!

• HRA Beats Claims Data at Counting
  SymptomCategorized Conditions (Migraine,
  Depression, Backache)

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Get Them to Open the Corporate PurseBy Showing
its For Better or For Worse (TLC, Wed.)

• Employee Health Wellness Its a long-term
  commitment!
• Predictive modeling (Yen and Edington, JOEM
  10/03) factors that raise medical costs.
• Dropping one point on aggregate wellness score
  equals 56/employee.
• Additional mean year of age 88/employee.
• Development of chronic disease 3,574/affected
  employee.

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Then You Can Persuade Management to do Extreme
Makeover (ABC Sundays)

• Or at Least, Design-On-A-Dime (HGTV Mondays)

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Here is Your Extreme Makeover Corporate
Edition!We Can Make You Look Like

• Pitney Bowes
• Healthcare University
• Integrated Database
• Healthy Work Environment
• On-Site Clinics
• Disability Management

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Here is Your Extreme Makeover Corporate
Edition!We Can Make You Look Like

• International Truck
• Vital Lives Program
• Healthwise Self Care Program
• Trucking Across North America Program
  (Fitness/Wellness Log, On-Site Fitness Centers).
• Allergy HPM Research

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Here is Your Extreme Makeover Corporate
Edition!We Can Make You Look Like

• Merrill Lynch
• Wellness Inventory at Health Fairs
• Risk Categorization for Absenteeism and
  Presenteeism
• Allergy Intervention
• FleetBoston Financial
• PATH Program Multi-Component Management and
  Prevention of Disabilities

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Here is Your Extreme Makeover Corporate
Edition!We Can Make You Look Like

• Federal Reserve Bank of Dallas
• Musculoskeletal Disorders HPM Intervention
• Calculated Baseline of Direct and Indirect
  Economic Impacts (Work Limitations
  Questionnaire-WLQ).
• Musculoskeletal Disorders Education, Promotion of
  Health Behaviors, Enhanced Communication to
  Medical Provider, Positive ROI on Outcomes
  Measurement

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Here is Your Extreme Makeover Corporate
Edition!We Can Make You Look Like

• United Auto Workers General Motors LifeSteps.
• Nationwide as well as focused pilot
  interventions.
• Website, online managers programs, newsletters,
  self care book, toll free audio health library,
  follow-up calls, vouchers for high risk
  participants, wellness support programs.
• Improvement in the population flow of risk
  status, reduction in days of disability.

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Here is Your Extreme Makeover Corporate
Edition!We Can Make You Look Like

• Union Pacific Railroad
• Multi-site interventions for smoking, weight,
  fatigue, inactivity, depression, asthma, BP,
  lipids, stress, diabetes
• Developed one of countrys largest fitness
  systems 535 Rolling Gyms
• Reduced lifestyle-related health care claims 10

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Here is Your Extreme Makeover Corporate
Edition!We Can Make You Look Like

• Johnson Johnson Health Wellness Program (JJ
  HWP) Since 1980
• Increasing integration over time health,
  wellness, disability management, EAP, OEM,
  benefits, fitness
• 90 participation due to financial incentives
  such as 500 insurance premium discount, and
  corporate culture)
• Published positive outcomes (224 health care
  savings per employee per year) and improved
  employee health risk category (most
  cholesterol, fiber, exercise, smoking, BP least
  BMI, diabetes risk, fat intake)

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I Cant Go On!I have a confession!Corporate
Redesign is not my Profession!

• Im a plain old ordinary
• Occ Med Physician
• And Hospital-Based is my Real Position

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But you can do HPM even down in the trencheswith
HRA for lumber and reports for wrenches
Grassroots HPM may be a patchwork thingCommunity
interventions tied up with stringBut it still
gets you numbers that make it look niceat least
enough to get clients to look at it twiceThe
point is employers want to do the right
thing-you can help their employees do healthier
living
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So much for TV fantasyHeres some at-home
reality Our 5,000 employee Health Care
Organization took a pokeAt helping its
employees who cant help but smoke
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Employee Smoking Trends
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Absence from work by smoking category (any cause)
- BEFORE
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Absence from work by smoking category (any cause)
- AFTER
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Excess Absence (Relative to Never Smokers) in
Days/yr for Ever Smokers

• 2001 (adjusted to 5K pop)
• 2,997.39

• 2004 (adjusted to 5K pop)
• 589.76
• Decreased by
• 2,407.63
• Reduced by both lower current prevalence and
  lower mean days absent in all groups

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Dollar value of reduced absenteeism

• 2,407.63 fewer days x 162.64 average daily wage
• 391,577 per year (wage replacement only)
• ROI 7 return for each 1 invested

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Why not go beyond smoking cessation?And how
about studying more than one corporation?Nine
disease HPM analysis in Manufacturing Corporation
HRA
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DISEASE PREVALENCE Company A 2005
Blue community ranges Red company Green
typical workforce
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BP Trends Company A 2003 2005 Prevalen
ce 16.0 20.0 On Medication
11.0 15.0 High Reading 12.6 8.1

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Absence Incidence, Company A, 2005 (Note after
BP, migraine and smoking interventions)
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Presenteeism Incidence, Company A 2005 (Note
after BP, Migraine, and Smoking Interventions)
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COST OF EXCESS LOST PRODUCTIVITY BY CATEGORY
(SELF-REPORTED) 2004 Company B (1213 person HRA)

•   1) Current Smoker 84,073
• 2)      Depression 82,612
• 3) Allergy 56,151
• 4)      Migraine 49,074
• 5)      Arthritis 46,305
• 6)      Heart Disease 19,845
• 7) Hypertension 17,999
• 8)      Diabetes 9,538
• 9)      Asthma 8,922

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COST OF EXCESS LOST PRODUCTIVITY BY CATEGORY
(SELF-REPORTED) 2005 Company A

• Depression 107,906
• Arthritis 75,911
• Allergy 53,744
• Hypertension 40,360
• Heart Disease 26,558
• Diabetes 17,357
• Asthma 13,802
• Current Smoker 7,737
• Migraine 0

was 37,641 in 2003
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So, Whats the Moral, After All?Dont Sit by
the Phone, Hoping Page Davis will Call

• Go ahead, try HPM
• Even if your Corporation is small