North Carolina Supplemental Cardiovascular Disease Prevention Project: Design and Objectives

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What do we really know

• About ROI?

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What was the problem?

• Performance was not real

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What was the problem?

• Took credit for something he did not create

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What is the Wellness Hook?
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ROI - The Wellness Hook

• Sometimes we
• talk about ROI in ways that are not real
• take credit for an ROI that we did not create

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What do we really know

• About ROI?

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Why are we talking about ROI?
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U.S. Health Care as a Percentage of the GDP
Today 16 of GDP
US Military uses 3.2
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Annual Spending per Capita
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Infant Mortality
2001, General Accounting Office, 2004
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Life Expectancy in the World
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Life Expectancy in the World
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Cost Shifting
Employer Health Benefits 2005 Annual Survey
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Cost Absorbing?
Bureau of Labor Statistics
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U.S. Health Care as a Percentage of the GDP
Today 16 of GDP
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U.S. Health Care as a Percentage of the GDP
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U.S. Health Care as a Percentage of the GDP
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U.S. Health Care as a Percentage of the GDP
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U.S. Health Care as a Percentage of the GDP
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Doctor Day, January 1, 2226
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Health Care Costs for Each Person
Centers for Medicare and Medicaid Services
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Health Care Costs for Each Person
7490
Centers for Medicare and Medicaid Services
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Relative Costs of Poor Health
Health Care Costs
Workers Comp
Absenteeism
Presenteeism
Edington, Burton. A Practical Approach to
Occupational and Environmental Medicine
(McCunney). 140-152. 2003.
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LPT
Presenteeism
Absenteeism

inability to concentrate poor interpersonal
communication need to repeat a job work more
slowly
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Value of Lost Productivity
Annual Health Care Costs
3 X
1. Edington DW, Burton WN. Health and
productivity. In McCunney, RJ A Practical
Approach to Occupational and Environmental
Medicine. PhiladelphiaLippincott Williams
Wilkins. 3rd ed. 2003140-152. 2. Burton WN,
Pransky G, Conti DJ, Chen CY, Edington DW. The
association of medical conditions and
presenteeism. J Occup Environ Med. 200446(6)
supplS38-S45. 3. Pelletier B, Boles M, Lynch W.
Change in health risks and work productivity over
time. J Occup Environ Med. 200446(7)746-754. 4.
Goetzel RZ, Long SR, Ozminkowski RJ, Hawkins K,
Wang S, Lynch W. Health, absence, disability, and
presenteeism cost estimates of certain physical
and mental health conditions affecting U.S.
Employers. J Occup Environ Med.
200446(4)398-412.
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More Risk Greater Cost
Dee Edington, Health Management Research Center
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Average Medical Care Costs
N1,706
StayWell Health Management
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Medical Care Costs by Age and Risk
N43,687
StayWell Health Management
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Days Absent
N941
StayWell Health Management
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Workers Comp
N23,916
StayWell Health Management
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STD Claims
N23,916
StayWell Health Management
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What is driving cost?
Chronic disease
Health care costs
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Portion of Total Health Care Costs Caused by
Chronic Diseases
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Obesity Trends Among U.S. Adults1985
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Obesity Trends Among U.S. Adults1987
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Obesity Trends Among U.S. Adults1989
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Obesity Trends Among U.S. Adults1991
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Obesity Trends Among U.S. Adults1993
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Obesity Trends Among U.S. Adults1995
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Obesity Trends Among U.S. Adults1997
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Obesity Trends Among U.S. Adults1999
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Obesity Trends Among U.S. Adults2001
No Data lt10 1014
1519 2024
25
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Obesity Trends Among U.S. Adults2003
No Data lt10 1014
1519 2024
25
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Obesity Trends Among U.S. Adults2005
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Obesity Trends Among U.S. Adults2006
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Excess Body Weight and Reduction of Lifespan
-3.1
-3.3
-5.8
-7.1
Ann Intern Med. 200313824-32
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Diabetes Among Adults in the U.S.,BRFSS 1990
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Diabetes Among Adults in the U.S.,BRFSS 1992

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Diabetes Among Adults in the U.S.,BRFSS 1994
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Diabetes Among Adults in the U.S.,BRFSS 1996
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Diabetes Among Adults in the U.S.,BRFSS 1998
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Diabetes Among Adults in the U.S.,BRFSS 2000
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Diabetes Among Adults in the U.S.,BRFSS 2001
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Diabetes and Reduction in Lifespan
-14.3 yrs
-11.6 yrs
JAMA 20032901884-1890
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Lifetime Risk of Diabetes for Children Born in
2000
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Venkat Narayan, JAMA 20032901884
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What happened?
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16 oz
32 oz
44 oz
52 oz
64 oz
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Percent of Chronic Diseases That Are Caused by
Poor Lifestyle
91
82
71
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Sources Stampfer, 2000 Platz, 2000 Hu, 2001
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The Bottom Line
Unhealthy behaviors
Health risks
Chronic disease
Health care costs
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What is ROI?
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Wellness ROI is not Investment ROI
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Wellness ROI is not Investment ROI
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Interpreting an ROI of 11
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Calibrating the Investment
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Understanding Program Intensity

• Low Intensity
• HRA, marketing campaigns and/or printed materials
• Under 50 PEPY
• Average ROI of 3.751

1. Aldana SG, Jacobson BH, Harris CJ, Kelley PL,
Stone WJ. Influence of a mobile worksite health
promotion program on health care costs. Am J
Prev Med 19939(6)37883. 2. Berg GD, Thomas E,
Silverstein S, et al. Reducing medical service
utilization by encouraging vaccines Randomized
controlled trial. Am J Prev Med 2004
27(4)284-8. 3. Fries JF, et al. Two-year
results of a randomized controlled trial of a
health promotion program in a retiree population
the Bank of America study, Am J Med, 1993 94
455-462. 4. Fries JF, McShane D. Reducing need
and demand for medical services in high risk
persons. West J Med, 1998 169(4) 201-207. 5.
Gibbs, JO, et al. Work-site health promotion
Five year trend in employee health care costs, J
Occup Med1985 27(11) 826-830. 6. Leigh, JP et
al. Randomized controlled study of a retiree
health promotion program The Bank of America
study, Arch Int Med, 1992152 1201- 1206. 7.
Schultz ALC, Barnett T, et al. Influence of
participation in a worksite health promotion
program on disability days. J Occup Environ Med.
200244776780.
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Understanding Program Intensity

• Medium Intensity
• Low intensity plus any type of intervention
• About 100 PEPY
• Average ROI of 61

1. Aldana SG, Merrill RM, Price K, Hardy A, Hager
R. Financial impact of a comprehensive multisite
workplace health promotion program. Prev Med
200540(2)131-137 2. Chapman L, et al. Ten-year
economic evaluation of an incentive-based
worksite health promotion program, Unpublished
data. 3. Golaszewski T, et al. A benefit-to-cost
analysis of a work-site health promotion program,
J Occup Med1992 34(12) 1164-1172. 4.
Hall-Barrow J, Hodges LC, Brown P. A
collaborative model for employee health and
nursing education. AAOHN J, 200149(9)429-36. 5.
Henritze J, Brammell HL. Phase II cardiac
wellness at the Adolph Coors Company. Am J Health
Promot 1989 4(1) 25- 31. 6. Leutzinger J, Hawes
C, Hunnicutt D, et al. Predicting the ratio of
benefit to cost in a cardiovascular disease
prevention program. Manag Employee Health
Benefits. 1995110. 7. Maniscalco P, Lane R,
Welke M, et al. Decreased rate of back injuries
through a wellness program for offshore petroleum
employees. J Occup Environ Med. 199941813820.
8. Mills P, Kessler RC, Cooper J, Sullivan S.
Impact of a Health Promotion Program on Employee
Health Risks and Work Productivity. AJHP.
200722(1)45-53. 9. Ozminkowski, Ronald J., et
al. A return on investment evaluation of the
Citibank, N.A., Health Management Program. Am J
Health Promot 1999 14(1)31-43. 10. Shephard
RJ, et al. The influence of an employee fitness
and lifestyle modification program upon medical
care costs. Can J Public Health, 1982 73
259-263. 11. Shi L. Health promotion, medical
care use, and costs in a sample of worksite
employees, Evaluation Review,1993 17(5)
475-487. 12. Stave GM, et al. Quantifiable
impact of the contract for health and wellness
Health behaviors, health care costs, disability,
and workers' compensation. JOEM
200345(2)109-17. 13. Thorsen N, Khalil L. Cost
savings associated with smoking cessation for
low-income pregnant women. WMJ 2004 103(5)67-9,
73. 14. Wood FA, et al. An evaluation of
lifestyle risk factors and absenteeism after two
years in a worksite health promotion program. Am
J Health Promot,1989 4(2) 128-133.
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Understanding Program Intensity

• High Intensity
• Medium intensity plus cultural or environmental
  change
• About 150 PEPY
• Average ROI of 7.751

1. Bertera, RL. The effects of workplace health
promotion on absenteeism and employment costs in
a large industrial population, Am J Pub Health
1990 80(9) 1101-1105. 2. Bowne DW, Russell ML,
Morgan JL, Optenberg SA, Clarke AE. Reduced
disability and health care costs in an industrial
fitness program. J Occup Med 198426(11)80916.
3. Dalton, BA, Harris J. A comprehensive approach
to corporate health management, J Occup Med1991
33(3)338-348. 4. Harvey MR et al. The impact of
a comprehensive medical benefits cost management
program for the city of Birmingham results at
five years. Am J Health Promot,1993 7(4)
296-303.
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What Companies Invest PEPY

• 5000 42
• 1000 - 5000 75
• 500 - 1000 105
• 50 - 500 135
• Under 50 250

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Impact on Trend
Small deviations over time or distance make a
huge difference
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