“A Workplace Culture of Health”

Population Health & Disease Management Colloquium

Ray Fabius MDStrategic Adviser to the President - Walgreens Health & Wellness

March 3rd, 2009

Date

Let’s Start with the Employer View

• Runaway health care costs without controls• Threatens company viability• Misuse, overuse, and underuse• Need for Transparency• Apply TQM, Six Sigma, TPS, Lean to Health care• Consumerism• Purchase & Perceive Care in Silo’s• Human Resources Leaders are Risk Advice • Often Depend on Payers and Consultants for next answer• Data deficient• Workplace Safety• Work Environment• Workplace Health

Today’s Agenda

• The Success of Occupational Health & Workplace Safety

• Translating that Success to Healthcare• How can you create a Culture of Health inside a

company?• What would the value be in creating a Culture of

Health?• Examples of Successful Efforts to Create a Culture

of Health

Occupational & Motor Vehicle Safety Improvements

• .US Vehicle & Workplace Death

Rates

01020304050

Motor VehicleWorkplace

Viewpoint on Public Issues, Mackinac Center for Public Policy, 3/1/99; No. 99-11

5

One Glaring Exception: The Healthcare Environment is Becoming More Hazardous

Effectiveness Pathway to Workplace SafetyIdentify Opportunities

Measure Baseline

Establish Interventions

Implement Action Plan

Re Measure Data

Analyze for Effectiveness

Prevention of Errors in Workplace Safety

• Technology– Automated Processes– Decrease Complexity– Worker Removed from Process– Operator Monitors Automated System for

Abnormal Events• Prepared to handle response or solution

– Standardization

Tipping the Scale

Safety

Errors

LeadershipResourcesAwarenessGuidelinesCollaborationStandardizationSimplification

DocumentationNon-PunitiveActive LearningChange AgentTechnologyTrainingFeedback

Healthcare Delivery

Conditions that Prevent Workplace Errors

• Good Managerial Decisions• Right Equipment• Maintenance of Equipment• Skilled & Knowledgeable Workforce• Reasonable Workload & Schedule• Well-Designed Jobs• Clear Guidance on Desired & Undesired

Performance

Lessons Learned in Workplace SafetyPotential Application to Workplace Health

• Growing Awareness • Comprehensive Strategies• Intolerance with Errors• National Focal Point for Leadership• Dissemination of Information• Regulatory Responsibility• Research• Expanding Knowledge Base• Substantial Resources

What About the White Collar World?

• Executive Health• Ergonomics• Stress Management• Resiliency• Work Accommodation• Ex pat Services• Work / Life Balance

Building a Culture of Health

STEP 1

STEP 2

STEP 3

STEP 4

STEP 5

COMPANY ASSESSMENT

DATA AND METRICS

OPERATIONAL PLAN

INTERVENTIONS

EVALUATION & REFINEMENTS

Changes Required to Create a Culture of Health

• Create Awareness• Identify Gap from Benchmark• Study Intervention Options• “Operationalize” Best Efforts• Training and Education• Establish Accountabilities• Celebrate Success

How can you create a Culture of Health inside your company?• Branding• Champions• Rack & Stack• Incentives • Mandates• An environment of health• Fitness• Risk Assessment• Risk Reduction• Disease Management• Proof of Concept• Mainstream success

Resources to Effect Change

• Leadership• Attention• Investment

How do Health & Wellness effect productivity?

• Health care – self-insured• Workers Compensation• Disability• Absence• Presenteeism• Poor performance

The Skill & The WillBut What About Not Being Ill!

Total Employee Health Related Costs

Medical 22%

Disability 4%

Productivity Loss 74%

Workers’ comp, sick leave & other wage replacement

Lost ProductivityLost Productivity

AbsenteeismAbsenteeism

Subpar QualitySubpar Quality

Employee and Customer DissatisfactionEmployee and Customer DissatisfactionPresenteeismPresenteeismTurnoverTurnover

Adverse Bottom Line ImpactAdverse Bottom Line Impact

DIR

ECT

OTH

ER C

OST

S

Temporary StaffingTemporary Staffing

Replacement TrainingReplacement Training AdministrativeAdministrative

Health Care CostsMedical CareHospitalizationPharmacyDiagnostic TestingBehavioral HealthPhysical Therapy

Illness & InjuryIllness & InjuryTravel to Off-site MDTravel to Off-site MD

Source: Integrated Benefits Institute, 2000

Overtime PayOvertime Pay

Missed DeadlinesMissed Deadlines

The Connection Between Health & Human Capital is Significant

• Over 22% of working age adults report health-related work impairment in the past 30 days from chronic illness. Those with impairment average 6.7 lost days. Equivalent to 2.5 billion impaired days/year. -Kessler

• American Productivity Audit: Top 5 reasons for productivity loss result in $180 billion in lost time. -Stewart

• Illness and disability reduced total work hours by approximately 8.6%. Nearly 8.7 million Americans were completely unable to work. The loss to the U.S. economy represented about $468 billion. -Berger

Leading by Example

• “Investment in health delivery is consistent with a long-term view of maximizing return on human capital.” Michael Critelli—CEO, Pitney-Bowes

• “A healthy, engaged, and productive workforce is critical to maximizing business performance and driving sustainable growth.” Dean Oestreich—President, Pioneer Hi-Bred International, Inc.

• “Our profit potential is inextricably linked to the capability and performance of our employees.” Andrew Liveris—President and CEO, The Dow Chemical Company

Factors Affecting Health & Productivity

Health-related factorsPhysical health issues

Chronic diseaseAcute illness

Lifestyle issuesHealth risksPreventive care compliance

Behavioral healthOther factors: Demographics Caregiving Work/life imbalance

Financial concernsEmployer health benefits

Productivity-related factorsAbsenteeism

STD and LTD programsFMLA policiesSick leave policyEffect on team moraleValue of time in production

Workers’ CompensationPresenteeism

Work relationshipsJob security and controlHealth issues

Work issuesErgonomic issuesSafety concerns

Integrated Data to Evaluate Health & Productivity Costs

Lost time data• STD• LTD• FMLA• PTO/sick leave

WC/Safety data• OSHA, accident reporting• drug testing• WC claims data

HR/payroll• employee demographics• time reporting• employee surveys• turnover/overtime data• performance appraisals

Medical data• group health• pharmacy• mental health• health risk appraisals• disease prevalence• EAP utilization

Productivity metrics• staffing/overtime• per employee costs and revenues• self-reported presenteeism

Business data• customer satisfaction• production data• quality data• operational data• net income• gross revenue• human capital costs

Integrated data analysis

IHPM Journal, 2003

Top 15 Drivers of Lost Work Time

0

50

100

150

200

250

300

350

400

450

500

Sleep disorders

Depression

FatigueBack/neck

AnxietyHypertension

Other emotional

ArthritisObesity

Chronic pain

Headache

Irritable bowel

High cholesterol

Heart disease

Allergy

Los

t wor

kday

s/100

FT

Es Absence Presenteeism

Source: Kessler’s HPQ – Adjusted to Workforce

$0

$50

$100

$150

$200

$250

$300

$350

$400

Ann

ual c

ost p

er e

mpl

oyee

(PEP

Y)

presenteeismabsenteeismST disabilityinpatientoutpatientERmedications

The Total Cost of IllnessGoetzel, et al. JOEM 2004

allergyarthritis

depressiondiabetes

migraine

Health Risks: Associated with Productivity Loss

0

2

4

6

8

10

12

14

0 1 2 3 4+Number of Risk Factors

Ave

rage

Day

s A

bsen

t per

Yea

r

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

50%

0 1 2 3 4 5 6+

Total Number of Medical Conditions

Perc

ent R

epor

ting

Lim

itatio

ns

TimePhysical

0

2

4

6

8

10

12

Risk Parameter

Avg

Hou

rs L

ost p

er W

eek

(mea

n)

Illness Absence STD Absence Productivity Loss

The More Health Risks the Greater the Absence The More Health Risks the Greater the Limitations

Some Health Risks Cause Greater Lost Work Hours

Poor Health Impact – Continuum of Employee Performance Outcomes

Lost to the workforce

Not at work

Not doing work on work time

Not doing wellwhile working

permanent disabilityearly retirement due to health issuespremature death spousal illness

unscheduled absencedisabilityworkers’ compreplacement workers

unscheduled breaksunfocused time

health exams on work timeinformation gathering

errorscomplaints

delaysteam breakdown

HHS - The Workplace is a great location for preventive programs

“Employers are becoming more awarethat obesity, lack of physical activity, andtobacco use are adversely affecting thehealth and productivity of theiremployees and ultimately, the businesses’bottom line.”As a result:• Innovative employers are providing a

variety of work-site-based health promotion & disease prevention programs

• Significant return on investment for the employer (median ROI of $3.14)

Health by Numbers

Smoking 0 Tobacco (None)

Diabetes / Heart Disease 5 Diet (5 Fruits/Vegetables A Day)

Lack of Exercise 10 Exercise (10,000 Steps A Day)

Overweight / Obesity 25 Weight (Body Mass Index, weight to height ratio, less than 25 = healthy)

Driving Healthy Lifestyles

Message: Don’t Smoke

Message: Eat healthy

Message: Be active

Message: Maintain a healthy weight

Rewards (intrinsic / extrinsic) vs. Competitions (rack & stack)

A High Performance Network can reduce an employee community’s random access of care

Studies show: • half or more employees believe all doctors and hospitals provide the same care

• half or more employees are not aware of guidelines of care

• physicians referral patterns are based on consanguinity, friendship, financial ties and proximity.

However the majority of an employee community seek validation from their trusted clinician before proceeding

with a treatment decision.

%Using Best Hospitals 2006 vs 2007 %Using Best Specialists 2006 vs 2007

Identifying best specialists & hospitals & directing employees to them

2007 ActualBilled Charges

Paid January thru June

2007 ActualBilled Charges

Paid January thru June

The TFHC specialty referral rate is 2/3 lower than the community referral rate.

9.4% 8.7%

28.3%* 28.3%*

Toyota presentation to IHPM

On-site health center provides the framework and technological infrastructurefor the delivery of effective H&P programs

Occupational Health Health and Wellness

Keeping EmployeesSafe and at Work

Keeping EmployeesHealthy

Employer’s Health, Safety and Productivity Programs

Philosophical Approach to Onsite Health Services

32

Clinical Outcomes for Health Center Users with Diabetes

Process Indicators Correlate with Outcomes LAB Value 2003

Year 12005

Year 3Variance

HbA1C 9.1 7.8 -14.0%HDL Cholesterol 43 47 +9.3%LDL Cholesterol 138 108 -21.7%Triglycerides 288 201 -30.0%Systolic PB 131 126 -3.8%

(2003 to 2005) N=336

Projecting Long-Term Economic Impact (Diabetes Care Improvement)

Analysis of risk factorspredictive modeling indicate asignificant reduction in risk ofdiabetes complications overthe 2003-2005 period fordiabetics under carePotential future economicimpact - reduced patientmorbidity has been estimatedat an average of $1,800 ofavoided medical costs perpatient per year (beforeinflation adjustment)Economic impact does notinclude impact onproductivity or disabilityoutcomes

Projected Cases Per 336 Patients

with Diabetes(10 Year Period)

Avoided Costs

(10 Years)

Risk Year 1

Risk Year 3

Lower extremity amputation

10.7 7.0 $156,600

Blindness 4.7 3.0 $54,400End stage renal disease

7.0 1.3 $4,934,200

MI or stroke 84 40 $1,094,000$6,238,600

Drivers Results

Population Health Excellence ™Toolkit & Requirements – Building Blocks

Community Prosperity

Extrinsic to Intrinsic

Self-Efficacy

Learning StylesHealth LiteracyDiversityAccessConvenienceEase of Use

Proven Efficacy

FlexibilityIntegration

Community of Health

Motivation

Participation

Multi-Modal

Spectrum of Care

Informatics

Platform

Health & Productivity Outcomes

Health & Productivity Outcomes

Behavioral Health

Behavioral Health

Incentives Rewards

Incentives Rewards

RecruitRecruit EngageEngage RetainRetain

Media Print, Audio,Video

Media Print, Audio,Video Web-BasedWeb-Based TelephonicTelephonic Face to FaceFace to Face

Health Promotion

Health Promotion

Lifestyle Risk

Management

Lifestyle Risk

ManagementHealth Risk

ManagementHealth Risk

ManagementHealth

AdvocacyHealth

Advocacy

Research & DevelopmentResearch &

DevelopmentScorecard DashboardScorecard Dashboard

Data Analysis

Data Analysis

Data Warehouse

Data Warehouse

Predictive Modeling

Predictive Modeling

Risk Management

Risk Management

Information TechnologyInformation Technology

Finance Contracting

Finance Contracting

Account Management

Account Management

Provider RelationsProvider Relations

Clinical IntensityClinical Intensity

Disease Management

Disease Management

Outcomes ManagementOutcomes

Management

Marketing Communications

Marketing Communications

35

GE Global Medical Network: 230 On-Site Clinics & 600 Doctors & Nurses

US: 97

GE Medical Clinics February, 2004

Rev. 4/29/02

226 Clinics1.5 MM Patient Visits Annually

Canada: 11 ClinicsEurope: 46 Clinics

China: 7 Clinics

India: 9 Clinics

Mexico: 24 Clinics

South America: 11 Clinics

Puerto Rico:11 clinics

Other Asia: 6 Clinics

The issue of benefits extends beyond our country's borders

Summary

• The Success of Occupational Health & Workplace Safety

• Translating that Success to Healthcare• How can you create a Culture of Health inside a

company?• What would the value be in creating a Culture of

Health?• Examples of Successful Efforts to Create a Culture

of Health