Building a Business Case for Worksite Health Promotion

IAWHP Global Symposium Las Vegas, Nevada

March 27, 2012

Nico Pronk, Ph.D. HealthPartners Harvard School of Public Health

Agenda

• Introduction

• What is a good business case?

• What do we know about the business case for WHP already?

• A proposed model to drive the business case for WHP

• Capturing the value of WHP

The Worksite Setting

• Population access

– Significant reach into the population

– Significant frequency to intervention exposure

– Significant access to tools, vehicles, resources, etc. that may be mobilized to increase awareness and PA behavior change

– Worksites can identify the population of interest

• Employees

• Employees and dependents

• Targeted subgroups of interest

– Interventions can be designed at various levels that interact with the individuals receiving the intervention

• Individual

• Inter-personal

• Organizational

• Environmental

The Worksite Setting

• Work matters for health – Unemployment is a major determinant of health

– Worker health may be affected by the organization of work, the policies at work, the relationships at work, etc.

• Health matters for work – Chronic conditions may be exclusion criteria for job fit

– Fitness for duty tests as indicators of inclusion criteria

• Healthy workers and a healthy culture appear to be a good business strategy

• Worksite health promotion also is a sound public health strategy and fosters economic growth in the community

What is a “Business Case”

• “A scenario in which an organization realizes a positive return on investment for a particular intervention.”

– Kilpatrick KE, et al. 2005

• Key components:

– Effective intervention

– Measured, meaningful outcomes

– Program relevance in context

– Realization of value

Broader context?

Employer recognize the need to:

– Reduce healthcare spending

– Reduce illness burden

– Reduce the likelihood of becoming ill

– Make healthy choices easy choices

– Maintain or improve economic vitality

– Reduce waste

– Increase longevity

– Enhance national security

– Prepare communities for the workforce

Source: Hertz, et al. JOEM 2004; 46:1196-1203.

% W

ork

Lim

itat

ion

s

0

2

4

6

8

10

12

14

16

Normal Weight 1.9 3.6 8.4

Overweight 2 3.6 8.1

Obese 4.1 8 14.5

20-39 40-59 60+

Impact of obesity on work limitations is akin

to 20 years of aging

Playing the game healthy has value

Playing the game healthy has value

• Impact of aging in a fit person is a reduction of ½% in cardiorespiratory fitness (oxygen use) per year

• Impact of aging in an unfit person is a reduction of 2% in cardiorespiratory fitness per year

• A fit person of 70 has the same health/disease profile as an unfit person of 40

• Fitness is a 30-year value proposition for health

Workplace Health Works!

• AHRF includes both health assessments and biometric screenings

• The Task Force finds insufficient evidence to determine the effectiveness of AHRF when implemented alone

• The Task Force recommends the use of assessments of health risks with feedback when combined with health education programs, with or without additional interventions, on the basis of strong evidence of effectiveness in improving one or more health behaviors or conditions in populations of workers

Healthy has value

ROI Literature Review Systematic review and meta-analysis Conclusion: Worksite Health Promotion programs can generate positive ROI for medical- and absenteeism-related savings:

Medical: 3.27 : 1 Absenteeism: 2.73 : 1

Workplace Health Design

Companies across a variety of industries report benefits: • Lower health care costs

• Greater productivity

• Higher morale

ROI can be as high as 6:1

Six Essential Pillars for Successful Programs: 1. Engaged leadership at multiple levels

2. Strategic alignment with the company’s identity and aspirations

3. A design that is broad in scope and high in relevance and quality

4. Broad accessibility

5. Internal and external partnerships

6. Effective communications

Program Best Practices

Leadership and Strategy • Organizational commitment • Shared program ownership • Identified wellness champions • Program connected to business

objectives • Supportive policy, physical, and

cultural environment

Operations • Clearly defined operations plan • Effective communications • Scalable, sustainable, and accessible

programs • Assessment, screening, and triage • Effective interventions • Meaningful participation incentives

Evaluation • Program measurement and

evaluation

Integration and Data Practices • Integration of program components

at the point of implementation • Integration across multiple

organizational functions and departments

• Integrated data systems • Efficient and effective data practices • Data privacy and confidentiality

Essential Elements List Guidance toward Integrated Health and Safety Programs

Organizational Culture and Leadership 1. Develop a “Human Centered

Culture” 2. Demonstrate Leadership 3. Engage mid-level management Program Design 4. Establish clear principles 5. Integrate relevant systems 6. Eliminate recognized

occupational hazards 7. Be consistent 8. Promote employee participation 9. Tailor programs to the specific

workplace 10. Consider incentives and rewards 11. Find and use the right tools 12. Adjust the program as needed 13. Make sure the program lasts 14. Ensure confidentiality

Program Implementation and Resources

15. Be willing to start small and scale up

16. Provide adequate resources

17. Communicate strategically

18. Build accountability

Program Evaluation

19. Measure and analyze

20. Learn from experience

TOTAL WORKER HEALTH™

Source: NIOSH Essential Elements List (see http://www.cdc.gov/niosh/TWH/essentials.html).

Building Healthier and Safer Workplaces

• Traditionally, workplace health protection and promotion programs have operated independently

• The “silo” approach has limited overall effectiveness in optimizing worker health and safety

• Integration of health promotion, safety, and environmental programs, policies, protocols, and processes will allow for synergy in improving worker health and safety

• A safer workforce is a healthier workforce and vice versa

Integrated Worker Health Protection and Promotion

TOTAL WORKER HEALTH™

Integrated Worker Health Protection and Promotion

Objectives • Connect workplace

safety, ergonomics, and occupational medicine with health promotion

• Create synergistic effects by leveraging the impact of interventions

• Optimize efficiency and effectiveness through integration (avoid continued silo activity)

Occupational Safety and

Health

Worksite Health

Promotion

Integrated Worker Health

Individual-level Organizational-level Environmental-level

Source: Pronk, NP. ACSM’s Health & Fitness Journal 2012;16(1):37-40.

Moving Beyond Available Evidence

• Evidence of what works needs to be applied in the context of the workplace environment

• Inflexible focus on program fidelity may limit adoption of programs with sustained success

• Practice-based evidence can only be generated if solutions are successfully implemented

• Worksite health promotion programs will only deliver on their promise when supported as a business strategy with leadership support and accountability

• Successful “translation” of available evidence into practical solutions is paramount

What About the Employers’ View?

• Non-clinical, community-based prevention policies and wellness programs appeal to employers

• Importance of family inclusion

• Importance of community connection

• Company recognition as a leader for health improvement and economic vitality

• Recognition that companies and organizations are complex social systems

Unsustainable Cost Pressure

$9,235(2002)

$10,168 $11,192

$12,214 $13,382

$14,500 $15,609

$16,771 $18,074

$19,393(2011)

$20,944 $22,620

$24,430

$26,384

$28,496

$30,774

$33,236

$35,895

$38,767

$41,868(2021)

2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021

Health care expenses for U.S. families:2002-2021 (projected at present growth rate)

Source: 2011 Milliman Medical Index

Or to look at it another way…

Source: Alliance of Community Health Plans

Or to look at it another way…

Income: $59,858

Source: Alliance of Community Health Plans

Possible Simple Socially

rewarding

Financially

rewarding

Personally

relevant

Organizationally

relevant

Community

connected

Individual

Inter-

individual

Organizational

Environmental

Leve

ls o

f In

flu

en

ce

Make Being Healthy and Productive…

Exceptional Customer and User Experience

Outcomes

Comprehensive, Multi-Level, Multi-Component Programming

Source: Pronk, NP. Journal of Physical Activity and Health, 2009, 6 (Suppl. 2), S220-S235.

Health

Productivity

Financial / ROI

What Does “Success” Look Like?

Low Risk

Moderate

Risk

High Risk

Disease:

Well Managed

Disease: Poorly

Managed

Baseline 44%

Baseline 24%

Baseline 24%

Baseline 7%

Baseline 1%

15.1%

0.8%

4.5%

1.3%

14.4%

2.5% 0.2%

36.3%

33.5%

13.2%

25.0%

Risk transitions

based on HA-derived risk

levels among employees

over 2 years (N=1,087)

21% 66% 13%

Net population health

improvement of 8%.

87% did not

get worse

Got Better

Stayed the Same

Got Worse

Without health and well-being programs, the net employee population’s

health may get worse by 7%

per year

This 2-year health and well-being

program was associated

with a ROI of 3:1

Discussion and Dialogue

• Questions?

• Observations!

• Viewpoints …