Culture of Health at Johnson & Johnson –A Model of Prevention

Hospital Authority Convention – Hong KongFikry Isaac, MD,11 May, 2010

Today’s Discussion

The world’s largest and most comprehensive health care company

2009 sales of $61.9 billionMore than 250 operating companies selling products throughout the world

Three worldwide business segmentsConsumerMedical Devices/DiagnosticsPharmaceutical

Managed by a unique form of decentralized management 115,500 employees worldwide.

New Wellness & Prevention growth platform established in 2008:Established to deliver workplace health and wellness programs and services –HealthMedia® and Human Performance® Institute

J&J – Corporate Background

Business Value

“The health of the employee is inseparable from the health of the Corporation.”

“An important part of our Credo responsibility to our employees is providing them with resources to lead healthier lives. Good health is important to all of us. Good health is also good business.”

William C. Weldon CEO Johnson & Johnson

Global Health Strategies

Transforming care for health from a financial liability to a

business advantage

WHO WE AREWHERE WE HAVE COME FROM

Our History

Why we do what we doOUR VISION: Have the healthiest, most engaged workforce for J&J - allowing for full and productive lives

OUR MISSION:Deliver a competitive business advantage to the J&J Family of Companies, by providing the leadership and resources that enable the well being, full engagement, and productivity of J&J employees worldwide.

Culture of Health Evolution: Our Roadmap

LIVE FOR LIFE®: Partnership between Benefits, Safety, Medical, Wellness and EAPJames E. Burke, J&J Chairman and CEO, set two major program goals:Encourage employees to become “healthiest in the world”Reduce health care costs through on-site programs and services

Established Health & Wellness Shared Service, integrating: Employee AssistanceOccupational HealthWellness & Health PromotionDisability Management

Global expansion of integrated services to provide:LeadershipConsultationGuidanceSupport

Health & Wellness key policies harmonized as part of Global HR Transformation (GHRT)

Wellness & Prevention identified as key New Business strategyAcquisition of HealthMedia, Inc. and Human Performance Institute, Inc.

Our Strategic Approach

Keep well—mind and bodyKeep safe

Identify and manage health and injury risks

Identify and manage/mitigate disease impact

Identify and focus medical and disease management resources

Address spectrum of needs 

Use proven programs/methods

Measure outcomes/manage program investments 

Emerging Global Health Issues

Global Health Programs seek to proactively address these issues

Global Health Concerns – WHOA Focused Effort

Mental Health450 Million people currently suffer from these conditions, placing mental health disorders among the leading causes of ill-health and disabilities

Obesity and Physical ActivityOne billion overweight adults – 300 million of them obesePhysical Activity causes 2 million deaths per year

Tobacco Use and CancerTobacco use is one of the biggest public health threats the world has ever faced. 100 million deaths were caused by tobacco in the 20th century. If current trends continue, there will be up to one billion deaths in the 21st century

Occupational Injury/Illness“Exposure to occupational hazards accounts for a significant proportion of the global burden of disease and injury, which could be substantially reduced through application of proven

risk prevention strategies.”

HIV/AIDSForty million plus people living with HIV and AIDS at end of 2006

Global Prevalence of Health Promotion Programs

77%

44%

42%

31%

43%

32%

North America

Latin America

Europe

Australia

Asia

Africa/ Middle East

2009 Wellness Survey- Buck Consulting

Health Issues Driving Wellness Strategy

Africa Asia Australia Canada EuropeLatin

AmericaUnitedStates

Stress 1 1 1 1 1 3 5Physical activity/exercise 4 2 2 4 2 1 1Nutrition/healthy eating 10 3 4 5 6 2 2Work/life issues 3 6 3 2 3 11 9Chronic disease (e.g., cardiac, diabetes) 8 7 5 8 10 6 3

High blood pressure 9 5 7 10 11 4 4High cholesterol 13 4 8 9 13 5 7Workplace safety 6 8 6 6 5 8 11Depression 5 11 10 3 7 13 10Tobacco use/smoking 12 14 12 11 4 10 8Psychosocial work environment 10 10 13 7 8 9 15Obesity 15 12 9 15 14 7 6Personal safety 6 9 14 12 9 15 13

2009 Wellness Survey- Buck Consulting

CRITICAL ELEMENTSCulture of Health

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5 Key Culture of Health Components

1. Leadership and Commitment

2. Enterprise Programs

3. Policies and Procedures

4. Promotion and Communication

5. Measurement and Results

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1. Leadership & Commitment

Public advocacy for healthy, innovative workplaces

Internal management emphasis (talking the talk and walking the walk)

Communications inside and outside

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Mental Health & Wellbeing

Mental Health & Wellbeing

Healthy LifestylePrograms

Healthy LifestylePrograms

• Access to Employee Assistance Professionals

• 24/7 Telephonic Counseling• Online Mental Health Screening • HealthMedia Digital Coaching Programs• Resiliency/Stress Management Training• Yoga and Meditation

Occupational Health & Disease Mgmt.

Occupational Health & Disease Mgmt.

Health Education & Awareness ProgramHealth Education & Awareness Program

• Health Profile & Biometrics• Health Profile Counseling• Digital Coaching Programs• Pedometers and Million Step Challenges• Weight Watchers and Nutritional Counseling• Tobacco Cessation Programs (PIQ)

• Onsite Occupational Health Clinics• Employee Health Centers• Medical Surveillance Compliance• Medical Case Management• Value Added Services (Phlebotomy, Pharmacy

and Physical Therapy)• CareConnect & Health Advocate

• My eHealth (Tip of the Day, Family Health Guides, Personal Trackers)

• Healthy People News• Healthy People Bulletin Boards• Global Health Observances (ie Move For

Health, World Diabetes Day, Breast Cancer Awareness, World AIDS Day)

Johnson & Johnson

Employees and Families

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2. Enterprise Programs

Wellness & Health Promotion

• To help employees achieve optimal health, Wellness & Health Promotion programs provide global affiliates with leadership, consultation, guidance and support for the delivery of a wide range of quality health promotion programs and services.

• Improving the health of employees can deliver significant corporate benefits, including increased productivity, but most importantly, employees can enjoy improved health, both on and off the job.

• Programs include: Activity Promotion; Eat Complete; Tobacco Cessation• US: Programs are delivered via Health Fitness Corporation• OUS: Program delivery varies but is usually coordinated with GH regional

managers and site HR

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Addressing Lifestyle Factors

• Healthy People Initiative• Annual Health Profile• $500 Medical Benefit Discount• Tracking and Enterprise-Wide

Reporting• Operating Company-Level

Reporting/Accountability• Started in U.S. in 1995 with

global expansion currently underway.

• US Participation Rates 2009: 83%

Mental Health & Wellbeing –Employee Assistance

• Provides employees, their families, and management confidential assistance with a wide range of work-related and personal problems

• EAP professionals are trained to facilitate solutions for a variety of challenges that may negatively impact individual or organizational health if left unresolved

• Programs include: employee counseling; critical incident debriefing; management/organizational consultations

• US: Provided to every site via Value Options

• Globally: Various service delivery approaches

• Healthier consumers

• Fewer ER Visits

• Decreased inpatient hospital stays

• Higher productivity

• Lower absenteeism

• Better controlled health care costs

• Improved bottom lines

• Healthier consumers

• Fewer ER Visits

• Decreased inpatient hospital stays

• Higher productivity

• Lower absenteeism

• Better controlled health care costs

• Improved bottom lines

HealthMedia, Inc.: Digital Health Coaching Treats the Individual, Not the Condition

• Health Risk Assessment

• Weight Management

• Smoking Cessation

• Stress Management

• Nutrition Counseling

• Insomnia

• Back Pain Prevention

• Adolescent Health

• Physical Activity

• Health Risk Assessment

• Weight Management

• Smoking Cessation

• Stress Management

• Nutrition Counseling

• Insomnia

• Back Pain Prevention

• Adolescent Health

• Physical Activity

•Chronic Illness Management Hypertension, Hyperlipidemia, etc.

•Doctor-Patient -Pharmacist Relationships

•Management of secondary symptoms: stress, fatigue, etc.

•Diabetes

•Pain Management

•Back Pain Mgmt

•Chronic Illness Management Hypertension, Hyperlipidemia, etc.

•Doctor-Patient -Pharmacist Relationships

•Management of secondary symptoms: stress, fatigue, etc.

•Diabetes

•Pain Management

•Back Pain Mgmt

• Insomnia

• Depression

• Binge Eating Disorder

• Obesity

• Alcohol and Addiction

• Insomnia

• Depression

• Binge Eating Disorder

• Obesity

• Alcohol and Addiction

DiseaseManagement

DiseaseManagement

Digital Health Coaching ProgramsDigital Health Coaching Programs

Health &WellnessHealth &Wellness

MedicationAdherenceMedicationAdherence

BehavioralHealth

BehavioralHealth

Proven science-based behavior change modelsProven science-based behavior change models

3. Policies & Procedures

Global harmonized policies • Tobacco Free• HIV-AIDS• And Others….

Standardized Procedures (“toolkits”) that allow for program/implementation WW

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4. Promotion & Communications-engaging employees

5. Measurement and Results

Making an Impact by Focusing on Risk Reduction

General health risks status and absence

High number of risks equals increased days lost

0

2

6

8

10

12

14

4 2.45 Days

0-1 Risks

5.28 Days

2-3 Risks 4+ Risks

DA

YS/Y

R

13.16 Days

HEALTH RISK IMPACT ON ABSENTEEISM

General health risks status and medical claims

High number of risks equalshigher costs

$1,000

$2,000

$3,000

$2,500

$1,500 $1,389

0-1 Risks

$1,730

$2,701

2-3 Risks 4+ Risks

HEALTH RISK IMPACT ON MEDICAL COSTS

Source: Wayne Burton, MD, IHPM North American Summit Meeting 2000

J&J Approach : Improving Health Risks via Tailored Health & Wellness Offerings and an Engaged Culture of Health

High Risk (5+)

Medium Risk (3-4)

Low Risk (0-2)

OVERALL INCREASE IN LOW-RISK CATEGORY OVER TIME. OVERALL DECREASE IN MEDIUM/HIGH-RISK CATEGORY OVER TIME.

POPULATION HEALTH RISK REDUCTION (2006 TO 2009)

20081.1%

13.9%

85%

1.6%

20.6%

2007

77.8%78.1%

1.4%2006

20.5%

20090.9%

12.0%

87.1%

Employee health risk trends between 2002 - 2008 suggest the Johnson & Johnson health and wellness program has an annual ROI of between $1.57 - $4.09 for every dollar spent.

High Risk Factor(in descending order by High Risk

Prevalence)

Johnson & Johnson

CDC US Data*

Unhealthy Eating(<5 Servings / Day)

60.0% 75.6%(2007)

Obesity (BMI 30.0+)

20.4% 34.1%(2003-2006)

Inactivity(<150 Moderate Minute Equivalents)

20.4% 30.5%(2005-2006)

Hypertension(Blood Pressure 140+/90+ mmhg)

6.3% 17.9%(2003-2006)

Cholesterol(Total Cholesterol 240+ mg/dl)

5.3% 16.3%(2003-2006)

Tobacco Use(Current User of Any Tobacco)

3.9% 29.6%(2006)

Glucose(126+ Fasting)

2.5% 10.2%**(2003-2006)

Stress (Heavily or Excessively Stressed)

1.6% 3.0%***(2006)

*Based on “Health, United States, 2008” a publication by the Centers for Disease Control and Prevention and National Center for Health Statistics, except for “Unhealthy Eating” which is based off of the Behavioral Risk Factor Surveillance System (BRFSS) data from 2007.

**CDC’s definition of high glucose / diabetes = “Physician Diagnosed and Undiagnosed Diabetes”***CDC’s definition of stress = “Serious Psychological Distress”n=30,595

• Population health risks trending superior to other industries

• Per capita health care costs consistently 1%-2% below benchmarks for past 10+ years

• J&J medical plan ranked in “top quartile” of peer group benchmark

• Projected ROI from 2002 to 2008 estimated at $4 :$1 (medical expenditure and productivity.

Proven Multi-dimensional Approach Yields Sustainable Results

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HealthMedia® Relax™

25.11%Baseline Productivity

Impairment(Participants who decreased stress)

$2,720Productivity savings per participant per year

180 Day Self-Reported Outcomes

19.67%180 Day Productivity

Impairment(Participants who decreased stress)

5.44Point Reduction

=-

=x $50,000 average salary/benefits

60%Of participants decreased stress

180 Day Self-Reported Outcomes

Realizing the impact of our programs – an illustrative example

For every employee who quits smoking….

Direct savings related to decreased burden on Insurance Rates, & Disability Costs

Direct savings related to decreased burden on Insurance Rates, & Disability Costs

Increased productivity realized via decreased Absenteeism, Improved Energy levels, less “breaks”

Increased productivity realized via decreased Absenteeism, Improved Energy levels, less “breaks”

Retention of J&J Human Resources via improved wellness, presenteeism and longevities of employees

Retention of J&J Human Resources via improved wellness, presenteeism and longevities of employees

Improved Environment and Safety for co-workers via absence of cigarette-related smoke and fires

Improved Environment and Safety for co-workers via absence of cigarette-related smoke and fires

“Our Stockholders”

“Our Employees”

“Our Environment”There is an impact to:

Realizing the impact of our programs – an illustrative example - Japan

Pictures of smoking area next to the J&J HQ building

Estimated Productivity Savings for NO SMOKING: JPY:

412,500,000

“This morning I felt very happy to find a white-eye (bird) at the former smoking area. If it continued to be a place for smoking, we would never see such a beautiful bird

there.”

Now 100% Tobacco-

Free!

Estimated Productivity Savings for NO SMOKING: JPY:

412,500,000

Achieving Global Health Objectives

• Global Health Assessment Tool (GHAT)

Culture of Health —Measuring our Progress

• Global Health Assessment Tool

– Captures metrics that support 3 Global Health goals and objectives

– 2009: 413 locations (worldwide) reporting

– Immediate feedback provided to the site after tool completion (Culture of Health Scorecard)

– Global Health Leaders review results 1:1 with Franchise Leaders for followup/next steps

Putting it all Together

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In Summary

• A focus on health risk factors can yield strong results• We believe driving behavior change and creating a sustainable culture of health are

critical to enhancing health, productivity and performance• A seamless and holistic approach is necessary at the organizational and individual

level, driving participation and behavior change• Increasing rates of chronic disease, rising health care costs, economic downturn,

stretched work force present the opportunity to make an impact with employee prevention & programs

• “Carrots” can work• Employee buy-in is important• Global wellness requires “feet on the ground”• Phased approaches and pilots to understand critical learnings and subsequent

course corrections• Nothing happens overnight!

BACK-UP

Key Elements of Success

CommitmentSenior/middle management commitment Visible leader or championBuild the most appropriate business caseSpeak the language and align with the business

ProgramsScience-basedCustomized and individualized interventionsApplying behavior change modelsLong-term efforts in maintaining changeRegulatory environment (laws, health systems, policies, etc.)

Effective ApproachTriaging individuals into programs that produce greatest impact/payoff

Protecting confidentiality

Collaboration between all involved parties

Leverage global, national and regional health trends and initiatives

MotivationSuccessful recruiting strategies

Easy access to programs and facilities

Effective marketing and communication