U.S. Chamber of Commerce Workplace Wellness Event ... · U.S. Chamber of Commerce Workplace Wellness Event Washington D.C. Innovations in Workplace and Community Wellness: Aligning

U.S. Chamber of Commerce

Workplace Wellness Event

Washington D.C.

Innovations in Workplace and Community Wellness:

Aligning Business Goals With a Healthy Workforce

The Value of Health and the Power of Prevention

April 7, 2016

Ron Loeppke, MD, MPH, FACOEM, FACPM

Vice Chairman U.S. Preventive Medicine

Overview

Delineate the Converging Trends that are advancing theBusiness Value of Health and the Power of Prevention inWorkplace Wellness

Discuss the solid Business Case for why employers should investin wellness and prevention strategies.

Analyze Published Results and Case Studies of reduced healthrisks and costs from evidence based, comprehensive workplacewellness initiatives.

Epidemiological Trends

Political Trends

Cultural Trends

Financial Trends The Problem: The Cost Crisis is due in large part to the Health Crisis

The Bigger Problem: Total Cost Impact of Poor Health to Employers

The Solution: Evidence Based Workplace Wellness/Population Health Mgmt

Converging Trends Driving the Demand for Wellness and Prevention

Epidemiological Trends: The Burden of Illness/Risk in Population


Mokdad AH, et.al. Actual Causes of death in the United States, 2000. JAMA. 2004; 291:1238-1245.

Personal Health Behaviors are the main Causes of Death

The Global Epidemic of Non-communicable Chronic Diseases

Global Drivers of Mortality Due to Unhealthy Lifestyle Behaviors:

5 Lifestyle Behaviors

Physical Inactivity Poor Nutrition Smoking Alcohol Medicine Non-adherence

5 Chronic Conditions

Diabetes Heart Disease Lung Disease Cancer Mental Illness

75% of Deaths worldwide

Need for Diabetes Prevention/Care in United States

8 millionare

UNDIAGNOSED

4 millionare

diagnosedbut NOT

TREATED

8.5 millionare treatedbut NOT

SUCCESSFULLYCONTROLLED

8.5 million havetheir disease

CONTROLLED

20.5 millionhave

Diabetes that isNOT

CONTROLLED

86 millionAmericanshave PRE-DIABETES

29 millionAmericans

haveDIABETES

17 millionof those

areTREATED

21 millionof those

areDIAGNOSED

Goal:Reduce or

Eliminate RiskFactors and Avert

Disease

Goal:Find and TreatDisease in Its

Earliest Stages toStop Its

Progression

Goal:Manage Disease toAvoid Complications

and DiseaseProgression

Goal:Manage Disease toAvoid Complications

and DiseaseProgression

Goal:Avert Onset of

Diabetes or Costsdue to Untreated or

UncontrolledDisease

77 millionare

UNAWARE

Sources: NIH, CDC, ADA.

Epidemiological Trends: The Burden of Illness/Risk in Population

The Age Wave—”Silver Tsunami” about to hit the healthcare system


As the Age Wave Hits the Shore:Implications of the Aging Workforce

$0

$3,000

$6,000

$9,000

$12,000

19-34 35-44 45-54 55-64 65-74 75+

$1,776$2,193 $2,740

$3,734$4,613

$5,756$2,565$3,353

$4,620

$6,625

$7,989$8,927$5,114

$5,710

$7,991

$10,785

$11,909 $11,965

Annual Medical Costs

Age RangeEdington. AJHP. 15(5):341-349, 2001

Low

Med Risk

High

Healthcare Costs: Which Matters More

Age or Health Risk?

Epidemiological Trends: The Growing Burden of Illness and Burden of Health Risks in Society

The Age Wave—Silver Tsunami about to hit the healthcare system

Political Trends: Aligning Incentives among Consumers, Providers, Employers

ACOs/P4P/PCMH… and ultimately the Consumer Centered Health Home


Focusing on the “Health” in Health Reform (ACA)

National Prevention Strategy

Employer-Based Wellness Program Incentives for Employees

Accountable Care Organizations (ACOs)

Patient Centered Medical Home (PCMH)

ACOs/PCMHs and Employers

Accountable Care Organizations (ACOs) and Patient CenteredMedical Home (PCMH) similarities:

Care models that make physicians and hospitals more accountableOutcomes oriented, performance-based with aligned incentivesGoal: improve value of health services, control costs, improve qualityACOs/PCMHs share in a portion of savings gained

Including workplace in ACO/PCMH development is logicalWork impacts health and health impacts work

Workplace is organically connected to home as personal health risks aren’tleft at home just as occupational risks aren’t left at work…

Employers have unique infrastructure advantages that could helpACO/PCMH initiatives.

PHM in the Triple Role and Triple Aim for Hospital/Health Systems

Employer

Provider

Insurer/ACO (Financial/Clinical Risk Bearer)

The 3 R’s of Healthcare Stakeholders

3 R’s ofHealthcareStakeholders

Responsibilities Risks Rewards

Employees/Consumers

• Health Management• Disease Management• Job performance

• Nutrition• Physical Activity• Tobacco use

• Improved health/wellness• Financial incentives• Enhanced performance

Employers

• Healthy and Safe corporateculture/workplace

• Value based benefit designaligned to PHM

• Investment in employeewell-being/safety

• Benefit designimpact on total costof care

• Employee turnover• Decreased business

performance

• Optimal health, well-beingand engagement ofemployees

• Enhanced Employee

satisfaction/retention• Improved business

performance/bottom line

HospitalHealthSystem/Providers/ACOs/Plans

• Wellness/PHM Outcomes• Healthcare Quality

management• Healthcare Cost

management

• Wellness/PHMprogram costs

• Data-driveninformation systems

• Financial Risk ofClinical/Health Risk

• Better Care at Lower Cost• Financial incentives for

lower total costs• Improved health

outcomes of population

Adapted from: Loeppke R. The 3 R’s of healthcare: responsibilities, risks and rewards. Health Prod Mang. 2002:5-19.

Physician and Employee Aligned Financial Incentivesrelated to Evidence Based Population Health Management Metrics

Total Savings Dollars: DIRECTV Shared 33% with Employees; 33% with Physicians $ Bonus Pool = $ Claims Cost Savings PLUS $ Worker Productivity Savings (1:1)

Example of Quality Point actions for both Physicians & Employeesand accounted for in their Incentive Accounts--for allocation of Bonus:

Evidence Based Medicine (EBM) Quality Criteria PHM Quality Points

Personal Physician Reviewing HRA with Employee (Patient) xxx

Perform USPSTF Age/Gender recommended Preventive screenings

(e.g. mammograms, colon cancer screenings)

xxx

Condition-specific treatment and monitoring –

(e.g. Diabetics testing HbA1C at least every 6 months)

xxx

Maintain ongoing participation/engagement in Health Management,Health Coaching and Disease Management programs

xxx

Loeppke R, Nicholson S, et al. “The impact of an integrated population health enhancement and disease management program onemployee health risk, health conditions and productivity”. Population Health Management. 2008: 11(6); 287-296.

Value of a Quality Point for Employee and Physician based on Actual Savings =

$19.00 per Quality Point




ACOs/P4P/PCMH…Consumer Centered Health Home

Cultural Trends: Wellness is the new Green: The Ultimate Sustainability Strategy

Mobile/Wireless Tech Transforming the Healthcare Industry

Game Theory Innovations in Wellness


Mobile Technology: The World’s most ubiquitous platform

MOBILE TECHNOLOGY: THE WORLD’S MOSTUBIQUITOUS PLATFORM.*

MOBILE TECHNOLOGY: THE WORLD’S MOSTUBIQUITOUS PLATFORM.*

*Source: IMS Report: The World Market for Internet Connected Devices, 2012.

More people have access to cell phones than

drinking water, electricity or a toothbrush.

By 2020, ~160 million Americans monitored

and treated remotely for at least one chronic condition

TRANSFORMINGHEALTHCARE

Johns Hopkins University. Chronic Conditions: Making the Case for Ongoing Care. Retrieved 10/20/12, fromhttp://www.partnershipforsolutions.org/DMS/files/chronicbook2004.pdf

Gamification in Healthcare

Since 2004 One Game has beenplayed 50 Billion hours(5.93 Million Years)

183 M people are “Gamers”(> 13 hours per week)

97% of Youth play regularly

25% of > 50 y/o play regularly

“Transformational Accomplishmentcan occur when we can celebrateSpectacular Failure”

Potential for Nobel Prize winners inMedicine using Gamified Apps





Cultural Trends: Wellness is the new Green: The Ultimate Personal Sustainability Strategy

Mobile/Wireless Tech Transforming the Healthcare Industry

Game Theory Innovations in Wellness

Financial Trends The Problem: The Cost Crisis is largely due to the Health Crisis


Of the more than $3 trillion/yr spent on U.S. health care

Patients with chronic diseases account for 75% of U.S. healthcare costs

Of every dollar spent…

…75 cents went towards treating

patients with one or more chronic diseases

22

150 Million Americans with 1 or more Chronic Conditions 27% of rise in healthcare costs associated with the increase in obesity rates

The Waist Line impacts the Bottom Line

And yet, less than 5 cents of each healthcare dollar is spent on Prevention

“An ounce of prevention

is worth a pound of cure.”

Ben Franklin

1736

Learning from the Past

5 Health Factors that mitigate Chronic Illness

1) Walking 30 minutes a day2) Eating healthy3) Not using tobacco4) Drinking alcohol only in moderation5) Waist size less than half of your height

These result in 33% to 50% Less Lifetime Healthcare Costs If 75% of Americans had these health characteristics, between

$600 Billion and $1 Trillion could be saved per year

Mike Roizen MD

Chairman Cleveland Clinic Wellness Institute

Michael F. Roizen and Ted Spiker, This Is Your Do-Over: The 7 Secrets to Losing Weight, Living Longer, and Getting a Second Chance at theLife You Want (New York, NY: Scribner, 2015). Agneta Akesson et al., “Low-Risk Diet and Lifestyle Habits in the Primary Prevention ofMyocardial Infarction in Men: A Population-Based Prospective Cohort Study,” Journal of the American College of Cardiology 64 (13) (2014):1299–1306. Andrea K. Chomistek et al., “Healthy Lifestyle in the Primordial Prevention of Cardiovascular Disease Among Young Women,”Journal of the American College of Cardiology 65 (1) (2015): 43–51.Meir J. Stampfer et al., “Primary Prevention of Coronary Heart Disease inWomen Through Diet and Lifestyle,” The New England Journal of Medicine 343 (2000): 16–22.






Wireless Technology Transforming the Healthcare Industry

Game Theory Innovations in Prevention/Wellness




Top 10 Health Conditions by Full Costs For Employers

$0

$50,000

$100,000

$150,000

$200,000

$250,000

$300,000

$350,000

$400,000

Presenteeism

Absenteeism

Drug

Medical

Loeppke, R., et al., "Health and Productivity as a Business Strategy: A Multi-Employer Study“. JOEM. 2009;51(4):411-428.

As Health Risks Go, so Go Health-related Costs

% of WorkplacePresenteeism

0-2 risks 3-4 risks 5+ risks

14.7%

20.9%

26.9%

6.4Days

9.3Days

12.6Days

1 risk 3 risks 4+ risks

Work days lost / Person / Year(Absenteeism)

STD Days / Year

0-1risks

2- 3risks

4+

risks

2.4Days 5.3

Days

13.1Days

Sources: Burton, et al, JOEM: Vol. 47. No. 8, August, 2005; Wayne Burton, MD, IHPM North American SummitMeeting 2000; also Tsai, et al. JOEM: Vol. 47, No. 8, August, 2005






Wireless Technology Transforming the Healthcare Industry

Game Theory Innovations in Prevention/Wellness



The Solution:

Evidence Based Workplace Wellness/Population Health Management


The Bottom Line for Employers:

29

Better Health – Population Health

Better Care – Patient Experience

Better Value – Higher Quality/Lower Cost

Cathy Baase MD, MPHChief Health OfficerDow Chemical Company

Goetzel, R; et al. “Do Workplace Health Promotion (Wellness) Programs Work.”J Occup Environ Med. 2014; 56 (9):927-934, September, 2014.

Evidence Based Wellness/Population Health Management

Total Population

Medium RiskLow Risk High Risk

DM RiskLS Risk

Population of One

Early Intervention/Care MgmtScreening/Early DetectionWellness/Health Promotion

Loeppke, R. “Making the Case for Population Health Management: TheBusiness Value of Better Health,” Chapter 7, pp 121-136 in Nash, D., et.al.,Population Health Textbook. Jones and Bartlett Learning. Sudbury, MA. 2010.

498

2291

55314666

Significant Overall Health Risk Reduction of PopulationParticipating in their personalized Preventive Plan for 2 Years

Net Movement of Health Risk Levels in CohortBaseline vs Year 2 on Preventive Plan

1775847

N = 7,804

Low Moderate High

60%

11%

6%

29%

23%

71%

Loeppke, R; Edington, D; Bender, J; Reynolds, A. “The Association of Technology in a Workplace Wellness Program with Health Risk FactorReduction” Journal of Occupational and Environmental Medicine: March, 2013; Volume 55, Number 3: pp 259–264

USPM 5 Year Cohort Reduction in Key Individual Risk Factors

KEYHEALTH RISK

FACTORSYear 5

N = 1,763

Participants

Health Risk Factor % PopulationReducing Risk

Blood Pressure -81.45%Physical Activity -91.11%Fasting Blood Sugar -48.01%Fatty Diet -31.82%Smoking -40.63%Stress -83.77%Total Cholesterol -71.76%HDL Cholesterol -46.15%Health Related Illness Days -51.92%Alcohol -86.25%Med/Drugs for Relaxation -84.62%Poor Perception of Health -76.12%BMI -15.16%Diagnosed Condition -19.02%

Intel-GE Validation Institute AnalysisTotal Hospital admits & ER visits across Conditions

vs *DMPC and *HCUP national averages (per 1000 members)

0

5

10

15

20

25

30

35

USPM

National Averages

HCUP

*Disease Management Purchasing Consortium and the federal

Healthcare Cost and Utilization Project (HCUP) databases

N = 33,459

http://www.validationinstitute.com/validated-organizations/

32% Reduction inHospitalizations and ER Visits in

USPM compared to HCUP and DMPC

ROI VOIReturn on Investment Value of Investment

Beyond ROI to the Full Value of the Investment in Health

Financial Indicators/Net Savings Financial Indicators/Net Savings

Participation Indicators

Engagement Indicators

Preventive Screening Indicators

Health Risk Indicators

EBM Clinical Indicators

Utilization Indicators

Performance Indicators

Shareholder Value

Loeppke R. “The Value of Health and the Power of Prevention”. Int J WorkplaceHealth Management. 2008; 1(2)95-108.

The Linkage: Healthy Companies drive Healthy Bottom Lines

Fabius, R; Loeppke, R; et.al. “Tracking the Market Performance of Companies That Integrate a Culture of Health and Safety: An Assessment of Corporate HealthAchievement Award Applicants”. JOEM. Volume 58: Number 1. Jan, 2016. Fabius R, et al. The link between workforce health and safety and the health of the bottomline: Tracking market performance of companies that nurture a “culture of health.” J Occup Environ Med. 2013;55(9):993-1000.

“Though correlation is not the same as causation, the preponderance ofevidence appears to be building that healthy and safe workforcesprovide a competitive advantage for employers.”

By living a healthier lifestyle, the compression of morbidity relates to postponingthe age of onset of morbidity, disability and cumulative health costs--even thoughlife expectancy is increased—

Adding Years to your Life and Life to your Years.

The Great News from 30 years of Scientific Studies:The Compression of Morbidity

Healt

h

“Acceptable QOL”

“Disability”

Hubert, Bloch, Oehlert and Fries. Lifestyle Habits and Compression of Morbidity.J Gerontol A Biol Sci Med. June, 2002; 57 (6) M347-51

Live Healthier Longer and Die more Suddenly at Lower Cost

“Sudden Death in Overtime”Healthier Lifestyle

Typical Lifestyle

Good Health

is

Good Business

From the Exam Room

to

the Board Room

The Bottom Line

Thank You!

Ron Loeppke, MD, MPH

Vice Chairman

U.S. Preventive Medicine, Inc.

615-289-5393 Cell

615-373-2946 Fax

[email protected]

Documents

U.S. Chamber of Commerce Workplace Wellness Event ... · U.S. Chamber of Commerce Workplace Wellness Event Washington D.C. Innovations in Workplace and Community Wellness: Aligning