DELAWARE STATE CHAMBER OF COMMERCE

WELLNESS @ WORK Conference

Carine Sakr, MD, MPHClinical DirectorChristiana CareOccupational Health & Wellness

June 14, 2010

Outline

Current situationWork-related mortality and morbidityNon work-related risk factors

Poor health and workWellness programsHealth care reformTake home messages

3

Work-Related Mortality and Morbidity

Non-Fatal Occupational Injuries and Illnesses

00.5

11.5

22.5

3

2003 2005 2006 2007

YearC

ases

per

100

full-

time

wor

kers

Fatal Occupational Injuries

0

1

2

3

4

5

6

1995 2000 2001 2004 2005 2006 2007

Year

Dea

ths

per

100,

000

empl

oyed

wor

kers

4

No Data <10% 10%–14% 15%–19%

Health Risk FactorsObesity Trends* Among U.S. Adults 1994

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

Behavioral Risk Factor Surveillance System

5

Health Risk FactorsObesity Trends* Among U.S. Adults 2008

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

Behavioral Risk Factor Surveillance System

6

Health Consequences of Overweight and Obesity

Cardiovascular diseaseHigh blood pressureAbnormal lipids Type 2 diabetesOsteoporosisConstipationDiverticular diseaseIron deficiency anemiaOral diseaseMalnutritionSome cancers

7

Health Risk Factors

Diabetes

6

7

8

9

10

11

1988-1994 1999-2000 2001-2002 2003-2004 2005-2006

Year

% P

erso

ns 2

0 ye

ars

ofag

e an

d ov

er

Hypertension

20

25

30

35

1988-1994 1999-2000 2001-2002 2003-2004 2005-2006

Year

% P

erso

ns 2

0 ye

ars

ofag

e an

d ov

er

Cigarette Smoking Adults US (2007)

010203040506070

NeverSmoker

FormerSmoker

CurrentSmoker

Perc

enta

ge

MenWomen

8

Consequences for Employers

Non-smoker

Former Smoker

Current Smoker

Mean days missed from work due to health conditions per year 4.4 4.9 6.7Total cost of productivity due to health per employee per year $2,623 $3,246 $4,430

*Bunn et al. Effect of Smoking Status on Productivity Loss. J Occup Environ Med. 2006;48:1099-1108

Unhealthy workforceIncreased medical costDecreased productivity

Absenteism + Presenteism

9

Wellness Programs

*Baicker et al. Workplace Wellness Programs Can Generate Savings. Health Affairs. 2010;29

METHOD OF DELIVERY% of

FirmsHealth Risk Assessment 81Self-Help Education Materials 42

Individual Counseling 39

Classes, seminars, group activities 36

Added Incentives for Participation 31

FOCUS OF INTERVENTIONWeight Loss and Fitness 66

Smoking Cessation 50

Multiple Risk Factors 75

Health Risk Assessment: Survey gathers baseline self-reported health data from the employee which are in turn used by employer to tailor subsequent interventions

10

Wellness Programs Work!

*Baicker et al. Workplace Wellness Programs Can Generate Savings. Health Affairs. 2010;29

STUDY FOCUSAverage

ROI

Health Care Costs 3.27Absenteeism 2.73

Medical costs fall by ~ $3.27 for every dollar spent on wellness programs and absenteeism costs fall by ~ $2.73

11

HRA Example: Christiana CareProgram Overview

2010 2008Eligible 7,957 8,241

Participated 6,217 6,403

% Participated 78% 78%Spouses eligible 2,869 N/A

Spouses Participated

1,925 N/A

% Participated 67% N/A

12

HRA Example: Christiana CareModifiable Risks 2010

Modifiable Risks

2010%

*National Norms %

Very Obese, very high risk (BMI >35)

18% 12%

Obese BMI >30 37% 32%

High levels of stress at home

13% 3%

High levels of stress at work

23% 4%

Low physical activity(1-4 days/wk)

68% 56%

* National Center for Health Statistics. Health, United States, 2007. Centers for Disease Control and Prevention. Accessed January 25, 2008.

13

HRA Example: Christiana CareNumber of Health Risk Comparison

0%

5%

10%

15%

20%

25%

30%

0 Risk 1 Risk 2 Risk 3 Risk 4 Risk 5 Risk 6 Risk 7 ormore

20082010

14

HRA Example: Christiana CareHRA/Biometric Program Highlights

0 Risk category went up by 4%

3, 4, and 5 risk categories went down by a total of 5% equating to a savings of $3,699,062!

Our savings between 2008 and 2010 is $228/employee or a total of$4,900,919!

*Wright et al. Comparing excess costs across multiple corporate populations. J Occup Environ Med. 2004;46:937-945

15

Smoking CessationFinancial Incentives for Smoking

Cessation

Randomly assigned 878 employees of a multinational company based in the US

442 employees: information about smoking-cessation programs436 employees: information about programs plus financial incentives

Financial incentives: $100 for completion of a smoking-cessation program

$250 for cessation of smoking within 6 months after study enrollment (confirmed by a biochemical test)

$400 for abstinence for an additional 6 months after the initial cessation (confirmed by a biochemical test)

*Volpp et al. A randomized, controlled trial of financial incentives for smoking cessation. N Engl J Med. 2009;360:699-709.

16

Smoking CessationFinancial Incentives for Smoking

Cessation

*Volpp et al. A randomized, controlled trial of financial incentives for smoking cessation. N Engl J Med. 2009;360:699-709.

Smoking Cessation

Incentive Group

Information Group

9-12 Months 14.7% 5%

15-18 Months 9.4% 3.6%

17

Provisions in the Patient Protection and Affordable Care Act

Bring value of Primary, Secondary, and Tertiary prevention to workplace beyond traditional wellness programs

Provide culture of health to workplace as a complement to the culture of safety:

Increased Productivity (less abs; less pres)Decrease cost to employers

18

Provisions in the Patient Protection and Affordable Care Act

Workplace Wellness and Productivity

Grants for Small Businesses to provide Comprehensive Workplace Wellness Programs

Employer-Based Wellness Programs: Directs CDC to providing services in areas of employer-based wellness programs

Wellness at WorkTake Home Messages

Health risk factors are increasing in the US

A healthy workforce is more productive

Wellness programs work!