Post on 18-Dec-2014
description
transcript
Maximizing the ROI of Worksite Wellness Programs
1
Larry S. Chapman MPHPresident and CEOChapman InstituteSeattle, WA 98155
(206) 364‐3448LChapman@ChapmanInstitute.net
Agenda
• Potential ROI of worksite health promotion efforts• Measuring ROI to meet management expectations• Model of health care utilization• Major pathways for health cost savings• Strategies for maximizing ROI• Objections to WW and counter-arguments• Summary of main points
2
© Chapman Institute, 2010. All rights reserved.
3
Potential ROI of Worksite Wellness efforts
© Chapman Institute, 2010. All rights reserved.
Key Terms
Economic Return: The monetary benefit (savings) associated with a program.
Return-on-investment (ROI): The monetary benefit (savings) associated with a program divided by the cost of that program expressed as a percent.
Cost/Benefit (C/B) Ratio:The monetary benefit(savings) associated with a program divided by the cost of that program expressed as an integer and/or a decimal.
Net Present Value:A commonly accepted way of estimating the time adjusted net monetary benefit(savings) associated with a program expressed as a dollar amount.
4
© Chapman Institute, 2010. All rights reserved.
New Meta-Analysis…
5
Source: Katherine Baicker, David Cutler, and Zirui Song, Workplace Wellness Programs Can Generate Savings, HEALTH AFFAIRS February,2010, 29(2) 1-8.
C/B = 1:6.0
© Chapman Institute, 2010. All rights reserved.
ROI Studies of Wellness Programs
• Bank of America• Blue Shield of CA• Duke University• Citibank• City of Birmingham• Coors• DuPont• General Foods• General Motors• GlaxoSmithKline• Indiana BCBS• Johnson & Johnson• Life Assurance• Nortel• Prudential• Travelers• Union Pacific• Washoe County
6Source: Proof Positive: An Analysis of the Cost-Effectiveness of Worksite Wellness, Chapman Institute, Sixth Edition, 2007.
Traditional
Newer Programs
OutliersC/
B Ra
tio
Study Number
C/B = 1:5.8
© Chapman Institute, 2010. All rights reserved.
Other Factors
• Limited economic scope of studies
• Few programs use VBD approaches
• Few direct healthcare utilization interventions
• Few use “best practice” incentives
• Few invest in good evaluation techniques
7
© Chapman Institute, 2010. All rights reserved.
8
Measuring ROI to meet management expectations
© Chapman Institute, 2010. All rights reserved.
Changing Management Expectations
• Platform for integration
• Connect to benefits• Becoming aware of
the “stakes”• Expect higher ROI• Expect measurement
validity• Expect dashboard
9
© Chapman Institute, 2010. All rights reserved.
Tips for Measuring ROI
#1 Define economic measures#2 Compare on “direct” only#3 Plan on “multiple” time series#4 Focus on growth rate trends#5 Use same framework each year#6 Look for other explanations#7 Match methods to expectations#8 Evaluate annually#9 Compose annual evaluation report#10 Ask for suggestions for improvement
10
© Chapman Institute, 2010. All rights reserved.
Model will Affect Outcomes
11
Quality of Work Life Approach
Program Model
• Fun activity focus• No risk reduction• No high risk focus• Not HCM oriented• All voluntary• Site-based only• No personalization• Minimal Incentives• No spouses served• No evaluation
Morale-Oriented
Main Features
Primary Focus
Traditional Approach
• Mostly health focus• Some risk reduction• Little high risk focus• Limited HCM oriented• All voluntary• Site-based only• Weak personalization• Modest Incentives• Few spouses served• Weak evaluation
Activity-Oriented
Population Health Management
• Add productivity• Strong risk reduction• Strong high risk focus• Strong HCM oriented• Some required activity• Site and virtual both• Strongly personal• Major Incentives• Many spouses served• Rigorous evaluation
Results-Oriented
Source: Chapman, Planning Wellness, Chapman Institute, 2008, p. 213. (available on Amazon.com)
© Chapman Institute, 2010. All rights reserved.
Reasonable Expectations?
Usual Outcomes:• 45% to 95% participation• 10% to 35% increase in
behavior change• 2% to 12% reduction in risk
prevalence• 17% - 28% reduction in sick
leave• 0% to 47% reduction in per
capita health costs• 15% to 25% reduction in per
capita health cost trends• ROI = 1:1.7 to 1:7.4
12
© Chapman Institute, 2010. All rights reserved.
13
Model of health care utilization
© Chapman Institute, 2010. All rights reserved.
Factors that Healthcare Utilization
14
Supply-Side Factors (outside the individual)
Extent and scope of insurance coverage*
Point-of-use cost sharing*
Geographic access to services
Supply-Side Factors (outside the individual)
Regional or local practice patterns
Provider incentives affecting diagnosis and treatment decisions*
Demand-Side Factors (inside the individual)
Age*
Sense of responsibility for personal
health*
Clinical risk factors*
Current morbidity*
Self-efficacy*
Gender
Personal health
behavior*
Attitudes about
personal health and
health care use*
* = Potentially modifiable.
Source: L. Chapman, 2008
© Chapman Institute, 2010. All rights reserved.
15
Major pathways for health cost savings
© Chapman Institute, 2010. All rights reserved.
Pathways to Health Cost Savings
• High risk intervention• Medical self-care• Consumer health skills• Early detection• Risk reduction• Targeted follow-up• Disease/condition management• Injury prevention• Treatment decision support• Point-of-use cost sharing• Comparative price information• Comparative provider information• Avoiding iatrogenic risk
© Chapman Institute, 2010. All rights reserved.
16
17
Strategies for maximizing ROI
© Chapman Institute, 2010. All rights reserved.
Key Strategies for Increasing ROI
#1 Expand economic measures#2 Enhance risk reduction/mitigation#3 Move to PHM program model#4 Include spouses#5 Require an annual HRA#6 Target benefit communications#7 Provide medical self-care and
Consumer health education#8 Address injury prevention#9 Use coaching intervention#10 Use multiple Wellness criteria
18
Source: Chapman, L., Health Cost Management Strategies for Health Promotion Programs, TAHP, 2002, Jan/Feb 5(6), p. 12.
© Chapman Institute, 2010. All rights reserved.
Key Strategies for Program Effectiveness
• Ongoing methods for raising awareness
• Ability to enhance motivation
• Opportunity to learn new skillsassociated with new behavior
• Opportunity to practice those new behavioral skills
19
Source: O’Donnell, M., A Simple Framework to Describe What Works Best: Improving Awareness, Enhancing Motivation, Building Skills and Providing Opportunity, The Art of Health Promotion, American Journal of Health Promotion, September/October, 2005, 20(1):1-12
© Chapman Institute, 2010. All rights reserved.
Issues Effecting Wellness Program ROI
“Situation-related” Issues• High risk prevalence• Older work force• Turnover profile• Greater occupational risks• Measurement methods used• Economic variables measured• Quality of baseline• Intensity of intervention• “Generosity” of health plan• Years of operation• Attitudes of employees• Extent of reach to spouses• Capital investment level• Balance of virtual vs. site-based
“Implementation-related” Issues• Behavioral targets selected• Program interventions used• Number of “touches”• Quality of implementation efforts• Plan design compatibility• Degree of HCM focus• Incentives used• Senior management support• Degree of integration
© Chapman Institute, 2010. All rights reserved.
Use of a “Virtual” Program Infrastructure
21
© Chapman Institute, 2010. All rights reserved.
Before After
Unified Administrative
Structure
Regular Staff Planning Meetings
Periodic Function and Operational
Review
Prospective Integration
Points
Integration Focused Review
22
Wellness Should be Well Integrated
Management Strategies
© Chapman Institute, 2010. All rights reserved.
23
Objections to WW and counter-arguments
© Chapman Institute, 2010. All rights reserved.
Worksite Wellness
“Objections”• Too much work• Don’t have the money
• ROI not guaranteed
• Its not our core business
• We are too busy
“Counters”• Depends…• How much are you spending?• How much will you be pending?• PL 111-148?• What is?• Do nothing and it will get worse!• Aren’t people part of your core
business?• Are your competitors too busy?
24
© Chapman Institute, 2010. All rights reserved.
25
Summary of Key Points
© Chapman Institute, 2010. All rights reserved.
Summary of Key Points
• Wellness is not “rocket science!”• Wellness just needs the same level of attention that
anything else of value deserves• You need to spend money to make money• There are a variety of ways that the economic return
from Wellness programs can be increased• Determine what you want from Wellness and then do
your homework• Get ready to have fun!
26
© Chapman Institute, 2010. All rights reserved.
27
Larry S. Chapman MPH(206) 364-3448Lchapman@ChapmanInstitute.net
© Chapman Institute, 2010. All rights reserved.