19
2011 © HealthPartners Good Health is Good Business Perspec’ves on ROI Es’ma’on for Workplace Health and WellBeing Programs Nico Pronk, Ph.D. April, 2013
2011 © HealthPartners
Good Health is Good Business Perspec'ves on ROI Es'ma'on for Workplace
Health and Well-‐Being Programs
Nico Pronk, Ph.D. April, 2013
2011 © HealthPartners 2
Agenda
• Building the business case for health promo<on at the worksite
• Where is the money being spent? • SeCng the context
• The Triple Aim at the worksite • The WHO Global Model
• Evidence of effec<veness • GeCng from ROI to “value” • Conclusions
2011 © HealthPartners 3
What is a “Business Case”
• “A scenario in which an organiza<on realizes a posi<ve return on investment for a par<cular interven<on.”
• Kilpatrick KE, et al. 2005
• Key components: • Effec<ve interven<on • Measured, meaningful outcomes • Program relevance in context • Realiza<on of value
2011 © HealthPartners 4
Challenges with ROI
• Es<ma<ng return on investment is not exactly an exact science…but at least plausibility is needed • Outcomes can not save more than 100% of costs • Use of preven<ve programs must go up in order to see reduc<ons in the costs of factors being prevented
• There must be a logical link between the goal of the program and the source of the savings
• Costs can not decline faster or more than the related preven<on variables improve (dose-‐cost response)
• Control groups tend to mislead unless carefully designed as an equivalent comparison/control
• Transparency of methods is paramount Source: Al Lewis. Why nobody believes the numbers, 2012.
2011 © HealthPartners 5
A U.S. PerspecIve
• Number 1 cost issue is health care • Total value of worksite health programs is not yet en<rely appreciated • Produc<vity • Worker performance • Turnover / reten<on • Corporate image • Corporate culture • Employee morale • …among others
2011 © HealthPartners 6
Where do U.S. health care dollars actually go?
Facing the challenges in health
care Social and economic factors
Physical environment
Healthy behaviors 30%
10%
40%
Medical services 20%
Medical services
8% Other
4% Healthy behaviors
88%
Where money spent Drivers of health
2011 © HealthPartners 7
Claims Cost DistribuIon
Healthy/low Risk At-‐‑Risk High Risk
Early Symptoms
Active Disease
20% of people generate 80% of costs
That means, 80% of people generate only 20% of the costs
Disease costs, prevention saves.
$
2011 © HealthPartners 8
Lower Risk Moderate Risk High Risk Well Managed
Poorly Managed/
Catastrophic
35% 30% 25% 8% 2%
Active Disease
Keeping healthy people healthy Preventing new disease Optimally managing active disease
Population segments (based on HA data)
PopulaIon-‐based SoluIons
Pre-Diagnosis
2011 © HealthPartners 9
High Cost Claimant Churn
Lower Risk Moderate
Risk High Risk Well
Managed
Low cost High cost
50% to 60% of the high cost claimant group is replaced, annually
Source: HealthPartners Health Behavior Group analysis, 2006
Poorly Managed/
Catastrophic
2011 © HealthPartners 10
Placing Employer Efforts in Context
Popula<on Health
Best Experience
Integrated Triple Aim
Cost Reduc<on
Non-‐tobacco use Physical activity Healthful diet Appropriate alcohol use Substance abuse avoidance Safe sex practices
Education Employment Workforce resiliency Family social support Income Community safety Affordability of care
Physical environment Psychosocial environment
(e.g., social norms) Environmental Quality (e.g., air, water, noise)
Access to care Health care beneIits coverage
Care quality Effective primary care Care process efIiciency IOM “STEEEP” aims
Source: Pronk, Koeke, Isham. Am J Lifestyle Med, in press
2011 © HealthPartners 11
WHO Global Model
• Robust • Applicable
across many types of companies
• Integrated improvement model
• Mul<-‐level
2011 © HealthPartners 12
Workplace Health Evidence of EffecIveness
• AHRF includes both health assessments and biometric screenings
• The Task Force finds insufficient evidence to determine the effec<veness of AHRF when implemented alone
• The Task Force recommends the use of assessments of health risks with feedback when combined with health educaIon programs, with or without addi<onal interven<ons, on the basis of strong evidence of effec<veness in improving one or more health behaviors or condi<ons in popula<ons of workers
2011 © HealthPartners 13
ROI Literature Review
Systema<c review and meta-‐analysis
Conclusion: Worksite Health Promo<on programs can generate posi<ve ROI for medical-‐
and absenteeism-‐related savings: Medical: 3.27 : 1
Absenteeism: 2.73 : 1
Workplace Health Evidence of EffecIveness
2011 © HealthPartners 14
Value through design
Companies across a variety of industries report benefits: • Lower health care costs • Greater produc<vity • Higher morale
ROI can be as high as 6:1
Six EssenIal Pillars for Successful Programs: 1. Engaged leadership at mul<ple levels 2. Strategic alignment with the company’s iden<ty and aspira<ons 3. A design that is broad in scope and high in relevance and quality 4. Broad accessibility 5. Internal and external partnerships 6. Effec<ve communica<ons
2011 © HealthPartners 15
Soource
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
Doing nothing may reduce the population’s health by as much as 7%
per year
This 2-‐year health and well-‐being program was associated with a ROI of
2.9:1
Source: HealthPartners Health Assessment Database, 2011
2011 © HealthPartners 16
Valuing PrevenIon A Report of the IOM
• The value of a program is defined as its benefits minus its harms and costs
• Requires a comprehensive assessment of both benefits, harms, and costs
• Community-‐based preven<on programs include worksite health promo<on programs and services
• Value should be assigned to its benefits across 3 domains: • Health
» Physical and mental, disease, HRQOL, etc. • Community well-‐being
» Social norms, educa<on, employment, etc. • Community process
» Local leadership, civic engagement, etc. Source: IOM 2012
2011 © HealthPartners 17
Link Health to “Value”
Health
Community Well-‐Being
Community Process
Benefits -‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐ Harms
Benefits -‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐ Harms
Benefits -‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐ Harms
Valuing – What should be counted?
Bene
fits a
nd Harms
Resources U
sed
Savings -‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐ Costs
Valuing – What should be counted?
Iden<fica<on of Investments and Resources
Value The value of an interven<on considers its
benefits, harms, and costs.
QALYs or HALE
Community Well-‐Being Indicator
Community Process Indicator
Monetary Units (USD)
Community Benefit
Community Cost
Source: IOM 2012
2011 © HealthPartners 18
Conclusions
• Good health is good business, when… • Employees need to be willing to engage in the program • Programs generate good health outcomes • Programs need to reach beyond the worksite into the family and community
• All stakeholders see the benefit of par<cipa<ng • The result:
• Experience is excep<onal • Popula<on health improves • Costs will decrease or stay low…affordability improves
2011 © HealthPartners 19
Thank You
