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Health Promotion in the Workplace:What is it?
Why do it ? How to do it?
Presented byRobert Karch, Ed.D.
30 de Septiembre de 2008SANTIAGO
Objectives
• To develop a common understanding of what is Health Promotion.
• To advance a rational as to why Health Promotion in the Workplace is important and has value.
• To present some key steps for how to conceptualize, develop, implement, operate, and evaluate a Worksite Health Promotion Program
Health
State of the complete physical, mental and social well-being and not merely the absence of disease and infirmity. Health is a resource for everyday life, emphasizing personal, social and physical capabilities.
Total Health
A state of complete physical, mental, and social wellbeing and not merely the absence of disease and infirmity.
In the context of health promotion, health is considered less as an abstract state and more as a means, as a resource
which permits people to lead an
individually, socially, andeconomically productive life.
Health Promotion
“is a process of enabling people to increase control over, and to improve, their health ”.
World Health Organization
Prevent or Prevention Pre - Coming before Vent - Letting/Getting out
Promote or Promotion Pro - For and/or in support of Motion - Action - Movement - Advocate
What isWorkplace Health Promotion?
Systematic approach endorsed by an organization designed to enhance the health of the company and its employees (AWHP)
Combined efforts of employers, employees and society to improve the health and well-being of people at work (Luxemburg Declaration on Workplace Health Promotion in the EU)
The philosophy, theory and strategic approach to enhancing the overall well-being of the workforce and the organization, through policies, programs and other initiatives based on the determinants of health
(Health Canada)
Why the Workplace?
Large number of people spend majority of waking hours at the workplace
Perceived impact of the work environment on health is very high
Captive audience at workplace
Origin of stress (US: work/family conflict) Modern corporate strategy (social management) Organizational investment for the future
(in human capital)
“healthy people in healthy organizations”
1.6 Trillion - 2003
US Health Care Expenditure by Year
0
0.5
1.0
1.5
2.0
2.5
3.0
1960 1970 1980 1990 2000 2010
Year
$$$(trillions)
Actual Expense
Projected Expense
Health Care Finance Administration, HHS, 2000
2008 -17% of GDP
Public Policy Associates, IncorporatedPublic Policy Associates, Incorporated 1919
National Health Expenditures in $Billions and National Health Expenditures in $Billions and as a Percent of GDP, 1990 – 2013as a Percent of GDP, 1990 – 2013
$0
$500
$1,000
$1,500
$2,000
$2,500
$3,000
$3,500
$4,0001990
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
$ B
illio
ns
0
2
4
6
8
10
12
14
16
18
20
Perc
en
t
Annual Health Expenditures Percent of GDP
Source: Centers for Medicaid and Medicare Services, Office of the Actuary
Public Policy Associates, IncorporatedPublic Policy Associates, Incorporated 2020
Employee’s Monthly Contributions to HealthEmployee’s Monthly Contributions to Health Insurance Premiums, 1988 - 2001Insurance Premiums, 1988 - 2001
$8
$52$30$28
$37$34
$124
$122$138
$150
$-
$20
$40
$60
$80
$100
$120
$140
$160
1988 1993 1996 2000 2001
Em
plo
yee
Co
ntr
ibu
tio
n
Single Coverage Family Coverage
Source: Kaiser/HRET Survey of Employer-Sponsored Health Benefits: 2000,2001; KPMG Survey of Employer Sponsored Health Benefits, 1988, 1993, 1996.
Public Policy Associates, IncorporatedPublic Policy Associates, Incorporated
Prescription Drugs as a Share of National Prescription Drugs as a Share of National Health Care Expenditures (Selected Years)Health Care Expenditures (Selected Years)
4.9% 5.5% 5.8%6.9%
7.6%8.5%
9.4%
12.9%
14.7%
0.0%
2.0%
4.0%
6.0%
8.0%
10.0%
12.0%
14.0%
16.0%
1980 1988 1993 1997 1998 1999 2000 2007proj
2011proj
Source: Health Affairs, Jan-Feb 2000, p. 173; Health Affairs, March-April 2002, p. 208.
Many modifiable health risks are associated with increased health care
costs within a relatively short time window A large proportion of disease and disorders from which employees suffer is preventable!
Findings: (Lifestyle linked)57% of Heart disease deaths37% of Cancers50% of Brain vascular disease23% of Pneumonia34% of Diabetes60% of Suicide70% of Chronic Liver disease (Cirrhosis)
WSHP Development and Trends in the US
• First Generation (1960’s)• Second Generation (1970’s)• Third Generation (1980’s)• Fourth Generation (1990’s)• Fifth Generation (2000’s)
Cost-Benefit Results General Motors 1 : 6.0 Equitable Life 1 : 5.5 McDonnell Douglas 1 : 4.0 Pillsbury 1 : 3.6 Metropolitan Life 1 : 3.2 Motorola 1 : 3.0 Prudential Life 1 : 2.9 Gillette 1 : 2.5 New York Telephone 1 : 1.9 Kennecot Copper 1 : 1.6 Adolf Coors 1 : 1.2 Army Materiel Comm. 1 : 1.19
“Fact”• Many of the risk factors that cause expensive diseases and
disorders can be ameliorated through the use of scientifically based and well-implemented health promotion/disease prevention programs
• When the risk profile of a population is changed over time, medical expenditures are likely to follow, though it may be more cost effective to prevent high-risk behavior in the first place.
• When an employed population shifts its health risk profile from high risk to low risk, the company realizes health care cost reductions. When population risk moves in the opposite direction, from low risk to high risk, the company realizes health care cost increases that are even more significant
10 KISS Steps to Program Success
1. Determine the desired outcomes of the stakeholders – (Get and Keep Healthy Workers & Save/Reduce Expenses for Healthcare).
2. Gather and analyze all available data.3. Conduct Policy Review.4. Assess the desires of #1 against the data of #2 the adjust as
needed.5. Conduct an Environmental Scan.6. Develop Cost Effective Intervention Strategies to maximize the
health of the population.7. Establish Priorities, Timelines, and Goals for any planned
Interventions.8. Determine all Resource needs and Costs. 9. Implement interventions and monitor progress.10.Evaluate Outcomes.
The Benfield Group
The following 15 slides are courtesy of the Chuck Reynolds President and CEO of the Benfield Group.
Health and Productivity Management—
Pattern of Success
Executive-Level Leadership
Integrated Management Team
Organizational Commitment
Information-Driven Intervention
Operational Infrastructure
• People• Systems
• Programs• Incentives
Integrated Data
Measurement
HPM: It’s What We Do
Players and Issues
Presenteeism
EmployersEmployers
Pharma CompaniesPharma Companies
OTC
Human Capital
Employees/Consumers
e-Health
Health Plans
Disease Management
Health Benefit Trends
Coalitions
Wellness
Associations
Government PBMs
Benfield’sHPM Lens
Our Market View
• Health Issues
• Economic Issues
• Key Players
• Key Trends
• Opportunities
Tactics & Support
• Internal Communication
• External Communication
• Training & Coaching
• Specialized Tool Development
• National Customer Programs
• Regional Customer Programs
• Outcomes Initiatives – Planning and Management
• Other… Creative
HPM
StrategyCustomer
Issues
To receive our eNewsletter, which provides news and perspectives on Health and Productivity Management, email [email protected].
Human Capital Issues Set the Stage for HPM
Deteriorating Health Impacts PerformanceAging and poor health habits conspire to increase costly and
debilitating conditions among employees
Shortage of TalentEmployers struggle to acquire and retain quality employees
Health Care Costs RiseEmployers face double-
digit inflation into foreseeable future
Human Capital ManagementHuman Capital Management
Employers are under intense pressure to Employers are under intense pressure to control costs while simultaneously control costs while simultaneously maximizing worker productivity and maximizing worker productivity and
sustaining an “employer of choice” statussustaining an “employer of choice” status
Human Capital ManagementHuman Capital Management
Employers are under intense pressure Employers are under intense pressure to control costs while simultaneously to control costs while simultaneously maximizing worker productivity and maximizing worker productivity and
sustaining “employer of choice” statussustaining “employer of choice” status
Global CompetitionProfit margins squeezed;
demand for innovation, quality, speed & service expands
More than ever, employee health is linked to corporate performance. Traditional strategies to manage health are insufficient to address health as part
of an integrated human capital strategy.
Example 1: Critical Success Factors
• Executive Leadership
• Integrated Data and Reporting Capabilities
• Organizational Structure & Incentive Alignment
FedExExecutive
Senior Management
Strategic Management GroupHuman Resource Admin
Human Resources | HRD_WC | Comp | Benefits |OCI | Ad-Hoc Members
HCMP Program ManagementLu Crowder
• HCMP/LOA Mgt.• RM/Workers’ Comp• Safety• Employee Benefits
• Human Resources• Legal• Compensation• Operations Management
OCI/FedExIntegratedInformation
System
Example 1:
IntegratedDatabase
Vehicles, Accident,and Training Detail
(FedEx Safety)
Employee, CEH, LOA History, OLPR
(FedEx PICC)
InternetIntegratedReporting
IntegratedAnalysis andConsultation
Case RiskAssessmentApplication
(CRAA)
FedEx Managers• HCMP/Ops Managers• Safety• Risk Management• Employee Benefits• HR• Compensation• Finance
Data Sources Data Integration Functions Reporting andManagement
Group STD/LTD(Kemper)
Group Medical/Provider Detail
(Cigna, UHC, & MBC)
Absenteeism(FedEx Payroll)
Workers’ Comp.Medical Detail
(Intracorp)
Productivity(FedEx/FAMIS)
Workers’ Comp.Claims Detail
(FedEx Risk Mgmt.)
Integrated Health and Productivity Database
Example 1: The Payoff
Health Benefit Savings Productivity Cost Savings
6-Year Cumulative Savings = Over $1 Billion
Example 2: • Vitals
– 6,500 Employees (U.S.)
– $8 Billion
– Leader in digital TV, broadband and satellite-based private business networks
• Investment Rationale
– Cost Management Mandate in Early ’90s
– Need to Attract and Retain Top Talent—Innovation and Service
• Critical Success Factors– Integrating Management Structure– Incentive Alignment– Integrated Interventions
P.T.O Policy
Training & Education
Wellness
HealthPlans
CaseMgmt.
Return to Work
Safety
Example 2:
• The Payoff– Focused wellness interventions—on top of
aggressive RTW policies and procedures—yield additional disability rate and cost reductions.
4.1%
7.8%
0%
1%2%
3%4%
5%6%
7%8%
9%
$224
$323
0
50
100
150
200
250
300
350
400% Filing STD% Filing STD Average STD CostAverage STD Cost
Participants Non-Participants
Example 2:
Example 3:
• Vitals– 32,000 Employees– $4.5 Billion– Manufacturing, Service, Technology
• Investment Rationale– Employee value part of corporate culture– Health as a component of HR/Benefits Strategy:
“Power of 2—Pitney Bowes & You”– HR Imperative—Attract and Retain Top Talent!
• Critical Success Factors
– Focus on Medical Cost Drivers
• Predictive Modeling to identify leading drivers
• Disease management interventions focused on top conditions
• Drug formulary strategy to foster compliance
– Focus on Lost Productive Time (Absenteeism + Presenteeism)
• Nearly 3 million lost productive hours per year
• Almost 1,500 FTEs
• $52 million cost
• 40% due to absence and 60% to health-related performance impairment
• 42% driven by top 3 conditions
• Site-specific drill-downs
• Flu shot program
• On-site clinic expansion
• Mental health screening
• Disease management programs
AuditAuditAudit AnalysisAnalysis Focused InterventionFocused Intervention
Example 3:
• The PayoffPotential Impact of Intervention:
SavingsSavings
Hours
FTEs
Cost
5%5%
142,000
74
$2.6 Million
10%10%
284,000
148
$5.2 Million
20%20%
568,000
296
$10.4 Million
Example 3:
• Vitals– 50,000 Employees– $30 Billion– Global Science and Technology Company
• Investment Rationale– Corporate commitment to employee health and safety– Total health cost analysis 1997 revealed $31 million
savings opportunity– New CEO—New commitment to increased
productivity
Example 4:
• Critical Success Factors– Information-based strategy– Dual focus on loss management and worker
effectiveness– Integrated Health Management—Council Structure
Example 4:
Integrated Health ManagementIntegrated Health Management
Health Promotion
Occ. Health
EAP
IndustrialHygiene
Safety GroupHealth
Occ. InjuryCompensation
HRD
DiversityWorklife
• The Payoff
– ROI analysis on health improvement identified health care cost savings potential of population health improvement intervention
Example 4:
$0.0
$5.0
$10.0
$15.0
$20.0
• Break-even impact over 10 years assuming $12.3 million invested
• NPV=0• $51 million saved over
10 years on investment of $12.3 million
• ROI 4.14 to 1.00
• NPV = $39 million
Do Nothing Reduce Risk.09%/Year
Reduce Risk1%/Year
An
nu
al R
isk-
Driv
en
He
alth
Exp
en
ditu
re I
ncr
ea
se (
$ M
illio
n)
A large proportion of disease and disorders from which employees suffer is preventable.
Findings: (Lifestyle linked)57% of Heart disease deaths37% of Cancers50% of Cerebrovascular disease23% of Pneumonia34% of Diabetes60% of Suicide70% of Chronic Liver disease (Cirrhosis) ? % Life/workplace STRESS
Morbidity & Mortality• 50% - 70% medical problems are associated
with modifiable health risk factors• Modifiable implies a potential for reduction
– Reduce risks and reduce morbidity and mortality
– Increase risks and increase morbidity and mortality
• Majority of risks stem from behavioral habits Smoking Obesity Alcohol Nutrition
Stress Seat belts Illicit drugs Sedentary
Lifestyle
Many modifiable health risks are
associated with increased health care costs within a relatively short time window
Projections of Savings in Medical Care Costs
0
100
200
300
400
500
600
700
800
900
1000
20002001 *
20022003
20042005 **
20062007
20082009
20102011
20122013
20142015
($ M
illi
ons)
Claims Cost Reduction Impact of Healthy Balance
Bending the Curve!
AMC Selected Results
Cost-Benefit Analysis– Assumption based methodology– Sensitivity analysis approach
Liberal assumptions Conservative assumptions
– Cost-Benefit ratio depends on assumptions Liberal 1 : 13.97 Conservative 1 : 1.19
Workplace Health Promotion: a
Win-Win-WinEmployers benefit:
Improved morale, higher productivity, enhanced recruitment and retention.
Employees benefit:Improved quality of life through better health, more control over work, better balance of work and social life.
Families and Communities benefit: Healthy people make healthy communities
Obesity• According to the Mayo Clinic, about 2/3 of Americans are
overweight; one in three is considered obese.
• This problem is not limited to America- it is a global concern!
• WHO reports that since 1995, the number of obese people in the world has doubled.
• There are now more than one billion overweight adults in the world, and at least 300 million of those are obese.
• Obesity, along with a stagnant lifestyle, increases risk for CHRONIC DISEASES such as high blood pressure, cardiovascular disease, diabetes, and stroke.
Confronting the Problem
World Health Organization: What can be done?
Established scientific evidence suggests there are major health benefits in:
• Eating more fruit and vegetables, as well as nuts and whole grains;
• Daily physical activity; • Moving from saturated animal fats to unsaturated
vegetable oil-based fats; • Cutting the amount of fatty, salty and sugary foods in the
diet; • Maintaining a normal body weight (within the Body Mass
Index (BMI) range of 18.5 to 24.9.); • Stopping smoking.
Speaking of Tobacco…
Why is tobacco a public health priority?
Tobacco is the second major cause of death in the world. It is currently responsible for the death of one in ten adults worldwide (about 5 million deaths each year). If current smoking patterns continue, it will cause some 10 million deaths each year by 2025. Half the people that smoke today -that is about 650 million people- will eventually be killed by tobacco.
Tobacco: We May Like to Smoke it, But it is Killing Us!!
Annual Deaths from Smoking Compared with Selected Other Causes in the United States
AIDS: 17,000Alcohol: 81,000Motor Vehicle: 41,000Homicide: 19,000Illicit Drugs: 14,000Suicide: 30,000Smoking: 430,000
Depression in the Workplace
Highest medical costs per employee (HERO study) + lost productivity
Defense strategies: Employee Assistance Programs (EAP) Health promotion programs Management training programs Reliable self-help information Anonymous depression screenings Skill training in resilience
PREDICTIONSCancer: increase in developing countries and
stabilization /decline in developed countries
Diabetes: 143 --> 300 million by 2025
European Union by 2005: - 33% increase in lung cancers in women - 40% jump in prostate cancers in men
Depression – one of the biggest issues for both develop and developing countries
Obesity and hypo-kinetics - a major world problem
The Future is Now!!!
• Increasing Health Care Cost• Aging Population• Physical Inactivity• Lifestyle Issues• Eating Habits • Smoking Habits• Chronic Disease • Stress• Obesity
Public Policy Associates, IncorporatedPublic Policy Associates, Incorporated 6767
Nationwide Physician Supply and Demand
1950 to 2020
219 259323
453
601
731837 881
266274260
236
195
155141
142
-100
100
300
500
700
900
1100
1300
1500
1950 1960 1970 1980 1990 2000 2010 2020
Ph
ysic
ian
s (
1,0
00s)
0
50
100
150
200
250
300
Ph
ysic
ian
s p
er
100,0
00 p
op
ula
tio
nTotal Physicians Physiicans per 100,000 population
Source: Lohr KN, Vanselow NA, Detmer DE. The Nation's Physician Workforce: Options for Balancing Supply and Requirements. National Academic Press, Washington DC, 1996.
Public Policy Associates, IncorporatedPublic Policy Associates, Incorporated 6868
Projected Supply and Demand for FTE RNs 2000 - 2020
1000000
1200000
1400000
1600000
1800000
2000000
2200000
2400000
2600000
2800000
3000000
2000 2002 2004 2006 2008 2010 2012 2014 2016 2018 2020
Supply Demand
Source: Bureau of Health Professions, RN Supply and Demand Projections
What is a healthy workplace?Five Guiding Principles (Health
Canada) Meet the needs of all employees, regardless of their
current level of health;
Recognize the needs, preferences and attitudes of different groups of participants;
Recognize that an individual’s “lifestyle” is made up of an interdependent set of health habits;
Adapt to the special features of each workplace environment; and
Support the development of a strong overall health policy in the workplace.
To reach Bob Karch
Bob Karch is a Professor at American University, is the founder and director of the Master of Science Program in Health Promotion Management (1980) and the founder and Executive Director of the National Center for Health and Fitness (also 1980) and the International Institute for Health Promotion (1996) at American.
He can be reached at - [email protected] or by phone At American - 202-885-6285