Page 1 Craig D. Thorne, M.D., MPH, FACP, FACOEM Medical Director, Employee Health & Safety University of Maryland Medical Center 443-257-0903 [email protected][email protected]Ensuring a Successful Workplace Health Protection and Promotion Program MARCOM V, October 13, 2007 Objectives 1. Discuss the latest research on the cost savings associated with employee health & wellness programs 2. Build a business case & demonstrate the return on investment for reducing health risk & preventing managing chronic diseases in the working population 3. Understand opportunities for Internists to provide leadership in creating & improving holistic workplace health & productivity management programs Agenda 1. Approaches to ensuring employee health 2. Scientific & business case for employee health & productivity 3. UMMC story: Step Up to Good Health 4. Key approaches to health & productivity management 9 Planning 9 Integrating 9 Implementing 9 Communicating 9 Measuring 9 Re-launching & growth 5. Discussion Background … Definitions Health & Productivity Management: joint management of services & benefits designed to address all dimensions of employee health. Includes medical benefits, disability & workers’ compensation programs, employee assistance programs (EAPs), paid sick leave, health promotion & occupational safety programs. These services & benefits are meant to enhance morale, reduce turnover, & increase on-the-job productivity Direct costs: dollars paid to others for health services (i.e. medical, dental, pharmacy, mental health & workers’ compensation costs) Indirect costs: costs associated with replacement workers, overtime premiums that are related to unscheduled absences, & productivity losses of workers while on the job Absenteeism: # of days missed from the workplace. Includes workers’ compensation, short term disability (STD), long term disability (LTD), sick leave, unscheduled absence, Family Medical Leave (FML), paid time off (PTO), unpaid leave, & premature mortality costs Family Medical Leave: federally mandated employee benefit that allows up to 12 weeks of paid or unpaid leave with job protection to care for serious personal or family illness Presenteeism: ‘At work - but out of it’. Describes the degree to which an employee is present but not fully functioning. Includes quality & quantity of work, & interpersonal factors University of Maryland Medical Center
Transcript
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Craig D. Thorne, M.D., MPH, FACP, FACOEMMedical Director, Employee Health & SafetyUniversity of Maryland Medical [email protected]@erickson.com
Ensuring a Successful Workplace Health Protection and Promotion Program
MARCOM V, October 13, 2007
Objectives
1. Discuss the latest research on the cost savings associated with employee health & wellness programs
2. Build a business case & demonstrate the return on investment for reducing health risk & preventing managing chronic diseases in the working population
3. Understand opportunities for Internists to provide leadership in creating & improving holistic workplace health & productivity management programs
Agenda1. Approaches to ensuring employee health 2. Scientific & business case for employee health &
productivity
3. UMMC story: Step Up to Good Health4. Key approaches to health & productivity management
DefinitionsHealth & Productivity Management: joint management of services & benefits designed to
address all dimensions of employee health. Includes medical benefits, disability & workers’compensation programs, employee assistance programs (EAPs), paid sick leave, health promotion & occupational safety programs. These services & benefits are meant to enhance morale, reduce turnover, & increase on-the-job productivity
Direct costs: dollars paid to others for health services (i.e. medical, dental, pharmacy, mental health & workers’ compensation costs)
Indirect costs: costs associated with replacement workers, overtime premiums that are related to unscheduled absences, & productivity losses of workers while on the job
Absenteeism: # of days missed from the workplace. Includes workers’ compensation, short term disability (STD), long term disability (LTD), sick leave, unscheduled absence, Family Medical Leave (FML), paid time off (PTO), unpaid leave, & premature mortality costs
Family Medical Leave: federally mandated employee benefit that allows up to 12 weeks of paid or unpaid leave with job protection to care for serious personal or family illness
Presenteeism: ‘At work - but out of it’. Describes the degree to which an employee is present but not fully functioning. Includes quality & quantity of work, & interpersonal factors
University of Maryland Medical Center
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Company Overview
• The University of Maryland Medical System (UMMS) is a national & regional referral center for:– Trauma– Cancer care– Neurocare– Cardiac care– Women's & children's health – Physical rehabilitation
• Partnered with the UMD School of Medicine
• The System is comprised of 7 hospitals:– University of Maryland Medical Center, downtown Baltimore
• Kernan Hospital, Baltimore• University Specialty Hospital, Baltimore
– Baltimore Washington Medical Center, between Baltimore & Annapolis– Maryland General Hospital, West Baltimore– Mt. Washington Pediatric Hospital, Northwest Baltimore– Shore Health System, Eastern Shore
• Our employees & their health benefits:– 6,000 employees; 12,000 covered lives when spouses & dependents are
included– 25/75% male/female split– Self-insured medical plan & workers’ compensation insurance fund– $34 million in direct health care costs
Company Overview
Our Vision for Employee Health & Productivity
By identifying & lowering health risks, managing chronic disease & by providing employees with free, confidential offerings that increase individual responsibility for health & wellness, we can manage medical costs, help employees & their family members remain healthy, & reduce unnecessary absenteeism, disability & presenteeism
Our Strategy for Improving Employee Health & Productivity
Provide & manage an over-arching framework that promotes the physical & emotional health, wellness & productivity of our valuable employees & their family members through the efficient delivery of cost effective, high quality health & wellness services
Doing the right thing for employees impacts business
The shift to total health management has a trickle down effect to the bottom line:
Healthy, engaged, productive employees↓
Increased employee satisfaction & retention↓
Increased patient satisfaction↓
Best place to live & work↓
Improved financial results
Where our Employee Health program was in 2005
Limited to:
1. Pre-employment questionnaire & vaccinations 2. Nurse-administered fitness for duty evaluations for drug or alcohol
Current offerings1. On-site injury care 2. Fitness for duty evaluations for any declining performance to determine need for medical
or psychological care, or rehabilitation3. Improved Disability Management Program by on-site RN Manager4. Improved ‘Stay at Work’ program & reduced disability costs5. Improvements in annual TB testing, compliance to follow-up testing post exposure, &
related record-keeping 6. Respiratory protection program, including improvements in respirator fit testing, & related
record-keeping7. Pre-employment assessment of physical capacity, & current/recent drug or alcohol
impairment. Medical clearance by MD/NP/PA 8. Improved compliance with annual flu vaccinations9. Focused preventative educational & ergonomics programs for new employees ‘at risk’ for
musculoskeletal injuries, & bloodborne pathogen exposures training using real data 10. OSHA-compliant medical surveillance programs, including Handling of Hazardous Drugs 11. Formal Workplace Violence Prevention & Response program12. New Safe Patient Lifting & Movement program
• Created & launched in September 2005 with true leadership support & employee involvement
• A comprehensive approach to maintaining, improving & managing the overall health, productivity & return to work/stay at work of our population by…– Segmenting the population according to health conditions &
risks– Designing quality driven, targeted interventions to meet the
needs of each individual– On-site health education & screenings (e.g. blood
pressure, cholesterol, body mass index, or BMI)– Encourage function by managing ‘stay at work’ programs
by a nurse Integrated Disability Manager
Our Business Case for Improving Health… Lower Employer Costs
University of Maryland Medical SystemEstimated Health Improvement Cost Comparison ($ in millions)
$44.4
$35.8
$40.7
$45.9
$51.3
$57.4
$47.2
$34.9$38.4
$41.6
$25.0
$30.0
$35.0
$40.0
$45.0
$50.0
$55.0
$60.0
2006 2007 2008 2009 2010Fiscal Year
UM
MS
Net
Med
ical
Cos
t ($
in m
illio
ns) No Programs
Full Program
Estimated $10.2M
Net Savings by
Year 4
NOTE: Full Program savings includes direct medical savings & indirect work loss savings (absenteeism, STD, LTD, workers' comp). Includes estimated program costs & consulting fees in each year. Does not include implementation costs . Assumes full comprehensive health improvement program with the following components: HRAs, lifestyle behavior change programs, health action programs, nurseline, health decision support, disease & case management. Assumes program is well communicated, embraced by all stakeholders & employees change behavior.
$100.00
$120.00
$140.00
$160.00
$180.00
$200.00
$220.00
2006 2007 2008 2009 2010
Con
tribu
tions
(Bi-W
eekl
y)
No Program
Full Program
Our Business Case for Improving Health… Lower Employee Costs
$119.09
$195.99
$161.33
$141.98
$156.67
Fiscal year
Comparing impact of program on projected employee co-contributions
Planning …
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Obesity Trends* Among U.S. AdultsBRFSS, 1985
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)
No Data <10% 10%–14%
Obesity Trends* Among U.S. AdultsBRFSS, 1986
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)
No Data <10% 10%–14%
Obesity Trends* Among U.S. AdultsBRFSS, 1987
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)
No Data <10% 10%–14%
Obesity Trends* Among U.S. AdultsBRFSS, 1988
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)
No Data <10% 10%–14%
Obesity Trends* Among U.S. AdultsBRFSS, 1989
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)
No Data <10% 10%–14%
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Obesity Trends* Among U.S. AdultsBRFSS, 1990
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)
No Data <10% 10%–14%
Obesity Trends* Among U.S. AdultsBRFSS, 1991
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19%
Obesity Trends* Among U.S. AdultsBRFSS, 1992
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19%
Obesity Trends* Among U.S. AdultsBRFSS, 1993
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19%
Obesity Trends* Among U.S. AdultsBRFSS, 1994
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19%
Obesity Trends* Among U.S. AdultsBRFSS, 1995
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19%
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Obesity Trends* Among U.S. AdultsBRFSS, 1996
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19%
Obesity Trends* Among U.S. AdultsBRFSS, 1997
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19% ≥20%
Obesity Trends* Among U.S. AdultsBRFSS, 1998
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19% ≥20%
Obesity Trends* Among U.S. AdultsBRFSS, 1999
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19% ≥20%
Obesity Trends* Among U.S. AdultsBRFSS, 2000
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19% ≥20%
Obesity Trends* Among U.S. AdultsBRFSS, 2001
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19% 20%–24% ≥25%
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(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)
Obesity Trends* Among U.S. AdultsBRFSS, 2002
No Data <10% 10%–14% 15%–19% 20%–24% ≥25%
Obesity Trends* Among U.S. AdultsBRFSS, 2003
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19% 20%–24% ≥25%
Obesity Trends* Among U.S. AdultsBRFSS, 2004
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19% 20%–24% ≥25%
Obesity Trends* Among U.S. AdultsBRFSS, 2005
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%
Is there a direct relationship between health risks &
medical costs?
Average Annual Medical Costs by Age & Risk
<35 35-44 45-54 55-64 65+
$0
$2,000
$4,000
$6,000
$8,000
$10,000
$12,000
AGE
5+ Risks3-4 Risks
0-2 Risks
N = 43,687
COSTS
Source: StayWell Data analyzed by University of MichiganSurviving the Perfect Storm by, David R, Anderson, PhD, Absolute Advantage Vol 2, No.5 2005
Page 8
Are indirect costs of employee illnesses &
injuries as important as direct medical costs?
1%6%
6%
24%
63%
Presenteeism
Medical &Pharmaceutical
Absenteeism
Short Term Disability
Long Term Disability
The Hidden Costs of Presenteeism
Source: Paul Hemp, Presenteeism: At Work – But Out of It, Harvard Business Review October 2004; 49-58
Valuing Health & ProductivityOpportunity: Reduce Costs & Show A Positive Return On Investment
Indirect Medical Costs• Presenteeism• Short Term Disability• Long Term Disability• Absenteeism• Workers Compensation
Indirect Medical Costs• Presenteeism• Short Term Disability• Long Term Disability• Absenteeism• Workers Compensation
Non-VisibleCosts
VisibleCosts
Represents 3 X Medical CostsDavid R. Anderson, PhD, “Building a First Class Workforce”, Absolute Advantage 2003;Vol 2, No.3:4-9
Represents 3 X Medical CostsDavid R. Anderson, PhD, “Building a First Class Workforce”, Absolute Advantage 2003;Vol 2, No.3:4-9
Direct Medical Costs• Medical• Pharmaceutical
What health care costs are out of control?
Increase
Incidence is up more than 20%Family Medical Leave
9% overall, more than 50% in some statesWorkers’ Compensation
30%Casual Absence
7% to 9%Disability
8% to 14%Health Care
20% of employers are very confident in their ability to manage health care costsOnly 10% are very confident in their ability to influence the quality of care& 50% are uncertain whether they will be offering health care benefits 10 years from now
outThe fact is…all health-related costs are of control
Source: National Business Group on Health
The fact is…health behaviors are of controlout
• Chronic illness affects more than one-third of working-age Americans & accounts for 75% of the nation’s annual health care costs
• Diabetes has increased 49% in the last 10 years − $44 billion in direct health care costs− $54 billion in indirect health care costs
• Obesity/overweight has increased 61% in the last 10 years − $70 billion in direct costs− 58 million days of work lost annually − $5.7 billion in lost revenue
• 60% to 75% of Americans do not engage in enough physical activity to benefit their health
• People living in counties marked by sprawling development are likely to walk less, weigh more & are more likely to have high blood pressure
Source: National Business Group on Health
Page 9
$3,804
$3,368
$2,349
$1,158$1,272 $1,363
$0
$500
$1,000
$1,500
$2,000
$2,500
$3,000
$3,500
$4,000
$4,500
Heart Disease Stroke PsychologicalProblems
With multiplehigher level riskfactorsWith lower levelrisk factors
1.98
5.94
0
1
2
3
4
5
6
7
Low Risk Moderate and High Risk
3x
Health Risk Affects Absenteeism Disease Affects Productive Time
Program Impact on STDHealth Risk Affects Costs
Source: The Health Enhancement Research Organization (HERO), 1998
Source: Martin Law, Presentation to World Mental Health Conference, “Wellness at the City of Calgary,” October 5, 2000
Source: Serxner, Gold, Anderson, Williams, Journal of Occupational & Environmental Medicine (JOEM), 2001
Source: Burton, et al. Journal of Occupational & Environmental Medicine (JOEM), October 1999
60%67%
77% 79% 79%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
Digestive Mental Health Respiratory Injury Musculoskeletal
29.2
33.2
27.8
38.1
0.0
5.0
10.0
15.0
20.0
25.0
30.0
35.0
40.0
45.0
Participant Non-Participant
Pre Post
The truth is…health affects costs, disability, absenteeism & presenteeism Typical health care spending behavior
ChronicDisease
AcuteConditions
HighRisk
ModerateRisk
LowRisk
CatastrophicIllness
ChronicDisease
AcuteConditions
HighRisk
ModerateRisk
LowRisk
CatastrophicIllness
• 66% of population has claims under $1,000
• 15% of total medical expenses are spent by this group
• 30% of population has claims between $1,000 & $10,000
• 50% of total medical expenses are spent by this group
• 4% of population has claims greater than $10,000
• 35% of total medical expenses are spent by this group
Maintain Health Manage HealthImprove Health
Can worksite health promotion programs result in cost savings & improve
productivity?
• Annual health care costs are 49% lower for individuals who are non-smokers, non-obese & who participate in physical activity three days per week
• Individuals with fewer risk factors & managed disease are absent less, injured less & return to work more quickly than individuals with more risks or unmanaged disease
• Increasing physical activity in individuals 50 years & older from zero to one day per week to three or more days per week results in a $2,200 decline in total health care costs compared to those who stay inactive
• Health improvement programs have a proven return on investment:– $4.30 per $1 spent when considering healthcare costs & absenteeism
(Wisconsin Public Health & Health Policy Institute)– $3.91 per $1 investment in second year (Discovery Channel)
Believe it…maintaining, improving & managing health has financial return
Source: National Business Group on Health
What have insurance industries done in
response to our healthcare crisis?
Insurance companies’ response
1. Utilization review: pre-certifying hospital admissions to ensure medical necessity
2. Case management: managing expenses once a patient has been admitted
3. Managed care: gatekeepers, managing referrals, preferred networks, etc.
4. Drug formularies5. Disease management
… etc.
Page 10
What have some employers done in response to our
healthcare crisis?
Some employers’ responses
Employers have taken action against the rising costs of healthcare by:
1. Purchasing managed care programs with gatekeepers, referrals & networks
• Some argue that these punish 100% of employees & their dependents in an effort to manage the 20% most affecting costs
2. Cost-shifting to employees through higher per-pay contributions (premiums), higher co-pays &/or deductibles & plan design reductions
And… What have employees done in
response?
Some employees’ responses
1. Gaining weight2. Controlling rising cholesterol through
costly pharmaceuticals rather than life-style changes
3. Living a sedentary life4. Continuing to smoke5. Depending on their employers to pay the
cost
What should we do for our employees & our own
bottom line?
Best practices in employee health & wellness
1. Focus on preventive health & wellness2. Engage employees & their dependents to
positively manage their health & their healthcare through useful information & on-site resources
3. Manage what matters most4. Instead of focusing on ‘What is our cost per
employee per month?’, ask:‘How healthy is our company & what are we doing to improve it?’
Page 11
Effectiveness of Medications in Reducing Productivity Losses Caused by Chronic Illness
*RCT, Randomized controlled study * PPT, pretest-post–test study
RCTs, PPTsMigraineTriptans
RCT, Retrospective cross-sectional analyses
DepressionTCAs
RCTDiabetesSulfonylureas
Retrospective cross-sectional analyses
DepressionSSRIs
RCTDysmenorrheaNSAIDs
RCTDepressionMAOIs
RCTAsthmaLeukotriene Receptor Antagonists
RCT, case control studiesInfluenzaInfluenza Vaccines
PPT*AsthmaBeta-Agonists
RCTPanic DisorderBenzodiazepines
RCTInfluenzaAntivirals
RCTs, Retrospective longitudinal study
Allergic rhinitisAntihistamines
RCT*Acute bronchitisAntibiotics
Study DesignIllnessDrug Class
Office of Disease Prevention& Health Promotion
Two major goals of Healthy People 2010
• Increase quality & years of healthy life
• Eliminate health disparities
Office of Disease Prevention& Health Promotion
Leading Health IndicatorsLeading Health Indicators
• Physical activity
• Overweight & obesity
• Tobacco use
• Substance abuse
• Responsible sexual behavior
• Mental health
• Injury & violence
• Environmental quality
• Immunization
• Access to health care
Ten Major Public Health IssuesTen Major Public Health Issues Office of Disease Prevention& Health Promotion
Healthy People 2010Actual Causes of Death Office of Disease Prevention
& Health Promotion
0
50,000
100,000
150,000
200,000
250,000
300,000
350,000
400,000
Estim
ated
No.
of D
eath
s*
Tobacco Alcohol ToxicAgents
SexualBehavior
Illicit DrugUse
*Data from 1990
Worksite health programs that fit well into the Healthy People 2010 initiativeWeight management
Back injury screening & education; ergonomics interventions
Hypertension management
Smoking cessation
Page 12
National Business Group on Health
• 12th annual study on health care trends & the actions employers are taking
• Report focuses on those companies who minimize cost trends – “best performers”
• 573 companies (27 locally) providing benefits to over 11 million individuals. Includes University of Maryland Medical Center
• Survey conducted from November 2006 to January 2007
Key findings
• Cost increases both nationally & locally have steadied at 8%– Very best performers have a two-year median cost increase of
2.5%, compared with 11% for poor performers• Best performers take an integrated approach
– Using data & evidence to manage– Maximizing health improvement– Emphasis on high-quality care– Effective use of financial incentives– Innovative & effective communication
Source: National Business Group on Health
Voice of the consumer:Most employees are ready to improve their health
69
Readiness to Make Changes
8
10
11
13
27
31
0 5 10 15 20 25 30 35
Definitely not considering changesat all/probably
should
Have made a commitment tochange in the next six
months
Successfully made a change Within the past six months
I currently have a healthy lifestylein all major ways
Am considering making changes
Am in the process of changing
% Selected
Source: 2007 Employee Perspectives on Health Care, Watson Wyatt
Group Health
Pharmacy
EmployeeDemographics
Employee Opinion Survey
Workers’Compensation
STD & LTD
Illness/Absence
Administrative Costs
Health Improvement & Disease
ManagementProgram Data
Manage benefit costs
Reduce absence
Improve workforce performance
Increase employee satisfaction
What to collect & how to use it
Source: National Business Group on Health
“State-of-the-art” health management
Population
Screenings
AssessmentsHealth
AdvocateSelf-Care
Guides
Plan Information
Cost & Quality
Information
General Health
Information
Disease Management
Maternity Management
• Worksite biometric screenings
• Health risk assessment
• Phone-based coaching
• Web-based behavior change programs
• Risk Factors− Physical inactivity− High cholesterol− Tobacco use− Overweight/obesity− High blood pressure• Supportive
environment
• Location champions
• On-site fitness or walking trails
• Health policies
• Health action programs
• Seminars/classes
Worksite Culture
• Asthma
• CHF
• CAD
• COPD
• Diabetes
• Low back conditions
• Cancer
Fitness Centers
EAP
• Preventive care reminders
• Health awareness campaigns
• Health fairs
CaseManagement
Individual
Prevention, early detection, self-care
Acute & chronic condition managementHealth decision support
Maintain Health Improve Health Manage Health
Risk reduction &self-care
Education
Support Health
Source: National Business Group on Health
Introducing…ACOEM’s Health & Productivity Toolkit
A Unique Resource In Building the Competitive Edge
Craig D. Thorne, M.D., MPHUniversity of Maryland Medical System
Page 13
The Problem: Rising Medical Costs/Eroding Profits
0
100
200
300
400
500
600
1996 1997 1998 1999 2000 2001 2002
Corporate Profits Health Benefit Costs
Source: The National Data Book & IRS Data Reports Copyright R. Loeppke MD; reprinted with permission
All U.S. Corporations*$7,000 Per EmployeeDirect Medical Costs
*2002 PEPY National AverageEstimated $14,000
Per EmployeeMedically Related
Productivity Costs
Medical& Pharmacy
Absenteeism
STDLTD
Presenteeism Estimated Total Costs $21,000
PEPY
The Real Problem: Total Costs
Reprinted with permission of R. Loeppke, MD
EmployeeCentricDataMedical
EmploymentHistory
WorkersComp
Absence
LTD
STD
Pharmacy
Performanceat work
h Quantify valueh Find net value for health
investmenth Understand “total” costh Build integrated solutionsh Define business outcomesh Set “best practice
benchmarks”h Set performance objectives
THE SOLUTION:Managing Health As a Component of
Business Success
Reprinted with permission of P. Hymel, MD
Integrated Structure
Vice President of HR, Medical Director
EmployeeBenefits
WellnessInitiatives
DisabilityManagement
ApplicableData
Utilization
Reprinted with permission of P. Hymel, MD
How to BeginIdentify problem
Analyze absenteeism, claims, short & long term disability dataIdentify high cost centers, reasons for absenteeismIdentify Health risk within the populationReview & discuss problem areas
Propose change Identify programs for changeChart proposed benefits with potential ROI
Select metric to guideState null hypothesis & study design
Adapted from M. Yarbrough, MD Reprinted with permission
ImplementEducate stakeholdersEducate employeesImplement program
Monitor metrics continuouslyi.e., graph-on-the-wall or “watch the dashboard”
Evaluate/Judge valueIdentify costs to implementIdentify lower absenteeism or lower claims costsImproved Health RisksPresenteeism Improvement
Adapted from M. Yarbrough, MD, Reprinted with permission
Continued
Page 14
Be committed & unwavering to your missionBe committed & unwavering to your mission
DonDon’’t be afraid to use lessons learned by otherst be afraid to use lessons learned by others
Be aggressive with initiatives yet patient with Be aggressive with initiatives yet patient with cultural transformationcultural transformation
Tips
Adapted from M. Yarbrough, MD, Reprinted with
Pursue the Bigger Picture, Broader Solution!
Occupational Medicine & Integrated Benefit Programs
Human Resources
Short Term Disability
Long Term Disability
Health Benefits
Workers’Compensation
The New Horizon - Pursuing opportunities across plans that affect change in health-related productivity -
The resource of Occupational Medicine can be the key to activate your integrated benefits programs.
Reprinted with permission of P. Hymel, MD
How To Order
Reprinted with permission of P. Hymel, MD
www.acoem.org (publications)
Mail-in order form
$115 for ACOEM members
Specific to the University of Maryland Medical Center
• Double digit medical trend for past 5 years• STD durations of 46 days• Significant increase in LTD costs• Our avoidable claims analysis confirms that that about
80% of costs are driven by 20% of employees:– Cardiovascular– Cancer– Lack of self care/inappropriate use of E.D. care – Maternity– Depression– Asthma– Musculoskeletal claims: low back pain & osteoarthritis of knees
1. Health Risk Assessment (HRA)2. 24/7/365 nurse line3. Lifestyle behavior change programs, both on-line & nurse-
coached4. Chronic disease management programs5. Maternity management6. On-site lunchtime programs that are culturally appropriate 7. On-site clinical services, including injury & exposure
management, biometrics, & fitness for duty evaluations8. On-site disability management, stay at work programs, & care
facilitation9. Incentives
Integrating …
Page 15
Integrating Health & Wellness Services
• New Employee Health Suite on main floor --- Free cholesterol screens, weight/BMI & BP measurement
• Integrated Disability Manager/Care Facilitator Office in Employee Health Services
– On-site benefits explanations & facilitation– Access the best medical care on campus– Coordinate transitional duty directly with Supervisors– Make referrals to other services, including wellness, EAP, etc.
• Employee/Patient Resource Center --- Free weight/BMI & BP measurements
• Employee Assistance Program• Benefits department• Offsite but integrated:
– Life Services (e.g., elder care, college tuition, relocation)– Case Management– STD/LTD Disability vendor– Workers’ Compensation Administration– Third party administrator
Implementing …
Primary Goals of a Health Risk Assessment (HRA)
• Raise employee awareness about the association of their health practices/measures & future problems
• Motivate employees to seek appropriate interventions & reinforce progress through health coaching (face-to-face, telephonic, &/or Internet) & follow-up assessments
• Identify the distribution of risk (i.e. percentage of low-risk & high-risk employees) across the population
• Serve as benchmarking, planning & evaluation tool
Participation Incentives
$50 for enrolling during the first trimester, $50 upon delivery, & an additional $25 for completing the post assessment
Maternity Program
$100 cash upon completion of a performance goalChronic Condition Performance Goal
$25 Target stores gift certificate shortly after enrollmentEnroll in a Chronic Condition Program
$25 Target stores gift certificate shortly after completionHealthy Living Program Completion
$25 food card for healthy cafeteria choices EACH yearHealth Risk Assessment
IncentivesProgram
Communicating …
Page 16
Our Communication Essentials
• Getting the right programs to the right people at the right time– Target specific groups – job title, gender, age group
• Brand the program– Employee-designed logo everywhere --- relentless!– Paging Dr. Craig
• Written strategy with objectives• 7 ways, 7 methods
– Glossy brochure – Displays next to time clocks– Every periodical– Targeted emails, etc.
• Cross promote with other initiatives– Race for the Cure– National Wear Red Day – Get fit challenges– National Nurses’ Week
• Testimonials
"I am health conscious now about what I eat & do... I am living healthier & more active... I found a work-out buddy at work & we started walking to the harbor daily..."
"The nurse specialist helped me get to know my medicine better & introduced some things about asthma my doctor hadn't mentioned"
What did we do in year one to pick up the pace?
• Promoting free biometric testing, including on-site measurement --- cholesterol profile, blood pressure & weight/BMI; personal health cards
• FAQ Help-line --- e.g. problems with access
• Using employee ID# in lieu of SSN to complete HRA
• Cross-referrals from vendors
• “Champions” Program --- volunteers throughout the organization are the ‘eyes, ears, hands & feet’; introduce health ‘challenges’ among departments; conduct a survey of non-participants
• Free “Care Package” seminars
• “Paging Dr. Craig” clinic on Wednesday mornings --- to help employee-patients navigate through the healthcare delivery system & access UMMC-related services
• Frequent communication “splashes”
E-X-T-E-N-D Your Life…Cancer Screenings for All
Presented by:Barry Meisenberg, MD
Professor of MedicineUniversity of Maryland School of Medicine
Deputy Director, Clinical AffairsUniversity of Maryland
Marlene & Stewart Greenebaum Cancer Center
* Learn about the latest screenings for all types of cancer* Get a FREE healthy meal* FREE gift to all attendees* Enter to win a raffle prize
June 6th12 noon in the Patient Resource Center (Weinberg Building)
Ladys’ Health Club…Answers to Your TOP 10Health Questions
2007? Stop by Employee Health, T1R05, to ask for your FREE magnet & how
to know your numbers
Measuring …
Results: where we are today…• Cost contained over $600,000 in the first year alone
– Additional savings of disability ($250,000) & productivity savings included (perhaps 1-3 times disability savings, per Integrated Benefit Institute)
• Reduced medical trend– 6% compared to average trend of 13% for last several years. Equates to
$2 million dollars cost containment
• Reduced average short term disability (STD) duration– First year STD duration reduced to 37 days– Second year STD durations reduced to 26– Current STD durations of 21 days– Significant reduction in LTD costs
• Increasing participation in Step Up to Good Health programs• Increasing number of personal testimonials• Increasing number of referrals to & from vendors
Page 18
HRA Participation
22
82
256189
32
96
146
7896
1
10
100
1000
Sept. 06 Oct. Nov. Dec. Jan. 07 Feb. March April
Month
Num
ber o
f Par
ticip
ants
New Incentive at Health Fair
“Happy New You”presentations with
magnet
“Biggest Winner”
Recent Chronic Condition Management Participation
0
20
40
60
80
100
120
140
160
Nov. 06 Dec. Jan. 07
Month
Num
ber o
f Par
ticip
ants
CAD
Diabetes
Asthma
LBP
Cancer
Depress.
COPD
OB
CHF
Our current trend is better than expected!University of Maryland Medical System
Estimated Health Improvement Cost Comparison ($ in millions)
$47.3
$49.7
$52.2
$71.5
$64.5
$58.3
$47.1
$36.9
$29.7
$40.6
$36.2
$29.7
$25.0
$30.0
$35.0
$40.0
$45.0
$50.0
$55.0
$60.0
$65.0
$70.0
$75.0
2005 2006 2007 2008 2009 2010Fiscal Year
UM
MS
Net
Med
ical
Cos
t ($
in m
illio
ns)
No ProgramsFull Program
Estimated $19.3M
Net Savings by
Year 5
NOTE: Full Program savings includes direct medical savings and indirect work loss savings (absenteeism, STD, LTD, workers' comp). Includes estimated program costs and consulting fees in each year. Does not include implementation costs . Assumes full comprehensive health improvement program with the following components: HRAs, lifestyle behavior change programs, health action programs, nurseline, health decision support, disease and case management. Assumes program is well communicated, embraced by all stakeholders and employees change behavior.
Trend AssumptionsNo ProgramFull Program
FY 200713.9%0.0%
FY 200810.6%4.0%
FY 20099.6%4.0%
FY 20099.7%4.0%
Re-launching & Growth…
Four-Year Strategic Plan for Improving Health
• Health Risk Assessments
• Chronic Condition Management
• Maternity Program
• Lifestyle coaching programs
• 24/7 nurseline
• “Champions”Program
• “Care Package”lunches
• FAQ Help-line
• “Paging Dr. Craig”
• Cross-referrals from vendors
• Participant testimonials
• Management Dashboard
• Enhanced HRA incentive
• Communication “splash”
• Wellness Committee
• Qtly Wellness Challenges
• HRA Scorecard
• Pharmacy “stuffers”
• Quarterly Wellness Challenges
• Manager toolkits
• Inter-departmental promotions
• Integrated data management system
• Measure increased employee satisfaction
• Groundwork for plan design changes in year 4
• Introduce “ Wellness Plan”: Employees who are willing to work at managing their health will be eligible for rich medical plan at a reasonably low cost
• Employees not willing to try to manage their own health will pay more for their coverage
• Expand Employee Health Services to include high quality acute care for non-work related conditions with access to specialty care, & preventive screenings
Year 4:Sustaining Health &
Accountability
Year 3:Fostering
Accountability at All Levels
Year 2:Increasing
Awareness / Participation
Year 1:Building the Foundation
Cost savings projected for expanding on-site employee health services to include acute care & preventive screenings
Page 19
Indirect savings associated with more comprehensive clinical services
Employee Morale and Culture• Improved access to health care services• Enhanced workforce health and wellness• Increased employee loyalty • Improved workforce recruitment and
retention
Health Care Costs and Productivity
• Reduced lost work time• Reduced absenteeism • Increased workforce productivity• Enhanced organizational effectiveness
Focus on Prevention• Provide self-care health information • Manage lifestyle risks and disease related
conditions• Provide referrals for behavioral counseling• Facilitate access to health promotion
programs
Quality of Care Improvement• Convenient and timely access to care• Comprehensive health care• Care coordination• Augment disease management
Summary: Characteristics of Promising Practice for Health Promotion Programs
1. Use features & incentives that are consistent with the organizations’ core mission & health benefits plan
2. Operate at multiple levels --- simultaneously address individual, environmental, policy & cultural factors in the organization
3. Study & then target the most important health care issues among the employee population
4. Engage & tailor diverse components to the unique needs & concerns of individuals
5. Monitor & achieve high rates of engagement & participation, both in the short & long term
