Practical Application in Business
John Harris Katie Bell
Chief Wellness Officer Partner
Vice President Innovations Global Wellbeing
Healthways, Inc. Gallup
How Poor Health Costs the United States:
$147 billion annual healthcare cost of obesity in the United States
75% of national health expenditures are due to chronic disease
$6,032 the average annual healthcare coverage cost for people with
a chronic condition; five times higher than for those without
$1.3 trillion direct health costs of chronic disease (2006)
American Prevention Success Story:
Leaders Have The Ability to Correct Public Health:
• How would you describe your personal role
as it pertains to wellness and well-being?
• Not responsible.
• Indirectly responsible
• Directly responsible
5www.healthways.com
Indirectly responsible
Directly responsible
Indirectly responsible
Directly responsible
6
• 25-year commitment, initiated January 2, 2008
• 1,000 completed surveys per day/7 days/week
• 1,000,000 completed surveys October 23, 2010
• For results based on this sample of respondents,
the maximum 95% margin of sampling error is ±0.3 percentage points
• Science-based design, support and oversight:
• Behavioral economists
• Psychologists
• Experts in psychometric statistical analysis
Six Domains:
1. Life Evaluation
2. Emotional Health
3. Physical Health
4. Healthy Behavior
5. Work Environment
6. Basic Access
Measuring Well-Being
Well-Being at the National Level
0
10
20
30
40
50
60
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan
Thriving Struggling Suffering
Source: Gallup-Healthways Well-Being Index Community Survey 2009, n=353,849
Well-Being Life Evaluation, U.S. Residents, 2009
2009 2010
8
Our Nation’s Well-Being by State - 2009
Source: Gallup-Healthways Well-Being Index Community Survey 2009, n=353,849
Fourth QuintileThird QuintileSecond Quintile Top Quintile Ranking: Bottom Quintile
9
2009 Congressional District Rankings
Source: Gallup-Healthways Well-Being Index Community Survey 2009, n=353,849
Fourth QuintileThird QuintileSecond Quintile Top Quintile Ranking: Bottom Quintile
10
2009 MSA Rankings
Source: Gallup-Healthways Well-Being Index Community Survey 2009, n=353,849
Fourth QuintileThird QuintileSecond Quintile Top Quintile Ranking: Bottom Quintile
• Do you believe an index of this magnitude
can bring value to your business planning:
• No
• Yes, but only indirectly
• Yes, significant value
• This index provides essential information for our
planning
11www.healthways.com
Harvesting the Value of
Well-Being
www.healthways.com 13
Making the Jump from Health to
Well-Being
14
Why It Matters:
The Economic Case for Well-Being
Well-Being
Improves
• Help healthy people
stay healthy
• Mitigate health-related
risk from lifestyle
behaviors
• Optimize care for those
with health conditions
Performance
Increases
• Engagement
• Absence
• Work Impairment
• Productivity
Total Medical
Cost Decreases
• Hospitalizations
• Event Rates
• Disease Rates
• Lifestyle Risks
Total Economic
Value Increases
• Public Payers
• Private Payers
• Employers
• Communities
• States
Impact of social time on daily affect for
different income levels
15
Positive affect: happiness, enjoyment, smiling/laughter
Gallup-Healthways Well-Being Index Jan-Dec 2009, controlling for demographics
BMI and Physical Pain
16
n = 254,987; after controlling for gender, education, and age
Real World Examples of
Opportunity
Thriving
Average 20% Lower
Medical Costs
Suffering
Average 50% Higher
Medical Cost
4.0
7.0
Struggling
“Please imagine a ladder with steps numbered from zero at the bottom toten at the top. The top of the ladder represents the best possible life for you and the bottom of the ladder represents the worst possible life for you.
On which step of the ladder would you say you personally feel you stand at this time?”
Source: Gallup-Healthways Well-Being Index Community Survey and Wellmark Corporate Survey 2008
Six well-being
domains
1. Life Evaluation
2. Work Quality
3. Basic Access
4. Healthy
Behavior
5. Physical Health
6. Emotional
Health
Example: Life Evaluation
Health Risk By Life Evaluation
0%
20%
40%
60%
80%
Suffering Struggling Thriving
0-1 risks
2-3 risks
4-5 risks
6-9 risks
Risk Category by Life Evaluation
Toward Integration to Enhance Health and Well-Being by Evers, KE, Prochaska, JO, Castle, P. & Prochaska, JM. 2009 (under review)
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Work Impact By Life Evaluation
Activity Impairment, Work Presenteeism and
Work Productivity Loss by Life Evaluation
25%
20%
15%
10%
5%
0%
Toward Integration to Enhance Health and Well-Being by Evers, KE, Prochaska, JO, Castle, P. & Prochaska, JM. 2009 (under review)
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Anger in the Workplace: Wellness Inhibitor?
12% 14%
79% 88% 86%
Poor Work
Environment
Quality Work
EnvironmentNation
No
Yes0%
20%
40%
60%
80%
100%
31%
Poorest 100
Richest 100
U.S. Counties
“Did you experience the following feelings during A LOT OF THE DAY yesterday: Anger?”
Source: Gallup World Poll, Gallup-Healthways Well-Being Index Community Survey 2008
Work Environment Affects Health and
Engagement of a Workforce
Service Mark SM 2008 Gallup-Healthways Well-Being Index. All rights reserved. Copyright © 2008 Gallup, Inc. All rights reserved. Copyright © 2008 Healthways. All rights reserved.
0%
10%
20%
30%
40%
50%
60%
70%
80%
Job ImpactsHealth
Disengaged
Negative Positive or Neutral
Impact of Negative Work Environment
Higher Disengaged Employees / Higher Productivity Losses
Work Environment Impact on Employees With
Chronic Conditions
6.6 Days/Year
16.2 Days/Year
Days Unable to Carry Out Usual Activities Per Year
Well-Being Disparities:
Work Environment
Source: Gallup-Healthways Well-Being Index Community Survey 2008, n= 355,334Based on congressional district in which Tyson Foods location is based
2.12.8
0.3
3.2
0.1
1.3
0.1
2.3
6.3
1.3 1.42.1
0.5
3.6
-7.1
-0.6-1.3
-4.6
-3.7
-1 -0.9
-2
4.6
1.7
-13.4
Pla
nt 1
Offic
e 1
Pla
nt 2
Offic
e 1
a
Pla
nt 3
Pla
nt 5
Pla
nt 6
Pla
nt 7
Offic
e 2
Pla
nt 9
Pla
nt 11
Pla
nt 12
Pla
nt 13
Pla
nt 14
Pla
nt 15
Pla
nt 16
Offic
e 3
Pla
nt 17
Offic
e 4
Pla
nt 17
Offic
e 5
Pla
nt 19
Pla
nt 20
Pla
nt 21
Pla
nt 22
Variance from National Score (points) for Congressional Districts of
Top 25 Company Locations (ordered by # team members)
Work
Environ-
ment
Score
(2008) =
51.4
Job satisfaction and engagement
• Satisfaction with community
• Are you satisfied or dissatisfied with your job or the work you do?
• At work, do you get to use your strengths to do what you do best every day?
• Does your supervisor at work treat you more like he or she is your boss or your partner?
• Does your supervisor always create an environment that is trusting and open?
Work Environment:Examples
Plans with worst work
environments were also the
worst performers
Commute Time and Well-Being
% Reporting Stress
44%
43%
43%
42%
39%
36% 37% 38% 39% 40% 41% 42% 43% 44% 45%
Over 60 Minutes
46-60 Minutes
31-45 Minutes
16-30 Minutes
15 Minutes or less
The Impact of Care-Giving
Caregiver Non-Caregiver
Caregiver Employed
Caregiver Non-Employed
Non-Caregiver Employed
Non-Caregiver Non-
Employed
Composite Score 64.39 57.15 68.00 62.14
Life Evaluation Index 39.50 25.26 47.29 32.77
Emotional Health Index 77.35 67.24 81.00 72.62
Physical Health Index 76.74 61.16 82.26 67.92
Healthy Behavior Index 62.43 60.38 61.34 60.77
Work Environment Index 49.47 n/a 51.19 n/a
Basic Access Index 80.83 71.71 84.95 76.62
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Life EvaluationSmokers vs. Non-Smokers
Thriving Struggling Suffering
39%
55%
6%
52%
45%
3%
Smokers Non-Smokers
“Please imagine a ladder with steps numbered from zero at the bottom toten at the top. The top of the ladder represents the best possible life for you and the bottom of the ladder represents the worst possible life for you.
On which step of the ladder would you say you personally feel you stand at this time?”
Source: Gallup-Healthways Well-Being Index Community Survey 2009, n=353,849
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Emotional HealthSmokers vs. Non-Smokers
“Did you experience the following feelings during A LOT OF THE DAY yesterday?”
% of Respondents Who Answered “Yes”
Worry Stress Anger Sadness Depression
43%
50%
21%
26% 27%
31%
37%
13%
17%15%
Smokers Non-Smokers
Source: Gallup-Healthways Well-Being Index Community Survey 2009, n=353,849
Drivers of BMI Risk
BMI Risk
Emotional
Health
Physical
Health
Negative Affect
Personal
Sources of
Presenteeism
Number of
Health Risks
Healthy Eating
Height Weight
Energy Level
Exercise
Recognition at
Work
Coping With
Stress
Days of Best
Work
Financial Stress
The only things we focused on in the “old days”
• What best describes your view of focusing on the broader value proposition of well-being?
• It does not change my view – well-being is only semantics
• I can see some value in taking a broader view
• I see significant value in taking a broader view
• I believe a broader view will redefine the value proposition, making it both measureable and more substantial
31www.healthways.com
What Innovations Will Emerge?
Strategic Process To Drive Sustainable
Engagement
33
Sustainable
Engagement
Business Objectives
Relevant Incentives
Consumer Insights
Effective Communications
Appropriate Interventions
Measurable Outcomes
Environment
Environment
34
Improved Use of Behavior Change SciencesPutting Science into Practice
Social Networks
• A social structure of “nodes” which are connected by
one or more specific types of interdependency, such as
friendship, kinship, common interest, knowledge, etc.
Decision
Making
Behavioral
Economics
Emotional and
Social Health
Social
Connectivity
Prochaska’s Transtheoretical Model
• Rational decision-making through stages of change
• Pro-Change Embedded in Healthways Core Products
Mindfulness and Neuro-plasticity
• Paying attention in a particular way: on purpose, in
the present moment, and non-judgmentally
• The changing of neurons via new experiences
Dynamic Intermittent Reinforcement
• Predictably irrational decision making in humans
• Already in use for medication adherenceHEALTHHONORS®
LifeMatters®
GamificationGaming theory
• Fun vs. fulfillment
• Explorer, achiever, socializer, competitor
New Approaches to Drive Physical, Emotional and
Social Well-Being Improvement
Traditional Coaching
Physical Health
Physical health background
Traditional training
Outcomes
N/A
HRA
Health Home
Three calls
Traditional
Telephonic
New Coaching
Emotional/social health approach
Coaches with behavioral health background
Experiential coach training
Research questions
Personality profiling
Well-Being Survey
Work & personal homes
Multiple brief coaching touches
New integrated platform
Multiple modalities
Innovative and integrated
methodology…
Mindfulness-based tools
Ntrinsx
…contributes to different
approach to coaching
…which results in an
engaging user experience
vs.
35
Product Starting
Points
Leveraging Social Networks and Mobile
Applications
Transformational Community Initiatives to
Support Well-Being Improvement
Etc.L
ead
ers
hip
Po
licy
Co
mm
un
-ic
atio
ns
Partic
ipatio
n
POWER 9 PRINCIPLES
(become norm)
IMPROVED VITALITY
Reduced Medical Trend AND Improved Productivity
IMPROVED WELL-BEING
(measurement)
CULTURE
Focused Investment Areas
Promote / Support Power 9
Engage and transform
communities …
Our Goal: Create a Movement
• Create “Vitality Cities” through
sustainable changes that
encourage people to practice
healthy behaviors so that they
can live well – longer
Our Plan:
• 2010- select 1st Vitality City
• 2011- scale the Vitality City
concept to cities across
America while creating a
national movement
• Use WBI to measure progress
… through a compelling value
proposition …
… that leverages our
strategic relationships
37
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Gaps in Care, PsychosocialEducational, Environmental
needs assessedCare Plan Generated
Care Coordinatordocuments progress on the
Care Plan. Provides Feedback to MD
Care coordinator assures Care Team Reviews andAgrees with Care Plan
Care Plan is implemented.MD engages with patient,
using care plan
Care Coordinator engagesw/ patient using care plan
Care Coordinator engagesspecific
Healthways andcommunity resources
as appropriate
Lifestyle ManagementDisease Management
Case Management Social Network
Cognitive Behavioral TherapyPatient Compliance Programs
Transitions of Care management
RegistryPredictive Modeling
Care Coordination
Medical Problem Diagnosis/
Treatment
Quality Improvement
Analytic Support
Reporting
Claims Data
Pharmacy Data
HRA
Biometrics/Lab
EMR/PHR
Self reporting
Leverage Healthways’ expertise in population analysis,
identification and analyticsBuild collegial and trusted relationships with physician practices. Use care
plans and care coordination to improve health one patient at a time.
Health Care Reform – Leveraging the Medical
Home and Accountable Care Concepts
• I believe these new well-being innovations
will be:
• Of only minimal value over the traditional
approaches used today
• Will better position the field to capture a broader
value proposition
• Will be instrumental in taking the health
promotion programs to an all new level
• Will revolutionize health promotion
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Closing Thoughts
Organizations With Higher Well-Being =
• Measurably healthier and happier people
• Longer life expectancy and productive life years
• Higher workforce productivity (employed)
• Increased independence rate (seniors)
• National recognition as an employer of choice
• Measurable accountability to shareholders
• Improved sense of purpose and corporate pride
• And hence, improved business performance and social vitality
Health
Productivity
Turnover
Corporate
Pride
Economic
Vitality
Health Costs
Business
Performance
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For More Information
www.well-beingindex.com
Questions/Discussion