Worksite Well-Being
Gaining Engagement
Pamela Hymel, MD, MPH, FACOEM
WDPR Chief Medical Officer
January 6, 2015
1
I, Pamela Hymel, MD, hereby declare that the content for this
activity, including any presentation of therapeutic options, is
well balanced, unbiased, and to the extent possible,
evidence-based.
I am employed by Walt Disney Parks and Resorts
I have no other financial relationships with commercial
entities producing, marketing, re-selling, or distributing health
care goods or services consumed by, or used on, patients
relevant to the content I am presenting, or evaluating.
2
Today’s Agenda
•
•
•
Foundation of Worksite Well-being
Programs
Overview of the WDPR Programs
Opportunities for Engagement
Creating a Culture of Safety
and Well-Being!
3
Introduction
US employers have long struggled with the rising cost of health
care for their employees. (Healthcare trend increase in 2013 fell to
15 year low but total healthcare costs were $12,500/employee).
Between 1997 and 2007, health care consumed 35.7% of the real
increase in per capita income
Employee contributions are increasing - $100 more per month for
healthcare than 3 years ago.
Employers care about health care costs, safety and productivity of
employees so they are increasingly engaged in finding solutions to
controlling costs.
TowersWatson/NBGH Employer Survey 2014 – Purchasing Value in Healthcare
4
Companies’biggest obstacles to changing employee behavior related to their health
Lack of employee engagement
(i.e., low participation or interest in programs)
Too many other demands on employees
Lack of evidence about which practices work best
Lack of adequate budget to support effective health management programs
Lack of sufficient financial incentives to encourage participation in programs
Lack of organizational structure to support it
Not enough time on the part of employees
Lack of adequate internal staff
Lack of senior management support
Lack of appropriate tools to be successful
Poor or inadequate communication of health management programs
Lack of actionable data
Poor coordination with partners (e.g., vendors, health plan)
Regulatory limitations and uncertainty surrounding wellness incentives
Source: 2012 Towers Watson/National Business Group on Health Employer Survey on the Value of Purchasing Health Care
Source: National Business Group on Health, 2012 Executive Series
5
Top Focus Areas of Employers’ Health Care Strategy
Develop a workplace culture where employees are accountable
and supported for their health and well-being
Stay up-to-date and comply with PPACA
Educate employees to be more informed consumers of health care (e.g.,
price transparency, quality care information, treatment decision support)
Adopt/expand the use of financial incentives to encourage healthy
behaviors
Develop/expand healthy lifestyle activities
Review health care benefits as part of total rewards strategy
Expand enrollment in account-based health plans
Develop a new health care strategy for retirees (including potential exit)
Make long-term changes to avoid excise tax ceiling
Develop a new health care strategy for active employees
(including potential exit)
Review competitors’ actions
Place more emphasis on effective condition management
Prepare for development of insurance Exchanges
Adopt/expand the use of new technologies to improve employee
engagement and change social workplace norms
Incent employees to use higher-quality providers of care
Place more emphasis on the mental health
(e.g., stress and anxiety) of employees
Source: 2012 Towers Watson/National Business Group on Health Employer Survey on the Value of Purchasing Health Care
Source: National Business Group on Health, 2012 Executive Series
6
World Health Organization
Healthy Workplace Model
•
•
•
•
• Worker’s
compensation
• Safety sensitive
restrictions
Communication
• Safety in Motion
Injury prevention
• Sleep/fatigue
Data analysis
management
Tobacco cessation
• Nutrition and food
and respiratory safety
safety
•
•
•
•
•
Personal Health
Assessments (PHA)
Biometric screenings
Immunizations
Wellness Rewards
“Health is a state of complete physical, mental and social wellbeing and not merely the absence of disease or infirmity.”
7
Bernardo Ramazzini – 1700
Health Affects Work
(Diseases of Workers)
The maladies that afflict the clerks afore
said arise from three causes: First,
constant sitting, secondly the incessant
movement of the hand and always in the
same direction, thirdly the strain on the
mind from the effort not to disfigure the
books by errors or cause loss to their
employers when they add, subtract or do
other sums of arithmetic..... In a word,
they lack the benefits of moderate
exercise.....
Bernardo Ramazzini
Diseases of Scribes and Notaries, 1700
8
Workplace Wellness Programs
are Effective When Well Done
Average Savings
Medical cost ROI = $3.27:1
Absenteeism cost ROI = $2.73
Overall average ROI = $6:1
Focus on studies of effective
wellness
9
The Magnitude of Health Risk
Costs
10
Reducing Personal Health Risks
Reduces Costs and Vice Versa
11
Reduce the “Natural Flow” to
Higher Risk = Savings
12
HRA Risk Tiers and Cost
(in 2001 dollars)
13
Health and Productivity (Absenteeism/Presenteeism)
are inextricably linked
14
Recent Evidence
Evidence accumulated over the past three decades shows that well-designed and wellexecuted programs that are founded on evidence-based principles can achieve positive
health and financial outcomes.(JOEM, 56, 9, Sept. 2014)
RAND study (2013) reported “significant,” “clinically meaningful,” and “long-lasting”
improvements in employees’ weight, smoking status, and physical activity—but not in
cholesterol values. In terms of financial outcomes, RAND found that participants had lower
health care costs and reduced service utilization compared with statistically matched
nonparticipants, but the results were not statistically significant. They inferred that
wellness programs were probably cost neutral. The small number of individuals included in
subcomponents the combined lifestyle and disease management program produced a
positive ROI for Healthy Living—estimated at $1.46 saved for every dollar invested.
Although not highlighted in the analysis, this paper did report absenteeism reductions
among workers engaged in lifestyle management.
15
Health Services and
Well-Being Programs
“An ounce of
prevention is worth a
pound of cure.”
~ Ben Franklin
(1736)
16
Health Protection
Health Promotion Activities
•
In most workplaces, health protection programs (i.e., safety) are
separated from workplace health promotion programs (i.e.,
wellness)
•
The two are often house in completely distinct organizational
divisions.
•
This lack of integration prevents optimal resource utilization and
impedes efforts to maximize the overall health and productivity of
the workforce.
•
A new worksite model has emerged the links all of the programs
and policies that share a common goal of improving employee
health and safety, reducing injury and illness and improving
workforce performance.
17
NIOSH-CDC Total Worker Health
Integrating health protection with health promotion to
prevent worker injury and illness and to advance health and
well-being
18
Integrating Health Protection and Health Promotion:
Business case for healthier and safer employees
... Are good for business and help improve the bottom line - Companies that have exemplary safety,
health, and environmental programs outperformed the S&P 500 by between 3% and 5%.
... Create a happier, less stressful, and more prosperous business environment - According to a
survey by Aon Hewitt, the National Business Group on Health, and the Futures Company,
employees who reported having a strong culture of health at work were more likely to report being
happy, less likely to report that stress has a negative impact on their work, and less likely to cite the
work environment as an obstacle to health. (2)
... Do better at their jobs and contribute more - Employers that have high employee engagement
performed better than employers with low employee engagement in profitability, customer ratings,
turnover, safety incidents, productivity, and quality. (3) Engagement includes feeling like someone at
work cares about the employee as a person and having the materials needed to do work right.
... Are absent from work less and more productive when at work - For every dollar spent on worksite
wellness programs, absentee day costs were reduced by $2.73, and medical costs were reduced by
$3.27.
... Enjoy their jobs more, reducing turnover costs - Employees who feel supported by their employers
are more likely to want to keep their jobs and will help attract and retain the best employees for the
business. A study by the World Economic Forum found that 64% of employees who reported that
their workplaces were active promoters of health intended to stay with their companies at least five
years. (4)
19
Research Supports Integration
Improvements in healthy behaviors
Coordinated programs increase smoking cessation, dietary improvements and increased
physical activity.
Source: Sorenson, 2004; Punnett, 2004; DeMoss, 2004
Higher levels of employee engagement
Employees are more likely to participate in wellness programs when they are aware of
work-site safety improvements.
Source: Sorenson, 2004.
Reduction in injury rates
Good physical condition, absence of chronic disease, and good mental health are
associated with low occupational injury rates. Adversely, workers with poor health are more
likely to be injured on the job.
Source: Ostbye, 2007; Maniscalco, 1999; Musich, 2001
Lower costs
Integrated programs reduce health care costs, administrative costs and costs resulting
from poor productivity because duplication is eliminated.
Source: Goetzel, 2012.
20
Overlapping Areas
21
Shift in Perspective
22
22
HOW CAN WE LEVEAGE A
WORKPLACE TO GAIN
ENGAGEMENT?
ALIGNING INTEGRATION POINTS
23
Setting the Baseline for Walt Disney
Parks and Resorts
“In order to have a safe Cast, we must have a healthy Cast first.”
~ Dr. Pamela Hymel, VP, Chief Medical Officer , Walt Disney Parks and Resorts
“Safety and health are intrinsically linked to holistic wellness.”
~ Rachel Hutter, VP Worldwide Safety
24
Walt Disney Parks and Resorts
Health Services/Wellness
Chief Medical Officer
Pamela Hymel, MD
Admin Assistant
Bob Roederer
Chief Physician
Clinical Practice
Michael Hankins, MD
Health Svcs. Ops
Chief Physician, DLR
Roger Hinkson, MD
Mgr, Health Services
Linda Tillis
Mgr, Ability
Management
Tracy O’Toole
Mgr, Wellness Strategy
& Integration
Cheryl Owens
Health Care
Administrator
Avery Smith
Mgr, Projects &
Integration
Mary Roche
Area Mgr - Guest
Health Services
Lori Knight, RN
November 2014
25
WDPR Health Services Value Proposition
26
OUR VISION FOCUSES ON POPULATION HEALTH WITH EMPHASIS ON
IMPROVING THE WELL-BEING AND SAFETY OF OUR CAST AND THE
CUSTOMER CARE OF OUR GUESTS
PRESENT
PAST
Reactive
Treatment
Center
Strategic
Partner to
Safety, Risk
Management,
Operations
NEAR
FUTURE
Proactive
Solutions to
Decrease
Injuries/Illness &
Support
Evidence-based
Care
VISION
Optimum Health
and
Performance of
All Cast
Members
26
WDPR Health Services
& Well-Being
27
INTEGRATED
STAKEHOLDERS
Well-being
Coaching &
Education
Safety, HR, Legal,
Risk Management
OUR OPERATING MODEL
FOCUSES ON THE HEALTH
AND WELL-BEING OF OUR
CAST BY INTEGRATING
OCCUPATIONAL
INJURY/ILLNESS
TREATMENT
MEDICAL
SURVEILLANCE
Prevention
OCCUPATIONAL MEDICINE
WITH A PROACTIVE FOCUS
ON CAST ENGAGEMENT IN
PREVENTION PROGRAMS.
RETURN
TO WORK
Ability Management
27
Average Trend
8%
7%
6%
5%
4%
3%
2%
1%
0%
-1%
150 - CCSD
250 - PR West
350 - PR East
28
Behaviors that Impact
Health and Performance
Health risks
and
behaviors
Drive chronic conditions
Musculoskeletal
Cardiac
Cancer
Gastrointestinal Issues
Neurological Issues
Diabetes
Kidney Disease
Individuals with
chronic
conditions drive
70%
of group health
costs.
Correlation also
with increases in
WC medical
treatment costs.
29
Integrating Health and Safety
The Strong Connection
Physical
Capacity
Previous
Injury
Direct Costs
• Lost Time
• Medical Claims Costs
• Workers’ Compensation
• Repeat Injuries
Severity
and Recovery
Likelihood
Incident
Multiple
Health Risks
Chronic
Condition
Indirect Costs
• Increased Recovery Time
• Reduced Productivity
• Increased OSHA Rates
30
WDPR Workplace Injuries/Illnesses
Underlying
Health Risks
Contact/Cut
(9.6%)
Other
(12.5%)
Struck (15.6%)
Will impact the
possibility of a workers'
compensation incident
Slip/Trip (17.3%)
Body Motion (45%)
Which increases the OSHA rate
FY13 OSHA Rates
FY13 Worker’s
Compensation
Costs
WDW
DLR
WDPR
0
5
10
31
Direct Correlation Between
Health Risks and Worker’s Compensation Costs
(An Employer Example)
Worker's Compensation Costs
Physical
Capacity
Likelihood
Body Mass
Index (BMI)
Previous
Injury
$90,000
100,000
80,000
Severity
and Recovery
$31,000
60,000
40,000
20,000
$16,000
$7,000
0
0
Chronic
1
2
Condition
3
# of Comorbidities
(at time of injury)
32
Health and Well-Being Components
Center/
Pharmacy
for Living
Well
Health Plan
Design
Behavioral
Health
Disability
Mgmt.
Case Mgmt.
Coordinate
Communicate
Measure
Health
Services
Condition
Mgmt.
Culture
of Health
& Safety
Safety
Lifestyle
Coaching
Health
Improvement
Strategy with
Personal
Wellness
Support
Leadership
Commitment
Emotional
Well-being
& Balance
Physical
Activity
Nutrition
Personal
Health
Assessment
Wellness
Rewards
33
Population Health Management
85% members = 15% cost
HEALTHY
HRA/ Biometric
Lunch & Learns
Immunizations
Travel Medicine
AT
RISK
detection
screenings
Patient outreach
& Education
Fitness
Health
Coaching
Healthy Environs
Lifestyle Prompts
HCI
Health Advocacy
Early
15% members = 85% cost
ACUTE/
EPISODIC
Scheduled/
Walk-in Clinic
Referral
Management
Access to
Primary Care
CHRONICALLY
ILL
CATASTROPHIC
Integrated DM
Emergency
Response
Health Coaching
Case
Management
Patient
Education
Referral
Management
Pharmacy Care
Management
Disability
Management
Pharmacy Care
Management
Face to Face with Trusted Clinicians
Integrated 360° Coaching and Care Management
Provider/Member Portal Content & Tools
* Ray Fabius, MD (2013)
34
Onsite Programs to Support
Health Engagement
Onsite Clinic and Pharmacy
Healthy Pursuits Wellness
Program
Safety and Wellbeing Pilots
Onsite Fitness Center
Healthy Pursuits/Mindful Meals at
Cafés
Workplace Design
35
Healthy Pursuits Wellness Program
36
PHA & Biometric
Screenings Completion
Note: Percent completions calculated on benefit eligible population;
Biometric Screenings - Enterprise data as of 4/30/14; WDP&R data as of
5/8/14; PHA - Enterprise data as of 4/30/14; WDP&R data as of 4/1/14
37
Healthy Pursuits Coaching Resources
Onsite
Onsite WDW & DLR
Wellness Coordinators,
Dietitians, Registered
Nurses and Health
Educators
Phone
Mobile Unit
Cast Members and
spouses/domestic partners on
a Disney medical plan can
schedule an appointment by
calling 1.800.577.7498 and
saying “Disney Healthy
Pursuits Wellness Team”
(or option 2)
The “mobile health
coaching office”
rotates on a 2-week
schedule to backstage
Resort locations at
WDW and is available
to all Cast Members
38
Onsite Fitness Resources
Athletic Trainers
39
Cast Resources
40
Safety and Wellness Pilot - 2014
Disneyland Resort Food & Beverage and Lodging
Safety
Job task analyses by
Safety Services &
Ergonomist
Likelihood
Body Mass
Index (BMI)
Well-Being
Aligning Health Coaches
and Athletic Trainers
Previous
Injury
Create the safest
possible workplace
and provide
opportunities and
resources for our
Cast to be healthy,
well and engaged.
Chronic
Condition
41
Hazard Severity
SEVERITY
5
FATAL
Physical
Capacity
PERMANENT DISABILITY,
4
DISMEMBERMENT
Likelihood
PARTIAL DISABILITY
3
LOST TIME
TREATMENT
2 Body Mass
BEYOND FIRST AID,
OSHA RECORDABLE
Index (BMI)
1
KNOWN HAZARDS
BASIC FIRST AID
.
HEALTH
SERVICES
Health
Services
Crush, Asphyxiation, Drowning,
Explosion
Previous Injury
Pyrotechnics, Burns, Rotating
Machinery, Moving Equipment,
Animals
Severity
Chemicals,
Powered Tools, Noise,
and Recovery
Lasers, Pedestrians, Stored
Energy, Burns
Medical treatment with focus on
return to work and full
functionality
Medical surveillance
Vehicle Collision, Cuts, Pinch Points,
Strains, Wet Floors, Repetitive Motion,
Chronic
Curbs and Cords, Manual Handling,
Condition
Inclement Weather, Night Work
Fitness for Duty Evaluations
Condition Management Programs
DOT
Athletic Trainers/ Functional Analysis
Minor Cut, Insects, Abrasions,
Bumps, Bruise
Health Coaching
Education
Strength and Conditioning
Programs
42
Disneyland Resort Pilot Recap
Initial Results:
• Increased Cast engagement in Wellness resources
Athletic Trainers /
Fitness
PHA Participation
Coaching Engagement
• 67% Lodging participants improved functional screen scores
• 93% F&B participants improved
•
•
•
•
•
•
Participants – 28%
Non-participants – 13%
Base Population – 11%
Participants – 15%
Non-participants – 2%
Base Population – 1%
 Participants = Cast Members that were selected for the pilot, completed a screen & received a conditioning plan
 Non-participants = Cast Members that were selected for the pilot but did not attend a conditioning plan session
 Base Population = Cast Members from the pilot areas that were not selected for the pilot
• Effect on injury reduction:
−
−
−
−
Cast Members who were selected for the pilot were 2.2 times more likely to have a claim injury prior to the pilot.
Cast receiving an intervention were 2.3 times less likely to see an injury.
Models show that F&B was approximately 1.65 times less likely than Lodging to have a claim injury.
In previous DLR pilot, after one year, participants filed more claims than non-participants, however claim costs
were 50% lower and had 67% fewer restricted and lost work days.
Next Steps:
• Conduct one year reassessment with pilot participants in Spring 2015
• Continue to track Pilot participants to analyze effectiveness
44
43
Business Case for Onsite Facility in Orlando
Offer a convenient medical home platform
from which to coordinate integrated care
Reduce ER visits and inpatient bed days
for patients managed at onsite facility
Favorable pricing on Rx ingredient costs
as provider vs. health plan
Onsite physician steerage of patients to
higher quality, more cost-effective specialists
Integrate vs. Stand-alone
Disney made the strategic decision to integrate the onsite health care facility – named the
“Center for Living Well” – as part of our Medical Plan for eligibility, cost sharing with
participants and vendor coordination of services
44
Integrating Care Delivery at
the CLW
Traditional Fragmented
Provider Care Model
CLW: Seamlessly Integrated as
Patient-Centered Medical Home
Pharmacist
(TakeCare)
?
Primary
Care Team
Digital
X-ray
(TakeCare)
Patient
(TakeCare)
(Cigna)
(Orlando BH)
Specialist
Referral
Coordinator
(TakeCare)
Patient
HLP Chronic
Condition
Nurse Coach
Behavioral
Health
Lab
(Quest)
Wellness
Educators
(TakeCare)
45
Center for Living Well
By the Numbers
One of the
largest Walgreens
pharmacies
in Florida



600+
Average medical
visits per week
(hit 789 visits in January
– cold & flu season)
• Cast accounts for
majority of visits (78%)
• ~1/3 of visits are
same-day visits
• Average 80+ new
patients per week




~3,000
scripts filled per week
41% of scripts filled are written by CLW providers
~50% of scripts filled are 90-day fills
FY12 CLW generic dispensing rate is 81%
(88% for CLW-written scripts, 76% for communitywritten)
Opened in October 2008
Operated by Take Care Health Systems
Accredited as a Patient-Centered Medical
Home in October 2011 by AAAHC
Eligibility principally for Cast Members,
spouse/partners and children enrolled in
Disney Medical Plan
46
Program Overview
Initial Results
for Patients With
four
• 15-month physician-directed
integrated program that includes
regular PCP visits, labs and visits
with onsite condition management
coaches (with financial incentive)
• Additional support from onsite
pharmacists, behavioral health
therapists and Cigna advocates
• Eligibility limited to CLW patients
with diabetes (a1C>8.5%),
hypertension (BP>160/90) or
hyperlipidemia (LDL>160)
5
data points
quarterly labs
baseline
Healthy Living Program (HLP)
14%
Diabetic
population
Hypertensive
population
Hyperlipidemic
population
reduction
in A1c from
baseline
16%
12%
reduction
reduction
(diastolic)
(systolic)
from baseline from baseline
21%
reduction
in LDL from
baseline
26% of active HLP participants have engaged with onsite
behavioral health counselors
47
Workplace Design
Supporting a Culture of Health Through
the Built Environment
48
Workplace Design
Supporting a
Culture of Health
through
the Built
Environment
49
Integrating Health and Safety
Leadership Engagement is Essential
“Some things are meant to work
together. Just as you wouldn‘t
wear only one protective glove
and leave the other sitting on the
toolbox, incorporating workplace
wellness initiatives into safety and
health programs may result in a
healthier, more productive
workplace”
“The two factors, personal health
and personal safety – each
essential to a productive worker
and to a productive workplace –
are effectively combined in a
symbiotic manner way that
increases their impact on overall
health and productivity. The
whole becomes greater than the
sum of its parts.”
- American College of
Occupational and
Environmental Medicine
(ACOEM)
CURRENT STATE
Strong focus on
Wellness
Rewards
Minimal Cast
engagement
in health
coaching and
wellness
resources
High
percentage
of Cast with
health risks
Loose
alignment
between safety
and health
Leadership Engagement
CULTURE OF HEALTH
“Knowing Your
Numbers” is the
starting point for
Cast as a part of
their wellness
journey
Cast seek out
wellness
resources/
coaching within a
supportive
leadership
environment
Improve
baseline
health of
all Cast
Strong
safety/wellness
integration
optimizes
organizational
vibrancy
50
Global Wellness:
Achieving a Healthy Workforce Worldwide
51
How This Can Help Your Patients
• Over 69% of employers have wellness programs
• Basic components include: Health Risk Assessments, Biometrics,
Health Coaching, Disease Management, Fitness Programs, Care
Coordination
• Be sure to ask patients whether their employers offer onsite wellness
programs and what is offered with their program
• Ask them to bring in their HRA, biometrics
• Use employer offered dieticians/coaches/disease management
nurses to augment employer treatment plans
• Have your office personnel follow up with patients to ensure they
follow through with coaching/disease management appointments
Working Together We Can Help Our Patients Engage!
52
May You have
a Happy and
2015!
MEET WHO WE ARE BEHIND THE Healthy
SCENES
SECTION BREAK NUMBER 03
OUR TEAM
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3