Nico Pronk, Ph.D., FACSM, FAWHP
HealthPartners
HealthPartners Institute for Education and Research
Harvard School of Public Health
The Value of Worksite Health
IAWHP Global Symposium
Atlanta, GA
April 1, 2014
Agenda
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The employers’ perspective
The workplace setting
Finding value in health
Best practices
Multiple levels of programming
Capturing the value of WHP
What About the Employers’ Perspective?
• Non-clinical, community-based
prevention policies and wellness
programs appeal to employers
• Importance of family inclusion
• Importance of community
connection
• Company recognition as a leader
for health improvement and
economic vitality
• Recognition that companies and
organizations are complex social
systems
Unsustainable Cost Pressure
$41,868
(2021)
Health care expenses for U.S. families:
2002-2021 (projected at present growth rate)
$38,767
$35,895
$19,393
(2011)
$9,235
(2002)
$33,236
$30,774
$28,496
$26,384
$24,430
$22,620
$20,944
$18,074
$16,771
$15,609
$14,500
$13,382
$12,214
$11,192
$10,168
2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021
Source: 2011 Milliman Medical Index
Or to look at it another way…
Source: Alliance of Community Health Plans
Or to look at it another way…
Income: $59,858
Source: Alliance of Community Health Plans
Facing the
challenges
in health
care
Drivers of health
20%
Where money spent
Medical
services
Healthy
30% behaviors
Social and
40% economic
factors
88% Medical
services
Where do
U.S. health
care dollars
actually go?
4% Healthy behaviors
Physical
10% environment
8% Other
The Worksite Setting
• Population access
– Significant reach into the population
– Significant frequency to intervention exposure
– Significant access to tools, vehicles, resources, etc. that may be
mobilized to increase awareness and PA behavior change
– Worksites can identify the population of interest
• Employees
• Employees and dependents
• Targeted subgroups of interest
– Interventions can be designed at various levels that interact with the
individuals receiving the intervention
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•
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Individual
Inter-personal
Organizational
Environmental
The Worksite Setting
• Work matters for health
– Unemployment is a major determinant of health
– Worker health may be affected by the organization of work, the
policies at work, the relationships at work, etc.
• Health matters for work
– Chronic conditions may be exclusion criteria for job fit
– Fitness for duty tests as indicators of inclusion criteria
• Healthy workers and a healthy culture appear to be a good
business strategy
• Worksite health promotion also is a sound public health
strategy and fosters economic growth in the community
Broader context
Employers recognize the need to:
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Reduce healthcare spending
Reduce illness burden
Reduce the likelihood of becoming ill
Make healthy choices easy choices
Maintain or improve economic vitality
Reduce waste
Increase longevity
Enhance national security
Prepare communities for the workforce
Workplace Health Works!
• AHRF includes both health assessments and
biometric screenings
• The Task Force finds insufficient evidence to
determine the effectiveness of AHRF when
implemented alone
• The Task Force recommends the use of
assessments of health risks with feedback when
combined with health education programs, with
or without additional interventions, on the basis of
strong evidence of effectiveness in improving one
or more health behaviors or conditions in
populations of workers
The value of health
ROI Literature Review
Systematic review and meta-analysis
Conclusion:
Worksite Health Promotion programs can
generate positive ROI for medical- and
absenteeism-related savings:
Medical: 3.27 : 1
Absenteeism: 2.73 : 1
The value of health
16
Impact of obesity on
work limitations is akin
to 20 years of aging
14
12
10
8
6
4
2
0
Normal Weight
Overweight
Ob ese
Source: Hertz, et al. JOEM 2004; 46:1196-1203.
20-39
40-59
60+
1.9
3.6
8.4
2
3.6
8.1
4.1
8
14.5
Value through design
Companies across a variety of industries report
benefits:
• Lower health care costs
• Greater productivity
• Higher morale
ROI can be as high as 6:1
Six Essential Pillars for Successful Programs:
1. Engaged leadership at multiple levels
2. Strategic alignment with the company’s identity and
aspirations
3. A design that is broad in scope and high in relevance and
quality
4. Broad accessibility
5. Internal and external partnerships
6. Effective communications
Best Practice Design Principles
9 Best Practice Dimensions
• Leadership
• Relevance
• Partnership
• Comprehensiveness
• Implementation
• Engagement
• Communications
• Data-Driven
• Compliance
Why then, such confusion?
• Confusion over the definition of a
worksite health/wellness program
– Population-based
• Even people with diagnosed
disease retain access to lifestyle
behavior change programs
• Disease and lifestyle management
programs are artificially
segregated into siloes
• Value of worksite health programs
goes far beyond medical care cost
savings
• Even this article showed a positive
ROI for the whole program
($1.46:1)
Environment shapes behavior
Abnormal reaction to a normal
environment?
A normal reaction to an
abnormal environment?
Individual decision do matter!
Choices for interventions
Cardiovascular disease, diabetes, cancers, lung
disease…Preventable deaths
Obesity, lack of fitness, high blood pressure, high
cholesterol, high blood sugar
Tobacco use, poor diet, lack of physical activity,
excessive alcohol use
Environments – physical, psychosocial (culture),
socioeconomic
Social policy, community mobilization
Making healthy choices easy choices
Individual
Effort
Health
Potential
Environmental (physical, psychosocial)
and
Policy Interventions
(Public, organizational, etc)
Source: Pronk NP, Kottke TE. Health Promotion in Health Systems. In: Rippe, J. Lifestyle Medicine, 2013.
Moving Beyond Available Evidence
• Evidence of what works needs to be applied in the
context of the workplace environment
• Inflexible focus on program fidelity may limit
adoption of programs with sustained success
• Practice-based evidence can only be generated if
solutions are successfully implemented
• Worksite health programs will only deliver on their
promise when supported as a business strategy with
leadership support and accountability
Comprehensive, Multi-Level, Multi-Component Programming
Make Being Healthy and Productive…
Possible
Simple
Socially
rewarding
Financially
rewarding
Personally
relevant
Organizationally
relevant
Levels of Influence
Individual
Interindividual
Exceptional Customer and User Experience
Organizational
Environmental
Outcomes
Source: Pronk, NP. Journal of Physical Activity and Health, 2009, 6 (Suppl. 2), S220-S235.
Health
Productivity
Financial / ROI
Community
connected
Valuing Workplace Health
i.e.,
Worksite
Valuing – What should be counted?
Benefits and Harms
Comprehensive
assessment
Health
Benefits
-----------Harms
Community
Well-Being
Benefits
-----------Harms
Community Well-Being
Indicator
Community
Process
Benefits
-----------Harms
Community Process
Indicator
Comprehensive
assessment
QALYs or HALE
Community Benefit
Value
The value of an
intervention
considers its
benefits, harms,
and costs.
Resources Used
Valuing – What should be counted?
Identification
of
Investments
and
Resources
Savings
----------Costs
Monetary Units (USD)
Community Cost
i.e.,
Worksite
What Does “Success” Look Like?
Risk transitions based
on HA-derived risk levels
among employees over 2
years
(N=1,087)
Doing nothing may
reduce the population’s
health by as much as 7%
per year
21%
66%
Got
Better
36.3%
14.4%
Baseline
24%
Moderate
Risk
13.2%
33.5%
15.1%
2.5%
Baseline
24%
High Risk
Net population health
improvement of 8%.
Baseline 7%
Disease:
Well
Managed
25.0%
1.3%
Baseline 1%
Disease:
Poorly
Managed
0.2%
0.8%
4.5%
87% did not get worse
Source: HealthPartners
Health Assessment Database, 2011
Got
Worse
Stayed the
Same
Baseline
44%
Low Risk
Soource
This 2-year health and
well-being program was
associated with a ROI of
2.9:1
13%
Conclusions
• When workplace health and wellness programs are
implemented according to best practice principles of
design, significant value may be generated
• Valuation models should go beyond traditional ROI
and capture those “values” that are relevant to the
company
Thank You!