Employee health and wellness metrics, measurements, and evaluation - - the building blocks for ROI David A. Alter, M.D., Ph.D., F.R.C.P.C Senior Scientist, Institute for Clinical Evaluative Sciences Division of Cardiology, The Li Ka Shing Knowledge institute of St. Michael’s Hospital Division of Cardiology, Cardiac and secondary prevention program, The Toronto Rehabilitation Institute Associated Professor of Medicine, University of Toronto
Employee health and wellness metrics, measurements, and evaluation - - the building blocks for ROI. David A. Alter, M.D., Ph.D., F.R.C.P.C Senior Scientist, Institute for Clinical Evaluative Sciences - PowerPoint PPT Presentation
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Employee health and wellness metrics, measurements, and evaluation - -
the building blocks for ROI
David A. Alter, M.D., Ph.D., F.R.C.P.CSenior Scientist, Institute for Clinical Evaluative Sciences
Division of Cardiology, The Li Ka Shing Knowledge institute of St. Michael’s Hospital Division of Cardiology,
Cardiac and secondary prevention program, The Toronto Rehabilitation Institute
Associated Professor of Medicine, University of Toronto
Disclosures
• Chief Scientific Officer, INTERxVENT Canada
“Ticking Clock” Hypothesis
Haffner SM et al. JAMA. 1990;263:2893-2898.
NGT IGT Hyperglycemia
MacrovascularDisease
MicrovascularDisease
Deferred Gratification
“Ticking Clock” Hypothesis
Haffner SM et al. JAMA. 1990;263:2893-2898.
NGT IGT Hyperglycemia
MacrovascularDisease
MicrovascularDisease
Deferred Gratification
“Ticking Clock” Hypothesis
Haffner SM et al. JAMA. 1990;263:2893-2898.
NGT IGT Hyperglycemia
MacrovascularDisease
MicrovascularDisease
Deferred Gratification
“Ticking Clock” Hypothesis
Haffner SM et al. JAMA. 1990;263:2893-2898.
NGT IGT Hyperglycemia
MacrovascularDisease
MicrovascularDisease
Deferred Gratification
How much?How long?
At what costs?
Metrics, measurement, and evaluation
Building blocks for ROI evaluation
• Choosing the appropriate question
• Selecting the appropriate population
• Designing the appropriate intervention
• Appropriate knowledge translation
• Determining the appropriate context
Asking the appropriate question
Benefits & payers
Pharmaceuticals
Appropriate use of meds
Efficient use of meds
Health Service ConsumptionAvoidable HospitalizationsEmergency Room Visits
Physician Visits ProductivityAbsenteeism
DisabilityImpairmentEngagement
Building blocksMetrics
MeasurementEvaluation
Government
EmployersPharmacy/Pharma
The evidence
-28.3
-26.1
-30.1
-40 -30 -20 -10 0 10 20
% change in disability management costs
% change in health care costs
% change in absenteeism
Chapman et al; The American Journal of Health Promotion 2003
Test case example
42.0%
-30.6%-50%
-30%
-10%
10%
30%
50%
70%
% C
han
ge
INTERxVENT Participants
Notes: INTERxVENT Program was implemented in January 2003. Participants enrolled in the INTER xVENT Program in 2003 and completed a full year of service and evaluations. Analysis performed by Milliman Consultants and Actuaries.
Notes: INTERxVENT Program was implemented in January 2003. Participants enrolled in the INTER xVENT Program in 2003 and completed a full year of service and evaluations. Analysis performed by Milliman Consultants and Actuaries.
Non-INTERxVENT Participants
Healthcare payer% Change in Average Health Care Claims Per Employee
(Oklahoma Employer): 2002 vs. 2003
Selecting the appropriate population
Early dividends
• Absolute risk reduction; population impact driven by baseline risk
Impact of interventions (ARR)
Baseline risk
Number of Health Risks and Productivity Loss
0
5
10
15
20
25
30
0 1 2 3 4 5 6 7
Pro
du
cti
vit
y L
oss
(%
)
Number of Health Risks
The average employee has 2.2 health risks, resulting in productivity losses of about $2,000/year.
Excess Productivity Loss
BaseCost
Journal of Occupational and Environmental Medicine 2005;47:769-77
n = 28,375
-6%-5%-4%-3%-2%-1%0%1%2%
Ch
ang
e in
pro
du
ctiv
ity
loss
-2 ormore
-1 0 1 +2 ormore
Change in Number of Health Risks
Adjusted for age, gender, medical conditions, other baseline risks, and each individual’s productivity loss at baseline.
Burton et al, J Occup Environ Med, 2006; 48:252-63
Designing the appropriate intervention
Organizational InterventionGlobal Health Risk Assessment:Global Health Risk Assessment:
Action Plan & ReportsAction Plan & Reports
Average or Low-riskAverage or Low-risk High-risk(e.g. Multiple risk factors, heart disease, depression, behaviors)