U.S. Chamber of Commerce Workplace Wellness Event Washington D.C. Innovations in Workplace and Community Wellness: Aligning Business Goals With a Healthy Workforce The Value of Health and the Power of Prevention April 7, 2016 Ron Loeppke, MD, MPH, FACOEM, FACPM Vice Chairman U.S. Preventive Medicine
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U.S. Chamber of Commerce
Workplace Wellness Event
Washington D.C.
Innovations in Workplace and Community Wellness:
Aligning Business Goals With a Healthy Workforce
The Value of Health and the Power of Prevention
April 7, 2016
Ron Loeppke, MD, MPH, FACOEM, FACPM
Vice Chairman U.S. Preventive Medicine
Overview
Delineate the Converging Trends that are advancing theBusiness Value of Health and the Power of Prevention inWorkplace Wellness
Discuss the solid Business Case for why employers should investin wellness and prevention strategies.
Analyze Published Results and Case Studies of reduced healthrisks and costs from evidence based, comprehensive workplacewellness initiatives.
Epidemiological Trends
Political Trends
Cultural Trends
Financial Trends The Problem: The Cost Crisis is due in large part to the Health Crisis
The Bigger Problem: Total Cost Impact of Poor Health to Employers
The Solution: Evidence Based Workplace Wellness/Population Health Mgmt
Converging Trends Driving the Demand for Wellness and Prevention
Epidemiological Trends: The Burden of Illness/Risk in Population
Converging Trends Driving the Demand for Wellness and Prevention
Mokdad AH, et.al. Actual Causes of death in the United States, 2000. JAMA. 2004; 291:1238-1245.
Personal Health Behaviors are the main Causes of Death
The Global Epidemic of Non-communicable Chronic Diseases
Global Drivers of Mortality Due to Unhealthy Lifestyle Behaviors:
5 Lifestyle Behaviors
Physical Inactivity Poor Nutrition Smoking Alcohol Medicine Non-adherence
5 Chronic Conditions
Diabetes Heart Disease Lung Disease Cancer Mental Illness
75% of Deaths worldwide
Need for Diabetes Prevention/Care in United States
8 millionare
UNDIAGNOSED
4 millionare
diagnosedbut NOT
TREATED
8.5 millionare treatedbut NOT
SUCCESSFULLYCONTROLLED
8.5 million havetheir disease
CONTROLLED
20.5 millionhave
Diabetes that isNOT
CONTROLLED
86 millionAmericanshave PRE-DIABETES
29 millionAmericans
haveDIABETES
17 millionof those
areTREATED
21 millionof those
areDIAGNOSED
Goal:Reduce or
Eliminate RiskFactors and Avert
Disease
Goal:Find and TreatDisease in Its
Earliest Stages toStop Its
Progression
Goal:Manage Disease toAvoid Complications
and DiseaseProgression
Goal:Manage Disease toAvoid Complications
and DiseaseProgression
Goal:Avert Onset of
Diabetes or Costsdue to Untreated or
UncontrolledDisease
77 millionare
UNAWARE
Sources: NIH, CDC, ADA.
Epidemiological Trends: The Burden of Illness/Risk in Population
The Age Wave—”Silver Tsunami” about to hit the healthcare system
Converging Trends Driving the Demand for Wellness and Prevention
As the Age Wave Hits the Shore:Implications of the Aging Workforce
$0
$3,000
$6,000
$9,000
$12,000
19-34 35-44 45-54 55-64 65-74 75+
$1,776$2,193 $2,740
$3,734$4,613
$5,756$2,565$3,353
$4,620
$6,625
$7,989$8,927$5,114
$5,710
$7,991
$10,785
$11,909 $11,965
Annual Medical Costs
Age RangeEdington. AJHP. 15(5):341-349, 2001
Low
Med Risk
High
Healthcare Costs: Which Matters More
Age or Health Risk?
Epidemiological Trends: The Growing Burden of Illness and Burden of Health Risks in Society
The Age Wave—Silver Tsunami about to hit the healthcare system
Political Trends: Aligning Incentives among Consumers, Providers, Employers
ACOs/P4P/PCMH… and ultimately the Consumer Centered Health Home
Converging Trends Driving the Demand for Wellness and Prevention
Focusing on the “Health” in Health Reform (ACA)
National Prevention Strategy
Employer-Based Wellness Program Incentives for Employees
Accountable Care Organizations (ACOs)
Patient Centered Medical Home (PCMH)
ACOs/PCMHs and Employers
Accountable Care Organizations (ACOs) and Patient CenteredMedical Home (PCMH) similarities:
Care models that make physicians and hospitals more accountableOutcomes oriented, performance-based with aligned incentivesGoal: improve value of health services, control costs, improve qualityACOs/PCMHs share in a portion of savings gained
Including workplace in ACO/PCMH development is logicalWork impacts health and health impacts work
Workplace is organically connected to home as personal health risks aren’tleft at home just as occupational risks aren’t left at work…
Employers have unique infrastructure advantages that could helpACO/PCMH initiatives.
PHM in the Triple Role and Triple Aim for Hospital/Health Systems
Employer
Provider
Insurer/ACO (Financial/Clinical Risk Bearer)
The 3 R’s of Healthcare Stakeholders
3 R’s ofHealthcareStakeholders
Responsibilities Risks Rewards
Employees/Consumers
• Health Management• Disease Management• Job performance
• Better Care at Lower Cost• Financial incentives for
lower total costs• Improved health
outcomes of population
Adapted from: Loeppke R. The 3 R’s of healthcare: responsibilities, risks and rewards. Health Prod Mang. 2002:5-19.
Physician and Employee Aligned Financial Incentivesrelated to Evidence Based Population Health Management Metrics
Total Savings Dollars: DIRECTV Shared 33% with Employees; 33% with Physicians $ Bonus Pool = $ Claims Cost Savings PLUS $ Worker Productivity Savings (1:1)
Example of Quality Point actions for both Physicians & Employeesand accounted for in their Incentive Accounts--for allocation of Bonus:
Evidence Based Medicine (EBM) Quality Criteria PHM Quality Points
Personal Physician Reviewing HRA with Employee (Patient) xxx
(e.g. Diabetics testing HbA1C at least every 6 months)
xxx
Maintain ongoing participation/engagement in Health Management,Health Coaching and Disease Management programs
xxx
Loeppke R, Nicholson S, et al. “The impact of an integrated population health enhancement and disease management program onemployee health risk, health conditions and productivity”. Population Health Management. 2008: 11(6); 287-296.
Value of a Quality Point for Employee and Physician based on Actual Savings =
$19.00 per Quality Point
Epidemiological Trends: The Growing Burden of Illness and Burden of Health Risks in Society
The Age Wave—Silver Tsunami about to hit the healthcare system
Political Trends: Aligning Incentives among Consumers, Providers, Employers
ACOs/P4P/PCMH…Consumer Centered Health Home
Cultural Trends: Wellness is the new Green: The Ultimate Sustainability Strategy
Mobile/Wireless Tech Transforming the Healthcare Industry
Game Theory Innovations in Wellness
Converging Trends Driving the Demand for Wellness and Prevention
Mobile Technology: The World’s most ubiquitous platform
MOBILE TECHNOLOGY: THE WORLD’S MOSTUBIQUITOUS PLATFORM.*
MOBILE TECHNOLOGY: THE WORLD’S MOSTUBIQUITOUS PLATFORM.*
*Source: IMS Report: The World Market for Internet Connected Devices, 2012.
More people have access to cell phones than
drinking water, electricity or a toothbrush.
By 2020, ~160 million Americans monitored
and treated remotely for at least one chronic condition
TRANSFORMINGHEALTHCARE
Johns Hopkins University. Chronic Conditions: Making the Case for Ongoing Care. Retrieved 10/20/12, fromhttp://www.partnershipforsolutions.org/DMS/files/chronicbook2004.pdf
Gamification in Healthcare
Since 2004 One Game has beenplayed 50 Billion hours(5.93 Million Years)
183 M people are “Gamers”(> 13 hours per week)
97% of Youth play regularly
25% of > 50 y/o play regularly
“Transformational Accomplishmentcan occur when we can celebrateSpectacular Failure”
Potential for Nobel Prize winners inMedicine using Gamified Apps
Epidemiological Trends: The Growing Burden of Illness and Burden of Health Risks in Society
The Age Wave—Silver Tsunami about to hit the healthcare system
Political Trends: Aligning Incentives among Consumers, Providers, Employers
ACOs/P4P/PCMH…Consumer Centered Health Home
Cultural Trends: Wellness is the new Green: The Ultimate Personal Sustainability Strategy
Mobile/Wireless Tech Transforming the Healthcare Industry
Game Theory Innovations in Wellness
Financial Trends The Problem: The Cost Crisis is largely due to the Health Crisis
Converging Trends Driving the Demand for Wellness and Prevention
Of the more than $3 trillion/yr spent on U.S. health care
Patients with chronic diseases account for 75% of U.S. healthcare costs
Of every dollar spent…
…75 cents went towards treating
patients with one or more chronic diseases
22
150 Million Americans with 1 or more Chronic Conditions 27% of rise in healthcare costs associated with the increase in obesity rates
The Waist Line impacts the Bottom Line
And yet, less than 5 cents of each healthcare dollar is spent on Prevention
“An ounce of prevention
is worth a pound of cure.”
Ben Franklin
1736
Learning from the Past
5 Health Factors that mitigate Chronic Illness
1) Walking 30 minutes a day2) Eating healthy3) Not using tobacco4) Drinking alcohol only in moderation5) Waist size less than half of your height
These result in 33% to 50% Less Lifetime Healthcare Costs If 75% of Americans had these health characteristics, between
$600 Billion and $1 Trillion could be saved per year
Mike Roizen MD
Chairman Cleveland Clinic Wellness Institute
Michael F. Roizen and Ted Spiker, This Is Your Do-Over: The 7 Secrets to Losing Weight, Living Longer, and Getting a Second Chance at theLife You Want (New York, NY: Scribner, 2015). Agneta Akesson et al., “Low-Risk Diet and Lifestyle Habits in the Primary Prevention ofMyocardial Infarction in Men: A Population-Based Prospective Cohort Study,” Journal of the American College of Cardiology 64 (13) (2014):1299–1306. Andrea K. Chomistek et al., “Healthy Lifestyle in the Primordial Prevention of Cardiovascular Disease Among Young Women,”Journal of the American College of Cardiology 65 (1) (2015): 43–51.Meir J. Stampfer et al., “Primary Prevention of Coronary Heart Disease inWomen Through Diet and Lifestyle,” The New England Journal of Medicine 343 (2000): 16–22.
Epidemiological Trends: The Growing Burden of Illness and Burden of Health Risks in Society
The Age Wave—Silver Tsunami about to hit the healthcare system
Political Trends: Aligning Incentives among Consumers, Providers, Employers
ACOs/P4P/PCMH…Consumer Centered Health Home
Cultural Trends: Wellness is the new Green: The Ultimate Sustainability Strategy
Wireless Technology Transforming the Healthcare Industry
Game Theory Innovations in Prevention/Wellness
Financial Trends The Problem: The Cost Crisis is due in large part to the Health Crisis
The Bigger Problem: Total Cost Impact of Poor Health to Employers
Converging Trends Driving the Demand for Wellness and Prevention
Top 10 Health Conditions by Full Costs For Employers
$0
$50,000
$100,000
$150,000
$200,000
$250,000
$300,000
$350,000
$400,000
Presenteeism
Absenteeism
Drug
Medical
Loeppke, R., et al., "Health and Productivity as a Business Strategy: A Multi-Employer Study“. JOEM. 2009;51(4):411-428.
As Health Risks Go, so Go Health-related Costs
% of WorkplacePresenteeism
0-2 risks 3-4 risks 5+ risks
14.7%
20.9%
26.9%
6.4Days
9.3Days
12.6Days
1 risk 3 risks 4+ risks
Work days lost / Person / Year(Absenteeism)
STD Days / Year
0-1risks
2- 3risks
4+
risks
2.4Days 5.3
Days
13.1Days
Sources: Burton, et al, JOEM: Vol. 47. No. 8, August, 2005; Wayne Burton, MD, IHPM North American SummitMeeting 2000; also Tsai, et al. JOEM: Vol. 47, No. 8, August, 2005
Epidemiological Trends: The Growing Burden of Illness and Burden of Health Risks in Society
The Age Wave—Silver Tsunami about to hit the healthcare system
Political Trends: Aligning Incentives among Consumers, Providers, Employers
ACOs/P4P/PCMH…Consumer Centered Health Home
Cultural Trends: Wellness is the new Green: The Ultimate Sustainability Strategy
Wireless Technology Transforming the Healthcare Industry
Game Theory Innovations in Prevention/Wellness
Financial Trends The Problem: The Cost Crisis is due in large part to the Health Crisis
The Bigger Problem: Total Cost Impact of Poor Health to Employers
The Solution:
Evidence Based Workplace Wellness/Population Health Management
Converging Trends Driving the Demand for Wellness and Prevention
The Bottom Line for Employers:
29
Better Health – Population Health
Better Care – Patient Experience
Better Value – Higher Quality/Lower Cost
Cathy Baase MD, MPHChief Health OfficerDow Chemical Company
Goetzel, R; et al. “Do Workplace Health Promotion (Wellness) Programs Work.”J Occup Environ Med. 2014; 56 (9):927-934, September, 2014.
Evidence Based Wellness/Population Health Management
Total Population
Medium RiskLow Risk High Risk
DM RiskLS Risk
Population of One
Early Intervention/Care MgmtScreening/Early DetectionWellness/Health Promotion
Loeppke, R. “Making the Case for Population Health Management: TheBusiness Value of Better Health,” Chapter 7, pp 121-136 in Nash, D., et.al.,Population Health Textbook. Jones and Bartlett Learning. Sudbury, MA. 2010.
498
2291
55314666
Significant Overall Health Risk Reduction of PopulationParticipating in their personalized Preventive Plan for 2 Years
Net Movement of Health Risk Levels in CohortBaseline vs Year 2 on Preventive Plan
1775847
N = 7,804
Low Moderate High
60%
11%
6%
29%
23%
71%
Loeppke, R; Edington, D; Bender, J; Reynolds, A. “The Association of Technology in a Workplace Wellness Program with Health Risk FactorReduction” Journal of Occupational and Environmental Medicine: March, 2013; Volume 55, Number 3: pp 259–264
USPM 5 Year Cohort Reduction in Key Individual Risk Factors
KEYHEALTH RISK
FACTORSYear 5
N = 1,763
Participants
Health Risk Factor % PopulationReducing Risk
Blood Pressure -81.45%Physical Activity -91.11%Fasting Blood Sugar -48.01%Fatty Diet -31.82%Smoking -40.63%Stress -83.77%Total Cholesterol -71.76%HDL Cholesterol -46.15%Health Related Illness Days -51.92%Alcohol -86.25%Med/Drugs for Relaxation -84.62%Poor Perception of Health -76.12%BMI -15.16%Diagnosed Condition -19.02%
Intel-GE Validation Institute AnalysisTotal Hospital admits & ER visits across Conditions
vs *DMPC and *HCUP national averages (per 1000 members)
0
5
10
15
20
25
30
35
USPM
National Averages
HCUP
*Disease Management Purchasing Consortium and the federal
Healthcare Cost and Utilization Project (HCUP) databases
Loeppke R. “The Value of Health and the Power of Prevention”. Int J WorkplaceHealth Management. 2008; 1(2)95-108.
The Linkage: Healthy Companies drive Healthy Bottom Lines
Fabius, R; Loeppke, R; et.al. “Tracking the Market Performance of Companies That Integrate a Culture of Health and Safety: An Assessment of Corporate HealthAchievement Award Applicants”. JOEM. Volume 58: Number 1. Jan, 2016. Fabius R, et al. The link between workforce health and safety and the health of the bottomline: Tracking market performance of companies that nurture a “culture of health.” J Occup Environ Med. 2013;55(9):993-1000.
“Though correlation is not the same as causation, the preponderance ofevidence appears to be building that healthy and safe workforcesprovide a competitive advantage for employers.”
By living a healthier lifestyle, the compression of morbidity relates to postponingthe age of onset of morbidity, disability and cumulative health costs--even thoughlife expectancy is increased—
Adding Years to your Life and Life to your Years.
The Great News from 30 years of Scientific Studies:The Compression of Morbidity
Healt
h
“Acceptable QOL”
“Disability”
Hubert, Bloch, Oehlert and Fries. Lifestyle Habits and Compression of Morbidity.J Gerontol A Biol Sci Med. June, 2002; 57 (6) M347-51
Live Healthier Longer and Die more Suddenly at Lower Cost