Presentation on theme: "Workplace Wellness - Going Beyond Promises to Achieve Results Larry Catlett, MD."— Presentation transcript:
Workplace Wellness - Going Beyond Promises to Achieve Results Larry Catlett, MD
Objectives for Today Define lifestyle’s role in our health care problem Understand the need for prevention Review behavior change techniques Demonstrate wellness outcomes in the workplace To understand what makes a Wellness Program successful and what your role is in this process
What is Our Health Care Problem Really About? Our current dysfunctional “sick care” system - and the claims management process put in place to control it – too often ignores primary prevention. Rather than being designed to prevent chronic disease, the system exploits the current epidemic.
The Chronic Diseases…. Diabetes Coronary Heart Disease Stroke COPD Cancer
… The Root of the Problem Consider: Rising chronic disease burden (133 million Americans have one or more chronic diseases) 75% of all health care spending on one or more chronic diseases
Not Convinced? Let’s Look at Diabetes
But it’s All Genes Anyway, Right? Factors contributing to all disease (CDC data) 20% - heredity 10% - lack of access to health care 19% - environment >50% lifestyle choices 80% of heart disease and stroke, most of diabetes, 40% of cancers preventable with lifestyle changes
It’s really Quite Simple Behaviors Change We become less active (“watch your kids do it”), yield to “convenient” food sources, and… Gain pounds- double your risk for diabetes, or… Gain pounds- triple your risk
What We Know About At Risk Health Behavior
Health Behaviors that Drive Costs Absenteeism Alcohol abuse Existing medical condition High Blood pressure Inactivity Life dissatisfaction Low back pain High total cholesterol Low HDL cholesterol Negative health perception No seat belt/helmet use Overweight Stress Smoking
Cost Risk Levels Low- 1-2 risks / “baseline spending” Medium- 3-4 risks / up to 50% more than baseline spending High- 5 or more risks /150 to 300% additional spending per year per person
Typical Employee Population Profile Low 30-40% Medium 30-40% High 20-30% –(2-3% migration to worse health risk status every 3-5 years)
Total Medical and Pharmacy Costs Paid by Quarter for Three Groups
What to Do?
Prevention is the solution Milken Study* Primary prevention (wellness, health promotion) Secondary prevention (early detection/diagnosis) Tertiary Prevention (chronic condition management) Could have an economic impact of $1 trillion annually… “An UnhealthyAmerica” 2007 study, Milken Institute
Wellness Risk Reduction Goals 1. “Zero trend” 2. Reduce high risk population 3.Increase low risk population
What’s Out There to Reduce Risk?
Health Awareness… Posters, pedometers, check stuffers, T-shirts, free fruit, health fairs and newsletters…..
Health education and population based programs…. 12 week walking program Fitness courses “Biggest Loser” contests 8 week men’s health course twice a year Smoking cessation classes Strength training classes and…. health education coaching from health “experts”…..
Client Centered Health Behavior Change Reducing individual and group risk burden by redcui9ng at risk behaviors improves quality of life, decreases medical spend within the group and enhances productivity
Understanding a Client Centered Health Behavior Change Intervention
Why Do People Change? People change because.. They want to… (their idea) The behavior they have decided to change has become a significant liability to them…(importance) They have come to believe they can change…(confidence) and A particular change at a particular time in their life is a high priority (readiness).
Intrinsic Motivation to Change The convergence of importance, confidence and readiness) to change. Achieved through collaboration, evocation of intrinsic beliefs and values and preserving autonomy! What does it sound like???
Losing Weight… HC: Let’s look at your risks (obesity, nutrition, exercise, seat belt ) C: I’ve been wondering when this would happen. HC: When what would happen? C: You’re going to tell me to lose weight. HC: You’re weight is a sensitive issue.
Losing Weight…. C:Well, it’s so hard to lose weight and I wonder if I really need to? HC: Your weight is not really problem for you. C: I didn’t say that. HC: Tell me what you think about your weight.
Losing Weight… C: It’s not that I wouldn’t like to lose weight- I guess I really should- but I just don’t know how I can do it. HC: Tell me why you think you should. C: Well, my foreman, Luke, is really overweight and he missed all of deer season last year after his heart attack. Hasn’t been out this year either. HC: Any other reasons
Losing Weight… C: Well, my wife says my knees would do better and I could keep up with my grandkids. HC: It’s not that losing weight is not important to you, it’s the “how” that worries you.
Losing Weight C: Well, I sure don’t want to have to quit deer hunting like Luke did after his heart attack, but I can’t stand diets. I am hungry all the time and I always gain all my weight back. HC: Losing weight might keep you deer hunting and help your knees, but it has been hard for you in the past.
Losing Weight…. C: Sure! That’s right. HC: Well then, on a scale of 1-10, where would you rank the importance of losing weight? C: I should lose weight. I know that- so I guess a 7 or 8. But how???
Losing Weight… HC: There are two ways to lose weight. Eat less of exercise more. Do either of these appeal to you? C: I stay active with chores and work but I don’t like to exercise. If I try to eat less, won’t that just be a diet? HC: Exercise is out and eating less may be too hard. C: How much less?
Losing Weight…. HC: Tell me what you ate for breakfast. C: Well, for breakfast I had 3 slices of bacon and a bowel of oatmeal with a couple tablespoons of sugar, a glazed donut, 2 cups of coffee with milk and a banana. HC: You are eating some healthy stuff and that is a great start. Any place in there you might make a change? Just so you know, if we can weed out 3500 calories over the course of a week you will lose a pound a week. If it takes 2 weeks that is fine too. That might be easier than you think.
Losing Weight…. C: No kidding? Maybe a slice of bacon and some sugar? I guess I could live without the donut. HC: There’s 300+ or so calories right there? C: That’s not much. HC: It’s a good start when we are looking for small painless changes that you can stick to and add to over time. 10 days of this totals 3000 Calories! Do you think you could look at all your meals and snacks this way and make some small cuts in calories, or should we just stick to breakfast now?
Losing Weight…. C: Yeah, let’s stick to breakfast. I just wonder if it will work? HC: Don’t be in a rush to see weight loss. We have plenty of time. Let’s remember that small, easy to reach goals work best. Is it fair to say your goal is to figure out how you can cut some calories (shooting for a total of 3500 every week or two)? C: Yes, that’s ok. HC: And the first thing you will do is look at what you are eating now for breakfast and change or substitute where you can? I will show you a web site for counting calories. C: That will be great.
Losing Weight..…. HC: Any questions? I will see you in a couple of weeks to see how you have done. C: No questions. This may actually work. HC: If it doesn’t, we’ll spend time next time figuring out how to improve the plan!
Does Health Behavior Change Really Work?
Cost Risk Savings Large Company (2000)
5 Year Experience (large company)… TOTAL SPENDING DECREASE $6,796,681.00
Expected vs Actual Costs
Medium Company After 4 Years…
Small Company After Two Years
Case study Two remarkably similar companies 2,000 employees each Heavy construction/manufacturing Company A – comprehensive wellness in place for 10+ years Company B – no wellness at time of snapshot (a new OMC client)
2009 Top 10 Conditions
Difference in incidence of diabetes with and without a wellness program Per 1,000 Employees
Difference in incidence of heart disease with and without a wellness program Per 1,000 Employees