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Rationale for Worksite Health Promotion Programs –Why Wellness? –Why the Worksite? –What’s the Goal? Published Research on WHP Programs –High Risk Employees Cost More –WHP Programs Have an Impact –Comprehensive Programs Have Positive ROI Bottom LineAgenda

Rationale for Worksite Health Promotion Programs

Rationale For WHP Programs Why Wellness? Health Spending in US Topped $1 trillion in 1996 ($1,035.1 billion) Doubles every 10 years 1960 $26.9 billion 1970 $73.2 billion 1980 $247.3 billion (tripled) 1990 $699.1 billion 2000 $1.3 trillion Forecast for 2010 is $3.07 trillion

Rationale For WHP Programs Why Wellness? Increasing Costs Health plans raising premiums US Business share of health expenditures is 25% Approximately 50% of a company’s profits are spent on healthcare benefits Productivity costs estimated at twice direct costs

Lifestyle Accounts for 50% of Deaths Source: CDC (1980 ) Rationale For WHP Programs Why Wellness?

Perceptions 1.Cancer30% 2.Heart Disease29% 3.Auto Accidents28% 4.Tobacco Use25% 5.Alcohol Abuse18% 6.Drug Abuse17% 7.Firearms15% 8.Obesity/Inactivity9% 9.AIDS8% Perceptions 1.Cancer30% 2.Heart Disease29% 3.Auto Accidents28% 4.Tobacco Use25% 5.Alcohol Abuse18% 6.Drug Abuse17% 7.Firearms15% 8.Obesity/Inactivity9% 9.AIDS8% Reality 1.Tobacco Use38% 2.Obesity/Inactivity28% 3.Alcohol Abuse9% 4.Nonsexual Infectious8% 5.Toxic Agents6% 6.Firearms3% 7.Sexual Behavior3% 8.Auto Accidents2% 9.Illicit Drug Use2% Reality 1.Tobacco Use38% 2.Obesity/Inactivity28% 3.Alcohol Abuse9% 4.Nonsexual Infectious8% 5.Toxic Agents6% 6.Firearms3% 7.Sexual Behavior3% 8.Auto Accidents2% 9.Illicit Drug Use2% Rationale For WHP Programs Premature Death: Fact or Fiction? Source: Partnership for Prevention. Survey of 1,000 adults in March Percentage who described each as the leading cause of premature death. Source: Partnership for Prevention. Based on research by McGinnis & Foege published in the Journal of the American Medical Association, November 10, 1993.

Rationale For WHP Programs Why the Worksite? Captive Audience Consistent Environment Social Support Organizational Support Employers Will Fund

Rationale For WHP Programs What’s the Goal? It’s Good for Business Employee Job Satisfaction Recruitment & Retention Enhance Competitiveness Decrease Absenteeism Decrease Workers Comp & Disability Manage Healthcare Costs

Published Research on Worksite Health Promotion

Published Research on WHP What the Research Says 1. High Risk Employees Cost More – –Higher Costs – –Less Productive 2. WHP Programs Have an Impact – –Health Risks – –Medical Claims – –Absenteeism – –Disability 3. Comprehensive Programs Have Positive ROI

Published Research: High Risk Employees Cost More

Published Research on WHP High Risk Employees Cost More Impact on Individual Health Care Costs: High versus Lower-Risk Employees Individuals at high risk for depression have 70.2% higher costs than those at lower risk Source: Goetzel et al. (1998 )

Published Research on WHP High Risks Impact Organizational Health Care Costs High stress generates 7.9% of annual medical expenditures $428 per employee annually (1996 dollars) 24.9% of health care costs High stress generates 7.9% of annual medical expenditures $428 per employee annually (1996 dollars) 24.9% of health care costs Annual Impact of High Risks on Organizational Health Care Costs Source: Anderson et al. (2000 )

Published Research on WHP Costs Follow Risks *Claims costs adjusted to 1996 dollars. Risk Change Changes in Cost Associated with Risk Source: Edington et al. (1997 ) Average Annual Costs* Time

Published Research on WHP High Risk Employees are Less Productive Worker Productivity Index Source: Burton et al. (1999 ) Productivity Level

Published Research: WHP Programs Have an Impact

WHP Programs Have an Impact on: Health Risks Targeted Programs Reduce Risks Net Risk Reduction is.85 Source: Gold et al. (2000 ) Average Number of Risks

WHP Programs Have an Impact on: Health Risks * Significant difference Targeted Programs Reduce Risks Percent Reduced Risks 44% 25% 14% 16% 46% 28% 45% 27% 41% 18% 38% 23% 25% 14% Source: Gold et al. (2000 )

WHP Programs Have an Impact on : Medical Claims Average Claims Paid per Employee and Retiree BaselineStudy Year Source: Fries et al. (1994 ) Nonparticipants’ expenses increased 27.7% more than participants. Possible Savings = $437/person Nonparticipants’ expenses increased 27.7% more than participants. Possible Savings = $437/person

WHP Programs Have an Impact on: Absenteeism * Significant difference Intervention Source: Wood et al. (1989 ) Mean Days Absent

WHP Programs Have an Impact on: Short-Term Disability Short-Term Disability Savings versus Non-Participants Average STD Days Lost * Significant difference 1996 Baseline 1997*1998* Estimated Difference = $1350 per participant Source: Serxner et al. (2001 ) Intervention

Published Research: Comprehensive Programs Have Positive ROI

Comprehensive Programs Have Positive ROI Health Promotion Short-TermLong-Term $3-$8 3-5 Years $2-$5 1st Year Demand Management

Comprehensive Programs Have Positive ROI $3.35 $4.87 $8.22 Source: Aldana (1998 ) Savings per Dollar Invested

Bottom Line: “What the Research Tells Us”

Behaviorally staged Focus on maintenance and reinforcement Program beyond risk or disease specific Tailored to health and safety risk Incentives for participation Bottom Line Principles of Effective Program Design Source: Serxner (in press)

Repeated contacts Varied formats Personalization Low cost & portable Easy to administer Emphasis on health and productivity Bottom Line Principles of Effective Program Design Source: Serxner (in press)

Multiple distribution channels Built in program evaluation Long-term orientation Integrated with Safety, Occupational Health, EAP, and Training Visible management support Bottom Line Principles of Effective Program Design Source: Serxner (in press)

Bottom Line Millions Can Be Saved Projecting Medical Care Cost Increases Using Four Scenarios of Lifestyle Risk Rates Source: Leutzinger et al. (AJHP 2000 ) *1998 Dollars Program holds risks constant Program reduces risks 0.1%/yr Program reduces risks 1%/yr No program w/ current risk trends Cost (in Millions*) $9.96 $8.85 $7.89 $2.22 $7.74 Million Saved/Year

Lower Health Care Costs Lower Absenteeism Additional Benefits –Higher Productivity –Lower Turnover –Improved Employee Satisfaction/Morale –Improved Employee Health/Quality of Life –Improved Recruitment –Improved Corporate Image Bottom Line Wellness is a Healthy Investment

Aldana SG. Financial impact of worksite health promotion and methodological quality of the evidence. Art of Health Promotion 1998; 2(1):1-8. Anderson DR, Whitmer RW, Goetzel RZ, Ozminkowski RJ, Wasserman J, Serxner SA. The relationship between modifiable health risks and group-level health care expenditures. American Journal of Health Promotion 2000; September/October: Burton WN, Conti DJ, Chen CY, Schultz AB, Edington DW. The role of health risk factors and disease on worker productivity. Journal of Occupational and Environmental Medicine 1999; 41(10): Edington DW, Yen LT, Witting P. The financial impact of changes in personal health practices. Journal of Occupational and Environmental Medicine 1997; 39(11): Fries JF, Harrington H, Edwards R, Kent LA, Richardson N. Randomized Controlled Trial of Cost Reductions from a Health Education Program: The California Public Employees’ Retirement System (PERS) Study. American Journal of Health Promotion 1994; 8(3): Goetzel RZ, Juday TR, Ozminkowski RJ. A systematic review of return-on-investment studies of corporate health and productivity management initiatives. AWHP’s Worksite Health 1999 (Summer); Gold DB, Anderson DA, Serxner, S. Impact of a telephone-based intervention on the reduction of health risks. American Journal of Health Promotion 2000; Nov/Dec: References

Leutzinger JA, Ozminkowski RJ, Dunn RL, Goetzel RZ, Richling DE, Stewart M, Whitmer RW. Projecting future medical care cots using four scenarios of lifestyle risk rates. American Journal of Health Promotion 2000; 15(1): Ozminkowski RJ, Dunn RL, Goetzel RZ, Canior RI, Murnane J, Harrison M. A return on investment evaluation of the Citibank, N.A., health management program. American Journal of Health Promotion 1999; 14: Pelletier KR. A review and analysis of the clinical and cost-effectiveness studies of comprehensive health promotion and disease management programs at the worksite: update (IV). American Journal of Health Promotion 1999; 13: Serxner SA. Practical Considerations for Design and Evaluation of Health Promotion Programs in the Workplace. Disease Management and Health Outcomes (in press). Serxner SA, Gold DB, Anderson DR, & Williams, D. The impact of a worksite health promotion program on short-term disability usage. Journal of Occupational and Environmental Medicine 2001; 43(1): US Department of Health and Human Services (1980) Ten leading causes of death in the United States. Atlanta: Center for Disease Control, July. Wood EA, Olmstead GW, Craig JL. An evaluation of lifestyle risk factors and absenteeism after two years in a worksite health promotion programs. American Journal of Health Promotion 1989; 4(2): References