1. Creating a Culture of Health at the University of Michigan LaVaughn Palma-Davis, M.A. Senior Director, University Health and Well-Being Services University of Michigan

2.  Multiple locations  Three academic campuses  Health System  40,000+ active employees  82,000 (approx.) family members  7,000 retirees  60,000 students Tremendous potential to positively impact community health!

3. Unique Characteristics  Three-fold mission: education, research, service  Multiple audiences (faculty, staff, families, retirees, patients, students, a “city” of jobs)  Decentralized organizational structure  Culture is one of “freedom of choice”

4. Our Unique Opportunity to Improve Health “We have the means to mount a broad, collaborative effort to fashion a prototype program to:  promote healthy living,  contain health care expenditures, and  define optimal insurance coverage for individuals and families. We can use our intellectual resources to help the nation in addressing the growing crisis in health care.” -President Mary Sue Coleman Future Directions Presentation UM Regents, 4/22/04

5. Our Vision  To be a model community of health where both the individual and the organization thrive

6. MHealthy Strategic Goals To improve the health status and quality of life of the U-M community by: 1. Keeping the well well 2. Identifying those at risk and helping them reduce risk 3. Improving the health management of those with chronic & disabling conditions 4. Building a university culture that supports healthy lifestyles To help control the long-term rate of health related cost increases.* *See Baicker Cutler article in Health Affairs, Dec. 2010

7. MHealthy Guiding Principles Programs and services will:  Address the significant health needs of our diverse populations  Maximize participation within the University community while supporting choice  Support and encourage the achievement of realistic goals among the populations we serve  Be data driven and cost-effective  Protect personal health information  Offer a variety of accessible options for individuals and departments to positively influence their health  Promote a safe and healthy work environment through shared responsibility with faculty and staff  Seek customer input and engagement in planning and evaluating our services.

8. How will we achieve a “community of health”?  Comprehensive long-term strategic plan addressing the continuum of health and targeting our most significant issues  Leadership and community engagement (committees and unit champs)  Organizational integration and culture/environmental enhancements  Alignment of benefit design and sustainable funding  Incentives for healthy behaviors to motivate high participation  Comprehensive evaluation to demonstrate outcomes and continuously improve programs

9. MHealthy’s Service Integration Partners  Safety  Disability Management  Recreational Sports  Food Services  Organizational Development MHealthy also provides health risk reduction services to Health System patients.

10. MHealthy Services  MHealthy Rewards Annual health risk assessment, goal setting and periodic screening Free health coaching for those with significant risk factors Monetary incentive for participation  Nutrition and Weight Management Ready to Lose Weight Watchers subsidy Nutrition Consultations Cooking Classes  Physical Activity Exercise Classes Personal Training

11. MHealthy Services  Tobacco Consultation & Alcohol Management Services  Mental and Emotional Health Services Faculty and Staff Assistance Program (FASAP) (Free, confidential short-term counseling and support) Understanding U website, on-line programs & resources Mhealthy Thrive! - stress and energy management programs & activities  Occupational Health Services Work-related injury and illness care Annual assessments, surveillance, immunizations & vaccinations Medical ergonomic services Key partner in disability management and RTW.

12. MHealthy Scorecard Goals & Metrics  Participation - By year 5, achieve at least 70% participation by benefit- eligible employees (Given the reduction in incentive to $100, 70% may not be feasible.)  Satisfaction - Achieve a customer satisfaction score of at least 4 out of 5  Health Risks Reduce the percentage of the UM benefit-eligible population that is high risk by 5 percentage points by year 5 Increase the percentage of the UM benefit-eligible population that is low risk by 5 percentage points by year 5  Medical Care Costs - In year 5, medical and pharmaceutical costs for participants will be 10% lower than for non-participants  Absenteeism - Decrease self-reported absenteeism by 0.5 day by year 5  Culture of Health Improvements - Improvements in total score from baseline HERO Scorecard and faculty and staff survey  Value on Investment 12

13. Health Risk Level Percentages by Year Demonstrates Movement to Lower Risk 2009-2012 Note: Differences between 2009 and 2012 are statistically significant for all variables (p < 0.05).

14. Top Health Risks Percentage at High Risk 2009-2012 Note: N=5108. Differences between 2009 and 2012 are statistically significant for all variables (p < 0.05).

15. 2009 and 2012 Biometric Screening Results

16. Healthcare Cost Trend-Adjusted for Age, Gender, Race and Job Class (Faculty, Staff, Other) Notes: Claims are truncated $0-$100,000. Costs for 2010 are statistically significantly different at p < 0.05.

17. U-M Culture Survey  UM HMRC Survey of approximately 2,500 faculty and staff  Assessed workplace environment and culture Findings:  Majority of staff are aware of and appreciative of wellness programs and services  Employees perceive senior leaders as supportive, but confirm need for middle managers support  Employees feel that inclusion of spouses/partners is important  49.3% of employees feel work environment enables them to maintain good health (stress is an issue)

18. What We’ve Done Well

19. Development of Strategic Plan  Know your Population Review claims data Conduct Faculty and Staff Interest Survey  Best Practice Benchmarking HERO Scorecard, Leading by Example Survey and Review of Koop Award Winners used to: Identify key program elements and Conduct a gap analysis, Develop a prioritization matrix & timeline  Input from key stakeholders and University-wide MHealthy Advisory Committee appointed by President

20. Strategic Plan Components  Leadership support  Communication & marketing  Wellness assessments with follow-up coaching  Population-wide programs  Targeted risk reduction programs  Disease management  Disability management  Supportive environment, culture, policies & infrastructure  Incentives and benefit design  Data management & evaluation  Collaboration with health care system  Innovation

21. Overview of Influencer Model Framework for MHealthy Activities

22. Engaging and Gaining Support from Leadership  Distribute leadership briefings from President and EVPs  Educate on the business case  Incorporate the leader’s role into existing leadership development programs and leadership competencies  Produce reports with department- specific participation levels and risk factors  Award and recognize leaders who have met goals or been exemplars in creating cultures of health

23. Engagement through Wellness Champions  Regional wellness coordinators mentor MHealthy Champions & provide programming tailored to unique needs of departments  MHealthy Champions  A network of 370+ employees across the university who serve a two year term (with option to renew)  Raise awareness and motivate co-workers to participate  Receive training and resources  Work with their managers to complete workplace wellness checklist & develop plan for creating a healthy culture at unit level.  Honored for their work & can earn awards for their departments.

24. Engaging Employees Through Culture and Environment  Large scale team competitions & events (e.g. Active U)  Targeted Interventions to High Risk Groups  Healthy catering, dining & vending  Farmers’ markets/produce carts  Ergonomics matching grants and awards  Walking maps & fitness center discounts

25. Smoke-Free Environment  No smoking or e-cigarettes allowed in buildings, parking lots or ramps (except inside personal vehicles) or outside specified boundaries  Free quit smoking programs for employees & patients with referral  Free nicotine replacement therapies through our benefits plan, including OTC products  Supervisor’s Enforcement Tool kit provides talking Supervisor’s Enforcement Tool kit points and information on how to handle disciplinary issues

26. Effective communications  Comprehensive communications plan  Multiple voices (cascades)  Targeted messages  Involve the consumer in the campaign  Use varied media

27. Program accessibility  Offer programs close to the customer at a variety of locations and times  Offer coaching and other programs in person, via telephone, and online  Use technology to expand reach

28. Utilize technology  Use technology to engage a wider audience  Webinars  Online trackers  Mobile apps  Streaming videos  Blogs  Leverage Social Media

29. Challenges  Size and complexity  Budget reductions in 2010 resulting in  Limited incentives - making it more challenging to achieve higher levels of participation  Delay in plan to reach out to spouses & OQAs  Delay in integrating incentive into benefit premium

30. Summary of “Lessons”  Broad leadership support & champions are essential  Setting clear expectations of a long-term commitment and process  Communication is critical and ongoing  Communicate a clear value proposition compared to other investments (tie to business success) <2% of health care expenses spent on preventive health  Integrating employee health and well-being into business objectives and practices  Rewards/incentives can “get people on the bus” but resources, culture, environment and polices sustain behaviors and improvements

31.  Demonstrating effective interventions that make a difference (e.g. obesity)  Sustainable change both at the individual and organizational level  Continuing to develop/improve leadership practices, policies, facilities and environment What Does the Future Hold? Aspirations  Partnering with our health care providers on population health management (ACA)

32. Major Recent Awards  2014 Healthiest 100 Award  2012 C. Everett Koop National Health Award Honorable Mention  2012 CUPA-HR Midwest Region Excellence in Human Resource Practices Award  WELCOA Well Workplace Gold Award

33. Questions? www.mhealthy.umich.edu www.mhealthy.umich.edu