1. Realizing the promise and Competitive Advantage of a: “Thriving, Healthy, High-Performing and Sustainable Workplace and Workforce” January 23, 2014 ©2014 Edington Associates Edington Associates LLC Shared Values-Shared Results, Positive Health and Measure What Matters

2. ©2012 Edington Associates2 Respect for and by Self, Others and the Organization In a stress-producing world, where it seems we can’t control very much. We each can impact our own Health and Lifestyle. And when we do, it makes a difference to others, our family and to the organization. Each manager should take a minute out of each day to look into the faces of the people we manage. And to realize that they are our most important resource. Each organization should provide supportive leadership, and a supportive environment, climate, and culture. And when they do it makes a difference to everyone in the organization.

3. ©2012 Edington Associates3 Estimated Prevalence of Health Risks OVERALL RISK LEVELS Low Risk = 0-2 risks Medium Risk = 3-4 risks High Risk = 5 or more OVERALL RISK LEVELS Low Risk = 0-2 risks Medium Risk = 3-4 risks High Risk = 5 or more From the UM-HMRC Medical Economics Report Estimates based on the age- gender distribution of a specific corporate employee population Health Risk Measure Body Weight Stress Safety Belt Usage Physical Activity Blood Pressure Life Satisfaction Smoking Perception of Health Illness Days Existing Medical Problem Cholesterol Alcohol Zero Risk High Risk 41.8% 31.8% 28.6% 23.3% 22.8% 22.4% 14.4% 13.7% 10.9% 9.2% 8.3% 2.9% 14.0%

4. Low Risk Excess Diseases Associated with Excess Risks (Heart, Diabetes, Cancer, Bronchitis, Emphysema Percent with Disease Med Risk Age Range High Musich, McDonald, Hirschland, Edington. Disease Management & Health Outcomes 10(4):251-258, 2002.

5. ©2012 Edington Associates5 Excess Medical Costs due to Excess Risks Edington, AJHP. 15(5):341-349, 2001

6. ©2012 Edington Associates 6 Natural Flow: by Risk Status 1640 (35.0%) 4,163 (39.0%) 678 (14.4%) High Risk (>4 risks) Low Risk (0 - 2 risks) Medium Risk (3 - 4 risks) 2,373 (50.6%) 21,750 (77.8%) 4,546 (42.6%) 10,670 (24.6%) 4,691 (10.8%) 27,951 (64.5%) 11,495 (26.5%) 5,226 (12.1%) 26,591 (61.4%) 892 (3.2%) 1,961 (18.4%) 5,309 (19.0%) Modified from Edington, AJHP. 15(5):341-349, 2001 Average of three years between measures

7. Change in Costs follow Change in Risks Cost reduced Cost increased Risks ReducedRisks Increased Updated from Edington, AJHP. 15(5):341-349, 2001. Overall: Cost per risk reduced: $215; Cost per risk avoided: $304 Actives: Cost per risk reduced: $231; Cost per risk avoided: $320 Retirees 65: Cost per risk reduced: $214; Cost per risk avoided: $264

8. ©2012 Edington Associates 8 Natural Flow of a Population by: Risks-Costs-Age Low Annual Medical Costs Med Risk Age Range High Non-Participant Edington. AJHP. 15(5):341-349, 2001

9. ©2012 Edington Associates9 Cluster Analysis Health Measure Cluster 1: Risk taking (N=6688) Cluster 2: Low Risk (N=3164) Cluster 3: Biometrics (N=3100) Cluster 4: Psychological (N=3927) Baunstein, Yi, Hirschland, McDonald, Edington. Am. J. Health Behavior. 25(4):407-417, 2001 Smoking Alcohol Physical activity Safety belt usage Body mass index Systolic blood pressure Diastolic blood pressure Cholesterol HDL cholesterol Self-perceived health Life satisfaction Stress Illness days Overall Risks Low risk (0-2 risks) Medium risk (3-4 risks) High risk (5+ risks) Average Number of risks 50.2% 35.7% 14.1% 2.8 97.6% 2.4% 0 0.6 26.5% 48.9% 24.7% 3.6 18.9% 35.9% 45.2% 4.4 31% 10% 28% 36% 27% 9% 5% 19% 34% 13% 4% 9% 21% 0% 25 % 0 % 19 % 10 % 0 % 16% 3% 19% 22% 38% 81% 61% 27% 33% 9% 2% 12% 27% 5% 26% 31% 27% 23% 20% 22% 24% 28% 73% 76% 26%

10. Development and Consequences of Metabolic Syndrome Risks:  Waist Circumference  Hypertension  Glucose Intolerance  Triglycerides  HDL Cholesterol Pre-Metabolic Syndrome Metabolic Syndrome Heart Disease Diabetes Retinopathy Neuropathy Nephropathy Costs to Individual:  Quality of Life  Morbidity  Mortality Costs to Employers:  Health care costs  Productivity costs Where do you want to intervene in the process?

11. ©2014 Edington Associates11 Development and Consequences of Mental Health Issues Risks:  Perception of Health  Life Satisfaction  Job Satisfaction  Stress  Job Related  Non-Job Related  Illness Days Pre-Mental Health Issues Mental Health Syndrome Job Issues Family Issues Serious Mental Health Diagnoses Costs to Individual:  Quality of Life  Morbidity  Mortality Costs to Employers:  Health care costs  Productivity costs Where do you want to intervene in the process?

12. ©2012 Edington Associates12 Medical and Drug Cost (Paid)* Improved=Same or lowered risks

13. ©2012 Edington Associates13 Total Value of Health Medical/Hospital Drug Absence Disability Worker’s Comp Effective on Job Recruitment Retention Morale Disease Health Risks The Economics of Total Population Engagement and the Total Value of Health Beyond Low or No Risks Where does cost turn into an investment? increase

14. ©2012 Edington Associates 14 Wellness Strategies: 2013 and Before Healthier Person Better Employee Gains for the Organization Health Status Life Expectancy Disease Care Costs Health Care Costs Productivity Absence Disability Worker’s Comp. Presenteeism Recruitment/Retention Company Visibility Social Responsibility 1981, 1995, 2000, 2006, 2008 Dee Edington Lifestyle Change Health and Disease Management Programs Behavior Change (Wellness) Treating Disease (Medical)

15. ©2014 Edington Associates15 Disease Emphasis results in 1. Focus on Treatment of Disease 2. Emphasis on Whose is at fault? Government, Health Plans, Providers, Employers, Individuals 3.Leads to Lowest Cost Solutions and to Higher Numbers of Uninsured

16. ©2012 Edington Associates16 What’s Next? Change the questions Get to a new level of thinking Adjust our vision of the future Have foresight to change our definitions Have the courage to change our beliefs

17. ©2012 Edington Associates17 Health Strategies for 2013 and Beyond Integrate the Whole Person into the Environment and Culture and Engage in Population Health (Follow the lead of Safety and Quality) (…in Quality terms this strategy translates into “fix the systems that lead to the defects”) (Deming, Drucker, Blanchard)

18. ©2013 Edington Associates 18 Thriving and Sustainable Workplace and Workforce for 2013 and Beyond: Strategic Create a Thriving and Healthy Workforce Champion Company Gains in Organizational Objectives Health Status Economics Absence Worker’s Comp. Presenteeism Financial Metrics Engaged Workers Recruitment Retention Happiness Company Visibility Social Responsibility 1981, 1995, 2000, 2006, 2008, 2012 Edington Associates Create a Supportive Environment and Culture Create the Vision and Strategy Move Healthy Well- Being into the Culture Senior Leadership Operations Leadership Self-Leadership Recognize Positive Acts Quality Assurance

19. Senior LeadershipLack of support Lack of clear vision Operations LeadershipSupervisor lack of support Lack of supportive culture Incomplete communications Self LeadershipDon’t understand why, what, how Lack of self-efficacy Lack of time, convenience Recognize Strengths Lack of positive recognition Quality AssuranceLack of feedback on progress Lack of shared values, vision 19 Previous Barriers during Implementation ©2013 Edington Associates

20. 20 Journey towards a Shared Values Company Communication and Outreach Outreach Enrollment and Engagement Prevention and Wellness RiskManagement Disease Management Workforce Engaged Engaged Thriving Thriving Best Place to Work Best Place to Work Workplace Shared Values Shared Values Positive Return Positive Return Clear Vision, Metrics, Culture and Environment Vision, Commitment, Leadership Supportive Culture and Environment Workforce Engaged Engaged Thriving Thriving Prevention and Wellness RiskManagement Disease Management Initiatives Along the Health Continuum Program Impact Best Place to Work Best Place to Work Workplace Shared Values Shared Values Positive Return Positive Return Enterprise Commitment and Support Impactful Thriving, Healthy and Well-Being Programs Sustainable Initiative to support the Vision C

21. ©2013 Edington Associates21 Committed, vocal and enthusiastic leadership promotes: Increased awareness More motivated employees Shared Values Clear Vision and Metrics Levers of Program Success: Pillar 1-Strategic Pillar 1: Senior Leadership Strong Vision Visible Committed Leadership Communication and Outreach Outreach Enrollment and Engagement Prevention and Wellness RiskManagement Disease Management Workforce Engaged Engaged Thriving Thriving Best Place to Work Best Place to Work Workplace Shared Values Shared Values Positive Return Positive Return Clear Vision, Metrics, Culture and Environment Vision, Commitment, Leadership Supportive Culture and Environment Workforce Engaged Engaged Thriving Thriving Prevention and Wellness RiskManagement Disease Management Initiatives Along the Health Continuum Program Impact Best Place to Work Best Place to Work Workplace Shared Values Shared Values Positive Return Positive Return Enterprise Commitment and Support Impactful Thriving, Healthy and Well-Being Programs Sustainable Initiative to support the Vision C

22. 22 Vision Vision for a Culture of Health “… a sustainable culture of health where individual’s happiness, quality of life, state of well-being and engagement in family and the organization are thriving”

23. ©2013 Edington Associates23 Supportive culture and environment: Create supportive employee health in the Environment and Culture Reduce barriers to self-leadership Further increases participation and strengthens engagement Support for self-leadership Pillar 1: Senior Leadership Strong Vision Visible Committed Leadership Pillar 2: Operations Leadership Culture of Health Supportive Environment Communication and Outreach Outreach Enrollment and Engagement Prevention and Wellness RiskManagement Disease Management Levers of Program Success: Pillar 2-Systematic Workforce Engaged Engaged Thriving Thriving Best Place to Work Best Place to Work Workplace Shared Values Shared Values Positive Return Positive Return Clear Vision, Metrics, Culture and Environment Vision, Commitment, Leadership Supportive Culture and Environment Workforce Engaged Engaged Thriving Thriving Prevention and Wellness RiskManagement Disease Management Initiatives Along the Health Continuum Program Impact Best Place to Work Best Place to Work Workplace Shared Values Shared Values Positive Return Positive Return Enterprise Commitment and Support Impactful Thriving, Healthy and Well-Being Programs Sustainable Initiative to support the Vision C

24.  Clear goals established by Senior Leaders  Well communicated goals  Understand the culture gaps and create employee work teams to fix the gaps  Train everyone on how to achieve a high-quality, healthy and thriving culture  Wellness program audit to align goals  Corporate scorecard available to all employees 24 How Do You Add Health to the Culture?

25. ©2013 Edington Associates 25 Promote self-leadership Greater self efficacy Increased commitment to stick to it Develop Life Skills Promote Engagement Pillar 1: Senior Leadership Pillar 2: Operations Leadership Strong Vision Visible Committed Leadership Culture of Health Supportive Environment Communication and Outreach Outreach Enrollment and Engagement Prevention and Wellness RiskManagement Disease Management Levers of Program Success: Pillar 3-Systemic Pillar 3: Self- Leadership Create Winners Help Employees Not Get Worse Help Healthy People Stay Healthy Workforce Engaged Engaged Thriving Thriving Best Place to Work Best Place to Work Workplace Shared Values Shared Values Positive Return Positive Return Clear Vision, Metrics, Culture and Environment Vision, Commitment, Leadership Supportive Culture and Environment Workforce Engaged Engaged Thriving Thriving Prevention and Wellness RiskManagement Disease Management Initiatives Along the Health Continuum Program Impact Best Place to Work Best Place to Work Workplace Shared Values Shared Values Positive Return Positive Return Enterprise Commitment and Support Impactful Thriving, Healthy and Well-Being Programs Sustainable Initiative to support the Vision C

26. What is SELF-LEADERSHIP? Self-leadership is the process of purposefully… engaging in change making thoughtful decisions having resilience which builds on strengths and is continuously learning and growing in thriving relationships 26© 2012 Edington Associates

27. 27 Incorporate Determinates of Health Individual Supportive Community Supportive Family and Friends Supportive Workplace Thriving Employee ©2012 Edington Associates Living and Thriving Assessment

28. Vision for Self-Leadership Personal Control Optimism Self-Leadership Resilience Confidence/ Self-efficacy Self- Esteem  Knowledge  Health Literacy  Negotiation Skills Vitality/Vigor  Consumerism  Engaged patient role  Social Support − Colleagues − Community − Family  Environment and culture 28© 2012 Edington Associates Other characteristics: Change, Integrity, Trust, Thrive, Enthusiasm, Ethical, Spiritual, Creative, Flexible, Low-Risks and Behaviors Purpose, Values, Mission, Vision

29. Positive Outlook  Happiness  Brain Health Emotions & Intuitions  Mental Shortcuts and Biases  Environment Values  Purpose  Vision Focusing on Strengths  Positive Reframing  Creating a Plan for Change Fundamental Skills for Self-Leaders

30. RayGraceAprilWill User-tested Design Elements © 2012 Edington Associates 30

31. Surveys and Quizzes 31 © 2012 Edington Associates

32. Interactive Activities – Example (Values) 32© 2012 Edington Associates

33. ©2013 Edington Associates 33 Recognize positive actions: Reinforces healthy, well-being behaviors Promote Shared Values Develop intrinsic motivation Promote Self- Efficacy Pillar 4: Recognize Actions Pillar 1: Senior Leadership Strong Vision Visible Committed Leadership Recognize Champions Reinforce at every touch point Clear Vision, Metrics, Culture and Environment Vision, Commitment, Leadership Supportive Culture and Environment Workforce Engaged Engaged Thriving Thriving Prevention and Wellness RiskManagement Disease Management Initiatives Along the Health Continuum Program Impact Best Place to Work Best Place to Work Workplace Shared Values Shared Values Positive Return Positive Return Enterprise Commitment and Support Levers of Success: Pillar 4-Systemic Pillar 3: Self- Leadership Pillar 2: Operations Leadership Culture of Health Supportive Environment Create Winners Help Employees Not Get Worse Help Healthy People Stay Healthy C Impactful Thriving, Healthy and Well-Being Programs Sustainable Initiative to support the Vision

34. ©201s Edington Associates34 Pillar 5: Quality Assurance Continuous Improvement Continuous feedback of information about program processes and outcomes Communication and Enrolment Engagement and Culture Prevention and Wellness CaseManagement Disease Management Levers of Program Success: Pillar 5-Sustainable Pillar 3: Self- Leadership Pillar 4: Recognize Actions Pillar 1: Senior Leadership Pillar 2: Operations Leadership Workforce Engaged Engaged Thriving Thriving Best Place to Work Best Place to Work Workplace Shared Values Shared Values Positive Return Positive Return Clear Vision, Metrics, Culture and Environment Vision, Commitment, Leadership Supportive Culture and Environment Workforce Engaged Engaged Thriving Thriving Prevention and Wellness RiskManagement Disease Management Initiatives Along the Health Continuum Program Impact Best Place to Work Best Place to Work Workplace Shared Values Shared Values Positive Return Positive Return Enterprise Commitment and Support Impactful Thriving, Healthy and Well-Being Programs Sustainable Initiative to support the Vision C

35. Systemic, Sustainable Reinforce the Culture of Health Align recognition with the vision Reward champions Set incentives for what matters Reinforce at every touch point “What is rewarded is what is sustained” Principles of Positive Actions 35 ©2010: Health Transformation Group, LLC Not for Distribution Step #4

36. Sustainable Integrate all data Measure What Matters Provide feedback on how progress was obtained and steps to get to vision Feedback on leadership, culture, self- leadership, positive actions, economic outcomes “Supports decisions with evidence” Principles of Quality Assurance 36 ©2010: Health Transformation Group, LLC Not for Distribution Step #5

37. ©2012 Edington Associates37 Vision for Your Organization Summary

38. 3Strategic Vision from Leaders Systematic & Thriving Culture Systemic Engage all in the Culture Recognize Positive Actions, WorkTeam Sustained Progress in all areas 2Speech from Leader Internal Wellness Program Screenings & Reduce High-Risks Coaching Incent High-Risk Reduction Change in Risks, ROI 1Inform Leader Out-source Wellness Screenings & Reduce High-Risks Incent High-Risk Reduction Change in Risks 0Do Nothing Pillar 1Pillar 2Pillar 3Pillar 4Pillar 5 Which Sustainability Level is for You Sustainability Rating Do Nothing Core to the Organization Comprehensive Traditional Senior Leadership Operations Leadership Self- Leadership Rewards for Positive Actions Quality Assurance Five Pillars

39. ©2012 Edington Associates39 Vision for Your Organization What’s the Point?

40.  Phone: 734.998.8326 (USA)  Email: dedington@edingtonassociates.com jspitts@edingtonassociates.com jmcintyre@edingtonassociates.com jmrichardson@edingtonassociates.com  Website: www.edingtonassociates.com  Address : Edington Associates LLC University of Michigan North Campus Research Center 1600 Huron Parkway Ann Arbor MI 48109 ©2012 Edington Associates40 Thank you for your attention