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Activating Your Community for Well-Being Ben Leedle, Chief Executive Officer, Healthways Inc.

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Page 1: Ben Leedle Wellmark 09/23/10

Activating Your Communityfor Well-Being

Ben Leedle, Chief Executive Officer, Healthways Inc.Ben Leedle, Chief Executive Officer, Healthways Inc.

Page 2: Ben Leedle Wellmark 09/23/10

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Discussion Topics

• Progress towards Improved Well-Being

• Evolution of the science

• Implications and action steps you can take

Intent is to frame a broad and deep set of discussions today into a pragmatic set of action steps and take-aways

Page 3: Ben Leedle Wellmark 09/23/10

Progress towards Improved Well-Being

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Individuals ● Experts ● Environments ● Relationships

Improve Well-Being

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• 25-year commitment, initiated January 2, 2008

• Telephonic-based for “community” survey

• 1,000 completed surveys per day/7 days/week

• Almost one million completed surveys to date

• For results based on this sample of respondents, the maximum 95% margin of sampling error is ±0.3 percentage points

• Science-based design, support and oversight:

• Behavioral economists

• Psychologists

• Experts in psychometric statistical analysis

Six Domains:

1. Life Evaluation

2. Emotional Health

3. Physical Health

4. Healthy Behavior

5. Work Environment

6. Basic Access

The Gallup-Healthways Well-Being Index

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Well-Being at the National Level

Source: Gallup-Healthways Well-Being Index Community Survey 2009, n=353,849

Fourth QuintileThird QuintileSecond Quintile Top Quintile Ranking: Bottom Quintile

20092008

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Well-Being at the Regional Level

199

200

173

174Des Moines

Cedar Rapids

Mason City

Davenport

Pierre

Sioux Falls

Rapid City

Fourth QuintileThird QuintileSecond Quintile Top Quintile Ranking: Bottom Quintile

295

241

South Dakota

Iowa

2008

Congressional District Ranking by Well-Being Index (out of 436 Districts)

Source: Gallup-Healthways Well-Being Index Community Survey 2008, n=352,549

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Well-Being at the Regional Level

40

50

133

66Des Moines

Cedar Rapids

Mason City

Davenport

Pierre

Sioux Falls

Rapid City

Fourth QuintileThird QuintileSecond Quintile Top Quintile Ranking: Bottom Quintile

156

194

2009

Congressional District Ranking by Well-Being Index (out of 436 Districts)

South Dakota

Iowa

Improvement by one quintile from 2008 to 2009

Source: Gallup-Healthways Well-Being Index Community Survey 2009, n=353,849

Page 9: Ben Leedle Wellmark 09/23/10

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Cedar Rapids, Iowa, June 15 2008

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The Transformational Recovery (I)Impact of 2008 Floods on Cedar Rapids and Surrounding Regions

Cedar Rapids

FEMA Public Asssistance and Hazard Mitigation Paymentsand DOT Payments Per Capita (2008)

Overlaid on Congressional District Quintiles by Well-Being Index (2009)

Very High

High

Moderate

Low

6

4

12

77

77%

7%

9%

8%

74%

5%

9%

11%

93%

1%

4%

2%

CountyImpact

Number ofCounties

Household Losses

Public SectorLosses

BusinessLosses

LossIntensity Ratio

2.0 +

1.0 – 2.0

0.5 – 1.0

< 0.5

Source: FEMA Individuals and Households Program, Small Business Administration’s Disaster Loan Program, Uninsured Losses Declared by Iowa State income tax filers (2008), FEMA Public Assistance Program, FEMA Hazard Mitigation Program, U.S. Department of Transportation Repairs to transportation infrastructure per capita, Small Business Administration’s Disaster Loan program per capita, agriculture crop peril payments per square mile; Evaluating Direct and Indirect Economic Outcomes of the 2008 Iowa Weather-Related Disasters, Swanson et al., Iowa State University Staff Report, August 2010; Gallup-Healthways Well-Being Index Community Survey 2009, n=353,849

Weather Related Loss Estimates

Housing and business structures

Infrastructure

Educational facilities

Cultural and historic landmarks

Agriculture and the environment

Total estimated losses

$1.33B

0.66

0.30

0.28

0.93

$3.50B

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The Transformational Recovery (II)Well-Being at the Local Level

Overall Rank 150 12

Life Evaluation 121 42

Emotional Health 170 1

Physical Health 64 5

Healthy Behavior 182 46

Work Environment 144 144

Basic Access 39 4

2008 2009

Metropolitan Statistical Area (MSA) Ranking by Well-Being Index and Composite Sub-Indices (out of 187 MSAs)

Fourth Quintile

Third QuintileSecond Quintile Top Quintile

Bottom Quintile

Cedar Rapids

63.2

I learned or did somethinginteresting yesterday

2009

66.5

I did not experience sadness yesterday

2009

Examples of Emotional Health Geographic DisparitiesRelative to National Composite Score for MSAs

+8.6+7.9

66.5

80.2

Examples of Healthy Behavior Geographic DisparitiesRelative to National Composite Score for MSAs

I ate healthy all day yesterday % who don’t smoke

2009 2009

+6.0

+2.5

Source: Gallup-Healthways Well-Being Index Community Survey 2009, n=353,849

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The Transformational Recovery (III)Families Retained, Some Employment Losses but Well Managed

41%47%

13%

35%

49%

16%

High ImpactCounties

Medium ImpactCounties

Low ImpactCounties

2007-8 2008-9

Shares of Statewide Population Gains

K-12 Public School Enrollment(Baselined to October 2005)

2.3% 1.8%

-2.7%

0.5%

-9.6%

-13.5%

One Year Before Year of Occurance One Year After

Cedar Rapids New Orleans102%

101%

98%

96%

100%

2005 2006 2007 2008 2009

2007 2008 2009

+3%

+2%

+1%

0%

-1%

-2%

-3%

-4%

Employment Changes 2007-2009High Impact Counties

Nonfarm Job Changes: Cedar Rapids vs. New Orleans

Source: Evaluating Direct and Indirect Economic Outcomes of the 2008 Iowa Weather-Related Disasters, Swanson et al., Iowa State University Staff Report, August 2010

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Evolution of the Science

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Productivity Impact is ~3x Health Care Cost Impact

Chronic Disease Economic Impact in the U.S. 2003 (Annual Costs)

Total Cost

$1.3 Trillion

Treatment Expenditures 21%

Lost Productivity Cost 79%

$0.3 Trillion

$1.0 Trillion

Source: Milken Institute 2007

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Science Linkages Confirming the Value Examples of Recent Publications on Risk Reduction

10 — 25% Risk Reduction

$0.4T — $1.1T

10 — 50% Risk Reduction

$0.6T — $1.4 T

10 Year Impact 10 Year Impact

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Emerging Science (I)

Well-Being Relationship to Medical Events

0-50 (n=109)

>50-60 (n=151)

>80-90 (n=683)

>70-80 (n=582)

>60-70 (n=347)

>90-100 (n=363)

Admission ER Visit

Percent

Well-Being Score (Composite)Low High

Impact of Well-Being on Event Frequency

-83%

-49%

Source: Wellmark Data, Healthways Center for Health Research Analysis (n=2,235)

0

5

10

15

20

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Well-Being Relationship to Medical Costs

0-50 (n=109)

>50-60 (n=151)

>80-90 (n=683)

>70-80 (n=582)

>60-70 (n=347)

>90-100 (n=363)

Annual Costs($)

Well-Being Score (Composite)Low High

Impact of Well-Being on Claims, RX and Total Medical Costs

Claims Rx Total Medical Costs

Source: Wellmark Data, Healthways Center for Health Research Analysis (n=2,235)

0

500

1,000

1,500

2,000

2,500

3,000

3,500

4,000

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Emerging Science (II)

Well-Being Relationship to Performance

Productivity Loss by Emotional Health

10 9 8 7 6 5 4 3 2 1 0

LowHigh

0

5

10

15

20

25

30

35

40

Productivity Loss(%)

Emotional Health

Source: Effects on Well-Being of Healthways Effective LifeStyle Programs Phase II, Evers, KE, Prochaska, JO, Castle, P. & Prochaska, JM. 2010 (under review), n=4100

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Well-Being Relationship to Performance Continued

Productivity Loss by Physical Health

0

5

10

15

20

25

30

35

40

Productivity Loss(%)

10 9 8 7 6 5 4 3 2 1 0

Physical HealthLowHigh

Source: Effects on Well-Being of Healthways Effective LifeStyle Programs Phase II, Evers, KE, Prochaska, JO, Castle, P. & Prochaska, JM. 2010 (under review), n=4100

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Emerging Science (III)

Market Research About Well-Being

• Mixture of family situations/living arrangements

• Preliminary segmentation:

― Influencer, Someday, Start/Stopper, Caretaker

• Range of motivational levels

• Two hours or more per week online

Source: Healthways MeYou Health, Essential Research March 2010Source: Healthways MeYou Health, Essential Research March 2010

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They Were Asked . . . “What are Your Goals?”

fitness

nutrition

job/career

relationships

big dreamsemotional

mental health

life events

hobby/skill development

financial

physical health

time management

weight loss

school

spiritualstress

personal time

environment

goal for others

quitting

learning

People reported a surprisingly complex tapestry of connected topics

Source: Healthways MeYou Health, Essential Research March 2010Source: Healthways MeYou Health, Essential Research March 2010

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Physical• exercise, rest/sleep• “staying young” • diet (self & others)

Emotional• relationships: work & home • socializing , having friends• helping others • dinner with family

Intellectual• going back to school• learning something new• dean’s list • travel, culture

Spiritual• “thanking whoever is up

there for this day,” faith • meditation • “getting out of my head”

Holistic

Deeply held views surfaced, mapping to the Gallup-Healthways Well-Being Index:

“What Does Well-Being Mean to You?”

22Source: Healthways MeYou Health, Essential Research March 2010Source: Healthways MeYou Health, Essential Research March 2010

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Different Well-Being “Personas” Emerged

• Fresh, diverse content

• New challenges, self-assigned goals (more rigorous)

• Options to coach others

• Social outlet

• Guilt free

• Valuable use of time

• Provide benefits for dependants

• Numbers, metrics

• Standards for personal comparison

• Reason for challenges

• Challenges they don’t do already

• Knowledge and inspiration

• Not interested in points

• Challenges must be fail-proof

• Extrinsic motivation to return

• Do with partner or group

• Anonymity and privacy—to eliminate shame

• Social groups based on same life situation

• Light-hearted approach

• Goals are “wants”

• Fast results

• Ability to have a personal coach or sponsor keep tabs on them

Excuse MakerMe-Time

Impoverished Idle EnabledAware and Achieving

Enlightened & Discovering

External Validation

Seeker

Source: Healthways MeYou Health, Essential Research March 2010Source: Healthways MeYou Health, Essential Research March 2010

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Putting Science into Practice (I)

Healthways Behavioral Change Science

Social Networks

• A social structure of “nodes” which are connected by one or more specific types of interdependency, such as friendship, kinship, common interest, or relationships of beliefs, knowledge or prestige

Decision Making

Behavioral Economics

Emotional and Social Health

Social Connectivity

Prochaska’s Transtheoretical Model

• Rational decision-making through predictable stages of change

• Pro-Change Embedded in Healthways Core Products

Mindfulness and Neuro-plasticity

• Paying attention in a particular way: on purpose, in the present moment, and non-judgmentally

• The changing of neurons, the organization of their networks, and their function via new experiences

Dynamic Intermittent Reinforcement

• Predictably irrational decision making in humans

• Already in use for medication adherenceHEALTHHONORS®HEALTHHONORS®

Multipledemonstration

sites

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Putting Science into Practice (II)

Modeling Behavior-Condition Relationships

A complex relationship between behavior – condition drives development and severity of health conditions

To understand what will happen to a population, a Monte Carlo Simulation Model is employed

Once a population is profiled, repeated random interactions weighted to epidemiologic probabilities are used to “age” a population five years

Effects of behavior change initiatives can be assessed by adding in probabilities that a program will have an effect along with the probability of recidivism

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Putting Science into Practice (III)

Vitality Simulation App

• Simplified version of the Simulation Model available for you today• Demonstrates application of the model to create awareness and

facilitate action by business leaders• Allows high-level overview of the process

Data inputs

• Input basic demographics

• Assess current health and risk status of population

Project future cost trend

• View projected 5-year medical and productivity cost trends

• View the most costly contributing conditions

Investigate interventions

• Use as a planning tool by selecting various intervention configurations

• View the potential impact on your cost trends

1 2 3

Intellectual Property +

Page 27: Ben Leedle Wellmark 09/23/10

Implications and action steps you can take

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Blue Zones Principles – Applying to an Employer Community

Move Naturally

Right Outlook - Purpose Now - Downshift

Eat Wisely - 80% Rule - Plant Slant - Wine@5

Belong - Right Tribe - Community - Loved Ones First

Move Naturally

Right Outlook - Purpose Now - Downshift

Eat Wisely - 80% Rule - Plant Slant - Wine@5

Belong - Right Tribe - Community - Loved Ones First

THE POWER 9THE POWER 9

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What Does it Mean to be a Healthways Blue Zone?

An employer community with high well-being . . . .

• Has high engagement, energy and vigor where it all seems to work because leadership and employees share a bond of great purpose and

• A work environment that promotes innovation and collaboration and

• Becomes a “best place to work” which in turns generates deep seeded pride and drives overall economic and social progress and

• Has measurably improved business performance and

• Has gained national recognition and positive media because of its game changing commitment to the vitality of its people

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Healthier People Cost Less and Perform Better

ImproveWell-Being

Adopt or maintainhealthy behaviors

Mitigate health-related risks

Optimize care for health conditions

Performance Increases

• Productivity

• Engagement

• Absence

• Work Impairment

Total Medical Cost Decreases

• Hospitalizations

• Event Rates

• Disease Rates

• Lifestyle Risks

Total Economic Value Increases

• States

• Communities

• Employers

• Individuals

Eliminate / delay next new case of disease / condition

Eliminate / reduce impact of the next new episode

Enhanced well-being

Economic Drivers

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How Do You Make it Real in 12 — 24 Months?

Improve Well-Being EXECUTIONEXECUTION

Improved Business Performance RESULTSRESULTS

Adopt Well-Being Principles, Power 9CULTURECULTURE

Leadership Policy Communi-cations

Participation(Social

Network)

AUDIT & BLUEPRINTAUDIT & BLUEPRINT

Environment

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Recommended Approach

Certification

Implement

Track Progress

Outcomes

Well-Being

Productivity

Business Performance

Well-Being Assessment

Vitality Coach and Compass

Vitality Simulation Model

Environmental Assessment

Assessments

Communications

Leadership

Environment and Policy

Participation

Blueprint

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What’s in the Healthways Blue Zone Toolkit

Well-Being Assessment: baseline & annual,

individual & organization

• Detailed blueprint focusing on communications, leadership, policies, physical site and participation

• Creation of multi-year strategy to improve Well-Being

• Identification of available resources, both Healthways provided and third party

• Customized communication packages

• Detailed blueprint focusing on communications, leadership, policies, physical site and participation

• Creation of multi-year strategy to improve Well-Being

• Identification of available resources, both Healthways provided and third party

• Customized communication packages

Blueprint Design

• Implementation and ongoing support onsite• Well-being leadership and people manager training & tools• Progress tracking

• Implementation and ongoing support onsite• Well-being leadership and people manager training & tools• Progress tracking

Implementation Support

Certification

“Healthways Blue Zone Under Construction” designation

Outcomes validation:

• Well-Being

• Productivity

• Business performance

“Healthways Blue Zone” certification and annual renewal

Healthways Blue Zone CEO round tables

Marketing Support

“Healthways Blue Zone Under Construction” designation

Outcomes validation:

• Well-Being

• Productivity

• Business performance

“Healthways Blue Zone” certification and annual renewal

Healthways Blue Zone CEO round tables

Marketing Support

Assessments and tools

e.g., Vitality Simulation Appto size opportunity

and engage your leaderse.g., Vitality Compassand Coach

Environmental Assessment:community & organization

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What You Can Do MondaySeven Steps to Improved Company Well-Being

Assemble Back of theEnvelope Data

# Employees

Gender %

Male Female

Age %

65+55-6445-5435-4418-34

Employees’ Current State of Health

Average WellPoor

Employees Lifestyle Behaviors

AverageHigh Risk Low Risk

Average Medical Costs Per Employee(estimate all-in for current year including Rx, Copays etc.)

$

X 0.3 =

Employee share

Costs of Absenteeism

Costs of Presenteeism

$

Company cost

$

Total costs PEPY

Multiply total medical costs by 0.3$

$Multiply absenteeism costs by 7.7

X 7.7 =

Assess your readinessto change

1 2 Pick 3 behaviors to targetbeyond current programs

Physical Activity

Diet

Non-smoking

Desirable alcohol use

Standard of care compliance

Stress management

Sufficient sleep

Health screenings

4

Write down the opportunityas sized by the simulation

5

$$

Healthcaresavings by 2015

$

Productivitysavings by 2015

Totalsavings by 2015

Let off some steam with agame of Community Clash

6

http://www.meyouhealth.com/clash/

Improved performance through improved employee well-being is or will be a top five CEO agenda item for next fiscal year

I personally plan to devote at least 15% of my time to this opportunity

I am dissatisfied with my current set of initiatives and plans around health

Improving the vitality of the communities in which my employees, customers and business partners work is aligned with my stated company goals, as well as being just the right thing to do

I recognize the community levers we can pull in the 30 mile home radius around each of my locations

http://wellness.weforum.org/

Simulate the costof doing nothing

3

I can personally mobilize visible and committee leadership to this effort

Investigate becoming a certified Healthways Blue Zone7

www.healthwaysbluezones.com

and share the results with a friend

Source: Healthways Blue Zone Toolkit 2010; all rights reservedSource: Healthways Blue Zone Toolkit 2010; all rights reserved

Page 35: Ben Leedle Wellmark 09/23/10

Activating Your Communityfor Well-Being

Ben Leedle, Chief Executive Officer, Healthways Inc.Ben Leedle, Chief Executive Officer, Healthways Inc.