employee health and wellness metrics, measurements, and evaluation - - the building blocks for roi...
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Employee health and wellness metrics, measurements, and evaluation - -
the building blocks for ROI
David A. Alter, M.D., Ph.D., F.R.C.P.CSenior Scientist, Institute for Clinical Evaluative Sciences
Division of Cardiology, The Li Ka Shing Knowledge institute of St. Michael’s Hospital Division of Cardiology,
Cardiac and secondary prevention program, The Toronto Rehabilitation Institute
Associated Professor of Medicine, University of Toronto
“Ticking Clock” Hypothesis
Haffner SM et al. JAMA. 1990;263:2893-2898.
NGT IGT Hyperglycemia
MacrovascularDisease
MicrovascularDisease
Deferred Gratification
“Ticking Clock” Hypothesis
Haffner SM et al. JAMA. 1990;263:2893-2898.
NGT IGT Hyperglycemia
MacrovascularDisease
MicrovascularDisease
Deferred Gratification
“Ticking Clock” Hypothesis
Haffner SM et al. JAMA. 1990;263:2893-2898.
NGT IGT Hyperglycemia
MacrovascularDisease
MicrovascularDisease
Deferred Gratification
“Ticking Clock” Hypothesis
Haffner SM et al. JAMA. 1990;263:2893-2898.
NGT IGT Hyperglycemia
MacrovascularDisease
MicrovascularDisease
Deferred Gratification
Building blocks for ROI evaluation
• Choosing the appropriate question
• Selecting the appropriate population
• Designing the appropriate intervention
• Appropriate knowledge translation
• Determining the appropriate context
Benefits & payers
Pharmaceuticals
Appropriate use of meds
Efficient use of meds
Health Service ConsumptionAvoidable HospitalizationsEmergency Room Visits
Physician Visits ProductivityAbsenteeism
DisabilityImpairmentEngagement
Building blocksMetrics
MeasurementEvaluation
Government
EmployersPharmacy/Pharma
The evidence
-28.3
-26.1
-30.1
-40 -30 -20 -10 0 10 20
% change in disability management costs
% change in health care costs
% change in absenteeism
Chapman et al; The American Journal of Health Promotion 2003
42.0%
-30.6%-50%
-30%
-10%
10%
30%
50%
70%
% C
han
ge
INTERxVENT Participants
Notes: INTERxVENT Program was implemented in January 2003. Participants enrolled in the INTER xVENT Program in 2003 and completed a full year of service and evaluations. Analysis performed by Milliman Consultants and Actuaries.
Notes: INTERxVENT Program was implemented in January 2003. Participants enrolled in the INTER xVENT Program in 2003 and completed a full year of service and evaluations. Analysis performed by Milliman Consultants and Actuaries.
Non-INTERxVENT Participants
Healthcare payer% Change in Average Health Care Claims Per Employee
(Oklahoma Employer): 2002 vs. 2003
Early dividends
• Absolute risk reduction; population impact driven by baseline risk
Impact of interventions (ARR)
Baseline risk
Number of Health Risks and Productivity Loss
0
5
10
15
20
25
30
0 1 2 3 4 5 6 7
Pro
du
cti
vit
y L
oss
(%
)
Number of Health Risks
The average employee has 2.2 health risks, resulting in productivity losses of about $2,000/year.
Excess Productivity Loss
BaseCost
Journal of Occupational and Environmental Medicine 2005;47:769-77
n = 28,375
-6%-5%-4%-3%-2%-1%0%1%2%
Ch
ang
e in
pro
du
ctiv
ity
loss
-2 ormore
-1 0 1 +2 ormore
Change in Number of Health Risks
Adjusted for age, gender, medical conditions, other baseline risks, and each individual’s productivity loss at baseline.
Burton et al, J Occup Environ Med, 2006; 48:252-63
Organizational InterventionGlobal Health Risk Assessment:Global Health Risk Assessment:
Action Plan & ReportsAction Plan & Reports
Average or Low-riskAverage or Low-risk High-risk(e.g. Multiple risk factors, heart disease, depression, behaviors)
High-risk(e.g. Multiple risk factors, heart disease, depression, behaviors)
Self-Help ProgramExercise, diet, weight management, stress management, tobacco, smoking cessation,
cardiovascular risk reduction
Self-Help ProgramExercise, diet, weight management, stress management, tobacco, smoking cessation,
cardiovascular risk reduction
Mentored Program Step-by-step guidance on exercise, diet,
weight management, stress management, tobacco, smoking cessation, cardiovascular risk reduction, drug safety & compliance.
Mentored Program Step-by-step guidance on exercise, diet,
weight management, stress management, tobacco, smoking cessation, cardiovascular risk reduction, drug safety & compliance.
Personalized
Organizational InterventionGlobal Health Risk Assessment:Global Health Risk Assessment:
Action Plan & ReportsAction Plan & Reports
Average or Low-riskAverage or Low-risk High-risk(e.g. Multiple risk factors, heart disease, depression, behaviors)
High-risk(e.g. Multiple risk factors, heart disease, depression, behaviors)
Self-Help ProgramExercise, diet, weight management, stress management, tobacco, smoking cessation,
cardiovascular risk reduction
Self-Help ProgramExercise, diet, weight management, stress management, tobacco, smoking cessation,
cardiovascular risk reduction
Mentored Program Step-by-step guidance on exercise, diet,
weight management, stress management, tobacco, smoking cessation, cardiovascular risk reduction, drug safety & compliance.
Mentored Program Step-by-step guidance on exercise, diet,
weight management, stress management, tobacco, smoking cessation, cardiovascular risk reduction, drug safety & compliance.
Personalized
Goal: reducing the Goal: reducing the prevalence of high-risk prevalence of high-risk
populationspopulations
Organizational InterventionGlobal Health Risk Assessment:Global Health Risk Assessment:
Action Plan & ReportsAction Plan & Reports
Average or Low-riskAverage or Low-risk High-risk(e.g. Multiple risk factors, heart disease, depression, behaviors)
High-risk(e.g. Multiple risk factors, heart disease, depression, behaviors)
Self-Help ProgramExercise, diet, weight management, stress management, tobacco, smoking cessation,
cardiovascular risk reduction
Self-Help ProgramExercise, diet, weight management, stress management, tobacco, smoking cessation,
cardiovascular risk reduction
Mentored Program Step-by-step guidance on exercise, diet,
weight management, stress management, tobacco, smoking cessation, cardiovascular risk reduction, drug safety & compliance.
Mentored Program Step-by-step guidance on exercise, diet,
weight management, stress management, tobacco, smoking cessation, cardiovascular risk reduction, drug safety & compliance.
Personalized
Goal: reducing the Goal: reducing the prevalence of high-risk prevalence of high-risk
populationspopulations
Variations in Variations in stratification stratification algorithmsalgorithms
ControlsControls
CultureCulture
To what extent is employee-To what extent is employee-engagement impacted by health engagement impacted by health
and wellness interventions?and wellness interventions?
http://www.scotland.gov.uk/Publications/2007/
Summary
• Building blocks for ROI– Appropriate questions– Appropriate population– Appropriate intervention– Appropriate knowledge translation– Appropriate context – employee-engagement
• Measurement, metrics, and evaluation– Quantification of both deferred gratification
and earlier dividends
Building blocks of the program
Therapeutic life-style and disease-management
Population Population screeningscreening
Self-management & Self-management & EducationEducation
Behavioral Behavioral learning theorieslearning theories
Evidence-based Evidence-based carecare
Information & Information & monitoring systemmonitoring system
Reporting & Reporting & feedback-loopsfeedback-loops
Personalized Personalized interventionsinterventions
33
INTERxVENT
% o
f C
han
ge
4.3%Percent Change in
10-Year Framingham CHD Risk Score in
Higher-Risk Employees (1-Yr Follow-Up; p<0.05 for
NBH vs Comparison Program )
-22.6%
INTERxVENT’s Health Lifestyle Health Coaching Program Versus Program Offered By a Leading Academic Institution/Healthcare System (Comparison Program):
Selecting a program
-20%
-15%
-10%
-5%
0%
5%
10%
-25%
Source: Abstract #62 May 2005 – AHA, CVD Epidemiology & Prevention Conference – Washington DC, Maron, David P, et al
Comparison program