Robert C. Karch, Ed.D.Professor

School of Education, Teaching & Health

j

Health Promotion in the Workplace:What is it?

Why do it ? How to do it?

Presented byRobert Karch, Ed.D.

30 de Septiembre de 2008SANTIAGO

Objectives

• To develop a common understanding of what is Health Promotion.

• To advance a rational as to why Health Promotion in the Workplace is important and has value.

• To present some key steps for how to conceptualize, develop, implement, operate, and evaluate a Worksite Health Promotion Program

First –What is Health?

Health

State of the complete physical, mental and social well-being and not merely the absence of disease and infirmity. Health is a resource for everyday life, emphasizing personal, social and physical capabilities.

Total Health

A state of complete physical, mental, and social wellbeing and not merely the absence of disease and infirmity.

In the context of health promotion, health is considered less as an abstract state and more as a means, as a resource

which permits people to lead an

individually, socially, andeconomically productive life.

What is Health Promotion?

Health Promotion

“is a process of enabling people to increase control over, and to improve, their health ”.

World Health Organization

Promotion and Prevention

Prevent or Prevention Pre - Coming before Vent - Letting/Getting out

Promote or Promotion Pro - For and/or in support of Motion - Action - Movement - Advocate

WHY

Workplace Health Promotion ?

Introduction and Perspectives

Promote Health

and

Prevent Disease

What isWorkplace Health Promotion?

Systematic approach endorsed by an organization designed to enhance the health of the company and its employees (AWHP)

Combined efforts of employers, employees and society to improve the health and well-being of people at work (Luxemburg Declaration on Workplace Health Promotion in the EU)

The philosophy, theory and strategic approach to enhancing the overall well-being of the workforce and the organization, through policies, programs and other initiatives based on the determinants of health

(Health Canada)

Why the Workplace?

Large number of people spend majority of waking hours at the workplace

Perceived impact of the work environment on health is very high

Captive audience at workplace

Origin of stress (US: work/family conflict) Modern corporate strategy (social management) Organizational investment for the future

(in human capital)

“healthy people in healthy organizations”

The BIG Why!

$ Money $$ Money $

1.6 Trillion - 2003

US Health Care Expenditure by Year

0

0.5

1.0

1.5

2.0

2.5

3.0

1960 1970 1980 1990 2000 2010

Year

$$$(trillions)

Actual Expense

Projected Expense

Health Care Finance Administration, HHS, 2000

2008 -17% of GDP

Public Policy Associates, IncorporatedPublic Policy Associates, Incorporated 1919

National Health Expenditures in $Billions and National Health Expenditures in $Billions and as a Percent of GDP, 1990 – 2013as a Percent of GDP, 1990 – 2013

$0

$500

$1,000

$1,500

$2,000

$2,500

$3,000

$3,500

$4,0001990

1998

1999

2000

2001

2002

2003

2004

2005

2006

2007

2008

2009

2010

2011

2012

2013

$ B

illio

ns

0

2

4

6

8

10

12

14

16

18

20

Perc

en

t

Annual Health Expenditures Percent of GDP

Source: Centers for Medicaid and Medicare Services, Office of the Actuary

Public Policy Associates, IncorporatedPublic Policy Associates, Incorporated 2020

Employee’s Monthly Contributions to HealthEmployee’s Monthly Contributions to Health Insurance Premiums, 1988 - 2001Insurance Premiums, 1988 - 2001

$8

$52$30$28

$37$34

$124

$122$138

$150

$-

$20

$40

$60

$80

$100

$120

$140

$160

1988 1993 1996 2000 2001

Em

plo

yee

Co

ntr

ibu

tio

n

Single Coverage Family Coverage

Source: Kaiser/HRET Survey of Employer-Sponsored Health Benefits: 2000,2001; KPMG Survey of Employer Sponsored Health Benefits, 1988, 1993, 1996.

Public Policy Associates, IncorporatedPublic Policy Associates, Incorporated

Prescription Drugs as a Share of National Prescription Drugs as a Share of National Health Care Expenditures (Selected Years)Health Care Expenditures (Selected Years)

4.9% 5.5% 5.8%6.9%

7.6%8.5%

9.4%

12.9%

14.7%

0.0%

2.0%

4.0%

6.0%

8.0%

10.0%

12.0%

14.0%

16.0%

1980 1988 1993 1997 1998 1999 2000 2007proj

2011proj

Source: Health Affairs, Jan-Feb 2000, p. 173; Health Affairs, March-April 2002, p. 208.

Many modifiable health risks are associated with increased health care

costs within a relatively short time window A large proportion of disease and disorders from which employees suffer is preventable!

Findings: (Lifestyle linked)57% of Heart disease deaths37% of Cancers50% of Brain vascular disease23% of Pneumonia34% of Diabetes60% of Suicide70% of Chronic Liver disease (Cirrhosis)

Solution !

Pay More

Get More

Pay Less Pay More

Get Less Get Less

Pay LessGet More

WSHP Development and Trends in the US

• First Generation (1960’s)• Second Generation (1970’s)• Third Generation (1980’s)• Fourth Generation (1990’s)• Fifth Generation (2000’s)

Cost-Benefit Results General Motors 1 : 6.0 Equitable Life 1 : 5.5 McDonnell Douglas 1 : 4.0 Pillsbury 1 : 3.6 Metropolitan Life 1 : 3.2 Motorola 1 : 3.0 Prudential Life 1 : 2.9 Gillette 1 : 2.5 New York Telephone 1 : 1.9 Kennecot Copper 1 : 1.6 Adolf Coors 1 : 1.2 Army Materiel Comm. 1 : 1.19

“Fact”• Many of the risk factors that cause expensive diseases and

disorders can be ameliorated through the use of scientifically based and well-implemented health promotion/disease prevention programs

• When the risk profile of a population is changed over time, medical expenditures are likely to follow, though it may be more cost effective to prevent high-risk behavior in the first place.

• When an employed population shifts its health risk profile from high risk to low risk, the company realizes health care cost reductions. When population risk moves in the opposite direction, from low risk to high risk, the company realizes health care cost increases that are even more significant

How??!!

10 KISS Steps to Program Success

10 KISS Steps to Program Success

1. Determine the desired outcomes of the stakeholders – (Get and Keep Healthy Workers & Save/Reduce Expenses for Healthcare).

2. Gather and analyze all available data.3. Conduct Policy Review.4. Assess the desires of #1 against the data of #2 the adjust as

needed.5. Conduct an Environmental Scan.6. Develop Cost Effective Intervention Strategies to maximize the

health of the population.7. Establish Priorities, Timelines, and Goals for any planned

Interventions.8. Determine all Resource needs and Costs. 9. Implement interventions and monitor progress.10.Evaluate Outcomes.

The Benfield Group

The following 15 slides are courtesy of the Chuck Reynolds President and CEO of the Benfield Group.

Chuckr@benfield.com

Health and Productivity Management—

Pattern of Success

Executive-Level Leadership

Integrated Management Team

Organizational Commitment

Information-Driven Intervention

Operational Infrastructure

• People• Systems

• Programs• Incentives

Integrated Data

Measurement

HPM: It’s What We Do

Players and Issues

Presenteeism

EmployersEmployers

Pharma CompaniesPharma Companies

OTC

Human Capital

Employees/Consumers

e-Health

Health Plans

Disease Management

Health Benefit Trends

Coalitions

Wellness

Associations

Government PBMs

Benfield’sHPM Lens

Our Market View

• Health Issues

• Economic Issues

• Key Players

• Key Trends

• Opportunities

Tactics & Support

• Internal Communication

• External Communication

• Training & Coaching

• Specialized Tool Development

• National Customer Programs

• Regional Customer Programs

• Outcomes Initiatives – Planning and Management

• Other… Creative

HPM

StrategyCustomer

Issues

To receive our eNewsletter, which provides news and perspectives on Health and Productivity Management, email chuckr@benfield.com.

Human Capital Issues Set the Stage for HPM

Deteriorating Health Impacts PerformanceAging and poor health habits conspire to increase costly and

debilitating conditions among employees

Shortage of TalentEmployers struggle to acquire and retain quality employees

Health Care Costs RiseEmployers face double-

digit inflation into foreseeable future

Human Capital ManagementHuman Capital Management

Employers are under intense pressure to Employers are under intense pressure to control costs while simultaneously control costs while simultaneously maximizing worker productivity and maximizing worker productivity and

sustaining an “employer of choice” statussustaining an “employer of choice” status

Human Capital ManagementHuman Capital Management

Employers are under intense pressure Employers are under intense pressure to control costs while simultaneously to control costs while simultaneously maximizing worker productivity and maximizing worker productivity and

sustaining “employer of choice” statussustaining “employer of choice” status

Global CompetitionProfit margins squeezed;

demand for innovation, quality, speed & service expands

More than ever, employee health is linked to corporate performance. Traditional strategies to manage health are insufficient to address health as part

of an integrated human capital strategy.

Example 1: Critical Success Factors

• Executive Leadership

• Integrated Data and Reporting Capabilities

• Organizational Structure & Incentive Alignment

FedExExecutive

Senior Management

Strategic Management GroupHuman Resource Admin

Human Resources | HRD_WC | Comp | Benefits |OCI | Ad-Hoc Members

HCMP Program ManagementLu Crowder

• HCMP/LOA Mgt.• RM/Workers’ Comp• Safety• Employee Benefits

• Human Resources• Legal• Compensation• Operations Management

OCI/FedExIntegratedInformation

System

Example 1:

IntegratedDatabase

Vehicles, Accident,and Training Detail

(FedEx Safety)

Employee, CEH, LOA History, OLPR

(FedEx PICC)

InternetIntegratedReporting

IntegratedAnalysis andConsultation

Case RiskAssessmentApplication

(CRAA)

FedEx Managers• HCMP/Ops Managers• Safety• Risk Management• Employee Benefits• HR• Compensation• Finance

Data Sources Data Integration Functions Reporting andManagement

Group STD/LTD(Kemper)

Group Medical/Provider Detail

(Cigna, UHC, & MBC)

Absenteeism(FedEx Payroll)

Workers’ Comp.Medical Detail

(Intracorp)

Productivity(FedEx/FAMIS)

Workers’ Comp.Claims Detail

(FedEx Risk Mgmt.)

Integrated Health and Productivity Database

Example 1: The Payoff

Health Benefit Savings Productivity Cost Savings

6-Year Cumulative Savings = Over $1 Billion

Example 2: • Vitals

– 6,500 Employees (U.S.)

– $8 Billion

– Leader in digital TV, broadband and satellite-based private business networks

• Investment Rationale

– Cost Management Mandate in Early ’90s

– Need to Attract and Retain Top Talent—Innovation and Service

• Critical Success Factors– Integrating Management Structure– Incentive Alignment– Integrated Interventions

P.T.O Policy

Training & Education

Wellness

HealthPlans

CaseMgmt.

Return to Work

Safety

Example 2:

• The Payoff– Focused wellness interventions—on top of

aggressive RTW policies and procedures—yield additional disability rate and cost reductions.

4.1%

7.8%

0%

1%2%

3%4%

5%6%

7%8%

9%

$224

$323

0

50

100

150

200

250

300

350

400% Filing STD% Filing STD Average STD CostAverage STD Cost

Participants Non-Participants

Example 2:

Example 3:

• Vitals– 32,000 Employees– $4.5 Billion– Manufacturing, Service, Technology

• Investment Rationale– Employee value part of corporate culture– Health as a component of HR/Benefits Strategy:

“Power of 2—Pitney Bowes & You”– HR Imperative—Attract and Retain Top Talent!

• Critical Success Factors

– Focus on Medical Cost Drivers

• Predictive Modeling to identify leading drivers

• Disease management interventions focused on top conditions

• Drug formulary strategy to foster compliance

– Focus on Lost Productive Time (Absenteeism + Presenteeism)

• Nearly 3 million lost productive hours per year

• Almost 1,500 FTEs

• $52 million cost

• 40% due to absence and 60% to health-related performance impairment

• 42% driven by top 3 conditions

• Site-specific drill-downs

• Flu shot program

• On-site clinic expansion

• Mental health screening

• Disease management programs

AuditAuditAudit AnalysisAnalysis Focused InterventionFocused Intervention

Example 3:

• The PayoffPotential Impact of Intervention:

SavingsSavings

Hours

FTEs

Cost

5%5%

142,000

74

$2.6 Million

10%10%

284,000

148

$5.2 Million

20%20%

568,000

296

$10.4 Million

Example 3:

• Vitals– 50,000 Employees– $30 Billion– Global Science and Technology Company

• Investment Rationale– Corporate commitment to employee health and safety– Total health cost analysis 1997 revealed $31 million

savings opportunity– New CEO—New commitment to increased

productivity

Example 4:

• Critical Success Factors– Information-based strategy– Dual focus on loss management and worker

effectiveness– Integrated Health Management—Council Structure

Example 4:

Integrated Health ManagementIntegrated Health Management

Health Promotion

Occ. Health

EAP

IndustrialHygiene

Safety GroupHealth

Occ. InjuryCompensation

HRD

DiversityWorklife

• The Payoff

– ROI analysis on health improvement identified health care cost savings potential of population health improvement intervention

Example 4:

$0.0

$5.0

$10.0

$15.0

$20.0

• Break-even impact over 10 years assuming $12.3 million invested

• NPV=0• $51 million saved over

10 years on investment of $12.3 million

• ROI 4.14 to 1.00

• NPV = $39 million

Do Nothing Reduce Risk.09%/Year

Reduce Risk1%/Year

An

nu

al R

isk-

Driv

en

He

alth

Exp

en

ditu

re I

ncr

ea

se (

$ M

illio

n)

Sixth Generation2010’s “Not Enough Money!”

A large proportion of disease and disorders from which employees suffer is preventable.

Findings: (Lifestyle linked)57% of Heart disease deaths37% of Cancers50% of Cerebrovascular disease23% of Pneumonia34% of Diabetes60% of Suicide70% of Chronic Liver disease (Cirrhosis) ? % Life/workplace STRESS

Explosion of Lifestyle Diseases

– Fast Food

– Tobacco

– Lack of Physical Activity

– Stress

Morbidity & Mortality• 50% - 70% medical problems are associated

with modifiable health risk factors• Modifiable implies a potential for reduction

– Reduce risks and reduce morbidity and mortality

– Increase risks and increase morbidity and mortality

• Majority of risks stem from behavioral habits Smoking Obesity Alcohol Nutrition

Stress Seat belts Illicit drugs Sedentary

Lifestyle

Many modifiable health risks are

associated with increased health care costs within a relatively short time window

Projections of Savings in Medical Care Costs

0

100

200

300

400

500

600

700

800

900

1000

20002001 *

20022003

20042005 **

20062007

20082009

20102011

20122013

20142015

($ M

illi

ons)

Claims Cost Reduction Impact of Healthy Balance

Bending the Curve!

AMC Selected Results

Cost-Benefit Analysis– Assumption based methodology– Sensitivity analysis approach

Liberal assumptions Conservative assumptions

– Cost-Benefit ratio depends on assumptions Liberal 1 : 13.97 Conservative 1 : 1.19

Workplace Health Promotion: a

Win-Win-WinEmployers benefit:

Improved morale, higher productivity, enhanced recruitment and retention.

Employees benefit:Improved quality of life through better health, more control over work, better balance of work and social life.

Families and Communities benefit: Healthy people make healthy communities

Diseases are the Interest we pay for our Pleasures.

J. Ray

A Quick Look at Two Diseases!

Two Lifestyle Diseases

• Obesity

• Tobacco

•

Obesity• According to the Mayo Clinic, about 2/3 of Americans are

overweight; one in three is considered obese.

• This problem is not limited to America- it is a global concern!

• WHO reports that since 1995, the number of obese people in the world has doubled.

• There are now more than one billion overweight adults in the world, and at least 300 million of those are obese.

• Obesity, along with a stagnant lifestyle, increases risk for CHRONIC DISEASES such as high blood pressure, cardiovascular disease, diabetes, and stroke.

Confronting the Problem

World Health Organization: What can be done?

Established scientific evidence suggests there are major health benefits in:

• Eating more fruit and vegetables, as well as nuts and whole grains;

• Daily physical activity; • Moving from saturated animal fats to unsaturated

vegetable oil-based fats; • Cutting the amount of fatty, salty and sugary foods in the

diet; • Maintaining a normal body weight (within the Body Mass

Index (BMI) range of 18.5 to 24.9.); • Stopping smoking.

Speaking of Tobacco…

Why is tobacco a public health priority?

Tobacco is the second major cause of death in the world. It is currently responsible for the death of one in ten adults worldwide (about 5 million deaths each year). If current smoking patterns continue, it will cause some 10 million deaths each year by 2025. Half the people that smoke today -that is about 650 million people- will eventually be killed by tobacco.

Tobacco: We May Like to Smoke it, But it is Killing Us!!

Annual Deaths from Smoking Compared with Selected Other Causes in the United States

AIDS: 17,000Alcohol: 81,000Motor Vehicle: 41,000Homicide: 19,000Illicit Drugs: 14,000Suicide: 30,000Smoking: 430,000

My Neighbor Stopped Smoking yesterday. He is Survived by a

Wife and Child.

Harry C. Bauer

Depression in the Workplace

Highest medical costs per employee (HERO study) + lost productivity

Defense strategies: Employee Assistance Programs (EAP) Health promotion programs Management training programs Reliable self-help information Anonymous depression screenings Skill training in resilience

Sixth Generation2010’s

Tomorrow

??? $$$/Sense

PREDICTIONSCancer: increase in developing countries and

stabilization /decline in developed countries

Diabetes: 143 --> 300 million by 2025

European Union by 2005: - 33% increase in lung cancers in women - 40% jump in prostate cancers in men

Depression – one of the biggest issues for both develop and developing countries

Obesity and hypo-kinetics - a major world problem

The Future is Now!!!

• Increasing Health Care Cost• Aging Population• Physical Inactivity• Lifestyle Issues• Eating Habits • Smoking Habits• Chronic Disease • Stress• Obesity

Public Policy Associates, IncorporatedPublic Policy Associates, Incorporated 6767

Nationwide Physician Supply and Demand

1950 to 2020

219 259323

453

601

731837 881

266274260

236

195

155141

142

-100

100

300

500

700

900

1100

1300

1500

1950 1960 1970 1980 1990 2000 2010 2020

Ph

ysic

ian

s (

1,0

00s)

0

50

100

150

200

250

300

Ph

ysic

ian

s p

er

100,0

00 p

op

ula

tio

nTotal Physicians Physiicans per 100,000 population

Source: Lohr KN, Vanselow NA, Detmer DE. The Nation's Physician Workforce: Options for Balancing Supply and Requirements. National Academic Press, Washington DC, 1996.

Public Policy Associates, IncorporatedPublic Policy Associates, Incorporated 6868

Projected Supply and Demand for FTE RNs 2000 - 2020

1000000

1200000

1400000

1600000

1800000

2000000

2200000

2400000

2600000

2800000

3000000

2000 2002 2004 2006 2008 2010 2012 2014 2016 2018 2020

Supply Demand

Source: Bureau of Health Professions, RN Supply and Demand Projections 

Health promotion has become an important business factor in a

comprehensive humanresource strategy.

What is a healthy workplace?Five Guiding Principles (Health

Canada) Meet the needs of all employees, regardless of their

current level of health;

Recognize the needs, preferences and attitudes of different groups of participants;

Recognize that an individual’s “lifestyle” is made up of an interdependent set of health habits;

Adapt to the special features of each workplace environment; and

Support the development of a strong overall health policy in the workplace.

To reach Bob Karch

Bob Karch is a Professor at American University, is the founder and director of the Master of Science Program in Health Promotion Management (1980) and the founder and Executive Director of the National Center for Health and Fitness (also 1980) and the International Institute for Health Promotion (1996) at American.

He can be reached at - rkarch@american.edu or by phone At American - 202-885-6285