2017 financial & risk management forum: achieving wellness in the workplace
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Enterprise Cost Containment –A Workforce Health Perspective
November 8, 2017Randall M JohnsonVice PresidentEmployer Benefits and Workforce Health Advisor
Workforce Health: Agenda
2
A common ground Impact on profits Impact on organizational engagement The broad approach of integrating health messagingUsing data Closing comments: high cost claimants & personal
choice
Managing Human Capital and Risk
Organizational Health Culture…
Workforce Health and Wellbeing…
Organization Health and Workforce Wellbeing:Affordable Workforce
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Organizational Costs1. Medical 2. Workers Compensation3. Recruitment/Retention4. Productivity5. CMV – License Status
WHY IS WORKFORCE HEALTH SO IMPORTANT?
5
Why Is YOUR Organization in Business?
And What is It’s Primary Objective? 6
Ultimately – Don’t ALL Organizations Share One Common Objective?
7
So Does Health Really Impact the Bottom Line?
8
“A portfolio of companies recognized as award winning for their approach to the health and safety of their workforce outperformed the market.…
Nevertheless, the literature increasingly links the health of a workforce to its safety and performance…
…the evidence seems to be building that healthy workforces provide a competitive financial advantage in the marketplace.” The Link Between Workforce Health & Safety and the Health of the Bottom Line, Fabius, Thayer et al, JOEM, Vol 55, No 9, September 2013
Workforce Health: The Value Proposition
99
A well-managed health and safety program
A positive and caring image
Improved staff morale
Reduced staff turnover
Reduced absenteeism
Increased productivity
Reduced health care/insurance costs
Reduced risk of fines and litigation
TO THE ORGANIZATION
TO THE EMPLOYEE
A safe and healthy work environment
Enhanced self-esteem
Reduced stress
Improved morale
Increased job satisfaction
Increased skills for health protection
Improved health
Improved sense of well-being
http://www.who.int/occupational_health/topics/workplace/en/index1.htmlhttp://www.who.int/occupational_health/topics/workplace/en/index1.html
Workforce Health: The Financial Impact
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Workforce Health: The Productivity Impact
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National Surface Transportation Safety Center for Excellence
86% of CMV drivers are overweight and 69% are obese
(BMI over 25)
– 68% of U.S. are overweight
– 34% of U.S. are obese
– 61% of CMV drivers reported two or more risk factors for
cardiovascular disease
High blood pressure
Obesity
Smoking,
High cholesterol
No physical activity
Sleep deprivation
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Ellin, Abby (2011-11-21). “A Hard Turn: Better Health on the Highway”. The New York Times. Retrieved 2012-03-14.
Sieber WK, Robinson CF, Birdsey J, Chen GX, Hitchcock EM, Lincoln JE, Nakata A, Sweeney MH (June 2014). "Obesity and other risk factors: the national survey of
U.S. long-haul truck driver health and injury". American Journal of Industrial Medicine 57 (6): 615–26.
Chronic Disease - Obesity & Health Care Cost
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A
B
C
Health Related Conditions
Increased risk for:
– Hypertension
– Dyslipidemia
– Sleep apnea
– Type 2 diabetes
– Coronary heart disease
– Stroke
– Gallbladder disease
– Osteoarthritis
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Short-Poor Sleep Habits
Transportation Industry has a fragmented work
schedule– Short Sleep Periods
– Poor Quality of Sleep
– Wake time Fatigue
– Certain Transportation Segments
Average only 3.8 to 5.2 hours of Sleep
– Sleep impaired driving attributed to commercial vehicle accidents
7% of CVM crashes (NTSB)
– Obstructive sleep apnea (OSA) one of the most common sleep
disorders
Estimated 1 in 4 CMV drivers has OSA in the U.S.
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Federal Law
H.R.3095 - To ensure that any new or revised requirement providing for the screening, testing, or treatment of individuals operating commercial motor vehicles for sleep disorders.– 391.41(b) - Federal Motor Carrier Safety Administration - A person is
physically qualified to drive a commercial motor vehicle if that person:
Has no established medical history or clinical diagnosis of diabetes mellitus currently requiring insulin for control
Has no current clinical diagnosis of myocardial infarction, angina pectoris, coronary insufficiency, thrombosis,
Any other cardiovascular disease of a variety known to be accompanied by syncope, dyspnea, collapse, or congestive cardiac failure,
Has no established medical history or clinical diagnosis of a respiratory dysfunction likely to interfere with his/her ability to control and drive a commercial motor vehicle safely.
Has no current clinical diagnosis of high blood pressure likely to interfere with his/her ability to operate a commercial motor vehicle safely
Has no established medical history or clinical diagnosis of a rheumatic, arthritic, orthopedic, muscular, neuromuscular or vascular disease which interferes with his/her ability to control and operate a commercial motor vehicle safely
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Health Related Conditions of OSA
Obesity
Cardiovascular Disease
– High Blood Pressure
– Coronary Heart Disease
– Stroke
– Abnormal Heart Rhythm
Metabolic Disease
– Diabetes and insulin resistance
Depression
Cognitive Impairment
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CMV- Transportation Emotional Related Stress
Social Isolation
Dangerous – High Risk
Lack of Job Satisfaction- Control
Chronic Fatigue
Relationship Impact– Mental Health – Depression
Motivation for Health and Lifestyle– Poor Eating and Nutritional Habits
– Lack of Exercise
High Tobacco usage > than 50% of CMV drivers
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Type 2 Diabetes
CVM Prevalence vs. US Population:– 16% vs 9.4%
Controlled Diabetes– Lifestyle (Nutrition and Exercise)
– Medications
Uncontrolled Diabetes– Neuropathy
– Impaired Vision
– Heart Disease/Stroke
– Kidney Failure
19
Diabetics and Healthcare Costs
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XYZ Incorporated
Chronic Disease - Combined
Chronic Disease - Combined Mbrs % Mbrs Plan Paid % Paid Paid/Mbr
Total 22,381 100.00% $93,069,202 100.00% $4,158
Chronic Disease Members 8,449 37.75% $63,978,460 68.74% $7,572
High Blood Pressure Patients 5,032 22.48% $46,781,296 50.27% $9,297
Depression-related Disorder Patients 2,594 11.59% $25,742,416 27.66% $9,924
Diabetics 2,008 8.97% $16,941,130 18.20% $8,437
Asthmatics 1,938 8.66% $14,389,578 15.46% $7,425
Coronary Heart Disease Patients 502 2.24% $12,652,309 13.59% $25,204
Obesity Patients 277 1.24% $2,571,060 2.76% $9,282
Non-Chronic Members 13,470 60.18% $25,972,580 27.91% $1,928
XYZ Incorporated
Chronic Disease - Diabetic Patients - Additional Conditions
Chronic Disease - Combined Mbrs % Mbrs Plan Paid % Paid Paid/Mbr
Diabetics 2,008 100.00% $16,941,130.02 100.00% $8,437
High Blood Pressure Patients 1,387 69.07% $13,837,840.94 81.68% $9,977
Depression-related Disorder Patients 391 19.47% $5,486,595.80 32.39% $14,032
Coronary Heart Disease Patients 174 8.67% $4,819,261.30 28.45% $27,697
Asthmatics 215 10.71% $3,706,816.09 21.88% $17,241
Obesity Patients 56 2.79% $725,992.67 4.29% $12,964
Workforce Health: Impact on Work Comp
Chart data as reported in a 2010 Study Conducted by CHCWS on the impact of comorbid conditions on WC medical costs
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Obesity – Medical/Workers Comp Costs
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The Right Metrics to Measure Impact
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BUT WAIT…THERE’S ALSO THE IMPACT ON EMPLOYEE ENGAGEMENT
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Engagement Matters
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Yet Engagement Levels Aren’t that Good
How does your workforce measure up?
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Engagement: Beyond the Organizational Level
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Correlating Engagement with Health Status
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Engaged employees are 63% more likely to report excellent health
Further Correlation with Engagement & Health
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Workforce Characteristics
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TAKING A BROADER APPROACH TO BUILDING AN INTEGRATED, HEALTH CENTRIC CULTURE
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Internal Competition for Employee Time & Attention
• Expectations• Culture• Sales • Customer Service• Revenue
• Multiple levels of leadership • Carriers/vendors/partners• Emails• Text messages• Policies• Non-verbal
• Safety/Quality Control• Wellness• Health benefits• Continuing Education• Worksite based
Communications
OfferedPrograms
Leadership
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Safety – How It Connects to Health
A great example of a program that has 100% engagement
Who doesn’t know about the Safety Program? What can we learn from them in terms of
creating a focused culture? What can we learn from them in terms of
onboarding? What can we learn from them in terms of
communication? What can we learn from them in terms of
incentives?
And most importantly, how can we connect & build the business case for well-being by integrating programs?
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Going Green
Environmental initiatives have a natural connection to wellness!
How many opportunities to connect with these initiatives exist? UNLIMITED! Nutrition Buy/Eat locally Physical activity Walking/biking versus driving Gardening/compositing
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Acquisitions
Can wellness programs help assimilate cultures and workers?
Can help establish commonality between different locations/populations
Establishes shared goals and communications Can use as a motivator in onsite challenges, for
example, walking or other tracking-type challenges
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Customer Service
Better health. Better customer service.
Engagement & good health critical to good performance
Call centers, especially, present a unique set of health risks
− Musculoskeletal (ergonomic opportunity)− Mental health (stress)
Does your program customize options and solutions for your customer service personnel?
36
Production/Productivity
Productivity is not just about manufacturing!
It’s not just absenteeism – it’s also presenteeism Is a natural link between workforce health and
the organization’s goals
But how many American employers are using productivity measures to evaluate their workforce health efforts?
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Cost Containment
It just makes cents
Cost containment occurs at every level within your organization
It is also an issue faced by most individuals What drives costs in your organization?
− Materials− Human capital− Turnover− Poor quality
How can your workforce health efforts connect to these cost drivers?
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It All Leads to One End Point
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LASTLY, DATA DRIVES DECISIONSHOW DO YOU VIEW & USE YOUR DATA WHEN
MANAGING YOUR WORKFORCE?40
Financial and Clinical Data
Benchmark
– Metrics
– Goals
Measure
– Strategy
– Resources
– Change
41
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The Continuum of Prevalence and Cost – Employer A
Healthy 58% Prevalence
6% of Cost
Employer A62.59% Prevalence
23.34% of Cost
At Risk 22% Prevalence
10% of Cost
Employer A33.41% Prevalence
40.30% of Cost
Chronic 17% Prevalence
29% of Cost
Employer A3.29% Prevalence
14.8% of Cost
Acute 3% Prevalence
55% of Cost
Employer A.71% Prevalence21.56% of Cost
Acute/Catastrophic. • Disease Management
• Case Management
Poly-Chronic• Case Management
• Disease Management
• Pregnancy Management
Early Chronic• Care Coordination
• Pre-disease Education
• Health Coach
• Physician Collaboration
Population Health• Health Engagement
• Prevention
• Health Risk Assessment
• Health Promotion
Accelerated risk progression
CRITICAL ISSUE
Individual Engagement
Relationship Between Lifestyle Risks & RX Solutions
43
Next Steps: Understanding the organization’s position on encouraging medication usage over making lifestyle changes
Statins are a class of drugs often prescribed by doctors to help lower cholesterol levels in the
blood. By lowering the levels, they help prevent heart attacks and stroke. Statins have been shown to reduce the risk of heart attack, stroke, and even death from heart disease by 25% to 35%
Male Employee Risk Factors by Cost
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BMI Underweight (18.5 or less)BMI Normal (18.5 – 24.99)BMI Overweight ( 25 to- 29.99)BMI Obese Class I (30 – 34.9)BMI Obese Class II (35-39.9)BMI Obese Class III (40 or greater)
B.P. Normal (systolic <120 and diastolic <80)B.P. PreHTN (systolic 120-139 or diastolic 80-89)B.P. Stg 1 (systolic 140-159 or diastolic 90-99)
B.P. Stg 2 (systolic >160 or diastolic >100)
In terms of costs, the highest risk categories are age (over 60), stage 1 hypertension and weight (Obese Class II and III).
Lifestyle Risk Factors for WC Claimants
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Next Steps: Modify wellness offerings/focus, change messaging, evaluate shift policies, etc.
Traditional Continuum of Costs
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Wellness Score Card Target
1) Total Employee Count ---
2) Covered Employees ---
3) Covered Spouses ---
4) Screening Participation
Health Measure Outcomes
5) Prehypertension and Hypertension 62.1%
6) High Cholesterol 25.3%
7) LDL<= 130 16.6%
8) At Risk BMI 75.5%
9) Pre-diabetes and Diabetics Not offered
10) A1c Not Controled 16.9%
Claim Experience (ee / sp) #
Members
%
Members
Plan
Paid
Paid /
Member
#
Members
%
Members
Plan
Paid
Paid /
Member
#
Members
%
Members
Plan
Paid
Paid /
Member
11) Alcohol Related Disorders 7 0.6% $113,398 $16,200 9 0.7% $194,944 $21,660 10 0.7% $282,956 $28,296
12) Asthma (1) 29 1.6% $485,928 $16,756 28 1.3% $248,895 $8,889 48 2.0% $463,497 $9,656
13) Certain Types of Cancer (2) 30 2.7% $133,496 $44,450 47 3.4% $893,578 $19,012 46 3.0% $923,991 $20,087
14) Coronary Heart Disease 17 1.5% $123,184 $7,267 25 1.8% $523,227 $21,409 28 2.5% $421,433 $11,090
15) Diabetes 72 6.6% $1,092,829 $8,179 96 7.1% $1,019,520 $10,620 131 8.6% $1,471,618 $11,234
16) Diabetes, A1c test 52 85.3% --- --- 55 58.5% --- --- 75 57.3% --- --- 100%
17) High Blood Pressure 104 9.4% $1,130,311 $10,868 150 11.0% $799,588 $5,331 195 12.8% $1,902,870 $9,758
18) High Cholesterol 17 1.5% $90,540 $5,326 26 1.9% $90,654 $3,487 28 1.8% $139,514 $4,983
19) Mental Health (3) 50 4.7% $526,808 $10,536 55 4.2% $315,244 $5,732 72 4.7% $338,098 $4,696
20) Neck / Back Problems 119 18.0% $1,421,803 $7,444 223 17.0% $2,166,098 $9,713 225 16.7% $1,970,367 $7,727
21) Obesity 2 0.2% $35,293 $17,646 3 0.2% $2,964 $988 9 0.6% $74,443 $8,271
22) Smoking-related disorders 24 2.2% $430,911 $17,955 37 2.7% $253,750 $6,858 48 3.1% $378,316 $7,882
23) Stroke 8 0.7% $280,469 $35,059 12 0.9% $327,377 $27,281 12 1.3% $667,853 $33,393
Preventive / Wellness (ee / sp)
24) Visits 100%
25) Cholesterol Screening 50%
26) Colonoscopy >40 years 10%
27) Mammograpy >40 years 35 - 40%
28) PSA no longer recommended
29) Pap Smear 35 - 40%
Impact
30) Prescription Drug PEPM
31) Paid Claims PMPM
no longer recommended
78.3%
14.0%
4.8%
15.0%
36.2% 37.5%
14.2%
no longer recommended
2015
1175
2013 2014
1153905
18.3%
4.3%
17.1%
7.3%
863 or 75%
18.7%
4.1%
75.5%
58.2%
28.0%
19.5%
71.8%
28.3%
20.2%
$240 $218 $224
673 or 74%
25.0%
$72 $91 $97
20.1%
no longer recommended
36.2%
0.2%
18.9%
873
20.7%20.7%
Turning Static Data Points into Actionable Initiatives
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Targeted, Patient Centric
Decision Making
Program Participation
HRA-Biometric
Pharmacy Claims
Health Plan Utilization
Claims
Risk-WC Claims
Safety
Plan Design Targeted
Outreach Incentive Design Program choices Opportunity
Analysis Communications Risk Stratification Partner
Collaboration Impact Analysis Value Based
Benefits
Organizational Health Structure
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Example: Turn-key Wellness Program
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Focused Health and Wellbeing
Five Pillars of Health
Engagement Technology
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Care Path Management
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Assessment Biometrics Clinical Review Claims Data Vitual Coaching Reporting
Employee – Spouse Biometric and Blood Profile
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Health Screening Intake Review blood panel
Review biometrics
Other:
Review Family History
Review Smoking Habits
Review Nutrition Habits
Review Physical Activity
Review overall health and general mental health
wellbeing, behaviors and attitudes.
Make recommendations for patient follow up and
referrals to other specialists.
Annual Preventative Care Counseling
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• Age and gender-appropriate review of physical condition, including vital signs such as blood pressure,
height/weight/BMI calculation (utilized to screen for obesity)
• Counseling regarding obesity, weight loss, healthy diet and exercise
• Review of family and personal health risks
• Guidance and counseling regarding substance abuse, alcohol misuse, tobacco
• use, obesity, exercise and healthy diet/nutritional counseling as indicated
• Screening for depression in adolescents and adults
• Behavioral dietary counseling for adults with hyperlipidemia and other known risk factors for
cardiovascular and diet-related disease
• Review of laboratory test results available at the time of the encounter
• Screenings -Cholesterol screening (dyslipidemia) in adults, Screening for glucose levels and tobacco
use
Virtual Health Advocate Coaching Engagement
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Populations Health Status Reporting
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Health Gaps in Care Reporting
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Virtual Patient Monitoring –Primary Care Provider and Coaches
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No Direct Cost
Biometric Screening
Health Risk Assessment
Clinical Review
Challenge Tracking Software Wellness
Coach and Consultant
Financial Wellness Seminars
Measurable Analytics
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A Turn-Key Wellness Program
Telehealth - Remote Driver Monitoring
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1. Polysomnography (PSG) – Sleep Study 2. Home-based sleep testing 3. Continuous positive air pressure
(CPAP)4. Sleep Oral appliances, and other
effective alternative treatments 5. Pulse oximeter6. Heart7. Weight - BMI
Workplace Health is an Essential Business Strategy!
61
Employers can impact an Individual in a very Personal Way
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