Is There a Link Between Stock Market Price and Having a Great Workplace Health Promotion (Wellness) Program?

Ron Z. Goetzel Ph.D. , Johns Hopkins University - Truven Health Analytics

Health Promotion Live Webinar – February 25, 2016

AGENDA

• Revisiting the Controversy: Do Workplace Wellness

Programs Work?

• Wall Street Studies

• Best and Promising Practices

• Q&A

Do Health Promotion Programs Work?

3

The Confusion

The Latest from Sharon Begley

What Do We Mean When We Say:A Wellness Program Works?

• “Make workers aware of their health and how it

improves quality of life.”

• “High participation and engagement.”

• “Lose weight, stop smoking, exercise more.”

• “Medical claims costs should go down.”

• “Less absenteeism, fewer safety incidents.”

• “Attract the best talent.”

• “Happier workers with more energy.”

• “Create a culture of health.”

6

7

What Do We Mean When We Say:A Wellness Program Works? (con’t)

“Produce a positive return on investment (ROI)?”

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Baxter et al., Review

AJHP, July/August 2014.

Baxter et al. Literature Review

• Fifty-one studies (61 intervention arms) published between 1984 and

2012 included 261,901 participants and 122,242 controls from nine

industry types across 12 countries.

• Overall weighted ROI was 1.38 : 1.00, which indicated a 138% return

on investment.

• When accounting for methodological quality, an inverse relationship

to ROI was found.

• Randomized control trials (RCTs) (n = 12) exhibited negative ROI,

−0.22 ± 2.41(−.27 to −.16).

• Conclusion. Overall, mean weighted ROI in workplace health

promotion demonstrated a positive ROI.

RCT Studies Intervention

Period

Sample SizeIntervention

Type

Vaccine Interventions

Quasi-Experimental and Modeling Studies

Johnson & Johnson Study

Johnson & Johnson – “Low Quality Study”

Dell Inc. Research – AJHP, Jan/Feb 2015

ROI Analysis – 2.48:1.00

Duke University Study

ROI Estimate: 2.53:1.00

Michael O’Donnell Analysis of Baxter et al. ROI Review–AJHP, Jan/Feb 2015, 29:3, v-viii

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Goetzel’s New Rule: An ROI of 1:1 is good enough…

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…if you can demonstrate health improvement!

But…what about the Value-on-Investment (VOI)?

It all started with Ray Fabius’ 2013 study

AECOM CHAA Winners – 1996 - 2013

ACOEM Winners vs. S&P 500

HERO Study: Connecting Corporate Health and Wellness Best Practices to Superior Market Performance

HERO Scorecard Study

Average Change In Medical Expenditures

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Average Percent Change in Medical Expenditures Over Three Years for the Study

Sample (Adjusted to 2012 Dollars – Not Adjusted for Confounders)

0

20

40

60

80

100

120

140

160

180

200

-10.0% -8.0% -6.0% -4.0% -2.0% 0.0% 2.0% 4.0% 6.0% 8.0%

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Average Percent Change in Medical Expenditures from 2009 - 2011

Comparison of Expenditures by HERO Score, Adjusted for Confounders

Predicted Average Annual Per Member Healthcare Expenditures (Adjusted to 2012

dollars) for Organizations with High and Low HERO Scores

2009 2010 (% Change from 2009) 2011 (% Change from 2010)

LOW $3,048 $3,050 $3,051

HIGH $2,948 $2,901 $2,855

$2,800

$2,850

$2,900

$2,950

$3,000

$3,050

$3,100

Ad

jus

ted

An

nu

al

Co

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HERO Score

(0.05%) (0.05%)

(-1.6%) (-1.6%)

Grossmeier et al., HERO S&P Study

HERO Study Results

Fabius et al. ACOEM II Study

High Health Promotion Scores vs. S&P 500

High Safety Scores vs. S&P 500

High Health and Safety Scores vs. S&P 500

Koop Award Winners and S&P 500 Index

Koop Winners: 1999-2014BP America BP 2014

Eastman Chemical EMN 2011

Prudential Financial PRU 2011

Pfizer, Inc. PFE 2010

The Volvo Group VOLVF 2010

Alliance Data Systems Corp ADS 2009

Dow Chemical Company DOW 2008

International Business Machines IBM 2008

Pepsi Bottling Group PBG 2007

WE Energies WEC 2007

Union Pacific Railroad UNP 2005

UAW-GM GM 2004

Johnson & Johnson Services, Inc JNJ 2003

FedEx Corp. FDX 2002

Motorola Solutions Inc. MSI 2002

Citibank C 2001

Union Pacific Railroad UNP 2001

Northeast Utilities NU 2001

Caterpillar Inc. CAT 2000

Cigna Corp. CI 2000

DaimlerChrysler Corporation DDAIF 2000

Fannie Mae FNMA 2000

Aetna AET 1999

Pfizer, Inc. PFE 1999

Glaxo Wellcome GSK 1999

UNUM/ Provident UNM 1999

Goetzel et al., Koop S&P Study

Getting the Word Out on Best and Promising Practices in Workplace Health Promotion

Best/Promising Practice Dissemination

• Robert Wood Johnson Foundation – Promoting Healthy

Workplaces

• Transamerica Center for Health Studies – Employer

Guide to Workplace Health Promotion

• American Heart Association -- Developing a Culture of

Health “Playbook”

• Centers for Disease Control and Prevention – Workplace

Health Research Network

• Centers for Disease Control and Prevention – Workplace

Health Promotion Resource Center (coming soon)

Kent et al. JOEM Study

Transamerica Center for Health Studies

American Heart Association

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The Secret Sauce

1. Culture of Health• More than just a wellness

program – It’s a way of life

• Ingrained in every part of the organization• Business Mission• Built Environment• Performance Metrics• Programs, Policies,

Health Benefits

2. Leadership Commitment

• CEO Driven

• Lead by Example

• Middle Management Support

• Budget/business plan

• Empowered workers/unions

3. Specific Goals and Expectations

• Think big, start small, act fast -- one step at a time

• Set short and long term objectives

• Be realistic about what can be achieved in 1, 3, 5, 10+ years

• Accountability – leaders and employees are accountable for doing their part to support a culture of health

4. Strategic Communications

• Messages need to be:

• Consistent

• Constant

• Engaging

• Targeted

• Two-way dialogue using a variety of channels

• Wellness champions

Relentless Surround Sound

5. Employee Engagement in Program Design/Implementation

• Wellness Committees

• Employee Feedback Surveys

• Participatory Based Program Design

• Focus Groups

6. Best Practice Interventions

• Convenience, removing barriers

• Many choices

• Making the healthy choice the easy choice

• Applying behavior change theory/practice

7. Effective Screening and Triage

• Health Risk Assessments with Follow-up -- PLUS

• Biometric Screenings (USPSTF Guidelines)

• On-site Clinics and Counselors

8. Smart Incentives

• Tailoring, and providing alternative paths to motivate, reward, and help employees achieve their goals

• Tiered Incentive Programs

• Non-Monetary Incentives

• Carrots, Not Sticks

• Voluntary – reasonable dollar amounts

• Long-term view - retirement

9. Effective Implementation

• Tailored to the company’s culture

• Integrated solutions

• Flexibility

• Fresh ideas

• Fun

Structure:

Process:

Outcomes:

10. Measurement and Evaluation

Modified Worksite Health Promotion (Assessment of Health Risk with Follow-Up) Logic Model adopted by the CDC Community Guide Task Force

HEALTH, SAFETY, AND PRODUCTIVITY MANAGEMENT

Employees

This Is Hard!

Workplace Health Promotion (Wellness) Works– If You Do it Right!

Financial Outcomes

Health Outcomes

QOL and Productivity Outcomes

Cost savings, return on investment (ROI) and net present value (NPV).Where to find savings:

Medical costs

Absenteeism

Short term disability (STD)

Safety/Workers’ Comp

Presenteeism

Adherence to evidence based medicine.

Behavior change, risk reduction, health improvement.

Improved “functioning” and productivity

Attraction/retention –employer of choice

Employee engagement Corporate social

responsibility (CSR) Balanced scorecard

Another Benefit: Engaged Workers Who Love Their job!

Learn More at….

http://www.jhsph.edu/promoting-healthy-workplaces