worksite wellness evaluation: basic strategies for worksites of all sizes w david chenoweth
TRANSCRIPT
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Worksite Wellness Evalua0on: Basic Strategies for Worksites of All Sizes
HPlive.org Webinar
March 15, 2013
David Chenoweth, Ph.D., FAWHP
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Well-‐planned Evalua0ons Can be a Decisive and Strategic Advantage
Assess quality of resources (personnel, equipment, facili>es, etc.) Determine level of impact Allocate your budget propor>onately Establish external benchmarking Guide strategic planning
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A growing impetus for evalua0on…
Recreational Benefits
Enhancement
Alcohol Abuse
Treatment
1890 1930 1950 1970 1980 1990 2000 2015
Structured Exercise
“Wellness” Programming
Horseback rides, gyms, swimming, etc.
•Pullman •NCR
• Hershey Foods
Employee Assistance Programs
Safety
Occupational Safety & Health
Act •PepsiCo •NASA
• Kimberly-Clark • Sentry Ins.
• Quaker Oats • Union Pacific
• Steelcase • First Chicago Bank
“Business Strategy”
Health & Productivity Management
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Purpose of Evalua.on…
“Evalua>on is not research; it is not done to prove or disprove anything;
it is done to improve something...”
Research Evalua>on
“Careful or diligent search” “Studious inquiry or examina9on”
“Determine or affix the value of” “Determine the significance,
worth, or condi9on…”
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The Seven Benchmarks
1. Capturing Senior Level Support
2. Crea>ng Cohesive Teams
3. Collec0ng Data
4. CraRing an Opera>ng Plan
5. Choosing Appropriate Interven>ons
6. Crea>ng Suppor>ve Environments
7. Carefully Evalua0ng Outcomes
Courtesy of Wellness Council of America (WELCOA).
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Perceived Values vs. Actual Performance…
Rank
WELCOA Faculty & Webinar Part. (480+) “Benchmarks”
Well Workplace Checklist (3,800+) “Norms”
Ranked Diff. Benchmarks vs.
Norms
% Criteria @ B-‐mark Status (>4 of 5)
1st Wellness Opera>ng Plan Choosing App Inter. +5 85%
2nd Sr. Level Support Wellness Teams +1 88%
3rd Evalua0ng Outcomes Sr. Level Support +4 100%
4th Crea>ng Wellness Team Healthy Environ. -‐2 50%
5th Choosing Appropriate Interven>ons
Collec>ng Data -‐4 58%
6th Crea>ng Healthy Environment
Well. Opert’g Plan -‐2 55%
7th Collec0ng Data Evalua0ng Outcomes -‐2 38%
Source: Chenoweth, D. and HunnicuM, D. WELCOA’s Benchmark Survey, 2013.
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Crea.ng a data-‐driven evalua.on…
1. Capturing Senior Level Support
2. Crea>ng Cohesive Teams
3. Collec0ng Data
4. CraRing an Opera>ng Plan
5. Choosing Appropriate Interven>ons
6. Crea>ng Suppor>ve Environments
7. Carefully Evalua0ng Outcomes
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Building a prac0cal, results-‐oriented [3-‐0ered] evalua0on…
Health Management
“Financial Outcome”
“Impact”
“Process”
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Chenoweth & Associates, Inc. 9
Insert slide of Eval’n book
Process Impact Financial outcome
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Transi.oning….from Process to Impact to Outcome… is a JOURNEY….that takes .me…
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The essence of “tailoring” an evalua.on around your wellness interven.on…
Process Impact $ Outcome
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Jan. July December July
Assessing par9cipant sa9sfac9on with instructor/coach,
facility, program quality, etc.
Risk factor status Behavior
Health care usage Produc>vity
Appraising the monetary value to wellness-‐generated
impacts “Process”
“Impact”
“Financial
Outcome”
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Jan. July December July
Quality
“Process”
“Impact”
“Financial
Outcome”
Quan0ty Business
Performance -‐ -‐ -‐ -‐ -‐ -‐ -‐ -‐ -‐ -‐ Financial
Accountability
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Jan. July December July
“Process”
Par>cipa>on Par>cipants’ sa>sfac>on with:
-‐ program content -‐ delivery -‐ feedback
Do employees like and respect the wellness program, etc.?
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“Process” Evalua.on [Qualita.ve]
• Employees’ sa.sfac.on with program content, delivery, availability, facili.es, instructors, policies, etc.
When using HRA and self-‐report tools, use non-‐biased statements and a
quan9ta9ve index
Please indicate your opinion with a check mark on the following scale:
“Level of customer service provided by wellness staff” [ -‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐] Very High Moderate Low Very High Low (5) (4) (3) (2) (1)
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Jan. July December
“Process”
“Impact”
Risk factor status Behaviors Health care usage Produc>vity
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Tools/techniques for assessing IMPACT…
Employee health records Environmental audit Culture audit Employee focus groups Health risk assessment (HRA) Biometric screening Produc0vity survey Medical care claim-‐cost data Visual observa0on
CAUTION: No single technique is a sufficient stand-‐alone diagnos0c tool
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Conduc.ng an IMPACT evalua.on…
1) Select key variables to measure (i.e., par9cipa9on, risk factor status, health care usage, worksite accidents, etc.)
2) Iden9fy your target popula9on 3) Prepare a format to record and format data 4) Collect data via screening, health risk
appraisal, etc. 5) Analyze data at designated intervals
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Preparing a format to record and analyze IMPACTS… “IMPACT”"Variable"
Baseline 01"
Jan."
02"March"
03"July"
04"Oct.!
05"Dec."
Blood"pressure"
Absences"
Visits to OHN"
Low back injuries"Productivity"
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Recording and analyzing impact data… Impact"Variable"
Baseline 01 [Jan.]"
02"[March]"
01 to 02"% Change"
03"[Oct.]!
01 to 03 "% Change"
Blood"pressure"
134/90" 130/89" -2.3"
Absences" 5/100" 4.8" -4.0%" 4.5" -10%"
On-site clinic visits"
348" 346" -1%" 321" -7.8%"
Low back injuries"
3/100" 2.9" -3.5%" 2.8" -6.7%"
Productivity" 78" 79" +1.3%" 83" 6.4%"
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A sample IMPACT variable… “Rate the availability of healthy vending machine items:” Very Good Good Neutral Poor Very Poor 5 4 3 2 1
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Jan. July December July
Appraising the monetary value of wellness-‐generated
impacts
“Impact”
“Financial
Outcome”
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…the real value proposi0on…
conver0ng human [health capital into business capital…
Work performance Revenue genera0on Compe00ve edge
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Transi0oning from IMPACT to $ OUTCOME…
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Impact (Non-‐financial) Values
BMI decrease Blood pressure decrease Physical ac>vity increased Self-‐confidence improved Perceived performance higher Fewer workers’ comp claims Fewer Rx drug claims Fewer medical claims
$ Financial Outcomes
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Ostbye, T. et al. Arch Intern Med 2007;167:766-‐773.
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When possible, build on today’s standards…(e.g., specificity)…
Source: Chenoweth & Associates, Inc.; North Carolina League of Municipali9es, Raleigh, NC, 2010.
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Medical care cost per risk factor
Source: Chenoweth, D. Promo.ng Employee Well-‐Being: Wellness Strategies to Improve Health, Performance and the Bo_om Line. SHRM Founda9on’s Effec9ve Prac9ce Guidelines Series. June 2011. [www.shrm.org/founda9on]
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Risk Condition Absenteeism Presenteeism Total
Diabetes mellitus 4.94% 18.26% 23.20%
Depression 2.61% 14.51% 17.12%
Alcohol abuse 5.00% 4.78% 9.78%
Obesity 1.40% 8.30% 9.70%
High cholesterol 3.14% 4.91% 8.05%
Smoking 2.84% 4.78% 7.62%
High stress 3.08% 4.45% 7.53%
Arthritis 2.36% 4.90% 7.26%
High blood pressure 0.37% 5.70% 6.07%
Asthma 4.80% 1.20% 6.00%
Migraine 3.96% 1.99% 5.95%
Physical inactivity .28% 4.59% 4.87%
Source: Chenoweth, D. 2011. Ibid.
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Full Report:
www.shrm.org/founda9on/products/documents/6-‐11%20Promo9ng%20well%20being%20EPG-‐%20Finalpdf
Execu9ve Summary: www.shrm.org/about/founda9on/products/documents/wellness/%20Exec%20Briefing-‐Final.pdf
Chenoweth & Associates, Inc. 29
Recommended resource…
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Calcula0ng the Cost of Lost Produc0vity Per Risk Factor
Risk Factor (A) % Workload
Lost
(B) # Employees
(C) Prevalence
(D) # At-‐risk employees
(E) Median Annual Compens’n
(F) Lost prod. cost
Alcohol abuse
Arthri0s .0726 500 .26 130 $50,000 $471,900 Asthma
Depression
Diabetes
High cholest.
Hypertension
Migraine
Obesity
Phy. inac>vity
Stress
“A” mul9plied by “D” [BxC] mul9plied by “ E “ = “F”
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Building a credible evalua0on approach …
$ Financial Outcome
Impact
Process
31 Chenoweth & Associates, Inc.
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CAUTION! What are the key prerequisites for construc0ng a credible evalua0on?
Chenoweth & Associates, Inc. 32
Suitable and suppor0ve poli0cal environment Programs – well established Sufficient par0cipa0on Data tracking: pre vs. post Evaluator’s competence and objec0vity
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Enhancing the quality of evalua.on by establishing goals that are…
Chenoweth & Associates, Inc. 33
compa0ble with stakeholders’ needs and values measurable: variables that can physically be measured quan0fiable: a value (#, %, $) can be assigned to a variable focused on an interven>on that has been opera0ng long enough to legi>mately generate an impact realis0cally achievable (e.g., wellness interven>on is likely to make a posi>ve impact)
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Wellness Strategies and Impact Timeframes
Chenoweth & Associates, Inc. 34
Wellness Interven>on Impact on Employee
Health Status Impact on Employee
Produc>vity
Impact on Organiza>on’s Health
Costs
Biometric Screening 12-‐18 months Not well established (NWE)
NWE
Condi0on mgmt (asthma, arthri0s, diabetes, etc.)
6-‐12 months 6-‐12 months 12-‐18 months
Drug-‐tes0ng 3-‐6 months 3-‐6 months 6-‐12 months
EAP 12-‐18 months 12-‐18 months >24 months
Ergonomics 3-‐6 months 3-‐6 months NWE
Financial incen0ves 6-‐12 months NWE NWE
Flex-‐0me work schedule
3-‐6 months 3-‐6 months 6-‐12 months
Health Risk Assessment (HRA)
NWE NWE NWE
Low back health 6-‐12 months 6-‐12 months 12-‐18 months
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Wellness Strategies and Impact Timeframes
Chenoweth & Associates, Inc. 35
Wellness Interven>on Impact on Employee
Health Status Impact on Employee
Produc>vity
Impact on Organiza>on’s Health
Costs
Medical self-‐care 3-‐6 months 6-‐12 months 12-‐18 months
Mental health/depression mgmt.
3-‐6 months 3-‐6 months 12-‐18 months
Non-‐financial incen0ves
NWE NWE NWE
Nutri0on 3-‐6 months 6-‐12 months 12-‐18 months
Physical ac0vity 3-‐6 months 6-‐12 months 12-‐18 months
Smoking cessa0on 3-‐6 months 6-‐12 months 36-‐48 months
Stress management 3-‐6 months 3-‐6 months 6-‐12 months
Tobacco free worksite 3-‐6 months 3-‐6 months 6-‐12 months
Weight management 6-‐12 months 12-‐18 months NWE
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Medical claims
Occupational
Absenteeism/presenteeism
Demographics
Ergonomics
Safety (Accidents/ Injuries)
Health risk status (HRA/Screening)
Work/life Health and
Productivity Management
Identifying and acquiring key data for evaluation…
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Designing a prac.cal plan for evalua.ng…
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Scope & Specificity
Evalua>on Goals
Evalua>on Design
Evalua>on Resources
Timeframe
What -‐ are we evalua9ng: program? policy? incen9ve?
-‐ do we want to generate: internal assessment? benchmark? proposal for expanding?
-‐ design is appropriate: non-‐exp? quasi exp?
-‐ types of resources are needed?
-‐ Is an appropriate 9meframe?
Why -‐ are we evalua9ng?
How -‐ can we best use each resource?
Who -‐ is the target popula9on?
-‐ is most qualified to use each resource?
Where -‐ is the evalua9on conducted?
-‐ can we obtain resources?
When -‐ is the best 9me?
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Iden0fying WHAT you are going to evaluate…
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Wellness Program Health Plan Policies
Enviro-‐ Cultural Incen>ves
Health coaching CDHP focus with incen>ves
Smoke free, drug free, safety
Healthy work semng/clean/safe
Health insurance premium discount
Fitness center Waived co-‐pays for main. Rx
drugs
Healthy food op>ons
Accessible, aorac>ve stairways
Fitness center subsidy
Women’s weekly health series
Medical self-‐care included
Lacta>on Healthy food op>ons
Flexible spending account (FSA)
Lunch ‘n Learn Flex-‐>me and telecommu>ng
Ergonomically-‐ enhanced worksta>on
Health reimbursement account (HRA)
Walking club
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Programs, policies, and incen0ve op0ons…
Physical Ac>vity Nutri>on Informa>on/Educa>on Other
Stairway signage Lunch ‘n learns E-‐mail daily >ps On-‐site medical clinic
Low impact walking On-‐line webinars Bull. Boards in high density areas
Health Kiosk with b.p. cuff, scales, etc.
Walking trails Color-‐coded healthy vending items
Medical self-‐care booklets
Quiet room
Exercise equip. in break area
Healthy potluck with recipe exchange
On-‐site library 5 minute on-‐>me stretching
Stretch breaks Gradually phase in healthy vend. items
Hlth mags in bathroom stalls
Days off for excellent aoendance
Fit ctr. $ subsidies Fruits/veggies @ mtgs. Health column in co. newsleoer
Establish smoke-‐free worksite
At-‐work showers and lockers
Subsidize healthier cafeteria food
Lacta>on suites for nursing employees
Dept. compe>>ons “Nutri-‐>ps” on café/break tables
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Environmental enhancements to boost more physical ac0vity…
Before ARer
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Environmental [physical environment] enhancements…
– Vending op9ons – Workout/fitness space – Cafeteria – Hea9ng/cooling/ven9la9on – Ergonomic/Safety
– Well lit areas
– Smoke-‐free
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Tailoring the scope of an evalua0on…
Process -‐ par>cipa>on -‐ like/dislike change
Impact -‐ # of steps/day -‐ # mins. exercise/day -‐ body mass index (BMI) -‐ # of health care claims -‐ perceived produc>vity
Financial outcome -‐ Health care cost$
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In a small worksite…
PCL Construc>on – Denver, CO “Keys to Wellness”
Provides healthy snacks in vending machines Fitness center subsidies “Ping-‐pong” tables Local 5K runs H1N1 and flu vaccina>ons Annual on-‐site health screenings Doesn’t use “program” as this creates a percep>on that healthy ac>vi>es are separate from the company’s normal business prac>ces.
Courtesy of PCL Construc9on, Inc.
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Aligning wellness (programs, policies, and incen0ves) within a feasible evalua0on plan…
PCL Construc>on – Denver, CO “Keys to Wellness”
Strategy “Process” “Impact” “$ Outcome”
Healthy vending snacks √ √
Fitness center subsidy √ √ √√
“Ping Pong” √
H1N1 vaccina9ons √ √ √√
On-‐site hlth screenings √ √
√√ Compare medical care claims and cost among par.cipants vs. non-‐par.cipants.
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Sample tools/techniques used for evalua0on…
Strategy “Process” (volume indicators)
“Impact” (changes)
“Financial Outcome”
Healthy vending snacks √ (Item counts)
√ (HRA, BMI
scr’g)
Fitness center subsidy √ (Par>cipa>on)
√ (HRA, biometric
scr’g)
√√ (Annual claims
data)
H1N1 vaccina9ons √ (Par>cipa>on)
√ (Aoendance, flu claims)
√√ (Annual influenza claim & cost data)
On-‐site hlth screenings √ (Par>cipa>on)
√ (HRA health
status)
√√ Compare medical care claims and cost among par.cipants vs. non-‐par.cipants.
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In a mid-‐size worksite…
Syngenta Crop Protec0on
Healthy snacks in vending machines Fitness center subsidy On-‐site Medical Clinic Weight Watchers™ on-‐site program Annual on-‐site health screenings
Courtesy of Judy Garreo, COHN. Syngenta Crop Protec>on, Greensboro, NC
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Strategy “Process” (volume indicators)
“Impact” (change)
“Financial Outcome”
Healthy vending snacks √ (Item counts)
√ (HRA, BMI scr’g)
Fitness center subsidy √ (Par>cipa>on)
√ (HRA, biometric scr’g)
√√
On-‐site Medical Clinic √ (U>liza>on)
√ (HRA, health records, # of medical claims)
√√ (Annual claim
costs)
Weight Watchers™ √ (Par>cipa>on)
√ (HRA, biometric scr’g)
√√ (Pre vs. Post claim costs)
On-‐site health scr’ning √ (Par>cipa>on)
√ (HRA health status)
√√ Compare medical care claims and cost among par.cipants vs. non-‐par.cipants.
Syngenta Crop Protec.on
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Courtesy of Bap0st Health South Florida 48
Bap0st Health South Florida…
“Wellness Advantage” award-‐winning program
Eight on-‐site fitness centers with 2x annual open houses
Classes: boot camp, urban training, walking and circuit training
Bi-‐annual wellness fairs with free screenings
$3 Wellness Meals (<600 calories & <30% fat) -‐ the fastest-‐selling items!
> Disease management program = posi>ve ROI
In a large worksite…
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Strategy “Process”
(volume indicators) “Impact” (changes) “$ Outcome”
On-‐site fitness centers √ (Par0cipa0on)
√ (HRA status & biometric scr’g)
√√ (Annual medical claim costs)
Classes √ (Par0cipa0on)
√ (HRA status)
Wellness Fair √ (Par0cipa0on)
Wellness Meals √ (# Meals sold)
√ (HRA health
status indicators)
Disability management √ (Par0cipa0on)
√ (RTW,
Produc0vity indicators)
√+ (Disability-‐specific claim
costs)
√√ Compare medical care claims and cost among par.cipants vs. non-‐par.cipants. √+ Track medical care and Rx drug use and costs at quarterly intervals.
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Tips for Enhancing your Evalua.on…
50
Establish a clearly delineated goal or vision for doing an evalua>on Allocate at least 5% -‐ 10% of your budget for evalua>on Iden>fy key stakeholders and tailor the evalua0on to their needs and values Have a realis0c expecta0on of what an evalua>on can produce Select only variables that you can reasonably track Assess data sources and types of data that are available before pumng an evalua>on into ac>on Give the interven>on >me to make a genuine impact Once essen>al resources (e.g., personnel, equipment, facili>es, etc.) are iden>fied, conduct a beta trial (test run) to iden>fy/resolve any barriers
Source: Chenoweth, D. “Decision Points Around Evalua9on.” AWHP’s Worksite Health, Summer 2001, 8-‐14.
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Crea0ng synergism for building successful evalua0ons today…tomorrow…and the future…
51
Worksite Infrastructure
Environment
Programs
Policies
Incen0ves
Evalua0on
PROCESS
IMPACT
$ OUTCOME
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David Chenoweth, Ph.D. Chenoweth & Associates, Inc.
128 St. Andrews Circle New Bern, NC 28562-‐2907
252-‐636-‐3241 www.chenoassociates.com [email protected]
EconohealthROI™
PRFCA™
CorpWellROI™
Thank You!