U.S. Chamber of Commerce Workplace Wellness Event Washington D.C.

Transcription

1 U.S. Chamber of Commerce Workplace Wellness Event Washington D.C. Innovations in Workplace and Community Wellness: Aligning Business Goals With a Healthy Workforce The Value of Health and the Power of Prevention April 7, 2016 Ron Loeppke, MD, MPH, FACOEM, FACPM Vice Chairman U.S. Preventive Medicine

2 Overview Delineate the Converging Trends that are advancing the Business Value of Health and the Power of Prevention in Workplace Wellness Discuss the solid Business Case for why employers should invest in wellness and prevention strategies. Analyze Published Results and Case Studies of reduced health risks and costs from evidence based, comprehensive workplace wellness initiatives.

3 Converging Trends Driving the Demand for Wellness and Prevention Epidemiological Trends Political Trends Cultural Trends Financial Trends The Problem: The Cost Crisis is due in large part to the Health Crisis The Bigger Problem: Total Cost Impact of Poor Health to Employers The Solution: Evidence Based Workplace Wellness/Population Health Mgmt

4 Converging Trends Driving the Demand for Wellness and Prevention Epidemiological Trends: The Burden of Illness/Risk in Population

5 Personal Health Behaviors are the main Causes of Death Mokdad AH, et.al. Actual Causes of death in the United States, JAMA. 2004; 291:

6 The Global Epidemic of Non-communicable Chronic Diseases Global Drivers of Mortality Due to Unhealthy Lifestyle Behaviors: 5 Lifestyle Behaviors Physical Inactivity Poor Nutrition Smoking Alcohol Medicine Non-adherence 5 Chronic Conditions Diabetes Heart Disease Lung Disease Cancer Mental Illness 75% of Deaths worldwide

7 Need for Diabetes Prevention/Care in United States 86 million Americans have PRE- DIABETES 29 million Americans have DIABETES 21 million of those are DIAGNOSED 17 million of those are TREATED 8.5 million have their disease CONTROLLED 77 million are UNAWARE 8 million are UNDIAGNOSED 4 million are diagnosed but NOT TREATED 8.5 million are treated but NOT SUCCESSFULLY CONTROLLED 20.5 million have Diabetes that is NOT CONTROLLED Goal: Reduce or Eliminate Risk Factors and Avert Disease Goal: Find and Treat Disease in Its Earliest Stages to Stop Its Progression Goal: Manage Disease to Avoid Complications and Disease Progression Goal: Manage Disease to Avoid Complications and Disease Progression Goal: Avert Onset of Diabetes or Costs due to Untreated or Uncontrolled Disease Sources: NIH, CDC, ADA.

8 Converging Trends Driving the Demand for Wellness and Prevention Epidemiological Trends: The Burden of Illness/Risk in Population The Age Wave Silver Tsunami about to hit the healthcare system

9 As the Age Wave Hits the Shore: Implications of the Aging Workforce

10 Healthcare Costs: Which Matters More Age or Health Risk? Annual Medical Costs $11,909 $11,965 $10,785 $7,991 $12,000 $5,114 $5,710 $7,989 $9,000 $8,927 $6,625 $6,000 $4,620 $2,565 $3,353 $3,000 $3,734 $1,776 $2,193 $4,613 $5,756 $2,740 $ Age Range High Med Risk Low Edington. AJHP. 15(5): , 2001

11 Converging Trends Driving the Demand for Wellness and Prevention Epidemiological Trends: The Growing Burden of Illness and Burden of Health Risks in Society The Age Wave Silver Tsunami about to hit the healthcare system Political Trends: Aligning Incentives among Consumers, Providers, Employers ACOs/P4P/PCMH and ultimately the Consumer Centered Health Home

12 Focusing on the Health in Health Reform (ACA) National Prevention Strategy Employer-Based Wellness Program Incentives for Employees Accountable Care Organizations (ACOs) Patient Centered Medical Home (PCMH)

13 ACOs/PCMHs and Employers Accountable Care Organizations (ACOs) and Patient Centered Medical Home (PCMH) similarities: Care models that make physicians and hospitals more accountable Outcomes oriented, performance-based with aligned incentives Goal: improve value of health services, control costs, improve quality ACOs/PCMHs share in a portion of savings gained Including workplace in ACO/PCMH development is logical Work impacts health and health impacts work Workplace is organically connected to home as personal health risks aren t left at home just as occupational risks aren t left at work Employers have unique infrastructure advantages that could help ACO/PCMH initiatives.

14 PHM in the Triple Role and Triple Aim for Hospital/Health Systems Employer Provider Insurer/ACO (Financial/Clinical Risk Bearer)

15 The 3 R s of Healthcare Stakeholders 3 R s of Responsibilities Healthcare Stakeholders Employees/ Health Management Consumers Disease Management Employers Hospital Health System/ Providers/ ACOs/Plans Risks Rewards Job performance Healthy and Safe corporate culture/workplace Value based benefit design aligned to PHM Investment in employee well-being/safety Nutrition Physical Activity Tobacco use Benefit design impact on total cost of care Employee turnover Decreased business performance Wellness/PHM Outcomes Healthcare Quality management Healthcare Cost management Wellness/PHM program costs Data-driven information systems Financial Risk of Clinical/Health Risk Improved health/wellness Financial incentives Enhanced performance Optimal health, well-being and engagement of employees Enhanced Employee satisfaction/retention Improved business performance/bottom line Better Care at Lower Cost Financial incentives for lower total costs Improved health outcomes of population Adapted from: Loeppke R. The 3 R s of healthcare: responsibilities, risks and rewards. Health Prod Mang. 2002:5-19.

16 Physician and Employee Aligned Financial Incentives related to Evidence Based Population Health Management Metrics Total Savings Dollars: DIRECTV Shared 33% with Employees; 33% with Physicians $ Bonus Pool = $ Claims Cost Savings PLUS $ Worker Productivity Savings (1:1) Example of Quality Point actions for both Physicians & Employees and accounted for in their Incentive Accounts--for allocation of Bonus: Evidence Based Medicine (EBM) Quality Criteria PHM Quality Points Personal Physician Reviewing HRA with Employee (Patient) xxx Perform USPSTF Age/Gender recommended Preventive screenings (e.g. mammograms, colon cancer screenings) xxx Condition-specific treatment and monitoring (e.g. Diabetics testing HbA1C at least every 6 months) xxx Maintain ongoing participation/engagement in Health Management, Health Coaching and Disease Management programs xxx Value of a Quality Point for Employee and Physician based on Actual Savings = $19.00 per Quality Point Loeppke R, Nicholson S, et al. The impact of an integrated population health enhancement and disease management program on employee health risk, health conditions and productivity. Population Health Management. 2008: 11(6);

17 Converging Trends Driving the Demand for Wellness and Prevention Epidemiological Trends: The Growing Burden of Illness and Burden of Health Risks in Society The Age Wave Silver Tsunami about to hit the healthcare system Political Trends: Aligning Incentives among Consumers, Providers, Employers ACOs/P4P/PCMH Consumer Centered Health Home Cultural Trends: Wellness is the new Green: The Ultimate Sustainability Strategy Mobile/Wireless Tech Transforming the Healthcare Industry Game Theory Innovations in Wellness

18 Mobile Technology: The World s most ubiquitous platform MOBILE TECHNOLOGY: THE WORLD S MOST UBIQUITOUS PLATFORM.* More people have access to cell phones than drinking water, electricity or a toothbrush. *Source: IMS Report: The World Market for Internet Connected Devices, 2012.

19 TRANSFORMING HEALTHCARE By 2020, ~160 million Americans monitored and treated remotely for at least one chronic condition Johns Hopkins University. Chronic Conditions: Making the Case for Ongoing Care. Retrieved 10/20/12, from

20 Gamification in Healthcare Since 2004 One Game has been played 50 Billion hours (5.93 Million Years) 183 M people are Gamers (> 13 hours per week) 97% of Youth play regularly 25% of > 50 y/o play regularly Transformational Accomplishment can occur when we can celebrate Spectacular Failure Potential for Nobel Prize winners in Medicine using Gamified Apps

21 Converging Trends Driving the Demand for Wellness and Prevention Epidemiological Trends: The Growing Burden of Illness and Burden of Health Risks in Society The Age Wave Silver Tsunami about to hit the healthcare system Political Trends: Aligning Incentives among Consumers, Providers, Employers ACOs/P4P/PCMH Consumer Centered Health Home Cultural Trends: Wellness is the new Green: The Ultimate Personal Sustainability Strategy Mobile/Wireless Tech Transforming the Healthcare Industry Game Theory Innovations in Wellness Financial Trends The Problem: The Cost Crisis is largely due to the Health Crisis

22 Patients with chronic diseases account for 75% of U.S. healthcare costs Of the more than $3 trillion/yr spent on U.S. health care Of every dollar spent 75 cents went towards treating patients with one or more chronic diseases 150 Million Americans with 1 or more Chronic Conditions 27% of rise in healthcare costs associated with the increase in obesity rates The Waist Line impacts the Bottom Line And yet, less than 5 cents of each healthcare dollar is spent on Prevention 22

23 Learning from the Past An ounce of prevention is worth a pound of cure. Ben Franklin 1736

24 5 Health Factors that mitigate Chronic Illness 1) 2) 3) 4) 5) Walking 30 minutes a day Eating healthy Not using tobacco Drinking alcohol only in moderation Waist size less than half of your height These result in 33% to 50% Less Lifetime Healthcare Costs If 75% of Americans had these health characteristics, between $600 Billion and $1 Trillion could be saved per year Mike Roizen MD Chairman Cleveland Clinic Wellness Institute Michael F. Roizen and Ted Spiker, This Is Your Do-Over: The 7 Secrets to Losing Weight, Living Longer, and Getting a Second Chance at the Life You Want (New York, NY: Scribner, 2015). Agneta Akesson et al., Low-Risk Diet and Lifestyle Habits in the Primary Prevention of Myocardial Infarction in Men: A Population-Based Prospective Cohort Study, Journal of the American College of Cardiology 64 (13) (2014): Andrea K. Chomistek et al., Healthy Lifestyle in the Primordial Prevention of Cardiovascular Disease Among Young Women, Journal of the American College of Cardiology 65 (1) (2015): Meir J. Stampfer et al., Primary Prevention of Coronary Heart Disease in Women Through Diet and Lifestyle, The New England Journal of Medicine 343 (2000):

25 Converging Trends Driving the Demand for Wellness and Prevention Epidemiological Trends: The Growing Burden of Illness and Burden of Health Risks in Society The Age Wave Silver Tsunami about to hit the healthcare system Political Trends: Aligning Incentives among Consumers, Providers, Employers ACOs/P4P/PCMH Consumer Centered Health Home Cultural Trends: Wellness is the new Green: The Ultimate Sustainability Strategy Wireless Technology Transforming the Healthcare Industry Game Theory Innovations in Prevention/Wellness Financial Trends The Problem: The Cost Crisis is due in large part to the Health Crisis The Bigger Problem: Total Cost Impact of Poor Health to Employers

26 Top 10 Health Conditions by Full Costs For Employers $400,000 $350,000 $300,000 $250,000 Presenteeism Absenteeism Drug Medical $200,000 $150,000 $100,000 $50,000 $0 Loeppke, R., et al., "Health and Productivity as a Business Strategy: A Multi-Employer Study. JOEM. 2009;51(4):

27 As Health Risks Go, so Go Health-related Costs % of Workplace Presenteeism Work days lost / Person / Year (Absenteeism) 26.9% 20.9% 14.7% 0-2 risks 6.4 Days 3-4 risks 5+ risks 1 risk STD Days / Year 2.4 Days 0-1 risks 9.3 Days 3 risks 12.6 Days 4+ risks 13.1 Days 5.3 Days 2-3 risks 4+ risks Sources: Burton, et al, JOEM: Vol. 47. No. 8, August, 2005; Wayne Burton, MD, IHPM North American Summit Meeting 2000; also Tsai, et al. JOEM: Vol. 47, No. 8, August, 2005

28 Converging Trends Driving the Demand for Wellness and Prevention Epidemiological Trends: The Growing Burden of Illness and Burden of Health Risks in Society The Age Wave Silver Tsunami about to hit the healthcare system Political Trends: Aligning Incentives among Consumers, Providers, Employers ACOs/P4P/PCMH Consumer Centered Health Home Cultural Trends: Wellness is the new Green: The Ultimate Sustainability Strategy Wireless Technology Transforming the Healthcare Industry Game Theory Innovations in Prevention/Wellness Financial Trends The Problem: The Cost Crisis is due in large part to the Health Crisis The Bigger Problem: Total Cost Impact of Poor Health to Employers The Solution: Evidence Based Workplace Wellness/Population Health Management

29 The Bottom Line for Employers: Better Health Population Health Better Care Patient Experience Better Value Higher Quality/Lower Cost Cathy Baase MD, MPH Chief Health Officer Dow Chemical Company 29

30 Goetzel, R; et al. Do Workplace Health Promotion (Wellness) Programs Work. J Occup Environ Med. 2014; 56 (9): , September, 2014.

31 Evidence Based Wellness/Population Health Management Wellness/Health Promotion Screening/Early Detection Early Intervention/Care Mgmt Total Population Low Risk Medium Risk High Risk LS Risk DM Risk Population of One Loeppke, R. Making the Case for Population Health Management: The Business Value of Better Health, Chapter 7, pp in Nash, D., et.al., Population Health Textbook. Jones and Bartlett Learning. Sudbury, MA

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33 Significant Overall Health Risk Reduction of Population Participating in their personalized Preventive Plan for 2 Years Net Movement of Health Risk Levels in Cohort Baseline vs Year 2 on Preventive Plan N = 7,804 71% 60% % 23% % 847 Low Moderate 6% 498 High Loeppke, R; Edington, D; Bender, J; Reynolds, A. The Association of Technology in a Workplace Wellness Program with Health Risk Factor Reduction Journal of Occupational and Environmental Medicine: March, 2013; Volume 55, Number 3: pp

34 USPM 5 Year Cohort Reduction in Key Individual Risk Factors KEY HEALTH RISK FACTORS Year 5 N = 1,763 Participants Health Risk Factor Blood Pressure Physical Activity Fasting Blood Sugar Fatty Diet Smoking Stress Total Cholesterol HDL Cholesterol Health Related Illness Days Alcohol Med/Drugs for Relaxation Poor Perception of Health BMI Diagnosed Condition % Population Reducing Risk % % % % % % % % % % % % % %

35 Intel-GE Validation Institute Analysis Total Hospital admits & ER visits across Conditions vs *DMPC and *HCUP national averages (per 1000 members) % Reduction in Hospitalizations and ER Visits in USPM compared to HCUP and DMPC USPM National Averages HCUP N = 33, *Disease Management Purchasing Consortium and the federal Healthcare Cost and Utilization Project (HCUP) databases

36 Beyond ROI to the Full Value of the Investment in Health ROI Return on Investment Financial Indicators/Net Savings VOI Value of Investment Financial Indicators/Net Savings Participation Indicators Engagement Indicators Preventive Screening Indicators Health Risk Indicators EBM Clinical Indicators Utilization Indicators Performance Indicators Shareholder Value Loeppke R. The Value of Health and the Power of Prevention. Int J Workplace Health Management. 2008; 1(2)

37 The Linkage: Healthy Companies drive Healthy Bottom Lines Though correlation is not the same as causation, the preponderance of evidence appears to be building that healthy and safe workforces provide a competitive advantage for employers. Fabius, R; Loeppke, R; et.al. Tracking the Market Performance of Companies That Integrate a Culture of Health and Safety: An Assessment of Corporate Health Achievement Award Applicants. JOEM. Volume 58: Number 1. Jan, Fabius R, et al. The link between workforce health and safety and the health of the bottom line: Tracking market performance of companies that nurture a culture of health. J Occup Environ Med. 2013;55(9):

38 The Great News from 30 years of Scientific Studies: The Compression of Morbidity Live Healthier Longer and Die more Suddenly at Lower Cost Sudden Death in Overtime Health Healthier Lifestyle Typical Lifestyle Acceptable QOL Disability By living a healthier lifestyle, the compression of morbidity relates to postponing the age of onset of morbidity, disability and cumulative health costs--even though life expectancy is increased Adding Years to your Life and Life to your Years. Hubert, Bloch, Oehlert and Fries. Lifestyle Habits and Compression of Morbidity. J Gerontol A Biol Sci Med. June, 2002; 57 (6) M347-51

39 The Bottom Line Good Health is Good Business From the Exam Room to the Board Room

40 Thank You! Ron Loeppke, MD, MPH Vice Chairman U.S. Preventive Medicine, Inc Cell Fax