Workplace Wellness - Going Beyond Promises

to Achieve Results

Larry Catlett, MD

Objectives for Today

What is Our Health Care Problem Really About?

Our current dysfunctional “sick care” system - and the claims management process put in place to control it – too often ignores primary prevention. Rather than being designed to prevent chronic disease, the system exploits the current epidemic.

The Chronic Diseases….

DiabetesCoronary Heart DiseaseStrokeCOPDCancer

…The Root of the Problem

Consider:• Rising chronic disease burden (133

million Americans have one or more chronic diseases)

• 75% of all health care spending on one or more chronic diseases

Not Convinced? Let’s Look at Diabetes

But it’s All Genes Anyway, Right?

Factors contributing to all disease (CDC data)• 20% - heredity• 10% - lack of access to health care• 19% - environment

>50% lifestyle choices 80% of heart disease and

stroke, most of diabetes, 40% of cancers preventable with lifestyle changes

It’s really Quite Simple

Behaviors Change• We become less active (“watch your

kids do it”), yield to “convenient” food sources, and…

• Gain 11-16 pounds- double your risk for diabetes, or…

• Gain 17- 24 pounds- triple your risk

What We Know About At Risk Health Behavior

Health Behaviors that Drive Costs

AbsenteeismAlcohol abuseExisting medical conditionHigh Blood pressureInactivity Life dissatisfactionLow back painHigh total cholesterol

Low HDL cholesterolNegative health perceptionNo seat belt/helmet useOverweightStressSmoking

Cost Risk Levels

Low- 1-2 risks / “baseline spending”

Medium- 3-4 risks / up to 50% more than baseline spending

High- 5 or more risks /150 to 300% additional spending per year per person

Typical Employee Population Profile

Low 30-40%

Medium 30-40%

High 20-30%– (2-3% migration to worse health risk status

every 3-5 years)

Total Medical and Pharmacy Costs Paid by Quarter for Three

Groups

What to Do?

Prevention is the solution

Milken Study*Primary prevention (wellness, health promotion)Secondary prevention (early

detection/diagnosis)Tertiary Prevention (chronic condition

management)

Could have an economic impact of $1 trillion annually…

“An UnhealthyAmerica” 2007 study, Milken Institute

Wellness Risk Reduction Goals

1. “Zero trend” 2. Reduce high risk

population 3.Increase low risk

population

What’s Out There to Reduce Risk?

Health Awareness…

Posters, pedometers, check stuffers, T-shirts, free fruit, health fairs and newsletters…..

Health education and population based programs….

12 week walking programFitness courses“Biggest Loser” contests8 week men’s health course twice a year Smoking cessation classesStrength training classes

and…. health education coaching from health “experts”…..

Client Centered Health Behavior Change

Reducing individual and group risk burden by redcui9ng at risk behaviors improves quality of life, decreases medical spend within the group and enhances productivity

Understanding a Client Centered Health Behavior

Change Intervention

Why Do People Change?

People change because..They want to… (their idea)

The behavior they have decided to change has become a significant liability to them…(importance)

They have come to believe they can change…(confidence) and

A particular change at a particular time in their life is a high priority (readiness).

Intrinsic Motivation to Change

The convergence of importance, confidence and readiness) to change.Achieved through collaboration, evocation of intrinsic beliefs and values and preserving autonomy!What does it sound like???

Losing Weight…

HC: Let’s look at your risks (obesity, nutrition, exercise, seat belt )C: I’ve been wondering when this would happen.HC: When what would happen?C: You’re going to tell me to lose weight.HC: You’re weight is a sensitive issue.

Losing Weight….

C:Well, it’s so hard to lose weight and I wonder if I really need to?HC: Your weight is not really problem for you.C: I didn’t say that.HC: Tell me what you think about your weight.

Losing Weight…

C: It’s not that I wouldn’t like to lose weight- I guess I really should- but I just don’t know how I can do it.HC: Tell me why you think you should.C: Well, my foreman, Luke, is really overweight and he missed all of deer season last year after his heart attack. Hasn’t been out this year either.HC: Any other reasons

Losing Weight…

C: Well, my wife says my knees would do better and I could keep up with my grandkids.HC: It’s not that losing weight is not important to you, it’s the “how” that worries you.

Losing Weight

C: Well, I sure don’t want to have to quit deer hunting like Luke did after his heart attack, but I can’t stand diets. I am hungry all the time and I always gain all my weight back.HC: Losing weight might keep you deer hunting and help your knees, but it has been hard for you in the past.

Losing Weight….

C: Sure! That’s right.HC: Well then, on a scale of 1-10, where would you rank the importance of losing weight?C: I should lose weight. I know that- so I guess a 7 or 8. But how???

Losing Weight…

HC: There are two ways to lose weight. Eat less of exercise more. Do either of these appeal to you?C: I stay active with chores and work but I don’t like to exercise. If I try to eat less, won’t that just be a diet?HC: Exercise is out and eating less may be too hard.C: How much less?

Losing Weight….

HC: Tell me what you ate for breakfast.C: Well, for breakfast I had 3 slices of bacon and a bowel of oatmeal with a couple tablespoons of sugar, a glazed donut, 2 cups of coffee with milk and a banana.HC: You are eating some healthy stuff and that is a great start. Any place in there you might make a change? Just so you know, if we can weed out 3500 calories over the course of a week you will lose a pound a week. If it takes 2 weeks that is fine too. That might be easier than you think.

Losing Weight….

C: No kidding? Maybe a slice of bacon and some sugar? I guess I could live without the donut.HC: There’s 300+ or so calories right there?C: That’s not much.HC: It’s a good start when we are looking for small painless changes that you can stick to and add to over time. 10 days of this totals 3000 Calories! Do you think you could look at all your meals and snacks this way and make some small cuts in calories, or should we just stick to breakfast now?

Losing Weight….

C: Yeah, let’s stick to breakfast. I just wonder if it will work? HC: Don’t be in a rush to see weight loss. We have plenty of time. Let’s remember that small, easy to reach goals work best. Is it fair to say your goal is to figure out how you can cut some calories (shooting for a total of 3500 every week or two)?C: Yes, that’s ok. HC: And the first thing you will do is look at what you are eating now for breakfast and change or substitute where you can? I will show you a web site for counting calories.C: That will be great.

Losing Weight..….

HC: Any questions? I will see you in a couple of weeks to see how you have done.C: No questions. This may actually work.HC: If it doesn’t, we’ll spend time next time figuring out how to improve the plan!

Does Health Behavior Change Really Work?

Cost Risk Savings 2010- Large Company (2000)

5 Year Experience (large company)…

$1,110,444.00

$2,400,459.00

$1,612,396.00

$401,169.00

$1,272,213.00

2006

2007

2008

2009

2010 TOTAL SPENDING DECREASE$6,796,681.00

Expected vs Actual Costs

Medium Company After 4 Years…

Small Company After Two Years

Productivity Lost

PRODUCTIVITY LOSS ANALYSISCompany: Duratherm

RISKS

% OF PRODUCTIVITY

LOSSAVG # WORK

HOURS / YEARAVG. EMPLOYEE

WAGE

# PEOPLE CURRENTLY WITH RISK

PRODUCTIVITY LOSS

ALCOHOL ABUSE 0.007 2077 $18.34 4 $1,066.58BACK PAIN 0.13 2077 $18.34 7 $34,663.88INACTIVITY 0.022 2077 $18.34 32 $26,816.89DEPRESSION 0.074 2077 $18.34 1 $2,818.82NO SEATBELT 0.022 2077 $18.34 9 $7,542.25OVERWEIGHT / SERIOUSLY OVERWEIGHT 0.01 2077 $18.34 28 $10,665.81STRESS 0.048 2077 $18.34 4 $7,313.70TOBACCO SMOKE 0.018 2077 $18.34 20 $13,713.18

0.04 2077 $18.34 $104,601.13

Productivity Gained

PRODUCTIVITY COST SAVINGS ANALYSISCompany: Duratherm

RISKS

% OF PRODUCTIVITY

LOSSAVG # WORK

HOURS / YEARAVG. EMPLOYEE

WAGE# PEOPLE

REDUCING RISKPRODUCTIVITY LOSS SAVINGS

ALCOHOL ABUSE 0.007 2077 $18.34 0 $0.00BACK PAIN 0.13 2077 $18.34 5 $24,759.92INACTIVITY 0.022 2077 $18.34 9 $7,542.25DEPRESSION 0.074 2077 $18.34 1 $2,818.82NO SEATBELT 0.022 2077 $18.34 6 $5,028.17OVERWEIGHT / SERIOUSLY OVERWEIGHT 0.01 2077 $18.34 4 $1,523.69STRESS 0.048 2077 $18.34 11 $20,112.67TOBACCO SMOKE 0.018 2077 $18.34 2 $1,371.32

0.04 2077 $18.34 $63,156.83

Absenteeism Improvement

Case study

Two remarkably similar companies2,000 employees eachHeavy construction/manufacturingCompany A – comprehensive wellness in place for 10+ yearsCompany B – no wellness at time of snapshot (a new OMC client)

2009 Top 10 Conditions

Difference in incidence of diabetes with and without a

wellness program

Per 1,000 Employees

Difference in incidence of heart disease with and without a

wellness program

Per 1,000 Employees

Questions?