Go For Health Workplace Wellness Forum Champion Companies: Investing in Employees and a Best Place to Work THE UNIVERSITY OF MICHIGAN HEALTH MANAGEMENT.

Go For Health Workplace Wellness Forum Champion Companies: Investing in Employees and a Best Place to Work THE UNIVERSITY OF MICHIGAN HEALTH MANAGEMENT RESEARCH CENTER Dee W. Edington June 1, 2011 Windsor, ON

Consortium UM-HMRC Corporate Consortium Ford Delphi Kellogg We Energies General Motors JPMorgan Chase Crown Equipment Delphi Automotive Southern Company University of Missouri Medical Mutual of Ohio Florida Power and Light St Luke’s Health System St Joseph Health System Allegiance Health System Cuyahoga Community College United Auto Workers-General Motors American Construction Benefits Group Australian Health Management Corporation Steelcase (H) Progressive (H) Affinity Health System (H) SW MI Healthcare Coalition (H) Wisconsin Education Association Trust (H) *The consortium members provide health care insurance for over two million individuals. Data are available from three to 20 years. Meets on First Wednesday of each December in Ann Arbor.

Business Problem Currently, most costs associated with workplace and workforce performance are growing at an unsustainable rate How are we going to be successful in this increasingly competitive world without a healthy and high performing workplace and workforce? How can we turn costs into an investment?

What if you worked for the best company you could imagine. A company that was a high performing company and a best company to work for. What words would you use to describe the workplace and how would you describe the workforce?

The Journey of Becoming a Champion Companies: Zero Cost Trends and as a Best Place to Work Mission Change the Economic Assumptions from Treating Disease to the 21 st Century Assumptions about Creating and Maintaining Healthy Populations Natural Flow of a Population High Risks and High Costs Business Case Health as a Serious Business and Economic Strategy Solution Engage Champion Companies in Systematic, Systemic and Sustainable Five Pillars which Promote a Healthy and High Performing Workplace and Workforce

Section I The Current Healthcare Strategy Natural Flow Wait for Disease and then Treat (…in Quality terms this strategy translates into “wait for defects and then fix the defects” …)

Estimated Health Risks Health Risk Measure Body Weight Stress Safety Belt Usage Physical Activity Blood Pressure Life Satisfaction Smoking Perception of Health Illness Days Existing Medical Problem Cholesterol Alcohol Zero Risk High Risk 41.8% 31.8% 28.6% 23.3% 22.8% 22.4% 14.4% 13.7% 10.9% 9.2% 8.3% 2.9% 14.0% OVERALL RISK LEVELS Low Risk 0-2 risks Medium Risk 3-4 risks High Risk 5 or more From the UM-HMRC Medical Economics Report Estimates based on the age- gender distribution of a specific corporate employee population

1640 (35.0%) 4,163 (39.0%) 678 (14.4%) Risk Transitions (Natural Flow) Time 1 – Time 2 High Risk (>4 risks) Low Risk (0 - 2 risks) Medium Risk (3 - 4 risks) 2,373 (50.6%) 21,750 (77.8%) 4,546 (42.6%) 10,670 (24.6%) 4,691 (10.8%) 27,951 (64.5%) 11,495 (26.5%) 5,226 (12.1%) 26,591 (61.4%) 892 (3.2%) 1,961 (18.4%) 5,309 (19.0%) Modified from Edington, AJHP. 15(5):341-349, 2001 Average of three years between measures

Low Costs Associated with Risks Medical Paid Amount x Age x Risk Annual Medical Costs Med Risk Age Range High Non-Participant Edington. AJHP. 15(5):341-349, 2001

Section II Build the Business Case for Health as a Serious Economic Strategy (200+ Publications) Engage the Total Population to get to the Total Value of Health Complex Systems (Synergy & Emergence) versus Reductionism (Etiology)

Business Concept Relationships of Risks and Disease with Measures of Productivity (Time away from work)

Total Disability Cost by Risk Status Wright, Beard, Edington. JOEM. 44(12):1126-1134, 2002

Estimated Productivity Loss by Risk Status *p<.05, **p<.01 Burton, Chen, Conti, Schultz, Pransky, Edington. JOEM. 47(8):769-777. 2005

Medical/Drug Cost Comparison by Risk Status *p<.05. Yen, Witting, Edington. AJHP. 6:46-54, 1991

Business Concept Excess Costs follow Excess Risks

Excess Disability Costs due to Excess Risks $491 $666 $783 $1,248 Wright, Beard, Edington. JOEM. 44(12):1126-1134, 2002 36% of Absence, STD, Worker’s Comp

Excess On-The-Job Loss due to Excess Risks Burton, Chen, Conti, Schultz, Pransky, Edington. JOEM. 47(8):769-777. 2005 14.7%

Excess Pharmaceutical Costs due to Excess Risks $345 $443 $526 $567 $750 $754 $1,121 Burton, Chen, Conti, Schultz, Edington. JOEM. 45(8): 793-802. 2003

Excess Medical Costs due to Excess Risks $2,199 $3,039 $3,460 $5,520 Edington, AJHP. 15(5):341-349, 2001

Outcome Measures Low- Risk Medium- Risk High- Risk Excess Cost Percentage Short-term Disability $ 120$ 216$ 33341% Worker’s Compensation $ 228$ 244$ 49624% Absence$ 245$ 341$ 52729% Medical & Pharmacy $1,158$1,487$3,69638% Total$1,751$2,288$5,05236% Association of Risk Levels with Corporate Cost Measures Wright, Beard, Edington. JOEM. 44(12):1126-1134, 2002

Low Risk Excess Diseases Associated with Excess Risks (Heart, Diabetes, Cancer, Bronchitis, Emphysema Percent with Disease Med Risk Age Range High Musich, McDonald, Hirschland, Edington. Disease Management & Health Outcomes 10(4):251-258, 2002.

Business Concept Managed the Person: Not the Risk or Disease

Intervention for Biometric Cluster (Metabolic Syndrome)

NCEP ATP III. JAMA. 2001;285:2486. >40 in (>102 cm) >35 in (>88 cm)  150 mg/dL <40 mg/dL <50 mg/dL  130/85 mmHg  110 mg/dL Defining Level Risk Factor 1.Waist Size Men Women 2. Triglycerides 3. HDL-C Men Women 4. Blood pressure 5. Fasting glucose Clinical Identification of Metabolic Syndrome: Any three of the following:

Development and Consequences of Metabolic Syndrome Risks:  Waist Circumference  Hypertension  Glucose Intolerance  Triglycerides  HDL Cholesterol Pre-Metabolic Syndrome Metabolic Syndrome Heart Disease Diabetes Retinopathy Neuropathy Nephropathy Costs to Individual:  Quality of Life  Morbidity  Mortality Costs to Employers:  Health care costs  Productivity costs Where do you want to intervene in the process?

Medical and Drug Cost (Paid)* Improved=Same or lowered risks Slopes differ P=0.0132 Impr slope=$117/yr Nimpr slope=$614/yr

Business Case Zero Trends follow “ Don’t Get Worse” and “Help the Healthy People Stay Healthy”

Total Value of Health Medical/Hospital Drug Absence Disability Worker’s Comp Effective on Job Recruitment Retention Morale Disease Health Risks The Economics of Total Population Engagement and Total Value of Health Low or No Risks Where does cost turn into an investment? increase decrease

Health and Wellness ProgramsHealthierPerson Better Employee Gains for The Organization 1. Health Status 2.Life Expectancy 3.Disease Care Costs 4. Health Care Costs 5. Productivity a. Absence b. Disability c. Worker’s Compensation d. Presenteeism e. Quality Multiplier 6. Recruitment/Retention 7.Company Visibility 8. Social Responsibility 1981, 1995, 2000, 2006, 2008 D.W. Edington Lifestyle Change Health Management Programs Employs a Behavioral Change Strategy

In December of 2006 we celebrated the first 30 years of our work: the Business Case was solid, although not yet perfect. Congratulations! However, nothing has changed in the population No more people doing physical activity No fewer people weighing less No fewer people with diabetes Why the disconnect between the business case and the intervention outcomes?

Many programs are Stuck 1.Percent participation between 20% and 70% of employees. Engagement? Family? 2.ROIs of 1.5 to 6.0 on participating versus non-participating employees 3.Little if any bottom line risk change improvements 4.Little if any bottom line financial improvements There is a disconnect between the business case and program results.

A short Health & Performance Quiz If you continue to wait for defects and then try to fix the defects: Will you ever solve the fundamental problems? If you put a changed person back into the same environment: Will the change be sustainable? Is it better to keep a good customer or find a new one? Is the action you reward, the action that is sustained?

The world we have made as a result of the level of thinking we have done thus far creates problems we cannot solve at the same level of thinking at which we created them. - Albert Einstein

Where do we go next? TO A NEW LEVEL OF THINKING…

From the Cost of Disease to the Total Investment and Value of Health the Total Investment and Value of Health From Health as the Absence of Disease to Disease as the Absence of Health From Individual Participation to Total Population Engagement … to a Transformation from the Tired Old 20 th Century Assumptions About Disease to the New 21 st Century Assumptions About Healthy and High Performing Populations From Behavior Change to Integration of Health into the Culture

Vision for Zero Trends Zero Trends was written to be a transformational approach to the way organizations ensure a continuous healthy and high performing workplace and workforce Based upon over 200 Research Publications

© 2011 Edington Associates, LLC Integrate Health into Core BusinessHealthierPerson Better Employee Gains for The Organization 1. Health Status 2.Life Expectancy 3.Disease Care Costs 4. Health Care Costs 5. Productivity a. Absence b. Disability c. Worker’s Compensation d. Presenteeism e. Quality Multiplier 6. Recruitment/Retention 7.Company Visibility 8. Social Responsibility 1981, 1995, 2000, 2006, 2008 D.W. Edington Lifestyle Change Health Management Programs Company Culture and Environment Senior Leadership Operations Leadership Self-Leadership Reward Positive Actions Quality Assurance

© 2011 Edington Associates, LLC Five Fundamental Pillars (Framework) Pillar 3: Self- Leadership Pillar 4: Reward Actions Pillar 5: Quality Assurance Pillar 1: Senior Leadership Pillar 2: Operations Leadership Strong Vision Visible Committed Leadership Culture of Health Supportive Environment Create Winners Help Employees Not Get Worse Help Healthy People Stay Healthy Reward Champions Reinforce at every touch point Continuous Improvement Drives Program Improvements Systematic, Systemic and Sustainable Communication and Enrollment Engagement and Culture Cost Savings Medical costs Medical costs Productivity Productivity Prevention and Wellness CaseManagement Disease Management Programs Along the Health Continuum Program Impact Best Place to Work Outcomes Self-leaders Self-leaders Healthier Healthier Communication, Engagement &Culture

© 2011 Edington Associates, LLC Senior Leadership Create the Vision Connect vision to business strategy Commit to healthy culture Provide adequate resources Leadership engaged as visible committed participants Courage “Establish the business value of a healthy and high performing organization and workplace as a world-wide competitive advantage” 42

© 2011 Edington Associates, LLC Create the Vision: Manage health as a strategic competency in order to: Improve Workforce Health & Performance Achieve Zero Trend in Annual Sick Care Expenditures Link Vision to Company Mission: Our mission is to create Shareholder value. We get value from creative and innovative products. We get innovative products from healthy and productive people. Create the Vision 44 Pillar 1: Senior Leadership

© 2011 Edington Associates, LLC Picture of the Future A picture of the end result, something you can actually see, not vague. Focus on what you want to create, not what you want to get rid of. Focus on the end result, not the process for getting there. Pillar 1: Senior Leadership

© 2011 Edington Associates, LLC Committed, vocal and enthusiastic leadership promotes: Increased awareness Increased awareness More motivated employees More motivated employees Higher levels of participation Higher levels of participation Increased Enrollment Levers of Program Success: Systematic Pillar 1: Senior Leadership Strong Vision Visible Committed Leadership Communication and Outreach Outreach Enrollment and Engagement Cost Savings Medical costs Medical costs Productivity Productivity Prevention and Wellness RiskManagement Disease Management Programs Along the Health Continuum Program Impact Best Place to Work Outcomes Self-leaders Self-leaders Healthier Healthier Communication and Enrollment Engagement and Culture Communication, Engagement &Culture

© 2011 Edington Associates, LLC Quality Assurance: Senior Leadership Management Metrics G Sick Cost Trend LineChange in Risk Profile Goal: Low Risk ≥ 70% Key Metrics for Senior Leadership Ensure high levels of engagement Does change in cost beat natural flow? Does change in risk beat natural flow? Goal: Low Risk ≥ 85% *Example metrics, goals and graphics Include on Executive Dashboard with other Core Company Success Metrics Key High Level Metrics of Program Progress Pillar 1: Senior Leadership

© 2011 Edington Associates, LLC Senior Leadership Key Learnings Commit to the vision and have the courage to see it through Connect & align the vision to business strategy Provide resources & ongoing support to realize the vision Role model & cheerlead along the way to success 49

© 2011 Edington Associates, LLC Short Quiz If you have been managing health (including its costs) the same way for years and you continue to get the same unsatisfactory results: Isn’t it time to find a new level of thinking? “Insanity: doing the same thing over and over again and expecting different results.” Isn’t it time for a Transformation? Discussion: Are your senior leaders: already getting it, never will get it, or you don’t know? What can you do to support and advance the “spirit” and heart of Zero Trends in your situation? 50 Pillar 1: Senior Leadership

© 2011 Edington Associates, LLC Align Workplace & Policies with the Vision Integrate policies into health culture Brand health management strategies Engage everyone “You can’t put a changed person back into the same environment and expect the change to hold” Operations Leadership 51

© 2011 Edington Associates, LLC 53 All Mid-level Managers Embody the Vision All First-level Supervisors Embody the Vision Employees Embody the Vision Support Each Other to Achieve Goals Pillar 2: Operations Leadership Pillar 3: Promote Self-Leadership Pillar 1: Senior Leadership Mid-level Manager Supervisor Communication & Dissemination Employee Engagement and communication Trained, engaged, and reinforcing message Formal and Informal Mechanisms for Communicating Feedback from all Levels Pillar 2: Operations Leadership

© 2011 Edington Associates, LLC The Transformation needs New Tools Next Generation Health Risk Assessments Corporate Culture and Environmental Audit and Gap Analyses Where do Employees go after Work? Community and Home From Best Practices to Next Practices

© 2011 Edington Associates, LLC …set of core attributes reflecting the prevailing values, underlying assumptions, expectations and definitions that members of a work organization collectively maintain. The sum of these characteristics effect the way members think, feel, and behave related to matters of personal and group health. What is a “Culture of Health” Pillar 2: Operations Leadership

© 2011 Edington Associates, LLC Secure Input From Employees –Naming contest –Input from target audience Look & Feel Consistent with Company Culture and/or Target Audience Brand Health Management 57 Pillar 2: Operations Leadership

© 2011 Edington Associates, LLC Strategies for Accomplishing Solid Engagement: Slightly modified from: Serxner, S. et al. Building Program Participation: Strategies for Recruitment and Retention in Worksite Health. Promotion Programs. American Journal of Health Promotion. March/April 2004. Engage Everyone 59 Manage all segments of the population Regular assessments of engagement process Position the program powerfully “brand identity” Target communications Include one-on-one outreach Offer a variety of intervention options Use incentives wisely Pillar 2: Operations Leadership

© 2011 Edington Associates, LLC Participation Versus Engagement Participation – Doing the steps of the wellness program process: – Complete a health assessment, – Participate in the requisite programs, – Based on extrinsic motivation (external carrot or stick) Engagement – Taking the changes to heart: – Continued behavior regardless of carrot or stick – Based on intrinsic motivation

© 2011 Edington Associates, LLC Supportive culture and environment: Creates supportive employee health community Creates supportive employee health community Reduces barriers to change Reduces barriers to change Further increases participation and strengthens engagement Further increases participation and strengthens engagement Pillar 1: Senior Leadership Strong Vision Visible Committed Leadership Pillar 2: Operations Leadership Culture of Health Supportive Environment Increased Enrollment and Better Engagement Communication and Outreach Outreach Enrollment and Engagement Cost Savings Medical costs Medical costs Productivity Productivity Prevention and Wellness RiskManagement Disease Management Programs Along the Health Continuum Program Impact Best Place to Work Outcomes Self-leaders Self-leaders Healthier Healthier Levers of Program Success: Systemic Communication and Enrollment Engagement and Culture Communication, Engagement &Culture

© 2011 Edington Associates, LLC Short Quiz If you have been managing health (including its costs) the same way for years and you continue to get the same unsatisfactory results: Isn’t it time to find a new level of thinking? “Insanity: doing the same thing over and over again and expecting different results.” Isn’t it time for a Transformation? Discussion: Given your senior leadership commitment, what are your priorities for establishing and/or sustaining a culture of health and/or self leadership? 63 Pillar 2: Operations Leadership

© 2011 Edington Associates, LLC Create Winners Help employees not get worse Help healthy people stay healthy Provide improvement and maintenance strategies “Create winners, one step at a time and the first step is don’t get worse’ Self-Leadership 64

© 2011 Edington Associates, LLC Pillar 3: Self-leadership Quick Assessment LowMediumHigh 1. To what degree has the vision been translated into an engaging experience? 2. To what degree is engagement in the vision occurring at an employee, family and the community level? 3. To what degree are self leadership and resiliency being promoted as the primary objective? 4. To what degree are monitoring and adjustments utilized to achieve the desired outcomes? Pillar 3: Self-leadership Quick Assessment LowMediumHigh 1. To what degree has the vision been translated into an engaging experience? 2. To what degree is engagement in the vision occurring at an employee, family and the community level? 3. To what degree are self leadership and resiliency being promoted as the primary objective? 4. To what degree are monitoring and adjustments utilized to achieve the desired outcomes? Pillar 3: Self-leadership Quick Assessment LowMediumHigh 1. To what degree has the vision been translated into an engaging experience? 2. To what degree is engagement in the vision occurring at an employee, family and the community level? 3. To what degree are self leadership and resiliency being promoted as the primary objective? 4. To what degree are monitoring and adjustments utilized to achieve the desired outcomes? Pillar 3: Self-leadership Quick Assessment LowMediumHigh 1. To what degree has the vision been translated into an engaging experience? 2. To what degree is engagement in the vision occurring at an employee, family and the community level? 3. To what degree are self leadership and resiliency being promoted as the primary objective? 4. To what degree are monitoring and adjustments utilized to achieve the desired outcomes? Quick Assessment 65 Pillar 3: Self-leadership Quick Assessment LowMediumHigh 1. To what degree has the vision been translated into an engaging experience? 2. To what degree is engagement in the vision occurring at an employee, family and the community level? 3. To what degree are self leadership and resiliency being promoted as a core objective? 4. To what degree are monitoring and adjustments utilized to achieve the desired outcomes?

Self-Leadership and High Performance PersonalPersonalControl OptimismOptimism Self-leadership ResilienceResilience Confidence / Self- efficacyConfidence / Self- efficacy Self- esteemSelf- esteem KnowledgeKnowledge Health LiteracyHealth Literacy Negotiation SkillsNegotiation Skills Vitality/Vitality/Vigor ConsumerismConsumerism EngagementEngagement Social SupportSocial Support – Colleagues – Community – Family Environment and cultureEnvironment and culture Other possible *constructs: Change, Vision, Trust, Thrive, Enthusiasm, Ethics, Energy, Spirituality, Creativity, … Low-Risk Health Status Purpose-Values-Mission-Vision ©2010: Edington Associates

© 2011 Edington Associates, LLC Population-Based Programs Create a “Winning” Culture A. First Six-Months: “Don’t Get Worse.” Health Status Winner Strategy The Failure Strategy Body Weight Don’t Gain WeightReduce Weight to 25 BMI Physical Activity Walk 500 steps/dayWalk 10,000 steps/day Blood Pressure Know Your Numbers Control Your Numbers Cholesterol Know Your Numbers Control Your Numb ers B. Second Six-Months: Raise the Bar in Small Intervals

© 2011 Edington Associates, LLC Supporting Self-Leadership Challenge Assumed Constraints Understand Points of Power: -Knowledge power -Position power -Task power -Relationship power -Personal power *Blanchard K, Fowler S, Hawkins L. Self-leadership and the One Minute Manager. 2005 Collaborate for Success -When competence is low, provide direction -When commitment is low, provide support Approaches that help employees: “When goals work out, it is usually because you instinctively take the initiative to be a self-leader and get what you need to succeed” Pillar 3: Self-leadership 68

© 2011 Edington Associates, LLC Supporting Self-Leadership Challenge Assumed Constraints Understand Points of Power: -Knowledge power -Position power -Task power -Relationship power -Personal power *Blanchard K, Fowler S, Hawkins L. Self-leadership and the One Minute Manager. 2005 Collaborate for Success -When competence is low, provide direction -When commitment is low, provide support Approaches that help employees: “When goals work out, it is usually because you instinctively take the initiative to be a self-leader and get what you need to succeed” Pillar 3: Self-leadership

© 2011 Edington Associates, LLC Weight Management Physical Activity Stress Management Communications Safety Belt Use Smoking Cessation Nutrition Education On-Line Information Nurse Line Newsletters Behavioral Health & EAP Pharmacy Management Case Management Absence Management Disability Management Business Specific Modules Career Development Communications Financial Management Social/Information Networks Clinic or Medical Center On-Line Information Ergonomics Vision Dental Hearing Chiropractic Complementary Care Integrative Medicine Physical Therapy 70 Population Based Resources Pillar 3: Self-leadership

© 2011 Edington Associates, LLC More Impactful Health Programs Promoting self-leadership through: Greater confidence to change Greater confidence to change Increased commitment to stick to it Increased commitment to stick to it Pillar 1: Senior Leadership Pillar 2: Operations Leadership Strong Vision Visible Committed Leadership Culture of Health Supportive Environment Increased Enrollment and Better Engagement Communication and Outreach Outreach Enrollment and Engagement Cost Savings Medical costs Medical costs Productivity Productivity Prevention and Wellness RiskManagement Disease Management Programs Along the Health Continuum Program Impact Best Place to Work Outcomes Self-leaders Self-leaders Healthier Healthier Levers of Program Success Pillar 3: Self- Leadership Create Winners Help Employees Not Get Worse Help Healthy People Stay Healthy Communication and Enrollment Engagement and Culture Communication, Engagement &Culture

© 2011 Edington Associates, LLC Self-Leadership: Key Learnings Create and structure an engaging experience for all employees across the health spectrum that includes family and community Programs designed to promote self- leadership, vitality and resilience Monitor and adjust approach and structure as necessary to achieve desired outcomes 72

© 2011 Edington Associates, LLC Short Quiz If you have been managing health (including its costs) the same way for years and you continue to get the same unsatisfactory results: Isn’t it time to find a new level of thinking? “Insanity: doing the same thing over and over again and expecting different results.” Isn’t it time for a Transformation? Discussion: What approaches to creating and supporting self-leadership would work (are working) in your organization? Pillar 3: Self-leadership

© 2011 Edington Associates, LLC Reinforce the Culture of Health Align recognition to the vision Reward champions Set incentives for healthy choices Reinforce at every touch point “What is rewarded is what is sustained” Recognize Actions 74

© 2011 Edington Associates, LLC Pillar 4: Recognition Quick Assessment LowMediumHigh 1. To what degree are participation and engagement being driven and achieved? 2. To what degree are self leaders and champions recognized? 3. To what degree is at least one good choice for participation provided to everyone? 4. To what degree are good choices and sustained results reinforced? Pillar 4: Recognition Quick Assessment LowMediumHigh 1. To what degree are participation and engagement being driven and achieved? 2. To what degree are self leaders and champions recognized? 3. To what degree is at least one good choice for participation provided to everyone? 4. To what degree are good choices and sustained results reinforced? Pillar 4: Recognition Quick Assessment LowMediumHigh 1. To what degree are participation and engagement being driven and achieved? 2. To what degree are self leaders and champions recognized? 3. To what degree is at least one good choice for participation provided to everyone? 4. To what degree are good choices and sustained results reinforced? Pillar 4: Recognition Quick Assessment LowMediumHigh 1. To what degree are participation and engagement being driven and achieved? 2. To what degree are self leaders and champions recognized? 3. To what degree is at least one good choice for participation provided to everyone? 4. To what degree are good choices and sustained results reinforced? Quick Assessment 75 Pillar 4: Recognition Quick Assessment LowMediumHigh 1. To what degree are participation and engagement being driven and achieved? 2. To what degree are self leaders and champions recognized? 3. To what degree is at least one good choice for participation provided to everyone? 4. To what degree are good choices and sustained results reinforced? Pillar 4: Recognize Action

© 2011 Edington Associates, LLC Tangible Incentives Cash Merchandise Vacation days Avoidance of costs (such as health care premiums or deductibles) Intangible Incentives Extrinsic: – Recognition – Group competition – Acceptance and approval of peers Intrinsic: – Personal challenges – A sense of accomplishment – A sense of belonging 76 Incentives can be tangible or intangible The Science and Art of Motivating Healthy Behaviors, by Barry Hall, BENEFITS QUARTERLY, Second Quarter 2008. http://www.buckconsultants.com/buckconsultants/portals/0/documents/publications/published_articles/2008/Articles_Hall_ Benefits_Quarterly_Q2_08.pdf Recognize Positive Action Pillar 4: Recognize Action Can be the tipping point that moves someone from inaction to action

© 2011 Edington Associates, LLC Quality Assurance: Recognition Metrics Regular Reports on Distribution of Rewards Track rewards as a proxy for program engagement and goal attainment Compare by group (work unit, employee type, site, etc…) Track costs relative to program savings G Rewards by GroupReward and Recognition CostsType of Rewards Distributed Key Recognition Metrics for Operations Leadership* 77 *% Adhering of individuals reporting a behavior change *In Thousands *Example metrics and graphics Pillar 4: Recognize Action

© 2011 Edington Associates, LLC Recognizing positive action: Reinforces healthy behaviors Reinforces healthy behaviors Impetus to begin changes Impetus to begin changes Develop intrinsic motivation Develop intrinsic motivation Sustained Behaviors Pillar 4: Reward Actions Pillar 1: Senior Leadership Strong Vision Visible Committed Leadership Reward Champions Reinforce at every touch point More Impactful Health Programs Increased Enrollment and Better Engagement Communication and Outreach Outreach Enrollment and Engagement Cost Savings Medical costs Medical costs Productivity Productivity Prevention and Wellness RiskManagement Disease Management Programs Along the Health Continuum Program Impact Best Place to Work Outcomes Self-leaders Self-leaders Healthier Healthier Levers of Program Success Pillar 3: Self- Leadership Pillar 2: Operations Leadership Culture of Health Supportive Environment Create Winners Help Employees Not Get Worse Help Healthy People Stay Healthy Communication and Enrollment Engagement and Culture Communication, Engagement &Culture

© 2011 Edington Associates, LLC Recognize Positive Actions Key Learnings Drive engagement Recognize Champions – support the behavior you desire Provide at least one good choice for everyone – including the low risk Reinforce everyone for making good choices & sustaining participation 79

Short Quiz If you have been managing health (including its costs) the same way for years and you continue to get the same unsatisfactory results: Isn’t it time to find a new level of thinking? “Insanity: doing the same thing over and over again and expecting different results.” Isn’t it time for a Transformation? Discussion: What are examples of current recognition programs that are increasing participation rates and facilitating self-leadership? Pillar 4: Recognize Action

© 2011 Edington Associates, LLC Integrate all data Evaluate program outcomes Use a conceptual outcomes framework Provide timely feedback of progress toward vision, culture, self-leaders, actions, economic outcomes “Supports decisions throughout the life of the program” Quality Assurance 81

© 2011 Edington Associates, LLC Onsite / Near-site Medical Fitness Center Behavioral Health Case Manageme nt Absence Manageme nt Employer Data Health Plan Design Disease Manageme nt Health Assessmen t Health Portal Data Integration: Core of Quality Management 83 Consolidated Data and and Relational Outcomes Reporting and Relational Outcomes Reporting Data Warehouse HealthAdvocacy Wellness/ Risk Reduction Program Compensatio n Compensatio n Employer/ Job type Employer/ Job type Performance Performance Safety/Risk Management Safety/Risk Management Risk information Risk information Health Outcomes Health Outcomes Web Metrics Web Metrics Program Participation Program Participation Risk information Risk information Behavior Change Behavior Change Health Outcomes Health Outcomes Medical Service utilization data Medical Service utilization data Performance Performance Safety/Risk Management Safety/Risk Management Program engagement data Program engagement data Data on use of Center Data on use of Center Exercise freq./ duration Exercise freq./ duration Data on plan coverage, copay levels, etc. Data on plan coverage, copay levels, etc. Absenteeism information Absenteeism information Mental health service utilization data Mental health service utilization data Program Engagement data Program Engagement data Adjunct risk and health behavior data Adjunct risk and health behavior data Pillar 5: Quality Assurance

© 2011 Edington Associates, LLC Evaluate Outcomes Were there changes in Psychosocial Outcomes? Did health behaviors improve? Did health and clinical outcomes improve? Were there changes in worker productivity ? What types of organizational outcomes were seen? Was there a positive return on investment? Program Outcomes Psychosocial (Examples) Self-efficacy Resilience Quality of Life Behavior Change (Examples) Healthy Diet Regular Exercise Smoking Cessation Stress Reduction Health Indicators (Examples) Health Status Clinical Indicators Performance Absence Disability Worker’s Comp Presenteeism Organization Level Impact Recruitment/ Retention Company Visibility Social Responsibility Financial Service Utilization Expected Cost Trend Demonstrated Cost Trend Measure and understand change in outcomes that drive cost trends… Outline an outcomes framework and system of measurement to determine the ongoing effectiveness of the program and the organization’s financial gains Quality Assurance Evaluate Outcomes Pillar 5: Quality Assurance

© 2011 Edington Associates, LLC Proof of Concept Five necessary and sufficient components: 1.Demonstrate change in risk beats natural flow of risks 2.Demonstrate that change in % of low cost for 2X HRA participants beats the natural flow of costs 3.Demonstrate that % of low cost individuals in total population beats the natural flow of costs 4.Demonstrate that annual cost trends for company: a.Show a lower rate of increase over past several years b.Show a lower trend rate than benchmark companies c.Eventually show a trend rate that approaches zero or negative trend 5.Demonstrate that total savings exceeds or equals total program costs 85 Pillar 5: Quality Assurance

© 2011 Edington Associates, LLC Pillar 5: Quality Assurance Continuous Improvement Program Impact Continuous feedback of information about program processes and outcomes Impactful Health Programs Communication, Engagement, Culture Communication and Enrolment Engagement and Culture Cost Savings Medical costs Medical costs Productivity Productivity Prevention and Wellness CaseManagement Disease Management Programs Along the Health Continuum Program Impact Best Place to Work Outcomes Self-leaders Self-leaders Healthier Healthier Communication Engagement &Culture Levers of Program Success: Sustainability Pillar 3: Self- Leadership Pillar 4: Reward Actions Pillar 1: Senior Leadership Pillar 2: Operations Leadership

© 2011 Edington Associates, LLC Quality Assurance Key Learnings Integrate and leverage data to support decision making throughout life of program Evaluation Framework that guides the assessment of relationships among the context, mechanisms, and outcomes of the program Key actionable metrics and company index score for each pillar 87

Short Quiz If you have been managing health (including its costs) the same way for years and you continue to get the same unsatisfactory results: Isn’t it time to find a new level of thinking? “Insanity: doing the same thing over and over again and expecting different results.” Isn’t it time for a Transformation? Discussion: What are the biggest hurdles you see for implementing a comprehensive sustainable evaluation approach in your organization? Any examples of successful approaches? 88 Pillar 5: Quality Assurance

© 2011 Edington Associates, LLC Create a Strategy What is Your Vision? 91 Vision from Leaders Healthy System & Culture Champion Everyone a Self- Leader Reward Sustained Results Progress in All Areas Comprehensive Traditional Do Nothing Speech from Leader Reduction in Risks Reduce Health Risks Reward Achievement Change in Risk & Sick Costs Inform Leader Programs Targeting Risks Health Risk Awareness Change in Risks Status Quo Senior Leadership Operational Leadership Self- Leadership Reward Positive Actions Quality Assurance Status Quo Reward Enrollment

© 2011 Edington Associates, LLC Thank you for your attention. Please contact us if you have any questions. Phone:(734) 647-7602 Fax:(734) 763-2206 Email: dwe@umich.edu Website: www.hmrc.umich.edu Dee W. Edington, Professor, Director Health Management Research Center School of Kinesiology University of Michigan 1015 E. Huron Street Ann Arbor MI 48104-1689

Go For Health Workplace Wellness Forum Champion Companies: Investing in Employees and a Best Place to Work THE UNIVERSITY OF MICHIGAN HEALTH MANAGEMENT.

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Go For Health Workplace Wellness Forum Champion Companies: Investing in Employees and a Best Place to Work THE UNIVERSITY OF MICHIGAN HEALTH MANAGEMENT.

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