1. Employee health and wellness metrics, measurements, and evaluation - - the building blocks for ROI David A. Alter, M.D., Ph.D., F.R.C.P.C Senior Scientist, Institute for Clinical Evaluative Sciences Division of Cardiology, The Li Ka Shing Knowledge institute of St. Michael’s Hospital Division of Cardiology, Cardiac and secondary prevention program, The Toronto Rehabilitation Institute Associated Professor of Medicine, University of Toronto

2. Disclosures Chief Scientific Officer, INTERxVENT Canada

3. “Ticking Clock” Hypothesis Haffner SM et al. JAMA. 1990;263:2893-2898. NGTIGTHyperglycemia Macrovascular Disease Microvascular Disease Deferred Gratification

4. “Ticking Clock” Hypothesis Haffner SM et al. JAMA. 1990;263:2893-2898. NGTIGTHyperglycemia Macrovascular Disease Microvascular Disease Deferred Gratification

5. “Ticking Clock” Hypothesis Haffner SM et al. JAMA. 1990;263:2893-2898. NGTIGTHyperglycemia Macrovascular Disease Microvascular Disease Deferred Gratification

6. “Ticking Clock” Hypothesis Haffner SM et al. JAMA. 1990;263:2893-2898. NGTIGTHyperglycemia Macrovascular Disease Microvascular Disease Deferred Gratification

7. How much? How long? At what costs? Metrics, measurement, and evaluation

8. Building blocks for ROI evaluation Choosing the appropriate question Selecting the appropriate population Designing the appropriate intervention Appropriate knowledge translation Determining the appropriate context

9. Asking the appropriate question

10. Benefits & payers Pharmaceuticals Appropriate use of meds Efficient use of meds Health Service Consumption Avoidable Hospitalizations Emergency Room Visits Physician Visits Productivity Absenteeism Disability Impairment Engagement Building blocks Metrics Measurement Evaluation Government Employers Pharmacy/Pharma

11. The evidence Chapman et al; The American Journal of Health Promotion 2003

12. Test case example

13. INTER x VENT Participants Notes: INTER x VENT Program was implemented in January 2003. Participants enrolled in the INTER x VENT Program in 2003 and completed a full year of service and evaluations. Analysis performed by Milliman Consultants and Actuaries. Non-INTER x VENT Participants Healthcare payer % Change in Average Health Care Claims Per Employee (Oklahoma Employer): 2002 vs. 2003

14. Selecting the appropriate population

15. Early dividends Absolute risk reduction; population impact driven by baseline risk Impact of interventions (ARR) Baseline risk

16. Number of Health Risks and Productivity Loss Productivity Loss (%) Number of Health Risks The average employee has 2.2 health risks, resulting in productivity losses of about $2,000/year. Excess Productivity Loss Base Cost Journal of Occupational and Environmental Medicine 2005;47:769-77 n = 28,375

17. Adjusted for age, gender, medical conditions, other baseline risks, and each individual’s productivity loss at baseline. Burton et al, J Occup Environ Med, 2006; 48:252-63

18. Designing the appropriate intervention

19. Organizational Intervention Global Health Risk Assessment: Action Plan & Reports Average or Low-risk High-risk (e.g. Multiple risk factors, heart disease, depression, behaviors) Self-Help Program Exercise, diet, weight management, stress management, tobacco, smoking cessation, cardiovascular risk reduction Self-Help Program Exercise, diet, weight management, stress management, tobacco, smoking cessation, cardiovascular risk reduction Mentored Program Step-by-step guidance on exercise, diet, weight management, stress management, tobacco, smoking cessation, cardiovascular risk reduction, drug safety & compliance. Mentored Program Step-by-step guidance on exercise, diet, weight management, stress management, tobacco, smoking cessation, cardiovascular risk reduction, drug safety & compliance. Personalized

20. Organizational Intervention Global Health Risk Assessment: Action Plan & Reports Average or Low-risk High-risk (e.g. Multiple risk factors, heart disease, depression, behaviors) Self-Help Program Exercise, diet, weight management, stress management, tobacco, smoking cessation, cardiovascular risk reduction Self-Help Program Exercise, diet, weight management, stress management, tobacco, smoking cessation, cardiovascular risk reduction Mentored Program Step-by-step guidance on exercise, diet, weight management, stress management, tobacco, smoking cessation, cardiovascular risk reduction, drug safety & compliance. Mentored Program Step-by-step guidance on exercise, diet, weight management, stress management, tobacco, smoking cessation, cardiovascular risk reduction, drug safety & compliance. Personalized Goal: reducing the prevalence of high-risk populations

21. Organizational Intervention Global Health Risk Assessment: Action Plan & Reports Average or Low-risk High-risk (e.g. Multiple risk factors, heart disease, depression, behaviors) Self-Help Program Exercise, diet, weight management, stress management, tobacco, smoking cessation, cardiovascular risk reduction Self-Help Program Exercise, diet, weight management, stress management, tobacco, smoking cessation, cardiovascular risk reduction Mentored Program Step-by-step guidance on exercise, diet, weight management, stress management, tobacco, smoking cessation, cardiovascular risk reduction, drug safety & compliance. Mentored Program Step-by-step guidance on exercise, diet, weight management, stress management, tobacco, smoking cessation, cardiovascular risk reduction, drug safety & compliance. Personalized Goal: reducing the prevalence of high-risk populations Variations in stratification algorithms Controls Culture

22. Attributing productivity- impairment to costs = Knowledge-Translation

23. Positioning Health & Wellness/Disease-management programs into their appropriate context

24. http://www.scotland.gov.uk/Publications/2007/

26. To what extent is employee- engagement impacted by health and wellness interventions? http://www.scotland.gov.uk/Publications/2007/

27. Test case example

28. Presenteeism – health metrics of employee engagement

30. Summary Building blocks for ROI –Appropriate questions –Appropriate population –Appropriate intervention –Appropriate knowledge translation –Appropriate context – employee-engagement Measurement, metrics, and evaluation –Quantification of both deferred gratification and earlier dividends

31. Selecting appropriate programs

32. Building blocks of the program Therapeutic life-style and disease-management Population screening Self-management & Education Behavioral learning theories Evidence-based care Information & monitoring system Reporting & feedback-loops Personalized interventions

33. 33 INTERxVENT % of Change 4.3 % Percent Change in 10-Year Framingham CHD Risk Score in Higher-Risk Employees (1-Yr Follow-Up; p<0.05 for NBH vs Comparison Program ) -22.6 % INTERxVENT’s Health Lifestyle Health Coaching Program Versus Program Offered By a Leading Academic Institution/Healthcare System (Comparison Program): Selecting a program -20% -15% -10% -5% 0% 5% 10% -25% Source: Abstract #62 May 2005 – AHA, CVD Epidemiology & Prevention Conference – Washington DC, Maron, David P, et al Comparison program

34. 34 Selecting a program Metrics, measurement, and evaluation