A Workplace Culture of Health

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• A Workplace Culture of Health
• Population Health Disease Management Colloquium
• Ray Fabius MD
• Strategic Adviser to the President - Walgreens
  Health Wellness
• March 3rd, 2009
• Date

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Lets Start with the Employer View

• Runaway health care costs without controls
• Threatens company viability
• Misuse, overuse, and underuse
• Need for Transparency
• Apply TQM, Six Sigma, TPS, Lean to Health care
• Consumerism
• Purchase Perceive Care in Silos
• Human Resources Leaders are Risk Advice
• Often Depend on Payers and Consultants for next
  answer
• Data deficient
• Workplace Safety
• Work Environment
• Workplace Health

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Todays Agenda

• The Success of Occupational Health Workplace
  Safety
• Translating that Success to Healthcare
• How can you create a Culture of Health inside a
  company?
• What would the value be in creating a Culture of
  Health?
• Examples of Successful Efforts to Create a
  Culture of Health

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Occupational Motor Vehicle Safety Improvements

• .

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One Glaring Exception The Healthcare Environment
is Becoming More Hazardous
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Effectiveness Pathway to Workplace Safety
Identify Opportunities
Measure Baseline
Establish Interventions
Implement Action Plan
Re Measure Data
Analyze for Effectiveness
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Prevention of Errors in Workplace Safety

• Technology
• Automated Processes
• Decrease Complexity
• Worker Removed from Process
• Operator Monitors Automated System for Abnormal
  Events
• Prepared to handle response or solution
• Standardization

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Tipping the Scale
Leadership Resources Awareness Guidelines Collabor
ation Standardization Simplification
Documentation Non-Punitive Active Learning Change
Agent Technology Training Feedback
Errors
Safety
Healthcare Delivery
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Conditions that Prevent Workplace Errors

• Good Managerial Decisions
• Right Equipment
• Maintenance of Equipment
• Skilled Knowledgeable Workforce
• Reasonable Workload Schedule
• Well-Designed Jobs
• Clear Guidance on Desired Undesired Performance

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Lessons Learned in Workplace SafetyPotential
Application to Workplace Health

• Growing Awareness
• Comprehensive Strategies
• Intolerance with Errors
• National Focal Point for Leadership
• Dissemination of Information
• Regulatory Responsibility
• Research
• Expanding Knowledge Base
• Substantial Resources

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What About the White Collar World?

• Executive Health
• Ergonomics
• Stress Management
• Resiliency
• Work Accommodation
• Ex pat Services
• Work / Life Balance

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Building a Culture of Health
STEP 1
COMPANY ASSESSMENT
STEP 2
DATA AND METRICS
STEP 3
OPERATIONAL PLAN
INTERVENTIONS
STEP 4
STEP 5
EVALUATION REFINEMENTS
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Changes Required to Create a Culture of Health

• Create Awareness
• Identify Gap from Benchmark
• Study Intervention Options
• Operationalize Best Efforts
• Training and Education
• Establish Accountabilities
• Celebrate Success

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How can you create a Culture of Health inside
your company?

• Branding
• Champions
• Rack Stack
• Incentives
• Mandates
• An environment of health
• Fitness
• Risk Assessment
• Risk Reduction
• Disease Management
• Proof of Concept
• Mainstream success

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Resources to Effect Change

• Leadership
• Attention
• Investment

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How do Health Wellness effect productivity?

• Health care self-insured
• Workers Compensation
• Disability
• Absence
• Presenteeism
• Poor performance

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The Skill The WillBut What About Not Being Ill!
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Total Employee Health Related Costs
Health Care Costs
Medical Care Hospitalization Pharmacy Diagnostic
Testing Behavioral Health Physical Therapy
DIRECT
Medical 22 Disability 4 Productivity Loss
74
Overtime Pay
Lost Productivity
Illness Injury Travel to Off-site MD
Subpar Quality
OTHER COSTS
Temporary Staffing
Absenteeism
Employee and Customer Dissatisfaction
Presenteeism
Turnover
Replacement Training
Administrative
Source Integrated Benefits Institute, 2000
Missed Deadlines
Adverse Bottom Line Impact
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The Connection Between Health Human Capital is
Significant

• Over 22 of working age adults report
  health-related work impairment in the past 30
  days from chronic illness. Those with impairment
  average 6.7 lost days. Equivalent to 2.5 billion
  impaired days/year. -Kessler
• American Productivity Audit Top 5 reasons for
  productivity loss result in 180 billion in lost
  time. -Stewart
• Illness and disability reduced total work hours
  by approximately 8.6. Nearly 8.7 million
  Americans were completely unable to work. The
  loss to the U.S. economy represented about 468
  billion. -Berger

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Leading by Example

• Investment in health delivery is consistent
  with a long-term view of maximizing return on
  human capital. Michael CritelliCEO,
  Pitney-Bowes
• A healthy, engaged, and productive workforce is
  critical to maximizing business performance and
  driving sustainable growth. Dean
  OestreichPresident, Pioneer Hi-Bred
  International, Inc.
• Our profit potential is inextricably linked to
  the capability and performance of our employees.
  Andrew LiverisPresident and CEO, The Dow
  Chemical Company

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Factors Affecting Health Productivity

• Health-related factors
• Physical health issues
• Chronic disease
• Acute illness
• Lifestyle issues
• Health risks
• Preventive care compliance
• Behavioral health
• Other factors
• Demographics
• Caregiving
• Work/life imbalance
• Financial concerns
• Employer health benefits

Productivity-related factors Absenteeism STD and
LTD programs FMLA policies Sick leave
policy Effect on team morale Value of time in
production Workers Compensation Presenteeism
Work relationships Job security and
control Health issues Work issues Ergonomic
issues Safety concerns
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Integrated Data to Evaluate Health
Productivity Costs
IHPM Journal, 2003

• HR/payroll
• employee demographics
• time reporting
• employee surveys
• turnover/overtime data
• performance appraisals

• Lost time data
• STD
• LTD
• FMLA
• PTO/sick leave

• Medical data
• group health
• pharmacy
• mental health
• health risk appraisals
• disease prevalence
• EAP utilization

Integrated data analysis

• Business data
• customer satisfaction
• production data
• quality data
• operational data
• net income
• gross revenue
• human capital costs

• WC/Safety data
• OSHA, accident
• reporting
• drug testing
• WC claims data

• Productivity metrics
• staffing/overtime
• per employee costs
• and revenues
• self-reported presenteeism

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Top 15 Drivers of Lost Work Time
Source Kesslers HPQ Adjusted to Workforce
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The Total Cost of Illness
Goetzel, et al. JOEM 2004
arthritis
diabetes
allergy
depression
migraine
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Health Risks Associated with Productivity Loss
The More Health Risks the Greater the Absence
The More Health Risks the Greater the Limitations
Some Health Risks Cause Greater Lost Work Hours
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Poor Health Impact Continuum of Employee
Performance Outcomes
Not doing well while working
errors complaints delays team breakdown
Not doing work on work time
unscheduled breaks unfocused time health exams on
work time information gathering
Not at work
unscheduled absence disability workers
comp replacement workers
Lost to the workforce
permanent disability early retirement due to
health issues premature death spousal illness
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HHS - The Workplace is a great location for
preventive programs

• Employers are becoming more aware
• that obesity, lack of physical activity, and
• tobacco use are adversely affecting the
• health and productivity of their
• employees and ultimately, the businesses
• bottom line.
• As a result
• Innovative employers are providing a variety of
  work-site-based health promotion disease
  prevention programs
• Significant return on investment for the employer
  (median ROI of 3.14)

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Driving Healthy Lifestyles
Smoking 0 Tobacco (None) Diabetes / Heart
Disease 5 Diet (5 Fruits/Vegetables A Day) Lack
of Exercise 10 Exercise (10,000 Steps A
Day) Overweight / Obesity 25 Weight (Body Mass
Index, weight to height ratio, less than 25
healthy)
Message Dont Smoke
Message Eat healthy
Message Be active
Message Maintain a healthy weight
Rewards (intrinsic / extrinsic) vs. Competitions
(rack stack)
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A High Performance Network can reduce an employee
communitys random access of care

• Studies show
• half or more employees believe
• all doctors and hospitals provide
• the same care
• half or more employees are not aware of
  guidelines of care
• physicians referral patterns are based on
  consanguinity, friendship, financial ties and
  proximity.

However the majority of an employee community
seek validation from their trusted clinician
before proceeding with a treatment decision.
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Identifying best specialists hospitals
directing employees to them
The TFHC specialty referral rate is 2/3 lower
than the community referral rate.
28.3
28.3
2007 Actual Billed Charges Paid January thru June
2007 Actual Billed Charges Paid January thru June
9.4
8.7
Using Best Hospitals 2006 vs 2007
Toyota presentation to IHPM
Using Best Specialists 2006 vs 2007
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Philosophical Approach to Onsite Health Services
Employers Health, Safety and Productivity
Programs
Occupational Health
Health and Wellness
Keeping Employees Safe and at Work
Keeping Employees Healthy
On-site health center provides the framework and
technological infrastructure for the delivery of
effective HP programs
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Clinical Outcomes for Health Center Users with
Diabetes
(2003 to 2005) N336
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Projecting Long-Term Economic Impact (Diabetes
Care Improvement)

• Analysis of risk factors
• predictive modeling indicate a
• significant reduction in risk of
• diabetes complications over
• the 2003-2005 period for
• diabetics under care
• Potential future economic
• impact - reduced patient
• morbidity has been estimated
• at an average of 1,800 of
• avoided medical costs per
• patient per year (before
• inflation adjustment)
• Economic impact does not
• include impact on
• productivity or disability
• outcomes

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GE Global Medical Network 230 On-Site Clinics
600 Doctors Nurses
The issue of benefits extends beyond our
country's borders
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Summary

• The Success of Occupational Health Workplace
  Safety
• Translating that Success to Healthcare
• How can you create a Culture of Health inside a
  company?
• What would the value be in creating a Culture of
  Health?
• Examples of Successful Efforts to Create a
  Culture of Health