Health Enhancement Research Organization

1
Health Enhancement Research OrganizationCreating
a Global Culture of HealthHyatt Regency
Chicago OHare AirportSeptember 18-19, 2006

• Jennifer A. Bruno
• Worldwide Director Wellness Health Promotion
• Johnson Johnson
• Deborah Gorhan
• Project Director - Healthy People
• Health Fitness Corporation

2

• The Worlds most comprehensive and most broadly
  based Health Care Company
• 2005 sales of 50.5 billion
• 230 operating companies in 57 countries selling
  products throughout the world
• Three worldwide business segments
• Consumer
• Medical Devices/Diagnostics
• Pharmaceutical
• Managed by a unique form of decentralized
  management 116,000 employees worldwide

3
Business Segments
Consumer Medical Devices/Diagnostics Pharmaceutical

4
Our Credo

• The Four Tenets
• Customers
• Employees
• Community
• Stockholders

5
Healthy People, Healthy Planet, Healthy Business
Healthy People
Healthy Employees
Workplace Safety
OUTCOMES
Lower Health Care Costs
Improve Productivity
Reduce Hazardous Workplace Exposure
Improve Health Risk Factors
DRIVERS
Medical Case Management
Talent and Competencies
Identification of Occupational Health Risks
Organizational Culture of Health
Management of Occupational Health Risks
6
History

• LIVE FOR LIFE Program in 1978 was a partnership
  of five unique areas
• Benefits - Medical - EAP
• Safety - Wellness
• James E. Burke, the Johnson Johnson Chairman
  and CEO, set two major goals for the LIVE FOR
  LIFE Program
• Encourage JJ employees to become the healthiest
  in the world through education and easy access to
  prevention programs
• Implement on-site programs and services to reduce
  the cost of health care for the corporation
• Organized as a shared service for the US in 1995
  integrating the functional areas EAP,
  Occupational Health, Wellness Fitness, and
  Disability Management under one umbrella
  reporting through HR.
• Today, aligned with the WW EHS organization
  providing leadership, consultation, guidance and
  support for the delivery of quality integrated
  health programs and services worldwide.

7
Occupational Health
Global Integrated Health
Executive Health
Health Promotion
Travel Health
Absence Management
Employee Assistance
8
Global Integrated Health Objectives

• Leadership, consultation, guidance and support
  for the delivery of quality employee health
  programs and services worldwide
• Absence Disability Management
• Employee Assistance
• Wellness Health Promotion
• Occupational Health
• Proactive injury and illness preventive
  strategies for employees worldwide
• Delivery of consistent global health services
• Uniform health standards with local consideration
• Performance metrics for the global health
  community

9
Organizational Structure Commitment

• Johnson Johnsons organization is structured to
  support an integrated approach to the design and
  delivery of Health, Wellness, Safety and Benefit
  programs

Health Safety Vision We are committed to
making JJ the world leader in health and safety
by achieving healthy lifestyles and injury-free
workplaces.
Benefits Vision Create a healthy, engaged and
productive workforce which will support Johnson
Johnson in becoming the most successful health
care company in the world.
JJ Executive Committee
Technical Resources Compliance
Vice PresidentWorldwide Health Safety
Worldwide Benefits Health Resources
Director, US BenefitsPlanning Operations
Executive DirectorWorldwide Health
SafetyTechnical Services
10
Integrated Health Services- US

• Absence Disability Management
• - Management Consultation
• Medical Case Management
• Short Term Disability (STD)
• Disability Appeal Committee
• Vocational Rehabilitation
• Return-to-Work Planning
• Medical Leave Certification
• Workers Comp Case Coordination
• Injury/Illness Prevention
• Workplace/Job Accommodation

• Employee Assistance
• Management Consultation
• Critical Incident Debriefing
• 800 Line Crisis Assistance
• Short Term Counseling and Referral
• Supervisor Training
• Coordination of Field Alcohol/Drug Training
• Case Management
• Educational Training
• Mental Health/Substance Abuse Screening

• Occupational Health
• Pre-placement Assessments
• Medical Surveillance
• Emergency Treatments
• Regulatory Compliance
• Ergonomics Program
• Preventive Screening
• Drug Free Workplace
• Global Health Standards Guidelines Policy
• Deployment
• Workers Comp Case Management
• Return to Work Evaluation

• Wellness Health Promotion
• Healthy People
• Health Profiles
• Target Risk Interventions
• Health Education
• Environmental/Cultural Support
• Wellness Center Management
• Exercise Classes/Personal Training
• Fitness Assessments
• Job Conditioning
• Exercise Reimbursement/Travel Fitness
• Integration with Benefits Disease Management

• Work, Family Personal Life
• LifeWorks Consultation Resource Referral
• Childcare, Parenting, Adoption
• Eldercare Nursing Home Evaluation
• Legal, Education, Consumerism
• LifeWorks 800 24/7
• Work/Life Seminars
• Educational Materials
• LifeWorks Online
• NURTURE SPACE?
• College Coach

11
Why Healthiest Workforce?
12
Creating a Culture of Health
Commitment
HealthyPeople
Motivation
Effective Approach
13
Commitment

• Leadership
• Public advocacy for healthy workplaces
• Internal management emphasis (talkingthe talk
  and walking the walk)
• Healthy Lifestyle Support
• Health Profile Lifestyle Counseling
• Physical fitnessfitness centers, walking
  trails, pedometer initiative, exercise classes,
  exercise reimbursement, contests
• Healthy eatingcafeterias, vending, meeting food
• Integration of Healthy People 2005 with Benefit
  Design
• Global Policies HIV/AIDS Tobacco Free
  Workplaces

14
Motivation

• Marketing CommunicationsHealthy People Branding

Biometrics Wallet Card
Lifestyle Program Promotion
Web Resource Promotion
Newsletter
Personal Profile Reminder

• JJs Better Health Better Future tag line
  addresses both the personal and business motives
  around health improvement

15
Effective Approach

• Objectives
• Address spectrum of needs, and invest in
  people/programs through strategies that can yield
  the biggest benefit.
• Use proven programs/methods
• Measure outcomes/manage program investments
  accordingly

16
Effective Approach

• Integrated data drives planning, enables
  evaluation to achieve total economic value from
  benefit investments

17
Healthy People Strategy
18
Integration of Health Benefits

• Improve Employee Overall Health and Well-Being
• Enhance Employee Productivity
• Contain Health Care Costs
• Emphasize Shared Responsibility to Better Manage
  Health
• Financial Incentives for Employees Around
  Participation
• Continue to Provide CareConnect to Assist Members
  With Chronic or Complex Conditions

19
Healthy People Medical Plan

• Employees receive annual 500 discount on medical
  plan contributions
• To maintain the 500 discount, employees must
• Complete the Health Profile every two years
• Participate in Health Profile Counseling, if
  identified by health risk criteria
• Participate in disease management program
  CareConnect - if identified by chronic or complex
  condition criteria
• If employee chooses not to participate in any one
  of the requirements, they forfeit the annual
  discount

20
Healthy Employees U.S.
Johnson Johnson Healthy People 2005 Progress Johnson Johnson Healthy People 2005 Progress Johnson Johnson Healthy People 2005 Progress Johnson Johnson Healthy People 2005 Progress Johnson Johnson Healthy People 2005 Progress United States Healthy People 2010 United States Healthy People 2010
Indicator Baseline 95-99 Target 2005 Results 2003 Results 2004 Results 2005 Baseline Target
Smoking Tobacco Use 12 9 6 6 5 24 12
Blood Pressure Above 140/90 14 10 10 9 10 28 16
Cholesterol Above 240 19 15 9 9 8 21 7
Inactivity lt 3 days/wk 39 20 41 38 38 40 20

• Healthy People Indicators provide US
  enterprise-wide focus and performance targets
• Performance meets or exceeds all targets, except
  physical activity/inactivity

21
Healthy People U.S.Impact on Health Outcomes
Excess Cost
17,940
17,480
8,740
6,440
5,520
4,600
3,680
2,300
Health Risk Factor Risk Improvement Excess Annual Health Care Costs per Employee with Risk Factor Estimated Cost Avoidance
Tobacco Use 3220 1074 3,458,280
High Blood Pressure 1940 979 1,801,360
High Cholesterol 5060 683 3,455,980
Inactivity 460 1068 491,280
Total Total Total 9,206,900
Data extrapolated to JJ average population of
46,000 and JJ per capital Health Care Costs
22
Health Financial Outcomes
Impact on Health Risks
For 4500 Employees identified as High Risk
Health Risk Change
Modified Risk Factors
23
Health Risk Reduction Financial Impact Physical
Activity
17,940 JJ Inactive Baseline
17,480 Inactive Current
MINUS
X
1068 Excess Cost/Inactive Employee
For every 1 improvement in our physical activity
risk, the potential cost avoidance is almost
500M.
Potential Cost Avoidance 491,280
24
Impact on JJ Salaried Health Care Costs

• In 2005, JJs per capita increase was 6
  (National Data 9.5)
• Since 1999, JJs average trend was at least 1
  below the national trend, despite having a
  significantly richer plan
• JJ initially attributed its success to their
  Healthy People programs and initiatives, now
  being expanded to the Global Employee community

25
Financial Health Outcomes

• HW Redesign Was a Sound Business Investment
• HW Saved Money and Generally Improved Employee
  Health - Above and Beyond an Already Established
  and Excellent LIVE FOR LIFE Program
• The High Risk Program Worked Well for the Risk
  Factors Targeted and, the Program Saved Money
• Financial Incentives Work High Participation
  Rates ( 90) Achieve Impressive Financial
  Results
• The Longest Ever Corporate Evaluation Study (9
  Years) Provides Scientific Documentation That
  Integrated Health and Productivity Management
  Programs Work

26
Population Health

• Addressing Lifestyle, Personal Health Risks and
  Public Health Risks

27
Physical Activity
At least 60 of global population fails to
achieve 30 minutes moderate intensity physical
activity daily (WHO)

• Physical Activity Programs
• Knowledge Building Behavior Change
• Pedometers 30,000 participants globally
• Million Step Challenge 10,000 participants
• Exercise Reimbursement Program 4,600
  participants
• Online Nurse Counseling 5,000 participants
• Environmental Cultural Support
• Fitness Centers/Fitness Rooms
• Walking Trails
• Stairwell Campaigns
• Fitness Center Design Activity Guidelines

Continue to build momentum toward a global
culture that encourages and supports healthy
lifestyles.
28
Mental Health Depression
Depression is the leading cause of disability
globally, and the 4th leading health burden
affecting humanity. (WHO)

• Employee Assistance Services (EAP)
• Worldwide
• 50 of employees have access to services
• 6,000 employees have received resilience training
• Productivity Outcomes Study - U.S.
• Absence decreased in 96 of EAP clients
• Mental health status improved in 78 of EAP
  clients
• 4,000 savings per EAP user
• Mental Health Screening
• Confidential self-assessment to identify
  individual vulnerability
• Referral to mental health resource if indicated
  by screen results
• Accessed by 13,000 employees

29
Cancer Prevention
Single largest preventable cause of disease and
premature death in the world

• Applies to all operating company locations,
  (property, buildings, leased buildings, company
  vehicles and company-sponsored meetings)
• Flexible guideline to comply with local, state,
  regional laws or collective bargaining agreements
• Operating companies manage transition to
  tobacco-free by no later than January 2007
• Partnership with Global Human Resources and
  Worldwide Benefits Health
• Support materials and toolkit from Worldwide
  Health Safety

80 of Operating Companies have implementation
plans in place 30 are already Tobacco Free
30
Avian Influenza The world is now closer to
another influenza pandemic than at any time since
1968, when the last of the previous centuries
three pandemics began. (WHO)

• Pandemic Preparedness
• Distributed Guidance on Preparedness for Human
  Influenza Pandemic to management
• Business Continuity Planning
• Developed detailed site specific BCP procedure
  that is pandemic phase dependent
• Communication Plan
• Education Awareness Campaign
• Human Resource Guidelines
• BCP Supply Chain management
• Assist contacts with access to antiviral
  prophylaxis and treatment
• Partnerships and Resources
• CDC, WHO, Local Health and Government Agencies
• International SOS, Business Group on Health

Continuing To Evaluate And Anticipate Needs
31
Population Health Risk Factors

• Definition of employees meeting the defined
  Health Risk Threshold levels (based on identified
  Health Risk Indicators)
• Formula of employees identified by HRA data as
  being at low health risk
• Benchmark/Goal
• 70 of population will be defined as low risk,
• 1 annual health risk improvement
• Data Source
• Health Risk Assessment Indicators
• ObesityTotal Cholesterol- Tobacco Use- Physical
  Activity- Hypertension- Stress- Alcohol Use
  Glucose Healthy Eating Behavior-Safety Belt
  Usage (Safety Helmet, where applicable)

• Update Freq Annually
• X-Axis
• Y1-Axis
• Risk is of employees in the following defined
  Low, Med High threshold levels

Low 0-2 Med 3-4 High 5 or greater
Visual Example Only
32
Population Health Risks Defined

• Obesity - BMIgt 30
• Total Cholesterol - gt 240 mg/dl or gt 6.17 mmol/l
• Glucose - gt 126 mg/dl FASTING or gt 200 mg/dl
  non-fasting or gt 7.0 mmol/l
• Hypertension- gt 140 systolic and/or gt 90
  diastolic
• Tobacco Use- Yes
• Physical inactivity - lt30 minutes and lt4
  days/week or ltmost days
• Stress Heavily or Actively Stressed
• Alcohol Use - gt14 alcoholic drinks/week
• Unhealthy eating behavior - lt5 total fruits
  vegetables/day and/or daily consumption of high
  fat foods
• Safety Belt Usage (Safety Helmet, where
  applicable) - lt Almost always or Always

33
Organizational Health

• Addressing Culture Environment

34
Organizational Culture of Health

• Definition of Operating Companies meeting the
  threshold of Healthy Culture Profile
• Formula of sites/companies will offer
  promote minimum of 5 of the 14 global health
  service offerings for 2007
• Benchmark/Goal 93 of WW sites/companies will
  promote offer health service opportunities to
  their employees
• Data Source Global On-Line Assessment Tool

• Update Freq Quarterly
• X-Axis
• Y1-Axis
• Defined as of sites/companies promoting
  offering Med High threshold levels
• Meets 5 or greater
• Caution 2-4
• Needs attention lt2

35
Menu of Annual Global HealthService Offerings

1. Implementation of WW Tobacco Free Workplace
   Policy
2. Implementation of Health Risk Assessment
3. Seventy percent (70) of employee population at
   low risk (0-2)
4. Employee education awareness on healthy
   lifestyle behaviors
5. Access to Employee Assistance Services
6. Resiliency Training program
7. Implementation of WW HIV/AIDS Policy
8. Implementation of a Healthy Eating, Healthy
   Cafeteria program
9. Cancer Awareness Prevention Program
10. Physical Activity opportunities (such as access
    to fitness centers, exercise rooms, walking
    trails, etc.)
11. Modified/Alternate or Light Duty Return to Work
    Program
12. Process for tracking Sickness Absence
13. Access to Travel Health Resources
14. Medical Surveillance (based on risk) in
    compliance with all regulatory and JJ
    requirements
15. Executive Health Program

36
Implementation of a Healthy Eating, Healthy
Cafeteria Program
37
Healthy Eating
One billion overweight adults 300 million of
them obese 20 or more of all cases of cancer
could be prevented with varied amounts of fruits
and vegetables.

• Support employees efforts to reduce their risk
  primarily for hypertension, high cholesterol,
  cancer and obesity
• Opportunities for employees to access and enjoy
  Nutritionally Dense Whole Foods at every
  cafeteria, food station, vending machine, catered
  event, and whenever food is served at company
  functions
• Piloted at 6 companies in the US
• Expansion of program by request in 2006

Results increased sales, decreased subsidy and
high customer satisfaction
38
- The Process

1. Commit
2. Build Relationships
3. Assess Plan
4. Education Marketing
5. Implement
6. Evaluate, Adjust, Continuous Improvement

39
Commit

• Baseline, Final Outcome, Other Related Factors
• Where you are today
• Where you want to be
• Your Intentions, Thoughts, Actions, Effects
• What do you mean by healthy eating?
• What will be different?
• What impact on customer service, profit, etc?
•  

40
2. Build Relationships

• Frame
• Build the business and employee case
• Why should they care?
• Speak to what is important to them (finances,
  health, public relations, etc.)
• Advocate
• What will happen?
• Illustrate
• Show what you mean
• Bring in an influential person
• Access resources (AICR, NBGH, internal resources)
• Have someone who has been successful present
• Inquire

41
3. Assess Plan

• Visioning, Strategizing, Performing, Assessing
• How will you know when you are successful?
• Develop the PLAN
• What will you measure?
• Checklists, customer surveys, menus
• Who is accountable?
• Policing
• Sustaining
• What are the desired outcomes?

42
4. Education/Awareness/Marketing

• Build a communication plan
• Audience
• Vehicle
• Presenter
• Key Messages
• Create Marketing/Education Materials
• Create Communication Materials
• Create Education Materials Trainings
• Food Service Professionals (training)
• Employee awareness education 

43
5. Implement/Launch

• However, don't let perfectionism become an excuse
  for never getting started. Marilu Henner

6. Evaluate, Adjust, Continuous Improvement