Transcript No Slide Title

Union Coalition Delegates Conference
Zero Trends: Health as a Serious
Economic Strategy
Leadership:
A Transformational
Approach to Health
UNIVERSITY OF
MICHIGAN
HEALTH MANAGEMENT
RESEARCH CENTER
Dee W. Edington
Think about what it would be like
if you worked in the best
performing organization you could
imagine and the best place to
work.
What words would you use to
describe the workplace and how
would you describe the
workforce?
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?
UM-HMRC Corporate Consortium
Steelcase (H)
 Ford
Progressive (H)
 Delphi
JPMorgan Chase (H)
 Kellogg
Affinity Health System (H)
 We Energies
SW MI Healthcare Coalition (H)
 General Motors
Wisconsin Education Association Trust (H)
 Crown Equipment
 Delphi Automotive
 Southern Company
*The consortium
 University of Missouri
members provide
 Medical Mutual of Ohio
health care insurance
 Florida Power and Light
for over two million
 St Luke’s Health System
individuals. Data are
 St Joseph Health System
available from three to
20 years.
 Allegiance Health System
 Cuyahoga Community College
Meets on First
 United Auto Workers-General Motors
Wednesday of each
December in Ann Arbor.
 American Construction Benefits Group
 Australian Health Management Corporation
Union Coalition Delegates Conference
Zero Trends: Health as a Serious Business
and Economic Strategy
March 25, 2011
Natural Flow of a Population
Business Case
Mission
Solution
High Risks and High Costs
Health as a Serious Business and
Economic Strategy
Change the Economic Assumptions from Treating
Disease to the 21st Century Assumptions about
Creating and Maintaining Healthy Populations
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%
From the UM-HMRC Medical
Economics Report
Estimates based on the agegender distribution of a specific
corporate employee population
OVERALL RISK LEVELS
Low Risk
0-2 risks
Medium Risk 3-4 risks
High Risk
5 or more
Risk Transitions
(Natural Flow)
Time 1 – Time 2
4,546
(42.6%)
10,670 (24.6%)
4,691 (10.8%)
1,961
(18.4%)
Medium Risk
(3 - 4 risks)
2,373 (50.6%)
High Risk
(>4 risks)
5,226 (12.1%)
892
(3.2%)
1640 (35.0%)
678
(14.4%)
11,495 (26.5%)
5,309 (19.0%)
4,163 (39.0%)
27,951 (64.5%)
Average of three years
between measures
Low Risk
(0 - 2 risks)
26,591 (61.4%)
21,750 (77.8%)
Modified from Edington, AJHP. 15(5):341-349, 2001
Total Medical and Pharmacy Costs
Paid by Quarter for Three Groups
The 20-80 rule is
always true but
terrifically flawed
as a strategy
Musich,Schultz, Burton, Edington. DM&HO. 12(5):299-326,2004
Costs Associated with Risks
Medical Paid Amount x Age x Risk
Annual Medical
Costs
$11,965
$11,909
$10,785
$7,991
$12,000
$8,927
$5,710
$5,114
$7,989
$9,000
$6,625
$6,636
$4,620
$6,000
$5,212
$3,353
$3,800
$2,565
$2,944
$1,414
$3,000
$1,776
$8,110
$5,756
$3,734
$4,613
$2,740
$2,193
$0
19-34
35-44
45-54
55-64
Age Range
Edington. AJHP. 15(5):341-349, 2001
65-74
75+
High
Med Risk
Non-Participant
Low
Section I: Four Learning Concepts
1. The flow of Risks is to High-Risks
2. The flow of Costs it to High-Costs
3. Without early identification, the High
Cost Spike is not Modifiable
4. Costs follow Risks and Age
Section II
Build the Business Case for the
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)
Excess Diseases Associated with Excess
Risks (Heart, Diabetes, Cancer,
Bronchitis, Emphysema
Percent with
Disease
100.0%
80.00%
80.0%
56.40%
61.40%
60.0%
25.30%
40.0%
20.0%
32.00%
High
9.50%
3.00%
Med Risk
10.50%
18.60%
Low Risk
0.0%
Less than 45
45 to 64
Greater than
65 Age
Musich, McDonald, Hirschland, Edington. Disease
Management & Health Outcomes 10(4):251-258, 2002.
Range
Percentage of Employees with a
Disability Claim by Risk Status*
HRA Participants
1998-2000 HRA
NonLow Risk Medium Risk
High Risk
0-2 Risks
3-4 Risks Participants 5+ Risks
(N=4,649)
(N=685)
(N=520)
(N=366)
WC Claims
25.4%
30.2%
30.2%
38.0%
STD Claims
23.4%
30.8%
29.6%
46.7%
Absence Record
49.9%
63.1%
41.0%
69.7%
Disability Claim
61.3%
72.5%
64.4%
81.7%
*Over three years 1998-2000
Wright, Beard, Edington. JOEM. 44(12):1126-1134, 2002
Excess Disability Costs due to Excess
Risks
$1,248
$666
$491
Wright, Beard, Edington. JOEM. 44(12):1126-1134, 2002
$783
Excess Medical Costs due to
Excess Risks
$5,520
$3,460
$3,039
$2,199
Edington, AJHP. 15(5):341-349, 2001
Excess Pharmaceutical Costs due
to Excess Risks
$1,121
$750
$526
$567
$443
$345
Burton, Chen, Conti, Schultz, Edington. JOEM. 45(8): 793-802. 2003
$754
Excess On-The-Job Loss due to Excess
Risks
14.7%
Burton, Chen, Conti, Schultz, Pransky, Edington. JOEM. 47(8):769-777. 2005
Association of Risk Levels with
Cost Measures
Outcome
Measures
LowRisk
MediumRisk
HighRisk
Excess Cost
Percentage
$ 120
$ 216
$ 333
41%
Worker’s
Compensation
$ 228
$ 244
$ 496
24%
Absence
$ 245
$ 341
$ 527
29%
Medical &
Pharmacy
$1,158
$1,487
$3,696
38%
Total
$1,751
$2,288
$5,052
36%
Short-term
Disability
Wright, Beard, Edington. JOEM. 44(12):1126-1134, 2002
Cost increased
Change in Costs follow Change in Risks
$600
$400
$200
Cost reduced
$0
-$200
-$400
-$600
3
2
1
Risks Reduced
0
1
2
3
Risks Increased
Overall: Cost per risk reduced: $215; Cost per risk avoided: $304
Actives:
Cost per risk reduced: $231; Cost per risk avoided: $320
Retirees<65: Cost
per risk reduced: $192; Cost per risk avoided: $621 Retirees>65: Cost per risk
reduced: $214; Cost per risk avoided: $264
Updated from Edington, AJHP. 15(5):341-349, 2001.
Medical and Drug Cost (Paid)*
Slopes differ
P=0.0132
Impr slope=$117/yr
Nimpr slope=$614/yr
Improved=Same or lowered risks
Business Case
Zero Trends follow
“Don’t Get Worse”
and
“Help the Healthy People
Stay Healthy”
The Economics of Total Population
Engagement and Total Value of Health
Low or
No Risks
Health
Risks
Total Value of Health
Medical/Hospital
Drug
Disease
Absence
Disability
Worker’s Comp
increase
Effective on Job
increase
Recruitment
decrease
Retention
Morale
Where does cost turn into
an investment?
Section II: Four Learning Concepts
1. Excess Risks lead to Excess Costs
2. Risks Travel in Clusters
3. Change in Risks lead to Change in
Costs
4. Controlling Risks leads to Zero
Trends
Health and Wellness Programs
Healthier
Person
Better
Employee
Lifestyle
Change
Health
Management
Programs
1981, 1995, 2000, 2006, 2008 D.W. Edington
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
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?
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?
Is it better to keep a good customer or
find a new one?
Is the action you reward, the action
that is sustained?
If you put a changed person back into the same
environment: Will the change be sustainable?
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
… to a Transformation from the Tired Old 20th
Century Assumptions About Disease to the New
21st Century Assumptions About Healthy and
High Performing Populations
1. From health as the absence of disease to health
2.
3.
4.
5.
as vitality and energy
From only caring for the sick to enabling healthy
people to stay healthy
From the cost of healthcare to the total value of
health
From individual participation to population
engagement
From behavior change to a Culture of Health
Section III
The Evidence-Based Solution:
Zero Trends
Integrate Health into the
Environment and the Culture
(…in Quality terms this strategy translates
into “…fix the systems that lead to the
defects” …)
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 175
Research Publications
Integrate Health into Core Business
Healthier
Person
Better
Employee
Gains for The
Organization
1. Health Status
2. Life Expectancy
3. Disease Care Costs
4. Health Care Costs
Lifestyle
5. Productivity
Company Culture
Change
a. Absence
and Environment
b. Disability
Senior Leadership
c. Worker’s
Operations Leadership
Compensation
Self-Leadership
d. Presenteeism
Reward
Positive
Actions
Health
e. Quality Multiplier
Quality Assurance
Management
6. Recruitment/Retention
Programs
7. Company Visibility
8. Social Responsibility
1981, 1995, 2000, 2006, 2008 D.W. Edington
LAYING THE GROUNDWORK
FOR TRANSFORMATIONAL
CHANGE
What is the value to you of a
healthy and high performing
champion workplace and
workforce?
To your organization?
To your community?
Characteristic of a
Transformational Champion
Organization
Systematic Strategies
Make the Solutions Systemic
Make it Sustainable
Transformation
Pillar 5
Quality Assurance
Where are you?
Senior
Leadership
Champion
Comprehensive
Traditional
Do Nothing
Operational
Leadership
SelfLeadership
Recognize
Positive
Actions
Quality
Assurance
Senior Leadership
Create the Vision
•Commitment to healthy culture
•Connect vision to business strategy
•Engage all leadership in vision
“Establish the value of a healthy and high performing
organization and workplace as a world-wide competitive
advantage”
Create the Vision
People are inspired by the purpose of the effort
Pillar 1:
Senior Leadership
People feel that their values and ideas are incorporated
into what the organization is trying to achieve
People can easily communicate the direction of the
effort
People recognize that both individual and organizational
needs are being addressed
People see how their day-to-day activities can support
the overall goals of the effort
A Vision Must be Woven into
Everything & Repeatedly Promoted!
Example Vision - Intel
Operations Leadership
Align Workplace with the Vision
•Brand health management strategies
•Integrate policies into health culture
•Engage everyone
“You can’t put a changed person back into the same
environment and expect the change to hold”
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
What is a Culture of Health
Pillar 2:
Operations
Leadership
A socially and structurally-constructed 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.
Promote Self Leadership
Create Winners
“Champions”
•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 and High Performance
•Purpose-Values-Mission-Vision
• Environment
and culture
•Personal
Control
•Resilience
• Consumerism
• Engagement
•Optimism
Self-leadership
•Confidence
/ Selfefficacy
•Knowledge
•Health Literacy
•Negotiation Skills
•Selfesteem
•Vitality/
Vigor
•Low-Risk Health Status
Other possible *constructs: Change, Vision, Trust, Thrive,
Enthusiasm, Ethics, Energy, Spirituality, Creativity, …
•Social
Support
–Colleagues
–Community
–Family
Strategies Focused on
Individuals
Pillar 3:
Self-leadership
Lifestyle/behavior change programs (e.g.,
programs to help employees stop smoking or
abusing drugs, lose weight, or better manage
stress)
Health and safety training (e.g., training employees
on general workplace safety practices and those
that apply to their specific jobs)
Clinical and preventive services (e.g., screenings
and immunizations for employees and their
families)
Source: UCI Health Promotion Center, Workplace Health Promotion, Information and Resource Kit.
http://www.seweb.uci.edu/users/dstokols/hpc.html
Population Based Resources
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
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
Pillar 3:
Self-leadership
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
Recognize Positive Actions
Reinforce the Culture of Health
•Recognize champions
•Set recognition for healthy choices
•Reinforce at every touch point
“What is rewarded is what is sustained”
Encourage Desired Behaviors
Pillar 4:
Recognize Action
Incentives Tied to Medical Plan Design:
• Premium reduction
• HRA completion
• HRA credits to offset deductibles
• Reduced co pays for preventative services
• Reduced co pays for Rx adherence of certain drug classes
• Non tobacco user incentive
Incentives Tied to Behaviors and Results:
• Wellness rebates for participation in physical activity; weight
management; tobacco cessation programs
• Greater subsidy of healthy foods in cafes, lower costs to
employees
• Recognition of employees that improve their health through
positive lifestyle changes
Recognize Positive Action
Pillar 4:
Recognize Action
Incentives can be tangible or intangible
Tangible Incentives
Intangible Incentives
Cash
Merchandise
Vacation days
Avoidance of costs (such
as health care premiums
or deductibles)
Can be the tipping point that
moves someone from inaction
to action
Extrinsic:



Recognition
Group competition
Acceptance and approval of
peers
Intrinsic:



Personal challenges
A sense of accomplishment
A sense of belonging
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_B
enefits_Quarterly_Q2_08.pdf
Quality Assurance
Outcomes Drive the Strategies
•Integrate all resources
•Measure outcomes
•Make it sustainable
“Metrics to measure progress towards the vision,
culture, self-leaders, actions, economic outcomes”
Data Integration: Core of Quality
Management
Pillar 5:
Quality Assurance
• Risk information
• Health Outcomes
• Performance
• Safety/Risk Management
• Web Metrics
• Program Participation
Health
Assessment
Health
Portal
Health
Advocacy
• Data on plan
coverage, copay
levels, etc.
Health Plan
Design
Employer Data
• Risk information
Wellness/ Risk
• Behavior Change
Reduction Program • Health Outcomes
Data
Warehouse
Absence
Management
• Absenteeism
information
•Program
engagement
data
Case
Managemen
t
•Program Engagement data
•Adjunct risk and health
behavior data
Fitness
Center
• Compensation • Performance
• Employer/ Job • Safety/Risk
type
Management
Onsite /
Near-site
Medical
Disease
Managemen
t
Behavioral
Health
Consolidated Data and
and Relational Outcomes
Reporting
• Data on use of
Center
• Exercise freq./
duration
• Medical
Service
utilization data
• Mental health service
utilization data
Evaluate Outcomes
Quality
Assurance
Evaluate
Outcomes
Pillar 5:
Quality Assurance
Outline an outcomes framework and system
of measurement to determine the ongoing
effectiveness of the program and the
organization’s financial gains
Measure and understand change in outcomes
that drive health and cost trends…
Were there changes
in Psychosocial
Outcomes?
Did health
behaviors
improve?
Did health and
clinical outcomes
improve?
Were there
What types of
changes in worker
organizational
productivity ? 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
53
Summary
Characteristic of a
Transformational Champion
Organization
Systematic Strategies
Make the Solutions Systemic
Make it Sustainable
Overall Business Strategy
What is your vision?
Senior
Leadership
Recognize
Positive
Actions
Pillar 2:
Operations Leadership
Operational
Leadership
SelfLeadership
Champion
Vision
from
Leaders
Healthy
System &
Culture
Everyone
a SelfLeader
Recognize
Positive
Actions
Progress
in All
Areas
Comprehensive
Speech
from
Leader
Reduction
in Risks
Reduce
Health
Risks
Reward
Achievement
Change in
Risk &
Sick Costs
Inform
Leader
Programs
Targeting
Risks
Health
Risk
Awareness
Reward
Enrollment
Change in
Risks
Status Quo Status Quo
Status Quo
Status Quo
Traditional
Do Nothing
Status Quo
Quality
Assurance
What’s the Point
Thank you for your attention.
Please contact us if you have any questions.
Phone: (734) 763 – 2462
Fax:
(734) 763 – 2206
Email:
[email protected]
Website: www.hmrc.umich.edu
Dee W. Edington, Ph.D. , Director
Health Management Research Center
School of Kinesiology
University of Michigan
1015 E. Huron Street
Ann Arbor MI 48104-1689