Post on 25-Jun-2015
Worksite Wellness Evalua0on: Basic Strategies for Worksites of All Sizes
HPlive.org Webinar
March 15, 2013
David Chenoweth, Ph.D., FAWHP
Well-‐planned Evalua0ons Can be a Decisive and Strategic Advantage
Assess quality of resources (personnel, equipment, facili>es, etc.) Determine level of impact Allocate your budget propor>onately Establish external benchmarking Guide strategic planning
A growing impetus for evalua0on…
Recreational Benefits
Enhancement
Alcohol Abuse
Treatment
1890 1930 1950 1970 1980 1990 2000 2015
Structured Exercise
“Wellness” Programming
Horseback rides, gyms, swimming, etc.
•Pullman •NCR
• Hershey Foods
Employee Assistance Programs
Safety
Occupational Safety & Health
Act •PepsiCo •NASA
• Kimberly-Clark • Sentry Ins.
• Quaker Oats • Union Pacific
• Steelcase • First Chicago Bank
“Business Strategy”
Health & Productivity Management
Purpose of Evalua.on…
“Evalua>on is not research; it is not done to prove or disprove anything;
it is done to improve something...”
Research Evalua>on
“Careful or diligent search” “Studious inquiry or examina9on”
“Determine or affix the value of” “Determine the significance,
worth, or condi9on…”
The Seven Benchmarks
1. Capturing Senior Level Support
2. Crea>ng Cohesive Teams
3. Collec0ng Data
4. CraRing an Opera>ng Plan
5. Choosing Appropriate Interven>ons
6. Crea>ng Suppor>ve Environments
7. Carefully Evalua0ng Outcomes
Courtesy of Wellness Council of America (WELCOA).
Perceived Values vs. Actual Performance…
Rank
WELCOA Faculty & Webinar Part. (480+) “Benchmarks”
Well Workplace Checklist (3,800+) “Norms”
Ranked Diff. Benchmarks vs.
Norms
% Criteria @ B-‐mark Status (>4 of 5)
1st Wellness Opera>ng Plan Choosing App Inter. +5 85%
2nd Sr. Level Support Wellness Teams +1 88%
3rd Evalua0ng Outcomes Sr. Level Support +4 100%
4th Crea>ng Wellness Team Healthy Environ. -‐2 50%
5th Choosing Appropriate Interven>ons
Collec>ng Data -‐4 58%
6th Crea>ng Healthy Environment
Well. Opert’g Plan -‐2 55%
7th Collec0ng Data Evalua0ng Outcomes -‐2 38%
Source: Chenoweth, D. and HunnicuM, D. WELCOA’s Benchmark Survey, 2013.
Crea.ng a data-‐driven evalua.on…
1. Capturing Senior Level Support
2. Crea>ng Cohesive Teams
3. Collec0ng Data
4. CraRing an Opera>ng Plan
5. Choosing Appropriate Interven>ons
6. Crea>ng Suppor>ve Environments
7. Carefully Evalua0ng Outcomes
8
Building a prac0cal, results-‐oriented [3-‐0ered] evalua0on…
Health Management
“Financial Outcome”
“Impact”
“Process”
Chenoweth & Associates, Inc. 9
Insert slide of Eval’n book
Process Impact Financial outcome
Transi.oning….from Process to Impact to Outcome… is a JOURNEY….that takes .me…
The essence of “tailoring” an evalua.on around your wellness interven.on…
Process Impact $ Outcome
Jan. July December July
Assessing par9cipant sa9sfac9on with instructor/coach,
facility, program quality, etc.
Risk factor status Behavior
Health care usage Produc>vity
Appraising the monetary value to wellness-‐generated
impacts “Process”
“Impact”
“Financial
Outcome”
Jan. July December July
Quality
“Process”
“Impact”
“Financial
Outcome”
Quan0ty Business
Performance -‐ -‐ -‐ -‐ -‐ -‐ -‐ -‐ -‐ -‐ Financial
Accountability
Jan. July December July
“Process”
Par>cipa>on Par>cipants’ sa>sfac>on with:
-‐ program content -‐ delivery -‐ feedback
Do employees like and respect the wellness program, etc.?
“Process” Evalua.on [Qualita.ve]
• Employees’ sa.sfac.on with program content, delivery, availability, facili.es, instructors, policies, etc.
When using HRA and self-‐report tools, use non-‐biased statements and a
quan9ta9ve index
Please indicate your opinion with a check mark on the following scale:
“Level of customer service provided by wellness staff” [ -‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐] Very High Moderate Low Very High Low (5) (4) (3) (2) (1)
Jan. July December
“Process”
“Impact”
Risk factor status Behaviors Health care usage Produc>vity
17
Tools/techniques for assessing IMPACT…
Employee health records Environmental audit Culture audit Employee focus groups Health risk assessment (HRA) Biometric screening Produc0vity survey Medical care claim-‐cost data Visual observa0on
CAUTION: No single technique is a sufficient stand-‐alone diagnos0c tool
Conduc.ng an IMPACT evalua.on…
1) Select key variables to measure (i.e., par9cipa9on, risk factor status, health care usage, worksite accidents, etc.)
2) Iden9fy your target popula9on 3) Prepare a format to record and format data 4) Collect data via screening, health risk
appraisal, etc. 5) Analyze data at designated intervals
Preparing a format to record and analyze IMPACTS… “IMPACT”"Variable"
Baseline 01"
Jan."
02"March"
03"July"
04"Oct.!
05"Dec."
Blood"pressure"
Absences"
Visits to OHN"
Low back injuries"Productivity"
Recording and analyzing impact data… Impact"Variable"
Baseline 01 [Jan.]"
02"[March]"
01 to 02"% Change"
03"[Oct.]!
01 to 03 "% Change"
Blood"pressure"
134/90" 130/89" -2.3"
Absences" 5/100" 4.8" -4.0%" 4.5" -10%"
On-site clinic visits"
348" 346" -1%" 321" -7.8%"
Low back injuries"
3/100" 2.9" -3.5%" 2.8" -6.7%"
Productivity" 78" 79" +1.3%" 83" 6.4%"
A sample IMPACT variable… “Rate the availability of healthy vending machine items:” Very Good Good Neutral Poor Very Poor 5 4 3 2 1
Jan. July December July
Appraising the monetary value of wellness-‐generated
impacts
“Impact”
“Financial
Outcome”
23
…the real value proposi0on…
conver0ng human [health capital into business capital…
Work performance Revenue genera0on Compe00ve edge
Transi0oning from IMPACT to $ OUTCOME…
24
Impact (Non-‐financial) Values
BMI decrease Blood pressure decrease Physical ac>vity increased Self-‐confidence improved Perceived performance higher Fewer workers’ comp claims Fewer Rx drug claims Fewer medical claims
$ Financial Outcomes
Ostbye, T. et al. Arch Intern Med 2007;167:766-‐773.
25
When possible, build on today’s standards…(e.g., specificity)…
Source: Chenoweth & Associates, Inc.; North Carolina League of Municipali9es, Raleigh, NC, 2010.
Medical care cost per risk factor
Source: Chenoweth, D. Promo.ng Employee Well-‐Being: Wellness Strategies to Improve Health, Performance and the Bo_om Line. SHRM Founda9on’s Effec9ve Prac9ce Guidelines Series. June 2011. [www.shrm.org/founda9on]
28
Risk Condition Absenteeism Presenteeism Total
Diabetes mellitus 4.94% 18.26% 23.20%
Depression 2.61% 14.51% 17.12%
Alcohol abuse 5.00% 4.78% 9.78%
Obesity 1.40% 8.30% 9.70%
High cholesterol 3.14% 4.91% 8.05%
Smoking 2.84% 4.78% 7.62%
High stress 3.08% 4.45% 7.53%
Arthritis 2.36% 4.90% 7.26%
High blood pressure 0.37% 5.70% 6.07%
Asthma 4.80% 1.20% 6.00%
Migraine 3.96% 1.99% 5.95%
Physical inactivity .28% 4.59% 4.87%
Source: Chenoweth, D. 2011. Ibid.
Full Report:
www.shrm.org/founda9on/products/documents/6-‐11%20Promo9ng%20well%20being%20EPG-‐%20Finalpdf
Execu9ve Summary: www.shrm.org/about/founda9on/products/documents/wellness/%20Exec%20Briefing-‐Final.pdf
Chenoweth & Associates, Inc. 29
Recommended resource…
30
Calcula0ng the Cost of Lost Produc0vity Per Risk Factor
Risk Factor (A) % Workload
Lost
(B) # Employees
(C) Prevalence
(D) # At-‐risk employees
(E) Median Annual Compens’n
(F) Lost prod. cost
Alcohol abuse
Arthri0s .0726 500 .26 130 $50,000 $471,900 Asthma
Depression
Diabetes
High cholest.
Hypertension
Migraine
Obesity
Phy. inac>vity
Stress
“A” mul9plied by “D” [BxC] mul9plied by “ E “ = “F”
Building a credible evalua0on approach …
$ Financial Outcome
Impact
Process
31 Chenoweth & Associates, Inc.
CAUTION! What are the key prerequisites for construc0ng a credible evalua0on?
Chenoweth & Associates, Inc. 32
Suitable and suppor0ve poli0cal environment Programs – well established Sufficient par0cipa0on Data tracking: pre vs. post Evaluator’s competence and objec0vity
Enhancing the quality of evalua.on by establishing goals that are…
Chenoweth & Associates, Inc. 33
compa0ble with stakeholders’ needs and values measurable: variables that can physically be measured quan0fiable: a value (#, %, $) can be assigned to a variable focused on an interven>on that has been opera0ng long enough to legi>mately generate an impact realis0cally achievable (e.g., wellness interven>on is likely to make a posi>ve impact)
Wellness Strategies and Impact Timeframes
Chenoweth & Associates, Inc. 34
Wellness Interven>on Impact on Employee
Health Status Impact on Employee
Produc>vity
Impact on Organiza>on’s Health
Costs
Biometric Screening 12-‐18 months Not well established (NWE)
NWE
Condi0on mgmt (asthma, arthri0s, diabetes, etc.)
6-‐12 months 6-‐12 months 12-‐18 months
Drug-‐tes0ng 3-‐6 months 3-‐6 months 6-‐12 months
EAP 12-‐18 months 12-‐18 months >24 months
Ergonomics 3-‐6 months 3-‐6 months NWE
Financial incen0ves 6-‐12 months NWE NWE
Flex-‐0me work schedule
3-‐6 months 3-‐6 months 6-‐12 months
Health Risk Assessment (HRA)
NWE NWE NWE
Low back health 6-‐12 months 6-‐12 months 12-‐18 months
Wellness Strategies and Impact Timeframes
Chenoweth & Associates, Inc. 35
Wellness Interven>on Impact on Employee
Health Status Impact on Employee
Produc>vity
Impact on Organiza>on’s Health
Costs
Medical self-‐care 3-‐6 months 6-‐12 months 12-‐18 months
Mental health/depression mgmt.
3-‐6 months 3-‐6 months 12-‐18 months
Non-‐financial incen0ves
NWE NWE NWE
Nutri0on 3-‐6 months 6-‐12 months 12-‐18 months
Physical ac0vity 3-‐6 months 6-‐12 months 12-‐18 months
Smoking cessa0on 3-‐6 months 6-‐12 months 36-‐48 months
Stress management 3-‐6 months 3-‐6 months 6-‐12 months
Tobacco free worksite 3-‐6 months 3-‐6 months 6-‐12 months
Weight management 6-‐12 months 12-‐18 months NWE
Medical claims
Occupational
Absenteeism/presenteeism
Demographics
Ergonomics
Safety (Accidents/ Injuries)
Health risk status (HRA/Screening)
Work/life Health and
Productivity Management
Identifying and acquiring key data for evaluation…
36
Designing a prac.cal plan for evalua.ng…
Chenoweth & Associates, Inc. 37
Scope & Specificity
Evalua>on Goals
Evalua>on Design
Evalua>on Resources
Timeframe
What -‐ are we evalua9ng: program? policy? incen9ve?
-‐ do we want to generate: internal assessment? benchmark? proposal for expanding?
-‐ design is appropriate: non-‐exp? quasi exp?
-‐ types of resources are needed?
-‐ Is an appropriate 9meframe?
Why -‐ are we evalua9ng?
How -‐ can we best use each resource?
Who -‐ is the target popula9on?
-‐ is most qualified to use each resource?
Where -‐ is the evalua9on conducted?
-‐ can we obtain resources?
When -‐ is the best 9me?
Iden0fying WHAT you are going to evaluate…
38
Wellness Program Health Plan Policies
Enviro-‐ Cultural Incen>ves
Health coaching CDHP focus with incen>ves
Smoke free, drug free, safety
Healthy work semng/clean/safe
Health insurance premium discount
Fitness center Waived co-‐pays for main. Rx
drugs
Healthy food op>ons
Accessible, aorac>ve stairways
Fitness center subsidy
Women’s weekly health series
Medical self-‐care included
Lacta>on Healthy food op>ons
Flexible spending account (FSA)
Lunch ‘n Learn Flex-‐>me and telecommu>ng
Ergonomically-‐ enhanced worksta>on
Health reimbursement account (HRA)
Walking club
39
Programs, policies, and incen0ve op0ons…
Physical Ac>vity Nutri>on Informa>on/Educa>on Other
Stairway signage Lunch ‘n learns E-‐mail daily >ps On-‐site medical clinic
Low impact walking On-‐line webinars Bull. Boards in high density areas
Health Kiosk with b.p. cuff, scales, etc.
Walking trails Color-‐coded healthy vending items
Medical self-‐care booklets
Quiet room
Exercise equip. in break area
Healthy potluck with recipe exchange
On-‐site library 5 minute on-‐>me stretching
Stretch breaks Gradually phase in healthy vend. items
Hlth mags in bathroom stalls
Days off for excellent aoendance
Fit ctr. $ subsidies Fruits/veggies @ mtgs. Health column in co. newsleoer
Establish smoke-‐free worksite
At-‐work showers and lockers
Subsidize healthier cafeteria food
Lacta>on suites for nursing employees
Dept. compe>>ons “Nutri-‐>ps” on café/break tables
Environmental enhancements to boost more physical ac0vity…
Before ARer
Environmental [physical environment] enhancements…
– Vending op9ons – Workout/fitness space – Cafeteria – Hea9ng/cooling/ven9la9on – Ergonomic/Safety
– Well lit areas
– Smoke-‐free
Tailoring the scope of an evalua0on…
Process -‐ par>cipa>on -‐ like/dislike change
Impact -‐ # of steps/day -‐ # mins. exercise/day -‐ body mass index (BMI) -‐ # of health care claims -‐ perceived produc>vity
Financial outcome -‐ Health care cost$
43
In a small worksite…
PCL Construc>on – Denver, CO “Keys to Wellness”
Provides healthy snacks in vending machines Fitness center subsidies “Ping-‐pong” tables Local 5K runs H1N1 and flu vaccina>ons Annual on-‐site health screenings Doesn’t use “program” as this creates a percep>on that healthy ac>vi>es are separate from the company’s normal business prac>ces.
Courtesy of PCL Construc9on, Inc.
44
Aligning wellness (programs, policies, and incen0ves) within a feasible evalua0on plan…
PCL Construc>on – Denver, CO “Keys to Wellness”
Strategy “Process” “Impact” “$ Outcome”
Healthy vending snacks √ √
Fitness center subsidy √ √ √√
“Ping Pong” √
H1N1 vaccina9ons √ √ √√
On-‐site hlth screenings √ √
√√ Compare medical care claims and cost among par.cipants vs. non-‐par.cipants.
45
Sample tools/techniques used for evalua0on…
Strategy “Process” (volume indicators)
“Impact” (changes)
“Financial Outcome”
Healthy vending snacks √ (Item counts)
√ (HRA, BMI
scr’g)
Fitness center subsidy √ (Par>cipa>on)
√ (HRA, biometric
scr’g)
√√ (Annual claims
data)
H1N1 vaccina9ons √ (Par>cipa>on)
√ (Aoendance, flu claims)
√√ (Annual influenza claim & cost data)
On-‐site hlth screenings √ (Par>cipa>on)
√ (HRA health
status)
√√ Compare medical care claims and cost among par.cipants vs. non-‐par.cipants.
46
In a mid-‐size worksite…
Syngenta Crop Protec0on
Healthy snacks in vending machines Fitness center subsidy On-‐site Medical Clinic Weight Watchers™ on-‐site program Annual on-‐site health screenings
Courtesy of Judy Garreo, COHN. Syngenta Crop Protec>on, Greensboro, NC
47
Strategy “Process” (volume indicators)
“Impact” (change)
“Financial Outcome”
Healthy vending snacks √ (Item counts)
√ (HRA, BMI scr’g)
Fitness center subsidy √ (Par>cipa>on)
√ (HRA, biometric scr’g)
√√
On-‐site Medical Clinic √ (U>liza>on)
√ (HRA, health records, # of medical claims)
√√ (Annual claim
costs)
Weight Watchers™ √ (Par>cipa>on)
√ (HRA, biometric scr’g)
√√ (Pre vs. Post claim costs)
On-‐site health scr’ning √ (Par>cipa>on)
√ (HRA health status)
√√ Compare medical care claims and cost among par.cipants vs. non-‐par.cipants.
Syngenta Crop Protec.on
Courtesy of Bap0st Health South Florida 48
Bap0st Health South Florida…
“Wellness Advantage” award-‐winning program
Eight on-‐site fitness centers with 2x annual open houses
Classes: boot camp, urban training, walking and circuit training
Bi-‐annual wellness fairs with free screenings
$3 Wellness Meals (<600 calories & <30% fat) -‐ the fastest-‐selling items!
> Disease management program = posi>ve ROI
In a large worksite…
49
Strategy “Process”
(volume indicators) “Impact” (changes) “$ Outcome”
On-‐site fitness centers √ (Par0cipa0on)
√ (HRA status & biometric scr’g)
√√ (Annual medical claim costs)
Classes √ (Par0cipa0on)
√ (HRA status)
Wellness Fair √ (Par0cipa0on)
Wellness Meals √ (# Meals sold)
√ (HRA health
status indicators)
Disability management √ (Par0cipa0on)
√ (RTW,
Produc0vity indicators)
√+ (Disability-‐specific claim
costs)
√√ Compare medical care claims and cost among par.cipants vs. non-‐par.cipants. √+ Track medical care and Rx drug use and costs at quarterly intervals.
Tips for Enhancing your Evalua.on…
50
Establish a clearly delineated goal or vision for doing an evalua>on Allocate at least 5% -‐ 10% of your budget for evalua>on Iden>fy key stakeholders and tailor the evalua0on to their needs and values Have a realis0c expecta0on of what an evalua>on can produce Select only variables that you can reasonably track Assess data sources and types of data that are available before pumng an evalua>on into ac>on Give the interven>on >me to make a genuine impact Once essen>al resources (e.g., personnel, equipment, facili>es, etc.) are iden>fied, conduct a beta trial (test run) to iden>fy/resolve any barriers
Source: Chenoweth, D. “Decision Points Around Evalua9on.” AWHP’s Worksite Health, Summer 2001, 8-‐14.
Crea0ng synergism for building successful evalua0ons today…tomorrow…and the future…
51
Worksite Infrastructure
Environment
Programs
Policies
Incen0ves
Evalua0on
PROCESS
IMPACT
$ OUTCOME
52
David Chenoweth, Ph.D. Chenoweth & Associates, Inc.
128 St. Andrews Circle New Bern, NC 28562-‐2907
252-‐636-‐3241 www.chenoassociates.com dave@chenoassociates.com
EconohealthROI™
PRFCA™
CorpWellROI™
Thank You!