The Business Case of Comprehensive Workplace Health

Atlantic Health and Wellness Institute, Research Affiliate

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The Business Case of

Comprehensive Workplace Health

Lydia Makrides, PhD

President, Creative Wellness SolutionsEditor-in-Chief, International Journal of Workplace Health Management

ECOSH/ROWER ConferenceSeptember 17-18, 2009

Amsterdam


Greetings from HalifaxNova Scotia!


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Agenda

•Health Risks for Chronic Disease

•10 Compelling Reasons

•Return on Investment


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Health Risks for Chronic Disease


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• Chronic disease related deaths account for 56% of all deaths in the working-age population in the world (World Health Organization).

• High prevalence of major modifiable health risks contributes to the epidemic of chronic disease.

Elevated BMI (BMI ≥25kg/m2) Obesity (BMI ≥ 30 kg/m2)

Inactivity Smoking

Stress Elevated blood pressure

Elevated cholesterol High blood sugar

Alcohol

• Places an increasing burden on employers: decreased productivity, increased absenteeism, increased health and worker’s compensation claims.

Health Risks for Chronic Disease


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• N=6067: 2665 Males & 3402 Females

• 51 Organizations: Private companies (N=2859). Pulblic Companies (N=1425), Health Care Facilities (N=1783)

• Average age 41.3 years

• 70% overweight (BMI ≥ 25) - 31% obese (BMI ≥ 30)

• 49% inactive (less than 3 times per week)

• 38% elevated cholesterol (greater than 5.2 mmol/L)

• 20% daily cigarette smokers

• 16% elevated blood pressure (greater than 140/90 mmHG)

• 18% elevated stress scores

Health Risks for Chronic Disease:Profile of Atlantic Canadian Employees


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• Multiple health risks compounding the health issues

• Average 2.4 health risks/employee• Average Wellness Score - 46%• Need to improve Wellness Score - 72% (scored

49% or lower)• Chronological age - 41.3 yrs • Achievable Health Age - 35.8 yrs• Coronary risk moderate to high - 46%

Health Risks for Chronic Disease:Profile of Atlantic Canadian Employees


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Health Risks for Chronic Disease:Profile of Atlantic Canadian Employees*

16

21

37

18

7

0

10

20

30

40

50

0 1 2 to 3 4 to 5 6+

Atlantic Canadian EmployeesAHWI data (n=6067)

Number of Risk Factors*** AHWI Database**Inactivity, overweight, elevated cholesterol, blood pressure, smoking, high stress, illness days, alcohol use, life satisfaction, existing medical condition.


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Atlantic Canadian vs. Healthy Company Profile

Shift in risk factors after 4 years of workplace wellness program

16

43

2125

37

24

18

77

1

0

10

20

30

40

50

0 1 2 to 3 4 to 5 6+

Atlantic Canadian EmployeesAHWI Data (n = 6,067)

Healthy Company*

Number of Risk Factors

*(Steelcase study: Amer. J. of Health Promotion, Vol. 6, No. 1:46-54, 1991)


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10 Compelling Reasons

1. The do-nothing strategy of waiting for sickness and then paying for treatment is a failed strategy.

2. Lifestyle related risk factors and behaviours of employees as well as unhealthy work environments and practices drive costs.

• High risk employees incur high costs whatever the outcome measure: pharmaceutical, absenteeism, compensation costs

or productivity.


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Productivity Decreases with Number of Health RisksExcess

Productivity Loss

Productivity Loss (%)

Base Cost

Number of Health Risks

(Journal of Occupational and Environmental Medicine 2005;47:769-77 (n = 28,375))


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Absenteeism Increases with Number of Health Risks

Excess

Work Loss Days / Year

Work Loss Days (#/yr)

Base Work

Loss Days / Year


( Summary of 10 Mid-sized U.S. Corporations (n=5,142 employees))



Healthcare Costs Rise with Number of Health Risks

Excess

Cost

Health Claims (RR)

Base Cost


( University of Michigan Study (n = 205,216)

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3. One of the root causes of unsustainable increases in costs is natural flow of individuals from low risk → high risk →disease →higher employer costs – natural flow estimated at 2% - 4% per year. (Edington et al, 2009).

3. The Health Risk Assessment (HRA) is the tool used in Comprehensive Workplace Wellness to raise awareness and determine employee health risk status.

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5. An effective Workplace Wellness strategy is to stop migration of people to higher risk and keep low risk people at low risk.

• Employers costs go up as people age, regardless of their

health risk status and as health risk status gets worse, costs go up regardless of age.

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6. Risk clusters likely to be associated with high healthcare costs within a 2-3 year period:

• Metabolic syndrome: combinations of high blood pressure

cholesterol, blood glucose and waist circumference/ BMI associated with higher risk for diabetes or heart disease.

• Pre-metabolic syndrome: combinations of one or two risk factors.( Edington, 2009)



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Relationship of Biometric Cluster to Diabetes and Heart Disease

( Edington, Zero Trends, 2009)

Risks: Waist Circumference,Hypertension,Glucose Intolerance,Cholesterol

Pre-Metabolic Syndrome

Metabolic Syndrome

Diabetes

Heart Disease

RetinopathyNeuropathyNephropathy

Costs to Employers:Health Care CostsProductivity Costs

Cost to Individual:Quality of LifeMorbidityMortality



7. Changes in healthcare costs follow changes in health risk: • As number of risks goes up, costs go up.• As number of risks goes down, costs go down.

(Wright et al, 2002)

8. Established relationship between lifestyle related risk factors (smoking, inactivity, obesity) and productivity absenteeism and health claims. (Buron et al,2005, Wellsource, 2006 & University of Michigan, 2006)

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Absenteeism, Productivity Loss, Health Claims and Number of Risk Factors

(Buron et al, 2005, Wellsource, 2006 & University of Michigan, 2006)

Number of Risks

Excess work loss days (%)

Excess Productivity

Loss (%)

Increase Health Claims Cost

0 Risks 0 0 0

1 Risk 0.6 1.9 0.317

2 Risks 1.2 4.4 0.667

3 Risks 1.9 7.5 1.032

4 Risks 2.2 9.1 1.498

5 Risks 2.5 13 1.956

6+ Risks 3.1+ 14.5+ 2.520+



9. Inverse relationship between health care costs and wellness score.

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Relationship between Health Costs and Wellness Score

(Yen et al, 2005)



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10.Changes in employer costs follow participation in HRA and Workplace Wellness activities.

• Employees who participate in Health Risk Assessment at least twice have annual cost increases of 4.2% while employees who never participated or took HRA only once

have annual increases of 12.6%. ( Edington, 2009)

• Participation in Workplace Wellness resulted in decreased annual absenteeism of 2.4% for participants vs 3.6% for non-participants.


Return on Investment

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From a review of 73 published studies:• Average $3.50 saved per $1 invested in reduced absenteeism and

health care costs.

From a meta review of 42 published studies:• Average 28% reduction in sick leave• Average 26% reduction in health costs• Average 30% reduction in WCB and disability claims• Average $5.93 saved per dollar invested

(The Art of Health Promotion, 2003)

Comprehensive Workplace Health Program at Citibank:• $4.56 – 4.73 saved per $1 invested in reduced health care costs

(Amer. Journal Health Promotion, 1999)


Return on Investment

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Organization Dollars Saved/ Dollars Spent

Bank of America $5.95/ $1

PacBell $3.10/ $1

Wisconsin School District Insurance Group $4.47/ $1

Prudential Insurance U.S. $2.90/ $1

Bank of America $4.73/ $1

General Mills $3.50/ $1

DuPont $2.05/ $1

Citibank $4.56-4.73/$1

BC Hydro $2.74/ $1

Review of 13 studies $3.45-$5.82/$1

(Chapman L., 1996.; Wellness Councils of America, May 1995.; Blair S., Pacific Bell 1996).


Thank YouCreative Wellness Solutions Inc.


Phone: +902 820-3096Email: [email protected]

www.wellnesssolutions.ca

The Business Case of Comprehensive Workplace Health

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