Slide 1

Wellness for

21st Century Miners:

Integrating Safety & Health

To Drive Employee, Family and

Business Performance1Michael D Parkinson, MD, MPH, FACPMNSSGA Convention March 2014

Definition of 21st century wellness for industry, employers and employees in globally competitive economyMilitary, NASA and private sector applicationsIntegration of Safety, Health Protection and Health PromotionNIOSH Total Worker Health initiativeEmployer Health & Productivity RoadmapImplications for 21st century mining industry, employers, miners and their families

2ObjectivesMy Perspective: Always Achieving the MissionAir Force flight surgeonMission achievement worldwide thru whole person orientation to worklife, professional and personal integration for hi-risk aircrew and familiesChief, US Air Force Preventive MedicineOptimizing preventive medical care programs for Air Force and DOD pre-, during and post- Persian Gulf operationsStudy and medical surveillance of occupational and environmental health risksDeputy Director, Air Force Medical Operations and MHS leadershipDeliver or buy care from private sector for 2M beneficiariesWhat functions are mission-essential for health, safety, performance?President, American College of Preventive MedicinePhysicians in public health, preventive care and occupational medicineInstitute of Medicine NASA Integrating Employee Health 2 yr studyConsumer-directed health care prevention paid 100%NIOSH Total Worker Health Advisor U of Iowa

3

$2.6 T: 75% Behaviors, 30% WasteWhat are We Trying To Do Anyway?

5521st Century Mining and Related IndustryGlobal scope and competition24-7 high risk, high impact industryCritical growth path and opportunitiesIncreasingly short cycle time to react and changeSafety and quality paramountMission critical personnel with time, attention, physical and mental health demands

Health and performance similarly critical to global success and company growth6How Many Americans Can Just Say Yes to All 5? I am within 5 pounds of my ideal body weight

I exercise 30 minutes or more most days of week

I eat a healthy diet with 5 fruits/vegetables most days I dont use tobacco products

I have 2 or fewer alcoholic drinks per day77Health Promotion or Health Protection . .Occupational or Non-Occupational . . A Picture Worth . . .

Mediterranean (or Asian) Diet + Nonsmoker + Daily Activity + Moderate Alcohol Use*9DiseaseReduction Compared to U.S.CommentHeart Disease64%*83%**80% due to modifiable risk factorsCancer60%*Approximates NCI estimatesDiabetes91%**No type 2 epidemicAll-cause Mortality50%* 25 year Okinawa program similar findings * Knoops et al and **Rimm, Stampfer, JAMA 2004;292:1433-143910Determinants of Health and Disease Where & How We Live, Learn, Work and Play

Social EnvironmentPhysical EnvironmentGenetic EnvironmentIndividualResponse--Behavior--BiologyHealth&FunctionDisease

HealthCare Well-BeingProsperityEvans, R. G., Barer, M. L., & Marmor, T. R. (1994)Why Are Some People Healthy and Others Not?. New York: Aldine De Gruyter1011F100 Engine Performance ThreatsFlight Hour Periodic Maintenance Schedule

3rd Fan Disk / Blade3rd / 4th LPT Disk / Blade#5 Bearing CompartmentFuel Manifold Pigtails/Flex Hoses/NozzlesHPT Distress4th Stage Compressor BladeCompressor Stalls11

Human System Performance Threats

Accidental InjurySuicideStress-InducedDisordersBack InjuryHearing LossAtherosclerosisHypertensionEnvironmentalToxin ExposureInfectiousDiseaseInjury/Illness From Hostile AttackOperational DemandsHuman System Performance ThreatMission-essential Preventive Maintenance?1213

Committee to Assess Worksite Preventive Health Program Needs of NASA EmployeesThe

National AcademiesInstitute of MedicineFood and Nutrition Board

http://www.iom.edu/CMS/3788/18021/26995.aspx

1314Institute of Medicine: What Does A Healthy Workforce Look Like?* HEALTHYDemonstrating optimal health status as defined by positive health behaviors; minimal modifiable risk factors; and minimal illnesses, diseases, and injuriesPRODUCTIVEFunctioning to produce the maximum contribution to achievement of personal goals and the organizational missionREADYPossessing an ability to respond to changing demands given the increasing pace and unpredictable nature of workRESILIENTAdjusting to setbacks, increased demands, or unusual challenges by bouncing back to optimal well-being and performance without incurring severe functional decrement.IOM: Integrating Employee Health: A Report for NASA 2007Behaviors Drive Medical, Disability, Absenteeism, Workers Comp, &Total Employer Costs

Medium RiskHigh RiskNon-ParticipantEdington. Am J Health Promotion 15(5):341-349, 2001 Low risk15Strategy To Address Rising Medical Costs and Improve Workforce Health & Productivity 20% drive 80% of cost but not the same 20%. 50% of those are new each year. Average employee has 2.2 health risks, resulting in $2,000/yr in productivity losses. (JOEM, 2005) 36% of absence including STD and Workers Comp is due to excess risk factors (JOEM, 2002) MAINTAINIMPROVEMANAGEHealth RiskHigh Risk CriteriaAlcohol UseMore than 2 drinks / dayBlood PressureSystolic > 139 mmHg or Diastolic > 89 mmHgBody WeightMen BMI > 27.8; Women BMI > 27.3Total CholesterolGreater than 239 mg/dlExisting Medical ConditionHeart, Cancer, Diabetes, StrokeHDLLess than 35 mg/dlIllness DaysMore than 5 days last yearLife SatisfactionPartly or Not SatisfiedPerception of HealthFair or PoorPhysical ActivityLess than one time/weekSmokingCurrent smokerStressHigh62%26%12%2%Low RiskModerate RiskHigh RiskWellManagedPoorlyManaged8%Medical Cost$3,273/yr$5,971/yr$9,221/yr$7,000/yr

$14,000/yr

Integrated Cost$4,621/yr$8,022/yr$13,057/yr

When Done Right: Positive ROI for Both Direct Medical and Indirect Total CostsMedical costs fall by about $3.27 for every dollar spent on effective wellness programs

Absenteeism costs fall by about $2.73 for every dollar spentSource: Katherine Baicker, David Cutler, and Zirui Song, Health Affairs, February, 201018

NASA Recommendation Job 1: A New VisionThe success and sustainability of an integrated health process must first and foremost begin with a clear understanding of the organizations mission. The Committee recommends that the administrator of NASA adopt a new vision for worker health, readiness, and resilience that directly links to NASAs mission and includes health as a core NASA value that is implemented through an integrated health and systems approach.

19A mission-driven vision for health should articulate why investment in health and employee-integrated health helps NASA achieve its core mission on time, under budget, and better than expected.

NASA #2: Link Health and Performance to Bottom Line and Mission20Develop a data-based approach to policy, planning, programming, budgeting, implementation, operations, evaluation, and management.Create a standardized health and performance full-cost accounting framework to define, standardize, prioritize, fund, and evaluate resource allocation for human-related mission performance and workplace safety, health, and productivity.Incorporate mission-essential elements of integrated health programs in contracting requirements. NASA #3: Visible Organizational Commitment21

NASA #4: Manager Education and OwnershipNASA should provide education and training to first-line managers and supervisors that focuses on the relationship between health and productivityNIOSH Total Worker Health: Integrating Health, Prevention, Safety and Occupational MedicineTotal Worker Health is a strategy integrating occupational safety and health protection with health promotion to prevent worker injury and illness and to advance health and well-being.

Most diseases, injuries, and other health conditions experienced by working people are multifactorial, especially as the workforce ages. Evidence supporting the role of work and personal risk factors in the health of working people is frequently underused in developing interventions. Achieving a longer, healthy working life requires a comprehensive preventive approach. To help develop such an approach, we evaluated the influence of both occupational and personal risk factors on workforce health.

Interaction of Occupational and Personal Risk Factors in Workforce Health and Safety, AJPM Mar 2012 Schulte et al

22Employer Health & Productivity Road Map *Understand, Improve, and Partner With Your Doctor

Incentivized Health Management Program or Consumer-Directed Health PlanOptimize EnvironmentSpeed TransitionsCare-Home-WorkOptimizeChronic Care

Minimize Acute Care

Increase Healthy BehaviorsReduce Excessive Surgery*Parkinson MD. Employer Health and Productivity Roadmap J Occup Environ Med 2013;55 (12):Total Worker Health Supp S46-51.Copyright 2013 UPMC Health Plan. All rights reserved. Employer Health & Productivity Road Map Understand, Improve & Partner With Your Doctor Health and Productivity Alignment Assessment Report and Gap Analysis

Health & Performance Total Economic Opportunity

Ergonomic evaluation and support

Wellness Course Participation

24Optimize EnvironmentSpeed TransitionsCare-Home-WorkOptimizeChronic Care

Minimize Acute Care

Increase Healthy BehaviorsReduce Excessive SurgeryHealth and Productivity Performance Index Assessment

Health and Productivity Performance Index (HAPPI)Leadership/Culture

IncentivesRewards AlignmentPrograms & ServicesPhysical Environment Ergonomics, Facilities &SafetyCommunicationsThe HAPPI assessment was developed from Best in Class tools to help employers identify areas for improvement and health related cost savings.

Fit-Friendly Worksites

Employer Health & Productivity Road Map Understand, Improve & Partner With Your DoctorChampion Index - % in optimal health

Population risk profile & movement

Biometric changes over time

Clinical preventive services

Lifestyle coaching enrollment & graduation

26Optimize EnvironmentSpeed TransitionsCare-Home-WorkOptimizeChronic Care

Minimize Acute Care

Increase Healthy BehaviorsReduce Excessive Surgery

Provided in partnership with

Understand Your Health and Know Your NumbersCoaching & Competitions Work

Employer Health & Productivity Road MapUnderstand, Improve & Partner With Your DoctorVisits/1000 by site of traditional and alternative care

Video and e-visits

Lower cost and onsite care options

Prevalence of impactable acute visits 29Optimize EnvironmentSpeed TransitionsCare-Home-WorkOptimizeChronic Care

Minimize Acute Care

Increase Healthy BehaviorsReduce Excessive Surgery

Norman Rockwell Had It Right!Medical Home Re-visited3030I Still Want My Rockwell But My Way, My Time, For Less $$31

Move Care Forward: Where Its Most Needed Not Where Most Comfortable

Employer Health & Productivity Road Map Understand, Improve & Partner With Your DoctorCondition prevalence

Identification & referral process % active self-identification % passive outreach

Disease Management Coaching: enrollment & graduation33Optimize EnvironmentSpeed TransitionsCare-Home-WorkOptimizeChronic Care

Minimize Acute Care

Increase Healthy BehaviorsReduce Excessive SurgeryOnsite Health CoachingPrescribe Engagement and We Fill the PrescriptionHealth Coaching for Lifestyle, Disease and Shared Decision-makingChronic ConditionManagementAsthmaCOPDDiabetesDepressionCardiac conditionsLow Back PainSurgery SDM for back, hip, kneeEvidence- & curriculum-based program/servicesIndividual and tele-group coachingCoach supported self-study (online & workbook options)Coach-on-Call e-mail & videoLifestyle ImprovementMyHealth Eating WellMyHealth Ready to QuitMyHealth Weigh to WellnessMyHealth Less StressMyHealth Step Up to WellnessMyHealth Selections

new

3434Employer Health & Productivity Road Map Understand, Improve & Partner With Your DoctorShared decision-making before surgery with interactive online tool

Best practice step therapy pathway for low back pain

Reduce:Number of low back surgeriesAdvanced imaging rate

Expand to more preference-sensitive discretionary surgeries and conditions35Optimize EnvironmentSpeed TransitionsCare-Home-WorkOptimizeChronic Care

Minimize Acute Care

Increase Healthy BehaviorsReduce Excessive SurgeryPrimary Care Physicians Opinions of Patients Need To Be Informed vs Actual Proportion Informed by Medical Service Type**Foundation for Informed Medical Decision Making survey, 2009 (n=462) National Priorities for Shared Decision Making:

Reduce unwarranted procedures, targeting:

Spine surgery PTCA/Stent Knee replacement Hip replacement Lumbar spine MRI prior to conservative therapy, without red flags Bone or joint x-ray prior to conservative therapy, without red flags Coronary artery bypass graft (CABG) Hysterectomy Prostatectomy Cesarean section Endoscopy Others

37PROPRIETARY & CONFIDENTIALEmployer Health & Productivity Road MapUnderstand, Improve & Partner With Your DoctorTop 4-5 conditions that drive Time Away From Work

Absence changes over time

Leave management

38Optimize EnvironmentSpeed TransitionsCare-Home-WorkOptimizeChronic Care

Minimize Acute Care

Increase Healthy BehaviorsReduce Excessive SurgeryPartners Program (Medical Home)Pharmacy OutreachEmployee Assistance ProgramIncentive Driven Wellness Program(s)Workers CompensationShort-Term DisabilityCentral Leave Management/FMLAWorksite Health ClinicsMember Services24/7 Nurse LineImprove HealthManageHealthMaintainHealthHealth ManagementCoachingLifestyle/WellnessPhysical Condition ManagementBehavior Condition ManagementComplex Case ManagementCoordination of Stove-piped Programs Decreases Absenteeism, Lowers Total Costs & Improves Productivity3939Employer Health & Productivity Road Map *Understand, Improve, and Partner With Your Doctor

Incentivized Health Management Program or Consumer-Directed Health PlanOptimize EnvironmentSpeed TransitionsCare-Home-WorkOptimizeChronic Care

Minimize Acute Care

Increase Healthy BehaviorsReduce Excessive Surgery*Parkinson MD. Employer Health and Productivity Roadmap J Occup Environ Med 2013;55 (12):Total Worker Health Supp S46-51.Copyright 2013 UPMC Health Plan. All rights reserved. Powering the Health & Productivity Road Map: Moving to Maximally Effective Health and Cost Savings PPO with Incentivized Comprehensive Health ManagementHRA only optionalHSA only optionalHRA only full replacementHSA only full replacementHRA/HSA/Hybrid optionalHRA/HSA full replacementFinancialEfficiency $$Migration Toward Consumer-Driven Health CareIncreasing Consumer and Patient EngagementPPO with or without Wellness Program41

Copyright 2013 UPMC Health Plan. All rights reserved. 41Rewarding Healthy Choices & Better Care Decisions$UnderstandImprovePartnerConsumer Engages in Health and Care ActivitiesUPMCHealth Plan incentivizes the member42Understand, Improve and Partner Incentivized Strategy to Optimize Engagement43

Health Risk Assessment Biometric Screening

Flu Shot Lifestyle & disease management coaching Preventive Screenings Partner with your DoctorShared decision-makingCare delivery innovations connectivity and eVisits

Earn up to $500/$1000 to use toward your Deductible and Coinsurance

Wellness, Health, Safety: Integration Saves Lives & Costs44

Take Homes For 21st Century Mining PerformanceIntegrated health, safety, performance, bottom line savings and top line growth all tied to productive employeesDefine what hi-performing mining workforce looks like using IOM 4 key elements then shoot for goalPreventive care should be standardized, emphasized, assured and measured as key component of human performance and achievement of corporate missionThe field, federal government and leading employers understand emphasis on total worker health paradigmHealth/wellness AND safety/occupational health one and sameTo maximize company and industry productivity maximize personal and family health, fitness and performance45