Worksite Wellness Evaluation: Basic Strategies for Worksites of All Sizes w David Chenoweth

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

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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”


Quality

“Process”

“Impact”

“Financial

Outcome”

Quan0ty Business

Performance -‐ -‐ -‐ -‐ -‐ -‐ -‐ -‐ -‐ -‐ Financial

Accountability


“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

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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


Appraising the monetary value of wellness-‐generated

impacts

“Impact”

“Financial

Outcome”

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…the real value proposi0on…

conver0ng human [health capital into business capital…

  Work performance   Revenue genera0on   Compe00ve edge

Transi0oning from IMPACT to $ OUTCOME…

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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.

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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]

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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


Recommended resource…

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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?


  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…


  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


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


Health Risk Assessment (HRA)

NWE NWE NWE

Low back health 6-‐12 months 6-‐12 months 12-‐18 months

Wellness Strategies and Impact Timeframes


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.


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…

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Designing a prac.cal plan for evalua.ng…


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…

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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

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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$

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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.

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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.

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Sample tools/techniques used for evalua0on…

Strategy “Process” (volume indicators)

“Impact” (changes)


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)


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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

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Strategy “Process” (volume indicators)

“Impact” (change)


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)


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…

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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…

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  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…

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Worksite Infrastructure

Environment

Programs

Policies

Incen0ves

Evalua0on

PROCESS

IMPACT

$ OUTCOME

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David Chenoweth, Ph.D. Chenoweth & Associates, Inc.

128 St. Andrews Circle New Bern, NC 28562-‐2907

252-‐636-‐3241 www.chenoassociates.com [email protected]

EconohealthROI™

PRFCA™

CorpWellROI™

Thank You!

Worksite Wellness Evaluation: Basic Strategies for Worksites of All Sizes w David Chenoweth

Health & Medicine

Transcript of Worksite Wellness Evaluation: Basic Strategies for Worksites of All Sizes w David Chenoweth