Age-Adjusted Prevalence of Obesity and Diagnosed Diabetes Among US Adults 2006 Obesity (BMI≥30 Kg/m 2 ) Diabetes Missing data <4.5% Missing Data <14.0% 4.5% – 5.9% 6.0% – 7.4% 14.0% – 17.9% 18.0% – 21.9% 7.5% – 8.9% ≥9.0% 22.0% – 25.9% ≥26.0% CDC’s Division of Diabetes Translation. National Diabetes Surveillance System available at http://www.cdc.gov/diabetes/statistics 27
Age-Adjusted Prevalence of Obesity and Diagnosed Diabetes Among US Adults 2007 Obesity (BMI≥30 Kg/m 2 ) Diabetes Missing data <4.5% Missing Data <14.0% 4.5% – 5.9% 6.0% – 7.4% 14.0% – 17.9% 18.0% – 21.9% 7.5% – 8.9% ≥9.0% 22.0% – 25.9% ≥26.0% CDC’s Division of Diabetes Translation. National Diabetes Surveillance System available at http://www.cdc.gov/diabetes/statistics 28
Age-Adjusted Prevalence of Obesity and Diagnosed Diabetes Among US Adults 2008 Obesity (BMI≥30 Kg/m 2 ) Diabetes Missing data <4.5% Missing Data <14.0% 4.5% – 5.9% 6.0% – 7.4% 14.0% – 17.9% 18.0% – 21.9% 7.5% – 8.9% ≥9.0% 22.0% – 25.9% ≥26.0% CDC’s Division of Diabetes Translation. National Diabetes Surveillance System available at http://www.cdc.gov/diabetes/statistics 29
Age-Adjusted Prevalence of Obesity and Diagnosed Diabetes Among US Adults 2009 Obesity (BMI≥30 Kg/m 2 ) Diabetes Missing data <4.5% Missing Data <14.0% 4.5% – 5.9% 6.0% – 7.4% 14.0% – 17.9% 18.0% – 21.9% 7.5% – 8.9% ≥9.0% 22.0% – 25.9% ≥26.0% CDC’s Division of Diabetes Translation. National Diabetes Surveillance System available at http://www.cdc.gov/diabetes/statistics 30
Age-Adjusted Prevalence of Obesity and Diagnosed Diabetes Among US Adults 2010 Obesity (BMI≥30 Kg/m 2 ) Diabetes Missing data <4.5% Missing Data <14.0% 4.5% – 5.9% 6.0% – 7.4% 14.0% – 17.9% 18.0% – 21.9% 7.5% – 8.9% ≥9.0% 22.0% – 25.9% ≥26.0% CDC’s Division of Diabetes Translation. National Diabetes Surveillance System available at http://www.cdc.gov/diabetes/statistics 31
LEADING CAUSES OF DEATH IN THE U.S. # of Cause of Death Deaths Percentage Heart Disease 710,760 30% Malignant Neoplasm 553,091 23% Cerebrovascular Disease 167,661 7% Chronic Lower Respiratory Tract 122,009 5% Disease Unintentional Injuries 97,900 4% Diabetes 69,301 3% Influenza / Pneumonia 65,313 3% Alzheimer's 49,558 2% Nephritis 37,251 2% Septicemia 31,224 1% Other 499,283 21% Total 2,403,351 100% *Source: Year 2000, Mokdad et al., JAMA,291:10, March, 2004 32
ACTUAL CAUSES OF DEATH IN THE U.S. (2000) in thousands 450 400 350 300 250 200 150 100 50 0 Tobacco Diet & Alcohol Microbial Toxic Motor Firearms Sexual Illicit Drug Use Inactivity Misuse Agents Agents Vehicles Behavior use Source: Mokdad, et al 33
BOTTOM LINE: THE VAST MAJORITY OF CHRONIC DISEASE CAN BE PREVENTED OR BETTER MANAGED The Centers for Disease Control and Prevention (CDC) estimates… • 80% of heart disease and stroke • 80% of type 2 diabetes • 40% of cancer …could be prevented if only Americans were to do three things: • Stop smoking • Start eating healthy • Get in shape 34
FTI CONSULTING ON NASHVILLE HEALTH 35 LINK: http://www.nashvillechamber.com/docs/default- source/pdfs/060315_fti_assessmentofnashville_final.pdf
36
Good News – Worksite Health Promotion Works! Caveat: If you do it right… 37
CDC Community Guide to Preventive Services Review – AJPM, February 2010 86 Studies Reviewed 38
Summary Results and Team Consensus Body of Consistent Magnitude of Outcome Finding Evidence Results Effect Alcohol Use 9 Yes Variable Sufficient Fruits & Vegetables 9 No 0.09 serving Insufficient % Fat Intake 13 Yes -5.4% Strong % Change in Those Yes +15.3 pct pt Sufficient 18 Physically Active Tobacco Use Strong – 2.3 pct pt Prevalence 23 Yes 11 Yes +3.8 pct pt Cessation – 27.6 pct pt Seat Belt Non-Use 10 Yes Sufficient 39
Summary Results and Team Consensus Body of Consistent Outcome Magnitude of Effect Finding Evidence Results Diastolic: – 1.8 mm Hq Diastolic blood pressure 17 Yes Strong Systolic: – 2.6 mm Hg 19 Systolic blood pressure Yes – 4.5 pct pt 12 Risk prevalence Yes – 0.5 pt BMI BMI 6 Yes – 0.56 pounds Weight 12 No Insufficient – 2.2% body fat % body fat 5 Yes – 2.2% at risk 5 No Risk prevalence – 4.8 mg/dL (total) Total Cholesterol 19 Yes Strong 8 No +.94 mg/dL HDL Cholesterol – 6.6 pct pt Risk prevalence 11 Yes 5 Yes Small Insufficient Fitness 40
Summary Results and Team Consensus Body of Consistent Magnitude of Outcome Finding Evidence Results Effect Estimated Risk 15 Yes Moderate Sufficient Healthcare Use 6 Yes Moderate Sufficient Worker Productivity 10 Yes Moderate Strong 41
What About ROI? Critical Steps to Success Financial ROI Reduced Utilization Risk Reduction Behavior Change Improved Attitudes Increased Knowledge Participation Awareness 42
Health Affairs ROI Literature Review Baicker K, Cutler D, Song Z. Workplace Wellness Programs Can Generate Savings. Health Aff (Millwood). 2010; 29(2). Published online 14 January 2010.+ 43
Results - Medical Care Cost Savings Description N Average ROI Studies reporting costs and 15 $3.37 savings Studies reporting savings only 7 Not Available Studies with randomized or 9 $3.36 matched control group Studies with non-randomized or 6 $2.38 matched control group All studies examining medical care 22 $3.27 savings 44
Results – Absenteeism Savings Description N Average ROI Studies reporting costs and savings 12 $3.27 All studies examining absenteeism 22 $2.73 savings 45
Goetzel’s Rule: an ROI of 1:1 Is Good Enough… 46
…if You Can Demonstrate Health Improvement! 47
Poor Health Costs Money Drill Down… • Medical • Absence/work loss • Safety • Presenteeism 48
Top 10 Most Costly Physical Health Conditions Medical, Drug, Absence, STD Expenditures (1999 annual $ per eligible), by Component 49
The Big Picture: Overall Burden of Illness Using Average Impairment and Prevalence Rates for Presenteeism ($23.15/hour wage estimate) $450 $400 $350 $300 Presenteeism STD Annual Costs $250 Absence RX ER $200 Outpatient Inpatient $150 $100 $50 $- Allergy* Depression/Sadness/Mental Illness Hypertension Migraine/Headache Respiratory Infections Arthritis Asthma Any Cancer Diabetes Heart Disease Source: Goetzel, Long, Ozminkowski, et al. JOEM 46:4, April, 2004) 50
HERO II Study 51
Cost Per Capita of Risk Factors 347 350 300 250 178.6 200 128.2 150 106.2 104.1 80.8 100 38.3 -75.4 -14 -6.4 50 0 -50 -100 52
Research on Risk-Cost Relationships - Novartis 53
Risk Factors and Presenteeism (N = 5,875) Risk factors predicted .80 – 1.67 additional presenteeism days/year 54
Risk-Cost Relationships at PepsiCo 55
BMI Breakdown by Category 50% 44% Percentage Sample In Each BMI 45% 40% 35% 30% Category 25% 25% 22% 20% 15% 10% 7% 3% 5% 0% Normal Overweight Class I Class II Class III BMI < 25 BMI 25-30 BMI 30-35 BMI 35-40 BMI 40+ 56
PepsiCo – Overweight / Obese Analysis (N=11,217) Difference between combined overweight/obese categories and normal weight is displayed Source: Henke RM, Carls GS, Short ME, Pei X, Wang S, Moley S, Sullivan M, Goetzel RZ. The Relationship between Health Risks and Health and Productivity Costs among Employees at Pepsi Bottling Group. J Occup Environ Med. 52, 5, May 2010. 57
NHLBI Multi-Center Study: Estimated Annual Costs of Healthcare Utilization, Absenteeism, and Presenteeism by BMI Category Normal $178 $182 Doctor Visits Overweight $229 * Obese $149 Emergency Room $155 Visits $219 * $1,535 Hospital Admissions $1,544 $2,034 $872 $918 Absenteeism Days $1,180 * $1,200 * $1,402 Presenteeism $1,416 * $0 $500 $1,000 $1,500 $2,000 $2,500 Source: Goetzel RZ, Gibson TB, Short ME, Chu BC, Waddell J, Bowen J, Lemon SC, Fernandez ID, Ozminkowski RJ, Wilson MG, DeJoy DM. A multi-worksite analysis of the relationships among body mass index, medical utilization, and worker productivity. J Occup Environ Med. 2010 Jan;52 Suppl 1:S52-8. 58
J&J Study – Health Affairs, March 2011 59
Health Risks – Biometric Measures -- Adjusted Results adjusted for age, sex, region * p<0.05 ** p<0.01 60
Health Risks – Health Behaviors -- Adjusted Results adjusted for age, sex, region * p<0.05 ** p<0.01 61
Health Risks – Psychosocial -- Adjusted Results adjusted for age, sex, region * p<0.05 ** p<0.01 62
Adjusted Medical and Drug Costs vs. Expected Costs from Comparison Group Average Savings 2002-2008 = $565/employee/year Estimated ROI: $1.88 - $3.92 to $1.00 63
VANDERBILT UNIVERSITY 64 64
SEVEN YEAR AGGREGATE AND COHORT ANALYSIS 65 65
PHYSICAL ACTIVITY 66 66
OBESITY 67 67
SMOKING 68 68
Vanderbilt – 8-Year Study 69
Obesity and Diabetes 70
DR. KOOP WITH 2008 WINNER – VANDERBILT UNIVERSITY http://www.thehealthproject.com 71 71
But…what about the Value -on-Investment (VOI)? 72
73
Wall Street Studies 75
Ray Fabius’ 2013 study 76
American College of Occupational and Environmental Medicine (AECOM) Corporate Health Achievement Award (CHAA) Winners – 1996 - 2013 77
ACOEM Winners vs. S&P 500 78
HERO Study: Connecting Corporate Health and Wellness Best Practices to Superior Market Performance 79
Grossmeier et al., HERO S&P Study 80
HERO Study Results 81
Koop Award Winners and S&P 500 Index 82
Koop S&P Study 83
Koop Winners: 1999-2014 BP America BP 2014 Eastman Chemical EMN 2011 Prudential Financial PRU 2011 Pfizer, Inc. PFE 2010 The Volvo Group VOLVF 2010 Alliance Data Systems Corp ADS 2009 Dow Chemical Company DOW 2008 International Business Machines IBM 2008 Pepsi Bottling Group PBG 2007 WE Energies WEC 2007 Union Pacific Railroad UNP 2005 UAW-GM GM 2004 Johnson & Johnson Services, Inc JNJ 2003 FedEx Corp. FDX 2002 Motorola Solutions Inc. MSI 2002 Citibank C 2001 Union Pacific Railroad UNP 2001 Northeast Utilities NU 2001 Caterpillar Inc. CAT 2000 Cigna Corp. CI 2000 DaimlerChrysler Corporation DDAIF 2000 Fannie Mae FNMA 2000 Aetna AET 1999 Pfizer, Inc. PFE 1999 Glaxo Wellcome GSK 1999 UNUM/ Provident UNM 1999 84
85
HERO Scorecard Study 86
Average Change in Medical Expenditures Average Percent Change in Medical Expenditures Over Three Years for the Study Sample (Adjusted to 2012 Dollars – Not Adjusted for Confounders) 200 180 160 Total Hero Scorecard Score 140 120 100 80 60 40 20 0 -10.0% -8.0% -6.0% -4.0% -2.0% 0.0% 2.0% 4.0% 6.0% 8.0% Average Percent Change in Medical Expenditures from 2009 - 2011 87
Comparison of Expenditures by HERO Score, Adjusted for Confounders Predicted Average Annual Per Member Healthcare Expenditures (Adjusted to 2012 dollars) for Organizations with High and Low HERO Scores $3,100 Adjusted Annual Cost $3,050 $3,000 $2,950 $2,900 $2,850 $2,800 2009 2010 (% Change from 2009) 2011 (% Change from 2010) LOW $3,048 $3,050 $3,051 (0.05%) (0.05%) HIGH $2,948 $2,901 $2,855 (-1.6%) (-1.6%) HERO Score 88
Getting the Word Out on Best and Promising Practices in Workplace Health Promotion 89
90
Case Studies – Companies That Do It “Right” 91
Kent et al., JOEM Study 92
Transamerica Employer Guide https://www.transamericacenterforhealthstudies.org/health-wellness 93
Harvard Business Review Translation 94
Employer Playbook 95
The Secret Sauce 96
1. Culture of Health • More than just a wellness program – It’s a way of life • Ingrained in every part of the organization – Business Mission – Built Environment – Performance Metrics – Programs, Policies, Health Benefits 97
2. Leadership Commitment • CEO Driven • Lead by Example • Middle Management Support • Budget/business plan • Empowered workers/unions 98
3. Specific Goals and Expectations • Think big, start small, act fast -- one step at a time • Set short and long term objectives • Be realistic about what can be achieved in 1, 3, 5, 10+ years • Accountability – leaders and employees are accountable for doing their part to support a culture of health 99
4. Strategic Communications Relentless Surround Sound • Messages need to be: – Consistent – Constant – Engaging – Targeted • Two-way dialogue using a variety of channels • Wellness champions 100
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