Brian D. Harrison MD, FACOEM Medical Director, Affinity Health and Productivity Management

1. Extreme MakeoverCorporate EditionReality TV Meets OEM,Showing YouHot Health and Productivity Management (HPM) Design Tips! Brian D. Harrison MD, FACOEM Medical Director, Affinity Health and Productivity Management 9/16/05 WAHU Conference

2. The following slides are the “Handout Version” of Dr. Harrison’s talk. Together with the bibliography, they contain all the information in the presentation, minus the pictures. But you may get lost if you try to follow this handout during the talk. Instead, sit back and watch the show!

3. “NowLet’s Hear From Our Team of Designers (They Know a LOT)What Corporate Health Ideas Are Really RED HOT?”

4. Unlike Home Designers on THE LEARNING CHANNELWe Use Corporate Execs for Our Expert Panel

5. WBGH/Watson Wyatt 2003 Survey of Corporate Execs: What do you do about those huge premium checks? • Without competitive bidding we’d be lost! • Require your employees to share that cost! • Make the health plans show quality; believe me I know! • Clinical case management will surely help the cash grow (and this wallpaper is killing me; one of us has to go!)

6. More Thoughts as Our Team Flies into Action: • How do you improve employee satisfaction? • Flexible work arrangements work for me! • You can’t beat a good corporate EAP! • Work and family programs are a big winner! • To really make ’em happy give ’em a fitness center!

7. “What else do our experts advise?”(WBGH/Watson Wyatt 2003 Survey) • How can you help employees live healthier lives? • Again, you need that fitness center! • But Health Promotion Programs are really better! • Do you have an on-site medical clinic? It’s a must! • Duh? Without disease management your program’s a bust! • I’m a traditionalist! Modernism be cursed – Safety First, Safety First!

8. “OK Experts, With Your Powers of Deduction: • Now they’re happy, now they’re healthy – What helps their production?” • A must-have, it’s true - EAP I say to you! • They’re not productive if never at work– RTW initiatives, RTW program, RTW supervisor training – a triple whammy will do! • Another reason an on-site medical clinic will click! • ALL THOSE THINGS will! Why, it’s automatic! (if they’re healthy and happy, production is never crappy)

9. DESIGNERS HAVE BUT, THEIR HEADS IN THE CLOUDS AND BUDGETS THAT AREBLING!WHAT CAN WE DO, WITH OUR OWN HPM THING?

10. WE WANT A MAKEOVERNOT LIFESTYLES OF THE RICH AND FAMOUS!WE JUST NEED SOMETHING THAT’S CHEAP!(BUT THAT STILL WON’T SHAME US!)

11. We’re Hurtin’ for Certain! • The average employer in ACOEM survey only does 6 out of 32 possible Value-Focused Activities in employee health • The main difference between those that do more and those that do less – available data and benchmarking – not just dollars!

12. What is it you like the LEAST when you look into the mirror?Our makeover team will bring your corporate health dreams nearer!

13. We Do an Annual HRA, But I Am Ashamed to Say… • Participation is low! My popularity is LOST! • Management wants to know what they got for the cost! • We got the corporate report – and here it will sit! • Employees want to know what’s next; “Is this it?”

14. Lets Start With That Embarrassing Participation Rate!You know, it’s what determines your program’s fate!

15. You’re Smart to Care About Your Participation Rate – You’ve Got to Get’em to Cooperate! • The rate of return is driven by the participation rate – greater than 3 to 1 if participation rate goes over 50% (Summex, 2001). • Positive ROI can be achieved just with HRA participation, even if follow-up participation is low (Citibank – 51% participation in HRA, 5% completion of follow-up, yet ROI almost 5:1). • High HRA participation is needed to change company culture.

16. $$$What’s on Their MindAll the Time?$$$ • What do employees care about?(per Summex 2001) • Improved compensation, security, financial protection – no doubt • Privacy and confidentiality they don’t want to lose • Few constraints, freedom to choose • Self-service ( but with support of course!)

17. They Want the Same Things As You! • Shifting costs now means they pay too • 83% of execs say cost shifting is what they do • Employee share is up 50% in 5 years - that’s what’s new • You’ve been Trading Spaces (TLC Sat. 9PM EST), they and you!

18. Home Builder, Bill Duggan, (Curb Appeal, HGTV Wednesdays) – he’s no clod:“Just Repainting the Front Door Can Transform Your Home’s Facade!”

19. Change the HRA Front Door! Cash incentive – just a little bit more • For $25, fifty percent would • If $100 then 90% could • But paying $100 is all you should (StayWell Corporation) Cash isn’t the only thing that brings this about - Pitney Bowes adds to a health spending account Sometimes even a pedometer gets them out.

20. Wondering “What Not To Wear”?(TLC, Fri. 8PM EST)How About Making Employees Go Bare? • No HRA means no health plan if you work for Birmingham! • Incentives versus disincentives • City of Birmingham, Alabama – Annual participation HRA required to receive healthcare coverage. Participation rate 97.5%, healthcare costs nearly flat over five years (SHOCKING yes, but it does work!)

21. ConfidentialityPerception is Reality! • Without it, your program is badly broken! • It is not like “Clean Sweep” (TLC, Saturdays) -don’t haul junk into the open! • Besides, info that is aggregated is the only kind that’s management-related • Consider out-sourcing for just that reason • HIPAA statement on the HRA is very eye-pleasing

22. We Can’t Get ‘em to Come to the InterventionThe Numbers are Too Small to Even Mention • Target the interventions – The right individual should be identified and recruited (by the HRA vendor). • Heaney and Goetzel (1997) – 48 studies of multi-component programs, effective programs target those at risk for individual counseling. • Erfurt and Foote (1993) – Participation in interventions increased 500% by targeting.

23. No BLING? Have to “Design on a Dime”?(HGTV Mondays, 10PM EST)Then do just one thing on your first time • Like BP, Depression, Smoking • Single Risks as Index to Other Problems: • Edington – Likelihood of association with other risks (e.g. - if in the high risk BP category, how likely to be at high risk overall?) • Diastolic BP risk group – 48% have 4 or more risks • Systolic BP group – 43% • Smokers – 38% • n=16,879 • Austin & Kostecki – Depressed employees are 8.5% of workforce but account for 18% of STD

24. Because One Thing Will Lead to AnotherCertain Risks are Key, You Will Discover! Find the hypertensives (hint – check their BP) Find the smokers (hint – they go outside on break) Find depressed employees (hint – screening tools like Beck, Prime MD)

25. Let the Employees do Some of the Choosing There are Popular Ones to Consider Using • HRA asks areas of interest. • Offer a variety of simple programs (Quality of Work Life Programs, per Chapman) for goodwill and fun; let them pick. • This gets them ready for more important HPM programs (disease management, risk management) services for which they are individually invited

26. “So What if it’s Popular With Employees -It’s Those Management Tight Wads I Have to Please!”

27. The “Sell This House” TV Crew(A & E Sundays)Comes to Your Budgetary Rescue! • They get three days to make a contestant’s house “show well” to potential buyers. • They remove clutter and outdated décor! They play up the good points! • And they know this is not your father’s corporate wellness program!

28. IN GOD WE TRUST All else MUST show data!

29. EMPLOYER HEALTH CARE SPENDING -WHICH IS IT? • Benefit – a gift you buy to make someone happy; a purchase from surplus • Commodity – a necessity you buy from the lowest bidder, only as much as you must have; an expense against the middle line • Investment - considered purchase based on ROI, including risk and return. If it’s good, BUY ALL YOU CAN GET! It will be a credit to the top line!

30. The Corporate HRA Report Doesn’t Get a Second Glance!(What do you want, it should sing and dance?) • Use it to show present and future costs (we’ll show you how) • Repeat HRA to set the stage for ROI calculation • Make it the linchpin to all your other programs • Risk stratify your population. • Identify top risk categories and chronic diseases, prioritize interventions accordingly

31. Your Corporate HRA Reports Show “Money At Risk” to Tight Wad Sorts • Monetize the annual lost productivity costs, using (from the HRA report): • Disease prevalence (With Benchmarks). • Self reported productivity losses • By disease category. • Mean per affected employee, compared to unaffected. • Total excess disease-associated productivity loss. • Self reported aggregate losses compared to literature benchmarks • “This was the cost of doing nothing!”

32. “Design on a Dime” (HGTV Mondays, 10PM EST)Tips to use if you haven’t got time! • Goetzel (JOEM 04/04) estimated distributed annual costs per employee (not just affected employees), medical + productivity: • Hypertension $392 • Depression/mental illness $348 • Arthritis $327 • Heart disease ($368) had the highest proportionate medical cost (81%). • Migraine Headache ($213) had the highest proportionate presenteeism cost (89%).

33. But watch out for these design traps! • Guessing prevalence is like shooting craps! • Allergy 9 – 41% • Arthritis 3.5 - 20% • Asthma 4 - 8.5% • Depression 3 - 20% • Diabetes 2 - 6% • Heart Disease 1 – 16.9% • Hypertension 8.5 – 19% • Migraine 8 - 26% • Smoking 12 - 31%

34. Attention All Benefits Management Boys and Girls:Accessorize Your Claims Data Base With HRA Pearls! HRA Beats Claims Data at Counting Symptom–Categorized Conditions (Migraine, Depression, Backache)

35. Get Them to Open the Corporate PurseBy Showing it’s “For Better or For Worse”(TLC, Wed.) • Employee Health & Wellness: “It’s a long-term commitment!” • Predictive modeling (Yen and Edington, JOEM 10/03): factors that raise medical costs. • Dropping one point on aggregate wellness score equals +$56/employee. • Additional mean year of age = $88/employee. • Development of chronic disease = $3,574/affected employee.

36. Then You Can Persuade Management to do “Extreme Makeover” (ABC Sundays) Or at Least, Design-On-A-Dime (HGTV Mondays)

37. Here is Your Extreme Makeover – Corporate Edition!We Can Make You Look Like: • Pitney Bowes • Healthcare University • Integrated Database • Healthy Work Environment • On-Site Clinics • Disability Management

38. Here is Your Extreme Makeover – Corporate Edition!We Can Make You Look Like: • International Truck • Vital Lives Program • Healthwise Self Care Program • Trucking Across North America Program (Fitness/Wellness Log, On-Site Fitness Centers). • Allergy HPM Research

39. Here is Your Extreme Makeover – Corporate Edition!We Can Make You Look Like: • Merrill Lynch • Wellness Inventory at Health Fairs • Risk Categorization for Absenteeism and Presenteeism • Allergy Intervention • FleetBoston Financial • PATH Program – Multi-Component Management and Prevention of Disabilities

40. Here is Your Extreme Makeover – Corporate Edition!We Can Make You Look Like: • Federal Reserve Bank of Dallas • Musculoskeletal Disorders HPM Intervention • Calculated Baseline of Direct and Indirect Economic Impacts (Work Limitations Questionnaire-WLQ). • Musculoskeletal Disorders Education, Promotion of Health Behaviors, Enhanced Communication to Medical Provider, Positive ROI on Outcomes Measurement

41. Here is Your Extreme Makeover – Corporate Edition!We Can Make You Look Like: • United Auto Workers – General Motors – LifeSteps. • Nationwide as well as focused pilot interventions. • Website, online managers’ programs, newsletters, self care book, toll free audio health library, follow-up calls, vouchers for high risk participants, wellness support programs. • Improvement in the population flow of risk status, reduction in days of disability.

42. Here is Your Extreme Makeover – Corporate Edition!We Can Make You Look Like: • Union Pacific Railroad • Multi-site interventions for smoking, weight, fatigue, inactivity, depression, asthma, BP, lipids, stress, diabetes • Developed one of country’s largest fitness systems – 535 “Rolling Gyms” • Reduced lifestyle-related health care claims 10%

43. Here is Your Extreme Makeover – Corporate Edition!We Can Make You Look Like: • Johnson & Johnson Health & Wellness Program (J&J HWP) “Since 1980” • Increasing integration over time – health, wellness, disability management, EAP, OEM, benefits, fitness • 90% participation due to financial incentives such as $500 insurance premium discount, and corporate culture) • Published positive outcomes ($224 health care savings per employee per year) and improved employee health risk category (most – cholesterol, fiber, exercise, smoking, BP; least – BMI, diabetes risk, fat intake)

44. I Can’t Go On!I have a confession!Corporate Redesign is not my Profession! I’m a plain old ordinary Occ Med Physician And Hospital-Based is my Real Position

45. But you can do HPM even down in the trencheswith HRA for lumber and reports for wrenchesGrassroots HPM may be a patchwork thingCommunity interventions tied up with stringBut it still gets you numbers that make it look niceat least enough to get clients to look at it twiceThe point is employers want to do the right thing-you can help their employees do healthier living

46. So much for TV fantasyHere’s some at-home reality: Our 5,000 employee Health Care Organization took a pokeAt helping its employees who can’t help but smoke

47. Employee Smoking Trends

48. Absence from work by smoking category (any cause) - BEFORE

49. Absence from work by smoking category (any cause) - AFTER

50. 2001 (adjusted to 5K pop) 2,997.39 2004 (adjusted to 5K pop) 589.76 Decreased by 2,407.63 Reduced by both lower current prevalence and lower mean days absent in all groups Excess Absence (Relative to Never Smokers) in Days/yr for “Ever Smokers”