Placing Workplace Wellness in Proper Context: Value Beyond Money

By Nicolaas P. Pronk, PhD, MA

Most companies in the United States now offer some kind of wellness programming to their employees. In 2012, about half of US employers with at least 50 employees and more than 90% with more than 50,000 employees offered a workplace wellness program (1).

Employer surveys (eg, the 2011 Automatic Data Processing Survey) suggest that the most often-cited reasons for offering these programs include improved employee health, health care cost control, increased productivity, and absenteeism reduction. Each of these reasons is quantifiable, and their value can be monetized, allowing for a calculation of savings and an estimation of a return on investment (ROI).

Yet it isn’t necessarily always about saving money. Dr Risa Lavizzo-Mourey, president and chief executive officer of the Robert Wood Johnson Foundation, notes in a recent online post that companies committed to nurturing a culture of well-being consider broader motivations, including low turnover rates, attraction of top candidates, job satisfaction, and recruitment and retention of workers (2). Each factor was reported as being a more important driver of workplace wellness programs than ROI.

There is understandable interest in learning if, and how, workplace wellness programs produce results and generate savings. Publications on the effect of workplace wellness on financial outcomes continue to accumulate (1–5), but instead of producing consistency and clarity, they have introduced doubt and controversy. Systematic reviews and meta-analytic findings indicate that workplace wellness can generate savings (3). However, recent ROI studies indicate that such savings come only from disease management (DM) programs not lifestyle management (LM) programs (1). To gain clarity, 2 issues must be addressed. First, there is a need to standardize the definition of workplace wellness programs so that casual use of what constitutes such programs can be avoided. Second, research approaches should more explicitly recognize that workplace wellness programs generate a range of outcomes, many of them non–health related, that provide substantial value to employers even though they are often not represented in ROI analyses.

This essay addresses these 2 issues in the context of a set of best practice program-design principles that allow for properly designed workplace wellness programs to be differentiated from other activities that, although well-intended, may not rise to the level of a bona fide program.

Read the article.

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Want to Contribute to the Industry’s Discussion on Value on Investment?

By Michael Connor, Dr.P.H., Senior Vice President, Alere Health and Bruce Sherman, MD, Medical Director, Employers Health Coalition

The Population Health Alliance (PHA) Quality & Research Committee has identified Value on Investment (VOI) as a key initiative for this year. The goal of this work group is to empower purchasers of population health management (PHM) programs to adopt a comprehensive value proposition, which more broadly captures the business impact beyond healthcare costs.  Initial objectives include defining the scope of the VOI construct and determining a compelling rationale that is embraced by PHM purchasers.

The Health Enhancement Research Organization (HERO) and PHA led a collaborative effort to develop guidelines related to value domains and corresponding core metrics. The VOI model encompasses all of these domains as outputs as well as a broad view of investment or inputs beyond program vendor fees and incentive costs.

The domains are organizational support, participation, health impact, productivity and performance, financial savings and satisfaction. The Organizational Support domain addresses the degree to which an organization commits to the health and well-being of its employees. Participation recommends measures and definitions related to meaningful program interventions. The Health Impact domain covers measures associated with preventable health conditions.  The Productivity and Performance domain provides an employee continuum ranging from absenteeism through optimal performance at work. Financial Health Care Savings incorporates claims data and modeling estimates.  Satisfaction addresses participant and provider perspectives.

Initial reactions have been very positive related to both the domains and the VOI approach. Most stakeholders are intrigued with the concept, and some have enthusiastically volunteered to pilot the process. Others have suggested the need to develop a more compelling business case to discuss with purchasers.  There are clearly data implications related to a broader set of outcome measures beyond the more traditional and narrower focus of financial health care savings.

Work group discussions have questioned whether organizational support is an outcome or rather an input within the VOI framework. Additional considerations have raised the need for a greater focus on participant program engagement as well as assessing program impact on employee engagement at work and other business outcomes.

So what are your thoughts regarding …

  1. What are the barriers to a purchaser acceptance of a broader value proposition and how these can be addressed?
  2. What practical measures and methodologies best assess value components and will be readily adopted?
  3. How do the value domains align with purchasers’ (employers, health plans and government) strategic priorities?

Comment here or email us your thoughts at kmoseley@populationhealthalliance.org

 

Improving Population Health: Creating Healthier Communities to Make Healthcare Better

Brenda Schmidt, MS, MBA, President and CEO of Viridian Health Management

A few weeks ago, I attended the 2013 CCA Forum in Scottsdale, Arizona. I am proud that Viridian Health Management was a CCA Forum contributor sponsorSolution Zone exhibitor and symposium speaker, as this conference is the largest gathering of healthcare professionals in prevention, wellness and chronic care management.

The days started early with the breakfast symposiums and were followed by sessions led by well-known organizations as Accenture, Aetna, Alere, Apixio, Banner Health, Optum, Mayo Clinic, Qualcomm, stickK, Walgreens, Weight Watchers, Zamzee, and many more. The days ended with great networking events in the evening. Despite the long days, I was completely energized and refreshed. Spending three days with over 1,000 innovative thinkers can certainly have that effect. I was fortunate to talk with many of these innovators throughout the duration of the CCA Forum and the common thread was that they all wanted to improve healthcare delivery, positively impact health outcomes, increase quality of care, and make sustainable improvements in healthcare for the future.

Looking back at the many CCA Forum speakers, they all were very aligned to this year’s theme of “The Value of Population Health: Implementation Matters.” Here are a few of those examples that really resonated:

  • Michael Taylor of Accenture: “Maintaining a ‘human touch’ in your engagement methodology is a key component of a successful wellness program. Sustainable engagement is necessary to drive value in population Health.”
  • Nilay Shah of Mayo Clinic: “Big data gives the opportunity to collaborate, to prototype, test new findings and speed adoption.”
  • William Crown of Optum Health: “Creating the right cadence for population health management is the key to success over a shotgun approach.”
  • Dee Edington of Edington Associates: “There is plenty of evidence to show health improvement and improved productivity as a result of a culture of health.”
  • Thomas Parry of Integrated Benefits Institute: “If ROI is your only driver for worksite wellness initiatives, then you’re missing out.”
  • Sean Sullivan of the Institute for Health & Productivity Management: “It’s about a consistent message from the top to create a culture of health at your organization.”
  • Robert Stone of Healthways:  “The things that can be measured the most, oftentimes are not the most important.”
  • Ron Weinert of Walgreens: “It’s not a complicated idea…provide patient care in a community setting. We’re bridging the gap…coordinating care through innovative pharmacy programs.”

It was also an honor to co-present with Marissa Hudson, Viridian’s EVP of Public/Private Partnerships at CCA Forum 2013 to discuss Viridian’s role as a strategic partner of the CDC to deliver the National Diabetes Prevention Program (National DPP); Viridian’s proprietary My Weigh 2 Prevent Diabetes™, a cloud-based technology developed exclusively for the National DPP; our diabetes lifestyle coach training; andMAESTRO™, Viridian‘s proprietary model for the identification, outreach and administration of diabetes prevention.

In addition, I am honored and privileged to accept my appointment as a member of CCA’s board of directors. As one of 10 new members of CCA’s board of directors, I look forward to collaborating with other leaders of the healthcare industry to focus on the implementation of effective population health models and strategies from development to delivery.

It’s not a complicated idea: creating healthier communities to make healthcare better and sustainable for the future. As a value-driven health management company, Viridian powers performance in population health, inspires healthy living and lowers healthcare costs. Our philosophy of integrative health management is an interdisciplinary approach that emphasizes a synergy between health protection and health promotion. This approach extends not only to individuals, but also to caregivers, providers and the larger healthcare system.

CCA Forum 2013 clearly chose a very relevant and timely theme. Without a doubt, there is tremendous value of improving population health…it really does matter.

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About the Author

Brenda Schmidt is the president and CEO of Viridian Health Management. As the architect of numerous successful health and wellness programs, Schmidt is widely recognized as an authority on developing best-in-class programs that engage diverse populations. In founding Viridian, Schmidt works in collaboration with the Centers for Disease Control and the U.S. Department of Health and Human Services on the National Healthy Worksite Program. This national initiative brings a new level of health to the American workplace to improve the lives of employees while lowering employer healthcare costs. In addition, Schmidt also serves a leadership role in the Health Enhancement Research Organization (HERO) Think Tank, the Clinton Global Initiative (CGI), NIOSH Total Worker Health™ and frequently speaks nationally on integrated health management and worksite health.

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Guest Blog Post Disclaimer CCA invites guest bloggers to post on Voice on Population Health Blog as a benefit for our members and the industry and to allow for exchange of ideas and information regarding population health. The views, opinions and positions expressed within these guest posts are those of the author alone and/or of the company the author represents and do not represent those of the Care Continuum Alliance (CCA), its members, or the industry as a whole. CCA is not responsible for the accuracy, completeness and validity of any statements made within this guest post article. We accept no liability for any errors, omissions or representations. The copyright of this content belongs to the author(s) and any liability with regards to infringement of intellectual property rights remains with them.

Guest Post: Implementation matters. Particularly if it relates to what matters to the purchaser

Paul Terry formal photoBy Paul E. Terry, Ph.D., Chief Science Officer, StayWell Health Management

I picked up an undercurrent during this year’s Care Continuum Alliance – CCA Forum 2013 that I tested often in break-time conversations. “Do you think there is a connection between the return on investment (ROI) and value on investment (VOI) discussions?” I asked. While the answers I got ranged from technical to philosophical, the general tenor from consultants and purchasers alike was a genuine appetite for broadening the criteria we use to judge success in population health management.

I think three things explain a great vibe at the conference that spoke to a readiness to take population health from what has been an inordinate focus on ROI to a preference for advancing VOI. Many view VOI as richer, if not more meaningful to purchasers, first, because of opportunities that accountable care organization (ACO) and regional exchanges could present; second, because of extant limitations in ROI methodology; and, probably most important, because VOI represents the next level of maturation and opportunity for the field.

Regional exchanges and the VOI of wellness

Most presenters who ventured into whether and how the exchanges could influence population health management acknowledged it’s too early to tell. I found Medical Director for Employers Health Coalition Bruce Sherman’s rendition especially edifying given his postulate that small employers may finally have enough critical mass to reconcile the VOI of prevention. Sherman, a medical director for Ohio’s Employer’s Health Coalition, is able to see more clearly than most how the lack of investment by one employer ultimately disadvantages the collective competitiveness of a region.

A scenario I posed to Sherman that he agreed was viable was one where exchanges and population health management providers become more focused. Businesses generally are adjusting to an era of hyper-specialization, and winning or losing in population health will relate to a VOI that is different from one employer to the next.

What I found telling about the VOI propositions offered by those who discussed exchanges or ACOs was the continued preoccupation with the employer as purchaser. It’s more than ironic that “patient centered” homes and value-based purchasing are watchwords, but that the consumer’s values and needs still get short shrift. When a conference has panels of patients replace experts, I’ll be convinced we are fully embracing patient-centered concepts.

At long last: positive proof that wellness works for everyone all of the time

Would the CCA Forum, or any science-oriented group, organize sessions to support this headline? Of course not, but it’s attention-getting isn’t it? That’s undoubtedly a goal behind the hyperbolic harbingers of the notion that wellness doesn’t work.  Nevertheless, the CCA Forum made room for a “great debate” on ROI so presenters could posit that piece meal programs tested using quasi-experimental methods will yield unimpressive or inconclusive results. Not much grist for disagreement but, ever the optimist, I’m predicting those bent on scaring up controversy will inadvertently help to advance VOI metrics.

Short of more randomized controlled trials for comprehensive, long-term population health programs that balance individual interventions with culture change, today’s ROI methods are about as good as they’re going to get. My Dad taught me that you don’t dignify some criticisms with an answer. If CCA is looking for debate questions, here are some that I’d find interesting: Do wellness programs over-measure and under-intervene? The ratio of incentives to educational program spending is nearing 4:1; could this do more harm than good? The Affordable Care Act (ACA) rules could lead to annual health screening for many who would otherwise not be due for screenings according to clinical consensus guidelines; how should this be reconciled? Qualified debaters would be credible scientists who don’t have a financial interest in proving or disproving the questions.

Taking PHM to the next level

Conferences are at their best when they offer healthy doses of both education and inspiration. That the behavioral economics principles advanced in the book “Nudge” are being successfully applied in a clever product like “StickK” is a grand testament to how research can drive innovation. Seeing how an icon to consumer-based health education such as Weight Watchers is mobilizing its formidable peer-support infrastructure as a population health strategy is also remarkable. Learning how the Joslin Diabetes Center is translating its exemplary results in diabetes management into the diabetes prevention sphere was another example of how champions for change build on their own success.

This year’s CCA Forum was, as usual, masterful at enabling networking. It was during an informal lunch debate I had with three of population health’s most prolific researchers — Ron Goetzel, Ph.D., vice president, Truven Health Analytics, Seth Serxner, Ph.D., MPH, chief health officer, OptumHealth and Dee Edington, Ph.D., Edington Associates — that I was reminded of a fourth tenet for why implementation matters. Thought leaders don’t bemoan the failings of others because looking for bad apples is precious time away from creating ever more effective systems that support implementation excellence. Leaders are problem solvers, not problem describers. What’s more, they have an abiding message advancing what they are for, not merely polemics about what they’re against. On this count, this year’s CCA Forum convinced me that when it comes to implementation matters, the value of population health management is in very capable, and constructive, hands.

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Guest Blog Post Disclaimer CCA invites guest bloggers to post on Voice on Population Health Blog as a benefit for our members and the industry and to allow for exchange of ideas and information regarding population health. The views, opinions and positions expressed within these guest posts are those of the author alone and/or of the company the author represents and do not represent those of the Care Continuum Alliance (CCA), its members, or the industry as a whole. CCA is not responsible for the accuracy, completeness and validity of any statements made within this guest post article. We accept no liability for any errors, omissions or representations. The copyright of this content belongs to the author(s) and any liability with regards to infringement of intellectual property rights remains with them.

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