CWWS exam

REALITY CHECK

"Heart disease is not the leading cause of death among men and women in the United States. Cancer, stroke, pulmonary disease, diabetes, and dementia are not the other leading causes of early mortality and/or chronic malady either. . . The actual, underlying 'cause' of premature death in our country fully 8 times in 10 comes down to bad use of our feet (lack of physical activity), our forks (poor dietary choices), and/or our fingers (holding cigarettes)." Dr. David Katz

INTEGRATION WITH BENEFITS

"Many employers regard their workplace wellness program as part of an integratedhealth and wellness strategy that provides additional resources and benefits."

COMMUNICATION OPTIONS: SELF MONITORING

"Quantified Self" Self management through data tracking Biometrics Genome profiling (e.g., 23andME®) Fitness wearables Diagnostic apps Health risk assessment

median incentive by program

$25: telephonic lifestyle coaching, telephonic condition coaching $20: digital coaching $40: on site fitness center visits $45: team challenges $100: physical activity tracking, health risk assessment, biometric screening

value on investment (voi)

...no one perfect measure of success. framework for comprehensive evaluation Multiple outcomes important to stakeholders: retention, organizational culture, employee morale productivity, absence, disability or turnover costsworkers' comp

SEVEN STEPS TO WELLNESS POLICY SUCCESS

1.Build a strong team 2.Assess the environment 3.Draft policy 4.Adopt policy 5. implement policy 6. measure and evaluate 7. communicate the results

why evaluate?

1st It helps appraise progress throughout the life of the program and the likelihood of achieving desired outcomes, thus justifying the program's existence. 2nd It helps you determine how to allocate your budget so you can focus your time and resources on meaningful programming. 3rd It is important because it provides you with tangible evidence you can share with your stakeholders. monitoring/process improvement function- little p program outcomes- big p

health and productivity programs - u.s

2015/2016 staying work report data, with comparison to previous years data HRA In Place 2015 85% ( up 1%) Planned 2016 3% (down 3%) Considered 2017/2018 8% ( up 5%) Participation 48% ( down 2%) Biometrics: In Place 2015 73% ( down3%) Planned 2016 5% ( down 4%) Considered 2017/2018 8% (nc) Participation 48% ( down 1%) onsite coaching: In Place 2015 38% (up 1%) Planned 2016 5% (down 1%) Considered 2017/2018 12% (down 1%) Participation 18% (down 3%) health CTRs: In Place 2015 32% (down 8%) Planned 2016 4% (down 2%) Considered 2017/2018 12% (up 2%) Participation 45% (up 5%) finess facilities: In Place 2015 (69%) Planned 2016 (3%) Considered 2017/2018 (6%) Participation (22%) preventive screening: In Place 2015 (70%) Planned 2016 (4%) Considered 2017/2018 (7%) Participation (41%)

COMMUNICATION OPTIONS: SMARTPHONES

71% of adults in the U.S. now own a web-enabled smartphone or other wireless device1 17% of cell phone owners have used their phone to look up health or medical information.2 29% of cell owners ages 18-29 have done such searches. 2 Number of consumers with at least one health or fitness app downloaded onto their smartphone has increased from 16% to 32% from 2013 to 2015.3 Uses continue to expand Virtual/diagnosis/treatment/health risk assessment Virtual, real-time health monitoring Health/fitness apps

return on investment (roi)

A performance measure used to evaluate the efficiency of an investment or to compare the efficiency of a number of different investments. roi= gains/benefits from program - costs of program divided by costs of program

WELL-BEING

According to the CDC, well-being: includes the presence of positive emotions and moods, the absence of negative emotions, satisfaction with life, fulfillment, and positive functioning. integrates mental health and physical health resulting in more holistic approaches to disease prevention and health promotion. is an outcome that is meaningful and a metric that is useful to multiple stakeholders involved in disease prevention and health promotion.

WELLNESS

According to the National Wellness Institute, wellness is: an active process through which people become aware of, and make choices toward, a more successful existence. Wellness is: a conscious, self-directed, and evolving process of achieving full potential. multi-dimensional and holistic. positive and affirming.

POLICY CHANGE

Adding, changing, or adapting policies to address wellness and improve the work experience is often a low-cost but high-impact way to impact employees and families.

MARKETING PROGRAMS: PITCHING YOUR PRODUCT

Align your organization's culture and the nature of your business when creating your brand and key messages. Sales Service Manufacturing Hospitality Financial Healthcare Tech

VALUE PROPOSITION

An integrated communications strategy: has consistent branding. improves management/employee/dependent buy-in. drives participation and engagement. improves awareness, knowledge, skill development, motivation, and reinforcement of desired health behaviors. solidifies and reinforces a culture of wellness—community. maximizes touch points. is aligned with the communication style of the organization.

integrated evaluation strategy

An integrated evaluation strategy: Measures key activities, and key outcomes they aspire to achieve Considers the environmental aspects (resources, work factors, contextual elements) that might be barriers and hinder success Focuses on how decision-makers judge program performance (quality, outcomes, impact) and evidence they find most credible Recognizes industry benchmarks that must be reached to be successful Leverages lessons learned to enhance the program through process improvement efforts

VALUE PROPOSITION

An integrated primary prevention and risk reduction strategy: Builds a strong program foundation of assessment, planning, and operational capabilities. Focuses on the different data sets and methods to prioritize health issues. Leverages the Affordable Care Act and "Don't get worse" as strategy drivers. Recognizes the power of a prevention plan and holistic program models for targeting and tailoring. Operationalizes program planning processes to optimize implementation and delivery.

PCMH IMPACT ON COST & QUALITY

Annual Update of Evidence 2014-2015: Improvements in cost of care Reductions in unnecessary or avoidable services Improvements in quality Improvement in access to care Improvement in patient satisfaction 30 peer-reviewed studies, state government program evaluations, and industry reports

KNOWING YOUR WORKFORCE: COMMUNICATING BETTER!

Annual audit/survey? What is your business? Demographics? Gender Age Ethnicity Education levels Job classifications Locations/Divisions? Domestic International

FIRST STEPS: MASSAGING ATTITUDES

Attitudinal shift of the end user to be open to considering "wellness" We wish "them" to: listen and learn understand the "product" be open to options/change weigh the relative value of options weigh the investment (PROI)

GETTING GROUNDED: DEFINE THE OBJECTIVE

Awareness Knowledge Skills Motivate/engageReinforce/support behavior; Create norms Build Community

WORKSITE CLUBS, SUPPORT GROUPS, SOCIAL NETWORKS

Beyond Salad vegetarian club Walking, biking, running clubs Weight loss/maintenance groups Meditation Club Working Mother Room—pass-it-on Community events/teams Softball, volleyball, recreational teams

BROADER FOCUS

Beyond assessing biometrics: Purpose Belonging Security Emotional Well-Being

TYPES OF BENEFITS

Business travel benefits Employee programs and services Family-friendly benefits Financial and compensation benefits Flexible working benefits Health-related benefits Housing and relocation benefits Leave benefits Professional and career development benefits Retirement savings and planning benefits Wellness benefits Other benefits

ASSESSMENT TOOLS

CDC and National Business Coalition on Health, Selecting a HRAhttp://www.eatsmartmovemorenc.com/Worksites/AdditionalToolkits/Texts/HRA-Toolkit.pdf Well-Being Gallup/Healthways Well-Being Index http://www.healthways.com/populationhealth Presenteeism Stanford Presenteeism Scale http://stresshealthcenter.stanford.edu/research/documents/Presenteeismactualmeasuresps-6.pdf WorkLife Quality CDC/NIOS Hhttp://www.cdc.gov/niosh/topics/stress/pdfs/qwl2010.pdf

beyond roi/voi

Career Well-being/Purpose: Metrics should reflect if people like what they do at work each day and if they have a sense of purpose. Social Well-being: The quality of relationships people have in their lives. Financial Well-being: Has more to do with feeling financially secure than making a lot of money. Physical Well-being: What contributes to good physical health and having enough physical energy to get important things done each day? Emotional Well-being: Metrics reflect a good sense of resiliency and work- life balance and having enough mental energy to get important things done each day. Community Well-being: How connected people feel to the community in which they live.

INCENTIVE DEFINITIONS

Carrot - commonly viewed as a positive reward (merchandise, health premium reduction, cash) Stick - commonly viewed as a negative or undesirable consequence (penalty, premium surcharge) Disincentive - anticipated negative/undesirable consequence designed to influence performance Formal incentive - reward communicated openly and directly Incentive - anticipated positive/desirable reward to influence performance Incentive feature - incentive dimension of a program Incentive program - organized set of incentive features Informal incentive - reward not openly communicated Reward - negative or positive perception associated with adherence or avoidance of a specific behavior Motive force - extent to which incentive produces behavioral compliance

making health and wellness the cfo's of business

Chief Financial Officers (CFO) are key participants in benefit decisions Health is an organizational priority Productivity is critical to the bottom line/role of health unclear CFOs understand that health impacts financial performance Internal information (claims costs, etc.) more credible than external modeling or estimates Critical information missing (ROI, impact on health) Use productivity measures available (absence days, output, labor input, etc.)

biometrics screening

Common tests: Bloodpressure Height/weight BMI Waist circumference Waist/hip ratio Body fat Metabolic syndrome questionnaire Blood draw Four options: 1. Internal team, trained, certified to implement onsite 2. Outsource screening and offer onsite 3. Outsource screening and offer offsite 4. Employee medical home

DEVELOPING AN INTEGRATED COMMUNICATIONS PLAN

Communicating is Selling "Decisions"! Communicating is Selling "Belief"!

REALITY CHECK

Communication is key to successful program strategy Good communications and supportive culture are major drivers of employee engagement.1 Good communications and strong organizational support reduce the need for significant incentives.2 Good communications = better savings3The "Quantified Self"—self knowledge through self tracking

COMMUNICATIONS PLAN

Communications Matrix/Calendar 6- to 12-month plan Aligned with communication goals: awareness, knowledge, skills, motivation, reinforcement Mix media and channels Stick to key messages! Try not to have an exclusive theme (e.g., monthly).If you do, design your communications to hit different goals. Use NWI's annual Health Observances Calendar at NationalWellness.org/HOC

INTEGRATED VIEW

Community influences in worker health and culture change: American Hospital Association's (AHA) Health For Life: Better Health. Better Health Care: Identifying emerging, successful practices in hospital employee health and wellness NIOSH /CDC Total Worker Model Robert Wood Johnson Foundation Partnerships RAND Corporation HERO American Hospital Association

PROGRAM PLANNING PROCESS, CONTINUED

Component Considerations: Program rules or requirements Registration or orientation process Participant goal setting Participant barrier discovery process Skill-building components Educational components Social support systems Environmental support systems Tracking systems Necessary forms Incentives and celebration process

BRANDING: YOU ARE SELLING A PRODUCT

Consider your "brand" identity :Recognizable?What features and benefits does the brand represent?Emotion—How does it make me feel? What's its personality? Does it represent value? Reinforces your culture Multiplies and strengthens your touch points Positions your products/services as unique

WRITTEN WELLNESS POLICIES

Critical to :creation and maintenance of a culture of wellness sustainability and effectiveness of worksite wellness efforts Provide: direction and leadership for wellness support for the long-term health and wellness

health risk appraisal selection

Culturally and language appropriate to the country Ability to customize and add questions Meaningful aggregate reports that highlight intervention opportunities Individual reporting identifies and explains modifiable risk factors Reasonable cost per participant Information technology capabilities, data security/confidentiality Core questions for global consistency Data Security Different modes of administration

engagement: its not participation

Definitions of employee engagement: Combination of perceptions - satisfaction, commitment, pride, loyalty, sense of responsibility/accountability Sense of purpose, focused energy, emotional commitment, persistence directed toward goals Measuring Engagement: Multiple participation points Sustainability of health & wellness outcomes "[Engagement is] an individual's ownership of, and active participation in,Blood the jouPrrneessyurteoward their optimal health and wellness.

COMMUNICATION OPTIONS E-HEALTH APPLICATIONS

Desktop and portable devices Information and support systems: General health information Health risk assessment Risk intervention/Tailored content Medical consumerism/Information therapy Demonstrations/Modeling (e.g., YouTube®) Tablet technologies (e.g., point-of-service) Smart-phone apps

BASIC STEPS TO DESIGNING AN INCENTIVE PROGRAM

Determine actions or behaviors you want to increase or decrease Brainstorm use of (interest or need) surveys that also provide data on obstacles and barriers Consider rewards (get input from participants, vendors, peers) Draft incentive rules and look for unintended consequences Test rules with focus group or interviews (multiple- or single-point rewards, point-based, outcome-based) Refine rules and pilot Market and implement Evaluate and revise

ACTIVE LIVING

Encourage use of mass transit: Employee reimbursement policies Offer parking cash-outs Build it into the workday: Flex-time/activity break policy Sit-stand or treadmill desks Walking meetings Offer incentives for logging activity time: Time off Insurance reimbursement Built environment: Walking paths, safe indoor routes Stairways Social Environment: Walking/running groups

three concepts to drive your evaluation strategy

Engage: employees in a wellness partnership. Sustain: behavior change through appropriate program design and delivery. accountability: Design and deliver programs that facilitate employee accountability for better health and wellness practices. -individuals -teams -neighborhoods -organizations -communities

structural evaluation

Environmental Support: CDC Worksite Health ScoreCard NBGH Wellness Impact Scorecard HERO Best Practice Scorecard WELCOA Well Workplace- Checklists Policies & Procedures: Policies & procedures manual HRA instrument Biometric screening Staff Leadership Engagement: Vision, mission, goals Senior leadership Middle management Supervisors Champs Mentors Committees Task groups Clubs

COMPLIANCE CONSIDERATIONS

Equal Employment Opportunity Commission (EEOC) Employee Retirement Income Security Act of 1974 (ERISA) Americans with Disabilities Act (ADA) Genetic Information Nondiscrimination Act (GINA) Health Information Portability and Accountability Act (HIPAA) Non- Discrimination Rules Healthcare Reform (Patient Protection & Affordable Care Act, [ACA]) Section 125 (Cafeteria) Plan Rules IRS Code Taxability issues Age Discrimination in Employment Act (ADEA) Title VII of the Civil Rights Act of 1964 The National Labor Relations Act (NLRA)

TYPES OF DATA TO BE COLLECTED

Evaluating Worksite Health Promotion: Primary - data you collect Secondary - data available from other sources Quantitative - data in numerical form; can be put into categories, rank order, measured in units (hard data) Qualitative - data not in numerical form; questionnaires, interviews, case studies, focus groups, observations (soft data) Objective - data that is fact based, measurable, and observable Subjective - personal opinions, interpretations, points of view

process evaluation

Examines all the steps and activities in implementing a program Useful for keeping implementation on track Determine if program met quality and/or other standards If program did or did not achieve intended outcomes, process looks at what went right wrong and barriers/facilitators Cost of operating a program Number of employees reached Most successful program locations Comparisons of program designs and activities

dose response

Exercise: dose-response concept refers to the interaction between the amount of exercise performed in an exercise program and the magnitude of the health benefits Program design and delivery: the possible dose-response relationship between more contacts, participation, tries, touches that lead to more effective and/or cost-effective programming Tobacco Cessation?Exercise?Nutrition?Stress? Healthy Back?Chronic Disease?Etc. dose increases with response

COMMUNICATION OPTIONS: SOCIAL MEDIA

Facebook®, Twitter®, Pinterest, YouTube, blogging, etc. Affinity Group Supports (e.g., bulletin boards) Professional networking Medical Consumerism/Patient Advocacy "Collective Intelligence"

FOCUS AREAS

Financial Health Stress and Resiliency Improved access to health-related technology and care Disease Management Health Care Consumerism Medical self-care, informed decision support, understanding benefits, and condition management Promoting quality initiatives/ Centers of Excellence Specialty areas Elder care New parents Strengths Assessments Others?

blood draw decision

Finger stick or venipuncture testing? Finger Stick: A bit less invasive Employees can immediately be coached and counseled High risk employees immediately identified High risk employees immediately told of next steps Generally higher participation rates CONS: Question of accuracy based on quality of procedure Venipuncture Testing: The gold standard of the industry Faster to administer because draw not processed on-site More upgrade options (PSA, thyroid, nicotine, etc.) CONS: Lack of immediate feedback and teachable moment

HEALTH RELATED POLICIES

Formal and informal written statement/policies designed to protect or promote employee health Supportive workplace health policies affect large groups of workers simultaneously and make adopting healthy behaviors much easier They can also create and foster a company culture of wellness Health Behaviors: Alcohol & substance misuse Nutrition Physical activity Tobacco use Depression Ergonomics Injury Prevention Health Screening: Blood pressure Obesity - BMI Cancer - Breast Cancer - Cervical Cancer - Colorectal Cholesterol Type 2 diabete

types of evaluations

Formative evaluation: provides immediate feedback during program planning and implementation Summative evaluation: determines achievements, objectives reached, number of individuals where behavior changed Process evaluation: documentation during program implementation to make adjustment for improvement Impact evaluation: assesses overall effectiveness, changes in knowledge, attitudes, behaviors, health status, etc. Outcome evaluation: program met its goals, reduction in morbidity or mortality rates, quality life/financial improvements

PARTICIPATION ONLY

Frequency - anytime Size of reward - unlimited Reasonable alternative Standard (RAS) - N/A Can physician verify medical condition? - N/A Must plan accommodate physician recommendations? - N/A Examples: Reward for completion of annual physical, reward/penalty for biometric test—regardless of test outcomes, reward/penalty for attending health-related course

HEALTH-CONTINGENT/OUTCOME-BASED

Frequency - must be offered once a year Size of reward - cannot exceed 30% of total cost of coverage or 50% for tobacco related incentives Reasonable Alternative Standard (RAS) - must be made available to all similarly situated individuals. RAS required if participant does not meet standard Can physician verify medical condition - medical certification NOT permitted Must plan accommodate physician recommendations? - Yes Examples: Reward for no tobacco use, reward for meeting certain measurement (e.g., CHO, BP, BMI, etc.)

HEALTH-CONTINGENT/ACTIVITY ONLY

Frequency - must be offered once a year Size of reward - cannot exceed 30% of total cost of coverage or 50% for tobacco-related incentives Reasonable Alternative Standard (RAS) - must be made available to all similarly situated individuals. RAS required if program is unreasonably difficult or medically inadvisable Can physician verify medical condition? - medical certification permitted Must plan accommodate physician recommendations? - Yes Examples: Reward for completing running program, reward for completion of weight management program

FIRST THINGS FIRST: HOW DO YOU COMMUNICATE?

General literacy of population?Health literacy of population?Average reading level? 7th - 8th grade level(e.g., high school graduates/above) 4th - 5th grade level (e.g., no degree) Formal communications channels? Day-to-day (e.g., email, video boards, bulletins, group) Company-wide (e.g., newsletters, Web, info packets) Business (e.g., social media, corporate reputation, product promo, annual reports)

LEADING BY EXAMPLE PROGRAM THE DOW CHEMICAL COMPANY

Global health strategy Benefit plan emphasis on prevention 1. Relevant workplace health policy More than 85% of North American employees participate voluntarily in one or more health services each year Standard Health Promotion Practices: -Physical activity and weight management counseling one or more health services each year 3. Partnership for Prevention, 2007, p. 27 -Health assessments -Online behavior change programs -Reimbursement for participation in community-based weight management, tobacco cessation, or diabetes education programs -Dissemination of health education materials -Preventive screening reimbursements

HARNESS "SOCIAL NETWORKS"

Grassroots peer-to-peer effort generating high interest & participation Leader/champion forms and maintains the group Under 10 individuals, self selected/nominated ideal Group decides wellness goal, metrics, and time commitment (4-12 weeks) Coach/wellness staff facilitate progress and provide guidance Group meets weekly with coach, multiple times a week participates in support activities: -walking together -eating together yoga, Tai Chi, stretching together -meditating together Coach/wellness staff facilitate, evaluate, and communicate results

EXPANDING RESOURCES AND SUPPORT

Health Care Advocacy and Navigation support -Health Advocate Transparency -Castlight Health -Clearcost Health Telemedicine -Teledoc -MDLive Second Opinion -Advanced Medical -2nd MD

TOTAL WORKER HEALTH

Health Information Privacy Reasonable Accommodations Return-to-Work Equal Employment Opportunity Family and Medical Leave Elimination of Bullying, Violence, Harassment, and Discrimination Prevention of Stressful Job Monitoring Practices Worker-Centered Organizational Policies Promoting Productive Aging

LEGAL ISSUES

Health Insurance Portability and Accountability Act (HIPAA), Americans with Disabilities Act (ADA), and the Equal Employment Opportunity Commission (EEOC) The wellness program must be a voluntary plan. Medical information obtained in the course of conducting the plan must remain confidential. The program must not penalize non-participants. Medical examinations should not be conducted in the workplace. Collective Bargaining Agreements State or Federal Policies

estimated prevalence of high health risks

Health Risk Measure: Body weight: 41.8 percent Stress: 31.8 percent Safety belt use: 28.6 percent Physical activity: 23.3% Blood pressure: 22.8% Life satisfaction: 22.4% Tobacco: 14.4% Perception of health: 13.7% Illness days: 10.9% Existing conditions: 9.2% Cholesterol: 8.3% Alcohol: 2.9% Zero risk: 14.0% Low Risk (0-2) 55.3% Medium risk (3-4) 27.7% High risk (5+) 17%

who owns the data

Health risk assessment Medical claims Medical utilization Drug utilization review Workers' compensation Disability Absenteeism Behavioral health Accidents/injuries Recruitment/turnover Productivity Case management Environmental assessment Cultural audit Employee satisfaction Program participation Program engagement Attitude/morale/satisfaction Modified from Chenoweth, 2011

HEALTH, WELL-BEING, & WELLNESS

Health: Often associated with biological functioning Well-being: Often associated with mental health Wellness: Often associated with an integrated and active process, ora way of life

healthy cafeterias - my plate

Healthy Options: Plate with 400-600 total calories 3 to 4 ounces of lean protein 1 serving of whole grains 2 servings of vegetables and/or fruits Café Initiatives: Increase availability of healthy food General point of choice messaging Messaging promoting fruits and vegetables Messaging about zero calorie drinks Reduce sodium, saturated fats, added sugars Eliminate trans fats Messaging about fast food Messaging about being aware of what you are doing while you eat

HEALTHCARE CONSUMERISM

Help employees know and understand health risks and status. Reduce in appropriate medical utilization. Increase transparency about health care costs, services, and quality. Personalize programs to make them more meaningful and engaging. Spend healthcare dollars more wisely.

think strategically

How would you rate your foundational practices? Leadership Policies Benefits Environment Communications Do you have clearly defined goals and objectives?

built environment

Human-made physical surroundings that provide settings for human activity Bike racks/storage areas Fitness rooms/centers Healthy dining areas Lactation areas Shower facilities Locker rooms Massage rooms Stairway programs Standing/walking workstations Walking paths Fit trails

tactic vs value

If employee health is merely a "tactic," it can easily be replaced when it underperforms. A value is part of the organization's DNA.

impact evaluation

Impact must occur to reach Outcomes: Assesses the overall effectiveness of a program Changes in knowledge, skills, attitudesChange in satisfaction Changes in behavior, health status Change in climate or culture How many individuals quit smoking, lost weight, can perform CPR?

WRITING A WELL WORKPLACE POLICY

Impact/Name of policy: Starting tips: Outline the issue —What do you hope to achieve? What is important? Does it relate to core values? What are the consequences of not addressing it? Mission statement or organization's view of issue: Is the organization committed? Does it recognize the positive impact of policy? Will it see the policy as high value and an encourager? Objectives & strategy: What steps will the organization take to achieve the objectives? Responsibility/scope, review, and monitoring: Who does it affect and who is responsible for maintaining the policy? Communications:How will employees be informed? Evaluation: Include a process to evaluate your wellness programming.

population health factors

Income & social status Education Physical environment Support networks Genetics Health services Gender six dimensions of wellness: 1. occupational 2. physical 3. social 4. intellectual 5. spiritual 6. emotional

FIRST THINGS FIRST: HOW DO YOU COMMUNICATE?

Informal Communications Channels "Water Cooler Talk" Personal Work groups Affinity groups/clubs Lunch groups Social media Privacy Protection How is health and personal information protected?HIPAA, GINA How are privacy policies communicated?

organizational support

Informal Structure: Grapevine Formal Structure: Policies and Procedures Example - hours of work, employee benefits, smoking policies Budget Mechanisms: Modeling, training, rewards and recognition, communication, orientation, relationship and interaction, resource allocation and commitment, confrontation, rituals, myths and symbols

COMMUNICATION OPTIONS: TELEPHONIC

Information and support systems General health information/audio health libraries Nurse lines Health risk assessment/keypad Health coaching Disease management Case management Smart-phone (apps)

COMMUNICATION OPTIONS: VIDEO

Instructional Motivates Multiple distribution (e.g., group, individual) Multiple platforms (e.g., DVR, smart-phone, computer, tablets) Timely Viral Shows off your culture Reinforces your brand Creates a "face" of management/employees Downside: production costs, privacy

evaluation terminology

Intervention: an intentional action designed for an individual, community, or team that alters behavior, reduces risk, or improves outcome Efficacy: intervention's ability to do more good than harm in an ideal setting (e.g., randomized controlled trial) Effectiveness: intervention's ability to do more good than harm in a in a real-world setting Evidence-based: means the intervention has undergone sufficient scientific evaluation to be proven effective Fidelity: refers to degree developers implement programs as intended Reach - participation rate among intended audience at the individual level Adoption - participation rates of intended settings or organizationsImplementation - level and consistency of delivery across program components (individual and organizational level) Maintenance - at individual level: long-term effectiveness.At setting or organizational level: program sustainability and adoption

incentives - what motivates us?

Intrinsic motivation - refers to motivation that is driven by an interest or enjoyment in the task itself, and exists within the individual rather than relying on external pressures or a desire for reward Extrinsic motivation - refers to the performance of an activity in order to attain an outcome, whether or not that activity is also intrinsically motivated Social psychological research has shown that extrinsic rewards canlead to over justification and subsequent reduction in intrinsic motivation, yet self-determination theory proposes that extrinsic motivation can be internalized by individuals if the task fits with their values and beliefs.

E-HEALTH DISADVANTAGES

Issues:The "program" is the screen or phone Computer literacy"On-the-clock" anti-access policies Dropped calls/access Competition among other websites Weak branding/limited touch points "Culture of health?" "Lifespan" of tech? Credibility of information?

BEST PRACTICES

Leadership Engagement: All levels Communication Partnerships: Internal and external Data-driven: Assessment through evaluation Engagement Multi-faceted and Customizable Culture of Health RIGHT Incentives

speak the cfo's language

Leading Indicators: Health risk Biometric screening Chronic condition prevalence Treatment Indicators: Preventive care Employee engagement Health services utilization Program participation Lagging Indicators: Financial Lost work timeLost productivity

FIRST THINGS FIRST: HOW DO YOU COMMUNICATE?

Learning Styles?Visual Auditory Tactile How do employees like to learn and receive information? Print Online Video Emails Group One-to-one How does your organization communicate?

categories of cultures

Macrocultures - nations, occupations that exists globally Organizational cultures - general culture within a company Subcultures - groups within organizations Microcultures - microsystems within an organization

MANAGEMENT/EMPLOYEES: REPORTING

Management Dashboard: Provides the C-suite with a standard "dashboard" that presents key health measures and economic indexes Aligns employee health to the organization's business goals Health Report Card: A means of transparency by providing an annual report not only to employees, but also to all levels of management Can be used to assess managers' support of programs/goals

E-HEALTH ADVANTAGE: TAILORED COMMUNICATIONS

Methods for creating communications that are individualized to users in order to improve intended effects (e.g., knowledge, self- efficacy, behavior change) Personalization: "This was created for you." Feedback: based on assessment—describes, compares, and/or evaluates Content matching: attempts to link content with such factors as readiness to change and self-described barriers

TYPES OF INCENTIVES & EXAMPLES

Monetary: Money-based compensation: Cash Additional paid vacations Health savings account contributions Premium differential Non monetary: Prospect-based compensation: Verbal or visual recognition Coveted parking space/office Flexible work schedule Gym Merchandise

health risk appraisals (hra)

Most prevalent method used to assess change Evaluate Changes- Individual risk status, readiness, health behaviors, self-efficacy Aggregate population health risks Same population health risks Relationship to other indicators: Leading Lagging

peer support

Natural systems provided by family, friends, co-workers Provide instrumental support money or advice Provide emotional support Encouragement Measurement Feedback from employees Skills/Training for peer support: Goal Setting Identifying Role Models Eliminating Barriers to Change Locating Supportive Environments Working Through Relapse Celebrating Successes

participation

Participation is probably the most common dependent variable in worksite wellness Despite this distinction, participation is not necessarily a valid indicator of an intervention's impact Its major limitation is it only reflects the number or percent of people attending or participating in an intervention It does not signify level of effort or progress in achieving a goal Utilization: number of individuals involved in program activities for a designated time frame Penetration: utilization divided by total population Adherence: regularity of participation

WAYS INCENTIVES CAN BE USED

Participation-based incentive - incentive awarded for completion of a task or participation in a behavior program Cash incentive or premium reduction for completion of annual HRA or biometric screening Outcomes-based incentive - awarded for achieving a health standard based on specific health outcomes Premium reduction for attaining and sustaining target ranges for BMI, blood pressure, CHO, and sugar levels Progress-based incentive - awarded for making meaningful progress toward specific health goals Employee with a 40 BMI setting a realistic weight-loss goal of 10% of body weight

COMMUNICATIONS OPTIONS: PEOPLE

People Direct Power of stories—word of mouth Lay leadership networks: "wellness champs" Mentoring Point of Service—health coaching/counseling Rotating road shows: health screenings, orientations Group events/support groups

SOCIAL CONTAGION THEORY

People are influenced more by those they resemble Friendship directly influences behavior Religion, education, occupation, and gender all play influencing roles in social network ties People's perception of their own health risks depends partly on the people around them There is a ripple effect of health behavior change on friends, spouses, and family Geographic distance does not alter the strength of the ripple effect

presenteeism measures

Presenteeism is highly prevalent and costly to employers. Presenteeism literature is young and heterogeneous. Preliminary evidence suggests programs can positively affect presenteeism. Presenteeism is defined as being present at work, but limited in some aspect of job performance by a health problem. Certain factors are of importance: Involve managers/supervisors Use of HRA for presenteeism/behavioral data collection Targeting environment/organizational factors Tailoring Standardized presenteeism metrics are needed.

SELECTED SCREENING RECOMMENDATIONS

Preventive screenings are an important part of health promotion efforts. Many preventive screenings have been recognized as a cost-effective way to identify and treat potential health problems before they develop or worsen. Alcohol Misuse Breast Cancer Cervical Cancer Chlamydial Infection Dental & Periodontal Disease Depression Diabetes Glaucoma Hearing Impairment Hepatitis B Hepatitis C HIV High Blood Pressure Lipid Disorders Obesity Oral Cancer Osteoporosis Prostate Cancer Skin Cancer Tobacco Use Visual Impairment

ONE VOICE: INTEGRATING YOUR COMMUNICATIONS

Print Group Events Person-to-person Web Telephonic Smart-phones E Readers/TabletsVideo

PROGRAMMING TIMELINE TASKS, CONTINUED

Program Maintenance: Ongoing communicationsMaintaining participant compliance Meeting rooms, etc. Program Celebrations, Evaluation, and Follow-Up: Purpose and organization of the celebration Process, impact or outcome evaluation What follow-up is appropriate? What does it look like? Reporting of results to participants, staff, and management

PROGRAMMING TIMELINE TASKS

Program Preparation and Design: Reserving rooms Marketing and communications-recruitment Ordering supplies—designing materials Incentive strategy, celebration planning Training staff or lay leaders Program Implementation: Kickoff date Scheduling staff or lay leader help

E-HEALTH ADVANTAGES

Providing health information and support through electronic and telephonic networks Advantages: Impact dispersed populations Scalability Distribution of content Affordability 24/7 Power to connect populations (e.g., affinity groups)

LACTATION/BREASTFEEDING FRIENDLY WORKPLACE POLICY

Recognizes that breast milk is the optimal food for growth and development of infants and encourages employees and management to have a positive and accepting attitude toward working women who are breastfeeding Compliance with legal requirements Time to express milk Space and equipment for expressing milk Atmosphere of tolerance Key locks or card reader for security The CDC Guide to Strategies to Support Breastfeeding Mothers and Babies (CDC, 2013a) Breastfeeding: A Vision for the Future (United States Breastfeeding Committee, 2011) Investing in Workplace Breastfeeding Programs and Policies (Slavit, 2009)

COMMUNICATION PLANNING SUMMARY

Review background information to define the problem Set communication objectives Analyze and segment target audiences Select communication channels Pre-test messaging when possible Develop promotion plan/production Implement communication strategies and conduct process evaluation Conduct outcome and impact evaluation

operational program planning pyramid

Risk Reduction: Targeted interventions, health coaching, risk specific online & print applications, topic-specific workshops/support groups Organizational Readiness & Support: Business alignment, total leadership support, benefit design, policies, environmental supports, incentives, communications Special Programs Disease management, EAP, behavior health, health concierge, prenatal education, work hardening, ergonomics Risk Avoidance/ Well-being: Screenings, HRAs, health coaching, benefit education, online resources, self-care

stock performance

S&P 500: -105% -increased from dec 2001 to June 1 2014 koop: -325% -increased from dec 2001 to June 2014

AFFORDABLE CARE ACT & PREVENTION

Selected Preventive Services Covered by Health Plans Cancer - mammography, genetic screening, Pap testing, high risk HPV DNA testing, FOB, colonoscopy Chronic conditions - hypertension, lipid disorders, obesity screening/counseling, type 2 diabetes, depression, osteoporosis Immunizations - DTaP, hepatitis, Influenza, HPV, pneumococcal Health promotion - metabolic, oral, tobacco, diet, violence, well-women Pregnancy-related - prenatal, alcohol, tobacco, breastfeeding support Reproductive health - STIs, HIV, contraception

COMMUNICATION STRATEGIES

Social Marketing "Social marketing is the use of marketing principles to influence human behavior in order to improve health or benefit society." The "Four P's of Marketing" PRODUCT— products/services, desired behavior PRICE— money, emotional, time, PROI PLACE— distribution, point-of-service, environmental supports PROMOTION— branding, messaging, channels

key approaches to reporting results

Stakeholder expectations: -Timing of evaluation -Periodic reviews Longitudinal analysis Quality assurance Monthly reviews Quarterly/semiannual reviews Annual reviews Health productivity dashboard merit or quality worth or value significance or importance -engage stakeholders -describe program -focus evaluation design -collect credible evidence -justify conclustions -use and share lessons learned

STRATEGIES

Start slow and small Promote activities that are already part of regular company activities- Injury prevention, benefits, training Organize a wellness committee to initiate programs-Designate a wellness leader Utilize community wellness resources for programming-Healthcare, fitness, universities, coalitions, government, non-profit Include employees' spouses/life partners in the wellness program. Support employee participation in community events. Locate free online tools/toolkits for planning- Big "P" and little "p" programs

why worksite wellness?

Support the mission of the organization Support the long-term goals of the organization Provide value to the organization by supporting: 1. Cost containment 2. Attracting and retaining talent

COMMUNICATION OPTIONS: PRINT

Tangible Transportable "Friendly" to those who are computer illiterate or have limited access Cost effective (e.g., medical self-care books) Ability to get into home Custom to your population/people Multiplies your "brand" and touch points Effective in cross-marketing Reinforces "culture" Downside:Distribution costs

A BLUEPRINT FOR HEALTHIER VENDING: AN INITIATIVE OF HEALTHIER CHICAGO

Target Policies Gold: 100% of food and beverage items in vending machines must meet guidelines for healthy vending Silver: 75% of food and beverage items in vending machines must meet guidelines for healthy vending Bronze: 50% of food and beverage items in vending machines must meet guidelines for healthy vending

targeting or tailoring?

Targeting: Demographics Gender Age Location Job category Health attitudes Perceptions of risks Perceptions of benefits Lifestyle patterns Tailoring: Any combination of information or change strategies intended to reach one specific person These messages or strategies are based on individual-level factors that are related to health or behavioral outcome of interest.

ARE WE IN THE MIDDLE OF A TIPPING POINT?

Ted Koppel asks Malcolm Gladwell, "Can you know you are in the middle of a tipping point, or is it only something you can see in retrospect?" Gladwell answers, "The most important thing...is whether it—the event—causes people to reframe an issue."

COMMON PRINCIPLES OF MEDICAL HOME

The Patient-centered medical home (PCMH) is a healthcare setting that facilitates partnerships between individuals and their physician and, when appropriate, the family. Personal relationship Whole-person orientation Coordinated care across setting Enhanced quality, safety, and evidence-based care Enhanced access to care by improved communications and scheduling

embedding a quality improvement process

The Plan, Do, Study/Check, Act (PDSA) cycle is a framework used for embedding a quality improvement process. The steps in the PDSA cycle lead to observing and learning from the consequences, and then making appropriate changes. For worksite wellness programs, embedding a quality improvement process adds sustainability to a new or established worksite wellness infrastructure. plan, do, study/check, act

presenteesim

The degree of lost productivity while on the job (e.g., job impairment) associated with health and work/life factors Usually used in the same negative context as absenteeism The higher the presenteeism, the greater the job impairment Some scales are the opposite

HEALTHY VENDING MACHINE POLICIES

Three approaches: Make healthy options available Make healthy options easier through pricing, marketing, and education Offer only healthy food and beverages sample policy: -ear well work well

CREATING A TOBACCO POLICY

Tobacco Cessation Support: Products & resources Support in the workplace Sample Policies: American Cancer Society American Lung Association State Worksite Toolkits Others? Develop workplace policy: Situation analysis Obtain leadership support Establish a working group Review sample policies Benchmark Stakeholder consultation Draft the policy Consultation and communication Finalize and implement the policy Periodic review Tobacco-free no hire policy? USA Today 1/6/2012 Workplaces ban not only smoking, but smokers themselves!

WORKSITE POLICIES THAT SUPPORT WORK-LIFE WELLNESS

Tobacco: family inclusion Paid time off to attend employee development/wellness training Worksite wellness committee Program champs or ambassadors Use of employee assistance program Participation in community-sponsored, company-supported events Flexible work hours/arrangements Commuting/biking Employee discounts, subsidies Childcare/eldercare New moms and dads Illness/injury prevention Well-care "The use of effective workplace programs and policies can reduce health risks and improve the quality of life for millions of workers in the United States."

comprehensive coaching model ensures accessibility

Unlimited scalability Flexibility Linkage to program Adds to program breadth Delivers across "delivery channels" Full reach of population management Takes advantage of all learning styles Good mix of quality control elements hybrid model: face to face telephone based computer based email group coaching

employee wellness perspective: what is value?

Value is determined by addressing the employee population's particular health, productivity, and work/life needs, and their ability to benefit the organization and the individual.

VALUE-BASED BENEFIT DESIGN

Value-Based Benefit Design is the explicit use of plan incentives to encourage enrollee adoption of one or more of the following: appropriate use of high value services, including certain prescription drugs and preventive services adoption of healthy lifestyles, such as smoking cessation or increased physical activity use of high performance providers who adhere to evidence- based treatment guidelines EXAMPLES: Increasing medication compliance rates Encouraging use of preventive services Encouraging use of health management programs Promoting use of high performing providers commonly used incentives in value based benefit programs: -cash or gift cards -copayment reduction -premium reduction -eligible for broader benefit plan -access to benefit (often used as a disincentive)

HEALTHCARE TRENDS

Variety of benefit designs to support wellness and employee engagement in health -High deductible plans (Consumer Drive Health Plans), account based health plans, value-based benefit design Incorporate Patient Centered Medical Home -On-site clinics, care team to address employee health issues

VALUE PROPOSITION

We are in the middle of a tipping point where health care is being seen as an investment in well-being rather than an expense for sickness. Benefits and the employee experience are top concerns for employers looking to retain top talent. The evidence suggests there are multiple options for benefits design that should be part of a health management strategy. Well-designed incentive programs and health-related policies make the healthy choice the easy choice.

PROGRAM PLANNING PROCESS

What is the major purpose of the program? What is the need for this program? What are the potential benefits of this program? What are 2-4 program goals? Include appropriate metrics in each goal statement. What are the program basics? Brief program description, population or targets, marketing ideas, delivery ideas, and evaluation focus.

WELLNESS INCENTIVES LITERATURE

What is the wellness incentive literature telling us? Completion of programs may increase, but health improvement does not necessarily follow Health effects appear limited, need more evaluation Effectiveness of outcome based incentives uncertain Some data suggest incentives when used with competition generated + ROI Completion rates are higher when combined with a lottery Seminal Studies: "Impact of financial incentives on behavior change..." (Gingerich et al., 2012) "The law, policy, and ethics of employers' use of incentives..." (Madison et al., 2011) "The role of incentives in improving employee engagement and outcomes..."(Terry & Anderson, 2011) "Redesigning employee health incentives..." (Volpp et al., 2011) "Worksite based incentives and competitions..." (Leeks et al., 2010)"The impact of alternative incentive schemes..." (Haisley et al., 2012)

THINK STRATEGICALLY

What's the nature and state of your business?How does your well-being strategy currently support it? Mission Vision

HEALTH RISK APPRAISALS (HRA)

Why use a health risk appraisal? Strategic planning and design of wellness program Individual health awareness Identify individuals for disease management services Guidance for refining health plan services Predictor of morbidity, & healthcare utilization Evaluate change Utility as a gateway intervention/Combine with other interventions

WEIGH THE INVESTMENT (PROI)

Will my investment (i.e., money, time, effort, sacrifice) in this activity or activities, provide greater value to me than the status quo? Bottom line? Promotional/marketing campaigns need to position the "product/service" within the context of PROI. Hint: Positioning health as a "Grim Reaper" strategy is short sighted and it doesn't work. Sell life effectiveness! Tangible benefits!

CDC DEFINITION OF WORKPLACE WELLNESS

Workplace health programs are a coordinated and comprehensive set of health promotion and protection strategies implemented at the worksite that includes programs, policies, benefits, environmental supports, and links to the surrounding community designed to encourage the health and safety of all employees.

VALUE PROPOSITION

Worksite Wellness Program Design: Adopt and maintain healthy behaviors Enhance awareness, increase motivation Create supportive policies and environmentsthat make positive health practices the easiest choice.

health risk and behaviors (health risk measures and health risk criteria)

alcohol•More than 14 drinks/wk men; 7 drinks/wk women blood pressure•Systolic >139 or Diastolic >89 mmHg •BMI 27.5 cholesterol •Greater than 239 mg/dl HDL •Less than 35 mg/dl existing medical problem •Heart, Cancer, Diabetes, Stroke illness days •>5 days last year life satisfaction •Partly or not satisfied perception of health •Fair or poor physical activity •Less than one time/week safety belt usage •Using safety belt less than 100% of time smoking •Current smoker stress• High

communication calendar alignment/heart health

awareness- cvd risk factor screening knowledge- signs of heart attack skills- cpr and healthy eating motivate - interpret screening results/referral to health coaching reinforce - testimonial on employee who has reduced risk profile build community - group walking programs, support group for post mi

norms and culture

balanced work life: existing culture=2 desired culture=4.5 physical activity: existing culture=2.5 desired culture=4 stress management practice: existing culture: 1.5 desired culture: 4 "There is a tendency to believe that behavior is guided by personal values. However, . . . cultural norms guide most health behavior."

BUILDING BLOCKS OF CULTURE THAT SHAPE LONG-TERM BEHAVIOR CHANGE

behavior choices: -organizational support -values -peer support -climate -norms

outcome evaluation

bottom to top: employee outcomes team outcomes neighborhood outcomes organizational outcomes community outcomes mortality morbidity quality of life financial

well being model

career social community financial physical

framework for program evaluation

cdc - program performance and evaluation office standards: utility feasibility propriety accuracy engaged stakeholders describe the program focus evaluation design gather credible evidence justify conclusions use and hare lessons learned

program mix and framework

delivery channels: Individuals Targeted groups Neighborhoods Departments Organizations Community

communications mix

delivery format continuum module 6 page 119

willis towers Watsons health and productivity scorecard

designing an effective employee health and productivity framework prevention: Safety Health Promotion Emotional Health personal support: • Return to Work • Financial Literacy • Care Delivery organizational support: • Leadership Support • Measurement • Flexibility • Work design and delivery: • Engagement • Communication • Program Environment

outcome evaluation metrics

dimension and summary of key metrics Financial: All health-related benefit expenditures Utilization: Amount of care delivered & setting where delivered Chronic conditions: Prevalence & distribution of employee chronic conditions Preventive care: Degree to which employees are being screened for age- and gender- appropriate tests Biometric screening: Biometric profile of the workforce Health risk stratification: Health risk profile of workforce Lost work time: Number of health-related lost workdays Lost productivity: Financial opportunity costs borne in responding to lost work time Program participation: Degree to which employees are registering and completing wellness programs Employee engagement: Degree to which employees are engaged in managing their health

INCENTIVES AND CULTURE OF HEALTH

employers with a culture of health offer: health account contributions: 46% 25% without coh gift cards: 37% 17% without coh cash: 26% 13% without coh $573 vs $336 not surprisingly, there is also a wide differential in the yearly dollar value of incentives per participant - $573 for firms with a culture of health compared with $336 for firms without a culture of health

CONFIGURATION MODEL: CULTURE, LEADERSHIP & ENVIRONMENTAL SUPPORTS

external environment: culture internal environment: leadership and environmental supports

SAMPLE TOBACCO PREVENTION AND CESSATION POLICIES

good: The use of all tobacco products is prohibited within the facility at all times. (Note: indoor smoking prohibitions are required by Delaware law.) An outdoor designated smoking area will be located at least 20 feet from the main entrance. Smoking is prohibited in all company vehicles. Worksite working toward a 100% smoke free environment. Really shouldn't encourage them to have a designated smoking area L. Identify enforcement and consequences for noncompliance. better: Good policy, plus: The use of all tobacco products is prohibited within the facility and on the company property at all times (i.e. "Tobacco-free Campus"). Employees will be informed of this policy through signs posted in company facilities and vehicles, newsletters, inserts in pay envelopes, the policy manual, e-mail, and/or orientation and training provided by their supervisors. Visitors will be informed of this policy through posted signs, and it will be explained by their hosts. Do not financially penalize workers who do not meet certain company or insurance health targets - tobacco is an addictive substance. Offer tobacco cessation resources. Require conferences and meetings outside of the worksite to be held at smoke-free venues and hotels. best: Good and Better policies, plus: The company will financially assist employees who want to quit smoking by helping them access recommended smoking cessation programs and materials (see programs for examples). This would cover multiple quit attempts.

direct medical costs to profits

health care costs as a percentage of profit 1996: before tax profit: 37% after tax profit: 53% 1997: before tax profit: 34% after tax profit: 49% 1998: before tax profit: 40% after tax profit: 60% 1999: before tax profit: 40% after tax profit: 59% 2000: before tax profit: 50% after tax profit: 59%

CUMULATIVE INCREASES IN HEALTH INSURANCE PREMIUMS, WORKERS' CONTRIBUTIONS TO PREMIUMS, INFLATION, AND WORKERS' EARNINGS, 1999-2015

health insurance premiums: 203% workers contribution to premiums: 221% workers earnings: 56% overall iflation: 42%

high touch/high tech balance

high tech and high touch approaches are blended high touch at bottom high tech at top

when do you start planning for evaluation

in the beginning

impact of a prevention plan

individual risk reductions Blood pressure 42.78% Fasting blood sugar 31.13% Stress 24.94% Perception of health 24.50% Alcohol 24.21% Cholesterol 22.67% Physical activity 18.53% Health related illness days 14.76% Fatty diet 14.72%

guidance for a reasonably designed, employer sponsored wellness program

joint consensus statement/elements of a reasonably designed program Strategic Planning: Organizational Assessment Goals Target Population Design Cultural Support: Leadership Support Champions Environment Policies Health Benefit Design Programs: Assessment and Screening Behavior Change Interventions Engagement Methods: Communication (channels, branding, status updates, messaging) Incentives (fit, size, drive, rewards vs. penalties) Measurement & Evaluation: Assessment 3-Party Tool Participation/Engagement/Retention Rates Participant Satisfaction Improvement of Health Risk/Status

provide direction

leadership function: Share the Vision leadership actions: Explain the purposes of the program, why they are enthusiastic about wellness, how employees can participate, and resources that will be available leadership function: Serve as Role Models leadership actions: Participate in wellness activities, tell employees how wellness has benefited them personally, and share their own wellness goals leadership function: Align Touch Points leadership actions: Address health culture influences (such as rewards, confrontation, and training), give permission to fully use program, and eliminate barriers leadership function: Monitor and Celebrate Success leadership actions: Acknowledge individual and group progress (with permission)

ecological model for prevention

left to right: policy societal community relationship individual

IMPROVING HEALTH/WELLNESS RISK STRATIFY THE POPULATION

low risk: educate, awareness re assess moderate risk: risk reduction high risk: more comprehensive risk reduction

impact evaluation metrics

metric, definition, changeability, example module 8 page 160

targeting/tailoring strategy

module 7 page 139

program reach and effectiveness and impact of prevention plan

module 7 page 140

REGULATION DEFINES THREE INCENTIVE-BASED WELLNESS PROGRAMS

participation only health contingent activity only health contingent outcome based

common pitfalls

pitfall: overcomplicated program consequence: people become overwhelmed by too many options or requirements to earn a reward and stop participating youve dodged a bullet if: you can explain your program in a couple of quick sentences pitfall: incentive IS the goal consequence: people do enough to earn the reward but don't make lasting changes for their health you've dodged a bullet if: short term rewards reinforce long term behavior change pitfall: unattainable goals consequences: if the goals that people need to meet seem unattainable they may not even try you've dodged a bullet if: rewards are set up to let people start small and build on their successes over time pitfall: focus on prizes consequence: prizes and giveaways may not drive sustained health changes you've dodged a bullet if: rewards reinforce your overall wellness program goals and your organizations health culture pitfall: penalties that hurt morale consequences: you lose your populations trust you've dodged a bullet if: people want to participate because your wellness program makes them feel good about themselves and their health

roi is part of the overall calculation of value to the organization

program costs: Salaries Training Travel Materials Marketing Administrative costs Incentive costs Etc. program benefits: Reduced healthcare costs Reduced healthcare utilization Reduced absenteeism Reduced workers' compensation Reduced turnover Reduced disability days Reduced presenteeism Increased productivity Change in health risk ROI

evaluation steps to success

program success takes more than roi bottom to top: 1-4 years awareness participation knowledge and skills attitude and commitment behavior change risk reduction reduced utilization roi/voi

process evaluation metrics

promotion program speaker module 8 page 157

program evaluation matrix

qualitative methods: structural and process quantitative methods: impact and outcome module 8 page 156

creating a positive climate

sense of community, shared vision, positive outlook

WELLNESS IS AN ACTIVE PROCESS THROUGH WHICH PEOPLE BECOME AWARE OF16, AND MAKE CHOICES TOWARD, A MORE SUCCESSFUL EXISTENCE.

six dimensions of wellness: 1. occupational:The enrichment of life through work, & its interconnectedness to living and playing 2. physical: benefits of regular exercise, healthy eating, strength and vitality, personal responsibility, self care when seeking medical attention 3. social: how a person contributes to their environment and community and how to build better living spaces and social networks 4. intellectual: creative and stimulating mental activities and sharing your gifts with others 5. spiritual: the development of belief systems values and creating a world view 6. emotional: self esteem, self control and determination as a sense of direction

the travelers taking care program marketing image campaign

the travelers

operational program planning pyramid

top to bottom: Special Programs Risk Reduction Risk Avoidance/ Well-being Organizational Readiness & Support left to right: assessment planning/design implementation operations evaluation

what is a health productivity dashboard?

wellness strategy + programs = vehicle to reach vision visions = wellness destination health scorecard/dashboard = tracks progress toward vision

de mystifying roi/voi

what you can expect from workplace wellness programs: Harvard economists review in Health Affairs1, 3:1 ROI Goetzel (as cited in Hunnicutt, 2012) more realistic 2:1 as opposed to 3:1 and notes to be skeptical of 4:1 - 17:12 Rand Study over 5 years' participation is associated with a trend toward lower costs, but not significant3 In reality there is no "one" ROI in worksite wellness programming, it all depends on too many factors4 Employers are wanting to ensure that their program $s are being spent effectively, this is not an ROI calculation3 Capturing productivity and presenteeism in these instruments is still an uphill battle to translate into dollars Cost calculators are an quick and effective way to project potential ROI Total value of worker health looks beyond ROI

know the why

why is most important, then how and then what

QUESTIONS TO ASK SCREENING VENDORS

"Are you legal with all federal, state, and local regulations?" "Are you secure and compliant with HIPAA?" "Is your staff qualified and do they hold appropriate credentials?" "Are you insured?" "Show me your screening operations plan!" "Can we observe onsite screenings at another client?" "Can we get/check references?"

ENVIRONMENTAL ASSESSMENT TOOL (EAT)

"Assessments of the environment can identify a number of opportunities for employers to create access and opportunity for employees to practice healthy behaviors." Physical activity: Parking/bike Stairs/elevators Showers/changing facilities Signs/bulletin boards Physical activity/fitness facilities Nutrition and Weight Management: Vending Cafeterias/food service Organizational Characteristics and Support: Site characteristics Work rules Written policies Wellness programs

jay samite

"Nothing helps calibrate reality [more] than the honest perceptions of those who work closest to you."-Jay Samit

OPPORTUNITY

"Opportunity is broadly defined as having access to the environment that makes choosing a healthy behavior the normative choice."

CULTURE OF HEALTH/WELLNESS

"The body of organizational factors that promote healthy lifestyle choices has been collectively referred to as a 'worksite culture of health.'"1 "In a culture of health, employee well-being and organizational success are inextricably linked. It aligns leadership, benefits, policies, incentives, programs, and environmental supports to reduce barriers to active engagement and sustainability in value-based health management practices across the healthcare continuum."2

THE GROWING COST BURDEN OF ILL HEALTH

$3 trillion—total health-related costs in 20141 17.5% gross domestic product1 3.2% annual increase1 10 modifiable health risks account for 20% of direct costs2

companies with a culture of wellness

-higher participation rates in wellness programs than firms with a cohH -employees take responsibility for their health, 46% vs. 11% without a coH -higher levels of employee satisfaction, 58% vs. 15% without a coH -higher degree of employee well being 49% vs. 13% without a CoH

why worksite wellness?

-impact business performance metrics and profitability -reduce health risks -job satisfaction -reduce absenteeism -manage or reduce health care costs -reduce sick days -checking the wellness box image -increase on the job safety -improve employee morale -improve employee energy levels -improve productivity -attract or retain talent -manage/reduce disability

health engagement

-more programs - low participation rates -lifestyle change and health management -program participation -program offered in 2015 -planned for 106 -being considered for 2017 or 2018 -module 1 book page 21

direct costs related to indirect costs

-presenteesim: estimated $12,000 per employee medically related productivity costs -6,000 per employee for direct medical costs estimated total costs: 18,000 PEPY

value drivers

1. cost containment 2. culture and employee experience

FRAGMENTED DELIVERY

Different people need different resources at different times Communication issues Data integration issues Different benchmarks and protocols

employee engagement

Employee engagement is the extent to which employees feel passionate about their jobs, are committed to the organization, and put discretionary effort into their work.

zero trends - health as a serious economic strategy

The University of Michigan Health Management Research Center, under Dee Edington, PhD, has been the leader in conducting research on the association between health status/risks and total healthcare costs.

systems and cultures that fail

The formal and informal leaders are responsible for modeling, reinforcing, and leading a company culture committed to the reputation and success of the organization Fail to ensure employees are clearly and strongly aligned Leave employees and teams unclear about what they are contributing to Employees are emotionally disengaged from why they are doing it Employees are confused and fearful because they don't really understand

VALUE PROPOSITION

Triad of culture, leadership, and environment: Provide a strong foundation from which to build and sustain a culture of wellness. Culture of wellness is one that values health and well-being on the individuals, team, and organizational levels. Multilevel leadership provides a total leadership model and spreads program ownership. Both the external and internal environments affect the work life and wellness of employees. The social networks within a community can help or hinder healthy behavior change.

begin with the business in mind

Understand the principles of business Understand the business of the organization Be an expert in the field of worksite wellness Help solve problems that need solving / impact the bottom line Share responsibility for business goals and plans Prepare to show outcomes of value to the organization

SHARED VALUES/PRIORITIES

Values: Core Program Values: Provide direction for culture change Help match personal values to corporate health promotion values Health: Identify Key project values Translate into language of the corporate culture Rate each program values using Likert Scale - Measurement

think strategically

What does your population look like?What's the health, productivity, attitudinal profile, etc. of your population?Do you have the right data?

INVESTMENT CHALLENGES

Where do we get the most "bang for the buck?" How can we use data to leverage investment decisions? Return-on-value versus return-on-investment

FORTUNE 100BEST COMPANIES TO WORK FOR

Why work at the culture level? critical factor in creating and supporting organizational values, directing behaviors, and uniting employees plays a large role in whether it is a happy or healthy environment in which to work vital in creating value for shareholders, customers, and the communities where these businesses are located healthy organizational culture facilitates strategy

individual behavior change and creating a culture of health

AMSO awareness: 5 percent motivation: 30 percent skills: 25 percent opportunity: 40 percent

reality check

-Employers increasingly view a healthy and productive workforce as a business imperative and a source of competitive advantage -Two-thirds of U.S. employees believe employers should play a role in helping them live healthier lifestyles -Employers are increasing their focus on employee well-being — including health, financial, and workplace experience -Organizations are making a healthy workplace culture a top strategic priority -High participation and engagement rates continue to be a challenge

basic principles of business strategy

-If you want to earn above the cost of capital (if you want to create value), you must get a higher return on your efforts than the average competitor. -To get a higher return than the average competitor, you must have an advantage or you must compete in an unusually attractive sector. -There are only two ways to get an advantage: Your prices must be higher or your costs, including the cost of your balance sheet and the cost of taxes, must be lower. -Unusually attractive sectors are those where the forces of competition are muted. Usually this is because there are few competitors. But there are other reasons, such as legislation or demand growing faster than supply.

what does it all mean?

-adapt as you go -everything changes -whats old is new again -anticipate change

employee engagement and health

-percentage who answered yes Experienced physical pain yesterday actively disengaged:23% engaged:14% Experienced stress yesterday actively disengaged:56% engaged:32% Diagnosed with high blood pressure actively disengaged: 19% engaged:15% Diagnosed with high cholesterol actively disengaged:15% engaged:11% Diagnosed with depression actively disengaged:16% engaged:9% Obese (based on reported height/weight) actively disengaged:28% engaged:24% Controlling for age, gender, marital status, education, income, race, and work category Gallup-Healthways Well-Being Index

understand your population - the healthcare continuum

1. Manage Disease: Case Management Onsite kiosks 2. Reduce Risk: Preventive Services Weight Watchers 3. Help Healthy People Stay Healthy: Walking, programs, healthy food 4. help employees thrive: EAP programs, development opportunities -strengthen resilience, optimism, creativity and purpose

workplace wellness program can generate savings

1. health care costs: -number of studies: 22 years: 3 average savings: $358 average costs: $144 average roi: 3.27 2. absenteeism: -number of studies: 22 years: 2 average savings: $294 average costs: $132 average roi: 2.73 roi: average of individual return on investment

top 10 human capital trends

1. organizational design: 92% 2. leadership: 89% 3. culture: 86% 4. engagement: 85% 5. learning: 84% 6. design thinking: 79% 7. changing skills of the HR organization: 8% 8. people analytics: 77% 9. digital HR: 74% 10. workforce engagement: 71%

health management strategy process

1. understand companies business focus 2. know your populations 3. assess current state of program 4. benchmark best/successful practices 5. Tactical strategic planning: -Cultural supports -Programs -Develop a health-supportive environment -Engagement methods 6. Measurement and evaluation

PREVALENCE OF CHRONIC CONDITIONS

117 million people had chronic conditions in 2012. 84 percent of healthcare costs are due to chronic conditions. This prevalence will continue to increase as the workforce ages. 70 percent of chronic conditions are attributable to lifestyle practices. Over one-third of deaths can be attributed to low physical activity, tobacco, low activity/diet, and alcohol use.2

average annual health insurance

2005: worker contribution - $2,713 employer contribution - $8,167 total - $10,880 2015: worker contribution - $4,995 employer contribution - $12,591 total - $17,545 from 2005 to 2015 : -83% worker contribution increase -61% total premium increase

DID YOU KNOW?

3 Eighty-one percent of large employers (200 or more workers) and 49% of small employers offer employees programs to help them stop smoking, lose weight, or make other lifestyle or behavioral changes.

who offers health benefits?

3 to 49 workers: 1999 to 2015 decrease from 63% to 54% 50 to 99 workers: 1999 to 2015 decreased from 96% to 89% 100 or more: 1999 to 2015 decreased from 98% to 97% all firms: 1999 to 2015 decreased from 66% to 57%

a wellness committee

8-15 members representing diversity within the organization Team charter, job description, subcommittee assignments, commitment pledge, meets regularly Engages the organization stakeholders and instills program ownership Serves as program cheerleaders/advocates Provides insight into program direction Helps balance the needs and wants of the different populations Lightens the load of program design, marketing, and delivery Provides program stability and sustainability Builds peer support for programs

CULTURE OF HEALTH FEEDS FROM BOTTOM UP AND TOP DOWN

A company needs to Down "engage people at all levels of the organization to drive a culture of health forward." Catherine Baase, MD,Dow Chemical health director Koster, 2012, Top down: Perceived as a business asset Recognized as having a big and important impact to the success of the organization Leadership participation and encouragement (Formal & Informal) Culture of Health Bottom up: Build a business case for senior management Illustrate the value proposition to the organization Pitch a comprehensive program Build unit-level management champion

cultural audits

A cultural audit consists of three stages: assessment, analysis and recommendation Review internal documents (job satisfaction and engagement survey, performance measures) Review print and other media (TV, newspaper, magazine, Internet content, etc.) Make site visits (internal and external benchmark) Hold focus groups (employees, managers) Interview stakeholders (internal and external) Design data collection for comparison with a cultural database

reality check

A culture of wellness initiative is not just high quality wellness programming, it's also the integration of leadership, environmental supports, policies, benefits, and incentives Culture of health is a tipping point strategy against the chronic disease that is crushing the healthcare system Health-care spending 17.5 percent of U.S. GDP in 2014, $3.0 trillion, or $9,523 per person. 20 percent in 2022 projected 75% of health care costs due to chronic conditions. Four of the five most expensive health conditions are chronic conditions: heart disease, cancer, mental disorders, and pulmonary conditions. The financial and human costs of chronic disease can no longer be ignored We are in the middle of a tipping point where health care is being seen as an investment in well-being rather than an expense for sickness. The crisis is clear!

CULTURAL TOUCH POINTS

A way to assess and change behavior: Subcultures and the broader society influence behavior through broad and overlapping mechanisms. Rewards and recognition Confrontation Relationships Modeling Recruitment and selection Orientation Training Communication Rites, rituals, symbols Resource commitment

COMMON CHALLENGES

Addressing and managing your entire population Creating and sustaining engagement Fragmented delivery of resources and programs Making value-based investments based on good numbers and evidence

risks/costs/age

Age range: ages 19-34: low risk: 1,776 annual medical cost: below 3,000 nonparticipitant: 1,414 annual medical cost: 3,000 medium risk: 2,565 annual medical cost: 6,000 high risk: 5,114 annual medical cost: 9,000 ages 35-44: low risk: 2,193 annual medical cost: 3,000 nonparticipant: 2,944 annual medical cost: under 6,000 medium risk: 3,353 annual medical cost: 6,000 high risk: 5,710 annual medical cost: 9,000 ages 45-54 low risk: 2,740 annual medical cost: 3,000 nonparticipant: 3,800 annual medical cost: 6,000 medium risk: 4,629 annual medical cost: 7,000 high risk: 7,991 annual medical cost: 12,000 ages 55-64 low risk: 3,734 annual medical cost: 3,000 nonparticipant: 5,212 annual medical cost: 6,000 medium risk: 6,625 annual medical cost: 9,000 high risk: 10,785 annual medical cost: 12,000 ages 65-74 low risk: 4,613 annual medical cost: almost 6,000 nonparticipant: 6,636 annual medical cost: 7,000 medium risk: 7,989 annual medical cost: 10,000 high risk: 11,909 annual medical cost: above 12,000 ages 75+: low risk: 5,756 annual medical cost: 6,000 nonparticipant: 6,110 annual medical cost: 9,000 medium risk: 8,927 annual medical cost: 12,000 high risk: 11,965 annual medical cost: above 12,000

small employers

Barriers: -Direct Costs -Indirect Costs (time, staff, facility) -Lack of Employee Interest -Lack of Management Support -Lack of Expertise -Uncertain ROI because of less employer-based health insurance -Rural setting with less access, or fewer health promotion providers -Manager fear of "paternalistic" image -Difficult to evaluate (expertise, cost to outsource) -Protecting employee privacy, avoid stigmatizing Opportunities: -Less bureaucracy, easier implementation -Employee suggestions incorporated more easily -Greater personal accountability -Potential for teamwork/bonding -Higher participation rates -Lower expense to screen, track, and evaluate health risks in a smaller population

culture audits - value driver

Build employees' loyalty and enhance their productivity, increase the client base adherence, and attract more new clients - thus driving the company's overall competitive advantage

ASSESSMENT TOOLS

CDC Worksite Health ScoreCard (2014) HERO Best Practices Scorecard (HERO & Mercer, 2014) NBGH Wellness Impact Scorecard (2016) WELCOA Wellness Workplace Checklist (n.d.) Measuring the Built Environment for Physical Activity (Brownson et al., 2009) Leading by Example (LBE) Instrument (Della et al., 2008) Worksite Supportive Environments for Active Living (Blunt & Hallam, 2009) Worksite Health Promotion Readiness Checklist (Faghri et al., 2010)

PROGRAM ASSESSMENT/ BENCHMARKING TOOLS

CDC Worksite Health Scorecard (2012) HERO Best Practice Scorecard (2015) NBGH WISCORE (Wellness Impact Scorecard) WELCOA Wellness Workplace Checklist Wellness and Well-Being Landscape Assessment (Edington, 2016)

CULTURAL NORMS

CULTURAL NORMS Building blocks of culture Expected and accepted behavior Wellness Becomes "the way we do things around here"

PILLARS FOR POSITIVE ORGANIZATIONAL CULTURE

Communicating What Matters Measure & Communicate What Matters

IMPORTANCE OF CULTURE

Culture and engagement is the most important issue companies face around the world. 87 percent of organizations cite culture and engagement as one of their top challenges. 50 percent call the problem "very important." status of retention and engagement strategy: updated in past 18 months: 28% currently updating: 38% outdated: 16% no strategy: 18%

culture and climate

Culture has been described as foundational and develops over the long-term, consisting of values, beliefs, norms, and traditions learned through socialization. Climate has been described as more surface-level and relates to the here and now; it is about the mood, attitude, or prevailing atmosphere of the organization. Manifestations of culture Climate is a main leverage point of culture. Judd Allen, culture psychologist, refers to climate as the "yeast" in culture change.

what is culture

Culture is "a pattern of shared basic assumptions learned by a group as it solves its problems of external adaptation and internal integration . . . a product of joint learning." Edgar Schein: Society of Sloan Fellows Professor of Management Emeritus & Professor Emeritus, MIT Sloan School of Management

iceberg phenomenon

Direct Medical Costs: -Medical -Pharmaceutical Indirect Costs: -Presenteeism -Short-term Disability -Long-term Disability -Absenteeism -Workers' Compensation -Employee Recruitment & Turnover visible = direct medical costs non visible = indirect costs -indirect costs represent 2-3 times direct medical costs

level 4: special programs - operational program planning pyramid

Disease management CVD Hypertension Diabetes Depression Asthma EAP Behavior health Health concierge Prenatal education Healthy back Ergonomics Clubs

leadership ownership for culture of wellness

Driven through goal alignment and doing the "right thing" Develops a clear understanding of the interface of systems, processes, behaviors, and culture Builds supportive organizational policies and processes Overcomes the leadership helplessness trap"Health is a personal decision." "Everyone is just getting old around here." "We have a work-life and wellness department; it's their job, not mine." Creates environments enabling the healthy choice to be the easy choice

value proposition

Employer Benefits: Increased productivity Reduced time away from work Reduced disability costs Decreased healthcare costs through cost avoidance Employee Benefits: Stronger health and well-being for themselves, their families and their communities Higher levels of energy, resilience, optimism, creativity, and fun during work and leisure A sense the employer cares about them, respects them, and values their opinions An overall greater satisfaction and meaning from work and life

big steps in creating a culture of wellness

Establish a sense of urgency. Form a powerful coalition of supporters. Create a vision. Communicate the vision. Empower others to act on the vision. Plan and create short-term wins. Learn from wins, consolidate, create more wins. Institutionalize through building blocks and leaders. book by Joh p. hotter: leading change

growing focus on employee experience

Examples: Airbnb - dedicated team to "drive the company's health and happiness" led by Chief Employee Experience Officer Fidelity Investments - shifted from benefits-only focus to appoint Head of Associate Experience and Benefits Nitro - focused on 3 Pillars = Fundamentals, the Fringe, and Fun

business focus, examples of business metrics

Focus Areas: Market Creation (new clients, products and markets) • Percent of revenue from new launches • Year-to-year growth > 10%• Revenue/employee > $500K Efficiency in Operations (cost control): • Very few new launches / year• Year-to-year revenue growth <5% • Revenue/employee <$500K Risk Management (license to operate, supply chain, and reputation): • Potential magnitude of any one safety incident caused by an employee is high • Number of safety incidents per year is high• Regulatory safety compliance is critical in operations Leadership Quality (development of leaders/long-term decision making): • Workforce percent is high in knowledge work, which is highly technical and where expectations matter • Talent retention and competition is competitive Adapted from Pagani-Tousignant & Tsumagari, 2014 10

THE FUTURE OF HEALTH PROMOTION

Focus on: Positive environments, cultures, and climates Purposeful alignment of organizational values, vision, policies, benefits, programs, and initiatives. Courage, commitment, persistence, and patience from leaders and everyone throughout organizations.

STEPS IN ENVIRONMENTAL ASSESSMENT

Identify opportunities to create access and opportunity for employees to practice healthy behaviors. -Choose appropriate assessment tools -Physical, culture, policy Implement strategies that support making the healthy choice the easy choice -Greater impact and sustainability

HEALTH CARE KEY OBSERVATIONS

Illnesses are expensive Risks are sort of expensive Illnesses and risks are really expensive! These expenses are unsustainable!

ONSITE HEALTH CLINICS EXPANDING FOCUS

Innovation, Cost Savings, Prevention, Care Coordination, ROI Integrated onsite prevention and wellness services Medical services Pharmacy Specialist care or referrals Telemedicine tools Medical home employers offering worksite clinic that provides general medical services (based on employers with 5,000 employees) -2013: 24% -2014: 29%

best practice design principles

Leadership: Set vision, policy, ensure resource, support implementation, and connect the program to business goals Relevance: Address factors critical to participation and employee engagement Partnership: Integrate the program with other entities and partners Comprehensiveness: Address health education, supportive environments, integration into the organizational structure, links to related programs Implementation: Planned, coordinated, and fully executed work plan Engagement: Promote connection between employees and the program that promote a culture of health and well-being Communications: Strategic communication plan that generates a day-to-day presence of the program in the workplace Being Data-Driven: Use data to measure, integrate, evaluate, and report Compliance: Program meets regulatory requirements and PHI protection

operational planning pyramid level 1

Level 1: Organizational Readiness & Support (bottom of pyramid) -Business alignment -Total leadership support -Policies -Benefit design -Environmental supports -Communications

level 2 risk avoidance/well being of operational program planning pyramid

Level 2 : Risk Avoidance/Well-being: HRA/Wellness Assessments Biometric/Preventive screenings Interpretation/ReferralHealth coaching Core programs: Activity Healthy eating Stress/Thriving/Resilience Family health Benefit education Medical consumerism/selfcare Safety Work/life Recreation Well-being

REALITY CHECK

Many companies offer health and well-being programs, but have not outlined a formally articulated strategy1 ACA requires that incentives need to be part of a "reasonable program design" 2 Good design reduces the need for higher incentives 2 Good design is indicative of better outcomes 2

ESTABLISHED PROGRAMS

Mature Programs: Conduct periodic cultural assessments Every three to five years Keeps programs on track Address gaps between current and desired culture Reveal shifts in employee needs

phases of changing culture

Phase1: PREPARATION • Analyze • Set Objectives • Develop Leaders -is done primarily through culture surveys, focus interviews, observation, and assignment of leaders. Phase 2: INVOLVEMENT • Introduce the Vision of the New Culture to All Levels -introduces the wellness program vision to employees and gives them an opportunity to set personal goals. Phase 3: INTEGRATION • Align Cultural Touch Points -emphasizes peer support initiatives and modification of touch points when new policies, procedures, and programs are implemented. Phase 4: SUSTAINABILITY • Evaluate Progress • Celebrate Success • Renew and Extend -involves measuring results, celebrating success, and planning a new round of culture change.

gaining and maintaining leadership support

Senior management ultimately controls budget and other program resources, but it is the middle managers who control participation and engagement. Consider offering wellness leader training for middle management on building a wellness culture Build relationships; become their partners by providing programs that have value and offer them solutions to their challenges Keep middle managers informed through face-to-face meetings and progress reports You want middle managers to become Wellness Champions, natural spokespersons for the program

culture of health born from years of successful safety cultures

Similar to a culture of safety, a culture of health provides a supportive work leadership, favorable work environment and health-related policies that promote employee health and wellness. Safety behaviors must be incorporated into the vision and goals of leadership.

level 3 risk reduction: operational program planning pyramid

Targeted interventions: Tobacco Obesity Inactivity Alcohol/drugs Metabolic syndrome Health coaching Risk specific online & print applications Topic specific workshops/support groups Affinity groups/virtual

total leadership model

Wellness staff, external consultant, wellness management company/vendors Wellness committee: employee volunteers who serve as a sounding board Neighborhood teams: group of neighborhood managers driving wellness strategies Wellness champ network: employee volunteers throughout the organization who promote and market the program Wellness mentor networks: employees trained as lifestyle change mentors to other employees Self-leaders: employees responsible and accountable to their personal wellness Dee Edington, Edington Associates

leadership support

improvement in employee health risk according to level of senior leadership support: no improvement: very: 10.7 somewhat: 42.6 marginal: 42.7 slight improvement: very: 36.6 somewhat: 47.6 marginal: 15.9 substantial improvement: very: 44.7 somewhat: 44.7 marginal: 10.5 improvement in medical cost trend according to level of senior leadership support: no improvement: very: 18.5 somewhat: 51.9 marginal: 29.6 slight improvement: very: 36.6 somewhat: 48.8 marginal: 14.6 substantial improvement: very: 46.3 somewhat: 46.3 marginal: 7.3

workplace wellness/evolution

late 1800s-early 1900s: employee recreation and athletic associations 60-70s: fitness 1980s: risk reduction/wellness early 1990s: HPM later 1990: population management 2000s: total worker/well being today: business sustainability

engagement drivers

meaningful work: autonomy, select to fit, small empowered teams, time for slack hands on management: clear, transparent goals, coaching, invest in management development, modern performance management positive work environment: flexible work environment, humanistic workplace, culture of recognition, inclusive, diverse work environment growth opportunity: training and support on the job, facilitated talent mobility, self directed dynamic learning, high impact learning culture trust in leadership: mission and purpose, continuous investment in people, transparency and honesty, inspiration -a focus on simplicity

gallup definition

three types of employees: 1. engaged: work with passion and feel a profound connection to their company. They drive innovation and move the organization forward 2. non engaged: employees are checked out, sleepwalking through workday, putting time but not energy or passion into their work 3. actively disengaged: employees are just unhappy at work, they're busy acting out their unhappiness , every day, these workers undermine what their engaged coworkers accomplish

lifestyle related risk factors and workforce performance

top 5 risk factors by cost per capita: 1. obesity: $347 2. physical inactivity: $179 3. depression: $128 4. tobacco use: $106 5. high blood glucose: $104 lifestyle related risk factors that can affect workforce performance: employer perception: 1. stress -to a great extent: 75 percent -to moderate extent: 20 percent -not at all: 5 percent 2. overweight/obesity: -to great extent: 70 percent -moderate extent: 22 percent -not at all: 9 percent 3. lack of physical activity: -great extent: 61 percent moderate extent: 28 percent -not at all: 11 percent 4. poor nutrition: great extent: 50 percent moderate extent: 30 percent: not at all: 20 percent 5. insufficient sleep: great extent: 31 percent moderate extent: 42 percent not at all: 27 percent 6. poor financial well being: great extent: 28 percent moderate extent: 37 percent not at all: 35 percent 7. tobacco use: great extent: 25 percent moderate extent: 30 percent not at all: 45 percent

REGARDLESS OF YOUR PROGRAM MODEL, 15BUILD A SOLID FOUNDATION

you: -health -social -community -career -financial