The document discusses rising healthcare costs driven by an aging population and the increasing prevalence of chronic diseases like obesity and diabetes. Healthcare spending per capita has risen dramatically in recent decades and chronic diseases account for 75% of total healthcare costs. Unhealthy behaviors and lifestyle factors are the primary causes behind the rise in chronic diseases. Addressing obesity, physical inactivity, and other modifiable risk factors through worksite wellness programs could help curb healthcare spending growth and improve worker productivity and health outcomes.

1. Aging Population Rising Medical Costs Epidemic of Chronic Disease

2. Medical Costs by Age and Risk N=43,687 Source: StayWell Health Management

3. Medical Costs as a % of GDP

4. Medical Costs as a % of GDP

5. Medical Costs as a % of GDP 16% US Military 3.2%

6. Medical Costs as a % of GDP 19.5%

7. Spending Trend Per Capita

8. Annual Spending Per Capita

9. Health Care Costs for Each Person Centers for Medicare and Medicaid Services

10. Health Care Costs for Each Person Centers for Medicare and Medicaid Services $7490

12. Infant Mortality General Accounting Office, 2004

13. Life Expectancy in 60 Countries Swaziland Japan

14. Life Expectancy in 60 Countries Swaziland Japan

15. What Have We Done?

16. Cost Shifting Employer Health Benefits 2005 Annual Survey

17. Why Are Costs Going Up?

20. The Cause Behind the Cause Unhealthy behaviors Health risks Chronic disease Health care costs

21. This will grow to 66% with the next 25 years CD is responsible for 50% of global mortality

22. Obesity Trends* Among U.S. Adults BRFSS, 1987 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14%

23. Obesity Trends* Among U.S. Adults BRFSS, 1990 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14%

24. Obesity Trends* Among U.S. Adults BRFSS, 1993 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%-19%

25. Obesity Trends* Among U.S. Adults BRFSS, 1994 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%-19%

26. Obesity Trends* Among U.S. Adults BRFSS, 1995 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%-19%

27. Obesity Trends* Among U.S. Adults BRFSS, 1996 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%-19%

28. Obesity Trends* Among U.S. Adults BRFSS, 1997 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%-19% ≥20%

29. Obesity Trends* Among U.S. Adults BRFSS, 1998 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%-19% ≥20%

30. Obesity Trends* Among U.S. Adults BRFSS, 1999 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%-19% ≥20%

31. Obesity Trends* Among U.S. Adults BRFSS, 2000 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%-19% ≥20%

32. Obesity Trends* Among U.S. Adults BRFSS, 2001 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%-19% 20%-24% ≥25%

33. (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) Obesity Trends* Among U.S. Adults BRFSS, 2002 No Data <10% 10%–14% 15%-19% 20%-24% ≥25%

34. Obesity Trends* Among U.S. Adults BRFSS, 2003 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%-19% 20%-24% ≥25%

35. Obesity Trends* Among U.S. Adults BRFSS, 2004 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%-19% 20%-24% ≥25%

36. Obesity Trends* Among U.S. Adults BRFSS, 2005 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%-19% 20%-24% 25%-29% ≥30%

37. Obesity Trends* Among U.S. Adults BRFSS, 2006 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%-19% 20%-24% 25%-29% ≥30%

38. Obesity Trends* Among U.S. Adults BRFSS, 2007 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%-19% 20%-24% 25%-29% ≥30%

40. Percent of adults who are overweight or obese 2/3 of adults are overweight or obese 67%

41. Percent of adults who are overweight or obese 81%

42. Excess Body Weight and Reduction of Lifespan Ann Intern Med. 2003;138:24-32 -3.3 -3.1 -7.1 -5.8

43. But it not just adults…

46. Diabetes Trends* Among U.S. Adults BRFSS 1991-92 Source: Mokdad et al., Diabetes Care 2000;23:1278-83. No Data <4% 4%-6% 6%-8% 8%-10% 10%+

47. Diabetes Trends* Among U.S. Adults BRFSS 1995 Source: Mokdad et al., Diabetes Care 2000;23:1278-83. No Data <4% 4%-6% 6%-8% 8%-10% 10%+

48. Diabetes Trends* Among U.S. Adults BRFSS 1997-98 Source: Mokdad et al., Diabetes Care 2000;23:1278-83. No Data <4% 4%-6% 6%-8% 8%-10% 10%+

49. Diabetes Trends* Among U.S. Adults BRFSS 1999 Source: Mokdad et al., Diabetes Care 2001;24:412. No Data <4% 4%-6% 6%-8% 8%-10% 10%+

50. Diabetes Trends* Among U.S. Adults BRFSS 2000 Source: Mokdad et al., J Am Med Assoc 2001;286:10 . No Data <4% 4%-6% 6%-8% 8%-10% 10%+

51. Diabetes Trends* Among U.S. Adults BRFSS 2001 Source: Mokdad et al., J Am Med Assoc 2001;286:10 . No Data <4% 4%-6% 6%-8% 8%-10% 10%+

52. Diabetes and Reduction in Lifespan JAMA 2003;290:1884-1890 -11.6 yrs -14.3 yrs

53. Lifetime Risk of Diabetes for Children Born in 2000 Venkat Narayan, JAMA 2003;290:1884 49%

54. What Happened?

56. Food Marketing = $25 Billion 5-a-day = $1 million

58. Texas Double Whopper 1910 mg 80% of daily Sodium 69 grams 106% of daily Fat grams 26 grams 130% of daily Saturated fat 1050 Calories

59. Serving Sizes Have Increased

61. 16 oz 32 oz 44 oz 52 oz 64 oz 48 Teaspoons Sugar

62. Motionless Lifestyle

63. Displaced Activity

65. Why is All This a Big Deal?

66. The Cause Behind the Cause Unhealthy behaviors Health risks Chronic disease Health care costs

67. Percent of Chronic Diseases That Are Caused by Poor Lifestyle Sources: Stampfer, 2000; Platz, 2000; Hu, 2001 71% 70% 82% 91%

68. $1,500-$3,500 in Excess Claims for Each Additional Health Risk Source: Dee Edington, Health Management Research Center

69. Average 2003 Medical Care Costs N=1,706 Source: StayWell Health Management

70. Days Absent in 2003 N=941 Source: StayWell Health Management

71. Percent with Worker’s Comp Claims in 2003 N=23,916 Source: StayWell Health Management

72. Percent with STD Claims in 2004 N=23,916 Source: StayWell Health Management

73. So What Is To Be Done?

74. Employee Population Health Management

75. Well Risk Urgent Disease

76. Well Risk Urgent Disease 25%

77. Well Risk Disease Urgent 5%

78. Well Risk Urgent Disease 60%

79. Well Risk Urgent Disease 10%

80. Well Risk Urgent Disease 10% 60% 5% 25% Top 15% of employees with disease = 85% of costs

81. Well Risk Urgent Disease 10% 60% 5% 25% The rest = 15% of costs

82. Well Risk Urgent Disease

83. Disease 25% Disability Management Case management Decision support Risk management Disease management Clinical management Compliance support Risk management

84. Disease 59% Turnover

85. Urgent 5% Demand Management Self care information Nurse advice line Decision support Coaching

86. Risk 60% Risk Management Targeted intervention Targeted screening Reimbursement

87. Well 10% Wellness Management

88. Who Needs Help Adopting and Maintain Healthy Behaviors?

89. 100% Who Needs Help Adopting and Maintain Healthy Behaviors?

93. The Solution

94. Return on Investment (ROI) 32 studies 14 studies

95. Health Care Costs for Each Person Centers for Medicare and Medicaid Services $7490

99. Relative Costs of Poor Health Edington, Burton. A Practical Approach to Occupational and Environmental Medicine (McCunney). 140-152. 2003. Health Care Costs Worker’s Comp Absenteeism Presenteeism

101. Value of Lost Productivity Your Annual Health Care Costs 3 X

103. Individual Family Worksite Community Nation/ world

104. Individual

107. Individual Family

110. Individual Family Worksite

114. Individual Family Worksite Community

116. Which group has the most skin in the game? Individual Family Worksite Community Nation/ world

118. Why Should I Care?

119. Mortality Rate from Chronic Living

120. Compression of Morbidity Lifespan in years Morbidity 76 0 critical illness Ann Intern Med, 2003:139:455-459

121. Lifespan in years Morbidity 0 ? 76 86 critical illness Compression of Morbidity

122. Lifespan in years Morbidity Lifespan in years Morbidity 10-20 Years Compression of Morbidity

123. Lifespan in years Morbidity Compression of Morbidity

124. Lifespan in years Morbidity Compression of Morbidity

125. Lifespan in years Morbidity Compression of Morbidity

126. Lifespan in years Morbidity Compression of Morbidity