Worksite Wellnes Index with Ron Goetzel

REVIEW OF WORKFORCE HEALTH INDICES
HOW ORGANIZATIONS CAN MEASURE AND IMPROVE WORKFORCE
WELLNESS

RON Z. GOETZEL, PH.D.
August 12, 2011

WHAT IS A WORKFORCE WELLNESS INDEX
• Qualitative tool to assess the extent to which a an
employer or worksite has adopted ―best practices‖
for population health improvement
• Quantitative tool that aligns employees‘ health risk
profile with outcomes of interest to the organization
(e.g., medical care costs and worker productivity)
• Produces a ―single number‖ reflecting the
interaction of population health risks and cost that
can be compared and contrasted over time

2

EXAMPLES OF QUALITATIVE TOOLS
• HERO Best Practice Scorecard
• National Business Group on Health Wellness Score Card
• Checklist of Health Promotion Environments at Worksites (CHEW)
• Employers‘ Health and Productivity Management Inventory, Emory
• Environmental Assessment Tool (EAT), UGA/Emory
• Leading by Example (LBE) – Leadership Support Tool, Emory, UGA
• Healthy Employees in Healthy Organizations, ENWHP
• Heart Check: Assessing Worksite Support for a Healthy Lifestyle,
NYSDH
• Heart Check Lite, Fisher & Golaszewski
• Well Workplace Checklist, WELCOA

3

EXAMPLE OF A WORKSITE HEALTH INDEX


Sample Results
Nation
ABC Maximu
al
Category Inc.’s m
Averag
Score Points
e

1. Strategic Planning 7 5 11

2. Leadership
18 16 33
Engagement

3. Program Level
7 11 22
Management

4. Programs 14 28 56

5. Engagement Methods 40 29 67

6. Measurement and
2 5 11
Evaluation

TOTAL 88 94 200

Based on ABC Inc.‘s response and database average as of [May 1, 2009].

4

LEADING BY EXAMPLE (LBE) ASSESSMENT

PHYSICAL ACTIVITY POLICIES AND
ENVIRONMENTAL SUPPORT
– Make available educational information on physical activity (print, web, video, audio) (e.g., brochures
in common areas, links from company website, video or audio library)
– Lay out walking routes and trails (onsite or offsite in surrounding community)
– Post signs at elevators, entrances, by exit signs, etc. that identify stairwell location and encourage
use
– Make available bikes free of charge for onsite transportation
– Install bike racks/bike lockers at common building entrance ways
– Offer pedometer programs (distribute free pedometers)
– Offer onsite fitness center or fitness room
– Encourage use of off-site fitness club subsidies (partial/full reimbursement to employees)
– Encourage use of fitness club discounts (discounts arranged with local fitness/athletic center to
reduce employee out-of-pocket costs)
– Offer time off for physical activity during work hours
– Install fitness equipment at the workstation (e.g., cardio equipment, hand weights/dumb bells,
stretching mats, exercise balls)
– Install sport-specific exercise areas (e.g., basketball, volleyball, racquet ball or tennis courts)
– Offer sports team sponsorship or organized physical activities
– Provide showers/locker rooms
– Develop a newsletter or column for physical activity related information (print or computer-based;
providing information on programs, feature articles, high-risk targeted messaging, etc.)
– Install posters/bulletin boards designated for physical activity information
– Develop policy statement supporting physical activity
9

CHANGE AGENT CULTURE OF HEALTH SURVEY

10

CDC Worksite Health Index (WHI) Project
Purpose – Why we need a Worksite Health Index:
• The workplace provides many opportunities for
promoting health and preventing disease.
• There is a need for widely available,
recognized tools to assist employers in their
assessment of workplace programs, particularly
small and medium sized businesses.
• Employers are increasingly looking to experts
for practical guidance and population-based
solutions.

11

CDC Initiative – Goals
• Develop a tool for use by employers of all sizes
and types to assess their organization‘s ―health‖ in
terms of:
• Worker health/risk factors
• Program, policies, environment, culture
• Other relevant areas important to the success
of workplace health programs
• Allow employers to receive immediate feedback
and link to additional tools and resources

12

Stakeholder Panel
• David R. Anderson, PhD, LP – StayWell Health Management
• Catherine M. Baase, MD, FAAFP, FACOEM –The Dow Chemical Company
• Ken Holtyn, MS – Holtyn & Associates Health Promotion Consultants
• Pamela Hymel MD, MPH, FACOEM – Cisco Systems
• Laura Linnan, ScD, CHES – University of North Carolina
• Dyann Matson-Koffman DrPH, MPH, CHES – CDC, National Center for
Chronic Disease Prevention and Health Promotion
• Nico Pronk, PhD, FACSM, FAWHP – Health Partners, Center for Health
Promotion
• Paul Schulte, PhD – CDC, National Institute for Occupational Health and
Safety
• Andrew Spaulding, MS – Maine CDC/DHHS Cardiovascular Health Program
• Cristie Travis, MS – Memphis Business Group on Health
• Tonya Vyhlidal, MEd, CHPD, CPT – Lincoln Industries
• Ed Watt, MS – Transport Workers Union

13

CDC Approach
• Phase I – Environmental Scan and Planning
• Literature review
• Expert consultation
• Phase II - Develop Worksite Health Index
• Finalize the domains, indicators, and metrics for the
index
• Build and pilot test a prototype
• Phase III - Develop Web Application and
Disseminate
• Translate prototype into functional application
• Promote adoption and utilization of tool
14

CDC Environmental Scan
• Used four sources to construct an organizing
framework of WHI best and promising practices
• Three main domains (with 25 subcategories)
• Leadership and Corporate Culture
• Program Design and Implementation
• Program Evaluation

15

CDC Worksite Health Index Project
Domain 1: Leadership and Corporate Culture
CATEGORY/CONCEPT DESCRIPTION/EXAMPLES
1. Leadership and Management Support Demonstrate organizational commitment and leadership
support by engaging mid-level management, sharing
program ownership with all staff levels, and leading by
example.
2. Organizational Culture and Policies A healthy company norm/culture that includes a supportive
physical environment and supportive policies (e.g., healthy
food, no tobacco, flex time).
3. Alignment of Business and Health Goals Explicit connection of health goals and programs to
organization‘s core business objectives and principles.
4. Wellness Champion Identified wellness coordinator/champion, council, or
employee-driven advisory board.
5. Sustainability Scalable and accessible programs.

8/11/2011 16 16

Domain 2: Program Design &Implementation
6. Planning and Program Goals Establish clear, consistent, theory and evidence-based principles and a
clearly defined plan of operations with specific program goals and
objectives (and with realistic expectations).
7. Diagnostics and Assessment Use/analysis of claims data, health risk data, biometrics, and measures
of productivity.
8. Integration, Data Systems Efficient and effective data practices and informatics, integration of
and Informatics relevant data systems across multiple organizational functions and
departments (e.g., with employee health risk data).
9. Incentives Consider meaningful incentives/rewards and incentives linked to
participation (not to changes in biometrics).
10. Adequate Resources Dedicated, adequate resources spent to achieve desired ROI.

11. Multi-Component Multi-component programs (e.g., health education,
Interventions and Effective counseling, behavior change/chronic disease risk reduction,
Implementation emergency preparedness, safety and the elimination of recognized
occupational hazards), integration of program components at the point
of implementation. Integrated staff (multi-disciplinary; cross
departmental); Integrate/ensure vendor, partners engagement.
12. Tailored Interventions Tailor programs to the specific workplace and provide individualized
interventions.

8/11/2011 17 17

Domain 2: Program Design & Implementation
13. Screening and Triage Scalable and effective assessment and screening to identify the highest risk
individuals, triaging of individuals into programs that produce the biggest
payoff/impact, providing public health interventions to keep people at low risk.
14. Piloting Start small/simple and scale up using success of pilot results.

15. Engagement of Local Community Coordinating with insurance and health care providers (especially primary care
providers), public health partners, and community based organizations, using
community resources and linkages.
16. Accessibility/ Reducing Barriers Accessible/attractive programs and initiatives at the worksite and in the
community with services that balance personal, face-to-face interactions with the
latest advancements in computers/technology, the promotion of employee
participation.
17. Confidentiality Relentless focus on safeguarding personal health information, privacy and
protecting confidentiality.
18. Ecological Interventions Environmental/ecological interventions, the social
environment, the built environment in the workplace and community, (e.g., LEED
buildings).
19. Communications Regular, strategic, multi-channel, effective marketing and communication of
results (to management, employees and their dependents).
20. Health Benefits Insurance plan design (coverage; payment structure, degree of innovation in
plan), vacation and sick leave.

8/11/2011 18 18

Domain 3: Program Evaluation
21. Measurement and Evaluation Program measurement, analysis and evaluation (e.g. claims data,
evaluation data, audit tools) using rigorous methods that stand up to
peer review.
22. Effective Tools Find and use effective, valid, and reliable tools.

23. Accountability Build accountability at all levels that is linked to rewards.

24. Learn from Results Learn from experience; adjust the program as needed, explicit
connection of results to core values.
25. Economics Return-on-investment (ROI), health care costs, workers‗
compensation, disability.

8/11/2011 19 19

DERIVATIVE INSTRUMENT – CDC HEALTH
SCORE CARD

20

OTHER EXCITING DEVELOPMENTS
• Development of quantitative health indices
– Novartis
– PepsiCo
– Thomson Reuters

• International applications: Discovery Holding
(South Africa)

21

EVOLUTION OF THE
WORKFORCE WELLNESS
©2010 Thomson Reuters

INDEX
22

PRIOR WORK ON INDEXES
• The Workforce Wellness Index evolved from prior
work carried out in-house at Thomson Reuters
– Health indexes for employer clients such as Pepsi Bottling
Company and Novartis
• Goetzel RZ, Carls GS, Wang S, Kelly E, Mauceri E, Columbus D, Cavuoti A. ―The
relationship between modifiable health risk factors and medical expenditures,
absenteeism, short-term disability and presenteeism among employees at
Novartis. Journal of Occupational and Environmental Medicine. 2009. 51(4): 487-499,
April 2009.
• Henke RM, Carls GS, Short ME, Pei X, Wang S, Moley S, Sullivan M, Goetzel RZ. The
Relationship between Health Risks and Health and Productivity Costs among
Employees at Pepsi Bottling Group. Journal of Occupational and Environmental
Medicine. 52(5):519-527 May 2010
• Kelly E, Carls GS, Lenhart G, Mauceri E, Columbus D, Cavuoti A, Goetzel RZ. The
Novartis Health Index: A method for valuing the economic impact of risk reduction in a

workforce. Journal of Occupational and Environmental Medicine. May 2010; 52(5): 528-
535.

23

PBC AND NOVARTIS HEALTH INDEXES
• Indexes based on relationship between observed
health risks and various employer health care and
productivity costs
– Include medical+Rx, workers‘ compensation, short-term
disability, absenteeism and presenteeism

• Indexes link employee health risks and cost data to
produce a single number, which can be used by
management to gauge employee health risks and
costs simultaneously

24

HEALTH INDEX PHASES
• Phase I: Develop Descriptive Statistics: Characteristics
of Employees at High vs. Low Health Risks
• Phase II: Investigate Relationships Between Health
Risks, Medical Expenditures, Productivity, and Other
Outcomes
• Phase III: Publish Finding
• Phase IV: Develop an Excel-Based Model to Forecast
the Financial Impact of Interventions Designed to
Improve Health and Lower Health Risks

25

NOVARTIS – DATA INTEGRATION
• Collect data needed to measure employee health
risks, productivity, and medical expenditures and
merge these data sets into a single analytic file:
– Medical claims data for inpatient, outpatient, and ancillary
services
– Pharmaceutical claims
– Health plan enrollment data
– Mayo Health risk appraisal (HRA)
– Work Limitations Questionnaire (WLQ) (i.e.,
presenteeism)
– Incidental absence data

– Short-term disability data

26


100%

0%
25%
50%
75%
General Health

34%
Nutrition Risk
81%
Emotional Health
Risk
70%

Safety Risk
63%

Weight Risk

27
Blood Pressure Risk
53% 49%

Exercise Risk
NOVARTIS RISK FACTORS

33%

Cholesterol Risk
15%

Triglycerides Risk
10%

Tobacco Risk
8%
PROPORTION OF STUDY POPULATION AT HIGH RISK

Blood Sugar Risk
7%

Alcohol Risk
5%

PHASE I EXAMPLE:
PRODUCTIVITY AT WORK*
General Health
Low High
Risk Risk p-value1
Sample Size 2,282 1,174

Percent Productivity Lost 1.1% 2.0% 0.00

Workdays Lost (Assuming 2.84 4.93
250-day Work Year)
1P-value for test of difference between low risk and high risk.

28

PHASE II:
FACTOR ANALYSIS RESULTS
Figure 1: Factor Loadings (importance) of each risk to each factor for all employees
Factor 1: Biometric Risk Factor 2: Alcohol and Tobacco Factor 3: Emotional Health Risk

Tobacco Tobacco Tobacco

Alcohol Alcohol Alcohol

Weight Weight Weight

Emotional Emotional Emotional

Exercise Exercise Exercise

Triglycerides Triglycerides Triglycerides

Cholesterol Cholesterol Cholesterol

Blood sugar Blood sugar Blood sugar
Blood
Blood pressure Blood pressure
pressure

0 0.5 1 -0.5 0 0.5 1 -1 -0.5 0 0.5 1
Loading (importance) Loading (importance) Loading (importance)

• Males and females: includes • Males and Females: includes • Females: includes those at risk
those at risk for blood pressure, those at risk for alcohol or for weight, emotional health or
blood sugar, cholesterol, tobacco exercise
triglycerides, or weight
• Males: includes those at risk for

emotional health or cholesterol
Females
Males

29

PHASE II:
RISK FACTORS AND MEDICAL EXPENDITURES
Outcomes and group of Predicted Predicted Impact on Impact as percent
health risks scenario Mean dollars or days difference from scenario
(95% CI) without the risk
(95% CI)

Medical Care Expenditures Annual
expenditures
Females High Biometric Lab Without risk(s) $3,952 $516 13.1%
Values With risk(s) $4,468 ($146, $885) (3.7%, 22.4%)

Alcohol - Tobacco Without risk(s) $3,910 $247 6.3%
Use With risk(s) $4,157 (-$366, $861) (-9.4%, 22.0%)

Emotional Health Without risk(s) $3,925 $500 12.7%
With risk(s) $4,425 ($137, $863) (3.5%, 22.0%)

Males High Biometric Lab Without risk(s) $2,540 $557 21.9%
Values With risk(s) $3,097 ($200, $914) (7.9%, 36.0%)

Alcohol - Tobacco Without risk(s) $2,652 $568 21.4%
Use With risk(s) $3,220 (-$106, $1,243) (-4.0%, 46.9%)

Emotional Health Without risk(s) $2,530 $561 22.2%

With risk(s) $3,091 ($166, $956) (6.6%, 37.8%)

Indicates a statistically significant difference between those at risk and those without risk.
30

PHASE II:
RISK FACTORS AND PRESENTEEISM
Impact as percent
Impact on difference from scenario
Outcomes and group of Predicted Predicted dollars or days without the risk
health risks scenario Mean (95% CI) (95% CI)
Presenteeism Annual unproductive days

Females High Biometric Lab Without risk(s) 0.73 0.88 121.6%
Values With risk(s) 1.61 (0.77, 1.00) (105.9%, 137.2%)

Alcohol - Tobacco Without risk(s) 0.69 1.65 238.1%
Use With risk(s) 2.34 (1.34, 1.95) (193.8%, 282.3%)

Emotional Health Without risk(s) 0.74 0.86 115.7%
With risk(s) 1.60 (0.75, 0.97) (100.7%, 130.7%)

Males High Biometric Lab Without risk(s) 0.50 0.73 146.2%
Values With risk(s) 1.23 (0.65, 0.81) (129.6%, 162.8%)

Alcohol - Tobacco Without risk(s) 0.59 1.33 224.0%
Use With risk(s) 1.93 (1.07, 1.59) (180.6%, 267.3%)

Emotional Health Without risk(s) 0.54 0.87 159.7%

With risk(s) 1.41 (0.76, 0.97) (139.8%, 176.9%)
Indicates a statistically significant difference between those at risk and those without risk.

31

PHASE III: JOEM PUBLICATION

32

PHASE IV: BUSINESS APPLICATION
DEVELOPING AN EXCEL-BASED MODEL
Model Inputs The Model Consists of
Enter the demographics Formulas that Combine
characteristics and the the Inputs to Calculate
baseline health risk profile Estimated Savings from:
for a target population.
• Medical Care
Choose small, medium, or
• Short-term Disability
large risk reduction for each
of the different health risk • Incidental Absence
factors.
• Workplace Productivity
References tables of • Sales Performance
regression equations and

factor loadings from Phase II.

33

EXCEL MODEL INPUTS
• Data points that can be
customized for each run
of the model include:
– Population size
– Percent female
– Age distribution
– Geographic distribution
(by region)
– Health plan distribution
– Percent participation in
program
– Percent of participants
‗at risk‘ (by 9 risk factors) at
baseline

– Average daily wage and
benefits load (for
monetized presenteeism)
34

CHANGES IN RISK B C D
• After customizing inputs, 2 Specify Hypothetical Changes in Risk Level

the predicted impact on 3 Females
Hypothetical Reduction
Males
Hypothetical Reduction
risk level of the program 4 in Risk Level in Risk Level

considered can be 5
FALSE FALSE

modeled. 6 Biometric
Risk
• For each factor – 7

biometric, alcohol and 8
tobacco, and emotional 9 TRUE TRUE

health, the impact on risk10
Alcohol &
Tobacco
can be selected for males 11
Risk

and females. 12

– No change 13
FALSE FALSE

– Small decrease 14
Emotional
Health
–

Medium decrease 15
Risk

– Large decrease 16

35

RESULTS FROM RISK CHANGES

Potential Savings Due to Reduction in Health Risk

Baseline Risk Reduction in Risk Change Minus
Level Level Baseline

Medical
$15,912,606 $15,788,088 -$124,518
Expenditure

Absence
$4,218,869 $4,150,426 -$68,443
Payment

Presenteeism $8,320,131 $7,870,190 -$449,940

36

MODEL OUTPUT: HEALTH INDEX
Predicted Average Annual Cost per Employee by Population Health Index
$16,000
Annual Cost per Employee Predicted by Model

$14,000
Annual Cost per Employee Predicted by Model

$12,000

$10,000

$8,000

$6,000

Baseline Health Index = 79
$4,000
Model Predicted PEPY Cost = $6,989
$2,000 Baseline Health Index = 79 Health Index after Reduction = 81
Model Predicted PEPY Cost = $6,989 Model Predicted PEPY Cost = $6,841

$0
0 10 20 30 40 50 60 70 80 90 100
High Risk
High Risk
Population Health index
Population Health Index Low Risk
Low Risk
Med & Rx Med & Rx Absence+STD
Absence+STD Presenteeism
Presenteeism Total Cost
Total Cost Baseline Reduction Reduction
Baseline Reduction
37


PEPSICO STUDY

38

PBC - OVERWEIGHT/OBESE ANALYSIS
Adjusted predicted annual costs for employees by BMI

*At least one difference significant at the 0.05 level

$10,000 Diff =
Diff =
25%,
29%, Normal
$8,000 $613*
$987
Overweight
$6,000 Class I
Diff = Diff = Class II
$4,000 Diff = 26%, 7%, Diff =
Class III
58%, $186* $49 10%,
$2,000 $111* $28

$0
Medical

STD

Total
Absences
Presenteeism
WC
Difference between
combined overweight/
obese categories and 74% of the
sample is

normal weight is
displayed overweight or
obese

39

MODEL INPUTS TAB
Model Inputs (you can click in any of the white boxes and type a new value)
Enter distribution (%) for demographics and health risks
41.1% 18-34 27,000 Number of employees
Employee
Age 28.4% 35-44 $204 Average daily wage & benefit
Statistics
22.9% 45-54 0% Percent who will participate

(Total = 100%) 7.6% 55-64 Intervention $0 Annual cost per participant

Gender 11.7% Female $2,505 Medical expenditure
Baseline
20.2% Northeast $664 Workers Compensation
Annual
Geographic Health and
10.6% North Central $293 STD payment
Region Productivity
Costs per
42.4% South 2.4% Presenteeism (%)
Employee
(Total = 129.1%) 26.8% West 2.7 Health-related absence days

29.1% Sales Select a work site from the drop-down list:

7.9% Professional/Non-manager National Total

Selecting a work site will populate the model inputs with
16.3% Manager
values specific for the site. Sites with 100+ employees are
Job Type
listed individually, sites with 50-99 employees are grouped
9.1% Technician
by geographic region; sites with fewer than 50 employees
5.4% Clerical/Office are grouped nationally.

31.6% Laborer/Production

(Total = 100%) 0.7% Unknown

42.8% Overweight

21.8% Obese Class I
Health
Risks 7.1% Obese Class II

3.1% Obese Class III

17.2% High blood pressure

3.0% High blood glucose

12.1% High total cholesterol

14.3% Physical inactivity

14.9% Poor diet

14.6% Stress

5.0% Depression

23.9% Tobacco use

10.1% Alcohol

0.6% Type I Diabetes

40

MODEL RESULTS – PROJECTED CHANGE
27,000 Number of employees
Employee
$204 Average daily wage & benefit
Statistics
30% Percent who will participate

Intervention $100 Annual cost per participant

Model Results (you can click in any of the white boxes and type a new value for percent risk reduction)
Enter percent risk reduction for the health risks; savings will update dynamically.
Risk Per Total
Health Risk Projected Savings from Risk Reduction
Reduction Employee Participants
Overweight 10% Baseline $2,505 $20,287,665 Health Index
Obese Class I 10% Medical expenditure Risk Reduction $2,426 $19,654,463 (after Risk Reduction)

Obese Class II 10% Savings = $78 $633,202
92.5
Obese Class III 10% Baseline $664 $5,381,721
High blood pressure 10% Workers Compensation Risk Reduction $644 $5,215,554 0 => highest possible risk
100 => lowest possible risk
High blood glucose 10% Savings = $21 $166,167
High total cholesterol 10% Baseline $293 $2,374,353 Return on Investment
Physical inactivity 10% STD payment Risk Reduction $279 $2,259,365 (ROI)

Poor diet 10% Savings = $14 $114,988
$1.26
Stress 10% Baseline $323 $2,620,156
Depression 10% Presenteeism cost Risk Reduction $318 $2,578,173 ROI is the net savings for each
dollar invested.
Tobacco use 10% Savings = $5 $41,983 An ROI of $1.00 indicates break
even.
Alcohol 10% Baseline $542 $4,388,019

Health-related Absence Risk Reduction $533 $4,320,296 Annual Savings/Employee
With a 1 Point Increase
Savings = $8 $67,723 in the Health Index
Total Savings $126 $1,024,064
$124

41

HEALTH INDEX SCORE BY WORKSITE

93.9 88.3 92.0 91.4 92.1 91.5
100
Healthier

80
Population Health Index

60
Higher Risk

40

20

0
Loc A Loc B Loc C Loc D Loc E PBC Avg

42

THOMSON REUTERS
WORKFORCE WELLNESS INDEX
• Background
– Modifiable health risk factors are associated with
increased healthcare and productivity costs

• Objectives
– Devise a methodology to create a health risk score that
can be applied to health risk assessment (HRA) data and
correlates with costs associated with health risk factors
– Devise a methodology that allows comparison of a
population subset to a total health risk score

43

DATA SOURCES
• MarketScan Medical and Drug Claim Database
– Eligibility, Medical and Drug Paid Claims Data for Self-Insured
Employers and Health Plans, 2005-2009
– Over 25 Million Covered Lives in 2009
– Eligibility and Medical Claims were used to Derive Employee
Demographics and Comorbidities (for Risk Adjustment)
– Medical and Drug Claims were used to Estimate Prospective
Healthcare Costs
• MarketScan Health and Productivity Management Database
– Health Risk Assessment Survey, Absenteeism, Workers
Compensation and Short Term Disability Data, 2005-2009
– Over 2 Million HRAs in 2009
– Linkable to the MarketScan Medical and Drug Claim Database

– HRA Survey Questions were used to Estimate Behavioral Risk
Prevalence Rates and to Identify the Presence/Absence of High Risks
44

THOMSON REUTERS
• Two indexes were constructed
• MARKETSCAN® INDEX: Prevalence and cost of 8 risk
factors based on MarketScan medical and drug claims
matched to Health Risk Assessment (HRA) data (privately
insured; adjusted to U.S. demographics)

- Body Mass Index (BMI) - Tobacco Use
- Blood Glucose - Alcohol Use
- Blood Pressure - Stress (U.S. rates not available)
- Cholesterol - Exercise (U.S. rates not available)

• U.S. INDEX: Prevalence of 6 risk factors for U.S. employed,
privately insured population age 18-64 with MarketScan cost

weights applied

45

SAMPLE
• Active full-time employees
• Ages 18-64
• Enrolled in non-capitated health plans
• Continuously enrolled for 365 days before and after
the index HRA date
• Non-pregnant individuals

46

HEALTH RISK INDEX—DATA SOURCES
High Risk Definitions

Risk Factor High Risk Definition
BMI BMI >= 30
Blood Pressure Systolic >=140 or diastolic >=90
Cholesterol Total Cholesterol >= 240
Glucose Total Glucose >= 126
Currently smoke cigarettes or use any form of
Tobacco tobacco
Alcohol More than 2 drinks per day
Sometimes or Often feel stressed and have
Stress trouble coping
Exercise less than two days per week or less
than 20 minutes per day or
non-exerciser/light exerciser in the previous

Exercise month

47

METHODS
• Prevalence of health risks was calculated for the
sample population
– To compensate for possible differences in demographic
composition of the MarketScan HRA sample and the
national employed workforce, adjustment weights were
applied when computing the yearly prevalence rates from
the MarketScan HRA sample
– Adjustment weights were derived from the Current
Population Survey for the years 2005-2009

48

METHODS
• Regression models were used to estimate the
importance weights used to derive the overall index
score
– Importance weights were computed from risk factor
coefficients from the regression model that estimated the
cost effect of the risk factors and other covariates.
– Each risk factor importance weight can be interpreted as
the annual percentage increase in medical and drug costs
due to presence of a risk factor, controlling for all other
risk factors, comorbid conditions and employee
characteristics

49

METHODS
• The U.S. Index was computed as follows:
– The Behavioral Risk Factor Surveillance Survey (BRFSS)
and the National Health and Nutrition Examination Survey
(NHANES) were used to estimate behavioral risk
prevalence rates for the insured, employed population of
the U.S. as a whole
– Importance weights were derived from the MarketScan
claims database
– The U.S. Index was then computed in a manner similar to
the Workforce Wellness Index

50

WORKFORCE WELLNESS INDEXES
U.S. AND MARKETSCAN 2005-2009
87.0

86.5

86.0

85.5

85.0

84.5

84.0

83.5

83.0

82.5
2005 2006 2007 2008 2009

U.S. Wellness Index MarketScan Wellness Index

Note: Each index is a composite of 6 risk factors:
BMI, Blood Glucose, Blood Pressure, Cholesterol, Tobacco Use, Alcohol Use
51

RESULTS
• Between 2005 and 2009, the U.S. Workforce
Wellness Index worsened, declining from 86.4 to
84.4
• The MarketScan sample improved, increasing from
84.1 to 86.2. An index of 100 represents the ideal
state where there are no behavioral risk factors
present in the employed population and, therefore,
no healthcare costs due to these risks

52

ESTIMATED ANNUAL COST IMPACT1
$450
$400
$350
$300
$250
$200
$150
$100
$50
$-
$(50)
BMI Blood Pressure Cholesterol Glucose Tobacco Alcohol

Implied Cost Impact (based on 2009 Prevalence Rates)

1Based on cost and prevalence rates in MarketScan data sets

Note: Cholesterol and Alcohol Use statistically have no medical/drug cost impact

53

DISCOVERY VITALITY WELLNESS
HEALTHY COMPANY INDEX

54

EMPLOYEE HEALTH ASSESSMENT

55

REPORTING BMI AND NUTRITION

56

ORGANIZATIONAL HEALTH

57


58
LEADERSHIP SUPPORT

AND THE WINNERS ARE…

59

SUMMARY
WORKFORCE WELLNESS INDEXES
• There are lots of them out there
• Some are qualitative, others quantitative, and yet
others are both
• They aim to connect organizational health,
individual risk factors, and financial metrics
• The goals – to come up with one number that
reflects a composite health/cost score – like the
―Dow Jones‖ industrial average
• Measures the impact of improving behavioral risk

factors on healthcare cost in employed populations

60

Worksite Wellnes Index with Ron Goetzel

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Worksite Wellnes Index with Ron Goetzel