Creating a Culture of Health at the University of Michigan

LaVaughn Palma-Davis, M.A.Senior Director, University Health and Well-Being Services

University of Michigan

University of Michigan

Multiple locations Three academic campuses Health System

40,000+ active employees 82,000 (approx.) family

members 7,000 retirees 60,000 students

Tremendous potential to positively impact

community health!

Tremendous potential to positively impact

community health!

Unique Characteristics Three-fold mission: education, research,

service Multiple audiences (faculty, staff, families,

retirees, patients, students, a “city” of jobs) Decentralized organizational structure Culture is one of “freedom of choice”

Our Unique Opportunity to Improve Health

“We have the means to mount a broad, collaborative effort to fashion a prototype program to:

promote healthy living,

contain health care expenditures, and

define optimal insurance coverage for individuals and families.

We can use our intellectual resources to help the nation in addressing the growing crisis in health care.”

-President Mary Sue Coleman Future Directions Presentation

UM Regents, 4/22/04

Our Vision

To be a model community of healthwhere both the individual and the organization thrive

MHealthy Strategic GoalsTo improve the health status and quality of life of the U-M community by:

1. Keeping the well well

2. Identifying those at risk and helping them reduce risk

3. Improving the health management of those with chronic & disabling conditions

4. Building a university culture that supports healthy lifestyles

To help control the long-term rate of health related cost increases.*

*See Baicker Cutler article in Health Affairs, Dec. 2010

MHealthy Guiding PrinciplesPrograms and services will:

Address the significant health needs of our diverse populations

Maximize participation within the University community while supporting choice

Support and encourage the achievement of realistic goals among the populations we serve

Be data driven and cost-effective

Protect personal health information

Offer a variety of accessible options for individuals and departments to positively influence their health

Promote a safe and healthy work environment through shared responsibility with faculty and staff

Seek customer input and engagement in planning and evaluating our services.

How will we achieve a “community of health”?

Comprehensive long-term strategic plan addressing the continuum of

health and targeting our most significant issues

Leadership and community engagement (committees and unit champs)

Organizational integration and culture/environmental enhancements

Alignment of benefit design and sustainable funding

Incentives for healthy behaviors to motivate high participation

Comprehensive evaluation to demonstrate outcomes and continuously

improve programs

MHealthy’s Service Integration

Partners

Safety

Disability Management

Recreational Sports

Food Services

Organizational Development

MHealthy also provides health

risk reduction services to Health System patients.

MHealthy Services

MHealthy Rewards• Annual health risk assessment, goal setting and periodic screening• Free health coaching for those with significant risk factors• Monetary incentive for participation

Nutrition and Weight Management• Ready to Lose

• Weight Watchers subsidy

• Nutrition Consultations

• Cooking Classes

Physical Activity • Exercise Classes

• Personal Training

MHealthy Services Tobacco Consultation & Alcohol Management Services Mental and Emotional Health Services

• Faculty and Staff Assistance Program (FASAP)(Free, confidential short-term counseling and support)

• Understanding U website, on-line programs & resources

• Mhealthy Thrive! - stress and energy management programs & activities

Occupational Health Services• Work-related injury and illness care

• Annual assessments, surveillance, immunizations & vaccinations

• Medical ergonomic services

• Key partner in disability management and RTW

.

MHealthy ScorecardGoals & Metrics

Participation - By year 5, achieve at least 70% participation by benefit-eligible employees (Given the reduction in incentive to $100, 70% may not be feasible.)

Satisfaction - Achieve a customer satisfaction score of at least 4 out of 5

Health Risks• Reduce the percentage of the UM benefit-eligible population that is high

risk by 5 percentage points by year 5• Increase the percentage of the UM benefit-eligible population that is low risk

by 5 percentage points by year 5

Medical Care Costs - In year 5, medical and pharmaceutical costs for participants will be 10% lower than for non-participants

Absenteeism - Decrease self-reported absenteeism by 0.5 day by year 5 Culture of Health Improvements - Improvements in total score from

baseline HERO Scorecard and faculty and staff survey Value on Investment

12

Health Risk Level Percentages by Year Demonstrates Movement to Lower Risk

2009-2012

Note: Differences between 2009 and 2012 are statistically significant for all variables (p < 0.05).

Top Health RisksPercentage at High Risk

2009-2012

Note: N=5108. Differences between 2009 and 2012 are statistically significant for all variables (p < 0.05).

2009 and 2012 Biometric Screening Results

Healthcare Cost Trend-Adjusted for Age, Gender, Race and Job Class (Faculty, Staff, Other)

Notes: Claims are truncated $0-$100,000. Costs for 2010 are statistically significantly different at p < 0.05.

U-M Culture Survey UM HMRC Survey of approximately 2,500 faculty

and staff Assessed workplace environment and culture

Findings:Majority of staff are aware of and appreciative of

wellness programs and services Employees perceive senior leaders as supportive,

but confirm need for middle managers supportEmployees feel that inclusion of spouses/partners is

important49.3% of employees feel work environment enables

them to maintain good health (stress is an issue)

What We’ve

Done Well

Development of Strategic Plan Know your Population

• Review claims data• Conduct Faculty and Staff Interest Survey

Best Practice Benchmarking• HERO Scorecard, Leading by Example Survey and

Review of Koop Award Winners used to:• Identify key program elements and• Conduct a gap analysis, • Develop a prioritization matrix & timeline

Input from key stakeholders and University-wide MHealthy Advisory Committee appointed by President

Strategic PlanComponents

Leadership support Communication &

marketing Wellness assessments

with follow-up coaching Population-wide

programs Targeted risk reduction

programs Disease management

Disability management Supportive

environment, culture, policies & infrastructure

Incentives and benefit design

Data management & evaluation

Collaboration with health care system

Innovation

Overview of Influencer ModelFramework for MHealthy Activities

Six Sources of Influence

Motivation Ability

Per

son

alS

tru

ctu

ral

1Do I enjoy it?

2Am I personally able?

3Do others motivate?

5Do “things” motivate?

6Do “things” enable?

4Do others enable?

So

cial

Engaging and Gaining Support from Leadership

Distribute leadership briefings from President and EVPs

Educate on the business case

Incorporate the leader’s role into existing leadership development programs and leadership competencies

Produce reports with department-specific participation levels and risk factors

Award and recognize leaders who have met goals or been exemplars in creating cultures of health

Engagement through Wellness Champions

Regional wellness coordinators mentor MHealthy Champions & provide programming tailored to unique needs of departments

MHealthy Champions A network of 370+ employees across the university who serve a two

year term (with option to renew)

Raise awareness and motivate co-workers to participate

Receive training and resources

Work with their managers to complete workplace wellness checklist & develop plan for creating a healthy culture at unit level.

Honored for their work & can earn awards for their departments.

Engaging Employees Through Culture and Environment

Large scale team competitions & events (e.g. Active U)

Targeted Interventions to High Risk Groups

Healthy catering, dining & vending Farmers’ markets/produce carts

Ergonomicsmatching grants and awards

Walking maps & fitness center

discounts

Smoke-Free Environment No smoking or e-cigarettes allowed

in buildings, parking lots or ramps (except inside personal vehicles) or outside specified boundaries

Free quit smoking programs foremployees & patients with referral

Free nicotine replacementtherapies through our benefits plan,

including OTC products

Supervisor’s Enforcement Tool kit provides talking points and information on how to handle disciplinary issues

Effective communications Comprehensive

communications plan

Multiple voices (cascades)

Targeted messages

Involve the consumer in the campaign

Use varied media

Program accessibility

Offer programs close to the customer at a variety of locations and times

Offer coaching and other programs in person, via telephone, and online

Use technology to expand reach

Utilize technology Use technology to engage a wider audience

Webinars Online trackers Mobile apps Streaming videos Blogs

Leverage Social Media

Challenges Size and complexity Budget reductions in 2010

resulting inLimited incentives - making it more

challenging to achieve higher levels of participation

Delay in plan to reach out to spouses & OQAs

Delay in integrating incentive into benefit premium

Summary of “Lessons” Broad leadership support & champions are essential

Setting clear expectations of a long-term commitment and process

Communication is critical and ongoing Communicate a clear value proposition compared to

other investments (tie to business success) • <2% of health care expenses spent on preventive health

Integrating employee health and well-being into business objectives and practices

Rewards/incentives can “get people on the bus” but resources, culture, environment and polices sustain behaviors and improvements

Demonstrating effective interventions that make a difference (e.g. obesity)

Sustainable change both at the individual and organizational level

Continuing to develop/improve leadership practices, policies, facilities and environment

What Does the Future Hold? Aspirations

Partnering with our health care providers on population health management (ACA)

Major Recent Awards 2014 Healthiest 100 Award

2012 C. Everett Koop National Health Award Honorable Mention

2012 CUPA-HR Midwest Region Excellence in Human Resource Practices Award

WELCOA Well Workplace Gold Award

Questions?

www.mhealthy.umich.edu