Practical Application in Business

John Harris Katie Bell

Chief Wellness Officer Partner

Vice President Innovations Global Wellbeing

Healthways, Inc. Gallup

How Poor Health Costs the United States:

$147 billion annual healthcare cost of obesity in the United States

75% of national health expenditures are due to chronic disease

$6,032 the average annual healthcare coverage cost for people with

a chronic condition; five times higher than for those without

$1.3 trillion direct health costs of chronic disease (2006)

American Prevention Success Story:

Leaders Have The Ability to Correct Public Health:

• How would you describe your personal role

as it pertains to wellness and well-being?

• Not responsible.

• Indirectly responsible

• Directly responsible

5www.healthways.com

Indirectly responsible

Directly responsible

Indirectly responsible

Directly responsible

6

• 25-year commitment, initiated January 2, 2008

• 1,000 completed surveys per day/7 days/week

• 1,000,000 completed surveys October 23, 2010

• For results based on this sample of respondents,

the maximum 95% margin of sampling error is ±0.3 percentage points

• Science-based design, support and oversight:

• Behavioral economists

• Psychologists

• Experts in psychometric statistical analysis

Six Domains:

1. Life Evaluation

2. Emotional Health

3. Physical Health

4. Healthy Behavior

5. Work Environment

6. Basic Access

Measuring Well-Being

Well-Being at the National Level

0

10

20

30

40

50

60

Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan

Thriving Struggling Suffering

Source: Gallup-Healthways Well-Being Index Community Survey 2009, n=353,849

Well-Being Life Evaluation, U.S. Residents, 2009

2009 2010

8

Our Nation’s Well-Being by State - 2009

Source: Gallup-Healthways Well-Being Index Community Survey 2009, n=353,849

Fourth QuintileThird QuintileSecond Quintile Top Quintile Ranking: Bottom Quintile

9

2009 Congressional District Rankings

Source: Gallup-Healthways Well-Being Index Community Survey 2009, n=353,849

Fourth QuintileThird QuintileSecond Quintile Top Quintile Ranking: Bottom Quintile

10

2009 MSA Rankings

Source: Gallup-Healthways Well-Being Index Community Survey 2009, n=353,849

Fourth QuintileThird QuintileSecond Quintile Top Quintile Ranking: Bottom Quintile

• Do you believe an index of this magnitude

can bring value to your business planning:

• No

• Yes, but only indirectly

• Yes, significant value

• This index provides essential information for our

planning

11www.healthways.com

Harvesting the Value of

Well-Being

www.healthways.com 13

Making the Jump from Health to

Well-Being

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Why It Matters:

The Economic Case for Well-Being

Well-Being

Improves

• Help healthy people

stay healthy

• Mitigate health-related

risk from lifestyle

behaviors

• Optimize care for those

with health conditions

Performance

Increases

• Engagement

• Absence

• Work Impairment

• Productivity

Total Medical

Cost Decreases

• Hospitalizations

• Event Rates

• Disease Rates

• Lifestyle Risks

Total Economic

Value Increases

• Public Payers

• Private Payers

• Employers

• Communities

• States

Impact of social time on daily affect for

different income levels

15

Positive affect: happiness, enjoyment, smiling/laughter

Gallup-Healthways Well-Being Index Jan-Dec 2009, controlling for demographics

BMI and Physical Pain

16

n = 254,987; after controlling for gender, education, and age

Real World Examples of

Opportunity

Thriving

Average 20% Lower

Medical Costs

Suffering

Average 50% Higher

Medical Cost

4.0

7.0

Struggling

“Please imagine a ladder with steps numbered from zero at the bottom toten at the top. The top of the ladder represents the best possible life for you and the bottom of the ladder represents the worst possible life for you.

On which step of the ladder would you say you personally feel you stand at this time?”

Source: Gallup-Healthways Well-Being Index Community Survey and Wellmark Corporate Survey 2008

Six well-being

domains

1. Life Evaluation

2. Work Quality

3. Basic Access

4. Healthy

Behavior

5. Physical Health

6. Emotional

Health

Example: Life Evaluation

Health Risk By Life Evaluation

0%

20%

40%

60%

80%

Suffering Struggling Thriving

0-1 risks

2-3 risks

4-5 risks

6-9 risks

Risk Category by Life Evaluation

Toward Integration to Enhance Health and Well-Being by Evers, KE, Prochaska, JO, Castle, P. & Prochaska, JM. 2009 (under review)

20

Work Impact By Life Evaluation

Activity Impairment, Work Presenteeism and

Work Productivity Loss by Life Evaluation

25%

20%

15%

10%

5%

0%

Toward Integration to Enhance Health and Well-Being by Evers, KE, Prochaska, JO, Castle, P. & Prochaska, JM. 2009 (under review)

21

Anger in the Workplace: Wellness Inhibitor?

12% 14%

79% 88% 86%

Poor Work

Environment

Quality Work

EnvironmentNation

No

Yes0%

20%

40%

60%

80%

100%

31%

Poorest 100

Richest 100

U.S. Counties

“Did you experience the following feelings during A LOT OF THE DAY yesterday: Anger?”

Source: Gallup World Poll, Gallup-Healthways Well-Being Index Community Survey 2008

Work Environment Affects Health and

Engagement of a Workforce

Service Mark SM 2008 Gallup-Healthways Well-Being Index. All rights reserved. Copyright © 2008 Gallup, Inc. All rights reserved. Copyright © 2008 Healthways. All rights reserved.

0%

10%

20%

30%

40%

50%

60%

70%

80%

Job ImpactsHealth

Disengaged

Negative Positive or Neutral

Impact of Negative Work Environment

Higher Disengaged Employees / Higher Productivity Losses

Work Environment Impact on Employees With

Chronic Conditions

6.6 Days/Year

16.2 Days/Year

Days Unable to Carry Out Usual Activities Per Year

Well-Being Disparities:

Work Environment

Source: Gallup-Healthways Well-Being Index Community Survey 2008, n= 355,334Based on congressional district in which Tyson Foods location is based

2.12.8

0.3

3.2

0.1

1.3

0.1

2.3

6.3

1.3 1.42.1

0.5

3.6

-7.1

-0.6-1.3

-4.6

-3.7

-1 -0.9

-2

4.6

1.7

-13.4

Pla

nt 1

Offic

e 1

Pla

nt 2

Offic

e 1

a

Pla

nt 3

Pla

nt 5

Pla

nt 6

Pla

nt 7

Offic

e 2

Pla

nt 9

Pla

nt 11

Pla

nt 12

Pla

nt 13

Pla

nt 14

Pla

nt 15

Pla

nt 16

Offic

e 3

Pla

nt 17

Offic

e 4

Pla

nt 17

Offic

e 5

Pla

nt 19

Pla

nt 20

Pla

nt 21

Pla

nt 22

Variance from National Score (points) for Congressional Districts of

Top 25 Company Locations (ordered by # team members)

Work

Environ-

ment

Score

(2008) =

51.4

Job satisfaction and engagement

• Satisfaction with community

• Are you satisfied or dissatisfied with your job or the work you do?

• At work, do you get to use your strengths to do what you do best every day?

• Does your supervisor at work treat you more like he or she is your boss or your partner?

• Does your supervisor always create an environment that is trusting and open?

Work Environment:Examples

Plans with worst work

environments were also the

worst performers

Commute Time and Well-Being

% Reporting Stress

44%

43%

43%

42%

39%

36% 37% 38% 39% 40% 41% 42% 43% 44% 45%

Over 60 Minutes

46-60 Minutes

31-45 Minutes

16-30 Minutes

15 Minutes or less

The Impact of Care-Giving

Caregiver Non-Caregiver

Caregiver Employed

Caregiver Non-Employed

Non-Caregiver Employed

Non-Caregiver Non-

Employed

Composite Score 64.39 57.15 68.00 62.14

Life Evaluation Index 39.50 25.26 47.29 32.77

Emotional Health Index 77.35 67.24 81.00 72.62

Physical Health Index 76.74 61.16 82.26 67.92

Healthy Behavior Index 62.43 60.38 61.34 60.77

Work Environment Index 49.47 n/a 51.19 n/a

Basic Access Index 80.83 71.71 84.95 76.62

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Life EvaluationSmokers vs. Non-Smokers

Thriving Struggling Suffering

39%

55%

6%

52%

45%

3%

Smokers Non-Smokers

“Please imagine a ladder with steps numbered from zero at the bottom toten at the top. The top of the ladder represents the best possible life for you and the bottom of the ladder represents the worst possible life for you.

On which step of the ladder would you say you personally feel you stand at this time?”

Source: Gallup-Healthways Well-Being Index Community Survey 2009, n=353,849

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Emotional HealthSmokers vs. Non-Smokers

“Did you experience the following feelings during A LOT OF THE DAY yesterday?”

% of Respondents Who Answered “Yes”

Worry Stress Anger Sadness Depression

43%

50%

21%

26% 27%

31%

37%

13%

17%15%

Smokers Non-Smokers

Source: Gallup-Healthways Well-Being Index Community Survey 2009, n=353,849

Drivers of BMI Risk

BMI Risk

Emotional

Health

Physical

Health

Negative Affect

Personal

Sources of

Presenteeism

Number of

Health Risks

Healthy Eating

Height Weight

Energy Level

Exercise

Recognition at

Work

Coping With

Stress

Days of Best

Work

Financial Stress

The only things we focused on in the “old days”

• What best describes your view of focusing on the broader value proposition of well-being?

• It does not change my view – well-being is only semantics

• I can see some value in taking a broader view

• I see significant value in taking a broader view

• I believe a broader view will redefine the value proposition, making it both measureable and more substantial

31www.healthways.com

What Innovations Will Emerge?

Strategic Process To Drive Sustainable

Engagement

33

Sustainable

Engagement

Business Objectives

Relevant Incentives

Consumer Insights

Effective Communications

Appropriate Interventions

Measurable Outcomes

Environment

Environment

34

Improved Use of Behavior Change SciencesPutting Science into Practice

Social Networks

• A social structure of “nodes” which are connected by

one or more specific types of interdependency, such as

friendship, kinship, common interest, knowledge, etc.

Decision

Making

Behavioral

Economics

Emotional and

Social Health

Social

Connectivity

Prochaska’s Transtheoretical Model

• Rational decision-making through stages of change

• Pro-Change Embedded in Healthways Core Products

Mindfulness and Neuro-plasticity

• Paying attention in a particular way: on purpose, in

the present moment, and non-judgmentally

• The changing of neurons via new experiences

Dynamic Intermittent Reinforcement

• Predictably irrational decision making in humans

• Already in use for medication adherenceHEALTHHONORS®

LifeMatters®

GamificationGaming theory

• Fun vs. fulfillment

• Explorer, achiever, socializer, competitor

New Approaches to Drive Physical, Emotional and

Social Well-Being Improvement

Traditional Coaching

Physical Health

Physical health background

Traditional training

Outcomes

N/A

HRA

Health Home

Three calls

Traditional

Telephonic

New Coaching

Emotional/social health approach

Coaches with behavioral health background

Experiential coach training

Research questions

Personality profiling

Well-Being Survey

Work & personal homes

Multiple brief coaching touches

New integrated platform

Multiple modalities

Innovative and integrated

methodology…

Mindfulness-based tools

Ntrinsx

…contributes to different

approach to coaching

…which results in an

engaging user experience

vs.

35

Product Starting

Points

Leveraging Social Networks and Mobile

Applications

Transformational Community Initiatives to

Support Well-Being Improvement

Etc.L

ead

ers

hip

Po

licy

Co

mm

un

-ic

atio

ns

Partic

ipatio

n

POWER 9 PRINCIPLES

(become norm)

IMPROVED VITALITY

Reduced Medical Trend AND Improved Productivity

IMPROVED WELL-BEING

(measurement)

CULTURE

Focused Investment Areas

Promote / Support Power 9

Engage and transform

communities …

Our Goal: Create a Movement

• Create “Vitality Cities” through

sustainable changes that

encourage people to practice

healthy behaviors so that they

can live well – longer

Our Plan:

• 2010- select 1st Vitality City

• 2011- scale the Vitality City

concept to cities across

America while creating a

national movement

• Use WBI to measure progress

… through a compelling value

proposition …

… that leverages our

strategic relationships

37

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Gaps in Care, PsychosocialEducational, Environmental

needs assessedCare Plan Generated

Care Coordinatordocuments progress on the

Care Plan. Provides Feedback to MD

Care coordinator assures Care Team Reviews andAgrees with Care Plan

Care Plan is implemented.MD engages with patient,

using care plan

Care Coordinator engagesw/ patient using care plan

Care Coordinator engagesspecific

Healthways andcommunity resources

as appropriate

Lifestyle ManagementDisease Management

Case Management Social Network

Cognitive Behavioral TherapyPatient Compliance Programs

Transitions of Care management

RegistryPredictive Modeling

Care Coordination

Medical Problem Diagnosis/

Treatment

Quality Improvement

Analytic Support

Reporting

Claims Data

Pharmacy Data

HRA

Biometrics/Lab

EMR/PHR

Self reporting

Leverage Healthways’ expertise in population analysis,

identification and analyticsBuild collegial and trusted relationships with physician practices. Use care

plans and care coordination to improve health one patient at a time.

Health Care Reform – Leveraging the Medical

Home and Accountable Care Concepts

• I believe these new well-being innovations

will be:

• Of only minimal value over the traditional

approaches used today

• Will better position the field to capture a broader

value proposition

• Will be instrumental in taking the health

promotion programs to an all new level

• Will revolutionize health promotion

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Closing Thoughts

Organizations With Higher Well-Being =

• Measurably healthier and happier people

• Longer life expectancy and productive life years

• Higher workforce productivity (employed)

• Increased independence rate (seniors)

• National recognition as an employer of choice

• Measurable accountability to shareholders

• Improved sense of purpose and corporate pride

• And hence, improved business performance and social vitality

Health

Productivity

Turnover

Corporate

Pride

Economic

Vitality

Health Costs

Business

Performance

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For More Information

www.well-beingindex.com

Questions/Discussion