1. health and fitness

Why Well-Being?
1
Agenda
Solving The Problem
Sustained Engagement
A Different Approach
2
Solving The Problem
3
You Know The Unsustainable Story…
Skyrocketing Health
Health Care Costs
Costs
Skyrocketing
Health Related Productivity Loss
Percentage Increase
Cumulative Increases in Health Insurance Premiums, Workers’
Contributions to Premiums, Inflation, and Workers’ Earnings,
1999-2012
DeVol, Ross, and Armen Bedroussian, An Unhealthy America: The
Economic Burden of Chronic Disease, Milken Institute, October 2007.
Ten employer study found that health-related
productivity costs are on average 2.3 times
greater than medical and pharmacy costs
Kaiser Family Foundation, 2009 http://www.kff.org/insurance/upload/7692_02.pdf
Source: Kaiser/HRET Survey of Employer-Sponsored Health Benefits, 1999-2012. Bureau of Labor Statistics, Consumer
Price Index, U.S. City Average of Annual Inflation (April to April), 1999-2012; Bureau of Labor Statistics, Seasonally Adjusted
Data from the Current Employment Statistics Survey, 1999-2012 (April to April).
Loeppke et al. J Occup Environ Med. 2009;51:411–428
“Dispassionate” economic forces driving health care towards the “Era of Value”
Adapted from Leavitt Partners Consulting
Copyright © 2011 Healthways, Inc. All rights reserved.
4
What is Health?
Individuals ● Experts ● Social Connections ● Environment ● Policy
Financial
Social
Community
Physical
Emotional
Career
“Health is a state of
complete physical, mental
and social well-being and
not merely the absence of
disease or infirmity.”
Source: Preamble to the Constitution of the World Health Organization as adopted by the International Health Conference, New York, 19-22 June, 1946
Copyright © 2011 Healthways, Inc. All rights reserved.
5
Healthier People Cost Less and Perform Better
Improve
Well-Being
•
•
•
Total Medical
Cost Decreases
Adopt or maintain
healthy behaviors
Mitigate health-related
risks
Optimize care for
health conditions
Performance
Increases
Total Economic
Value Increases
•
Hospitalizations
•
Productivity
•
•
Event Rates
•
Engagement
• Communities
•
Disease Rates
•
Absence
•
•
Lifestyle Risks
•
Work Impairment
• Individuals
States
Employers
Eliminate/delay next new case of disease/condition
Economic
Drivers
Copyright © 2011 Healthways, Inc. All rights reserved.
Eliminate/reduce impact of the next new episode
Sustained engagement
6
Solving the Big Problem Requires Complete Data
Effect
Cause
7
• Morbidity
• Mortality
• Event
• Utilization
• Disease
• Cost
•
•
•
•
•
•
•
•
•
•
Stress
Sleep
Nutrition
Activity
Job
Hope
Mood
Relations
Purpose
Experiences
Measuring Well-Being
• 25-year commitment initiated January 2, 2008
• 1,000 telephonic “community” surveys
completed per day, 7 days/week
• 2,000,000+ completed surveys
•
For results based on this sample of respondents, the maximum 95%
margin of sampling error is ±0.2 percentage points
• Design support and oversight from leading
behavioral economists, psychologists, and
experts in psychometric survey design and
statistical analysis
• Largest and most comprehensive health survey
and database
Copyright © 2011 Healthways, Inc. All rights reserved.
8
Life Evaluation
Emotional Health
Social Health
Physical Health
Healthy Behavior
Career
Financial
Well-Being Varies Across the U.S.
Striking Differences Between Regions and Within Regions of the U.S.
U.S. Congressional Districts of Texas
Ranking:
Top Quintile
Second Quintile
Third Quintile
9 9
Fourth Quintile
Bottom Quintile
Well-Being Appears in an All-Too Familiar Pattern
Striking Similarities Between Regions with Low Well-Being and Poor Health
Well-being
Obesity
Darker shades = Higher Prevalence
Physical Inactivity
Diabetes
Darker shades = Higher Prevalence
Source: 2010 Gallup-Healthways WBI Community Data and CDC, 2007-2009
Darker shades = Higher Prevalence0
10
Individual and Organizational Well-Being
Well-Being Index™
Life
Evaluation
Healthy
Behavior
Work
Quality
Emotional
Health
Basic
Access
Physical
Health
Healthways Well-Being Assessment™
HRA
Biometrics
Productivity
11
Life
Evaluation
Healthy
Behavior
Work
Quality
Emotional
Health
Basic
Access
Physical
Health
Well-Being Is Predictive of Cost & Utilization
Higher Well-Being = Lower Utilization
Higher Well-Being = Lower Cost
Harrison, Pope, Coberley, and Rula. Evaluation of the Relationship Between Individual Well-Being and Future Health Care Utilization and Cost.
Pop Health Management, 2012.
12
12
Well-Being Can Be Improved
•
RESULTS OF A RANDOMIZED
CONTROLLED TRIAL
•
3,391 individuals randomized to 3 groups: Control; Telephonic coaching; Online coaching
•
Interventions were shown to produce significant behavior change as compared to control.
•
Telephonic coaching produced significantly better improvement than the online tool
•
Significant improvement in overall Well-Being, Emotional Health, Physical Health, Life Evaluation and
Healthy Behaviors.
Prochaska, JO, et al; Enhancing Multiple Domains of Well-being by Decreasing Multiple Health Risk Behaviors: A Randomized Clinical Trial. Population Health Management
13
Copyright © 2011 Healthways, Inc. All rights reserved.
Cross-Sectional Relationship to Outcomes
Health Care Utilization
Annual Health Care Cost
Annual Unscheduled Days Absent
Unplanned Absence
Well-Being
Segment
Age
Age
Overall Presenteeism Score
Presenteeism
Well-Being
Segment
Age
Copyright © 2011 Healthways, Inc. All rights reserved.
14
Well-Being
Segment
Longitudinal Odds of Adverse Outcomes by Well-Being
Declining Well-Being Increases Odds of Adverse Outcomes
Copyright © 2011 Healthways, Inc. All rights reserved.
15
Cost Goes Down When Well-Being Goes Up
Population Well-Being
1 Point
2.2%
1.7%
1.0%
likelihood of
hospital
admission
likelihood of
ER visit
likelihood of
incurring
healthcare costs
Source: “Evaluation of the Relationship Between Individual Well-Being and Future Health Care
Utilization and Cost” Population Health Management, Volume 15, Number 00 2012. Patricia L.
Harrison, MPH, James E. Pope, MD, Carter R. Coberley, PhD, and Elizabeth Y. Rula, PhD
Copyright © 2011 Healthways, Inc. All rights reserved.
Performance Goes Up When Well-Being Goes Up
Workforce Well-Being
10 %
5%
24%
fewer
unscheduled
absences
5%
6%
lower
presenteeism
higher reported
job performance
more days of
‘best work’ in
28-day period
Source: “Evaluation of the Relationship Between Individual Well-Being and Future Health Care
Utilization and Cost” Population Health Management, Volume 15, Number 00 2012. Patricia L.
Harrison, MPH, James E. Pope, MD, Carter R. Coberley, PhD, and Elizabeth Y. Rula, PhD
Copyright © 2011 Healthways, Inc. All rights reserved.
Well-Being Varies Among Employers
Distribution of Well-Being Scores from Multiple Samples
4.0%
U.S. National Well-Being
3.5%
% Employees
3.0%
2.5%
2.0%
1.5%
1.0%
0.5%
0.0%
0
5
10
15
20
25
30
35
40
45
50
55
60
Well-Being Score
18 18
65
70
75
80
85
90
95
100
Well-Being Score and Outcomes
Distribution of Well-Being Scores from Multiple Samples
Low
4.0%
Low-Mid
Mid
Hi-Mid
High
3.5%
% Employees
3.0%
2.5%
2.0%
1.5%
1.0%
0.5%
0.0%
0
5
10
15
20
25
30
35
40
45
50
55
60
Well-Being Score
Copyright © 2011 Healthways, Inc. All rights reserved.
19
65
70
75
80
85
90
95
100
Fortune 100 Case Study
A comprehensive program for a Fortune 100 client,
Healthways implemented the following :
…and Well-Being Improved Significantly
in Matched Respondents
• Well-Being Assessment
• Well-Being Connect
∆ = 1.86*
• Health Risk Coaching
2011
Average
76.14
• Disease Management
% of Employees
2010
Average
74.29
Individual Well-Being Score
T1-T2 Matched Cohort, N = 6,108
Copyright © 2011 Healthways, Inc. All rights reserved.
20
*Paired sample t-test, p < 0.05
Fortune 100 Case Study
Healthways Longitudinal Well-Being Improvement
Net positive shift in well-being
2010
2011
High Well-Being
Score 88+
16%
20%
Mid-High Well-Being
Score 75-88
33%
Middle Well-Being
Score 66-75
25%
Low-Mid Well-Being
Score 53-66
18%
Low Well-Being
Score <53
8%
Copyright © 2011 Healthways, Inc. All rights reserved.
+6%
35%
23%
15%
6%
21
-5%
Fortune 50 Case Study
A pilot study for a Fortune 50 client,
Healthways implemented the following :
• Well-Being Assessment
• Well-Being Connect
…and Well-Being Improved Significantly
in Matched Respondents
• Biometric Screening
Δ= 2.90*
• Health Risk Coaching
• Daily Challenge
2011 – T1
Average
71.0
% of Employees
• QuitNet
2012 – T2
Average
73.9
Individual Well-Being Score
T1-T2 Matched Cohort, N = 780
Copyright © 2011 Healthways, Inc. All rights reserved.
22
*Paired sample t-test, p < 0.05
Improved Performance in Addition to Lower Cost
Fortune 50 Case Study
“Early Adopters” willing to
pay for this additional value
Performance
Unplanned Absence
Unintended Turnover
$ Value
Copyright © 2011 Healthways, Inc. All rights reserved.
Sustained Engagement
Copyright © 2011 Healthways, Inc. All rights reserved.
24
Well-Being Improvement Value Is Substantial
•Lower claims costs
•Improved utilization
•Improved health indicators
•Lower absence
•Lower claims costs
•Improved utilization
•Improved health indicators
•Lower absence
•Improved productivity
Population
Total $ Value
•Lower claims costs
•Improved utilization
Keep Healthy
Reduce Lifestyle Risks
Optimize Care
Year 1
Year 2
Year 3
25
Year 4
Year 5
~1.5x
Medical
Savings
Sustained Engagement Amplifies the Value
Measured Risks
Year 1
Year 2
Year 3
Year 4
Year 5
Alcohol
$203
$429
$637
$900
$1,168
Blood Pressure
$267
$563
$836
$1,181
$1,533
Body Weight/BMI
$244
$515
$764
$1,080
$1,401
$4,004
Total Cholesterol
$238
$501
$744
$1,051
$1,364
16.4x
HDL Cholesterol
$238
$501
$744
$1,051
$1,364
Smoking
$381
$803
$1,193
$1,685
$2,188
$97
$204
$304
$429
$557
Stress
$455
$960
$1,426
$2,014
$2,614
Medication/Drugs
for Relaxation
$356
$751
$1,115
$1,575
$2,044
Illness Days
$247
$520
$773
$1,092
$1,417
Life Satisfaction
$188
$397
$590
$833
$1,082
Perceived Health
Status
$236
$497
$739
$1,043
$1,354
Physical Activity
26
Open Social
Each person can invite anyone they know
to join them in using the application.
Open social
applications are
more likely to
engage a mass
audience and
create the dense
social connections
required for
sustained
engagement.
27
MeYou Health is a Healthways company
Daily Challenge!
1. A Focus on Small Actions
2. Sustained Engagement
3. Well-Being Improvement
4. Supports Open Social Interaction
MeYou Health is a Healthways company
The result?
Daily Challenge Return Engagement
100%
80%
Activity Patterns
90%
78%
72%
68%
60%
40%
20%
0%
1-30 days >30 days >60 days >90 days
29
MeYou Health is a Healthways company
The result?
Daily Challenge Return Engagement
100%
90%
78%
80%
72%
68%
>60
days
>90
days
60%
40%
20%
0%
1-30
days
>30
days
30
MeYou Health is a Healthways company
Large Employer - Aug 2012
Blue dots: Employees
Red dots: Others
31
MeYou Health is a Healthways company
Large Employer - April 2013
Blue dots: Employees
Red dots: Others
32
MeYou Health is a Healthways company
Large Employer - April 2013
Blue dots: Employees
Red dots: Others
Significant clustering
among employees and
between employees and
others.
33
MeYou Health is a Healthways company
A Different Approach
34
Improving Well-Being
Well-Being is all the things that
are important to us, what we
think about and how we
experience, our lives
Community
Social/
Emotional
Physical
Financial
Career
Key Levers
Individuals ● Experts
●
Social Connections
35
●
Environment
●
Policy
Innovation Through Collaboration
Academic
Partnerships
MIT AgeLab
Working to advance health education
and support for an aging population
Johns Hopkins University
Unique research and innovation
relationship with the schools of medicine,
nursing and public health
Pro-Change Behavior Systems
Jointly developing leading approaches
to improved behavior modification
Strategic
Partnerships
Gallup-Healthways Well-Being Index
Creating definitive measure of well-being
through the Gallup-Healthways WellBeing Index
Activate Networks
Applying the science of social network
mapping to population management
techniques
Wholly-Owned
Subsidiaries
MeYou Health
The development of products and solutions at
the intersection of mobile technology, social
network science, gaming, and Well-Being
improvement.
Navvis
Focused on health system strategy, leadership
and performance to help healthcare leaders
achieve success in a complex, ever-changing
marketplace.
Blue Zones
Joint venture to scale population longevity
interventions of permanent and semipermanent environmental changes
Ascentia
Comprehensive Physician-Directed
Population Health solution. Outcomesbased processes, systems and tools
designed by physicians, for physicians.
36
Technology
Partnerships
Hewlett-Packard
Enhancing an already powerful platform
with greater scalability and sustainable
timely innovation at a lower cost
RoundArch
Deliver a unique, total digital experience
for our Well-Being Improvement Solution
that drives sustained engagement
through web, mobile and social media
Join the Movement
Blue Zones Project™
The Blue Zones Project Builds upon the Work and
Credibility of Dan Buettner and National Geographic
Blue Zones is the creation of Dan Buettner,
who in 2004 teamed up with National
Geographic and hired the world’s best
longevity researchers to identify pockets
around the world where people lived
measurably better. After identifying the
world’s Blue Zones, Buettner and National
Geographic took teams of scientists to each
location to identify lifestyle characteristics that
might explain longevity.
• Healthways and Blue Zones have partnered
exclusively to work with select communities
and organizations to improve their well-being.
• Implementing sustainable environmental
changes that promote improved physical,
social and emotional health.
• Utilizing the Gallup-Healthways Well-Being
Index to measure the impact and quantify the
value
38
Blue Zones
Ikaria, Greece
39
Common Principles: Blue Zones Power 9™
Move Naturally
1. Make daily physical activity an unavoidable
part of your environment
Right Outlook
2. Know your purpose
3. Downshift: Work less, slow down, take vacations
Eat Wisely
4. Eat until 80% full
5. More veggies, less meat & processed food
6. Drink a glass of red wine each day
Belong
7. Create a healthy social network
8. Connect/reconnect with religion
9. Prioritize family
40
Blue Zones Project Purpose
Blue Zones Project™ is a community well-being
improvement initiative designed to make healthy choices
easier through semi-permanent and permanent changes in
environment, policy and social networks.
By helping people live longer, better communities can:
Lower
Healthcare
Costs
Improve
Productivity &
Performance
41
Great
Place to Live,
Work & Play +
Increased
Community
Vitality
Make Healthy Choices Easier
1.
Engage
Communities
2.
Change where people
live, work and play
42
42
3.
Make healthy
choices easy
Unified Approach to Well-Being Improvement
Measure
Citizens
+
Healthcare
Providers
Government
Restaurants
Schools
Grocery
Stores
Employers/
Organizations
43
1.
2.
3.
4.
5.
6.
Life Evaluation
Work Quality
Basic Access
Healthy Behavior
Physical Health
Emotional Health
Vitality Compass
(Longevity)
Prototype: Albert Lea, Minnesota
44
Results from Albert Lea, Minnesota
• 27% community participation
• Planted 70 community gardens
• Added 1.7 miles of walkways
• Established “Walking School Buses”
• Schools adopted 9 new policies
• Changed restaurant menus
• Participants reported weight loss of 2.9 lbs
• Added 3.1 years of longevity per participant
• City reported reduced medical costs
• Employers reported absenteeism down by 20%
45
South Bay Los Angeles (Beach Cities)
Key Selection Factors:
• Readiness, Motivation and Leadership
• Strong Partner for innovation with the Beach Cities Health District (BCHD)
• A diverse and aging population (Silver Tsunami)
• Opportunities to improve walkability, bikeability, emotional health
• High Profile Media near Los Angeles
46
Highlights of Beach Cities Actions
During the first two years of the Blue Zones Project:
•
The Beach Cities adopted bicycle master plans, “complete streets”, livability
policies and smoking restrictions.
•
Thousands of residents pledged to complete at least one action to improve their
well-being.
•
Dozens of local restaurants have taken steps to promote a healthier experience for
patrons.
•
More than 150 local employers have committed to implement simple changes
that increase employee well-being and create healthier work environments.
•
More than 5,500 students have been reached by school based strategies and
programs like Walking School Bus” programs that encourage increased physical
activity and social connection through chaperoned walks to school… and MindUP
along with changes to the cafeterias, menus, policies, etc.
Significant Change in Overall Wellbeing and Life Evaluation
Since 2010, residents of the Beach Cities have seen their overall wellbeing improve at a
rate that far exceeds what has been measured nationally or in the state of California.
Life Evaluation is way up.
Beach Cities Change
Since 2010
U.S. Change
Since 2010
CA Change Since
2010
OVERALL GHWBI COMPOSITE SCORE
+3.0
0.0
+0.8
LIFE EVALUATION INDEX
+8.3
+0.4
+1.7
Ladder Today
+0.1
-0.1
+0.1
Ladder 5 Years From Now
+0.3
+0.1
+0.1
% Thriving
+8.2
+0.4
+1.1
% Suffering
-0.3
0.0
-0.6
Change in Healthy Behaviors Key Metrics
Beach Cities residents are exercising more and eating better than they were in 2010,
and at a rate that considerably exceeds what is found in California generally.
Beach Cities
Change Since
2010
U.S. Change
Since 2010
CA Change
Since 2010
HEALTHY BEHAVIORS INDEX
+3.7
+0.3
+1.1
% who don't smoke
+3.6
0.0
+1.7
% who ate healthy all day “yesterday”
+0.2
-1.1
-0.5
3+ days in the last week of 30+ minutes
of exercise
+5.6
+1.6
+1.4
5+ servings of fruits/veggies 4+ days in the
last week
+6.2
-0.3
0.7
49
Well-Being Jump by the Numbers!
• $2.35M savings
• 1,645 Fewer Obese
• $6.97M savings
• 3,000 fewer smokers
Dramatic Well-Being Improvement Results!
“The positive well-being trend in the Beach Cities is
both authentic and impressive. The rate at which the
community has improved since 2010 far surpasses
what has been measured in the large majority of other
communities nationwide, in California and in the
greater Los Angeles metropolitan area.
Given the timing of this progress, we believe the Blue
Zones Project has been a strong driver of the Beach
Cities success.”
—Dan Witters, Principal at Gallup—
Scale the Movement Across America
52
Working Together to Transform Iowa
53
Blue Zones Project Communities
18% (540,000) of the Population of Iowa (~3,000,000)
City
Cedar Falls
Waterloo
Mason City
Spencer
Cedar Rapids
Muscatine
Sioux City
Marion
Iowa City
Oskaloosa
Small (9)
Population
39k
68k
28k
11k
126k
23k
83k
35k
69k
12k
46k
54
Iowa’s Well-Being Jump
• Iowa’s Gallup-Healthways Well-Being
Index jumped up from 16 to 9th out of 50
states
• Iowa’s Work Environment Index ranking
increased significantly from 23 to 4th
• Iowans reported a big lift in the feeling
that their community is getting better as
a place to live
• Iowans' Healthy Behavior Index
improved with more residents reporting
they’re eating 5 or more servings of
fruits/vegetables 4+ times/week
55
Becoming a Blue Zones Community™
Community Assessment
Leadership
1.
2.
3.
4.
5.
6.
Readiness
County Policy / Built Environment
School Policy
Employers & Worksites
Restaurants
Grocery Stores
Citizen Engagement / Media
Motivation
Blue Zone Project Community Process
Selection of
Demonstration Sites
Blueprint
Implementation &
Sustainability
• Sites selected
• Attend Blue Zones Institute™ • Participate in webinars
• Staff hired/trained
• Community focus groups
• Local leadership oriented • Blueprint written & approved
• Local committees formed
17
• Strategies and activities start
Engagement Strategy
Citizens
Employers
Awareness
• Highlight Blue
Zones Project
benefits for
individuals and
community
• Promote
participation and
sign ups
Restaurants
Pledge
• Organizations
and individuals
from each sector
understand and
take their
respective
pledge
• Everyone
commits to
completing the
pledge
Schools
Grocery
Participation
• People and
organizations
progress steadily
through their
respective
pledge actions
toward
certification
23
Policy
Advocacy
• Encourage and
equip
participating
people and
organizations to
recruit others
and encourage
movement
through this
same process
Blue Zones Project™ Certification
20% sign up and complete one pledge action
50% of top 20 employers designated Blue Zones Worksites™
25% of locally owned restaurants designated Blue Zones Restaurants™
25% of grocery stores designated Blue Zones Grocery Stores™
25% of schools designated Blue Zones Schools™
Adopt recommended policies and complete recommended projects
Closing Thoughts
Improving Well-Being
Well-Being is all the things that
are important to us, what we
think about and how we
experience, our lives
Community
Social/
Emotional
Physical
Financial
Career
Key Levers
Individuals ● Experts
●
Social Connections
62
●
Environment
●
Policy