The document discusses workplace wellness programs. It provides data showing increases in health risk factors like obesity in the US population. Unhealthy behaviors can negatively impact employers through increased medical costs and decreased productivity from absenteeism and presenteeism. Wellness programs that conduct health risk assessments and provide resources like smoking cessation programs can generate savings through reduced health risks. The Affordable Care Act includes provisions to promote employer-based wellness programs and grants to help small businesses implement comprehensive programs.

1. DELAWARE STATE CHAMBER OF COMMERCE
WELLNESS @ WORK
Conference
Carine Sakr, MD, MPH
Clinical Director
Christiana Care
Occupational Health & Wellness
June 14, 2010

2. Outline
Current situation
Work-related mortality and morbidity
Non work-related risk factors
Poor health and work
Wellness programs
Health care reform
Take home messages

3. Work-Related Mortality and
Morbidity
Fatal Occupational Injuries Non-Fatal Occupational Injuries and
Illnesses
6
D e a th s p e r 1 0 0 ,0 0 0
e m p lo y e d w o rk e rs
5 3
Cases p er 100 fu ll-
4 2.5
tim e w o rkers
2
3
1.5
2
1
1 0.5
0 0
1995 2000 2001 2004 2005 2006 2007 2003 2005 2006 2007
Year Year
3

4. Health Risk Factors
Obesity Trends* Among U.S. Adults 1994
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19%
4
Behavioral Risk Factor Surveillance System

5. Health Risk Factors
Obesity Trends* Among U.S. Adults 2008
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%
5
Behavioral Risk Factor Surveillance System

6. Health Consequences of
Overweight and Obesity
Cardiovascular disease
High blood pressure
Abnormal lipids
Type 2 diabetes
Osteoporosis
Constipation
Diverticular disease
Iron deficiency anemia
Oral disease
Malnutrition
Some cancers
6

7. Health Risk Factors
Diabetes
11
% Persons 20 years of
10
Cigarette Smoking Adults
age and over
9
8 US (2007)
7
6 70
1988-1994 1999-2000 2001-2002 2003-2004 2005-2006 60
Percentage
50
Year 40 Men
30 Women
20
Hypertension 10
0
35 Never Former Current
% Persons 20 years of
Smoker Smoker Smoker
age and over
30
25
20
1988-1994 1999-2000 2001-2002 2003-2004 2005-2006 7
Year

8. Consequences for Employers
Unhealthy workforce
Increased medical cost
Decreased productivity
Absenteism + Presenteism
Non- Former Current
smoker Smoker Smoker
Mean days missed from work
due to health conditions per year
4.4 4.9 6.7
Total cost of productivity
due to health per employee per year
$2,623 $3,246 $4,430
8
*Bunn et al. Effect of Smoking Status on Productivity Loss. J Occup Environ Med. 2006;48:1099-1108

9. Wellness Programs
% of
METHOD OF DELIVERY Firms
Health Risk Assessment 81
Self-Help Education Materials 42 Health Risk Assessment:
Individual Counseling 39 Survey gathers baseline self-
Classes, seminars, group activities 36 reported health data from the
Added Incentives for Participation 31 employee which are in turn
used by employer to tailor
subsequent interventions
FOCUS OF INTERVENTION
Weight Loss and Fitness 66
Smoking Cessation 50
Multiple Risk Factors 75
9
*Baicker et al. Workplace Wellness Programs Can Generate Savings. Health Affairs. 2010;29

10. Wellness Programs Work!
Average
STUDY FOCUS ROI
Health Care Costs 3.27
Absenteeism 2.73
Medical costs fall by ~ $3.27 for every dollar spent
on wellness programs and absenteeism costs fall
by ~ $2.73
10
*Baicker et al. Workplace Wellness Programs Can Generate Savings. Health Affairs. 2010;29

11. HRA Example: Christiana Care
Program Overview
2010 2008
Eligible 7,957 8,241
Participated 6,217 6,403
% Participated 78% 78%
Spouses eligible 2,869 N/A
Spouses 1,925 N/A
Participated
% Participated 67% N/A
11

12. HRA Example: Christiana Care
Modifiable Risks 2010
Modifiable 2010 *National
Risks % Norms %
Very Obese, very 18% 12%
high risk (BMI >35)
Obese BMI >30 37% 32%
High levels of stress 13% 3%
at home
High levels of stress 23% 4%
at work
Low physical 68% 56%
activity(1-4 days/wk)
* National Center for Health Statistics. Health, United States, 2007. Centers for
Disease Control and Prevention. Accessed January 25, 2008.
12

13. HRA Example: Christiana Care
Number of Health Risk Comparison
30%
25%
20%
15% 2008
10% 2010
5%
0%
0 Risk 1 Risk 2 Risk 3 Risk 4 Risk 5 Risk 6 Risk 7 or
more
13

14. HRA Example: Christiana Care
HRA/Biometric Program Highlights
0 Risk category went up by 4%
3, 4, and 5 risk categories went down by a total of 5% equating to a
savings of $3,699,062!
Our savings between 2008 and 2010 is $228/employee or a total of
$4,900,919!
*Wright et al. Comparing excess costs across multiple corporate populations. J Occup Environ Med. 14
2004;46:937-945

15. Smoking Cessation
Financial Incentives for Smoking
Cessation
Randomly assigned 878 employees of a
multinational company based in the US
442 employees: information about smoking-cessation programs
436 employees: information about programs plus financial incentives
Financial incentives:
$100 for completion of a smoking-cessation program
$250 for cessation of smoking within 6 months after study enrollment (confirmed
by a biochemical test)
$400 for abstinence for an additional 6 months after the initial cessation
(confirmed by a biochemical test)
*Volpp et al. A randomized, controlled trial of financial incentives for smoking cessation. N Engl J Med. 15
2009;360:699-709.

16. Smoking Cessation
Financial Incentives for Smoking
Cessation
Smoking Incentive Information
Cessation Group Group
9-12 Months 14.7% 5%
15-18 Months 9.4% 3.6%
*Volpp et al. A randomized, controlled trial of financial incentives for smoking cessation. N Engl J Med. 16
2009;360:699-709.

17. Provisions in the Patient Protection
and Affordable Care Act
Bring value of Primary, Secondary, and Tertiary
prevention to workplace beyond traditional wellness
programs
Provide culture of health to workplace as a
complement to the culture of safety:
Increased Productivity (less abs; less pres)
Decrease cost to employers
17

18. Provisions in the Patient Protection and
Affordable Care Act
Workplace Wellness and Productivity
Grants for Small Businesses to provide
Comprehensive Workplace Wellness Programs
Employer-Based Wellness Programs: Directs CDC to
providing services in areas of employer-based
wellness programs
18

19. Wellness at Work
Take Home Messages
Health risk factors are increasing in the US
A healthy workforce is more productive
Wellness programs work!