For more slides from the San Diego 2012 Corporate Wellness Symposium visit, www.intercaresolutions.com/cws/slidelibrary

1. Why Wellness
Can Health be a Business
Strategy?
William B. Baun, EPD, CWP, FAWHP
Wellness Officer, MD Anderson Cancer Center
President, National Wellness Institute
wbaun@mdandeson.org/ 713-745-6927

2. Wellness – a lifelong journey Worksite Wellness – an organized
and an active process of making program designed to assist employees
choices and commitments to be and their family in behavior change
healthy and well. that reduces health risks, improves
quality of life and maximizes personal
potential and impacts the bottom-line.

3. Lifestyle Risk Factors Direct Health Impact
•Physical activity •Medical problems
•Stress •Health status
•Smoking
•Nutrition
•Seat Belts
•Multiple Health Risks
Indirect Outcome
•Health care utilization
Clinical Risk Factors •Health care cost
•Obesity •Absenteeism
•Blood pressure •Employee productivity
•Cholesterol •Job/life satisfaction
•Blood sugar •Other
•Musculoskeletal
*Anderson, D.R. (AJHP, 2004)

4. The State of Working America
• USA has highest per person • 55-74 employed population =
healthcare cost of industrialized 70.1% employed
world and ranked 37th of 91
countries, $1 out of $7 spent on • 74+ = 12.5% employed
medical goods or services
• 2/3 of 55-74 outside of
• 1% of population account for workforce consider themselves
ill
30% of costs and 5% account
for 70%
• Employers health benefits cover
3/5 nonelderly
• 35% deaths attributed to poor
diet, smoking, physical • Healthcare spending by 2015
inactivity predicted at $4T, 20%GDP,
$12,320
Healthy Workplace 2010 & Beyond PFP 2009

5. • 7 out of 10 deaths among Americans each year are from chronic diseases.
Heart disease, cancer and stroke account for more than 50% of all deaths
each year
• In 2005, 133 million Americans – almost 1 out of every 2 adults – had at least
one chronic illness
• Obesity has become a major health concern. 1 in every 3 adults is obese3 and
almost 1 in 5 youth between the ages of 6 and 19 is obese (BMI ≥ 95th
percentile of the CDC growth chart)
• About one-fourth of people with chronic conditions have one or more daily
activity limitations
• Arthritis is the most common cause of disability, with nearly 19 million
Americans reporting activity limitations
• Diabetes continues to be the leading cause of kidney failure, non-traumatic
lower-extremity amputations, and blindness among adults, aged 20-74

6. Costs
$10,095
$12,000 $9,221
$10,000
$6,664
$7,268
$8,000
$4,130 $5,445
$6,000 $3,432
$3,601
$4,000 $2,741 $4,319 5+ Risks
$2,025 $3,366
$2,000 3-4 Risks
$1,247 $1,515 $1,920
Age 0-2 Risks
$0
<35 35-44 45-54 55-64 65+
StayWell 2006 (N = 43,687)

7. Direct Costs:
Indirect Medical & Pharmacy
costs a
bigger part
of the Workers’
pie….. Compensation
STD
Absenteeism
Presenteeism
LTD
Time Away from
Work
Edington & Burton (2003)

8. Direct Medical Costs
• Medical
• Pharmaceutical
Visible
Costs
Indirect Costs
• Presenteeism
• Short Term Disability Non-Visible
• Long Term Disability Costs
• Absenteeism
• Workers Compensation
Indirect Costs represents 2-3 times Direct Medical Costs

9. • Is there a “business case”
to be made for worksite
wellness?
• What is the evidence and
is it compelling?
• Can we develop an ROI
argument?

10. Health Risk Measure High Risk Criteria
Alcohol More than 14 drinks/week
Blood Pressure Systolic >139 or Diastolic >89 mmHg
Body Weight BMI 27.5
Cholesterol Greater than 239 mg/dl
HDL Less than 35 mg/dl
Existing Medical Problem Heart, Cancer, Diabetes, Stroke
Illness Days >5 days last year
Life Satisfaction Partly or not satisfied
Perception of Health Fair or poor
Physical Activity Less than one time/week
Safety Belt Usage Using safety belt less than 100% of time
Smoking Current smoker
Stress High
Edington (2011) AJHP

11. The Five Fundamental Pillars
of the Health Management
Strategy
• Senior leadership creates the vision
• Operations leadership aligns the
environment with the vision
• Self-leadership creates their personal
health and performance environment
• Reward action and touch points
• Quality assurance measures progress
toward a champion company
• Keep the healthy, healthy

12. 1 Year Transition Natural Flow Prevention Plan
High to moderate 31% 48.70%
Moderate to low 35% 46.35%
High to low 21% 15.65%
Low to low 70% 87.33%
Low to High 5% .62%
Moderate to high 20% 7.66%
Moderate to moderate 45% 45.98%
High to high 63% 35.65%
Loeppke, Edington, Beg (2010) PHM

13. • Henke (2011) Recent Experience In Health Promotion at Johnson & Johnson
Lower Health Spending, Strong Return on Investment
• Trogdon (2009) Workplace obesity interventions result in a reduction of $90
for every 5% of body weight
• Naydeck (2008) Highmark wellness program four year cost savings
$1,335,524 showing programming lowers rate of healthcare costs
• Baker (2008) over 1 year, 7 of 10 health risks decreased for a total savings of
$311,755, 59% attributed to reduced healthcare expenditures
• Dall DOD Health Risks Costs (2007) tobacco use $564m, obesity $1.1b,
alcohol $425m / non-medical excess of $965m

14. • Baicker (2010) meta analysis of literature shows
every wellness $ spend reduces absenteeism by
$2.73
• Rodbard (2009) 15,132 ~ greatest impairment
of work and daily activities among obese
individuals
• Kuoppala (2008) evidence that health promotion
decreases sickness absence / range .1 – 1.57
• Bachman (2007) health promotion interventions
provide cost savings from decreased
absenteeism rates
• Halpern (2007) impact of a smoking cessation
program resulted in a total saving in year 4 and
included reduced absenteeism

15. • Gibson (2010) cost sharing adherence to
anti-diabetic medication, increase adherence
decrease costs in emergency room visits and
STD
• Lambeek (2010) integrated care programs
reduce chronic low back in working &
private life
• Jover (2009) early cognitive-behavioral
treatment complementary to rheumatologic
care reduces duration of relapse
• Burton / Financial Service (2007)
antidepressant medication adherence, low
compliance resulted in almost 40% increase
in chance of STD

16. • Palumbo (2010) workplace wellness Tai Chi classes cost effective option for
older female workers, 3% increase in productivity
• Kirsten (2010) a global perspective making the link between health and
productivity
• Katcher (2010) vegetarian / vegan diets effective in treating several chronic
diseases, vegan group reports 40-60% decrease in health-related productivity
impairments
• Goetzel (2009) factor analysis identified relationship between increase in
health risks and > presenteeism
• Schultz (2009) the cost of presenteeism is much larger that the costs of direct
healthcare
• Loeppke (2009) strong link between health and productivity / integrating
productivity and health data leads to development of effective programming

17. • Bakker (2010) Canadian cancer nurses view of recruitment – retention as a
continuum / developing an environment facilitates culture change
• O’Brien (2010) by creating a generally healthier work environment, data suggests
that these programs will also have a positive effect on recruitment and retention.
• Reed (2009) case study of creating a healthy workplace in a surgical trauma unit
essential in recruitment and retention
• Angeletti (2008) workplace lactation program – a nursing friendly environment
impacts recruitment, retention, productivity efforts
• Stichler (2005) recruitment & retention strategies that create the best workplace
for women’s services, culture of excellence, job satisfaction measured by social
climate, relationships, job stress, resources, control, etc
• Tsai / Baun (1987) relationship of employee turnover to exercise adherence in a
corporate setting

18. • Is there a “business
case” to be made for
worksite wellness?
• What is the evidence
and is it compelling?
• Can we develop an
ROI argument?

19. Categories of Worksite Program Evaluation
Basic
Process – qualitative & quantitative look at programming process
Impact – overall effectiveness indicating immediate effects
Outcome – stated long-term objective & goals met
Project Effectiveness
Claims analysis Chenoweth (2011) Evaluating
Risk factor costs appraisal Worksite Health Promotion
Financial Analysis
Forecasting / cost avoidance benefits
Cost effectiveness
ROI Return on investment (tangible financial benefits / tangible costs)
Cost benefit analysis (tangible & intangible benefits / tangible & intangible costs)

20. • Pelletier (2011) A Review and Analysis of the Clinical and Cost-
effectiveness: Studies of Comprehensive Health Promotion and
Disease Management Programs at the Worksite
• Schaafsma (2010) 37 studies looking at back pain / analysis found
severe back pain improvements gained through physical activity
programming
• Baicker (2010) Workplace Wellness Programs Can Generate Savings, $3.27
medical and $2.73 absenteeism
• Blackburn (2009) workplace weight-loss programs are a win-win
with a $2.10 ROI
• Trogdon (2009) 5% weight loss would result in a annual cost
(medical/absenteeism) or $90
• Conn (2009) These findings document that some workplace physical
activity interventions can improve both health and important
worksite outcomes

21. ROI studies of worksite wellness
programs: ROI estimates in these nine
studies ranged from $1.40 -
– Canada and North $4.90 in savings per dollar
American Life spent on these programs.
– Chevron Corporation
– Dow Chemical
Median ROI was $3 in
– City of Mesa, Arizona
– General Mills benefits per dollar spent on
– General Motors program.
– Highmark
– Johnson & Johnson Sample sizes ranged from
– Pacific Bell 500 - 50,000 subjects in
– Procter and Gamble these studies.
– Tenneco

22. • Is there a “business
case” to be made for
worksite wellness?
• What is the evidence
and is it compelling?
• Can we develop an
ROI argument?

23. But how?
Who, what, when,
where, how often?
What results?
When?

24. Families
Peers / Buddies
Individuals
Communities
Teams
Organizations

25. Core Factors
Impacting Behavior Change &
Culture of Health
Individual Opportunity 40%
Behavior Self confidence
Change Action
Skill 25%
and Support
Behavioral efficacy
Creating Self efficacy
Motivation readiness 30%
Culture of
Knowledge
Health Awareness 5%

26. Both corporate climate and
culture have significant influence
in shaping health behaviors and
practices!

27. Born from
years of
successful
safety
cultures
Culture of safety is one in which employee behavior is guided by
safety procedures, norms, and supports that encourage a safe
working environment. Safety behaviors are incorporated into
the vision and goals of leadership.

28. Alcon Laboratories
“With a mission of cultivating a culture of health, Alcon has supported
employee wellness since 1993. Beginning with healthy nutrition and fitness
activities, Alcon’s program has since grown and expanded to incorporate a
broader set of initiatives coupled with incentives. In 2010, Alcon’s
employees participated in an average of 31 unique wellness activities with
63% completing a health assessment and biometric screenings.”
Eastman Chemicals
"Eastman is honored to receive the C. Everett Koop award in recognition
of the company's efforts in building a culture of health," said Edna Kinner,
Vice President of Human Resources. "This award not only reflects
Eastman's commitment to health improvement, but the significant
involvement of Eastman men and women with their personal health."

29. Harvard Business Review, December 2010
Berry, Mirabito, Baun
Six Essential Hard Return Pillars
Regardless of Organizations Size
• Multilevel Leadership
• Alignment
• Scope, Relevance, and Quality “We manage what
• Accessibility we measure.”
• Partnerships Are you measuring
things that have high
• Communications value in your wellness
programs?

30. • C-suite – “walks the talk”, policies &
mandates, shows an interest in employees
wellness behaviors – “how’s your wellness”
• Middle Managers – shaping mini-wellness
cultures
• Wellness Program Managers – expert who
develops, coordinates a comprehensive
program connected to company culture and
strategies
• Wellness Champions – volunteer wellness
ambassadors serving as on-the-ground
encouragement, education & mentoring

31. • Planning and Patience – look for way to
permeate the culture with wellness,
emphasize early communications & clear
explanations, develop a long-term
comprehensive strategy
• Carrots not Sticks – positive incentives
promote trust & provide employees
choices
• Complement to Business Practices –
wellness programming must make
business sense // sustaining a healthy,
talented, satisfied labor pool is a matter of
corporate responsibility & business
necessity

32. • More than Cholesterol – think beyond
diet & exercise, stress & depression major
sources of lost productivity
• Individualization – online health risk
assessment combined with biometric data
• Signature Program – high profile, high
quality initiative fosters employee pride &
involvement
• Fun – never forget the pleasurable
principles in wellness initiatives
• High Standards – health related services
are personal, employees won’t use
substandard services, “no one will come
for free and lousy”

33. • True On-Site Integration –
carefully consider your
wellness model & how best to
integrate it across your
company culture
Facilities
• Going Mobile – high tech
tools (virtual wellness
programs & online resources)
not only deliver the wellness
message & provide
individuals tracking tools &
individual reports, but also
compliment the high touch
programs that unite
individuals in a culture of
health

34. • Internal Partnerships – help
wellness gain credibility
• External Partnerships – enable
staff to benefit from vendor
competencies & infrastructure
without the extra investment
• Leveraging Resources – internal
& external partnerships help grow
& maintain comprehensive
programs

35. • Tailor Messages - to fit
the
intended audience, hone effective
practices overtime
Mass Marketing
• Media Diversity – use a variety of
different communication tools to
reach the audience
• Embedded Wellness Clues –
wellness needs to become a “viral
Developing Social
thing” spreading throughout the Networks
workplace

36. • Multilevel Leadership
• Alignment
• Scope, Relevance, and Quality
• Accessibility
• Partnerships
• Communications

37. Sustain behavior
Engage employees change through
in a wellness appropriate program
partnership design / delivery
Individuals / Teams / Organization
Design / deliver programs that facilitate
employee Accountability for better health
& wellness practices

38. Why Wellness
Can Health be a Business
Strategy?
YOU BET! As long as:
* Health becomes a value / part of culture
* Total health becomes a benefit not a cost
* Leadership model expects
Engagement
Sustainability
Accountability
William B. Baun, EPD, CWP, FAWHP
Wellness Officer, MD Anderson Cancer Center
President, National Wellness Institute
wbaun@mdandeson.org/ 713-745-6927