John Harris, Chairman of the Health Enhancement Research Organization (HERO), discussed the significant body of information accumulating to demonstrate the link between employee well-being, optimal wellness outcomes, and business performance.

1. O N E M I L L I O N D ATA P O I N T S
The Link Between Well-Being, Optimal Wellness
Outcomes, & Business Performance
Worksite Wellness Council of Massachusetts
John Harris, Chairman
HERO
March 20, 2012
Health Enhancement Research Organization
John.h.harris3rd@gmail.com
Follow me on Twitter: @johnhharris

2. R e s e a r c h & To o l s A d v a n c i n g t h e F i e l d
• HERO Scorecard
• Gallup-Healthways Well-Being Index®
• Healthways Well-Being Assessment
• Other Peer Reviewed Research
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3. Results from The HERO Employee Health Management Best
Practice Score Card 2010 Annual Report
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4. Results from The HERO Employee Health Management
Best Practice Score Card 2010 Annual Report
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5. Results from The HERO Employee Health Management Best
Practice Score Card 2010 Annual Report
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6. Results from The HERO Employee Health Management
Best Practice Score Card 2010 Annual Report
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7. Other HERO Scorecard Findings
• Over 600 companies, evenly • Scorecard users who believe the
divided between large, medium, health benefit design is very
and small companies supportive are far more likely to
report that EHM programs have
• Strong leadership and cultural
had a substantial positive impact
support results in better EHM
on medical plan cost trend
program participation
• Scorecard users reporting
• Larger organizations more likely
highest levels of consumerism
to collect and use EHM data
are far more likely to report a
• Strongly integrated programs substantial positive impact on
produce greater employee cost trend
engagement and better outcomes
• Just under two-thirds of
• % of employers that believe Scorecard respondents say that
health plan is supportive of EHM medical plan access and design
– 57% very supportive support EHM program objectives:
– 40% somewhat supportive – “Effectively” (55%)
– 3% not at all supportive – “Very effectively” (9%)
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8. The Gallup | Healthways Well-Being
Index
• 25-year commitment initiated January 2, 2008 Six Domains:
• 1,000 telephonic “community” surveys completed 1. Life Evaluation
per day, 7 days/week
2. Emotional Health
• Approaching 1.5 million completed surveys
• For results based on this sample of respondents, the maximum 95% margin 3. Physical Health
of sampling error is ±0.1 percentage points
4. Healthy Behavior
• Design support and oversight from leading
behavioral economists, psychologists, and experts 5. Work Environment
in psychometric survey design and statistical
6. Basic Access
analysis
• Largest and most comprehensive health survey and
database
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9. The Healthways Well-Being Assessment
Gallup-Healthways Well-Being Index® Healthways Well-Being Assessment™
Community Individual and Organization
Life Healthy
Evaluation Behavior
Life Healthy
Work Emotional Evaluation Behavior
HRA
Quality Health
Work Emotional
Basic Physical Quality Health
Productivity
Access Health
Biometrics Basic Physical
Access Health
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10. Making the Transition from Health to Well-Being
Well-being is bigger
than Physical Health Community
Financial
Physical
Social
Emotional
Career
Proprietary Healthways Construct
Individuals ● Experts ● Social Connections ● Environment ●
Policy
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11. The Interconnectedness of All Domains
Healthy Eating Drivers of BMI Risks: Example of New Insight
Height Weight
Energy Level
Exercise
Physical Health
# of Health Risks
BMI Risk
Coping with Stress
Emotional Health
Negative Affect
Personal Sources
of Presenteeism Recognition at
Financial Stress
Work
Days of Best Work
Source: Healthways Internal Analysis traditional approach current approach future areas of exploration
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12. Cost Disparity of Life Evaluation
& Possible Reasons Why
“Please imagine a ladder with steps numbered from zero at the bottom to
ten 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?”
Thriving
Average 20% Lower
Six well-being Medical Costs
domains
1. Life Evaluation 7.0
2. Work Quality
3. Basic Access Struggling
4. Healthy Behavior
5. Physical Health
4.0
6. Emotional Health
Suffering
Average 50% Higher
Medical Cost
Source: Gallup-Healthways Well-Being Index Community Survey and Wellmark Corporate Survey 2008
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13. Risk Disparity By Life Evaluation
Risk Category by Life Evaluation
80%
60% 0-1 risks
2-3 risks
40% 4-5 risks
6-9 risks
20%
0%
Suffering Struggling Thriving
Toward Integration to Enhance Health and Well-Being by Evers, KE, Prochaska, JO, Castle, P. & Prochaska, JM. 2009
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14. L i f e E v a l u a t i o n & O t h e r Va r i a b l e s
% With Significant Stress % Feeling Well Rested
Suffering 80% Suffering 30%
Struggling 61% Struggling 57%
Thriving 33% Thriving 82%
0% 20% 40% 60% 80% 100% 0% 20% 40% 60% 80% 100%
% With Sufficient Energy % Satisfied with Job
Suffering 50% Suffering 50%
Struggling 79% Struggling 74%
Thriving 95% Thriving 91%
0% 20% 40% 60% 80% 100% 0% 20% 40% 60% 80% 100%
Source: Gallup-Healthways Well-Being Index Community Survey and Healthways Well-Being Assessment
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15. Life Evaluation & Presenteeism
Drivers
During the past four weeks (28 days), how often have you been at work but had
trouble concentrating or doing your best because of:
Thriving Struggling Suffering Thriving Struggling Suffering
80% 69% 70%
65% 60%
70% 60%
60% 54% 49% 48%
50%
50%
40% 33% 40% 35%
24% 24% 30%
30% 21% 30%
20% 11% 20% 15%
10% 10% 11% 7%
0% 10% 4%
% With Personal % With Financial % With Caregiver 0%
Problems Stress or Responsibilities Depression/Anxiety Health and Regulatory/Legal
Concerns Physical Condition Issue
Thriving Struggling Suffering Thriving Struggling Suffering
80% 45% 42%
70%
70% 65% 40%
35% 32% 32%
60% 53% 30%
30%
50% 45% 25% 20%
39% 18% 19%
40% 33% 20%
30% 15% 11%
30% 23% 9%
10%
20% 13% 5%
10% 0%
0% Supervisor Issues Insufficient Lack of
Job Overload Co-Worker Technology Training Resources to
Issues Issues Effectively do
Source: Gallup-Healthways Well-Being Index Community Survey and Healthways Well-Being Assessment
Work
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16. Productivity Impairment Disparity by
Life Evaluation
Activity Impairment, Work Presenteeism and Work Productivity Loss by Life Evaluation
25%
Productivity Impairment
Activity Impairment
20%
Work Presenteeism
15%
10% Work Productivity Loss
5%
0%
Suffering Struggling Thriving
Source: Toward Integration to Enhance Health and Well-Being by Evers, KE, Prochaska, JO, Castle, P. & Prochaska, JM. 2009
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17. C ommute Ti me & Wel l - Bei ng
%%% %% Obese
Eating Healthy
Exercising
Feeling Well Rested
Reporting Anger
15 minutes or less
15 minutes or less less
15 minutes or 58%
67%
28%
1-15 Minutes
15 Minutes or Less 13% 71%
16-30 minutes
16-30 minutes 56% 69%67%
16-30 16-30 Minutes
16-30 minutes
Minutes 29%14%
31-45 Minutes
31-4531-45 minutes
31-4531-45 minutes
Minutes
minutes 52% 67%
65% 14%
32%
46-60 Minutes 66%
46-6046-60 minutes
Minutes
46-60 minutes
46-60 minutes 63% 15%
34%
50%
Over 60 Minutes 64%
Over 60 Minutes
Over 60 minutes 63% 17%
Over 60 minutes
Over 60 minutes 50% 36%
60% 62% 64% 66% 68% 70% 72%
0%61%
0% 2%
5%
62% 4%
10% 6% 15%
63% 8%
64%
20% 10% 25%
65% 12% 66%30%
14% 16%
67%
35% 18%
68%
40%
46% 48% 50% 52% 54% 56% 58% 60%
Source: Gallup-Healthways Well-Being Index Community Survey
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18. Work Environment Impact on
Employees With Chronic Conditions
Days Unable to Carry Out Usual Activities Per Year
80 16.2 Days/Year
68.9
70
60
52.7
50
40
30 6.6 Days/Year
20.1
20
13.5
10
0
1-3 Conditions 4+ Conditions
Neutral or Positive Work Negative Work
Source: Gallup-Healthways Well-Being Index Community Survey and Healthways Well-Being Assessment
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19. Other Research
Price Waters
Cooper, 2010 – 1 in 4
Gallup Research – Only high-potential
28% of American workers employees intend to
are engaged in their work leave their employers
in the next 12 months
Research by Ratey in
AON Hewitt – Global a book published in
engagement scores 2008 – People learn
are on the decline with vocabulary words
recent drops being the 20% faster after
largest in 15 years exercise than before
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20. WELL-BEING, COST & PERFORMANCE
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21. W e l l - B e i n g R e l a t i o n s h i p t o To t a l
Medical Costs
ANNUAL MEDICAL AND RX CLAIMS COST | Low:High Well-Being = ~3.5x more cost
Annual Costs
(Indexed)
4.0
3.0
2.0
1.0
0-50 (n=109) >50-60 >60-70 >70-80 >80-90 >90-100
(n=151) (n=347) (n=582) (n=683) (n=363)
Low Well-Being Score (Composite) High
Source: Wellmark Data, Healthways Center for Health Research Analysis (n=2,235)
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22. Well-Being & Productivity
HIGHER OVERALL WELL-BEING IS ASSOCIATED WITH HIGHER PERFORMANCE & PRODUCTIVITY
Well-Being and Performance Well-Being and Absenteeism
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Source: Healthways Well-Being Assessment and , Healthways Center for Health Research Analysis

23. Well-Being and Work Withdrawal
HIGHER OVERALL WELL-BEING IS ASSOCIATED WITH HIGHER ENGAGEMENT AND RETENTION
Well-Being and Engagement Well-Being and Retention
Source: Healthways Well-Being Assessment and , Healthways Center for Health Research Analysis
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24. W e l l - B e i n g & Te a m
Effectiveness, Leadership and
Productivity
Implementation of Survey: March, 2010
Well-Being and Team Effectiveness
************* NO INCENTIVES *************
84
Team Effectiveness Score
Eligible WBA Population: 27,090 employees
82 WBA Completion Rate: 52.7%
80 Completed Surveys: 14,276 employees
78
76 80 Well-Being and Productivity
74 75
64 to 66 67 to 69 70 to 72 73+
Well-Being Score 70
Well-Being Score
65
Well-Being and Leadership
86
60
84
Leadership Score
55
82
80 50
78
45
76
74 40
64 to 66 67 to 69 70 to 72 73+ 1 2 3 4 5 6 7 8 9 10
Well-Being Score
N= 11 32 88 337 564 2,133 4,980 4,267 1,582
Overall Productivity
Source: Healthways Well-Being Assessment and , Healthways Center for Health Research Analysis Self-reported on a scale of 1-10
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25. W e l l - B e i n g & Te a m F i n a n c i a l
Performance
TOP QUINTILE 2ND QUINTILE 3rd QUINTILE 4TH QUINTILE 5TH QUINTILE
Source: Healthways Well-Being Assessment and , Healthways Center for Health Research Analysis
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26. W e l l - B e i n g & Te a m F i n a n c i a l
Performance
Well-Being Assessment Results by Business Unit
Life Emotional Physical Healthy Work % at Optimal
Overall Evaluation Health Health Behavior Environment Basic Access Income
Caterpillar 68.4 60.9 76.4 78.1 62.6 46.9 85.5 41.7%
BU #16 68.6 61.6 75.5 76.8 65.2 46.4 86.2 51.8%
BU #17 68.6 59.6 76.3 80.3 66.4 44.4 84.8 41.6%
BU #18 68.1 59.9 77.9 78.9 61.5 45.3 85.0 40.8%
BU #19 67.8 58.0 75.7 78.1 63.9 43.4 87.7 57.2%
BU #20 66.3 58.3 74.7 76.4 59.2 46.0 83.3 31.7%
BU #21 66.2 52.4 75.0 76.9 61.1 45.4 86.5 37.9%
BU #22 65.8 59.1 76.4 75.8 53.4 45.6 84.2 28.4%
BU #23 65.7 57.3 73.9 76.8 61.7 40.1 84.2 36.6%
BU #24 65.5 56.8 76.3 76.7 56.8 43.2 83.4 28.3%
BU #25 64.5 52.5 73.0 75.3 60.2 42.4 83.8 26.8%
TOP QUINTILE 2ND QUINTILE 3rd QUINTILE 4TH QUINTILE 5TH QUINTILE
High Well-Being BUs
vs. + 84% Better Performance
Low Well-Being BUs
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Source:

27. E x p a n d e d Va l u e P r o p o s i t i o n
Improve Reduce Total Increase Increase Total
Well-Being Medical Cost Performance Economic Value
Adopt or maintain • Hospitalizations • Productivity • States
healthy behaviors
• Event Rates • Engagement • Communities
Reduce health-related risks
• Disease Rates • Absence • Sponsors
Optimize care for health
conditions and disease • Lifestyle Risks • Work Impairment • Individuals
Proprietary Healthways Construct
Prevent or delay next new case of disease or condition
Economic Prevent or reduce impact of the next new episode of care
Drivers
Enhance one’s ability to actively manage their well-being
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28. Lincoln Industries
A Culture of Well-Being for the Whole Person
• Vertically integrated manufacturer of Program Elements
metal finishing-intensive parts 4 “levels” of participation
• 600 employees Each level is based on seven criteria:
• 15% revenue growth rate per year • Tobacco use, quarterly checks (blood
pressure, flexibility, body fat),
sustained for 15 years participation in wellness events, health
information update, health risk appraisal,
• “50 Best Small and Medium Companies blood profile, behavior based safety
to Work For” for five years in a row participation and work behavior
Highest level are eligible for a company-
• Culture of caring for people and paid trip to climb a 14,000 foot mountain
innovative wellness program • Last year 77 made the climb
Wellness for the Four dedicated wellness resources
Whole Person: Focus on “Wellness for the Whole
Company “Wellness Wheel” Person” based on six domains (shown
Intellectual left)
Occupational
Numerous program components
Physical including free pedometers, tobacco free
Social campus, onsite tobacco cessation, health
education seminars, gym
Spiritual Emotional reimbursements, annual “poker walk”,
“brain „n pain challenge”, etc.
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29. Well-Being Culture Impact
Exceptional Performance on All Dimensions
• Since 2000, tobacco use has gone from 77% to 23%
• The industry average of health care costs per person is almost $10,000; for
Lincoln Industries, it is just over $3,500 per person
• In 2003, workers compensation costs were over $500,000; in 2006, these
costs were less than $50,000 Life Evaluation Healthy Behavior
Well-Being Assessment: Nation 58.8 Nation 60.5
Gallup-Healthways Well-Being Index
Local City 48.6 Local City 58.2
Company 65.1 Company 60.9
Nation 69.1
Emotional Health Work Environment
Nation 80.6 Nation 48.7
Local City 66.4
Local City 78.5 Local City 49.6
Company 82.4 Company 57.2
Company 72.2 Physical Health Basic Access
Nation 81.6 Nation 84.1
62 64 66 68 70 72 74 Local City 78.3 Local City 84.8
Participation rate = 87% Company 82.5 Company 85.4
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30. The Lincoln Industries Story
Four well-being domains according to company and selected
demographic variables, 100 point scale, 2009
Lincoln Mental &
Physical Health Basic
Industries Number % Environmental
Health Behavior Access
Employee Health
Mean* Mean* Mean* Mean*
Yes 422 25 79.4 80.8 61.7 84.4
No 1,276 75 76.5 77.2 56.0 83.4
Note: Shaded estimates reflect significant difference at the 0.05 level.
*Means were simultaneously estimated for each of the variables shown in the table.
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31. HOW WILL PROGRAMMING
CHANGE BASED ON THE
KNOWLEDGE GAINED?
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32. We Can‟t Rely on the Status Quo
• Worksite health programs have been in existence for about 40 years
• There is evidence that these programs can generate an ROI
• However, penetration and sustained engagement have been lacking
The Result?
• 67% of American adults overweight or obese
• 60% do not exercise
• 83% report high to moderate levels of stress
• 21% still smoke
• 56% have at least one chronic illness
Insanity: doing the same thing over and over again and expecting different results
- Albert Einstein
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33. The Best Science Behavioral Change
Prochaska’s Transtheoretical Model
Decision • Rational decision-making through stages of change
Making • Leveraging of learning style, decisional balance, and other techniques
Predictably irrational decision making in humans
Behavioral • Dynamic intermittent reinforcement
Economics • Hyperbolic discounting
• Stimulating pleasure centers of the brain
Neuro-plasticity and other approaches
• Paying attention in a particular way: on purpose, in the
Mindfulness present moment, and non-judgmentally
• The changing of neurons via new experiences
• Archetyping
Social Social Networks
• A social structure of “nodes” which are connected by
Connectivity one or more specific types of interdependency, such as
friendship, kinship, common interest, knowledge, etc.
Gaming Theory
• Fun vs. fulfillment
Gamification • Appealing to all…Explorer, achiever, socializer, competitor
• Small actions
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34. The Theory of Small Actions
Source: BJ Fogg, Stanford University
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35. The Daily Challenge –
B y M e Yo u H e a l t h
Small Daily Actions | Conversations | Assessment | Social Engagement
1. Complete Daily Challenges 3. Assess & track well-being
2. Share, discuss, celebrate
4. Social support & comparison
www.dailychallenge.com MeYou Health is a wholly owned subsidiary of Healthways
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36. Make it Fulfilling – “Gamification”
Adapted from Dr. Richard Bartle
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37. Make it Social
• Social graph
analysis
provides “Dynamics of
breakthrough Smoking
insights Cessation,” -
• Dense social Christakis &
ties drive Fowler
sustained
health
behavior
change
• Facebook
integration
creates
immediate &
social context
and diffusion
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38. Make it Grow
Daily Challenge members invite their friends to form therapeutic communities
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39. Make it Realistic
The likely impact of one person reducing
their soft drink consumption over time?
• They lose weight
• Their overweight friends may lose
weight
• Their normal weight friends will be less
likely to gain weight
Now, imagine if
100,000 people
do it?
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40. Make it Accessible Anywhere
Smart Phones and Mobile Devices
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41. FINAL THOUGHTS
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