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“Wellness” for 21 st Century Miners: Integrating “Safety” & “Health” To Drive Employee, Family and Business Performance. Michael D Parkinson, MD, MPH, FACPM NSSGA Convention March 2014. Objectives.

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Wellness for 21 st century miners integrating safety health to drive employee family and business performance

“Wellness” for 21st Century Miners:Integrating “Safety” & “Health”To Drive Employee, Family and Business Performance

Michael D Parkinson, MD, MPH, FACPM

NSSGA Convention March 2014


Objectives

Objectives

  • Definition of 21st century “wellness” for industry, employers and employees in globally competitive economy

  • Military, NASA and private sector applications

  • Integration of “Safety”, “Health Protection” and “Health Promotion”

    • NIOSH Total Worker Health™ initiative

  • Employer Health & Productivity Roadmap

  • Implications for 21st century mining industry, employers, miners and their families


My perspective always achieving the mission

My Perspective: Always Achieving the Mission

  • Air Force flight surgeon

    • Mission achievement worldwide thru “whole person” orientation to worklife, professional and personal integration for hi-risk aircrew and families

  • Chief, US Air Force Preventive Medicine

    • Optimizing preventive medical care programs for Air Force and DOD pre-, during and post- Persian Gulf operations

    • Study and medical surveillance of occupational and environmental health risks

  • Deputy Director, Air Force Medical Operations and MHS leadership

    • Deliver or “buy” care from private sector for 2M beneficiaries

    • What functions are “mission-essential” for health, safety, performance?

  • President, American College of Preventive Medicine

    • Physicians in public health, preventive care and occupational medicine

  • Institute of Medicine NASA “Integrating Employee Health” 2 yr study

  • Consumer-directed health care – prevention paid 100%

  • NIOSH Total Worker Health Advisor U of Iowa


2 6 t 75 behaviors 30 waste what are we trying to do anyway

$2.6 T: 75% Behaviors, 30% WasteWhat are We Trying To Do Anyway?


21 st century mining and related industry

21st Century Mining and Related Industry

  • Global scope and competition

  • 24-7 high risk, high impact industry

  • Critical growth path and opportunities

  • Increasingly short “cycle time” to react and change

  • Safety and quality paramount

  • Mission critical personnel with time, attention, physical and mental health demands

  • Health and performance – similarly critical to global success and company growth


How many americans can just say yes to all 5

How Many Americans Can Just Say “Yes” to All 5?

I am within 5 pounds of my ideal body weight

I exercise 30 minutes or more most days of week

I eat a healthy diet with 5 fruits/vegetables most days

I don’t use tobacco products

I have 2 or fewer alcoholic drinks per day


Health promotion or health protection occupational or non occupational a picture worth

“Health Promotion” or “Health Protection” . .“Occupational” or “Non-Occupational” . . A Picture Worth . . .


Mediterranean or asian diet nonsmoker daily activity moderate alcohol use

Mediterranean (or Asian) Diet + Nonsmoker + Daily Activity + Moderate Alcohol Use*

* Knoops et al and **Rimm, Stampfer, JAMA 2004;292:1433-1439


Determinants of health and disease where how we live learn work and play

Determinants of “Health” and “Disease” Where & How We Live, Learn, Work and Play

Social

Environment

Physical

Environment

Genetic

Environment

Individual

Response

--Behavior

--Biology

Health

&

Function

Disease

Health

Care

Well-Being

Prosperity

Evans, R. G., Barer, M. L., & Marmor, T. R. (1994)

Why Are Some People Healthy and Others Not?. New York: Aldine De Gruyter


F100 engine performance threats flight hour periodic maintenance schedule

F100 Engine Performance ThreatsFlight Hour Periodic Maintenance Schedule

4th Stage Compressor Blade

3rd / 4th LPT Disk / Blade

3rd Fan Disk / Blade

#5 Bearing Compartment

HPT Distress

Compressor Stalls

Fuel Manifold Pigtails/Flex Hoses/Nozzles


Human system performance threats

Human System Performance Threat

Mission-essential Preventive Maintenance?

Human System Performance Threats

Atherosclerosis

Environmental

Toxin Exposure

Stress-Induced

Disorders

Back Injury

Suicide

Operational Demands

Accidental Injury

Injury/Illness From

Hostile Attack

Hearing Loss

Infectious

Disease

Hypertension


Wellness for 21 st century miners integrating safety health to drive employee family and business performance

Committee to Assess Worksite Preventive Health Program Needs of NASA EmployeesThe

National Academies

Institute of Medicine

Food and Nutrition Board

http://www.iom.edu/CMS/3788/18021/26995.aspx


Institute of medicine what does a healthy workforce look like

HEALTHY

Demonstrating optimal health status as defined by positive health behaviors; minimal modifiable risk factors; and minimal illnesses, diseases, and injuries

PRODUCTIVE

Functioning to produce the maximum contribution to achievement of personal goals and the organizational mission

READY

Possessing an ability to respond to changing demands given the increasing pace and unpredictable nature of work

RESILIENT

Adjusting to setbacks, increased demands, or unusual challenges by bouncing back to optimal “well-being” and performance without incurring severe functional decrement.

Institute of Medicine: What Does A Healthy Workforce Look Like?*

IOM: Integrating Employee Health: A Report for NASA 2007


Behaviors drive medical disability absenteeism worker s comp total employer costs

Behaviors Drive Medical, Disability, Absenteeism, Worker’s Comp, &Total Employer Costs

High Risk

Medium Risk

Non-Participant

Low risk

Edington. Am J Health Promotion 15(5):341-349, 2001


Strategy to address rising medical costs and improve workforce health productivity

Strategy To Address Rising Medical Costs and Improve Workforce Health & Productivity

Poorly

Managed

Well

Managed

High

Risk

Moderate

Risk

Low

Risk

2%

8%

62%

12%

26%

IMPROVE

MAINTAIN

MANAGE

  • 20% drive 80% of cost – but not the same 20%. 50% of those are new each year.

  • Average employee has 2.2 health risks, resulting in $2,000/yr in productivity losses. (JOEM, 2005)

  • 36% of absence– including STD and Workers’ Comp – is due to excess riskfactors (JOEM, 2002)


When done right positive roi for both direct medical and indirect total costs

When Done Right: Positive ROI for Both Direct Medical and “Indirect” Total Costs

  • Medical costs fall by about $3.27 for every dollar spent on effective wellness programs

  • Absenteeism costs fall by about $2.73 for every dollar spent

Source: Katherine Baicker, David Cutler, and Zirui Song, Health Affairs, February, 2010


Nasa recommendation job 1 a new vision

The success and sustainability of an integrated health process must first and foremost begin with a clear understanding of the organization’s mission.

The Committee recommends that the administrator of NASA adopt a new vision for worker health, readiness, and resilience that directly links to NASA’s mission and includes health as a core NASA valuethat is implemented through an integrated health and systems approach.

NASA Recommendation “Job 1”: A New Vision


Nasa 2 link health and performance to bottom line and mission

A mission-driven vision for health should articulate why investment in health and employee-integrated health helps NASA achieve its core mission on time, under budget, and better than expected.

NASA #2: Link Health and Performance to Bottom Line and Mission


Nasa 3 visible organizational commitment

Develop a data-based approach to policy, planning, programming, budgeting, implementation, operations, evaluation, and management.

Create a standardized “health and performance” full-cost accounting framework to define, standardize, prioritize, fund, and evaluate resource allocation for human-related mission performance and workplace safety, health, and productivity.

Incorporate mission-essential elements of integrated health programs in contracting requirements.

NASA #3: Visible Organizational Commitment


Nasa 4 manager education and ownership

NASA should provide education and training to first-line managers and supervisors that focuses on the relationship between health and productivity

NASA #4: Manager Educationand Ownership


Niosh total worker health integrating health prevention safety and occupational medicine

NIOSH Total Worker Health™: Integrating Health, Prevention, Safety and Occupational Medicine

  • Total Worker Health™ is a strategy integrating occupational safety and health protection with health promotion to prevent worker injury and illness and to advance health and well-being.

  • “Most diseases, injuries, and other health conditions experienced by working people are multifactorial, especially as the workforce ages. Evidence supporting the role of work and personal risk factors in the health of working people is frequently underused in developing interventions. Achieving a longer, healthy working life requires a comprehensive preventive approach. To help develop such an approach, we evaluated the influence of both occupational and personal risk factors on workforce health.”

  • Interaction of Occupational and Personal Risk Factors in Workforce Health and Safety, AJPM Mar 2012 Schulte et al


Employer health productivity road map understand improve and partner with your doctor

Employer Health & Productivity Road Map™ *“Understand, Improve, and Partner With Your Doctor”

Increase Healthy Behaviors

Minimize Acute

Care

Optimize

Chronic

Care

Reduce Excessive Surgery

Speed Transitions

Care-Home-Work

Optimize Environment

Incentivized Health Management Program or

Consumer-Directed Health Plan

*Parkinson MD. Employer Health and Productivity Roadmap™ J Occup Environ Med 2013;55 (12):

Total Worker Health Supp S46-51.


Employer health productivity road map understand improve partner with your doctor

Employer Health & Productivity Road Map “Understand, Improve & Partner With Your Doctor”

Increase Healthy Behaviors

Minimize Acute

Care

Optimize

Chronic

Care

Reduce Excessive Surgery

Speed Transitions

Care-Home-Work

Optimize Environment

  • Health and Productivity Alignment Assessment Report and Gap Analysis

  • Health & Performance Total Economic Opportunity

  • Ergonomic evaluation and support

  • Wellness Course Participation


Health and productivity performance index assessment

Health and Productivity Performance Index Assessment

Health and Productivity Performance Index (HAPPI)

Leadership/Culture

Communications

Incentives

Rewards Alignment

Programs & Services

The HAPPI assessment was developed from Best in Class tools to help employers identify areas for improvement and health related cost savings.

Physical Environment Ergonomics, Facilities &

Safety

Fit-Friendly Worksites


Employer health productivity road map understand improve partner with your doctor1

Employer Health & Productivity Road Map “Understand, Improve & Partner With Your Doctor”

Increase Healthy Behaviors

Minimize Acute

Care

Optimize

Chronic

Care

Reduce Excessive Surgery

Speed Transitions

Care-Home-Work

Optimize Environment

  • “Champion Index” - % in optimal health

  • Population risk profile & movement

  • Biometric changes over time

  • Clinical preventive services

  • Lifestyle coaching enrollment & graduation


Understand your health and know your numbers

Understand Your Health and “Know Your Numbers”

Provided in partnership with


Coaching competitions work

Coaching & Competitions Work


Employer health productivity road map understand improve partner with your doctor2

Employer Health & Productivity Road Map“Understand, Improve & Partner With Your Doctor”

Increase Healthy Behaviors

Minimize Acute

Care

Optimize

Chronic

Care

Reduce Excessive Surgery

Speed Transitions

Care-Home-Work

Optimize Environment

  • Visits/1000 by site of traditional and alternative care

  • Video and e-visits

  • Lower cost and onsite care options

  • Prevalence of impactableacute visits


Wellness for 21 st century miners integrating safety health to drive employee family and business performance

Norman Rockwell Had It Right!

“Medical Home” Re-visited


I still want my rockwell but my way my time for less

I Still Want “My Rockwell” But My Way, My Time, For Less $$


Move care forward where its most needed not where most comfortable

Move “Care Forward”: Where Its Most Needed – Not Where Most Comfortable


Employer health productivity road map understand improve partner with your doctor3

Employer Health & Productivity Road Map “Understand, Improve & Partner With Your Doctor”

Increase Healthy Behaviors

Minimize Acute

Care

Optimize

Chronic

Care

Reduce Excessive Surgery

Speed Transitions

Care-Home-Work

Optimize Environment

  • Condition prevalence

  • Identification & referral process

    • % “active” self-identification

    • % ”passive” outreach

  • Disease Management Coaching:

    • enrollment & graduation


Wellness for 21 st century miners integrating safety health to drive employee family and business performance

“Prescribe Engagement” – and We “Fill the Prescription”Health Coaching for Lifestyle, Disease and Shared Decision-making

Chronic Condition

Management

Asthma

COPD

Diabetes

Depression

Cardiac conditions

Low Back Pain

Surgery SDM for back, hip, knee

new

  • Evidence- & curriculum-based program/services

  • Individual and tele-group coaching

  • Coach supported self-study (online & workbook options)

  • Coach-on-Call e-mail & video

  • Onsite Health Coaching

Lifestyle Improvement

MyHealth Eating Well™

MyHealth Ready to Quit™

MyHealth Weigh to Wellness™

MyHealth Less Stress™

MyHealth Step Up to Wellness™

MyHealth Selections™


Employer health productivity road map understand improve partner with your doctor4

Employer Health & Productivity Road Map “Understand, Improve & Partner With Your Doctor”

Increase Healthy Behaviors

Minimize Acute

Care

Optimize

Chronic

Care

Reduce Excessive Surgery

Speed Transitions

Care-Home-Work

Optimize Environment

  • Shared decision-making before surgery with interactive online tool

  • Best practice step therapy pathway for low back pain

  • Reduce:

    • Number of low back surgeries

    • Advanced imaging rate

  • Expand to more preference-sensitive discretionary surgeries and conditions


Wellness for 21 st century miners integrating safety health to drive employee family and business performance

Primary Care Physicians’ Opinions of Patients’ Need To Be Informed vs Actual Proportion Informed by Medical Service Type*

*Foundation for Informed Medical Decision Making survey, 2009 (n=462)


Wellness for 21 st century miners integrating safety health to drive employee family and business performance

  • National Priorities for Shared Decision Making:

  • Reduce unwarranted procedures, targeting:

    • Spine surgery

    • PTCA/Stent

    • Knee replacement

    • Hip replacement

    • Lumbar spine MRI prior to conservative therapy, without red flags

    • Bone or joint x-ray prior to conservative therapy, without red flags

    • Coronary artery bypass graft (CABG)

    • Hysterectomy

    • Prostatectomy

    • Cesarean section

    • Endoscopy

    • Others


Employer health productivity road map understand improve partner with your doctor5

Employer Health & Productivity Road Map“Understand, Improve & Partner With Your Doctor”

Increase Healthy Behaviors

Minimize Acute

Care

Optimize

Chronic

Care

Reduce Excessive Surgery

Speed Transitions

Care-Home-Work

Optimize Environment

  • Top 4-5 conditions that drive Time Away From Work

  • Absence changes over time

  • Leave management


Coordination of stove piped programs decreases absenteeism lowers total costs improves productivity

Coordination of “Stove-piped” Programs Decreases Absenteeism, Lowers Total Costs & Improves Productivity

Partners Program (Medical Home)

Employee Assistance Program

Incentive Driven Wellness Program(s)

Worksite Health Clinics

  • Health Management

  • Coaching

  • Lifestyle/Wellness

  • Physical Condition Management

  • Behavior Condition Management

  • Complex Case Management

Improve Health

Manage

Health

Member Services

Central Leave Management/FMLA

24/7 Nurse Line

Short-Term Disability

Pharmacy Outreach

Maintain

Health

Workers’ Compensation


Employer health productivity road map understand improve and partner with your doctor1

Employer Health & Productivity Road Map™ *“Understand, Improve, and Partner With Your Doctor”

Increase Healthy Behaviors

Minimize Acute

Care

Optimize

Chronic

Care

Reduce Excessive Surgery

Speed Transitions

Care-Home-Work

Optimize Environment

Incentivized Health Management Program or

Consumer-Directed Health Plan

*Parkinson MD. Employer Health and Productivity Roadmap™ J Occup Environ Med 2013;55 (12):

Total Worker Health Supp S46-51.


Powering the health productivity road map moving to maximally effective health and cost savings

Powering the Health & Productivity Road Map: Moving to Maximally Effective Health and Cost Savings

Increasing Consumer and Patient Engagement

HSA only – full replacement

HRA/HSA – full replacement

HRA only – full replacement

Financial

Efficiency

$$

HRA/HSA/Hybrid – optional

HSA only – optional

HRA only – optional

PPO with Incentivized Comprehensive Health Management

PPO with or without “Wellness Program”

Migration Toward Consumer-Driven Health Care

41


Rewarding healthy choices better care decisions

  • Partner

  • Understand

Rewarding Healthy Choices & Better Care Decisions

  • Improve

UPMC

Health Plan incentivizes the member

$

Consumer Engages in Health and Care Activities


Understand improve and partner incentivized strategy to optimize engagement

“Understand, Improve and Partner” Incentivized Strategy to Optimize Engagement

  • Health Risk Assessment

  • Biometric Screening

  • Flu Shot

  • Lifestyle & disease management

  • coaching

  • Preventive Screenings

  • Partner with your Doctor

    • Shared decision-making

    • Care delivery innovations – connectivity and eVisits

  • Earn up to $500/$1000 to use

  • toward your Deductible and

  • Coinsurance


Wellness health safety integration saves lives costs

Wellness, Health, Safety: Integration Saves Lives & Costs


Take homes for 21 st century mining performance

Take Homes For 21st Century Mining “Performance”

  • Integrated health, safety, performance, bottom line savings and top line growth all tied to productive employees

  • Define what hi-performing mining workforce “looks like” using IOM 4 key elements – then shoot for goal

  • Preventive care should be standardized, emphasized, assured and measured as key component of “human performance” and achievement of corporate mission

  • The field, federal government and leading employers understand emphasis on “total worker health” paradigm

    Health/wellness AND safety/occupational health – one and same

  • To maximize company and industry productivity – maximize personal and family health, fitness and performance


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