The Well-Being Journal

New Methodology Helps Organizations Better Measure the Impact of Absenteeism

Madison Agee

New studies have shown some of the positive outcomes associated with well-being improvement programs among employers, such as improvements in overall well-being and individual well-being elements, higher productivity, lower rates of absenteeism, and gains in job performance. And now, recently published research helps organizations that are looking to better measure the impact of these programs. A new study authored by the Healthways Center for Health Research expands upon existing, widely accepted methodologies and provides organizations with a more comprehensive and robust way to gauge the impact of their well-being improvement programs.

The study “Regional Economic Activity and Absenteeism: A New Approach to Estimating the Indirect Costs of Employee Productivity Loss”, was published in Population Health Management and introduces a new method for measuring the economic impact of work-related absences. Called the Regional Productivity Loss (RPL) method, the new method expands upon the most commonly used and widely accepted method, the Human Capital Approach (HCA). The study showed that measuring the impact of workplace absenteeism using the RPL method resulted in materially higher cost estimates than would have been found via the HCA method (34 percent higher for two smaller employers and 51 percent higher for a larger employer).

For decades, the HCA method has been the most widely accepted measure for helping employers quantify the economic impact of workplace absenteeism, but the method has some significant weaknesses. To address these deficiencies, Healthways researchers developed the RPL model, which has three significant advantages over the HCA method:

  • Measures lost output and not simply lost wages. The RPL method recognizes that employees are expected to generate value for an employer above and beyond their hourly wage — otherwise, how would an organization be profitable?
  • Accounts for labor replacement for the absent employee. The RPL method acknowledges that when an employee is absent, a co-worker often steps in to cover the workload.
  • Extends the impact of lost productivity to the regional level. The RPL method takes into account the “ripple” effect of workplace absenteeism, by measuring the impact of a single employer’s workplace absenteeism on businesses that interact with that employer, such as vendors and customers, as well as organizations that interact with those businesses.

Because of these advantages over the HCA method, the RPL method more comprehensively calculates the economic impact of workplace absenteeism and thus better conveys the value of programs aimed at reducing absences, such as well-being improvement programs. This is especially true in industries where employees are highly skilled or trained and not easily replaced if they are absent.

In an upcoming article, we’ll take a look at another study authored by the Healthways Center for Health Research that also makes an important contribution to the science of well-being improvement program measurement.

Topics: Science and Research

New Study Shows Positive Impact of Australia’s Largest Health Management Program

Sophie Leveque

The impact of chronic disease on the U.S. healthcare system is staggering – 86 percent of all healthcare spending is for individuals with a least one chronic condition. But unfortunately chronic disease is not an issue unique to the United States. Chronic conditions such as diabetes and cardiovascular disease are also highly prevalent in other parts of the world.

In Australia, approximately one million people are living with diabetes. What’s more, 100,000 new cases are diagnosed annually – making it the fastest growing chronic illness in the country. Cardiovascular disease is also a serious health issue in Australia, as it’s the leading cause of death, accounting for 30 percent of all deaths. In terms of financial impact, diabetes and cardiovascular disease combined are expected to cost Australians $31.2 billion in annual healthcare expenditures by 2033 – representing nearly 12.7 percent of all healthcare spending.

In 2009, Australia’s largest not-for-profit private health insurer, The Hospitals Contributions Fund of Australia (HCF), decided to meet this critical issue of chronic disease head-on by partnering with Healthways to provide comprehensive well-being improvement solutions through a program called My Health Guardian (MHG). The largest program of its kind in Australia, MHG works to actively manage and improve the health and well-being of HCF members by offering them an extensive suite of resources. Members with chronic conditions, such as diabetes and cardiovascular disease, are eligible for telephonic support from registered nurses, helping to drive adherence to proven standards of care, medications and physician care plans.

A four-year study of the MHG program was recently published in BMC Health Services Research. “Long-term Impact of a Chronic Disease Management Program on Hospital Utilization and Cost in an Australian Population with Heart Disease or Diabetes” definitively illustrates the positive impact MHG has had on reducing costs and hospital utilization for insured HCF members with heart disease or diabetes. Overall, participants were 27 percent and 45 percent less likely to have any admission or readmission, respectively, over the four year study period than matched non-participants. The study also found that average per-member savings across the four-year period totaled $3,549.

These results build on earlier published research that looked at the outcomes from the first 18 months following the implementation of the MHG program. This 2012 peer-reviewed study showed that MHG significantly reduced the rate of hospital admissions for participants with heart disease and diabetes. Both the 2012 and 2015 studies found the magnitude of program effect increased over time, demonstrating the importance of sustained participation in the program.

Managing chronic conditions is a global issue and the MHG study demonstrates that there are viable solutions to help address it that can be successful in countries outside the United States. You can read the complete study here.
Topics: Chronic Disease Science and Research Cardiac Disease International Diabetes

What Can Happen When an Employer More Visibly Supports a Culture of Well-Being?

Madison Agee

As we’ve explored earlier, organizational culture can play a pivotal role in the overall success of a well-being improvement program. If their cultures aren’t supportive of (or even worse, if they’re inhospitable to) well-being, even the most thoughtful, well-designed programs can struggle to deliver the kinds of valuable outcomes employers want to see.

A mid-sized employer in the insurance industry recognized this link between culture and program outcomes, so it worked with Healthways to develop and implement a more purposeful culture of well-being within the organization. Some of the initiatives the employer and Healthways focused on were fostering support among leadership and launching activities such as employee challenges and access to fitness classes. Additionally, the employer partnered with Healthways to create and deploy an overall well-being improvement program, which included assessments, action plans, health coaching and web-based resources.

A study recently published by the Journal of Occupational and Environmental Medicine (JOEM) explores the outcomes of this well-being improvement program and the associated cultural enhancements. Covering a two-year period and authored by the Healthways Center for Health Research, “Well-Being Improvement in a Mid-Size Employer: Changes in Well-Being, Productivity, Health Risk and Perceived Employer Support after Implementation of a Well-Being Improvement Strategy is unique in that it’s the very first study to show that employer support for a well-being culture can positively contribute to program outcomes. Specifically, the study established that, for every 1.0 point increase in the perception of employer support for well-being, there was a corresponding 1.9 point increase in overall well-being score.

Over the two-year period of the study, overall well-being among employees improved 7.3 points, a 10.4 percent increase. By the conclusion of the study, overall well-being at the employer had, in fact, even outpaced the well-being of the surrounding community, despite starting significantly below the community average.

The six specific dimensions of well-being measured by the study also all improved. For example, healthy behaviors jumped an impressive 42 percent over the two years, while emotional health improved 12 percent. This improvement in overall well-being and its dimensions was mirrored by a corresponding decrease in the percentage of employees with health risks such as high blood pressure, cholesterol levels and tobacco usage. The group of employees who have two or fewer of these risks increased 13 percent over the study period.

The study also shows a boost in productivity that occurred after the well-being improvement program was implemented. Self-reported job performance improved 2 percent, and on-the-job productivity loss (i.e., presenteeism) decreased by a notable 21 percent. All of these outcomes support earlier research that showed the positive results that can occur following implementation of a well-being improvement strategy.

Employers interested in seeing similar results may be wondering how they can get started on building a culture that is more supportive of well-being. In our “9 Ways to Think Big, Start Small,” we’ve compiled nine top ways to activate a culture of well-being within your organization. We’ve even included easy examples of each to help start the process today.

Topics: Well-Being Productivity Science and Research

Well-Being Improvement:
The Path to Population Health

Madison Agee

At the 15th Population Health Colloquium in March in Philadelphia, PA, innovators across the health care industry gathered to discuss building a culture of health and examine real world examples of population based care being implemented by leading companies and organizations. Participants discussed the value of having a scientifically validated measurement of well-being in order to enable public- and private-sector leaders to know where they stand and how best to develop and prioritize strategies that help their populations live their best lives. All attendees received a copy of the ‘‘Best of Population Health Management’’ supplement, which compiled the most requested articles of 2014. The introduction to that supplement was authored by Ben R. Leedle Jr., President and CEO of Healthways, and appears in its entirety below. It is reprinted with permission of Population Health Management.


Introduction by: Ben R. Leedle Jr., former President and CEO, Healthways

Measurement is the first step that leads to control and eventually to improvement. If you can’t measure something, you can’t understand it. If you can’t understand it, you can’t control it. If you can’t control it, you can’t improve it.”

— H. James Harrington, Ph.D., performance improvement expert

The United States is facing an unprecedented health crisis. Rising costs, declining quality of life, lost productivity, stress, care provider shortages and an aging population continue to place a heavy burden on the American economy, on the vitality of our communities, on the viability of our enterprises and on individuals in need of both health improvement and services to optimize their care. How do we effectively, sustainably reverse these trends?

Our industry has been grappling with this question for some time now, a question that propels us to bring our research to increasingly more rigorous levels, to collect richer data from myriad perspectives, to continuously refine metrics of value and to innovate at a faster pace than ever before. Where we collaborate on these endeavors, the best results ensue.

On January 2, 2008, Healthways began a journey with Gallup to define and measure well-being. Our goal was to understand what is fundamentally important to people, how we experience our day-to-day lives, how we make thousands of decisions every day, and what we think our lives will be like in the future. This information would help us look beyond just physical health and more fully explore its multifaceted nature, including what causes our behaviors and habits to move in positive or negative directions.

The concept of health encompassing more than overt physical symptoms or disease was nothing new, but organizations like ours that deliver population health interventions largely had physical health data — primarily retrospective effect data — to direct our efforts. Without a deeper understanding of what distinguishes a thriving life from one spent suffering, we realized, those interventions would fall short of our three aims: to keep healthy people healthy, to reduce or eliminate lifestyle risks, and to optimize care for those with known conditions or chronic disease. In other words, we needed to uncover and address other aspects of life that either reinforce or work against our best intentions — we needed real-time root cause data.

Decades of clinical and behavioral economics research as well as experience delivering interventions aimed at positively changing behaviors formed the foundation of what eventually became the Gallup-Healthways Well-Being Index®, an in-depth, real-time view of how individuals, organizations, communities, states and countries perceive their well-being. Why are perceptions valuable? Measures such as unemployment, GDP and health statistics are essential, but they do little to help us understand why people change or do not change. Without that information, determining how best to support the improvement of their health and well-being is impossible.

Since 2008, we have fielded millions of well-being surveys around the world. This accumulated data has enabled research indicating us that improving well-being is the best — indeed, the only way — to positively influence populations, and to sustain positive change. When we have a strong sense of purpose, supportive relationships, financial confidence, and strong connections to our community in addition to good physical health, we truly thrive. Scientifically proven and published in the pages of Population Health Management as well as other peer-reviewed journals, this fact is also basic common sense.

Having a scientifically validated measurement of well-being enables public- and private-sector leaders to know where they stand and how best to develop and prioritize strategies that help their populations live their best lives. As David B. Nash, MD, MBA, Dean of the Jefferson School of Population Health, noted recently, “Researchers, policy makers and healthcare leaders need good information about the well-being of populations that they serve. Well-being sheds light on the issues that drive quality, cost and productivity. A well-being metric also supports the creation of an action plan for our nation, in order to achieve sustained improvement in the health of our citizens.” Well-being measurement affords diagnostic, design, process and value outcome specificity and clarity. Perhaps most importantly in terms of creating the change we all want, such measurement ensures the accountability of leadership.

Population health is important work for us all. In fact, our recent analysis of global well-being revealed that only 17% of the world’s population is thriving in 3 elements of well-being or more[1]. This tells us much work remains to be done to improve well-being and population health around the globe. Insights and best practice for improving well-being are universal — applying to all humans — and transcend the traditional boundaries for understanding health that are often ascribed to a population’s education, demographics, location and economy.

Encouragingly, population health is getting the recognition it deserves as a strategic competence for healthcare and other organizations. As just one example, businesses are now hiring chief population officers. The need for the expertise, evidence and next-generation of leadership underscores the importance of the work being performed at the Jefferson School of Population Health. Another example of dynamic growth in the field is the new partnership formed between the Jefferson School of Population Health and the Population Health Alliance. The relationship blends the best of each group and assures the development and execution of innovative solution in our field.

Healthways is proud to support these organizations and sponsor this inaugural “Best of Population Health Management” supplement, which compiles the most requested articles of 2014. Clearly, the rising incidence of chronic disease both in the United States and throughout the world shows that we are ready for a new approach, and these articles highlight some of the exciting advancement in our collective study. Together, we are learning from those on the front lines of population health practice and discovery, collaborating with greater transparency than ever before, and establishing the best practices in total population health that will truly transform health and care.

[1] As defined by Gallup and Healthways, the five elements of well-being are: 1) purpose (liking what you do each day and being motivated to achieve your goals), 2) social (having supportive relationships and love in your life), 3) financial (managing your economic life to reduce stress and increase security), 4) community (liking where you live, feeling safe and having pride in your community), and 5) physical (having good health and enough energy to get things done daily).

Topics: Well-Being Well-Being Index Gallup Science and Research