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What is the Evidence and Return on Investment
(ROI) of Obesity Prevention and Control in
Worksite Settings?
Ron Z. Goetzel...
Q: What problem are we trying to solve?
A: Spending a lot of money on sick care!
• The United States spent $3.056 trillion...
WHY IS HEALTH CARE SO EXPENSIVE?
Source: K.E. Thorpe, "The Rise in Health Care Spending and What to Do About It," Health A...
WHY IS HEALTH CARE SO EXPENSIVE?
(THORPE - PART 2)
• About ¾ of all health care
spending in the U.S. is
focused on patient...
DISEASES CAUSED (AT LEAST PARTIALLY) BY LIFESTYLE
• Obesity: Cholesystitis/Cholelithiasis, Coronary Artery Disease, Diabet...
ENVIRONMENTAL CORRELATES OF OBESITY
More driving
• Rise in car ownership
• Increase in driving shorter distances
• Less wa...
Opportunities for Health Promotion: Workplace
-- 156 Million Americans at Work Each Day
Certain policies,
procedures and p...
Convince me…
Why should I invest in the health
and well-being of my workers?
#GWICF2015
IT SEEMS SO LOGICAL…
If you improve the health and well being of your
employees…
…quality of life improves
…health care ut...
What Is The Evidence Base?
• A large proportion of diseases and disorders is preventable. Modifiable health risk
factors a...
#GWICF2015
POOR HEALTH COSTS MONEY
Drill Down…
• Medical
• Absence/work loss
• Presenteeism
• Risk factors
#GWICF2015
THE COST OF CHRONIC DISEASE
TOP 10 MOST COSTLY PHYSICAL HEALTH CONDITIONS
#GWICF2015
©2008ThomsonReuters
$-
$50
$100
$150
$200
$250
$300
$350
$400
$450
A
llergy*
A
rthritis
A
sthm
a
A
ny
C
ancer
D
epression/...
HERO II STUDY – PUBLISHED NOV. 2012
#GWICF2015
RISK-COST IMPACTS – HERO II
EXHIBIT 1 Average Unadjusted And Adjusted Medical Expenditures, In 2009 Dollars, By Risk
Level...
Individual vs. Population-Based Costs
#GWICF2015
Cost Per Capita of Risk Factors
-100
-50
0
50
100
150
200
250
300
350
347
178.6
128.2
106.2 104.1
80.8
38.3
-6.4 -14 -75.4...
RESEARCH ON RISK-COST RELATIONSHIPS - NOVARTIS
#GWICF2015
RISK FACTORS AND PRESENTEEISM (N = 5,875)
RISK-COST RELATIONSHIPS AT PEPSICO
#GWICF2015
10%
16%
4%
15% 15%
5%
23%
77%
18%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
PercentageSamplewithHighRisk
HEALTH RISK PREVALEN...
BMI BREAKDOWN BY CATEGORY
25%
44%
22%
7%
3%
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
50%
Normal
BMI < 25
Overweight
BMI 25-30...
PEPSICO – OVERWEIGHT / OBESE ANALYSIS (N=11,217)
*At least one difference significant at the 0.05 level
Source: Henke RM, ...
NHLBI MULTI-CENTER STUDY: ESTIMATED ANNUAL COSTS
OF HEALTHCARE UTILIZATION, ABSENTEEISM, AND
PRESENTEEISM BY BMI CATEGORY
...
Worksite Health Promotion Works!
#GWICF2015
CDC Community Guide to Preventive Services
Review – AJPM, February 2010
86 Studies Reviewed
#GWICF2015
SUMMARY RESULTS AND TEAM CONSENSUS
Outcome
Body of
Evidence
Consistent
Results
Magnitude of
Effect Finding
Alcohol Use 9 Y...
Outcome
Body of
Evidence
Consistent
Results Magnitude of Effect Finding
Diastolic blood pressure
Systolic blood pressure
R...
CDC Community Guide Obesity
Review
#GWICF2015
SUMMARY RESULTS AND TEAM CONSENSUS
Outcome
Body of
Evidence
Consistent
Results
Magnitude of
Effect Finding
Estimated Risk ...
WHAT ABOUT ROI?
CRITICAL STEPS TO SUCCESS
Reduced Utilization
Risk Reduction
Behavior Change
Improved Attitudes
Increased ...
HEALTH AFFAIRS ROI LITERATURE REVIEW
Baicker K, Cutler D, Song Z. Workplace Wellness Programs Can Generate
Savings. Health...
RESULTS - MEDICAL CARE COST SAVINGS
Description N Average ROI
Studies reporting costs and
savings
15 $3.37
Studies reporti...
RESULTS – ABSENTEEISM SAVINGS
Description N Average ROI
Studies reporting costs and
savings
12 $3.27
All studies examining...
The Dow Chemical Company
An Environmental
Obesity Prevention
Program at The Dow
Chemical Company
NHLBI: 5 R01 HL079546-05
...
• Quasi-experimental – treatment vs.
control/pre vs. post (3 data points –
baseline, year 1, year 2)
• 12 Dow Chemical Com...
The Dow Study - Interventions at All Sites #GWICF2015
The Dow Study - Interventions at High Intensity Sites #GWICF2015
The Dow Study: Health Behaviors (T1–T3):
High Risk Category
#GWICF2015
The Dow Study: Biometric Values (T1–T3) – Cohort Data
#GWICF2015
Consistent Improvement in
High-Priority Risk Since 2004
Baseline.
Between 2004 and September 2011
high priority risks:
• t...
DOW RESULTS
• 2004 – 2011
– Saved over $120 Million in US healthcare costs
via Health Strategy
• In 2011
– 9% better healt...
Identifying “Best Practices” in Workplace
Health Promotion: What Works?
Source: Goetzel RZ, Shechter D, Ozminkowski RJ, Re...
What Is Needed to Achieve Success?
1. Leadership commitment
2. Specific goals and expectations
3. Healthy company culture
...
Creating a…
#GWICF2015
Workplace Health Promotion Programs Work –
If You Do Them Right!
Financial
Outcomes
Health
Outcomes
QOL and
Productivity
O...
To watch Dr. Goetzel’s presentation online,
visit: www.icfi.com/ObesityPrevention-
RonGoetzel
#GWICF2015
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What is the Evidence and Return on Investment (ROI) of Obesity Prevention and Control in Worksite Settings?

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Originally presented at George Washington University's and ICF International's Research and Evaluation Forum (#GWICF2015), Dr. Ron Goetzel demonstrates why employers should look at value on investment (VOI) rather than return on investment (ROI) of workplace health promotion. Dr. Goetzel goes through:
• The severity and cost of obesity
• Why the workplace is the optimal environment for health programs
• Evidence and examples of how workplace health programs can bring VOI
• How employers can get VOI

To watch the video of Dr. Goetzel presenting these slides at the GW/ICF Research and Evaluation Forum, visit: http://www.icfi.com/ObesityPreventionRonGoetzel

Veröffentlicht in: Gesundheit & Medizin
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What is the Evidence and Return on Investment (ROI) of Obesity Prevention and Control in Worksite Settings?

  1. 1. What is the Evidence and Return on Investment (ROI) of Obesity Prevention and Control in Worksite Settings? Ron Z. Goetzel, Ph.D., Johns Hopkins University - Truven Health Analytics GW-ICF Research and Evaluation Forum -- January 21, 2015 -- Washington, DC #GWICF2015
  2. 2. Q: What problem are we trying to solve? A: Spending a lot of money on sick care! • The United States spent $3.056 trillion in healthcare in 2014, or $9,596 for every man, woman and child. • Spending by sector • Private health insurance - $1.102 billion • Medicare - $615.9 billion • Medicaid - $507.2 billion • Out of pocket -- $338.1 billion • Health expenditures as percent of GDP: 7.2 % in 1970 17.6% in 2014 19.3% in 2023 (projected) Source: Sisko et al., Health Affairs, 33:10, September 23, 2014, 1841-1850 #GWICF2015
  3. 3. WHY IS HEALTH CARE SO EXPENSIVE? Source: K.E. Thorpe, "The Rise in Health Care Spending and What to Do About It," Health Affairs 24, no. 6 (2005): 1436-1445; and K.E. Thorpe et al., "The Impact of Obesity on Rising Medical Spending," Health Affairs 23, no. 6 (2004): 480-486. Innovation/advancing technology (pharmacologic, devices, treatments) • Newborn delivery costs – five-fold increase from 1987-2002 – NICU, incubators, ventilators, C-sections • New/better medicines for treating disease – Depression (SSRI introduction – 45% treated in 1987 to 80% treated in 1997 – Allergies (Claritan, Allegra, …) • New treatment thresholds – Blood pressure – High blood glucose – Hyperlipidemia Rise in spending for treated diseases (37%) Ken Thorpe #GWICF2015
  4. 4. WHY IS HEALTH CARE SO EXPENSIVE? (THORPE - PART 2) • About ¾ of all health care spending in the U.S. is focused on patients who have one or more chronic health conditions • Chronically ill patients only receive 56% of clinically recommended preventive health services And 27% of the rise in healthcare costs is associated with increases in obesity rates… Rise in the prevalence of disease (63%) #GWICF2015
  5. 5. DISEASES CAUSED (AT LEAST PARTIALLY) BY LIFESTYLE • Obesity: Cholesystitis/Cholelithiasis, Coronary Artery Disease, Diabetes, Hypertension, Lipid Metabolism Disorders, Osteoarthritis, Sleep Apnea, Venous Embolism/Thrombosis, Cancers (Breast, Cervix, Colorectal, Gallbladder, Biliary Tract, Ovary, Prostate) • Tobacco Use: Cerebrovascular Disease, Coronary Artery Disease, Osteoporosis, Peripheral Vascular Disease, Asthma, Acute Bronchitis, COPD, Pneumonia, Cancers (Bladder, Kidney, Urinary, Larynx, Lip, Oral Cavity, Pharynx, Pancreas, Trachea, Bronchus, Lung) • Lack of Exercise: Coronary Artery Disease, Diabetes, Hypertension, Obesity, Osteoporosis • Poor Nutrition: Cerebrovascular Disease, Coronary Artery Disease, Diabetes, Diverticular Disease, Hypertension, Oral Disease, Osteoporosis, Cancers (Breast, Colorectal, Prostate) • Alcohol Use: Liver Damage, Alcohol Psychosis, Pancreatitis, Hypertension, Cerebrovascular Disease, Cancers (Breast, Esophagus, Larynx, Liver) • Stress, Anxiety, Depression: Coronary Artery Disease, Hypertension • Uncontrolled Hypertension: Coronary Artery Disease, Cerebrovascular Disease, Peripheral Vascular Disease • Uncontrolled Lipids: Coronary Artery Disease, Lipid Metabolism Disorders, Pancreatitis, Peripheral Vascular Disease #GWICF2015
  6. 6. ENVIRONMENTAL CORRELATES OF OBESITY More driving • Rise in car ownership • Increase in driving shorter distances • Less walking and bicycling At home, more convenience • Increase use of “labor saving” devices • Increase in ready-made foods • Increase in television viewing, computers, and video games At work • Sedentary occupational fields (“knowledge workers”) In public • More elevators, escalators, automatic doors and moving sidewalks #GWICF2015
  7. 7. Opportunities for Health Promotion: Workplace -- 156 Million Americans at Work Each Day Certain policies, procedures and practices can be introduced and organizational norms can be established Workplaces contain a concentrated group of people who share common purpose and culture Financial or other types of incentives can be offered to gain participation in programs Workplace programs can reach large segments of the population not exposed to and engaged in organized health improvement efforts Social and organizational supports are available Communication with workers is straightforward US Bureau of Labor Statistics, December 2014 #GWICF2015
  8. 8. Convince me… Why should I invest in the health and well-being of my workers? #GWICF2015
  9. 9. IT SEEMS SO LOGICAL… If you improve the health and well being of your employees… …quality of life improves …health care utilization is reduced …disability is controlled …productivity is enhanced #GWICF2015
  10. 10. What Is The Evidence Base? • A large proportion of diseases and disorders is preventable. Modifiable health risk factors are precursors to a large number of diseases and disorders and to premature death (Healthy People 2000, 2010, Amler & Dull, 1987, Breslow, 1993, McGinnis & Foege, 1993, Mokdad et al., 2004) • Many modifiable health risks are associated with increased health care costs within a relatively short time window (Milliman & Robinson, 1987, Yen et al., 1992, Goetzel, et al., 1998, Anderson et al., 2000, Bertera, 1991, Pronk, 1999) • Modifiable health risks can be improved through workplace sponsored health promotion and disease prevention programs (Wilson et al., 1996, Heaney & Goetzel, 1997, Pelletier, 1991, 1993, 1996, 1999, 2001, 2005, 2009, 2011) • Improvements in the health risk profile of a population can lead to reductions in health costs (Edington et al., 2001, Goetzel et al., 1999, Carls et al., 2011)) • Worksite health promotion and disease prevention programs save companies money in health care expenditures and produce a positive ROI (Johnson & Johnson 2002, Citibank 1999-2000, Procter and Gamble 1998, Chevron 1998, California Public Retirement System 1994, Bank of America 1993, Dupont 1990, Highmark, 2008, Johnson & Johnson, 2011) #GWICF2015
  11. 11. #GWICF2015
  12. 12. POOR HEALTH COSTS MONEY Drill Down… • Medical • Absence/work loss • Presenteeism • Risk factors #GWICF2015
  13. 13. THE COST OF CHRONIC DISEASE TOP 10 MOST COSTLY PHYSICAL HEALTH CONDITIONS #GWICF2015
  14. 14. ©2008ThomsonReuters $- $50 $100 $150 $200 $250 $300 $350 $400 $450 A llergy* A rthritis A sthm a A ny C ancer D epression/S adness/M entalIllness D iabetes H eartD isease H ypertension M igraine/H eadache R espiratory Infections AnnualCosts Presenteeism STD Absence RX ER Outpatient Inpatient THE BIG PICTURE: OVERALL BURDEN OF ILLNESS BY CONDITION Using Average Impairment and Prevalence Rates for Presenteeism ($23.15/hour wage estimate) Source: Goetzel, Long, Ozminkowski, et al. JOEM 46:4, April, 2004) #GWICF2015
  15. 15. HERO II STUDY – PUBLISHED NOV. 2012 #GWICF2015
  16. 16. RISK-COST IMPACTS – HERO II EXHIBIT 1 Average Unadjusted And Adjusted Medical Expenditures, In 2009 Dollars, By Risk Levels Risk measure Risk level Unadjusted means ($) Adjusted means ($) Unadjusted difference (%) Adjusted difference (% ) Depression High 6,207 6,738 59.1 48.0 Lower 3,902 4,553 Blood glucose High 6,532 6,849 70.0 31.8 Lower 3,842 5,196 Blood pressure High 5,264 5,734 27.4 31.6 Lower 4,132 4,356 Body weight High 4,956 5,078 41.7 27.4 Lower 3,498 3,988 Tobacco use High 4,192 4,184 10.8 16.3 Lower 3,784 3,597 Physical inactivity High 4,477 4,582 26.6 15.3 Lower 3,537 3,976 Stress High 5,024 5,249 13.0 8.6 Lower 4,444 4,836 Cholesterol High 4,780 4,913 2.0 -2.5 Lower 4,688 5,037 Nutrition and eating habits High 3,245 3,261 -23.2 -5.2 Lower 4,226 3,440 Alcohol consumption High 3,857 3,843 -3.94 -9.48 Lower 4,015 4,246 #GWICF2015
  17. 17. Individual vs. Population-Based Costs #GWICF2015
  18. 18. Cost Per Capita of Risk Factors -100 -50 0 50 100 150 200 250 300 350 347 178.6 128.2 106.2 104.1 80.8 38.3 -6.4 -14 -75.4 #GWICF2015
  19. 19. RESEARCH ON RISK-COST RELATIONSHIPS - NOVARTIS #GWICF2015
  20. 20. RISK FACTORS AND PRESENTEEISM (N = 5,875)
  21. 21. RISK-COST RELATIONSHIPS AT PEPSICO #GWICF2015
  22. 22. 10% 16% 4% 15% 15% 5% 23% 77% 18% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% PercentageSamplewithHighRisk HEALTH RISK PREVALENCE Biometric Risks Health Behavior RisksPsychosocial Risks
  23. 23. BMI BREAKDOWN BY CATEGORY 25% 44% 22% 7% 3% 0% 5% 10% 15% 20% 25% 30% 35% 40% 45% 50% Normal BMI < 25 Overweight BMI 25-30 Class I BMI 30-35 Class II BMI 35-40 Class III BMI 40+ PercentageSampleInEachBMI Category #GWICF2015
  24. 24. PEPSICO – OVERWEIGHT / OBESE ANALYSIS (N=11,217) *At least one difference significant at the 0.05 level Source: Henke RM, Carls GS, Short ME, Pei X, Wang S, Moley S, Sullivan M, Goetzel RZ. The Relationship between Health Risks and Health and Productivity Costs among Employees at Pepsi Bottling Group. J Occup Environ Med. 52, 5, May 2010. Difference between combined overweight/obese categories and normal weight is displayed Diff = 29%, $613* Diff = 58%, $111* Diff = 25%, $987 Diff = 10%, $28 Diff = 7%, $49 Diff = 26%, $186* • 74% of the sample is overweight or obese #GWICF2015
  25. 25. NHLBI MULTI-CENTER STUDY: ESTIMATED ANNUAL COSTS OF HEALTHCARE UTILIZATION, ABSENTEEISM, AND PRESENTEEISM BY BMI CATEGORY $1,416 $1,180 $2,034 $229 $1,402 $918 $1,544 $155 $182 $1,200 $872 $1,535 $149 $178 $219 $0 $500 $1,000 $1,500 $2,000 $2,500 Presenteeism Absenteeism Days Hospital Admissions Emergency Room Visits Doctor Visits Normal Overweight Obese * * * * * * P < .05 Source: Goetzel RZ, Gibson TB, Short ME, Chu BC, Waddell J, Bowen J, Lemon SC, Fernandez ID, Ozminkowski RJ, Wilson MG, DeJoy DM. A multi-worksite analysis of the relationships among body mass index, medical utilization, and worker productivity. J Occup Environ Med. 2010 Jan;52 Suppl 1:S52-8. #GWICF2015
  26. 26. Worksite Health Promotion Works! #GWICF2015
  27. 27. CDC Community Guide to Preventive Services Review – AJPM, February 2010 86 Studies Reviewed #GWICF2015
  28. 28. SUMMARY RESULTS AND TEAM CONSENSUS Outcome Body of Evidence Consistent Results Magnitude of Effect Finding Alcohol Use 9 Yes Variable Sufficient Fruits & Vegetables % Fat Intake 9 13 No Yes 0.09 serving -5.4% Insufficient Strong % Change in Those Physically Active 18 Yes +15.3 pct pt Sufficient Tobacco Use Prevalence Cessation 23 11 Yes Yes –2.3 pct pt +3.8 pct pt Strong Seat Belt Non-Use 10 Yes –27.6 pct pt Sufficient #GWICF2015
  29. 29. Outcome Body of Evidence Consistent Results Magnitude of Effect Finding Diastolic blood pressure Systolic blood pressure Risk prevalence 17 19 12 Yes Yes Yes Diastolic:–1.8 mm Hq Systolic:–2.6 mm Hg –4.5 pct pt Strong BMI Weight % body fat Risk prevalence 6 12 5 5 Yes No Yes No –0.5 pt BMI –0.56 pounds –2.2% body fat –2.2% at risk Insufficient Total Cholesterol HDL Cholesterol Risk prevalence 19 8 11 Yes No Yes –4.8 mg/dL (total) +.94 mg/dL –6.6 pct pt Strong Fitness 5 Yes Small Insufficient SUMMARY RESULTS AND TEAM CONSENSUS #GWICF2015
  30. 30. CDC Community Guide Obesity Review #GWICF2015
  31. 31. SUMMARY RESULTS AND TEAM CONSENSUS Outcome Body of Evidence Consistent Results Magnitude of Effect Finding Estimated Risk 15 Yes Moderate Sufficient Healthcare Use 6 Yes Moderate Sufficient Worker Productivity 10 Yes Moderate Strong #GWICF2015
  32. 32. WHAT ABOUT ROI? CRITICAL STEPS TO SUCCESS Reduced Utilization Risk Reduction Behavior Change Improved Attitudes Increased Knowledge Participation Awareness Financial ROI #GWICF2015
  33. 33. HEALTH AFFAIRS ROI LITERATURE REVIEW Baicker K, Cutler D, Song Z. Workplace Wellness Programs Can Generate Savings. Health Aff (Millwood). 2010; 29(2). Published online 14 January 2010. #GWICF2015
  34. 34. RESULTS - MEDICAL CARE COST SAVINGS Description N Average ROI Studies reporting costs and savings 15 $3.37 Studies reporting savings only 7 Not Available Studies with randomized or matched control group 9 $3.36 Studies with non-randomized or matched control group 6 $2.38 All studies examining medical care savings 22 $3.27 #GWICF2015
  35. 35. RESULTS – ABSENTEEISM SAVINGS Description N Average ROI Studies reporting costs and savings 12 $3.27 All studies examining absenteeism savings 22 $2.73 #GWICF2015
  36. 36. The Dow Chemical Company An Environmental Obesity Prevention Program at The Dow Chemical Company NHLBI: 5 R01 HL079546-05 #GWICF2015
  37. 37. • Quasi-experimental – treatment vs. control/pre vs. post (3 data points – baseline, year 1, year 2) • 12 Dow Chemical Company worksites received environmental/ecological interventions at varying levels of intensity • Intervention sites*: Texas (8) and Louisiana (1) • Control sites: New Jersey (1), West Virginia (1), and Louisiana (1) • Other Dow sites in US providing benchmark/comparison data The Dow LIGHTENUP Study ©2009 Google – Map Data ©2009 Tele Atlas *One intense site was part of a business unit that was sold to another company. Data from this site were not included in any process evaluations but were included in other evaluations. #GWICF2015
  38. 38. The Dow Study - Interventions at All Sites #GWICF2015
  39. 39. The Dow Study - Interventions at High Intensity Sites #GWICF2015
  40. 40. The Dow Study: Health Behaviors (T1–T3): High Risk Category #GWICF2015
  41. 41. The Dow Study: Biometric Values (T1–T3) – Cohort Data #GWICF2015
  42. 42. Consistent Improvement in High-Priority Risk Since 2004 Baseline. Between 2004 and September 2011 high priority risks: • the average risk prevalence is improving (see graph). • a 22 percentage point (28%) reduction in high risk people. • a 23 percentage point (20%) increase in low risk people in these three categories. 0.0% 10.0% 20.0% 30.0% 40.0% 50.0% 60.0% 70.0% 2004 2005 2006 2007 2008 2009 2010 2011 Positive Trend in Targeted Health Risks BMI, Tobacco, Physical Activity High Risk Low Risk AvgRiskPrevelance DOW RESULTS: IMPROVING EMPLOYEE HEALTH #GWICF2015
  43. 43. DOW RESULTS • 2004 – 2011 – Saved over $120 Million in US healthcare costs via Health Strategy • In 2011 – 9% better health risk profile than comparison companies – 17% fewer chronic health conditions #GWICF2015
  44. 44. Identifying “Best Practices” in Workplace Health Promotion: What Works? Source: Goetzel RZ, Shechter D, Ozminkowski RJ, Reyes M, Marmet PF, Tabrizi M, Chung Roemer E. Critical success factors to employer health and productivity management efforts: Findings from a benchmarking study. Journal of Occupational and Environmental Medicine. (2007) February; 49:2, 111-130. #GWICF2015
  45. 45. What Is Needed to Achieve Success? 1. Leadership commitment 2. Specific goals and expectations 3. Healthy company culture 4. Employee driven program design 5. Excellent communication 6. Smart incentives 7. Effective screening and triage 8. State-of-the-art interventions 9. Effective implementation 10. Measurement and evaluation #GWICF2015
  46. 46. Creating a… #GWICF2015
  47. 47. Workplace Health Promotion Programs Work – If You Do Them Right! Financial Outcomes Health Outcomes QOL and Productivity Outcomes Cost savings, return on investment (ROI) and net present value (NPV). Where to find savings:  Medical costs  Absenteeism  Short term disability (STD)  Safety/Workers’ Comp  Presenteeism  Adherence to evidence based medicine.  Behavior change, risk reduction, health improvement.  Improved “functioning” and productivity  Attraction/retention – employer of choice  Employee engagement  Corporate social responsibility (CSR)  Balanced scorecard #GWICF2015
  48. 48. To watch Dr. Goetzel’s presentation online, visit: www.icfi.com/ObesityPrevention- RonGoetzel #GWICF2015

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