1. Worksite
Wellness
Evalua0on:
Basic
Strategies
for
Worksites
of
All
Sizes
David
Chenoweth,
Ph.D.,
FAWHP
HPlive.org
Webinar
March
15,
2013

2. Well-­‐planned
Evalua0ons
Can
be
a
Decisive
and
Strategic
Advantage

Assess
quality
of
resources
(personnel,
equipment,
facili>es,
etc.)

Determine
level
of
impact

Allocate
your
budget
propor>onately

Establish
external
benchmarking

Guide
strategic
planning

3. A
growing
impetus
for
evalua0on…
Alcohol Health &
Benefits Abuse Structured “Wellness” Productivity
Recreational Enhancement Treatment Safety Exercise Programming Management
Horseback rides, Occupational “Business Strategy”
Employee
gyms, swimming, • Hershey Assistance Safety & Health •PepsiCo • Quaker Oats
etc. Foods Programs Act •NASA • Union Pacific
•Pullman • Kimberly-Clark • Steelcase
• Sentry Ins. • First Chicago Bank
•NCR
1890 1930 1950 1970 1980 1990 2000 2015

4. Purpose
of
Evalua.on…
“Evalua>on
is
not
research;
it
is
not
done
to
prove
or
disprove
anything;
it
is
done
to
improve
something...”
Research
Evalua>on
“Careful
or
diligent
search”
“Determine
or
affix
the
value
of”
“Studious
inquiry
or
examina9on”
“Determine
the
significance,
worth,
or
condi9on…”

5. The
Seven
Benchmarks
1. Capturing
Senior
Level
Support
2. Crea>ng
Cohesive
Teams
3. Collec0ng
Data
4. CraRing
an
Opera>ng
Plan
5. Choosing
Appropriate
Interven>ons
6. Crea>ng
Suppor>ve
Environments
7. Carefully
Evalua0ng
Outcomes
Courtesy
of
Wellness
Council
of
America
(WELCOA).

6. Perceived
Values
vs.
Actual
Performance…
WELCOA
Faculty
&
Well
Workplace
Checklist
Ranked
Diff.
%
Criteria
@
B-­‐
Webinar
Part.
(480+)
(3,800+)
Benchmarks
vs.
mark
Status
Rank
“Benchmarks”
“Norms”
Norms
(>4
of
5)
1st
Wellness
Opera>ng
Plan
Choosing
App
Inter.
+5
85%
2nd
Sr.
Level
Support
Wellness
Teams
+1
88%
3rd
Evalua0ng
Outcomes
Sr.
Level
Support
+4
100%
4th
Crea>ng
Wellness
Team
Healthy
Environ.
-­‐2
50%
5th
Choosing
Appropriate
Collec>ng
Data
-­‐4
58%
Interven>ons
6th
Crea>ng
Healthy
Well.
Opert’g
Plan
-­‐2
55%
Environment
7th
Collec0ng
Data
Evalua0ng
Outcomes
-­‐2
38%
Source:
Chenoweth,
D.
and
HunnicuM,
D.
WELCOA’s
Benchmark
Survey,
2013.

7. Crea.ng
a
data-­‐driven
evalua.on…
1. Capturing
Senior
Level
Support
2. Crea>ng
Cohesive
Teams
3. Collec0ng
Data
4. CraRing
an
Opera>ng
Plan
5. Choosing
Appropriate
Interven>ons
6. Crea>ng
Suppor>ve
Environments
7. Carefully
Evalua0ng
Outcomes

8. Building
a
prac0cal,
results-­‐oriented
[3-­‐0ered]
evalua0on…
Health
Management
“Financial
Outcome”
“Impact”
“Process”
8

9. Insert
slide
of
Eval’n
book
Financial
Process
Impact
outcome
Chenoweth
&
Associates,
Inc.
9

10. Transi.oning….from
Process
to
Impact
to
Outcome…
is
a
JOURNEY….that
takes
.me…

11. The
essence
of
“tailoring”
an
evalua.on
around
your
wellness
interven.on…
Process
Impact
$
Outcome

12. “Financial
Outcome”
“Impact”
Appraising
the
 Risk
factor
status
monetary
value
to

Behavior
wellness-­‐generated
“Process”

Health
care
usage
impacts
 Produc>vity
Assessing
par9cipant
sa9sfac9on
with
instructor/coach,
facility,
program
quality,
etc.
Jan.
July
December
July

13. “Financial
Outcome”
“Impact”
“Process”
Business
Quan0ty
Performance
-­‐ -­‐
-­‐
-­‐
-­‐
-­‐
-­‐
-­‐
-­‐
-­‐
Financial
Quality
Accountability
Jan.
July
December
July

14. “Process”
Do
employees
like
and
respect
the
wellness
program,
etc.?

Par>cipa>on

Par>cipants’
sa>sfac>on
with:
-­‐
program
content
-­‐
delivery
-­‐
feedback
Jan.
July
December
July

15. “Process”
Evalua.on
[Qualita.ve]
•
Employees’
sa.sfac.on
with
program
content,
delivery,
availability,
facili.es,
instructors,
policies,
etc.
When
using
HRA
and
self-­‐report
tools,
use
non-­‐biased
statements
and
a
quan9ta9ve
index
Please
indicate
your
opinion
with
a
check
mark
on
the
following
scale:
“Level
of
customer
service
provided
by
wellness
staff”
[
-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐]
Very
High
Moderate
Low
Very
High
Low
(5)
(4)
(3)
(2)
(1)

16. “Impact”

Risk
factor
status

Behaviors

Health
care
usage

Produc>vity
“Process”
Jan.
July
December

17. Tools/techniques
for
assessing
IMPACT…

Employee
health
records

Environmental
audit

Culture
audit

Employee
focus
groups

Health
risk
assessment
(HRA)

Biometric
screening

Produc0vity
survey

Medical
care
claim-­‐cost
data

Visual
observa0on
CAUTION:
No
single
technique
is
a
sufficient
stand-­‐alone
diagnos0c
tool
17

18. Conduc.ng
an
IMPACT
evalua.on…
1) Select
key
variables
to
measure
(i.e.,
par9cipa9on,
risk
factor
status,
health
care
usage,
worksite
accidents,
etc.)
2) Iden9fy
your
target
popula9on
3) Prepare
a
format
to
record
and
format
data
4) Collect
data
via
screening,
health
risk
appraisal,
etc.
5) Analyze
data
at
designated
intervals

19. Preparing
a
format
to
record
and
analyze
IMPACTS…
“IMPACT” " Baseline 02" 03
" 04
" 0 5"
Variable" 01
" March" July" Oct.! Dec."
Jan."
Blood"
pressure"
Absences"
Visits to OHN"
Low back
injuries"
Productivity"

20. Recording and analyzing impact data…
Impact" Baseline 02" 01 to 02" 03
" 01 to 03 "
Variable " 01 [Jan.]
" [March]
" % Change " [Oct.] % Change"
!
Blood" 134/90
" 130/89
" -2.3"
pressure"
Absences" 5/100" 4.8" -4.0%" 4.5" -10%"
On-site 348" 346" -1%" 321" -7.8%"
clinic visits"
Low back 3/100" 2.9" -3.5%" 2.8" -6.7%"
injuries"
Productivity" 78" 79" +1.3%" 83" 6.4%"

21. A
sample
IMPACT
variable…
“Rate
the
availability
of
healthy
vending
machine
items:”
Very
Good
Good
Neutral
Poor
Very
Poor
5
4
3
2
1

22. “Financial
Outcome”
Appraising
the
“Impact”
monetary
value
of
wellness-­‐generated
impacts
Jan.
July
December
July

23. …the
real
value
proposi0on…
conver0ng
human
[health
capital
into
business
capital…

Work
performance

Revenue
genera0on

Compe00ve
edge
23

24. Transi0oning
from
IMPACT
to
$
OUTCOME…
Impact
(Non-­‐financial)
Values
$
Financial
Outcomes

BMI
decrease

Blood
pressure
decrease

Physical
ac>vity
increased

Self-­‐confidence
improved

Perceived
performance
higher

Fewer
workers’
comp
claims

Fewer
Rx
drug
claims

Fewer
medical
claims
2
4

25. Ostbye,
T.
et
al.
Arch
Intern
Med
2007;167:766-­‐773.
25

26. When possible, build on today’s standards…(e.g., specificity)…
Source:
Chenoweth
&
Associates,
Inc.;
North
Carolina
League
of
Municipali9es,
Raleigh,
NC,
2010.

27. Medical
care
cost
per
risk
factor
Source:
Chenoweth,
D.
Promo.ng
Employee
Well-­‐Being:
Wellness
Strategies
to
Improve
Health,
Performance
and
the
Bo_om
Line.
SHRM
Founda9on’s
Effec9ve
Prac9ce
Guidelines
Series.
June
2011.
[www.shrm.org/founda9on]

28. Risk Condition Absenteeism Presenteeism Total
Diabetes mellitus 4.94% 18.26% 23.20%
Depression 2.61% 14.51% 17.12%
Alcohol abuse 5.00% 4.78% 9.78%
Obesity 1.40% 8.30% 9.70%
High cholesterol 3.14% 4.91% 8.05%
Smoking 2.84% 4.78% 7.62%
High stress 3.08% 4.45% 7.53%
Arthritis 2.36% 4.90% 7.26%
High blood pressure 0.37% 5.70% 6.07%
Asthma 4.80% 1.20% 6.00%
Migraine 3.96% 1.99% 5.95%
Physical inactivity .28% 4.59% 4.87%
28
Source:
Chenoweth,
D.
2011.
Ibid.

29. Recommended
resource…
Full
Report:
www.shrm.org/founda9on/
products/documents/
6-­‐11%20Promo9ng
%20well%20being%20EPG-­‐
%20Finalpdf
Execu9ve
Summary:
www.shrm.org/about/
founda9on/products/
documents/wellness/%20Exec
%20Briefing-­‐Final.pdf
Chenoweth
&
Associates,
Inc.
29

30. Calcula0ng
the
Cost
of
Lost
Produc0vity
Per
Risk
Factor
“A”
mul9plied
by
“D”
[BxC]
mul9plied
by
“
E
“
=
“F”
Risk
Factor
(A)
%
(B)
#
(C)
(D)
#
At-­‐risk
(E)
Median
(F)
Lost
Workload
Employees
Prevalence
employees
Annual
prod.
cost
Lost
Compens’n
Alcohol
abuse
Arthri0s
.0726
500
.26
130
$50,000
$471,900
Asthma
Depression
Diabetes
High
cholest.
Hypertension
Migraine
Obesity
Phy.
inac>vity
Stress
30

31. Building
a
credible
evalua0on
approach
…
Process
Impact
$
Financial
Outcome
Chenoweth
&
Associates,
Inc.
31

32. CAUTION!
What
are
the
key
prerequisites
for
construc0ng
a
credible
evalua0on?

Suitable
and
suppor0ve
poli0cal
environment

Programs
–
well
established

Sufficient
par0cipa0on

Data
tracking:
pre
vs.
post

Evaluator’s
competence
and
objec0vity
Chenoweth
&
Associates,
Inc.
32

33. Enhancing
the
quality
of
evalua.on
by
establishing
goals
that
are…

compa0ble
with
stakeholders’
needs
and
values

measurable:
variables
that
can
physically
be
measured

quan0fiable:
a
value
(#,
%,
$)
can
be
assigned
to
a
variable

focused
on
an
interven>on
that
has
been
opera0ng
long
enough
to
legi>mately
generate
an
impact

realis0cally
achievable
(e.g.,
wellness
interven>on
is
likely
to
make
a
posi>ve
impact)
Chenoweth
&
Associates,
Inc.
33

34. Wellness
Strategies
and
Impact
Timeframes
Impact
on
Impact
on
Employee
Impact
on
Employee
Organiza>on’s
Health
Wellness
Interven>on
Health
Status
Produc>vity
Costs
Biometric
Screening
12-­‐18
months
Not
well
established
NWE
(NWE)
Condi0on
mgmt
6-­‐12
months
6-­‐12
months
12-­‐18
months
(asthma,
arthri0s,
diabetes,
etc.)
Drug-­‐tes0ng
3-­‐6
months
3-­‐6
months
6-­‐12
months
EAP
12-­‐18
months
12-­‐18
months
>24
months
Ergonomics
3-­‐6
months
3-­‐6
months
NWE
Financial
incen0ves
6-­‐12
months
NWE
NWE
Flex-­‐0me
work
3-­‐6
months
3-­‐6
months
6-­‐12
months
schedule
Health
Risk
NWE
NWE
NWE
Assessment
(HRA)
Low
back
health
6-­‐12
months
Chenoweth
&
Associates,
onths
6-­‐12
m Inc.
12-­‐18
months
34

35. Wellness
Strategies
and
Impact
Timeframes
Impact
on
Impact
on
Employee
Impact
on
Employee
Organiza>on’s
Health
Wellness
Interven>on
Health
Status
Produc>vity
Costs
Medical
self-­‐care
3-­‐6
months
6-­‐12
months
12-­‐18
months
Mental
health/ 3-­‐6
months
3-­‐6
months
12-­‐18
months
depression
mgmt.
Non-­‐financial
NWE
NWE
NWE
incen0ves
Nutri0on
3-­‐6
months
6-­‐12
months
12-­‐18
months
Physical
ac0vity
3-­‐6
months
6-­‐12
months
12-­‐18
months
Smoking
cessa0on
3-­‐6
months
6-­‐12
months
36-­‐48
months
Stress
management
3-­‐6
months
3-­‐6
months
6-­‐12
months
Tobacco
free
worksite
3-­‐6
months
3-­‐6
months
6-­‐12
months
Weight
management
6-­‐12
months
12-­‐18
months
NWE
Chenoweth
&
Associates,
Inc.
35

36. Identifying and acquiring key data for evaluation…
Occupational
Health and
Work/life Safety (Accidents/ Demographics Productivity
Injuries) Management
Medical Ergonomics
claims
Health risk status
Absenteeism/presenteeism (HRA/Screening)
36

37. Designing
a
prac.cal
plan
for
evalua.ng…
Scope
&
Evalua>on
Evalua>on
Evalua>on
Timeframe
Specificity
Goals
Design
Resources
What
-­‐
are
we
-­‐
do
we
want
to
-­‐
design
is
-­‐
types
of
-­‐
Is
an
evalua9ng:
generate:
appropriate:
resources
are
appropriate

program?

internal

non-­‐exp?
needed?
9meframe?

policy?
assessment?

quasi
exp?

benchmark?

incen9ve?

proposal
for
expanding?
Why
-­‐
are
we
evalua9ng?
How
-­‐
can
we
best
use
each
resource?
Who
-­‐
is
the
target
-­‐
is
most
popula9on?
qualified
to
use
each
resource?
Where
-­‐
is
the
evalua9on
-­‐
can
we
obtain
conducted?
resources?
When
-­‐
is
the
best
9me?
Chenoweth
&
Associates,
Inc.
37

38. Iden0fying
WHAT
you
are
going
to
evaluate…
Wellness
Enviro-­‐
Program
Health
Plan
Policies
Cultural
Incen>ves
Health
coaching
CDHP
focus
Smoke
free,
drug
Healthy
work
Health
insurance
with
incen>ves
free,
safety
semng/clean/safe
premium
discount
Fitness
center
Waived
co-­‐pays
Healthy
food
Accessible,
Fitness
center
subsidy
for
main.
Rx
op>ons
aorac>ve
stairways
drugs
Women’s
weekly
Medical
self-­‐ Lacta>on
Healthy
food
Flexible
spending
health
series
care
included
op>ons
account
(FSA)
Lunch
‘n
Learn
Flex-­‐>me
and
Ergonomically-­‐
Health
reimbursement
telecommu>ng
enhanced
account
(HRA)
worksta>on
Walking
club
38

39. Programs,
policies,
and
incen0ve
op0ons…
Physical
Ac>vity
Nutri>on
Informa>on/Educa>on
Other
Stairway
signage
Lunch
‘n
learns
E-­‐mail
daily
>ps
On-­‐site
medical
clinic
Low
impact
walking
On-­‐line
webinars
Bull.
Boards
in
high
Health
Kiosk
with
b.p.
density
areas
cuff,
scales,
etc.
Walking
trails
Color-­‐coded
healthy
Medical
self-­‐care
Quiet
room
vending
items
booklets
Exercise
equip.
in
break
Healthy
potluck
with
On-­‐site
library
5
minute
on-­‐>me
area
recipe
exchange
stretching
Stretch
breaks
Gradually
phase
in
Hlth
mags
in
bathroom
Days
off
for
excellent
healthy
vend.
items
stalls
aoendance
Fit
ctr.
$
subsidies
Fruits/veggies
@
mtgs.
Health
column
in
co.
Establish
smoke-­‐free
newsleoer
worksite
At-­‐work
showers
and
Subsidize
healthier
Lacta>on
suites
for
lockers
cafeteria
food
nursing
employees
Dept.
compe>>ons
“Nutri-­‐>ps”
on
café/
break
tables
39

40. Environmental
enhancements
to
boost
more
physical
ac0vity…
Before
ARer

41. Environmental
[physical
environment]
enhancements…
– Vending
op9ons
– Workout/fitness
space
– Cafeteria
– Hea9ng/cooling/ven9la9on
– Ergonomic/Safety
– Well
lit
areas
– Smoke-­‐free

42. Tailoring
the
scope
of
an
evalua0on…

Process
-­‐
par>cipa>on
-­‐
like/dislike
change

Impact
-­‐
#
of
steps/day
-­‐
#
mins.
exercise/day
-­‐
body
mass
index
(BMI)
-­‐
#
of
health
care
claims
-­‐
perceived
produc>vity

Financial
outcome
-­‐
Health
care
cost$

43. In
a
small
worksite…
PCL
Construc>on
–
Denver,
CO
“Keys
to
Wellness”

Provides
healthy
snacks
in
vending
machines

Fitness
center
subsidies

“Ping-­‐pong”
tables

Local
5K
runs

H1N1
and
flu
vaccina>ons

Annual
on-­‐site
health
screenings

Doesn’t
use
“program”
as
this
creates
a
percep>on
that
healthy
ac>vi>es
are
separate
from
the
company’s
normal
business
prac>ces.
Courtesy
of
PCL
Construc9on,
Inc.
43

44. Aligning
wellness
(programs,
policies,
and
incen0ves)
within
a
feasible
evalua0on
plan…
PCL
Construc>on
–
Denver,
CO
“Keys
to
Wellness”
Strategy
“Process”
“Impact”
“$
Outcome”
Healthy
vending
snacks
√
√
Fitness
center
subsidy
√
√
√√
“Ping
Pong”
√
H1N1
vaccina9ons
√
√
√√
On-­‐site
hlth
screenings
√
√
√√
Compare
medical
care
claims
and
cost
among
par.cipants
vs.
non-­‐par.cipants.
44

45. Sample
tools/techniques
used
for
evalua0on…
Strategy
“Process”
“Impact”
“Financial
(volume
indicators)
(changes)
Outcome”
Healthy
vending
snacks
√
√
(Item
counts)
(HRA,
BMI
scr’g)
Fitness
center
subsidy
√
√
√√
(Par>cipa>on)
(HRA,
biometric
(Annual
claims
scr’g)
data)
H1N1
vaccina9ons
√
√
√√
(Par>cipa>on)
(Aoendance,
(Annual
influenza
flu
claims)
claim
&
cost
data)
On-­‐site
hlth
screenings
√
√
(Par>cipa>on)
(HRA
health
status)
√√
Compare
medical
care
claims
and
cost
among
par.cipants
vs.
non-­‐par.cipants.
45

46. In
a
mid-­‐size
worksite…
Syngenta
Crop
Protec0on

Healthy
snacks
in
vending
machines

Fitness
center
subsidy

On-­‐site
Medical
Clinic

Weight
Watchers™
on-­‐site
program

Annual
on-­‐site
health
screenings
Courtesy
of
Judy
Garreo,
COHN.
Syngenta
Crop
Protec>on,
Greensboro,
NC
46

47. Syngenta
Crop
Protec.on
Strategy
“Process”
“Impact”
“Financial
(volume
indicators)
(change)
Outcome”
Healthy
vending
snacks
√
√
(Item
counts)
(HRA,
BMI
scr’g)
Fitness
center
subsidy
√
√
√√
(Par>cipa>on)
(HRA,
biometric
scr’g)
On-­‐site
Medical
Clinic
√
√
√√
(U>liza>on)
(HRA,
health
records,
(Annual
claim
#
of
medical
claims)
costs)
Weight
Watchers™
√
√
√√
(Par>cipa>on)
(HRA,
biometric
scr’g)
(Pre
vs.
Post
claim
costs)
On-­‐site
health
scr’ning
√
√
(Par>cipa>on)
(HRA
health
status)
√√
Compare
medical
care
claims
and
cost
among
par.cipants
vs.
non-­‐par.cipants.
47

48. In
a
large
worksite…
Bap0st
Health
South
Florida…

“Wellness
Advantage”
award-­‐winning
program

Eight
on-­‐site
fitness
centers
with
2x
annual
open
houses

Classes:
boot
camp,
urban
training,
walking
and
circuit
training

Bi-­‐annual
wellness
fairs
with
free
screenings

$3
Wellness
Meals
(<600
calories
&
<30%
fat)
-­‐
the
fastest-­‐selling
items!
>
Disease
management
program
=
posi>ve
ROI
Courtesy
of
Bap0st
Health
South
Florida
48

49. “Process”
“Impact”
Strategy
(volume
indicators)
(changes)
“$
Outcome”
On-­‐site
fitness
centers
√
√
√√
(Par0cipa0on)
(HRA
status
&
(Annual
medical
biometric
scr’g)
claim
costs)
Classes
√
√
(Par0cipa0on)
(HRA
status)
Wellness
Fair
√
(Par0cipa0on)
Wellness
Meals
√
√
(#
Meals
sold)
(HRA
health
status
indicators)
Disability
management
√
√
√+
(Par0cipa0on)
(RTW,
(Disability-­‐
Produc0vity
specific
claim
indicators)
costs)
√√
Compare
medical
care
claims
and
cost
among
par.cipants
vs.
non-­‐par.cipants.
√+
Track
medical
care
and
Rx
drug
use
and
costs
at
quarterly
intervals.
49

50. Tips
for
Enhancing
your
Evalua.on…

Establish
a
clearly
delineated
goal
or
vision
for
doing
an
evalua>on

Allocate
at
least
5%
-­‐
10%
of
your
budget
for
evalua>on

Iden>fy
key
stakeholders
and
tailor
the
evalua0on
to
their
needs
and
values

Have
a
realis0c
expecta0on
of
what
an
evalua>on
can
produce

Select
only
variables
that
you
can
reasonably
track

Assess
data
sources
and
types
of
data
that
are
available
before
pumng
an
evalua>on
into
ac>on

Give
the
interven>on
>me
to
make
a
genuine
impact

Once
essen>al
resources
(e.g.,
personnel,
equipment,
facili>es,
etc.)
are
iden>fied,
conduct
a
beta
trial
(test
run)
to
iden>fy/resolve
any
barriers
Source:
Chenoweth,
D.
“Decision
Points
Around
Evalua9on.”
AWHP’s
Worksite
Health,
Summer
2001,
8-­‐14.
50

51. Crea0ng
synergism
for
building
successful
evalua0ons
today…tomorrow…and
the
future…
PROCESS
Environment
Programs
Evalua0on
IMPACT
Worksite
Infrastructure
Policies
$
OUTCOME
Incen0ves
51

52. Thank
You!
David
Chenoweth,
Ph.D.
Chenoweth
&
Associates,
Inc.
128
St.
Andrews
Circle
New
Bern,
NC
28562-­‐2907
252-­‐636-­‐3241
EconohealthROI™
www.chenoassociates.com
dave@chenoassociates.com
PRFCA™
CorpWellROI™
52