University of Michigan

MHealthy supports U-M’s philosophy that well-being encompasses the whole person with many factors playing a role in achieving balance, purpose and vitality at work and home. U-M is dedicated to delivering effective, evidence-based health and well-being programs and services that improve people’s lives and foster a culture of health at the university.

MHealthy offers a wide variety of health behavior change programs and services that are organized around a socioecological approach that intervene on the individual, interpersonal, and organizational level. Many of the programs utilize motivational interviewing and the transtheoretical model framework; for example, our outpatient tobacco cessation program utilizes motivational interviewing and our inpatient tobacco cessation program utilizes the transtheoretical model. Counselors use a patient’s staging to inform their next step in intervention and how they follow up.

Leadership training courses focus around specific organizational development strategies. These include aligning organizational values to the company culture, where the company culture is a philosophy of well-being with eight dimensions of well-being (physical, emotional/mental, environmental, financial, occupational, social, intellectual, and spiritual health). Workshops are also designed around the human experience in that participants are highly encouraged to share their stories, successes and failures. Many of these principles are also used across strategy, programming, and communications. MHealthy has worked with many faculty across the university to develop various models and principles to guide its work.

Kristi Rahrig Jenkins

2060 Wolverine Tower, 3003 South State Street, Ann Arbor, MI, 48109

734-395-2888, kristirj@umich.edu

 

The methods used to evaluate MHealthy for this application include descriptive statistics as
well as bivariate tests (e.g. McNemar’s) and advanced statistical modeling. These advanced
statistical models include multivariate logistic regression and linear mixed-effects regression
while using various methods such as propensity score matching and co-variate controls to
control for confounding factors in these associations and relationships.

The results from these analyses show that:

1. There are percentage point decreases between 2009 and 2019 in seven of the eight
   health risks, and all seven associations are statistically significant.
2. Defining participation as participating in the wellness program all 4 years, the percent
   increase when comparing 2016 and 2019 medical and pharmaceutical claims costs is lower
   for participants than non-participants.
3. U-M has lower per capita claims costs for each year reported compared to the IBM
   Watson Health University benchmark.
4. The percent increase when comparing 2016 and 2019 illness-related absenteeism is
   lower for participants than non-participants.
5. Illness related absenteeism is lower for the U-M compared to the BLS benchmark.
6. The percent increase when comparing 2016 and 2019 turnover rates is about the same
   for participants and non-participants. However, participants have lower turnover rates
   compared to non-participants. Also, participants compared to non-participants have lower
   odds of subsequent turnover.
7. Turnover is lower for the U-M compared to the CUPA-HR benchmark.
8. The majority of U-M employees surveyed agree that overall, U-M has a strong and supportive culture of health.
9. MHealthy has much higher scores on the HERO scorecard compared to HERO’s
   national benchmark.

• 2021_U-M_Koop Application_Public

REVIEWER 1

• Impressive, well-articulated MHealthy mission/vision and strategic and operational goals provide readily-evaluated roadmap beyond that seen in many programs.
• Very comprehensive programs resources aligned with organizational strategy and goals.
• Explicit, resourced focus on social determinants of health.
• Statistically significant improvements in 7 of 8 health risks measured over 10-year period.
• Participant/non-participant outcome comparisons generally support positive impact
• Turnover impact positive and substantial in both participant/non-participant and benchmark comparisons.

REVIEWER 2

• Robust program with lots of resources. Partners with offices across the university to build alignment.
• Shifted to telehealth for tobacco cessation, alcohol management, mental and emotional health, and medical ergonomics programs during the pandemic.
• Well-defined program with vision, mission, goals, and principles.
• Health risk reduction 2009-2019.
• Use of propensity score matching.
• Excellent results on the HERO scorecard.

REVIEWER 3

• Excellent view of holistic health and understanding how the work environment can influence one’s health.
• Very well integrated with other aspects of the university that can impact health.
• The specific health outcomes are in a positive direction and important to highlight the changes in questions which can impact the comparison.
• The data collection on health disparities is very good and I like the statement about maintaining a sense of humble curiosity since there is much to learn.
• The comparison with benchmark organizations for absence and turnover is a nice addition.

REVIEWER 4

• Strong wellness design. Comprehensive program which did a good job addressing the challenges to health and wellbeing initiated by the pandemic. Specifically, program shifts to address emotional wellbeing (especially targeting connectedness and social isolation), financial and other needs during the pandemic are noteworthy.
• Leadership training to support a culture of health. Multiple dimensions were addressed, and a strong focus could be seen on promoting a wellness culture.
• Strong socioecological foundations.
• Focus on disparities and health equity.
• Targeting essential workers was commendable.
• Digital innovations were a plus.
• Strong community health approach – this is an often inadequately targeted area. Per the WHO, healthy workplaces should include attempts to improve the health and wellbeing of the surrounding communities – this was a welcome inclusion.
• Good evaluation and outcomes approach.

REVIEWER 5

• Conflict

REVIEWER 6

Individual-level efforts:

• Very comprehensive program addressing many areas of well-being including occupational health, spiritual well-being, financial well-being, and loneliness/isolation among the more typical areas of physical, mental, emotional well-being.
• Compelling program components include emergency hardship fund and crisis support services, low interest rate loan program, loneliness, and social isolation resources.
• Strong representation of AMSO model components.

Organizational-level efforts:

• Strong integration with partners across university, including Poverty Solutions Center, Disability Management, DE&I, Organizational Learning, and others.
• Strong commitment to ongoing evaluation and process improvements as represented by written, objective goals that align to strategic priorities.
• Development of a leadership dashboard is impressive.
• Strong Wellness Champion network.
• Integration of measures into organization’s Culture of Health survey.
• Integration of well-being into upper leadership and managerial leadership training is exemplary.

Methodology:

• All outcomes were supported with a very complete methods table.
• Evaluation design, sample sizes and ratios were reported along with information on data used, data handling/adjustments, and statistical analyses.
• Cost impact analyses included differences-in-differences approach, propensity score weighting, and control for potential confounders.

Health Outcomes:

• Demonstrated improvements in 7 out of 8 reported health risk areas over a 10-year period, based on a validated health risk assessment survey.
• Use of statistical comparisons in risk change comparisons.

Organizational Outcomes:

• Demonstrated improvements on at least two measures in Culture of Health Survey
• Demonstrated improvements in some cohorts for medical costs, illness-related absence, and turnover.

Comparative Analyses:

• While medical cost and absence cost trends were not favorable compared to benchmarks, the attempt to do the analysis with the level of rigor used is exceptional.
• Turnover analyses compared to benchmark were more favorable.

Innovation:

• Use of Resource Coach Program could not have been more timely given increased awareness of social determinants and the specific challenges associated with COVID.
• Special efforts to address health inequities and attention to DE&I is noteworthy.
• Actions to increase accessibility and accommodations for diverse abilities is noteworthy. Incorporation of Stress Response team, Resilience Rounds, support groups, and resources for the community on coping with remote work/school arrangements is noteworthy.

REVIEWER 7

• Demonstrated decrease in risks (table 4) for low back pain, nutrition, depression and anxiety, etc. (albeit there is mention of measurement changes for nutrition and back pain over the studied timeframe). Note also made about increasing age likely possibly responsible for obesity increase.  The top two reductions, low back pain and nutrition risks, appear to match to targeted services per next point.
• Targeting of “high risk” occupations such as logistics and support services, lower wage workers around nutrition, finances and musculoskeletal supports including for nurses and other vulnerable occupations.
• The vast majority of employees who participated in the HQ also participated in programs (n=15,207). 4,107 employees participated in programs all four years (2017 included).

REVIEWER 8

• MHealthy is a premier integrated, comprehensive wellness program that serves the faculty, staff, students, retirees, family members and community of the University of Michigan. This robust program sets the standard for program design and evaluation with fully supported leadership and infrastructure.
• In addition to a program, the approach focuses on leadership engagement, strong communications, a culture and environment of health. The program design also lends itself to strong collaboration with partners - both within and external to the University.  The Wellness Champion network, extraordinary staff, and sustained efforts all demonstrate a commitment to health and well-being. U-M has a history of leading efforts in the University space and this application serves as a true reminder of the vision and leadership that designs and delivers this effort. The data analytics (and internal staff) are also unique for wellness programs.
• The inclusion of a third-party vendor provides additional insight and program metrics to both evaluate and strategically guide the program. Health improvements over a 10-year period were significant with all measures outside of BMI.
• Ongoing and sustained cost and absentee measures over time, plus favorable turnover data.
• Tremendous creativity and innovation for Covid-19 transition. Leaders in health and well-being innovation to include resource coaches, health equity, and community engagement.

REVIEWER 9

• Overall very good program and application!
• Comprehensive goals and thoughtful changes in program direction over the years
• Comprehensive offerings – good use of internal experts
• Able to demonstrate significant risk reduction from 2009-2019
• Good participant/nonparticipant results – healthcare, absenteeism, and turnover
• Good COVID response
• Liked how addressed health disparities
• Great work to address company culture

REVIEWER 10

• Loved that the program is focused on not only faculty, staff, but also patients, students, families, and community.
• Nice organizational measures from survey (supervisor support of well-being). Interesting and valuable correlations with participation and turnover, and absence.  I am curious of how job type and tenure in role contributes to turnover and absence and would recommend controlling for this in future analysis given the nature of some roles having higher expected turnover than others in hospital/university populations.  Especially given that younger and lower wage earners were found to have higher turnover.  The participation in the organizational survey is rather low at 16%.
• Overall, good, comprehensive programming. Very nice inclusion of social determinants concerns in programming with Resource Coach and food insecurity programs.

REVIEWER 11

• The application is very well organized and clearly written.
• Strategic and operational planning is outstanding.
• Macro-level goals are comprehensive in scope, sufficiently ambitious to be challenging, but realistic. The challenges established by leadership following the 5-year evaluation reflect insight into the organization’s dynamic needs.
• Focusing on a small number of relevant scientific principles provides a feasible strategy to enhance outcomes. You are fortunate to be able to draw on so many experts.
• Sounds like you adapted your efforts well to overcome logistical challenges created by COVID.
• Individual program offerings are very comprehensive.
• The “Why” Wall and related campaigns and “Be Kind, Be Well” to enhance social responsibility sound like great ideas.
• Organizational integration is outstanding.
• Methodology used to measure medical costs, absenteeism and turnover are strong, outcomes are good and having multiple outcomes measured is outstanding. Results of the culture survey are encouraging despite the small sample size.
• Your self-reported scores for the HERO Scorecard are very strong relative to the national average. It sounds like you attribute the 8-point drop between 2016 and 2019 to “measurement error” caused by lack of objectivity caused by self-scoring.  Has that nudged you to consider what you might do to increase objectively of these self-scores?
• The ways you are integrating equity into your offerings is encouraging. You seemed to adapt to COVID very well. I wish we could have seen participation rated for 2020. Your strategies to reach a distributed workforce are creative. Your efforts to serve the community are laudable but the rationale for doing so is not clear.  Are you trying to reach children of employees, enhance the image of UM in the community, or serve some other purpose?

REVIEWER 12

• Conflict

REVIEWER 13

• This is an exemplary program from individual to organizational goals, programs, and evaluation. Comprehensive services for all lifestyle and wellbeing issues. Highly innovative approaches to addressing diverse, remotely distributed and socially vulnerable population.  Impact on health risks address 7 out of 8.  Impact on claims costs and absence showed significant cost savings and lower absence.  Culture of health indicators remain strong over time.  Participation meets standards even in this challenging environment including health system and all faculty and staff.
• The application was well written and addressed all the requirements. MHealthy has drawn on its unique and incredibly valuable internal assets with best-in-class researchers, practitioners, and physical infrastructure.
• The focus on intrinsic and extrinsic motivation was also very strong with the “What’s your why?” approach combined with cash and SWAG

REVIEWER 14

• Conflict

REVIEWER 15

• Organization: This well documented application shows a strong commitment by the University to health promotion and disease prevention.