Posts from — January 2009

Ten Steps Toward Strategic Employee Wellness Programs

The Company Health and Wellness Program management world is evolving rapidly. Each month, there are new  research findings that support the premise that Employee Wellness Programs and disease management have  a long-term impact on health care costs. Many large corporations that started Employee Wellness  Programs three to five years ago are showing savings in health, disability, and workers compensation  costs. Small to mid-size corporations are watching all this and wondering where to start with wellness.

Getting upper management support and budget approval is one of the challenges at the beginning of a  Employee Wellness Program. This is the case because Employee Wellness Programs can be expensive,  averaging $150-300 per worker per year in large corporations. The majority of of the savings are not  realized for a number of years. This long-term investing is hard for corporations on the move.

The key to success for Employee Wellness Programs is to take a strategic approach. Here are ten steps  to consider when starting a Employee Wellness Program.

1. Begin with upper management. Without upper management support, a health promotion strategy can fall  flat. Begin with the health of your executive team and discover your wellness champions at the top of  the employer.
2. Assess the problem. Look at your health care claims and assess the trends. Which conditions are  driving your medical, disability, and workers’ compensation claims and which are modifiable? What’s  worked and what hasn’t thus far? What is the long-term impact of doing nothing?
3. Hold an initial wellness meeting. Invite your key stakeholders both outside and inside the employer.  Ask your broker to facilitate the meeting and invite key health vendors including health, disability,  Employee Assistance Program (EAP), fitness, and occupational nursing. Review claims and utilization  data and identify key areas of concern. Look at current offerings and see how they can be tailored to  the needs of the population.
4. Look at both healthy and unhealthy employees. Since 85 percent of claims are usually attributed to  15 percent of claimants, it is essential to reach those with the most costly conditions while also  reaching staff members who are at risk for developing preventable diseases in the future. Voluntary  Employee Wellness Programs such as lunchtime wellness seminars miss many of the staff members who need  them most. Look at initiatives that are population-wide or target intact workgroups. Wellness  incentives help but do not motivate everyone.
5. Establish short-term goals for the Employee Wellness Programs. Establish some realistic short-term  goals based on your key areas of concern. Are there any plan design changes that could have an  immediate impact on spending? Are there some programmatic actions that could have immediate results?
6. Find out what employees are thinking. Hold some focus groups to determine where staff members are  with wellness. What’s working? What isn’t? How much interest do staff members have in the Employee  Wellness Programs? What obstacles and barriers are employees experiencing when they try to change  behavior?
7. Make sure you have a high-impact Employee Assistance Program (EAP). Your first wellness dollars  should go into upgrading your Employee Assistance Program (EAP). A highly utilized Employee Assistance  Program (EAP) can provide a foundation for all of your future wellness activities. A good Employee  Assistance Program (EAP) is a trusted link to the hearts and minds of employees. At no additional cost,  the Employee Assistance Program (EAP) can provide needed follow-up coaching and personal attention for  employees who are working on modifiable health behaviors or involved in disease management initiatives.  Nutritionists, fitness, pregnancy, and stress management specialists are all part of a high-value  Employee Assistance Program (EAP).
8. Establish three to five year goals for health care savings and measure them. Get help from your  broker and insurance carrier help you on long-term goals for your health, disability, and workers  compensation plans. Establish program metrics that will help you to measure return on investment (ROI).  Go beyond participation rates, completion rates and program satisfaction. Measure changes in readiness,  changes in behavior, and changes in risk factors. Establish rigorous methods to measure health care  savings over the long term.
9. Establish goals for organizational health. Look at the more intangible benefits of a Employee Health  and Wellness Program and quantify them whenever possible. Include worker turnover rates, cost of new  hires, worker morale, benefit satisfaction data, and employer of choice issues in setting goals.  Establish ways to measure success in these areas.
10. Add specifics to your short and long-term plan. Include a Company Health and Wellness Program  strategy, a communication strategy, and a Company Health and Wellness Program incentive strategy that  will fit with your organization culture. Focus on integration of related components along a health  continuum with communications that are focused, simple, and human. Establish a budget that includes key  components such as consumer education, health promotion, Health Risk Assessments (HRAs), and regular  biometric screens.

Employee Wellness Programs are crucial to improving the health of our nations. The majority of adults  spend more of their waking hours at work than anywhere else, making it a excellent venue for promoting  healthful habits. The worksite organizational culture and environment are powerful influences on  behavior and this needs to be put to use as a way of assisting employees to adopt a healthier  lifestyle. Advantages to Employee Wellness Programs include:
• Weight reduction
• Enhanced physical fitness
• Increased stamina
• Lower levels of stress
• Increased well-being, self-image and self-esteem

Companies can also benefit from Employee Wellness Programs. According to recent research, employers’  benefits are:

• Enhanced recruitment and retention of healthy employees
• Reduced health care costs
• Decreased rates of illness and injuries
• Reduced worker absenteeism
• Enhanced worker relations and morale
• Increased productivity

A United States Department of Health and Human Services report revealed that at worksites with physical  activity initiatives as components of their Employee Wellness Programs have:

• Reduced health care costs by 20 to 55%
• Reduced short-term sick leave by six to 32%
• Increased productivity by two to 52%

Thanks to modern medicine, life expectancy for Americans has continually improved. How much we enjoy  these additional years, however, depends greatly on how we have lived our lives. If our quality of life  is to remain high so that we can fully enjoy these extra years, we must practice good eating habits, be  active and refrain from using tobacco products.

Who needs Employee Wellness Programs? If you work in an office or a worksite or are a member of an  employer who spends a considerable amount of time at work, you will benefit from a well-designed worker  Employee Wellness Program. Employees spend a minimum of about 200 hours a month at work – a  considerable amount of time.

Furthermore, stress, distractions and the pressures of the job can take its toll on the worker, which  makes it important that a Company Health and Wellness Program is implemented. Today, all across  America, Canada, Europe and Asia, top Employee Wellness Programs are being used to help improve worker  conditions at work and reduce the cost of worker health care.

Some of the top Employee Wellness Programs currently in use today include:

Health Risk Assessments (HRAs)

Health Risk Assessments (HRAs) is a top Company Health and Wellness Program currently in use globally.  Organizations that begin it determine the safety and health concerns of workers by the assessment of  appropriateness of the facilities and equipment against the needs of the employees.

It can, by way of example, guide the employer into determining how much air quality within an office  room affects the users and then help the assessment team to come up with the measures necessary to  correct the problem. Health Risk Assessments (HRAs) can also evaluate the level of exposure workers  have to certain hazardous or dangerous materials and practices.

Immunizations

This isn’t always practiced in every country since there are regions where government sponsored  immunization shots are available. However, it has also become an important component of the top  Employee Wellness Programs in many corporations in North America.

Immunization, flu shots, such as those used to combat flu, by way of example, are offered to workers  for free.

Employee Assistance Programs (EAPs)

Employee Assistance Programs (EAPs) consist of a wide variety of services. It can range from offering  educational resources to employees regarding health issues to sponsoring health services and medical  care. In many corporations, medical and insurance have also become a staple part of their benefits  system.

Weight Management Programs

This is another Company Health and Wellness Program that corporations use, particularly those that  offer in-house commissary or cafeteria services. Instead of serving richer, high-calorie fare,  cafeterias offer options for a healthier diet, usually in the form of low-calorie foods and sugar  substitutes.

Employee Wellness Newsletters – Health Education Programs

One of the top Employee Wellness Programs that corporations can begin is a self-powered tool using a  newsletter to promote wellness, coupled with a visible campaign. The campaign may be done periodically  and focus on a specific topic, such as tobacco use hazards, cancer, stress, carpal tunnel syndrome,  safety in the worksite, etc.

The newsletter in itself can be an effective way to deliver information to employees or members of an  employer but it is far from perfect. Some employees, by way of example, may not read the newsletter in  its entirety or even pay attention to it. If the issues outlined in the newsletter are promoted through  an active and highly visible campaign, it will be easier to maximize positive results.

Physical Fitness and Exercise Programs

Another top health promotion program for corporations is one that involves physical activities.  Companies often sponsor physical fitness-related events such as marathons and employer sports  initiatives to encourage employees to remain fit or lose excess weight. In mid- to large-sized  corporations, corporations may even pay for gym memberships or in-house physical fitness facilities.

Company Health and Wellness Program Incentives

Some of the top Employee Wellness Programs implemented by corporations involve incentive rewards. This  involves employer-sponsored initiatives that reward employees for achieving specific wellness goals.  Participation in health campaigns and signing up for Employee Wellness Programs are two of the most  commonly rewarded schemes. Rewards can range from special recognitions to points (for bigger rewards)  to specific gifts. In a few cases, cash may also be used.

However, incentive systems have had mixed reactions and levels of success. But it continues to be one  of the top choices among corporations who are willing to modify it in order to fit their unique needs.

Group Activities

In many corporations, corporations take advantage of peer pressure in order to encourage workers to  take part in Employee Wellness Programs. This is currently one of the favorite worker Employee Wellness  Programs currently in use today and growing in popularity. Peer pressure is often leveraged to help  promote competitions and to persuade employees to be active in employer-sponsored health fairs.

Employee Wellness Programs at the organization level are beneficial, right? Wellness statistics clearly  show that such Employee Wellness Programs are not only cost-effective for the employer but can assist  the worker in developing a healthier lifestyle. With the increasing cost of health care, Employee  Wellness Programs simply make sense. So where does the problem come in? Let’s examine the topic from  both perspectives.

Employee Wellness Programs: The Good
• A sampling of return on investment (ROI) for Employee Wellness Programs: Bank of America: 600%;  General Motors:370%; Pepsico: 300%; Citibank: 465%; and the Washoe County School District leading the  pack at a whopping 1,560%. (Campbell,J., Wellness Improvement Experts,  www.wellnessimprovementexperts.com, Albuquerque, New Mexico.)
• Companies with Employee Wellness Programs have realized a 28 percent reduction in sick leave, a 26  percent reduction in adjunctive health care costs and a 30 percent reduction in disability and workers  compensation costs. (Health Affairs, Volume 21, No.2, March, 2002.)
• The Washoe county School District in Northern Nevada realized a $15.60 return on investment (ROI) for  every dollar spent due to a 20 percent reduction in absenteeism. (Hardy,A. (2005). At the Top Of The  Class. WELCOA’s Absolute Advantage Magazine, 5(1), 14-20.)
• Employee Wellness Programs provide the structure, encouragement, incentives and ongoing support that  many individuals need in order to make lifestyle changes.
• Employees also realize returns on their efforts. FiServ, a financial services technology employer,  gave employees who filled out a health risk assessment a significant discount on their medical  insurance premium. (Holland, Kelley, The New York Times, July 22, 2007.)

Employee Wellness Programs: The Bad
The flip side of the argument centers on basic human rights. Do we want/need our employer to tell us to  eat our veggies or lose 30 pounds? Some corporations are doing just that and at least one lawsuit has  resulted because of it.
• Three hundred corporations have requested assistance from a national employment and labor law firm to  institute more aggressive Employee Wellness Programs.(Cornwell, Lisa, Associated Press, Albuquerque  Journal, September 10,2007.)
• Clarian Health, based in Indianapolis, Will start reducing worker paychecks by $10.00 for every  worker who has a Body Mass Index (BMI) of greater than 29.9 because not enough employees were utilizing  their wellness services.(Cornwell, Lisa, Associated Press, Albuquerque Journal, September 10,2007.)
• Scott Rodrigues filed a suit against his prospective employer, Scotts Miracle-Gro, because he  believed the employer’s antitobacco use policy violated his civil rights. The employer has a policy  against hiring employees who smoke and Mr. Rodrigues’drug screen was positive for nicotine.(Holland,  Kelley, The New York Times,July 22,2007.)
• worker advocates are concerned that health discrimination may not be covered under the Americans with  Disabilities Act.(Cornwell, Lisa, Associated Press, Albuquerque Journal, September 10,2007.)

Penalizing employees by hitting them where it hurts the most,their pocketbook, does not appear to be a  a good approach to molding human behavior.
Such tactics may result in increased resentments and retaliation, primarily in the form of absenteeism  and presenteeism (decreased productivity on the job.) Voluntary, incentive-based initiatives, such as  the one in the Washoe County School District, can and do produce results. A positive attitude on the  part of management along with an opportunity for employees to have a stake in the decision-making may  yield the greatest dividends to both employer and worker.The motivation and resolve needed to change  unhealthy lifestyle habits can best be derived from the basic tenets of encouragement, respect and  support.

Getting Started – Secure management support
• Justifications for having a Wellness Fair
• Health Risk Assessments (HRAs)
• Help for high-risk population: smokers, obese employees
• Early detection of diabetes, heart disease risk factors (high cholesterol, high blood pressure)

Wellness Fair Participation – Establish your audience
• Employees only, whole family, retirees?
• Community involvement? Theme?

Wellness Fair Time Line
• Establish a date and time Allow 4-6 months of planning time

Wellness Fair Planning
• Establish health-related screenings, tests, other activities you’ll offer Establish educational  literature and other learning opportunities Wellness Fair will provide Include any “fun” activities, or  food/beverage needs for the fair

Wellness Fair Location & Logistics
• Look at location big enough to accommodate the largest volume of staff members at “peak time” periods
• Determine how booths/stations will be set up

Wellness Fair Vendors
• Target relevant health/safety-related community and corporate vendors to provide services,  educational materials, incentives and giveaways

Wellness Fair Marketing
• Determine marketing tools to be used to inform employees/participants (posters, mailings, e-mail)
• Determine any incentives or giveaways that will be included in the fair or used to encourage  participation in the fair

Wellness Fair Scheduling
• Coordinate timing and events with staff and/or volunteers

Wellness Fair Personnel
• Schedule appropriate experts Physician or similar health care personnel to provide patient  consultation for review of blood draw lab results
• Nurse(s) to administer vaccinations
• Administrative/all-purpose individual to facilitate paper work, finger sticks and to provide general  assistance
• Pharmacist or pharmacist assistant if appropriate Dietitian for nutritional counseling suggested  personnel designated for health fairs

Footnotes

1 The Robert Wood Johnson Foundation via Reuters Health E-Line.
2 Kaiser Daily Health Policy Report, (9/11/03)
3 www.cdc.gov/nccdphp/dnpa/press/archive/lower_cost.htm
4 “Is Stress Nibbling Away at Your Bottom Line?” By Stephen Alper, Nov. 15, 2002.
5 Health Promotion in the Workplace, Michael P. O’Donnell, page 415.
6 http://www.bmpcoe.org/bestpractices/internal/dayto/dayto_6.html

According to Gordian Health Solutions, the effectiveness of Employee Wellness Programs in improving  health and reducing health care costs is directly linked to incentives: the more substantial the  incentives, the higher the success rate. Incentives can range from tokens of achievement, such as  t-shirts, water bottles and sports equipment, to more substantial financial awards, such as cash  incentives or copay vouchers for the successful completion of a program.

Nationwide Insurance is seeing results from a small incentive program initiated by one of the  employer’s worksite nurses. To encourage lunchtime walking, the worker has informally launched a  “shoelace program” modeled after the karate-belt color system. Employees progress through the color  scale until they reach “black-lace” status. The reward system has resulted in more employees making  commitments to walk during their lunch hour.

At the high end of the reward spectrum, some corporations pay cash to employees who meet wellness  goals. LuK, Inc. offers employees $250 for kicking the tobacco habit and remaining smoke free for 12  months. For logging fitness points that add up to 10 miles a month, employees are eligible for health  assessments, which can result in reward amounts of up to $225.

The most effective motivator, according to Gordian research, comes through linking participation in  Employee Wellness Programs directly to insurance premiums. Doing so clearly demonstrates to employees  the positive effects of wellness on their own health care costs. often, the first step in linking  wellness programming to insurance coverage is lowering deductibles for wellness care or eliminating  deductibles altogether. By adding this benefit, corporations can encourage employees to undertake  routine screenings and other procedures to respond to health problems before they become chronic. Early  detection benefits both patient health and employer health costs.

Incentivizing Company Health and Wellness Program participation with health care credits

More frequently, corporations are going beyond improved wellness care coverage and looking to  demonstrate the importance of wellness by linking participation to employees’ bottom lines. Worthington  Industries has recently rolled out a program that allows employees to eliminate their portion of the  insurance premium by enrolling in a Healthy Choices Employee Wellness Program.

During the first year of the Healthy Choices program, employees and their spouses complete Individual  Health Assessments and medical screenings to determine their levels of health risks. Nurses, dietitians  and physical fitness specialists are available to help moderate- and high-risk participants develop  individual action plans for improved health through the use of educational materials, behavior  modification, telephone help from third-party program health coordinators, and formal health management  initiatives. By completing the assessments, employees earn their full premium credit. Because some  plans at Worthington require no worker contribution, a cash award takes the place of a credit in those  cases.  During year two of the program, the wellness bar is raised slightly. To continue to receive the  wellness credit, participants in the moderate- to high-risk category will be necessary to work at  setting goals with third-party health coordinators.

Year three raises the bar again, requiring participants to show progress in meeting goals and to  continue to work with health coordinators to reach goals.

After year three, Worthington Industries employees will be on the wellness track. The employer believes  that will mean a healthier workforce and cost savings for employees and the employer. The well being of  Worthington employees is the foundation of this program, and both employees and the company are  expected to benefit from the long-term advantages of the Healthy Choices Employee Wellness Program.

While Worthington has taken a broad approach to wellness, other corporations have found success in  offering incentives in specific areas. Longaberger, for example, offers a discount on health care  policies for employees who do not use tobacco. An individual worker who doesn’t use tobacco saves $7  per bi-weekly pay. For tobacco-free employees with family coverage whose families are also  tobacco-free, the savings increases to $14 per pay.

The next step: Penalizing harmful behaviors

As it stands, health care is the only type of insurance that doesn’t focus on penalizing for behaviors  that put the insured party at risk. With health care costs increasing so dramatically, that could soon  change. Just as an accident likely raises auto insurance premiums, increasing premiums for those who  engage in unhealthy behaviors is a possible next step in employers’ attempts to manage health care  costs.

Reports that employees would support this type of action are stacking up. One Ohio employer conducted  an informal survey that indicated employees would consider it a morale boost if health-conscious  employees were relieved of some of the burden of subsidizing care for employees who engage in behaviors  that adversely affect their health. Whether or not this type of program gains popularity, one thing is  sure: the need to control the rise in health care costs is becoming ever more pressing.

The Last Step: Getting Started

No matter what strategy, from offering employees health resources to offering incentives for healthy  behaviors, corporations have a real opportunity to improve morale and productivity, reduce absenteeism  and control health care costs through wellness. The first step is committing to taking one, no matter  what size effort is appropriate for your organization.

Small steps lead to big strides.

Preventing injuries is a high priority for corporations, especially in factory settings such as Honda.  That’s why the employer offers several initiatives—including line-site process evaluations —to identify  potential hazards and help reduce the chance of injury. As part of an early intervention program, Honda  employees who are feeling pain can receive a massage of the affected area during work time.

Stretching initiatives are another effective tool in injury prevention. According to the Best Practices  in Manufacturing Web site, Dayton Parts, Inc. (DPI) in Harrisburg, Pa., conducted research that  revealed approximately 80% of all manufacturing injuries occurred within the first two hours of each  shift. After implementing a program that required production employees to stretch for 10 to 15 minutes  at the beginning of their shifts, they saw a dramatic reduction in injuries.

While the DPI Company Health and Wellness Program costs about $75,000 a year to operate, in conjunction  with other employer initiatives, it has helped bring the annual cost of workers’ compensation from  $700,000 to $200,000 per year.6

To help prevent lengthy absences and reduce workers’ compensation claims, Honda instituted a work  recovery program. Through the program, workers who have had an injury can work in a modified  job—getting better. Employees in the program spend their work days receiving physical conditioning to  increase overall fitness, physical therapy to restore functionality, health education and nutrition  counseling. The program is based on data that shows fewer work days are lost when an worker stays  connected to the work environment.

The Ohio Bureau of Workers’ Compensation, www.ohiobwc.com, provides a “10-Step Business Plan” as a  guide for corporations in offering Employee Wellness Programs that aim to reduce injuries. The plan  includes information on safety and health initiatives to prevent occurrences of on-the-job accidents,  including:

worker involvement – To ensure the success of any Employee Wellness Program, employees must take part  in the safety and health-management process. This can be done through safety and health audits,  accident investigations, or by forming safety and health involvement teams, focus groups or committees.

Orientation and training plan – Conduct orientation and training sessions to educate employees on the  employer’s safety policies. These sessions should include procedures for the safe use of machinery and  tools, chemical hazards and how to prevent contact or exposure, specific job/task safe practices, and  hazard recognition and prevention.

Communication – Open communication keeps employees informed and provides suggestions and feedback on  the effectiveness of the Employee Wellness Program. Through memos, bulletin boards and staff meetings,  important safety and health information can be conveyed throughout the organization, keeping all  management staff and employees knowledgeable about the employer’s safe practices.

The employer plan also outlines incentives for post-injury procedures, including:

Medical treatment and return-to-work practices – arly return-to-work strategies help injured or ill  workers return to work in a timely manner. Companies should begin a disability management policy to  help injured or ill employees obtain quality medical treatment, making their transition back to work  quick and effortless.

Timely notification of claims – Companies should document worksite injuries immediately after they  occur and promptly send that documentation to a claims handler. Quickly offering claim information  demonstrates care and concern for the injured worker, prevents delays and confusion with the claim  process, and reduces the potential for abuse or needless litigation.

Record keeping – Internal documents should be kept to record work-time injuries and to assess the  success of the employer’s safety efforts. Corporation audits, surveys and injury or illness reports can  all be used to assess which safety practices and policies have proven successful, and what areas of  health and wellness need improvement.

Dr. Moore of Nationwide maintains that immunization is the most cost-effective treatment in medicine.  For example, vaccinating children against the influenza virus averages a savings (including health care  costs, parents’ missed work, etc.) of up to $35 per vaccine recipient. And experts predict that  estimate is low, because it doesn’t take into account the rapid spread of the flu.

The American Association of Family Physicians’ Web site, www.aafp.org, offers a recommended adult  immunization schedule created by the Advisory Committee on Immunization Practices. This schedule,  tiered by age and chances of exposure, recommends diphtheria, tetanus, influenza, pneumonococcal,  hepatitis B, hepatitis C, measles, mumps and rubella, varicella and meningococcal vaccinations.

Ideas to incorporate prevention and early detection:

• Hold a wellness fair and invite organizations that provide testing services for such conditions as  blood pressure, blood iron, cholesterol, body mass index (BMI) and diabetes.
• Provide educational materials about well-baby care and vaccinations.
• Choose health care coverage plans that include wellness check-ups and vaccinations.
• Provide worksite mammograms for employees.
• Sponsor worksite flu vaccinations to coincide with flu season.

Advantages of Stress Reduction Programs

While stress cannot be eliminated from life, or even from the worksite, coping skills can be developed  with relative ease. Stress management skills lead to reduced absenteeism and more effective, more  productive employees. Because stress has been shown to contribute to such physical conditions as  ulcers, high blood pressure and stroke, stress reduction has a direct impact on improving physical  health.

Studies have shown that heart patients who attend stress management initiatives have 42% lower health  care costs. Other studies have documented a 50% reduction in medical services use when stress  management initiatives are employed. Further, Employee Assistance Program (EAP) experts estimate that  20% of any workforce is affected by personal problems that can influence work performance.

Stress reduction tactics to consider:

• Provide worksite yoga or meditation classes.
• Organize support groups among employees.
• Sponsor stress management classes during the workday.
• Provide an employee assistance program that includes both counseling and referral.
• Provide worksite counseling for employees in the case of a work-related trauma, such as the death of  a co-worker.

Advantages of Prenatal Care and Breastfeeding

The old adage “an ounce of prevention is worth a pound of cure” is particularly relevant to when  applied to preventive measures taken during pregnancy, when a few extra ounces of birth weight can save  a child’s life. During pregnancy, simple precautions can help avoid catastrophic results; giving up  tobacco use, for instance, drastically reduces the risk of miscarriage and pre-term labor.

The March of Dimes reports that if all women took adequate folic acid before conception and during  pregnancy, the number of babies born with a neural tube defect could drop by as much as 70%. The  physical and emotional benefits of proper prenatal care to a mother and child are underscored by a  strong employer case for offering prenatal wellness benefits. Nationwide’s Chief Medical Director, Dr.  Michael Moore, estimates costs to care for one baby delivered prematurely could approach $500,000.

First steps in fostering a prenatal program:
• Invite the March of Dimes to present information about prenatal health at an worker brownbag lunch or  breakfast meeting.
• Hold prenatal care information classes for interested employees at lunchtime.
• Provide educational materials about the effects of alcohol, drugs and tobacco use on an unborn child.
• Provide incentives for adopting healthy lifestyles during pregnancy.
• Provide prenatal initiatives and education as part of the employer health care package.