Comprehensive Wellness Management Changes Behaviors
Joe Kuchera and fellow management at Western New York's Unifrax I LLC knew not to expect an immediate return on investment when infusing nearly a quarter of a million dollars into a year-long workforce wellness program for employees plus their spouses.Regardless, one year after the program was introduced by a third-party health promotion provider, the percentage of people at risk of health complications due to nutrition, exercise, weight and stress decreased. And little by little, the first signs of a culture shift started appearing - from the employee who committed himself to a weight-loss program after originally intending to be just a program observer, to company leaders who sat beside their employees to learn about health topics and hit the pavement for company-sponsored walks.Wellness is not a 100-yard dash. Quick fixes don't work, nor do haphazard programs with few resources or little foresight.Comprehensive Wellness Management is the answer.
Why Comprehensive Wellness Management?
A Comprehensive Wellness Management program is:
- Dependent on data (through assessments) to identify needs and set goals
- Proactive, stressing prevention through education and one-on-one counseling (through health coaching)
- Inclusive of incentives to encourage healthy behaviors and lifestyles
Combined, these tools not only provide a well-rounded approach, but a powerful foundation for implementing a successful behavior modification infrastructure, which is necessary for sustained lifestyle changes.Comprehensive Wellness Management is the best way to create a culture whereby individuals do not feel pressured to take action, but comfortably ease into attending educational sessions or fitness classes, or seek the counsel of an expert on their own accord. Individuals are encouraged to make change for themselves.Comprehensive Wellness Management empowers employees.
Unifrax seeks long-term lifestyle behavior changes to decrease health risks. Changes begin at home, so it made sense to include spouses in a program.Recognizing that they needed to provide a supportive environment, officials designed a program with three primary features: health factor awareness and incentives, wellness education and health coaching, and policy changes.The initiative would also focus on three "modifiable" risk factors that have the most critical impact in leading to potential health hazards: tobacco use, blood pressure and cholesterol ratio.Health promotion professionals are typically the force behind shaping a company's wellness program. However, Unifrax proved to be a true intellectual consumer by researching what works and what doesn't, and came to the table knowing exactly what they wanted to achieve.For delivery, they turned to the expertise of a Western New York-based company offering the gamut of health promotion services, from health data gathering to health coaching. It was important for employees to be engaged through in-person interaction with an accessible, flexible multidisciplinary team of health professionals.The program kicked off in February 2009, one year after a pilot launched at an Indiana Unifrax facility.
All employees - including both full-time and part-time - and their spouses were eligible to participate. Every participant initially underwent a 45 to 60 minute health assessment to obtain real-time data in capturing a snapshot of personal health.Data is integral to not only raise awareness of health status, but to identify the changes needed for improvement and determine personal goals. An accurate view was gained through the following assessments administered by the professional third-party team:
- Biometric screening to determine blood pressure, glucose and cholesterol levels
- Fitness assessment to gauge physical fitness through weight, BMI (body mass index), body composition, girth measurements, lung volume, flexibility and strength
- Health risk appraisal (HRA) to analyze overall wellness through self-reported data, including physical and emotional factors, and possibly unlock clues to health concerns
Individuals received a personalized, comprehensive 12 page report of their biometric data. Each person met confidentially with a health professional to decipher the results and have questions answered. Immediate discussion of the collected data provided an "educational opportunity" - an essential step in successful behavior change.Nutritional habits were discussed, ideal weight was calculated and short- and long-term goals were set. Participants were urged to start a personal health file and share it with their physicians.Reports contained an overall wellness score based on a 0 to 100 scale. Scores were also assigned to eight health factors: weight, exercise, nutrition, stress, smoking, cancer risk, cholesterol and blood pressure. Less than 80 in any category placed the individual "at risk" for adverse health outcomes, such as cardiac issues, cancer or other significant illness.Assessments were used to increase awareness about overall employee health among company executives, who were provided aggregate data that compared risks appearing companywide with national averages, such as high blood pressure or the occurrence of being overweight. This data was delivered blindly - reported as a whole through scales and percentages, and not connected to individuals.
Impacting the Individual
Pre-assessment findings prompted the offering of hour-long classes targeted at nutrition and eating sensibly, diabetes risk, tobacco and physical activity. An injury prevention program was delivered based on the high occurrence of employees visiting doctors for musculoskeletal problems.Kuchera said that the most successful component of the program proved to be one-on-one health coaching. Sixty-four percent of individuals who received attention from health coach-advisors rated it as "excellent," while 29 percent found it to be "very good."The service was optional for those deemed to be within the top 50 percent of being at risk for health issues. Qualified individuals received 20 minutes each month of confidential health advisement from credentialed health professionals and were provided access to open office hours if extra time was needed.Health coaching institutes a layer of accountability, and delves into personal health issues, behavior concerns, family health history and risk factors. Health coach-advisors ask the right questions and listen to build trust. They break down barriers to address the underlying causes obstructing positive choices, whether the culprit is family habits or a lack of knowledge, and point participants toward resources in the community. Sometimes, they are simply a non-judgmental sounding board.Most importantly, health coach-advisors empower individuals to identify their own pathways, making for a stronger approach more likely to result in sustainable change.Although not everyone responded on the same level, many individuals were actively engaged in the program and attended the coaching sessions each month, whether through in-person appointments, phone calls or communicating via email. Less than 2 percent of the eligible population initially declined involvement and, overall, 90 percent continued to receive health coaching for one year.
Championing the Program
If Unifrax was to expect participation, its leaders needed to buy into the program. Not only did they involve themselves alongside employees, but the company joined the "eat well live well" challenge - a free, online, eight-week program designed by grocer Wegmans to encourage healthier living.The company's top decision-makers also gave a large boost to the program by rewarding participants who successfully met targeted goals.A married couple could potentially earn $700, deposited in their health savings account. Each participant received $50 for solely participating in the assessment. Thereafter, the post-assessment completed six months later determined the incentive payout. Participants earned $100 for each of the following criteria met:
- A blood pressure of 120/80 or less
- A cholesterol ratio equal to or under 4.5
Health professionals returned six months after the program start, in September and October 2010, to conduct a posttest.From winter 2010 until then, the average overall wellness score increased from 68 to 71. The percentage of people considered to be at risk in the top four risk areas of nutrition, exercise, weight and stress decreased considerably over 6 months. The comparison is outlined in Table 1 below.
Improvements were seen in the following categories: systolic blood pressure, dystolic blood pressure, BMI, cholesterol ratio and the number of recorded tobacco users. There was very minimal change in body composition. The results are represented in Table 2 below.Winter 2010 Pre-TestFall 2010 Post-TestDataScoreRisk CategoryScoreRisk Category% changeAverage Systolic Blood Pressure123.5 mmHgPre-Hypertensive121.4 mmHgPre-Hypertensive1.7Average Diastolic Blood Pressure81.4 mmHgPre-Hypertensive79.4 mmHgOptimal/Normal2.5Average BMI29.8 kg/m2Overweight28.5 kg/m2Overweight4.4Average Body Composition27.8%Moderate Risk27.9%Moderate Risk-0.004Average Cholesterol Ratio3.8Good3.3Good13.2Number of Tobacco Users70N/A62N/A11.5
Though it is too early to determine healthcare cost savings after just one year, Unifrax can eventually expect a 2-to-1 ROI, minimally, if it continues its wellness program.A meta-analysis of literature on costs and savings associated with worksite wellness programs, published in the February 2010 issue of "Health Affairs," found that medical costs fall by about $3.27 for every dollar spent. Absenteeism costs decrease by about $2.73 for every dollar spent. The findings are a result of the study "Workplace Wellness Programs Can Generate Savings," conducted by Katherine Baicker, David Cutler and Zirui Song, all of Harvard University.In the case of Unifrax, $250,000 was invested. Applying the above formulas, it is estimated that medical costs would fall by $817,500 and absenteeism costs would decrease by $682,500.A shift in individual and corporate behavior/mentality is evident, from one of treatment and cure to one concentrated on prevention and improved well-being.
So what can we learn from Unifrax?
- Ensure that upper management understands and supports the goals of a wellness program. It is a long-term culture change, and it may take years before the company sees the benefits.
- Because it is difficult for people to change, it is important to include some form of incentive for motivation purposes.
- Enlist the help of a third-party health promotion provider, which should be composed of health professionals (dietitians, educators, exercise physiologists, nurses) trained in prevention, health education and behavior change, and who create personal relationships with employees and spouses.
Employers have immense power to shape the future health of our nation by providing information and tools for change. Now is the time for them to help their employees make better lifestyle choices, which ultimately leads to a healthier workforce and healthier country.
About the Author
Shawna Dosser, MS, CWPM, CLSSGB, is founder and president of BWI Health Promotions, the creative wellness solutions, team-building and health education company that provided health promotion services to Unifrax. In 2010, the BWI National Health Promotion Training Institute was launched to offer web-based certification courses to health-related professionals and employee populations.