Simply put, good health is good business. Experts agree there is a direct correlation between employee health and bottom-line results - and that building a culture of health improvement can result in a "health dividend" that includes lower costs, improved performance and overall business success for the employer and employee alike.
Until recently, employers saw wellness ROI in terms of lower healthcare costs. Now, attention has turned to overall productivity. Many have come to realize that the indirect costs of poor health (absenteeism, presenteeism, disability), can be two or three times higher than direct medical costs.
As Dee Edington, PhD, Director of the Health Enhancement Research Center at the University of Michigan, points out, "the business community is what's driving all the change because they have to. They're the only ones in this country that benefit from people being healthy. Everyone else benefits from people being sick."
Employers offer the Ideal Environment
Employers have a naturally captive audience, unique resources and the built-in infrastructure necessary to institute cultural change.
Communication via corporate intranets, newsletters, bulletins, signage and so forth can help employers get their wellness message across. Policies, procedures and promotions can be introduced and reinforced with relative ease and frequency. Plus, employee interaction can be a powerful support system for behavioral change.
Environment design can help encourage healthy lifestyles. Walking paths, break rooms, cafeterias and vending spaces, as well as catered meals for meetings, conferences and employee events, are some ways employers are helping influence good health habits.
Incentives have proven to be a useful tool in behavioral change. Employers are in the prime position to offer financial or other incentives that can engage employees in wellness initiatives and maintain participation.
Program Integration and Alignment are Key
Successful wellness pioneers have restructured their programs into integrated, branded, company-wide initiatives focused on helping employees take responsibility for their health, becoming more effective consumers of healthcare. This strategy can:
- clarify functional responsibilities and reporting;
- expand the reach and resources health-related activities;
- promote sharing of data and ideas to improve quality and manage costs; and
- allow the company to align its health-related efforts to support company wide goals.
Employer "Must have" Components
As knowledge is shared by companies that have seen positive results from their wellness initiatives, a short list of essentials is developing.
1. Health and productivity management model- Wellness programs that are based on a true health and productivity management model focus attention on developing objectives that emphasize outcomes. By tracking results and using them to apply continual program improvements, employers can measure cost savings and, therefore, ROI, and decide which programs are efficient and which programs need to be cut.
2. A focus on outcomes- Program managers must set clear goals based on accurate data and organizational considerations. Demographics, health claims and health risk assessments can establish a baseline of health costs and behaviors. Program design, then, must include agreed-upon measures of success and the mechanisms for reporting progress.
3. Senior management support- Senior executives who participate in health activities and programs in a visible and sincere way validate to their employees that this is an important, permanent change in corporate culture.
4. Ease of access- There is a direct correlation between high employee participation rates and wellness program accessibility. While a well-designed Web portal with a user-friendly interface can reach a majority of employees, local physical presence is important for many of the most measurable activities.
5. Health Risk Appraisal (HRA)- Designed properly, HRAs can help establish baseline workforce health information, direct environmental and individual health needs and measure progress over time. HRAs are frequently followed by tailored health education programs in order to affect behavior change. However, because an HRA relies on self-reported information, it is not subject to audit.
6. Personalized interventions- Experience shows that short, individualized behavioral interventions using goal-setting techniques and reflective counseling are more effective than general information awareness-building and education programs.
7. Verifiable measures- Because HRAs alone can leave 70 percent or more of clinical questions unanswered or incomplete, many organizations are adding employee biometric measurements, including weight and Body Mass Index (BMI), blood pressure, cholesterol, fasting glucose and assorted other metrics into the mix. Verifying healthy activities via computer uploads from pedometers, heart monitors and even Apple iPods, plus card swipes at fitness clubs and health kiosks on-site are also growing in use.
8. Incentives- Recently, shared research and results show that incentives are highly effective in health management initiatives, and can provide individuals with quick and tangible feedback to help motivate them to participate in short-term activities that are actually in their long term best interest.
9. Multiple delivery channels- Diverse workforces require varied channels of communication and education. Efforts can be delivered in electronic, paper or seminar formats. On-site interactive kiosks also are effective in collecting and disseminating health information, particularly at companies that face different worksite types, limited employee access to computers and 24/7 operating shifts.
10. Messaging frequency- Successful programs have frequent contact with every employee. The key is to enhance awareness of health and wellness opportunities and reinforce the company's commitment to wellness through frequent and multiple "touches."
11. Family involvement- Many programs encourage family members to participate in company wellness activities. It is far easier for the employee to have a healthy lifestyle if his/her family does so as well.
Driving Engagement
In general, employees who participate fully in benefit programs tend to have a greater sense of connection to their employers that can translate into increased loyalty and greater job satisfaction. Employers may receive a higher return on their benefits spending through economies of scale, experience better program outcomes and workforce performance advantages, and their employees pay less for more benefits - in the form of programs, resources and tools.
Employee privacy and confidentiality are vital to the engagement effort. Corporations should consider adopting a policy of total transparency on the issue of personal health information (PHI), making it clear to employees that federal and state laws require the protection of worker privacy.
For example, an organization separate from the employer must collect and store personal health data, and managers may use only de-identified, aggregated data to assess risk factors, choose health interventions and monitor effects.
Federal Laws Can Affect Wellness Program Design
HRAs are at the heart of every comprehensive wellness program. Organizations must be careful, however, when it comes to using this information in certain ways. A recent review of current federal law provides these cautions:
- Americans with Disabilities Act (ADA)
While the ADA permits asking employees disability-related questions if the information is job-related, the Equal Employment Opportunity Commission says companies may NOT make eligibility for health insurance contingent on completing an HRA.
- Health Insurance Portability and Accountability Act (HIPAA)
HIPAA addresses providing incentives for completing HRAs. The law rules that all "similarly situated individuals" must be offered the same incentive; that incentive may not be based on meeting a particular health standard, and its value cannot exceed 20 percent of the total group health premium cost.
- Genetic Information Non-discrimination Act (GINA)
Recently enacted (and yet to be tested) legislation may have serious impact on certain HRA questionnaires in use in the marketplace. The law prohibits an insurer from using an individual's family health history to make underwriting decisions. This prohibition could be applied to HRAs that include questions about an employee's family medical background if the employer is offering a financial incentive for completing the assessment.
The Power of Incentives (and Disincentives)
A recent study by PricewaterhouseCoopers showed that workers are two to four times more likely to enroll in wellness programs if they receive incentives. Employers agree. The vast majority (91 percent) believe that they could reduce their healthcare costs by incentivizing employees to adopt healthier lifestyles.
Some organizations have adopted, or are considering, aggressive policies toward unhealthy lifestyles.Using disincentives, or penalizing employees for health issues or at-risk lifestyle factors (e.g., obesity and smoking) could result in dramatic effects.
According to a recent article in the Harvard Public Health Review, "people are much more averse to losing something than they are excited about the possibility of a gain."In spite of this, employers who have existing incentive or disincentive programs in their wellness initiative are more likely to use incentives.
In the end, employers may find the use of disincentives may not be worth the risk of redefining the corporate culture or endangering employee good will.
The Need for Independent Vendors
Outside vendors can be instrumental in underscoring the purpose, potential and credibility of an organization's wellness initiative. Convincing employees of the validity of the programs and sincerity of the employer can be an uphill battle. According to Hewitt Associates, only 12 percent of employees agree their employer has a role in helping them understand how to stay healthy.
Additionally, employers' attempts at tying incentives to completing HRAs are viewed by employees as an employer tactic to retrieve sensitive personal information. Thus, a third party vendor is an ideal way to combat employee privacy concerns.
The American Recovery Reinvestment Act of 2009 expands the scope of the HIPAA privacy and security regulations to include vendors "who generate or use identifiable health information." Vendors are now required by contract to protect identifiable health information under HIPAA standards.
The Need for Expertise
According to recent studies, employers sorely need accurate, evidence-based information from reliable, objective sources. They specifically want to know how to judge efficacy, behaviors to target, and results, and are willing to pay for this expertise. There are many types of wellness vendors; however, the types and levels of services available vary widely.
Major health plans offer basic initiatives such as HRAs and online health education tools. Full-service, specialty health management vendors can offer these as well as integrated behavior change and outreach programs, sophisticated Web and educational tools, on-site capabilities for health fairs and preventive screenings, and customized programs.
Specialist vendors can offer a la carte, single-serve wellness program such as smoking cessation or weight management programs. Even local health systems and hospitals often offer community wellness programs. Regardless of the partnership of choice, the need for knowledge and expertise in health management is of the utmost importance.
A Window of Opportunity
For real behavioral change to take place, all stakeholders need to be on the same page. For the first time in recent memory, it appears they are.Carriers are re-vamping plans to reduce costs and offer more solid preventive care coverage. Government is seeking to cut waste and broaden wellness access.
Employees are being challenged to take more responsibility for their own health. Wellness companies have evolved to a new level of sophistication and measurability. And, employers are realizing that good employee health is an investment in economic growth, and are looking for holistic solutions to give them a competitive edge.
The single greatest opportunity to improve health and reduce premature deaths lies in modifying personal behavior - and the workplace offers the greatest potential for achieving large-scale health and economic impact.
About the Author
Barbara D. Correll is a seasoned marketing communications professional with more than thirteen years of experience in the health and wellness arena. She holds the position of Vice President of Marketing for The Vitality Group, a member of Discovery Holdings Limited, a leading international financial services institution founded on the principles of consumer engagement and wellness and the originator of the Vitality health promotion program.
Today, Vitality wellness programs serve more than 1.5 million members in companies in a wide range of sizes and industry categories. Early adopters in the United States include some of America's most forward-thinking companies. They join global organizations in the United Kingdom and South Africa who together are proving the effectiveness of the Vitality health enhancement solution in reducing healthcare costs.
The Vitality Group has forged partnerships with some of the most respected names in the health and wellness field to help extend the reach and effectiveness of its mission. A true partner in risk management, the company capitalizes on its heritage of actuarial and clinical expertise to respond to the varying needs and cultures of American businesses in their pursuit of increased workforce health and productivity.
Contact Ms. Correll at bcorrell@TheVitalityGroup.com or by calling The Vitality Group at 877.224.7102. You may also download the complete white paper from which this article was excerpted at www.TheVitalityGroup.com/whitepaper.
