Scripps Health Steps Forward for Corporate Wellness

Scripps Health, a self-insured, tax-exempt healthcare organization with five hospital campuses and 22 clinics, 13,700 employees and 2,600 affiliated physicians across greater San Diego, launched a corporate wellness program in March 2006.


More than 75 percent of Scripps Health employees actively participate in the program. Population health has improved substantially since 2006, bolstered by a 51-percent increase in the low-risk population and a 42-percent decrease in the high-risk population. Participant satisfaction is at 98 percent, and Scripps now offers wellness programming to local businesses.

Program Design

The Scripps corporate wellness program is offered to all employees and adult dependents age 18 and above at no cost. A robust, interactive website acts as an administrative platform, providing a variety of resources to program participants, who are asked to complete an annual Health Risk Assessment (HRA) along with biometric screening.


A detailed personal health report is generated immediately upon completion, and follow-up counseling is available to all participants. Proactive outreach solicits participation in personal health coaching, which is triggered by specific HRA results. Health coaching may be telephonic, electronic or face-to-face. A third-party vendor provides Scripps with telephonic and electronic health coaching, as well as a tobacco cessation program.


Scripps clinicians provide face-to-face coaching through Employee Care Clinics when indicated or requested. Every year, the Scripps wellness program offers 3-4 wellness challenges, each running 4-6 weeks with a primary focus, such as physical activity, diet and nutrition, or stress management.


Participants record daily activity during the course of each challenge electronically, earning points for daily efforts. Accumulation of a threshold number of points is required to receive credit for completing a challenge. Scripps offers a wide variety of on-site wellness activities, and provides the infrastructure for success.


More than 100 on-site fitness classes are offered throughout the organization each week. Class schedules provide maximal convenience and avoid interfering with normal work routines. Scripps has several fully equipped gyms, and provides alternate exercise space and equipment at other sites.


Additionally, Scripps provides gym membership subsidies for those who prefer to exercise outside of work.In recognition of the stresses routinely encountered by healthcare workers, Scripps offers regularly scheduled on-site chair massage at all locations. Additionally, Scripps hosts on-site seminars focusing on stress-management and related lifestyle topics led by professional psychologists.


Seminar topics change monthly and, to assure accessibility, each presentation is offered at a variety of times and locations. To assist employee efforts to maintain a healthy diet, Scripps cafeterias offer daily healthy menu selections. Healthy options are clearly identified and heavily promoted.


At locations without cafeterias, Scripps provides vending machines containing fresh, pre-portioned healthy meals. Additionally, Scripps utilizes two teaching kitchens to provide vegetarian cooking classes taught by chefs. Menus are designed to be inexpensive and easy to prepare, as well as nutritious.


Participation-based incentives are awarded to employees who complete a predetermined number of activities during the course of a program year. "Wellness Credits" are assigned to each activity and weighted to encourage completion where sustained behavior change is most likely to occur.


Accumulation of a threshold number of credits is required to earn incentives. Incentive earners receive a reduction in health insurance premiums the following calendar year. Employees not enrolled in the health plan receive a lump-sum cash award.


The exact dollar value of the incentive may change from one year to the next, but always represents a substantial portion of the employee's share of cost in the health plan. Dependents are not eligible to earn incentives.

Program Evolution

The wellness program at Scripps reflects a purposefully designed evolutionary process. Program design was structured to progress incrementally across three distinct "phases" of development:

(1) Awareness and Acceptance,

(2) Personal Behavior Change and

(3) Culture Change.


The "Awareness and Acceptance" phase spanned the first two years of the program. The primary goal was to offer programming perceived as fun and non-threatening. Wellness administrators were very sensitive to the potential for employee participation to be perceived as too burdensome or disadvantageous.


Great care was taken to create a user-friendly experience and to explain the rigorous methods used to protect participant privacy. "Personal Behavior Change" introduced health coaching, which was not presented until proactive outreach based upon HRA results had been provided and safety in the minds of participating employees established.


"Culture Change" is not a truly discrete phase. An eye toward creating culture change dictated program design from day one. By 2010, the fourth year, more than 62 percent of all Scripps employees proved ready for "Culture Change" and participation in the wellness program.


In 2010, the average number of health risk factors per participant dropped from 3.68 per person in 2006 to 3.05 per person, a 17 percent improvement. This result was reflected in health-plan costs, which were substantially below anticipated values.


Scripps was recognized as "San Diego's Healthiest Employer" in 2010, and the wellness program was recognized as a differentiator in Fortune Magazine's Top 100 Places to Work, AARP's Best Employer for Workers over 50, and Working Mother Magazine's Top Employer. A solid track record of success justified creation of the on-site facilities and programs during the third phase of program evolution.


While certainly helpful in supporting employees to reach health-related goals, perhaps, the greatest benefit these elements provide is to serve as visible evidence of the importance Scripps ascribes to employee health and well-being. When employees consistently see tangible evidence of the value their employer places on their health and well-being, attitudes and habits begin to change.


When a "tipping point" is reached, organizational culture can shift dramatically. Effective communication is central to sustaining culture change. Since the onset, the Scripps wellness program has communicated with employees frequently by using a variety of methods.


The greatest impact has been achieved through a robust "Wellness Champion" program. These volunteers with an inherent interest in health and wellness understand concepts that underlie the wellness program design. Monthly conference calls provide champions with informational updates and are used to gather feedback from the field.


The ideal champion is a social maven whom peers perceive to be naturally credible. Champions encourage participation and provide timely, accurate information about the program. They also recruit new champions from within their social networks. Currently, 125 Wellness Champions create grass-roots momentum for the Scripps wellness program.


In an effort to keep the wellness program fresh and relevant, Scripps regularly surveys participants for satisfaction, environment and interests and preferences. Survey information is used to design programming, and helps to engender ownership among participants.


The Scripps wellness program, Employee Occupational Health Services, Worker's Compensation, and Employee Care Clinics were integrated as a single service line in 2012. Under the rubric "Scripps Wellness and Employee Care," integration resulted in many favorable synergies and improved efficiency across all service-line components. Consistent messaging and cross-program referrals created a vast net of mutually reinforcing touch-points. Far fewer people "slip through the cracks" than prior to integration.

Outcomes

More than 75 percent of all employees are now active participants in the Scripps wellness program. The average number of risk factors among all participants has decreased by more than 20 percent since 2006. Cohort analysis demonstrates clearly the benefits of both year-over-year and long-term program participation.


Risk change among program participants correlates strongly with trends related to favorable health-plan costs, worker's compensation claims and organizational productivity. Recently, the Scripps Health Board of Trustees requested commercialization of the Scripps Wellness and Employee Care service line, validating the effectiveness of the approach. Services are currently provided to external clients, and growth in this direction is anticipated.

Future of Wellness

Behavioral economics and social marketing theory increasingly influence wellness, and for good reason. There is a growing understanding that health-related behaviors are frequently motivated by subtle influences that are extremely powerful, operating at the emotional and subconscious levels. Product marketers recognized this phenomenon long ago, and use these strategies to influence consumers.


Future wellness strategies are likely to proceed down the same path. The role of a person designing a wellness program will be seen as that of a "Choice Architect," to borrow a term coined by Richard Thaler and Cass Sustein, designing environments that make a desired choice seem natural and occur without much thought.


In the future, wellness communication strategies are likely to de-emphasize traditional approaches used today. Future communication strategies will attempt to leverage social networks, where information flows quickly, naturally and where not much is missed to spread ideas and influence behavior.


Social networks will be accurately mapped, and great efforts will be made to identify those influential trendsetters who live at the hub of each network. The power to influence trendsetters and the efficiency of social networks will spread desired behaviors in a manner similar to the way new fashions emerge.


This approach will attempt to position desirable health behaviors as a new "social norm," and will leverage the desire for group inclusion to generate conformity. Program outcomes based on attainment or the use of financial disincentives are unlikely to survive much longer.


Legal considerations, administrative complexity and concerns regarding the physiological relevance of certain outcome measures will likely render such programs obsolete. Increasingly, the use of disincentives is seen as destructive to a culture of health, driving avoidance behaviors rather than desired health practices.


The application of disincentives will likely disappear. Successful wellness programs of the future will focus on helping individuals develop a healthy mindset, while simultaneously creating healthy environments both physically and psychosocially.


There will be a broad understanding that a person's state of mind and the environment in which they operate are co-equal determinants of health behaviors. The fundamental perspective in the future will be that a sense of well-being must exist both at work and outside to be sustained.


I am very optimistic about the future of corporate wellness initiatives. My belief is that the desire to feel good and be healthy is universal. As the industry becomes increasingly effective at producing these outcomes, wellness programs will cease being considered an expense and, instead, be seen as a strategic imperative.

About the Author

Hamilton Mears is the architect and current administrator of the Scripps wellness program.