The Price of Doing WELL

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As I was lifted on the gurney and strapped in, emergency radio equipment exchanging my vital statistics and co-workers staring at me from doorways, I begged the adorable EMTs not to parade me through the lobby of my workplace like the many others I had witnessed. Everyone seemed to be in shock. Less than one hour earlier I was busy making and accepting calls, writing and responding to hundreds of emails, meeting with employees, planning projects and editing reports.


I was 45 years old, a senior executive and I was having a heart attack! As most Americans do, I believed I lead a healthy lifestyle. I ordered low-fat dressing on the side to accompany my broiled skinless chicken breast salad. I parked my car far enough away from my office to ensure a brisk walk at least once a day. I ate nothing but whole wheat bread, limited my coffee to 4 cups a day (all before noon) and clung to my Jamba Juice as if it were the Holy Grail. On the outside, I was the picture of health and vitality.


On the inside, I was killing myself. The activity in the ambulance was chaotic as the EMT straddled me, trying to keep his balance as he adjusted the IV and called out numbers I did not understand. It reminded me of a bad episode of "ER." My only hope was that George Clooney would be waiting in the emergency room to assure me that I would be OK. I was not OK and my life from that moment forward would never be the same. Even George could not un-ring the bell.


I immediately started the bargaining process. You know the one "I promise, if you get me through this I will be the person I am meant to be." Hours seemed like days as I contemplated all the ways I could have avoided my fate and the choices that had lead me to it. After three days in the hospital, I left feeling fragile and vulnerable but at the same time empowered and determined. This experience was the defining moment in my life as I took the first steps into a journey that would become my life's purpose - wellness.


That was six years ago. Since then I have dedicated my career to raising the awareness of as many people as possible through one of the most significant and effective information channels available, the American employer. I speak on topics we are all familiar with such as chronic conditions, prevention, the impact poor choices have on our health and why stress and our self-image (mental awareness) play a large part in how we care for ourselves. I speak from experience that we must learn to take control and become proactive instead of reactive and of the inescapable need to modify our behaviors.


Back in 2003 when I decided what to do with my life when I grew up, worksite wellness had not grown much beyond the adolescent stage. After years of research, many of the pioneers in our industry such as Dee Edington, Ron Goetzel, Larry Chapman and Ken Mitchell were just beginning to uncover clear evidence that could validate their assertions. Simply stated (forgive me if I oversimplify), their message was to deal with the crisis of rising healthcare costs systemically. Only when we successfully changed behavior, reduced risks and helped those with chronic conditions improve their health and support our healthy population to remain healthy, could we expect a different and more positive long-term result.


The consistent statistical data derived from their collective research was and still is difficult to challenge, having been used successfully to implement thousands of robust health management programs across the nation and even the world for companies such as Pacific Bell, IBM, General Mills, GM, countless municipalities and so many more. Being a newbie to the wellness industry but relying on their hard work and research, I believed that I had everything in my briefcase to justify why every employer would benefit and want to make this essential investment.


It was an investment toward the future sustainability of their employees' health, as well as a way to relieve some of the burden of rising operating costs. Their facts and figures made it a no-brainer. That was until I came face to face with a no-nonsense CEO who cut to the chase and asked, "What's my ROI and how much can I save on my insurance premiums?" I was stopped dead in my tracks in the middle of my preliminary wellness presentation. I switched gears and began with great confidence sharing ROI projections, research results and academic papers written by the top gurus in the industry.


There was a dead stare from across his desk and I knew I had to do better than that. "All this stuff is great but none of it applies to me. I am not a Fortune 500 company with tens of thousands of employees. I have just over 400 workers, sometimes fewer. The only thing we have in common with your research groups is our struggle to reduce costs. We are not self-funded, our claims experience is pooled, we cannot get information from our insurance carrier to help us determine our risks and I do not have a clue how we would track our savings." I realized at that moment I was dealing with a frustrated CEO who felt he had been left out of the wellness movement.


This CEO wanted answers he could apply to his own business experience. I needed to give him answers quickly and with the same confidence and conviction I had launched into our original conversation. I took a deep breath and continued. I responded in agreement to what seemed like an indictment of my esteemed colleagues and me. "This is very true. Because of your company's size, your insurance carrier pools, your rates and for better or worse you are impacted by the utilization and health (or lack thereof) of the thousands of employers just like you."


"However," (I immediately sifted through the information in my mind) "There are many other ways to reduce costs. Healthcare premiums are just one way. By gathering more information about your specific issues and understanding your expectations, we can design a program that will not only improve the health of your employees but also create definitive ways to measure the success and ROI of your wellness plan." I began asking some probative questions and it became obvious no one had spent time to examine these points with him previously. He was jotting down my every word, pencil to paper. I continued my questions."

  • What are your expectations and what do you hope to achieve through a worksite wellness program?
  • What is your annual absenteeism rate?
  • What is your annual average number of workers compensation claims?
  • What is the nature of your disability claims?
  • How long does it typically take employees to return to work from injuries or an illness?
  • Do you have a challenge with attracting or retaining quality employees?
  • Have you ever tracked your lost productivity due to impaired work performance?

It was as if our meeting had just begun, turning from inquisition to dialog, and by the end of our meeting he felt as if he owned a Fortune 500 company. He embraced the idea that his employees deserved better health and that his company's bottom line could benefit from increased productivity, quality engagement, decreased absenteeism, reduced claims and maybe even a well-thought-out health management program.


By understanding that true ROI was a before-and-after story determined only by past, present and future data, he was able to establish realistic expectations which set everyone up for success. He was anxious to customize a health management plan based on his company's demographics, specific needs, measurements methodologies, goals and evaluation periods. He was now able to accept that health management was an investment in the future and not just another cost of doing business.


As I drove away with my marching orders, I still had lingering questions of my own. If over 83 percent of all U.S. businesses employ 1,000 workers or fewer, who was helping the majority of our nation's workers change behaviors and improve their health? Why didn't this employer, who made up a part of that 83 percent, know there was hope and he too had options? Who researched the impact of wellness on employers with fewer than 1,000 workers and did they take into consideration the unique obstacles facing small employers? Who was pointing out that for every health care dollar an employer pays, the silent cost of lost productivity equals two to four times that amount? Why didn't he know that reducing the average absenteeism rate from four to two (eight hour) days per month used by employees suffering from poor health and chronic conditions, it could potentially save tens of thousands of dollars annually?I had my answers.


The groundwork had been laid years ago. The best of the best had provided me with all the resources needed to think critically and apply their finding to employers of all sizes. With over four million small employers in the U.S. and a handful of futurists, I realized they had not failed to educate the small employer - I heard you may have concluded that George Clooney wasn't waiting for me at the emergency room doors. What I was met with however, was a group of people, candidates just like myself in need of health education, support, empowerment and resources that could not only prevent but improve the quality and longevity of my life.


I saw myself in all of them regardless of their conditions. We all needed a new perspective that would encourage us to be the best we could be. I offer my observation that wellness isn't the absence of disease but the constant pursuit of optimal health. We as health management professionals have a great opportunity and responsibility to educate, do the research, create options and help improve the total health and wellbeing of all companies, regardless of size.


We are accountable to our clients to present them with both the price of doing well and the cost of not promoting wellness. My answer to my client will always be "Therein lies your ROI." Sources: Goetzel, Long, Ozminski, JOEM, U.S. Bureau of Labor Statistics, Dee Edington, University of Michigan, WorkRX Group, LTD, Kenneth Mitchell PHD, Dr. Steve Aldana

Miki Kobane has spent 17 years in the health insurance industry and 10 years in Human Resources which provides her with a comprehensive understanding of the relationship between chronic illness, claims experience, insurance premiums and the need for lifestyle education and change. Providing services throughout her career as a broker and as account manager for major health insurance carriers, having to explain and sell double digit increases was difficult but not uncommon.


One fact remained consistent and obvious to her, increases would continue until action was taken by employers to encourage lifestyle changes and individual accountability. In 1998 Ms. Kobane transitioned from the health insurance industry to Benefits Director for Children's Hospital of San Diego. She accepted the position of Manager of Benefits and Health & Wellness at Viejas Enterprises in 2003. Ms. Kobane utilizes her extensive background and knowledge to help employers recognize the correlation between lifestyle choices, healthcare costs and the need to implement wellness initiatives in an effort to control soaring premiums and reduced productivity.


Ms. Kobane believes, "An employer must understand the relationship between healthcare costs and lifestyle choices before a wellness program can be fully effective. They must be in a position of readiness and understand the level of commitment needed to reduce costs and increase productivity." Meeting that challenge Miki has focused her career on, and is dedicated to, the implementation of workplace wellness programs. Assisting employers at reviewing claims and demographic data allows the employer to determine the depth and design of a program that best suits their organization's needs.

Strong and consistent communication is necessary to build trust. Without the proper information and communication wellness programs can be met with strong resistance by employers and almost certainly by employees. Wellness programs can range from simple smoking cessation and weight management programs to a very robust menu of activities, resources and educational opportunities. All employers regardless of their size should consider augmenting their health insurance, workers compensation plans, leave policies and any other areas in which premium costs and productivity are concerned.


The success of the Viejas wellness program which Miki designed and implemented was recognized by the California State Senate for its efforts to assist employees in understanding the need for lifestyle change. Programs such as the "Group Weight Loss Challenge" in which 140 employees lost a total of 1535 pounds in five months and "Department Boot Camp Challenge" where 17 teams competed to complete a fitness par course, proved successful in both building moral and increasing productivity. These programs were also essential in engaging employees to take control of their nutritional choices and physical activity. Among other programs Miki Kobane has implemented are the following:

  • Hispanic Health Education Complimentary Wellness Committee
  • Disease Management Program
  • On-site Weight Watchers
  • Health Education Workshops
  • Healthy Cooking Demonstrations
  • Weekly Email Health and Exercise Tips
  • Stretching, Cardio and Strength Training Classes
  • Quarterly Newsletter
  • In-House Healthy Lifestyle Expo
  • On-site Mammogram Services
  • Walking Groups
  • Healthy Employee Dining options
  • Risk and Leave Integration Program

About the Author

Miki Kobane is currently the Director of Health Promotions at Barney & Barney LLC, located in San Diego California and is an active member of The Wellness Councils of America (WELCOA). She received her training and certification as a "Wellness Program Director and Consultant" from the National Wellness Institute.

Miki was invited to speak at the (RIMS) National Conference, 2007, and has presented her insights at various seminars and conferences throughout California. Miki will be teaching a workshop at the World Research Group Conference on Health Management ROI July 27, 2009 in Washington DC.To contact Miki Kobane: mikik@barneyandbarney.com