What's Wrong With Wellness?
In order to build a culture of wellness in an organization, it's important to be clear about what wellness means, the goals of the wellness program, what the program's components are, and how the program "fits" into the work of the organization. Historically, wellness programs have underestimated the importance of "fit" with an organization's goals, have accepted token leadership from senior management and have focused on programs and communication tools.
Having a "culture of wellness" has often meant little more than having an employee wellness committee. According to the 2013 Employer Benefits Survey[i], 77% of firms offering health benefits to employees also offer at least one of a panel of wellness programs[ii]. Encouragingly, about half of the organizations that make wellness programming available extend eligibility to spouses.
Disappointingly, 80% of the firms offering wellness benefits reported that most were "off the shelf" and provided by health plans. This fact alone suggests that wellness programming is often viewed as part of a benefits package rather than an integral part of the organization, and that wellness probably doesn't really have the attention of executive leadership and buy-in from the organization.
In an HBR Blog post, Al Lewis (of disease management fame) identified four "fundamental flaws" of many wellness programs:
- Wellness programs that should empower employees have morphed into employee control tools linked to financial incentives and disincentives;
- Wellness has become a marketing tool for health plans;
- Member participation (rather than improving well-being) has become the emphasis of wellness programming; and,
- Wellness programs often have requirements for screening tests and physician visits that are at odds with evidence-based clinical guidelines[iii].
These issues of employee control and cookie cutter programming run counter to basic principles of establishing a high-performing corporate culture, in part because they have had very real impact on employee attitudes and behavior. Absent persuasive financial incentives or disincentives, health plan provided wellness programs have dismal participation rates.
Moreover, financial incentives for participation and positive health outcomes are viewed negatively by most employees[iv]. Interestingly, according to the National Business Group on Health, "incentives" have doubled since 2009 to $521.
To make things worse, the evidence that traditional wellness programs have any meaningful impact on employee (and spouse) well-being is at best mixed. We're left with the uneasy feeling that wellness programs are costly, relatively ineffective and can be destructive to employee morale.
A New Direction
So, what is the new thinking around wellness? Wellness programs as we've known them become, at best, a commodity; and goals for programs are changing. There is a growing realization that well-being depends on organizational culture, a supportive work environment, and programming that "fits" the organization.
Forward-thinking employers are moving cautiously toward population health management with an emphasis on multidimensional programming[v] that has been shown to impact health outcomes. Wellness and prevention are becoming part of a more holistic approach.
More importantly, newer strategies such as Total Worker Health[vi] (Total Worker HealthTM is based on integrating occupational safety and health protection with health promotion to prevent worker injury and illness and to advance health and well-being) and Wellness 2.0 ("Taking a Culture-First Mentality With Workplace Wellness") are based on three fundamental cultural tenets.
First, keeping employees and their families healthy (in the broadest sense) must be an organizational priority. Second, there must be a supportive environment that fosters well-being. Third, the emphasis is on using data to identify opportunities and find things that work.
Creating the Culture: Best Practices
Having a plan. A formal plan for member well-being is crucial to success. The plan should be based on data about drivers of poor health and financial outcomes in the organization. In the best of all worlds, the plan is woven into the organization's strategic and business planning cycle.
The plan should clearly identify and prioritize organizational burdens, consider the potential impact of the actions in the plan (including the proportion of members that might benefit), and focus on actions that are feasible given organizational resources and other priorities.
- Leadership should set the goals for the program. Commitment to member well-being should be stressed and communicated frequently. The connection of workforce health to the core products, services and values of the company should be acknowledged by leaders and communicated widely. Data about the program's performance should be distributed to all levels of the organization.
Having Skin in the game. The organization should demonstrate a willingness to commit financial and human resources to member well-being. Support for the plan should be part of the budget. Executives should be held accountable for implementing the plan. Based on the plan, performance expectations for leaders and middle managers should be put in place and should be part of the regular performance evaluation.
HR policies providing employees with time to engage in health promotion activities and to access onsite health resources, if they exist, should be implemented. Plan designs should support Health-Value-Based Insurance Design for drugs, as an example. Vendors should be held accountable for their program outcomes.
Evaluating effectiveness. Formal metrics for measuring program performance should be in place. Examples of metrics[vii] might include:
- Change in medical trend for program participants vs. nonparticipants;
- Change in total claims costs for program participants;
- Change in lifestyle-related claims for program participants;
- Costs for absenteeism;
- Employee satisfaction;
- Reductions in biometric risks; and,
- Use of preventive screenings.
Tracking financial metrics alone does not provide a true sense of the impact of programs on plan members. Subjective measures and health outcomes must be included. Effectiveness data should be used to update and improve the program and should be the basis for the annual revision of the member well-being plan.
Traditional wellness programs have not convincingly demonstrated effectiveness, and there is a growing recognition that workplace well-being requires a multi-dimensional approach organizational commitment to provide programs with a real potential to influence well-being.
There is an increasing body of evidence suggesting that making well-being a part of the everyday work of an organization can provide benefits. Using information to craft and evaluate programs for promoting health is a fundamental part of the strategy.
About the Author
Dr. Bruce Campbell is the Chief, Health and Informatics Services at Benefit Advisors Network (BAN), an exclusive, national network of independent employee benefit brokerage and consulting companies known for their knowledge of the industry, ethical approach, and strategic vision. Dr. Campbell is also the Chief Medical Officer at C.M. Smith Agency. For more information, or to contact the author, please visit: www.benefitadvisorsnetwork.com or email firstname.lastname@example.org.
[i] Employer Health Benefits 2013 Annual Survey; Kaiser Family Foundation and the Health Research & Educational Trust.
[ii] HRAs and biometric screening, weight loss programs, gym memberships or onsite exercise facilities, smoking cessation programs, lifestyle or behavioral coaching, health education activities, web-based wellness resources, EAP programs or a wellness newsletter.
[iii] Al Lewis cites the example of annual physicals which are of unproven benefit for healthy individuals.
[iv] 80% of employees view employers offering wellness programming positively, but 62% have a negative view of financial incentives for participation or benefit eligibility and 82% think it is inappropriate for employers to require higher premium contributions if employees are unable to meet health (outcome) goals. Kaiser Family Foundation Health Tracking Poll; June 2014.
[v] Biometric screening, preventive screening, disease management and care coordination.
[vi]National Institute for Occupational Safety and Health (NIOSH). Essential Elements of Effective Workplace Programs and Policies for Improving Worker Health and Wellbeing.
[vii]Proving the Value of Employer Well-being Programs. National Business Group on Health.