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Ten Steps Toward Strategic Employee Health Promotion Programs

The Employer Wellness Program management world is evolving rapidly. Each month, there are new research findings that support the premise that Employee Health Promotion Programs and disease management have a long-term impact on healthcare costs. Many large businesses that started Employee Health Promotion Programs three to five years ago are showing savings in health, disability, and workers compensation costs. Small to mid-size businesses are watching all this and wondering where to start with wellness.

Getting upper management support and budget approval is one of the challenges at the beginning of a Employee Health Promotion Program. This is the case because Employee Health Promotion Programs can be expensive, averaging $150-300 per employee per year in large businesses. The majority of of the savings are not realized for a number of years. This long-term investing is hard for businesses on the move.

The key to success for Employee Health Promotion Programs is to take a strategic approach. Here are ten steps to consider when starting a Employee Health Promotion Program.

1. Start with upper management. Without upper management support, a health promotion strategy can fall flat. Start with the health of your executive team and discover your wellness champions at the top of the employer.
2. Analyze the problem. Look at your healthcare claims and analyze the trends. Which conditions are driving your medical, disability, and workers’ compensation claims and which are modifiable? What’s worked and what hasn’t thus far? What is the long-term impact of doing nothing?
3. Hold an initial wellness meeting. Invite your primary stakeholders both outside and inside the employer. Ask your broker to facilitate the meeting and invite primary health vendors including health, disability, Employee Assistance Program (EAP), fitness, and occupational nursing. Review claims and utilization data and identify primary areas of concern. Look at current offerings and see how they can be tailored to the needs of the population.
4. Consider both healthy and unhealthy workers. Since 85 percent of claims are usually attributed to 15 percent of claimants, it is essential to reach those with the most costly conditions while also reaching workers who are at risk for developing preventable diseases in the future. Voluntary Employee Health Promotion Programs such as brown bag wellness seminars miss many of the workers who need them most. Consider initiatives that are population-wide or target intact workgroups. Wellness incentives help but do not motivate everyone.
5. Establish short-term goals for the Employee Health Promotion Programs. Establish some realistic short-term goals based on your primary areas of concern. Are there any plan design changes that could have an immediate impact on spending? Are there some programmatic actions that could have immediate results?
6. Determine what workers are thinking. Hold some focus groups to determine where workers are with wellness. What’s working? What isn’t? How much interest do workers have in the Employee Health Promotion Programs? What obstacles and barriers are workers experiencing when they try to change behavior?
7. Ensure that you have a high-impact Employee Assistance Program (EAP). Your first wellness dollars should go into upgrading your Employee Assistance Program (EAP). A highly utilized Employee Assistance Program (EAP) can provide a foundation for all of your future wellness activities. A good Employee Assistance Program (EAP) is a trusted link to the hearts and minds of workers. At no additional cost, the Employee Assistance Program (EAP) can provide needed follow-up coaching and personal attention for workers who are working on modifiable health behaviors or involved in disease management initiatives. Nutritionists, fitness, pregnancy, and stress management specialists are all part of a high-value Employee Assistance Program (EAP).
8. Establish three to five year goals for healthcare savings and measure them. Get help from your broker and insurance carrier help you on long-term goals for your health, disability, and workers compensation plans. Start program metrics that will help you to measure return on investment. Go beyond participation rates, completion rates and program satisfaction. Measure changes in readiness, changes in behavior, and changes in risk factors. Start rigorous methods to measure healthcare savings over the long term.
9. Establish goals for organizational health. Consider the more intangible benefits of a Employee Wellness Program and quantify them whenever possible. Include employee turnover rates, cost of new hires, employee morale, benefit satisfaction data, and employer of choice issues in setting goals. Start ways to measure success in these areas.
10. Add specifics to your short and long-term plan. Include a Employer Wellness Program strategy, a communication strategy, and a Employer Wellness Program incentive strategy that will fit with your organization culture. Focus on integration of related components along a health continuum with communications that are focused, simple, and human. Start a budget that includes primary components such as consumer education, health promotion, Health Risk Assessments, and regular biometric screens.

Employee Health Promotion Programs are crucial to improving the health of our nations. The majority of adults spend more of their waking hours at work than anywhere else, making it a excellent venue for promoting healthful habits. The worksite organizational culture and environment are powerful influences on behavior and this needs to be put to use as a way of assisting workers to adopt a healthier lifestyle. Advantages to Employee Health Promotion Programs include:
• Weight reduction
• Improved physical fitness
• Improved stamina
• Lower levels of stress
• Improved well-being, self-image and self-esteem

Companies can also benefit from Employee Health Promotion Programs. According to recent research, employers’ benefits are:

• Improved recruitment and retention of healthy workers
• Decreased healthcare costs
• Decreased rates of illness and injuries
• Decreased employee rates of absence
• Improved employee relations and morale
• Increased productivity

A U.S. Department of Health and Human Services report revealed that at worksites with physical activity initiatives as components of their Employee Health Promotion Programs have:

• Decreased healthcare costs by 20 to 55%
• Decreased short-term sick leave by six to 32%
• Improved productivity by two to 52%

Thanks to modern medicine, life expectancy for Americans has continually increased. How much we enjoy these additional years, however, depends greatly on how we have lived our lives. If our quality of life is to remain high so that we can fully enjoy these extra years, we must practice good eating habits, be active and refrain from using tobacco products.

Who needs Employee Health Promotion Programs? If you work in an office or a worksite or are a member of an employer who spends a considerable amount of time at work, you will benefit from a well-designed worker Employee Health Promotion Program. Employees spend a minimum of about 200 hours a month at work – a considerable amount of time.

Furthermore, stress, distractions and the pressures of the job can take its toll on the employee, which makes it important that a Employer Wellness Program is started. Today, all across America, Canada, Europe and Asia, top Employee Health Promotion Programs are being used to help improve employee conditions at work and reduce the cost of worker healthcare.

Some of the top Employee Health Promotion Programs currently in use today include:

Health Risk Assessments

Health Risk Assessments is a top Employer Wellness Program currently in use globally. Organizations that begin it determine the safety and health concerns of workers by the assessment of appropriateness of the facilities and equipment against the needs of the workers.

It can, for example, guide the employer into determining how much air quality within an office room affects the users and then help the assessment team to come up with the measures necessary to correct the problem. Health Risk Assessments can also evaluate the level of exposure workers have to certain hazardous or dangerous materials and practices.

Immunizations

This isn’t always practiced in every country since there are regions where government sponsored immunization shots are available. However, it has also become an important component of the top Employee Health Promotion Programs in many businesses in North America.

Immunization, flu shots, such as those used to combat flu, for example, are offered to workers for free.

Employee Assistance Programs (EAPs)

Employee Assistance Programs (EAPs) consist of a wide variety of services. It can range from offering educational resources to workers regarding health issues to sponsoring health services and medical care. In many businesses, medical and insurance have also become a staple part of their benefits system.

Weight Management Programs

This is another Employer Wellness Program that businesses use, particularly those that offer in-house commissary or cafeteria services. Instead of serving richer, high-calorie fare, cafeterias offer options for a healthier diet, usually in the form of low-calorie foods and sugar substitutes.

Health-Wellness Newsletters – Health Education Programs

One of the top Employee Health Promotion Programs that businesses can begin is a self-powered tool using a newsletter to promote wellness, coupled with a visible campaign. The campaign may be done periodically and focus on a specific topic, such as smoking hazards, cancer, stress, carpal tunnel syndrome, safety in the workplace, etc.

The newsletter in itself can be an effective way to deliver information to workers or members of an employer but it is far from perfect. Some workers, for example, may not read the newsletter in its entirety or even pay attention to it. If the issues outlined in the newsletter are promoted through an active and highly visible campaign, it will be easier to maximize positive results.

Physical Fitness and Exercise Programs

Another top health promotion program for businesses is one that involves physical activities. Companies frequently sponsor physical fitness-related events such as marathons and employer sports initiatives to promote workers to remain fit or lose excess weight. In mid- to large-sized businesses, businesses may even pay for gym memberships or in-house physical fitness facilities.

Employer Wellness Program Incentives

Some of the top Employee Health Promotion Programs started by businesses involve incentive rewards. This involves employer-sponsored initiatives that reward workers for achieving specific wellness goals. Participation in health campaigns and signing up for Employee Health Promotion Programs are two of the most commonly rewarded schemes. Rewards can range from special recognitions to points (for bigger rewards) to specific gifts. In a few cases, cash may also be used.

However, incentive systems have had mixed reactions and levels of success. But it continues to be one of the top choices among businesses who are willing to modify it in order to fit their unique needs.

Group Activities

In many businesses, businesses take advantage of peer pressure in order to encourage workers to take part in Employee Health Promotion Programs. This is currently one of the favorite worker Employee Health Promotion Programs currently in use today and growing in popularity. Peer pressure is frequently leveraged to help promote competitions and to persuade workers to be active in employer-sponsored health fairs.

Employee Health Promotion Programs at the organization level are beneficial, right? Wellness statistics clearly show that such Employee Health Promotion Programs are not only cost-effective for the employer but can assist the employee in developing a healthier lifestyle. With the rising cost of healthcare, Employee Health Promotion Programs simply make sense. So where does the problem come in? Let’s examine the topic from both perspectives.

Employee Health Promotion Programs: The Good

• A sampling of return on investment for Employee Health Promotion Programs: Bank of America: 600%; General Motors:370%; Pepsico: 300%; Citibank: 465%; and the Washoe County School District leading the pack at a whopping 1,560%. (Campbell,J., Wellness Improvement Experts, www.wellnessimprovementexperts.com, Albuquerque, New Mexico.)
• Companies with Employee Health Promotion Programs have realized a 28 percent reduction in sick leave, a 26 percent reduction in adjunctive healthcare costs and a 30 percent reduction in disability and workers compensation costs. (Health Affairs, Volume 21, No.2, March, 2002.)
• The Washoe county School District in Northern Nevada realized a $15.60 return on investment for each dollar spent due to a 20 percent reduction in rates of absence. (Hardy,A. (2005). At the Top Of The Class. WELCOA’s Absolute Advantage Magazine, 5(1), 14-20.)
• Employee Health Promotion Programs provide the structure, encouragement, incentives and ongoing support that many individuals need in order to make lifestyle changes.
• Employees also realize returns on their efforts. FiServ, a financial services technology employer, gave workers who filled out a health risk assessment a significant discount on their health insurance premium. (Holland, Kelley, The New York Times, July 22, 2007.)

Employee Health Promotion Programs: The Bad

The flip side of the argument centers on basic human rights. Do we want/need our employer to tell us to eat our veggies or lose 30 pounds? Some businesses are doing just that and at least one lawsuit has resulted because of it.
• Three hundred businesses have requested assistance from a national employment and labor law firm to institute more aggressive Employee Health Promotion Programs.(Cornwell, Lisa, Associated Press, Albuquerque Journal, September 10,2007.)
• Clarian Health, based in Indianapolis, Will start lowering employee paychecks by $10.00 for every employee who has a Body Mass Index (BMI) of greater than 29.9 because not enough workers were utilizing their wellness services.(Cornwell, Lisa, Associated Press, Albuquerque Journal, September 10,2007.)
• Scott Rodrigues filed a suit against his prospective employer, Scotts Miracle-Gro, because he believed the employer’s antismoking policy violated his civil rights. The employer has a policy against hiring workers who smoke and Mr. Rodrigues’drug screen was positive for nicotine.(Holland, Kelley, The New York Times,July 22,2007.)
• employee advocates are concerned that health discrimination may not be covered under the Americans with Disabilities Act.(Cornwell, Lisa, Associated Press, Albuquerque Journal, September 10,2007.)

Penalizing workers by hitting them hardest where it hurts the most,their pocketbook, does not appear to be a favorable approach to molding human behavior.
Such tactics may result in raised resentments and retaliation, primarily in the form of rates of absence and presenteeism (decreased productivity on the job.) Voluntary, incentive-based initiatives, such as the one in the Washoe County School District, can and do produce results. A positive attitude on the part of management along with an opportunity for workers to have a stake in the decision-making may yield the greatest dividends to both employer and employee.The motivation and resolve needed to change unhealthy lifestyle habits can best be derived from the basic tenets of encouragement, respect and support.

Getting Started – Secure management support

• Justifications for having a Wellness Fair
• Health Risk Assessments
• Help for high-risk population: smokers, obese workers
• Early detection of diabetes, heart disease risk factors (high cholesterol, high blood pressure)

Wellness Fair Participation – Identify your audience

• Employees only, whole family, retirees?
• Community involvement? Theme?

Wellness Fair Time Line

• Establish a date and time Allow 4-6 months of planning time

Wellness Fair Planning

• Identify health-related screenings, tests, other activities you’ll offer Identify educational literature and other learning opportunities Wellness Fair will provide Include any “fun” activities, or food/beverage needs for the fair

Wellness Fair Location & Logistics

• Consider location big enough to accommodate the largest volume of workers at “peak time” periods
• Determine how booths/stations will be set up

Wellness Fair Vendors

• Target relevant health/safety-related community and corporate vendors to provide services, educational materials, incentives and giveaways

Wellness Fair Marketing

• Determine marketing tools to be used to inform workers/members (posters, mailings, e-mail)
• Determine any incentives or giveaways that will be included in the fair or used to promote participation in the fair

Wellness Fair Scheduling

• Coordinate timing and events with staff and/or volunteers

Wellness Fair Personnel

• Schedule appropriate experts Physician or similar healthcare personnel to provide patient consultation for review of blood draw lab results
• Nurse(s) to administer vaccinations
• Administrative/all-purpose individual to facilitate paper work, finger sticks and to provide general assistance
• Pharmacist or pharmacist assistant if appropriate Dietitian for nutritional counseling suggested personnel designated for health fairs

Footnotes

1 The Robert Wood Johnson Foundation via Reuters Health E-Line.
2 Kaiser Daily Health Policy Report, (9/11/03)
3 www.cdc.gov/nccdphp/dnpa/press/archive/lower_cost.htm
4 “Is Stress Nibbling Away at Your Bottom Line?” By Stephen Alper, Nov. 15, 2002.
5 Health Promotion in the Workplace, Michael P. O’Donnell, page 415.
6 http://www.bmpcoe.org/bestpractices/internal/dayto/dayto_6.html

According to Gordian Health Solutions, the effectiveness of Employee Health Promotion Programs in improving health and lowering healthcare costs is directly linked to incentives: the more substantial the incentives, the higher the success rate. Incentives can range from tokens of achievement, such as t-shirts, water bottles and sports equipment, to more substantial financial awards, such as cash incentives or copay vouchers for the successful completion of a program.

Nationwide Insurance is seeing results from a small incentive program initiated by one of the employer’s worksite nurses. To promote lunchtime walking, the employee has informally launched a “shoelace program” modeled after the karate-belt color system. Employees progress through the color scale until they reach “black-lace” status. The reward system has resulted in more workers making commitments to walk during their lunch hour.

At the high end of the reward spectrum, some businesses pay cash to workers who meet wellness goals. LuK, Inc. offers workers $250 for kicking the tobacco habit and remaining smoke free for 12 months. For logging fitness points that add up to 10 miles a month, workers are eligible for health assessments, which can result in reward amounts of up to $225.

The most effective motivator, according to Gordian research, comes through linking participation in Employee Health Promotion Programs directly to insurance premiums. Doing so clearly demonstrates to workers the positive effects of wellness on their own healthcare costs. frequently, the first step in linking wellness programming to insurance coverage is lowering deductibles for wellness care or eliminating deductibles altogether. By adding this benefit, businesses can promote workers to undertake routine screenings and other procedures to respond to health problems before they become chronic. Early detection benefits both patient health and employer health costs.

Incentivizing Employer Wellness Program participation with healthcare credits

More frequently, businesses are going beyond increased wellness care coverage and looking to demonstrate the importance of wellness by linking participation to workers’ bottom lines. Worthington Industries has recently rolled out a program that allows workers to eliminate their portion of the insurance premium by enrolling in a Healthy Choices Employee Health Promotion Program.

During the first year of the Healthy Choices program, workers and their spouses complete Personal Health Assessments and medical screenings to determine their levels of health risks. Nurses, dietitians and physical fitness specialists are available to help moderate- and high-risk members develop individual action plans for improved health through the use of educational materials, behavior modification, telephone help from third-party program health coordinators, and formal health management initiatives. By completing the assessments, workers earn their full premium credit. Because some plans at Worthington require no employee contribution, a cash award takes the place of a credit in those cases.  During year two of the program, the wellness bar is raised slightly. To continue to receive the wellness credit, members in the moderate- to high-risk category will be needed to work at setting goals with third-party health coordinators.

Year three raises the bar again, requiring members to show progress in meeting goals and to continue to work with health coordinators to reach goals.

After year three, Worthington Industries workers will be on the wellness track. The employer believes that will mean a healthier workforce and cost savings for workers and the employer. The well being of Worthington workers is the foundation of this program, and both workers and the company are expected to benefit from the long-term advantages of the Healthy Choices Employee Health Promotion Program.

While Worthington has taken a broad approach to wellness, other businesses have found success in offering incentives in specific areas. Longaberger, for example, offers a discount on healthcare policies for workers who do not use tobacco. An individual employee who doesn’t use tobacco saves $7 per bi-weekly pay. For tobacco-free workers with family coverage whose families are also tobacco-free, the savings increases to $14 per pay.

The next step: Penalizing harmful behaviors

As it stands, healthcare is the only type of insurance that doesn’t focus on penalizing for behaviors that put the insured party at risk. With healthcare costs rising so dramatically, that could soon change. Just as an accident likely raises auto insurance premiums, increasing premiums for those who engage in unhealthy behaviors is a possible next step in employers’ attempts to manage healthcare costs.

Reports that workers would support this type of action are stacking up. One Ohio employer conducted an informal survey that indicated workers would consider it a morale boost if health-conscious workers were relieved of some of the burden of subsidizing care for workers who engage in behaviors that adversely affect their health. Whether or not this type of program gains popularity, one thing is sure: the need to control the rise in healthcare costs is becoming ever more pressing.

The Last Step: Getting Started

Whatever the strategy, from offering workers health resources to offering incentives for healthy behaviors, businesses have a real opportunity to improve morale and productivity, reduce rates of absence and control healthcare costs through wellness. The first step is committing to taking one, no matter what size effort is appropriate for your organization.

Small steps lead to big strides.

Preventing injuries is a high priority for businesses, especially in factory settings such as Honda. That’s why the employer offers several initiatives—including line-site process evaluations —to identify potential hazards and help reduce the chance of injury. As part of an early intervention program, Honda workers who are feeling pain can receive a massage of the affected area during work time.

Stretching initiatives are another effective tool in injury prevention. According to the Best Practices in Manufacturing Web site, Dayton Parts, Inc. (DPI) in Harrisburg, Pa., conducted research that revealed approximately 80% of all manufacturing injuries occurred within the first two hours of each shift. After starting a program that required production workers to stretch for 10 to 15 minutes at the beginning of their shifts, they saw a dramatic reduction in injuries.

While the DPI Employer Wellness Program costs about $75,000 a year to operate, in conjunction with other employer initiatives, it has helped bring the annual cost of workers’ compensation from $700,000 to $200,000 per year.6

To help prevent lengthy absences and reduce workers’ compensation claims, Honda instituted a work recovery program. Through the program, workers who have had an injury can work in a modified job—getting better. Employees in the program spend their work days receiving physical conditioning to increase overall fitness, physical therapy to restore functionality, health education and nutrition counseling. The program is based on data that shows fewer work days are lost when an employee stays connected to the work environment.

The Ohio Bureau of Workers’ Compensation, www.ohiobwc.com, provides a “10-Step Business Plan” as a guide for businesses in offering Employee Health Promotion Programs that aim to reduce injuries. The plan includes information on safety and health initiatives to prevent occurrences of on-the-job accidents, including:

employee involvement – To ensure the success of any Employee Health Promotion Program, workers must take part in the safety and health-management process. This can be done through safety and health audits, accident investigations, or by forming safety and health involvement teams, focus groups or committees.

Orientation and training plan – Conduct orientation and training sessions to educate workers on the employer’s safety policies. These sessions should include procedures for the safe use of machinery and tools, chemical hazards and how to prevent contact or exposure, specific job/task safe practices, and hazard recognition and prevention.

Communication – Open communication keeps workers informed and provides suggestions and feedback on the effectiveness of the Employee Health Promotion Program. Through memos, bulletin boards and staff meetings, important health and safety information can be conveyed throughout the organization, keeping all management staff and workers knowledgeable about the employer’s safe practices.

The employer plan also outlines incentives for post-injury procedures, including:

Medical treatment and return-to-work practices – arly return-to-work strategies help injured or ill workers return to work in a timely manner. Companies should begin a disability management policy to help injured or ill workers obtain quality medical treatment, making their transition back to work quick and effortless.

Timely notification of claims – Companies should document workplace injuries immediately after they occur and promptly send that documentation to a claims handler. Quickly offering claim information demonstrates care and concern for the injured employee, prevents delays and confusion with the claim process, and reduces the potential for abuse or needless litigation.

Record keeping – Internal documents should be kept to record work-time injuries and to assess the success of the employer’s safety efforts. Organization audits, surveys and injury or illness reports can all be used to analyze which safety practices and policies have proven successful, and what areas of health and wellness need improvement.

Dr. Moore of Nationwide maintains that immunization is the most cost-effective treatment in medicine. By way of example, vaccinating children against the influenza virus averages a savings (including healthcare costs, parents’ missed work, etc.) of up to $35 per vaccine recipient. And experts predict that estimate is low, because it doesn’t take into account the rapid spread of the flu.

The American Association of Family Physicians’ Web site, www.aafp.org, offers a recommended adult immunization schedule created by the Advisory Committee on Immunization Practices. This schedule, tiered by age and chances of exposure, recommends diphtheria, tetanus, influenza, pneumonococcal, hepatitis B, hepatitis C, measles, mumps and rubella, varicella and meningococcal vaccinations.

Ideas to incorporate prevention and early detection:

• Hold a wellness fair and invite organizations that provide screening services for such conditions as blood pressure, blood iron, cholesterol, body mass index (BMI) and diabetes.
• Offer educational materials about well-baby care and vaccinations.
• Choose healthcare coverage plans that include wellness check-ups and vaccinations.
• Offer worksite mammograms for workers.
• Sponsor worksite flu shots to coincide with flu season.

Advantages of Stress Reduction Programs

While stress cannot be eliminated from life, or even from the workplace, coping skills can be developed with relative ease. Stress management skills lead to decreased rates of absence and more effective, more productive workers. Because stress has been shown to contribute to such physical conditions as ulcers, high blood pressure and stroke, stress reduction has a direct impact on improving physical health.

Studies have shown that heart patients who attend stress management initiatives have 42% lower healthcare costs. Other studies have documented a 50% reduction in medical services use when stress management initiatives are employed. Further, Employee Assistance Program (EAP) experts estimate that 20% of any workforce is affected by personal problems that can influence work performance.

Stress reduction tactics to consider:

• Offer worksite yoga or meditation classes.
• Organize support groups among workers.
• Sponsor stress management classes during the workday.
• Offer an employee assistance program that includes both counseling and referral.
• Offer worksite counseling for workers in the case of a work-related trauma, such as the death of a co-worker.

Advantages of Prenatal Care and Breastfeeding

The old adage “an ounce of prevention is worth a pound of cure” is particularly relevant to when applied to preventive measures taken during pregnancy, when a few extra ounces of birth weight can save a child’s life. During pregnancy, simple precautions can help avoid catastrophic results; giving up smoking, for instance, drastically reduces the risk of miscarriage and pre-term labor.

The March of Dimes reports that if all women took adequate folic acid before conception and during pregnancy, the number of babies born with a neural tube defect could drop by as much as 70%. The physical and emotional benefits of proper prenatal care to a mother and child are underscored by a strong employer case for offering prenatal wellness benefits. Nationwide’s Chief Medical Director, Dr. Michael Moore, estimates costs to care for one baby delivered prematurely could approach $500,000.

First steps in fostering a prenatal program:

• Invite the March of Dimes to present information about prenatal health at an employee brownbag lunch or breakfast meeting.
• Hold prenatal care information classes for interested workers at lunchtime.
• Offer educational materials about the effects of alcohol, drugs and smoking on an unborn child.
• Offer incentives for adopting healthy lifestyles during pregnancy.
• Offer prenatal initiatives and education as part of the employer healthcare package.