cdhcsolutionsmag.com : Making Wellness Programs Work

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WHY HEALTH COACHING PROGRAMS FAIL: MISTAKES WELLNESS PLANNERS MAKE AND WHAT THEY CAN DO INSTEAD

Elias & Associates

WALTER S. ELIAS, Ph. D., of Elias and Associates, has over twenty years experience in programming, strategic planning, business development, and marketing in population health management with extensive experience in health assessment and communications. Walter Elias is Hummingbird Coaching Services Advisory Board member and was commissioned by Hummingbird Coaching Services to create this white paper.

Let’s cut to the chase – you’re reading this white paper because you want to know what makes wellness programs work. We know a lot more today than the industry predecessors of years past.

Why? Because so many corporate health promotion initiatives have failed – failed to keep employees healthier, failed to meet expectations, failed to reach the employees who need to be reached, failed to assist employees to make healthier behavior changes. Failure is an excellent teacher. Here’s what we have learned about success from less successful programs:

LOSING SIGHT OF THE BOTTOM LINE

No matter the industry, no matter the department, your company’s bottom line is what counts. Never forget that your company’s health promotion programming is no different.

GOING IT ALONE

Nothing happens inside a company without support from the top. This support comes in the form of senior-level involvement, but also includes capital. Gone are the days when a shoestring budget could make a measurable difference. Low-budget programs are a start, but true success comes when a company makes a real investment in its employees. You won’t have success without support from the C-suite.

MAKING DECISIONS WITHOUT DATA

Program planners should know the demographics of their workforce. Accurately measuring employees’ wants and needs when it comes to health and then programming accordingly makes a difference. No best guesses or disease-of-the-month programming here – rely upon relevant, accurate data.

SERVING ONLY CERTAIN EMPLOYEES

All employees are given opportunities to make lifestyle change – not just high risk employees. Keeping the healthy people healthy is just as important as helping high-risk employees control their diseases and conditions. Understand the dynamics of health in your workplace. If you don’t, you will make this mistake.

LACK OF COMMUNICATION

All employees can be reached with life-altering health messages. You just have to know how. Effective communication is the foundation for success. Without adequate communication channels, your message is lost.

SCRIMPING ON COST

Employees really will respond to incentives as long as they are meaningful and attainable. That’s where the budget component kicks in. Nothing happens without money. It’s a tough sell, but it seems simple enough: spend money to save money on health care costs.

GOALS, WHAT GOALS?

Make them measurable. Otherwise, you won’t have a clue whether your efforts are working. What’s that old saying, if you don’t know where you’re going, any road will get you there? If you find yourself up that road and don’t know how you got there, you will have made this mistake.

KNOWING YOUR BOTTOM LINE

Employers are often unaware of employee health impact. Half of executives interviewed said they do not know the full costs of employee health- and disability-related issues. Companies who said they did have information available to assess the true costs of employee health issues tended to be the most active in offering value-focused employee health activities such as employee health and wellness programs.

Make sure your senior executives know the impact of health promotion, or lack of it, on their bottom line. If you don’t have the authority to gather aggregate health insurance claims data, get to a senior executive who can open that door. You can’t program to your needs unless you know what health conditions are costing your company. If you guess, you will be wrong.

SUPPORT FROM THE TOP

Why programs fail:

· Lack of support from senior management

· No champion within the company

· No dedicated wellness coordinator

· No established culture of wellness that supports behavior change

The American Association of Occupational Health Nurses (AAOHN) released its employer research findings that uncover employer perceptions of and attitudes toward employee health at the AAOHN 2005 Symposium & Expo. One of their primary research findings is that employee health is crucial. 72 percent of executives interviewed indicated that keeping employees healthy is crucial to business success and felt it is their duty to keep employees safe and well.

If you already have a CEO who’s on board with health promotion, leverage that support. Be prepared with data and an operating plan. And before you leave the boardroom, make sure the executives will commit to supporting your efforts by attending events, writing memos of support and earmarking funds for the budget you present.

Creating a culture of wellness may be the most difficult hurdle to overcome. You can’t just declare yourself a healthy workplace and, voila, you are. The work climate must evolve to support employees making lifestyle change.

You accomplish that by developing policies and practices that help, not hurt. Going to a no-smoking work campus, for example, must evolve over months and even years. Just deciding one day that you won’t hire or continue to hire smokers can create a hostile environment. Working with the food service (cafeteria and vending machine suppliers) is one way to ease into healthier choices. Ensuring voluntary participation and confidentiality goes a long way toward removing employee mistrust of management.

But often, the meaningful culture changes come from the ranks. Employees who feel empowered by a flexible work schedule may feel less stress, work smarter and be happier at work, for example. Employees who see senior management supporting the walking program, playing volleyball, and taking the stairs will benefit from the role modeling. It is also important to schedule programs appropriately to accommodate employees. That’s how meaningful culture change happens.

“When it comes to helping foster a company’s innovative culture, HR can – and must – play a critical role. A variety of innovation experts, including business school professors, human resource consultants and corporate executives, say HR possesses many of the most important tools a company needs to build its innovative culture,” according to a commentary on Human Resource Executive Online.

“But the obstacles can be formidable. Many CEOs and other top executives don’t understand innovation or support its underpinnings, the experts say. And when an organization has a rigid, closed culture, its air can be permeated with the poison most fatal to innovation – the fear of failure,” the article explains.

“Often, HR is its own worst enemy. As the profession struggles to define itself as a strategic partner with a strong business sense, some HR executives have become even more conservative and cautious – and less open to new ideas – than the line managers they support,” said Rosabeth M. Kanter, a professor at the Harvard Business School who has studied innovation for more than 25 years.

Find the innovators within your company and make them your champions. Put them on your wellness committee. Whatever innovative principles your company applies to its products and services, apply those to your in-house wellness program. Innovation is more than lip service; you have to practice it. If your corporate culture supports innovation, tap into it.

KNOWING YOUR DEMOGRAPHIC AND COMMUNICATING YOUR MESSAGE: MARKETING AND PROMOTION

Why programs fail:

· Wellness message not consistent or frequent enough

· Not reaching all employees

· Difficulty reaching employees working remotely

· Not using the right communication channel

· Using only one communication tool (such as only telephonic coaching as opposed a combination of
telephonic, Web-based and in-person options)

If you want to reach employees with health promotion programs, understand their greatest concerns. Results from an online poll conducted by LifeCare delineate employees’ issues and concerns:

In determining your wellness message, you have to know your workforce. This poll shows that health and wellness is certainly an issue, but for most people, family and finances trump health. To look at it another way, stress about family and finances can affect health negatively, as can child and elder care issues. An employee worried about an aging parent’s care cannot focus, for example, on controlling diabetes or making time to get to the gym. “Life issues” are health issues.

Life issues are also a moving target, just like the demographics of your workforce. Look who’s not retiring: The Boomers. Although many are eligible to retire now and more are headed into retirement years, 68 percent of 50- to 70-year-old workers say they plan to work into their retirement years or never retire. What does this mean for your company and the focus of your wellness program?

An AARP study, The Business Case for Workers Age 50+, says that companies with more highly engaged employees, such as older workers who are more motivated to exceed expectations on the job than younger workers, will outperform industry peers. Mature workers bring value to the business.

They also bring the health concerns older people develop. Any number of excellent health risk assessments can give you a snapshot of the health and life concerns of your workforce. Choose an assessment that gives you the information you need to focus your programming.

Your biggest challenge, unless incentives drive very high levels of participation, will be getting enough participation in the assessment to gather enough data to make smart decisions about programming. Without accurate and representative data, you are only guessing.

Fortunately, employees are willing to assume greater responsibility for their health care than employers might think, but few employees are actively engaged in health care decision making and are looking to employers for guidance. Where is the disconnect here?

A national study from human resource consultants Hewitt Associates of more than 39,000 employees found that while 93 percent say they are comfortable taking responsibility for their health care decisions, most struggle with how to do so.

According to the survey, 80 percent don’t estimate their health care expenses each year or believe they can personally take action to help control costs. Half have never researched provider costs or quality, and a quarter has never asked about prescription drug options.

Further, less than half say they do a great job of taking preventive measures, getting screened or having immunizations, and those in the poorest health are the least likely to do so. Ironically, many companies are already offering targeted information in these areas, but is anybody listening? Hewitt experts suggest leveraging all communication channels (face-to-face meetings, print and online communications) to drive a consistent and clear message on consumer health behavior.

Get the most bang for your prevention buck. Just pretend you have a limited budget (okay, not everybody has to pretend on this one), and you want to put health promotion programs in place that will make the most impact.

Results from a detailed study by Partnership for Prevention indicated the following top 15 wellness interventions of greatest impact for employers (*indicates not being used enough):

· *Discuss daily aspirin use (for men 40+, women 50+)

· Childhood immunizations

· *Quit smoking advice and help to quit

· *Colorectal cancer screening (adults 50+)

· High blood pressure screening

· Flu shots (annually for adults 50+)

· *Problem drinking screening and brief counseling

· Cervical cancer screening (women)

· Cholesterol screening (men 35+, women 45+)

· Breast cancer screening (women 40+)

· *Chlamydia screening (sexually active women under age 25)

· Calcium supplements to prevent bone fractures (women)

· Folic acid (women of childbearing age)

· Obesity screening (counseling follow-up)

· Depression screening

How do these initiatives fit with the data you have gathered from your health risk assessment and employee preference surveys in light of aggregate health claims? Surely there’s something for everyone on your employee list this year.

Now about that fitness center. Gone are the days when health promotion planners felt they needed to have an onsite fitness center. For many (if not most) companies, a gym is not practical, feasible or necessary. And you notice that having a fitness center is not on the previous list of interventions. Far from it.

If you build it, will they come? Yes and no. A research study conducted by University of Virginia Professor Diane Whaley, PhD, pinpoints the main reasons people start and remain committed to exercise programs. Dr. Whaley is a national sports and exercise psychology expert. The study was developed in conjunction with a fitness center franchise (fair warning here on a conflict of interest).

“If people can find an exercise routine and facility that map to their individual lifestyle and fitness goals, they will be more likely to reap the full health benefits of working out,” said Dr. Whaley. For the small and limited worksite center, a one-size-fits-all or a few treadmills in a converted supply room simply will not “workout” anyway.

What makes exercisers “stick” with it? Here is what Dr. Whaley’s study shows:

Most important:

· Facility is less than 15 minutes away for most people

· Don’t have to wait to use machines

· Facilities are clean and well lit

· Staff friendly and helpful

· Hours of operation fit my schedule

· Can complete workout in 30 minutes

· Music/TV while I work out

Least important:

· Child care available when I work out

· Facility open before 6 am

· Optional classes offered

· Separate rooms, free weights and machines

· Facility open after 8 pm

· Experts on staff

· Can go to any associated facility

Now you see why an onsite facility just can’t meet everyone’s expectations? Let the health clubs, gyms and YMCAs do what they do best and make membership options available and part of your corporate culture.

A recent survey by the International Health, Racquet & Sportsclub Association (IHRSA) found that while most Americans (91%) believe exercising at a health club would improve their overall health, only 18 percent of those surveyed actually belong to a health club. Nearly half of those surveyed said their spouses or partners were not supportive of exercising. And only 40 percent said their doctors were supportive.

Solution: “If we are to help more people build exercise into their daily lives, we must provide the social support and positive reinforcement that Americans need to change their lifestyle behaviors,” according to IHRSA’s former president, John McCarthy.

If your employees are not getting support at home or from their doctors, look to the workplace to provide an ideal environment to foster social support for exercise (at offsite fitness centers) and lifestyle change. How can the worksite provide that social support? Certainly in person, but other communication channels are just as effective.

If you email, they will read. That’s the bottom line from a study in the Journal of Medical Internet Research. Researchers from Boston and New York looked at less costly ways, other than mailing to employees at home, to reach employees such as email and Web-based worksite programs.

The study found that employees will open and read email messages (in this case, promoting fruit and vegetable consumption) sent daily over 26 weeks. The study reports general acceptance of electronic communication but did not, however, look at whether the messages changed eating behaviors.

Using email to deliver well-designed communication messages about healthier eating and exercise just might change employees’ outlook and behavior [or at least nudge them in the direction of awareness], concludes a Canadian study in the American Journal of Health Promotion. The 12-week study looked at the effectiveness of plain-text emails employees received at the workplace.

The intervention group via self-reports showed an increase in physical activity levels and was more open to making dietary changes. Weekly email messages highlighted the value of activity and good nutrition.

Text messaging just might be the way to reach a younger working population who let their thumbs do the talking. Some worksites are experimenting with mass text messages, especially those with 20-somethings. Watch for this trend to either take off or continue to serve a very limited population.

Electronic communication certainly solves the issue of reaching employees in the field, at remote sites, working at home, and even those working overseas. And electronic communication is cost effective. The same message is out there for everyone, not just for the privileged few working in the headquarters building or at the plant. D

Do not discount the effects of using multiple channels to reinforce your health messages. An online newsletter can be enhanced with click-through links to a Web site with more in-depth information and health centers. An on-site poster/paper-and-ink newsletter can drive employees to an intranet site to sign up for activities and interface with other employees, say, to join a walking club or for MySpace-type interaction for cyclists, white-water rafters and gardeners.

Trend: Health information delivered on intranets helps control health costs. As more US companies embrace health care consumerism to help stem rising costs, they are placing far more emphasis on employee education and the technologies that facilitate better employee decision making, according to experts and research from Watson Wyatt Worldwide.

A survey of more than 550 large employers by Watson Wyatt and the National Business Group on Health showed a sharp increase in the number of companies providing detailed information online to help employees become better health care consumers.

· 71 percent of companies are providing information on specific health issues (up from 38

percent in 2003)

· 35 percent are providing information on providers and/or hospital quality (up from 16 percent in

2003)

“Not only are companies providing more health care information to workers, they are changing how they provide that information,” said Cathy Tripp, national practice leader for health and welfare technology at Watson Wyatt. “While traditional print communication is still important, company portals have become the health care information hub for workers at many large employers. And these portals, especially when supported by useful tools [such as lifestyle coaching], can be very effective. Workers who access health plan information from their employers’ intranets have a better understanding of health care costs and available services.”

SERVING ALL OF YOUR POPULATION

Why programs fail:

· Target only high-risk employees and fail to keep others at low risk

· Unable to offer programs to all employees (fitness center only at headquarters, for example)

· Not offering comprehensive empowerment tools for all employees

After more than 20 years of study by the University of Michigan’s Health Management Research Center, the secret is out. The key to controlling health care costs is managing the health of low-risk people, rather than attempting to improve the risk status of those at high risk only. That’s the secret.

According to Dee Edington, PhD, director of the Center and lead researcher, “Over the years, intervention people developed the medical model of going after high-risk people, waiting for health problems to surface. They missed an opportunity. The real opportunity is to keep the healthy people healthy [because costs tend to rise or fall based on the number of actual health risks],” said Dr. Edington in the Health Promotion Practitioner.

Here’s the research bottom line:

· You can’t expect your low-risk population to stay low risk, any more than a magazine can

expect all current subscribers to renew year after year. Without low-risk maintenance programs

in place in your worksite, 20 to 40 percent of an employee population is likely to move to

higher-risk status within a year. Target some of your programs to the low-risk employees.

· Maintaining low risk may be as good or better an investment than intervening with high risks.

According to Edington, risk reduction has a potential employer value of $153/person/year vs. $350/person/year for risk avoidance. Of course, the figures will vary based on your population’s needs. If your employees have a particularly high incidence of back injury, diabetes, or asthma, for example, targeted disease management interventions may be particularly cost-effective. The best strategies integrate both low-risk maintenance and high-risk management.

Health management programs work, said Dr. Edington. But if the program addresses only high-risk employees, they work on just a small percentage of your population.

“When you assess the return on investment for participants alone, you may see a 3 to 1 ROI and say, ‘What a wonderful thing I’ve done.’ But the CEO looks at the entire picture and will see you got only about 15 percent of the population participating,” said Dr. Edington. “Viewed over the whole population, the program may not have made a ripple.”

The challenge: Move employees to low risk and keep them there with workplace health promotion programming and disease management interventions. The cost: If you do nothing, people will naturally migrate to higher risk over time. And it doesn’t take many individuals migrating to high risk to change your economics.

Workplace health promotion programs can decrease absenteeism and provide a significant ROI. “Many corporations use health promotion programs as a reactionary effort to curtail ever-increasing, employee-related expenses of health care and lost productivity,” said Dr. Steven Aldana, a BYU Professor of exercise science. “This new information provides additional evidence why companies should help employees have healthy lifestyles.” (Preventive Medicine, March 2005)

If you could invest in just one winning health promotion strategy, what would it be? Coaching is a critical component for successful worksite health programs. Researchers from the Centers for Disease Control and Prevention say individual coaching about personal health and risk factors “may be the critical component for an effective worksite health promotion program.”

When high-risk employees are identified early, especially those with risks for heart disease (such as high blood pressure and cholesterol), and given counseling to make healthier lifestyle choices, employers might expect to see a return for every dollar invested in worksite health promotion programs over a 2- to 5-year period. The researchers summarized 19 worksite studies and consulted with experts and employers to find out what programs work. Findings were published in the American Journal of Preventive Medicine.

Heart disease was targeted because no other disease has a greater impact on the health of a company’s workforce, said the researchers. Four of the top 10 most costly health conditions are related to heart disease and stroke. In most cases, lost productivity costs were higher than the medical costs, especially among adults with many heart risk factors.

In addition to coaching, other components of successful worksite programs were:
· Regular medical screenings

· Company-wide environmental changes such as healthier cafeteria food

· Frequent and simple prevention messages

· Regular health education classes

· Financial incentives (such as lower insurance premiums) to encourage participation

WHAT’S IT WORTH?

Why programs fail:

· No budget to give incentives for lifestyle change

· Can’t track program participation to validate rewards/recognition

· Rewards/recognition not creative, not motivating

What’s it worth to get employees to stop smoking? Manage their weight? Wear seat belts? Exercise regularly?

As companies start to offer financial incentives in the form of different levels of insurance premiums, co-payments or deductibles, a Wall Street Journal Online/Harris Interactive Healthcare Poll (2006) showed that employees generally support the idea of being given incentives (money) to choose a healthier lifestyle.

The biggest proponents of incentive-driven health and wellness programs are women, seniors, and those with higher education and incomes. BUT a majority polled only favors charging more for smokers, those who drink heavily and people who do not wear seat belts. A majority of employees oppose incentives/penalties for people who are overweight and do not exercise regularly.

Companies are using carrots in the form of cash, gift certificates and merchandise discounts, days off, and lower medical premiums to give employees a financial incentive to participate in wellness programs, according to the Hay Group, a Philadelphia-based consulting firm in a survey.

How much is enough to boost participation? One consultant says $250 for a lower-paid workforce and $500 to get attention. Yet another consultant thinks any amount over $50 isn’t likely to boost participation measurably.

The data are obviously not in on what the incentive thresholds need to be but keep watching the literature. Studies on appropriate levels of incentives to drive participation in HRAs and intervention programs will be available soon.

It pays to be active: “If you have only one preventive activity that you focus on, physical activity can buy you so much,” said Joyce Young, MD, MPH, IBM’s Regional Well-being Director. IBM’s online Virtual Fitness Center, developed with the help of Medifit Corporate Services helped nearly 70 percent of the company’s 130,000 eligible employees get active and collect $150. The cash incentive could be earned if employees were active 10 of 12 consecutive weeks – with three 20-minute workouts a week – and reported the activity online.

In an interview in Employee Benefit News (March 2006), Dr. Young said, “Don’t think in terms of building a fitness center. That’s going to consume a lot of resources. Look at whatever you can do to help your employees become more active. That could be flextime, relationships with fitness centers, stairwell programs, a paper version of our Virtual Fitness Center, an education program . . . Think about doing it for 12 months . . . Make it a part of your culture.”

What incentives are companies offering for participation? According to a survey released by ERISA Industry Committee and the Deloitte Center for Health Solutions, led by Tommy G. Thompson, former HHS Secretary and former Governor of Wisconsin, these are the forms incentives are taking:

· Rebate of program costs (30%)

· Cash (29%)

· Reduced medical co-pay costs (15%)

· Other (gift certificates, prizes, free membership in onsite exercise facilities) (48%)

Unfortunately, overall, fewer than 25 percent of employees participate. Hardly encouraging news. Trinkets, t-shirts, cash rewards and reimbursements for gym membership must meet HIPAA standards.

Some wellness programs automatically meet the HIPAA standard, because they are not based on satisfying a standard related to a health factor. Examples of wellness programs that are automatically permissible include programs that:

· Reimburse the cost of a gym membership or the cost of a smoking cessation class (regardless

of whether an individual stops smoking),

· Provide a reward just for participation in a diagnostic testing program or a monthly health

education seminar (not on any health outcome), and

· Encourage preventive care by waiving co-payments or deductibles for the cost of care (for

example, prenatal or well-baby care).

Wellness programs that provide for a reward that is conditioned on a participant satisfying a

standard related to a health factor will have to meet additional standards, as follows:

· The reward for the wellness program must not exceed 20 percent of the cost of the category of

coverage in which participants are enrolled. The cost of coverage is based on the total amount

of employer and employee contributions for the benefit package the employee is receiving.

· The program must be reasonably designed to promote health and prevent disease.

· Individuals must be allowed to qualify for the reward at least once a year.

· The wellness program must have a reasonable alternative standard for those for whom it will

be unreasonably difficult or medically inadvisable due to a medical condition to satisfy the

condition needed to obtain the reward. Plans are allowed to require verification from a

physician that satisfying the health factor is unreasonably difficult or medically inadvisable.

· The wellness program must disclose in all plan materials describing the terms of the wellness

program that a reasonable alternative is available. Model language is included in the

The real cost of incentives: Next time you tie incentives into health behavior change, consider the true “cost” of the t-shirts, baseball tickets and gift certificates.

“Anything you give to an employee is considered to be taxable income,” said Michael Dermer, President of IncentOne, a New Jersey-based incentive solutions company. Certain exceptions apply for minor items ranging in price up to $100, he said, but even experts (including the IRS) don’t agree on what’s taxable and what’s not.

In most cases, the “value” of the incentive needs to be reported on the employee’s W-2 and the associated Social Security, Medicare and income taxes need to be paid, said one tax specialist. Dermer said a company, however, may decide to pay taxes for the employees on these items.

With the federal government taking the creativity out of incentives – taxing them and making them HIPAA compliant -- offering them can become a burden. One company turned the tables: Dow Chemical is paying incentives if employees lose weight, quit smoking, exercise more frequently or lower their stress levels.

But those incentives are being paid, not to the employees, but to health promotion staff who can expect to earn larger performance bonuses. The company wants to cut millions from health care costs over the next decade.

Innovative or idiotic? Industry experts have their say about this strategy:

“Providing incentives to health staffers is essentially adding a reward for them to do their jobs. The incentive system should be designed to increase the primary endpoint – the employee behavior. . . . until the employee is able to change habits and routines, the incentive is misaligned,” said Joshua Klapow, PhD, Associate Professor, Psychology, University of Alabama at Birmingham and author of Stop Telling Me What – Tell Me How!

“It is unbelievable that huge companies with so many resources cannot come up with anything more creative than this – certainly a great example of ‘paradigm paralysis,’” according to Jon Robison, PhD, MS, Michigan State University.

“It has two major risks: First, those who can’t control the results sometimes decide to manipulate the numbers . . . the bigger risk, though, is that the health staff are being measured and rewarded on short-term results when the goal is long-term health. . . . It also seems to shift responsibility from the individual to the ‘care manager.’ I wonder if better results wouldn’t be achieved by investing the same money in personal health coaching,” observed an industry consultant.

“Dow is to be congratulated for making a major, long-term commitment to health improvement. [However] employees may perceive these initiatives as controlling and evoke the opposite reaction – generating more resistance to change. . . . Incentives are only a small component of a comprehensive program. Incentives are great for launching new initiatives, but an over reliance on them for maintaining behavior change may be counterproductive. Take away the incentives and guess what happens to the behavior,” said Dr. Rick Botelho, Professor of Family Medicine & Nursing, University of Rochester and author of Motivate Healthy Habits: Stepping Stones to Lasting Change.

GOAL SETTING: WHERE ARE WE GOING?

Why programs fail:

· Didn’t establish reasonable goals for wellness program

· Can’t track results

· Unable to evaluate program success

· Setting unrealistic expectations (such as decreasing health care costs the first year)

Employers are incorporating health and productivity initiatives in setting their goals for overall health care planning. According to the 2005/2006 Staying [at] Work Survey, most large employers who are implementing these practices are seeing lower health costs, reduced lost time and improved worker health. Results are from the survey conducted by Watson Wyatt Worldwide and the National Business Group on Health.

Certainly meeting these ambitious goals is unrealistic in the first year, but companies must first set the stage for behavior change with targeted health promotion programs. Employers aim to hit employee productivity by aiming for these targets (and the percentage surveyed who list these areas): stress (72%), personal/family issues (59%), chronic medical conditions (58%), unscheduled absences (57%), presenteeism (49%), lifestyle medical conditions (49%).

These are the programs employers surveyed are using to improve health and productivity:

· Employee assistance programs (94%, up from 88% in 2003))

· Return-to-work programs (81%, up from 56% in 2003)

· Health promotion programs (75%, also up from 56% in 2003)

· Health risk appraisals (72%)

· Work and family balance (71%, up from 44% in 2003)

· Paid time off (40%)

· *Personal health coach/advocate (40% expected to offer by 2006 at the time of the initial

survey)

The appeal of motivational interviewing

Employees won’t quit smoking, eat smarter, start exercising or follow a diet plan unless they buy into the change, no matter how large or exciting the incentive. Motivational interviewing is an alternative one-on-one approach to helping employees change, said Robert Rhode, PhD, Assistant Professor, University of Arizona Health Sciences Center. The technique helps employees access their own reasons and desires to adopt health promoting behaviors. That’s not the job of the health planner. It’s the job of the employee.

By having a health coach ask leading questions and thereby helping the employee describe his or her own reasons to choose a healthy alternative, the more likely the employee will make the change.

The conversation might open with a question such as, “What are some of the good things about [smoking, not exercising, eating high calorie foods]?” And follow with questions such as “What are you worried about most [with this behavior]?” “How important is it for you to make any changes in your [risky behavior]?” “What would have to happen for it to become much more important for you to change?”This practice as part of individual health coaching may be the key to unlock true and lasting behavior change.

WHAT IS SUCCESS?

Success, according to the National Business Group on Health can be defined as prevention efforts that:

Improve health. With 75 percent of all illness and early death attributed to poor lifestyle choices that can be changed, wellness programs can assist people who want to change to make healthier choices that result in longer and better quality of life.

Increase productivity. Healthier people are more productive in the workplace. They have less costly absenteeism.

Reduce costs. Prevention results in lower medical claims for employees at all levels of risk and can produce positive results on a corporate investment in employee health.

Success is, of course, a different animal for every company. For every program you initiate, you should ask yourself first, “How will we measure success?” If you can’t answer that question, you will want to rethink your programming. Just throwing up posters and organizing a lunchtime walking club won’t take you where you want to go.

Health promotion programmers should also consider the answers to these questions:

· Are employees involved and engaged in the wellness programming at your company? Are the

right employees involved and engaged or is it the same 20 percent who come to everything?

· Do you know what health claims are hitting your health plan, and are you programming to

reduce the fiscal and physical effects of those health conditions?

· Are you working with your health insurer to track aggregate claims?

· Are employees and their insured dependents taking a consumer directed approach to

managing their health costs? Do you have incentives built into your insurance plan to put the

brakes on out-of-control costs?

· Are you giving employees incentives that truly change behavior for the long term?

Evaluation measures must be considered upfront. Surveys and other instruments asking about participation, assessing quality of life and employee satisfaction are one way to measure employee engagement at two points in time. You can track costs by evaluating aggregate claims data.

You can look at absenteeism rates. In some work settings, you can measure productivity, safety records, injuries and workers’ compensation claims. You can evaluate encounters with EAPs. And you can do qualitative analysis on health coaching interactions.

Reasonable goals can be met with programs that meet employee needs and wants. Watch for the traps other health promotion practitioners have fallen into and step around them as you plan and execute your successful health promotion programs.

A FINAL WORD ABOUT THE BOTTOM LINE

Ultimately, the success of your program will be measured in dollars. At stake is your company’s bottom line. Health care costs are quickly eroding profits, and there’s little relief in sight except for innovative and effective health promotion initiatives.

If at first you don’t succeed (or haven’t succeeded in the past), step back and learn from your initial mistakes. If some of the errors outlined here sound familiar, rest assured you’re in good company. Even the most seasoned health promotion practitioners have made dumb mistakes on the wellness journey. The smart money is on effectively communicating a goal-oriented, motivational health promotion program based on representative data, offered to all employees, with support in person and in dollars from the top.

REFERENCES

AARP. The Business Case for Workers Age 50+. 2005. <http://assets.aarp.org/rgcenter/econ/workers_fifty_plus.pdf.>

Aldana, Steven G.; Merrill, Ray M.; Price, Kristine; Hardy, Aaron; and Hager, Ron. Financial impact of a comprehensive multisite workplace health promotion program. Preventive Medicine, February 2005, 40(2):131-137.

American Association of Occupational Health Nurses (AAOHN). Employer-Based Research: Wellness in the Workplace Crucial to Business Success. Presented to the AAOHN 2005 Symposium & Expo, May 2005).

<www.aaohn.org/practice/employer_research2005.cfm.>

Burton, Wayne N.; Chen, Chin-Yu; Conti, Daniel J.; Schultz, Alyssa B.; and Edington, Dee W. The association between health risk change and presenteeism change. Journal of Occupational and Environmental Medicine. 48(3):252-263, 2006.

Dead presidents enliven workers. Employee Benefit News, March 2006.

ERISA Industry Committee and Deloitte Center for Health Solutions. Survey: US employers turning to wellness programs to manage health care costs. June 22, 2005.

Flander, Scott. Innovation Mavens. Human Resource Executive Online, <www.hreonline.com/HRE/story.jsp?storyId=15709874.>

Franklin, Patricia D.; Rosenbaum, Paula F.; Carey, Michael P.; and Roizen, Michael F. Using sequential email messages to promote health behaviors: Evidence of feasibility and reach in a worksite sample. Journal of Medical Internet Research. March 30, 2006; 8(1):e3.

Hay Group. Financial incentives for wellness: Showing everyone the money. WorldatWork Total Rewards Conference & Exhibition, 2006.

Health Enhancement Systems. Spotlight on Managing Your Low-Risk Population. Health Promotion Practitioner(www.hesonline.com). Jan/Feb 2005, 14(1):7-8.

Herman, Christopher; Musich, Shirley; Lu, ChiFung; Sill, Stewart; Young, Joyce; and Edington, Dee W. Effetiveness of an incentive-based online physical activity intervention on employee health status. Journal of Occupational and Environmental Medicine. 48(9):889-895, 2006.

Hewitt Associates. 2006 Health Care Expectations Survey. 2006. <www.hewittassociates.com/_MetaBasicCMAssetCache_/Assets/Articles/2006_hce_report.pdf.

International Health, Racquet & Sportsclub Association (IHRSA). US health club membership reaches 42.7 million in 2006. April 25, 2007.

Why spacing?

Kottke, Thomas E.; Edwards, Brooks S., MD; and Hagen, Philip T., MD. Counseling: Implementing our knowledge in a hurried and complex world. American Journal of Preventive Medicine, November 1999, 17(4):295-298.

Levin-Epstein, Jodie. Presenteeism and Paid Sick Days. Center for Law and Social Policy (CLASP), Feb. 28, 2005. <www.clasp.org.>

LifeCare Online Poll. What are your employees’ greatest work/life challenges? Feb. 28, 2007. <http://lifecare.com/news/archives/wl_0207.html.>

Musich, Shirley A.; Schultz, Alyssa B.; Burton, Wayne N.; and Edington, Dee W. Overview of disease management approaches: Implications for corporate-sponsored programs. Disease Management & Health Outcomes. 12(5):299-326, 2004.

National Business Group on Health. Improving Health. Improving Business. A 4-Part Guide to Implementing Employee Health Improvement and Preventive Services. <www.businessgrouphealth.org.>

National Business Group on Health/Watson Wyatt Worldwide. 2005/2006 Staying [at] Work Survey. <www.watsonwyatt.com.>

Partnership for Prevention. Healthy Workforce 2010: An Essential Health Promotion Sourcebook for Employers, Large and Small. Fall 2001. www.prevent.org.

Plotnikoff, Ronald C.; McCargar, Linda J.; Wilson, Philip M.; Loucaides, Constantinos A. Efficacy of an e-mail intervention for the promotion of physical activity and nutrition behavior in the workplace context. American Journal of Health Promotion. July/Aug 2005, v19(I6),422. (Is it I6 or 16?)

US Preventive Services Task Force. Behavioral counseling in primary care to promote a healthy diet. American Journal of Preventive Medicine, January 2003, 24(1):93-100.

Wall Street Journal Online/Harris Interactive Healthcare Poll. Kicking a bad habit could pay off. Dec. 12-14, 2005 (released Jan. 6, 2006).

Watson Wyatt Worldwide. Employee education and intranets play central role in shift to consumer-directed health care. Survey conducted with National Business Group on Health. March 31, 2005. <www.watsonwyatt.com>

Whaley, Diane; Redding, Tiffany. Turning want to into will do: The role of future-oriented plans in exercise behavior. Melpomene Journal, fall/winter 2001.

Yen, Louis; Schultz, Alyssa B.; Schnueringer, Elaine; and Edington, Dee W. Financial costs due to excess health risks among active employees of a utility company. Journal of Occupational and Environmental Medicine. 48(9):896-905, 2006.

Additional resources

Centers for Disease Control and Prevention, Healthier Worksite Initiative, <www.cdc.gov/nccdphp/dnpa/hwi/index.htm>

National Business Group on Health, <www.businessgrouphealth.org>

Partnership for Prevention, <www.prevent.org>