Getting well

Addressing worker health with wellness programs

Health care costs are rising faster than ever in U.S. history, and the bulk of this burden falls on employers. Between 70 and 75 percent of these costs go toward treating employees’ preventable illnesses, of which most can be attributed to poor health choices such as unhealthy diets and physical inactivity, according to 2010 Department of Health and Human Services data.

Some of those choices lead to obesity and other problems linked to dangerous health conditions such as heart disease – as well as higher workers’ compensation costs. A Duke University Medical Center study published in the Archives of Internal Medicine (Vol. 167, No. 8) found that obese individuals with a body mass index greater than 40 had nearly 12 claims per 100 full-time equivalents, almost double the amount of claims made by those within the normal BMI range.

Facing rapidly increasing costs for providing health care to workers, employers are seeking strategies to address underlying health problems among their employees.

Wellness programs are one such strategy. According to the National Institute for Health Care Reform, one of the most common wellness programs is a health risk assessment, in which questionnaires help identify an employee’s risk of developing a chronic illness. Other common wellness programs incorporate biometric screenings, which evaluate an employee’s underlying health status; health coaches; and behavior modification programs such as smoking cessation and weight-loss tools.

Some companies have reported that their wellness programs are working. A report from the Omaha, NE-based Wellness Council of America found that employers investing $100 to $150 per employee on wellness can potentially generate $300 to $450 in returns on investment in reduced medical care costs.

Effective design

Optimal wellness programs are customized to the needs of the workplace, said William B. Baun, manager of wellness programs at the University of Texas M.D. Anderson Cancer Center and president of the National Wellness Institute. Baun said employers implementing wellness programs for the first time sometimes run into the trap of modeling them after those of other companies without considering the needs of their own employees. “The same thing in the safety arena – if you take a safety program from a company and put it somewhere else where it is not going to fit, it will not work,” he said.

Support from leadership directly impacts the effectiveness and participation levels of employer wellness programs, according to a study from the Washington-based Center for Studying Health System Change. Michelle Todzy, vice president of human resources for Green Bay, WI-based Trudell Trailers, has come to a similar conclusion regarding her company’s program. “When regular employees see the management team getting dedicated and involved in [the wellness program], it sends a message,” she said. One of the best examples of this at her company is its president’s involvement in a “Biggest Loser”-type weight loss program, Todzy said. When the program launched, she noted, the president sent out an email to the entire staff saying “there is no shame in making second place.”

Leadership does not only apply to management – self-leadership also applies, Baun said. “Ultimately, wellness is something you need to do for yourself,” he said. Part of self-leadership in wellness involves being a role model, such as demonstrating to friends and family that staying physically active is important, he said.

The debate on using incentives

A wellness program will not have much impact without employee participation. Some employers choose to use incentives to increase participation, including cash prizes or better rates on health care premiums. According to a report from the St. Louis-based Incentive Research Foundation, U.S. employers most frequently offer incentives for taking health risk analyses, joining a fitness program or not smoking.

Although stressing that incentives should not be used as the only method to change wellness behavior, Todzy believes they still serve a role. “Even though [our employees] might have done our programs in the short-term to be part of the competition and get a particular prize, I have seen people maintain their behaviors. So, from at least a starting point, they are beneficial,” she said.

Not everyone agrees. Judd Allen, president of the Burlington, VT-based Human Resources Institute LLC, said he is skeptical when employers with recently created incentive-based wellness programs claim they have been successful at saving on health care costs. “What happens in most wellness activities, the moment the activity is over people revert back to their old behaviors,” he said.

Allen said he questions whether incentive-based wellness programs truly create meaningful change. “It is not that I think wellness programs cannot be useful or effective; I think they could have a much bigger impact if they move toward a supportive cultural environment,” he said.

From a psychological perspective, the best way to encourage healthier behaviors is to start with achievable, incremental changes, said Paul Hebert, managing director for incentive program design company I2I, located in Greenville, SC. “If you tell a cigarette smoker to ‘just quit,’ that is a big thing,” he said. “But if you tell a smoker to just go five minutes longer between cigarettes today than they did yesterday, I just now broke that into a digestible piece of information that is based on their behavior. It is always better to do smaller objectives, shorter periods of time, and focus on behaviors that they can control.”

Establishing a wellness culture

An organizational wellness culture encompasses training, social norms and communications received by employees both consciously and unconsciously, according to Allen.

Environmental cues are an important part of an effective wellness culture, Hebert said. “Moving the smoking areas away from the building – those are cultural touchstones that people see,” he said. “They think, this company does not want me to do unhealthy things.” Hebert provided another example: placing vending machines that offer sugary foods in an area that requires people to walk farther to reach them.

Although employers are not necessarily legally required to ensure their employees practice healthy behaviors, Hebert said, they should take responsibility for providing healthy choices. For instance, it would be irresponsible to offer high-sugar and high-fat-content food to employees without making alternatives available.

“If you think of your own personal relationships, you would never let someone you love engage in destructive behaviors,” he said. “Smart, socially responsible and caring companies are going to see [wellness] as a way to have a better relationship with their employees.”