Employer Wellness

Business America is increasingly investing in employee wellness because it is good business.  In order to meet productiveness demands, businesses must rely on a healthy, constructive workforce to succeed in the highly competitive global marketplace.  Over a hundred studies in both corporate and governmental settings have documented the economic benefits of Workplace Health Promotion Programs, including reduced absenteeism, reduced injuries and workman’s compensation costs, reduced medical care costs, reduced employee turnover, as well as enhanced productiveness, greater worker satisfaction, and improved morale.1-10  

The more recent literature reflects improvements in wellness programming along with greater return on investment.  In general, the more focused and intensive the program, the greater profit realized.  To enhance their effectiveness federal government Employee Health Promotion Programs may be able to incorporate some of the features described.  Employee wellness programs demonstrated to have positive returns on investment often include the following features:

1.   Health and productivity management model
Programs characterized by this model focus attention on identification and reduction of specific risks or behaviors such as smoking, lack of physical activity, excess weight, unhealthy diet, elevated blood lipids, high Blood Pressure (BP), stress, depression, and so on.  High-risk staff members are specifically targeted for intervention, even though the most successful programs also direct efforts towards healthy staff members in order to maintain their low-risk status.  This model emphasizes outcomes as opposed to simply offering wellness activities for their own sake.  

2.   Health risk appraisal
Use of a computerized health risk appraisal (HRA) instrument with individualized feedback and recommendations is almost universal in successful programs.  Employees take the questionnaire each year in numerous cases.  The HRA serves to broaden awareness, support direction, and innervate people to better specific behaviors.  In some cases, the personalized report is directly linked to appropriate resources related to identified risks.  Research indicates that the use of an HRA is effective if it is followed by some kind of educational or therapeutic intervention for identified risks.  It often serves as the entry point into wellness programs.

3.   Biometric Testing
Many programs combine the results of the health risk appraisal with measurement of each employee’s biometrics, including weight and Body Mass Index (BMI), Blood Pressure (BP), cholesterol, fasting glucose, and assorted other metrics.  Combining the results of the HRA with biological measures results in a more accurate risk profile.   Computerized health risk appraisals often incorporate biometric data in their risk analysis.

4.   Incentives
staff members are commonly given monetary or other valuable rewards for completing an HRA, participation in a program or class, specific accomplishments such as stopping smoking, losing weight, or working out, and for maintaining healthy status and/or behaviors.  In numerous cases the monetary incentives are associated with reductions in medical insurance premiums.  Some programs use disincentives as well as incentives, such as charging staff members who use tobacco higher rates for their medical insurance contribution.

5.   High participation rates
Effective programs use incentives and rewards to drive participation rates up.  They also market their programs extensively, and may use contest or challenge strategies to heighten enthusiasm and bolster participation.

6.   Wellness coaching
workers with identified risks or desire to improve their health habits may be periodically coached via phone by trained wellness coaches.  Health Coaching helps workers set and achieve realistic lifestyle-related goals and objectives including those discussing stress, work life balance, smoking, weight, physical exercise, and various behavior modifications.  Three or more sessions are generally available.  In some intensive programs, the coaching extends to actual disease management intervention for workers with identified high-risk diseases.

7.   Multiple formats
Programs may offer wellness content in web-based, paper, and seminar formats to support stimulating variety and alternatives in order to accommodate the needs of all staff members.  In addition to onsite physical activity and healthy eating programs, on-line programs, e-mail reminders and notices, printed newsletters and materials, and organization courses are common dissemination strategies.

8.   Upper Management reinforcement
Enthusiastic and frequent endorsement by senior staff is critical to achieving high rates of participation.  When senior executives are wellness role models themselves the effects of endorsement are enhanced.

9.   Frequent contact
Effective programs have successive contact of some sort with every employee.  This may be through marketing efforts (e.g., posters, e-mail notices, reminders, or messages, etc.), bulletin boards, newsletters, employee meeting presentations, discussion in new employee orientation, supervisory sessions, etc.   The key is to enhance employee awareness of health & wellness opportunities and reinforce the corporate emphasis on wellness through successive and multiple “touches”.

10.   Open enrollment
To bolster high participation rates staff members must have easy access to the wellness programs and activities.  Open and uncomplicated enrollment processes achieve this.  Some employers automatically enroll all staff members and then allow those who do not wish to take part to “opt-out”.  This practice has been demonstrated to boost enrollment rates in some settings.

11.   Family involvement
Many programs encourage spouses and other family members to participate in the company wellness activities and to adopt a healthy lifestyle along with the designated employee.  It is far easier for the employee to have a healthy lifestyle if his/her family does so as well.

12.   Smoking cessation
Because smoking and other tobacco use is the number one threat to health it is vital to offer employees effective and convenient assistance with stopping.  Access to smoking cessation pharmaceuticals is often part of such programs.  In-house programs support the most convenient access to these services, even though on-line or phone-based programs may be available as well.  

13.   Physical Activity
Regular physical activity is a core component of every wellness program.  Workers must be strongly encouraged to engage in regular physical activity.  Most programs provide either periodic or continuous onsite opportunities, and some locations have onsite gyms, swimming pools, walking trails, etc.  Discounted or paid memberships to area exercise facilities is a common alternative to onsite facilities.

14.   Weight management
Because obesity is a primary threat to health it is imperative that programs offer effective assistance with weight management.  Enthusiastic encouragement from upper management to shed excess weight is important.  Internet based programs, worksite programs, or discounted access to weight management programs in the community may all be available.  Long-term follow-up is critical for maintenance of weight loss.

15.   Stress management
Workplace stress is perhaps the most common complaint among workers and a major contributor to absenteeism, presenteeism (reduced productivity), and low morale.  Almost all efficacious wellness programs offer assistance with personal and worksite stress.  Some programs refer workers to outside resources for more weighty conditions like depression and anxiety disorders, but most offer web-based or successive worksite general stress reduction programs.  Some corporations endeavor to structure the work environment to minimize stress, both physically and operationally.

16.   Wellness screenings/immunizations
workers are actively encouraged to complete recommended medical care screenings for Blood Pressure (BP), blood lipids, BMI, colorectal and breast cancer, and others.  Annual influenza immunizations are also encouraged.  Some sites provide these services at the worksite.  Incentives are frequently awarded for completion of these screenings/immunizations.

17.   Onsite health care
Actual provision of on-Site primary care medical services is a growing trend.  The rapidly escalating expenditures of medical care insurance for staff members has stimulated this trend.  Some businesses have found that it is less expensive to support primary care services themselves than to fund those services through healthcare insurance.  Onsite care also reduces the amount of time staff members would otherwise spend away from the worksite getting such services.

References

1.   Aldana, Steven G.  (2001)   Financial Impact of Worksite Wellness Programs:  A Comprehensive Review of the Literature.   Am J Health Promotion 15(5):296-320.
2.   Chapman, Larry.  (1998)   The Role of Incentives in Health Promotion.  The Art of Health Promotion  2(3):1-8.
3.   Chapman, Larry.   (2003)   Biometric Screening in Health Promotion:  Is it Really As Important as We Think?  The Art of Health Promotion  7(2):1-12.
4.   Chapman, Larry.  (2005)   Meta-Evaluation of Worksite Health Promotion Programs Economic Return Studies: 2005 Update.  The Art of Health Promotion, July/August, 1-15.
5.   Chapman, Larry.   (2006)   Employee Participation in Corporate Health Promotion Programs and Corporate Health Promotion Programs:  How Important are Incentives, and Which Ones work Best?   North Carolina Medical Journal   67(6):  431-432.
6.   Chapman, Larry, Lesch, Nancy, and Passas Baun, Mary Beth.   (2007)   The Role of Health and Wellness Coaching in Employee Health Promotion Programs.   The Art of Health Promotion, July/August, 1-12.
7.   Chapman, Larry.  (2007)   Proof Positive:  An Analysis of the cost-Effectiveness of Job Site Wellness.  Northwest Health Management Publishing, Seattle, WA.
8.   Chapman, Larry.  (2007)   An In-Depth Look at the Economic Evidence for Rewarding Health Behavior Change.   Workshop presentation at the World Research Group “Rewarding Healthy Behaviors for Health Plans and Employers” Conference, Orlando, FL, January 23-24.
9.   Edington, Dee.   (2001)   Emerging Research:  A View from One Research Center.  American Journal of Health Promotion 15(5): 341-349.
10.   Edington, Dee W.  (2007)   Health Management as a Serious Business Strategy.  Presentation at the World Research Group “Rewarding Healthy Behaviors for Health Plans and Employers” Conference, Orlando, FL, January 23-24.
11.   Pelletier, Barbara, Boles, Myde, and Lunch, Wendy.  (2004)  Changes in Health Risks and Work Productivity.   Journal of Occupational and Environmental Medicine, 46(7): 746-754.
12.   Pelletier, Kenneth R.  (2005)   A Review and Analysis of the Clinical and Cost-Effectiveness Studies of comprehensive Health and Disease Management Programs at the Worksite: Update VI 2000-2004.  JOEM 47(10)1051-1058.
13.   DeVol, Ross, Bedroussian, Armen, et. al.  (2007)  An Unhealthy America:  The Economic Burden of Chronic Disease.  Report released by the Milken Institute.   www.milkeninstitute.org.
14.   Partnership for Prevention.  (2008) Investing in Health:  Proven Health Promotion Practices for Workplaces.   http://www.prevent.org/images/stories/2008/investinginhealth_finalfinal.pdf.