Workplace wellness programs improve the health, productivity and attendance of employees. They help curb health care costs and turnover. And they are widely available—95% of employers with over 50 workers have a health promotion or disease prevention program.
So why don't workplace wellness efforts succeed?
Frequently, workplace wellness activities are only random or sporadic, says David DeJoy, director of the Workplace Health Group at the University of Georgia in Athens. “Maybe an American Heart Association representative asks to do a presentation, leaves some brochures and that’s it.”
A flourishing program, by contrast, is comprehensive, ongoing, multi-faceted, and supported by management. “It attempts to categorize each participant appropriately by needs—such as disease management—and then provides follow-up,” he says.
Even when a concerned employer invests in a well-designed program, participation is often meager. In one survey, where 43% of adults had access to workplace smoking cessation programs, only 5% made use of them.
Common barriers vary from simple logistics to subtle resistance:
• too little promotional material describing available options
• confusing activities and services
• generic health messages, rather than specific, personalized information
• programs not targeted to those who need them most
• low motivation to change familiar behaviors
• insufficient encouragement from managers or co-workers
• services available only at inconvenient times or locations
• no time off for lengthy procedures, including diagnostic tests
Elements of Risk
The best wellness programs group individuals into risk categories and target suitable programs to each. One goal is keeping them from becoming catastrophic claimants or members of higher-risk, higher-cost categories.
“Businesspeople use the language of risk reduction and think of risk as financial,” says Pat McGovern, associate professor of environmental health science at the University of Minnesota, “but healthcare people may not use the same terms. Higher probability of disease exposes the employer to risks of higher health care costs and lower productivity. Health promotion specialists need to broaden their framework to include chronic disease prevention and environmental protection.”
Some employers offer screenings as benefits, convinced they will pay off in productivity, alertness, mental health and positive attitudes, as well as reduced costs. Wellness programs can also be bargaining chips in negotiations with health plans.
Nationally, the benchmark for employee assistance program utilization is 4%. In contrast, utilization of the carefully-developed wellness services at Mercy Medical Center – North Iowa in Mason City has averaged 8% over nine years. During that time, turnover among both registered nurses and overall employee population has fallen by 50%.
Bottom Lines
Ever-rising health care costs are powerful incentives to promote wellness programs. These can require significant initial outlay, however, and early gains are intangible. “In treatment, we don’t ask if spending $80,000 for heart bypass surgery is a good investment. It’s dramatic to save a life,” says DeJoy. “But in prevention, we talk about ROI. Employers ask if $200 [for screening] is a good investment. If we can get 70% of workers with high blood pressure into treatment and prevent five heart attacks in a workforce of 5,000, the potential savings are tremendous.”
Hoffman Construction Company in Portland, Oregon has 600 employees and a budget of $100,000 for its health program. After two years, workers’ use of medical services has declined by 10%. (According to the American Journal of Health Promotion, impact on medical costs usually requires three to five years to appear. Wellness programs achieve an average ROI of $3.48 per dollar in health care costs and $5.82 in absenteeism.)
Experts estimate that a depressed employee generates $3,200 in annual medical costs—$1,500 more than a nondepressed individual. The 42 Mercy employees who have lowered or eliminated depression symptoms have saved the hospital an estimated $154,000 to $262,000 annually in lost productivity and healthcare claims.
Inexpensive services are often the most effective. In a nationwide survey, only 20% of employers offer programs for smoking, alcoholism, nutrition or exercise. Flu shots, another low-cost measure with high savings potential, are covered infrequently. “Employers seek financial return by offering clinical preventive services...but are least likely to offer the services most likely to provide the return,” says lead researcher Jeffrey Harris of the University of Washington School of Public Health.
Meaningful work in workplace health promotion can be done without spending much on bricks and mortar, however. And by using employee feedback, Mercy now provides more services than activities. Their most popular offering is five-minute chair massages. “Research on what these do for stress and physical conditions is compelling,” says Kelly Putnam, Mercy’s health promotion coordinator. “Put a nurse in that massage chair for five minutes, and I want to be her next patient.”
Getting Started
To launch a successful program, “provide the resources, take away the barriers,” says Susan Butterworth, director of Oregon Health Sciences University Health Management Services.
Identify employee health issues, then develop wellness programs to match. Some employers use personal health risk assessments, which evaluate modifiable risk factors. The higher the participation, the more accurately health screenings suggest specific wellness services, from smoking cessation to cholesterol screenings. In initial surveys, Mercy’s 2,800 employees mentioned weight loss, nutrition advice, etc. However, as workers grew more trusting, they stopped saying the expected and confided more personal issues like exhaustion, depression and domestic violence.
Market programs with frequent clear and friendly messages about services and activities. Make it clear that everyone is welcome. “For example, invite smokers to come and talk—even if they’re not ready to quit,” says Butterworth.
Involve managers in encouraging use of available services. “You’ll get support from individual managers when they have accountability,” says DeJoy. “Otherwise it’s not a priority. We’re experimenting with giving each department a target goal for participation in their workforce.”
Make it convenient. Schedule activities beyond just on-site from nine to five. Some employers find web-based health education especially useful for telecommuters and workers in separate locations. “It’s there 24/7 and helpful in terms of privacy, distance and each employee’s available time,” says McGovern, co-author of a recent study on low participation. Flex-time or an optional break also prod participation in wellness activities.
Promise confidentiality. A Mercy social worker provides self-referred individual counseling with hours that rotate to match hospital shifts. In one year, employee use of counseling rose by 171%. “That means psychosocial distress is out there,” says Putnam. “Create a safe, accessible place where employees can go privately—and they will.”
Acknowledge ambivalence. People do not change behavior until they see benefits and believe these outweigh “costs” (like sacrificing 30 minutes of television to exercise.) “Make it fun.” Butterworth says. “People like doing things in groups—that social piece helps a lot. Create motivating opportunities. Set up walking clubs, support groups and exercise classes.”
Popular Promotions
Mercy’s wellness program, called Kailo, promotes through affirmative messages in brochures, e-mail, flyers, its website and face-to-face contact. A Kailo representative attends every new employee orientation. All new managers visit Kailo’s office to learn about its services for their own and their employees’ benefit.
Larry McDaniel, Hoffman’s plan administrator, also stresses the ongoing need to communicate program highlights to all employees. “We’ve tried to get a culture change, as people start seeing benefits,” he says. “I’ve had at least six people tell me they’ve lost 70 or 80 pounds over the past two years. One dad gets to play soccer with his son now, which he couldn’t before because of weight.” Such visible, unmistakable changes encourage other employees to take part and generally increase participation companywide.
Lighthearted enticements work, too. Try small rewards (“Take a Health Risk Assessment, get a $10 Amazon gift card”) or raffle off prizes like free parking or a weekend trip. “Solicit gifts in the community or build incentives into your budget,” says Butterworth. “When choosing an insurance vendor, be sure to ask what kinds of incentives they’ll offer to raise participation.”
For a free Kailo t-shirt, Mercy employees will gladly fill out health surveys. The popular “Kailo On Vacation” gambit invites workers to send travel photos of themselves wearing that t-shirt. “People love seeing those photos, from all over the world,” Putnam says. Any reinforcement or reminder of a health program is worthwhile.
Other lures are financial, like an annual premium rebate or discount for having a clinical screening. Some companies offer a year-end cash incentive if an employee does a modest amount of exercise, attends certain health seminars or meets other criteria. Any employee enrolling in a health insurance plan through Hoffman is invited into Hoffman’s wellness program. So far, 75% have voluntarily joined and receive an annual incentive of about $120. Mid- and smaller-size employers typically offer nonmonetary incentives, like time off, to use a wellness service. (Do not use “savings” as an inducement, however, as the IRS may possibly consider this to be taxable income.)
Gaining Commitment
Successful wellness programs cultivate unequivocal executive support. “The research is clear: we know health management works,” says Butterworth. “But it’s still a challenge for benefits managers to choose the right services and programs, and make sure the infrastructure supports it. It’s more than picking a wellness vendor from the phone book.”
Propose companywide goals to reduce costs related to a particular category, like obesity, advises DeJoy. Executives respond more to data than to concepts, so use industry statistics to project potential health care savings over a specific time period. “Look at your number of obese or overweight employees, for instance.” he says. “Set a target: reduce that from 70% to 60% over three years. With several thousand employees, that’s a lot of people.”
“It’s easy to say, ‘We want our employees to be healthy.’ The investment is changing policies and procedures to support these lifestyle decisions,” says Butterworth. “We see participation rates up to 70%-80% with management support and incentives, but only 10%-20% without it.”
Hoffman Construction executives, already committed to safety protection, balked when McDaniel first presented a carefully detailed wellness program. “My concept was that employers have no control over health costs. All we can control is incentivizing employees to take better care of their own health,” says McDaniel. “Over the previous five or six years, our health care costs had increased by 100% to $2 million. Looking at [those figures], they grew more receptive to ultimately reducing costs with our [proposed] wellness plan, and at least slowing down the increase. Then they understood the payback is savings in health care and premium costs.”
Initially, Kailo requested an annual operating budget of $250,000. (Nine years later, it is $325,000.) Putnam’s business plan “proved to be the turning point with our senior leadership. It’s one thing to say that stress is a problem; another to present data showing our employees’ level of depression and exhaustion,” she says. After her CEO saw the data, he said, “We can’t afford not to do this.”
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Carol Milano is a New York-based writer specializing in health care and environmental topics. She is a frequent contributor to RM.
