All’s Well that Ends Well

Companies are waking up to the importance of wellness programs as continued evidence shows how it is shaping business success. HRM gathered CIGNA’s Dr. Jodi Prohodsky, HealthFitness Corporation’s Gregg Lehman, Life Time Fitness’ Glen Gunderson, and US Corporate Wellness’ Brad Cooper to find out more.

HRM. Rising healthcare costs are proving to be a major issue for employers. Is it possible to demonstrate real ROI for companies that invest in corporate wellness programs?
JP. Yes, but the results cannot be measured overnight, so it’s important to adopt a longer-range view. According to a study in the March/April 2004 issue of American Journal of Health Promotion, employees who improved three or more health risk factors over a two-year period on average saved their employers $146 per employee per month. And a study in the 2002 Journal of Occupational and Environmental Medicine showed that for each overweight or obese employee who becomes more active, there is a savings of $450 a year . When evaluating wellness programs, it’s important to remember these long-term goals. Keep healthy people healthy to avoid claims and maintain or improve their productivity and vitality; help those individuals at risk for complex medical conditions to avoid complex claims and improve their productivity and vitality; help those people with acute and chronic illnesses to manage their condition and return to stable health, and improve their productivity and vitality.

GL. The ROI question has been answered both in scientific studies and anecdotally many times. One of our clients, Florida Power and Light, had an outside accounting firm analyze their program and found it brought a 3:1 ROI.

Of course, ROI is a dependent on a number of program factors – personalized messaging, consistent marketing through launch and continuing throughout the program, leadership support and a good incentive component. According to a recent Mercer survey, if all those factors are in play, companies can see a year-three ROI of between 2.5:1 and 3:1.

GG. Yes, we have seen proven ROI from wellness programs. The ROI range commonly cited for wellness programs is 1.50 – 3:1 in reduced healthcare costs for every dollar invested, depending on level of investment. We have seen similar results with our programs.

For example, Glenbrook High School District has saved over $5M in healthcare costs since implementing our wellness program in 2004. Prior to that, their average healthcare costs had been growing at more than 24% annually from August 2000 to September 2003.

We also partnered with Medica Health Plans to offer participants an incentive-based fitness program. When participants exercise at Life Time Fitness centers, they are rewarded with monthly membership savings. The average monthly medical costs of participants were 33.6% lower than those in a matched control group.

BC. Without question; standard areas of measureable ROI focus around the ‘Big 5:’ Healthcare, Disability, Sick Time, Recruitment and Retention. These figures are relatively easy to isolate and measure and are accompanied by many other components wrapped around the more subjective , but nonetheless significant , category of presenteeism.

Interestingly, we’re finding that while wellness is traditionally seen as requiring a two to three year incubation period, they’re seeing immediate reduction in sick time, clear improvement in retention and even a reduction in insurance claims during year one of the program.

The critical component to achieving a strong ROI is not to settle for generic, impersonal programs. Make absolutely certain the program you select is the right fit for your team, and the variety of personalities, pursuits and backgrounds of your employees. There are many ‘wellness programs’ available in the market today, but very few that are truly effective wellness programs.

HRM. Can wellness programs have an effect on worker satisfaction and productivity outside of the obvious health benefits?
GL. Worker satisfaction and productivity need to be part of the equation when an employer is thinking about health and productivity programs. These programs go beyond what used to be called ‘wellness’ programs. They start with fitness and health awareness programs for those at low or no risk and they also identify those who could benefit from health risk behavior change programs. These are people at risk for developing chronic illness because of unhealthy habits. Finally there are programs for those already filing claims for chronic disease that can benefit from better self-care and disease management to ensure they don’t get worse. These programs definitely impact worker satisfaction and productivity.

FPL annually assesses employee satisfaction with its health and wellness programs and gets high numbers (84 percent for all employee, 89% for those who participated in a program). The long-term effects of prevention and better health are well documented. A study published in July 2007 in the Journal of Occupational and Environmental Medicine found that health-related productivity costs were four times greater than medical and pharmacy costs to business 1.

GG. Comprehensive and engaging wellness programs have been proven to improveemployee satisfaction, productivity and morale. As cited in the Health Affairs article, ‘The Case for More Active Policy Attention to Health Promotion,’ companies with wellness programs have seen an average of 28% less sick leave taken by participants.

Our Life Time Fitness wellness programs have increased satisfaction as well. In addition to healthcare savings, Glenbrook High School District accrues additional savings with fewer sick days and reduction in substitute staff.

BC. Absolutely, but unfortunately, that ‘effect’ can be either positive or negative, depending on the design of the program. For example, a generic, one-size-fits-all program can actually reduce satisfaction and productivity of employees, as they see it as simply being ‘another thing I have to do.’

On the other hand, a personalized program customized specifically for (and in many ways by) each individual employee can and will have a powerful effect on worker satisfaction and productivity. It becomes clear that the employer cared enough to go one step beyond ‘checking off the wellness box’ in selecting a program that is truly individualized. And, if your read the studies such as Watson-Wyatt, indicating companies with engaged employees outperform others by 47 to 202%, this is not a small matter.

JP. Employers should expect and demand that wellness programs will lead to improved productivity. When these programs are delivered as part of a well -established health and wellness strategy, they can also improve worker satisfaction and morale. Knowing that their company cares about their health and wel l-being can have a positive effect on employee morale and might cause employees to adopt a more favorable opinion of their employer. According to a 2007 Yankelovich study, individuals whose employers offer health and wellness programs are more concerned about their health (12% extremely concerned vs. 8%), they rate themselves as healthier (66% in excellent health vs. 61%), and are more likely to say that their health has improved in the past year . They also are more likely to seek and trust health information from their employer.

HRM. What should companies look for when seeking to take on an outside provider of wellness programs? Are there benefits to employing an outside provider over running an internal program?
GG. Compare your company’s core competencies to those of a wellness partner. It’s hard to duplicate the quality, consistency and investment perspective of experienced wellness providers.

A key product attribute to a wellness provider is a trusted consumer brand. This yields higher participation levels thereby increased overall program results. Benefit equity is equally important. You want to provide similar benefits to all employees so look for a provider with capabilities to offer programs nationwide.

Does a provider have in-house capabilities to ensure quality service delivery? Does a provider offer variety to ensure all employees will engage in wellness benefits? We refer to this as access to ‘bricks and clicks,’meaning the provider should offer physical destinations and web-based applications for its wellness offerings. Finally, you need strong internal champions to drive your culture of wellness and ensure its success.

BC. Organizations will quickly discover the value of an outside provider on many fronts, including cost savings , engagement by employees and elimination of the ‘pushed aside’ factor due to other job responsibilities for the internal champion. There are also many legal and privacy issues tied to running a program internally, all of which are resolved when utilizing a respected outside provider.

In seeking a provider, be sure to do your research. It’s critical to go deep in regards to long-term participation rates, personalized approach and engagement over time. For example, ‘unlimited coaching ,’ that requires the employee to initiate , will likely see no more than 10 to 15% participation. By comparison, a coach-initiated model can produce 50 to 70% participation, if not higher. The key to long-term results is very simply creating a ‘one -size -fits -one’ model and avoiding the generic, impersonal approaches that quickly fade from view.

JP. Running a successful health and wellness program is complex, and not all companies have the internal resources and expertise to do it well, so looking to a vendor that specializes in wellness programs for both the body and mind often makes the most sense. Sometimes employers choose multiple vendors, as the employer might perceive one vendor to excel in one area , while perceiving a second vendor to excel in another. Relying on multiple vendors can cause confusion among employees as they receive multiple outreaches and mailings from multiple companies. They may feel overwhelmed, uninterested, disengaged. So if an employer chooses the multi-vendor route, it will be important to reinforce partnerships among vendors and ensure that somebody is in charge of delivering a coherent, coordinated and seamless program.

GL. The evidence is overwhelming that a successful health and productivity program makes bottom line sense. HealthFitness has a long track record for providing program expertise in this area that would be difficult to duplicate for most companies because it’s not their core business. When searching for a partner in health and productivity management, companies should look for expertise in four key areas. Firstly, the expertise in the health risk assessment (HRA). HRA is the gateway for most employees into the overall program and a scientifically developed and properly administered HRA is essential to the process. It should include the capacity to do onsite biometric screening that is incorporated into HRA design.

Secondly, the ability to create and deliver effective programs. Can they give your company the programs you need? Are they engaging and accessible to your employees? Can they adapt to your unique culture and be a true catalyst for meaningful and measurable change? Then there is the ability to integrate programs with other health-related programs and HR functions. Finally, proven program evaluation and measurement capability: you need a partner who can provide a ‘data dashboard’ so you can evaluate the program’s effectiveness.

HRM. How important is it that wellness programs be flexible and allow employees to utilize them in a way that suits their needs. How can such flexibility be achieved?
BC. It is crucially important: generic approaches may provide an inexpensive way to ‘check off the wellness box,’ but they do very little in terms of behavior modification or long-term engagement. Individualizing a program, on the other hand, allows each employee to participate based on their own place in life and their own wellness goals. Some people may not even be prepared to identify specific goals early on. In a ‘stock’ program, they’d immediately be eliminated. In a personalized, ‘one -size -fits -one’ program, they have the opportunity to be engage d and work toward positive pursuits over time.

Your organization doesn’t set a goal to ‘do some business.’ Rather, you create very specific, measureable goals, built around core competencies. The same strategy applies to your wellness program. Successful organizations know the value of personalization and flexibility in a corporate wellness program, and align with organizations that can provide such a program.

JP. One size doesn’t fit all. Not all employees are alike and not all companies are alike, either; so flexibility is very important in both program design and communication. Using the aggregate data from a company’s health assessment may show that Employer A has very few smokers but many employees who could benefit from exercise, weight loss or nutrition programs. Employer B , however, may have a lot of smokers, so adding a smoking cessation program would be worth the investment. Some employees might prefer onsite programs , some might prefer telephonic coaching and others might respond better to online coaching. To achieve maximum success, it’s very important to be flexible and use a variety of ways to communicate with employees, and deliver health and wellness programs on multiple platforms. Flexibility is absolutely a key driver of success.

GL. Flexibility is important to maximize program participation. The two components of flexibility in these programs are time and place. Companies that allow employees to flex their time really show a commitment to the concept of a culture of health. They go on to see better participation numbers. As participation drives program success , it’s in the employer’s best interest to allow time for them.

Companies should provide programs where employees work enhances the effectiveness of the program. One of the things HealthFitness does best is provide onsite services; we have more than 3,000 professionals working onsite in fitness centers and managing health and productivity programs within corporations across the country.

GG. Flexibility is very important. Employees are at different levels of readiness to change and need multiple health engagement tools. So one size doesn’t fit all. Look for a program that can impact an entire company, but is nimble enough to provide solutions that are specific to an individual’s needs. Individuals need the flexibility to choose how they will best engage in a program, whether it is via a physical destination, in-person support, worksite-based options or telephonic and web-based access to wellness tools.

Flexibility can be achieved by implementing a wellness program that includes an identification and stratification model. These offerings start by assessing each individual’s needs, providing individuals with insight into their current health status and directing them to programs that will best suit their needs. It’s helpful when your wellness provider can do all of this for you in a seamless fashion.

HRM. Can corporate wellness programs be a factor in attracting and retaining talent?
JP. A strong culture of wellness that includes a corporate health and wellness strategy could be a strong factor in attracting and retaining talent. These programs might also attract healthier employees who can be strong champions of such programs.

GL. We think so. One thing we emphasize with our clients is creating a culture of health; that’s a top-down corporate mindset that says the company values employees and wants to invest in their health and wellbeing. When you emphasize a culture of health as a corporate value, it builds an environment of positive employee engagement and loyalty.

One of our clients, Florida Power and Light, recently told us that the new generation of highly skilled employees is looking for companies that provide more than a paycheck – they really want to find an organization that is willing to invest in them. They want work/life balance, and a culture of health nurtures that balance.

GG. We’d be foolish to think offering ‘wellness -lite’ programs will retain employees, however, companies can increase retention if they create an entire culture built around wellness. When programs are supported from a C-level and offer tangible benefits, your employees care.

Providing access to various wellness benefits does influence energy level and commitment. Employees see that company leaders are making a commitment to them personally, and they’ll be more likely to reciprocate that behavior.

Offering wellness initiatives builds teams and competition within a workforce. This increases ‘stickiness’ within the workplace.

BC. Without question and the data now backs this up. We recently pulled the data from a large 3,200-employee client of ours and reviewed turnover among participants versus non-participants in the wellness program. The difference was dramatic. 18% turnover of non-participants compared with three and a half percent turnover of participants. This matches the Gallup organization data, which showed that engaged employees are 87% less likely to leave their place of employment.

In terms of attracting talent, there’s no question a personalized employee wellness program will help organizations attract high-end talent. You’re likely offering similar salary, benefits and working conditions as your competitors. However, what if you were to share with potential employees that you not only have a customized corporate wellness program, but also that well over half of your employees are participating and there is truly a culture of wellness in the organization? Would that tilt the hiring scales in your favor? Absolutely.

About the contributors:

Dr. Jodi Prohofsky, PhD, L.M.F.T. is Health Solutions SVP of Operations at CIGNA where she has been since 1992, helping the organization become nationally recognized for its innovative health advocacy programs. She has championed industry-leading initiatives in the areas of depression, tobacco cessation and behavioral health, helping people identify their internal motivators for successful behavioral change. 

Gregg Lehman, PhD, President and CEO of HealthFitness Corporation. Lehman is a nationally recognized leader in health management services and brings more than 20 years of experience in the healthcare industry. Prior to HealthFitness, he served as President and CEO of INSPIRIS, a Nashville-based specialty care medical management company. Lehman also was President and CEO of Gordian Health Solutions Inc., a health management company, and President and CEO of the National Business Coalition of Health.

Glen Gunderson is vice president of the Business-to-Business division at Life Time Fitness, Inc. As a founding member of the senior management team, Gunderson has supported the growth of the organization. Most recently, he led the launch of a total health product suite aimed at reducing healthcare utilization through preventative screenings, healthy lifestyle programs and wellness driven health plan consultation.

Brad Cooper, MSPT, ATC is CEO of US Corporate Wellness, the industry’s most personalized employee wellness provider. He is an award-winning columnist, the author of three books and a nationally recognized speaker. Consistent with the message, he is also an All-American Triathlete, top Masters runner and veteran of the Hawaii Ironman Triathlon.