Healthy Returns

Dow Chemical’s Dr Cathy Baase tells HRM about the company’s industry-leading wellness provision and the role that business has to play in population health.

“One of the detriments of the current situation in the US is that we spend a lot of money and yet our health outcomes are not better than all other countries with the same proportion of increased spending”
-Dr Cathy Baase, Dow Chemical

Dow has quite a reputation as a company with some very comprehensive health and wellness provisions. Could you give us a little background?
Cathy Baase. Dow has a very long history of having a health program within the corporation. In fact, over 90 years ago we started our onsite occupational health program. And the current health and wellness programs are really incorporated with the full spectrum of our employee health and wellness program. So the formal motive for the health promotion programs have been in place for about 20 years.

They’re all underneath a corporate health strategy. That formal corporate strategy was established in 2004 to bring together at the strategic and tactical level into an integrated program, linking all the corporation’s activities that are related to health across any functional boundaries so that the strategies really make sense together. The elements of that strategy are prevention, quality and effectiveness with care, health system management and advocacy.

And under those four elements of our strategy, we see that our health promotion and our health and wellness program fit in this prevention theme. That’s one of our four themes. We have what I would define as a comprehensive health promotion program, which includes all of the macro aspects of what’s defined as a comprehensive program. You have awareness activities, motivation programs and strategies to engage people, skill building programs and educational programs as well as a supportive environment.

There are a great many programs out there. Over 90 percent of people in surveys will say that they have a corporate health promotion program, but less than seven percent actually could fulfill the requirements of a comprehensive health promotion. So what that looks like at the tactical level is that we do health screening, consultation, referral and follow-up for personal health risk health education through both internet/intranet channels, small group programs, health and disease risk topic campaigns, onsite health centers, healthcare on consumer education, the provision of many tools.

We have corporate policies in place on things like tobacco, and we also have a very broad prevention coverage in our benefits plan. So if you ask, “How do we approach health and wellness?” it’s all of that. It’s fit within this strategy, and we have this comprehensive programm which focuses at the individual level, at the site level, and at the corporate level in terms of environment and culture and policy activity.

So how do you promote these initiatives amongst your people? Do you use the carrot or the stick to encourage interest in wellness and preventative care?
CB. We have really worked on making sure that this is a program that’s highly valued by the employees, and it’s so highly valued that they participate voluntarily and of their own accord. They seek it out because they have experienced value from it, and so they keep coming back and participating. You mentioned the ‘carrot and stick,’ but we don’t really characterize our efforts in those terms. We’re unique among many corporations in that we use minimal to no financial incentive.

We don’t offer people cash payments for participating in programs or filling out surveys or doing things like I know is common in the of rubric of financial incentives to stimulate participation. And yet we have extremely high participation levels, and we also have very high satisfaction with our program. Our satisfaction ratings are consistently strong, depending on the particular program. I’ll give you just one example. We’ve got our employees on our health surveillance, which is where we would incorporate something like our health risk assessment, in that our voluntary participation in that program is very high.

Our participation in that is over 75 percent of our US population, and over 85 percent of our global population voluntarily participate in that with no cash incentive.

How do we do that, is that we have embedded this programming right into the fabric of the organization. We have strong communication strategies, but it’s not sort of an appendage on the organization. It’s embedded into and aligned with the corporate priorities. So our health risk assessment is embedded within our broader occupational health programs. We’re aligned to our 2015 goals of our corporate sustainability strategy.

This is built into the leadership development curriculum of the leaders of the company. We bring the health topics into that, and we’ve worked very intentionally on the development of a culture that really is supportive and encouraging of participation in health programs and in living a healthy lifestyle. People feel this from all parts of the organization. It’s not just from our department or some billboard; it’s built into the fabric of the company.

From a purely business perspective, it can be difficult to establish a hard-dollar ROI on wellness programs. What do you think needs to be done to demonstrate how valuable these programs are?
CB. I agree that that is certainly a broad challenge, and we hear about it and talk about it a lot. I’ll say upfront that one critical thing for us was the development of the viewpoint that our health programs are really an important investment to be optimally managed rather than just a cost to be minimized. We’ve used that because it is part of our strategy. But how do you approach this whole concept of ROI? 

I would say it’s critical to have your program developed and built upon a strong business case. Establishing that upfront, renewing it regularly and being able to understand the relationship between the health of your people and the success of the organization is critical. We’ve mapped that out, so our health strategy that I mentioned at the beginning of our discussion really is built upon a strong business case that made this link.

In addition to that, I would say that it’s important for people to put in perspective the question of whether or not prevention saves money versus how it’s a good investment that’s similar to other investments. For example, we don’t hear people say, “Well, is it a good investment to provide for healthcare services in general,” and so what we’re trying to do is say, “Let’s make sure that every dollar we spend related to health is delivering the most value possible.” We’re trying to improve the dollars we spend on our benefits as well as make sure that the dollars we’re spending on prevention are really delivering that value. In most organizations, prevention really accounts for a very small fraction of the total dollars that they spend.

You mentioned before the idea of seeing it as an investment rather than a cost. Do you think that’s something that’s kind of catching on across the HR and wellness space?
CB. I’ve certainly seen a change in that and a growing trend in the last several years. But I think we need to take caution. One of the messages that I share with my colleagues frequently in the field that it’s an important sort of philosophical point, but you still must be very serious about your business case and be accountable for results and have a sound measurement infrastructure to be able to deliver results. Just because something is a sound investment, that’s a useful starting point, but it doesn’t erase any obligations for accountability for delivering results. And so the pressure is still on to deliver results.

What kind of metrics can you apply to show that you’ve spent X amount of dollars this year and these are the results? With wellness you’re essentially spending to stop something happening, so are there ways you can break that down to show what it’s worth?
CB. When we’re looking at our overall health strategy that I mentioned, we have a set of metrics. We look at our direct medical benefit plan costs. We look at our indirect costs like absenteeism and presenteeism. We look at the satisfaction of the participants. We look at our health culture, and we look at the health status of our population. That’s a critical leading indicator and we’ve set very aggressive targets.

For example, we have a target to improve by ten percent the health risk profile of our population in ten years. We know that there is a link between changes in our health risk profile and our total economic impact to the corporation. By discovering that and documenting it, we know what the economic return is for those sequential improvements in our health risk profile. And then we have other programs that we do, too.

Those are the macro metrics, but then we look at specific programs, and one is our health advocacy case management where we take the people who are out ill and we work to partner with them to improve to a state of health as effectively and as quickly as possible. With that program, we look at the number of days saved in terms of absenteeism, and you can translate that into dollars. That’s an example on a specific activity that we have.

The new administration is making some encouraging noises about the need for prevention to be a part of US health policy. What do you think are the key things government should be doing in this area and what do they need to address first?
CB. I hope, first and foremost, that in our discussions on health reform that we really remember the fact that we’re focused on health, not just healthcare. And I’d like to emphasize that point, which was in my testimony to the Senate committee, that health has to be the outcome that we are aligned and seeking and assuring that we’re achieving. One of the detriments of the current situation in the US, is that we spend a lot of money and yet our health outcomes are not better than all other countries by the same proportion of increased spending that we have.

I hope that we would have a focus on prevention included in the entire US policy and a stronger investment in that. There are some specifics that I’ve recommended such as addressing tax policy that really supports individuals and corporations in the provision of prevention programs. There’s such a strong rationale that to achieve population health outcomes from a public health standpoint, working through worksites is a very important and effective strategy.

In addition, there are things that the government could do to bolster the effectiveness of worksite health programs. This could include better communication of results, increasing funding for research in this area, developing more tools and resources and disseminating them effectively to the employers and piloting innovative programs, particularly at the federal and state departments, so that those results can be shared as well.

They should also bring more focus and visibility to the effectiveness of these types of programs, and have a resource center that can support businesses and employers in the provision of them. Perhaps another idea is the establishment of a public/private advisory council, which could bring the best of thinking together from the private sector to continue to inform these efforts from the policy perspective. They could also enable collective purchasing consortia for small employers because they can then have some of the advantages of scale.

One of the other things that is going on right now is to further support the establishment of workplace health program certification and accreditation efforts so that employers have some external validation of those programs which are meeting the best evidence standards.

Cathy Baase MD is Global Director of Health Services for Dow Chemical. She has direct responsibility for leadership and management of all Occupational health, epidemiology and health promotion staff and programs around the world. In addition to these roles, she is deeply involved in the design and implementation of Dow’s Health Strategy for employees, retiree and their families.

Dollars and sense
Baase outlines the importance of focusing spending on health outcomes.

We have in this country what has been described as an “illness” care system and not a health care system. We do not focus on health outcomes. The dialogue and debate about the many ills of our health care system has escalated in recent weeks because of the economic crisis and the substantial funding for health included in the economic stimulus bill that was recently signed into law. As implementation of the stimulus bill’s health provisions begins, it is vital that we keep sight of the fact that the “health” of our people is the critical outcome and leading indicator of the success of our expenditures. The money we spend on health is an investment in our sustainable future and intended to make people healthier. How much we spend or who has access to our illness care system has limited meaning if we’re not focused on results and whether our health is sustained or improving. Every dollar should seek maximum value.