Well Said

The concept of wellness has fast become one of Corporate America’s most important assets. Here, we gather Ceridian LifeWorks’ Zachary Meyer, Anne Marie Kirby of CoreHealth Techonlogies, eni’s Gene Raymondi, Lee Dukes of the Principal Wellness Company and UnitedHealthcare’s David Ellis to get the lowdown.

“Some wellness programs involve tangible rewards, and some discipline, while others focus on intrinsic motivation and make the experience the life-changing event”
-Anne Marie Kirby, CoreHealth Technologies

What are the key factors that a wellness program should possess? What should companies look for when trying to implement a wellness strategy?
Zachary Meyer. An effective wellness program starts with a culture of wellness. Our experience shows that the most successful programs have visible support from the top and by the entire management team. Every level needs the tools and commitment to promote a healthy workforce. Acting as role models reassures employees that they are supported and builds momentum for an enduring program.

If you want to predict someone’s behavior, you need to understand what’s driving it. That’s why many of our customers add incentives to their wellness programs. The most effective incentives drive behaviors from program enrollment through completion. Recognition is an important motivator for many, and accumulating reward points towards items that promote healthy behaviors can be quite successful without breaking the bank.

Finally, focus on key areas of need, and set realistic short and long term goals. Organizations should analyze workforce assessments, healthcare and disability claim information to determine their biggest opportunities. Once specific goals are set and programs developed, you can monitor your success and adjust as necessary. Your wellness partner should help guide you through your initial implementation and beyond.

Anne Marie Kirby. In an ideal world, senior executives bring forth, by word and example, a corporate culture of wellness with a personalized program of support for each employee. In the real world, there is always a crisis to tend to such as the economy, where the best-laid plans cannot be easily executed. Our customers have found success using the grassroots approach delivering an affordable online health challenge. They start small, build enthusiasm while proving outcomes and ROI, and grow their strategy organically.
 
Companies should look for wellness programs that improve health through sustained behavioural change, look for programs people will enjoy, find tools that will improve your workplace culture of wellness, and be sure that choices fit the lifestyles of their employees.
 
If you do have the luxury, major wellness suppliers such as Ceridian, Principle Wellness, or United Healthcare can assist with a high level strategy. They can help establish realistic ROI targets and identify options to maximize and report achievement. Consider a combination of high tech and high touch programs to complement, as both are necessary for maximum results and return.

Gene Raymondi. Above all else, a successful wellness program must have a consistent and relevant message that is demonstrated visibly by senior members of your organization. A sustainable program must integrate into your existing corporate culture, with a personalized approach for each individual participant to receive the appropriate interventions, education, motivation and encouragement needed to succeed. Ideally, your program will have an unbiased and trusted central point of contact for both the employer and employees. The most successful programs integrate and communicate effectively with other existing benefits for a total wellness approach.

It is critical for organizations to first identify and understand their corporate culture, in order to determine the most appropriate and effective ways to engage, incentivise/disincentivise, and communicate with their employees. It is also essential to collect accurate data to identify current health risks that your program needs to address and reduce/prevent before they become chronic conditions that weigh heavily on your bottom line.

Employers need to prepare for long-term efforts that will create a sustainable program. Employees will only engage when they understand goals and objectives, and are given consistent and reliable tools and resources, including your communication components, that they can identify with, interact, and trust.

Lee Dukes. Three essential elements are a simple data-driven strategy, effective communications, and meaningful incentives (or disincentives). The strategy should include long-term goals, measurable objectives, and simple strategies to achieve the objectives. Avoid the temptation to piece together assorted activities and vendor solutions that are not focused on your strategy or that do not contribute to data integration.

David Ellis. Wellness programs should be designed to meet the needs of the employee population. To that end, the employer should consider the health status of their employees, their work environment and the culture in which they live both at home and at work. To build a successful wellness programs we recommend the company consider issues including the provision of executive level sponsorship; building a wellness oversight team and incorporating wellness champions into your worksite (they will build and drive your strategic wellness plan); measuring the health status of employees through health risk assessments and biometric screening; reaching out not only to employees but to heir families(they provide the social support for employees to make healthy lifestyle changes); and providing employee incentives for participation.

“Demonstrating ROI is difficult, especially when the employers don't clearly identify their definition of what they believe 'wellness' really is”
-Gene Raymondi, eni

Why has it traditionally been so difficult to measure the ROI of wellness initiatives? Is it possible for companies that invest in corporate wellness programs to demonstrate real ROI?
AMK. Historically, people managing wellness programs have not been specialized in health promotion. Without this education or training, they have been unable to effectively define objectives and evaluate programs to prove ROI. The means to prove ROI are better understood today, though funding shortages are still common in many organizations. Wellness administrators can position themselves to show impressive ROI and thrive even in difficult environments. A small grassroots program has a greater chance of rapid measurable success; provides more control over the process, health and ROI outcomes; and can be a great springboard for wellness.
 
Grassroots wellness begins with a low cost, proven program that serves a large population. Quality suppliers of this technology demonstrate high ROI and require minimal outlay. Reinvested, the returns help expand the program to address the highest risk individuals where significant expenses are incurred. ROI will decrease with program expansion, but total savings will still increase.

GR. Demonstrating ROI is difficult, especially when employers don’t clearly identify their definition of what they believe ‘wellness’ really is, as well as defining what they consider as ‘participation’. Employers are challenged to hit many moving targets as healthcare dollars continue to rise, and human capital, productivity, and retention remain difficult to measure.

Preventative programs are focused on treating conditions that would eventually draw heavily from healthcare dollars - but when and how much is unpredictable. A simple example to consider for ROI is to realize the true impact of identifying and preventing just one employee from suffering a stroke. Once you consider the savings in not only healthcare dollars, but in disability, prescriptions, absenteeism, and productivity, it becomes easier to identify the ROI.

LD. If ROI is defined as a ratio of the dollars invested in a wellness program to the financial impact on health plan costs, there are several problems. Many factors have a significant impact on healthcare costs — changes in plan design, mergers, acquisitions, downsizing, demographics, labor relations, technologies, inflation, etc. To try to assign impact over time to any one factor is impossible.

Numerous studies clearly indicate a correlation among health risk status of a population and costs related to healthcare, productivity, disability, and workers’ comp. These financial outcomes, along with improvements related to clinical indicators, recruitment and retention rates, morale, and quality of life factors, combine to produce a comprehensive value of investment (VOI). A well-designed and implemented wellness program will have a positive impact on the health risk status of the eligible population, and an employer can model the estimated economic impact of its wellness program by evaluating changes in its collective health risk status over time. As risks of a population are improved, the overall value of its investment increases.

DE. Wellness ROI has been difficult to measure in that some of that measure has been tied to the soft savings created through improved presenteeism or it is difficult to tell if the wellness interventions alone have improved outcomes. Many studies have documented wellness initiative savings of at least a $3.48 for every dollar spent ROI in health care costs and a potential $5.80 for every dollar spent ROI in absenteeism reduction.

ZM. Wellness programs are designed to prevent poor health and avert downstream costs — and it’s difficult to measure something that doesn’t happen. Having employees quit smoking can reduce the amount of break time taken, and hopefully, prevent cancer, but most employers don’t monitor break time that closely, nor can they connect the avoidance of a cancer diagnoses to workers who quit smoking.

Another challenge is that we simply don’t build in enough time for the programs to achieve their desired outcomes, although we understand that behavior change takes time and effort. It wouldn’t be realistic to see a reduction in medical claims after the first year of implementing a tobacco cessation program. Realistic goals would be a certain program participation level in year one and quit rates in year two.

Finally, while health claims, absenteeism, STD and LTD rates can be measured, they don’t get at productivity or presenteeism – estimated to cost employers 7.5 times more than absenteeism. With each of these variables, you’re often working with different systems and providers, so integrating the data can be tough.

Despite these challenges, I do believe it’s possible to demonstrate true ROI with your wellness program. Partnering with a provider that can help you set realistic goals and pull together and analyze not only claims, but absences and productivity measures, will help you show tangible results.

Do you think that a move from traditional reactive medicine to a more proactive focus on wellness can help address the rising costs of healthcare?
GR. Absolutely. We also believe that employers will see the greatest results by implementing a fully-integrated wellness benefit offering that overlaps wellness with behavioral and occupational health. As an established provider of both Employee Assistance Programs and wellness services, we recognize that physical health problems are profoundly interconnected with an employee’s mental health issues. We see many cases where mental health concerns cause problematic behavior at work that leads to absenteeism or injuries, and higher usage of your healthcare plan and short-term or long-term disability. Rather than wasting valuable time and healthcare resources, these employees will often resolve their issues within our EAP.

LD. Absolutely. It has been estimated that as much as 70 percent of the financial burden of healthcare is driven by preventable chronic diseases such as high blood pressure, diabetes, coronary artery disease, and certain forms of cancer. Healthy lifestyles that prevent or delay onset of these diseases, along with early detection efforts, can reverse the rapid growth of many conditions that drive over-utilization.

DE. Addressing the rising cost of healthcare will require attention to everything. There will still be a need to engage employees to make optimal healthcare service choices for their episodic or chronic conditions. A more proactive focus on wellness can help manage long-term healthcare costs for larger, less engaged populations making suboptimal health decisions around weight, tobacco and exercise. More time should be spent preventing illness than treating illness, and this investment can have a much broader impact on rising health costs.

ZM. I absolutely believe that prevention and proactively focusing on wellness are the keys to putting the brakes on rising healthcare costs. Modifiable behaviors such as tobacco use, overeating and not exercising put an immense burden on our healthcare system. Some of the most costly conditions, such as diabetes, cancer, cardiovascular and asthma can be attributed to these few risky behaviors. Instead of waiting for an individual’s unhealthy habits to lead them into more serious and costly health concerns, we need to provide access and incentives for wellness programs.

AMK. Since the landmark 1974 Lalonde report, research and applied programs have clearly demonstrated the benefits of wellness. A recent weight loss program in Lee County saw a return of $26 for every dollar spent. Returns of this nature are split between healthcare and productivity costs, both demonstrating positive return.
 
Some wellness programs involve tangible rewards, and some discipline, while others focus on intrinsic motivation and make the experience the life-changing event. We find intrinsic motivation crucial to developing long-term results and addressing the rising costs of healthcare. Where programs lean towards tangible rewards and prizes, investment must remain high for outcomes to be realized. Motivational wellness provides social benefits and cultural reinforcement as motivators, with prizes as tokens instead of focal points. This environment is conducive to long term change and healthcare cost reduction.
 
Would you agree that making organizations see wellness as an investment rather than a cost is key? How can we go about effecting this attitude change?
LD. Employers and those who provide benefits guidance must understand that costs follow risks. Recent efforts to control healthcare costs have targeted the costs themselves through aggressive changes to plan design — increased premiums, higher deductibles, higher co-pays, etc. Long-range sustainable management of healthcare costs will happen only when a large percentage of eligible employees and family members accept appropriate responsibility for their health, and take action to reduce their risks. Employer investments should focus on implementing and managing an effective wellness strategy, and encouraging engagement in the activities of the wellness program. Necessary steps include creating awareness about opportunities to improve health, educating and engaging the right people in the right action steps. It also includes creating a culture of wellness at the workplace — one that supports healthy behaviors, policies, and environments.

DE. Companies have to view wellness as a financial investment as well as investment in their human capital. Data drives employers to make changes in their strategy. It is important that we have fact-based discussions to push the wellness agenda. Studying their claims experience and getting them behind measuring their employee’s health risk status can help them set the stage for any real change in focus.

ZM. One of the biggest mistakes organizations make is throwing money at a wellness program and then expecting a major ROI in the first year. We work with you to develop realistic goals and design a program that fits your company culture. Wellness needs to be viewed as a core business strategy that creates a competitive advantage with a healthy, resilient workforce.

AMK. Since the landmark 1974 Lalonde report, research and applied programs have clearly demonstrated the benefits of wellness. A recent weight loss program in Lee County saw a return of $26 for every dollar spent. Returns of this nature are split between healthcare and productivity costs, both demonstrating positive return.
 
Some wellness programs involve tangible rewards, and some discipline, while others focus on intrinsic motivation and make the experience the life-changing event. We find intrinsic motivation crucial to developing long-term results and addressing the rising costs of healthcare. Where programs lean towards tangible rewards and prizes, investment must remain high for outcomes to be realized. Motivational wellness provides social benefits and cultural reinforcement as motivators, with prizes as tokens instead of focal points. This environment is conducive to long term change and healthcare cost reduction.
 
GR. Of course. However, this is especially challenging with the current economic climate, and more CFO’s are getting involved in the wellness game. It will always be difficult to measure an accurate ROI, and many employers aren’t willing to wait to see the three to five year numbers. Therefore, we encourage employers to set smaller goals that lead to an ultimate achievement. Try looking at the increase in premium costs without a wellness program, review your high cost claims and determine if they are preventable, and map out your strategy using the 18-month to three-year guideline for showing positive ROI.

Wellness programs are very effective at improving and engaging corporate culture, and creating a team-centred environment where employees respond positively to your recognition and investment in their wellbeing.

Do you anticipate the new administration having a significant impact on the popularity and scope of employee wellness programs?
DE. President Obama’s reform ideas included promotion of public health, prevention and wellness. Proposals included mandates around preventive service coverage, expanding community based health initiatives and rewarding worksite wellness programs. While details are still forthcoming, everyone involved in the health reform dialogue agrees that strengthening preventive medicine and primary care programs is a wise and much needed investment.

ZM. The new administration recognizes that employee wellness programs are a key component to health care reform, and wellness programs have consistently drawn bipartisan support. An example is The Healthy Workforce Act (H.R. 1837), which would require wellness programs to include components such as health education, participation monitoring, behavioral change and a supportive environment for healthy lifestyles. Employers would receive an annual tax credit based on the number of employees participating in the program, encouraging employers to add or expand their wellness programs. I anticipate that any healthcare reform would include significant funding for wellness programs.

AMK. The answer can be seen by looking at other nations such as Canada or the UK: Whether healthcare costs are paid by direct taxation (employer pays) or indirect taxation (government pays from tax proceeds) the benefits of wellness are strong. Employers realize the need to reduce losses such as presenteeism, absenteeism, depression, and to help the team operate efficiently. Where this benefit proves higher than the cost of wellness, preventative health products will be in demand.

GR. We expect to see a great increase in interest within the small business arena in response to the employee tax incentive proposed in the pending Healthy Workforce legislation. We’re especially encouraged to see the administration’s value towards a behavioural approach to wellness, and hope that approaching health and wellbeing on a national level will create a larger sense of engagement and consciousness among the American workforce as a whole.

LD. Strong bipartisan support for wellness is gaining traction in both the House and Senate. What is yet to be seen is how wellness will be defined. Prevention seems to be interpreted as something that a healthcare professional does to someone (exams, vaccinations, immunizations, etc.) and wellness is something that a person does for himself. The benefits of wellness programs will be maximized if it is acknowledged that wellness involves both individual and organizational efforts, and that the goal is to involve 100 percent of the population, regardless of age, employment status, health plan choice, or current health status. Much of the proposed legislation would support employers who are committed to investing in the wellbeing of their entire population.

Zachary Meyer is the Senior Vice President and General Manager of Ceridian LifeWorks. He has held management positions in various regional and national health care organizations and was involved in patient education and research at the Mayo Clinic early in his career.

Anne Marie Kirby is a proven leader in the healthcare information sector, with over 20 years of combined software, HMO, and health systems experience. As CEO of CoreHealth, she directs development of a refreshingly affordable wellness platform used by mid to large organizations and EAPs throughout North America.

Gene Raymondi is the Founder and Chief Executive Officer of eni. Over the past 25 years, Raymondi earned his reputation as an innovative leader and active pioneer in behavioral health delivery systems. He continues to create dynamic EAP, Wellness and work/life solutions that maximize employee engagement, well-being and productivity within large organizations across the nation.

As President of the Principal Wellness Company, a subsidiary of the Principal Financial Group, Lee Dukes provides a business perspective to the delivery of effective wellness solutions. He has consulted with more than 600 employers, health plans, and federal and state agencies in the US, Canada, Great Britain, Mexico, and Germany.

Dr. David Ellis is National Medical Director for UnitedHealthcare’s Customer Analysis and Solutions. Prior to this, he was Senior Medical Director for North Texas and Oklahoma, and before that practiced Primary Care Medicine in Texas. He studied at the University of Toronto and completed residency at Queen’s University. Dr. Ellis has practiced in both the Canadian and American Healthcare systems.