Look at Health Risk Factors that are Modifiable
What can we change as organizations? How can we change it? How as employers can we best make sure that we are encouraging individuals to make movement in the right direction? What are the key components?
Key Components of a Wellness Program
Years ago before wellness was part of our everyday vernacular, corporate wellness was basically simply the health risk assessment (HRA). The University of Michigan now has over 25 years of data to support the fact that there is value in doing health risk assessments. Although it has its critics, it is really a standard part of workplace wellness in terms of health management. The value is not just in the report an individual gets back, basically their health report card. It is also in the aggregate data the organization receives. That is why the HRA is an important component of designing wellness programs and measuring ROI, because that aggregated data has documented validity a can provide organizations change in their programs’ key performance indicators (KPIs) year over year.
Biometrics are another great source, whether you choose to provide access through onsite programs or offsite preventative screening through your benefit plan, biometric data is great because it is objective. We generally know this information is fairly accurate and we can look at it on a population basis. Also, it is arguably one of the strongest ways to quantitatively see the impact of behavior change components of workplace wellness programs.
- Are we making any kind of change in BMI?
- Are we making a change in blood pressure rates?
- Are making a change in the total cholesterol and the blood glucose rates?
All of these questions are important in terms of managing overall health and the likelihood of developing chronic conditions. As employers concerned about the efficiency of our workplace wellness program, these question are also incredibly important to consider when looking at the health of our employee population.
- Behavior Change
The second component to critical examine is behavior change. If we aren’t changing anything, how do we expect to get a return on our investment? That is really where behavior change becomes important. Those particular pieces of the program that result in people modifying their lifestyle risks. Behavior change is really just a fancy way of saying: getting people to quit smoking, moving more and eating better.
We all know that we should do these things. The challenge is knowledge alone is not an enough. That is where wellness programs can really shine, in terms of the way they can get employees to engage.
- Engagement Strategy
Lastly, the engagement strategy. This is the unsexy part of wellness, but it is one of the most important parts. Employers often have an aversion to having to invest in employees to be healthy, and engagement strategies defer this by attempting to intrinsically motivate and extrinsically reward an organization’s workforce. The practice of paying an employee to fill out a health risk assessment is antiquated. The process is only 10 minutes of work, and the measurement instrument alone really does not result in anything. A better approach is somehow using your incentives and linking them to some sort of health expenditure. This increases the employee’s participation in funding their own healthcare.
A big part of engagement is also effective communication. Typically you are going to have to message an employee multiple times to get through to them, even if you are a very sophisticated employer with good communication channels. Putting one article up on an Intranet is really not going to be enough to move your wellness program forward. You need to have a varied, yet comprehensive, communication campaign. Never underestimate the power of word of mouth as well. Getting wellness champions embedded in an organization’s environment is key, since leadership is an important element of effective communication. This also highlights the importance of company culture. If you have ginormous cookies available at every big meeting as the company’s snack of choice it really sends a very mixed message regarding how health is viewed within the organization.
Value-based Benefit Design
Value-based benefit design is a way to look at incentivizing or engaging employees and wellness programs. Rewards and incentives are tied to HRA and/or biometric data, and this becomes compulsory (by the employee) in order to have access to preferred health plan options. Within this paradigm there is a heavy focus on outcome, so you have baseline data HRA and/or biometric data for an individual for things such as blood pressure, cholesterol, BMI and blood glucose. If the employee is at acceptable measures they are rewarded with incentives. If they do not meet those standards (ex. they have an elevated BMI or their cholesterol is non-optimal) they are given an opportunity to engage in some kind of behavior change component. Rewarding the behavior change intervention is a way to incentivize healthy behavior despite the fact that the employee did not meet initial healthy criteria and then would be eligible for a premium differential through the intervention. The goal being that the employee would start to make lifestyle changes that would get themselves into an optimal range for the biometric measures that are associated with the development of chronic conditions.
Workplace wellness use to talk about carrots and sticks. Now we talk about value-based benefit design. This is a much more understandable and transparent way of engaging folks in wellness, especially when the employee is confident that as an employer you are never going to see someone’s individual data without the consent of the employee. And letting the employee know, giving them a chance to be in charge of their own wellness is important.
Important Program Elements to Track
What should you be tracking when you look at this information? You are really trying to implement at a very basic level some kind of behavior change initiative(s) around lifestyle risks. This is important not to forget when an organization is developing its program. It sounds somewhat simplistic when you say organizations just need people to basically start doing healthy things, but it is getting people to do healthy things that is the hard part. Seventy-five percent of our healthcare costs (as estimated by the CDC) are related to the things that we can change, mainly smoking and obesity. So tracking and helping an employee improve has a real impact, on the employee and healthcare costs. Since each organization and employee base is different, good benchmarks are important. That means getting health risk assessment data and biometric data specific to your organization so you know where you stand in terms of BMI, blood pressure, blood glucose, and cholesterol. Measuring the productivity of employees and impact on productivity is also important. An organization should also track the impact on medical claims. The estimate commonly cited is that 25 to 40 percent of these claim costs are avoidable – either through prevention, early detection, or physical activity.
What health risks impact employee productivity?
Typically productivity correlates with BMI, high cholesterol, blood glucose, high blood pressure, smoking and low activity. Blood pressure has a couple of statistics that support this. An incredible number of people actually have high blood pressure, yet it is one of the least compliant medications. Employees that keep their blood pressure within a healthy range decreases their risk for strokes, cardiovascular disease, heart attacks, and other very costly chronic conditions as well. About 31 percent of the population as a whole has high blood pressure. This is not something that we should ignore in terms of focus, whether it be a health education program or giving people resources about what they can do to improve.
Smoking (and the benefits of stopping) needs little discussion. Blood glucose is commonly associated with diabetes, so it important employees keep their blood sugar in a healthy range. One can have early onset diabetes and not necessarily even realize it. Early detection can really pay an important role in preventable disease. If an organization is able to reduce some (or any) of these health risks we can undoubtedly have an impact on the excess of medical claims costs.
How do you get people engaged?
It is not easy. You have to address issues and concerns around confidentiality and trust. This is not something that can be overlooked whenever you are putting a wellness program in place, because without these two things no one will engage. Quality third party health coaching programs for things such as tobacco, weight, nutrition, exercise, and stress management have proven to be effective when they are properly fitted with the organization. Having an online option, as well as self-study modules are important for those that value accessibility and/or like to self-direct themselves, or maybe simply have an aversion to asking for help from a physical presence. Onsite wellness events when delivered well can be effective, if the presenter is engaging. Lastly, wellness challenges (or “co-opetitions”) are great if the organization already has an existing competitive environment.
Best Practices When Looking at ROI
What are the most important things to do when you are looking at return on investment regarding workplace wellness? Make sure you are looking at your baseline data. Measure before you roll out any workplace wellness program if possible. We know improving health risks improve costs, but figure out the quantifiable measure important to the organization. Is it productivity and absenteeism? Is it only the excess costs on medical claims? Figure out what “success” means to the organization, then obtain as much baseline data in terms of your own individual organization (or get outside/external benchmarks if needed). Build the trust and credibility within the organization needed to measure, because that is how you are going to get quality data. If no one opts in, no data. Make sure you focus on engagement, because without engagement you are not going to be able to get change (which means no positive outcomes for the employee and organization). Finally, really focus your effort on impacting lifestyle risk factors. That means focusing on things you can influence like: making healthy choices, exercising, and (of course) smoking cessation.
[credit: content inspired by fellow Alliant alum Dr. Michele Dodds.]