Wellness Staying Power: Executive Backing Essential

Wellness programs are like New Year’s resolutions – they begin with lots of enthusiasm, but they are difficult to sustain.

That’s the cautionary tale of wellness experts like Sara Hames and Jo Steinberg, who bluntly state that if an organization is contemplating a wellness program, its top executives must not only buy in, they must also be active participants. Without executive buy-in and leadership, wellness programs lose their momentum over time, and the potential benefits – moderating health insurance costs and greater work productivity – are compromised.

“The best support starts at the top, and if you don’t have the buy-in from the C-suite, your program is likely to fail,” said Hames, vice president of the Milwaukee-based Hays Companies of Wisconsin. “The first thing to do is talk to the senior management and ask, ‘Are you going to support this, both monetarily and through flexibility by allowing employees to do some of these things on work time? Are you going to be a role model?’

“If any of those are ‘no,’ you’re going to be exceptionally challenged to make the program a success.”

Team concept

Hames says that once “C-suite” support is secured, organizations should form a design team of five wellness evangelists. This typically falls on the human resources department, but it’s better to have representation from several departments to promote a higher participation rate.

Asked if the program should target the largest cost drivers, Hames said that depends on workforce demographics. “You take a look at what you’ve got, both in terms of the culture and the environment and the risks you have,” she explained. “Try to tailor the programs to your specific population. Generally, the big drivers are smoking cessation, healthy eating, and exercise.”

Wellness programs typically begin with individual health-risk assessments. Jo Steinberg, owner and president of Midland Health in Brookfield, said the health-risk assessment should give employees an idea of how they rank on lifestyle habits. “Keep in mind that they could lie through their teeth on all these questions,” Steinberg cautioned. “What we did to circumvent that is called a ‘Know Your Numbers Program,’ where we actually give them two scores – a score on the health-risk assessment and a separate score based strictly on their biometric measurements and their nicotine use, because those are controllable and those can be monitored from year to year.”

A wellness program without incentives (or penalties) is unlikely to have the desired results. Most incentives center around company health insurance coverage and how much of the per-employee cost the company is willing to pick up. “You will find that participation in a program that does not have an incentive probably will be no greater than 30%, and what you have are people who are healthy and who want to see how they are doing,” Steinberg said. “If you don’t incentivize people, the chances of you getting high participation and success are very low.”

One company cited by Hames had very high deductible, and it paid well for preventive care. However, employees were not getting their preventive exams, so the employer established a system in which employees could earn dollars to help offset their deductible. They could earn dollars by getting a health-risk assessment and by getting preventive care, including dental checkups and vision exams, and by taking steps like contributing to a health savings account every month.

“Employees for the most part were excited about it because they were earning money they could use for health-related purchases, including professional trainers or some type of membership at the YMCA – in some cases, even running shoes,” Hames added.

Nora Vrakas, risk manager for Construction Resources Management in Waukesha, helped form the company’s wellness program. As a geographically diverse construction company with operations in Wisconsin, Michigan, and Illinois, many of its employees are spread out in different areas, and many do not work in an office environment. “Having a system that is easy to understand and also accessible from remote locations is key,” Vrakas explained. “Executive support is important and exists at our company, but the plan is driven by the benefit and HR functions.”

Vrakas said the company has tied its health insurance program to wellness. In the past, the company always paid the full premium, and Vrakas said there has been a large disconnect between what that benefit is and how employees perceive it.

Now, the company provides a high deductible insurance benefit and then provides premium rebates and dollar incentives – to offset deductibles, copays, or coinsurance – in a health reimbursement fund. The premium rebate and incentives are tied to wellness activities.

For example, if non-smoking employees take a health-risk assessment, they receive health insurance at no cost; there is a full rebate of the premium charge. Smokers who have a health-risk assessment do not receive the premium rebate, which equates to 20% of the premium cost. Smokers are able to offset health care costs by earning “HRA,” or health reimbursement arrangement dollars, through more healthy activities, including a smoking-cessation effort.

“With the increased deductible and more attention being paid to where they spend health care dollars, we’re hoping to eliminate that disconnect and get people thinking about their health and health spending in a more holistic way,” Vrakas explained.

“The dollars earned by employees to offset their large deductible, coinsurance, and copays on their HRA card are earned by doing preventive care activities (mammograms, annual physicals) and wellness activities (diet, exercise),” Vrakas explained. “We differentiate those.”

The next component, which is being put in place for 2012, is participation in chronic condition management for individuals who’ve been identified as falling into one of the six major disease categories, including diabetes, heart disease, and cancer. If an employee falls into one of those categories, he or she will earn points by going through established chronic condition management protocols.

The long view

As with many business initiatives, a key challenge with wellness programs is to keep them rolling and refreshed, and to track progress both in terms of return on investment and employee health.

Surveying and soliciting employee input is invaluable in the development of new ideas. “The possibilities are endless, but you need some type of motivation,” Hames explained. “Creating the right environment is important, but it’s not enough. Success requires a plan and continuous effort.”

That continuous effort will be needed for reluctant participants because there will be an unhealthy percentage of employees, 15% to 20%, who resist. Following the health-risk assessment, a smoker ideally would take part in a smoking-cessation program, but the ideal response does not always occur.

“You can’t put people into smoking-cessation programs unless they really want to quit,” Hames noted. “It’s time and money, but you can educate them on the pros and cons of kicking the habit.”

Employees and employers should check progress on an annual basis because “if they know they will only get tested once every two years, they will put off their changes,” Steinberg said. “If they know they will get tested each year, the chances are greater that they will make an improvement sooner.”

“I think you need to carefully evaluate your outcomes,” Hames added, “and that is probably where we haven’t done the best job – determining if there was ROI. Sometimes we have a tendency to only do that on costs, but health care costs in general only deviate so much, even if you have a large claim.”

Construction Resources Management is working on the honor system. Preventive care activities are tracked on a Web program; the company does not require any sort of proof of activity, other than for preventive care screening and routine annual physicals. Health outcomes usually tell the tale.

The program was established only last year, so there are no tangible results yet. “What we’re seeing is that our health costs are highly influenced by the small part of our population that is in a disease management category, so we’re actually seeing a slight upward trend in medical costs due to increased preventive care efforts and then some cancers, heart issues, and other disease areas,” Vrakas said. “We’re hoping to be able to take a closer look at identifying the population with chronic conditions, and then pull those individual costs out and look at overall cost for the rest of population. We’re essentially calling those outliers and then looking at costs within disease populations to see if those are being influenced at all, and then the costs within the overall population to see if that is going down.

“I do think wellness programs like this are a long-term commitment. You won’t be changing things quickly, but changing people’s behaviors is what we’re trying to do, and that takes time.”