Online Health Promotion and Wellness Programs

Wellness programs come in all shapes and sizes. But regardless of plan design there are five common components that set the successful programs apart from the rest.

At their core, wellness programs require constant monitoring and periodic adjustments. the programs that get mediocre results are the ones that are left to run on autopilot. That’s why it’s crucial to –

1. Know thine enemy You’ve to know what’s driving your biggest claim costs on your health care plan – both among workers and their dependents.

2. Create realistic expectations. With wellness, what an corporation gets will nearly always depend on how much it spends, how well it plans and how well it sustains communications with participants and the provider.

3. Maintain strong communications. the wellness programs that achieve the greatest success are those which are communicated aggressively from the get go and are sustained. Repetition is your friend when doing employee education.

4. Integrate wellness with other benefits. Real-life experience has shown that you should consider your staff member assistance programs (EAPs) an extension of the wellness program. You should also consider issues like absenteeism, disability and worker’s compensation to be pieces of the wellness puzzle.

5. Practice what you preach. the key to ensuring employee buy-in is for management to lead the program by setting a positive example. When upper-level managers are unwilling to participate and address their own health issues, don’t expect many staff members to take the program seriously.

Here’s more evidence that wellness programs pay for themselves –

Over the last two years, one organization in five has seen meaningful betterment in employees’ health status – and started to stabilize their costs – as reported by one study.

Among firms noting improvement, nearly two-thirds (64%) feature wellness programs offering incentives for healthier lifestyles.

Here are three twists on traditional incentives that’re getting good results –

1. Health coach outreach

A lot of firms require staff members to work with a personal health coach to get a discount on monthly premiums or earn cash incentives.

The most common set-up –  on a regular basis, the employee must set up appointments with and report to (either over the phone or face to face) his or her health coach.

But experience has shown there’s often a high dropout rate.

Individuals  get off to a great begin – and they’re enthusiastic about the incentive – but once they realize there’s some effort involved, they lose interest.

The good news –  Firms have found a simple-to-arrange alternative that keeps  individuals  on the right track. Rather than requiring workers to contact the health coach, a growing number of organizations require participants to take calls from the health coach.

Potential result –  Fewer folks fall off the wagon. There’s no outreach effort involved, and the health coach keeps individuals  accountable.

2. Nutritional education/therapy

A newer – and cost-effective – feature in the battle against worker obesity –  offering an worker nutrition-education program administered by a specialist nutritionist.

Just 11 percent of organizations – 18 percent  of large employers and 7.5 percent of small to medium ones – have such programs, according to SHRM’s most recent benefits survey.

Even fewer offer (via their EAPs) nutritional therapy for individuals  with consuming disorders. But available data on these programs shows they normally pay for themselves.

The stronger the firm’s emphasis on teaching healthy consuming, the faster and more dramatic the reduction in major health claims.

Common plan features –  lunch and learns featuring healthful food options, giving out nutrition-linked gift cards and extending obesity-prevention incentives to people ‘s family members.

3. Assertive smoking cessation

A small, but rapidly growing number of businesss are taking more aggressive measures to avoid the costs associated with employees who smoke.

The step can be broken down into three levels of aggressiveness and potential risk/reward.

Level one –  the employer installs a wellness program in which non-tobacco use employees and those who commit to maintaining a healthy weight receive financial incentives that lower their share of monthly premiums.

Level two –  the corporation disqualifies job candidates who smoke from hiring consideration. Alternatively, some firms require health risks assessments as a condition of being hired.

Level three –  the company docks pay or fires staff members who fail to control their lifestyle-related health risks.

Example –  Clarian Health made news last fall for sending notice to staff members that as of Jan. 1,  2009, people  who smoke or chew tobacco would start be charged $5 per paycheck.

Are these strategies legal? at level one, the answer is a certified yes. health insurance portability and accountability act (HIPAA)s non-discrimination rules permit such incentives within limits.

In a nutshell, it’s legal to reward workers who quit tobacco use but illegal to punish those who try and fail. When an worker tries but fails to quit tobacco use, you’re still legally obligated to give them another shot next year.

Also keep in mindthat, by law, the size of the reward or penalty under your wellness program can’t exceed 20 percent of the total cost of coverage.

At levels two and three, it remains to be seen if such policies would hold up in court. Proceed with caution.

Wellness programs are a long-term investment. But how long should you wait for results?

Finance and the Chief Executive Officer (CEO) want hard numbers to show return on investment (ROI). and wellness ROI is tougher to calculate than, say, a 401(k).

18-month guideline

Recent studies have established some benchmark data on wellness ROI you are able to use as a guideline. It’s useful whether you already have a wellness program or are thinking about beginning one.

It normally takes at least 18 months from the launch of a wellness program to see any leads to your healthcare plan bottom line.

For many firms, 18 months is the point at which workers’ improving health begins to cancel the cost of sponsoring and administering the wellness program.

By and large, the long-term cost savings from a wellness program will be driven by how much you’re willing to spend. Usually, businesses get what they pay for – both in time and money invested.

As a rule of thumb, the typical cost to the business is about $3 to $5 per participating staff member per month. Within three years of launch, you must be seeing meaningful savings.

The average ROI tends to be about $4 to $5 saved for every dollar spent. So how can you manage the costs in the short-term in order to achieve the long-term savings?  and how can you maximize the long-term payoff?

Consider making wellness programs budget-neutral

For a lot of corporations, the most effective way to manage the cost of a wellness program in the start-up phase is to make it a budget-neutral expense.

In other words, the program neither adds to your healthcare costs at the outset, nor decreases them. Example –  You plan to roll out a wellness program effective Jan. 1. the program will cost the company $5 per employee.

You can roll the $5 per month cost directly into the employee’s monthly share of their healthcare premium. In this age of continuous cost-shifting, most staff members are used to seeing small increases in their monthly contributions each plan year.

Just make sure you’re not hitting folks with a big hike on top of that $5. Comparably designed wellness programs pay off about the same – meaning workers purchase in and participate at the same rate – whether they’re budget neutral or the company absorbs the cost.

But when staff members get clobbered by large-scale contribution hikes at the outset, they often resist the wellness program. the long-term ROI for these programs is often disappointing.

If you’re faced with a situation where achieving a budget-neutral program would cause push-back, your firm is better off absorbing most or all of the wellness costs.

The largest hurdle is to get over the hump for those first 18 months or so.

A few years ago, company health fairs were all the rage. Now they’re making a comeback, with a slight twist.

In the past, the fairs often better served the vendor(s) who came on-site than the needs of the hosting company or their employees. More recently, businesses have refined the planning of the events to serve specifically to launch or promote a wellness program.

To be successful, the events need to serve two purposes –  improveing worker education and building their enthusiasm to participate in the wellness program.

To make certain you and your employees get the most out of a health fair, it helps to be aware of the plusses and minuses – and some little touches that can mean the difference between a so-so event and a hit.

Wellness Fairs –  Double-edged sword

On the plus side, workers received easy-to-grasp information on key wellness topics like disease detection, symptom control and smarter medication practices. They also receive important services like free blood-pressure screenings.

On the down side, some professionals said the more newfangled events were more like “disease fairs” than “wellness fairs.” In other words, the tone was little too somber and staff members weren’t in particular tuned in because they weren’t enjoying themselves.

Wellness program advisor Dr. Ron Goetzel believes that the savviest firms strike a balance in their health fairs. Stick with the screenings, but also feature exhibitors who offer “lighter,” more enjoyable services. Examples –

• a booth from a local health-food store

• a chair-massage station

• elder-care info from the AARP, or

• a “complimentary medicine” info booth (e.g.,a chiropractor or an acupuncturist).

Offering incentives

In many cases, staff members still need an incentive to attend the fair and get the desired screenings, also to doing the fun stuff. Some real-life programs that’ve worked –

• a contest offering prizes to workers who visit every station

• quizzes and prizes based on info from different vendors’ literature

• flex-scheduling or time-off incentives for getting screened (e.g., a comp day or an extra afternoon off), and

• cash incentives (as little as $20 and as much as $100) to people  who voluntarily participate in various screenings.

Medical research has long shown quitting use of tobacco at any age can improve a person’s health.

But a Duke University shows that the group you could think would be the least likely to quit – individuals  over the age of 50 –  might actually have the best odds for quitting through a tobacco use cessation program.

Scientists tracked 573 older patients over 10 years. They found that just 16% of those who joined the smoking cessation program later returned to smoking.  Meanwhile, previous research has found young smokers who try to quit have a 35% to 45% relapse rate within two years.

Bottom line –   Given the aging worker population and the cost of retiree health care, you could want to keep trying with tobacco use cessation education for your older staff members.

The organizations with the most cost-efficient health plans are the ones that streamline the services employees receive for both their physical and mental health.

As a long-term goal, having your general health plan, employee assistance program (EAP) and wellness program communicating regularly with one another about employees’ treatments is the single best way to reduce redundant or contradictory treatments, eliminate unnecessary claims and improve the quality of the plans for which you pay.

Let’s look at the relationship between your wellness program and your employee assistance program to illustrate the importance of attacking health care costs cross a wide front.

You can start a wellness program with a health risk (assessment|appraisal} and then, if appropriate, roll out a use of tobacco cessation program or a weight loss program.

But ultimately you want to be sure that your wellness provider works joined with your EAP provider.

Here’s why –  It’s very common for an staff member to contact the EAP because the individuals feels depressed about his or her weight. What you want is for the EAP vendor to treat the employee’s depression and behavioral issues, plus you want the EAP to refer the staff member to the wellness program to deal with the root cause of the problem – obesity.

The same thing accompanies the relationship your wellness program and your workers’ comp provider, STD and LTD providers, rehab people , and/or illness managers. You want all them talking to – and sharing data with – each other. When they’re not, it’s costing you money.

In general, the employers who achieve the greatest cost savings through their wellness programs are the ones who overlap wellness with behavioral and occupational health issues.

Trying to do more with less money? Here are three proven ways to align the dollars and cents of a wellness program in your budget.

Common thread –  the way you prepare – and control – your budget for a wellness program is vital to its success.

1. Top-down budget

Depending on the size of your organization and wellness program, you may have full budget responsibility or might need to work with a C-level who’s budgeting expertise.

Regardless of the arrangement, you’re likely to face one of two distinct challenges –  a top-down budget or a zero-based budget.

A top-down budget is when you’re given a finite dollar amount and told to run the wellness program within the limit. When that’s the case, here are three crucial questions to ask –

• Does this limit include money set aside for employee incentives and future initiatives?

• Should we keep long-tenured programs that keep going up in price, and

• Does Benefits/HR have to deliver all education about the program, or is there additional funding to hire staff?

2.  Zero-based budgeting

In zero-based funding, you submit to  upper management an itemized list of the programs/features you want and the cost of each. Best practices –

• Rank programs by priority (health-risk assessments should be at or near the top)

• Indicate which expenses are fixed and which are variable, and

• List ways to incorporate existing resources (like an employee assistance program program) for a better return on investment.

3. Estimating ROI

On average, wellness programs typically take at least 18 months to break even. After three years, you ought to see savings.

If not, it’s time to take a fresh look at the program design.

Thinking about an obesity-related disease management program for your organization? Here’s what you need to know.

In order to be effective, the program must meet participants’ individual medical and psychological needs, not to mention your own organization’s need to control long-term medical costs.

How wide-reaching should the program be? After all, it doesn’t make sense to pay for services your employees don’t want or can’t use.

Mary Beth Chalk of Resources for Living suggests that obesity programs could be broken down into four tiers of worker need, from which your organization’s return on investment (ROI) can also be measured.

Tier 1 –  Education

Tier I staff members struggle with weight control problems but don’t need a health coach.  Instead, they may benefit from a self-directed program that provides weight-management related materials online, targeted mailing, and/or access to nurse call line.

How to measure ROI –  utilization. Do workers click on the Web site? Do they return to the site regularly? Do people  use the nurse line? Your program provider ought to provide you detailed use stats.

Tier 2 –  Clinical supervision

When the worker has been diagnosed as obese – a BMI  score over 30 is obese, over 35 is clinically obese – he or she’d do better working with a health coach in a clinically supervised program.

Three keys to getting maximum results –

1. Periodically have participants rate their relationship with their health coaches. Not everybody clicks, so a change may  be in order.

2. Coordinate your disease management (DM) care with your staff member assistance program (EAP)services. Reason –  Inability to control weight is often closely tied with mental health issues – and one can negatively affect the other. the more closely your employee assistance program and obesity program managers work together, the higher the chance for success.

3. Beware of the fade-out effect. Many workers in weight-loss programs get off to a excellent begin and then fall back into old habits. People  should re-commit to the program after three sessions, four months and nine months.

To measure ROI, look at utlization, goal achievement and lowered presenteeism. of course, presenteeism is notoriously difficult to measure with reliable dollar figures. So how can you overcome that problem?

• Begin with employees’ salaries. Let’s suppose one participant earns $40,000 per year.

• Ask staff members to self-report how energetic and productive they feel on the job, on a percentage scale. Then have supervisors estimate the employee’s productivity and split the difference. for this example, let’s assume it averaged to 50%.

• Collect scores again six months and one year into the program and then multiply the difference by salary. the result is your estimated productivity ROI.

In the example above, if the staff member earning $40,000 improves from 50 percent to 75 percent after one year, the productivity related ROI is $10,000.  

Tier 3 –  Medical management

At this level, the obese worker needs a higher level of care than a health coach can offer. the worker has chronic medical conditions related to obesity – like diabetes, high blood pressure, and/or sleep apnea – and needs a physician case manager. Namely, the worker needs to set up regular visits with the physician and create a treatment plan.

To measure ROI, begin with the lower-tier criteria, then track quarterly and year differences in FMLA or compensated absences, and prescription drug costs. Then compare it to the per-participant cost of the obesity program.

Tier 4 –  Morbid obesity

At this level, the employee has been diagnosed as morbidly obese – Body Mass Index (BMI) over 40 – and is considered a potential candidate for gastric bypass surgery.

ROI is measured through ongoing health claims as well as the previous criteria.

Given the immense growth of wellness programs over the last two years, it was inevitable resistance would creep up among watchdog groups.

In Washington, lobbyists have spearheaded a push for Congress, the DOL and IRS to crack down on “punitive” wellness programs.

Especially, the groups seek to limit programs in which employees’ share of their health care costs are directly tied to their willingness to participate in a wellness program.

HIPAA’s non-discrimination rules prohibit businesss from creating negative financial incentives for employees with health risks.

For example, you can’t raise someone’s premium share because he or she smokes. What you are able to do is offer a discount when someone completes a tobacco use cessation program.

Reason –  the law does allow for financial incentives to workers who willingly participate in wellness programs.

The watchdog groups seek greater regulation to make certain incentives and discounts are used only as rewards for healthy behavior, not as a thinly veiled form of discrimination against high-risk workers.

A recent survey finds nearly 42 percent of employers with 200 or fewer workers have some sort of disease management (DM) program.

That’s a huge increase from four years ago, when just 28% of smaller employers offered such programs.

There’s more to come, too. Fifteen% of respondents that didn’t currently have a disease management (DM) component to their medical plan hope to add one by 2011.

The highest-demand disease management (DM) programs are for diabetes, asthma and heart illness.

Source –  Small Company Benefits Survey, PDR Consulting Group, 9/1/2008.