1

REFRAMING WELLNESS AND

HEALTH PROMOTION FOR

WORKSITE WELLNESS POPULATONS

Derek Bell

Health Educator

Ministry Medical Group Occupational

Medicine

Stevens Point, WI

FRAMING THE WORKSITE

WELLNESS QUESTION

What are we talking about when we talk about worksite

wellness?

• Organized, employee-sponsored program that is designed to

support employees (and sometimes, their families) as they

adopt and sustain behaviors that reduce health risks, improve

quality of life, enhance personal effectiveness, and benefit the

organization’s bottom line

- W. Baun (2010)

ISSUES FACING WORKSITE

WELLNESS TODAY

• Chasing the ROI

• Avoid the lure of the “extra” or “add-on”

• Current legislation, tax incentives and

grants

• Creative methods to chip away at health

care costs

• Moving beyond start-up phase

2

WHAT DO WE EXPECT FROM

WORKSITE WELLNESS

WE ARE SPENDING MASSIVE AMOUNTS ON SICK CARE

WHERE TO PLACE THE BURDEN FOR COSTS?

•In 2010, the US spent $2.7 trillion in healthcare, or $8,680 for every man, woman and child

•Per enrollee spendingPrivate sector -$4,786

Medicare -$11,610

Medicaid -$7,434

• Big picture – U.S. Government paid $1.2 trillion (45% of total), private businesses financed $558 billion (21%), and households incurred $749 billion (28%) in costs

- Hartman et al., Health Affairs, 32:1, January 16, 2013, 87-99

SHIFTING THE BURDEN

EMPLOYERS’ AND EMPLOYEES’ COSTS ARE

RISING RAPIDLY2005 2010 % Increase

Worker Contribution $2,713 $3,997 47%

Employer Contribution $8,167 $9,773 20%

Total $10,880 $13,770 27%

WORKSITE WELLNESS TRENDS

WHAT’S TRENDING IN WORKSITES

• Outsourcing, downsizing, layoffs, reductions in force

• Mergers, acquisitions, consolidations

• Global competition

• Pressure for innovation, adaptation, reengineering

• Increased reliance on technology

• Information overload

WHAT IS MEANS…

• Need for loyal, skilled laborers

• Partnerships, shared service opportunities

• Cultural awareness

• Creating new methods

• High-level with high-touch

• Always worry about information overload

3

IMPACT TO WORKERS

CHANGING WORK DEMANDS

• Introducing new methods, practices and technology

• Less workers means more hours for current staff

• Absenteeism has greater impact

• Mental health awareness, presenteeism, and stress-related issues matter more

• Less room for errors combined with need for innovation and cheaper production

• Not a lot of elasticity in working expectations

• Productivity is at an all time high –especially since businesses now need to do more with fewer workers

• But, $260B is wasted each year in the U.S. on health-related productivity losses

WORKER FALLOUT

THE FALLOUT FROM A PUSH FOR HIGHER PRODUCTIVITY

• Increased job demands

• Detachment and depersonalization

• Increased health care usage

• Increased absenteeism

• Low job morale

• Increased disability rates

• On the job accidents

• Work-life imbalance

• HIGH STRESS

GREATER RISKS FOR EMPLOYEES

INCREASING DEMANDS INCREASES RISKS

MEDICAL

• Chest/back pain, heart disease, GI disorders, headaches, dizziness, weakness, repetitive motion injuries.

PSYCHOLOGICAL

• Depression, anxiety, aggression, irritability, apathy, boredom, isolation, loneliness, fatigue, moodiness, insomnia.

BEHAVIORAL

• Accidents, drug/alcohol abuse, eating disorders, smoking, tardiness

ORGANIZATIONAL

• Absence, work relations, turnover, morale, job satisfaction, productivity

4

SOLUTION FOCUSED WELLNESS

WHAT WE EXPECT WORKSKITE WELLNESS TO SOLVE

• Manage disease, disability and absence

• Manage and help navigate health care system

• Reduce stress

• Provide Employee Assistance Program

• Increase morale

• Incentivize production

• Cut costs for care, pharmaceutical benefits

RISING COSTS

Rise in costs and spending for treatment• Innovation/advancing technology (pharmacologic, devices, treatments)

leading to better treatment and medicine practices

• Newborn delivery costs –five-fold increase from 1987-2002

• Increases in identifying and treating some conditions

• Allergies maintenance and daily medication use (Claritan, Allegra, …)

Rise in prevalence of disease• Nearly 75% of all health care spending in the U.S. is focused on patients

who have one or more chronic health conditions

• Chronically ill patients only receive 56% of clinically recommended preventive health services.

• And 27% of the rise in healthcare costs is associated with increases in obesity rates…

EVIDENCE FOR WELLNESS

SOLUTIONS

BASIC PREMISE

If you improve the health and well being of your employees, then health care costs diminish, quality of life improves, productivity is enhanced, everyone is happy. Seems simple, right?

CURRENT RESEARCH BACKS THIS PREMISE UP • A large proportion of diseases and disorders is preventable. Modifiable health risk factors are precursors to a large

number of diseases and disorders and to premature death – (Healthy People 2000, 2010, Amler & Dull, 1987, Breslow, 1993, McGinnis & Foege, 1993, Mokdad et al., 2004)

• Many modifiable health risks are associated with increased health care costs within a relatively short time window– (Milliman & Robinson, 1987, Yen et al., 1992, Goetzel, et al., 1998, Anderson et al., 2000, Bertera, 1991, Pronk, 1999)

• Modifiable health risks can be improved through workplace sponsored health promotion and disease prevention programs

– (Wilson et al., 1996, Heaney & Goetzel, 1997, Pelletier, 1991, 1993, 1996, 1999, 2001, 2005, 2009, 2011)

• Improvements in the health risk profile of a population can lead to reductions in health costs – (Edington et al., 2001, Goetzel et al., 1999, Carls et al., 2011))

• Worksite health promotion and disease prevention programs save companies money in health care expenditures and produce a positive ROI

– (Johnson & Johnson 2002, Citibank 1999-2000, Procter and Gamble 1998, Chevron 1998, California Public Retirement System 1994, Bank of America 1993, Dupont 1990, Highmark, 2008, Johnson & Johnson, 2011)

5

COSTS OF DISEASE

THE COST OF CHRONIC DISEASETOP 10 MOST COSTLY

PHYSICAL HEALTH CONDITIONS (TREATMENT, ABSENCE, DISABILITY)

WHAT WELLNESS SAVES

CURRENT RESEARCH

ON MEDICAL CARE COST SAVINGS

WITH WELLNESS PROGRAMS

Description Average ROI

Studies reporting costs and savings $3.37

Studies with control groups $2.38-3.36

Studies examining medical care savings $3.27

Absenteeism savings $3.27

WHAT IS SUGGESTED FOR

WORKSITE WELLNESS PROGRAMS

• Integrate programs –insure vendor (stakeholder) engagement – match goals and objectives with benefits, clinic/on-site staff, services and programs

• Accessible/attractive programs

• Start simple

• Offer multi-component options for diversified audience, a variety of topics and engagement modalities

• Integrate wellness programming staff into the fabric of the organization

• Spend the right amount of money to achieve a desired ROI

• Designed for behavior change

• Tailored and individualized interventions

• Balancing high touch with high tech

• Individual and Environmental/ecological interventions

• Effective, reliable, valid tools

6

CORE PRINCIPLES OF WELLNESS

PROGRAMS

There is general agreement, focusing on improving the health and quality of people’s lives will improve productivity and competitiveness, and create a loyal workforce.

A growing body of research suggests that well-designed, evidence-based health promotion and disease prevention programs can:

• Improve the health of workers and lower their risk for disease;

• Save businesses money by reducing health-related medical losses and limiting absence and disability;

• Heighten worker morale and work relations;

• Improve worker productivity; and

• Improve the financial performance of organizations instituting these programs.

WELLNESS IS NOT THAT SIMPLE

• Traditionally thought of as a nice extra

• While ROI suggests cost savings, finding money is critical to companies

• Wellness is often thought of as a trade-off

• Wellness programs are often marginalized

• Changing tides: Responsibility between employer and employee is shifting

• Rising Health Care Costs

• Shifts in legislation, practices and services helping promote wellness at work

REFRAMING WELLNESS

2010 Study – Hard Return on Employee Wellness

Programs? (Berry, Mirabito, Baun)

• 10 organizations reviewed for wellness programs

• 300 people participated with interviews

• Basic questions - what works, what doesn’t?

• Regardless of size

• Recognized a shift in traditional programming

7

PILLAR 1: Multilevel Leadership

MULTILEVEL LEADERSHIP

Creates a culture of health takes passionate and

persuasive leadership for all levels, promote

putting “wellness” in job descriptions.

– CSuite

– Middle Managers

– Wellness Program Managers

– Wellness Champions

– Employees

PILLAR 2: Alignment

ALIGNMENT

Wellness program has to be a natural

extension of the firm’s identity and

aspirations. Consider mission and vision

statements and where wellness can be

mentioned.

• Planning and Patience

• Thoughtful about incentives and rewards

• Complement business priorities

PILLAR 3: Scope, relevance, and

quality

SCOPE, RELEVANCE, AND QUALITYMust be comprehensive and excellent

• Wellness is not just physical fitness

• Consider the highest contributing factors to employee health are stress and depression

• Employee Assistance programming

• Consider what home looks like in your program designs

• Consider how to best develop individualized programming

• Utilize risk stratification in data collection

• Taking a leap of faith and move beyond “best practices”

• FUN

8

PILLAR 4: Accessibility

ACCESSIBILITY

Aim for low-costs, to no-cost services and ways where wellness is a normal part of the day-to-dayculture.

• Ask “why don’t” and remove those barriers.

• Implement complimentary programming to increase traffic – do your own inside sales!

• Health Fairs are traditional ways to initiate workers, but need supporting programs

• Simple ideas – food at work?

• Going mobile, don’t forget those who are not

PILLAR 5: Partnerships

PARTNERSHIPS

Active and ongoing relationships will deliver

program enhancements

• What are your external partnerships with

vendors?

• What can be grown outside the company walls?

• Community membership, community resources,

and community development

• Low-investment alternatives and options

PILLAR 6: Communications

COMMUNICATIONS

Wellness is not just a mission, it’s a message.

Delivery is critical.

• Overcome issues: Apathy, sensitivity of

personal health issues, diversity/cultural

heterogeneity of employees

• Technology, intranet’s, postings

• Regular processes

• Wellness “clues”

9

FRUITS OF WELLNESS

LOWER COSTS

– Degree might shift, but wellness programming saves costs,

diminishes days lost and time missed

GREATER PRODUCTIVITY

– Absenteeism + presenteeism (depression, anxiety, migraines,

respiratory illness, arthritis, diabetes, back/neck pain)

HIGHER MORALE

– Most wellness research focuses on hard dollars

– Do not overlook potential to strengthen organization’s culture, build

employee pride and commitment

– Competitive marketplace demands strategy change

WELLNESS PROGRAM METRICS

WHAT ARE YOU CAPTURING?

• EMPLOYEE PARTICIPATION

– Utilization

– Penetration

– Depth

– Sustainability

• EMPLOYEE SATISFACTION

– Attitudes and beliefs

• HEALTH-RISK STATUS

– Raw data about the health and wellness

– Health Risk Appraisals with wellness/lifestyle components

– Review of lab work?

WHAT ORGANZATIONAL METRICS

ARE YOU CAPTURING?

• HEALTH CARE

– Actual care costs – medical visits, pharmaceutical costs, etc..

• SAFETY

– Incidents

– Lost and modified work days

• PRODUCTIVITY

– Absenteeism and presenteeism

• ORGANIZATIONAL CULTURE

– Trust in management

– Voluntary and involuntary turnover

– Recommendations and recruitment

10

REFRAMING WORKSITE WELLNESS

• What does our program say about our company?

• What does our wellness look like at our company day-to-day?

• Could our employees easily describe our wellness programs?

• Do we know how our company thinks about wellness?

• Is our wellness program easily transferrable to the home and families?

• Does our wellness program provide fulfillment today?

IS OUR WELLNESS PROGRAM

REALLY A WELLNESS PROGRAM?

• Six Dimensions of

Wellness

• National

Wellness Institute

• Wellness as a

process

ILLNESS-WELLNESS CONTINUUM

11

WELLNESS AT THE TIP OF THE

ICEBERG

WELLNESS FIELDWORK

• Research on diet, exercise and heart health

• Less than 3% Americans get recommended exercise

• Less than 12% eat right amount of fruits and vegetables

• CDC figures on impact of lifestyle changes

– 80% of heart disease is preventable

– 80% of Type 2 diabetes is preventable

– 40% of cancer cases are preventable

• Too often we rely on mechanistic interventions and program, like

energy in-energy out or disease prevention only

• Forget the role of social relationships

• Underestimate the Feeling of now!

• Does your wellness program address these?

HAPPINESS CONTAGION

• General agreement that a person optimism provides a 50% greater chance of health living

– Fewer health problems

– Fewer difficulties with work

– Less conflict

• Framingham Heart study

– Happiness can act like a contagion

– Spread through social networks

– Encourage healthy behaviors

Nearby people becoming happy, increases probability by 25%

Nearby mutual friend becoming happy, increase your happiness by 63%

Your next door neighbor can increase happiness by 34%

Siblings that live close to each other (within 1 mile) can increase happiness by 14%

Three Degree of Influence Rule

12

ATTITUDES, ACCESS AND BARRIERS

• University of Michigan Study (2012)

• Individuals who were exercising for long-term health actually

exercised less than those who aimed to enhance the quality of their

daily lives

• Challenges convention

– People have been taught to consider exercise as medicine

– Results happen at some future time

– What an individual espouses does not lead to behavior change

– Distant benefits are not compelling

BEHAVIORAL IMPACTS

• Underestimate the psychology of behavior change, and how to move people through stages of change

• We are fearful when our health is at question

• We learn from each other

• Access is more than gym memberships and lunch and learns

• More beyond long-term health as the primary benefit for programming

THOUGHTS FOR REFRAMING

• Don’t assume information and education matter most – don’t rely on production to mask convention

• Cultivate a culture of support, promote self-efficacy, and foster environmental changes (policy)

• Consider inclusivity and multiple reward factors

• What role does daily satisfaction play?

13

WHAT DOES OUR WELLNESS

PROGRAM LOOK LIKE NOW? WHAT CAN YOU DO?

Promote physical activity

Find creative ways to integrate activity, movement, stress-reduction, participation, events, education, groups and teams into the day-to-day activity programming. Utilize walking trails, open stairwells, slow down the elevator, promote public transport, subsidize gym membership or fitness activities, provide pedometers, sponsor competitions, work with your local schools, celebrate achievements, publicize events –don’t rely on internal programming only to change the culture

Promote access to healthy foods

Consider day-to-day what can be done between policy and practice to make for a healthier worksite and home.

Make the healthy choices the easy choices – labeling, advertising, only allow healthy food at company-sponsored events, change vending machine contractors, sell half portions in the cafeteria, give people smaller plates, provide free water, make people wait for unhealthy food, promote and subsidize nutritious food, provide healthy cupboards, pay for microwaves and refrigerators, educate

Advocate for legislation that supports healthy lifestyles

Do not forget local community resources

Cultivate partnerships with community groups, and sharing wellness program duties with vendors

Build a healthy company culture

Write “wellness” initiatives into job descriptions, allow for “wellness” team interactions, promote wellness advocates and champions, create wellness leadership roles with outcome measurements and incentives, start walking meetings, build social groups and events, and encourage wellness to be taken home and shared.

Change the norms of the organization, reward employees and managers for healthy lifestyles, provide social support for employees who want to lose weight, make the workplace fun

WHAT DOES OUR WELLNESS

PROGRAM LOOK LIKE NOW?