Wellness Program A to Z

Looking for incentives to get overweight staff to buy into a wellness program? A recent study  suggests many staff are even willing to pay much â.” or all â.” of the cost themselves.

Roughly 35% of firms with health promotion programs focus on providing personnel with convenient access to losing weight resources.

A poll of 1,352 workers by the Strategies to Overcome and Prevent Obesity Alliance found that many people  would gladly chip in for the cost of the wellness program if they believed it would help them lose weight. What workers want -

o  confidential support and counseling

o  Access to a expert nutritionist or personal trainer, and

o  onsite exercise programs.

Until lately, only big organizations were able offer such wellness programs as part of their wellness benefits.   But the fastest growth of these wellness programs in the last two years has been in smaller firms (sometimes with as few as 50 full-time employees).

The majority of firms split the cost with staff members. Ordinarily, staff members pay up to about 25% of the cost. But some plans are fully worker paid.

Studies show that roughly five% of employees drive about 80% of your health benefit costs.

No shocker here -  Smokers and obese staff members are the highest risk group for developing the sorts of chronic medical problems that send costs through the roof.

A small, but quickly growing number of businesss are taking desperate measures to avoid the costs associated with these workforce.  The step can be broken down into three levels of aggressiveness and potential risk/reward.

Level one -  the business installs a health promotion program in which non-use of tobacco employees and those who commit to maintaining a healthful weight receive financial incentives that lower their share of monthly insurance premiums.

Level two -  the business disqualifies job candidates who smoke or are significantly overweight from hiring consideration. Alternatively, some firms require new hires to undergo a health risk appraisal as a condition of being hired.

Level three -  the employer docks pay or fires personnel who fail to control their lifestyle-related health risks. Example -  A company called Clarian Health has sent notifications to personnel that starting in 2009, personnel who smoke or chew tobacco are going to be charged $5 per paycheck.

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

Health Promotion incentives walk a fine line for HIPAAs non-discrimination rules. It’s legal to reward staff for wellness participation but its illegal to punish those who fail to improve their health.

Example - When an worker follows a weight-loss program in good faith but fails to lose weight, you can’t withhold the incentive. Likewise, when an worker fails repeated tries to quit smoking, you’re still legally obligated to give them another shot next year.

Likewise keep in mindthat, by law, the size of the reward or penalty under your wellness program cant exceed 20 percent of the sum cost of coverage.

The other two are still largely uncharted waters in the courts. Businesss considering these policies should proceed with extreme caution. Remember that the question of “can you do it” (i.e., is it legal?) is different from “should you do it?” (i.e., is it good business?)

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

At their core, wellness programs require constant monitoring and periodic adjustments.  The wellness 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 employees and their dependents.

2. Develop realistic expectations. With wellness, what an employer gets will almost always depend on how much it spends, how well it plans and how well it sustains communications with participants and the vendor.

3. Maintain strong communications.  The health promotion 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 worker 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 upper management to lead the wellness program by setting a positive example. If upper managers are unwilling to participate and address their own health issues, don’t expect many workers to take the wellness program seriously.

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

Over the last two years, one business in five has seen meaningful betterment in employees’ health status â.” and began to stabilize their costs â.” as reported by one study.

Among firms noting improvement, nearly two-thirds (64%) feature health promotion programs offering incentives for healthier life choices.

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 an individual 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 wellness Coach.

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

People  get off to a great start â.” and they’re enthusiastic about the incentive â.” 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 workforce to contact the wellness Coach, a growing number of organizations require participants to take calls from the wellness Coach.

Potential result -  Fewer folks fall off the wagon. There’s no outreach effort involved, and the wellness coach keeps people  accountable.

2. Nutritional education/therapy

A newer â.” and cost-effective â.” feature in the battle against staff member obesity -  offering an staff member nutrition-education program administered by a professional nutritionist.

Just 11% of companies â.” 18%  of large businesss and 7.5% of small to medium ones â.” have such health promotion programs, as reported by SHRM’s most recent benefits survey.

Even fewer offer (via their EAPs) nutritional therapy for individuals  with eating disorders. But available data on these wellness programs shows they usually 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 choices, giving out nutrition-linked gift cards and extending obesity-prevention incentives to people ’s family members.

3. Assertive use of tobacco cessation

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

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

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

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

Level three -  the employer docks pay or fires employees who fail to control their lifestyle-related health risks.

Example -  Clarian Health made news last fall for sending notice to employees that as of Jan. 1,  2009, individuals  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. HIPAAs non-discrimination rules permit such incentives within limits.

In a nutshell, it’s legal to reward staff who quit use of tobacco but illegal to punish those who attempt and fail. If an staff member tries but fails to quit use of tobacco, you’re still legally obligated to give them another shot next year.

Additionally keep in mindthat, by law, the size of the reward or penalty under your health promotion program can’t exceed 20 percent of the sum cost of coverage.

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

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

Finance and the CEO want hard numbers to show Return On Investment.  And wellness Return On Investment is tougher to calculate than, say, a 401(k).

18-month guideline

Recent studies have established some benchmark data on wellness Return On Investment (ROI) you are able to use as a guideline. It’s useful whether you already have a health promotion program or are thinking about starting one.

It usually takes at least 18 months from the launch of a health promotion program to see any results in your healthcare plan bottom line.

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

By and large, the long-term cost savings from a health promotion program will be driven by how much you’re willing to spend. Typically, organizations get what they pay for â.” both in time and money invested.

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

The typical Return On Investment 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 health promotion programs budget-neutral

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

In other words, the wellness program neither adds to your health care costs at the outset, nor decreases them. Example -  You plan to roll out a wellness program effective Jan. 1.  The wellness program will cost the organization $5 per worker.

You can roll the $5 per month cost directly into the employee’s monthly share of their health care 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 certain you’re not hitting folks with a big hike on top of that $5. Comparably designed health promotion programs pay off about the same â.” meaning workforce purchase in and participate at the same rate â.” whether they’re budget neutral or the business absorbs the cost.

But when employees get clobbered by large-scale contribution hikes at the outset, they often resist the wellness program.  The long-term Return On Investment (ROI) for these wellness programs is often disappointing.

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

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

A few years ago, corporation 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 organization or their employees. More recently, companies have refined the planning of the events to serve especially to launch or promote a wellness program.

To be successful, the events need to serve two purposes - increaseing employee education and building their enthusiasm to participate in the health promotion program.

To make sure you and your workforce get the most out of a health fair, it helps to be conscious 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, workforce 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 specialists said the more newfangled events were more like “disease fairs” than “health fairs.” In other words, the tone was little too somber and staff weren’t specifically tuned in because they weren’t enjoying themselves.

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

o  A booth from a local health-food store

o  A chair-massage station

o  elder-care info from the AARP, or

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

Offering incentives

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

o  A contest offering prizes to staff members who visit every station

o  quizzes and prizes based on info from different providers’ literature

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

o  cash incentives (as little as $20 and as much as $100) to individuals  who voluntarily take part in various screenings.

Medical research has long shown quitting tobacco use 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 - people  over the age of 50 - may actually have the best odds for quitting through a use of tobacco cessation program.

Researchers tracked 573 older patients over 10 years. They found that just 16% of those who joined the use of tobacco cessation program later returned to use of tobacco.  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 staff member population and the cost of retiree healthcare, you may want to keep trying with tobacco use cessation education for your older workers.

The organizations with the most cost-efficient healthcare programs 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, worker 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 health promotion program and your EAP to illustrate the importance of attacking medical costs cross a broad front.

You can start a wellness program with a health risk appraisal and then, if appropriate, roll out a smoking cessation program or a weight reduction program.

But ultimately you want to make sure that your wellness provider works combined with your employee assistance program (EAP) provider.

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

The same thing accompanies the relationship your wellness program and your workers’ comp vendor, STD and LTD vendors, 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 â.” and control â.” your budget for a health promotion program is critical to its success.

1. Top-down health promotion budget

Depending on the size of your corporation and health promotion program, you could have full budget responsibility or might need to work with a C-level who has 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 health promotion program within the limit. If that’s the case, here are three crucial questions to ask -

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

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

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

2.  Zero-based health promotion budgeting

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

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

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

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

3. Estimating wellness ROI

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

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

Given the immense growth of health promotion 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.

In particular, the groups seek to limit health promotion programs in which employees’ share of their healthcare costs are directly tied to their willingness to take part in a health promotion program.

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

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

Reason -  the law does allow for financial incentives to workforce who willingly take part in health promotion programs.

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