To date much of the discussion around health reform has been focused on cost containment, IT and the delivery system but little has been mentioned about a key pillar in President Obama’s health reform initiative, the pillar of wellness and prevention. Today, wellness and prevention took front and center stage in the dialog that President Obama continues to have with the public, employers and other stakeholders regarding the national imperative for health reform.

What does President Obama’s announcement mean for preventive health? Like much of the initial dialog around health reform, I think that this is the beginning of reframing the discussion around individual accountability and the health system’s responsibility to lead the effort in educating and motivating critical behavior change. If the goal of the health reform effort is ultimately to bend the cost curve, through efficiency and inclusion of all into a system the root cause of cost escalation needs to be addressed. While I may be oversimplifying this, evidence continues to mount that individual health habits and behaviors are associated with a significant portion of preventable healthcare conditions and now is the time to address a root cause of healthcare costs - change health behaviors.

What I found interesting today is that employers who have successfully managed to contain their healthcare costs such as Pitney Bowes, Safeway and J&J have done so through effectively building an integrated wellness culture. In addition to experimenting with various benefit coverage and designs, these organizations actively talk, treat and reward their employess for personal health accountability. The organizations that President Obama mentioned today have some other fundamental elements that are critical to their success in developing a wellness culture. Their program elements are integrated, tied to a performance culture and include the recognition that incentives, rewards and continuous awareness and dialog with their employees enables the emotional connectivity that ultimately leads to individual engagement. These companies have proven that it is possible to lower costs through a focused effort on health and wellness. These companies have proven that an integrated health and wellness solution that truly engages individuals ultimately leads to increased productivity and a return on investment. Isn’t it time that we all begin to take a page from their playbook?

Hewitt Associates recently published a survey on what to expect in healthcare in 2009 and the news is not pretty. With average raises hovering somewhere between 0-2%, the average healthcare premium is expected to increase 8.9% - well above inflation and salary increases. Yet, employees will continue to see more of the cost burden shifted to them in their benefits this year. I am no mathematician but it doesn’t take much to clearly see that this isn’t sustainable for employers and employees alike.

Health plans and employers must find ways to reduce these costs and employees have to become an active part of the solution. In a recent post, (link to the Employers Role in Health) I discussed the fact that only 12% of employees felt that employers had a role in educating and encouraging them to be healthy. That number must increase if we are to collectively stem the skyrocketing costs of care. Obviously the entire system contributes to these cost escalations, but employers and health plans can act as the catalyst for reshaping their organizations by making the right investments in wellness programs that become part of the organizational culture.

Once again, the key challenge for organizations is driving participation and engagement in these programs in order to encourage healthier habits and decision making. Health Risk Assessments are no longer good enough. While incentive and reward programs are focused right now in trying to drive initial participation and engagement, I wonder if organizations should start getting bolder with their incentive and reward strategy by offering meaningful rewards for health outcomes as opposed to participation. Have we reached a point where organizations need to push the envelope in thinking more about what is driving these costs up – inappropriate utilization and poor health outcomes and engage individuals in proving that they can indeed be healthy and recognize them for such an accomplishment?

Marc Siegel wrote an interesting op-ed piece in USA Today regarding the effects the economy is having on overall health and wellbeing. The general point he was making is that the stress levels and anxiety people are feeling right now are beginning to take a toll as individuals lose sleep, eat poorly, fall into depression and increase anxiety levels over job concerns, 401(K) values and general financial health … all of these activities also impact the general health and well being of an individual.

Given the amount of concern over the economy and the general state of morale at most corporations, I am surprised that more organizations are not focusing wellness efforts on stress management and mental health. The USA Today piece offers some relatively simple suggestions for dealing with stress: “The best advice is often the simplest: Eat healthy food, sleep right and avoid obsessing on the doom and gloom. Do yoga, meditate or exercise regularly to combat the growing stress.” It is difficult to imagine that individuals can focus on these measures given what is going on around them. These are extraordinarily challenging times but even under normal conditions, stress is a major contributor to health issues.

Organizations have an opportunity to focus their health efforts on stress management campaigns as a means of helping employees through these tough times. Since stress is a catalyst to many poor health habits, now is an ideal time to focus wellness efforts on managing stress and improving overall mental health. This is an area that has been long neglected in wellness programs, perhaps due to the asymptomatic nature of stress.

I would be interested in hearing your thoughts on USA Today’s piece and what your organization is doing to focus on stress management.

An interesting survey by Hewitt Associates came out regarding the role that employers feel they must play in keeping the workforce healthy versus the role that employees see their employer playing. Below are some interesting sections from the report:
• The number of employers who say they will get more directly involved in managing the individual health of their employees jumped 25 percent from last year, reflecting a nationwide trend to find more ways to save money in a tightening economy.
• For the first time, keeping employees healthy was named as one of U.S. companies’ top business and workforce issues this year.
• But while companies believe they need to get more involved in keeping their workforce healthy, employees are less convinced.
• 75% of employees think that employers are responsible for helping them understand how to use their health plan, just 12% believe that companies have a role in helping them understand how to stay healthy.
• 88% of employees claim they engage in healthy behaviors, but when asked about specific steps they take toward living healthy, less that half actually take appropriate actions to reinforce the claim.

Wow. The statistic that stands out to me is that only 12% of employees believe that companies have a role in helping them understand how to stay healthy. That is a huge hurdle that employers need to tackle before they can expect wellness programs to work. I believe that Tim Stebtiford, principal of Hewitt Associates Communications practice, summed it up best when he said, “Companies need to stop communicating and start motivating. People don’t like to be told what to do and with a mind numbing array of Web sites and brochures from their employer, they often just tune out.”

There lies the opportunity. If employers are going to address the skepticism that employees have about their role in encouraging healthy behavior, why not use a strategic incentive and communication solution to begin to engage their employees in their wellness programs. It is apparent from this study that simply building and offering wellness services are not enough to entice employees’ participation. Employers must establish a trust factor and find methods to energize and motivate employees to use these services. Wellness incentives could and should be the next investment employers make to mobilize their employees to utilize the wellness services.

What are your thoughts on these findings and how employers can reposition their role in helping employees understand how to stay healthy?

A study released by Blue Cross and Blue Shield of North Carolina indicates that companies offering comprehensive wellness programs can realize an approximate cost savings of 25% in medical and absenteeism in about 3.6 years after implementation.

I find this study interesting because it speaks to some of my earlier posts that discuss the whole-brained approach that Maritz employs in the health and productivity solutions we deliver to clients. The bottom line is that human beings are complex individuals and that asking individuals to adopt and consistently act on new health behaviors is a very personal journey that requires time and continuous reinforcement.

Blue Cross and Blue Shield of North Carolina further discusses the mindset change employers are embracing – less cost shifting to drive behavior and more health services and wellness offerings to drive healthier outcomes.

The key to seeing this type of cost savings resides in a highly integrated approach to supporting the participant. Obviously, the wellness offering needs to include a wide variety of offerings and campaigns that keep it fresh and top of mind with participants. As I mentioned in a previous post, communication around five questions that participants want to know is critical:

1) What do you want me to do?
2) Why do you want me to do it?
3) How do you want me to do it?
4) What’s in it for me?
5) How am I doing?

Organizations tend to either neglect or take a prescriptive approach to questions four and five. The result: poor participation and engagement rates. Organizations that want to see 25% cost savings need to consider incentives and communications to be equally important investments in their comprehensive wellness programs.

In previous posts, I’ve mentioned briefly about Maritz’ “whole-brained” approach to implementing successful wellness programs. Just to reiterate, what I mean by “whole-brained” is essentially rewiring the brain to activate new behaviors and sustain them long term. At Maritz, we apply the focus, repetition and positive reinforcement model to ensure the wellness program’s success. More specifically:

Focus: the act of paying attention, which creates chemical and physical changes in the brain.

Repetition: repeated, purposeful and focused attention, which leads to long-lasting personal evolution or change.

Positive reinforcement: people receive positive feedback; it creates a synapse in the brain, encouraging the behavior to continue.

When companies take a whole-brained approach to health and wellness incentives and answer the five integral questions – what do you want me to do, why is it important, how do I do it, what’s in it for me, and how am I doing – successful health and productivity programs becomes a continuous cycle resulting in optimum member participation and, more importantly, healthier members.

I came across an interesting article in the Kansas City Star regarding corporate wellness programs impacting the bottom line. According to Hewitt Associates, 88%of companies it surveyed this year “plan to make investments in longer-term solutions aimed at improving the health and productivity of their work force over the next three to five years, up from 63% last year.”

Even more interesting to me is the fact that Health2Resources (http://www.health2resources.com/) this year calculated that 80% of survey respondents more than broke even with their investment in wellness programs. Yet, what my organization is seeing in the marketplace and where we see clients struggling the most with these programs is how to gain the awareness, participation and ongoing engagement in wellness programs. It truly seems as though organizations that have been able to break even or calculate an ROI of $3 to $1 have been few and far between.

Why is that? Perhaps it is due to what many of my clients are struggling with – I call it the “wellness cliff.” People start off the program with good intentions and a commitment to participate, but then two things happen:
1) Employers and health plans that have invested a lot of time and money communicating an awareness about the program stop communicating (usually due to budget constraints).
2) Employees have a little thing called life that tends to interrupt their good intentions and without continuous communications wellness activities begin to slide down on their priority scale.

If the trend continues as the Hewitt Associates survey indicates, health plans and employers are going to need to develop strategic methods for continuing to engage people in their programs. While it may sound altruistic, shouldn’t living a long and healthy life be enough to engage people in using services that will help them? The reality is that while it seems like an obvious benefit, we live in a more instantaneous gratification world where “what’s in it for me?” really does motivate people to take action.

If employers and health plans are going to reap the $3 to $1 ROI benefit on these programs, using interventions such as personalized one-to-one communications and memorable, meaningful rewards that touch an individual’s intrinsic motivators will be critical to success. The use of a blended rewards strategy to truly engage participants in the program and actually continue to take them down the path of committing to healthier decisions and behaviors will continue to be a necessary component of a health and wellness program. Why you might ask? Because the natural human instinct to adopt very personal lifestyle changes is starts with most people asking what’s in it for me? The natural human instinct is that accomplishments are met with recognition and recognition continues to feed motivation.

In 2007, 75 percent of employers surveyed said they offered a corporate-sponsored wellness program. Many of these programs are in their infancy and involve employees or members filling out HRAs in return for cash or a gift card. This simple “do this, get that,” approach works well for a basic type of wellness program. However, as the pressure to greatly reduce healthcare and lack-of-productivity costs increases, health insurance companies are launching the next generation of wellness programs. These programs include personalized health coaching, disease management, preventive care education and outcomes-based tracking. The programs are ongoing, require continuous engagement on the part of members and, when successful, have a significant impact on both healthcare costs and outcomes.

As they roll out next-generation health & productivity programs, health insurance companies are discovering two important hindrances to the success of these more complex and sophisticated programs: 1) members aren’t motivated by the promise of longer, higher-quality lives and 2) prescriptive one-size fits all incentive rewards alone do not engage members long-term.
But, why aren’t people simply motivated by the knowledge that they will lead healthier more productive lives? And, why don’t incentives sweeten the deal? The answer is simple: because our brains don’t work that way.

Change is hard and doesn’t happen overnight. According to the authors of “The Neuroscience of Leadership,” changing one’s behavior is actually painful, causing physiological discomfort. The authors describe how hard the brain must work to remember a new behavior and must rewire itself to make a behavior become a habit. The most important and relevant of the authors’ findings is this: One-time incentives or punishment, or single instance communications and training are not enough to establish brain wiring for a behavioral habit.