A recent study released by RTI International, the CDC and the Agency for Healthcare Research found that 26%, yes, one quarter of the US population is classified as obese. Think about this as it relates to the conversation that is currently occurring in Washington DC as it relates to the continuing increase in healthcare costs. Accounting for nearly 10% of medical spending or approximately $147B a year, obesity and other associated co-morbidities continue to increase at an alarming pace.

When thinking about the health reform agenda, it seems to me that prevention and wellness efforts can’t be underscored as critical to any truly sustainable outcome. Yet, the current health reform legislation continues to focus on access and financing, with little more than obligatory agreement that wellness and prevention are important. I would argue that with statistics like this, wellness and prevention are not only important but may ultimately be the only method of bending the cost curve.

I often spend my days in deep discussion with clients regarding the disease states that they believe are the catalyst to their medical and claims costs. The focus of their health and wellness programs are typically centered on containing the costs associated with conditions that drive the highest costs . It makes sense given that the top five conditions are usually chronic in nature (cancer, coronary heart disease, chronic pain, neck/back pain and high cholesterol).

A recent study by the Journal of Occupational and Environmental Medicine regarding the cost impact of presenteeism leads me to ponder whether employers should be focusing on less tangible measurements than medical and pharmaceutical claims costs. Based on this study, presenteeism appears have significantly more impact on healthcare costs than previously thought. Even more interesting is the fact that conditions that drive claims costs often are not the same conditions that lead to presenteeism and affect productivity losses. Some interesting findings in the study included:

- The five costliest conditions that drive employer costs, when productivity losses are factored into the equation, as a result of presenteeism are: depression, obesity, arthritis, back/neck pain, and anxiety.
- For every dollar spent on medical costs and pharmaceuticals, there is $2.30 of health-related productivity losses due to absenteeism and presenteeism.
- For certain conditions, such as anxiety, employers can lose $20 in productivity for every dollar they spend on medical costs and pharmaceuticals.

In the wake of the continuing workforce reductions, corporations are running extremely lean, requiring more productivity from employees. Uncertainty, stressful environments, less resources, and an increased focus on productivity may be perpetuating presenteeism conditions that aren’t being addressed in a health & productivity program because these conditions aren’t driving claims, conditions such as anxiety

When assessing the goals and objectives of a health & wellness program, these study outcomes should trigger discussion regarding where to place emphasis – on tangible costs or on more significant productivity costs? What are your thoughts?

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?

In a recent study published by the New England Journal of Medicine smoking was identified as the top cause of preventable death in the U.S., responsible for killing about 438,000 people each year. Even more astounding was the fact that General Electric spends $50 million annually on healthcare costs for smokers which didn’t include associated costs due to lost productivity.

Interestingly enough, GE ran a study to better understand how incentives influenced smoking cessation programs. The results further validate that incentives, when implemented strategically throughout the progression of behavior change have a significant effect on better health behaviors. Several points highlighted in the study include:

• The trial was designed to see how many of the 836 participants remained non-smokers over a 12 month period.
• Half of the participants were given: $100 for completing the smoking-cessation program, $250 for not smoking within six months after enrolling in the study and $400 for abstinence after six months more, confirmed by saliva or urine tests.
• After an additional six months, 9.4 percent of the paid group still wasn’t smoking though they were no longer receiving cash rewards.

Clearly the investment of $750 per participant to motivate smoking cessation is significantly less than the cost per employee that GE pays for smoking related health issues. And clearly, GE also understood that nicotine addiction is an extremely difficult behavior to break even when an individual wants to change. I believe that GA has seen success in their smoking cessation efforts for two reasons: 1) the use and value of incentives was meaningful enough to motivate participation and meaningful enough to sustain a changed behavior, and 2) GE’s commitment to this program over a longer period of time.

A study published in Postgraduate Medicine found that automated self-testing health stations in the workplace helped employees improve their management of hypertension and obesity.

Highlights from the study include:
• Over 21% of the employees voluntarily used worksite health stations to measure their blood pressure or weight.
• Worksite health stations identified 27% as hypertensive, 40% as pre-hypertensive, 38% as obese, and 35% as overweight.
• Approximately half of the employees with hypertension and 10% of the employees with obesity successfully reduced their health risks.

I found this study interesting due to the continuing lack of awareness that most individuals have around their health risks. In addition, the convenience that health stations afford employees mitigates the “I don’t have time to leave work and go to the Doctor” excuse that often times delays health risk or condition identification

A rather disconcerting Hewitt & Associates Survey indicates that 19% of respondents plan to drop health care coverage as a benefit over the next 3-5 years. While the survey respondents only numbered 343, the continuing undercurrent to the discussion around healthcare costs leaves little doubt that the impact of escalating costs is forcing companies to make decisions in an effort to protect corporate profitability and global competitiveness.

Health care reform is not an option it is a business imperative. The inefficiency of a massive system coupled with the lack of individual health accountability has created the perfect storm. If employers continue to drop coverage, a single payer system may end up being the only option.

“Promoting employee accountability” was ranked the chief health and prevention component of employers’ health care strategies in 2009. Employers have made significant investments in providing health services to better support healthy behaviors and mitigate acute care episodes. But that alone will not achieve the goal of employee accountability. While Consumer Directed Health Plans may shift a higher cost burden onto employees, I continue to believe that accountability has to be tied to a performance based culture.

Is there value in investing in a corporate health and wellness program in a tight economy? Stress related to job security, loss of personal wealth, and overall gloom about the future has caused many employees to be less focused at work, bring higher levels of presenteeism to the workplace and overall, less productive at a time when employers need heightened levels of productivity.

The benefits to investing in a corporate health and wellness program can be many but most notably the investment in human capital can result in:

• Mitigating catastrophic risk
• Decreased healthcare costs
• Reduced absenteeism
• Improved morale and employee productivity

Given the proven benefits, company-sponsored health and wellness programs are conceivably more important now than ever. With obesity rates on the rise and increasingly more stress than usual in the workplace and on the home-front, employee well-being is becoming more and more crucial to a company’s bottom-line.

Several weeks ago my company presented a webinar on Health and Productivity Strategy with an emphasis on the “motivation” factor, truly rewiring the brain to change behavior. Since last week I have had numerous conversations with audience members on our Whole Brain Philosophy and the need to strategically integrate wellness rewards with strong communications, social networks and gaming in order to truly engage individuals in the behavioral change progression. The discussions have centered around Maritz framework of focus-repetition and reinforcement to rewire the brain.

Some very enlightening observations have come out of those conversations such as:
- There are opportunities to better integrate health management services with stronger motivation strategies to fully derive the benefits of your health and productivity investment.
- A critical component seems to be lacking in most health and productivity programs - communication.
- Health incentives are being used but not as strategically as they could in order to reinforce new behavior adoption
- Understanding your population in terms of ensuring appropriate rewards options, health support services and communication support is not happening

The result of this is disjointed health and wellness programs that are not really promoting behavior change. The one issue that continues to stand out to me as a challenge for organizations is in communications. I continue to see programs that front load the communications about health and wellness benefits during open enrollment but there are little to no communications pulsed throughout the year to keep the health and wellness program top of mind. The focus on the program is non-existent. The other ramification of not communicating throughout the year is that employers are missing an opportunity to recognize how their employees are doing with their wellness goals. The repetition and reinforcement are virtually non-existent.

The net-net in all of this is that in thinking about your wellness program, it is very easy to focus on the health services piece and then the incentive strategy but the importance of a robust communication strategy can’t be overlooked as a critical success factor.

This is what I am talking about! The attached article in Progressive Grocer highlights the initiative that Kroger launched earlier this week in offering consumers free, yes, free preventive screening services.

While I realize that Kroger will reap the benefits of driving additional traffic to their store locations with such an initiative, my altruistic side likes to believe that companies like Kroger are realizing that it is going to take a collective effort to start turning our health behaviors around in this country. Now, if they would only stop stocking their shelves with cookies, ice cream, candy…we may be on to something.

I recently read a whitepaper by Hummingbird Health entitled Why Wellness Programs Fail and it got me to thinking about some additional observations I would make on why programs are not optimized as they should be. The whitepaper highlights some key failure points that are consistent with what I see when helping clients assess why their program isn’t delivering the results expected.

- The wellness movement has to start at the top. Executive management needs to embrace wellness as a business imperative not a “nice to have” and they need to live to that mission.
- Know the demographics of the workforce. Demographics are one key data point that help in disseminating the appropriate communications and rewards but I would suggest going a step further in taking the pulse of your population and their readiness for change. Understand what they expect, prefer and what types of tools, communications and rewards may actually engage them in the collective process of adopting healthier behaviors.
- Serving all employees. Understand the health of your workplace. Sounds easy enough but I am continually amazed at how difficult that is for organizations.
- Lack of communication. This is probably the single biggest reason that I would say wellness programs fail. There is not enough budget or emphasis given to the importance of communication either in content or frequency. Effective communication continues to reinforce attention on the wellness movement and it answers five key questions that employees continue to have: 1) what do you want them to do 2) why do you want them to do it 3) how do you want them to do it 4) what’s in it for them and 5) how are they doing.
- Scrimping on costs – spend money to save money on healthcare costs. I couldn’t agree more on this finding. Too often an organization tries to cast too broad a net and spreads investment dollars too thin with the result being a rather disjointed and haphazard program with very little strength to drive change. Make the most of those investment dollars and focus them on a couple of objectives with the idea that you can always phase in more services and interventions after the wellness movement picks up momentum.
- Goals – make them measurable. Begin with the end state in mind. What will be your measure of success in your wellness movement?
- Know the bottom line. Understand the impact of your workforce’s health on corporate productivity, value and profitability. At Maritz we call it the lifetime value of an employee.

Creating a wellness movement in an organization takes time, resources and investment. The last thing that you want is for it to fail. Taking some of these observations to heart may help in mitigating the risk of failure.