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.

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.

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.

Note to health plans: if you are offering health and productivity incentives for members to use health tools and services … make sure to pay them out or it could really impact your members’ feelings of goodwill and loyalty.

My health plan recently launched a health and wellness program with a great amount of enthusiasm and fanfare. To go along with what looks like some wonderful health services, the plan was also offering some intriguing and exciting wellness incentives and rewards for participating, staying engaged throughout the year and providing feedback on their program.

Sounds great doesn’t it? The first order of business was to take a Health Risk Assessment and earn a $100 gift card. Given that I am very focused on proactive healthcare and preventative maintenance (because of what I do for a living), I immediately called the 800 number and energetically informed them that I wanted to enroll in the new Health & Productivity program. This is what I heard, “I am sorry, but you are not eligible for this program. In fact you aren’t in our database as even being a member of our plan.”

I ask, “How could that be? I have my member card with my member ID and I just received a packet with all of the wellness program information.” I was then told that they would have to escalate this for further investigation … that investigation took 14 days. Ten calls later and many chats with “managers” of my health plan it was indeed confirmed that I was a member and eligible for the health and wellness program, however, there was one day left for me to take the Health Risk Assessment and receive my $100 gift card promotion.

I immediately took the Health Risk Assessment and awaited my gift card in the mail, dreaming of the things that I could do with that gift card – a nice 90 minute stress relieving massage … aahh. I waited and waited for weeks and then months. Finally, I called my health plan again and inquired about the status of my gift card only to be told that even though I had completed the HRA, the information was not received until the morning after the promotion ended and therefore I didn’t qualify for the gift card.

The long and short outcome of this story: I will never participate in my health plan’s wellness program again Instead I will stay healthy my own way, and if I have a choice to change health plans, you can bet that I am going to do it in a heartbeat.

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?

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.