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.

Reuters published an article regarding the growing support for a mandate for health insurance as part of the reform effort that are currently being debated. There are 46 million individuals uninsured in this country, the majority have no coverage because they simply can’t afford it. This is an interesting debate to me for several reasons:

- These uninsured individuals usually wait until absolutely necessary (read: really really really sick) before they utilize health services and usually the point of entry into the system is the ER…the most expensive entry point.
- The costs to care for this uninsured population is already being transferred to employers, individuals and the govenment.
- Providing some type of coverage seems to make sense if enables the system to provide more preventive care, thereby reducing the costs of entry.
- Providing some type of coverage should result in less cost shifting to other payers in the system.
- There will and should be trade-offs for providing coverage and health plans need to ensure that the coverage is reasonable and affordable.

Employers are certainly feeling the burden of cost of care for not only their employees but assuming the cost shifting that takes place for care of the un and under-insured. The only way that we are going to truly reduce healthcare costs is if we understand the root causes of what drives those costs up. One of those root causes is the massive number of people who are uninsured. They pay the price in terms of poor healthcare but we all pay the price when it comes time to pay the bill.

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.

From Kelly Sonora from MastersinHealth.com, 10 Things You Need to Know About the Healthcare Stimulus:

Barack Obama’s American Recovery and Reinvestment Act of 2009 was signed on February 17, and is already beginning to filter out funds to hopefully stimulate the economy. One of the principal goals of the package is to reform the health care system while creating jobs and insuring more Americans. Through measures to support the unemployed, integrate cutting-edge information technology systems into medical networks, and insuring more children, the act may in some way affect how you receive health care. Find out how.

- Health care industry set to go tech: One of Obama’s umbrella strategies for reforming health
care and stimulating the economy involves pumping money into health care technology
systems. He hopes to create a health information network for hospitals, rural and urban
clinics, and other health care centers by making all medical records electronic; making existing
medical technologies more accurate and effective; and reducing errors in medical care. This
technology boost to the health care system will, Obama hopes, save money, create jobs, and
improve the standards and delivery of health care and medical information. The Dallas
Business Journal reports that the stimulus package will invest $19 billion for health information
technology.
- The unemployed will still receive health care benefits, at least temporarily: Obama plans to
ease the burden of health care costs for the unemployed and reduce the number of uninsured
Americans by extending Medicaid benefits to the unemployed, at least for a time. Individuals
who get unemployment checks would also be able to receive Medicaid, as would their spouses
and children who are under the age of 19, reported the New York Times in January. States
will receive federal aid to help ease Medicaid costs. In late February 2009, TheState.com
reported that Obama “released $15 billion in economic stimulus Medicaid funds for states” to
disperse.
- Children’s Health Insurance Program Reauthorization Act of 2009: The Senate and House
reformed the Children’s Health Insurance Program under this legislation, which extends
insurance to nearly 4 million more children by reworking the Social Security Act. The program
will help families of low-income children who do not qualify for Medicaid pay for their health
insurance, and states will still be able to set their own income eligibility requirements. The
program is funded by a tax increase on cigarettes.
- Governors hold power over releasing funds: While the federal government has designed and
approved the health care stimulus package, governors are in charge of actually releasing
funds, creating eligibility requirements when appropriate, and overseeing the implementation of
the stimulus plan in their states. In late February, governors like Louisiana’s Bobby Jindal (R),
opposed many parts of the economic plan and may reject at least some of the money that is
coming to their state from the federal government. The New Orleans Times-Picayune reports
on Nola.com that Jindal will most likely accept the Medicaid supplements, but according to
Medical News Today, other governors are begrudging about accepting funds that are meant to
be used in a specific way. Instead, governors like New Hampshire Gov. John Lynch (D) are
arguing for more flexibility in how they disperse the federal funds.
- Federal government helps states fund COBRA for unemployed: The Consolidated Omnibus
Budget Reconciliation Act (COBRA) gives individuals who are laid off, retired, switching
between jobs, or have dependents at the time they stop working the option to continue their
group health benefits for a limited time. Some beneficiaries may have to pay for the group rate
insurance, however, but the U.S. Department of Labor holds that “COBRA generally requires
that group health plans sponsored by employers with 20 or more employees in the prior year
offer employees and their families the opportunity for a temporary extension of health
coverage.” Under Obama’s stimulus plan, the federal government will provide states with
subsidies to help offset the costs of COBRA. They will pay for up to 65% of COBRA
premiums “for eligible workers who are involuntarily terminated,” according to the accounting
firm Amper, Politziner and Mattia. Qualifying workers include those who have been involuntarily
terminated on and after September 1, 2008, and qualifying employers include those who are
subject to COBRA legislation, as well as small employers who are subject to State Continuation
legislation.
- Job training funding for those entering health care industry: In another measure to stimulate
the economy while improving health care standards, Obama plans to increase job training
opportunities for those entering the health care industry. The stimulus budget has allotted
$750,000,000 “for a program of competitive grants for worker training and placement in high
growth and emerging industry sectors,” $500,000,000 of which will go to renewable energy
programs. The rest will be distributed by the Secretary of Labor “giv[ing] priority to projects
that prepare workers for careers in the health care sector.”
- Preventive care takes precedent: In his address to Congress in February, Barack Obama
outlined the promised benefits of his economic stimulus benefits, highlighting the fact that the
health care reform boasts “the largest investment ever in preventive care, because that is one
of the best ways to keep our people healthy and our costs under control.” According to a
report by NPR, this move would also create jobs, at least in the short term, even if it did not
result in sustainable medical research projects, as hoped.
- A contract for accountability: In order to promote accountability in health care reform and to
make sure that all of this funding is actually helping the economy and the health care industry,
Obama’s plan includes a contract between the federal government and the Institute of
Medicine. The stimulus package outlines that the $1.5 million contract will require the Institute
to “produce and submit a report to the Congress and the Secretary [of Health and Human
Services] by not later than June 30, 2009, that includes recommendations on the national
priorities for comparative effectiveness research” that will eventually be subjected to public
commentary and review.
- Health IT dominates in all areas of medical industry: The stimulus package lists several ways in
which new health care information systems and technologies will help the facilitation of
medical care and the industry as a whole. These include the exchange of patient medical
records and a subsequent reduction in wait times at hospitals and health care facilities; the
increase of telemedicine technologies for those living in rural areas and who do not have
access to cutting edge medical resources; “technologies that help reduce medical errors;”
and “technologies that meet the needs of diverse populations.”
- Total health care stimulus cost: $150 billion: The total cost of all these (and more) health
care reforms under the American Recovery and Reinvestment Act of 2009 is $150 billion,
according to the Dallas Business Journal, including $17 billion for Medicare and Medicaid
incentive programs, $2 billion for technology grants, and $19 billion for a health information
technology.

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.

Note from Mindy: In another contribution to Rewarding Health, Amy Kramer, Healthcare Sector Strategist at Maritz, addresses the correlation between hospital employee satisfaction and patient satisfaction. At Maritz, Amy provides industry expertise in the areas of healthcare and wellness and works with clients and account teams in addressing business challenges

The rising costs of healthcare our crippling our nation. Our health system is in desperate need of reform in order to help us mitigate these costs. The push for electronic records is one way that Congress is attempting to curb these costs. Technology is very much a part of the US population’s culture. From music downloads to virtual worlds where people can interact, people are adapting their lives to the changing technology that is available to them. Hospitals have also been early adapters to technology and have been some of the first segments within the healthcare industry to adopt electronic records and use this as a cost savings tool within there organizations and are seeing some great benefits. First and foremost it is much more timely and effective to communicate with patients, physicians and other healthcare personal digitally. It provides real time information from patient history, test results, prescribing medications and linking to other healthcare professionals. The use of this technology in hospitals has decreased medical errors, due to illegible handwriting and better accuracy filing prescriptions and diagnosis. It provides physicians and other hospital personnel with all the information they need about the patient they are treating without having to connect the dots. It has also streamlined the billing system and created one central database for payment. This allows hospitals to better track their financials and encourage better follow up on unpaid bills.

Congress has been talking about placing a mandate on e-records for the health industry. I still think we are a ways off from a nation wide push to e-records, but President Obama has recommended this as part of the 2009 stimulus package. Not only will e-records promote better practices in the hospitals, but this will also equate to a better patient experience and better patient care and wellness overall.

Note from Mindy: In another contribution to Rewarding Health, Amy Kramer, Healthcare Sector Strategist at Maritz, addresses the correlation between hospital employee satisfaction and patient satisfaction. At Maritz, Amy provides industry expertise in the areas of healthcare and wellness and works with clients and account teams in addressing business challenges.

Long hours, nights, weekends, holidays, strenuous physical and mental workload…such are the demands of nurses and allied health professionals. And demanding it is. As healthcare utilization continues to increase and focus on service delivery begins to take center stage, the healthcare industry is continuously looking to acquire new talent and retain their current workforce.

At current utilization rates, demand outpaces availability of these skilled professionals. In an environment of high stress and high burn-out health systems are challenged with providing enough benefits to be perceived as a profession and employer of choice. According to the American Association of Colleges of Nursing the United States could face a shortage of up to 500,000 nurses. With an aging population, the need for nurses and allied health professionals becomes even more critical to our health system.

Hospitals are initiating strategies geared at acquiring and retaining their top talent. In the past these new recruits have been tossed into new jobs with little experience and been told “sink or swim.” This has caused many new comers to the professions to leave and seek other careers thus adding to the number of vacancies in nursing and allied health.

Hospitals are now offering residency programs and flex schedules for the nursing staff and allied professionals. They are also offering training programs, mentoring programs, and recognition programs to help build confidence with new employees. These programs are driving a more supportive culture and have been proven to decrease turnover and increase employee satisfaction. They also help ease the stress in this exhaustive industry. These are just a few examples of how some hospitals are implementing retention strategies, but much more needs to be done to ensure that hospitals and healthcare systems have the necessary staff to operate and serve patients. Recognition and appreciation for the effort and skills of nursing and allied help professional is critical in this industry. Since we are amidst an aging population the demand for these professions will continue to increase hospitals need to continue to investigate opportunities to increase their retention of key staff.