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Creating a Culture of Worksite Health and Wellness

A workplace culture that promotes healthy lifestyles leads to sustainable behavior change, which leads to health improvements, costs savings and improved productivity.

This article accompanies Innovations in Wellness.

Friday, April 1, 2011
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While many employers are beginning to show some signs of stability after surviving a traumatic recession, one factor that remains a critical risk to their long-term survival is the inexorable rise of healthcare costs.

However, studies have shown that our healthcare-cost crisis is mainly caused by the health crisis in our society. The total cost consequences of the increasing burden of chronic illness and underlying health risks in the U.S. workforce are threatening to sink many corporate ships.

The good news is that employers do have the power to positively impact the health of their employees and dependents and lower health-related costs, not only through benefit design and incentives, but, more importantly, by creating a culture of health and expectation of prevention and wellness.

Studies are have proven that organizations with effective wellness programs can achieve remarkably lower total healthcare costs, with shorter sick leaves, reductions in long- and short-term disability, and improved general workforce health.

For instance, medical costs fall by about $3.27 and absenteeism costs fall by about $2.73 for every $1 spent on comprehensive workplace wellness and prevention programs, according to a Harvard meta-analysis study of the literature entitled "Workplace Wellness Programs Can Generate Savings" published in Health Affairs.

Research also shows that implementing a comprehensive health-promotion strategy will enable an organization to enhance its image and goodwill, employee morale and retention of talent.

But, to paraphrase a famous line from the movie Field of Dreams, just because you build it doesn't mean your employees will come. Even the most robust, well-intentioned worksite program can under-deliver on expectations without high levels of participation.

In fact, employee engagement is the single most important factor in improving health outcomes and lowering costs. So how do you motivate employees to become actively involved in their health?

Employees not only must be educated about the benefits of joining the program, they also must be motivated to improve their health behaviors and maintain the change. It is not easy to convince people to put down the cigarettes or spend time at the gym instead of on the sofa.

Extrinsic incentives can only go so far. Real sustainable health-behavior change requires a cultural shift supporting prevention and wellness that enables individuals to discover their intrinsic incentives to improve their health.

This shift can only begin with employee awareness of their unique health risks. A 2008 study published in the Journal of Occupational and Environmental Medicine, involving 124 employers, 882,275 eligible employees and 344,825 who completed health-risk assessments, showed that the strongest predictors of HRA completion rate were:

1. Commitment to a corporate culture of health by all levels of management.

2. Comprehensive communications and branding regarding the wellness initiatives.

3. Incentive value.

Entitled "A Cross-Sectional Analysis of Factors Associated with Employee Participation in Health Risk Assessments," the study showed that the commitment to a culture of health and good communications about the wellness initiatives were more powerful influencers upon participation rates than the value of the incentives.

In fact, to achieve a 50-percent HRA completion rate, employers with a low level of commitment and communications needed an average incentive value of approximately $120, whereas employers with a high level of commitment and communications only needed approximately $40.

Dee Edington, director of the Health Management Research Center at the University of Michigan, supports and reinforces the value of this philosophy.

A distinguished pioneer in the field of wellness and integrated health management, Edington writes in his book Zero Trends: Health as a Serious Economic Strategy, "We know that if individuals are to make a sustainable behavior change, they must be in an environment that supports that change. If someone changes a behavior and then returns to the same unhealthy environment that caused or aggravated the behavior, the chances are pretty good that they will return to their original behavior."

He identifies five fundamental pillars that support a successful health-management strategy and create measurable, sustainable health improvements across the organization:

* Senior Leadership: Create the Vision.

* Operations Leadership: Align Workplace with the Vision.

* Self-Leadership: Help Healthy People Stay Healthy.

* Reward Positive Actions: Reinforce the Culture of Health.

* Quality Assurance: Allow Outcomes to Drive the Strategy.

To measure the value of creating this cultural shift, Edington categorizes companies into one of four levels and then compares the percentage of employees who remained in the low-risk category for each:

* Level 0 organizations basically do nothing, wait for people to get sick and then treat their illness or disability.

* Level 1 organizations focus primarily on individuals who are already at high risk for conditions. They incorporate traditional health-promotion strategies such as HRAs, onsite screenings and coaching for high risk and/or disease management.

At this level, companies often begin to evaluate the work environment and begin to offer healthier food choices in vending machines and at the company cafeteria.

* Level 2 organizations have a more comprehensive view of health promotion. They not only engage in the traditional programs above, but also realize the value of keeping healthy people healthy.

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These companies also incorporate education, employee involvement through wellness committees, healthy activities and evidence-based interventions to maintain low-risk employees.

* Level 3 organizations are what Edington terms "Champion Companies." These organizations build their wellness initiatives on all five of the pillars outlined previously, including top-down leadership, bottom-up employee engagement, benefits alignment to employee and dependent needs, measurement and recognition of healthy behaviors, branding and consistent communications, and results-driven program design.

Edington found the number of individuals who remained at low risk increased from 60 percent to nearly 75 percent at the Champion (Level 3) company, while the number of healthy individuals declined to 45 percent in the company that focused only on those at high risk. (Levels 1 and 2 fell in the middle).

Projected healthcare costs remained flat over five years for the Champion Company and were expected to increase nearly 40 percent at the Level 0 company.

Case studies from numerous organizations support Edington's research: Culture leads to sustainable behavior change, which leads to health improvements, costs savings and improved productivity.

While most companies may only aspire to Champion status, more employers are beginning to realize the economic value of their human capital and the important role the workplace plays in helping to improve and sustain employee health and wellness.

According to Aon Consulting's 2010 Benefits Survey, only 26 percent of respondent companies currently measure, require or reward healthy changes in employee lifestyles; the figure is just 13 percent for company dependents.

However, the same study showed that more than 43 percent of companies planned to implement this practice as early of 2011.

The shift to more innovative solutions is extremely encouraging. From Eat This, Not That highlights on national news shows to the spread of calorie-count requirements on restaurant menus across the country, a cultural shift towards personal responsibility for better health is starting to emerge.

If employers want to navigate these perilous economic times and avoid the looming icebergs of cost from poor employee health, now is the time to invest in the power of prevention and implement proven integrated health-management strategies. The bottom line is that good health is good business.

Ron Loeppke, MD, MPH, FACOEM, FACPM, is vice-chairman of U.S. Preventive Medicine and serves as co-chair of the company's International Advisory Board. USPM provides primary, secondary and tertiary prevention services for all size employers, health plans, and government entities as well as directly to consumers. Dr. Loeppke has more than 30 years of clinical and physician executive experience. He is a frequent presenter and has authored and contributed to numerous articles and books. He is board certified in preventive medicine; fellowship trained in occupational medicine and is a fellow of both the American College of Occupational and Environmental Medicine and the American College of Preventive Medicine.

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