A Culture of Health

There's no easy cure for escalating healthcare costs, which one recent study predicts will climb another 9 percent this year. But some experts say creating a "culture of health" can make a difference and point to several corporate examples as proof.

Sunday, May 1, 2011
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You could be forgiven for feeling a twinge of envy at the lavish wellness center enjoyed by employees at the Mayo Clinic's Rochester, Minn., campus. The 115,000-square foot, five-story facility includes two swimming pools, a landscaped courtyard, acres of state-of-the-art exercise machines, yoga studios, workout rooms and even a demo kitchen where chefs show employees how to cook healthy, delicious meals.

The Dan Abraham Healthy Living Center, as it's called, also has a large staff of experts on hand who conduct classes on stress reduction, swimming, pilates, yoga, strength training, nutrition and weight management, self-defense . . . the list goes on.

Employees who wish to use the center pay a $27 monthly fee, but if they're frequent users, that fee is reduced to $17 per month, says Dr. Kerry Olsen, a professor at the Mayo Clinic's medical school and a member of its wellness executive committee, which helped plan and now oversees the four-year-old center.

Mayo's facility didn't come cheap, of course. The organization spent north of $20 million building and equipping it. Yet it's still a relative bargain, says Olsen.

"When you consider that we spend $300 million annually on employee healthcare, we think it's a small investment," he says.

A good portion of the cost was covered by a donation from a former Mayo patient named Daniel Abraham, founder of Slim-Fast Foods Co., for whom the center is named.

"He wanted to give something back to our employees in gratitude for the care he received," says Olsen.

The center isn't intended to appeal just to your average gym rat. Instead, it's designed to lure people who don't ordinarily go to health clubs, says Olsen.

"Fifty percent of the people who've joined never belonged to a gym before, and 50 percent are overweight," he says. "We're reaching out to the broad base of Mayo employees who look like the rest of the world -- who are struggling with the same issues of stress, weight and inactivity."

Approximately 16,000 of the 30,000-plus people who work at Mayo Clinic-Rochester have become members so far, and the center has about 4,000 users per day, says Olsen. "We understood that we can make the biggest impact on people's health by addressing lifestyle behavioral changes," he says. "And with this center, I think we've hit a home run."

Last year, the Mayo Clinic was one of 16 organizations to be awarded the Platinum Award for Best Employers for Healthy Lifestyles by the Washington-based National Business Group on Health. (See sidebar.) The award recognizes companies that the NBGH believes do a stellar job of promoting healthy work environments and encouraging employees to choose healthier lifestyles.

Award-winners such as the Mayo Clinic may be bright spots amid what continues to be a somewhat grim scenario for healthcare costs and trends. According to Towers Watson's 16th annual healthcare-costs report, entitled Employer Survey on Purchasing Value in Health Care, employers are paying 36 percent more for healthcare than they did just five years ago, while the share paid by employees has grown by 45 percent over the same period.

The short-term outlook for bringing these costs down doesn't look promising: Costs this year are expected to rise by 9 percent, according to PricewaterhouseCoopers. One of the great unknowns, of course, is the impact that the Patient Protection and Affordable Care Act will have.

Supporters of the healthcare-reform law say it will start bringing costs into line by the middle of this decade, when its most far-reaching statutes go into effect.

Opponents say it will only make things worse, driving costs up further still while increasing taxes and possibly leading to care-rationing. This is assuming, of course, that the law survives the constitutional challenges being brought against it in court by a number of state attorneys general and efforts by Congressional Republicans to repeal it.

Amid all the wrangling, the destruction wrought by some of today's most deadly and expensive chronic conditions -- including cardiovascular disease, Type 2 diabetes and certain types of cancers -- continues to spread. According to the American Heart Association, the costs of cardiovascular disease -- including treatment and loss of productivity -- will exceed $1 trillion per year by 2030. Type 2 diabetes is expected to cost $500 billion per year by 2020. What's especially galling is that in many cases, these diseases are preventable.

The workplace can be an excellent place to attack them. Consider research that finds the social networks formed at work -- formal and informal, online and face-to-face -- can play very important roles in influencing people's health behaviors. Harvard University's Dr. Nicholas Christakis and his associates discovered, for example, that if one worker at a small firm stops smoking, his or her colleagues have a 34 percent chance of quitting.

They found that a person in a social network is 20 percent more likely to quit smoking if someone else in that network quits, even if the two don't know each other. Meanwhile, they found that a person's risk for obesity increases 37 percent if their spouse is obese, 40 percent if a sibling is obese and 57 percent if a friend is obese.

Wellness programs, financial incentives and high-deductible health plans have long been touted as solutions for improving workforce health. But costs have continued to rise, and part of the problem is that too many companies take a scattershot approach to health promotion -- a tactic that fails to engage employees, says Dr. Ronald Loeppke, vice chairman of U.S. Preventive Medicine, a Jacksonville, Fla.-based healthcare-consulting firm.

"Health promotion needs to be part of a comprehensive, integrated business strategy -- you can't just be focused on the sickest 10 percent of employees, you also need to seriously engage the other 90 percent, because it's just as important to keep the healthy people healthy," he says.

Creating a healthy workplace requires a "culture of health," says Loeppke, in which company leaders are visibly engaged in the effort, healthcare providers and wellness vendors are aligned with the company's goals for health outcomes, proper incentives are in place to help motivate employees to live healthier and the message of health improvement permeates every corner of the workplace.

Other experts concur with Loeppke about the importance of culture. In his book Zero Trends: Health as a Serious Economic Strategy, Dee Edington, a highly regarded expert on wellness and director of the University of Michigan's Health Management Research Center, writes "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."

What does a culture of health "look" like? As of now, there are no specific benchmarks for creating such an environment.

However, a closer look at some of the NBGH's Platinum Award winners, which represent the cream of the crop from among the total of 66 companies honored last year, may offer the next-best thing.

The winners exemplify what it means to have a "culture of health," says LuAnn Heinen, who oversees the NBGH's Institute on Innovation in Workforce Well-being, which chooses the winners.

"What really distinguishes these companies is that they have a fully integrated health program that's firing on all cylinders," she says. "Having a culture of health means you're not just focusing on the employees enrolled in your medical plan, but offering these programs to all employees and constantly tweaking them to make them better."

In It Together

One Platinum Award winner from last year, window and door-maker Andersen Corp., has had a wellness program in place for the last five years called "A+ Health," which provides a variety of online, in-person and telephone-based resources.

Through it, workers at the 9,000-employee, Bayport, Minn.-based company are encouraged to complete health-risk assessments, follow exercise and dietary guidelines, get physicals and participate in other health-related offerings, which include health coaches, Weight Watchers, phone-based counseling and fitness challenges.

"Andersen is significant because, for a mid-sized company, it does a lot in this area," says Heinen.

Employees and their spouses can each receive $5 off their monthly insurance premium for completing an HRA and knock another $5 off for participating in at least one A+ Health health-improvement program, for a total potential cost-savings of $240 per year.

Since A+ Health was launched in 2005, Andersen's rate of annual healthcare cost increases has declined from 16 percent per year to 2 percent, while the overall health risks of participants have decreased by 13.5 percent, says Chris Lindstrom, director of compensation and benefits.

"As we look at the program, our assessment is that it's resulted in cost avoidances for us of about $10 million," he says.

A+ Health, which is administered for Andersen by StayWell Health Management in St. Paul, Minn., is the centerpiece of the company's comprehensive effort to get its workers and their families focused on staying healthy and managing their illnesses, says Lindstrom.

This effort also includes getting vendors to work in sync whenever health problems crop up. For example, when employees must go out on disability leave, Andersen's disability vendor -- The Hartford -- automatically notifies the company's employee-assistance program vendor, which then reaches out to the workers via phone, e-mail or regular mail to let them know about the services available to them.

Andersen bolsters employee awareness through a regular stream of electronic and print communications and the work of a full-time health-improvement program manager, who regularly consults with the HR and business leaders in the company's different business units and at each of its 20 different facilities in North America on ways to beef up employee participation rates.

Currently, more than half of the company's employees are involved in one or more A+ Health activities and an equal number take the HRA each year. Although these are better-than-average numbers, says Lindstrom, the company hopes to increase them.

The company also stresses to employees the importance of healthy behaviors to its bottom line -- and theirs.

"We're a self-insured company, and we've spent a lot of time making sure employees understand what that means -- that the payment for their hospital stay or procedure didn't come from the health-insurance company, it came from Andersen," says Lindstrom.

"We offer profit-sharing and an employee stock-option purchasing program, and we remind them, 'The better you are at staying healthy, the more beneficial it is for you and your family and oh, by the way, it'll mean stronger performances in profit-sharing and the ESOP.' It benefits us all, not just the company."


All Aboard

Eating well is a big priority for Barbara Schaefer, senior vice president of human resources at Union Pacific Railroad Corp., another Platinum winner that's also one of only six companies that have been on the Healthy Lifestyles list since its inception in 2005. Thanks in no small part to Schaefer's efforts, healthy eating has become a priority for many of her colleagues, as well.

Prior to the company's move to a new headquarters building in downtown Omaha, Neb., seven years ago, she says, "We had a cafeteria that had a truly horrible food selection -- the top four dishes were meatloaf, fried chicken, chicken-fried steak and mashed potatoes with gravy. I complained all the time, but couldn't get anything done about it."

So, when the new headquarters was being planned, Schaefer made sure she played a key role in selecting the vendor that would manage the cafeteria. She also flew around the country to visit other companies well-known for offering healthy eating options, including Microsoft and Nike, to get some ideas. Today, she says, Union Pacific's employee cafeteria (which is also open to the public) is a paragon of healthy eating.

"Right when you walk in the door, you see what the most nutritional items are on the menu, so you can see that a salmon with two side dishes is 390 calories, or a taco salad is 400 calories," she says.

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The kitchen uses healthy ingredients whenever possible and the cafeteria has a "huge" salad bar, says Schaefer. "Forty percent of the food sales come from healthy items," she says. "We've completely changed the dietary habits of people at headquarters."

Of course, the railroad company's health-promotion programs aren't just geared to its 4,000 headquarters employees. It takes a keen interest in the health and welfare of the 40,000 or so employees who run its operations in 23 states, mostly in the western United States.

In addition to a 19,000-square-foot fitness facility at its headquarters that's open 24 hours a day, the company has deals with 1,600 fitness clubs throughout its territories that allow employees to use their facilities for free, with the expense paid out of Schaefer's budget. It has banned smoking on every square inch of its facilities, including its 32,000 miles of railroad track, and -- in states where it's legal to do so -- refuses to hire applicants who are smokers.

"There are three main things that affect employee health: whether or not they exercise, eat right and smoke," she says. "Focusing on those three things over the last 20 or so years has become such a mantra for us that I think anyone at the company could tell you that we're always worrying about them."

People who join Union Pacific tend to stick around, says Schaefer, adding that it's not uncommon to encounter employees who've been there for 40 years or longer. These long-tenured employees (the average age of a Union Pacific worker is 47) are one more reason the company has been focusing on health awareness since the late 1980s, she says.

"We know that how well people take care of themselves early on in their careers means a lot in terms of their safety and their healthcare costs when they're 40, 50 or 60 years old," says Schaefer.

The company's safety program has served as a foundation for its health-promotion program.

"Union Pacific has this long, amazing tradition of safety awareness," says Heinen. "In the transportation industry, you find that companies often have very strong safety programs, with a great deal of trust between the employees and the safety teams, and [Union Pacific] has been able to layer their wellness program on top of that."

The company has a cadre of occupational-health nurses stationed throughout its service units and locomotive shops who've long played an important role in safety awareness. One of their primary responsibilities is to improve the health of the railroad workers, says Schaeffer.

"These are the most popular people on the railroad, even though they're often approaching employees to take their blood pressure or asking them if they got their flu shot," she says. "They see the crews when they're getting on or off the locomotives; they talk to them about how their families are doing, whether they're eating right, getting enough sleep." 

Andersen Corp. has also integrated its safety- and health-awareness programs, says Lindstrom. "One thing we're really proud of is, we've focused a lot on safety and improving safety results, from the point of view that we'll never be happy until we get to zero safety mishaps in the workplace," he says. "We've seen, through engagement with our employees and investments in safety awareness, significant improvements in our safety results, which wraps into health-awareness."

Be Healthy, Live Well 

Having a strong culture of health also means ensuring that your health-promotion programs are not one-size-fits-all, says Heinen.

"You have to segment your employee population, understanding that what may work for one group may not for another," she says.

Women, for example, are far more likely to enroll in weight-management and stress-management programs than men, says Heinen.

At the Mayo Clinic, this has meant taking a different approach when encouraging men to lose weight and manage stress. The Healthy Living Center offers "Ride It Out," an exercise-bike-based program for male employees that encourages them to work off stress and stay fit.

"Men prefer to be educated while they're active, so, while they're riding their bikes, we run PowerPoint and video presentations on stress management and weight-loss tips on the screens in front of them," says Olsen.

The center's staff is also trained to work with medical providers to set up programs intended to help employees work on specific health risks, including stress, he says.

"Our staff interacts with primary care providers on a regular basis and they have access, where appropriate, to employee medical records," says Olsen. "So an employee's doctor can say, 'I think you need to go to a stress-management program at the Abraham Center,' and they can work with the staff to get the employee assessed and into the right program."

At Union Pacific, Schaefer and her team are tackling stress-management -- and treading carefully.

"When you're dealing with a workforce that is predominantly male, things like stress-management and depression are subjects that aren't easily broached -- men tend to want to brush it off, to say they're handling things fine," she says. "But you can't ask people to change their health behaviors if they're stressed-out or depressed. So we're spending a lot of time on this right now, trying to get the right approach."

CEOs "walking the talk" is also key when it comes to promoting health awareness, says Heinen.

At Union Pacific, former chairman Dick Davidson took a leading role in promoting the company's new nonsmoking policy for all of its sites, noting that he is a reformed smoker himself, says Schaefer. Jim Young, Union Pacific's current chairman, is a distance runner who can regularly be seen working out at the company's fitness center at its Omaha headquarters. 

Union Pacific continues to refine its approach to getting employees to live healthier. It recently unveiled a new mission statement for its health-awareness program that Schaefer says reflects a new philosophy of health for its own sake: "Every step you take on the path of wellness leads to a richer, fuller life. Take charge. Feel better. Live more. And know you have Union Pacific's support."

The new message is being supplemented with brochures that feature photographs of people enjoying life -- fishing with their grandkids, for example -- to illustrate the long-term rewards of taking better care of yourself, says Jackie Austad, Union Pacific's general director for health promotion and wellness.

"We've found that offering financial incentives can be good for getting employees' attention but they don't necessarily sustain behavior change," she says. "With our new philosophy, we're focusing on the intrinsic value of health, that rather than doing something to get an incentive, do it for yourself, for your family, for your quality of life."

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