Creating a Healthy Workplace Planning a Staff Wellness Program

Objectives To provide information on how to initiate a staff wellness program that fits the mission, vision, and values of an organization. To review ways to determine the wellness needs of an organization’s staff and identify their greatest health risk factors. 3.To provide a framework describing steps on how to plan, develop, implement and evaluate a wellness program.

What is Wellness (Health Promotion)? Perspectives on Wellness: Physical – fitness, nutrition, medical self-care Emotional – stress management, depression, crisis care Social – community, family, friends, co-workers Intellectual – educational, career development, achievement Spiritual – love, hope, charity Occupational – safe, nurturing worksite environment You define wellness for your organization! Source: Am.J of Health Promotion & National Wellness Institute

What is Wellness? Wellness: “An intentional choice of a lifestyle characterized by personal responsibility, moderation, and maximum personal enhancement of physical, mental, emotional and spiritual health.” Worksite Wellness Program: “An organized program in the worksite that is intended to assist employees and their family members (and/or retirees) in making voluntary behavior changes which reduce their health and injury risks, improve their health consumer skills, and enhance their individual productivity and well-being”. The purpose of worksite wellness programs is to improve the health and productivity of the staff and reduce health-related costs by helping to change towards a healthy lifestyle. Source: Larry Chapman, WebMD Health Services

Health risks increase health costs The relationship between modifiable health risks and health care expenditures: Staff who are/have: Depressed have 70% higher annual health plan costs. Stressed have 46% higher annual health plan costs. Elevated blood sugar have 35% higher annual health plan costs. Obesity have 21% higher annual health plan costs. Smokers have 20% higher annual health plan costs. High Blood pressure have 12% higher annual health plan costs. Not exercising have 10% higher annual health plan costs. Source: Goetzel RZ, et.al (1998, October). The relationship between modifiable health risks and health care expenditures: An analysis of the multi-employer HERO health risk and cost database JOEM, 40(10):843-54.

Health Risks Increase Sick Leave Use Sick Leave Absenteeism – impact of behavioral health risks (n=34,451) Mental health related sick leave results in a 150% higher absenteeism Back Pain – 140% higher Stress – 131% higher No exercise – 118% higher Obesity – 116% higher Source: Serxner, S., et al., (2001). The impact of behavioral health risks on worker absenteeism. JOEM, 43(4), 347-354.

Health risks increase workers comp cost Workers Comp (WC) Costs are higher for increased health risks (n= 3,338) Low Overall Wellness Score – 1989% higher annual WC costs Smoking – 1243% higher Poor health – 836% higher No exercise – 556% higher Low life satisfaction – 255% higher Multiple health risks multiply WC cost Low health risks = $106 average annual WC cost High (multiple) health risks = $1241 average annual WC cost Source: Musich, S., et al (2001, June) The Association of Health Risks with Workers’ Compensation Costs, JOEM, p. 534-541.

Health Risk are Common in our workplace! Percent of Working Adults with Major (Preventable) Risk Factors Poor Nutrition – 71% Little or no Exercise – 63% Stressed – 61% Cholesterol – 54% Back Care – 44% Driving related (seat belt use, speeding, DUI, texting/cell phone)– 32% Smoking – 22% High Blood Pressure – 21% Alcohol Use – 16% What is your organization’s “fingerprint” of health risks?

Employee Health is a significant cost to organizations Estimated 2004 Median Health Cost per Employee - $18,538 N=46,000 + x 3 years Health Claims - $7,465 Turnover - $5,908 Absenteeism - $1,296 Disability - $820 WC - $496 Presenteeism - $2,554 Source: Goetzel RZ, et.al (1998, October). The relationship between modifiable health risks and health care expenditures: An analysis of the multi-employer HERO health risk and cost database JOEM, 40(10):843-54.

A Good Place to Start for Your Organization’s Wellness Program Plan on Addressing Physical activity Tobacco use Stress Weight Management Blood pressure Cholesterol Nutrition Medical self-care Back care Injury prevention

Gaining Senior Management Support Challenges To make a case for a wellness program – a clear economic rationale To demonstrate importance in reducing health costs To propose a model program and evaluation plan that best fits your organization To propose a reasonable budget that will achieve your program goals. To identify a senior level wellness champion To show that prevention can result in a return on investment within as little as one year Implement an annual evaluation and regularly report progress and results. It is also the right thing to do for your employees!

Assessing Your Employee Wellness Needs For Planning a Wellness Program, look at: Historical data (if any) Demographic data Employee Wellness Interest Survey Focus groups Design team Medical claims data For Evaluation of your program, look at: Medical claims Prescriptions claims Workers Comp Sick leave Disability Presenteeism

Wellness program models Quality of Worklife Quality of Worklife Model The fun approach, morale-building A good fit with smaller work-sites (< 1,000 employees) ROI is a low priority New to wellness Limited follow-through capability This model may have: Group activities Fun and social events Awareness-oriented Light focus Limited biometric testing No spouses served

Quality of Work Life Model Primary Wellness Targets: fun events, stress relief, nutrition, community service, general wellness and health information Typical Activities: health fairs, lunch and learn, wellness event, free fruit, chair massages, nutritious pot lucks, movie events, company games Participation: 15% to 35% of staff Approximate cost / EE / Yr: < $45 Likely ROI: < 1:1.0

Wellness program models Traditional Approach Traditional Approach Model A good fit for medium sized or larger worksites (>1,000 and > 10,000) ROI is a moderate priority 2-10 years of wellness Some follow-through capability Follows corporate direction This model may have: Both group and individual activities More health emphasis Education-oriented Mixed focus Moderate biometric testing Knowledge building Spouses served

Traditional Approach Model Primary Wellness Targets: In addition to the Quality of Work Life Model, plus the overall wellness score, cholesterol, BP, tobacco use, obesity, medical self-care, physical activity Typical Activities in addition to QWL: Health risk assessment (HRA), biometric testing option, fitness club memberships/facility, weight management program, smoking cessation, web-based health info, healthy cafeteria/vending options, preventive medical benefit coverage, wellness newsletter, short-term incentive program Participation: 28% to 58% of staff Approximate cost / EE / Yr: $46 - $150 Likely ROI: 1:1.5 to 1:3.0

Wellness program models Population Health Management Population Health Management model A good fit with larger work forces (> 10,000) ROI a very high priority Very mature wellness Prepared to educate staff Strong follow-through capability Strong virtual corporate and site-driven This model is: Mostly individual based More risk emphasis Behavior-oriented Serious focus Heavy biometric testing Skill building Most spouses served

Population Health Management Primary Wellness Targets: In addition to the Traditional Model, plus productivity, injuries, HC utilization, presenteeism, health consumerism, Typical Activities in addition to Traditional: HRA (incented and used for targeting with 80% minimum), risk stratification and incented interventions, telephonic coaching, medical self-care and consumer workshops, injury prevention, benefit linked incentive, wellness achievement incentives, resiliency initiative for productivity, spouses also served Participation: 65% to 95% of staff Approximate cost / EE / Yr: $250 - $450 (this cost does not include staffing and incentive costs) Likely ROI: 1:2.5 to 1:6.5

Wellness Program Infrastructure Virtual –based program infrastructure: On-line Health risk assessment (HRA) Incentives for Wellness (track on-line) Wellness newsletter Email and messaging Health guides Welcome kit Telephone/on-line coaching Site-based program infrastructure: On-site programs, facilities such as yoga class, gyms, tobacco cessation classes, massage therapy, challenges, etc. A good wellness program will have an infrastructure that includes both virtual and site-based!

Administrative Infrastructure Brand your program! Program Name Logo Tag line Art style Internal program staff Vendor staff (HRA, lifestyle management, coaching, incentive program) Form a Wellness Team with good employee representation Program proposal and work plan Program goals/objectives Program budget Program evaluation plan Develop a strong communication plan!!

A supportive environment for wellness Onsite fitness facilities and training facilities. Shower facilities Bike racks Walking trails Healthy food options No tobacco vending – tobacco-free campus! Computer access to E-health resources Quiet space Wellness as a formal organizational value Employee orientation Flex time for exercise Incentive rewards for wellness HR policies Wellness recognition Medical benefit coverage for prevention Performance appraisals Financial incentives Environmental change Employee involvement Reminders Consistent focus Policies Benefits Communications Supervisor support Leadership support

Staff Health Risk Assessment and Addressing Health Risk Factors HRAs function to: Help the individual view his or her health risk factors; Provide a personalized plan that serves as a catalyst for health behavior change; Allows the individual to monitor their health over time; Determines readiness for change; and Evaluates any changes in personal health. Employers gain valuable group data to identify greatest health risk factors, attitudes, readiness and perceptions of their staff over time. Select an HRA (HRA vendor) that will meet your wellness program goals!

HRA Completion Maximize completion by: Addressing employee concerns (confidentiality) Make it a part of your annual open enrollment Connect to flex plan choices Provide a premium reduction for completing Require for HSAs Provide cash for completion (size of reward will increase participation; 80% or greater completion if reward is at least $200).

Getting the most out of your HRA! Select a good HRA Incent it strongly Use the data for planning Plan and implement virtual interventions Use cohort data for evaluation and future planning

Group Activities Most popular: Walking events and clubs Weight loss groups Women’s and Men’s health issues Smoking cessation Fitness center membership Sports leagues Support groups Stress management

Site-based programs Employee health services Fitness camps and exercise classes Smoking cessation classes Nutrition classes Massage therapy Individual and group challenges with incentives Health fairs Sports challenges and teams Weight loss challenges and groups Walking /cycling challenges and groups Blood pressure screenings Flu shots

Communication is Key! Websites Email Supervisors Flyers Table tents News ads

Program Evaluation Did the program meet its objectives? How many people participated in the program (or in each component of the program?) – include HRA completion. How did the users like the program (individual program evaluations) What improvements in individual health or risk factors occurred? – include comparison to previous years HRA What positive effects did the program have on our organization? – health claims, sick leave, WC, etc. How much did the program cost? What was the net economic effect (C/B or ROI?) How should the program be changed for this next year?

Thank You! Lisa Reeve Director of Wellness and Health Human Resources Scott & White Healthcare wellness@swmail.sw.org