Wellness programs have moved into the mainstream as a growing number of organizations have concluded that the health of the organization drives the health of the workforce…and, conversely, the health of the workforce drives the health of the organization. (See Figure 1 below.) Successful wellness programs use education, motivation and support to guide employees, retirees and dependents to make wise lifestyle decisions, motivate those who are "ambivalent" to take action, reduce the chance that individuals will develop chronic diseases like diabetes, and help people to be in the best health they can be.

 

Wellness Programs Defined

Wellness programs are wide-ranging and diverse. They can include everything from offering on-site flu shots to having vending machines that dispense healthful food. Other common offerings include health-risk appraisal questionnaires, weight-loss programs, stress/depression screening, personal health coaches and mobile mammogram screening.*

Today’s wellness programs tend to be scattershot efforts that lack formal organization. There is no rhyme or reason to the benefits they offer. Some services may duplicate others while valuable health promotion offerings are lacking. Some may have a limited impact. Many people in the organization may not even know what services are available, which results in low utilization.

How did this happen? In most cases, wellness programs evolved piecemeal over the past 15 or so years as health-related programs were added one by one by different departments or advocates. Perhaps the organization’s HR/benefits department launched a smoking-cessation initiative, the IT department started a before-work walking club, and another group invited Weight Watchers™ to hold after-hours meetings in the conference room. Then the employee assistance program (EAP) began hosting brown-bag lunchtime classes and the health insurance provider offered a $25 gift card to anyone who completed a health-risk appraisal in addition to coming each fall to give onsite flu shots. Even pharmacy benefit managers have started offering wellness programs. Over time, many organizations have amassed a quantity of wellness-related initiatives without a clear sense of direction. The result is a program in need of order and a thorough inventory to ensure it is on target and to support the organization’s goals.

Conducting a Wellness Inventory

Most wellness programs could profit from an inventory or gap analysis to determine exactly what services and benefits are currently available. Such an inventory should look throughout the organization for evidence of wellness/health-related services and support, paying particular attention to where programs overlap or are lacking altogether. It should also look for services that are advertised as wellness efforts, but are designed to help people who already have chronic diseases, like diabetes or asthma. The goal of an inventory is not only to bring order to the program, but also to ensure that the organization is meeting the needs of its people and getting the best possible return on its investment.

The first step in conducting a wellness inventory is to identify all the areas of the organization that are currently offering health-related services. These include investigating the health plans, employer departments, Web sites and subcontracted vendors. Look for what is offered, to whom it is offered, what out-of-pocket costs are associated with the service and who is using it. The goal is to gather comprehensive information about all the organization’s wellness services and organize it into one document.

The next step is to match each of the current services to the degree to which it supports the six most common treatable/modifiable health-risk factors that many Americans possess. These common health-risk factors are (in no particular order):

• Obesity,
• High blood pressure,
• High cholesterol/lipids,
• Smoking,
• Sedentary lifestyle/lack of exercise, and
• Stress/depression/anxiety.

Poorly controlled health-risk factors lead to chronic disease. (See Figure 2 below.)

 

Source: Sibson Consulting

Next, all of the wellness services that the organization offers should be grouped with the health-risk factor(s) that they address (some services may work with more than one risk factor). Then ask:

• Are there any health-risk factors for which the organization does not yet have a wellness-related support service?
• Is there a significant emphasis on cancer screening and much less support for reducing health-risk factors?
• Is too much effort and money being expended on one health-risk factor at the expense of the others? Are there a variety of services, but low participation?
• Are the current wellness services available only for employees, and not for dependents and early retirees?
• Are the wellness services available at all worksites, for all shifts?
• Is there adequate awareness of the array of wellness services currently offered?
• Is there evidence that the organization truly embraces a culture of wellness?

Controlling Health-risk Factors

With the help of a wellness program, health-risk factors can be controlled and their negative effects can be reduced in ways that improve the health of the organization’s employees, along with the health of the organization itself. Support and guidance can be made available to people who are overweight or obese, smoke or chew tobacco, or have high blood pressure.

A carefully designed wellness program will:

• Make sure employees are aware of the six common health-risk factors, why it is important to do something about them and the array of wellness services the organization offers,
• Actively identify and screen individuals to find who is affected by a particular health-risk factor,
• Provide educational information to guide individuals who have one or more health-risk factors on how they can change their lifestyle to reduce those risk factors and improve their health, and
• Develop a culture of health promotion at the worksite(s), in the benefits offered, in the incentives or penalties applied and in the messages from the organization to its population.

Although a balanced wellness program will provide support for all health-risk factors, many organizations cannot afford to implement comprehensive support for all six. Instead, they focus on the most common health-risk factors in their population and then design their program to maximize support for them. Alternatively, many organizations choose to focus more on a specific health-risk factor or two each year while simply providing education regarding the others.

To prioritize their wellness efforts, organizations need to look for benefits that would have the most impact on their population. Organizing the investments will optimize the returns. In addition, creating a plan to advertise and educate individuals on the available services is important to the success of the program. It is difficult to use what you do not know about. (The next issue of Perspectives, which will be published in the fall, will include an article on wellness program communications.)

Conclusion

Wellness programs, which promote a healthy work environment and help people attain maximum personal health, can reduce workforce costs while enabling employees to fully engage in their work. Without a carefully planned strategy, however, these programs are likely to be less effective and less utilized than they could be. Conducting an inventory of current wellness efforts and then designing the organization’s wellness program to address the six common health-risk factors will help refresh the program and maximize its effectiveness.

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*Late in 2007, the Department of Labor released guidelines (Field Assistance Bulletin No. 2007-04) on the implications to plan sponsors offering wellness programs, prohibiting rewards or penalties based on health status, unless the plan complies with specific requirements. For more information, see the Sibson Bulletin "New Guidance Affecting Health Plans Offering Wellness Programs".
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About the authors:

Chris Calvert is a vice president and senior health consultant in the New York office of Sibson Consulting. He has 18 years of experience working within the health care industry. He can be reached at 212.251.5310 or ccalvert@sibson.com.

Nancy R. Hakes, RN, MSN is a vice president and health care benefits consultant in the Phoenix office of The Segal Company, the parent company of Sibson Consulting. A technical expert on wellness, disease management and utilization management programs, she has performed numerous wellness inventory projects for employers. She can be reached at 602.381.4025 or nhakes@segalco.com.

Copyright © 2008 by The Segal Group, Inc., the parent of The Segal Company. All rights reserved.