Research Paper
Abstract
Health improvement programs, which use a variety of techniques to assist individuals in achieving and maintaining optimal health are increasingly being introduced by employers as an employee benefit. Health improvement programs include wellness/prevention programs, population health improvement, population-based disease management, high risk disease management and case management. Health improvement programs initiatives focus on promoting healthy lifestyles among employees by targeting the risks that result from poor nutrition, lack of physical activity, excessive stress, tobacco use and other unhealthy habits. These risk factors can lead to expensive chronic diseases and health issues that also affect workforce productivity, absence from work, safety and employee morale.
Promoting health and preventing disease is everybody’s business. In order to achieve their potential of containing health care cost trend, today’s health promotion programs require intelligent program design, ongoing measurement and refinement, attention to the uniqueness of each company’s culture and effective incentives that motivate lifestyle changes and improve the health of individuals and the employee population as a whole. Creating and maintaining a healthy workplace culture can accomplish a number of goals for an employer. For starters, by showing real rather than token support for healthy choices, employers and management can greatly increase employee participation in wellness programs. Increased engagement leads to greater potential for lasting health behavior change, as well as encouraging even more employees to get involved. Employees who make positive changes in their lifestyles are likely to be healthier, more productive and happier.
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Background
Health improvement programs, which use a variety of techniques to assist individuals in achieving and maintaining optimal health, are increasingly being introduced by employers as an employee benefit. Many different terms and definitions are used for health programs. Health improvement programs include wellness/prevention programs, population health improvement, population-based disease management, high risk disease management and case management. The growth of these programs is the result of several intersecting trends. Health promotion programs use a research-driven, cognitive-behavioral model to impact behavior change (Selecky, 2007).
Unlike reflexive conditioning (think of Pavlov’s dogs), a cognitive-behavioral model engages the participant in understanding the thought process and motivations leading to positive habit and behavioral changes. In order to effect change, behavioral patterns are analyzed and modified using both education and a system of incentives as reinforcement. Of all workplace benefits, health care is one of the most valued by employees; yet it is the most expensive benefit for employers to provide. Due to rapidly increasing costs, many employers have cut back on health benefits or shifted costs to employees. Consequently, some employers that reduced benefits have also decided to give something back to employees in the form of health improvement programs, more specifically wellness programs. Employers increasingly recognize the great degree to which their bottom line is impacted by absenteeism and low productivity which are often directly connected to employee health and wellness. Wellness programs offer the potential for better quality of life for employees and better financial results for employers, a win-win situation.
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Lifestyle behaviors related to health risk factors, such as eating, exercising and smoking, are among the most challenging to modify. For lasting results, individuals must make a conscious choice to permanently implement positive lifestyle changes. People generally do not change their behavior without good reasons that outweigh the pain and annoyance associated with giving up longstanding habits. The purpose of wellness programs is to help provide those good reasons.
What are Wellness Programs?
Wellness programs have been around for decades and are directed at a broad population that is generally healthy and not necessarily suffering the impact of unhealthy behaviors in which they engage. These programs focus on helping employees become aware of how to make healthier lifestyle choices and to encourage the practice of healthy behaviors. They can include everything from flu shots to gym membership discounts to weight management programs, healthy eating incentives, health risk questionnaires, online health monitoring tools and individual healthcare coaching sessions. Preventable illnesses often result when individuals do not adequately address a number of modifiable health risk factors such as nutrition, weight control, physical activity, cholesterol, blood pressure, tobacco use, safety and mental wellbeing. Health wellness programs seek to reduce these risk factors by promoting healthy lifestyle choices and discouraging behaviors and attitudes that are detrimental to good health. Increasingly, employers are offering financial and other incentives to drive participation and results. Some 63% of employers surveyed by human resources consulting firm Hewitt Associates this year said that they do provide or plan to provide workers with incentives such as lower healthcare premiums in exchange for participation. And while most employees are on the honor system, more employers are requiring that workers prove they completed these programs.
Government Regulation of Wellness Programs
Wellness programs and health promotion must comply with the Health Insurance Portability and Accountability Act (HIPAA) nondiscrimination regulations. In December of 2006 the Department of Labor, the Treasury, and Health and Human Services published joint regulations regarding the nondiscrimination provisions of HIPAA including how the nondiscrimination provisions apply to wellness programs. The regulations generally prohibit group health plans and insurance issuers from denying an individual eligibility for benefits based on health factors and from charging an individual a higher premium than a similarly situated individual based on a health factor. Health factors include health status, medical conditions, claims experience, receipt of health care, medical history, genetic information, evidence of insurability, and disability. The regulations do provide an exception that permits plans to vary benefits and premiums or contributions based on whether an individual has met the standard of a wellness program that complies with the HIPAA nondiscrimination regulations. The Department of Labor uses a bulletin to clarify what types of programs must comply with the HIPAA nondiscrimination regulations and how to apply the standards in the regulation to particular wellness program. The wellness program is only subject to the HIPAA nondiscrimination regulations if it is part of a group health plan. If the company operates a wellness program as an employment policy separate from the group health plan, the program may be covered by other laws, but is not subject to the HIPAA nondiscrimination regulations. Not only does a company have the HIPAA regulations but they must also be mindful of other laws such as the Americans with Disabilities Act (ADA), Age Discrimination in Employment Act of 1967 (ADEA), Title VII of the Civil Rights Act, and other state employment related laws. (Burch, 2008)
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Results
Employee Participation in Wellness Programs
Employer sponsored wellness programs focus on promoting healthy lifestyles among employees by targeting the risks that result from poor nutrition, lack of physical activity, excessive stress, tobacco use and other unhealthy habits. Once a wellness program is in place, an organization still needs to persuade employees to use it. Some employees will be resistant or defensive or simply in denial that they need help managing their health. A good way to start is to appropriately configure the program and communicate how it works. It is important to take into account employees’ literacy issues and language needs. Employees with less education may benefit from videos or in-person presentations. Organizations with a diverse employee base may need to provide communications in other languages as well. To increase employee participation some employers offer incentives. The belief is that incentives will motivate employees to better manage their health and take more responsibility for it, ultimately saving money for the employer. Incentives can vary some organizations offer discounts on health insurance premiums based on behavior, for instance, a $30 monthly premium reduction for an employee who quits smoking. Other organizations give paycheck credits, allot additional vacation time or even assign points that can be used to select merchandise from a catalog.
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... Cooper, C. (1996, December). Healthy, Wealthy and Wise. Incentive , 170 (12), p. 25. Employee Wellness Programs. (2007). Employee Wellness Programs Simplified. Retrieved October 27, 2011 from http://www.employee ... organized, employer-sponsored program that is designed to support employees (and sometimes their families) as they adopt and sustain behaviours that reduce health risks, ...
Incentives
Incentives are widely used in employer wellness programs because they can have powerful behavioral effects. If incentive rewards and rules are well designed, they can induce a significant change in behavior for a significant percentage of the target population. They also can be flexible, relatively simple to comprehend and easy to administer. Additionally, incentive rewards can be combined to increase motivation, for example, combining a tangible reward with an intangible reward.
Incentives also have possible disadvantages. For instance, with certain reward approaches some individuals may figure out how to cheat the system or be dishonest in self-reporting. Additionally, some incentives may inadvertently reward unhealthy behaviors, for example, a per pound weight loss incentive could encourage unhealthy or hazardous weight loss practices. Finally, desired behavior may last only as long as the reward does. For example, a reward for regular fitness center usage that expires after one year could result in employees ceasing their regular exercise program when the reward stops. However, experts say that a habit such as regular exercise tends to “stick” once the individual makes it past the 30-day point. A key objective of incentive design is motivating individuals to explore and acquire desirable behaviors that become permanent, sustainable lifestyle changes over time.
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Some employers also express a concern about rewarding certain people for doing something they would have done anyway, such as regular exercise. However, there are several arguments to counter this concern. First, it’s important that an incentive program is equitable to all employees. Those who are already making responsible life choices deserve the same rewards and support as those who are just starting. Both groups contribute to the employer’s objective of creating and maintaining a lower risk population. Remember, incentive rewards are not just about encouraging change; they are also about sustaining healthy lifestyles. For example, a “good driver” auto insurance discount applies to everyone who maintains a good driving record, not just those who achieved good driver status for the first time. Further, anyone can “fall off the wagon” at any time. An incentive, such as a fitness club subsidy, may be just what’s necessary to keep someone’s exercise routine on track for the long term.
Advantages and Disadvantages of Wellness Programs
The advantage of wellness programs to employers is simple-healthier employees mean reduced claim activity, reduced absenteeism, and improved productivity. Several studies have documented the cost benefits of wellness programs, including, for example, a significantly lower medical claims trend for wellness program participants over a four-year period. Employees themselves say that company wellness programs help improve their health by eating healthier, exercising more, and thinking about healthier options more often. One company gives two clear examples of cost savings due to its wellness efforts. One employee, who was on blood pressure medication, started working out regularly at the company. After six months, he was able to get off the medication. Another employee was on a cholesterol-lowering medication. After exercising more regularly, he too was able to stop using the medication.
Not only do wellness programs boost employee health, but participants in such programs also are more engaged employees, according to a recent study. While it might not be surprising that employees who participate once per week in a wellness program took significantly less sick time than those who never do so, even workers who participate sporadically-once a year, once a month or a few times a year-had better attendance records than those with zero participation, the survey found. That may be attributable to a perception among participants that their employer cares about their well-being, coloring their attitude toward their workplace, theorizes Mindy McGrath, vice president of strategy for Maritz’s health care sector. Employees at companies that offer wellness programs are significantly more satisfied with their jobs, more likely to remain with the company long term, and more likely to recommend it to a friend or family member as a place to work.
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Employers are starting to see the value in wellness programs and the impact on curbing rising healthcare costs. Results from the latest Principal Financial Well-Being Index show employees participate at work in blood pressure checks (81%), cholesterol screenings (73%) and online health screenings (72%).
In addition, more than three-fourths (82%) of those who are offered health education tools use them, while nearly two-thirds (68%) whose employers offer wellness seminars attend. “Consistently, employees surveyed have rated health insurances as the most important workplace benefit, and at the same time say it is a benefit they would like to see their company improve,” says Jerry Ripperger, director of consumer health for the Principal Financial Group. Responses to the survey show workers recognize a financial incentive from participating in wellness offerings with more than half (57%) of those surveyed believing wellness benefits are very or somewhat successful in reducing healthcare costs. What might be more encouraging to employers, Ripperger says, is that 74% of workers surveyed agree wellness benefits encourage them to work harder and even perform better while 48% said wellness offerings would encourage them to stay in their current position. (Walker, 2006)
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Disadvantages
Suspensions at Whirlpool related to a nonsmoker insurance discount illustrate how wellness programs can give employers new headaches. Encouraging employees to engage in healthy behavior may seem like an easy thing for companies to do. But as Whirlpool learned last month, such initiatives often can reveal a whole new set of challenges for employers. The Benton Harbor, Michigan-based home appliance maker for years has offered nonsmoker discounts worth several hundred dollars, depending on the facility, in workers’ health care coverage premiums, according to spokeswoman Jody Lau. But last month, the company suspended 39 workers at its Evansville, Indiana, facility who were caught smoking in designated locations outside the plant after initially claiming that they were not tobacco users on their benefits enrollment forms, which earned them a $500 discount. “When there appears to be a discrepancy between an individual’s documented status and their behavior, the company investigates,” Whirlpool said in a statement. “Falsifying company documents is a serious offense. Those found to have done so are subject to disciplinary action, which could include suspension and termination.” The events at Whirlpool underscore how difficult it is for employers to offer wellness programs that are viewed by employees as a perk while being effective in cutting companies’ health care costs, experts say. Traditionally, companies offered incentives for healthy behaviors based on employees’ pledges, says Jim Winkler, leader of Hewitt Associates’ health management consulting practice. For example, employees could earn credits based on making the pledge that they wouldn’t smoke. (Marquez, 2008)
A notable example is Marysville, Ohio-based lawn care company Scotts Miracle-Gro, which has a smoke-free policy and enforces it by screening employees. Yet the company is in the midst of a lawsuit filed by an employee who was fired for failing the test. “Current law related to wellness programs is vague, and employers that take action against employees may be opening themselves up to lawsuits, says Joe Lazzarotti, a partner at Jackson Lewis. “Employers also must consider the cultural implications of testing employees,” says Kathryn Bakich, director of health compliance at the Segal Co., a New York-based benefits consultant. “Employers need to ask, is this right for their workforce?” she says. “Many companies offer smoking cessation programs, where employees can earn credits if they agree to try to stop smoking,” Bakich says. But if employers are going to take a more aggressive approach in following up on employees’ behavior, they need to ask how far they are willing to go if people lie, experts say. (Marquez, 2008)
Conclusion
Unhealthy behaviors and poor lifestyle choices are a growing threat to the nation’s wellbeing. The time has come to move toward a model of health care that puts more focus on health promotion and disease prevention. If the current health trends in the U.S. population continue, we will see dramatic increases in serious health problems and early mortality due to preventable conditions such as diabetes and heart disease. Fortunately, employers are getting actively involved in the health and wellness of their employees by implementing health improvement and wellness programs. Employers face the challenge of motivating employees to adopt healthier behaviors and supporting them in maintaining healthy lifestyles. Many large employers are leading the way by offering wellness programs that improve their employees’ health while reducing costs, increasing productivity, and offering a return on investment. Education plays a role in raising awareness and building a desire for change. While some employees may feel uncomfortable with these programs they can be reassured that under the Health Insurance Portability and Accountability Act (HIPAA) their rights and privacy are not violated nor are they discriminated against for participating in wellness programs. The research is very clear that if you get employees to participate, to take health risk appraisals, to participate in lifestyle coaching, things like that, that they reduce their number of risk factors, and the reduction in health risk factors results in a reduction in health care cost trends.
Bibliogragphy
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