In my last blog, I told you about data showing the benefits of employer wellness programs. But how, exactly, do you go about developing a successful employee wellness program? Here are some top-line tips based on WhiteGlove’s experience with our clients, as well as evidence-based research on employee wellness programs.

• Determine a baseline. Survey your employees to gather baseline information about the state of health in your company. Typical questions include information about weight, eating habits, physical activity levels, chronic illnesses, stress, etc. This will highlight specific areas on which you need to focus. Employees should be able to provide this information in a completely confidential manner.

• Identify what success looks like. Once you choose which programs to start with (such as smoking cessation, weight loss, increased physical activity, stress reduction, etc), identify metrics of success. Initially, you might start with the number of employees who participate; eventually, those markers might be more specific to the health outcome, such as percentage of body weight lost, or number of cigarettes smoked per day. Other metrics to consider are sick days, employee turnover, presenteeism (coming to work sick), and workers’ compensation claims.

• Incentivize your employees. The reality is that simply putting the program out there is not enough. You also need to provide either a carrot (reduced healthcare premium, prizes, extra vacation days, money) or sticks (higher deductibles or premiums).

• Champion the program at the top levels of the organization. If you’re pressuring your employees to eat better, exercise more, and lose weight, they need to see that you’re doing the same. If you offer gym discounts or have an on-site gym, let your employees see you working out there. Change the cafeteria offerings to more healthful fare and let your employees see you eating it. Send out e-mails and post blogs on the company intranet updating your progress and the progress of the organization as a whole (i.e., “Our employees have lost a total of 1,500 pounds in the past 3 months!”). The idea is to create a “culture of health.”

• Publically celebrate success. Every month or so hold a recognition ceremony for employees who met their personal wellness goals. Also publish articles and photos in the company newsletter/blog.

And be patient. You are not going to see the immediate return-on-investment you might gain from, say, purchasing more fuel-efficient vehicles. Many negative health behaviors took years to develop and will take time to improve.

The key is taking the first step: deciding to improve the health of your employees. Once you do that, I can promise, you will also improve the health of your business.

Bob Fabbio
CEO
WhiteGlove Health, Inc.

Employers have crunched the numbers and realized that wellness programs can provide a substantial return on investment with healthier, more productive employees. However, we also know that there are numerous companies out there that have yet to embrace these efforts for their employees.

Both groups, those who offer wellness programs and those who don’t, should be interested in a recent report I just read from the National Business Group on Health (NBGH). The nonprofit organization is devoted to representing large employers’ perspective on national health policy issues and providing practical solutions to its members’ most important health care problems.

Every year NGBH commissions a survey from Towers Watson to evaluate employer efforts in the area of employee health. I found the 2011-2012 Staying@Work report just fascinating. As the consultants summed up on the opening page: “This year’s survey results show a strong link between highly effective health and productivity strategies and strong human capital and financial results.”

How strong? Companies that offer highly effective health and productivity programs report industry-adjusted average revenues per employee 40% higher than low-effectiveness strategy companies, a difference of $132,000 per employee.

The survey also found that companies with highly effective health and productivity programs:

• Report they perform better than their top competitors
• Save more than $1,000 per employee in annual health care costs
• Lose fewer days due to unplanned absences and disability. Combined with the health care cost savings, these indirect savings can increase a company’s benefit savings by “considerably more” than 30%.
• Experience employee reductions in at least some health risks (tobacco use and sedentary lifestyles/physical inactivity)
• Have lower voluntary turnover rates

The survey also finds more US employers use penalties as well as rewards to incentivize their employees to participate in wellness programs, while about a third only provide the rewards after employees participate in multiple activities, not just when they enroll.

Rewards pay off, with participation rates averaging 46% in companies that use them vs. 19% in those that don’t.

Room for Improvement

The survey also highlighted several areas ripe for improvement. For instance, average participation rates in disease management programs for chronic conditions hover at just above 14% and are not very responsive to incentives.

One clear message from this year’s survey: Senior management needs to get more involved. Just a quarter of firms surveyed said managers and/or senior leaders volunteer to be “health champions;” less than a fifth have senior leaders who share their own health stories; and fewer than 20% of managers participate in periodic employee health communication.

The survey also found that a key differentiator for high-effectiveness programs was offering easy access to preventive and other health care services, like those that WhiteGlove provides. In fact, WhiteGlove’s clients have made us an integral part of their wellness initiatives and have reaped the rewards of doing so.

In my next blog, I’ll report on some of the specific employee wellness findings. Hint: the biggest opportunity lies in changing employee behavior.

Bob Fabbio
CEO
WhiteGlove Health, Inc.

If I told you that your salary was based on how many widgets you produced rather than on the quality of those widgets, what would you do? Why, you’d produce more widgets, of course, regardless of the quality!

That’s pretty much how our healthcare system works when it comes to paying physicians. Most insurers, including the federal government, pay doctors on a fee-for-service basis: a separate payment for each visit and/or procedure. Order an x-ray? Bill the insurer. Bring the patient back for another visit? Bill the insurer. Clean out ear wax? Bill the insurer. Thus, there is a built-in incentive for doctors to do more, but little incentive for them to do it better or, most concerning, to keep patients well so they don’t turn up in the office to begin with. In fact, the number two reason why patients go to see a doctor is for a follow-up visit. Come on! After all, how much can you bill for patients who aren’t sick?

Many experts say that this fee-for-service system, which began more than 50 years ago, is at the very heart of our healthcare system woes. Although Medicare and private insurers have implemented some pay-for-performance measures, these are relatively modest and don’t address the core payment issue. They also obviously haven’t significantly affected cost, since healthcare costs in this country continue to rise (it’s now about 18% of gross domestic product) without any concurrent benefit in quality. (1)

Everyone agrees that prevention, helping patients manage chronic conditions so they don’t use more expensive emergency department and hospital care, and reducing hospital-acquired infections, complications, and readmissions could save money. (2) The problem is that, as I mentioned above, doctors generally aren’t paid to keep patients healthy.

That may change under the Affordable Care Act, aka healthcare reform. A cornerstone is the creation of accountable care organizations (ACOs) for Medicare patients. These organizations are networks of primary care and specialist physicians that are held accountable for the cost and quality of all care provided to a group of patients. (3) The better the groups do at improving the health of patients, the more money they make. Now there’s an incentive I can understand!

The idea is that this “bonus” would come out of savings that results from healthier patients and the use of fewer medical resources. Conversely, if patients do worse then expected, the ACO has to pay a penalty.

Given that the private sector trends follow in the footsteps of Medicare, many hold out hope that the ACO model can truly reform our bloated healthcare system.

A federal demonstration project involving nine multispecialty group practices and one physician/hospital partnership found that the organizations were able to improve the quality of care they provided while providing some savings, albeit a “small” savings. (4)

I think ACOs have potential for both benefits and pitfalls. As with so many things in life, only time will tell if they will be the white knight to finally slay the fee-for-service dragon. Too bad they are only focused on the Medicare population.

Bob Fabbio
CEO
WhiteGlove Health, Inc.

(1) Centers for Medicare and Medicaid Services. National Health Expenditures 2012 Highlights. Available at: https://www.cms.gov/NationalHealthExpendData/downloads/highlights.pdf. Accessed February 2, 2012.
(2) Center for Healthcare Quality & Payment Reform. CHQPR Testimony to Congress. Available at: http://www.chqpr.org/news.html. Accessed March 2, 2012.
(3) Health Affairs. Health Policy Brief: Next Steps for ACOs. January 31, 2012. Available at: http://www.healthaffairs.org/healthpolicybriefs/brief.php?brief_id=61
(4) Centers for Medicare and Medicaid Services. Physician Group Practice Demonstration: Performance Year 1 – Preliminary Performance Year 5 Summary Results. Available at: http://www.cms.gov/DemoProjectsEvalRpts/downloads/PGP_Summary_Results.pdf. Accessed March 2, 2012