September/October 2012
A small investment in a workplace wellness program can reap big dividends by lowering health care costs and absenteeism, improving morale and retention, and enhancing employees’ quality of life.
By Diana Mota
Scrapyards are accustomed to thinking about employee health in terms of safety—protecting workers from potential hazards in the workplace—but a safe workplace isn’t necessarily a healthy one. A facility with long stretches of accident-free workdays might still experience high health insurance costs and absenteeism due to illnesses and chronic health conditions that workers and their family members face. If that’s the case at your company, a wellness program might help. Such programs use a variety of approaches to influence employee health behaviors and improve health skills and knowledge.
Consolidated Scrap Resources (York, Pa.) recently assembled a wellness team to promote healthy lifestyles for its 140 employees and their families across six facilities. CSR President Ben Abrams, who championed the move, says he looks forward to the day when his employees embrace wellness as much as they do safety. He emphasizes one difference between the two, however: Safety is mandatory; wellness is voluntary. “If employees choose not to follow safety rules and procedures, they’re not going to work here very long. We have control over that,” he says. With wellness, “you want people to embrace the concept, but you can’t make them.”
Wellness Benefits
Companies measure every employee benefit against the bottom line, and wellness programs generally hold up well to this scrutiny. Each dollar spent on a quality wellness program can return $3 from medical and absenteeism savings over a three-year time horizon, according to estimates by three Harvard economists drawn from decades of research, says Ron Goetzel, vice president of consulting and applied research for Truven Health Analytics and director of Emory University’s Institute for Health and Productivity Studies, both based in Washington, D.C. “It’s a great investment for companies,” says L. Casey Chosewood, senior medical officer for the Total Worker Health initiative of the National Institute for Occupational Safety and Health (Washington, D.C.). “The return is very real.” Although most studies have looked at the benefits for large companies, “we still think small and midsized companies have a lot to gain from wellness programs,” he says. “Program costs vary widely, with some companies spending less than $50 per employee per year. Others invest more than $1,000 [per employee] per year, but even that’s a bargain when compared with annual health plan costs, which can be 10 times that price.”
Employee health can affect a company’s bottom line in several ways, Chosewood explains. Because healthy employees have fewer absences or health-related distractions and are better engaged with their work than workers with poor health, they tend to be more productive, he says. Employees with higher health risk factors—such as obesity, smoking, and diabetes—cost more to insure than people with lower risk factors, researchers say. Thus, a healthier work force can translate into lower health care spending and lower insurance premiums over time. Healthier employees also can be safer employees, which could translate into fewer or smaller workers’ compensation claims, Chosewood says. “Healthy people tend to have more energy, get more sleep, and focus on the task at hand more easily.” They also are more likely to weather work stressors and demands better, he notes. The employees themselves might even save money due to lower out-of-pocket health care costs.
That said, it’s important to have realistic expectations of what savings a wellness program can achieve. “A lot of employers get interested because they want to cut down on health care costs,” says Jason Spangler, a medical officer with the Partnership for Prevention (Washington, D.C.), which provides research and best practices for company wellness programs. Though that does happen, “two-thirds to three-quarters of the costs saved [are] indirect health costs related to absenteeism, productivity, and presenteeism—people not working at their full capacity because they don’t feel well.” Some companies could even see a rise, initially, in direct health care costs from more workers seeking health interventions from previously undiagnosed or untreated problems. The indirect savings offset those costs, however, he adds.
Wellness programs also can have less tangible benefits. “Healthy employees mean happier employees and more consistent employees,” Abrams says. Typically, job satisfaction and morale get a boost, Spangler says. Participation empowers individuals by giving them some control over their health and builds morale and a social support network among co-workers, supervisors, and family. Also, wellness programs can educate employees and give them skills to manage or cope with health issues, which can “facilitate adopting healthy behaviors in the short-term and lead to changes in physical, mental, and/or emotional health in the long-term,” according to NIOSH’s Total Worker Health initiative website (www.cdc.gov/niosh/twh). Employees often perceive the programs as an investment their company makes in them and a reflection of how much the company cares about them.
Though safety is an employer’s responsibility, wellness is an opportunity, Chosewood says. “The number of people who work 40-plus hours a week is increasing. It’s not uncommon for [people] to spend more than half the time they’re awake at work.” Employers can use that time to help reduce a worker’s health risks—on and off the job—and improve his or her quality of life. “It’s an opportunity to add health throughout the day,” Chosewood says. “Wouldn’t it be great if an employee leaves work healthier than when he or she arrived?” It’s an investment in an employee, similar to training, mentoring, or other employee development programs, Spangler says.
Bringing Wellness Into the Workplace
An effective workplace wellness program takes planning and support, Chosewood, Spangler, and Goetzel say. The process involves setting goals, selecting health interventions, and building an infrastructure to support the program. This can be done alone or with help from health insurance providers, local hospitals, or other community-based organizations, Spangler says. Here’s a guide to getting started.
1. Get the right people involved. A wellness program won’t take root without the commitment and involvement of senior managers and front-line managers, say Spangler and Ken Lammi, chief technology officer of AmesMyFile Systems (Hingham, Mass.), a company that designs and implements such programs. “The programs that work the best and last the longest don’t start from the bottom up,” Spangler says. “They start from the top down. Senior leadership encourages employees, and they [participate] themselves.” Sometimes the push starts with a core group of employees, but “it doesn’t become successful until management buys in.” Carol Strayer, CSR’s human resources administrator and wellness chairwoman, concurs. She had been interested in launching a wellness program for a decade, she says, but the idea didn’t take off until Ben Abrams became president of the company about three years ago. “He understands it. He realized we needed to help employees.”
In addition to providing visible support, managers can build wellness into the corporate structure by connecting employee health to business goals, Chosewood says. “Wellness has to become part of the strategy of the corporation, and that’s hard,” Lammi says. “That’s why you need executive commitment.” Their involvement helps develop a culture that values, supports, and promotes employee health as well as safety, Goetzel says. To show its support, management can give employees time during the workday to plan and participate in programs, for example.
The company should designate a wellness coordinator to communicate the program’s goals, objectives, and activities, Chosewood says, and it should appoint a wellness team with employees from all levels of the organization. At CSR, a committee develops the program, solicits involvement, and promotes wellness among the company’s six locations. “We really tried to pick a mix of employees and supervisors” across all six sites, Abrams says. “The team has taken a concept and put it into practice with concrete goals for people to achieve.”
2. Assess and prioritize workers’ health needs, risks, concerns, and interests. Because each company and its employees are unique, strategies to address employee health will vary from company to company and location to location, says Alwyn Cassil, director of public affairs for the Center for Studying Health System Change (Washington, D.C.). Ways to determine the highest priority health issues include individual health assessments, appraisals, insurance data analysis, and surveys. Health information is sensitive—and in some cases, legally protected—so it’s important to take care when collecting and analyzing it. A company’s health insurance provider should be able to provide aggregate data on a facility’s health care costs that can be used to identify common health risks, the target audience, and appropriate interventions, Lammi says. In the aggregate, the information is unlikely to compromise health care privacy laws. Vendors that perform health risk appraisals typically provide companies with an aggregate report of health risks, Chosewood says. For worksites with fewer than 25 employees, he suggests receiving only recommendations, not the report of risks, which could inadvertently identify someone due to the size of the employee pool.
Employers also can conduct surveys or in-depth health assessments. Chosewood suggests using an outside organization to do so, however, because employees might be reluctant to participate if they think their employer might use the information against them. AmesMyFile will conduct a basic assessment and construct an action plan with incentives for about $25 to $30 per employee a year plus one-time setup fees, Lammi says. Surveys can target a single health issue, such as daily physical activity levels, or encompass a wide variety of subjects, such as nutrition, physical activity, tobacco and alcohol use, vaccinations, physical examinations, as well as wellness interests and opinions, according to the NIOSH program website.
3. Develop a plan and the initiatives to carry out the plan. Many insurance companies offer one-size-fits-all wellness programs, but Chosewood and the others suggest companies use the knowledge they’ve gained about employees’ specific risks and needs to create their own wellness programs, policies, and benefits. To get started, NIOSH’s Total Worker Health initiative provides free resources for company health, safety, and well-being programs, and Partnership for Prevention’s free “Lead by Example” reports (www.prevention.org) describe wellness program best practices.
Wellness initiatives can target a single health issue or address multiple health issues simultaneously, Spangler says. For example, a company could establish a smoke-free workplace policy and then offer smoking cessation classes for a greater impact. Alternatively, a physical activity program such as a walking contest, when combined with a nutrition program, can target several risks, including obesity, Type 2 diabetes, high blood pressure, and high cholesterol.
Interventions don’t have to cost a lot, Spangler says. Low-cost measures include policy changes (such as banning smoking), marking a walking trail around the facility, or providing healthy food options at company meetings and events as well as in company vending machines, Goetzel says. Companies should review their current health insurance policy documents to see if the plan covers wellness services such as fitness programs or nutrition counseling. To further manage costs, employers can partner with community organizations such as hospitals, the local YMCA, or community health centers as well as neighboring businesses, Chosewood says. “There’s a growing number of community resources that provide these programs. We’re also hearing about groups of small employers in a region sharing program costs.”
Common initiatives include classes or seminars on health topics such as fitness, nutrition, and stress management; friendly competitions; and free or low-cost health screenings. “Online programs are increasingly popular, but not everyone is computer-savvy,” Chosewood says. Making wellness discussions a part of other meetings—such as staff or safety meetings—is one way to start, he adds. “All you have to do is tack on 10 minutes of health information. That’s going to make a difference over time.” Most programs engage workers in wellness a couple of times a month with a menu of choices, Chosewood says. “It’s important to think beyond individual interventions, however,” he adds. “Companies that build more health opportunities into their benefits plans, improve workplace policies, change the physical environment, and improve work-life balance options [create benefits for] all current and future employees.”
Competitions should be easy to implement, economically feasible, have a reasonable time frame, and hold employees’ interest. In retrospect, Strayer says, CSR’s first attempt at a wellness competition lasted too long. “We held a weight-loss competition that lasted a year,” she says. Though some employees lost significant amounts of weight, quite a few of them lost interest over the course of the year. Currently, the company is offering employees a one hour, one-on-one session with a dietician followed by two 30-minute follow-up sessions. “It’s behind closed doors during company time,” she says. “They can bring in their spouse.” That’s something to consider as well: Extending a wellness program to employees’ families can identify health issues that contribute to an employee’s absenteeism, the NIOSH website states.
Sims Recycling Solutions, Americas (West Chicago, Ill.) offers all of its employees annual wellness screenings and monthly wellness newsletters as well as a comprehensive employee assistance program, and each facility can opt to offer other programs as well, says Marie Burke, corporate human resources director. Some sites have held contests that reward employees who lose the greatest proportion of body weight or participate in lunchtime or charity walks.
Wellness initiative participation incentives might include financial rewards such as gift cards or discounts on insurance premiums, merchandise such as T-shirts, or other recognitions. CSR recently held a 12-week walking contest that encouraged employees to take at least 10,000 steps a day, Strayer says. The company sold participants pedometers at cost, then those who completed the program by documenting how much they walked each week were reimbursed for the cost of the pedometer. The person with the most steps over the 12-week period received an extra day of paid vacation, and each participant at the winner’s facility received a $10 Wal-Mart gift certificate. “Incentives are effective in increasing participation in health promotion programs, but it is unclear if they are effective in sustaining long-term behavior change,” Chosewood says. “What sustains a program is when people start to see how these programs improve their own lives or the lives of the people they care about.”
The Yaffe Cos. (Muskogee, Okla.) offers several wellness initiatives in an effort to control health care costs for the self-insured company, says Lyle Bachman, executive vice president of administration. Each employee gets a discount on his or her insurance premium for completing a yearly physical and a health assessment. About five years ago, Yaffe hired a firm that finds doctors to take shifts at health clinics at or near its facilities in Wichita, Kan., and Muskogee and Tulsa, Okla. The Oklahoma clinics are open to employees five days a week during the workday; the Kansas clinic provides care one day a week for four hours, Bachman says. Yaffe employees can use the clinics without paying a deductible or copayment; other nearby companies have similar arrangements with the clinics. Employees at facilities with clinics tend to seek care for their illnesses sooner, Bachman says, and the clinics have helped reduce absenteeism: Because of the clinics’ proximity to the scrapyards, employees don’t need to take off as much time to see a doctor. The firm’s more remote facilities don’t have a large enough employee base to support a clinic, however. The company and employees both put money into a health fund that covers routine care as part of its self-insurance program. “The fund makes it a cooperative effort,” Bachman says. “Employees have a vested interest” in staying healthy, he adds, “because it keeps their premiums down.” The firm also purchases certain common prescription drugs in bulk and provides them to employees at no cost when needed, Bachman says. In 2011, the Oklahoma State Department of Health Community Development Services recognized Yaffe with an “Oklahoma Certified Healthy Business” award for its efforts.
Employers can choose wellness programming options that fit their budget and interests, Chosewood says, but he recommends choosing wisely. “Talk to employees. What are they most interested in for themselves and their families?”
4. Communicate the program’s opportunities and successes. If employees don’t know about the wellness program or don’t understand it, they’re not likely to participate, Chosewood says. Use a variety of media—e-mail, bulletin boards, newsletters, and presentations—to reach as many employees as possible. “Lots of companies have had success communicating with spouses,” he adds. “Some male-dominated companies use ‘send-homes’ with the employee or mail information [to home addresses]. Often it’s the women in the home who make the vast majority of health decisions.”
The company also should share and celebrate employee success stories to help motivate others, according to the Total Worker Health program website. Materials and messages should keep in mind cultural and ethnic differences, such as traditional diets and speakers of languages other than English, as well as differing educational levels and physical abilities, NIOSH states.
5. Evaluate and adjust the program. In most cases, financial returns such as reductions in health care costs or improved worker productivity take at least two years to achieve, Chosewood says. “We recommend committing to at least a three-year program because you’re not going to see results right away,” Lammi says. To evaluate results over a shorter time period, each company has to determine what success looks like for it, he says. Companies might want to evaluate the success of various program elements as well as employee awareness of, satisfaction with, and participation in the program, they say. The wellness team also should review what worked and what didn’t.
A workplace wellness program has the potential to keep healthy employees healthy by promoting health maintenance and improve the lives of employees with higher risks while lowering overall costs, Chosewood says. “Few things in life are truly a win-win. This is.”
Diana Mota is associate editor of Scrap.
A small investment in a workplace wellness program can reap big dividends by lowering health care costs and absenteeism, improving morale and retention, and enhancing employees’ quality of life.