Making Employee Wellness Work

Employee wellness is gaining increased attention as requirements for wellness programs have been built into the Affordable Care Act. What is the appropriate metric for determining the effectiveness of those programs? Is return on investment even measurable? 

Let’s examine some projected data points for 2014, based on a corporate employer survey conducted by Fidelity Investments and the National Business Group on Health:

• 95% plan to offer some kind of employee health improvement program 
• 93% plan to expand or maintain program funding over the next 3-5 years
• 75% plan to offer participation incentives, up from 57% in 2009
• Employers to spend an average of $594 per employee on incentives, up 15% from 2013 and more than double from five years ago

A primary metric often used to gauge the success of employee wellness programs is participation rate. Obviously, the program can’t generate meaningful results if a significant portion of the employee base is not involved. But the ultimate goal of a wellness program is not simply participation. It takes a change in behavior to tangibly improve employee health and, over time, reduce avoidable healthcare costs.

Nevertheless, the great majority of employers tie financial incentives to participation, with relatively few basing their incentives on real, sustained behavior change. Behavior change goals should be realistic, specific, time sensitive and broken down into achievable steps with rewards along the way. Behavioral programs should also be more effective in addressing the small number of employees who disproportionately skew costs.

The first place to start is establishing an organizational culture that values and encourages wellness, based on clear objectives. Those objectives should carry the same importance as balance sheet, diversity, productivity and customer satisfaction targets. They should be quantifiable and tracked on a regular basis. Top leadership support for this key effort must be genuine and visible. Effective communication across all platforms is essential to making sure everyone understands the importance of the program, its value to the company and its benefits for the individual. Recruiting internal “ambassadors” who are popular and well respected can be especially effective as influencers with their peers.

Participation is an essential first goal, but true behavioral change needs to be the focus. That means identifying specific desired outcomes. There are plenty to choose from related to physical activity, obesity, stress, nutrition, tobacco use, alcohol consumption and other risk factors. Studies indicate potential savings can be achieved by making changes in these areas. The organization may decide to address some or all of them. A comprehensive but user-friendly online platform for taking an initial health risk assessment and tracking activity is a first step. Health coaching is a personal and motivating approach to help people get started, maintain their commitment and appreciate the results they achieve.

Technology offers a number of ways to engage participants that can be fun, personalized and convenient. Options include wearable personal fitness monitors, mobile apps, games and sharing on social media.

Lastly, incentives must be aligned with objectives. They need to be relevant and tailored to the particular employee population. And they should drive specific behavioral changes. For some people, that may mean discounts on health insurance premiums. For others, a straight cash reward or gift certificates may be more meaningful. Some organizations are also exploring negative reinforcement in the form of premium penalties. A combination of these “carrot” and “stick” incentives is probably the most effective approach to promote the desired behavioral changes in an organization’s workforce.

With the Centers for Disease Control’s National Healthy Worksite Program in place and specific guidelines in effect under the ACA regarding allowable employer charges for health plans tied to making reasonable efforts to help people improve their health, generating change at the behavioral level is critical. Both payers and providers can play a pivotal role in pushing their constituencies to focus on behavior change.

 After all, it’s not what people say they will do that counts, it’s what they actually do that delivers results.

Henry Loubet is chief strategy officer for Keenan, a healthcare brokerage and consulting firm. He is a member of the Payers & Providers editorial board.