Volume 9, No 2 | March 2011
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EDITOR’S LETTER
Healthcare Reform a Welcome or Unwelcome Anniversary ?
W
e just passed the one year anniversary of the Healthcare Reform law on March 23, 2011. I think the question everyone is asking is where do we stand with healthcare reform. People are still shaking their heads and asking what it means, how parts of it will be interpreted and what changes will occur because of negotiations between Republicans and Democrats, and where do we stand since two courts found the law unconstitutional but many found it to be constitutional. Unfortunately there is no special insight because I believe no one really knows what is going on, especially up in DC. In fact, Anthony Weiner, a democrat in the House of Representatives, and one of the biggest supporters of healthcare reform is now looking to get a waiver so that New York City doesn’t have to comply with certain mandates of healthcare reform. He actually said ”maybe New York City can come up with a better plan.” This example of a big proponent and supporter of the law now trying to get out of it for his constituents is just an example of the bigger problems healthcare reform faces in the future. The real problem we face, is we still need true healthcare reform, which this law did not provide.
EDITORIAL STAFF EDITOR Jonathan Edelheit jon@employerhealth� carecongress.com
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Jonathan Edelheit
Copyright © 2011Corporate Wellness Magazine. All rights reserved. Corporate Wellness Magazine is published monthly by Global Health Insurance Publications. Material in this publication may not be reproduced in any way without express permission from Corporate Wellness Magazine. Requests for permission may be directed to info@ CorporateWellnessMagazine. com. Corporate Wellness Magazine is in no way responsible for the content of our advertisers or authors.
FEATURES
CONTENTS Issue 21 • April 2011
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IS YOUR ORGANIZATION A HEALTHY ENTERPRISE? by Steve Cyboran
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by Jacquelyn Ferguson
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Health Risk Assessments: A Waste of Time and Money
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by Lisa Holland
IMPROVE RELATIONSHIPS THROUGH ASSERTIVENESS AND LOWER YOUR STRESS TOO
A LOOK INTO MD ANDERSON CANCER CENTER’S WELLNESS PROGRAM ~ AN EMPLOYER CASE by Jane Sherwin
CORPORATE WELLNESS ~ A GLOBAL PHENOMENON WITH WORLDWIDE RESULTS by Glenn Riseley
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REMAKING HEALTHCARE IN GEORGIA
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THE FUTURE OF THE AFFORDABLE CARE ACT
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by Archil Undilashvili, Brian McCotter and H. Kenneth Walker
by David Goldstein
RETURN ON INVESTMENT MODELS FOR EMPLOYEE WELLNESS ~ FACT OR FICTION? by Jonathan Spero
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49 The Environment of Change by Neil Treitman and Mache Seibel
WHY HEALTHCARE REFORM IS A “PERFECT STORM” by Kevin Seeker
FOLLOW US ON:
WORKSITE WELLNESS
Is Your Organization a Healthy Enterprise? Written By Steve Cyboran
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WORKSITE WELLNESS
major, but often unrecognized, factor underlying most employers’ health care problems is that the current system was designed to treat rather than prevent illnesses. The result, as Dr. Nancy Nielsen, the president of the American Medical Association, noted, is that “We are living longer, but we are not living healthier.” Moreover, the relatively poor health of Americans has the potential to undermine an organization’s ability to execute its strategy. For example, according to one study, employees who have three or more health risks have health care expenditures that are 38 percent higher and absence-related costs (i.e., short-term disability, workers’ compensation and incidental absence) that are 30 percent higher than those for employees who have fewer risks. In addition, the costs of health-related productivity problems are, on average, 2.3 times greater than medical and pharmacy costs. To build on this notion, the World Health Organization defines health as “a state of complete physical, mental and social well-being and not merely the absence of infirmity.” Recognizing these factors, some forward-thinking organizations — what we call healthy enterprises — have taken steps to address both the health and the health care needs of their employees. They do so by partnering with their employees on not just health care problems, but also on preventive health care solutions that aim to optimize health and fitness, not just eliminate risks. This shift is evident in the orientation many organizations demonstrate as they strive to become a fullfledged healthy enterprise.
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The Continuum of a Healthy Enterprise Based on investigations of best practices, our independent research and experience with clients, Sibson Consulting has identified three stages of healthy enterprises:
1. Focus on Treatment In the first stage of the continuum, the
focus is reactive rather than preventive. The organization addresses behaviors and health issues after they occur. Many organizations in this stage become aware of issues through large claims increases or workplace incidents and concentrate on reducing costs rather than
Companies in this stage are increasingly proactive in sharing responsibility and encouraging safety, personal accountability and health risk and condition management through healthy personal and workplace behavior.
3.
improving health and behavior. Enterprises that focus on treatment may overlook the costs associated with productivity losses caused by health-related absences or disruptive workplace behavior.
2. Focus on Prevention/Management
In the second stage of the continuum, the focus is more proactive. The organization promotes better physical and mental health for employees and family members by helping them to identify health risks and conditions and then address them through supportive resources.
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Focus on Optimal Behavior and Health
In the third stage of the continuum, the focus moves beyond risks and conditions to a demonstrated commitment to improve the health and behavior of employees and the organization. This is imbued throughout the culture as a means to enable employees to engage fully in their work and their personal lives. (See the sidebar “Optimal Health.”) Evidence of a “healthy culture” is reflected in all aspects of organizational behavior, from encouraging a teambased environment with a climate of trust and respect to maintaining a smoke-free environment. Healthy behavior is encouraged, exhibited and rewarded. Some healthy enterprises also consider the financial wellbeing of their employees as part of the total picture. Trying to achieve a healthy culture right out of the blocks can be a daunting task that is outside the scope of HR. A more realistic approach is to start by defining a strategy that clearly aligns with and supports the business strategy. Companies can then begin by making investments that optimize success within the current culture. Many organizations start promoting health and wellness by repackaging the programs and services they
Optimal Health A number of organizations are taking a growing interest in the holistic health of their employees to promote complete health and fitness. Optimal health is defined as “a balance of physical, social, spiritual and intellectual health.”* *Source: O’Donnell, American Journal of Health Promotion, 1989 3(3):5
WORKSITE WELLNESS already have in place to support the strategy. They then add resources (e.g., health-risk assessments and screenings) to help employees and their families understand their risks and conditions and to better manage them through behavior modification (e.g., using health coaches, education and other tools).
second stage will focus on managing risks and conditions by shaping behavior. An organization in the third stage, however, will focus on optimizing health and behavior by maintaining a healthy culture that is evident at every level of the organization.
In addition to this strategic orientation, each stage of How Healthy Is Your Organization? maturity is characterized by its approach to addressing the various elements of its programs/initiatives, such as health A number of factors differentiate the three stages of a healthy plans, time-off programs, workplace support, behavioral enterprise. For example, where an organization in the first health programs, communications, organizational behavior stage will primarily be reactive in treating conditions and and measurement and metrics. (See the table below, for a dealing with unacceptable behavior, an organization in the sample of key distinguishing features.)
KEY DISTINGUISHING FEATURES ALONG THE HEALTHY ENTERPRISE CONTINUUM Focus on Treatment
Focus on Prevention/Management Focus on Optimal Health/Behavior Characteristic Distinguishing Features Provides high-quality and costReduces health risks and manages Optimizes health and fitness Health effective treatment conditions Replaces pay, manages disability and Advocates safety, accountability and Promotes life-long health and personal Time-Off returns people to work risk management and professional renewal Behavioral Health
Addresses personal and work-related Addresses factors leading to substance Promotes a “whole-life” approach to mental health/substance-abuse issues abuse and mental health issues maximize all aspects of personal wellbeing — mind, body and spirit Shapes desired behavior Organizational actions are consistent Organizational Addresses unacceptable behavior with the organization’s values Behavior
While relatively few organizations have evolved into full-fledged healthy enterprises, their numbers are increasing as more leaders recognize the strategic benefits of leveraging a strong health orientation into improved productivity in support of financial success. (For a look at how one employee might fare at organizations in each of the three stages of a healthy enterprise, see the sidebar “Three Health-Focused Enterprises: One Hypothetical Employee’s Experience.”) *Source: Sibson Consulting
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Three Health-Focused Enterprises: One Hypothetical Employee’s Experience One way to illustrate the differences in the three stages of a healthy enterprise is to look at what would happen to a key employee named D.K. (a 55-year-old male who is at risk for developing heart disease), depending on the kind of organization for which he works: Focus on Treatment D.K. is driven to develop risk factors for heart disease by years of eating unhealthful food coupled with increasing pressure in the workplace. His underlying risk factors go undetected for years and his heart disease is likely to be diagnosed as the result of a medical emergency. D.K. may need surgery, which will mean an extended absence from work and lost productivity. When he returns, he may find it hard to commit to healthier behavior due to stresses and temptations in the workplace. D.K. also will be challenged to get the mental and emotional support he needs to change his health-risk behavior. Focus on Prevention/Management D.K. receives strong support at work and may become aware of his risk for heart disease through a health-risk assessment, for which he receives an incentive to complete before he develops clear symptoms. He may also receive support from various programs to delay the onset of the condition, but he will still face challenges in the workplace and will probably revert to his previous behavior. Focus on Optimal Health and Behavior D.K. works in a strongly supportive environment that encourages and incentivizes healthy behavior, which makes him less likely to develop risk factors for heart disease. He learns the importance of personal renewal and taking care of his health for both personal and professional reasons. D.K. understands the organization’s commitment to a healthy workforce. Moreover, he views the organization as a support system for a healthier lifestyle, with leadership serving as models of healthy behavior and an environment with limited temptations and potential pitfalls.
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WORKSITE WELLNESS How to Become a Healthy Enterprise The first step to becoming a healthy enterprise is to develop a healthy enterprise strategy and identify opportunities for improvement. (For a look at the outcomes achieved by one organization, see the sidebar “Research University and Health System Case Study.”) Some of the steps that may be part of the strategy development include: Develop a philosophy and strategy, a health and productivity mission and vision that supports the organization’s goals and fits its culture. Establish clear guiding principles that become the foundation for testing each current and future investment made. The strategy statement will shape the focus of the initiative. Conduct a wellness inventory to identify the existing wellness benefits and practices included in the organization’s health and welfare plans (i.e., medical, prescription drug, disability, dental and vision) as well as any supplemental wellness benefits (i.e., an employee assistance program, work/life programs, safety training, online resources and official/unofficial workplace programs and support). Assess the effectiveness with which wellness benefits and programs are branded, communicated and made accessible to employees. Look at whether current practice supports the organization’s vision and strategy and determine whether the health plan presents barriers to healthy behavior (e.g., no coverage for nutritional counseling).
Establish a metrics scorecard to measure the progress of achieving the strategy. Although there may be thousands of items an organization may track and measure, an organization needs to be selective and identify those key metrics that will track progress toward achieving the stated strategy. Metrics need to include markers that lead to success (e.g., participation, satisfaction and behavior change) as well as the outcomes themselves. This requires looking beyond utilization and biometric statistics that just measure physical health. Research indicates that there are actually five dimensions to our health (physical, intellectual/mental, emotional, social and spiritual) that need to be measured. In addition, organizational measures need to be included (e.g., a climate of trust and respect). Conduct a cultural assessment to review the behavior that affects the organization’s health. This evaluation needs to examine the relationships between the organization’s healthy enterprise investments and the employees’ sense of affiliation, work content, career opportunities, benefits and compensation. Establish a communication strategy to get leadership and the workforce to embrace the initiative and shape the desired behaviors. After an organization has defined its strategy, it needs to devise a plan to implement it. It is of utmost importance to keep things fresh and respond to new ideas and initiatives as they present themselves.
Most organizations seek to optimize their workforce by reevaluating all of their investments to determine what is essential to carry out their business strategy while maintaining and enhancing the current and desired culture of the organization. A well-thought-out healthy enterprise initiative can lead an organization to better control its health care, turnover and absence-related costs while helping its employees stay engaged, healthy and productive. 9 CorporateWellnessMagazine.com
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Research University and Health System Case Study A large research institution with extensive investments in various health initiatives aimed at controlling costs, requested assistance to: Facilitate discussions between its faculty, staff and leadership to define the desired state of health care on campus, and Identify the metrics and stages of maturity across the different dimensions of a healthy campus so it could measure and communicate progress.
The Solution
Sibson Consulting helped conduct literature research to identify state-of-the art practices in both higher education and business. Sibson worked in partnership with the institution to develop a “straw man” of the desired state that was used in focus groups with key clinical and administrative leaders to finalize the desired state and profile of a healthy campus. Metrics were developed to measure the current state along with the institution’s progress along the stages of maturity toward its desired state.
Result
The institution’s health care costs have increased only 1 percent per year for the past four years. There has been significant improvement in participation, compliance rates, rates of absence and outcomes for targeted programs addressing prevention, diabetes, cardiovascular disease and pediatrics. Annual savings are conservatively estimated to be approximately $18 million. Specific documented outcomes include: Reduced rates of hospital admissions, emergency room visits and average lengths of stay for those admitted to the hospital, Lower health risks with large percentages of participants becoming risk-free (e.g., over five years, 69 percent of participants who were at risk for cholesterol and 59 percent for blood pressure became risk-free); the institution’s smoking rate is almost 70 percent lower than the national average (, and
A 17 percent decrease in the use of sick leave over a four-year period for the non-exempt staff.
Bio Steven Cyboran is a vice president and consulting actuary in the Chicago office of Sibson Consulting. He leads Sibson’s Healthy Enterprise Initiative and has been actively involved in a variety of projects focusing on cultural transformation. He can be reached at 312.984.8558 or scyboran@sibson.com.
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Improve Relationships
Through Assertiveness and Lower Your Stress Too Written By Jaquelyn Ferguson
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ssertiveness means standing up for your own rights in a way that respects the rights of others. It’s one of the best ways to lower stress and why I include a section on this self-esteem boosting skill in all wellness programs.
It’s Based on Basic Human Rights Assertiveness was created in the 1970s by Robert Alberti and Michael Emmons, authors of the groundbreaking book, Your Perfect Right, for their female clients who were doormats to the people in their lives. They noticed how people treated each other depended upon whose rights were being respected, such as, you have the right to:
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There are four communication styles that exist along a violates the rights of others; you’re concerned with getting continuum from which you can choose no matter the what you want without concern about others getting what situation. Each style honors different parties’ rights and they need; each +brings about a different outcome. 3. Passive-aggressive: The indirect expression of 1. Passive: Not standing up for yourself, or ineffectively anger or frustration; it appears passive and non-hostile but doing so that your rights are easily violated; you allow you sabotage the other person; you’re too indirect to assert others’ rights to be more important than your own and cave your own needs so communicate in a manipulative way, in to others’ wants and needs denying your own; like through gossiping in a covert attempt to defend your rights; 2. Aggressive: Standing up for yourself in a way that 4. Assertive: Standing up for yourself in a way that CorporateWellnessMagazine.com
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FEATURES respects the rights of others; you’re direct, honest and appropriate in expressing your feelings and opinions; Assertive people accept others’ rights are as important to them as yours are to you. When rights collide the assertive assumption is that you’ll negotiate in a way that helps everyone get their most important needs met and their rights respected, which is easier said than done.
Rights and Responsibilities
achievers. Since balance between extremes is mentally healthier being overly passive or aggressive is unproductive, not to mention stressful.
Passivity Decreases Control, Raises Stress Women have progressed significantly on the road to assertiveness over recent decades but some things haven’t changed much.
There were two fascinating videotaped research experiments that aired on ABC’s 20/20 in 2006. In For every right there’s a corresponding responsibility each the test subjects were either one or two boys or that we often forget in our rights-oriented society. For one or two girls ages 9 – 11. The researchers said example, to be respected your responsibility is to act the results broadcast represented how virtually every in respectable ways, which includes treating others child reacted. with respect, honoring your word, etc. In the first experiment children were given a glass of Your choice of reactions -- from passive to assertive lemonade that had no sugar but rather salt added to it. -- brings about different results. Identify your goal When the girls took a sip they grimaced and said, “Gee in situations and determine which of these styles is that’s good. Thanks.” The boys gagged dramatically most appropriate. Hopefully, you’ll usually choose and said, “Why did you give me this? It’s terrible!” assertive responses. Sometimes, however, a nonresponse may be your wisest choice. For example, a colleague speaks disrespectfully to you in front of a customer. Your goal is to remain calm and give great service so you ignore her (it can be assertive to appear passive). This choice helps you accomplish your goal.
Caution: “I train people how to treat me,” is one
of my favorite quotes (Source Unknown.) If you allow someone to treat you disrespectfully without responding you’re training that person it’s OK to treat you that way. Next month I’ll provide several skills for standing up for yourself.
Women are Still Socialized to be More Passive, Men to be More Aggressive Historically, females have been socialized to be passive people-pleasers while males to be aggressive 13 CorporateWellnessMagazine.com
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In the second experiment the children were given a giftwrapped-box. In each was a pair of socks or a pencil. Virtually every little girl upon opening hers remarked, “Thank you, I could use a pencil.” Virtually without fail the boys opened up theirs and exclaimed, “What a stupid gift!”
Passive Non-verbal Communication
When asked why they said the lemonade was good virtually every girl said, “I didn’t want to hurt your feelings.”
• Poor or averting eye contact; • Slumped, pulled-into-yourself posture; • Protective stance, appears compliant and hesitant; • Pouting, crying;
These girls were acting out their socially sanctioned role by deferring to others’ needs. As Oprah said, “When you don’t stand up for what you need, you slowly strangle your spirit.” If you strangle your own spirit you won’t get your needs met, either. You’ll live in greater frustration, therefore stress. To get what you want you’ll rely on indirect, unhealthy ways like passive-aggressive manipulation, hinting, and suffering.
You can generally spot a passive person a mile away. I’ve heard multiple interviews with prison inmates who in describing their vulnerable targets describe passive behaviors:
• Beat around the bush conversationally; • Fidgety, playing with face, hair, earrings, neck-tie; • Head down; • Tentative, soft, small voice, poor projection; • Hedge phrases (“sort of,” “maybe”); • “Silent words” (dramatic sighs, slamming doors); • Tag questions (following a statement with, “don’t you think?”); • Indirect communication; “closet hinters”; Passive people are often overly concerned with what others think about them, can be excessively apologetic, and need be liked so try to please others. To be taken seriously passive people must take themselves seriously.
Aggressive Behavior is Stressful, Too Aggression means standing up for yourself in a way that violates the rights of others. It’s often confused with assertiveness but there’s a huge difference: Assertive people respect others’ rights; aggressive people are unlikely to consider others’ rights. Aggressive people tend to see life as a win/lose game 14 CorporateWellnessMagazine.com
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FEATURES with little appreciation for the win/win mentality. who Their competitiveness fuels their need to be right, does anything!” to win and to score points. They can be overly • Name callers, “You’re incompetent.” goal-focused and assume if you get what you • Threats: “If you make me look bad again, I’ll want they won’t get what they want. make your life miserable.” • Demanding of others; may use fear to get what They’re more likely to get their way but may feel they want; guilty afterward. Plus, they also suffer hidden • Blame: Frequent “you” messages, “You’re not a consequences like the “20 second payback.” team player.” Synectics of Boston, MA coined this term. In videotaped research they discovered that when a person perceived himself to have been disrespected it took him on average 20 seconds to get even for the affront. His payback might be to sabotage his opponent, skip work, etc. He may not actually get even within 20 seconds but at some level of awareness decided to at some point.
Aggressive people becoming more assertive are generally met with greater receptiveness than are passive people becoming more assertive since others often want them to remain submissive.
• Use of touching to intimidate;
Assertive Non-verbal Behaviors
Assertiveness Enhances Self-esteem, Control
Greater assertiveness leads to increased control Aggressive people may win the battle but they in your life, higher self-esteem and less stress. often lose the war. It doesn’t mean you’ll get everything you want all of the time but you’ll increase your batting Aggressive Non-verbal Behaviors average. Your frustration lessens, you become more flexible with others, others cooperate more with you – it’s a package deal. • Invade others’ space; • Daring non-verbal behavior like an aggressive stance; • Hard eyes that bore into their “opponent;” • Forceful voice, possibly loud; • Racist, sexist, ageist language; • Exceedingly focused on the goal versus the people-side of interactions; • Overly direct and blunt; • Use of vocabulary to intimidate; • Abusive language, threatening tone and words;
Other Tactics
• Exaggerate, “I’m tired of being the only one 15
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It’s not what you say but how you say it that’s important. To be more assertive use respectful nonverbal behaviors, which also enhance your credibility: • Direct, appropriate eye contact; • Congruency between words and nonverbal behavior; e.g., if you’re upset you need to look upset;
• Confident stance: Shoulders back, chest out, head up; • Hands in comfortable position: In pockets, down by sides, clasped behind back or in front,
non-fidgety; • Even vocal tones so breathe! •“I” language, e.g., “I think this is unfair,” vs. “You’re unfair,” a “you” message; • Goal-oriented words; • Direct questions and answers; • Excellent use of listening skills;
Asserting Yourself Also Requires • Asking directly for what you want • Being tactful and honest; • Having concern for others’ feelings but not ruled by them; • Being personal responsible – you’re not responsible for others nor are they responsible for you; • Being willing to nip problems in the bud; • Positively confront others; • Negotiate fairly;
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Beliefs Drive Human Behavior~ Challenge Unassertive Beliefs Human behavior is driven by corresponding beliefs. For example, your supervisor believes that people cannot be trusted so she’ll probably exhibit micromanaging behavior. When it’s difficult to act assertively, it’s because you have inhibiting beliefs. Uncover and challenge them and you’re more likely to successfully assert yourself.
Passive Beliefs Drive Passive Behavior • I shouldn’t hurt anyone’s feelings. • I shouldn’t be bossy. • It’s rude to say “no.” • I shouldn’t disagree with authority figures. • You’re more important than I.
FEATURES Aggressive Beliefs:
Challenge Unassertive beliefs
• I’m the boss! • It’s my way or the highway. • I’m more important than you. • I’m right. • It’s important to win!
To be assertive consistently challenge your largely irrational beliefs with more rational ones. After you fail to assert yourself, identify the blocking beliefs and challenge them to gradually loosen their grip. When you discover the sky doesn’t fall you’ll develop more courage to stand up for yourself more frequently. It’s a freeing and powerful feeling well worth the risks!
Assertive Beliefs: • I respect and value everyone. • I work for inclusion, open communication and creative problem-solving. • Everyone’s rights are as important to them as mine are to me. • It’s better to set appropriate limits than to mislead people. • I’m not responsible for others’ emotions.
“Repetitive Why” Technique
In the above situation, you could: • Speak directly to him about your fears and perhaps he’d dissuade you of them; • Convince yourself that if you promise to do something you can’t deliver it’ll make you look bad and put him into a worse situation than if you’d been honest from the beginning.
To respond more assertively identify your underlying, hindering beliefs using “the repetitive To become more assertive requires conscious effort. It pays off through lower stress, better why technique:” relationships, higher self-esteem and more • Ask “why” you did something, then ask “why” control over your life. Next month we’ll look at how to do this. again for each successive answer: • E.g., You agreed to do something by 3:00 but know you can’t get it done: “Why did I just agree to do it when I know I don’t have the time?” “Because he’s always helping me.” • “Why must I repay someone even when I know I don’t have the time?” “Because it’s not nice to refuse.” • “Why isn’t being honest nice?” “Because it might hurt his feelings.” In this example, the underlying, inhibiting beliefs to assertiveness are: • It isn’t nice to refuse; • It may hurt his feelings; 17
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Bio Jaquelyn Ferguson is the founder of InterAction Associates, her speaking and coaching firm. For over 25 years Jackie has designed and presented keynotes and workshops on stress management, diversity, workplace harassment, motivation, and communication skills. Jackie is also a Stress & Wellness Coach helping people achieve more success with less stress. Jackie is the author of “Let Your Body Win: Stress Management Plain & Simple” and a weekly column “Stress for Success” in Gannett Newspaper, at www.letwin.com.
Join The Corporate Health and Wellness Association www.WellnessAssociation.com
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Corporate Wellness Magazine
CorporateWellnessMagazine.com | March 2011 14 w w w. C o r p o r a t e We l l n e s s M a g a z i n e . c o m
FEATURES
A Look Into MD Anderson Cancer Center’s Wellness Program ~ An Employer Case Written By Jane Sherwin
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n 1976 Bill Baun was flat on his back, staring at a brick wall outside a hospital room. Six months later he was in a full body cast. A youth activities director at a church in Dallas, he had been rear-ended at an intersection. “Across the hall I could see a young man who had lost both legs in a motor cycle accident. I realized I was really lucky. I decided I would get up and walk again, and that I was going to help others not as lucky.”
A Wellness Culture within Each Department
Senior management, from Bill’s point of view, is fully committed to wellness and prevention. “Leadership gives people the opportunity to be well. Patients as well as employees benefit as they learn to be cancer survivors. We are all human—many employees face the challenge of weight loss, and obesity is a huge factor for some cancers. So when a staff member can put a hand on a patient’s shoulder and say ‘I’ve been Today Bill is Manager of Employee Wellness Programs there, too—I lost 40 pounds last year,’ it can make a at The University of Texas MD Anderson Cancer difference.” Center in Houston, where he has been since 1999. MD Anderson is an 18,000 employee hospital with the “We work to set up a wellness culture within each mission “to eliminate cancer in Texas, the nation, and department,” said Bill. “Departmental leadership the world,” as its website tells us. “We’re a cancer accepts responsibility for their staff members’ wellness center,” said Bill, “and the high stress of cancer is part and we encourage the whole team to acquire the same of our business—our clinicians must deal with this knowledge, skills, and commitment. Everybody stress every day. At the same time, we’re a hospital, makes changes together.” The coaches work to get so we’re a wellness culture by nature.” leadership support, and usually it’s a manager who requests help for a team. “But when a manager is not
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FEATURES ready, the workforce team may invite us in and drive the program. “About three years ago we had a new coach who was a natural at small group work, and he set up a pilot intervention called ‘Simple Change.’ People had been calling him for individual coaching, and when he met with them, friends would want to join the coaching session. ‘Simple Change’ became a very successful small group change program where participants would get together and decide on their rules of engagement, meet weekly, and support each other in behavior change. We found that 80 percent of them were successful in what they chose to do, and 40 percent of the groups stayed together.”
Wellness is All About Relationships When Bill left his body cast behind in 1977, he decided to get a Master’s degree in exercise science—a brand new field at the time—from the University of North Texas in Denton. In 1981 he joined Tenneco, in Houston, Texas, which had set up one of the country’s first corporate fitness centers, free for every employee. “Tenneco was an oil conglomerate and oil was over $70 a barrel, so they decided to spend it on the health of their 101,000 employees worldwide. I started up 25 fitness and wellness programs around the world and managed the corporate headquarter center for 16 years—it was a blast, a lot of fun.” Under Bill’s direction, Tenneco was one of the first worksite programs to receive the C. Everett Koop Health Project Award. “At Tenneco,” said Bill, “I learned how to work my way through the system and spot ways to build relationships—wellness is all about relationships, especially with leaders, and this is even more 21 CorporateWellnessMagazine.com
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important in a big system.” Soon after he and a colleague had published the “Health Promotion Source Book for Small Businesses,” MD Anderson hired him as a ‘health and productivity consultant.’ “They had just started their wellness program for patients, and recognized the need to have healthy employees. Like most people they thought about wellness and prevention as programs and activities like classes and fitness centers.” But Bill believes that the heart of worksite wellness is not so much programs as changing the culture and getting and maintaining management support.
Wellness Works When it’s “In Your Face” Bill began at MD Anderson’s water coolers, putting up signs and quick tips about wellness, and quickly got at least 50 departments to be ‘water cooler program pilots.’ “It was just me for one or two years and I knew that wellness works when it’s in your face,” he said. “If it’s not in your face, it tends to get forgotten. It’s about perseverance and habits.” Today Anderson’s wellness coaches have a slogan: “We make house calls,” and they are all called ‘Coach.’ “In a hierarchical place like this, Manager Bill would be threatening. People see me and they say, ‘You’re the coach, aren’t you?’ Coach Bill has an easy and unthreatening ring to it, better than ‘personal trainer’ or ‘counselor.’ If you reach Bill’s voice mail you’ll hear, “Hi, this is Bill, your wellness coach.” His email signature ends, “Be well.” The MD Anderson wellness model relies on its internal staff to teach, facilitate support groups, and coach. Along with his four fellow coaches, 22 CorporateWellnessMagazine.com
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FEATURES
Bill stays intimately involved with worksite wellness for MD Anderson employees. Their only outside vendors are MediFit Corporate Services, who run their fitness center; Weight Watchers; and several local massage therapists. Recently they’ve been focused on changing the work environment. When the vending machine contractor refused to switch to healthier choices, they found a new vendor willing to make those changes. Unhealthy foods in vending machines are now priced higher.
Lactation Rooms and Stress-buster Stations
are female and at least 60 percent are in their childbearing years. Bill had learned at Tenneco the importance of lactation rooms and they now have 10 of these serving between 225 – 275 mothers each week. “They get companionship, they share their stories, and they feel better—so they get back to work faster, and their babies are healthier.”
Education and Social Networking Connections
In addition to department-specific programs, Anderson’s coaches offer hospital-wide courses. Several of the new courses for 2011 will include When a high-stressed physician in the palliative familiar topics like meditation and calming the care unit said, “If we just had an elliptical machine mind, along with Attitude, the Difference Maker; I could use for five minutes that would break my Put the Brakes on Stress!; and Tickling the Funny stress level,” Bill arranged for an elliptical to Bone. be nearby. The hospital now has stress buster stations – an elliptical, a band chair for strength When asked about social media and wellness, training, and a PreCor stretch trainer to increase Bill said, “It’s a great way for people to engage flexibility and promote relaxation, which, Bill each other, but not everybody is computer said, “takes up a small space and costs only literate or has time to be on a computer, or a $600.” cell phone. In some cases you can be fired if you’re caught surfing on a computer at work. On Almost seventy percent of Anderson’s employees line programming does not work for everyone. 23 CorporateWellnessMagazine.com
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Wellness portals and websites have a role in wellness, but they have yet to replace the value of face-to-face coaching, counseling or bonding in a support group. “People can be at work up to 12 hours a day. They spend so much time here that their networking with each other is very important. Learning to be well and realizing that we don’t do this alone is what worksite wellness is all about – it’s the social networking connections at work that can make a difference in getting and staying well.”
“
When he’s not coaching Anderson employees, said Bill, “I have to practice what I preach. I enjoy what I do at work so it’s hard to stop. I’m an avid walker and in-line skater. I do some weights but I like to be outside, chopping down trees, gardening. My daily stress relievers are meditation and taking time for myself. Move as much as you can and get outside after work. You can’t stop being active just because you get older.” He’s devoted to health at home and at work. “It becomes a passion, and my reward is doing well.”
If it’s not in your face, it tends to get forgotten. It’s about perseverance and habits.
”
Bio
Jane Sherwin is the owner of WordDrive Communications and a professional writer specializing in marketing materials for the health care industry. She works with health care clients to transform ideas and rough drafts into powerful communication tools, from newsletters and website copy to annual reports and sales proposals. WordDrive clients range from hospitals and home health agencies to health care consultants and associations. WordDrive is a business built on more than thirty years of experience in copywriting and healthcare, including twelve with Blue Cross Blue Shield of Massachusetts, a leading national provider of managed health care coverage. To reach Jane and learn more about how she can support your marketing initiatives, contact her at Jane@WordDriveCommunications. com or 617.489.1834. To learn more, visit her website: www.WordDriveCommunications.com, where you can sign up for her monthly e-newsletter.
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FEATURES
With the worldwide obesity epidemic continuing to snowball, employers face the challenge of making sure that their own workforce is healthy enough to turn up to work, and once there, that they’re productive and mentally fit enough to be able to perform their tasks. The distinction between mental and physical fatigue is getting harder to define, as workers seated for most of the day may be going home tired, but the energy they use is ‘above the neck’.
aim is to motivate workers to re-assess their sedentary lifestyles and make time for regular physical activity, by providing participants with a way of measuring their activity (using pedometers) and recording their results on an interactive website. Companies involved can compete with other companies taking part, or with groups or offices spread across the State, country or globe. Critically, the program helps participants develop new habits in relation to health and regular activity which often extend beyond the work place and into the homes and hearts of families.
Corporate Wellness ~ A Global Phenomenon with Worldwide Results Written By Glenn Riseley
Add to this the increasing hours we’re spending in the workplace and the common struggle to achieve work life balance, and perhaps unsurprisingly, we’re seeing an increase in work place health-related issues, from depression to Type 2 diabetes. We recognised this trend in early 2000, and developed a program that sought to address health issues by developing positive fitness habits in the workplace. In 2004, we launched the Global Corporate Challenge (GCC).
Over six years of being in operation, the Global Corporate Challenge team has collected data and statistics that demonstrate unequivocally how a regular program of daily exercise supported by employers positively affects productivity, emotional wellbeing, and attitudes towards physical activity. Our data also reveals some fascinating insights into the most and least active industries in the US.
Through the GCC, we are making corporate wellness a sound business strategy for workplaces worldwide. Since The figures from the US are based on an extraction from launch in 2004, the program has reached 65 countries the GCC database, and give a simple indication of the including the US, with nearly 250,000 participants. Its activity levels and weight of different industries, based CorporateWellnessMagazine.com
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W
ith the worldwide obesity epidemic continuing to snowball, employers face the challenge of making sure that their own workforce is healthy enough to turn up to work, and once there, that they’re productive and mentally fit enough to be able to perform their tasks. The distinction between mental and physical fatigue is getting harder to define, as workers seated for most of the day may be going home tired, but the energy they use is ‘above the neck’. Add to this the increasing hours we’re spending in the workplace and the common struggle to achieve work life balance, and perhaps unsurprisingly, we’re seeing an increase in work place health-related issues, from depression to Type 2 diabetes. We recognised this trend in early 2000, and developed a program that sought to address health issues by developing positive fitness habits in the workplace. In 2004, we launched the Global Corporate Challenge (GCC). Through the GCC, we are making corporate wellness a sound business strategy for workplaces worldwide. Since launch in 2004, the program has reached 65 countries including the US, with nearly 250,000 participants. Its aim is to motivate workers to re-assess their sedentary lifestyles and make time for regular physical activity, by providing participants with a way of measuring their activity (using pedometers) and recording their results on an interactive website. Companies involved can compete with other companies taking part, or with groups or offices spread across the State, country or globe. Critically, the program helps participants develop new habits in relation to health and regular activity which often extend beyond the work place and into the homes and 26 CorporateWellnessMagazine.com
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hearts of families. Over six years of being in operation, the Global Corporate Challenge team has collected data and statistics that demonstrate unequivocally how a regular program of daily exercise supported by employers positively affects productivity, emotional wellbeing, and attitudes towards physical activity. Our data also reveals some fascinating insights into the most and least active industries in the US. The figures from the US are based on an extraction from the GCC database, and give a simple indication of the activity levels and weight of different industries, based on employees that took part in the program in 2010. The figures don’t make conclusions; they highlight potential ‘problem industries’ (in terms of corporate wellness, these are the most sedentary industries) within the United States. Employers within these industries should be assessing the health of their workforce and determine whether further action needs to be taken. The research from the UK, conducted externally and independently by the Lancaster University, looks at the link between exercise, workplace productivity and mental wellbeing, using a sample size of 922 employees who took part in the program. This research draws broad conclusions about the positive effect of exercise on employee mental health and productivity, and also a business’ overall bottom line.
Physical Activity and Weight Averages in US Workplaces In 2010, employees from a variety of industries in the US took part in the Global Corporate Challenge. Our program encourages employees
FEATURES to take at least 10,000 steps per day for 16 weeks. Participants were from industries including health, IT, manufacturing, hospitality, retail, accounting, plus many others. By the end of the program, participants around the world had increased their average daily
step count to an average of 12,693 steps per day. Worldwide, 42 percent of participants lost weight and the average weight loss was 10.5lbs. Participants walked a total combined distance of 45,782,485 mi, the equivalent of walking across the entire USA 15,260 times. US participants added over 3.5 billion steps to this tally.
US Stats and Facts GCC used the data from 3,468 event participants to rank industries in order of physical activity and weight. The overall results indicate that a number of industries in the US exceed the average weight range for males and females.
Activity Statistics The three most active industries in the US, based on average steps taken per day throughout the GCC:
The three least active industries, based on average steps taken per day throughout the GCC:
1. Manufacturing and Operations; 2. Insurance and Superannuation; 3. Government and Defence.
1. Advertising, Sales and Marketing; 2. Consulting and Corporate Strategy; 3. Education and Training.
Weight Statistics According to National Health and Nutrition Industries with the highest average weight males: Examination Survey (NHANES) conducted from 1999-2002: 1) Advertising, Sales and Marketing (220.7 lbs) 2) Hospitality and Tourism (211.4 lbs) • the average weight of an American woman is 3) Science and Technology (211.2 lbs) 162.9 pounds • the average weight of an American man is Industries that recorded the highest average 189.8 pounds weight loss per person following completion of the Global Corporate Challenge. Industries with highest average weight females: 1) Electricity, Gas and Water Supply (12.3 lbs) 1. Hospitality and Tourism (176.0 lbs) 2) Real Estate and Property (11.8 lbs) 2. Education and Training (176.0 lbs) 3) Banking and Financial Services (11.2lbs) 3. Science and Technology (173.8lbs)
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Lancaster University Study into the Effects of Physical Activity on Workplace Productivity and Mental Health - UK According to research undertaken by the UK’s Lancaster University Centre for Organisational Health and Wellbeing, employees who increased their step count to take between 9,000 and 15,000 steps per day recorded significant improvements in their productivity and engagement levels at work. The survey also showed that the program changed employees’ permanent approach to exercise, demonstrating longer lasting health and productivity benefits than the 16 week GCC period. More than 90 percent of those that took part said they intended to maintain their current level of exercise, and nearly 60 percent said that the GCC had changed their long term approach to exercise.
Research Study ~ Centrica Gas, UK The research focused on 922 employees at Centrica, a UK energy provider, where participants were surveyed before and after taking part in the Global Corporate Challenge. Overall, 82 percent of Centrica employees said the GCC had a positive impact upon their health, with employees recording significant improvements in their perceptions of:
• • • • • • • • •
Their level of concentration at work Their feeling of playing a useful part in things at work Their capability to make good decisions Their capability of overcoming their difficulties Their enjoyment of day to day activities Their ability to face up to their problems Their confidence level Their self-esteem Their general happiness
Centrica employees were more likely to feel satisfied with their current employment following the completion of the GCC. In addition, employees who increased their daily activity through the GCC said they felt less stressed about their family, health, emotional wellbeing, their work and finances, compared to before they took part in the program. The results of the research have highlighted a phenomenon that has the potential to improve workplace culture and productivity, and will have a major impact on the way employers view the health of their employees. 28 CorporateWellnessMagazine.com
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FEATURES
According to the Wellness Council of America, job stress in the United States is estimated to cost $200 to $300 billion annually in absenteeism, tardiness, and lost productivity. Because an increase in physical exercise can improve the overall mental wellbeing of the workforce and increase productivity, the GCC and its associated health benefits impact positively on a company’s bottom line.
company culture in a positive and quantifiable way. While the World Health Organisation has warned that sedentary job functions increase the risk of chronic disease amongst white-collar workers, the Lancaster University report has demonstrated that the simple act of putting one foot in front of the other can make for healthy employees and healthy profits alike.
The outcome is that employers who invest in the physical health of their workforce will benefit More information about the GCC can be found from the flow on effect of increased performance at www.gettheworldmoving.com and improved mental health. This will impact 29
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Remaking Healthcare in Georgia Written By Archil Undilashvili, Brian McCotter and H. Kenneth Walker
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FEATURES
W
hile many of the world’s first ladies travel their countries to spotlight pressing issues, the first lady of the republic of Georgia, Sandra Roelofs, went abroad last month to raise awareness about her favorite cause: transforming Georgia’s healthcare system. With her help, Georgia convened a high-level discussion in Washington, D.C., between international healthcare professionals and doctors from the Georgian diaspora that spotlighted important, universal lessons about moving from authoritarian histories to democratic futures, and from central economies to market ones. Citizens of nations going through this transition to freedom consider access to healthcare an inalienable right. Georgia’s two-day forum demonstrated the importance that improved medical care can play in building support for a country’s democratic reform -- and will continue to play in Georgia’s evolution as a model for transformation in post-Soviet nations and elsewhere. It’s painful to recall what Georgia was like in the early 1990s: no electricity in winter time, corrupt traffic police shaking down motorists, no functional banks (let alone supermarkets), and a once-reliable central healthcare system that was underfunded and failing. A general feeling of post-Soviet malaise pervaded the population. But uplifted by the Rose Revolution in 2003 -- led by a Westerneducated modernizer, President Mikheil Saakashvili, Roelofs’ husband -- a new generation of young leaders has revitalized the country, society, and people. In the process, inefficient, centralized state health facilities were privatized, underwritten by the growth of the private health insurance industry. Individuals who live below the poverty line now have their healthcare paid for from public funds but provided by private insurers. New hospitals and clinics are slowly replacing old, deteriorating facilities. Today, while most of the former-Soviet Union continues to struggle with autocratic rule and resource dependency, Georgia has transformed itself into a functional democracy with a 31 CorporateWellnessMagazine.com
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market-oriented economy, and the accompanying success in delivering health services to the people has helped consolidate support behind the transition.
residency training at Emory; eighteen Georgians have received Master’s Degrees in Public Health; and we have organized bilateral exchanges of seventy-five medical students. Emory faculty have collaborated extensively with Georgian Amid this achievement, much remains to be colleagues in AIDS and tuberculosis programs, the done if Georgia is to provide modern, cost- introduction of emergency medicine to Georgia, effective healthcare to its citizens. The current and most recently a nurse training and education medical school curriculum was designed in project that upgraded the skills of 1,000 nurses. the 1930s and has evolved little since. While Georgian physicians are trained superbly in the What’s needed now is a clear vision of where fundamentals—their physical diagnostic skills Georgia’s healthcare system should head, and benefit from clinical examination that has been a long-range plan for how to get there. We and discarded in more modern medicine—they many others from the Washington forum are eager have no access to modern technology, and they to help generate such a strategic plan and look to cannot use the clinical data that forms the core the government of Georgia to lead the effort. of medicine in developed countries. Continuing education -- a vital requirement for physicians It is time once again to take the energy and courage and nurses -- does not formally exist in Georgia, that resurrected a downtrodden nation and focus it so there is limited opportunity for improvement. on reenergizing the reform of Georgia’s healthcare Because of outdated Soviet models, some essential system. We have no doubt that through this specialties, including emergency medicine, do not process, other countries moving towards greater exist. Nursing is in a similarly dire state; in fact, democracy will continue to find inspiration in the there are more physicians than nurses in Georgia. example Georgia sets. This is where Mrs. Roelofs comes in. The forum she hosted sparked a dynamic debate of ideas about how to harness the energy, resources and commitment of Georgian doctors in the Diaspora, government officials in Tbilisi and stakeholders in the United States to improve healthcare in Georgia. There is a model for this sort of engagement. Since 1992, Emory University -- and more recently, Partners for International Development, the non-governmental organization that implements many of Emory’s international programs -- has worked with Georgian partners to improve the healthcare sector, with assistance from the United States Agency for International Development (USAID). Fifty physicians have received 32 CorporateWellnessMagazine.com
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Bio Dr. Archil Undilashvili is the
Director of International Programs in the Department of Medicine at Emory University and Director of Partners for International Development
Brian McCotter is a Board
Member of Partners for International Development (PfID) and an international development consultant.
Dr. H. Kenneth Walker is
Professor of Medicine at Emory University and Executive Director of Partners for International Development (PfID)
The Future of the Affordable Care Act ~ Foreseen Challenges and Implications for Insurance Companies and Medicare Patients Written By David Goldstein
T
he Affordable Care Act will have numerous effects on the healthcare industry. Most notably to insurance agents, brokers, Medicare and Medicaid patients.
of their premiums on medical care. If they fail to hit the 85% mark they will be required to offer rebates to their enrollees. For small groups the percentage for the rule is 80%. One major effect that this is going to have on the industry is going to be the commissions for agents and Healthcare Reform & Insurance brokers. They will no longer be receiving the Companies same commissions they have in the past as many may move to a one-time fee setup instead The Affordable Care Act (ACA) has meant big of in the past what they have seen which could changes for premiums. Large groups with 100 have been a few hundred a month. or more enrollees must now spend at least 85% 33 CorporateWellnessMagazine.com
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Insurance companies will see a drastic change to their current commissions. These regulations are going to cause many people to lose their coverage as some insurance companies will be forced to shut down. These plans, called limited or ‘mini-med’ plans are lower cost plans which don’t provide enough coverage to be considered ‘essential benefits’ under the new law. The effects will be a lack of coverage and higher premiums. The elimination of these plans will lead to a lack of competition resulting in an increase in premiums and many without coverage. However, the Department of Health and Human Services (HHS) can provide a one year waiver to those plans whose elimination will cause a major disruption in their market. In simple terms, a major disruption means a significant increase in premiums or a 34 CorporateWellnessMagazine.com
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significant decrease in access to care. Currently about 900 companies covering 2.4M people or 2% of all those with employer sponsored coverage have received waivers from HHS to remain in business. Shareholders will be upset so the company will raise the cost of premiums to make up the difference. Another interesting point to note is that the ACA has placed a new tax on executive pay
to all those who work in the health insurance industry. Specifically, insurance companies will no longer be able to deduct the payroll costs of executives who earn over $500k a year. This means that the first $499k can be deducted but any earnings thereafter will be taxed at the full rate. On the surface, this may appear as a way to keep costs down; however it will most likely have the opposite effect. The likelihood of finding a CEO willing to run a billion dollar company for less than $500k a year is very rare. Instead, that person would use their skills and talents in other companies where they will make more money. As a result, insurance companies will pay these folks what the going market rate is for CEOs (well over $500k a year) and will incur a big tax hit for doing so. This of course will affect their bottom line; to offset that, the companies will raise the cost of premiums to make up the difference. Ultimately, it will be the purchasers of health insurance who end up paying for the extra payroll tax. There is currently 1 Geriatrician for every 2,700 Americans over the age of 75. A major benefit for patients resulting from the ACA is that nobody can be denied coverage or care. In 2012, no matter how sick one is or how much cost they’ve incurred, they will have access to care. The law further mandates that those who are sick cannot be charged more than those who are healthy. As great as this provision is, it unfortunately removes the power of incentives which will create an economic inefficiency. Meaning there is no longer a financial reward for becoming less sick and therefore requiring less care and thus less cost. Yes, the ACA does impose a fine to those who do not purchase health insurance, however those fines or penalties will be much less than the cost of health
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coverage. Since the ACA mandates that insurance premiums must be equal, insurance companies will have to raise the rates of the healthy to match those of the sick.
The Effects on Medicaid Many states are on the verge of bankruptcy due to the effects of the Great Recession. One of those in particular, high unemployment, is taking its toll on Medicaid. The reason is that as people have lost their jobs, they’ve also lost their health insurance leaving with no choice but to join their state’s Medicaid program. To help alleviate some of this burden, part of the 2009 stimulus package provided short-term cash to the states, however much of that cash is now drying up. As a result, 33 governors recently wrote to members of Congress as well as the Obama Administration asking for relief from many of the health care related federal mandates. For example, in California, Governor Jerry Brown is asking to cut $1.7 billion from his state’s Medicaid program by limiting the number of visits to a physician to 10 per year. Likewise, Arizona Governor Jan Brewer is trying to cut 280,000 people from their Medicaid rolls. These states simply cannot afford to continue in this manner. To make matters worse, more and more physicians are not accepting Medicaid patients. Because they get paid so little and are burdened with tedious paperwork, many of these doctors just don’t feel that it’s worth their time. The problem further intensifies when an additional 16 million people will be added to the Medicaid system per the ACA. Without an extra capacity of providers, existing Medicaid patients will have to compete with new enrollees to get access to physicians. Most likely, these patients will continue using their local hospital’s
emergency room, which is costly to the system and inefficient for both patients and hospitals. Unless changes are made, in 2019 there will be 84 million people on Medicaid rolls costing $900 billion a year.
Medicare Donut Hole Starting this year, the ACA will begin closing The Medicare Donut Hole, the portion of prescription drugs that Medicare beneficiaries must pay for. For instance, there are minimal out-of-pocket expenses on the first $2,800 for prescription drugs, then the ‘Donut Hole’ kicks in where the individual is on the hook for the next $3,600, and then relief kicks back in for all medications going forward. For those who hit the donut hole in 2010, they will receive a $250 rebate from the government. In addition, Medicare patients this year will also receive a 50% discount on brand-name drugs in the donut hole. The goal is that this donut hole will be completely closed by 2020. Another benefit of the ACA is that it eliminates all co-payments for preventive services to all Medicare patients.
this continues, Medicare will become insolvent by 2030 as more money will be required to be spent. Another problem Medicare patients are finding is that there are less and less qualified primary physicians and geriatricians. The reason is simple; doctors in these specialties make less than those in other fields. If these trends continue, there won’t be enough people properly trained to take care of an aging population. According to the American Geriatrics Society, there are now 7,000 board-certified Geriatricians in the US. That is 1 for every 2,700 Americans aged 75 and older. It is estimated that by the year 2030 this ratio will drop in half to 1 Geriatrician for every 5,500 seniors.
Conclusion
Even though it is difficult to see exactly what the Affordable Care Act will mean for insurance companies and Medicare patients it is clear that lots will change over the next few years. It will be interesting to see how insurance companies Medicare ~ Access to Care will adjust without large commissions and what A growing concern for Medicare patients is in the system is going to do to prepare for the large finding a physician who is willing to treat them. number of seniors entering into Medicare. Since the cost of running a doctor’s practice is increasing significantly and the payments they receive from Medicare is decreasing rapidly, David Goldstein, President many doctors are no longer accepting Medicare of Health Options Worldwide patients. In fact, about 25% of seniors looking (HOW), has extensive experience for a primary care doctor are having trouble in the healthcare industry. HOW finding one that will see them. The timing of delivers a tailored network of this is unfortunate as this year marks the time global medical facilities within when the first of the 75 million baby boomers our technology platform to engage employees into turn 65 and thus start joining the Medicare bettering their health as well as reducing overall system. If left unchanged, this will have healthcare costs. For more information visit severe consequences as the baby boomer Http://www.HealthOptionsWorldwide.com or contact generation has more health problems than David.Goldstein@healthoptionsworldwide.com . other generations in the past. In fact, if
Bio
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Return on Investment Models for Employee Wellness ~
Fact or Fiction? Written By Jonathan Spero
C
orporate wellness programs have been reported to improve employee health, increase productivity, and yield a significant return on investment for the employer. Wellness trade publications, conference presentations, and employer and vendor studies are chock-full of case studies claiming the impressive ROI of employee wellness programs. Portions of these reports and studies are very solid. But even data from the most respected corporations are incomplete. None come close to proving that, as a whole, their wellness programs are working. Furthermore, both vendors and employers are applying wildly unrealistic financial goals. Even some of the most esteemed proponents of wellness as a worthwhile investment have acknowledged privately that the real ROI of employee wellness programs is probably in the range of 1.1:1 to 2:1.
theoretical dollars. In order to persuade senior management, especially chief financial officers, of the value of wellness programs, corporate benefits managers need to begin using real data with solid evidence, and setting realistic ROI goals.
This paper outlines the current problems with wellness and prevention ROI studies, and offers suggestions for achieving accurate and Despite the apparent logic of wellness programs meaningful results. (Keep people healthier and they’ll need less health care), many companies continue to be Flaws in Current Wellness/Prevention skeptical about their value. CFOs and other Studies decision-makers are not convinced by projected expenses. They demand, and rightfully so, a Many of the strategies utilized to determine reduction in real medical claims costs, not in wellness program ROIs are flawed and would 37 CorporateWellnessMagazine.com
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not stand up in a respected, peer reviewed medical or financial journal. Methods are suspect, studies are poorly designed, and assumptions are often shaky. Some of the fundamental flaws in the methodologies used to support the case for positive wellness ROI are as follows:
studies showing positive outcomes are being published. • Use of Projected, Not Actual Savings - Many case studies demonstrating the payoff of wellness programs are based on projected, not actual, health care expenses. For example, annual health care costs for obese employees are, on average, $1,723 higher than • Biased Research - Most of the studies costs for healthy weight employees. It’s tempting to demonstrating positive ROI have been conducted by argue, then, that $1,723 is the actual annual savings for wellness vendors and by the companies implementing weight loss. But $1,723 is not an actual saving—it is an the programs. Not only does this bring the objectivity of average, or a projected cost. the findings into question, but it also leads to publication bias. Neither vendors nor employers are motivated to Similarly, we find case studies arguing that reduced publish results showing negative results—only the health risks per employee mean dollar savings. If 38 CorporateWellnessMagazine.com
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health risk factors are reduced from 5 to 4, the argument goes, and each risk factor costs $1,000, then program savings are $1,000 times the number of participants. But, again, a risk factor is not an actual dollar saving.
clear which expenses they include in their analyses. Often, vendors include in ROI studies only fees for their services (such as health risk appraisal and health coaching services). In doing so they often neglect significant, though worthwhile, costs to the employer. For ROI • Difficulty of Measuring Productivity calculations to have any credibility, they must Savings - Most ROI studies attach a high include at least the following costs: value to the calculated benefits of productivity improvements. Most ROI models claim that • Employer’s time spent managing the productivity gains in dollars are two to four vendor times as large as health cost savings. However, • Employee participation hours (completing because productivity can only be measured health risk assessments, coaching sessions, indirectly, productivity metrics are the weakest etc). For example, if 8,000 employees link in any ROI model. Assigning a link take 30 minutes of work time to complete between improved health and productivity, an HRA, and their average pay is $25 per though possible, is not a straightforward proposition. Rather than assigning possible hour, that’s a $100,000 salary expense. real dollar savings from productivity, wellness • IT costs associated with providing web program managers would do well, instead, access to utilize simple, more easily calculated • Costs of incentives and communications measurements such as absenteeism. • Failure to Include Significant Factors – Most ROI studies omit a variety of significant factors, most notably benefit design and changes in employee health demographics. Any solid assessment of wellness ROI, including changes to health claims data, needs to take into account many variables beyond the wellness program itself.
Recommendations for Evaluating Wellness ROI
Bear in mind that executives often must select from numerous strategies that may achieve a comparable, or superior, ROI to wellness programs, such as purchasing new equipment, investing in new product lines, and acquiring other businesses. How can wellness proponents make a strong case for their programs as • Use of Biased Study Groups compared to these other options? Employees participating voluntarily in corporate-sponsored wellness programs create Accurate and persuasive evaluation of wellness a skewed, preselected group. Such employees ROI should include the following steps: are already motivated to change. They want to improve their healthy behaviors more 1. Focus on real (as opposed to projected than those in the non-participating group. or average) healthcare cost savings linked to Even with no wellness intervention at all, the individual employee claims data. preselected participants will show a better health risk profile over time as compared to 2. Avoid putting a dollar amount on non-participants. Therefore, an ROI model that projected productivity gains. Instead discuss uses non-participating employees as a control the inherent benefit of improved productivity group is bound to be faulty. in subjective terms. • Failure to Include All Expenses - When 3. Keep in mind that a control group of vendors conduct ROI studies, it’s not entirely non-participating employees will not yield a CorporateWellnessMagazine.com | March 2011 39
true, unbiased controlled study. In other words, when comparing a group of participants with non-participants, be sure to use statistically accurate measures that account for the bias associated with “pre-selection.” 4. Avoid the confusion of other factors. Measure the ROI of a program during a period when there have not been substantial changes in the plan design or significant employee turnover. 5. In planning for wellness intervention, look for targeted interventions that have a high probability of realizing short term results. 6. Consider having an outside vendor perform a meticulous ROI analysis of your wellness program. In summary, wellness initiatives aimed at a corporation’s workforce do hold enormous promise for addressing escalating healthcare costs. But the industry has a long way to go in accurately measuring ROI for these initiatives. Before widespread investment by corporate America is to be expected, both proposals and ROI measurements must be based on solid data and careful study, using proven statistical methods and realistic goals. 40 CorporateWellnessMagazine.com
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Bio Jonathan Spero, MD, is CEO of InHouse
Physicians and board certified in Internal Medicine. Dr. Spero is an expert in the field of targeted employee wellness programs with measureable ROIs. InHouse Physicians is a global employee health and wellness provider delivering innovative cost containment solutions to corporations around the world. InHouse Physicians high touch employee health services include a wide range of offerings such as cost effective worksite health centers, evidence based “pre-disease” wellness initiatives, health screenings plus analytics, flu vaccinations, and travel medicine. To learn more about InHouse Physicians visit their website at www.inhousephysicians.com or Dr. Spero can be reached at jspero@ihphysicians.com.
Why Healthcare Reform is a
“Perfect Storm� How Voluntary Benefits can Provide a Crucial Lifeline
Written By Kevin Seeker
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M
LR’s, Cadillac Plan taxes, grandfathering, higher deductibles and co-pays all are, increasing costs and premiums.
Somewhere in this swirling chaos, there are some solutions that can help all involved: employers, employees, and their brokers, agents and consultants. After all, everyone is on the same surging wave, struggling to make sense of it all – and in need of a lifeline like Voluntary Benefits. Let’s examine the raging storm – and some solutions – from various perspectives: Employers As employers deal with rapidly rising health costs and burdensome regulations, balanced with keeping employees satisfied with their benefit plans, here comes the Patient Protection and Affordable Care Act (PPACA). Not only does this legislation create additional confusion, it also causes many employers to brace for additional increases in their expenses, driving them to introduce Consumer Driven Health Plans (CDHP) along with Health Savings Accounts (HSA) to avoid excise taxes -- or to drop health benefits completely. Employees As confusing as this is to employers, think of how employees must feel as they contemplate increased out-of-pocket costs in the form of premium contributions, higher deductibles and co-pays. Even with HSA’s (which may or may not be subsidized by an employer), there are still gaps in coverage, which can impact their overall financial wellbeing. Statistics show that the majority personal bankruptcies are due to medical expenses, even though more than 70 percent of people had medical coverage in place. Brokers, Agents and Consultants As employers search for a beacon in the storm, intermediaries are also threatened by PPACA’s strong undertow and rip currents. In the small group market, there is growing concern about the impact of Medical Loss Ratios (MLRs) CorporateWellnessMagazine.com
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on fully insured plans, resulting in lower – or no – commissions. This could deliver a devastating blow, especially if there are no plans for additional product lines to offset this. Fee based consultants are also facing revenue pressures. Organic growth is down, and competition is fierce. Clients are demanding more value-added solutions, and often at the brokers’ expense. Without additional revenue, this model can be difficult to sustain.
Enter the Lifeline ~ Voluntary Benefits Although Voluntary Benefits cannot completely stem the rising tide, they have entered the mainstream of employee benefit plan design strategies and can offer valuable solutions for everyone. Here’s how: Employers As employers grapple with balancing new costsaving strategies with employees’ financial wellbeing, they are considering products, such as Group Critical Illness and Group Accident plans, which have gained momentum because they: 43 CorporateWellnessMagazine.com
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• Help plug the gaps in coverage without being “underlying coverage”, when HSA compatible. • Do not impact the so-called Cadillac Plan excise tax issue. • Are valued by employees, which may help increase adoption rates of CDHP elections. • Leverage wellness benefits, by increasing health awareness and participation inherent in corporate wellness programs. • Send a positive message to employees, while also lowering employer costs. Employees Instead of going under the surging wave in the storm, employees can better protect themselves and their assets (i.e. their savings, HSA’s and 401k plans) with voluntary benefits that: • Provide valuable supplemental coverage. • Offer cash when it is needed most to retain control of the situation and to help offset many of the incidental expenses. • Are available on a simplified or guarantee issue basis, making them easy to enroll in and qualify for. • Include valued family coverage.
• plan.
Enhance the overall value of the benefit reduce it if the employee completes the test. In essence this pays for the plan).
Brokers, Agents and Consultants You can offer your clients a port in the storm, by introducing some of these types of voluntary benefits: • HSA-compatible products, like Critical Illness and Accident Plans, which can help offset some of the employee risk and alleviate some of the employer concerns about higher deductibles. • Newer generation products, like GAP and Hospital Indemnity, along with Critical Illness and Accident Plans, which provide excellent plan design strategies that help plug the holes. • Wellness benefit riders that are included in Critical Illness and some Accident plans, which help to drive participation in testing, thereby enhancing long-term savings. For Example: Employer funds $5000 of Critical Illness for each employee (with a Voluntary Employee Buy-up Option that includes a wellness rider), under the condition that they will fund the base plan IF employees complete testing. Employer also raises employee contribution, but agrees to 44 CorporateWellnessMagazine.com
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Voluntary Benefits can also include commission revenue. In many instances, commissions can now be level, providing a more predictable revenue stream and fit nicely with traditional group product compensation structures. In the small group market, consider what adding two Voluntary Benefit products like Critical Illness and Accident can do to your revenue stream. In lager case markets, Voluntary Benefit commissions can often be redirected to offset employer fees, or to use towards additional value-added services such as online benefit administration. For fee-based consultants, this can be significant in riding out the storm of shrinking organic growth. While we all weather the same “perfect storm”, Voluntary Benefits are rapidly gaining acceptance as a sound product set to be integrated into welldesigned benefit plans. Catch the wave and show your clients the advantages of Voluntary Benefits.
Health Risk Assessments: A Waste of Time and Money Written By Lisa Holland
W
hen an employer is interested in beginning a wellness program the first thing that comes to mind is the implementation of a Health Risk Assessment (HRA). After all, an HRA has been introduced by the wellness community as one of the foundational data collection tools necessary to ensuring program success. The fact is an HRA is a needless investment that consumes employer resources, costs employers an enormous amount of money (i.e. incentives) and provides no meaningful data that would drastically change the fundamental health issues facing employers today.
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A Health Risk Assessment (HRA) is a selfreported survey comprised of at least 15 to 45 lifestyle and behavior questions. The tool asks individuals pertinent health questions as well as questions about an individual’s family medical history, readiness to change, mental health and personal safety. The HRA outcomes are meant to support and assist employers with targeting health risks of their population so that they can use this information to craft a wellness program strategy. Employers are committing tremendous resources via benefit and human resource professionals in terms of implementation campaigns and monetary resources for incentives to attract participation.
In most instances, even with a linked incentive, aggregate data. employee participation is limited and the aggregate results provide the employer with no 2. Self-funded employers have access to real value. all of their non-identifiable employee medical, pharmacy, worker’s compensation and other The following factors substantiate the notion that related data points that can be compiled and HRA’s provide little value and offer employers analyzed to provide a real snapshot of employee significant rationale for eliminating an HRA medical trend. This data can be extrapolated from their wellness program strategy: in order to target, design and implement an appropriate wellness strategy that will impact 1. The 2008 Genetic Information and Non- the health of the employee population. Disclosure Act (GINA) legislation prohibits employers from asking pertinent family history 3. HRA’s are self-reported tools. As questions in an HRA when the employer links such the reliability and validity of the outcome incentives to HRA completion. Family history data is questionable. Generally, the best way can be an important piece of information that to validate HRA data is to include biometric can support medical trend forecasting of a screening in conjunction with an HRA campaign, population. The elimination of these questions then crosswalk the outcome data against the significantly reduces the value of the outcome employer medical trend reports. This method 46 CorporateWellnessMagazine.com
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improves validity but adds administrative burden HRA. Employers can achieve a successful wellness and costs more because the employer now must fund program through a Consumer Directed Health incentives and biometric screening. Plan and appropriate biometric monitoring without spending additional dollars, exasperating your 4. Lastly, there is significant and readily benefits team and annoying employees. available data that concludes that roughly 75% of About Simplicity Health Plans all chronic disease can be prevented or delayed by changing certain lifestyles and health behaviors. Cleveland, Ohio - Simplicity Health Plans is the Additionally, the CDC continues to release alarming best implementation of a CDHP/HSA. It aligns evidence on the obesity epidemic in the United the interests of the Employer, Employee and the States. This information alone assists employers Provider to provide a turn-key, fully integrated with easily targeting interventions and programs Consumer Directed Health Plan. It also delivers a without the use of an HRA. low cost, scalable solution to control claim costs. The Plan fuses unparalleled technology, point of There is no need for employers to spend thousands service adjudication, real-time data, and first of of dollars on HRA campaigns and incentives to its kind anti-fraud controls. Services include an achieve a successful wellness program. So what ERISA compliant health plan, HSA administration do employers really need to begin their wellness and banking, medical claims administration, TPA program? The answer is simple, implement a functions, pharmacy, dental & vision, COBRA, stop Consumer Directed Health Plan (CDHP). loss reinsurance, real-time Utilization Review and Case Management, Health Coaching, Comparison A consumerism model is “wellness by design” and Shopper, Health & Wellness programs, and a host of has proven to promote health and change individual on-line tools for Providers, Employers and Members. health behaviors by as much as 25%. Secondly, initiate health campaigns that address the “Big Three”; diet, exercise and tobacco cessation. These three factors address the 75% of today’s chronic disease. By Lisa M. Holland, RN, targeting these critical health factors employers will MBA has been in the healthcare begin to impact population health trend and support care industry for over 18 years employees with achieving optimal health and welland held senior level positions being. To monitor and measure program success within the largest healthcare use the following biometric screenings: Cholesterol organization in the US. Lisa’s (full lipids), Body Mass Index, Blood Pressure and professional objective is to use her knowledge and Nicotine screening (Tobacco Use). Each of these expertise to encourage and promote the appropriate measures contributes directly to the total health of utilization of healthcare services and solutions an individual. When these measures are maintained that empower healthcare consumerism and impact within established clinical ranges optimal health national healthcare affordability. Yo may contact can be achieved and chronic disease and illness Lisa Holland at 401-487-1450. can be prevented, ultimately equating to improved population health and healthcare affordability.
Bio
Don’t waste another day or another penny on an 47 CorporateWellnessMagazine.com
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Give your employees something to smile about. They will thank you.
Offer affordable discount plans to help them save on their wellness and family needs. With Careington discount wellness and lifestyle plans, you can offer affordable plans that will help your employees save on health care. They no longer miss check-ups or forgo filling prescriptions because of cost. Plus, our lifestyle discount plans can help them simplify their busy life - and reduce their overall stress. Careington Discount Plans can be customized to meet your organization's needs. We also offer discounts on a variety of lifestyle and wellness products, including, mental health services, child and elder care, a 24-hour nurseline, financial counseling, pet care, pet medicine, and more.
Some of the premier products we offer:
Discount plans can be ...
Added to your current benefits package anytime Bundled with voluntary insurance plans or flex plans Available to full-time or part-time employees Employee or employer can pay for plan membership Can be customized to your organization's needs ®
To learn more about Careington and our discount plans, call (800) 400-8789 or visit www.careington.com
The Environment Written By Neil Treitman and Mache Seibel
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of Change
T
he events and rhetoric leading to the inauguration of President Obama swept the mindset of the Nation in a tsunami of healthcare changes - to embrace healthy lifestyle changes and changes in attitudes that shift the responsibility of employee wellness to their employers. Why? Because the cost of high cost claims are causing the employer contribution to employee health insurance to soar. Employee wellness will lead to a more productive work force and lower healthcare cost. A Google search for the phrase “environment of change,” reveals article after article on issues in need of transformation such as global warming and atmospheric pollution. Glaringly absent was anything related to creating a safe and supportive space to encourage employees to make behavioral changes that lead to better health – the “human environment” that leads to the betterment of the human condition.
in manufacturing, service or employee wellness must fully embrace that initiative and make it part of the corporate philosophy and values. In practice, what that really means is that all employees must ultimately accept the offering as both positive and necessary and value it as a personal benefit. It is not enough for management to talk about changes, they must model it; and when observed in the workforce, reward and celebrate it.”
So recognize that making the decision to change when nothing is changing around you is difficult. The decision in itself can cause stress. Posters in the lunchroom or an occasional postcard from your health insurance provider will be ineffective if there is no noticeable awareness of the process of behavioral change. The key in evoking participation is to reduce the stress associated with making the decision to move toward better health by developing a new corporate culture. Those companies that While we rightfully are concerned with the are most successful create a new social norm that environment in which we live, we are neglecting embraces a healthier lifestyle. It begins with the the environment in which we spend the second reduction of stress. most abundant amount of our lives – the work environment. The environment we work in has both Is there really additional stress in making a decision the power and the potential to either enhance or that is good for you? In 1958, J. V. Brady, the pioneer detract. To stimulate or inhibit the essential elements in behavioral psychology, conducted a study in that motivate our employees to step out of a lifestyle which a monkey was strapped to a chair for six hours that has become too familiar, and begin to embark a day. During that time the monkey would receive on a new decision tree that can lead to a healthier an electric shock sufficient to be uncomfortable, but and more productive life. To contain your healthcare not physically harmful to the monkey. The shock costs you must create an environment of change; was automatically administered to the monkey and one that makes it easy for your employees to every 20 minutes unless the monkey pushed a large adopt a plan of action. red button placed within its reach. If the monkey stayed alert and made the decision to press the The administrators of a company create the work button at least once every 20 minutes, the monkey environment. Just as they set the example for avoided the shock. The experiment continued for work, they must set the example for health in the three weeks, six hours a day. The monkey died. work place. Employees will in turn follow the Upon examination, the researcher found that the example of leadership and become attracted to cause of the monkey’s death was an ulcer. The what is comfortable. Jim Gyurke, Vice President of experiment was repeated with a second monkey Marketing and Sales of PAR, Inc. the world leader in and at the end of three weeks, the second monkey psychological testing says, “Any company that hopes also died which also was found due to an ulcer. The to successfully implement a new program, whether assumption was that the electric shock had created 50
the condition that caused the monkeys’ deaths. Brady repeated the experiment again with a modification. This time he placed two monkeys side by side. One monkey had the button that could be used to avoid the shock. The other monkey did not have a button. The experiment continued for another three weeks until one of the monkeys died. Which one? The “executive monkey,” the monkey with the button. The companion monkey that was shocked but was not repeatedly forced to decide whether or not to push the red button remained healthy and happy. Brady concluded that the monkeys who developed the ulcer died because they had an extremely stressful job.
routes around the campus or neighborhood that should take 15 to 30 minutes at a casual pace. You’ll be amazed at how liberating and stimulating your meetings will be. 2. Encourage stretch breaks. Ergonomics are often not ideal and many of the sub- acute injuries treated in private practice stem from repetitive physical stress in the workplace. Not from lifting in the warehouse as much as headaches and neck pain from people who sit at their work station for hours with no break. An excellent reference for low cost remedies is Pete Egoscue’s book titled “Pain Free at your PC.” Backs were meant to be straight; heads and backs aligned.
Mitigating stress may be as simple as taking “the straps” off of the chair and promoting 3. Offer help and simple tools for time movement around the office. Here are some management that cause people to get up and ideas: move, like a calendar or to-do list on the wall. While technological improvement seems very 1. Meetings in motion-When two or three cool, it can sometimes become a time drain that team members need to meet face- to- face, creates “virtual straps” that bind people to their encourage that meeting to occur outside. Suggest chairs.
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4. Keep schedules flexible enough to accommodate emergencies or changed work requirements. Allow time for exercise during the work day. Adding 15 minutes to lunch can provide the needed time for a walk.
seem a huge departure from your current work environment and a potential risk. But consider the potential gain - containing rising healthcare costs without cutting benefits. People seldom make lasting changes without some external stimuli. Changes in how we eat, cope with stress, our 5. Yoga classes or simple exercise classes physical activity, self-talk or relaxation activities incorporated into the lunch hour or work day as a can all lead to better health and result in lower 30 - minute “in house� fitness and stress reduction claim costs. But to be lasting, the environment program that becomes part of the day. must support that change, and the employer must be willing to set the example. The influence of Incorporating these and related approaches might leadership is an extraordinary resource as leaders
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are in the position of authority and power that dictate rewards and sanctions, shaping employee behavior. It has to start at the top. Be aware of how your behavior affects the employee’s behavior. They are looking to you as the example.
measures to mitigate them. Because people are different, the greatest success comes from providing a variety of options available. When leadership sets the example through participation, the employees are much more likely to participate..
So what about those rewards? Invest in your employee’s wellness and offer incentives to ensure participation. Not every reward is expensive; recognition goes a very long way. The idea of celebrating an individual’s performance by recognizing their accomplishments is often more effective than their rebate for joining the gym.
Cambium’s team of experts comes from diverse fields. We examine medical claims by codes and procedures. Using this approach, we determine your company’s potential to realize a savings on healthcare costs by offering alternatives to traditional treatment protocols. Our unique method of analysis is the first step in working together to create a customized plan for your company’s needs that leads to sustainable At Cambium Wellness, our job is to analyze a cost containment. These tools are the basis of company’s healthcare expenditures and design developing a Cambium Wellness Program. The effective programs to contain costs. We ask a lot “diagnosis” is reached, the problems identified and of questions and when we ask the percentage of the solutions made simple and actionable. We help management’s participation in the company’s you identify those areas for cost reduction first, so wellness program, the answer is usually surprisingly you can reinvest the savings in an expanded approach low. We design executive programs and have to better educate and motivate your employees. This developed ways to analyze each individual’s interest approach ultimately can lead to a lower incidence of to promote participation. To contain healthcare cost disease, and reduce unnecessary medical visits and it’s essential to first understand the trend that leads claims for both acute and chronic conditions. to your company’s high cost claims and institute
Bio Neil Treitman is the President of
Cambium Wellness. Mr. Treitman followed his entrepreneurial instincts in 2001 after 25+ years of success in the real estate development industry to pursue an undeniable trendworthy shift into studying healthcare prevention and wellbeing. As a wellness coach and neuromuscular therapist, he pulled together a team of multi-specialty professionals to create a company that offers a solution to corporations nationwide for programs that increase the health of employees and decrease the cost of rising healthcare claims, crippling the overhead of both small and large businesses. 53
Dr. Seibel is a Professor at
the University of Massachusetts Medical School. He is author of 14 health related books, over 200 scientific articles and consistently listed in Best Doctors in America. He speaks internationally about health and wellness. Dr. Seibel founded www.HealthRock.com to help America stay well. He serves as Medical Consultant to Cambium Wellness. You can find more about him on www.DoctorSeibel.com.