Corporate Wellness Magazine by Employer healthcare Congress

Volume 9, No 2 | March 2011

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March 2011

EDITOR’S LETTER

Rhetoric of Politics in Our Industry

normally try to stay out of politics. In fact isn’t that what everyone always tells you. Don’t mix politics or religion with business. This month I simply cannot sit on the sidelines anymore. Unfortunately, politics has become like reality TV. It is more about the ratings and drama than “reality.” Scenes are staged, some shows are scripted, and the producers edit films, switch up video and actually change the time sequence of events, solely for the purpose of making things look more dramatic and emotional. For those of you who don’t realize it, most things in Reality TV, are not really “reality.” Politics has truly become reality TV. It’s no longer about what is good for the people or what is right or wrong, or what the moral high ground is. It is now about positioning, drama, emotion with an end focus on only one thing, getting reelected. In Wisconsin and other states some Democrats went into hiding, some left the state to hold up voting indefinitely on Unions, one part of the legislation was requiring the Union members to pay for their own health insurance. Have we really fallen so low that politicians now go into hiding to hold up voting? Are we five years old again and playing hide and seek? Why is it that we are allowing our politicians to behave like children and take action that would never be tolerated as an adult or in the business world? Everyone is getting caught up in the drama and not calling for an end to it. I find other editorials in benefits magazines, blogs from people in the health insurance industry, focus on blasting one political party, or blasting Obama or democrats on Healthcare Reform. What is happening is they are all keeping your eye off the real game. They are just part of the show, keeping you distracted and emotional. Now that the Republicans have taken over the House of Representatives, do any of you really expect anything different? Do you see Republicans and Democrats working together and making change? Are you demanding change? Or are you trapped in the “reality” of it all.

Jonathan Edelheit

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FEATURES

CONTENTS Issue 20 • March 2011

CORPORATE YOGA REVIVE YOUR WELLNESS PROGRAM COSTS by Anurag Lohia

PASSIVE- AGGRESSIVE BEHAVIOR DESTROYS RELATIONSHIPS by Jacquelyn Ferguson

Think & Be Well by Franklin Drob

A WELLNESS PARTNERSHIP WELL WORTH TOASTING by Christopher Silva

WOMEN, WORK, AND LONG-TERM CARE

EVALUATING HEALTH PROMOTION PROGRAMS

WE’RE GIVING DIETING TOO MUCH WEIGHT IN WELLNESS COMMUNICATION

by Susan Blais

by Philip A. Smeltzer, Ron Ozminkowski, Shirley Musich

by Shawn Connors

WHY YOU SHOULD MAKE YOUR LOCAL HOSPITAL YOUR PARTNER IN WELLNESS

HOW TO REDUCE HEALTH COSTS AND SAVE LIVES

by EdwarRd J. Haeaz, Ddavid Supratt,c and eLes C . MHe

by Kevin A. Klockenga

ENGAGEMENT & PARTICIPATION ARE KEY FOR A SUCCESSFUL CORPORATE WELLNESS PROGRAM by Deborah MacArthur

WORKSITE WELLNESS

Corporate Yoga Revive your Wellness Program Costs Writen By Anurag Lohia

WORKSITE WELLNESS We have come a long way from the days when corporate wellness programs were viewed as good-to-have rather than as a need-tohave. Indeed, employee wellness has become a strategic imperative for most organizations across the globe and not without reason. An increasing number of studies point to evidence that the returns on wellness programs go way beyond healthy and happy employees. A study by Towers Watson Wyatt and the National Business Group on Health shows that organizations with highly effective wellness programs report significantly lower voluntary attrition than do those whose programs have low effectiveness (9% vs. 15%). On the other hand, an internal assessment by Johnson & Johnson found that the return on their wellness programs have been $2.71 for every dollar spent, resulting in cumulative savings of $250 million on health care costs for the company over the past decade.

Thus, the question no longer is ‘why employee wellness’ but ‘how?’ As workplace wellness gradually becomes the norm, offering membership passes to a fitness centre is no longer enough to generate and sustain employee interest in wellness. Employers are now riddled with the need to offer creative and comprehensive wellness facilities in order to bring about a real difference in employee health and more importantly, motivation.

is now a trend towards enhancing onsite programs aimed at stress management and holistic wellness. Since almost about 50% of corporate healthcare costs are said to be lifestyle related and therefore, potentially preventable, organizations not only want to spend on cure but also invest on prevention and good health.

Reviving Workplace Wellness The same study by The National Business Group on Health also found that there

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It is in this respect that the ancient science of Yoga

March 2011

Regular practitioners of Yoga would stress that its many benefits include emotional wellness, improved strength, flexibility, balance and postural alignment amongst others. In the boardrooms of companies, Yoga adds dimensions such as stress reduction, energy-enhancement, enhanced creativity and focus and healing for employees and convenience and increased productivity for the employer.

Why Yoga?

has found preference in the corporate world as a comprehensive wellness prerogative, replacing all other healthcare investments. A growing number of businesses are finding that offering Yoga to their employees is a low-cost, preventive and holistic healthcare measure, making the discipline a resonating success with human resource teams looking for strategic returns on their wellness investments.

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Yoga is not just about being able to perform complicated poses and movements. It is a holistic approach to physical and mental health, as well as a personâ&#x20AC;&#x2122;s well-being and personal growth. Corporate Yoga is the extended concept of working peacefully in the midst of a hectic corporate environment. An international report by the World Health Organization reveals that depression is the most disabling illness for the corporate sector, second only to cardio-vascular diseases. Long hours, multi-tasking, stiff competition, rigorous commute, irregular eating habits, sedentary desk jobs and bad sitting postures, all combine to create a pool of highly stressed, inefficient and thus despairing workforce. The National Institute of Mental Health estimates that U.S. employers lose $70 billion a year due to absenteeism, lost productivity and disability caused by mental distress. The benefits of corporate Yoga to encounter this malaise are unmatched by other wellness programs, as the very crux of the Yogic discipline is a mindbody balance. It is the only form of exercise known to increase flexibility, strength, balance, concentration and breath capacity while reducing stress and anxiety. Yoga also helps boost morale and interpersonal communication â&#x20AC;&#x201C; which for an employer means no more bickering teams or dissatisfied individuals, power struggles or dirty politics.

March 2011

WORKSITE WELLNESS There is conclusive evidence supporting the fact that offering even one Yoga session in a week brings about noted changes in employee behavior by helping them manage stress better, enhance clarity and creative thinking, improve communication skills, cultivate leadership and teamwork, and increase overall effectiveness in the workplace.

Yoga, Anytime, Anywhere Perhaps the strongest reason for incorporating Yoga into your employeesâ&#x20AC;&#x2122; wellness routine is the ease with which a corporate Yoga program can be implemented with any kind of resources. The only equipment required for a session of Yoga are some floor mats and a bunch of willing participants with a strong desire for a healthier, more fulfilled life. A Yoga program can be conducted just about anywhere such as a conference room or an empty lunchroom. What is even most interesting now is the development of online Yoga training that is fast gaining popularity with organizations across the globe. The offering has added a new perspective to corporate wellness by making available world class Yoga training by experts in the confines of an office cubicle in any corner of the world. Live and interactive Yoga sessions delivered right to the companyâ&#x20AC;&#x2122;s conference room with an assembly of participants is a glove-in-hand fit for most corporations as the sessions can be personalized to suit the timings and space constraints of companies as also the individual needs of participants. Yoga in general is geared for people of all levels and age groups and can be tailored to address the needs of people with completely different fitness levels. Although it may sound simple, the creation of a yoga program, if you want it to be successful, requires serious commitment. 7

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March 2011

Here is what you must keep in mind while assessment and post-assessment measurements to track improvements is essential. developing a corporate Yoga program: • Assess Employee Interest This is to ensure that there is sufficient interest and that enough number of people will sign up for Yoga classes once organized. You could ascertain this by sending out an email on the intranet and asking employees to confirm attendance or send an expression of interest.

• Duration and length of sessions Six to eight week Yoga sessions with 15-20 classes work well but you could alter it depending on your budgets and requirements. For fresher’s, signing up for even a one-week program with two or three classes is plausible. While it is possible to accommodate effective Yoga poses even in a 15-minute session, a 45 to 60-minute devoted practice works best for Yoga • Find a Yoga provider This is an extremely important process, as your Yoga as it helps participants establish proper breathing and instructor needs to be an experienced and capable connect with the instructor. person. It is recommended to find someone with at Eventually you need to remember that least five to ten years of experience in teaching Yoga. corporate Yoga should be designed to increase well Once again, online Yoga sessions are highly being for employees’ optimal health, productivity beneficial since the issues of geographical and other and performance. It must thus be made accessible boundaries become irrelevant on the worldwide web to people at all levels and offered in a safe and and one can choose to get trained by experts in the comfortable environment to pursue balance, healing practice. Certain online offerings for example make it and inner strength. possible for one to organize a class instructed by gurus About the Author directly from India, the land of Yoga. If you can find someone to assist in nutrition and diet schedules as well, the overall benefits can be maximized. • Personalized sessions Do ensure that participants get to spend individual time with the instructor. It is important for every employee to take back something positive at the end of each class. Continuous monitoring through pre-

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Mr. Anurag Lohia is the CEO of Divine Wellness. Divine Wellness (www.divinewellness.com), is an online service provider of natural health solutions based on Indian wellness traditions. Within the first two years of its inception, the site has seen tremendous interest from users across the US, Canada, Australia, UK, and the Middle East.

March 2011

FEATURES

Think & Be Well Writen By Franklin Drob

The purpose of this informative and engaging article is for you to feel better and have a new thoughtful experience around being well. If you choose to read along and participate in this interactive experience, you will become calmer and clearer with less tension in your body and a practical understanding around the subject of Wellness at Work. This article consists of a three tier interactive process, which incorporates the multiple intelligences and greater sense of mind body functioning. First we’ll engage the present moment using our conscious minds through our senses. Next, we will enhance vitality using our breath. Lastly, we will create a new behavioral modification that serves as a reminder for ongoing results. Learning to engage the present is profitable because it allows employees to be alert, awake and energetic, which results in increased levels of focus, productivity and overall health. In addition, employers and employees who are able to engage the present, have a greater capacity and tenacity towards creative problem solving and leadership. Albert Einstein best described the phenomena when he said; “you cannot solve a problem from the same consciousness that created it. You must learn to see the world anew.” Being able to engage the present

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March 2011

is the prerequisite for a truly successful work day because it allows employees to access a deeper level of consciousness for problem solving. Companies with a present minded workforce team are empowered and healthy. Louise L. Hay the famous American author says it best â&#x20AC;&#x153;the point of power is always in the present moment.â&#x20AC;? If the point of power is truly in the present moment, then the senses are the key. To engage the present, enjoy this simple exercise. Follow along, keep your body perfectly still and do not move; we are about to shift our perspectiveâ&#x20AC;Ś. Notice the feeling of the clothes against your skin. Is the material loose or tight, smooth or textured, soft or coarse? What about the air and the temperature; is it cool or warm, stuffy or fresh? Notice the sounds around you are they noisy or calm, loud or quiet? In just a moment, you will close your eyes and imagine as though your ears are tape recorders. Allow the sound waves to enter your ear drums and record the noise around you. Regardless if the sound is cacophonous or harmonic; simply listen with a neutral attitude. Move from sound to sound and then bring your awareness outwards to hear it all at once. Enjoy this sound listening exercise for several moments. One of the benefits of this exercise is that it teaches your team how to truly listen. Oftentimes, employees, colleagues or peers pretend to listen, when internally they are just waiting for their turn to speak. Customer service employees, and individuals working with the general public, who are able to truly pay attention, serve their clients because it builds trusting relationships. In addition, coworkers who truly listen to one another generate connections that improve morale and working conditions. Engaging the present using the senses is a cost effective and inexpensive way to create a healthy working climate. Another free solution to being well at work is the breath.

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March 2011

FEATURES Breathing exercises do not require any external support or conditions and are a cost effective way to increase energy and reduce health costs. In other words, employees who learn how to manipulate breathing patterns are able to do so at their desk, standing in line, in the car etc... The benefits of learning how to control the breath are that it can reduce high blood pressure, induce a euphoric state, and improve sleeping patterns. Since we live in the information age, oftentimes it seems as though there is too much data to sort through or process in one day. As a result, employees shift into a fight or flight mode of behavior, which impacts the respiratory, digestive and nervous system. The body moves into a defense physiology and the overall system is weakened. All of these counterproductive symptoms can be prevented though the breath, which results in greater locus of control in and outside of work.

reminded, the likeliness of preventive long-lasting sustainability is unlikely. Bottom line, if wellness becomes work, it gets thrown at the bottom of a laundry list of more important tasks. Therefore, if employers are truly interested in investing in a company wellness program for both profit and human energy enhancement, then the program requires a routine that is seamless and instantly gratifying.

Wellness is not a program, its every-bodies birthright. Corporations that initiate any kind of agenda should incorporate internal behavioral modification combined with external positive reinforcement through a multi tier system. Every moment is an opportunity to engage being effective and present at work and the key ingredients involve the breath and consistency. Otherwise, all interventions will not last long-term, which then results in a waste of time, money and energy. The A practical way to use breathing techniques best way to make a difference is to keep it simple in the workplace is to begin and conclude meetings and fun. with an exercise which will improve attentiveness and memory retention. To experience the power About Inside Smiles of your breath follow along. Keep your body perfectly still and do not move. Through your InsideSmiles Consulting shares a common goal nose take a deep breath and hold for five seconds of reducing double digit insurance healthcare 1…2….3…..4…….5…..….Through your nose costs, loss of human energy capital and employee exhale 5…4…3….2... Now, sit up tall with both feet turnaround. We are the most comprehensive flat on the floor, head on straight, shoulders down Volunteer HR Benefits on-site intervention, in-house and back, chest up, close your eyes and repeat the implementation, off site vacations & niche events process of breathing in and out through the nose online company. We make dollars and sense by for three more rounds. When you finish, engage the being well and energized. sound listening exercise and notice how you feel. Engaging and vitalizing the present moment using the external senses and breathing capacities serve as free wellness tools. However, unless employees are positively reinforced and

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March 2011

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.

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To learn more about Careington and our discount plans, call (800) 400-8789 or visit www.careington.com CorporateWellnessMagazine.com | March 2011

COLUMN

Passive-aggressive

Behavior Destroys Relationships Writen By

Jacquelyn Ferguson

Much stress in life comes from interactions with colleagues, family, and friends who are less- than-direct. Particularly stressful is being on the receiving end of a passive-aggressive person. Passive-aggressive behavior, in my opinion, is the most destructive to the health of a relationship. It is a form of manipulation. It’s indirect and dishonest. Anyone can be passive- aggressive at times. We exhibit this behavior when we’re too unassertive to speak directly and truthfully for whatever our reasons. Passive-aggressive people resist you in covert ways, like the angry person who slams the door - but says nothing with words, or the person who sighs dramatically about something they are displeased with – but says nothing. Other typical conscious or unconscious behaviors include: • Gossip; • Refusal to talk but give off the cold shoulder; • Sabotage, like discrediting your idea; • Obstructionist behavior, like purposeful procrastination; • Exaggerated interest or sweetness (but you feel like you’ll be stabbed in the back the moment you leave the person.) Because this kind of behavior is covert, you may not be able to put your finger on what’s bothering you about an interaction. This is one reason it’s so harmful. Someone who openly disagrees with you is easier to deal with than one who rolls her eyes when you present an idea in a meeting. Wouldn’t you rather a co-worker who’s upset with you tell you directly rather than talk about you behind your back? Indirect attacks can be more exasperating than direct ones.

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March 2011

COLUMN Another reason passive-aggressive behavior is so harmful is because the behavior is so indirect you may think the problem is with you. For example, when your co-worker rolled her eyes you may have assumed your idea was stupid rather than considering the possibility that she’s too unassertive to communicate her reservations about your idea directly to you.

“Your employees were over yesterday and they actually did a good job!” Doesn’t it sound like they usually don’t do a good job? Is he being indirect because saying something negative is difficult for him? To clarify the customer’s real message you could say, “Gee, Todd, it sounds like what you’re really saying is that they usually don’t do a good job. Is that right?” This could open the door to get some honest feedback from him. Whenever you expose the person’s indirectness you’ll need to be prepared to deal with what s/he has to say.

A key to understanding passive-aggressive behavior is to realize that it’s an attempt to get even with you; it’s an indirect expression of anger or frustration. Apparently your co-worker feels the need to discredit your idea and doesn’t have the Passive-aggressive behavior is very courage to do it openly. difficult for most of us to handle well, especially when the relationship is one of love, friendship or Defuse manipulative behavior by of power. Learn to surface the passive-aggressive exposing it….speak up! behavior in a non-defensive manner to create an To deal with this behavior you’ll need to opportunity to resolve the underlying issues. Then expose it. Here’s one very effective three-step and only then can you know what you’re dealing with. surfacing technique: 1.

State your observations of the person’s behavior to that person;

2. 3.

State how you interpret your observations; Ask if your interpretation is accurate; For example, when the co-worker rolls her eyes you could say,

Deal with Manipulation Remember, manipulation, such as passive-aggressive behavior, harms relationships. Even though we all manipulate subconsciously or consciously at times, the real stress comes when you have someone in your life who manipulates you habitually.

“Jane, when I gave my idea in the meeting For instance, have you ever been on I noticed you rolled your eyes. I’m wondering if that means you disagree with me. Do you have a the receiving end of the stereotypical maternal manipulation to get you to visit more often, problem with my idea?” If the passive-aggressive person were a customer or a boss with whom you’d be unlikely to use the above surfacing skill, here’s another idea. Let’s say you have a customer who says,

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“I carried you for nine months and you can’t come to visit your poor old mother once in awhile?” (Parents’ manipulations carry extra punch given their authority status in your mind.)

March 2011

Or, how about the co-worker who softens you up with a compliment, only to hit you up for a favor? “Susan, you did a wonderful job on the XYZ project. It turned out so much more creatively because of your ideas. I can hardly wait to get you involved in this next project. Here, let me tell you about it and get your input.”

When manipulated, are you part of the problem? When you believe you’re being manipulated keep in mind that “it takes two to tango.” If you want the manipulation to stop you must change what you’re doing - or, wait for manipulative people to stop. But when will that happen? Never! Why should they change? They’re probably getting what they want through manipulation. It works for them! A better option is changing your own reaction to the manipulator, such as using the above mentioned surfacing skill. If you still have a chronic manipulative person in your life, you are almost certainly part of the problem. Focus on how you can change your reaction, something that is within your control.

For manipulation to work two conditions must be present:

1. Manipulation must remain hidden. A person doesn’t warn you before he manipulates you. He wouldn’t say, “OK, I’m going to compliment you now but I don’t really mean it. I’m just softening you up so I can then ask a favor of you.” He would simply say, “You are the greatest. I don’t know how this office could function without you.” (He’d allow this compliment to sink in and have its desired softening effect, then,) “By the way, I could really 16

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COLUMN use your expertise in writing this report. When all you have true control over is your own choices, could I get a few minutes of your time?” you must make the choice of exposing the manipulation and striving for the outcome in the 2. For manipulation to work, you must situation that you desire --- or continue to dance cooperate with the manipulator. When your mother the manipulative dance. uses the “I carried you for nine months” line, and you scurry over to visit her you are teaching her When You’re Manipulating that manipulating you works. Or if you help the co-worker after he praised you, you’re teaching When you consciously or unconsciously him to say something nice to you and then you’ll manipulate another person remember you are help him out. harming the relationship.

To deal with manipulation:

Also, remember that manipulating someone • Identify your desired outcome in the situation. means you are being indirect because: With Mom, maybe it’s to expose her manipulation in hopes of discouraging it. Exposing it is within your control. However, her response back to you is beyond your control.

• You are overly passive and fear being more direct for whatever your reasons;

“Mom, I get the feeling I’m being manipulated when you say that and I feel uncomfortable with it.” To the co-worker, “It seems when you compliment me you will soon ask me for a favor. I would much prefer you directly make your request.”

To become more conscious, look for red flags that you might be manipulating:

• You’re normally quite assertive, if not aggressive, but the person you’re being indirect with has more With the co-worker you’ll request he directly power than you so you’re hesitant to be honest and ask for the favor rather than couching it in a direct; compliment. To change any behavior you must first be • Surface the manipulation, then ask for what consciously aware that you are doing it and that you want (if anything) or say how you feel you’re uncomfortable with doing it. Without about it: conscious awareness, you’ll change nothing.

• You get your feelings hurt by someone and rather than speaking directly to that person you tell someone else about it; you’re being indirect;

To diminish others’ ability to manipulate • You’re negatively judgmental of someone but you, you must take responsibility for your own say nothing directly to that person but likely say it complicity. Since you have no power to make to someone else; others be different (less manipulative) and since

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• You do something to get even with a person; E.g., Sabotage their idea, do something you know irritates them, negatively judge them to another person; • You’re very frustrated with someone but say nothing, but rather you stew over it;

The Cure~ Be Assertively Direct Regardless of why you’re manipulating someone, the basic cure is to be assertively direct. This doesn’t mean you need to be a bull-dozer in your directness. Just state what you think or feel and be sure to use the “I” message (e.g., “I think this is unfair,” versus “You’re unfair.”) Think before you address your manipulative person to avoid reacting defensively, the subject of my next article.

About the Author 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. Order her 2010 published book, Let Your Body Win: Stress Management Plain & Simple and request her weekly, published, emailed column, Stress for Success, published in a Gannett Newspaper, at Judgments are assumptions you make of others. www.letyourbodywin.com. Don’t confuse facts with judgments. Judgments are not factual, they’re opinions; E.g., You label the person boring, stupid, unfair, ignorant, lazy, etc.

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March 2011

FEATURE ~ CASE STUDY

A Wellness Partnership Well Worth Toasting Writen By Christopher Silva

I have a job that makes me the envy of many people around the world: I am the CEO of a winery. For most people that conjures up images of grapestomping festivals, bountiful picnics amidst Sonoma County vineyards and long evenings by the fire with a great glass of “Old Vines” Zinfandel. There is all of that. But a thriving winery like St. Francis Winery is still a business and, as with any business, it comes with its fair share of challenges, including employee health.

In recent years, wineries like ours have seen rising healthcare costs and increasing employee absenteeism—both of which impact productivity. Though we didn’t have a clear picture of why costs were rising at businesses like ours, we knew we needed to get to the root of the problem. I became familiar with a new worksite wellness concept – the Workforce Health Initiative -- being offered by St. Joseph Health System in our county. After meeting with St. Joseph’s Workforce Health Initiative representative and hearing about the success of the program at other local worksites, we were convinced that St. Joseph’s program offered a As with most businesses, healthcare costs number of advantages that other wellness plans are a heavy burden to the bottom line. So it makes could not offer. For example: sense to encourage employees to be healthy. At St. Francis Winery, a majority of our 138 employees • The program sponsor, St. Joseph Health are skilled laborers charged with very physical System-Sonoma County, has long been the duties that require them to be constantly on the health and wellness pillar of our community and move. They work an array of jobs that support a trusted source of healthcare information. We the planting, growing, harvesting, winemaking, knew any program we introduced with St. Joseph bottling and distribution of our products. Thus, would have instant credibility in the eyes of our they need to be particularly healthy. employees.

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• The program’s mission and approach were 2. Identification of primary issues and highconsistent with the values of St. Francis Winery: risk areas specific to St. Francis’ workforce. quality products, quality people and quality relationships. 3. Development and implementation of health education workshops to focus on • The Workforce Health Initiative was available at prevention and lifestyle management to help a very low cost for local employers – an important give employees the information and motivation distinction in today’s difficult economic climate. to live fuller and healthier lives. • The program was developed in collaboration between St. Joseph and Aegis Health Group, in Nashville, Tennessee, a highly regarded workforce health partner.

Rolling Out the Workforce Health Initiative After initial planning, a small team of individuals put together a three-step launch plan for our Workforce Health Initiative that consisted of: 1. An onsite kick-off program of screenings and health risk assessments.

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Our kick-off program was held in our outdoor park and included both English- and Spanish-speaking nurses and nurse practitioners to take blood draws, check blood pressure, discuss health and diet, and explain the importance of preventive health screenings and healthy lifestyle choices. The kick-off was very exciting— with plenty of healthy snacks and natural juice offerings—and we had virtually 100 percent participation from employees. The mere act of having everyone there discussing health and wellness was very powerful – and empowering. For many of the employees, this was the first time anyone had acknowledged the importance of their personal health and happiness or offered

March 2011

FEATURE ~ CASE STUDY

them a health profile to assess their health. All information was collected confidentially. The hospital later presented our management team with aggregate population health data, allowing us to better understand which health issues affect our population. What we discovered was eye opening. Despite enjoying one of the best health insurance packages in our local industry: • More than half of our employees had no primary care physician (the national average is 23.5 percent). • 42.7 percent had never had a physical exam, compared to a national average of around 10 percent. • Nearly half had high blood pressure (hypertension).

since implemented to support our goals include: • Quarterly company-wide lifestyle seminars to focus on nutrition, exercise, stress management, smoking cessation and the importance of preventive screenings.

• 29.3 percent of employees had high triglycerides • Linking employees to health specialists who can and 8.1 percent were severely obese. address their specific health issues, as identified by the individual’s initial health risk assessment. • 7.1 percent had diabetes and 4.9 percent had high glucose levels, a precursor for diabetes. • Mailings and emails of health awareness and improvement messages and hospital-sponsored interventions.

• Almost one in three employees smoked. • Upwards of 27 percent of workers complained of depression.

• Sponsorship of healthy activities and events to encourage healthy living, such as lunch-time walks, healthy snacking and hydration awareness.

Clearly it was time to change our culture about wellness. • Encouraging family participation. By encouraging employees to discuss health issues Since the majority of our employee health at home with their families, we felt we could issues revolved around lifestyle choices, we set a achieve greater family buy-in and increase strategic goal to positively impact the health of chances for successful lifestyle changes at home. our employees through prevention, intervention and management. The tactical tools we have • Role modeling by senior management, ensuring 21

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By catching potentially serious health and wellness issues early, we are reducing employee absenteeism and enhancing productivity and foresee reducing future claims costs. The projected year one savings will be in the $40,000 range.

that they “walk the talk” and set a good example for others.

In addition, our program also serves to remind employees that they have a stake in their own health and wellness, and that their ability to be healthy and well is largely in their own hands. Like any employer, St. Francis must continue to play a leadership role in bettering people’s lives—both inside and outside of our company. We chose to lead by example. Employee health and wellness knowledge elevates health awareness and engagement not just throughout our company, but across our community at large. I encourage all business leaders to respect and empower their employees by giving them information and the tools to help them live healthier and better lives. Our Workforce Health Initiative program does precisely that.

We found that the more information we shared with employees and their families, the more contagious the program became. Information is power and it’s hard to close an informed and open mind. When you enlighten people about the power of their choices, it’s About the Author like a light bulb goes off. Armed with the right information, people can and do make better A fifth-generation native of Sonoma County, choices. Calif., Christopher Silva 33, became chief operating officer of the winery, traveling the Results world as its spokesperson. Five years later, he became president and CEO. He currently serves Since implementing the program, we as Chairman of the Board of Trustees of Santa have been able to identify and address significant Rosa Memorial Hospital, a voluntary position. health risks that could have led to serious employee illnesses. That change doesn’t happen overnight. Change is incremental, and we’re on the right path. We have started referring our Be Sure To Read Kevin A. Klockenga employees to St. Joseph’s Mobile Health Clinic Article on located on page 24 for medical care and have offered flu shots onsite.

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March 2011

FEATURE ~ CASE STUDY

Why You Should Make Your Local Hospital Your Partner in Wellness

Writen By Kevin A. Klockenga

Over the last decade, as businesses large and small have struggled to contain healthcare costs, theyâ&#x20AC;&#x2122;ve turned to health plans, wellness and benefits consultants, business coalitions, and a vast array of other experts for solutions. Yet costs have continued to spiral out of control, on a parallel track with the rising incidence of chronic diseases like diabetes, obesity and other markers of poor health among working populations. Many employers may not have found the right health partners to help them engage employees in improving their health and wellness.

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Employers need a trusted partner who: a) has inherent credibility with workers; b) is an established expert in patient care; and c) has a stake in patient outcomes and improving the health of the population. Community-based hospitals are often perfectly positioned to partner strategically with local businesses to facilitate employee health improvement, manage chronic care issues and help contain healthcare costs. That is what inspired us to create our Workforce Health Initiative program two years ago.

March 2011

Why Partner with a Hospital?

This trust often is rooted in hospitals’ quality and longevity. The doctors and staff While there are numerous advantages for at hospitals have demonstrated for decades a employers when it comes to partnering with a commitment to fostering health and quality of life hospital and its medical staff for workforce health, in the communities we serve. These are established I will share four that are particularly noteworthy: institutions, created to provide compassionate care, promote health improvement and create healthy communities. 1. CREDIBILITY Hospitals offer employers a key benefit… that is, trust. Hospitals have long topped the list of the most trusted health organizations in the U.S., according to the annual Harris Poll surveys taken over the last decade. They offer a largely untapped opportunity to enhance employee feelings of value about their health plans and to improve engagement in employer health improvement programs.

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2. EXPERTISE About 75 percent of today’s healthcare costs stem from preventable illnesses caused by behavioral choices, which can be modified – such as poor diet, lack of exercise, smoking, or mismanagement of chronic diseases, which can turn into serious and costly hospitalizations and surgeries. Missed opportunities to detect

March 2011

FEATURE ~ CASE STUDY potentially catastrophic health issues, such as cancer Action, a multi-disciplinary council of community and heart disease, negatively affect employees’ well- leaders and volunteers working together to improve being and employers’ health-related costs. the health of all of us who live in Sonoma County. Through these partnerships and others, we’re Hospitals, with their physicians and vast proactively helping create a healthier community – array of health professionals, are well equipped to and by extension, a more attractive place to live and help employers establish effective health prevention, work. intervention and management programs. Hospitals inherently have a broad range of resources, expertise 4. LOW COST and experience to help motivate employees to improve their health, see their doctors, participate Teamed up with health professionals like in annual checkups, and live healthier lives. We ours, employers can benefit from a low-cost, work with local businesses, using tools provided turnkey program that is easy to implement and by our partner Aegis Health Group, to identify which can impact employee health and well being and address health risks within the employee within weeks of the program’s launch. Popular population. The information we gather allows us to health initiatives such as stress reduction, nutrition link employees to the resources they most need and and exercise programs, as well as personalized to provide personalized follow-up care. Hospitals, health consultations with our nurses and affiliated affiliated physicians and other community partners primary care physicians, can motivate employees collaborate with employers to match solutions to and their families to make healthy changes in their their employees’ particular health needs. lives. These changes further help to lower employer health-related costs. We also have the capabilities to track and document outcomes and improvements across key If your business is searching for more health categories. proactive ways to increase employee satisfaction, productivity and well being while helping to contain 3. MOTIVATION healthcare costs, turn to a trusted partner in your community – your hospital. It could be the healthiest In communities across the nation, hospitals decision you’ll make for your business this decade. and their clinicians represent a cornerstone to good health and are valued for the many services they About the Author offer in the interest of the community-at-large, from free or low-cost flu shots to free health screenings. Kevin A. Klockenga is the President and CEO of St. Motivated by our mission to serve others and Joseph Health System- Sonoma County in the North create healthy communities, we also serve as key Bay area of California. He oversees a broad network collaborators within the community. For example, of inpatient and outpatient services, including those at St. Joseph we’re collaborating with Santa Rosa provided at the 80-bed Petaluma Valley Hospital Junior College’s Health Sciences Department and and 278-Santa Rosa Memorial Hospital. St. Joseph with Empire College, enlisting their nurses to assist is a wellness partner with more than 88 employer us with community health screening events. And groups in the Sonoma County area. we’ve partnered with fellow members of Health

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March 2011

WORKSITE WELLNESS

Women, Work, and Long-Term Care Writen By Susan Blais

In the past several decades, women have made great gains in the workplace. Today, more than 40 percent of women are in management positions, and 28 percent of all U.S. businesses are owned by women1. With those gains, though, has come a negative impact on women’s health and an increase in heart disease, and other ailments that were more common to men in an earlier time. These health issues are a direct result of the stress and pressure that come from working in a competitive business environment.2

This is not to minimize the effect of caregiving on men’s health as well, but recent statistics show 59 to 75 percent of caregivers in long-term care situations are women.3 This can be due to economic factors if others in the family are the main breadwinners, and is also an effect of women’s natural tendencies toward nurturance and caregiving.

While caregiving for a long-term care patient is a noble and selfless act, it can create significant and sometimes traumatic damage to the caregiver, in many aspects of her life. Care giving impacts a person’s physical, mental and emotional health and impacts their job performance, their earnings, and their savings. One stressor that is often overlooked There is also a ripple effect on the caregiver’s when looking at women’s health though, is the family, as the caregiver becomes less available significant impact that long-term care-giving for to spend time with their spouse or partner, a disabled family member puts on the caregiver. children and friends.

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March 2011

WORKSITE WELLNESS In reality, there is more than one type of caregiver. The primary caregiver is the person who provides hands-on care and often financial support for the long-term care recipient, while a secondary caregiver may make arrangements for care, oversee primary caregivers, find resources and give financial support to the long-term care recipient. Even though the secondary caregiver may not be as intimately involved with day-to-day issues, the stress on them is similar to the primary caregiver and cannot be overlooked. A recent study was done by Genworth Financial on the true impacts of caregiving, and the findings are sobering. First, almost half of long-term care recipients had never considered the possibility of needing long-term care.4 Therefore they had no plan in place and their children were compelled to provide handson care and financial support, often without warning or preparation. This creates havoc with the adult children’s careers, businesses, children, and social life. And, many of the care recipients moved into a family member’s home for a period of time, creating further pressure Other stresses on the caregiver’s family and stress on the caregiver and the caregiver’s come into play, including spouse’s resentment spouse and children. at losing time and emotional nurture with the caregiver; children feeling neglected and Currently, the average age of primary missing the parent’s companionship; conflicts caregivers is 53.5 This is a major career and with caregiver’s siblings over how care will family-building time of life. Caregivers in be provided, and how physical and financial this group find themselves in the “sandwich support will be shared, and resentment from generation,” caring for ailing parents at the the caregiver’s spouse and children if they feel same time they’re raising their children. the caregiver’s siblings are not contributing as The stress and pressure from juggling these much as they should. responsibilities cannot be overstated, along with the guilt that comes from the caregiver As if the emotional stresses weren’t feeling they’re not giving enough, and enough, there is also a financial impact to continually disappointing someone they love. providing care that impacts the caregiver and

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March 2011

their family. Over 80 percent of caregivers reported that they contributed financially to the care of the recipient, at an average cost of $8800, not including facility care costs. More than 50 percent of caregivers had to dip into their own savings and/or retirement funds, and 63 percent reported a loss of income (an average of 23% loss) due to their inability to work at full capacity or to take advantage of promotions or other career opportunities. Almost two-thirds of caregivers reduced their family’s savings, 40 percent reduced family vacations and 45 percent cut back on their own family expenses.6 The resentment and hurt to spouse and children by these occurrences can only be imagined.

productivity8. In the current economic climate, it is one more challenge employers can ill afford, especially if key employees are affected. So what can be done to help employees and businesses better deal with employee caregiving?

There are a number of solutions that approach the problem from different angles. One of the simplest solutions is for employers to offer long-term care insurance to their employees. There are several types of group programs available, and smaller businesses can take advantage of individual policies with simplified underwriting and discounts off In addition to these family stresses, there standard premiums. These are called “multiare continual pressures from trying to maintain life” policies and have a number of advantages a career or business while providing care. Many over a true group model of providing coverage, of us don’t work just to get a paycheck: we such as: find work a creative outlet for our talents and a source of satisfaction and personal growth. 1. Policies are owned by each employee instead But primary caregiving takes a big toll on this of by the employer, and thus are completely aspect of the caregiver’s life as well. Almost portable; half of caregivers had to give up a job, reduce their hours or pass up promotions, while 38 2. If an employee leaves, there is no administration percent incurred repeated absences and lateness for the employer, such as COBRA, conversion, to work. The inability to focus on the job creates or continuation policies. The employer simply additional stress on the caregiver, along with the removes the employee from their billing and physical exhaustion they feel from providing the insurance carrier will offer the employee the care in addition to their time at work. 57 percent option to pay directly; of caregivers provide care for more than 16 hours each week, and 31 percent provide care for 3. Because the plans are individual, the employer more than 30 hours each week.7 It’s not hard to has great flexibility in to whom the plan is offered see how a job or career will quickly suffer when and the type and amount of contribution; an employee needs to spend this much time in caregiving. 4. Benefit options are flexible and can be tailored to the employer’s and the employee’s budget; At the macro level, the losses to American and businesses from employee caregiving are huge: an estimated $33.6 billion per year in lost 5. Premium discounts are also offered to the

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March 2011

employee’s family members, such as spouse or partner, parents, grandparents and in-laws. This is a direct benefit to the employer, because these are the very individuals for whom the employee is likely to be a caregiver. Depending on the state where the employer is located, requirements differ regarding the minimum number of employees needed for multi-life coverage. And, while purely voluntary plans are available, it is often in the employer’s best interest to make even a small contribution. This ensures greater participation and more protection for the employer’s bottom line. Employers have been surprised at the number of employees who enroll, with a

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contribution as small as 50 percent of monthly premium, to a maximum of $25 per employee. Many employers have found it necessary to cut back on medical and dental benefits in the past couple of years. Some of them are helping boost employee morale by offering small LTCi benefits to make up the difference. LTCi is actually an essential part of retirement planning, and even a $50 daily benefit for two years creates an immediate benefit of $36,500, which protects the employee’s savings and investments. The cost for a benefit like this will average from$20 to $40 per month per employee, depending on employee ages. This

March 2011

can be a valuable investment for an employer, their families, and an increasing cost to especially if the option for family members to business in lost productivity, but the losses apply is well publicized. can be minimized and managed with some foresight and planning. It is in the interests of In addition to making long-term care all men and women, employers and agents to insurance available to employees, employers understand and plan ahead for the realities of who have employee assistance programs in long-term caregiving. place can provide valuable support to employees who are in caregiving situations. The long hours, stress, and exhaustion caused by longterm caregiving often deprive caregivers of Susan Blais is a principal of Barry J. Fisher/ emotional support, and the opportunity to get Paradigm Insurance Marketing, a brokerage some counseling can be a huge relief and can general agency focusing on long-term care provide important perspectives the employee insurance and related products. Barry J. may not see when theyâ&#x20AC;&#x2122;re mired in the daily Fisher/Paradigm Insurance Marketing has grind of caregiving. offices in California and Arizona, and works with agents across the country. You can Another option may be to offer key reach Susan at 818-444-7757 or at susanb@ employees more flexible hours or to allow paradigmins.com, www.bjfim.com. A national them to work offsite for all or part of their listing of professional long-term caregivers work schedule. This may allow them to trade and facilities can be found on this page: www. caregiving duties with other family members, bjfim.com/miscellaneous/my-senior-care/. and may relieve some of their stress due to daily commuting and the rigidity of fixed hours.

BIO

As the U.S. population ages and 75 million Boomers race into retirement age, the need for long-term care will multiply exponentially. The U.S. Department of Health and Human Services estimates that 70 percent of people aged 65 and older will need long-term care at some point in their lives.9 Individuals and employers can plan ahead for this eventuality by having open discussions with their families and their work teams, and take steps to protect the health, stability, and finances of their employees by facing the issue squarely. Caregiving for long-term care patients is a growing issue for women workers and

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References

1. U.S. Department of Labor, Statistics on Women Workers, 2009 2. Job Strain, Job Insecurity, and Incident Cardiovascular Disease in the Womenâ&#x20AC;&#x2122;s Health Study, presented at American Heart Association Annual Meeting, November 2010 3. Family Caregiving Alliance, Women and Caregiving: Facts and Figures 4. Genworth Financial publication, Beyond Dollars: The True Impact of Long Term Caring, September 2010 5. Ibid. 6. Ibid. 7. Ibid. 8. MetLife Mature Market Institute, Caregiving Cost Study: Productivity Losses to U.S. Businesses, July 2006 9. U.S. Department of Health and Human Services, National Clearinghouse for Long-Term Care Information, http://www. longtermcare.gov/LTC/Main_Site/Paying_LTC/Costs_Of_Care/ Costs_Of_Care.aspx

March 2011

ECONOMICS

Evaluating Health Promotion Programs Applying Best Practices to Evaluate and Study the Impact of Health Promotion Programs Benefit Costs, Health and Productivity Writen By Philip A. Smeltzer, Ron Ozminkowski, Shirley Musich

Current Situation

in human resource management evolved during the 1990s. Today, we find worksite health promotion migrating as a common strategy from large self insured employerâ&#x20AC;&#x2122;s into smaller and smaller employer groups.

The establishment of the health risk appraisal and advent of corporate fitness centers more than 20 years ago was the beginning of worksite health promotion as we know it today. A comprehensive strategy for improving health in the worksite, including a more general whole-person concept across multiple domains

Todayâ&#x20AC;&#x2122;s worksite health promotion programs are primarily aimed at secondary or tertiary prevention and care management efforts. Health management programs such as disease management, case management are commonly available for individuals with degraded health as a result of a chronic condition or acute issue.

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March 2011

The various programs are intended to improve health status, productivity and safety; enhance the appropriate utilization of healthcare services and work loss programs; and control the ever rising expenditures associated with poor health.

their health risks, we may observe a change an improvement in health at any age [5].

A variety of surveys and studies have documented the operation of worksite health promotion programs in the U.S. A fair estimate is that 50-75% of employers with more than 10,000 employeeâ&#x20AC;&#x2122;s offer worksite health promotion programming that includes an HRA and multiple programs across several different delivery media such as seminars, phone based counseling, and Internet applications.

It is estimated that more than 500 studies evaluating health promotion initiatives have been published in peer-reviewed journals [6]. However, there are several issues that challenge a scientific approach to the study of health promotion program impact. Worksite health promotion is an applied field. When a pharmaceutical company studies the effects of nicotine replacement on smoking use, they are able to use a small number of participants and randomize volunteers into a treatment group and a comparison or control group.

Why Worksite Health Promotion The health risk profile of U.S. adults poses multiple threats to a high quality of life. Tobacco use in young adults age 18-24 exceeds one in four (25.3%). Almost two out of five (38.0%) adults report virtually zero physical activity in an average week. Approximately one in four adults (23.4%) is obese and almost two-thirds are either overweight or obese. Adherence to recommended self-care and preventive health services can range from 50% - 70%. These lifestyle issues drive degraded functionality, productivity and impact a host of financial factors for U.S. employers [4].

The Science of Health Promotion Evaluation

When we design an evaluation study of worksite health promotion programs, we typically are not able to perform this type of randomization process. The ability to randomly select participating and non-participating employees is often viewed as denying the opportunity to participate for many who may benefit. In some instances, it may be possible to use lotteries or randomization to tailor the timing when people can gain access to health promotion programs (thus enabling similar comparison groups to be used for evaluation purposes), but this is not always possible either. A solution to this dilemma may be to use rigorous statistical processes in the evaluation to assure that the demographic, health status, and other differences between participating and non-participating subjects are accounted for before making inferences about the impact of the programs they use.

Health care costs for employers are estimated at a 12% rate of annual inflation. In addition, disability and workersâ&#x20AC;&#x2122; compensation costs are increasing by 9% in many states, and Family Medical Leave Act (FMLA) costs are escalating every year. There is often a strong association found when health risks and the previous costs are studied. Health risks tend to accumulate as we age. However, when A competent evaluation of a worksite individuals change lifestyle habits and decrease health promotion program can address this issue, 32

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March 2011

ECONOMICS and many others. A checklist for consideration making by senior leaders. when conducting program evaluations is outlined below with additional issues to consider. 8. Recognize and describe the consequences of any limitations in the analysis. [9]

Checklist for Sound Worksite Health Promotion Evaluations

As the above checklist is executed, other challenges may need to be addressed in the 1. Decide both financial and non-financial evaluation, including: questions to address and which hypotheses to test in the impact study. • The distribution of financial and utilization data is skewed. 2. Choose an evaluation design that is well suited to testing that addresses these questions • In the absence of randomization, self selection and hypotheses. (As noted above, statistical of program participants may lead to differences analyses are likely to be required to estimate in demographics, health status, motivation or the benefits of program participation and find other factors that create a potential bias. unbiased answers about the impact of the programs of interest.) • The size of participant or non-participant groups under evaluation is small compared to 3. Before conducting any analyses of dollar the extreme variability of medical costs. metrics, adjust for inflation. • Medical inflation is different between various 4. Before generating the final ROI and financial categories such pharmacy, inpatient services, metrics of interest, estimate and discount outpatient surgeries, office visits. costs for each programmatic alternative under consideration. (for multi-year evaluations) • Health benefit coverage changes occur annually and may shift costs dramatically. 5. Similarly, estimate and discount monetary and nonmonetary benefits. (The adjustments • A small but not insignificant percentage in items 4 and 5 are necessary because, even of employees may not enroll in employer after adjusting for inflation, dollars received or sponsored health plan benefits, with subsequent spent today are more valuable than the same medical expense data missing. dollars spent in the future. These adjustments account for the reasons why dollar values differ • A small to moderate segment of the employees over time in order to generate useful financial with health plan coverage will not use any metrics.) medical services or very few (< $100) in a given year. 6. Perform sensitivity analyses to deal with uncertainties and test assumptions that had to be • New hires, retirees, and terminated employment made in order for the evaluation research to be create turbulence within the study population. conducted. • A very small segment of the population (< 7. Present results to aid effective decision- 10%) typically accounts for 40%-60% of all 33

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March 2011

health related expenses.

the skewed data and non-normal distributions of expenditures in the population of interest. â&#x20AC;˘ Costs associated with pregnancy and These analyses can be conducted twice, once birth, or hospital admissions may not be related with all sample members and once without to lifestyle issues impacted by programs. those who have extremely high expenditures, to assess the impact that a few â&#x20AC;&#x153;outlierâ&#x20AC;? members Best Practices in Evaluation will have on the program impact estimates.

Methodology

The issues described above can be addressed via competent statistical analyses. For example, two-part regression models can be used to account for the likely 20% of subjects who utilize no health care services in any given year, versus the remaining 80% or so who do. Two-part models therefore help address

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Other statistical techniques can be used to account for demographic, health status and other differences between program participants and non-participants before the impact of program participation is estimated. For example, propensity score-based matching or weighting techniques can be used to overcome the challenges posed when participants and

March 2011

ECONOMICS comparison groups are not randomly assigned. These methods, and other multiple-regressionbased strategies are well known to competent program evaluators and expertise with these techniques can often be found at leading universities and evaluation research firms. I ssues related to small sample sizes can be addressed using permutation testing approaches that create thousands of smaller samples for analysis and thereby increase the statistical power of the analytics. This may enhance the reliability of the findings when sample sizes are small. Generally speaking, health promotion program impact estimates amount to welldesigned cost-benefit or cost-effectiveness analyses. The metrics devised from these analyses include the net present value estimate and the ROI ratio. The net present value (NPV) calculation is the difference between the total inflation-adjusted and discounted set of benefits and costs associated with the program of interest over its useful life [9]. The ROI ratio is the ratio of benefits to costs, rather than the mathematical difference between the two. The statistical analyses mentioned above are typically focused on estimating the benefit values used in these metrics, to make sure apples to apples comparisons are made between program participants and non-participants before benefits are estimated.

the best ways to use health promotion programs to increase the health, safety, and productivity of the workforce.

Money Isnâ&#x20AC;&#x2122;t Everything, Though â&#x20AC;Ś A hallmark of successful programs is the contribution to multiple business objectives. The varying goals of the health promotion program should be established a priori. A common observation in program evaluation is the assumed main goal of medical benefit cost reductions. However, interviews with corporate leaders substantiate that medical benefit cost reductions are not the primary goal in as many as 50% of all programs . If program goals such as lower employee turnover, improved morale, or other desired outcomes are important, the program evaluation must be tailored to gauge progress in reaching these goals. This is not to suggest that the financial evaluations should be minimized, but that a total picture of business objectives must be identified in order to establish the evaluation plan [2, 3, 11].

Summary

Worksite health promotion has enjoyed a prosperous journey over the past 30-40 years. What started out in the 1970s and 1980s as predominantly on-site fitness centers and the use of executive physicals has grown into sophisticated programs that engage a very large percentage of employees in some cases. The consideration of multiple The health risk appraisal is commonly used perspectives when evaluating a health promotion as a gateway program that helps stimulate program yields a more accurate appraisal of the participation in higher intensity interventions. total program and will result in a better set of NPV and ROI estimates. Conducting the ROI The evaluation of worksite health promotion and NPV analyses several times to address the programs has evolved from relatively differences of opinion among key stakeholders straightforward group comparisons to include will lead to more informed discussions about the use of more sophisticated statistical

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March 2011

As Senior Research Director, Shirley Musich is responsible for providing decision support to lead employers and other Ingenix clients through health evaluation, program design and measurement and evaluation processes. Her recent experience includes serving as a Senior Data Analyst at the University of Michigan involved with Integrated database systems and the decision support teams for corporate clients Evaluation areas must be tethered to the in the administration of their health promotion business objectives established by corporate programs. leaders. Continuous assessment of health risk expenditures and other outcomes of interest References can help predict these outcomes in future years. While heavy-duty statistical analyses may be 1. USDHHS, U.S.D.o.H.a.H.S., Healthy People 2010, required to obtain the most accurate estimates P.H.S. U. S. Department of Health and Humana Services, Office of the Surgeon General, Editor. 2000, U.S. of program impact, engaging in this process will Government Printing Office: Washington DC. p. 60. yield the information that program managers 2. Bartholomew, L.K., et al., Planning Health Promotion need to modify program designs and menu Programs. 2006, San Francisco, California: Josseychoices to continually enhance the welfare of Bass. 724. 3. Oâ&#x20AC;&#x2122;Donnell, M.P., Health Promotion in the Workplace. the workforce and dependents. 1984, Albany NY: Delmar Publishers. techniques. Regression analysis, propensity score approaches, randomization tests and other features of good cost-benefit or costeffectiveness analyses are being used more often than in the past. These evaluation techniques are designed to yield more accurate estimates of the financial and non-financial impacts of program participation.

About the Authors Philip A. Smeltzer serves as a Senior Consultant in the Ingenix, Employer Advisory Services Group. In his current position Philip capitalizes on more than 20 years of experience in the health promotion and health management field. He has focused on worksite health promotion activities and evaluation throughout his career. Ron Ozminkowski, Ph.D., is Vice President of Research and Development in the Healthcare Innovation and Information Group at Ingenix and also serves as Vice President, Research and Policy, at UnitedHealth GroupÂŽ Alliances. In his current role, he developed and now leads a major research and reporting unit that helps monitor and evaluate health promotion and care management programs.

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4. CDC, BRFSS Data 2001-2004. www.cdc.gov, 2005. 5. Hartman, M., et al., National health spending in 2007. Health Affairs, 2009. 28(1): p. 16. 6. Chapman, L., Meta-Evaluation of worksite health promotion economic return studies. American Journal of Health Promotion, 2003. 6(6): p. 15. 7. Pelletier, K.R., A review and analysis of the clinicaland cost-effectiveness studies of comprehensive health promotion and disease management programs at the worksite: 1998-2000 update. American Journal of Health Promotion, 2001. 16(2): p. 10. 8. Goetzel, R.Z. and R.J. Ozminkowski, The health and cost benefits of work site health-promotion programs. Annual Review of Public Health, 2008. 29(17): p. 18. 9. Ozminkowski, R.J. and R.Z. Goetzel, Getting closer to the truth: overcoming research challenges when estimating the financial impact of worksite health promotion programs. American Journal of Health Promotion, 2001. 15(5): p. 6. 10. Musich, S.A., L. Adams, and D.W. Edington, Effectiveness of health promotion programs in moderating medical costs in the USA. Health Promotion International, 2000. 15(1): p. 11. 11. Chenoweth, D.H., Evaluating Worksite Health Promotion. 2002, Champaign IL: Human Kinetics.

March 2011

COLUMN

We’re Giving Dieting Too Much Weight in Wellness Communication Dieting is a popular ingredient in wellness communication, but true wellness goes by the wayside when food intake becomes an all-consuming focus. A smarter approach is to deliver relevant, compelling messages about intuitive eating. Writen By Shawn Connors Most wellness committees deliver frequent messages about food—tips sent with good intentions that prescribe what to eat, when to eat, and how much to eat. Employees who receive this communication (and thousands of other food-related tips, advertisements, and images from various media) are conditioned to believe they’ll feel better if they simply pay attention and act accordingly: Apply these steps! Avoid these foods! Want to feel better? Go on a diet! Get in shape!

The Obstacles at Work

“Dieting is a $52 billion industry with a 92% failure rate,” points out Ronda Bokram, a registered dietician in Michigan State University’s Health Education Department who serves as an adjunct faculty member. “It’s an industry built around the fear of obesity. People are so afraid of becoming fat—the word has such a stigma attached to it—that the idea of food becomes all-consuming. To avoid being labeled as fat or obese, many students here and many people in general start restricting themselves to certain foods, or start working Instead, we need to reshape our out for three hours a day. Wellness goes by the relationship with food. We’re giving it way too wayside when food gets that much attention.” much power.

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March 2011

The concept of dieting is a popular ingredient how we relate to the fear of weight gain and the in health communication for multiple reasons: importance of being thin makes a difference in how we feel and behave. • The diet industry’s presence: The diet The Value of “Intuitive Eating” industry has thousands of methods and plans, Messages diet clubs, and weight loss programs. Bigname authors write diet books because they To become physically and mentally know they’re seducing a captive audience. healthier, Bokram says, companies and communities shouldn’t deliver information • Quick-fix mentality: Our can-do culture loves fast solutions, no matter if they’re about food and nutrition in judgment terms of “good” and “bad.” And instead of trusting realistic. Many of us have little respect for newfangled diet crazes or instant-gratification the change process, and for concepts such as concepts, we should start putting some faith in gradual, incremental, and progressive. ourselves, trusting what our bodies are telling us. • Diet-oriented medical professionals: Many health care professionals bombard patients with nutritional information, lecturing about the importance of weight loss and encouraging surgical procedures to reduce obesity.

• Difficulty of changing behavior:

Relatively little psychology is used in educating people to take better care of themselves around food. Until we address the conflicting and (more often than not) contradictory emotions and motivations people have about eating intuitively, we are not going to see much change in mainstream thinking or behavior around food. Genetics, temperament, biochemistry, and neuropsychology have as much to do with eating and weight as do proper nutrition and exercise. In fact, research shows that more people engage in thoughts about their weight and eating habits, the more likely they will be prone to negative emotions, distress, and psychological ill-health. A recent paper published in the journal Eating Behaviors (Masudo and Wendell, 2010) indicates that 38

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Bokram says each person has an intuitive sense of hunger and appetite. Following those normal-eating cues, rather than a harsh calorie restriction, shifts the focus on food inward, where it belongs. “People crave external forces—they love diets because they’re told what to do,” Bokram says. “It’s the equivalent of getting a good math grade without actually understanding the material. After a while, you run into the same kinds of problems, and you really haven’t learned anything.” Bokram should be applauded. She tries to help Michigan State students become at peace with their bodies, and to delight in the pleasures of food. In addition to scheduled appointments, her department publishes educational fliers and other printed material, holds empowering meetings and events about wellness and nutrition, and trains students to help others in a peer-to-peer way. The university’s Health Education Department also distributes a customized version of an electronic newsletter quarterly. It, too, takes the focus off food and instead includes a department called “Outer

March 2011

COLUMN Aisle Fresh.” Another proponent of intuitive-eating messages is Dr. Lynn Rossy, a health psychologist who teaches a series of “Eat for Life” classes at the University of Missouri. She founded the university’s Mindfulness Practice Center. Her basic philosophy on food is refreshingly holistic, incorporating mindfulness, the intuitive wisdom of the body and mind, and educational insight. Rossy encourages wellness committees to use the acronym “BASICS” to deliver messages about intuitive eating. It stands for Belly Check, Assess Your Food, Slow Down, Investigate Your Hunger, Chew Your Food Thoroughly, and Savor Your Food.

Nix the Notion of a Quick Fix Wellness committees can play an important part in stopping the madness propagated by our culture of dieting, bodily discontent, and the prevailing belief in a quick fix. Let’s start by simply giving food less weight.

About the Authors Shawn M. Connors is president of Hope Health. He believes behavior change requires a mix of both art and science. He founded the International Health Awareness Center, Inc. (IHAC) in 1981, which focuses on the importance of communication in positively affecting workplace cultures. Recently, he worked to develop a workable, realistic health communication system.

CorporateWellnessMagazine.com

March 2011

How to Reduce Health Costs and Save Lives

Individual Health Opportunity Assessment considered key ingredient to success

How to Reduce Health Costs and Save Lives Writen By Edward J. Haaz, David Spratt, and Les C. Meyer

climate, and it hinges on the establishment of a “culture of health” wherein beneficial lifestyle, health and wellness distinctive choices are made from a convergence of interests and support systems, as well as structures and processes. Only then can forward-thinking employers improve the health and productivity of their It’s a rare feat in today’s business world when an workforce, and in that manner, bend the curve organization can avoid reducing health insurance of their healthcare costs. benefits or shifting costs onto employees in the face of runaway healthcare expenses. And there The linchpin of this high-touch are plenty of cynics who believe the Patient approach combines the tenets of early detection Protection and Affordable Care Act (known as and effective intervention with direct physician the ACA) will further tie the hands of employers and behaviorist involvement for a more holistic that are trying to accomplish these goals. result. Together, these elements have the power to substantively change – and even avoid a But truth be told, there’s no reason for catastrophic incident. Known as an Individual Corporate America to believe it cannot defy Health Opportunity Assessment (IHOA), it those odds, nor is it necessary to fear the long offers employees and their spouses a face-toarm of government. Success is achievable, face annual assessment and clinical consultation regardless of the nation’s economic or political with a trusted physician and health behaviorist

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who integrates with an employee assistance program (EAP). These meetings, which last about 8 minutes because of the sheer volume of many employee populations, drive a process that can be likened to speed dating, but the result is anything but superficial. Behaviorists are trained to ask key questions that get people to open up as they would during a counseling session, in roughly 10% of the time. Afterward, they may be referred to an EAP or a health behavior coach. What is so compelling about this process is that it removes much of the mystery or stigma around behavioral health and EAP, an incredibly valuable but underused resource that can guide

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people to embrace relevant information and make wiser choices and pursue the right course of action.

HRA on steroids One creative way to describe an IHOA is that itâ&#x20AC;&#x2122;s like a health-risk appraisal (HRA) on steroids. How so? In a nutshell, there are enough moving parts to achieve a more meaningful outcome than traditional programs. Hereâ&#x20AC;&#x2122;s how it works: Once all the necessary forms are filled out, employees meet with a team of clinicians that include a phlebotomist, nutritionist, physician and psychologist to review their personal health profile and make recommendations. The main

March 2011

objective is to motivate more people to align themselves with a trusted clinician and/or embrace a more aggressive ongoing treatment regimen with their family physician. This tool tracks process indicators that include the extent to which employees are participating in HRAs, biometric and cancer screenings, immunizations and health fairs and gauges their willingness to make important lifestyle changes. An IHOA also promotes annual physicals and lunch-and-learn sessions, while also providing guidance before specialty care needs to be accessed. In addition, follow-up coaching and education lead willing participants down the path of a healthier lifestyle.

is surprisingly widespread among people with health insurance who aren’t taking full advantage of the resources that are available to them, and it is counterintuitive to the notion of expanding access to healthcare under the ACA.

Preventive medicine

One area that’s ripe for a significant return on investment and improved health outcomes as part of an IHOA is when a team of clinicians can better ensure that patients suffering from leading chronic disease states are adhering to their prescription drug regimen. It is commonplace for a segment of this employee population to cut back on their dosage because of side effects or ration their supply of The larger point is to engage people medication out of financial necessity. But the where they work, whether it’s in an office setting fact is that more prescriptions are written as a or on the factory floor, which can have a very result of IHOA interventions because patients positive influence on how they choose to live are receiving proper medications, which can since so much time is spent in the workplace. help reduce or eliminate needless – and costly An IHOA fits nicely in the emerging age of – trips to the ER. employee engagement and population health promotion. And, with a proven track record If an employer is trying to avoid cost, of high impact engagement and intervention C-Suite executives and front line management at various large corporations, this approach must become heavily engaged creating a culture raises the bar in terms of what an organization of health that showcases prevention. “Sick can expect from employees who may have care” costs money. Prevention saves. It’s that been reluctant to improve their health, but are simple. given the tools they need to move from simply contemplating solutions into taking action. Following up on patient care is an integral part of every IHOA, buttressed by an extensive Since the IHOA resembles a health fair, database with physician and behaviorist notes it could be turned into an event where people concerning elevated blood work or other risk who have not chosen a physician would have factors. This enables almost verbatim quotes an opportunity to see a local primary care from previous conversations that were delegated physician (PCP) from their provider network to various members of the clinician team and (also known as the “medical home” concept) easily identify each individual’s particular in action and decide whether or not to seek his needs. or her services in the future. This phenomenon

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An IHOA is one of seven core programs developed in recent years to help employers benchmark their health promotion vis-Ă -vis competitors, determine how they can improve those efforts to the point of bending the cost curve, and conduct what-if scenarios for planning and budgeting purposes. Similar tools include an Employer Health Opportunity Assessment and Community Provider Opportunity Assessment. Rounding out the toolkit are productive advantage dashboards, care management centers-of-excellence support to improve efficiency in the delivery of care for costly chronic, catastrophic and disability cases, physician executive solutions, and community provider reward and recognition programs. This multi-pronged approach helps pave the way for several opportunities to create meaningful productive interactions with the workforce, reduce an employerâ&#x20AC;&#x2122;s healthcare costs and improve personalized experiences of consumers and population wellbeing outcomes. They include fewer inpatient admissions,

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medication compliance or adherence, the establishment of a PCP relationship and interaction with a behaviorist. Of course, it all starts with creating a self-perpetuating culture of health. There are five common denominators for employers that share this vision. They have taken the time to develop an integrated multi-year strategic scorecard and roadmap for improving the wellbeing of their workforces, as well as expand their focus on sick care to integrated population health improvement. Other characteristics include engaging employees in early detection and prevention programs, recruiting and rewarding the best community providers and empowering a dedicated physician executive to assist in program design, implementation and vendor management. Once these innovative components are in place, it becomes much easier to chart higher expectations in regard to employee health and productivity. This leads to creating the culture of health necessary to bend the healthcare cost curve â&#x20AC;&#x201C; even at a time when achieving such actions has become one of the biggest challenges that any business encounters.

About the Authors Edward J. Haaz, M.ED., LPC, ABMPP, clinical behaviorist, David Spratt, D.O., FAOEM, wellbeing specialist and Les C. Meyer, M.B.A., healthcare strategist are business partners in HealthNEXT, an emerging leader in establishing corporate cultures of health and work life wellbeing initiatives as a measurable competitive advantage. Les C. Meyer can be reached at 303-916-0017 or les.meyer@ healthandperformance.info.

March 2011

FEATURES

Engagement & Participation are Key for a Successful Corporate Wellness Program Writen By Deborah MacArthur Many companies have or are beginning to establish corporate wellness programs for employees as it uniquely benefits both the employee and the company. The benefits for the company include a higher level of productivity, retention, achievement, better peer relationships, and reduced absenteeism among others. Sounds great, but this can only happen when there is engagement in the program and consistent participation. This is an age old question in the world of corporate wellness. How do we get our employees to engage, but more importantly, how do we keep consistent participation. This article will explore some options for not only engaging employees, but also keeping them consistently participating in your corporate wellness programming. 44

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Company Leadership Support One of the foundational requirements of a successful corporate wellness program is that executive management be on board and supportive. The leadership and culture of the company will steer the initial engagement and in turn continued participation in the program. The tone is established by the leadership of the company and must encourage and support each employeeâ&#x20AC;&#x2122;s efforts to utilize the corporate wellness programming. It is extremely important for management to create an environment that is conducive to engagement and participation. In other words, management needs to create a program that actually makes it easy to participate in. Human nature will find excuses not to participate, so it is important

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FEATURES that the company stands behind the wellness investment and facilitates participation.

Employee Engagement Once you have strong management support for the corporate wellness program, you will have to plan how to engage employees in the program. As you plan your wellness program, it is important to keep in mind that you need a variety of options to offer the workforce. Below are a few suggestions to encourage employee engagement. You may also come up with an original idea that will speak specifically to your workforce:

Having a fitness professional on-site also gives your employees a resource for health and fitness information, support and motivation. Once an employee engages in wellness and fitness programming, he or she will feel better about life and work. The employee will exhibit a more positive outlook regarding work product and the work environment. There is a two-way benefit for the employee and the company. A win-win, if you will.

Keeping Consistent Participation

Once your employees decide to engage in your Corporate Wellness program, the next step • Education: By educating your is consistent participation. Our research has employees, especially the sedentary or non- shown that this can be accomplished through wellness population, you can draw them into the the 3-P’s to participation leading to program program. This is a vital part of any successful success: health and wellness program. The sedentary population of your workforce needs to know and 1. Presence: Having highly trained, goalunderstand the many benefits of living a healthy oriented fitness personnel on-site to facilitate lifestyle and how to make those changes. This the program. A fitness professional can provide will be the most challenging group to reach, but education, support, and motivation to your once you do it will be the most rewarding. workforce. • Incentives: Depending upon the culture of your company this can be a fundamental method to engage your employees in a wellness program, especially when the incentive is monetary. But keep in mind that this can also provide a temporary motivation when the goal is to create long term positive behavioral changes. • On-site fitness professional: Whether you have a fitness center within your company or not, you can hire someone to perform fitness assessments, personal training or to teach classes. This shows each employee that you are serious about the wellness programming.

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2. Programming: Cutting edge programming and execution of services provides incentives and interest to your corporate wellness programming. Offering a variety of the top programs in the fitness world will draw in different audiences of your workforce. 3. Promotion: Promoting your wellness programming with targeted internal marketing that offers an educational value will help create interest in corporate wellness. There are many avenues to market to your workforce including newsletters, informational and educational emails, social media, etc.

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Combining presence, programming and promotion will drive participation, thus resulting in increased retention and reduced attrition. Consistent participation is critical because the more the employees participate, the more likely they will experience results. The results in turn fuel the continued participation of the employee. The ultimate goal of the company is behavioral change and engaging all employees, especially the sedentary population, into a healthy and fit lifestyle. For the company, this has a multitude of benefits that they are offering to their workforce, as well as creating an ROI for the company. Additionally, there is a cutting edge way to engage employees in a corporate wellness program: technology. This concept is fairly new to the health and fitness world and will transform corporate wellness programming. By combining social media and fitness you will open up numerous avenues for employees to engage and participate in your company wellness program as well as with coworkers. With the blend of social media and fitness, your employees can communicate with each other online which will create team building, bonding and even healthy competition. Each participating employee will have access to online nutrition, and health and fitness tools. This electronic tool includes educational health and fitness blogs, networking with colleagues, forums, and a comprehensive calendar of healthy events within the company community. This type of platform will tie together the entire corporate wellness program through open communication between coworkers, education, rewards and incentives. Your corporate wellness program will become a desired commodity within the company which will encourage the engagement and participation necessary to drive results and

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eventually the ROI the company is looking for from the investment. As an employer, you may be wondering whether or not having a corporate wellness program is vital to your workforce and worth the initial investment. The bottom line is that when employees feel cared for by their company, they are more likely to have a â&#x20AC;&#x2DC;sell outâ&#x20AC;&#x2122; mentality toward the employer and their position in the company. This will lead to the additional cost benefit of employee retention. The benefits of a corporate wellness program are numerous and with wise planning and executive management support, you can engage your employees to participate, thus leading to healthier employees and a healthy ROI.

About the Author Deborah MacArthur is the Director of Marketing and PR for FACTS Fitness, a Commercial and Corporate Fitness Management Company located near Philadelphia, PA FACTS Fitness currently owns and/or manages commercial fitness centers including Ellis Athletic Center in Newtown Square, PA and Steel Fitness in Bethlehem, PA. Corporate Wellness clients have included BPG Properties, BPG Elite Properties, Coca Cola, T-Mobile, Penn State Lehigh Valley and many more.

March 2011