EDITOR’S LETTER
Corporate Wellness Agenda and Participant List Announced
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Jonathan Edelheit
his year we have worked extremely hard to totally redesign this years Corporate Wellness Conference and Employer Healthcare Congress. We stripped everything down to the shell, and gave it a complete upgrade from speakers and agenda topics, to new networking software, and excitingly, to a new city. We are going to Chicago, in a true convention center, and everyone is ecstatic for the conference to move to Chicagoland and to be centrally located in the United States.
Editor-In-Chief
The results have been amazing for us. The industry has seen the changes and spoken. Our attendance is up 93% compared to last year around this same time, and it keeps growing day by day. www.corporatewellnessconference.com/2011-participants. html Part of that, I believe, is our investment in bringing in some of the brightest and best keynotes possible. This is an area where we focused heavily and tried to get innovative keynotes that are well known experts. We searched for those who not only inspire, but provide key insight we all need to stay motivated and to succeed in our business, passions and personal lives.
EDITORIAL STAFF EDITOR Jonathan Edelheit Jon@EmployerHealthcareCongress.com
ASSISTANT EDITOR Sarah Hunt
jon@employerhealthcarecongress.com
All of our KeyNote speakers are outstanding, but I believe my favorite would have to be John Casey, Director of International Benefits for Google with his topic, Creating the Healthiest Employee in the World. Google is at the cutting edge of innovation and everything they do is usually inspiring and successful. I can’t wait to see how they are changing the curve and making their employees healthier, more productive and lowering their costs. I am very passionate about the power of social media. It is a very important topic for me to bring to the forefront for our attendees. Most of us know social media but don’t really understand it or know how to use it effectively. Social Media is being used for everything today; even enrolling and educating employees for benefits programs. I diligently searched and was able to get Mitch Joel, who Mashable.com (the top rated social media website out there), rated Mitch as one of the top social media experts in the world and his book, Six Pixels of Separation was rated one of the top 5 social media books to read. As most companies in US healthcare and benefits initiate their plans in social media, this will be an eye opening and critical session Our outside the box keynote speaker this year is Bill Rancic, Season 1 Winner of Donald Trump’s The Apprentice. Bill competed on national television and is a true entrepreneur. We have brought Bill in specifically to discuss the challenges we are facing in the healthcare and insurance industry today and he will be teaching us the importance of becoming “adaptable.” Adaptability is critical for all of us to survive, and I couldn’t imagine a more important topic for us to be addressing, especially in the face of all the changes and obstacles our industries are facing with PPACA and the economy. This year we are also adding in Global Benefits and have some of the largest multinational employers and insurance companies presenting on the growing trend of international benefits and providing case studies to attendees. We have put a lot of effort into our Employer VIP program and even upgraded it to include Agents and Third Party Administrators. There have been so many requests for VIP Passes, sometimes it can be difficult to manage! Attendees will see a major difference in the number of employers, agents and TPA’s coming this year that qualified for our complementary passes and other benefits. I really want to thank everyone who has made our magazines and the conference so successful. More importantly, you have helped us accomplish, in just three years, what many of our competitors who have been around for 20 years, have been unable to surpass. With your support, you have made us the the biggest benefits conference in the country for employers, agents, TPA’s and insurers.
Jonathan Edelheit
President Employer Healthcare Congress
www.employerhealthcarecongress.com
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Copyright © 2011Corporate Wellness Magazine. All rights reserved. Corporate Wellness Magazine is published monthly by Global Health Insurance Publications. Material in this publication may not be reproduced in any way without express permission from Corporate Wellness Magazine. Requests for permission may be directed to info@ CorporateWellnessMagazine.com. Corporate Wellness Magazine is in no way responsible for the content of our advertisers or authors.
THAT 10 BENEFITS REALLY MATTER:
IMPACT OF THE 14 THE AFFORDABLE CARE ACT
WHAT FEMALES WANT
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HEALTH PROMOTION VERSUS DISEASE MANAGEMENT
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ON CORPORATE WELLNESS PROGRAMS – GOOD, BAD OR UNKNOWN?
LIVE WELL AND BE WELL
STRESS HORMONE CORTISOL 23 DOES CAUSE WEIGHT GAIN, DEPRESSION AND
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USING REMOTE HEALTH MANAGEMENT SYSTEMS TO MANAGE CHRONIC CONDITIONS
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WOULD YOU PAY YOUR CREDIT CARD BILL BEFORE REVIEWING IT?
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COMPREHENSIVE WELLNESS MANAGEMENT CHANGES BEHAVIORS
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KEY ISSUES IN WORKPLACE MENTAL HEALTH
CHRONIC FATIGUE SYNDROME?
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ave you ever wanted more time? More time to get things done and more time for you to live life? Just having an extra hour in the day or an extra day in the week would make life a bit easier wouldn’t it?
Time management is one of the biggest challenges we face as businesses and people. There are only so many hours in the day and only so many days in the week. In that given time frame, we must accomplish a certain number of tasks in order to be efficient and proficient at what we do. If we’re not good at what we do, even if we do it fast, it can take too long to get the necessary result or outcome right. If we’re slow at what we do, we might get the necessary result or outcome right but again it can take too long. Both instances are a problem. So what do we do? We schedule our work and our life in order to dedicate the time needed or the time allotted to accomplish all the things that have to get done and that need to get done. It seems reasonable to most people to operate in this fashion. However, as most people will attest, we always seem to run out of time to get things done and we never seem to have enough time to ourselves—which is what we really want! Is there a better solution? Yes, there is. It’s called freedom management. Instead of allowing time for all those necessary tasks and hoping that there is some time left over for us at the end, which there never is, it’s best to schedule that time for ourselves first and use the rest of the time to get things done. The leverage comes from using your freedom time to recharge, be happy and get focused so your productivity time is at optimum. As they say, all work and no play make you a dull person.
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And it works. If you give yourself four hours to get something done, you’ll use all four hours. If you give yourself three hours to do the same thing, you’ll get it done in three. A given task will always fill the time allotted and you will always operate at a level of efficiency and proficiency given the nature of a situation. Because you can control the nature of most situations, you can also control your tasks. So from now on, instead of cramming your free time into your schedule, schedule your free time first and then cram in the work. You’ll be surprised at the results when you actually accomplish more in less time. There is a valuable lesson in freedom management versus time management when it comes to health, especially in the workplace. Most people and businesses operate with a focus on their desired product, service and revenue at the expense of their health, wellness or lifestyle. Then, if and when a health issue arises, which it most certainly will, we dedicate resources to deal with the problem so we can get back to work.
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As we know statistically and experientially, this costs businesses time and money. It also creates tension in the workplace and affects the corporate lifestyle of the company. Fortunately, there is a better way. Just like our example of trying to squeeze in more personal time with all the work we have to do, most people are living life trying to squeeze in all the healthy things they should do amongst all the work they have to get done. This is a challenge at best. Interestingly, if time is scheduled and built into our day through habits and defined initiatives, we can invest in our health while we work so that not only do we gain the health benefits but our work quality and quantity also improves. Again, this is supported by the current research and the case studies regarding wellness in the workplace. Once a health problem exists, it takes much more time and money to heal, recover and treat that problem then it would have to prevent it in the first place. Just like customer service, if there are procedures and systems in place to deliver
September 2011
the best experience for buyers and people who use About the Author our products, we can avoid the scenario where a customer encounters poor service or a bad product, Dr. David Koivuranta operates which then takes considerable resources and a health and wellness company, expenses to counteract. After all, a happy customer Time Health Management. It is a repeat customer willing to spend money! is founded on over a decade’s worth of experience and Similarly, a healthy employee is a performing knowledge derived from treating employee. The benefits, however, go beyond the employees suffering from ergonomic stress, strain workplace and affect the employee’s entire life. and disease. It’s time to manage your corporate When the company plays such a pivotal and vital health, visit www.timehealthmanagement.com and role in the health and welfare of its team, the rewards contact us for a free business wellness evaluation. are significant. The business is more productive with Learn why our workplace wellness solutions lower costs on health claims while the employees make sense. For more information email drdave@ are happier and more in tune with life and work. timehealthmanagement.com or call 416-697-7918. Ask us about our 5 minute onsite ergonomic and This is what happens when there is a focus on stress reducing system, perfect for every business. health promotion versus disease management. Yes, diseases, illnesses and injuries will happen and you will want to have a plan and the resources or benefits to deal with them when they do. However, this should not be the entire management plan or the selling feature to employees. It’s good to know you’re going to be looked after when and if something does happen to your health, but it’s even better to know that something is being proactively done to ensure that likelihood is being minimized. That’s the kind of company we all want to work for and with. In the end, disease management is nothing more than symptom treatment, crisis triage and a final product of things gone wrong. It’s a fight to make up for what could have been and what should have been and what will one day be true health promotion in the workplace. By adopting physical, chemical and emotional strategies for helping employees with nutrition, exercise, ergonomics, stress reduction, environmental adaptation and rest periods, the workplace will no longer be a place where we get drained, rather a place that energizes and revitalizes our lives for the better.
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shift is taking place in workplaces across America. Women are repositioning their careers in and in the process, are looking for something different. Do you offer the benefits that they want? A logical first step is to understand which benefits women, and many times men, want. To answer this question, I conducted research, a qualitative phenomenological study, in 2009. From this independent research, five major themes emerged. You can provide your employees with many of these benefits, often at little or no cost.
Concern for Family Responsibilities Nearly a third of the women interviewed cited concern for family members as catalysts for job change. They wanted options that would allow them to tend to spouses, children, and parents. Approximately 25 percent of those expressing concern for family members would have stayed with a previous employer if more options had been available to them. Consider offering your employees time to address family needs. Workplace options that promote a balanced, healthy family life will also help you retain employees.
Desire for Increased Flexibility and Control Nearly half of all women who left their positions expressed a desire for increased flexibility and more control over their work including their work schedule. Many employees are interested in compressed work weeks, flexible hours, and telecommuting options. Recently I spoke to a male employee in his late 20’s. He was working late into the evening and I asked him if he was tired and wanted to go home. “No way!” he responded. “I get into my zone late into the day and my productivity spikes. I’d rather work tonight and be able to have Thursday morning off
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to play golf. It’s good for me and it’s good for [the company].” In addition to flexible work schedules, giving employees control over work assignments can also improve your ability to retain employees. If how the work completed is less important than the end product, consider giving your employees more freedom to determine the process they want to use to complete a task or work assignment.
Interest in Another Career Twenty-five percent of the women interviewed cited interest in another career as reason for their exodus. Many of these women were ready for a major shift in their type of work so it is possible that employers would have had difficulties keeping these employees regardless of what they would have done. Still, this makes a case for allowing employees to move from one area to another or one job assignment to another. A move from production to marketing might be what keeps one employee engaged while an opportunity to learn a new skill might be enough for you to retain another. Crosstraining also gives an organization more depth so everyone benefits.
The Business Environment
Dissatisfaction with the environment in their places of business caused at least 25 percent of the women interviewed to eventually leave their positions. Some of the women interviewed explained that desire for increased security played into their thought process regarding an exodus. Employees want to feel secure. Although employers may be limited in what Lack of Support they can offer employees in the way of security, Nearly one quarter of the women interviewed increased communication and an overall sense cited lack of support as a determining factor of stability can assist employers with this when they decided to leave their positions. endeavor. Often supervisory support was listed as a concern although in some cases support at home So what is the bottom line? Forty-five percent of was listed as a concern. Providing employees those interviewed indicated there was something with a supportive work environment where the their employer could have done to make them employee feels valued can be the difference stay. Forty-five percent – nearly half! What are between a content employee and an employee you doing to make your employees want to stay? who is not engaged.
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About the Author Dr. Carrie Stringham has been teaching undergraduate and graduate courses in human resources for more than fifteen years. Carrie is a consultant and trainer in the areas of human resources, healthcare administration, and organizational leadership and can be reached at www.stringhamresources. com.
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ne of the major thrusts of the Patient Protection and Affordable Care Act (PPACA) is an increased focus on prevention and wellness, as opposed to a historical federal focus on responding to disease and injury as they become apparent and reach epidemic proportions. Although there are many unknowns, both in the application of the PPACA, and the effect of prevention and wellness programs on individuals making lifestyle choices, wellness programs are seen as one of the few constructs available that might modify behavior and result in a healthier population overall.
programs. The Affordable Care Act certainly acknowledges the existence and benefits of employer-based wellness programs. From 2011 to 2015 the Act provides $200 million in grant funds to assist small employers with the implementation of wellness programs. “Small employers� are defined as those with fewer than 100 employees working 25 or more hours per week. The grants are eligible only for those employers who have not already embarked upon a wellness program, and other criteria apply.
In addition to these grants, the PPACA provides for technical assistance to employers seeking to Only time will tell whether the intersection of the implement and manage a wellness program and will PPACA and the concept of employer-sponsored be conducting surveys and studies regarding wellness wellness programs net a discernible benefit or program structures and results throughout the nation. interrupts current momentum in the growth of such
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Another provision in the Act increases the health insurance premium discounts an employer can extend to employees who participate in wellness programs. Prior to the passage of the Act, such discounts were limited to 20 percent of the cost. Under the Act, the discount can now be up to 30 percent, and may even reach 50 percent under some circumstances. Providing discounts to participants can be seen as a punitive measure taken against non-participants, and employers are required to adhere to guidelines that assure a nondiscriminatory implementation of such incentives. An acknowledgement of the importance of workplace wellness programs is implicit in their inclusion within the healthcare law. However, there are some provisions, which may not be interpreted as being quite so favorable. The PPACA establishes prevention and public health outreaches that would appear to compete with employer-based programs. These outreaches are community-based and will be funded more aggressively than the workplace-related programs, starting at $500 million in 2010 and increasing to $2 billion in 2015. Employers will continue to fund wellness programs predominantly on their own, whether directly, or through their health care insurance premiums. These community-based programs may compete directly with employers and reduce participation in the employer-sponsored program. For the employees and their families, this is of little consequence, and more choice is generally a good thing for the consumer. The employees will choose the program that suits them the best, and will use it as they see fit. But for the employer, reduced participation in their workplace program could have a negative effect on their insurance pricing, even though the employees themselves are becoming healthier. Some insurance carriers require a certain percentage
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of employees participate in a wellness program in order to allow a discount in the company’s healthcare insurance premium. If discounts are available to individual employees, and employee utilizing a program outside the employer may not be eligible. The employees that choose to use a community-based program may also be creating hardship for other employees by not participating in the employer-sponsored plan. Employers may also find themselves thwarted in their attempts to provide wellness programs through their insurers. The PPACA mandates minimum percentages of premium dollars to be spent on clinical or quality services. A wellness program will likely not qualify as either, although the law does not specifically define those services at this time. Many insurers will need to extract their wellness programs from their suite of free value-added services and provide them only at a cost, or will terminate them altogether in order to comply with these mandates. Employers will then need to pay the insurance company separately for wellness program services or will need to contract with wellness program vendors. Either way, they will be incurring additional costs. If an employer is faced with this decision regarding funding of the workplace wellness program at a juncture where the program has not yet proven its value in reduced absenteeism and increased productivity, it is quite possible the employer will not continue to provide such a program. And, unfortunately, since the employer was already engaged in a wellness program offering, it would be unable to qualify for one of the Act’s grants to offset these increased costs so that it could continue with its program. The Affordable Care Act also provides for a nationwide study of wellness programs, which could result in statistically meaningful information
September 2011
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regarding outcomes, productivity, absenteeism, improvement in health characteristics and other metrics. Unfortunately, several of the metrics to be monitored by the administrators of the national study to produce this valuable information are beyond the scope of what is currently considered proper and respectful of employees’ privacy regarding healthcare information in the work place. Section 4303 of Title IV of the Act indicates the following metrics will be assessed: Employees’ health behaviors, health outcomes and health care expenditures; and Changes in the health status of employees, absenteeism, productivity, rate of workplace injury, and medical costs incurred by employees. In order to avoid even the appearance of impropriety, and to avoid any implication of discriminatory behavior, many employers studiously avoid knowledge of several of the above metrics. Employees’ fear of being taken to task regarding such issues as health outcomes, health care expenditures and health-related absenteeism is a concern that works against employee acceptance of a wellness program in the first place. If the employer has a self-insured plan, human resources personnel take care to avoid employee-specific cost analysis to ensure employee privacy. If the plan is a commercial one, the human resources personnel tend to have less of an opportunity to come into contact with employee-specific information in the first place. Even with workers compensation claims, employee medical information is closely guarded, and the employer receives only those details needed to determine the duties to which the employee may be returned, and the probable time frame in which that return may occur. Employees gain a significant level of comfort with wellness programs when they understand that their participation is completely voluntary, that they won’t be judged for good or ill based on whether
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they choose to participate, and no one is watching over them to ensure that their health improves due to participation. This federal study will compromise the painstakingly developed reinforcement of employees’ privacy in these regards and could well have a chilling effect on their desire to participate in their employer’s program, even if they have been participating previously. The downside to this is obvious and multi-faceted. The employees will lose the benefit of their participation in a wellness program, regardless of how marginal that benefit may have been. The employer will lose the benefit of that employee’s participation in the program. And the study will be skewed by the employees who prefer less intrusion into their healthcare specifics being under-represented in the demographic studied. This does not bode well for a statistically sound result from the study. Concerns about the erosion of employees’ privacy were voiced frequently prior to the passage of the Act. Reconciling those concerns with the required metrics and analysis seems a nearly impossible task. By contrast, the community-based programs sponsored by the Prevent and Public Health Fund do not specify metrics to be gathered from subject individuals. The pertinent subsection of Title IV, Section 4003 indicates that the Community Preventive Services Task Force has the duty to assess, every five years, “…the health effects of interventions, including health impact assessment and population health modeling…” Between the kinder, gentler evaluation of community-based programs, and the extraordinary disparity in funding, it’s not hard to imagine that workplace wellness programs will quickly be eclipsed by their community-based counterparts. For those employers that participate in PPACAestablished state insurance exchanges, wellness programs may net no benefit related to insurance costs. The state insurance exchanges are allowed to
September 2011
About the Author Greg Justice, MA owner of AYC Health & Fitness, Kansas City’s Original Personal Training Center and founder of Corporate Boot Camp System has been actively involved in the fitness industry since the early ‘80s. His growing network of Trainers spans 9 countries, 45 states, and 6 Canadian Provinces, helping fill the gap in corporate wellness with on-site workplace exercise programs. Speaker, author, and coach, Greg can be reached at aycfit@ gmail.com.
utilize only very limited criteria in establishing their premium rates. Participation in wellness programs does not appear to be an authorized criterion at this time. The criteria could be subject to change, as the exchanges are not yet active, and many rules, regulations, procedures and details have yet to be formulated and promulgated. Overall, the impact of the PPACA upon the implementation and continued use of workplace wellness programs appears to be a mixed bag. The Act is generally supportive of wellness programs, encouraging and supporting them in the workplace, the community, and for persons insured by individual plans. But the Act also brings unique pressures to bear upon wellness programs in the workplace by requiring intrusive metrics for federal analysis and creating and significantly funding competing programs.
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he buzzword among employers, especially this year, is wellness. Many employers have put an employee plan in place that includes a wellness element. However, the wellness topic covers many areas and can be somewhat nebulous by definition depending upon who is answering the question, “What is wellness?” For the most part, some employers think that when they throw together a gym membership, a coaching session, a smoking cessation plan, and an interactive website, they have a wellness plan. But wellness goes much farther as a concept and can be very broad-based depending on your opinion on what wellness means.
definition of wellness. There is, however, a set of common characteristics seen in most thoughtful attempts at a definition of wellness. You generally see a reference to a “state of wellbeing,” which is vague, to say the least, according to DefinitionofWellness.com. Also frequently seen is a “state of acceptance or satisfaction with your present condition.” The truth is wellness is a tough word to define. That said, Charles B. Corbin of Arizona State University gives this definition of wellness: “Wellness is a multidimensional state of being describing the existence of positive health in an individual as exemplified by quality of life and a sense of well-being.”
Interestingly, there is no universally accepted
But more than just providing weight loss or a
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feel good attitude, wellness plans help improve the overall health of employers and businesses. For every dollar spent on wellness programs by employers, medical costs were reduced by about $3.27 and absenteeism costs reduced about $2.73, according to a report on U.S. workplace diseaseprevention and wellness programs by Health Affairs, a health policy research journal. Studies also have shown wellness programs can provide a return on investment of between $3 and $6 for every dollar spent as reported by the Society for Human Resource Management. That’s a great ROI for anyone or any company. Besides helping lower health care costs, the real pot of gold has to do with a healthy work force being a much more productive work force, according to Health Care Service Corporation. As health insurance costs continue to rise, more businesses are getting motivated to offer new wellness programs or improve existing ones, and the latest research shows such programs can pay off in dollars, as well as pounds and inches. However, many seemingly good wellness programs fail to achieve their potential due to poor implementation.
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Employers need to follow a plan on how to set up wellness programs. Somebody with good project management skills needs to shepherd the implementation, but it can’t fall on one person’s shoulders, according to The Portland Business Journal. A wellness program requires the support of executives, as measured by their participation in the program. You need strong CEO support and role modeling, you need strong middle-management leadership and you need strong leadership from the person who coordinates the wellness program. You need a passionate advocate of wellness and healthy living in every work unit. But just offering a wellness plan to workers is only part of the equation. You must get them engaged in the process. When it comes to encouraging people to get healthy, it seems a free water bottle or a T-shirt doesn’t cut it anymore — cold, hard cash is where it’s at. Industry reports indicate that a rising number of employers are offering wellness programs and financial incentives and things like lower premiums to, for example, employees who don’t smoke, according to Health America Insurance.
September 2011
While it might seem like a no-brainer that people should make their health a priority without being bribed to do it, the fact is many do not. There are those people who really do care about themselves and it wouldn’t matter if we were providing incentives or not, but there’s also a very large percent of the population who may not be aware of the importance of health and wellness. Money talks. People pay attention to cash. The ideal would be if everyone would engage in the health and wellness effort, the nation could potentially slow the growth of medical cost trends. Additionally, free karate and yoga classes, biggestloser weight reduction contests with prizes, and incentives to encourage employees to go to the doctor are among creative initiatives that have emerged in wellness programs at small and large employers. These programs are expanding and increasingly making use of technology, according to the Chicago Sun-Times. In addition to lower health care benefit costs, employers that provide wellness programs
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experience greater employee productivity, higher morale, lower turnover and a stronger organizational culture. Researchers have found the most successful wellness programs have six essentials: engaged leadership at multiple levels, alignment with the company’s identity, a broad and highly relevant design, broad accessibility, internal and external partnerships and effective communications. Employers launching a wellness program need to commit to it for the long haul and realize that financial returns will take time to achieve, according to the Mid-America Coalition on Health Care. Wellness is not something that you can go in and do it for a year and see a return on investment. The typical ROI computation that works for whether or not you invest in a new plant will not immediately work for wellness. Businesses launching wellness programs should start by collecting data about their employees through individual health-risk assessments. They should then use the data to classify the workforce’s biggest risks, such as chronic diseases, accidents, inactivity, poor diet, smoking and other lifestyle choices. The data should then be used to establish goals and make workplace changes that remove
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barriers to healthy choices. The outcome should be measured and evaluated to see if the program is working. Here are some tips about providing wellness options that work, according to the Portland Business Journal: • Start at the top. Nobody will take the wellness program seriously if it doesn’t have strong support from the CEO and others in leadership positions.
There are plenty of vendors that offer wellness plans or services, but choosing the right strategic partner makes a huge difference in the success rate of your plan. Companies like Trotter Wellness, Careington, Weight Watchers and American Specialty Health are some of the key players in this market. There are more, but working with these corporations who have a proven track record over a long time and are very good at what they provide makes sense when you are interested in sourcing the “best in class” to offer your employees.
• Get employees involved. Even a well-designed wellness program won’t work if employees don’t participate. Offer incentives that make a difference.
Making the investment in a wellness plan can be expensive, but making poor choices in vendors or in program implementation can be even more costly if you pick the wrong company to help advise and implement your program. Creating an alliance with a nationwide provider that knows the business can make all the difference. Realizing that too late is a mistake you cannot afford.
• Take measurements. Track and report results.
About the Author
• Don’t expect miracles. A good wellness program will cut health care costs over time, but it typically takes 18 months or longer before the savings associated with the program outweigh the cost.
Mark Roberts’ professional sales background includes 30 years of sales and marketing in the tax, insurance and investment markets. Mark is a licensed life, health and accident insurance agent in all 50 states and DC for insurance products and discount health plans. He serves as Manager of National Accounts at Careington International Corporation ( www.careington.com ).
• Assess your needs. Perform employee health risk assessments and diagnostic screenings.
Wellness plans have definitely proven to be worth the investment, but overnight results are not what you will reap. The culture in the employee community within your business must be changed, and that takes a long time. For the most part, adults don’t like to change, especially as they grow older. But providing options for workers to participate in with the right approach definitely makes a long-term impact, not only on the personal health of individual employees, but also on the corporate health of your company. Profitability is a major concern, and business owners and senior executives realize that in order to stay in business, a company must make more money than it loses. Having healthy employees is a really great way to make that part of the equation.
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Additionally, Mark works with clients needing insured products ( www.careingtonbenefitsolutions. com ) in the US and discount dental and optical schemes in the UK (www.healthydiscounts.co.uk ). Mark has been writing a health care blog for the past three years, (www.yourbesthealthcare.blogspot.com ), which is a topical weblog about various health care issues. He also regularly contributes articles to magazines for both medical and dental topics both in the US and the UK. You can reach Mark at markr@careington.com.
September 2011
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s you probably know by now, cortisol is a fight or flight hormone that is released every time you’re stressed by anything. Part of its purpose is to replenish your energy after exerting yourself through fighting or fleeing your perceived threat. Primitive humans certainly needed this energy boost after physically battling a wild animal, for example. But generally, we modern humans respond mentally to stress, like worrying, not physically fighting or fleeing. And herein lies much of our health problems. Unlike our ancestors whose stressors had a more definitive beginning and ending (hunting and
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defending) today we have more continuous stress (traffic, work deadlines, kids’ schedules). We release cortisol into our systems far too often throughout the typical day with little break from our stress. Whether or not your stressor requires you to physically respond, cortisol is released, saturating your blood and tissues. For many people cortisol courses through their bodies near constantly, never shutting down and dangerously affecting their bodies. Chronically elevated cortisol makes you vulnerable to developing higher blood pressure, diabetes, lowered immunity, and weight gain to name just a few disorders.
September 2011
Cortisol and weight gain ties debated We Americans, always looking for the quick fix for whatever ails us, search endlessly for weight-loss products. My advice--don’t hold your breath, at least not yet. Here’s the theory of the connection between weight gain and the cortisol released into your system from stress. Stress hormones, including adrenaline, which gives you instant energy, along with corticotrophin releasing hormone (CRH) and cortisol, provide the biochemical energy you need to fight or flee from your stressors. High levels of adrenaline and CRH decrease appetite at first and for a short time. Cortisol helps replenish your body after the stress has passed, and lasts longer in your system. The problem, according to Sean Talbot, Ph.D., associate professor with the University of Utah’s Department of Nutrition and the author of the “Cortisol Connection,” is that, “…too often today’s response to stress is to sit and stew in our frustration and anger, without expending any of the calories that we would if we were physically fighting our way out of a wild animal hunt (as our ancestors did).”
move the sugar from our blood to our muscles requires insulin, the hormone that opens the gates to the cells and lets the sugar in,” says Perfetti, who directs the outpatient diabetes program. And high levels of sugar and insulin set the stage for the body to store fat. “So people who are under stress, metabolically speaking, will gain weight for that very reason.” (Can this at least in part explain the obesity epidemic in America?) But according to Mayo Clinic dietitian, Jennifer Nelson, R. D., and physician Dr. Berge Kenneth, there is no reliable evidence that cortisol blockers such as CortiSlim, CortiStress, and Cortistat lead to weight loss. The manufacturers of these products tell you that stress creates high levels of cortisol in your system causing you to accumulate excess fat. Ms. Nelson says what they don’t tell you is this occurs only when your body produces large amounts of cortisol due to side effects of medication or an underlying medical condition like Cushing’s syndrome. There’s no evidence that the amount of cortisol produced by a healthy person under stress is enough to cause weight gain.
Another unresolved research question is whether elevated cortisol causes fat to deposit in your abdominal area. Some research shows that abdominal fat causes specific chemical changes that can lead to lower metabolism and cravings for Your neuroendocrine system doesn’t know that sweets, possibly leading to even more weight gain. you’re not physically fighting or fleeing, so it still responds to stress with the hormonal signal to Dr. Caroline Cederquist, board certified family replenish nutritional stores making you feel hungry. physician and bariatric physician (the medical This can lead to weight gain and a tendency to store specialty of weight management), the majority of whose patients have abdominal weight issues, “visceral fat” around the midsection. believes our high stress lifestyles create cortisolTo complicate matters, the “fuel” your muscles induced symptoms, including the abdominal weight need during the fight or flight response is sugar, a gain. This can also lead to higher cholesterol and reason you crave carbohydrates when stressed, says blood sugar levels and elevated blood pressure, all endocrinologist Ricardo Perfetti, M.D., Ph.D., of factors for heart disease especially when combine Cedars Sinai Medical Center in Los Angeles. “To with less exercise.
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I normally don’t include research I cannot credit but Officially, however, the research on the role of the following research is so compelling I’ll make an cortisol in obesity is still speculative. Blaming your exception. weight gain on stress neglects the fact that you may have developed a habit of eating in response to There was a fascinating PBS special featuring Dr. stress, which is a learned habit, encouraged by brain Robert Sapolsky of Stanford University, a renowned chemistry. stress response researcher, and a female researcher whose name I Googled and could not find. (The Limit lifestyle weight gain by dealing with recording was lost when we switched from TIVO your stress to DVR) The female researcher, like Sapolsky, researches the effects of the stress response by Given that the research jury is still out on whether studying wild primates in Africa. Her research high levels of cortisol actually cause weight gain, the focuses on status as a stress factor. She showed the minimum that seems to be true is that since the role lowest status apes, the most stressed in other words, of cortisol during stress is to provide your body with with rolls of fat on their bellies. These are wild energy, it can cause an increase in appetite. In other animals! Her research tips the scales for me in favor words, stress might lead you to eat more. of stress causing abdominal weight gain.
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“During the first couple of days following a stressful event, cortisol is giving you a cue to eat highcarbohydrate foods,” says Dr. Perfetti. “Once you comply, you quickly learn a behavioral response that you can feel almost destined to repeat anytime you feel stressed.”
increase insulin levels increasing stress hormones and making you feel hungrier. Cereals like oatmeal or multi-grain flakes, along with fruits, help keep your insulin levels in check, which help control blood sugar levels and ultimately, hunger, according to Pamela Peek, MD, MPH, author of “Fight Fat after Forty.”
Whether your eating is driven by stress hormones, by habits or a combination of both, research shows • Avoid caffeine, cigarettes and alcohol because that there are ways to interrupt the cycle and stop the these can cause stress and cortisol levels to weight gain. increase, and blood sugar to drop, which spurs hunger. Notice how the advice is the same as it is for living a healthier lifestyle. • Take vitamins regularly since stress depletes the B complex and Vitamin C, and possibly calcium • Solve your stressors or cope more effectively and magnesium. These nutrients help balance with them. the effects of cortisol and may even play a role in burning fat so take a good multi-vitamin • Exercise is always one of the best ways to burn supplement. calories and to produce a variety of biochemicals that counter the negative effects of stress If you’re experiencing chronic stress don’t go on a hormones. Exercise helps control your insulin strict diet, though. Canadian researchers found that and sugar levels with as little as 20 minutes a severely limiting calorie intake can kick off a series day three to five days a week. Be careful, though, of biochemical events that ultimately increase stress because too much exercise can raise your cortisol and can make you feel hungrier. levels and increase your stress. Here’s the bottom line about weight loss. It always • Eat a balanced diet and never skip a meal. Eat has been the bottom line, which suggests it always six small vs. three large meals a day and include will be --- until a miracle weight loss treatment is foods from all the food groups. This helps to invented. There are two ways to lose weight, eat balance your blood sugar levels inhibiting insulin fewer (and better) calories and burn more of those production and reducing cortisol levels, all calories by moving your body more. It’s truly that helping to control appetite and weight. simple. • Get enough sleep because when you don’t, cortisol levels rise, increasing your hunger. Cortisol related to depression, fatigue • Relaxation, much like exercise, produces brain chemicals that counter the effects of stress, whether you do yoga, deep breathing, or meditation, multiple times a week do whatever reaches that sea of calm that’s within you.
Does elevated cortisol also contribute to depression and chronic fatigue syndrome (CFS)?
To answer this let’s consider the theories of Drs. George Chrousos, Chief of the Pediatric and Reproductive Endocrinology Branch at the National • Snack on whole-grain, high-fiber foods vs. the Institute of Child Health and Human Development, typical American habit of high sugar and simple- and Philip Gold, of the Clinical Neuroendocrinology carbohydrates like cookies, crackers, chips, which Branch at the National Institute of Mental Health.
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They explain the hormonal system known as the • Glandular systems producing reproductive, hypothalamus - pituitary – adrenal (HPA) axis, growth, and thyroid hormones. a complex series of events that takes place when you’re stressed. It affects a variety of stress-related According to Dr. Chrousos, the HPA axis varies person conditions including depression and CFS. to person and is probably influenced by heredity. In most people it functions well, appropriately The HPA axis is a feedback loop where the brain responding to a threat and switching off when the signals the release of hormones needed for the fight threat is over. Others however under- or over-react. or flight response, affecting your With major stressors in early childhood, the HPA • Autonomic nervous system (controls heart rate, axis feedback loop becomes stronger with each new digestion, etc.); stressful experience. By adulthood this can produce an extremely sensitive stress circuit where the person • Brain’s limbic system (controls motivation in overreacts hormonally to comparatively minor mood), the amygdala (generates fear in response situations. to danger), and the hippocampus (involved in memory formation, in mood and motivation); It’s largely accepted that chronic stress and its released also brain regions that control body temperature, cortisol are related to depression. Cortisol is produced suppress appetite, and control pain; in excess in depressed people and has a toxic effect on the hippocampus. Chrousos finds that people with
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About the Author Jackie Ferguson has designed and presented keynotes and workshops on stress management, diversity, workplace harassment, motivation, and communication skills. Her mission is to inspire you to live a conscious life of personal responsibility in your relations with yourself and others, which she weaves into every presentation to help you “wake up” to your responsibility in making your desired changes. Literally hundreds-of-thousands of people throughout North America, the United Kingdom, depression can turn on the fight or flight response, Australia and points in between have benefitted but can’t turn it off again, producing constant from her programs. anxiety and overreaction to stimulation. This can be followed by “learned helplessness,” where they Jackie is also a Stress & Wellness Coach helping give up trying to improve. Some neuroscientists people achieve more success with less stress. believe that the major changes in serotonin and other neurotransmitters seen in depression are not Order her 2010 published book, Let Your Body Win: the cause of depression, but secondary to changes in Stress Management Plain & Simple and request the stress response. her weekly, published, emailed column, Stress for Chronic fatigue syndrome is also generally accepted Success, published in a Gannett Newspaper, at as a stress-related disease and a dysfunction of the www.LetYourBodyWin.com. HPA axis but with lower levels of cortisol; even though people with difficulty sleeping had higher You can now follow Jackie on Twitter @ cortisol levels in the evening. Practicing regular JacquelynFergus deep relaxation helps lower the cortisol to enhance sleep. Dr. Chrousos concludes that chronic stress shouldn’t be taken lightly or accepted as a fact of life. “Persistent, unremitting stress leads to a variety of serious health problems. Anyone who suffers from chronic stress needs take steps to alleviate it … by learning to relax and calm down.” To minimize your own mounting physical problems consider that stress management can be as important as any medication you take. Employers who want to control health-care and workers’ comp costs provide support for your employees to manage their stress better; the sooner the better for your mental and physical health. 28
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August 2011
O
ver last twenty years, we have seen the emergence of a major trend in North America: employee health and wellness are suffering. Less than one third of American employees (28 percent) say their overall health is “excellent�, a significant decline of 6 percent since 2002 (Families and Work Institute). In Canada and the United States, there have been alarming increases of hypertension, diabetes and obesity over the last number of years. Between 1994 and 2005, the rates of arterial hypertension among Canadians increased by 77 percent, diabetes by 45 percent and obesity by 1 8 percent, affecting people of every age. Even more concerning: hypertension rates among Canadians aged 35 to 49 rose 127 percent during the same period, and almost doubled among young people over the last 15 years (CBC News). The long-term effects of these issues will be dire; for the first time in decades, life expectancy has decreased in the United States, according to a study published in December 2010.
Healthcare costs increasing For employers, all of these factors should be very worrisome,
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especially since research shows that employee health directly impacts work behaviour, attendance, on-the-job performance and of course, healthcare costs. In fact, 76 percent of American businesses report healthcare cost increases of as much as 10 percent year-over-year. According to the 2010 Healthcare Cost Survey by the firm Towers Watson, employers are now paying 28 percent more for health care than they did just five years ago, and employees are paying 40 percent more. This growth in health costs is far outpacing wage growth, but it doesn’t have to be this way.
Retaining talent A serious challenge faced by businesses today is a high turnover of qualified, motivated and loyal workers. Many employers are failing to support and sustain their best people and create trusting relationships with their best employees. The evidence: according
to a report by TLNT, 74 percent of workers are passive job seekers ready to consider a move. In today’s competitive markets, employers must find new ways to attract and retain the best and brightest talent. One way to do this is to offer employees an environment that promotes healthy and active lifestyles.
Root of the problem
companies such as SAS, Wegmans Food Markets and Google have understood the profound connection between employee health, productivity and insurance costs. According to a report by the SHRM Foundation, “more than 75 percent of highperforming companies regularly measure health and wellness as a viable component of their overall risk management strategy”. A survey conducted by Towers Watson and the National Business Group on Health “found that 83 percent of companies have already revamped or expect to revamp their health care strategy within the next two years, up from 59 percent in 2009. This year, more employers (66 percent) plan to offer incentives for employees to complete a health risk appraisal, up from 61 percent in 2009. Also, 56 percent of employers now offer health coaches and 26 percent now offer on-site health centers.”
Many of our health problems in Canada and the United States are due to the aging population, but this is far from being the only factor. “Seventy-five percent of healthcare costs result from unhealthy lifestyles,” writes Barbara Schaefer, senior vicepresident, human resources for Union Pacific Corporation, in her article, “Long Train Running”. In health matters, factors such as smoking, physical inactivity and poor eating habits are responsible for the vast majority of health risks and their associated And it’s working! The Public Health Agency of Canada reported that by implementing a physical costs. activity program, Canada Life in Toronto improved There is good news for employers however: these productivity and reduced turnover and insurance leading causes of illness are largely preventable. costs while achieving a return on investment A 2007 study of more than 200,000 employees, (ROI) of $6.85 per corporate dollar invested. A conducted by the University of Michigan, determined study conducted by the U.S. Centers for Disease that 61 percent of employees have 2 or less health Control found that “comprehensive worksite health risks, 28 percent have a moderate risk (3 to 4 risk programs focused on lifestyle behaviour change have factors) and that only 11 percent have an elevated been shown to yield a $3 to $6 ROI for each dollar risk (5 or more health risk factors). The study invested.” According to a report by the Medisys determined that a realistic expectation for reducing Health Group, out of the Top 100 Employers in health risk factors would have employers saving Canada, 77 have a structured wellness program in $354 per employee, per year, for an organization of place and those who track the results generally find 1973 employees. These are savings that can add up that their expectations are met or exceeded. quickly. The managers and HR directors of these Top 100 High performance companies: health companies report that the benefits of workplace wellness programs include decreases in insurance and wellness leaders costs, absenteeism, presenteeism and turnover Businesses today are left with no choice but to rates; increases in productivity and recruitment; and create a healthy workplace culture if they want to improved creativity and overall motivation of the perform to their best potential. High performance workforce.
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How to build an efficient wellness GP2S also emphasizes the importance of effective communication. As stated in the Harvard Business program The most important questions still need to be answered: what makes a wellness program efficient and how do organizations implement them? To be efficient, a wellness program must be well structured, meaning the program is tied to the overall business objectives and the implementation process must include leaders from every division of the business. Moreover, it must have an organizing committee that includes members at all levels, from top management to entry-level employees. To truly be successful, staff members must adhere to the program and ultimately claim personal ownership of it. Corporate wellness programs should focus on the changing of poor health habits as a top challenge in order to maintain affordable benefits coverage. A successful wellness program will help employees improve their physical health, will improve communication throughout the organization and improve the workplace culture. Quebec’s Groupe de promotion pour la prévention en santé (GP2S) is an organization that has worked for a number of years to establish an ISO standard for workplace wellness. According to GP2S, there are a number of factors that will affect the success of wellness programs. Firstly, commitment must come from top management; the leaders of the company must be convinced of the value of the endeavour and must lead by example. Secondly, the program should be structured and integrated; managers need to define a comprehensive wellness strategy that is integrated to the business strategy, with a budget, timeline and thorough planning of resources. Third, the objectives of the program must be linked to the business objectives and the needs of employees, meaning that the program must be well integrated into the management system.
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Review’s article, “The Pillars of an Effective Workplace Wellness Program”, “Wellness is not just a mission—it’s a message. How you deliver it can make all the difference. Sensitivity, creativity and media diversity are the cornerstones of a successful communications strategy.” Backing up the launch of a wellness program with a strong marketing and communication strategy prevents employee cynicism and scepticism and builds employee enthusiasm and excitement. There is one very critical action that must be taken to ensure that a wellness program achieves a return on investment; the entire implementation process should be based on a detailed diagnostic that evaluates the global health of the business and the health risk factors of the employees. Conducting a diagnostic to uncover employee needs and find out the most common health risk behaviours allows companies to invest in real problems, which drastically improves the potential return of the wellness program. Finally, the program must be supported by an adequate budget. Employers, entrepreneurs and human resources managers must understand that when it comes to health and wellness, they must invest now to save later.
About the Author Fabien Loszach is a visionary sociologist and co-owner of Loszach Report, the provider of an innovative workplace wellness diagnostic. Employers use the Loszach Report – which includes detailed results, innovative solutions and a customized catalogue of the best wellness vendors – to improve productivity, reduce absenteeism and minimize their insurance costs.
| September 2011
An estimated 133 million Americans are currently living with one or more chronic conditions – a figure that is only expected to grow as the baby boomer generation ages. Many experience frustration with monitoring and managing their own or their loved ones’ complex medical needs.
Remote health monitoring has the potential to not only drastically reduce health care costs, but also to improve patients’ quality of life by allowing them to continue living independently at home rather than being hospitalized or moved into an assisted living facility.
In addition, hospitals are especially challenged to find ways to improve management of all critical illnesses in the face of proposals to slash Medicare payments to facilities that readmit patients within a specific time period. According to the American Hospital Association, these new regulations would raise costs to hospitals an estimated $19 billion over 10 years.
High blood pressure alone affects 73 million Americans. As of 2008, the estimated direct and indirect cost of high blood pressure was $69.4 billion, according to the American Heart Association. In an attempt to combat these high costs, the use of home blood pressure monitoring is recommended by several national and international guidelines for the management of hypertension, including The American The good news is that today health management Heart Association and The American Society of providers are offering solutions that make it possible Hypertension. In one study’s analysis of 904 patients for these individuals to manage their health from using real-time readings from a remote hypertension anywhere, at any time, while also providing important management program for a period of six months, informational updates to their caregivers or doctors. the average reduction of systolic blood pressure was
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| September August 2011 2011
A
n estimated 133 million Americans are currently living with one or more chronic conditions – a figure that is only expected to grow as the baby boomer generation ages. Many experience frustration with monitoring and managing their own or their loved ones’ complex medical needs.
six months, the average reduction of systolic blood pressure was 9 mmHg. These decreases in blood pressure are significant because controlled blood pressure has been associated with a 35 to 40 percent mean reduction in stroke incidence, 20 to 25 percent mean reduction in myocardial infarctions and more than 50 percent reduction in heart failure. A 12mmHg drop in average systolic blood pressure will save one In addition, hospitals are especially challenged to life in every 11 treated patients over ten years. This find ways to improve management of all critical means that in the 904 patient population, almost 40 illnesses in the face of proposals to slash Medicare lives would be saved. payments to facilities that readmit patients within a specific time period. According to the American Regarding congestive heart failure (CHF), there Hospital Association, these new regulations would are approximately 5.3 million people suffering raise costs to hospitals an estimated $19 billion over from CHF in the United States. The lifetime risk 10 years. of developing heart failure at the age of 40 is 20 percent, and approximately 380,000 people above The good news is that today health management the age of 65 will be diagnosed with CHF annually. providers are offering solutions that make it possible The estimated total of direct and indirect cost of heart for these individuals to manage their health from failure in the United States for 2008 is $34.8 billion, anywhere, at any time, while also providing important with the greatest share being hospitalizations. The informational updates to their caregivers or doctors. increasing number of patients being hospitalized Remote health monitoring has the potential to not with CHF has been great cause for concern. The only drastically reduce health care costs, but also to number of patients with CHF discharged from the improve patients’ quality of life by allowing them hospital rose from 400,000 in 1979 to over 1 million to continue living independently at home rather than in 2005. Furthermore, within 4-6 months after being hospitalized or moved into an assisted living discharge, 47 percent of the patients are likely to facility. be readmitted. A recent study of 417 CHF patients using a remote health monitoring system proved that High blood pressure alone affects 73 million this was an effective method to reduce congestive Americans. As of 2008, the estimated direct and heart failure hospital admissions by 57 percent, indirect cost of high blood pressure was $69.4 billion, demonstrating that these systems can significantly according to the American Heart Association. In reduce healthcare costs. an attempt to combat these high costs, the use of home blood pressure monitoring is recommended Our company has created a revolutionary remote by several national and international guidelines for health management platform that addresses many the management of hypertension, including The of today’s most challenging and costly healthcare American Heart Association and The American issues. For people managing critical conditions such Society of Hypertension. In one study’s analysis of as congestive heart failure, hypertension, diabetes, 904 patients using real-time readings from a remote asthma or obesity, our system provides relevant, realhypertension management program for a period of time, reliable and actionable data. This can deliver
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w w w. C o r p o r a t e We l l n e s s M a g a z i n e . c o m
August 2011
interactive, personalized communication, allowing individuals to become more engaged and active participants in their own health. This approach also makes proactive prevention more realistic than ever, as it is instrumental in gauging health issues before critical conditions manifest themselves into acute events. For example, daily blood pressure readings are more indicative of someone developing hypertension than having one reading taken every six months at the doctor’s office. Remote health monitoring devices and programs are designed to empower patients to take an active role in the management of their personal health. Patients with a critical illness need to be able to easily follow their care plans and make necessary lifestyle or medication modifications. This can minimize the chance that they will develop additional complications that could further jeopardize their health, thus requiring expensive treatment. Consistent and regular monitoring of blood glucose levels or body weight, for example, can help reinforce adherence to good health practices as well. As a bonus, because some remote 36
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health monitoring devices, like ours, are wireless, they can also make it possible to manage health while traveling or on the go. Many remote health management systems not only offer solutions for patients, but for their caregivers as well. Often caregivers look to technology for assistance in tracking a person’s status or progress, and now computers, smart phones and even tablets can enable health care providers to monitor patients in their homes and let adult children and other family members keep an eye on aging parents. When a patient steps on the scale in the morning or checks their blood glucose level before a meal, for example, a designated caretaker team can be notified, even if they are hundreds or thousands of miles away. The compact, affordable and easy-to-use devices monitor data and can automatically and wirelessly transmit this information to the individual’s healthcare team without the need for cumbersome wires or manual data entry.
Septrmber 2011
Join The Corporate Health and Wellness Association www.WellnessAssociation.com
One person who has experienced firsthand the benefits of remote health monitoring is 70-year-old Ira Roberts, who is living with diabetes. A church minister for 35 years, he also teaches at William Patterson University and travels over 300 miles a week as a gospel musician. With such a busy schedule, Ira can’t afford to let his diabetes slow him down. At home or on the road, he stays on a healthy track by providing his doctors with 24/7 access to all his latest health information.
healthcare team, including physicians, family and other designated caregivers. That team can then access this information to assist with timely and appropriate healthcare decisions. Health care is increasingly top of mind for Americans, as well as those around the world, from physicians and hospitals, to patients and caregivers. If patients with chronic conditions are able to manage them at home or remotely, healthcare costs would likely decrease, people would have Ira does this by using a remote glucose meter, which better understanding of their own health and their makes it easy to capture and transmit important caretaker will be able to have more peace of mind. blood sugar data, no matter where he happens to be. For Ira, being able to send his glucose readings wirelessly and automatically via our system is About the Author what has allowed him to remain active and fully independent. Jason Goldberg founded IDEAL LIFE in 2002. As The device “helps me manage my health by getting president, Goldberg oversees all my doctors on the same page,” said Ira. “The overall product development, system acts as a watchdog of my diabetes.” management and corporate direction. Under his guidance, Ira once took injected medications to manage his IDEAL LIFE has grown from a simple idea into Type II diabetes, which tended to cause significant a leading global health technology company fluctuations in his body weight. Now, in addition spanning multiple continents with the largest to his glucose meter, Ira uses a digital body weight implementation of remote health management scale, to monitor his weight on a daily basis. solutions. Such accurate, up-to-the-minute information has allowed his doctors to make timely and effective medication adjustments. Together, the two products have proved so successful that Ira has been able to stop taking three medications. These easy, affordable, consumer-inspired devices are a perfect solution for busy people such as Ira. When assessing remote health monitoring systems conducive to travel, it’s essential that they be compatible with various modes of communication – such as cell phones, telephone lines and the Internet – so no matter where you are, you can capture, store, and send health information to your
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Comprehensive Wellness Management Changes Behaviors By Shawna R. Dosser
J
oe Kuchera and fellow management at Western New York’s Unifrax I LLC knew not to expect an immediate return on investment when infusing nearly a quarter of a million dollars into a year-long workforce wellness program for employees plus their spouses. Regardless, one year after the program was introduced by a third-party health promotion provider, the percentage of people at risk of health complications due to nutrition, exercise, weight and stress decreased. And little by little, the first signs of a culture shift started appearing – from
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the employee who committed himself to a weight-loss program after originally intending to be just a program observer, to company leaders who sat beside their employees to learn about health topics and hit the pavement for company-sponsored walks.
September 2011
Wellness is not a 100-yard dash. Quick fixes don’t work, nor do haphazard programs with few resources or little foresight. Comprehensive Wellness Management is the answer. Why Comprehensive Wellness Management?
Comprehensive Wellness Management is the best way to create a culture whereby individuals do not feel pressured to take action, but comfortably ease into attending educational sessions or fitness classes, or seek the counsel of an expert on their own accord. Individuals are encouraged to make change for themselves.
Comprehensive Wellness Management empowers A Comprehensive Wellness Management program is: employees. • Results-oriented
Unifrax’s Story
• Dependent on data (through assessments) to Unifrax seeks long-term lifestyle behavior changes identify needs and set goals to decrease health risks. Changes begin at home, so • Proactive, stressing prevention through it made sense to include spouses in a program. education and one-on-one counseling (through health coaching) • Inclusive of incentives to encourage healthy behaviors and lifestyles Combined, these tools not only provide a wellrounded approach, but a powerful foundation for implementing a successful behavior modification infrastructure, which is necessary for sustained lifestyle changes.
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| September 2011
Recognizing that they needed to provide a • Fitness assessment to gauge physical fitness supportive environment, officials designed a through weight, BMI (body mass index), body program with three primary features: health factor composition, girth measurements, lung volume, awareness and incentives, wellness education and flexibility and strength health coaching, and policy changes. • Health risk appraisal (HRA) to analyze overall The initiative would also focus on three “modifiable” wellness through self-reported data, including risk factors that have the most critical impact in physical and emotional factors, and possibly leading to potential health hazards: tobacco use, unlock clues to health concerns blood pressure and cholesterol ratio. Individuals received a personalized, comprehensive Health promotion professionals are typically 12 page report of their biometric data. Each person the force behind shaping a company’s wellness met confidentially with a health professional to program. However, Unifrax proved to be a true decipher the results and have questions answered. intellectual consumer by researching what works Immediate discussion of the collected data provided and what doesn’t, and came to the table knowing an “educational opportunity” – an essential step in exactly what they wanted to achieve. successful behavior change. For delivery, they turned to the expertise of a Western New York-based company offering the gamut of health promotion services, from health data gathering to health coaching. It was important for employees to be engaged through in-person interaction with an accessible, flexible multidisciplinary team of health professionals.
Nutritional habits were discussed, ideal weight was calculated and short- and long-term goals were set. Participants were urged to start a personal health file and share it with their physicians. Reports contained an overall wellness score based on a 0 to 100 scale. Scores were also assigned to eight health factors: weight, exercise, nutrition, stress, smoking, cancer risk, cholesterol and blood The program kicked off in February 2009, one year pressure. Less than 80 in any category placed the after a pilot launched at an Indiana Unifrax facility. individual “at risk” for adverse health outcomes, such as cardiac issues, cancer or other significant Assessing Health illness. All employees – including both full-time and parttime – and their spouses were eligible to participate. Every participant initially underwent a 45 to 60 minute health assessment to obtain real-time data in capturing a snapshot of personal health.
Assessments were used to increase awareness about overall employee health among company executives, who were provided aggregate data that compared risks appearing companywide with national averages, such as high blood pressure or the occurrence of being overweight. This data was Data is integral to not only raise awareness of delivered blindly – reported as a whole through health status, but to identify the changes needed scales and percentages, and not connected to for improvement and determine personal goals. An individuals. accurate view was gained through the following assessments administered by the professional third- Impacting the Individual party team: Pre-assessment findings prompted the offering of • Biometric screening to determine blood hour-long classes targeted at nutrition and eating pressure, glucose and cholesterol levels sensibly, diabetes risk, tobacco and physical 41
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| September 2011
activity. An injury prevention program was delivered based on the high occurrence of employees visiting doctors for musculoskeletal problems. Kuchera said that the most successful component of the program proved to be one-on-one health coaching. Sixty-four percent of individuals who received attention from health coach-advisors rated it as “excellent,” while 29 percent found it to be “very good.” The service was optional for those deemed to be within the top 50 percent of being at risk for health issues. Qualified individuals received 20 minutes each month of confidential health advisement from credentialed health professionals and were provided access to open office hours if extra time was needed. Health coaching institutes a layer of accountability, and delves into personal health issues, behavior concerns, family health history and risk factors. Health coach-advisors ask the right questions and listen to build trust. They break down barriers to address the underlying causes obstructing positive choices, whether the culprit is family habits or a lack of knowledge, and point participants toward resources in the community. Sometimes, they are simply a non-judgmental sounding board. Most importantly, health coach-advisors empower individuals to identify their own pathways, making for a stronger approach more likely to result in sustainable change. Although not everyone responded on the same level, many individuals were actively engaged in the program and attended the coaching sessions each month, whether through in-person appointments, phone calls or communicating via email. Less than 2 percent of the eligible population initially declined involvement and, overall, 90 percent continued to receive health coaching for one year.
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Championing the Program If Unifrax was to expect participation, its leaders needed to buy into the program. Not only did they involve themselves alongside employees, but the company joined the “eat well live well” challenge – a free, online, eight-week program designed by grocer Wegmans to encourage healthier living.
incentive payout. Participants earned $100 for each of the following criteria met: • A blood pressure of 120/80 or less • A cholesterol ratio equal to or under 4.5 • Tobacco-free Short-term Results
The company’s top decision-makers also gave Health professionals returned six months after the a large boost to the program by rewarding program start, in September and October 2010, to participants who successfully met targeted goals. conduct a posttest. From winter 2010 until then, the average overall A married couple could potentially earn $700, wellness score increased from 68 to 71. The deposited in their health savings account. Each percentage of people considered to be at risk in the participant received $50 for solely participating top four risk areas of nutrition, exercise, weight in the assessment. Thereafter, the post-assessment and stress decreased considerably over 6 months. completed six months later determined the The comparison is outlined in Table 1 below.
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A meta-analysis of literature on costs and savings associated with worksite wellness programs, published in the February 2010 issue of “Health Affairs,” found that medical costs fall by about $3.27 for every dollar spent. Absenteeism costs decrease by about $2.73 for every dollar spent. The findings are a result of the study “Workplace Wellness Programs Can Generate Savings,” conducted by Katherine Baicker, David Cutler and Zirui Song, all of Harvard University. In the case of Unifrax, $250,000 was invested. Applying the above formulas, it is estimated that medical costs would fall by $817,500 and absenteeism costs would decrease by $682,500. A shift in individual and corporate behavior/ mentality is evident, from one of treatment and cure to one concentrated on prevention and improved well-being.
tools for change. Now is the time for them to help their employees make better lifestyle choices, which ultimately leads to a healthier workforce and healthier country.
About the Author Shawna Dosser, MS, CWPM, CLSSGB, is founder and president of BWI Health Promotions, the creative wellness solutions, teambuilding and health education company that provided health promotion services to Unifrax. In 2010, the BWI National Health Promotion Training Institute was launched to offer web-based certification courses to health-related professionals and employee populations.
Changing Behaviors So what can we learn from Unifrax? 1. Ensure that upper management understands and supports the goals of a wellness program. It is a long-term culture change, and it may take years before the company sees the benefits. 2. Because it is difficult for people to change, it is important to include some form of incentive for motivation purposes. 3. Enlist the help of a third-party health promotion provider, which should be composed of health professionals (dietitians, educators, exercise physiologists, nurses) trained in prevention, health education and behavior change, and who create personal relationships with employees and spouses. Employers have immense power to shape the future health of our nation by providing information and
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T
he cold and flu season is right around the corner. Expect sneezes, sniffling and snot from the coworker who just borrowed your stapler. In an ideal world, people would not show up to work sick. But with the economy the way it is and people lax to miss work for fear of losing a paycheck or losing their job, we have to protect ourselves
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instead. Here are some tips to keep you healthy in the work place this time of year: Let’s start with the basics. Our mothers were right; hand washing can protect you from germs. Make sure you wash your hands with soap and hot water and get between your fingers and under your fingernails. I know a lot of office staff that keep hand sanitizer at their desks and disinfectant wipes close by in case you are covering someone else’s phone or using their supplies. Don’t get too germadverse though, because we do build up our immune system by being around germs. In between hand washing, avoid touching your face and eyes too. Taking a multivitamin containing extra vitamin C and Zinc has been shown to help prevent colds and speed their recovery time. Some people mega dose on Vitamin C, but we can only absorb a certain amount at a time (opinions vary on how much), so if you are going to take extra vitamin C, spread out the dose. Too much vitamin C can cause loosen bowels and gas, which is a good hint that you’ve had too much. I personally am a big fan of Airborne ™. I find it works for me and is worth a shot for you too. Herbs
like
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Echinacea
Golden Seal have properties that can help speed healing of colds and flu. Garlic is another helpful herb and can be taken in your food or bought in a “de-smelled” supplement form like Kyolic™. There are numerous supplement formulas on the market to boost your immune system; I recommend trying some and seeing what you like best. Homeopathics are a safe and easy way to try to stave off illness. Homeopathy works on the principle of “like cures like” and you decide on the remedy based on a combination of very specific symptoms like: Is your nose stuffy on just the right side? Does your headache get better when you
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drink cold water? Are you craving salt? Is your face flushed? Are you cranky and want to be left alone? Answering a series of questions such as those can guide you to the right single remedy.
allows the body to relax as you concentrate on both the breath and the words and keeps other thoughts from intruding. If thoughts do penetrate, just acknowledge and dismiss them without judgment.
Combination remedies are also readily available and tend to mingle the most common remedies for the ailment. There are remedies simply named Cold and Flu and there is an effective combination called oscillococcinum™, which has worked for me in the past. You can inquire in your favorite health food store or contact a trained professional.
Try to be as happy as you can. I’ve observed people who are always sick, you know them; they catch everything that comes around. And they always try to blame someone for “getting them sick”. I’ve noticed that these folks more often than not are basically unhappy people. Perhaps they don’t like their jobs, maybe their marriage is less than ideal, could be some depression. Whatever Keep drinking that water! Not only should we have the source of the unhappiness is, I think that if they a large amount of water for health in general, but can be happier, they will also be healthier. Illness it’s even more important when we are sick. Water is very often used as excuse to not face something can help thin out that mucous and keep our noses and for someone that is “always sick”; I’d ask them and lungs clear. Tea, broth and juice are good too! to examine what else is going on in their lives. It’s sometimes a really hard question to ask, but worth We have enormous power in our mind. I fully the work if you want to stay healthy and have a believe that we can talk ourselves in and out of long and productive life. being sick. If you are afraid of every germ and sure that so and so from you office is infecting you, Now, what about western medicine, what does it chances are you are going to catch it. Our attitude have to offer at this time of year? Not much frankly. and what we say in our minds strongly effects Right now people are rushing to get their flu shots. what happens in our bodies. Repeating to yourself These are recommended for older adults, children that you are healthy and well or that your immune and people with compromised immune systems. system is strong can actually prevent you from Every year the formula changes in an effort to battle catching the latest thing and boost your defenses. the virus of the year. Some people have found the flu shot makes them sick, and others get the De-stress yourself! So much research has been flu anyway. I have read numerous reports that the done on the effects of stress on the immune system. flu shot increases the risk for Alzheimer’s disease And let’s be clear, it’s not so much the stress, from the additives like mercury and aluminum it’s your reaction to the stress. If you can take which are contained in the vaccine. I’ve also seen things in stride and make sure you are allowing evidence that the vaccine doesn’t do anything at yourself some downtime to process all of what is all. Remember that the flu shot is a combination happening in your life, you can keep that immune of many chemical and natural compounds, some system healthier. I recommend what are called of which can have side effects. I’m not suggesting “minis”. They are small meditations that invoke you skip the shot, just be informed before you the relaxation response as opposed to the stress make any medical or natural health choice. response. On the inhale say in your mind “I am” and on the exhale say “at peace” or “pure love” or Antibiotics are another thing that just isn’t going “pure joy” or “truly well”. You get the idea. This to help you get rid of that cold. A cold is caused
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About the Author Dr. Kathy Gruver PhD, author of The Alternative Medicine Cabinet, has been featured as an expert in countless publications and has written dozens of health and wellness articles. She has appeared as a guest on over 50 radio shows and has done over 40 educational lectures around the country. For more information and free health tips and resources go to www.thealternativemedicinecabinet.com
by a virus, antibiotics work on bacteria. So, if it develops into an upper respiratory infection or sinus infection that would be the time to take some antibiotics. Some doctors recommend flu anti-virals, which are effective if taken at the first signs of being sick (within the first two days). It can decrease the length of the flu by 1 or 2 days and makes you less contagious to others according to the CDC website. These specific drugs will not work on a cold, just the flu. And remember, all the negative effects that you get when you have a cold, the sneezing, runny nose, coughing? That is the body’s effort to get the bad stuff out. Try not to repress the symptoms too much or it may prolong the illness. But if you can, get plenty of rest and take the time off work! I hope you all make it through the year healthy, well and disease free. But if you do happen to catch something, I hope these natural health hints make it an easier time for you. Good luck and good health!
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I
magine receiving your credit card bill every month, and the only information you’re provided is an amount due and a “pay by” date of 48 hours from now. The amount due doesn’t look too far off
from what it was on your last statement, so you shrug and just pay your bill – you can trust your credit card company, right? Let’s say you realize one month you should be responsible and decide to check your bill for accuracy. You contact your credit card company for a full statement complete with the charges you’ve made, but they tell you you’re not allowed to review your bill now but can conduct a spot audit at the end of the year. For the audit, only a couple weeks of a detailed account of your purchases will be provided and referenced for accuracy, and the weeks chosen will be at the credit card company’s discretion.
Sound ridiculous? Of course it is. We may scoff at this scenario and think
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no corporate entity can be this unaccountable with people’s hard-earned money. Yet a similar system has been used for prescription medication bills across the nation for decades now. Every two weeks, $12 billion of pharmacy benefit claims is paid to pharmacy benefit managers (PBMs) without review. Corporations, government entities, and unions – to name a few – receive their prescription claim bills every other week and often have only 48 hours to write checks to their PBMs for the amount due. Payers do not receive detailed statements of all the claims for which they are being charged, and even if they did, their HR departments certainly do not have the resources to review spreadsheets with millions of fields of data for accuracy—and certainly not within 48 hours. Compound this lack of oversight with the fact that errors and overcharges do occur. Insurance companies and PBMs play a crucial role in ensuring healthcare is available to people across the country. But while their functions are indeed valuable, the cost to payers of doing this kind of business is billions of dollars each year in preventable overcharges. You might ask why these errors even occur. The reasons center around the complexity of the current drug payment system in the United States. PBM contracts are long and complex, and the systems used to process
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claims data are old and never move out of production. As a nation, we have come to accept margins of error. They seem to be inevitable. However, with skyrocketing healthcare costs stifling economic recovery and significantly impeding the ability of businesses to grow, the margin of error on drug spend has a direct impact on the level of success that companies, government entities, states, and the nation as a whole are so desperately looking to achieve or sustain. IMS Institute reports U.S. national drug spend to be at $307.4 billion for 2010. Looking at a reasonable margin of error anywhere from 2 to 5 percent, we as a country are spending $6 billion to $15 billion in errors. Our governments have put policies and measures in place to help protect health information and enforce responsibility and accountability through legislation such as Medicare Prescription Drug Improvement and Modernization Act of 2003 (Medicare Part D) and the Sarbanes-Oxley Act (SOX). But there is nothing in place to mandate transparency or drug spending accountability, despite great pressure on entities to comply in such
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a complex drug care system. Prescription drug costs continue to grow at 7 percent year over year and are on pace to double within ten years, so this issue will only grow in importance going forward. While credit card holders are generally not held responsible for errors on their credit card bills, payers are responsible for errors on their prescription claim invoices – PBMs assume no liability, so payers alone have the fiduciary responsibility to protect their plan members. As prescription drug costs continue to rise, reviewing the PBM bill with each invoice is an important step to providing immediate plan savings today and ensuring cost containment in the future.
About the Author Dr. Kristin Begley is responsible for developing and implementing strategic programs for pharmacy benefit management at Truveris.
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P
revalence
to mental illness have overtaken claims associated with cardiovascular disease as the fastest growing One in five Canadians will experience category of disability costs in Canada. Most mental a mental illness in their lifetime. In any year, 12 health problems in the workplace occur in people percent of Canadians age 15 to 64 suffer from a who are in their prime working years. mental disorder or substance dependence, at least 4 percent suffer from major depression and three Mental health issues affecting the workplace fall times that many have minor depression. Mental generally into two categories: illness accounts for more than 15 percent of the burden of disease in Canada, but gets only about 1. Stress and related conditions from the workplace itself; 5.5 percent of public health dollars. And stigma, although on the decline, is still a big issue. 2. Employees dealing with issues originating outside the workplace In the workplace, mental illness is the second leading cause of disability, each day 500,000 Canadians are absent from work for mental health issues and In either case, productivity suffers and employees accounts for nearly 30 percent of disability claims may either take additional time off or come to work and 70 percent of total costs and claims attributable at diminished capacity.
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A study of days per year absent from work, for they have to pay, either out-of-pocket and/or those who did and did not report a mental health through private (often employer sponsored) issue, in Canada, 2003 showed: insurance. One study showed that in 2003, for people over age 20, almost 500,000 persons Getting Help consulted a psychologist; over 70 percent had at least some portion of the cost paid by private insurance; the rest paid entirely out-of-pocket. But there is good news. The chart below shows the results of patient perceived outcomes for users of mental health services, Ontario, 2004: Relatively few Canadians who need mental health services get help. One study indicated that only 32 percent of those with a mental disorders or substance dependency saw or talked to a health professional during the 12 months prior to the survey. The professional most often contacted is a family physician, followed by psychiatrists and psychologists.
Workplace Response
In general, the response from business and industry to workplace mental health problems has not been adequate. Much has fallen to Employee Assistance Programs (EAP). While an EAP may In Canada, there are about 12 psychiatrists be appropriate for certain items, when it comes for every 100,000 people, compared with 35 to mental health care for employees, EAP’s do psychologists. Other professionals providing not go far enough. EAP’s may best work as a mental health services include psychiatric nurses short-term way for employees to enter the mental and social workers. A lot of mental health services health service arena, but they are not set up to are provided in the private health sector. If a effectively deal with many issues. person sees a psychologist outside of a hospital, 54
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Depression is one of the most prevalent mental health conditions, in and out of the workplace, and while medication is often a big help, psychotherapy is also very beneficial, often in combination with medication. One of the most widely accepted interventions showing excellent results is Cognitive Behaviour Therapy (CBT), often done over a course of 12 to 16 sessions. However, most EAPs allow for only a few visits in any one year (often four to six) or a few visits for any one condition.
In the workplace, two of the most common ways of addressing the issue, EAP’s and health benefits programs, have significant limitations. And of course, offering more under benefits plans, even though there may be a longer-term payback, has short-term cost implications which businesses are not likely to assume, especially in the current economic climate.
Employers can take some proactive approaches to deal with mental health in the workplace, including education. Workplaces can link with Another shortcoming of EAP’s is they often only resources in the community, whether directly or use clinicians who are not trained or able to offer through their EAP. treatments such as CBT. But EAP’s can refer depressed employees to other facilities and/or Being aware of issues, ensuring a workplace that service providers; the issue then comes back to doesn’t stigmatize, educating, and promoting availability of professionals and cost. Still, EAP’s optimal mental health, are good places to start. should be aware of local resources and at least be able to screen those who present with depression About the Author and/or other mental health problems. David Michaels is the CEO at The Clinic For Health benefits offered by the workplace are also Emotional Wellness Inc in Vaughan, Ontario. David largely inadequate for dealing with mental health. holds a Master’s degree in health administration Many plans do not cover psychological services from the University of Toronto and experience sufficiently to allow for a proper course of therapy. in government, public and private health care, Another issue with health benefits plans is that including over 16 years as the Administrator of coverage for “other professionals”, usually referred one of Canada’s largest children’s mental health to in those plans as “para-medical” providers, centres. may lump these disciplines with a cap on services each year. Services from a psychologist may be References covered under the same umbrella as services from Centre for Addiction and Mental Health: optometrists, physiotherapists, chiropractors, etc., 1. 2. http://www.camh.net/News_events/Key_CAMH_facts_for_media/ addictionmentalhealthstatistics.html with a limit of perhaps $500 per year. 3. Great West Life: 4. 5. 6.
Going Forward The current situation with workplace mental health mirrors mental health in Canada generally. Those with mental health issues face difficulty accessing services as not a lot is covered by the public health system. Also, there is the issue of stigma; many people fear what others will think. A lot of people are not aware of the fact that current approaches to dealing with mental health conditions show excellent results.
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7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18.
http://www.gwlcentreformentalhealth.com/english/display.asp?l1=3&d=3 Institute for Health Economics: http://www.ihe.ca/documents/Spending percent20on%20Mental%20 Health%20Final.pdf http://www.ihe.ca/documents/AMHB_Statistics_pktbk07_eng.pdf Lin E, Durbin J, Koegl C, Murray M, Tucker T, Daniel I, et al. Hospital report, 2004. Toronto, ON: http://www.longwoods.com/product.php?productid=16820&cat=350&page=1 Canadian community health survey Cycle 2.1 2003 The Canadian Collaborative Mental Health Initiative: http://www.ccmhi.ca/en/products/documents/09_Prevalence_EN.pdf Canadian Mental Health Association: http://www.cmha.ca/BINS/content_page.asp?cid=3-86-87 Mental Health Commission of Canada: http://www.mentalhealthcommission.ca/SiteCollectionDocuments/Key_ Documents/en/2009/Stress%20at%20Work%20MHCC%20V%203%20 Feb%202009.pdf Depression and Work Function: Bridging the Gap between Mental Health Care and the Workplace: http://www.comh.ca/publications/resources/dwf/Work_Depression.pdf
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