Corporate Wellness Incentive Plans

Company America is increasingly investing in employee wellness because it is good business.  In order to meet work rate demands, employers must rely on a healthy, beneficial workforce to succeed in the highly competitive global marketplace.  Over a hundred research studies in both corporate and governmental settings have documented the economic advantages of Corporate Wellness Programs, including reduced absenteeism, reduced injuries and workman’s compensation costs, reduced medical costs, reduced employee turnover, as well as increased work rate, greater worker satisfaction, and improved morale.1-10  

The more recent literature reflects improvements in wellness programming along with greater return on investment.  In general, the more focused and intensive the program, the greater profit realized.  To enhance their success federal government Employee Wellness Programs may be able to incorporate some of the features described.  Employee wellness programs shown to have beneficial returns on investment often include the following features:

1.   Health and work rate management model
Programs characterized by this model focus attention on identification and reduction of specific risks or behaviors such as smoking, lack of physical activity, excess weight, unhealthy diet, elevated blood lipids, high Blood Pressure (BP), stress, depression, and so on.  High-risk staff members are specifically targeted for intervention, even though the most efficacious programs also direct efforts towards healthy staff members in order to maintain their low-risk status.  This model emphasizes outcomes as opposed to simply offering wellness activities for their own sake.  

2.   Health risk appraisal
Use of a computerized health risk appraisal (HRA) instrument with individualized feedback and recommendations is almost universal in successful programs.  Workers take the questionnaire each year in a myriad of cases.  The HRA serves to increase awareness, provide direction, and motivate people to improve specific behaviors.  In some cases, the customized report is directly linked to appropriate resources related to identified risks.  Research indicates that the use of an HRA is effective if it is followed by some kind of educational or therapeutic intervention for identified risks.  It frequently serves as the entry point into wellness programs.

3.   Health Screening
Many programs combine the results of the health risk appraisal with measurement of each employee’s biometrics, including weight and Body Mass Index (BMI), Blood Pressure, blood lipids, fasting glucose, and assorted other metrics.  Combining the results of the HRA with biological measures results in a more accurate risk profile.   Computer health risk appraisals frequently incorporate biometric data in their risk analysis.

4.   Incentives
employees are generally given monetary or other valuable rewards for completing an HRA, participation in a program or class, specific accomplishments such as stopping smoking, losing weight, or working out, and for maintaining healthy status and/or behaviors.  In countless cases the monetary rewards and incentives are associated with reductions in healthcare insurance premiums.  Some programs use disincentives as well as rewards and incentives, such as charging employees who use tobacco higher rates for their healthcare insurance contribution.

5.   High participation rates
Effective programs use rewards and incentives to drive participation rates up.  They also market their programs extensively, and may use contest or challenge strategies to heighten enthusiasm and bolster participation.

6.   Wellness coaching
employees with identified risks or desire to better their health habits may be periodically coached via phone by trained health coaches.  Health Coaching helps employees set and achieve realistic lifestyle-related objectives and goals including those approaching stress, work life balance, smoking, weight, physical activity, and various behavior modifications.  Three or more sessions are generally provided.  In some intensive programs, the coaching extends to actual disease management intervention for employees with identified elevated-risk diseases.

7.   Multiple formats
Programs may offer wellness content in online, paper, and seminar formats to provide stimulating variety and alternatives in order to accommodate the needs of all staff members.  In addition to on-Site physical activity and healthy eating programs, on-line programs, e-mail reminders and notices, printed newsletters and materials, and corporation classes are common dissemination strategies.

8.   Senior Management reinforcement
Enthusiastic and persistent endorsement by upper management is essential to achieving high rates of participation.  When senior executives are wellness role models themselves the effects of endorsement are enhanced.

9.   Frequent contact
Effective programs have successive contact of some sort with every employee.  This may be through marketing efforts (e.g., posters, e-mail notices, reminders, or messages, etc.), bulletin boards, newsletters, employee meeting presentations, discussion in new employee orientation, supervisory sessions, etc.   The key is to enhance employee awareness of wellbeing and health opportunities and reinforce the corporate emphasis on wellness through successive and multiple “touches”.

10.   Open enrollment
To advocate high participation rates employees must have easy access to the wellness programs and activities.  Open and uncomplicated enrollment processes achieve this.  Some companies automatically enroll all employees and then allow those who do not wish to participate to “opt-out”.  This practice has been established to boost enrollment rates in some settings.

11.   Family participation
Many programs encourage spouses and other family members to take part in the organization wellness activities and to adopt a healthy lifestyle along with the designated employee.  It is far easier for the employee to have a healthy lifestyle if his/her family does so as well.

12.   Smoking cessation
Because smoking and other tobacco use is the number one threat to health it is essential to offer workers effective and convenient assistance with quitting.  Access to tobacco cessation pharmaceuticals is often part of such programs.  In-house programs support the most convenient access to these services, even though on-line or phone-based programs may be available as well.  

13.   Exercise Programs
Regular physical activity is a core component of every wellness program.  Staff Members must be strongly encouraged to engage in regular physical activity.  Most programs provide either periodic or continuous worksite opportunities, and some locations have worksite gyms, swimming pools, walking trails, etc.  Discounted or paid memberships to neighborhood exercise facilities is a common alternative to worksite facilities.

14.   Weight management
Because obesity is a major threat to health it is imperative that programs offer effective assistance with weight management.  Robust encouragement from senior staff to shed excess weight is significant.  Internet based programs, worksite programs, or discounted access to weight management programs in the community may all be available.  Long-term follow-up is vital for maintenance of weight loss.

15.   Stress management
Workplace stress is perhaps the most common concern among employees and a primary contributor to absenteeism, presenteeism (reduced work rate), and low morale.  Almost all successful wellness programs offer assistance with personal and workplace stress.  Some programs refer employees to outside resources for more weighty conditions like depression and anxiety disorders, but most offer online or frequent worksite general stress reduction programs.  Some businesses endeavor to structure the work environment to minimize stress, both physically and operationally.

16.   Health screenings/immunizations
employees are actively encouraged to complete recommended healthcare screenings for Blood Pressure, blood lipids, BMI, colorectal and breast cancer, and others.  Annual influenza immunizations are also encouraged.  Some sites provide these services at the worksite.  Incentives are often awarded for completion of these screenings/immunizations.

17.   Onsite medical
Actual provision of onsite primary care medical services is a growing trend.  The rapidly escalating expenditures of medical care insurance for workers has stimulated this trend.  Some employers have found that it is less expensive to offer primary care services themselves than to fund those services through healthcare insurance.  On-Site care also reduces the amount of time workers would otherwise spend away from the worksite getting such services.

References

1.   Aldana, Steven G.  (2001)   Financial Impact of Workplace Wellness Programs:  A Comprehensive Review of the Literature.   Am J Health Promotion 15(5):296-320.
2.   Chapman, Larry.  (1998)   The Role of Incentives in Health Promotion.  The Art of Health Promotion  2(3):1-8.
3.   Chapman, Larry.   (2003)   Biometric Screening in Health Promotion:  Is it Really As Important as We Think?  The Art of Health Promotion  7(2):1-12.
4.   Chapman, Larry.  (2005)   Meta-Assessment of Worksite Health Promotion Programs Economic Return Studies: 2005 Update.  The Art of Health Promotion, July/August, 1-15.
5.   Chapman, Larry.   (2006)   Employee Participation in Worksite Health Promotion Programs and Worksite Health Promotion Programs:  How Important are Incentives, and Which Ones work Best?   North Carolina Medical Journal   67(6):  431-432.
6.   Chapman, Larry, Lesch, Nancy, and Passas Baun, Mary Beth.   (2007)   The Role of Health and Wellness Coaching in Workplace Wellness Programs.   The Art of Health Promotion, July/August, 1-12.
7.   Chapman, Larry.  (2007)   Proof Positive:  An Analysis of the cost-Effectiveness of Job Site Wellness.  Northwest Health Management Publishing, Seattle, WA.
8.   Chapman, Larry.  (2007)   An In-Depth Look at the Economic Evidence for Rewarding Health Behavior Change.   Workshop presentation at the World Research Group “Rewarding Healthy Behaviors for Health Plans and Employers” Conference, Orlando, FL, January 23-24.
9.   Edington, Dee.   (2001)   Emerging Research:  A View from One Research Center.  American Journal of Health Promotion 15(5): 341-349.
10.   Edington, Dee W.  (2007)   Health Management as a Serious Business Strategy.  Presentation at the World Research Group “Rewarding Healthy Behaviors for Health Plans and Employers” Conference, Orlando, FL, January 23-24.
11.   Pelletier, Barbara, Boles, Myde, and Lunch, Wendy.  (2004)  Changes in Health Risks and Work Productivity.   Journal of Occupational and Environmental Medicine, 46(7): 746-754.
12.   Pelletier, Kenneth R.  (2005)   A Review and Analysis of the Clinical and Cost-Effectiveness Studies of comprehensive Health and Disease Management Programs at the Job Site: Update VI 2000-2004.  JOEM 47(10)1051-1058.
13.   DeVol, Ross, Bedroussian, Armen, et. al.  (2007)  An Unhealthy America:  The Economic Burden of Chronic Disease.  Report released by the Milken Institute.   www.milkeninstitute.org.
14.   Partnership for Prevention.  (2008) Investing in Health:  Proven Health Promotion Practices for Workplaces.   http://www.prevent.org/images/stories/2008/investinginhealth_finalfinal.pdf.