Start with a health fair paired with a health screening. You need data to take action—identify and help those with chronic conditions, create awareness for employees and their spouses/dependents, create an opportunity for change.

Incentives and fun are typically the key ingredients.

Clients have used a gift incentive to get folks to go to the Health Fairs and do the health screening. $15 - $30 items are typical (soft-sided cooler w/ company logo, polar fleece pullover w/ company logo, etc.); sometimes the gift can be donated from a partner (health system, fitness facility, etc.). Getting them to go through the screening provides an awareness that may not otherwise exist. That awareness can overcome lethargy.

Lose 5 pounds and get a prize ($ or something like 2 movie tickets). Wall of Honor – individuals who participate and reach milestones post them on the board. Post the Height/Weight guidelines to create an awareness.

Pitney Bowes has a terrific program which has been in place for a number of years. For an overview, visit the case study.

One strategy would be to point to what executives at other companies are doing -- companies, that is, that have already embarked down the road of becoming more proactive in promoting health and wellness in their work setting.  Leading companies that come to mind include Pitney Bowes, Dow Chemical, and International Truck and Engine Corporation.  Each of these companies has a very active company program; each is working with third party vendors to identify risk factors (in ways that preserve full employee confidentiality); each has recently or is now in the process of substantially beefing up its outreach/case management/advocate program linking those with disease with professionals and para-professionals; etc.   The point here is that there is a fast-growing list of examples that can be singled out to support the need for buy-in.Read the wonderful article published by Partnership for Prevention. It tells the story of CEO’s setting the example for a healthy style of living.

Use the Health Fair/Health Screening event as an opportunity to include spouses and children. Again, incentives for participating make a big difference. Make it clear that not only are spouses included but encouraged to take advantage of the services and opportunities.

All wellness materials should include spouses and families. Newsletters with wellness content should reference both employees and spouses. Target spouses with an incentive gift different than for employees.

Disease management programs use actual health plan data to identify chronic illness without regard to status (employee vs. dependent).

Wellness benefits are typically non-specific—both employee and spouse have access to physicals, tests and screenings.

Fitness benefits should provide additional funding incentives to include spouses.

Lifestyle coaches typically are not nurses. They are trained counselors, with a minimum of 4-year degrees, who are well-versed in behavior change, motivation techniques and telephone-based coaching skills. They are each trained on each the various modules offered, and are required to participate in on-going education throughout the year. The phone skills are very important. These coaches need to be good listeners who can engage the enrollee in an open, trusting dialogue. It’s the one-to-one trust and relationship that we think makes these programs work.

It all starts with the participants who take the Health Risk Appraisal. Let’s start with an employer who has 1,000 employees. With the appropriate benefit incentives, an employer can expect to see up to 80%, or 800 of their employees take the HRA. Of those who take the HRA, approximately 42%, or 336 will have 5 or more risks. 50% or 168 of these employees will consent to being contacted. Typically 80% of these or 134 employees will be reached within 3 attempted calls. 60% of them, or 80 will enroll in the coaching programs, and 35% or 47 of them will opt for an educational call. The remaining 5% will decline to participate.

It is always best to reward all those who participate and complete the desired activity, even if their goal was not fully achieved. A person who is trying to lose weight, but loses only 15 pounds versus the 20 they set as a goal, has still made great progress. It’s the behaviors that should be rewarded and reinforced.

Telephonic coaching is relatively new. While there are case studies and self-reported results that are quite impressive, there are not any readily available scientific studies that can yet be cited.

It’s always best to provide this service through a third party in order to avoid any perceived conflict of interest or lack of confidentiality/privacy that comes with an employer providing the service. The service can be through any third party as long as the counselors are properly trained, they have the appropriate tracking tools, and of course they get the appropriate consent from the participant.

Web-based programs have shown a reasonable return on investment. Some organizations say a 2:1 return, others may claim something higher. The success is really based on incentives provided by the employer, as well as how well the programs are communicated. We all have different ways that we like to participate. Some people like groups programs, others like one-on-one, others like something they can do themselves in the privacy of their own space. That’s why it’s important to offer many different options for employees to participate in ways they feel they can be successful.

There will always be those individuals that game the system for personal gain. However, most studies have shown that HRA results are accurate to approximately a ±5%. There is a great deal of corporate culture that plays into these strategies as well. Employees must feel that the employer is doing these initiatives in the best interest of the employees. They need to trust that the results are confidential and that there will be no ramifications for being honest. They also need to see that an employer is serious about these programs, that it’s not perceived as just another passing fad. If leadership is openly behind these initiatives, if the culture is one where employees feel secure and confident this is for their own best interest, if communications are handled well, and if incentives are appropriately designed, the results will improve dramatically over time.

While we are not aware of other weight management company At-Work programs, there are a number of corporations who have been successful at developing their own programs. Here are a couple to check out:

General Mills

Dow

Can you say more about the kind of employees who were surveyed in your study?

This employer has about 35,000 employees worldwide.  Domestically, about half of the workforce is devoted to manufacturing machines and hardware used in office settings, and about half are devoted to servicing these products in the field. 

As mentioned in my remarks, a preliminary estimate of the potential workplace productivity gains can be found in comparing the pain group and the healthy benchmark group on Days Absent From Work and "Days At Work less than 100 percent" (a measure of presenteeism) during the previous four weeks. The two types of productivity loss -- when combined -- averaged just over a third of day for healthy employees; the corresponding figure for employees with pain was approximately four days. The difference (three and two thirds days over a 20-day work period) was directly attributable to the impact of pain.

Some clarification helps to give context here.  The pain group consisted of all employees meeting the study's pain criteria, not just those with musculoskeletal pain.  Yet, the musculoskeletal disease group also exhibited the greatest potential "bang for the buck" by virtue of recording the largest prevalence X per person impact of all disease groups we examined).  As such, its average likely exceeded the overall pain group average, meaning that the above figure of four days was probably an underestimate for this subgroup.  In contrast, the healthy group in this age-sex adjusted comparison consisted of those employees reporting no chronic disease (from a checklist of 20+ medical conditions) and above average health status.  This benchmark retained the kinds of everyday maladies (i.e. colds) that one inevitably finds in populations .  It arguably thus provided a realistic norm for comparison that was neither theoretical or arbitrary.

Given these factors, the three and two-thirds figure divided by the total possible number of days in question (20) yields an estimate -- just over 18% --  of the productivity loss that may in fact be actually recoverable through effective intervention for pain in this employee population.

What is your opinion of instituting "tier" level premiums strategies which require a higher level of premium contributions by employees who have 5 or more of the "high risk" factors.

If the idea is to shift toward treating health care expenses as an investment rather than a cost, one might consider a different approach.  Instead of increasing the premiums of those with greater risk, how about instituting a (voluntary) program which: a) identifies employees at risk; b) defines a recommended course of action or treatment, depending on the nature and severity of the risk; c) and decreases the premiums (or more likely the premium increases) for those employees who can document that they have adopted and/or followed through on this course of action.   We have been working with a major employer that is now implementing such a program.  Under this program, all employees will be subject to an increase in premium this next year.  Those at risk however will have their increase "forgiven" if they can show that they are following or have followed the recommended course of action.  Under this program, for example, employees classified at medium risk for smoking who complete a designated telephonic/online educational course on the health consequences of this behavior are saving $240 per year. Employees classified at high risk for smoking need to attend and complete a smoking cessation class to enjoy the same result.

The companies that are proving most successful at promoting improved health and productivity -- at least in our experience -- are those that are actively seeking to reshape their corporate culture. By culture I mean things like the prevailing behavior patterns, what is considered acceptable or not acceptable, important or not important.  The key, here, seems to be promoting the perception that the company cares about the health and well-being of its workforce. This perception is critical to the environment of trust that employees need to be receptive to the efforts of the company to promote better health.  How to do this?  Senior leadership can begin with a clear, public and highly visible delineation of its expectations as to the responsibilities of the company, versus the work environment, versus the employee for maintaining and improving employee health.  Pitney Bowes offers a nice example in this regard with its "Power of Two: Pitney Bowes and You" program. Senior leadership further builds the relationship of trust when it actually allocates and secures the company funding, space and personnel needed for the programs and resources (e.g., exercise facilities) that employees can tap to maintain and improve their health. Perhaps the most vivid demonstrations of intent, however, come when the leadership makes public its own personal behavioral commitments and encourages or challenges fellow employees to do the same. The CEO at Johnson & Johnson who every Wednesday issues an open invitation to employees for weekly lunch walks is a good example in this regard.

Can we get a copy of this presentation?

Sure. Simply click on one of the links at the top of this page. The archive is a complete replay of the event. The slides are a PDF version of the PowerPoint that accompanied the presentation.