By Paul E. Terry, Ph.D.
StayWell CEO and Editor of The Art of Health Promotion

For the May/June 2013 issue of The Art of Health Promotion, Dr. Ron Goetzel has assembled a stellar team of  experts to describe the state-of-the-art in organizational health scorecards and we compare and contrast the following instruments:

• The Health Enhancement Research Organization (HERO) Scorecard
• The National Business Group on Health (NBGH) WISCORE
  
• Samueli Institute Optimal Healthy Environments in the Workplace (OHE-W)

(Note: We will be featuring “The Centers for Disease Control and Prevention Worksite Health ScoreCard” in a forthcoming issue of TAHP.)

You’ll see that the instruments presented have more in common than not. That is reassuring because it shows that researchers and practitioners have reached similar conclusions about what constitutes effective programs. Read on for Paul’s full blog.

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Webinar on May 29, 2013: What is a “Reasonably Designed” Wellness Program?: A Conversation with Dr. Ron Goetzel on the Current and Future State of Worksite Wellness Scorecards.

Please join Dr. Terry for a webinar on May 29, at 1:00 pm ET. He will host Dr. Ron Z. Goetzel, Research Professor; Bonnie R. Sakallaris, PhD, RN Vice President, Optimal Healing Environments, Samueli Institute; Jessica Grossmeier, PhD, MPH Vice President, Research, StayWell Health Management; and Karen O. Marlo, Vice President, Benchmarking & Analysis National Business Group on Health. The panel will discuss the current and future state of worksite wellness scorecards.

Dr. Goetzel, Dr. Grossmeier, Dr  Sakallaris, and K. Marlo are contributors to the May/June 2013 issue of The Art of Health Promotion available here.

Keynote speakers Dr. Andy Baldwin, family physician, Naval officer and Dr. Jim Rippe, of Rippe Lifestyle Institute, serve as wellness champions in their own arenas — whether on television (Dr. Baldwin was “The Bachelor” in 2007) or in public health. Both speakers shared practical examples of what we can do in our daily lives to be wellness champions. Dr. Rippe reminded practitioners that we must close the gap between those who know the right thing to do and those who are actually doing it, saying, “A behavior is not a behavior until you do it.”

Throughout the Worksite Health Promotion track, we found more wellness champions and learned how relevant wellness champion networks are. Whether we were drafting positioning statements with Heather Marie Wilson, MBA, consultant, facilitator and author, or reviewing complexity maps with Nico Pronk, Ph.D., FACSM, FAWHP, Vice President for Health Management, Health Science Officer, HealthPartners, we were constantly reminded of how a strong grassroots communication network can add value to wellness programming.

Our presentations combined research and practice. Stefan reviewed data from the Framingham Study, national surveys, and our very own StayWell research team on how strong wellness champion networks can strengthen the relationship between age and risk improvement. Sarah shared champion recruitment and retention strategies based on established health promotion practices as she reviewed how one StayWell client built a champion network from the participant population.

Mary Kruse, President, HealthSource Solutions, LLC, presented on the topic entitled, “You Built It, So Why Don’t They Come?” explaining that wellness program awareness is built on a coiling process of constantly resurfacing health topics over time. This is one important way that wellness champions can help encourage healthy behaviors. By being visible and consistently spreading the word about living a healthy lifestyle or getting involved in a health improvement program, the wellness champions can act as a catalyst and reminder for others to improve or maintain their health, perhaps without even realizing it. We were happy to discuss wellness champion networks at this conference, and can only hope the topic resurfaces in future industry conversations.

In good health,
Stefan Gingerich, MS, senior research analyst
Sarah Monley, program manager
StayWell Health Management

In this month’s issue of The Art of Health Promotion we feature an article from Seth Serxner Ph.D., MPH, entitled: “A different approach to population health and behavior change: Moving from incentives to a motivation-based approach.”   Dr. Serxner describes a model for designing and implementing health promotion programs with a greater focus on the use of intrinsic reinforcements.   I was delighted to have Dr. Bonnie Spring, Professor in Preventive Medicine at Northwestern University Feinberg School of Medicine join me in a “journal club” discussion about Seth’s article.  Now it is your turn to join in via this blog post. Read on.
 
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Please join Dr. Terry for a webinar on April 9, at 1:00 pm ET. He will host Dr. Seth Serxner, Chief Health Officer and Dr. Bonnie Spring. They will discuss an evidence-based approach to using incentives and together will field your questions and observations about how incentives are advancing and/or inhibiting progress in population health management. The panelists are contributors to the March/April 2013 issue of The Art of Health Promotion available here.

The population health management industry, and ultimately employee health management, benefitted from Dr. Koop’s unwavering commitment to issues like tobacco use and AIDS prevention. His many contributions ranged from his ability to connect with, educate and inspire consumers to his ability to influence political leaders to change public policy on these key issues. Today, there is a resurgence of interest in the financial and productivity merits of keeping healthy employees healthy and affecting the changes needed to accomplish this takes leadership. No one better personifies the moral courage and personal sacrifices required to protect and serve the health of the public.

StayWell Health Management’s connection to Dr. Koop began in 1992 when he joined forces with The Health Project to create the C. Everett Koop National Health Award program. Dr. Koop served as honorary chairman of this recognition program, allowing his name to be used and working to build awareness for the important role of the workplace in shaping individual health behaviors and, ultimately, population health and health care costs.

The C. Everett Koop National Health Awards recognize employers who implement workplace health management programs that demonstrably improve employee health and reduce health care costs. StayWell has partnered with its clients to create best-practice programs, many of which have been recognized for their efforts through the Koop award. Since 1992, an unprecedented 19 StayWell clients have won the Koop award or received an honorable mention for their successful employee health initiatives.

The benefit for employers who embrace the challenge of submitting their employee health management program for consideration in the Koop Award program extends beyond the award itself. The ultimate benefit lies in the process of opening their wellness program strategy and outcomes to review by a panel of industry experts. StayWell is a strong proponent of benchmarking program outcomes through tools like the HERO Scorecard in Collaboration with Mercer, and through submission to award programs like the Health Project’s C. Everett Koop National Health Award and the National Business Group on Health’s “Healthiest Employers for a Healthy Lifestyle” Award. Not only does the process of applying for these awards foster continuous improvement for the employer, it is also a catalyst for innovation by wellness providers like StayWell. In addition, the Koop award pays tribute to the select group of employers who can demonstrate a measurable commitment to improving population health—just as the program’s namesake did.

Dr. Koop wrote about the strain on himself and his family as he struggled through some of his most controversial times in office. Fittingly, there is a syndicated cartoon of one of the Surgeon General’s warning banners with the caption, “That Dr. Koop just doesn’t let up, does he?”

His extraordinary leadership was defined by a tenacity guided by his dedication to science and a profound personal faith. Koop wrote: “Just when things seemed darkest, there would be a ray of light. Just when it all seemed senseless, I would be given reassurance of a purpose.”

Countless lives were saved and scores were spared from suffering because of Koop’s fight for principles of prevention. On behalf of everyone at StayWell Health Management, we extend our deepest gratitude to Dr. Koop for his contributions to the health of our country and to his family for sharing his passion with the rest of us.

With respect and admiration,
Paul Terry, Ph.D., CEO
David Anderson, Ph.D., senior vice president and chief health officer

As employers consider investing in wellness, many want to know there will be a positive return on investment (ROI). ROI is calculated as a ratio of dollars saved per dollar invested, or as net dollars saved, Wellness ROI evaluations typically focus on savings in health plan expenditures, including medical and pharmacy costs.

A 2010 review of peer-reviewed ROI studies by Katherine Baicker and colleagues reported average medical cost savings per dollar invested in wellness programs of $3.27. Published in the respected journal, Health Affairs, this review was conducted by a team of Harvard health economists and based its conclusions on a thorough analysis of more than 20 peer-reviewed ROI studies.

So, why is the ROI of wellness still controversial and why are many employers still hesitating to invest? Because despite the favorable review, these 20 studies varied widely in methods and rigor and none met all the criteria for a gold-standard randomized controlled trial (RCT) that would definitively answer the key question, “Were the changes in employee costs caused by the wellness program?”

How to move forward in this imperfect world? To begin with, investments must align with goals. If health plan costs are increasing 7 percent annually, per employee, and the goal is 2 percent, the average employer would have to reduce their trend by over $500 per employee plus the additional cost of the wellness program.

If the Baicker ROI estimate of about 3:1 after about three years of programming were correct, that would mean investing about $250 per employee annually on health and well-being. Our own research suggests a 2:1 ROI by the third year of a program may be more realistic. This more conservative ROI estimate increases the required investment to about $500 per employee annually to hit the medical-cost trend target.

Employers spending this kind of money need evidence to justify the value of their investment. For most employers, I’d recommend straightforward value measures in five broad categories:

• Engagement: Active leadership engagement drives culture change and year-round employee engagement drives individual health improvement.
• Health trends: Consider if your company’s rates of smoking, obesity, elevated blood pressure and cholesterol, depression, diabetes, heart disease and other measures are trending better than external benchmarks?
• Health care utilization trends: In addition to medical cost trends, a leading success indicator is a shift away from in-patient hospital stays toward preventive care, non-urgent care, and medication adherence.
• Medical cost trends: Relevant metrics include whether current medical trends are better than before the program, and better than actuarial projections and outside benchmarks.
• Performance trends:  The questions here are similar to those for medical cost projections, but may be applied to health-related metrics like absence and disability costs or to employee performance metrics and business results.Researchers and program evaluators should continue building evidence on the value of wellness and what works best. In the meantime, employers should say “good enough, move on,” because inaction is simply not a sustainable option.

More on this topic: See SHRM Online article, ROI of Wellness: How Good Is the Data?

The Department of Labor has issued new guidelines concerning the wellness provisions of the Affordable Care Act (ACA) that relate to the use of financial incentives, and the Office of Health Plan Standards and Compliance Assistance is seeking public comment. This document proposes “amendments to regulations, consistent with the Affordable Care Act, regarding nondiscriminatory wellness programs in group health coverage.” These regulations increase rewards for wellness participation or outcomes from 20 to 30% or up to 50% related to reducing tobacco use. (Federal register)

In the past several years, StayWell Health Management has published several studies concerning the use of financial incentives in wellness programs, so my colleagues, Drs. David Anderson, David Gregg, and I, felt obliged to offer some reactions to the proposed new language. All public comments will be posted at: http://www.dol.gov/ebsa/. By way of summary, we commended the department for its painstakingly earnest attempt to placate the detractors of the original proposal who believe that incentives could too readily become a subterfuge for insurance underwriting. Still, we believe their attempt to divide incentives into participation based or health contingent models may well shed more heat than light on the matter. Jump to Paul’s Managed Care blog to read more.

Involving families in a company’s wellness program has broad social as well as health benefits as highlighted by Judd Allen and his colleagues in the January/February issue of The Art of Health Promotion. I expect that for those working in employee health management, the examples we offer in this issue are just the beginning of the work on social norms and creation of wellness traditions for families that can be inculcated by employers. In my closing commentary I relate how parents and their kids from the American Express Company were invited to participate in a half day of basketball drills and learning about healthy eating at the NBA Fit program. “We think family and community support is critical for sustainable behavior change,” says Anita Shaughnessy, Vice President of US Benefits and leader of the Healthy Living program at American Express.  Read on.

More on this topic

Please join Dr. Terry for a webinar on January 29, at 1:00 pm ET. He will host Judd Allen, President of Human Resource Institute, Anita Shaughnessy, Vice President of Benefits at American Express and Tsitsi Masvaure, a researcher at Columbia University as they discuss the role of families and generational differences designing and delivering successful health promotion programs. The panelists are contributors to the January/February 2013 issue of The Art of Health Promotion available here.

I’m proud to have been involved in a groundbreaking research study that was recently published as part of an ongoing collaboration between StayWell and Towers Watson researchers that answers this all-important question of, “How much, by when?” The study, “Association Between Changes in Health Risk Status and Changes in Future Health Care Costs: A Multi-employer Study,” was published in the November 2012 issue of the Journal of Occupational and Environmental Medicine (JOEM).

This study is significant for a number of reasons. For starters, it’s one of the first multi-employer studies to explore the specific timing of changes in health care costs related to increases or decreases in health risks. More than 20,000 individuals from six large employer organizations were included in the analysis, which combined standardized health assessment data with health care (i.e., medical and pharmacy) claims data.

The research is also important because it supports a greater focus on prevention and wellness. In fact, the findings show that for every health risk added, costs increased by 45 percent above the cost savings that resulted from eliminating a risk. This means that if organizations prevent individuals from adding new health risks over time, their cost savings will be greater than if they focus on eliminating a health risk after it emerges.

And, finally, this study helps employers better estimate the short-term financial impact of changes in individual and population health risks. More specifically, employers who commit to changing employee behaviors can start seeing immediate average health care cost savings of $100 per employee per health risk eliminated in the year of the change, and $105 per risk reduced in the year following the reduction. However, if you don’t keep healthy people healthy and employees start accumulating new health risks, you not only negate this savings but stand to add health care costs of $145 per employee per health risk added within the following year.

This research is a tremendous leap forward in our understanding of how changing health risk status impacts health care spending. While there is still much to know and understand, this research closes an important gap in the business case for a population health management approach to health care cost containment. On behalf of the entire research team at StayWell, I can say that we look forward to taking part in future studies that further explore the long-term financial impact of changing health status.

We invite you to review the research brief summarizing the objectives, methods, results and conclusions, and key findings. To request a copy of the full JOEM article, email information@staywell.com.

In good health,

Jessica Grossmeier, Ph.D.
Vice President of Research

Tuesday, November 27, Dr. Terry interviewed Michelle Nunn, CEO of Points of Light Institute (POL) and national leader in the community volunteerism and Corporate Social Responsibility (CSR) movements.   The idea that volunteerism and social connectivity rate right up there with the most potent of personal health practices.

The webinar featured the article “Borrowing Ideas from a Sister Movement” in the November/December 2012 issue of The Art of Health Promotion, published in the American Journal of Health Promotion, as they discuss the role of a wellness champion or an ambassador and how it is one of the most vital links to success in advancing behavior change. To request a complete copy of this edition, email information@staywell.com.

Jump to Paul’s blog to learn more.

Writing for Managed Care, Paul discusses “a concept that’s long overdue but now fully ensconced in the field of population health management.  Employee health management (EHM) practitioners, in particular, are coming to understand that the environments in which health promotion interventions occur are a primary determinant of the effectiveness of the interventions.”

Are we acknowledging that the sustainability of healthy lifestyle improvements in diet, exercise, or tobacco use is fundamentally linked to our surroundings? Jump to Paul’s blog to learn more.