Employee Health and Wellness

I will use this module to share with you some of the latest news or research I learn about. The postings will be short and may include a link to where you might go for further information.

April 24, 2009
Obesity Related Articles

The current edition, Volume 87, Issue 1, March 2009, of The Milbank Quarterly,
A Multidisciplinary Journal of Population Health and Health Policy, contains 11 articles on the issue of obesity.

One of the articles focuses specifically on the role of the employer. That article, "Addressing Obesity in the Workplace: The Role of Employers by Luann Heinen and Helen Darling from the National Business Group on Health, and all the others are available free at the following link:
http://www3.interscience.wiley.com/journal/118541241/home?CRETRY=1&SRETRY=0

April 13, 2009
International Worksite Wellness

If your interest in worksite wellness includes an international orientation, you might be interested in reading the current edition of Buck Consulting's Global View Magazine. It contains several articles on worksite wellness, including the international perspective. You can link to the magazine through Buck's main Web site at: http://www.buckconsultants.com

Please be sure to scroll down for my earlier postings to the Current News and Events module.

National Resources
U.S. Centers for Disease Control Swine Flu Page - http://www.cdc.gov/swineflu/

This is the page to go to for the most recent, up-to-date information on the national level. The page contains information on the number and location of cases, notices, guidance, and press releases.

Pandemic Flu Planning and Preparation - U.S. Government http://www.pandemicflu.gov/

This site offers one-stop access to U.S. Government swine, avian and pandemic flu information. While this page does link back to the CDC's Swine Flu Page, its strength lies in all the planning and preparation resources that can be found here. These resources are categorized by families & individuals, workplace, community, health care and state and local governments.

Ready.gov - http://www.ready.gov/

This site is the all hazards planning and preparation page for the U.S. Department of Homeland Security. The site is categorized for individuals and families (Ready America), worksites (Ready Business) and for children (Ready Kids). Each category offers tools, kits and planning templates.

International Resources
World Health Organization - http://www.who.int/csr/disease/swineflu/en/index.html

This is the English speaking swine flu site for the World Health Organization. This site contains highlights, disease outbreak information and other health related information related to swine flu around the world.

During a public health emergency, mental health services will play a key role. While pulling together some Swine Flu information resources for my HR folks, I came across the following archived Webcast on the role of mental health in pandemics.

From the U.S. government's PandemicFlu.com Web site:

PlanFirst Webcasts on Pandemic Influenza
Mental Health Services and Their Role in Pandemic Planning, Response and Recovery (February 18, 2009) - 60 minutes
Brian McKernan, SAMHSA
Dr. Dana R.Taylor, SAMHSA
Linda Ligenza, SAMHSA

Overview: Archive of February 18, 2009 Webcast on mental health services and their role in pandemic planning, response and recovery.

Here is the link:
http://www.pandemicflu.gov/news/panflu_webinar10.html

The following two, new free resources related to employee health and wellness programs have come to my attention.

Employer Health Asset Management: A Roadmap for Improving the Health of Your Employees and Your Organization from the Institute for Health and Productivity Management.

The Employer Roadmap is a guide to help decision makers make employee health an integral part of their human capital management strategy. Here is the link:
http://www.ihpm.org/pdf/EmployerHealthAssetManagementRoadmap.pdf

Improving the Health and Productivity of the American Workforce: A Blueprint for Action from the Integrated Benefits Institute and the American College of Environmental and Occupational Medicine.

This document contains the consensus statements and recommendations from
the first national Workforce Health and Productivity Summit, sponsored by IBI and ACOEM, that was held in November 2008. Here is the link:
http://ibiweb.org/do/PublicAccess?documentId=911

While this post is a little outside the employee health and wellness realm I normally write about, an April 14, 2009 Reuters Health Report story caught my eye. The title of the story was: "Many Americans Ignore Food Recall." The story was based on the findings of researchers at Rutgers University. The researchers surveyed 1101 Americans in September and October of 2008.

The researchers found that only 60% of those surveyed stated that they search their homes for recalled food, despite the fact that 84% of the respondents said they pay close attention to the news reports about food recalls. Eighty-one percent of the respondents indicated that they tell others about the recall after hearing about it themselves.

More than 25% of the people surveyed said that if they had the recalled food, they threw it out. What amazed me is that 12% of the respondents reported eating food they thought had been recalled. Consistent with other types of issues, 40% of the respondents, who reported paying attention to the news reports, stated that it was less likely that they had purchased the recalled food as opposed to others.

So, how do you respond to food recalls?

Introduction
The answer, if you are using a comprehensive employee health and productivity model, is that it really doesn't matter. Either way, ergonomic injuries are costing your organization both directly as medical costs and indirectly as lost productivity costs. What is ergonomics? Simply put, ergonomics is the science of matching the work environment with the individual characteristics and capabilities of the worker.

Types of Risks
Both manufacturing and non-manufacturing type employers face ergonomic risks. Ergonomic injuries are probably the greatest risk faced by a non-manufacturing type employer. Within an office type setting, the biggest ergonomic risk comes from computer use. Industrial type ergonomic risks include working in an awkward position and repetitive movements, including shoveling and raking.

Computer Use
Risks arising from computer use generally arise from poor body position in relationship to the height of the chair, keyboard, mouse and monitor. Secondary is the risk from uninterrupted, repetitive key strokes. Employees permanently assigned to a workstation should undergo a workstation evaluation. If multiple employees use one workstation, the workstation should be fully adjustable.

If having a physical/occupational therapist or ergonomics specialist evaluate your workstations is not feasible for financial reasons, consider training one or two of your employees as "peer evaluators." Employee self evaluation tools and resources can also be found on the Web, though I would caution the reader that self evaluation should, in my opinion, be a last resort. Some examples of available resources include:
State of Wisconsin - http://www.doa.state.wi.us/ergonomics/course/f_lesson04.html
University of California Santa Cruz - http://ehs.ucsc.edu/safety/pubs/ergo/SelfEvaluation.pdf
University of Wisconsin River Falls - http://www.uwrf.edu/risk/documents/Ergonomics%20booklet-2.pdf

In addition to workstation evaluations, a comprehensive approach to ergonomic injury prevention includes stretching and education. Employees should be mandated or encouraged to participate in group stretch breaks at regularly scheduled times during their workday. Employers should also encourage employees to take quick mini-breaks every hour. For every 60 minutes of computer use, employees should take a 3 minute mini-break and get up and stretch or take a quick walk around their immediate office area.

Employees can reduce their risks by being better educated and aware of ergonomic risks. The training can be accomplished either in a classroom setting or electronically via interactive CD-ROM or on the Web.

Laptops
If employees are issued a laptop to work from home or other off site location on a regular basis, consider supplying the employee with an external keyboard, mouse and monitor. Laptops are not designed for extended use at a fixed location. Ideally, the home office or other regularly used off site location should also receive a workstation type evaluation.

Role of the Supervisor
Ergonomics should be a part of the everyday language of the supervisor. To promote an ergonomically healthy workplace, supervisors should:
* Learn the ergonomic risk factors for the jobs in their unit and how these risk factors can be minimized
* Supply ergonomic training to their employees
* Encourage employee input into solving ergonomic related issues and problems
* Designate a peer evaluator for their work unit and then support the person by providing the necessary time and resources
* Secure ergonomic appropriate furniture and tools for their employees
* Promote periodic scheduled stretch breaks and frequent, short mini-breaks as well as alternative work activities when necessary
* Encourage staff to report pain and discomfort symptoms early

Remember, it is always more cost effective and morale boosting to identify and proactively address areas of high risk before an injury results. Injuries are costly and demoralizing.

When it comes to worksite wellness, what is 2009 likely to bring?

Standards
In November, URAC (Utilization Review Accreditation Commission) adopted wellness program standards. This is the first, of several I suspect, national standards to be published by an accrediting body. So 2009 will not doubt see vendors, health plans and employers working to figure out how to best work with the new standard.

Presenteeism
As the new administration struggles with health care reform and its associated costs, more employers and researchers are likely to devote increasing attention to the indirect costs associated with presenteeism. An article in the November issue of the Journal of Occupational and Environmental Medicine reported that a meta-analysis of 46 published studies on the effects of worksite health promotion programs revealed that these programs yield meaningful improvements in several key areas, including a 22% reduction in sick leave use. The other key areas identified included emotional exhaustion and burnout. The lead author, Jaana Kuoppala, suggested that worksite health improvement programs "should target both physical and psychosocial environments at work." This is great support for the continued transition of worksite wellness programs to employee health and productivity programs. Research like this will also no doubt, help to drive wellness programs into additional organizations, especially small employers who generally do not offer health insurance. Given the importance of human capital in today's creative economy, it is likely that the costs associated with presenteeism will continue to be researched and documented.

Mental Health Parity
A recent survey of 972 U.S and Canadian employers and benefit plans by the International Foundation of Employee Benefit Plans revealed that 71% of the respondents offered mental health benefits to employees. This is important because Congress passed and the President signed legislation in late fall requiring parity between mental health and physical health benefits. Beginning in January 2010, if an employer offers mental health/substance abuse treatment coverage to employees, the mental health benefits must be equivalent to the physical health benefits offered. The parity law is likely to cause employers to take a closer look at their mental health and substance abuse costs. As one possible cost control strategy, employers are likely to ramp up the substance abuse/mental health prevention education they offer through their worksite wellness program.

Health Coaching
Health coaching remains a "hot topic". Generally, the availability of coaching has been limited to employees with a diagnosed chronic disease or who show a high number of risks on a health risk assessment. As the trend of putting employees into a position of having to take responsibility for their personal health care choices continues upward, greater emphasis will be placed on the use of wellness coaches. As the field of coaching continues to improve at demonstrating its effectiveness, wellness (lifestyle) coaches will play an increasing role in helping to keep low risk employees in the low risk category.

Speaking of coaching, Nationwide Better Health has announced the implementation of benefits coaches. They describe their benefit coaches as helping employees to take full advantage of their employer's benefit offerings as determined by the employee's health, lifestyle and personal situation. According to Nationwide, early employee satisfaction results have included:
* 90% reporting that they felt more confident about choosing the best benefits for their situation
* 79% reporting they felt they would receive more value from their chosen benefits
* 63% reporting they felt more satisfied with their benefits
* 81% reporting that they will take steps to improve their health
* 89% reporting that they will take steps to improve their wealth

Obesity and other Weight Issues
Obesity, weight loss and weight management will also remain a "hot topic" in both employer and health circles. Our challenge lies not in helping employees to lose weight, but in helping them to maintain their weight loss. A study reported in the December issue of the International Journal of Obesity found that "it is possible to maintain large weight losses through intensive behavioral efforts, such as changing your approach to eating and exercise, regardless of whether you lost weight with bariatric surgery or through non-surgical methods." In comparing surgical and non-surgical weight loss patients, researchers identified behavioral differences between the groups. Bariatric patients reported "greater fat and fast food consumption, less conscious control over their eating and higher incidences of depression and more stress than non-surgical patients." When it came to physical activity, the researchers found that "one third of the surgical group reported engaging in a level of physical activity consistent with recommendations for preventing weight gain compared with 60% of the non-surgical group." Interesting implications for worksite weight management programs.

So....it looks like the 2009 wellness ride will no doubt be exciting.

With the R word (recession) being used ever more frequently these days, I thought it was an appropriate time to look at the financial aspects of wellness programs. There are several different strategies you might use to fund a wellness program. They include:
* Determine a per employee per use charge for each activity or strategy
* Ask existing programs to fund one or more wellness related strategies
* Request a specific amount per employee
* Use the Play or Pay Method - Employees who don't participate do not receive a premium discount and this additional money is used to fund the wellness program.
* Request a percentage (0 - 2%) of the organization's total healthcare or health insurance costs

Wellness program costs are as varied the organizations offering programs. At the 2008 National Wellness Conference, I heard figures ranging from $150 - $450 per employee per year. At a recent Wellsource Successful Health Management Systems training program, we were given the following information:

Source - Cost ee/yr
Univ. of Michigan (Dee Eddington) $300-$400
Cornell Univ. (Ron Goetzel) $150
WELCOA $100-$150

At a recent WELCOA Well Workplace University training program, David Hunnicutt stated that programs rated as Good, Better and Best spend, on average, the following:

Rating - Cost ee/yr
Good $10 - $20
Better $30 - $75
Best $100 - $150

Dr. Hunnicutt also stated that Blue Cross Blue Shield of Nebraska spends $125 - $150 per employee per year for their Platinum Award winning program.

When talking with the CEO and other senior managers about a wellness budget, remember to remind them that wellness is as much about the long haul, as it is the current situation. Most wellness and health management strategies are not short term strategies. While lowering health insurance premium and healthcare related costs are important, wellness programs also result in engaged, healthy and productive employees and a healthy organization, both of which help to drive organizational objectives. Regardless of the state of the economy, just like other organizational operations and cost structures, healthcare and personnel costs need to be managed.

Resources:

Building Your Wellness Budget - WELCOA
http://www.welcoa.org/freeresources/pdf/wellness_
budget.pdf

Tips:
1. If you already have an existing program:
a. Make sure you are doing all the program evaluation necessary to demonstrate the merits and value of your program.
b. Make sure you are meeting the expectations of your CEO and other senior managers. Stay in touch with the expectations as these may change quickly due to changing economic and/or market conditions

2. If you are looking to start a program:
a. Make sure you have the complete support of the CEO and other senior managers
b. Build a solid business case for your program that specifically addresses the problems and issues within your organization
c. Make sure you emphasize the non-financial benefits of a wellness program such as increased productivity, decreased absenteeism and presenteeism
d. Propose starting out with a pilot program or two

3. Make sure you are fully aware of all the wellness and preventive services offered by your insurance company. Give careful consideration as to how you can capitalize on them and incorporate them into your wellness activities.

4. Think and act creatively, while keeping to your program's core vision and mission.

5. Make sure that your program's strategies remain connected to the organization's overall strategies, as these might change due to market or economic conditions

6. Explore how existing programs and services might be slightly expanded or tweaked to address wellness related issues. For example, workers' compensation and employee assistance programs

7. Consider sharing program resources with neighboring employers

8. Connect with community based programs and evaluate how you might incorporate the resources they offer into your program

9. Review and think about the perceived value of any incentives you offer. For example, a $25.00 gas card takes on new meaning with current gas prices and the lousy economy

There are probably as many definitions to worksite wellness as there are worksite wellness programs. The various definitions I have seen have included some of the following phrases:
* worksite based health related activities
* employer sponsored activities
* promotion of healthier lifestyles
* organized worksite programs
* voluntary behavior change
* health and injury risk reduction
* improvement of health related consumer skills
* enhance personal wellbeing and productivity

One of the originators of what we now consider to be the wellness movement was Don Ardell, Ph.D. Don is known to say that each person needs to decide what wellness is for them. Therefore, wellness becomes what they say it is.

Traditionally, worksite wellness programs have focused on physical health and involved programs and activities such as:
* corporate fitness centers
* awareness and education
* behavior change
* health assessments
* health fairs
* worksite biometric screenings

Wellness means more than just the absence of disease. Wellness is about consciously choosing to live life in a way that brings about optimal health and life satisfaction. It is generally recognized that there are 6 dimensions of wellness that continually interact with each other. These 6 dimensions are:
* physical
* intellectual
* emotional
* environmental (occupational)
* social
* spiritual

While worksite wellness programs have traditionally focused on the physical dimension, increasing recognition of the interrelatedness of the dimensions is resulting in worksite wellness programs beginning to address the environmental and emotional dimensions as well.

A comprehensive worksite wellness program today is likely to include some or all of the following components:
* Awareness and education
* Behavioral change
* Medical self help
* Chronic disease self care/Disease Management
* Policy and environmental changes that lead to cultural change

For many Americans, health insurance coverage is tied to employment. Employers often pay all or a portion of the employee's health insurance premium. It is estimated that as much as 80% of the U.S. population has ties to a workplace, either as an employee, family member or retiree.

Using the worksite to promote employee wellness and optimize health makes sense for the following reasons:

1. Direct Costs - Health insurance costs directly impact the organization's bottom line. Reducing costs has an immediate, direct reflection on the bottom line. Research has also shown that employee health and wellness also has a direct impact on worker's compensation claims (Archives of Internal Medicine, April 23, 2007), as well as the frequency of disability claims (Employee Benefit News, July 2007).

2. Indirect Costs - Research has shown that both absenteeism and presenteeism are significant cost factors for an employer and both can be positively impacted by the implementation of a worksite wellness program. To learn more, a good source of information is the Institute for Health and Productivity Management at http://www.ihpm.org.

3. Captive Audience - Most employees spend at least 1/3 of their day at work. For many employed Americans, in 2006, according to the Bureau of Labor Statistics, a full time worker across all industries worked an average of 42.9 hours a week.

4. Recruitment and Retention - Worksite wellness and health promotion have been shown to be great employee recruitment and retention tools.

5. Opportunity for the Effective Use of Incentives - Employees are often covered by benefits and policies which can be modified to incorporate the use of participation and adherence related incentives. The workplace also represents a consistent and stable enough environment to allow the use of these varied types of incentives in both short and long term timeframes. In the workplace, many different types of incentives are both feasible and appropriate. I will address the issue of incentives more specifically in another module.

6. Opportunity to Influence - Worksites offer the opportunity to deliver repeated, consistent communications through multiple channels. Worksite physical, social and cultural environments can also be modified as a way to influence employee lifestyle and behavior change. Supervisors, managers and peers can serve as either facilitators or barriers, as well as adding both pressure and support.

Currently, worksite wellness programs generally fall into one of three types:
1. The Humanistic Model
2. The Traditional Model
3. The Health and Productivity Model

The Humanistic Model

The Humanistic Model is also referred to as the feel good model or the quality of work-life model. The primary focus of this model is to increase morale. Program activities within this model have a focus on having fun. There is no attempt to reduce employee health risks, nor is there any special programming emphasis placed on high risk employees. Activities within this model are not orientated toward managing an employee's healthcare and all program activities are of a voluntary nature. Activities are worksite based and there is no attempt to personalize or individualize them. Activities offer minimal incentives and are not available to spouses or dependents. Activities are not evaluated in any way.

The Traditional Model

In the traditional model, the focus is on delivering activities, which are mostly health focused. Activities attempt to address some risk reduction, though few activities are targeted at the high risk employee. There is also a limited orientation towards healthcare management related activities. Participation in the activities is completely voluntary and all the activities are worksite based. There is also some attempt to personalize or individualize the activities. Incentives are often modest in nature and there is some attempt to include spouses and dependents in the activities. While activities may be evaluated, the evaluation strategy is, however, often limited in nature to activity outputs.

The Health and Productivity Model

In this model, the primary focus is results. This results focus includes productivity, as well as health. There is a strong attempt to target overall health risk reductions, as well as employees with high risks. There is a strong orientation towards healthcare management related activities, with some activities even requiring participation. Activities offered within this model include both worksite based and electronic Web based activities. Major incentives are offered to encourage participation and there is a major attempt to personalize or individualize the activities. The activities offered are available to spouses and dependents, in addition to the employee. Activities are rigorously evaluated, including both output and outcome type evaluations.

As I researched information for this module, I was surprised to learn that the roots of worksite wellness go back to the late 1800's. David Chenworth's book, Worksite Health Promotion, is a great source of information on the early history of worksite wellness programs.

According to Dr. Chenworth, "In 1879, the Pullman Company formed a fitness and recreation program within its own athletic association."(1) Dr. Chenworth reported that in "1894 John Patterson, President of National Cash Register instituted morning and afternoon exercise breaks and then in 1904, built an employee gym."(2)

Leading up to 1941, enough companies were involved in employee health, fitness and recreation that the National Employee Services and Recreation Association was formed. This association, according to Dr. Chenworth, "spearheaded greater interest in employee health."(3)

Dr. Chenworth also reported:
"* In the late 1950's, PepsiCo established its physical fitness program
* Since 1960, Rockwell International has encouraged daily exercise for employees and dependents.
* Xerox Corporation has stressed physical fitness since 1965
*American Can and NASA established physical fitness programs in 1968.
* In the late 1970's, Kimberly Clark Corporation and Sentry Insurance built state of the art fitness facilities, serving as a major impetus for other companies to follow suit."(4)

Writing in "The History and Future of Health Promotion and Wellness" in 1998, Bill Hettler, MD, wrote: "Many of the major corporations in the United States had begun to recognize the positive benefits of exercise and health promotion activities by the early 1980's."(5) Dr. Hettler went on to write: "A group of professionals evolved from among the leaders of these programs to form a national group that became known as the American Association of Fitness Directors in Business and Industry (AAFDBI)."(6) The name of the association changed over the years, eventually becoming known as the Association for Worksite Health Promotion, which operated until 2002.

Notes 1 - 4
David Chenworth, Ph.D., Worksite Health Promotion. Champaign, Illinois: Human Kinetics, 1998.

Notes 5 - 6
Bill Hettler, MD, "The History and Future of Health Promotion and Wellness: A Physician's Perspective," pp. 8 - 11 in "Exploring the Nature of Health Promotion in the 21st Century," The Health Monograph Series, Volume 16, Number 3, 1998.

In the early 1970's, the medical community began to look at the concept of wellness. In 1979, The U.S. Surgeon General's Office released a report entitled, "Healthy People." In 1990, the U.S. Government set national health objectives through the document "Healthy People 2000." One of the challenges set out in Healthy People 2000 was for companies to provide worksite health promotion programs.

The third edition of Healthy People, "Healthy People 2010," was released in 2000. Healthy People 2010 contains two major worksite specific objectives related to health promotion:
1. By 2010, 75% of employers, regardless of size, will offer a comprehensive employee health promotion program
2. By 2010, 75% of all employees are participating in employer sponsored health promotion activities.

An additional 50 objectives in Healthy People 2010 can be incorporated as objectives for any comprehensive worksite wellness program. The Healthy People 2010 document also spawned a sister document put out by the Partnership for Prevention entitled "Healthy Workforce 2010." This document was designed to specifically serve as a health promotion sourcebook for both large and small employers. This document can be accessed free at:
http://www.prevent.org/images/stories/Files/
publications/Healthy_Workforce_2010.pdf

Whether we like it or not, or whether we even care, 2008 will be a year dominated by politics (though I think we should care). On Saturday, January 5, 2008, the ABC television network aired both the Republican and Democratic debates held in New Hampshire, just prior to the New Hampshire primary. The debates were moderated by Charles Gibson, ABC Evening News Anchor.

One of the questions Charles asked the Republican candidates was what were their personal guiding principles? A number of the candidates responded by reciting the things they would do if they were elected President. This answer begs the question.

The more I thought about the question, the more I realized how profound a question it is. I am glad that I did not have to answer the question on national TV without having had the benefit of time to think about and craft my answer.

Self awareness is a critical part of personal wellness. Answering the question, "What are your personal guiding principles?" will contribute to your self awareness. So as I contemplate an answer to this question, I challenge you to do the same.

In the inaugural issue of the American Journal of Lifestyle Medicine, authors Michael Harris, Rhea Oelbaum and David Florrio identified the keys to changing and maintaining lifestyle changes. The keys they listed were:
* Past health behavior
* Demographics
* Personality traits
* Social Support
* Family functioning
* On-going contact with healthcare providers
* An individual's social ecology or network
So, if we know what the keys to success are, how might we incorporate them into our worksite wellness efforts?

Past Health Behavior

Discontinuing unhealthy behaviors or the starting of healthy behaviors are greater challenges for people than just changing or modifying an already existing unhealthy behavior. So in addition to helping employees stop unhealthy behaviors or start healthy ones, worksite programs should also offer employees the opportunity to take small, healthy steps over time that both ensure success and lead towards achieving a larger health goal.

Demographics

According to the authors, "some of the most powerful predictors of health behavior are individual factors." These include gender, education and marital status. Therefore, worksite wellness programming should include:
* Individual health risk assessments
* Individual wellness/lifestyle assessments
* Gender specific programming
* Couples specific programming
* Family targeted programming
* Offering health/wellness and life coaching

Personality Traits

Research has shown that healthy behaviors are related to the personality traits of conscientiousness, delayed gratification and goal direction. Worksite wellness programming should therefore include programming on helping employees learn goal setting, delaying gratification, developing persistence, flexibility and adaptability.

Social Supports

According to the authors, "lifestyle change interventions are more effective when others close to the individual are included in the intervention." Knowing this, worksite wellness programming should target or involve not only the individual employee, but also complete work units, couples and families. In addition, the worksite should seek to promote activities that incorporate social support such as a buddy system, walking clubs or groups, designated walking schedules and routes, disease specific support groups, and group focused activities such as competitions and contests.

(To be continued)

Family Functioning

Family behavior or functioning can shape an individual's health behaviors. Employer based health insurance often includes dependent coverage, in addition to employee coverage. As a result, family focused interventions may benefit attempts to reduce an organization's health insurance costs. While many organizations may take the position that family focused interventions are beyond their purview, I believe at the very least, worksite wellness programs could:
* Incorporate wellness related activities or awareness into any family type days the organization might hold
* Link or partner with community based health and recreational services to promote family based activities
* Mail wellness and health benefit related information to the employee's home
* Provide employees with awareness and educational opportunities and materials that relate to family related issues

On-Going Contact

Research suggests that health related behavior changes are not permanent. "Most individuals return to their pre-intervention lifestyle within 2 to 4 years after receiving the intervention." This suggests there is a need for on-going support for the employee who has made lifestyle or behavior changes. Worksite based health management is one way for this to occur. Worksites could:
* Provide on-going disease specific support groups
* Incorporate promotion and support for on-going contact into the performance appraisal process
* Link benefits to on-going support
* Provide incentives for maintaining on-going support

Social Ecology or Networking

The social ecology model suggests that the systems within which people operate can influence an individual's personal health behaviors. The more these individual systems are aligned, the greater the influence on the person. The implications for worksite wellness include:

External to the Organization
* Linking the organization's program with community based resources and activities
* Finding ways to link the worksite program with area healthcare providers
* Linking the worksite program with the insurance carrier's disease management program

Internally Within the Organization
* Linking the worksite wellness program with employee benefits
* Linking the employee benefits, wellness, safety, worker's compensation, disability management and work - life programs together to achieve optimal health, performance and success for both the individual and the organization.

(continued)

Conclusion

Chronic diseases are the four leading causes of death in the U.S. today. Given the link between chronic disease and lifestyle, understanding the factors that either promote or obstruct lifestyle change is key. Having this understanding is critical to the success of any worksite wellness endeavor. Success is important not only for the individual seeking a healthier lifestyle, but also for the worksite wellness program itself.

Reference: Michael A. Harris, Rhea Oelbaum, and David Flomo. State of the Art Reviews: Changing and Adhering to Lifestyle Changes: What Are the Keys? American Journal of Lifestyle Medicine, May 2007; vol. 1: pp. 214 - 219.

The Substance Abuse Mental Health Services Administration of the U.S. Department of Health and Human Services just released, on August 23, 2007, a report entitled "Worker Substance Use by Industry Category." This report reviews the data collected during the National Survey on Drug Use and Health for the combined years of 2002 - 2004.

Based on this combined data, an annual average of 8.8 percent of the full time employees surveyed acknowledged heavy alcohol use, while 8.2 percent of the full time employees surveyed acknowledged illicit drug use in the month preceding the survey.

Research conducted by Larson, Eyerman, Foster and Gfroerer, published June 2007, showed that the rate of substance use varies by occupation and industry. The 2002 - 2004 combined data showed that the highest rate of illicit drug use occurred in the accommodations and food service industry at 16.9 percent. Other industries reported to have double digit illicit drug use rates included:

* Construction - 13.7%
* Arts, Entertainment and Recreation - 11.9%
* Information - 11.3%
* Management of Corporations and Enterprises - 10.9%

The construction industry at 15.9 percent was listed as the industry with the highest reported rate of heavy drinking. The other industries reporting double digit heavy drinking rates included:

* Arts, Entertainment and Recreation - 13.6%
* Mining - 13.3%
* Accommodations and Food Services - 12.0%
* Wholesale Trade - 11.5%
* Management of Corporations and Enterprises - 10.4%
* Information - 10.4%
* Utilities - 10.1%

Sharon Larson, J. Eyerman, M. Foster and J. Gfroerer. Substance Use and Workplace Policies and Programs. OAS Analytic Series #A-29. June 2007. Office of Applied Statistics, Substance Abuse Mental Health Services Administration. http://www.oas.samhsa.gov/work2k7/toc.cfm

The NSDUH Report, August 23, 2007. Worker Substance Use by Industry Category.
http://www.oas.samhsa.gov/2k7/industry/worker.cfm

HR professionals are often the first point of contact when a supervisor or manager has concerns regarding an employee's use or misuse of drugs and/or alcohol. Given their important role, the Hazelden Foundation has surveyed HR professionals to gather their thoughts and beliefs. The survey revealed that HR professionals believe substance abuse and addiction are among the most serious problems facing the workplace today. According to the survey, employer policies and practices are not, however, adequately addressing the problem.

The survey of 1,000 senior HR professionals was designed to assess the HR professional's knowledge of substance abuse and addiction in the workplace and the role HR plays in helping employees and employers identify and address the issue.

According to the survey:
* 67% of the HR professionals believe substance abuse and addiction to be one of the most serious issues facing their company
* Absenteeism, reduced productivity and lack of trust stemming from substance abuse affect the efficiency and success of their companies
* Less than 22% of the HR professionals reported that their organization openly and proactively deals with substance abuse and addiction issues
* The HR professionals identified the following barriers to their helping employees:
> 54% of the HR professionals reported getting employees to acknowledge or talk about their substance abuse as the toughest challenge
> 49% of the HR professionals reported facing one or more of the following personal hurdles to helping employees:
> 20% reported a lack of expertise identifying substance abuse and addiction
> 16% reported a lack of information regarding treatment resources
> 13% reported a personal discomfort in approaching employees about the issue
> 13% reported not having enough time to address the issues
*85% of the HR professionals reported believing that offering educational programs to build a better understanding of addressing addiction in the workplace would be an effective component of a solution
* 32% of the HR professionals reported they would personally benefit from information on how to identify substance abuse and addiction in the workplace
* 25% of the HR professionals reported they would benefit from information on how to discuss the issue with their employees
* 19% of the HR professionals reported they would benefit from information on how to choose the most effective treatment options for their employees
* The HR professionals reported that the most significant problems their organizations experienced were:
> 62% reported absenteeism
> 49% reported decreased productivity
> 39% reported a lack of trustworthiness
> 32% reported a negative impact on their organization's external reputation
> 31% reported missed deadlines
> 29% reported increased healthcare costs
> 29% reported unpredictable, defensive interpersonal relations

The HR professionals (92%) agreed that effective treatment increases productivity. Two-thirds (67%) of the HR professionals believe that access to treatment reduces overall healthcare costs for employers. The HR professionals (85%) reported they believe drug testing is an effective way to diagnose workplace substance abuse and addiction. This contrasts, however, with research form NIDAA (National Institute on Drug Abuse and Addiction) which shows that 69% of drug abusers or addicts in 2005 also used alcohol, which goes undetected through drug testing alone.

The U.S. Substance Abuse and Mental Health Services Administration (SAMHSA) conducts an annual national survey on drug use. The SAMHSA Office of Applied Statistics periodically publishes an analysis from the national survey data in the form of a report called The NSDUH Report (The National Survey on Drug Use and Health Report).

The November 15, 2007 edition of the NSDUH Report focused on the 18 - 25 year olds. I thought the results were kind of interesting:
* Combined data for the years 2005 and 2006 found that 9.4 percent of the 18 - 25 year olds surveyed experienced at least one major depressive episode (MDE) during the 12 months prior to being surveyed. An MDE is defined as a period of two weeks or longer during which the individual experiences either a depressed mood or lost interest or pleasure and at least four other symptoms such as problems with sleep, eating, energy, concentration or self image.
* Among the 18 - 25 year olds who had not previously used alcohol, those who experienced MDE in the preceding 12 months were more likely to have initiated alcohol use in the past year (33.7%) than those who had not experienced MDE (24.8%).
* Among the 18 - 25 year olds who had not previously used any illicit drug, those who experienced MDE in the preceding 12 months were twice as likely to have initiated illicit drug use in the past year (12%) than those who had not experienced MDE (5.8%). Illicit drug use is defined as the use of illegal drugs and the non-medical use of prescription drugs. The most frequent illicit drugs used were:
> Marijuana - 9.1%
> Non-medical use of pain relievers - 7.1%
> Non-medical use of tranquilizers - 4.0%
> Cocaine (including crack) - 3.5%
> Hallucinogens - 3.1%
* Among the 18 - 25 year olds who had not previously used cigarettes, those who experienced MDE within the previous 12 months were more likely to have initiated cigarette use (12.7%) than those who had not experienced MDE (7.8%).

The research has shown a strong association between mental disorders and substance use disorders. (1) There is also evidence that this linkage may be bi-directional: depression may be associated with an escalation of substance use and chronic substance abuse may be a factor in the development of depression. (2)

The 18 - 25 year old group of employees is generally considered to be healthy and is therefore not often the focus of worksite wellness programming. The information contained in this report offers opportunities for the creation of worksite wellness programming that could be targeted at the 18 - 25 year old employee population. These programs could also serve as a mechanism to engage the 18 - 25 year olds in a more global worksite health promotion initiative.

(1) E. Jane-Llopis and I. Matytains. "Mental Health and Alcohol, Drugs and Tobacco: A Review of the Co-morbidity Between Mental Disorders and the Use of Alcohol, Tobacco and Illicit Drugs." Drugs and Alcohol Review, 2006, 25, pp. 515-536.
(2) R. Sinha and B.J. Rounsaville. "Sex Differences in Depressed Substance Abusers." Journal of Clinical Psychiatry, 2002, 63, pp. 616-627.

As a baby boomer, one of the resources I utilized transitioning from grad school student to the workforce was Richard Bolles' classic, "What Color Is Your Parachute? I have also referred to the book on several occasions during transition points in my professional career. As I approach retirement, it seems only logical that I read the new book, "What Color Is Your Parachute - For Retirement?" also by Bolles and John E. Nelson.

John Nelson left his career as a pension consultant to pursue a Ph.D. in adult education at the University of Wisconsin - Madison. During his studies, Nelson developed the Retirement Well-being Model upon which the book is based. Since baby boomers are so familiar with Bolles' book, using it as a career guide, Bolles and Nelson wrote the new book to help prepare and guide boomers into the retirement phase of their life. While there are many definitions out there for well-being, Nelson defines well-being as having three components: health, prosperity and happiness.

In an article about the book in the October 2007 edition of Employee Benefit News, author Jill Elswick reports Nelson as saying he thinks his definition of well-being is useful because each of the three components is not interchangeable and "you have to create each one of those things in its own right." Personally, I found it very interesting that my work and focus encompasses two of the three components identified by Nelson - health and happiness.

While geared to baby boomers approaching retirement, the book's content is relevant to the work - life, employee health and wellness and the creative aging processes. In the article, Nelson made an interesting comment about why he included social relationships as part of the book. He stated: "People are so used to having social relationships at work. Most retirees are taken by surprise to realize that they are not part of that social network once they are retired."

The book includes exercises and resources for each of the three components of well-being. In addition, Nelson reports additional resources are available on his Web site at www.retirementwellbeing.org. Individuals, as well as work-life, employee wellness and financial planning professionals can benefit from reading this book.

We have probably all heard the expression "Whistle while you work." Walt Disney's Seven Dwarfs recommended whistling while you work to help get through the day's work (chores). Now, James Levine, M.D. at Minnesota's Mayo Clinic recommends replacing employee cubicles with workstations attached to treadmills. Developed by Dr. Levine in 2005, the treadmill workstation is a fully functioning office.

Reporting in the October 2007 edition of Employee Benefit News, Kelly Butler quotes Dr. Levine as saying: "This is a fully functioning office. My entire staff works here. The idea is to introduce an environment that will encourage activity in the workplace. Just as it is hard to be a couch potato without a couch, it's hard to sit all day at work without a chair, conventional desk or cubicle." Phone calls are made via mobile phones attached to employees' belts.

Dr. Levine's invention is the culmination of ten years of research. He concluded that people can increase their caloric burn rate by increasing their daily movement. Duh. In the worksite wellness area we call this increasing your daily physical activity level.

What about meetings you say? No problem. According to Butler, Dr. Levine and his colleagues hold meetings on a walking track that is surrounded by magnetic white boards for scribbling notes or ideas. All typing, phone calls and brainstorming take place on their treadmill workstations.

Costs:
Dr. Levine's research - millions
Treadmill workstations - $2,700
Walking shoes - $100
Mobile phone $40/month
Belt - $6
Workers Comp Claims - Pending
Tired employees - Priceless

The new mantra for worksite: Walk, don't whistle while you work. Whistling may disturb your treadmill neighbor.

The paradigms in both the health and mental health arenas appear to be changing, if even ever so slowly. Within the health community, recognition is developing that the absence of disease does not equal well-being. Within the mental health (AKA behavioral health) community, a recognition is also developing that the absence of a diagnosable mental illness does not equal being mentally healthy or flourishing.

According to Cory Keyes at Emory University, "the absence of mental illness is not the presence of mental health; flourishing individuals function markedly better than all others, but barely one-fifth of the adult U.S. population is flourishing." Just as curing or eliminating all diseases does not create optimal health or well-being, curing or eliminating mental illness does not create a mentally healthy population or flourishing. It would therefore seem logical that to create a flourishing society with optimal health requires strategies in addition to those strategies already targeted at curing or eliminating disease and mental illness.

To date, our approach to health has involved three strategies:
1. The pathogenic approach
2. The salutogenic approach
3. The complete state model or holistic approach

The pathogenic approach views health as being the absence of disease, disability and pre-mature death. The salutogenic approach views health as the presence of positive states of thinking, feeling and behavior, while the complete state model or holistic approach views health as the combination of the pathogenic and salutogenic states where the state includes positive thinking, feeling and behavior as well as the absence of disease.

As we have become more knowledgeable about disease and disease states, the cause of death has shifted from acute and infection related causes of death to chronic and lifestyle causes. Unfortunately, the gain achieved in life expectancy has resulted in living more years with chronic diseases and mental illnesses, not in better health.

Up until lately, the medical and public health practices contributing to increased life expectancy have been beneficial and cost-effective. Keyes now believes, however, that "the continued attempt to improve population health solely by disease and illness prevention and panaceas has proven extremely costly and largely ineffective."

According to Keyes, "Until the mid-1990's, mental illnesses were overlooked as sources of economic burden to developing and developed nations." Keyes reports that "before the age of 55, half of all adults will have experienced at least one serious mental illness; approximately one-quarter of adults experience a serious mental illness each year."

As a result of his research, Keyes believes the mental health of a person can be placed into one of three categories:
1. Languishing
2. Moderately mentally healthy
3. Flourishing

Through his research, Keyes has identified three factors with 13 dimensions that reflect flourishing mental health. They are:
1. Positive Emotion - Emotional Well-being
* Positive affect
* Avowed quality of life
2. Positive Psychological Functioning - Psychological Well-being
* Self acceptance
* Personal growth
* Purpose in life
* Environmental mastery
* Autonomy
* Positive relations with others
3. Positive Social Functioning - Social Well-being
* Social acceptance
* Social actualization
* Social contribution
* Social Coherence
* Social integration

As a society, why should we strive to achieve flourishing mental health? Using data from the 1995 MacArthur Foundation's Midlife in the Unites States telephone and mail survey, Keyes concluded that "anything less than complete mental health results in increased impairment and disability. Adults, who were diagnosed as completely mentally healthy, functioned superior to all other adults."

According to Keyes, "a flourishing adult experienced:
* The fewest work days missed
* The fewest half day or less cutbacks of work
* The lowest level of health limitations of activities of daily living
* The fewest chronic physical diseases and conditions
* The lowest health care utilization
* The highest levels of psychosocial functioning"

It is increasingly being recognized that mental illness, particularly depression, is often a co-morbid condition of a number of physical illnesses. Keyes' research found that "chronic physical conditions increased as the level of mental health decreased." Keyes felt it was noteworthy that "mental health status was a significant predictor of chronic physical conditions, even after adjustment for the usual sociodemographic variables, as well as body mass index, diabetes status, smoking status, and level of physical exercise. Adults who were completely mentally healthy (flourishing) had the lowest number of chronic physical conditions at any age."

Since medical and public health sciences have added to life's longevity, Keyes' work would suggest that we must now also target an improvement in the quality of life. As more and more work - life and employee health and wellness programs begin to target risk factors and outcomes, now seems like the perfect opportunity to also incorporate a focus on the 13 dimensions of flourishing. This approach would coincide nicely with society's increased interest in and acceptance of a holistic approach to health.

Source: Corey L.M. Keyes. "Promoting and Protecting Mental Health as Flourishing: A Complementary Strategy for Improving National Mental Health." American Psychologist, February-March 2007, pp. 95-108.

I am taking a class on wellness and the baby boomers. The class will focus on both the mind and the body. The first session on the body was led by Mark Hyman, M.D. Dr. Hyman is a functional medicine physician. Functional medicine is an approach to medicine that looks at the body as a total system, not just individual systems commonly found in todays dissective or specialty based medicine. Functional medicine is based on systems biology - the basic laws of nature and the unified theory of biology.

Functional medicine views illness as arising out of a dysfunction of the bodily systems rather than from a disease. New scientific discoveries are changing the way medicine is thinking about diseases and health. With this paradigm shift, a new road to health is emerging: UltraWellness.

UltraWellness is about understanding and treating causes, dysfunctions and imbalances rather than treating the symptoms of a disease. UltraWellness is based on answering two questions:
1. Does the individual need to get rid of something toxic, allergic or infectious?
2. Does the individual have some unmet need particular to them?

What do you need to get rid of?
* Toxins
* Allergens
* Microbes
* Poor diet/lifestyle
* Stress

What do you need to get?
* Foods
* Vitamins, minerals or nutrients
* Light, water or air
* Sleep
* Rhythm
* Relaxation
* Love, community meaning or connection

Functional medicine believes that the root of illness is when our core bodily systems are out of balance. When the core systems are in balance, they are the keys to UltraWellness. The seven keys to UltraWellness are:
1. Environmental Inputs - diet, lifestyle, toxins, stress and trauma
2. Inflammation and Immune Balance
3. Hormone and Neurotransmitter Balance
4. Gut and Digestive Health
5. Detoxification Imbalances and Function
6. Creating Energy
7. Mind-Body/Body-Mind Connection
> Change your mind - change your body
> Change your body - change your mind

Dr. Hyman believes that the relationship between the functioning of the body and the mind (the body-mind effect) is the new frontier. From Dr. Hyman's perspective, an individual's wellness needs to be created outside of the healthcare system and the individual is solely responsible for doing it.

Dr. Hyman indicated he has a lot of free resources on his Websites. They are:
http://www.drhyman.com
http://www.ultrawellness.com

The national and international attention being focused on the issue of obesity is having an impact at the worksite. The issue of obesity, referred to at the worksite as weight management, appears to becoming the new frontier for worksite wellness programs. A recent employee poll conducted by LifeCare, a vendor of work-life programs, found that 49% of the employees responding indicated that weight management was their main concern. The electronic survey was available to employees of companies who subscribe to LifeCare's services. No details about the poll were made available.

Scott MacStravic, a regular contributor to the World Health Care Blog, posted on October 8, 2007 "A Healthy Place to Start Employee health Management." In this post, he stated it was his belief that employers should begin a worksite wellness program with a weight management program as its initial offering. I disagree.

The issue of weight management is complicated and a successful program that not only helps employees to loose weight, but to sustain that weight loss over time requires multiple components, all operating simultaneously. I believe this type of program undertaking is too much for the new worksite wellness coordinator and new worksite wellness program. I believe it is important for both the new coordinator and program to demonstrate early success.

I believe a better initial program would be some type of walking related program. A walking program is easy to implement, administer and quick to demonstrate success. The good news is that a successful walking program will also contribute to the weight management issue.

Another issue associated with worksite based weight management programs is the lack of a successful program model that sustains weight loss over time. I have begun a deep dive into the obesity - weight management research literature to identify the components of successful programs in other venues. With the components identified, we can then engage in a conversation as to how to best incorporate these elements into a worksite setting.

While my research dive unfolds, we have begun a discussion within my own organization about offering a weight management program to members of our health insurance plan. The program components currently on the table for discussion include:
* Weight loss
* Use of incentives
* Incorporation of physical activity
* Incorporation of nutrition education
* Provision of social support

I welcome your comments.

Worksite wellness is certainly in the spotlight. With the release of the final HIPAA wellness regulations in July 2007, organizations have begun to take a closer look at the type of wellness program they are offering to employees. In some cases, the organizations are adopting stricter wellness related policies as a way of trying to control their healthcare costs or health insurance premium costs. These stricter policies have generated quite a bit of media attention and controversy as a result.

The controversy and attention no doubt impacted the October 2007 Wall Street Journal/Harris Interactive Healthcare Poll that asked if people with unhealthy lifestyles should pay more for healthcare. The online poll was conducted in the U.S. between October 8 - 10, 2007 among a national cross section of 2, 267 adults aged 18 and over. The survey was conducted among adults who have agreed to participate in Harris Interactive Surveys. The results were weighted as needed for age, gender, race/ethnicity, education, income and region.

This latest survey revealed a significant drop in support for charging higher health insurance premiums, deductibles and co-pays to those individuals with unhealthy lifestyles. Compared to 53% in 2006, only 37% of those surveyed in October think it is fair for individuals with unhealthy lifestyles to pay higher insurance premiums. Just 35% said it was fair to ask individuals with unhealthy lifestyles to pay higher deductibles and co-pays for the medical care they receive. This compares to 53% who felt it was fair in July of 2006.

When asked if it was fair or unfair for people with unhealthy lifestyles to pay more for healthcare, 51% of the responding males said it was fair, compared to 32% of the females responding. Of the respondents who said they regularly exercise, 48% said it was fair for the individual with an unhealthy lifestyle to pay more. Of the total sample, 14% considered themselves to be overweight or obese, while 18% said they regularly smoke cigarettes and 56% reporting exercising on a regular basis.

It is interesting to note that 82% of all respondents agreed that people who live unhealthy lifestyles are likely to incur more medical costs than others. When asked why they consider it fair for those with unhealthy lifestyles to pay more, 80% responded that it was the individual's choice to live an unhealthy lifestyle, so others should not have to pay for it. Seventy-five percent (75%) of those responding felt that charging individuals with an unhealthy lifestyle more would encourage more people to live healthier lifestyles, which would be better for society overall.

When it came to smoking cessation, 29% of all respondents felt it was ok for employers to require smoking employees to participate in smoking cessation programs, but the employer should not be able to fire an employee who fails to quit smoking. This contrasts with 65% of the respondents who felt than an employer should not have the right to either require smoking employees to participate in a smoking cessation program or to fire an employee who is unwilling to quit. Only 7% of the respondents supported an employer firing an employee who was unwilling to quit smoking.

When it comes to weight loss, 30% of those responding said it was ok for an employer to require an overweight employee to participate in a weight loss program, but the employer should not be able to fire the employee who tries, but fails to loose weight. Sixty-seven percent (67%) of the respondents said that an employer should not have the right to either require an employee to participate in a weight loss program or to fire an employee who is unwilling to loose weight. Only 4% said an employer should have the right to fire an employee who is obese or seriously overweight.

As might be expected, there does not appear to be much support for mandatory program participation and certainly not for the firing of an employee. It would be interesting to see what the responses would have been to a question asking about the fairness of giving health insurance premium and/or deductible and co-pay discounts to individuals for wellness program participation or for living a healthy lifestyle.

As long as employers continue to foot the bill for healthcare costs or health insurance premiums and healthcare costs continue to dramatically increase, employers will continue to look at all avenues to try and control their costs. With HIPAA wellness rules giving employers the opportunity to adjust premiums by up to 20%, the issue of play or pay will no doubt remain in the spotlight, until the courts decide some of the wellness related cases now pending before them.

Securing management support and involvement in worksite wellness programs has long been considered a necessary element for having a successful program. The worksite wellness and work-life literature is now suggesting that employee health and productivity management needs to be considered a core business strategy. A recent survey, 2007/2008 Staying @ Work, conducted by the Watson Wyatt consulting group and the National Business Group on Health found that 29% of the responding 355 large companies are currently linking employee health and productivity programs to their broader initiatives or plan to do so in 2008. Another 26% said they plan to do so in 2009.

The same survey also examined the use of incentives to encourage employee participation in wellness programs. The survey found nearly one-half (46%) of the employers currently offer incentives or will begin to offer them in 2008. The number is expected to exceed 70% by 2009.

One interesting section of the survey related to company performance. The survey found that companies with effective employee health and productivity management programs have superior performance. These companies had:
* 20% more revenue per employee
* 16.1% have higher market value
* 57% delivered higher shareholder value in 2004 - 2006
* 5 times lower cost increases for sick leave
* 4.5 times lower long term disability costs
* 4 times lower short term disability costs
* 3.5 times lower costs for general health coverage

The results from the 2007 Benefits Decisions Impact Study co-sponsored by Employee Benefit News and Forrester Research have been released. This year, over 900 benefits professionals were surveyed regarding the current and future benefits landscape. The survey found a focus on wellness, disease management and preventative care initiatives.

The top five benefits identified as either currently being offered or being planned within two years were:
* Prescription benefits - 99%
* Preventative care - 92%
* Health and wellness benefits/programs - 80%
* Flexible spending accounts - 79%
* Structured disease management programs - 68%

The top four cost containment strategies currently being used or being planned included:
* Promotion of preventative health benefits and behaviors - 90%
* Use of a prescription formulary or benefit design to encourage use of favorably priced medications - 88%
* Increased use of generic medications - 81%
* Increased employee cost sharing - 79%

The survey results suggested that by 2010, it is likely that consumer driven health plans will hold about 24% of the market. Employers are currently trying out a number of different types of CDHPs, with the current leading product being a CDHP linked with a Health Savings Account at 28%of the CDHP use. It is expected that another 17% will try out this model within the next two years.

The survey revealed that the three most common diseases targeted by disease management programs are diabetes (78%), asthma (60%) and cardiovascular disease (50%). The survey revealed 80% of the responding employers currently offer or are planning to offer health and wellness benefits and programs, up from 75% in 2006. The survey also revealed that 93% of the large employers in the survey offer health and wellness programs compared to 67% of the small employers.

The survey statistics I found most revealing were that only 50% of the employers reported being satisfied with their health plan's disease management offerings, while only 53% reported being satisfied with their health plan's wellness and prevention programs. I thought this was pretty interesting and wished the article discussing the survey had contained more about this issue.

Source: Julie Hanson. "2007 EBN/Forrester Benefits Study Reveals Focus on Consumerism, Wellness. Employee Benefit News, November 2007, pp. 1+.

Not every organization has the physical space or can afford to build a fitness center for its employees. If you occupy a building with stairways, take advantage of them. Incorporate the stairways into your wellness program by creating stairway programs. Since stairways are part of your building's evacuation system, before making any changes to the stairways, be sure to get the approval of your local fire department or code enforcement. Information about stairway programs can be found at both the U.S. Centers for Disease Control and Health Canada Web sites. Go to:

StairWell to Better Health - U.S. CDC
http://www.cdc.gov/nccdphp/dnpa/stairwell/index.htm

Stairway to Health - Health Canada
http://www.phac-aspc.gc.ca/sth-eus/english/index.htm

The journal Preventive Medicine recently reported on a study conducted in the Netherlands using posters to promote stair use in both a factory and office building. The question was whether posters alone would prompt stair use. The researchers found both white and blue collar employees increased their stair use while the posters were in place. Stair use decreased after the posters were removed.

Source: Kwack, Kremers, et el. "A Poster Based Intervention to Promote Stair Use in Blue and White Collar Worksites." Preventive Medicine, 2007, 45, pp. 177-181.

Communicating benefit information to employees is an on-going challenge. Every issue of Employee Benefit News seems to carry an article about how and when to communicate benefit information to employees. According to a recent survey by Prudential Financial, as reported in the November 2007 edition of Employee Benefit News, "only 35% of responding employees and 21% of responding employers rate benefits communications as "highly effective."

A different July 2007 survey by the consulting group Watson Wyatt found 43% of the 2,100 workers they surveyed did not understand what their health plan covered. Less than half (49%) reported they felt comfortable explaining common health benefit terms. Less than 25% said they felt comfortable describing such terms as health saving accounts, co-insurance, formulary and center for excellence.

According to the Watson Wyatt survey, 7 in 10 employees said they preferred receiving information in print form. Receiving information via the Internet was preferred by 64%, while 46% favored an in-person meeting. Only 52% of the respondents said they read all the health insurance information they received, while 3 % reported not reading any of the materials. Delivering benefit information in a format desired by the employee is a key point. The Prudential Financial survey found that "about 70% of surveyed employees showed a high interest in tailored benefits information."

Source: Leah Carlson Shepherd. "Communications, Wellness Prove Challenging for HR." Employee Benefit News, November 2007, p1+.

The State of Wellness in 2008

As 2008 winds to a close, I thought now was the perfect time to look at the state of worksite wellness. The state of worksite wellness was captured by two surveys in 2008:
* Aon Consulting's 2008 Benefit and Talent Survey
* Hewitt Associate's two 2008 Road Ahead Surveys

Aon surveyed 11,000 employers, broken down as follows:
* 36% represented organizations with less than 500 employees
* 41% represented employers with 500 - 5,000 employees
* 22% represented employers with more than 5,000 employees

The survey found:
* The number of employers implementing specific wellness programs has increased three fold from 2007.
* Specific wellness programs being implemented include:
> Exercise/physical activity - 68% (up from 19% in 2007)
> Disease management programs - 60% (up from 18% in 2007)
> Health Risk Assessment - 48% (up from 14% in 2007)
> Biometric screening - 47% (up from 12% in 2007)
> Telephonic health coaching - 46% (up from 14% in 2007)
< Smoking cessation - 46% (up from 14% in 2007)
* Incentives used:
> 23% of the respondents used incentives to drive participation in an HRA
> 20% of the respondents used incentives to complete a health risk reduction program such as weight management, tobacco cessation, etc.
* Types of incentives used were:
> 22% used non-cash awards such as gift cards or merchandise
> 10% used a reduction in premium contribution
* The majority of the responding employers do not have a process in place to measure their program's impact or to track their return on investment

* According to the survey, 64% of the employers responding reported having a benefits strategy that promotes the importance of health and productivity to their employees.

The two Hewitt surveys included both an employer and employee survey. A total of 508 executives responded to the employer survey, while nearly 30,000 employees responded to the employee survey. The size of the organizations responding to the employer survey broke down as follows:
* 44% represented organizations with less than 5,000 employees
* 22% represented organizations with between 5,000 - 9,999 employees
* 34% represented organizations with 10,000 or more employees

Hewitt combined the two surveys results to create the 2008 Hewitt Annual Health Care Survey. The combined survey results were organized around three themes:
* Employer Strategies and Employee Reactions
* Improving the Health and Productivity of Employees
* The Washington Influence

Employer Strategies and Employee Reactions
* 88% of the employers stated that they have started focusing on long-term solutions aimed at improving the health and productivity of their workforce
* Employers reported keeping employees healthy as being critical to their business success and improving health should be the primary focus of their health care strategies
* 74% of the employees agreed that there employer has a role in helping them to understand how to use their health plan, while just 12% agree or strongly agree that their employer has a role in helping them to understand how to remain healthy
* Employers reported that keeping employees healthy was one of their top three business issues and one of their top three workforce issues
* 88% of the employees stated they engaged in healthy behaviors, but only 47% said they ate right, while just 40% said they exercised three or more times per week.
* Six out of ten employees said they get preventive screenings, while just four of ten said they did a good job of tracking their essential health numbers and asking for advice on how to stay healthy
* 67% of the employers stated that their health and productivity strategies focused on improving the overall health of their employees to enable them to be both at work and productive while they are there
* 95% of the employees reported believing that taking care of their health today would have a direct impact of what they pay in the future for out-o-pocket health care expenses
* 96% of the employees reported believing that catching health problems early or preventing them before they can happen will save them money
* Approximately 25% of the employees reported foregoing necessary health care due to cost. This included not seeing a health care practitioner when sick and not filling or completing a prescription

Improving the Health and Productivity of Employees
* 99% of the responding employees agreed or strongly agreed that it is important to know their personal risk factors in order to prevent or treat chronic disease
* 93% of the employers reported knowing which conditions are most pressing for their employees and they said they plan to target those conditions over the next 3 - 5 years
* Employers identified their top three health conditions as:
> Diabetes - 49%
> Overweight/Obesity - 45%
> Heart disease - 38%
> Currently, 50% of the employers reported they do not target specific employee conditions
* 50% of the responding employers reported targeting one or more specific condition through enhanced medical and/or prescription drug benefits
( Employers specifically ranked weight management (77%), physical fitness (62%) and smoking cessation (49%) as the top three health improvement programs needed for their employees over the next three - five years
* Employees supported linking healthy behavior decisions and practices to incentives
* When it comes to health risk assessments:
> 64% of the employees disagreed with the practice of requiring employees to complete an HRA
> 54% of the employees disagreed with the strategy of offering lower health insurance premiums to employees who complete an HRA
> 85% of the responding employees indicated a willingness to complete an HRA in order to learn more about their health risks
* Of the responding employees who had an opportunity to take an HRA, 80% reported doing so
* Based on the results from their HRA, 60% of the employees reported taking action
> Of the 40% yet to take action:
* 55% stated they were already doing the recommendations
* 35% said they plan to take action
* 10% said they did not plan to take action

The Washington Influence
* 78% of the employers indicated the 2008 presidential election would have no impact on their current health care strategy. The employers said they would continue implementing their 2008 and 2009 health care strategies regardless of what is going on in Washington
* When asked which possible federal government reforms the employers supported, the top reforms chosen were:
> 81% - using healthcare data and measurement to drive their organization's health care strategy
> 75% - providing incentives in private and government sponsored coverage that promotes preventive care, wellness and better health outcomes
> 67% - tax deductibility for all medical expenses and insurance premiums
> 67% - modifying current reimbursement systems to allow doctors to spend more time with patients and to better coordinate care
> 62% - reforming insurance market to increase the availability and affordability of the individual insurance market
> 52% - creating a National Health Insurance Exchange allowing consumers to shop among private plans

My Closing Thoughts
In 2008, I think we have seen several interesting developments. Worksite wellness has remained on the top of the pile of issues facing employers and the field continues to experience significant continued growth.

While the continued interest of employers is a good thing, employers are shifting program focus from a more generic one size fits all format, to a more customized and targeted format. Coming along with this, growing attention and emphasis is being paid to program measurement and evaluation.

As a large payer of the health care bill, employers are seeking greater control and influence over wellness program goals, expectations and employee participation. Employees for their part, while recognizing and acknowledging the importance and value of wellness, are pushing back on employers' attempts to play a greater role in employee health care decision making and finances.

In 2008, we also saw the release of two draft national standards directed at wellness programs. Looking ahead, it will be interesting to see what impact the final versions of these standards have on the field now that they have been adopted and released by their respective organizations.

I was honored recently to be asked by the Workplace Health Promotion Program of the University of Toronto's Health Communication Unit (www.thcu.ca/workplace/workplace) to present a U.S. perspective on worksite health promotion as part of their February 4, 2008 Webinar on the International Perspectives of Worksite Health Promotion. (Feel free to contact me for a copy of my PowerPoint slides.)

Being included in the presentation has made me more aware of the international perspective to worksite health promotion. A recent report, "Health of the Workplace," from the Norwich Union Healthcare of the U.K., revealed several interesting results:
* 64% of the businesses surveyed believe employee wellbeing has a direct impact on employee productivity levels
* 33% of the employers reported not investing more due to a lack of government incentives
* 24% of the employers reported they don't know where to access occupational health information. This percentage rose to 43% for the small business respondents.
* 55% of the respondents said that subsidized occupational healthcare would encourage small and medium sized companies
>Tax incentives for small businesses was reported by 57% of the respondents
> For medium size companies, better partnerships with the National Health Services was listed by 48% of the respondents
> Large companies listed better National Health Services relationships and legislation (51%), followed by tax incentives at 49%
* What did employers see as pressing health concerns?
> Sickness - 41%
> Aging workforce - 20%
> Perceived lack of government support for small and medium sized businesses - 23%
*79% of the responding businesses reported they felt thay had a "duty of care" towards their employees
* Most businesses (82%) and employees (69%) agree that the responsibility for workplace health is mutual between employer and employee
* Employees (59%) agree with businesses that employers should be more proactive in providing workplace health solutions

October 20, 2008
The R word (recession) is being spoken more and more these days. So how are wellness programs fairing in this down turning economy? When money gets tight, organizations often trim expenses by eliminating programs they don't consider vital, or core to their organization, including wellness programs. According to a recent Society of Human Resources Management survey published in the October 2008 edition of Employee Benefit News, "41% of employers offered health screening programs in 2008, down from 47% last year, while 21% provided an onsite fitness center, a decrease from 25% in 2007. In addition, the SHRM 2008 survey of benefit trends shows that 31% of companies offered a weight-loss program, compared to 32% in 2007. The good news is that 67% of employers offered vaccinations onsite, up from 62% from last year, and 36% provided fitness center membership reimbursement, up from 30% in 2007," according to the SHRM survey results.(1)

(1) Lydell Bridgeford, "Belt Tightening," Employee Benefit News, Vol. 22 (13), October 2008, pp 48-50.

July 21, 2008
A Report from the 2008 National Wellness Conference
Another National Wellness Conference is in the books. This year's 33rd annual conference concluded on July 17. There is no doubt that the National Wellness Conference is the premier conference for the health and wellness practitioner. Worksite wellness is always a significant focus of the conference, and this year was no exception.

IntelliPrev System
This year, the conference for me began with a two day pre-conference Level 1 Coach certification training class on the use of the IntelliPrev Web based system. The IntelliPrev system was developed by Joel Bennett, Ph.D. and is a Web based organizational assessment and e-learning platform. IntelliPrev enables wellness professionals to monitor and assess workplace substance abuse and mental health prevention needs, design and deliver evidence based solutions and to then evaluate implementation results. I will receive certification in the use of the system following my completion of several post training related activities. Once I am certified, this system will be available to me for use with clients.

General Conference
The initial keynote speaker, Marion Nestle, Ph.D., spoke about personal vs. societal responsibility for today's obesity epidemic. She raised a couple of interesting points:
* The abundance of food in the U.S. has led the food industry to offer bigger and bigger portion sizes
* Eating less is bad for business

The breakout sessions I attended included sessions on personal development, worksite wellness and positive psychology.

Worksite Wellness
Some nuggets from the worksite wellness sessions include:
* Of the some 80% of the people who attempt a health related behavior change, only some 20% report being successful
* ROI or Return On Investment was the subject of several sessions
> Presenters and attendees alike acknowledged a continued strong demand on the part of CEOs and CFOs to see their program's ROI
> While most senior managers are looking for a positive ROI, an ROI of 1:1 is still respectable. This means that the wellness program is not costing the organization any money.
> One presenter reviewed the published ROI literature and found that:
* A low intensity program (just an HRA) showed a 3.75:1 ROI
* A medium intensity program showed an ROI of 6.00:1
* A high intensity program showed an ROI of 7.75:1
> From a WELCOA survey of 1700 reporting organizations:
* An organization of more than 5,000 employees spends on average $42.00 per employee per year for their wellness program
* An organization of between 1,000 and 5,000 employees spends on average $75.00 per employee per year for their wellness program
* An organization of between 500 and 1,000 employees spends on average $105.00 per employee per year for their wellness program
* An organization of between 50 and 500 employees spends on average $135.00 per employee per year for their wellness program
* An organization of less than 50 employees spends on average $250.00 per employee per year for their wellness program
* There seemed to be a greater emphasis placed this year on wellness leadership and the need to have an organizational culture supportive of health and wellness, as opposed to individual behavior change.

Positive Psychology at Work
I was pleased to see a number of sessions on positive psychology included in the conference's offerings. These sessions looked at the role of positive psychology from a health and wellness perspective at both the individual and organizational level.

Keep your eye on the field of positive psychology. The fact that Martin Seligman (the father of positive psychology) wrote an article entitled "Positive Health" in the July 2008 edition of Applied Psychology suggests there may some interesting links in the future between positive psychology and health and wellness.

Alliance for Wellness ROI
June 5, 2008

I have come across an organization known as the Alliance for Wellness ROI,Inc. Their Web site states they were founded in January 2005 as "an inter-company cooperative formed to standardize the terminology and measurement of the Return on Investment of Wellness Programs." It is a membership based, 501(c)(3) non-profit. While some of the materials are for members only, the public can access their survey results for 2005, 2006 and 2007. What I found interesting was their definition of a wellness program. They list a wellness program as having the following components:
* Work/Life Balance
* Employee Assistance Program
* Disease Management
* Health Risk Appraisal
* Telephonic Wellness Services
> Nurse Call Line
> Telephonic coaching
* Onsite Medical
> Onsite nurse and or physician
> Onsite safety plan
* Weight Management
> Financial incentives to lose weight
> Discounts for weight loss medications
> Discounts for weight loss interventions
> Benefits for weight loss surgery
> Nutritional counseling
> Healthy food choices in company cafeteria
* Smoking Cessation
> Rewards or financial incentives for smoking cessation and continued smoking abstinence
> Health plan benefits for smoking cessation
> Discounts for coverage for medications
> Self-help interventions
* Wellness Education/Communication
> Print, audio-visual and online communications
> Self-care guides
> Pre-natal interventions
> Health fairs
> Educational workshops
* Preventive Care
> A comprehensive physical
> Diagnostic tests
> Screenings
* Fitness
> Onsite exercise facilities
> Fitness club subsidizes and discounts
> Exercise plans
> Subsidies and sponsorships for community events

You can access the Alliance for Wellness ROI, Inc. at http://www.roiwellness.org

Catching Up
May 29, 2008

Things have been busy so I haven't posted new items as regularly as I would have liked.

On May 1, I presented at a conference in San Diego. The theme of the conference was linking health benefits to employee wellness programs. I was surprised by two things my fellow presenters said:
1. The number of organizations that have shifted to High Deductible Health Plans
2. The number of organizations that are mandating participation in health/wellness activities as a condition of enrolling in the health plan. Nearly every organization presenting mandated at least participation in a Health Risk Assessment.

I think the issue of mandates is going to be a big issue for wellness programs in the not to distant future.

Concerns About Health Coaching
May 29, 2008

As someone trained both as a clinician and coach, I have been concerned for awhile now about the proliferation of coaching (seems like everyone today calls themself a coach) and the claims of success made by coaching, especially health and wellness coaching, organizations.

A couple of recent statements about health/wellness coaching caught my eye. Both have added to my increasing concerns regarding the heavy promotion and explosive proliferation of health and wellness coaching.

In the article " Wellness Incentives Need Oversight" by Gloria Gonzales, published May 26, 2008 in Business Insurance (http://www.BusinessInsurance.com) Elona DeGooyer, Senior Consultant Health and Wellness for Humana, Inc. is quoted as saying: "Humana, Inc. gave incentives to employees to sign up for health coaches, but it found that some employees ignored their coach's advice."

In the article "Wellness Programs on the Rise" by Kristen Frasch, published May 14, 2008 in Human Resource Executive Online,(http://www.hreonline.com) Tom Lerche, Health Practice Leader for Aon Consulting is quoted as saying: "Employers and health insurers alike are now getting it, that healthcare is neither health nor care without wellness coaching."

My comments about the two quotes:
1. What a shock to find out that employees didn't follow a health coach's advice! Just because a coach says it doesn't mean that people are going to respond any better than when they get advice from their healthcare provider or someone else. True health and wellness coaching works because it is not about giving advice! A true coach is about guiding and facilitating, not giving advice!
2. When it comes to employer health related costs and employee health, coaching is only one tool or strategy to be considered. Coaching is not a silver bullet!

Go! Platinum
April 5, 2008

I found this article interesting. "Lincoln Industries Ties Performance Management and Wellness," by Christina Fuoco-Karasinski, which can be found in WorkSpan, Volume 51(4), April 2008, pp. 50-54.

Go! Platinum is the name of Lincoln Industries worksite wellness program. Lincoln Industries is a metal fabrication and plating manufacturing company located in Lincoln, Nebraska.

I found two points in the article to be very interesting:
1. Employee personal health and wellness is linked to the company's performance management system
2. The company's individual employee award program

According to the article, "Everyone in the organization participates in quarterly wellness checks that include a review of each employee's personalized wellness goals." Each employee's wellness goals are tied directly into the performance management process and "ultimately will influence the merit increase you receive."

When making the business case for worksite wellness, we often refer to the benefits received from decreased absenteeism and increased productivity. Despite this, I am only aware of two examples where individual employee wellness is linked directly to the organization's performance appraisal system:
* Lincoln Industries
* MSAD #11 (Maine School Administrative District) in Gardiner, Maine

The second point I found interesting was Lincoln Industries' individual employee award program. They use the following categories: nonmetal contention, bronze, silver, gold and platinum. Unfortunately, the article does not contain the specifics of the award criteria for each category, only the platinum award. This is the first time I have seen these award titles applied to the individual, rather than organizational level.

I have written to Lincoln Industries requesting more information about their program.

As far I can tell, the article is not available for free via the Internet. If you would like a copy of the article, contact your local library and ask them to get you a copy of the article via interlibrary loan. Most libraries provide this service for free.

What Is Happening in Texas? March 21, 2008

A March 15, 2008 article in the Houston Chronicle caught my attention. The article states that as of January 1, 2008, employers can access employee medical records. According to the article, the Texas legislature passed a law, which was signed by Governor Perry last summer, which makes Texas the first state in the country to require insurance companies to send employee and family member health records to their employer.

As of January 1, companies are entitled to receive a list of their employees and family members, identified by some number or other identifier except name, whose health bills exceed $15,000 during the previous year. The information will include diagnoses, dates of service, amounts paid, prognoses, future costs and treatment plans. The article states that employers can also receive "detailed health information on those who have been pre-certified for hospital stays of five or more days." Insurance companies who don't comply
are subject to a fine of up to $25,000.

According to the article, the Texas law is in compliance with HIPAA. The article states that in order to get access to the information, an employer must pledge not to use the health information for any purpose other than health plan administration. According to the article, health information related to HIV status, genetic test results and mental illness remain protected and not available to the employer.

Apparently, employers and their associated lobbyists were able to convince the Texas legislature and Governor that they needed this information to get a clearer picture of their health expenses and allow them to shop for better insurance rates. Employee advocates are concerned that because of the law, employees will be less inclined to seek care and the information will be used to target for discrimination and/or termination. Employee advocates say this can happen because employers can use regularly collected HR related data to match individual employees to the reported health information.

It will be interesting to follow this law's implementation to see:
1. If other states follow Texas' lead?
2. What impact this will have on employee and family member healthcare utilization.
3. What impact this will have on worksite wellness program participation.

February 20, 2008 - What Are Employees Concerned About?

A recent survey of employees by LifeCare, a vendor of work-life programs, focused on the issue of personal health concerns. The results were reported in the Fourth Quarter 2007 edition of LifeCare's newsletter. In response to the question, "When it comes to your personal health, what is your main area of concern?" responding employees reported:
* Weight management - 49%
* General health - 18%
* Other - 15%
* Heart health - 11%
* Diabetes - 4%
* Blood pressure - 3%
* Smoking cessation - 1%

The "Other" category included such responses as healthy aging, cancer, mental health and others, each of which represented less than one percent.

The electronic survey was available to employees of companies who subscribe to LifeCare's services. No additional details of the survey were provided.

For more information on weight management, see my post on this blog.

February 20, 2008 - The results of the 2007 CCH Unscheduled Absences Survey were reported recently in Continuity Central's Newsflash Service (http://www.continuitycentral.com) According to the survey, 87 percent of the employers responding to the survey reported having employees sick with acute illnesses such as a cold or the flu showing up at work. A total of 38% of the employers surveyed reported presenteeism as a being a problem for their organization.

According to the survey, 54% of the employers responding stated they addressed the issue of presenteeism by sending sick employees home. The other ways employers stated they addressed presenteeism included:
* 40% stated they educated employees about the importance of staying home when they are sick
* 34% reported fostering a culture that discouraged sick employees from coming to work
* 30% reported using telecommuting programs to deter presenteeism

The CCH survey found the most common reasons given that sick employees showed up at work included:
* 65% cited too much work or work deadlines
* 56% cited no one else was available to cover the workload
* 55% cited employees not wanting to use vacation time
* 49% cited employee wanted to save sick leave time for use later in the year
* 49% cited fear of discipline as the reason employees show up (According to the survey, 89% of the organizations responding cited using discipline as a way of controlling absences.)

The good news is that this year's CCH survey found nearly a 100% increase, over 2006, in the number of organizations reporting they have a plan in place to address the event of having a large percentage of employees becoming ill and not showing up for work (a pandemic flu type plan). The bad news is that just 27% of the organizations responding reported having such a plan in place.

Policies and programs that can help an employer address the issue of presenteeism might include:
1. A policy that addresses the issue of employee's coming to work sick and the circumstances under which a manager can direct the employee to return home
2. Educating employees and establishing guidelines to help employees determine when they should stay home or if they can safely come to work. A good source of educational materials about good health habits and the spreading of germs is the U.S. Centers for Disease Control and Prevention (www.cdc.gov)
3. Make sure your absence control policies don't unnecessarily make employees feel they need to report to work sick or fear the consequences of not coming to work
4. Create and support an environment and organizational culture that supports health and employees making healthy choices
5. Make sure your managers and supervisors lead by example. When they are sick, they need to stay at home too.
6. Offer annual seasonal flu shots to employees and adult dependents. Research has shown that flu shots benefit both the organization and the employee
7. Establish a worksite wellness program for employees. Worksite wellness programs have demonstrated having a positive impact on presenteeism.

January 7, 2008 - Stress Institute's 2007 Awards

With the recognition of the impact that stress has on our health, a plethora of stress management tools have hit the market. To separate the good, bad and ugly, the American Institute of Stress, (https://www.stress.org) has identified the following tools as recipients of their 2007 Award for Distinction and Innovation.

Personal Stress Reliever
www.emWave.com

Biofeedback device
www.StressEraser.com

Assorted tress management tools
www.StressStop.com

Peak Achievement Trainer
www.peakachievement.com

Relaxation supplement
www.relaxity.net

Medical device stress control system
www.alpha-stim.com

November 13, 2007 - IBM's Child Health Rebate

While many organizations are just now launching employee focused worksite wellness and health management programs, other organizations are continuing to push out worksite wellness program based boundaries. IBM is one of the companies continuing to push the boundaries. IBM has announced the roll out of a new wellness initiative targeting children of IBM employees.

The Children's Health Rebate is being offered to U.S. based IBM employees and rewards the employee based on their family's good nutrition and physical activity practices. The new Children's Health Rebate is one of four healthy living rebates offered to U.S. based IBM employees. The Children's Health Rebate is for $150.00 cash. An IBM Senior VP for Human Resources said that IBM is initiating the rebate because IBM believes employers must join with other groups focusing on childhood health and obesity.

The Children's Health Rebate program is available to employees online and consists of educational resources, recommendations and a self-paced tracking tool to track the family's eating and exercise habits over a twelve week period. The tracking tool can be printed off so it can be filled out by the children. The program does not establish either weight or exercise targets.

Participating employees also receive a copy of the book Family Power by Karen Miller Kovach. The focus of the book is eliminating childhood weight problems and establishing a healthy weight home.

November 1, 2007 - Out of Role Days High

In a recent survey, 9,282 adult Americans were asked how many days they were completely unable to work or carry out their usual daily activities as a result of their physical or mental health. The lost day was referred to as an out of role day. Researchers extrapolated the results and suggest an estimated total of 3.7 billion out of role days, per year, are experienced nationwide by adults due to physical and mental health problems.

Of these 3.7 billion out of role days, an estimated 2.4 billion are due to chronic physical conditions, while an estimated 1.3 billion are due to mental health conditions.
* The physical condition associated with the largest number of 1.2 billion days, was chronic back - neck pain.
* The mental health condition associated with the largest number of out of role days, 387 million, was major depression.
* The researchers found that the effects of individual mental health conditions were as large as those of most chronic physical conditions.

Based on the data, the researchers estimate that more than half of U.S. adults have a mental or physical condition resulting in the excess days out of role.

This and other recent data suggests that worksite wellness programs need to address mental health issues, in addition to the physical health - lifestyle issues currently being addressed.

Source: Healthcare Daily Data Byte, Volume 111, Issue 211, October 29, 2007

October 16, 2007 The Wellness Phone

The next generation wellness toy made its debut at the recent Tokyo electronics show. The prototype Wellness Phone was developed by Mitsubushi Electric Corp. and DoCoMo, Japan's largest mobile phone carrier.

So what can this cellular phone do?
* detect and record body motion whether it is running, walking or climbing stairs
* calculate calories burned
* play music through headphones
* calculate body fat
* take your pulse
* record time and distance run as well as set targets
* measure your bad breath
* ask questions to assess your stress level
* offer inspirational advice - pep talks
* keep track of meals
* has the capability to network to let users share data

No release date or price for the phone has been set yet. DoCoMo also has no immediate plans to sell it outside Japan.

Oh and by the way, it works as a cell phone too.

Tickets to Japan anyone?

October 12, 2007 - Pikes Peak or Bust

I recently returned from a business/pleasure trip to Colorado. The business portion of the trip was to attend an instructor training program in holistic stress management. The training was led by Brian Luke Seward, Ph.D. through his organizations Inspiration Unlimited and Paramount Wellness Institute (http://brianlukeseward.net). Dr. Seaward is a nationally recognized leader in the area of holistic stress management. I have been following his work for a while now, so I am grateful I finally got to attend his Instructor Certification Program.

Following the training, I played tourist traveling around much of central Colorado. The weather was absolutely beautiful and warm the whole time I was there. The one day of rain we had brought snow to the higher elevations, so when I got into the mountains, they were snow capped. Coming from Maine, snow is nothing new, but the Rockies were even more impressive with their snow covering. The snow covered peaks definitely added to their majestic beauty.

Now it is back to the grind, ramping up for our flu shot clinics between now and the holidays. I also need to complete the "homework" portion of the certification program so I can begin teaching and facilitating holistic stress management workshops and programs.

And oh by the way, I did make it to the top of Pikes Peak, thanks to the Manitou Springs and Pikes Peak Cog Railway.

September 10, 2007 - Healthcare 20 Years From Now

U.S. Comptroller General David M. Walker has been on the stump across America this past year delivering the following message: "Unless we fix our healthcare system - in both the public and private sectors - rising healthcare costs will have severe, adverse consequences for the federal budget as well as the U.S. economy in the future."

As part of the Government Accountability Office's (GAO) exploration into healthcare, Walker held a forum on May 17, 2007 with 29 healthcare experts. The results from that forum were just released by the GAO in its document "Healthcare 20 Years From Now: Taking Steps Today to Meet Tomorrow's Challenges." GAO-07-1155SP (www.gao.gov/cgi-bin/getrpt?GAO-07-1155SP)

Three of the recommendations related to employee health and wellness. They were:

* No agreement among attendees that the U.S. should continue to rely on employer sponsored health care coverage as the backbone of the U.S. system of coverage.
* There was agreement among attendees that fostering efficiency incentives at the individual patient level is an appropriate and effective way to moderate healthcare spending increases.
* There was strong agreement among the attendees that steps should be taken to encourage individuals to assume more personal responsibility for their own health and wellness.

Unfortunately, the personal responsibility theme was lumped into the costs theme and there was nothing in the body of the report addressing any proposals, ideas or suggestions floated by the experts as to what the greater assumption of personal responsibility might look like.

Given the caliber of healthcare experts present, this is indeed unfortunate.

September 10, 2007 - Patient Compliance

In a recent post, I reflected on the number of persons who responded to a survey stating that they did not follow their physician's advice when it came to getting a diagnostic test, undergoing treatment, or filling a prescription their physician gave them. A recent study from the University of Iowa and published in the Journal of Behavioral medicine sheds additional light on this topic.

According to the news release from the University of Iowa, "patients are more satisfied with care and most likely to follow treatment plans - like taking medication or making diet changes - if they see a doctor whose attitudes toward patient - physician roles are in line with their own." Some patients, especially older patients, prefer a physician who is more directive, spends little time explaining the condition, and who seeks little patient input when it comes to prescribing a course of treatment. Other patients want a physician who is more patient centered, educating them about their condition, encouraging questions and seeking collaboration in treatment decisions.

One of the researchers, psychology professor Alan Christensen, reports that patients who experience a mismatch between their own expectations and preferences for a doctor's visit and what actually occurs during that visit are less likely to follow treatment recommendations because their expectations were not met during the visit, leaving the patient less than satisfied with their care.

As I have pointed out in another post, not feeling in control can have a significant impact
on the individual. As Christensen points out in the article, "when people's expectations aren't met, the psychological reaction can be to try and restore control by doing your own thing or by doing the opposite of what you are told."

Having a healthy and satisfying relationship with your physician is critical. A healthy and satisfying relationship is based on having your expectations met, being satisfied and having trust. Your health and wellness depends upon your finding a physician with the type of style you prefer.

September 4, 2007 - Some Interesting Numbers

Commonsense suggests and data verifies that employees with chronic diseases generate higher health care spending than employees without chronic disease. In response, most national health insurance carriers today offer disease management programs as part of their package of services. Despite their availability, I have often wondered why these programs are very often underutilized by plan members.

The results from a 2007 Harris Interactive online survey may offer an explanation. The survey included 2,673 adults and was conducted from March 5 - 7, 2007. Survey results showed:

*44% of the responders said that either they or an immediate family member have ignored a doctor's treatment recommendations or sought a medical second opinion because they felt the doctor's recommended treatment was either to overly aggressive (83%) or unnecessary (73%)
*25% reported not filling a prescription written by the doctor because they did not feel it was necessary
*20% sought a second opinion because they felt the doctor's recommendations were too aggressive
*13% reported not getting a recommended diagnostic test
*7% reported choosing not to have a recommended surgery
*7% reported changing doctors because of the physician's aggressive approach
*Only 1 in 10 respondents indicated that their decision not to follow a physician's recommendations resulted in problems because of their decision

If people are not following a physician's recommendations regarding diagnosis and treatment and not experiencing any negative consequences as a result is it any wonder why people are not making suggested lifestyle changes?

August 29, 2007 - Health Coaching Article

Incorporating the use of health coaches into worksite based wellness programs is all the rage right now. Here is the link to a recent article by Larry Chapman on health coaching from the July/August 2007 edition of The Art of Health Promotion.
http://www.webmdhealthcommunications.com/announcements/AHP_53_Coaching.pdf

August 28, 2007 - Worksite Based Physical Activity Programs

Physical activity programs are often the core program offered by worksite wellness programs. The Alberta Canada Centre 4 Active Living has a new Web site that focuses on physical activity at work. The site offers: a planning guide, practical ideas, keys to success, company success stories, making the business case and other valuable resources. Check it out. Here is their link:
http://www.centre4activeliving.ca/workplace/index.html

August 27, 2007 - Drug Free Work Week
October 14 - 20, 2007

The worksite risks from alcohol and drug use and abuse are significant. These risks include employee health, productivity and safety. When we think of drug use and abuse, we normally think of the effects from illicit or street drugs. The use and misuse of prescription and over-the-counter drugs can pose risks at the worksite as well.

To combat the alcohol and drug abuse problem, the U.S. Government's Department of Labor (DOL) promotes an intervention strategy called Drug Free Workplace. The Drug Free Workplace consists of several components:
* Drug free workplace policy
* Employee education
* Supervisor education
* Offering an employee assistance program (EAP)
* Drug and alcohol testing

Workplace wellness programs are now being seen as a good venue for the introduction of substance abuse prevention programs at the worksite. I believe, at the very least, that workplace wellness programs can incorporate substance abuse activities through:
* Policy initiatives
* Training and education initiatives

For more information on:

Drug Free Work Week 2007 visit::
www.dol.gov/asp/programs/drugs/workingpartners/DFWW-introduction.asp

The U.S. DOL Drug Free Workplace Program visit:
www.dol.gov/workingpartners

For additional information on substance abuse and prevention in the workplace, see additional modules below.

August 22, 2007 - New Certification

I have received notification from the National Wellness Institute that I have successfully completed the requirements for certification by them as a Worksite Wellness Program Consultant. The certification was offered for the first time this year as part of the National Wellness Institute's Wellness Conference which is held each July at the University of Wisconsin - Stevens Point. The certification is based upon the successful completetion of four levels of training focusing on worksite wellness programs and the passage of an examination at each level of training. My understanding is that this first group to achieve certified consultant status consists of 37 professionals from around the globe, including the U.S., Canada, Denmark and Australia.

August 15, 2007 - Another Certification!

I have been notified by the Certification Program Manager at WorldatWork that I am the first person in the country to achieve certification as a Work - Life Certified Professional (WLCP). WorldatWork, in association with the Alliance for Work-Life Progress (AWLP), initiated the certification program in 2006. The focus of the certification program is the work-life components of a total rewards benefit structure. The certification program was originally designed to be seven or eight courses and exams. Three courses were introduced in 2006, with the fourth launching in February 2007. WorldatWork staffers told me in February that I was the first person in the country to complete all four of the courses and pass the associated exams. Since February, I have been waiting for the additional courses to be released, so I could continue along in the certification process.

I was therefore very surprised to receive the call saying that the decision has been made to cap the certification program at four courses and I will be the first person to be awarded certification by virtue of my having completed course four and its exam last February. The WLCP designation is based on a body of knowledge that supports a comprehensive understanding of work-life effectiveness. To learn more about the work - life certification program, go to:
http://www.worldatworksociety.org/society/
certification/html/certification-wlcp.jsp

August 13, 2007 - Good News - Bad News

The results of a 2006 survey of HR professionals, by WorldatWork, on the issue of employee healthcare consumerism were reported in the August 2007 edition of Workspan.

The good news is:
*73% of the respondents indicated that their organization had implemented health promotion and wellness initiatives as a strategy to offset healthcare costs (up 8% from the 2004 survey)
*31% reported increased participation in wellness initiatives
*22 % reported increased utilization of wellness Web sites and intranet sites
*18% reported reduced health care costs

The bad news is:
*17% reported just having a perception of overall improvement in employee healthy lifestyle behaviors
*17% reported having a gut feeling or impression of improvement by employees
*16% reported no positive results
*8% reported having a perception of or actual aggregate employee weight loss
*7% reported improved results on employee health risk appraisals

The reported increase in worksite wellness program implementation is consistent with what I am seeing anecdotally here in Maine and hearing from my colleagues elsewhere.

While there are a lot of reasons why and questions that could be asked relative to the "bad news," that is not my chief concern. My chief concern is that the HR professionals, who responded to the survey, responded not from a position of direct knowledge, but apparently from a position of "perception", "impression" or "gut feeling."

To be successful and demonstrate effectiveness, a worksite wellness program should:
*Use evidence based strategies where they exist
*Seek outcomes, rather than just conduct activities
*Continuously evaluate each aspect of the program
*Incorporate the use of incentives known to drive participation upward

Robert Burnett and Ruth Hunt. "A Report Card on Health-Care Consumerism and Employee Education." Workspan, Vol. 50, No. 8, August 2007, pp. 20 - 26.

July 25, 2007 - Good News from a June 21, 2007 ERISA/NAM Press Release "Major Employers Increase Health and Disease Management - Use of Incentives."

Unfortunately, the subtitle "Return on Investment Still an Important but Unanswered Question" could not be further from the truth. Research by Ron Goetzel, Dee Eddington and Larry Chapman, among others, has demonstrated time and again that worksite based health and wellness programs consistently return a positive ROI up to 6:1, depending upon the program elements and structure.

Good news from the press release is that:

1. "Three-quarters of employers surveyed offer health management programs to their employees, and of those companies offering these programs, two-thirds encourage their employees to participate with incentives."
2. "The most common incentive offered across health management programs is premium reductions, with 40 percent of companies using these as incentives. A strong second is cash or bonuses, offered by 29 percent of companies." Of all available incentives, the literature has identified these two as being the strongest and most successful in driving program participation.
3. "Almost two-thirds (62 percent) of companies offering incentives had not attempted to measure ROI for their programs." Depending upon the type of ROI measure selected, establishing a cause-effect relationship can be quite expensive. I am encouraged that 62% of the respondents are using incentives without, apparently feeling the need to do ROI type evaluations.

Since we know worksite health promotion works thanks to the some 60 studies already published, why do we need to continue to spend money continuing to prove the point? Let's put that money back into benefits and/or services or even better, new research regarding employee motivation and behavior change.

You can link to the press release here:
http://www.eric.org/forms/documents/DocumentFormPublic/viewDoc?id=BFFC00000006

July 23, 2007 - 8 Days of Training with Larry Chapman

I have just returned from completing 8 days of training with Larry Chapman. What an awesome experience! The training was held at the National Wellness Institute on the campus of the University of Wisconsin. If you ever have the opportunity to go, don't pass it up!