Best Practices for Wellness Programs

These programs are an important long-term tool your organization can use to combat rising health care costs and to help employees live healthier lives.

• By Michael Rosen, Todd Spaulding
• Jul 01, 2009

Total annual health care costs reached $2.4 trillion in 2008 and are projected to reach $3.1 trillion in 2012. In fact, there appears to be no end in sight to this trend.¹ As a result, organizations and individuals continue to search for strategies to deal with escalating health care costs that are outpacing the rate of inflation.

To reduce health care costs and increase value, a growing number of organizations are empowering their employees to take charge of their health through wellness programs. In 2008, 77 percent of employers offered health and wellness programs, and more than half of those currently without programs plan to add them, many within the next six to 12 months. These organization-sponsored wellness programs encourage individuals to modify behaviors in order to live healthier lifestyles, which ultimately reduce the use of health care services related to unhealthy lifestyles. Research shows that 50 percent of a person's health status is a result of behavior,² and 75 percent of health care costs can be prevented, delayed, or curtailed through lifestyle modifications.³

Defining and Building Wellness Programs

Wellness programs help organizations and employees manage long-term health care costs, and studies show employees are receptive to these programs. In fact, nearly two out of three individuals are interested in participating in wellness programs, and 20 percent even are willing to pay extra for a wellness program.⁴ Additionally, 46 percent of those who have participated in a wellness program felt that it positively impacted their behavior choices.⁵ The following best practices will help you build, expand and continuously evolve a successful wellness program. (Wellness programs are subject to various state and federal regulations. Organizations should seek legal counsel when establishing wellness programs.)

Best Practice #1: Assess Your Population

The first step of building a successful wellness program is to gain an understanding of your population's health risks, health status, and readiness to change before implementing a program. This enables organizations to design effective plans and choose interventions that are most likely to engage and benefit members. There are three primary sources of data that you should use to uncover your population's underlying health issues and needs:

1. Claims. Evaluating data obtained from laboratory, pharmacy, and medical claims of your population provides a comprehensive and accurate insight into your population's conditions, medications, health care utilization patterns, current medical status, and risks.
2. Self-reported data and employee surveys.
3. Biometric on-site screenings.

Best Practice #2: Secure Visible Leadership Commitment, Support and Participation

Your organization's executive leadership must vigorously and visibly support, participate in, and forcefully communicate the importance of living a healthy lifestyle to make your initiative successful. According to the Wellness Council of America (WELCOA): "For any organization change initiative to be effective, there has to be a champion. When CEOs value healthy lifestyles and openly practice good health habits, the rest of the organization is likely to follow in their footsteps. To be genuine in promoting health, CEOs need to embrace health as an individual priority."⁶

Best Practice #3: Build a Program That Focuses on Behavior Changes Across the Health Care Continuum

Within any population, there are three stages of health risk: low, moderate, and high. To develop a true culture of health, your organization should adopt programs that encourage everyone in the population to become healthier, regardless of their health risk or current health status.

Low risk: Generally, individuals within this group are physically active, within a healthy weight range, and have low stress. Target this group with programs that help them maintain good health.

Moderate risk: People within this category have some risk factors and are at an increased risk for developing chronic conditions. These people may have a high body-mass index, use tobacco, or may be physically inactive. Provide this group with more intense programs to help them get healthy.

High risk: These people already have a chronic condition or are very close to developing one (e.g., they may have prehypertension or pre-diabetes). Direct this group to intense support programs that help them to live a better quality of life with their condition(s) and prevent future complications.

Building a personalized program based on a person's risk level will not necessarily result in behavior change. Programs must be personalized to a ccount for an individual's readiness to change. To accomplish this, your wellnes s programs should leverage behavior change models such as the Diclemente/Prochaska Transtheoretical Stages of Change approach to guide members to better health. The Transtheoretical model provides a framework to address and categorize an individual's readiness to modify a problem behavior or acquire a positive behavior. Instead of viewing change as a single event (e.g., losing weight, quitting smoking, etc.), the model evaluates long-term change.

There are five stages of change in the Transtheoretical model: precontemplation, contemplation, preparation, action, and maintenance. Although it's natural for individuals to move back and forth throughout the health care continuum and stages of change, it's important to provide those individuals with education, encouragement, and support to keep them moving forward toward positive behavior change. Using this model as the basis for a wellness program enables tailored behavior interventions and outreach based on the individual's current stage. Studies show this approach improves outcomes and increases the potential impact on entire populations of individuals with behavioral health risks.⁷

Best Practice #4: Leverage Data to Proactively Identify Health Risks and Personalize Programs

Synchronized data on a single, scalable platform is the foundation of today's wellness programs. With the right technology, your organization can leverage these data to:

Proactively identify potential chronic conditions and health risks.
Apply segmentation models to provide meaningful, relevant program content
Increase enrollment by better understanding individual consumer preferences Personalize communications to optimize consumer engagement Synchronize care across care providers Early detection and treatment have the potential to result in significant savings through current disease- and case-management techniques.⁸ In addition, leveraging technology and data can enable your organization to personalize communications based on individual preferences and life-stage (e.g., young singles, families, mature singles, empty nesters, etc.). Communication preferences can range from e-mail and Web portal usage to direct contact via mail or personal interactions with wellness coaches or case management nurses.

Best Practice #5: Develop Compelling Communications and Incentives

Communications are vital to a successful wellness program. Compelling communications create awareness, pique interest, motivate, and improve engagement rates.

Maximize Engagement with Incentives

When used appropriately, incentives can be a great way to drive enrollment and engagement. In one study, the use of a $100 incentive for health assessment completion achieved an 85 percent response rate. In contrast, within the same group, the request to complete a health assessment without an incentive produced a 10 percent response rate.⁹ Best practices to consider when implementing incentive programs include:

Take a gradual, multi-year approach. Keep strategies simple, but strive for an approach that eventually incorporates health outcome achievement.

Choosing the right incentive value is vital to program success. There should be a correlation between the value of the incentive and the level of effort needed to meet a requirement.

Carefully select incentive types, such as gift cards, reimbursements to health savings accounts, or a point system that can be redeemed for merchandise.

Best Practice #6: Design a Personalized Program for the Whole Person

Wellness programs must address all factors that influence behavior, as well as those that can prevent or help behavior change. For instance, someone who suffers from back pain often experiences depression that can affect other aspects of life.

Best Practice #7: Create a Culture of Health

To create a true culture of health, your organization must provide individuals with ways to be healthy at the workplace so health is not just topof- mind, but individuals are immersed in a healthy culture. On-site programs that can together provide this immersion include health fairs, health seminars, workout facilities, walking/exercise and nutrition programs, coaches, clinics, nurses, health and wellness publications, biometric screenings, health kiosks, healthy vending machines, flu shots, and immunizations.

Best Practice #8: Track and Evaluate Results

Tracking and evaluating results is key to the long-term success of your wellness program. It's important for your wellness program's management team to monitor performance, evaluate effectiveness, and make adjustments as needed.

 

References: 1. Katherine Capps, Health2 Resources. John B. Harkey Jr., Ph.D., Harkey Research, June, 2008. 2. Institute For The Future, Centers for Disease Control and Prevention. 3. Health, United States, 2006; U.S. Department of Health and Human Services; http://www.cdc.gov/nchs/hus.htm. 4. 2008 Survey of Health Care Consumers. Deloitte Center for Health Solutions. 5. North American Technographics Finance, Healthcare, Government, Automotive, And Travel Benchmark Survey, Q4 2007. 6. Wellness Council of America: WELCOA’s Seven Benchmarks of Success. Absolute Advantage, Volume 6, Number 1, 2006. 7. Materials prepared for the center based on research from Velicer, WF, Prochaska, JO, Fava, JL, Norman, GJ, Redding, CA. A Transtheoretical Model, Cancer Prevention Research Center. 1998. 8. You Are What You Eat—Using Consumer Data to Predict Health Risk, from Stehno CE, and Johns C. Milliman, Inc. 9. Results from a 2007 Uniprise client study where employer groups representing nearly 40,000 members were analyzed compared to book of business results for health assessment and online health coach completion statistics.

This article originally appeared in the July 2009 issue of Occupational Health & Safety.