That wellness programs could weigh on a company to the extent presented by Samuel Coleridge in the Rime of the Ancient Mariner may seem a stretch of poetic justice. Yet, missteps in implementing and operating these programs potentially results in financial hardships. Harkening back to Coleridge’s quote in the title of this piece – there are currently many programs out there, but how have they fared in the workplace? Have they been accepted by employees? Do they lead to increased productivity or enhanced recruitment? In health care, are patients adhering to treatment protocols and are their satisfaction scores improved? Are physicians utilizing measures to improve wellness and prevention? These questions and many others like them are starting to surface; and yet, the clamor for companies to start new programs or expand existing ones shows no signs of slowing. Programs are seemingly everywhere, but how much can we glean from them to ensure future success?

The first step is to see what is currently available. As discussed in Part 1 of this series, in America most wellness programs focus on health, or disease management/prevention to be more precise. The workplace has been accepted as an ideal location to approach these issues. Work-site programs range from traditional health-promotion services to specific diagnosis-related management (Goetzel 2008), with a focus on topics like quitting smoking, losing weight, prevention strategies, and chronic care solutions. From mammography and influenza vaccine (more recently H1N1) reminders to noise control and stress relief, wellness programs offer a plethora of health options. The underlying premise is to augment employee/patient satisfaction and thereby improve various metrics of work (decrease absenteeism, improve productivity, maintain treatment protocols, etc). Of course, the larger picture and the source of most of the pressure on organizations and providers to implement these programs stems from the push to solve two distinct problems: the ballooning costs of health care, and the public health ramifications of Americans in poor health.

There is little debate about the effects of certain behaviors or conditions on the health care system. For instance, the direct cost of cigarette smoking was approximately $96 billion from 2000-2004 and over $193 billion annually if productivity is included (Commonwealth Fund report, 2009). Similarly, obesity cost the health care system over $147 billion in 2008 alone. One in four, or about 125 million persons, suffers from a chronic condition such as heart disease or diabetes. Simultaneously, the health system is facing pressures of overcrowding, lack of coordination, and escalating costs (PWC, 2009). Average premiums in 2006 for individual and family were $3,615 and $8,508 respectively.  Seven preventable diagnoses are directly related to at least 25% of total health care costs (obesity, high cholesterol, high blood pressure, alcohol consumption, smoking, stress depression, and high glucose). Employees with these behaviors cost companies up to 228% more in health care costs (Goetzel, 1998).

Reviews of programs designed to combat these behaviors are generally positive. They indicate many are effective, increasing productivity and profit while reducing absenteeism and turnover (Goetzel, 2008). Additionally, return on investment on some programs is estimated to reach $3.00 or more per dollar spent. Given these published reviews and others like them, it is reasonable to assume that programs are working, that they are actively used, and that they have had measurable effects on health care costs.  Employers report however, that less than 15 percent of employees participate in disease management programs and health care costs have continued to rise (PWC, 2009). Suggestions have also been made that current reviews do not capture a representative population from these organizations (Goetzel, 2008). In other words, there is a distinct group of employees who participate and respond positively, while the large majority does not and is therefore unheard. This situation creates a natural bias in reported results. So if current programs are missing the mark, what is the problem?

Does the lack of participation and financial impact stem from employees/patients themselves, who simply do not care about their health? It does not seem that way. A recent report establishes that Americans are definitely interested in their health and wellness. The following facts support this argument (Deloitte, 2009):

• 54% are actively putting effort into learning more about their health
• 44% are trying to reduce stress
• 39% are trying to manage their weight
• 35% are exercising
• 19% are participating in programs to improve their health
• 64% are willing to use in-home devices to help them monitor their health (blood pressure cuff for example)

Of course, ranges closer to 90% for these categories might be more compelling. Nonetheless, these facts merely reflect those who are active, not those who would like to be involved. Perhaps the most telling number is that only 19% are participating in programs, leaving a very wide margin for improvement.

So, does the fault then lie with employers? Though it might be easy to point the finger at this group, most companies are targeting health promotion and dedicating resources to address it. Due to a lack of defined return on investment studies, a fragmented system in which specific approaches have little statistical support, and obstacles to understanding the target population fully, employers face a maelstrom of information that makes it difficult to create a solid foundation. As a result, only 7% of employers offer all of the key components of a successful program (Goetzel, 2005).

Ultimately, the fault is arguably not solely with either employers or employees, but rather with the interconnection of the two and the general ideological approach currently adopted. The main assessment tool available to employers is the Health Risk Assessment (HRA). In nearly all cases, this survey focuses exclusively on health behavior and biometrics (blood pressure, cholesterol level, etc), with little emphasis on other constituents of an individual’s well-being. The Agency for Healthcare Research and Quality (AHRQ) stresses a multimodal approach for example that includes elements of physical and mental health, occupational health, stress management, environmental improvement, nutrition, and prevention. Additionally, in order to improve what is currently available these programs must become more personalized, rather than relying on generic messaging. Studies show that delivering customized information to employees can increase participation 15-20% along nearly all metrics while accomplishing successful outcomes (Harter, 2003; Task Force, 2009; McClure, 2009). Of course, carefully constructed incentives can also have dramatic effects.

The dichotomy painted in this scenario returns us to the analogy of the ancient mariner. There are programs seemingly everywhere for employees and patients to join; the entire system is promoting these programs; and employees/patients want to be involved. And yet, throats are parched.  Why aren’t more persons participating? Why aren’t these programs yielding more results that are quantifiable? More money and resources are being poured into this problem than ever before with only minimal improvement. So how do we change this situation and shift the momentum?

These questions are just some of the ones we are working on uncovering here at Widmeyer. Through understanding what is currently available and then turning a creative eye to what is possible, companies may alter these programs to improve results and outcomes. What seems clear is that the notion of well-being and all it encompasses must be integrated more fully into available programs, rather than just focusing on the rudiments of health. The fragmented system of wellness and well-being must be aligned to maximize return on investment and to understand employee participation more clearly. By utilizing a carefully constructed model of health and communication approaches, Widmeyer hopes to bridge the current disconnect, thereby offering all stakeholders a firm foundation from which to progress.

Two great, albeit very different, artists comment on the idea of happiness and well-being: Groucho Marx once stated, “I have just one day, today, and I’m going to be happy in it.” While Walt Whitman asserts: “Happiness, not in another place but this place. Not in another hour, but this hour”. Ah, such notions of living in the moment and getting the most out of everything are undeniably attractive. Perhaps with the help of social media and a new vision of what constitutes well-being, we can transform current approaches and adequately address the health and wellness of employees, their families, and patients.

There is no one answer obviously. Scholars, researchers, philosophers, and policy-makers have all approached this from different angles, providing a myriad of definitions and insights into well-being. However, the precise definition seems to be as elusive as harnessing the sustained feeling of happiness itself. The notion of well-being is undeniably a multidimensional construct. Yet, its importance to many facets of life is indisputable. In the world of business, well-being has garnered special attention, as employers and other key stakeholders strive to improve productivity, cut costs, and drive employee participation and results. Despite recent economic turmoil in fact, one element of business that has not suffered is wellness programs (Faircloth, Inc 2009). Consider the following facts:

• 89 percent of employees expect their workplace culture to promote healthy lifestyle concepts (Faircloth, Inc 2009)
• 91 percent of employers believe they can reduce their health care costs by promoting healthier living among employees (Mello, NEJM 2008)
• Health plans and employers now provide access and incentives for employees to maintain a healthy lifestyle and promote well-being.  This amazingly has now extended to penalties for not adhering to these same requirements (Mello, NEJM 2008)
• From 2004 to 2006, there was almost a three-fold increase in employers with more than 500 or more employees offering workers incentives to complete a health-risk appraisal, demonstrate good health behavior, or participate in a risk-reduction program (Mello, NEJM 2008)
• The use of premium differentials as incentives increased among large employers (Mello, NEJM 2008)
• Total annual health care costs reached $2.4 trillion in 2008 and are projected to reach $3.1 trillion in 2012 (Rosen)
• 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 (Rosen)
• Research shows that 50 percent of a person’s health status is a result of behavior, and 75 percent of health care costs can be prevented, delayed, or curtailed through lifestyle modifications (Rosen)
• 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 (Rosen)
• 46 percent of those who have participated in a wellness program felt that it positively impacted their behavior choices (Rosen)

Aligning existing and new programs that contribute to the well-being of a company’s employees or beneficiaries can create a greater impact on its business objectives– well-being therefore is imperative. Well-being efforts and how they relate to improving a company’s image, reputation, and return on investment are becoming paramount in this discussion.

Obstacles to implementing effective wellness programs and addressing well-being of employees or beneficiaries are multifold. Most importantly, there is no standard definition of well-being and the system surrounding this issue remains clouded and fragmented. In the United States, notions of well-being center on the absence of disease, prevention, and access to treatment. On the other hand, in Europe, well-being includes happiness, work-life balance, and value in life. How to balance these characteristics, and more, is the trick. Additionally, companies are implementing programs as short-term remedies rather than focusing on long-term goals and objectives. By fomenting an interchange of information and cohesion of program infrastructure and corporate culture with health, work, and life improvement, companies may improve their approach and their desired results.

Different organizations have been attempting to relate well-being to everyday society, such as Gallup Research and the Princeton Center for Health and Well-Being. However, both of these, and others, seem to focus on health as the primary constituent/outcome of well-being, perhaps missing the overarching implications and importance of other factors.  It is our goal at Widmeyer Communications to shed light on both sides, to delve into the conundrum of why happiness is so difficult to quantify, and to help formulate solutions to solve the disconnect between employers and employees, providers and beneficiaries and between the European and U.S. approaches.

We hope you will join us in this journey and respond with questions, comments and insights.  In future posts, we will focus on the role of technology, current wellness program reach, future plans and endeavors employers could adopt, social media presence and other communications tools, and finally best strategies for managing this burgeoning area.

Contact:

212-260-3401

henry.engleka@widmeyer.com