On May 16th, 2016 the Equal Employment Opportunity Commission (EEOC) ruled on the much anticipated laws regarding the ADA, GINA and financial incentives associated with wellness programs.
Many consumer advocacy groups were arguing that providing steep financial incentives for participation in certain wellness programs essentially made those programs involuntary.
The EEOC made its final ruling in favor of wellness programs stating that the programs are, indeed, voluntary and that the financial incentives may continue in accordance with the Affordable Care Act.
There were two rules set forth by the EEOC. One of the rules defines what wellness programs must do to comply with the Americans with Disabilities Act (ADA). And the other rule defines what must be done to comply with the Genetic Information Nondiscrimination Act (GINA).
The important takeaway is that wellness programs may continue to provide financial incentives or surcharges of up to 30% of the cost for an individual’s insurance.
Tobacco programs may continue to reward or penalize up to 50%, however, if a medical test is administered to determine tobacco use then the maximum amount is dropped down to 30%.
This year’s Art & Science of Health Promotion conference was overwhelmingly positive. It was great to see old friends, meet new ones, and discuss this year’s theme: The Future of Health Promotion.
The Manchester Grand Hyatt in San Diego was jam packed with informative sessions presented by some of the greatest thought leaders in Health Promotion. One of the most difficult things about the conference is deciding which sessions to attend as there are so many good options. I’m going to focus on three key takeaways that I would like to share.
Wake Up: Sleep is a Big Issue!
One third of America’s workforce suffers from a lack of sleep. The CDC has declared insufficient sleep as a public health epidemic. The total cost due to reduced productivity, errors on the job, and injury is estimated at $2280 per employee (source: Harvard Medical School, Insomnia Study, 2011). For some reason sleep has been largely ignored in workplace wellness. This year, however, many presenters pointed to sleep as a necessary area to focus on. This has not been an area of demand in the past and as a result many providers do not focus on sleep enhancement. This is likely to change as more and more programs begin to recognize the importance of a good night’s rest for their population.
Let’s end the debate over incentives.
If you’re like me, you’ve started to feel like the debate over whether or not incentives are a good strategy has become a political issue. This issue has become so heated that it feels like you’re either in the incentive camp or the non incentive camp in the same way you’re either liberal or conservative. The reality is that sometimes incentives work and sometimes they don’t. I’ve seen some companies use them successfully and other companies not so successfully. Research supports the use of incentives for simple short term tasks like filling out a health assessment. But research does not show that incentives are effective in producing long-term behavior change. Let’s for a minute (hopefully much longer) take the focus off of whether or not incentives work and put that effort towards building stronger wellness programs.
The future is behind us?
This year’s theme asked the leaders in our field: what’s next for Health Promotion? Dr. David Katz addressed that very question in the opening keynote. While profound, his answer was nothing new at all. He pointed to a 1993 edition of the journal of the American Medical Association where Will Foege and Mike McGinnis, two leading epidemiologists, reported that the long held notion that chronic diseases were the leading causes of premature death wasn’t indeed accurate. That those diseases aren’t causes rather they are effects. They are the effects of lifestyle factors of which we are very much in control. They and others have found that four factors (smoking, diet, exercise, weight control) can result in an 80% reduction in the lifetime risk of all major chronic diseases. Dr. Katz jokingly remarked “What if I told you there was a pill that could reduce your risk of all chronic disease by 80%? Who would you call first, your doctor or your stockbroker to invest in the company?”
It’s true though. We see the same lifestyle factors come up in nearly every population we treat. We know what we need to do. Let’s stop arguing about which fad diet is best or which incentives are best and let’s use the great knowledge and programs we have developed to start helping 100% of people live happier, healthier, more fulfilling lives.
- Young adults can stay on their parents’ health insurance until they are 26 years old
- It’s easier and less expensive to buy insurance through the exchange if employer does not offer insurance coverage
Some consulting firms estimate that 7.5 million adults age 19-26 have or will gain insurance through HCR.
But it remains to be seen if young people will:
- Use insurance for regular preventive care
- Develop a relationship with a primary care physician or use pharmacy clinics or walk-in urgent care instead
- Practice wise health care consumerism — since about a third of them have been uninsured since they graduated from college
If your wellness program doesn’t currently serve the needs of your younger employees — or if you’re not sure whether or not it does — this is a great opportunity to get them involved, educated, and more engaged in their health.
But why? Aren’t they pretty much healthy, anyway?
1. Yes, but they still have health risks
Young people are healthier on average than your older employees and less likely to suffer from high cholesterol, hypertension, heart disease and other chronic conditions.
But there’s still plenty of room for improvement — and you have a unique opportunity to stop bad habits and health problems before they become damaging and costly. Problems like:
- Heavy drinking
- Stress management
- Anxiety, depression and other mental health issues
- Weight management
- Sedentary habits
I can think of a dozen other examples and I bet you can too. Are they educated about nutrition and smart grocery shopping or do they subsist on frozen pizza and take-out? Do they protect their skin from sun damage or hit the tanning bed regularly? Do they buckle their seat belt when driving or wear a helmet when riding their bicycle?
2. You can manage the spectrum
In general, health risks flow from low to high. So do health care costs.
Low-risk employees, as younger employees tend to be, won’t stay low-risk forever.
- As many as 10-20% of low-risk employees will move to a higher risk category in a year
- The best worksite wellness programs address both high-risk and low-risk employees
Make it a strategic priority to keep healthy people healthy.
3. Include young employees in your wellness efforts
The best way to get young employees involved in workplace wellness efforts might be just inviting them to be involved.
Do your young employees have a seat at the table?
- Do you have a young employee on your wellness committee?
- Do you take their opinions and suggestions seriously?
What do they want in a wellness program?
- Yoga classes? Healthier cafeteria food? A smartphone app instead of a self-care book?
- Longer breaks so they can go to the gym? Bike racks?
- Clearer and more accessible information about how their insurance plan works and what it covers? (This is a big one, especially for the first-time insured)
- What incentives would make them more likely to participate?
How’s your current program working for them?
- Do they use it?
- What do they like? What do they dislike? What did they not even know you offered?
- Don’t make assumptions: Just because you offer new technology channels or social networking features doesn’t mean your younger employees are using it.
You won’t know unless you ask. Send out a survey, recruit a young employee wellness summit, or just drop by to chat.
Once you have a program in place, don’t forget to check in periodically and ask how your program is going and how it can be improved!
You may be thinking: What? This year just started! Believe it or not, wellness calendar season starts pretty early, with many of our clients placing orders as early as March. This is especially true for those who are looking for custom features, such as unique cover art or reminders for company events.
Maybe you’re also wondering: Who uses calendars these days? With the rise of the smartphone and digital timekeeping, a paper wall calendar might seem a little old-fashioned. But you might be surprised at how many people still use them every day, especially at their desk.
Some prefer to have information available at-a-glance. (Let’s be honest — we all lose track of what day it is.) Others like the physicality of a printed calendar, while some like the simplicity of having one calendar, in one place, that doesn’t require syncing across applications and devices. For whatever reason, calendars remain a popular item to give to your employees as part of wellness promotion efforts.
Here are 6 creative ways to use them in your workplace:
Offer wellness calendars as an incentive.
Want more employees to get a flu shot? Looking to improve attendance at a lunch-and-learn? Offering a free wellness calendar as an incentive to participate is a great way to bring more employees to your health-related events, or encourage participation in health risk assessments.
Give away wellness calendars as prizes …
… For completing surveys, winning contests or at health fairs, company parties, or achieving a health goal.
Promote calendars as a health tracking tool.
Many wellness calendars include space for tracking health information such as blood pressure, cholesterol, BMI, preventive screenings and health tests. Pick a calendar with plenty of room for vital stats tracking and encourage your employees to use it to get healthier!
Bundle wellness calendars with other communications.
Distribute wellness calendars with your first health newsletter of the year, with open enrollment packets, or with flyers for upcoming health events. Or include a healthy perk when you distribute the calendars, like a list of healthy local take-out options or a map of walking routes on your workplace campus.
Build in company events and healthy activities in your community.
It requires a little planning, but if you already have a schedule of next year’s events, why not print them in your wellness calendar so your employees can plan ahead? Include health fairs, open enrollment, company holidays, outings, retreats or seasonal events. Or make note of events in your community, like charity walks/runs, or contact information for local community fitness centers.
Celebrate National Health Observances.
Let your employees know when your company — and the rest of the country — will be observing Heart Health Month, Mental Health Month, American Diabetes Month and Breast Cancer Awareness Month.
How do you use wellness calendars in your workplace? Do your employees like them? Let us know!
By Ginny (ginger chicken Uploaded by Partyzan_XXI) via Wikimedia Commons
At AIPM, we know that a healthy diet is a huge component of overall health and well-being. We’re also a small business. Our office kitchen does quadruple-duty as a coat room, a stock closet, and a copy center. Making it easier for employees to eat well during the work day is a topic that’s close to our hearts.
So yesterday, we were excited to discuss Cooking & Company (a project of Jamie Oliver’s Food Revolution) and other experiments for better food at work.
The gist? What if companies offer their employees:
- Take-home kits for fresh, healthy, home-cooked meals, with fully prepped ingredients and a recipe — e.g., vegetable fajitas?
- Cooking classes, led by local chefs or personal cooking consultants?
- “Pop-up” community cooking events, like a singles night, wine tasting, or make-your-own-omelet breakfast stations?
- A communal kitchen/cooking space at the office where employees can cook and eat together?
Are you thinking: Do we have the space? Who has a budget for this stuff? Will my boss sign-off? Fire hazards?
Yeah, we were thinking that too. But go ahead and download the free toolkit, and read it with an open mind. It includes plenty of flexible planning ideas to help you scale. Maybe you can:
- Take advantage of a cooking class at an off-site community center?
- Use designated employee break time (lunch seems natural)?
- Instead of paying for a full-flight cooking program (or total office kitchen rehab!), subsidize take-home meal kits to offer to employees at an affordable price?
It was helpful for me to realize that this is about more than offering healthy options for your employees.
It’s about engagement.
Not just watching a cooking demonstration: actual, hands-on cooking. Not just grabbing the least-unhealthy option in the vending machine: actively preparing a healthy meal with your co-workers, and building skills that employees can bring home to their families.
What do you think? How do you handle food at work? Would any of these Cooking & Company experiments work at your workplace? What have you tried to help employees make healthy, nutritious choices?
Wee all know that health care costs have risen at rates beyond comprehension. We constantly hear numbers thrown around as to what health care is costing, but it’s impossible to imagine what a billion dollars really looks like. Let’s take a look at the increase from another angle, possibly making it easier to digest …
If food prices had risen at medical inflation rates since the 1930’s:
|1 dozen eggs
|1 pound apples
|1 pound sugar
|1 roll toilet tissue
|1 dozen oranges
|1 pound butter
|1 pound bananas
|1 pound bacon
|1 pound beef shoulder
|1 pound of coffee
|10 item total
Source: American Institute for Preventive Medicine, 2013
Here are five tips to improve the likelihood that employees will use a self-care guide instead of high-tailing it to the doctor or ER:
1. Distribute a guide annually.
You move, and it ends up in a box you never unpack. You use it and then misplace it. You never remember to bring it home from work and your family never has the chance to take advantage of it. Or it just blends into the scenery on your bookshelf.
Distributing a new guide every year is an easy way to send a regular message about the importance of self-care and wise consumerism. It’s a little bit like getting a new toothbrush every time you go to the dentist.
And most self-care guides are updated and medically reviewed annually, so employees have access to the latest and most accurate health information available.
2. Include medical self-care in your newsletter.
Whether your newsletter is online or in-hand, it is really easy to tie-in medical self-care — and a reminder about using the book.
Here’s an example from our latest HealthyLife Newsletter:
With a friendly reminder bar at the bottom: “Many topics like the one of this page are contained in a medical self-care guide … If you have a self-care guide, use it whenever you are unsure about what to do for symptoms and health issues you are experiencing.”
3. Hang posters and flyers.
Here’s one we recently developed.
Do you know what to do? I don’t. True story — I looked it up in my self-care guide just because I was curious.
Make sure you change it up often (every 2-3 weeks) to keep your message fresh! And you don’t have to stop at posters — stick up a fridge magnet in the office kitchen, pass out postcards, or send a regular self-care email.
4. Host a workshop.
Help employees make better use of their self-care guide, and they’ll be more likely to use it. It may seem self-explanatory, but the density of information, the flow-chart format and the variety of recommendations for action — what’s the difference between “See a doctor” and “Call a doctor”? — can be intimidating for some. Do an in-person lunch-and-learn, conduct a webinar, or distribute a how-to video.
5. Remember that promotion is a process, not a one-time event.
Don’t make the mistake of doing one self-care quiz with a cash incentive and calling it a day. It’s an ongoing effort. The good news is that the more people use their self-care guides,
- The more you will save on health care costs.
- The higher your return on invesment.
- The healthier your employees will be.
So don’t be daunted! Jump in!
How do you promote your self-care program to your employees?
1) It’s not ALL about ROI.
When the field of Worksite Health Promotion became popular some 40 years ago there were no studies claiming ROI for investment in employee health. Leading companies decided to invest in wellness programs because it was the right thing to do. It only makes sense, right? Healthy employees are better employees. They are productive, happier, less stressed, less absent and, of course, they cost less.
Somewhere along the line companies started showing a positive ROI for health promotion programs. Yes, it makes sense if employees are healthier they will cost less. And yes, there are hundreds of studies to prove this point. Lately, however, there have been some reports claiming that there is actually no ROI associated with wellness programs.
For one, that simply isn’t true. Those of us in the field know that well-designed programs achieve great financial ROI. But that simply isn’t the point and it’s not the only reason we should be investing in employee health. In the rest of the world, where often times paying for health insurance isn’t a responsibility of the company but rather the government, wellness programs still exists. Why? Because of all the other value associated with having a wellness program: recruitment, retention, productivity, reduced absenteeism, and morale to name a few.
A new term came up several times at the conference and I think it may stick. VOI: Value on Investment. I can’t think of a better value on investment than improved health.
2) Less finger pricks, more purpose.
Dr. Victor Strecher delivered a powerfully motivating opening keynote focusing on finding one’s purpose in life. It was quite refreshing to hear a well known industry researcher take a step back from the numbers and focus on individuals. This is a field, after all, that focuses on improving the lives of people. And the research tells us that there are three things that, more than any other factors, lead to behavior change: autonomy, mastery, and purpose. Autonomy: the feeling of being self-directed. Mastery: the feeling of self-efficacy. Purpose: the feeling of living a meaningful life.
As it turns out, people feeling a sense of purpose is fairly important. Does your organization focus on allowing employees to feel a sense of purpose? Does your wellness program address these needs? Health Risk Assessments and Biometric screenings may seem important, but so is an individual feeling like they have a sense of purpose.
3) Incentives do not work.
The secret is out: incentives don’t work. At least not in producing long-term behavior change, which is often times what they are used for as part of wellness programs. If you pay someone $100 to fill out an HRA, are they likely to comply? Sure. Will they show up to a weight loss class? Maybe. Will they lose weight and keep it off? No.
The research is very clear on this subject. For simple tasks (filling out a quick survey) incentives are great, they work quite well actually. One problem in this scenario, however, is the underlying message you are sending is that “this is not something you should want to do on your own volition and that is why I am bribing you to do it.” When goals become more complex (and changing one’s behavior towards a healthier lifestyle is very, very complex) incentives, at best, will not improve your chances and, at worst, make them worse. That’s right, incentives for long term behavior change do not work, and it’s well documented. This was echoed by expert after expert at the conference and I’m not sure why incentives are still so pervasive throughout health promotion programs.
4) Culture is key.
If incentives don’t change behavior, what does? Well, the term “culture of health” has been thrown around quite a bit for several years but that doesn’t mean anyone actually has a clue what that means or what it looks like. One thing that was repeated many times over the week was that it’s not even worth trying to change behavior if you don’t have a healthy, supportive environment. I’m not prepared to take it that far, although, I do agree culture is a very important component to a successful wellness program. Can you really provide nutrition education and allow employees access to unhealthy vending machine and cafeteria options at the same time? It’s certainly worth a long look at whether or not your organization’s culture is supporting healthy choices.
5) The more things change, the more they stay the same.
We would like to think that wellness programs have evolved quite a bit over the years. But we heard from many experts who have been in the field for a long time that they largely remain the same, at least in their format. Generally, an organization starts with all its employees (let’s say 1000). They assess those employees in some manner. Maybe half of them complete the assessment so we are down to 500 now. Then we target the highest risk employees with interventions thinking that they are driving the cost (maybe 20% of the 500, or 100 employees). Of those 100 employees maybe half of them will take part in the interventions we are offering and before we know it we have engaged 50 employees out of 1000.
Sure the assessments and interventions have changed over time, but this model really has not. And it’s about time it does.
6) The future is bright.
This field is full of bright minds and great companies really looking to improve health. There is no shortage of truly passionate people in the field and the conference saw its largest attendance in history this year.
Dr. Don Powell and his 35+ years of experience weighed in on the topic “Future Trends in Health Promotion” and he presented some thought-provoking ideas.
To highlight a few:
1) HRA’s and screenings will decline. We should be doing wellness with our employees, not to them. Additionally, we already know the risk factors of a population before we assess them. The data is readily available.
2) More emphasis on stress management. Most employees report that they experience increased levels of stress in their lives and the most common source is work. In order for organizations to successfully manage health, they must manage stress.
3) Personalized Self Care. Self care programs will become tailored in the way that other health programs have. When you enter symptoms into a program that software will have your family history and health record to help draw conclusions.
4) “Fit for Hire” certificates. There will be a governing body to award and monitor health status across employers. If you were deemed “fit” at your former job you can use that status to help gain employment at a new company.
5) Wellness will become Well-being. The focus of well-being will become more holistic include physical, emotional, social, spiritual, and financial health.
Are you ready to bring wellness to the table?
1. Show some numbers.
Do your research and get some data together that supports the cost savings of wellness programs. Our data tends to show an ROI of about $3 for every $1 invested in a program, but recent data suggests that as health care costs escalate, those returns could climb even higher. A self-care program alone can help employees reduce costly doctor and ER visits (averaging over $200 / $700 per visit, respectively) — a significant relief to your health care costs.
Start with this Harvard Business Review study on the hard return of employee wellness programs — some of the most recent and comprehensive hard financial data available. (Harvard shows a $6 to $1 ROI for wellness programs, by the way.)
And our Medical Self-Care Savings white paper shares in-depth results of several independent studies on our self-care guides.
2. Emphasize strategy.
Your company has short-term and long-term strategic priorities in place, as well as core values that guide decisions at the executive level. Do you know what those priorities and core values are?
If not, it’s worth finding out. Why?
Because wellness can be a business strategy. Just ask our friends at the LinkedIn group Wellness is a Business Strategy.
How can a wellness program help your business meet its strategic goals? How does wellness reflect your organization’s values? Answer those questions and you are well on your way to success at the executive table.
3. Find a champion.
Odds are there is at least one person in your organization’s upper ranks who already values wellness. You know the type: hits the gym during lunch, sits on an exercise ball instead of a desk chair, uses the office microwave to steam veggies for lunch, just got back from a yoga retreat, has an enviously healthy snack stash, or bikes to work.
That’s a partnership you can’t pass up. Talk to that person about your interest in starting a wellness and see if (s)he’s on board. Find an advocate for wellness on the executive level, and you’ll have someone to persuade fellow members of the c-suite to get behind your plan. It’s like having a seat at the table.
4. Start small.
Maybe you’ve been dreaming about a wellness program with all the bells and whistles: mobile biometric screening trucks, expensive incentives, a full-fledged fitness center with state-of-the-art equipment and flat-screen TVs, a huge online portal with an exhaustive library of information.
A wellness manager can dream, right? But if you know that your budget is the primary eyebrow-raiser for upper management, don’t despair. An effective, comprehensive wellness program can cost as little as $15 or $20 per employee.
The basics of a low-budget wellness program might include:
- Health risk assessment to determine population risks
- Self-care book
- Telephonic health coaching for lifestyle change programs like weight loss and smoking cessation
- Monthly wellness newsletter
- Online resources: A learning center, e-book, customized nutrition plan, or wellness challenge
- Promotional materials
- Supplemental health education materials (brochures, self-care kits, screening magnets)
We have loads more ideas for promoting wellness on a shoestring budget here.
5. Pilot your program.
If your executive team is still skeptical, consider piloting a program to a sample population. Keep it simple and low-cost, give it 9 months to produce results, and then do a thorough evaluation on how much you spent vs. how much you saved. You can offer a limited sign-up phase for interested employees and then do a random lottery if you have too many registrants.
If your program was successful — if it improved health, reduced costs, and met your goals and the goals of your organization — you’ll have a much easier time convincing upper management to support a company-wide wellness program.