15 Do-This-Not-Thats to Transform Your Wellness Program Into a Recruitment, Retention, Engagement, and Productivity Health-a-Palooza

in Commentary, Employee Wellness Programs
Strawberries and workers

Photo by JD Hancock

Only about half of employers evaluate their employee wellness program’s effectiveness, so it may be time to own up to the possibility that you have no idea whether your program is helping or hurting, or whether anyone even knows you have a program. Or whether your company even knows it has you. That’s okay. You’re okay.

Here are 15 Do’s and Don’ts to help you rise out of the abyss of employee wellness mediocrity:

  1. Don’t:  Start with changing employees’ behaviors.
    Do: 
    Focus on changing your organization. Healthy employees require reasonable job demands, input regarding job demands, appropriate rewards, reasonable work schedules, fair treatment, empowerment, less work-life conflict, and more social support.
  2. Don’t: Expect your program to reduce health care costs. Most likely, it won’t.
    Do: Strive to support your employees’ wellness aspirations. Positive outcomes originate with your good intentions.
  3. Don’t: Encourage your employees to get annual screenings.  Screenings are probably one of the least cost-effective components of your program.
    Do: Offer your employees paid time off and good health insurance so they can get the care they need, when they need it.
  4. Don’t: Invest heavily in health incentives. Incentives don’t support behavior change, and may stand in the way.
    Do: Offer wellness programs and opportunities employees want.
  5. Don’t:  Get caught up in language: “Wellness” vs. “well-being”; “return-on-investment” vs. “value-on-investment”; “health risk appraisal” vs. “health assessment.” Not only are these sideshows, but in most of these debates, the wellness industry is settling for the less specific — hence, less measurable — option. That said…
    Do:  Distinguish between “participation” and “engagement.” To use them synonymously is downright fraudulent. Especially: If you have incentives, you have unengaged participation.
  6. Don’t:  Call your health surveillance program an “outcomes-based wellness program.” It gives a bad name to those of us, and those employers, who truly care about worker wellness.
    Do:  Speak out — in professional networks, on social media, at conferences, in journals, and in your company — against the scourge of “outcomes-based wellness.” If you don’t stand up to protect employees from mercenaries trying to pass off discriminatory tactics as “wellness,” who will?
  7. Don’t:  Try to address all the dimensions of wellness.
    Do:  Pursue those dimensions of wellness that employees want addressed, that they will respond to, and that are actionable by and meaningful to your organization. (The dimensions of wellness — physical health, emotional health, spiritual health, financial health, occupational health, environmental health, relationship health, and so forth — are interdependent. When you influence one, you’ll influence others.)
  8. Don’t:  Rely on wellness committees to do the work. You don’t use committees to run your other employee benefits or your total rewards programs, do you?
    Do:  Hire qualified professionals to do the work.
  9. Don’t:  Do something just because you heard about it at a conference.
    Do:  Avoid insularity by attending wellness conferences and conferences focusing on unrelated industries.
  10. Don’t:  Limit yourself to the conventional American perspective on wellness.
    Do:  Read the World Health Organization Healthy Workplace Framework and also RWJF’s Work, Workplaces and Health. (They make scant mention of biometric screenings, health risk assessments, incentives, coaching, apps, portals, or wearables.)
  11. Don’t:  Fret about what external critics think.
    Do:  Define a clear goal and measure progress toward achieving it. Satisfy the needs of the organization.
  12. Don’t:  Expect much from your health risk assessment. It’s outdated and was never an effective catalyst for behavioral change.
    Do:  Leverage your aggregate health risk assessment data as a tool to assess how you’re doing and how you can most effectively serve employees.
  13. Don’t:  Obsess over obesity in the absence of population-based solutions.
    Do:  Provide employees with delicious, fresh, whole food, when it’s necessary to provide food, and with opportunities to move.
  14. Don’t:  Get preoccupied with employees’ families. They don’t want you messing in their business.
    Do:  Get preoccupied with the health of the community you are in. They do want you messing in their business, and you’ll stand to affect employees and their families in the process.
  15. Don’t:  Take it from me…
    Do:  Seek diverse sources of evidence and opinion, and draw your own conclusions.
    ……

[15 Do-This-Not-Thats to Transform Your Wellness Program Into a Recruitment, Retention, Engagement, and Productivity Health-a-Palooza was originally published on the InTEWN blog, April 2015. Some of the links have been updated]

Health Risk Assessments: The Baby and the Bath Water

in Uncategorized, Commentary, Employee Wellness Programs

 

There may be some employees whose health has benefited based on some feedback they got on an HRA, but not enough to warrant the investment you are making in the HRA (that investment includes your organization’s money; your time; and, perhaps most importantly, your participants’ time, energy, and goodwill). But don’t listen to me. Your employees will also tell you that your HRA doesn’t make much difference to their health. That’s why some employers pay employees up to $500 just to complete an HRA.You wouldn’t have to pay employees to complete a simple form if they actually saw any value in it to begin with.

A series of blog posts about HRAs  has deconstructed HRAs with an eye toward better understanding their value or lack of value. Here are the cliff notes:

  • The conventional framework of employee wellness programs is predicated on the principle that improvements in the health risk profile of a population can lead to reductions in healthcare costs and improved employee productivity.
  • HRAs are techniques or processes of gathering information to develop health profiles, using the profiles to estimate future risks of adverse health outcomes.
  • HRAs are dependent on self-reported data, which is valid for effective use in population health management intervention, although its value at the individual level is questionable.
  • Importing clinical screening values — such as blood pressure and cholesterol — to an HRA does not add much validity to the HRA on an individual basis, but, like the self-reported data, should be sufficient to measure the health risk of a population.
  • HRAs may help steer individuals towards more intensive programs based on the position of the individual in the strata of the population’s health risk and predicted health care costs.

These findings point to the same thing: Health risk assessment is a population health tool. HRAs’ primary utility is in helping employers identify the health risks that deserve the most attention in order to achieve positive health and financial outcomes. The same tool can then be used to measure a program’s success in shifting the health risk of the population.

Unfortunately, employers have been using HRAs, a population health measurement instrument, as a behavioral intervention. No wonder you are disappointed. Be honest with yourself and with your employees: The HRA is for you — a potentially useful tool in the administration of your program. It’s not an employee benefit, and your employees know it.

Part of the reason employers have mistaken HRAs with a full-fledged health intervention is that vendors have marketed them as such. As a measurement tool, you should reassess whether your HRA is worth what you are paying.

But don’t rush to throw the baby out with the bath water. If you decide that your HRA’s capacity to measure risk in your employee population justifies its use, your next step is to reconsider whether you truly need to have all your program participants complete an HRA every year. Your vendor doesn’t want to hear it, but you may be able to realize the measurement potential of your HRA more cost effectively by having a sample of your employee population complete it every two or three years.

I’m not making a case for or against health risk assessments, just encouraging you to make a well informed and critical decision. What do you want your HRA to do? What does your HRA do? Is your organization getting its money’s worth?

[This article was originally posted on the InTEWN blog July 11, 2012].

Are Health Risk Assessments Effective?

in Uncategorized, Employee Wellness Programs

Are health risk assessments effective? Three systematic reviews have sought to answer this question.

One of the most rigorous and most recent analyses, Health Risk Assessment: Technology Report, conducted by McMaster University Evidence-based Practice Center for Agency for the Healthcare Research and Quality, examined 118 studies of health outcomes associated with HRAs. The report concluded:

Many HRA programs demonstrated improvements on intermediate health outcomes such as blood pressure, cholesterol, physical activity, or fat intake. However, only one article considered hard health outcomes (i.e., freedom from any of the following after 24-month followup: death, myocardial infarction, stroke, Class II-IV angina, or severe asymptomatic ischemia ). Also, followup periods were often shorter than 24 months. Therefore, we were unable to assess whether HRA programs produced health benefits over the medium to long term.

A previous, similarly comprehensive, review was conducted by RAND Corporation. RAND’s study endeavored to evaluate the effectiveness of HRAs for Medicare populations, but in order to do that their study focused on the evidence of HRAs’ effectiveness in any setting, especially worksites. Rand’s conclusions foreshadowed the AHRQ study, stating, “Interventions that combine HRA feedback with health promotion programs are most likely to show beneficial effects… It is not known if these effects persist over the long term.” But Rand also examined cost-effectiveness — importantly for corporate wellness programs — and added:

Current literature is insufficient to accurately estimate the cost effectiveness of programs using HRA. Limited evidence suggests that a carefully designed program that uses a systematic approach to implement HRA and subsequent disease prevention/health promotion interventions has the potential to be cost-beneficial. Considerable effort is needed to optimize program design, implementation, and evaluation.

Yet another study, conducted by the Task Force on Community Preventive Services and published in the American Journal of Preventive Medicine in 2010, suggested more positive outcomes for HRAs, but still with qualifications. The study concluded that HRAs with feedback “has utility as a gateway intervention to a broader worksite health promotion program that includes health education lasting at least one hour or being repeated multiple times during one year….Results of this review suggest that this intervention may be more effective for some outcomes (e.g., smoking behavior or cholesterol) than for others (e.g., change in body composition).”

(These three reviews, in addition to trying to measure the value of HRAs, also provide comprehensive background information about HRAs — their history, their intended purpose, their modes of delivery, their strengths and weaknesses. If you haven’t studied HRA methodology, I strongly recommend that you read at least one of these reviews.  Any of these three reviews will provide much-needed context. The AHQR review is the best place to start.)

Each of these reviews suggests that there is or may be some potential for HRAs in evoking positive health outcomes for individuals, but none of them are a ringing endorsement. In an upcoming post, I’ll offer my own opinion on why employers may want to hang in there with their HRAs.


[This post was originally published on the InTEWN blog on July 6, 2012]

The (Theoretical?) Framework of Employee Wellness

in Uncategorized, Employee Wellness Programs

tape measure, notebook, appleHow is employee wellness supposed to work?

For starters, here’s the prevailing rationale that serves as the framework of most employee wellness programs today:

  1. Most health problems, and their associated costs, are preventable.
  2. Modifiable health risk factors — such as tobacco use, sedentary lifestyle, and unhealthful eating habits — are precursors to many of these health problems.
  3. Many modifiable health risks are predictive of higher healthcare costs and decreased worker productivity.
  4. Employer sponsored wellness programs can reduce modifiable health risks.
  5. Improvements in the health risk profile of a population can lead to reductions in healthcare costs and improved employee productivity.

Important to this understanding of employee wellness are a few other learnings about health risks and their impact on health and productivity:

  • The number of health risks an individual has may have greater impact on financial outcomes than the severity of any one health risk. This is especially true for clusters of health risks related to heart disease, stroke, or psychosocial disorders (such as depression and anxiety).
  • Keeping low-risk employees low-risk may be a more direct route to health care cost containment compared to trying to improve the risk profile of high-risk employees. This focus on the low-risk, advocated by Dee Edington, is counter to a commonly accepted approach in which high-risk employees are targeted — based on the theoretical efficiency of targeting the 20% highest risk individuals believed to incur 80% of health care costs.
  • While it is unsurprising that risk is an indicator of future health problems, risk also is correlated — via mechanisms not fully understood — to near-term health care costs. In other words, one might expect that someone with cardiac risk factors is likely to incur higher health care expenses when they have, say, a heart attack, studies by Goetzel, Anderson, et al have shown that risk factors are associated with higher health care costs even in the near term, before the emergence of full-blown disease.
  • In employee wellness, absenteeism and presenteeism are the most common productivity metrics.

The model described by Goetzel and Ozminkowski is not the only rationale for conducting employee wellness programs. It may not even be the best rationale. But as we move forward in the next few posts to understand health risk appraisals — what they do, what they don’t do, and how they are perceived by wellness managers — it is essential to understand modifiable health risk and its role in the proliferation of employee wellness programs.


This post originally was published on Bob Merberg’s InTewn blog on May 27, 2012.