Wellness: Obligation or Opportunity

Wellness: Obligation or Opportunity?

By: Todd Whitthorne, ACAP Health president

This article is featured in the July/August issue of Texas CEO Magazine.

An effective CEO shouldn’t spend too much time worrying about today, or even tomorrow for that matter.  CEO’s need to gaze out the window and ask, “How should I be preparing my organization for the next five to ten years?”  Obviously managing healthcare will be a primary concern.  But what about health?

The term “wellness program” has come a long way in the past decade.  It wasn’t long ago that whenever the term was mentioned most people would respond with a furrowed brow and a “What’s that?”  Today it’s a different story.  Now whenever “wellness program” is mentioned, more times than not, the response is a nod and an “Oh yeah, we have one of those!”

For most companies a wellness program is par for the course, much like water coolers, holiday parties, and 401K’s.   The problem is not all wellness programs are created equal and more importantly, most of them don’t make much of a difference.  That’s right…the majority of wellness programs are a waste of time and resources!

Most…but certainly not all.

There are five mandatory requirements for a wellness program to be successful…and the first one may be a bit surprising.

Stop calling it a Wellness Program!  What does “wellness” even mean?  To be honest, companies are encouraging employees to be healthier so they can be more productive and save money.  The driving force is economics, not philanthropy.  There’s nothing wrong with that.  It makes perfect sense because companies primarily exist to generate a profit.  Unfortunately that’s become increasingly more difficult in light of annual double-digit increases in the cost of healthcare.

“Wellness” is a vague term that usually includes things like lunch-and-learns, fruit and vegetable challenges, and fun runs.  These activities are all fine and can contribute to the overall culture of an organization but if the goal is to improve the health of the troops then it’s imperative to be laser-focused on measureable outcomes.  That means make sure to prioritize and incentivize the things that will make a difference…then measure the results!

Instead of “wellness” consider the term Clinical Improvement Program.  Why?  Because it all boils down to risk factors…the risk factors that lead to diseases like diabetes, obesity (yes, the A.M.A. has defined obesity as a disease), arthritis, depression, heart disease, and cancer.

If the “wellness” efforts are not measurably improving clinical risk factors then the organization is simply spinning its wheels.

Look in the Mirror.  What kind of company is it?  Is it one that’s willing to create a culture that holds employees accountable for their behavior or one that’s interested in offering some “wellness” options that may or may not be embraced by the workforce?  If it’s the latter that’s OK, but realize that won’t do much to slow the production and destruction of disease and is not going to have much, if any, economic impact.

If a company really wants to move the needle around health it’s imperative that leadership engages in honest dialog.  Be willing to ask some tough questions in order to determine the core beliefs concerning the organizations role in healthcare.
For example, which of these best reflects the organizations beliefs:

As an employer the limit of the company’s role is to provide access to market competitive health insurance and to share in paying the cost.

vs.

As a provider of health benefits, it is the company’s responsibility to influence personal behavior and medical outcomes.

There is no right or wrong answer and its probable the organization will fall somewhere in between the two extremes.  The real goal is to help leadership define “rights” and “roles.”

Here’s another example to help an organization define its’ position regarding healthcare:

It is part of HR’s job to design and administer benefits, but health status is a private matter.

vs.

It is part of HR’s job to improve the health status of employees and covered dependents.

Remember the only way to improve corporate health is to get individuals to change the behaviors that impact the risk factors we know lead to claims.  If an individual has “skin in the game” the odds that a positive change will occur improve dramatically.  It ultimately boils down to accountability.

Think about an individual’s driving habits.  If someone knows that getting a speeding ticket would not cost a dime they would most likely not think twice about driving too fast.  The same concept applies to personal health.  If someone else is paying for the office visit, acid reflux medication, or bypass surgery then an individual is going to be much less likely to skip the Krispy Kream or go for a walk.

For some companies that’s an easy concept to embrace.  The leadership understands that the status quo is not a sustainable option.  They recognize they must get their employees to participate in their own healthcare.

Other companies fear the fallout.  They believe their employees will complain and that morale will suffer.  It’s often just a matter of how the message is communicated.  Now that the Affordable Care Act is picking up considerable steam most employees understand they have to be more accountable.  Messaging and strategy are critical.  Are the changes perceived as carrots or sticks?  Keep in mind that often the sticks can be painted orange or the carrots can be frozen.

Assess Your Problem.  If your organization has 100 employees, and they reflect the national averages, then:

69 are overweight

36 of those are obese (a Body Mass Index above 30)

12 have diabetes (3 of those don’t know it…yet)

37 have pre-diabetes (this is a very important number…the clock is ticking)

33 have high blood pressure

17 have high cholesterol

33 have high triglycerides

17 smoke

95 fail to get enough physical activity

62 have sleep issues

77 struggle with stress

9 suffer from depressive issues

41 live with chronic pain

All companies, and their employees, are unique but most reflect the national averages.  To be sure it’s extremely helpful to collect aggregate data which requires doing biometric screening on an annual basis.  This assessment needs to include height, weight, waist circumference, a simple survey of family history (i.e. cancer, heart disease, stroke, diabetes, etc.), and blood pressure.  It must also include a fasting blood analysis that measures cholesterol (including HDL and LDL), triglycerides, blood glucose, and for those that qualify hemoglobin A1c.

The biometric screening can either be done in a doctor’s office or during an onsite assessment. (Screenings are often done during open enrollment or at an annual health fair).  Participation in annual screenings might allow your employees to receive a discount on their premiums…up to 30% which is a very powerful “carrot.”

One of the most important lessons from a biometric screening is…in the aggregate…how many employees have diabetes or pre-diabetes.  The outcomes can often be shocking.  The cost of healthcare for someone with diabetes is at least twice that of someone without the disease.

The real opportunity to impact both the health of the employees and the cost of healthcare is to keep those with pre-diabetes from “converting” to diabetes.  More than 90% of diabetes is Type II diabetes, which is primarily a “lifestyle disease” attributed to both obesity and physical inactivity.  In other words…it’s preventable!  From an impact perspective this is the low-hanging fruit.

An excellent predictor of diabetic risk is metabolic syndrome, or MetS.  Metabolic syndrome is a cluster of conditions-increased blood pressure, high blood glucose, excessive body fat around the waist, elevated HDL cholesterol, and elevated triglycerides-that dramatically increases the risk of heart disease, stroke and diabetes (by as much as 2100%).   When an individual has three or more of these factors out of range they, by definition, have metabolic syndrome.  It’s estimated that at least 25% of adults in the United States have metabolic syndrome and over 50% of those above the age of 50.

This is a perfect example of why it’s critical to accurately assess the health of the workforce.  Unless risk is objectively measured it’s impossible to know how many serious, and expensive, illnesses lie in wait.

Have a Definitive Strategy!  Once risk is determined it’s then possible to develop a strategic game plan.  By combining aggregate biometric data with demographics and claims history it’s possible to accurately predict what  future costs will be.  Then the leadership can design a plan that will not only improve employee health but also flatten the cost curve.

The cost of healthcare ultimately boils down to just two factors, utilization and price.  To effectively move the needle both must be addressed.

Aggressively working to improve the health of the workforce will result in lower utilization…employees simply won’t need to as many “ectomies.”  This will only happen by positively impacting the appropriate risk factors.  For instance, if only 3% of the workforce smokes then investing in a smoking cessation program is not a good use of resources.  However, if a significant percentage of the workforce has metabolic syndrome then that would be an excellent place to start.

There are multiple solutions available that allow employers to measurably improve the health of their workforce.  Be sure to look for programs that are scalable, easy to implement, and that offer clinical results.  Don’t hesitate to ask for performance guarantees.

Rely on Experts.  The key to any successful Clinical Improvement Program is dovetailing it with the organizations health plan.  More times than not companies have a “benefits” program that includes healthcare coverage and then a separate “wellness program.”  That’s a mistake…the two must be integrated.

While compliant “wellness programs” have been sanctioned by law since the ‘90s, there are exciting changes ahead for employers.  As of January 1, 2014 employers can now charge a 30% differential on healthcare premiums based on outcomes such as body mass index, cholesterol, blood pressure, blood glucose, etc.  [k2]

This gives employers a tremendous ability to hold employees accountable but you must follow the rules established by EEOC, HIPPA, GINA, ADA, ERISA, etc.  HIPPA privacy issues matter for companies of all sizes but can be a particular challenge for smaller organizations.
Healthcare costs have been rising for years and the worst is yet to come.  There are really only two choices.  Stand by and pretend everything is going to be fine…or…evaluate the options and develop a plan that will measurably improve the physical and fiscal health of the organization.  If you would like to learn more about how your organization can impact the health of employees, lower cost, improve your organizational effectiveness and productivity join us on September 14th for a free webinar hosted by ACAP Health and the North American Healthcare Forum.   See our events page for details and registration by September 12th.