Fighting costs with good health.

When management officials think of the word "health," the first thought that comes to mind is often health care, and the rising costs that can put a strain on their company. Good employee health, however, can help diminish those rising costs.

By taking the health of your employees into consideration, companies can not only improve their employee's well being, but also their bottom line through reduced health care costs. This article will discuss the wellness program in place at the American Cast Iron Pipe Co. (ACIPCO), Birmingham, Alabama, and illustrate the benefits that effective wellness programs have for both a company and its employees.

With more than 3000 employees nationwide, ACIPCO is a manufacturer of ductile iron and steel pipe, valves, fire hydrants and pumps for the waterworks, capital goods and energy industries.

Understanding Wellness

While everyone would like to improve their health, few people feel that the workplace is an ideal environment. However, by starting a corporate health program, which focuses on the early identification of chronic health risk factors as well as management of chronic disease conditions, there are several benefits that make the program ideal for the company's bottom line.

Health care costs have seen significant rises over the last several years. According to the Wellness Councils of America, Americans spend more than $1 trillion annually for health care, with an average annual health care cost of $4200 per person. This trend is not diminishing, as national health expenditures are projected to reach $2.1 trillion by 2007.

By establishing a corporate health program, employees become more physically fit and are less susceptible to diseases and other health problems. According to Partnership for Prevention, 95% of the nation's health expenditures, including most of the billions of dollars employers spend on health coverage, is committed to diagnosing and treating disease only after it becomes symptomatic. Table 1 shows the estimated number of deaths annually from preventable illnesses such as tobacco use, diet/activity and alcohol.

According to the Centers for Disease Control, more than 60% of adults in the U.S. do not exercise the recommended 3 times per week, and obesity is reaching monumental proportions with more than 25% of adults being obese. Other preventable problems include tobacco use, stress and chronic health conditions.

But why should a company address these health concerns in the workplace? Sixty-seven percent of the U.S. adult population is employed and working an average of 50 hr/week. As the payers of health care, an employer's profits are consumed by medical care costs and employee paychecks. Poor health habits take an enormous toll not only on health care costs, but also on an individual's productivity.

The National Safety Council estimates that 1 million employees are absent on an average workday because of stress related problems. At least 100 million workdays are lost each year to lower back pain at a cost of about $20 million to employers. A corporate wellness program can help to reduce both. Table 2 shows a cost-benefit of worksite wellness programs at several companies.

Wellness at ACIPCO

The first stages of ACIPCO's wellness program were established in the early 1990s. The first step was the formation of a wellness committee that had representatives from all areas of the company, including health services, safety, human resources, the work manager's office and elected employee representatives.

The committee advised the establishment of a back injury prevention program and a focus on reducing the risks of cardiovascular disease and cancer. The back injury program began with a focus on ergonomics. Job descriptions and task analyses were completed and ergonomic corrections were made. Additionally, injury prevention classes and nutrition and exercise classes were implemented.

To reduce the risks of developing cardiovascular disease and cancer, four programs were implemented: tobacco control, physical fitness and nutrition, employee health screens and stress management. Tobacco control was achieved through policies prohibiting smoking in buildings and vehicles. Sales of tobacco products were discontinued on-site and tobacco cessation classes were offered.

Physical fitness and nutrition programs began with the design of a walking track, and was followed by the implementation of weight-loss and exercise classes delivered by contract vendors. On-site physicians conducted employee health screenings, and employees who completed a healthy checkup received a free T-shirt. Last, stress management and positive thinking classes were offered through coordination of the employee assistance program.

In 1993, a full-time wellness coordinator also was hired to design and implement new and evaluate existing health promotion programs. Current ACIPCO wellness program offerings include: the Well Body Club (employee wellness screening), diabetes management, stress management, tobacco cessation, physical activity classes, nutrition education, CPR classes and on-site physical and occupational therapy.

Prevention Efforts

In establishing the foundation of the wellness program, ACIPCO defined three "Areas of Prevention."

Primary Prevention--The primary prevention was to promote good health and health education amongst the firm's employees. The goal is to maintain maximal health and functioning by reducing biologic, economic, social and environmental risk factors that are related to disease and injury.

Primary prevention includes the weight loss program, low-fat cafeteria entree choices, monthly health fairs, exercise classes and wellness discussions at all departmental meetings.

Secondary Prevention--The secondary prevention covers risk appraisal and screening in an effort to detect preclinical diseases. This can lead to early intervention for people who are at risk of illness or are beginning to encounter health-related problems.

Examples of secondary prevention include nutrition counseling for individuals at risk of cardiovascular disease, cholesterol screening for persons with a family history of cardiovascular disease, diabetes education and back classes for departments with higher incidences of back injuries.

Tertiary Prevention--The last level of prevention focuses on the treatment and rehabilitation of individuals who are experiencing illness or injury. This promotes maximum health and can help to prevent disability and secondary conditions that may result from the initial health problem.

Tertiary prevention include diabetes education for persons recently diagnosed with diabetes, physical therapy, cardiac rehabilitation for people with heart problems and hypertension management for those with high blood pressure.

Well Body Club

In an effort to achieve a higher level of employee wellness, ACIPCO started the Well Body Club, a wellness program that encourages employees to maintain healthy lifestyles, while simultaneously preventing illness and reducing health costs. This program was designed to reward those employees who practice healthy lifestyles with salary bonuses.

Employees first become eligible for the Well Body Club after six months of employment. After completing a wellness profile regarding current lifestyle practices, family and personal health history, and demographic information, each employee completes a wellness evaluation including the following eight categories:

* body fat percentage (associated with heart disease, cancer and other lifestyle related diseases);

* blood LDL cholesterol value (risk of heart disease);

* blood triglycerides (risk of heart disease);

* blood glucose (risk of diabetes);

* blood pressure (risk of stroke, heart and kidney disease);

* exercise (reduces risk of heart disease, obesity, psychological disorders);

* flexibility (associated with a risk of lower back injury);

* tobacco use (associated with cancer and heart disease).

After an employee participates in the evaluation, they are placed in one of four categories. The healthiest employees will be placed in Club 200. The next healthiest are placed in Club 50, followed by Club 25 and Club 10. Club members receive annual wellness incentives of the identical amount as their club number (i.e. Club 200 members receive $200 bonuses annually). Table 3 shows the number of ACIPCO employees in each category and how they have advanced over recent years.

Most wellness programs attract only healthy employees. The emphasis of this program is to reward healthy employees and provide incentive for the higher risk employees to improve their lifestyles. Employees are also eligible to receive an advancement incentive for moving up into higher health categories.

During the first five years of the program's existence, the wellness program at ACIPCO featured several health achievements, including:

* 200 employees quit smoking;

* 285 employees lowered their blood pressure to normal;

* 699 employees lowered their cholesterol to normal;

* 75 employees improved their blood glucose (sugar);

* 725 employees began a regular exercise program;

* 50 employees were diagnosed with diabetes.

The success of the program has been measured in more than improved health variables. The reduction in employee health risk factors have resulted in a cost savings for the foundry. The ACIPCO program has yielded more than $1 million cost savings in the first year from employee's participation and improved health, with savings realized in reduced employee absenteeism and health care utilization.

Based on information gathered in 2000, employees in Club 200 (the healthiest club) expended one-third the health care cost than employees in Club 10. Additionally, when employees moved to a healthier club, a 20% cost savings was noted the following year.

Building Your Own Program

When building your own corporate wellness program, there are several things that you must first consider.

Senior Level Support--Senior level support is critical to the success of every work site health initiative. Management controls the money, organizational agenda and communicational challenges.

Create Wellness Team--Establish a wellness team to include representatives from management, personnel, human resources, safety, information services, occupational health, elected officials and labor representatives.

Collect Data--Before a company can offer health activities, it first needs to understand both the needs and interests of its employees. This can include health care claims, health risk appraisals, health screenings, culture audits, facility assessments and demographic information.

Design an Annual Operation Plan--It is important to put in place a formal wellness plan that coincides with the corporate business plan. Without the document you have no goals or objectives that can be used to measure the success of your programs. Table 4 shows optimal budget guidelines per employee.

Identify Appropriate Interventions--All wellness programs are not equal and firms must choose the program that is right for them. Most common wellness programs include tobacco cessation, nutrition and weight loss, physical activity, stress management, employee health screening, self care and disease management.

Companies that are looking to begin wellness programs should learn from other successful programs. While 93% of U.S. companies report that they have offered at least one health promotion activity for their employees, only 27% of those conducted a needs assessment 17% had a written set of goals and only 12% conducted evaluations, according to the Wellness Councils of America.

Table 1. Annual Deaths Caused by
Preventable Illnesses in the U.S.

Cause           Estimated Deaths   Deaths per Day

Tobacco             430,000             1178
Diet/Activity       320,000             877
Alcohol             110,000             301

Table 2. Cost Benefit Worksite Wellness

      Company           Basis     Population   Cost Benefit
                                               per Employee

       DuPont           HC,SL       43,888        $2.05
    Ind BC & BS           HC        1,559         $2.51
     Prudential        HC,SL,DM     1,573         $2.90
Traveler's Insurance   HC,SL,P      36,000        $3.40
   General Foods          SL        1,705         $3.50
   City of Tempe          HC        1,325         $3.60
  Providence H.S.       HC,SL        955          $4.24
  Bank of America         HC        5,686         $4.73
 Canada Life Assur.       HC         628          $4.85
  Small Businesses        HC        4,712         $5.96
      Citibank            HC        22,933        $6.70
        P&G               HC        8,334         $6.82
   Coors Brewing          DM         180          $10.10
 City of Birmingham       HC        4,000         $19.40

Terminology

HC=Health Care
SL=Sick Leave
DM=Disabitity Management
P=Productivity

Table 3. Well Body Club Incentive and Monitoring
(based on participation of 1500 employees)

Club Category   1996 Results   1998 Results   2000 Results

     200            15%            22%            47%
     50             52%            58%            43%
     25             30%            20%            10%
     10              3%            0.5%           0.1%

Table 4. Health Care Budget Guidelines per Employee (Annually)

      Minimal Program           $1-7
      Moderate Program          $8-15
       Medium Program          $16-35
Fairly Comprehensive Program   $36-75
   Comprehensive Program       $76-125
          Optimal               >$125
           ACIPCO               >$200

For More Information

Visit the Wellness Councils of America at www.welcoa.org and the American Heart Assn. at www.heart.org.

Rebecca Kelly is the wellness coordinator at ACIPCO, Birmingham, Alabama.