Helping employees make informed decisions: by viewing employee health as an asset to be managed, employers can use health promotion and wellness programs to instill healthy behaviors among workers and encourage them to make smarter health choices.

Take a walk down the hall of a large metropolitan business. You'll see lots of cubicles and maybe a few meeting rooms and offices. Look more closely and you may see a company fitness center. The lobby may sport a coffee bar with Internet connectivity. Further observation might reveal an on-campus daycare center providing significant discounts for employees. Across the parking lot, employees can take advantage of a full-service primary care clinic offering medical, dental, and chiropractic appointments.

A look into the company of tomorrow? No, just a healthy company of today. More and more businesses are beginning to appreciate the intrinsic value of healthy, happy employees and are starting to view employee health as human capital. Consequently, they are beginning to view health as a manageable asset. Many employers are even going the extra mile and developing workplace wellness programs so they can provide convenient and affordable health-promoting services to employees.

LONG-TERM PROBLEM

Underlying these developments is a string of double-digit increases in health insurance premiums dating back to 2001. Though the rate of growth in health care costs appears to have slowed, most employers are still feeling the pinch. According to the National Coalition on Healthcare, employer health insurance premiums increased last year by 11.2 percent--nearly four times the rate of inflation.

Employers are starting to recognize, however, that the total health care value equation is about more than just costs and who bears responsibility for them. A 2004 survey of a cross-section of employers by the Integrated Benefits Institute (IBI) found that cost shifting--by which employers offset rising health care costs by increasing employees' deductibles and co-pays for doctors' visits and prescriptions--seems to be merely a short-term response to what employers see as a long-term problem. According to the survey report, employers "view promoting health and providing employees with the tools needed to make informed healthcare decisions to be as important as shifting costs to employees."

But even as employers begin to acknowledge that encouraging employees to take more responsibility for their health care is an effective way to manage costs, they are also starting to recognize that the success of this approach is contingent on employees making smarter choices related to their health. Indeed, almost half of the IBI survey respondents said that "encouraging healthy behavior in their employees is the best long-term approach to addressing rising costs," while fewer than one in five believe that "passing additional costs along to employees is the best long-term strategy."

Employers are not alone in favoring programs to encourage healthy behavior; the perceived value of such initiatives has been demonstrated time and again in employee satisfaction surveys as well. According to a 2002 study conducted by the American Association of Occupational Health Nurses, more than half of employees said they would remain at their current job if their employer offered a health and wellness program.

Unfortunately, some employers still view investments in human capital as overhead--that is, as costs that may not directly add value to the bottom line. If nothing else, however, investments in improving the health status of human assets add direct value because they curb productivity losses stemming from absenteeism. Given current literature on health promotion outcomes boasting an average return on investment (ROI) of approximately $3 for every $1 spent, the capital expense required to get a wellness program off the ground and keep it operating would appear to be more than justified by the payback.

HEALTHIER ORGANIZATIONS

The clinical evidence supporting the need for workplace wellness programs is imposing as well. According to a recent RAND report, one in five Americans is obese, and three in five are either overweight or obese. The researchers who compiled the report examined the comparative effects of obesity, smoking, heavy drinking, and poverty on chronic health conditions and health expenditures. Their finding: Obesity is the most serious of the four problems--and it affects more people.

"Obese people suffer from an increase in chronic conditions of approximately 67 percent when compared to normal-weight individuals of the same age and sex having similar social demographics," the report states The corresponding increase for normal-weight daily smokers, in contrast, is only 25 percent; for normal-weight heavy drinkers, the increase is just 12 percent.

What does this mean in terms of productivity and health care costs? The Journal of Occupational and Environmental Medicine reported on a study by Dr. Wayne Burton and others which found that the total number of sick days tended to rise with increasing body mass index (BMI). Those with higher BMI calculations recorded an annual average of 8.45 sick days, compared with 3.73 sick days for those with lower BMI figures. Average health care costs over a 3-year period for those with a higher BMI totaled $6,822, compared with $4,496 for those who were not overweight.

Ultimately, the "dollars and sense" all add up--wellness programs can provide for healthier employees and healthier organizations. Not every employer, however, has the physical space or the financial resources to install a state-ofthe-art fitness center. Employee assistance professionals can help in these situations because they are very well positioned to help identify and implement less costly but equally effective onsite programs and services.

One such option is a lifestyle management program for weight loss or tobacco cessation. These are gaining in popularity, in part because a well-structured program is able to offer a measurable return on investment over time. Other options for low-cost, easily implemented health and wellness interventions are online health risk appraisals (HRAs), health newsletters, onsite health screenings and fitness testing, health fairs, and education seminars. These are very effective methods of keeping people with minimal health concerns aware of risk factors and on the road to continued good health.

For those who are considered to be at higher risk and potentially less likely to engage in and/or sustain lifestyle changes, telephonic health coaching can be a very effective tool. Personal health coaching provides employees with support, education, feedback, and resources to help them eliminate barriers to healthy behaviors and achieve goals they may not be able to reach on their own. Health coaching is designed to guide people through the various stages of change--from the point of just thinking about whether it would be a good idea to initiating a plan of action and finally to relapse management.

REACH THEM TO TEACH THEM

The first question is, where to start? There are several approaches an employer can take to developing a wellness program. The first stage in the process is to clearly define the organization's goals and determine how health promotion will fit into the current organizational structure. A second critical step is to assess the needs and interests of the employee population. For example, injury prevention training may be a focus in a manufacturing setting, while ergonomics or cumulative trauma injury may be a source of concern in an office setting where employees spend four or more hours each day composing or responding to e-mail messages.

Finally, it's important to remember that understanding how best to engage employees and then planning a suitable communication strategy is critical to a successful outcome. The old adage, "You must reach them before you can teach them," should be the mantra for every employer as launch plans are developed.

Health promotion and wellness programs can enhance employees' job satisfaction, help make them aware of the importance of understanding their health status, and encourage them to take more responsibility for making informed decisions about their health. Employee assistance professionals can enhance the value of such programs by assessing organizational needs, planning a promotional strategy, and serving as a resource for establishing a workplace wellness program.

References

Burton, Wayne, Chin-Yu Chen, Alyssa Schultz, and Dee Edington. 1998. "The Economic Costs Associated with Body Mass Index in a Workplace." Journal of Occupational and Environmental Medicine 40 (9): 786-792.

Sturm Roland, and Kenneth Wells. 2001. "Does Obesity Contribute as Much to Morbidity as Poverty or Smoking?" Public Health 115: 229-295.

Nance Moeller-Roy, R.N.

Nance Moeller-Roy is a registered nurse with more than 20 years of experience in a variety of healthcare settings. She is director of clinical operations for CIGNA Behavioral Health's EAP, Disability and Depression Disease Management programs. She can be reached by calling 1-800-241-4057, ext. 2517, or sending an e-mail to [e-mail]