Planning a Staff Wellness Program

1.To provide information on how to initiate a staff wellness program that fits the mission, vision, and values of an organization.
2.To review ways to determine the wellness needs of an organization’s staff and identify their greatest health risk factors.
3.To provide a framework describing steps on how to plan, develop, implement and evaluate a wellness program.

Perspectives on Wellness :
• Physical – fitness, nutrition, medical self-care
• Emotional – stress management, depression, crisis care
• Social – community, family, friends, co-workers
• Intellectual – educational, career development, achievement
• Spiritual – love, hope, charity
• Occupational – safe, nurturing worksite environment
You define wellness for your organization!
Source: Am.J of Health Promotion & National Wellness Institute

• Wellness: “An intentional choice of a lifestyle characterized by personal responsibility, moderation, and maximum personal enhancement of physical, mental, emotional and spiritual health.”
• Worksite Wellness Program: “An organized program in the worksite that is intended to assist employees and their family members (and/or retirees) in making voluntary behavior changes which reduce their health and injury risks, improve their health consumer skills, and enhance their individual productivity and wellbeing”.
The purpose of worksite wellness programs is to improve the health and productivity of the staff and reduce health-related costs by helping to change towards a healthy lifestyle.
Source: Larry Chapman, WebMD Health Services

The relationship between modifiable health risks and health care expenditures:
Staff who are/have:
Depressed have 70% higher annual health plan costs.
Stressed have 46% higher annual health plan costs.
Elevated blood sugar have 35% higher annual health plan costs.
Obesity have 21% higher annual health plan costs.
Smokers have 20% higher annual health plan costs.
High Blood pressure have 12% higher annual health plan costs.
Not exercising have 10% higher annual health plan costs.
Source: Goetzel RZ, et.al (1998, October). The relationship between modifiable health risks and health care expenditures: An analysis of the multi-employer HERO health risk and cost database
JOEM, 40(10):843-54.

Sick Leave Absenteeism – impact of behavioral health risks (n=34,451)
• Mental health related sick leave results in a 150% higher absenteeism
• Back Pain – 140% higher
• Stress – 131% higher
• No exercise – 118% higher
• Obesity – 116% higher
Source: Serxner, S., et al., (2001). The impact of behavioral health risks on worker absenteeism.
JOEM, 43(4), 347-354.

Workers Comp (WC) Costs are higher for increased health risks (n= 3,338)
• Low Overall Wellness Score – 1989% higher annual WC costs
• Smoking – 1243% higher
• Poor health – 836% higher
• No exercise – 556% higher
• Low life satisfaction – 255% higher
Multiple health risks multiply WC cost
• Low health risks = $106 average annual WC cost
• High (multiple) health risks = $1241 average annual WC cost
Source: Musich, S., et al (2001, June) The Association of Health Risks with Workers’ Compensation
Costs, JOEM, p. 534-541.

Percent of Working Adults with Major (Preventable) Risk Factors
• Poor Nutrition – 71%
• Little or no Exercise – 63%
• Stressed – 61%
• Cholesterol – 54%
• Back Care – 44%
• Driving related (seat belt use, speeding, DUI, texting/cell phone)– 32%
• Smoking – 22%
• High Blood Pressure – 21%
• Alcohol Use – 16%
What is your organization’s “fingerprint” of health risks?

Estimated 2004 Median Health Cost per Employee - $18,538
N=46,000 + x 3 years
Health Claims - $7,465
Turnover - $5,908
Absenteeism - $1,296
Disability - $820
WC - $496
Presenteeism - $2,554
Source: Goetzel RZ, et.al (1998, October). The relationship between modifiable health risks and health care expenditures: An analysis of the multi-employer HERO health risk and cost database JOEM, 40(10):843-54.

Plan on Addressing
• Physical activity
• Tobacco use
• Stress
• Weight Management
• Blood pressure
• Cholesterol
• Nutrition
• Medical self-care
• Back care
• Injury prevention

Challenges
• To make a case for a wellness program – a clear economic rationale
• To demonstrate importance in reducing health costs
• To propose a model program and evaluation plan that best fits your organization
• To propose a reasonable budget that will achieve your program goals.
• To identify a senior level wellness champion
• To show that prevention can result in a return on investment within as little as one year
• Implement an annual evaluation and regularly report progress and results.
It is also the right thing to do for your employees!

For Planning a Wellness Program, look at:
• Historical data (if any)
• Demographic data
• Employee Wellness Interest Survey
• Focus groups
• Design team
• Medical claims data
For Evaluation of your program, look at:
• Medical claims
• Prescriptions claims
• Workers Comp
• Sick leave
• Disability
• Presenteeism

Quality of Worklife Model
• The fun approach, morale-building
• A good fit with smaller work-sites (< 1,000 employees)
• ROI is a low priority
• New to wellness
• Limited follow-through capability
This model may have:
• Group activities
• Fun and social events
• Awareness-oriented
• Light focus
• Limited biometric testing
• No spouses served

Primary Wellness Targets: fun events, stress relief, nutrition, community service, general wellness and health information
Typical Activities: health fairs, lunch and learn, wellness event, free fruit, chair massages, nutritious pot lucks, movie events, company games
Participation: 15% to 35% of staff
Approximate cost / EE / Yr: < $45
Likely ROI: < 1:1.0

Traditional Approach Model
• A good fit for medium sized or larger worksites (>1,000 and > 10,000)
• ROI is a moderate priority
• 2-10 years of wellness
• Some follow-through capability
• Follows corporate direction
This model may have:
• Both group and individual activities
• More health emphasis
• Education-oriented
• Mixed focus
• Moderate biometric testing
• Knowledge building
• Spouses served

Primary Wellness Targets: In addition to the Quality of Work Life Model, plus the overall wellness score, cholesterol, BP, tobacco use, obesity, medical self-care, physical activity
Typical Activities in addition to QWL: Health risk assessment (HRA), biometric testing option, fitness club memberships/facility, weight management program, smoking cessation, web-based health info, healthy cafeteria/vending options, preventive medical benefit coverage, wellness newsletter, short-term incentive program
Participation: 28% to 58% of staff
Approximate cost / EE / Yr: $46 - $150
Likely ROI: 1:1.5 to 1:3.0

Population Health Management model
• A good fit with larger work forces (> 10,000)
• ROI a very high priority
• Very mature wellness
• Prepared to educate staff
• Strong follow-through capability
• Strong virtual corporate and site-driven
This model is:
• Mostly individual based
• More risk emphasis
• Behavior-oriented
• Serious focus
• Heavy biometric testing
• Skill building
• Most spouses served

Primary Wellness Targets: In addition to the Traditional Model, plus productivity, injuries, HC utilization, presenteeism, health consumerism,
Typical Activities in addition to Traditional: HRA (incented and used for targeting with 80% minimum), risk stratification and incented interventions, telephonic coaching, medical self-care and consumer workshops, injury prevention, benefit linked incentive, wellness achievement incentives, resiliency initiative for productivity, spouses also served
Participation: 65% to 95% of staff
Approximate cost / EE / Yr: $250 - $450
(this cost does not include staffing and incentive costs)
Likely ROI: 1:2.5 to 1:6.5

Virtual –based program infrastructure :
• On-line Health risk assessment (HRA)
• Incentives for Wellness (track on-line)
• Wellness newsletter
• Email and messaging
• Health guides
• Welcome kit
• Telephone/on-line coaching
Site-based program infrastructure :
• On-site programs, facilities such as yoga class, gyms, tobacco cessation classes, massage therapy, challenges, etc.
A good wellness program will have an infrastructure that includes both virtual and site-based!

Brand your program!
• Program Name
• Logo
• Tag line
• Art style
Internal program staff
Vendor staff (HRA, lifestyle management, coaching, incentive program)
Form a Wellness Team with good employee representation
Program proposal and work plan
Program goals/objectives
Program budget
Program evaluation plan
Develop a strong communication plan!!

• Onsite fitness facilities and training facilities.
• Shower facilities
• Bike racks
• Walking trails
• Healthy food options
• No tobacco vending – tobacco-free campus!
• Computer access to E-health resources
• Quiet space
• Wellness as a formal organizational value
• Employee orientation
• Flex time for exercise
• Incentive rewards for wellness
• HR policies
• Wellness recognition
• Medical benefit coverage for prevention
• Performance appraisals
• Financial incentives
• Environmental change
• Employee involvement
• Reminders
• Consistent focus
• Policies
• Benefits
• Communications
• Supervisor support
• Leadership support

HRAs function to:
• Help the individual view his or her health risk factors;
• Provide a personalized plan that serves as a catalyst for health behavior change;
• Allows the individual to monitor their health over time;
• Determines readiness for change; and
• Evaluates any changes in personal health.
Employers gain valuable group data to identify greatest health risk factors, attitudes, readiness and perceptions of their staff over time.
Select an HRA (HRA vendor) that will meet your wellness program goals!

Maximize completion by:
• Addressing employee concerns (confidentiality)
• Make it a part of your annual open enrollment
• Connect to flex plan choices
• Provide a premium reduction for completing
• Require for HSAs
• Provide cash for completion (size of reward will increase participation;
80% or greater completion if reward is at least $200).

• Select a good HRA
• Incent it strongly
• Use the data for planning
• Plan and implement virtual interventions
• Use cohort data for evaluation and future planning

Most popular:
• Walking events and clubs
• Weight loss groups
• Women’s and Men’s health issues
• Smoking cessation
• Fitness center membership
• Sports leagues
• Support groups
• Stress management

• Employee health services
• Fitness camps and exercise classes
• Smoking cessation classes
• Nutrition classes
• Massage therapy
• Individual and group challenges with incentives
• Health fairs
• Sports challenges and teams
• Weight loss challenges and groups
• Walking /cycling challenges and groups
• Blood pressure screenings
• Flu shots

• Websites
• Email
• Supervisors
• Flyers
• Table tents
• News ads

1. Did the program meet its objectives?
2. How many people participated in the program (or in each component of the program?) – include HRA completion.
3. How did the users like the program (individual program evaluations)
4. What improvements in individual health or risk factors occurred? – include comparison to previous years HRA
5. What positive effects did the program have on our organization? – health claims, sick leave, WC, etc.
6. How much did the program cost?
7. What was the net economic effect (C/B or ROI?)
8. How should the program be changed for this next year?

Lisa Reeve
Director of Wellness and Health
Human Resources
Scott & White Healthcare wellness@swmail.sw.org