SAN DIEGO – The nation’s big corporations go to great lengths to get employees to exercise, lose weight, eat better and quit smoking. But all-too-often these corporate wellness programs leave employees’ physicians out of the loop.
“We need to form better connections with the primary care practitioners,” said Larry Chapman, Senior Vice President of WebMD Health Services, a provider of information technology for corporate wellness programs.
Speaking at a conference sponsored by World Research Group, Mr. Chapman presented a survey of more than 20,000 employees at 8 different corporations. He noted that 90% of respondents said a doctor’s recommendation is a strong motivator of participation in a company-offered wellness program. Yet fewer than 25% of these programs engage physicians at all.
Better Health, Big Savings
When they work, wellness programs can greatly improve employee health. Patti Clavier, RN, manager of Intel Corporation’s “Health For Life” program reported that of 5,455 employees participating, 21% transitioned from high to low risk status over the course of a year, as measured by a Mayo Clinic Health Risk Assessment (HRA) tool. The risks that changed included high blood pressure, elevated blood glucose, sedentary lifestyle, overweight and smoking.
The coaching program is available at all US Intel work sites, and is “wildly popular with employees,” Ms. Clavier said.
Intel’s productivity improves by about 0.5% for each employee who successfully reduces a major risk factor. “We can save about $782 per employee per year for each employee that moves from high to low nutritional risk categories,” she said.
Given the huge burden of medical costs and absenteeism, corporate leaders have strong incentive to push employee wellness. At the same time, wellness programs are a big up-front investment and the payoff is seldom immediate.
Corporations typically contract with outside vendors that provide standardized online HRA and self-care tools, as well as trained health coaches to encourage exercise, healthy diets, smoking cessation and stress management. The coaches sometimes play a quasi-clinical role, taking vitals and tracking biometric data, but they rarely communicate with employees’ doctors.
Why the Cold Shoulder?
Why do so many wellness programs exclude doctors? In some cases, it is because executives see physicians as the embodiment of the very medical costs they’re trying to cut. Some also believe—rightly or wrongly—that doctors are clueless about prevention.
WebMD’s Mr. Chapman said conventionally trained physicians do often miss prevention opportunities because they’re overly fixated on particular organ systems. “A doctor will see a patient complaining of knee problems, and he’ll focus on the knee, but never talk about the patient’s weight.” He added that many doctors believe, consciously or unconsciously, that patients with longstanding unhealthy habits are unwilling to change, so time spent on prevention is not only non-reimbursable, but also futile.
Ms. Clavier said Intel is among a handful of big employers that see the value of primary care in the wellness equation. Intel has on-site primary care clinics at two of its Arizona facilities. “If they (employees) already have relationships with community-based physicians, we don’t break them. But men in their 30s, who represent our core employees, don’t usually have primary care doctors.”
It is the health coaches provided by Take Care Health Solutions, who are doing the bulk of the wellness work for Intel insiders, and Ms. Clavier gives them high marks. They “are very well versed in behavioral change, and work with employees very well.”
Of Bribes & Betterment
Most corporations must incentivize people to participate, and the inducements are significant: paid leave, reduced insurance co-pays or premium shares, and straight cash rewards are common. Not surprisingly, the bigger the reward, the better the participation.
Twenty years ago, executives hoped they could engage employees with the promise of better health, and inexpensive tchotchkes like T-shirts, baseball caps, and gift cards. These days, they’re spending thousands of dollars per employee per year— and that’s on top of the basic costs of the wellness programs.
“People respond well to bribery,” said Stuart Slutsky, Chief Marketing Officer for Vitality Health Engagement Solutions, a proprietary wellness program provider with corporate contracts covering over 1.5 million people worldwide. The challenge for employers is to find the right incentives.
In the 20,000-employee survey by WebMD, 49% of respondents said their preferred incentive was a lower monthly health insurance payment, something Mr. Chapman said more companies are now offering. Thirty-three percent said they preferred cash rewards.
Some companies find that paid time off is even more alluring. “This is particularly true for higher-ranking employees who are already well compensated,” said Tanya Lewis-Walls, Senior Director of UnitedHealth Group’s “Clinical Solutions” wellness program.
Cathy Murphy, VP of Human Resources at Blue Shield of California, strongly agreed. Under its new “WellVolution” program, the California Blue offers an extra “Health Day” off to employees who complete an HRA and undergo some basic biometrics. Ms. Murphy said 52% of all company employees have now taken advantage of this, at a cost to the company of about $2 million last year.
Kellogg’s, as part of an effort to reclaim its roots in health and nutrition, gives employees chances to shave up to $1,100 per year on their insurance premiums if they complete an HRA, demonstrate that they are non-smokers (or participate in a cessation program) and make other lifestyle changes. David Tanis, one of the company’s health promotion specialists, said employee participation was up to 71% last year.
Executives are also learning that healthy behaviors don’t occur in a vacuum. They’re part of a culture of health that involves community and family outreach.
The WebMD survey identified employees’ spouses as key drivers of wellness participation. Some companies proactively extend the wellness programs to employees’ entire families
Worker Health=Employer Wealth
There’s a reason companies will spend so much to get their people on the road to wellville. A longitudinal study of 375,000 employees at companies offering Mr. Slutsky’s Vitality programs for five years or more showed a 79% increase in the number of people who exercise regularly. Frequent exercisers show a 29% reduction in net health care spending, and have 8-20% reductions in hospital admissions for things like CVD, cancer, metabolic disorders, and musculoskeletal problems. When they are hospitalized, their lengths of stay are 7-10% shorter.
Employees who achieve healthy weight goals can save their companies as much as $2,500 per year in reduced medical cost, absences, and lost productivity. Workers who quit smoking can save their bosses up to $3,500.
Corporate wellness advocates acknowledge that the programs are a tougher sell these days, given the bad economy. And with the enactment of the new Genetic Information Non-discrimination Act (GINA) law, collection and utilization of HRA data in corporate wellness programs is going to be a lot harder. Under some interpretations of the law, certain family history information is considered “genetic information” and therefore cannot be disclosed to employers or employer-backed insurers.
Still, employer-funded wellness programs are likely to be around for quite some time. Physicians are wise to ask patients who work at large corporations if they’re participating in a wellness program and to offer support to the extent the patient and his or her company is willing to accept it.