With businesses, municipalities, and hospitals jumping onboard in record numbers, worksite health promotion has earned a place at the employee protection table. The value of wellness programs, when used as an adjunct to traditional safety and health offerings, is clearly worth the investment, say proponents.

Many participating employers report a return on investment of several dollars for every dollar spent. And even when the programs break even, their contributions to reduced absenteeism and a more engaged workforce are considered valuable.

This Compliance Report examines an award-winning corporate program and a county-based initiative, both with satisfied clients and solid health and financial benefits. We also talk with the chief executive of one of the country’s leading health promotion companies to learn about industry trends. Look for solid ideas and money-saving tips that get employees engaged in their own health improvement.

There is a growing body of evidence that supports anecdotal reporting about the value of on-the-job wellness efforts. At the recent Psychologically Healthy Workplace Conference, Dr. Nico Pronk of the wellness provider JourneyWell addressed the connection between worker health and business performance.

Among his points:

• Four behaviors are the cause of nearly 40 percent of U.S. deaths. These are: tobacco use, poor diet, physical inactivity, and alcohol use. He believes personal behavior patterns rather than social or environmental circumstances provide the best opportunity for improving health.
• The cost of productivity loss for workers who eat poorly, are inactive, smoke, and overuse alcohol is five times higher than that of employees who have healthier habits.
• The healthcare costs for employees with good habits compared to those described above are nearly 50 percent lower.
• Additional support comes from the online resource WellnessProposals, which suggests that it typically takes about 18 months for a health promotion program to recoup investment costs of about $3 to $5 per month per employee. The return on investment can be as high as $4 to $5 for each dollar spent.

A recent University of Michigan (U-M) study described a utility-based program that saved $12.1 million on an investment of $7.3 million. Savings came from reduced medical and pharmacy costs, time away from work, and lower workers’ compensation costs.

Research scientist Dee Eddington explains that the U-M study differed from others in three important ways. It looked at the long-term impact of employees who participated and aged during the study. It took into account all bottom-line costs for implementing the wellness plan. And it studied lost work time as well as pharmacy and medical costs. Eddington says it’s not enough to offer a benefit plan that helps a company’s sick people get healthy. Also needed is a strategy to keep healthy people healthy and on the job.

Unum is a leading provider of employee benefits and services in the U.S. and the United Kingdom. Through its subsidiaries the company provided customers with nearly $6 billion in benefits in 2009. Andrew P. Molloy is assistant vice president for health management and insurance programs.

Molloy helps design Unum’s self- insured plan by reviewing data on claims, trends, specific conditions, and expenditures. About 17,000 Unum employees and dependents are enrolled in the health plan.

In the early 2000s Unum’s healthcare costs rose significantly. Options included sitting by as this continued and shifting those increases to employees. “Instead,” Molloy recalls, “We took the approach that we needed to get at the root of what was driving the costs.” The company learned that the bulk of its healthcare expenditure was (and continues to be) chronic conditions that can be affected by behavior.

So, beginning in 2003, Unum added a variety of health options and services to its medical plan under the name Take Advantage, It’s to Your Benefit.

In 2005 the company established health resource centers at three of its four largest locations. Each is staffed by a nurse whose primary role is as an educational resource for employees. Personnel need not participate in the health plan to take advantage of the service.

“So if I were overweight or had diabetes or hypertension I could consult the nurse at no cost to get guidance about a course of action and treatment,” explains Molloy. The nurse is not a replacement for a physician or other health resources, but is a source of free, confidential information.

Unum, like other health-minded businesses, wants employees to become aware of their blood pressure, blood sugar, and other key metrics. To that end it offers incentives for completing a health risk assessment (HRA) and offers free biometric screenings at the health resource centers. The nurses review the findings with employees, note changes from the previous year, and make recommendations for behavioral changes.

For employees with chronic conditions, Unum provides telephone-based disease management (DM) services. The counseling is performed by a reputable and vetted third-party vendor. Individuals are identified on the basis of medical claims or self- reported information on the HRA, says Molloy.

“For instance if I’m diabetic and the claims calculator sees I have been taking my medications for 3 years but suddenly stopped, it may precipitate an outreach.” Molloy says that once contacted, the employee may accept or decline the offer of help.

The Unum wellness program includes other elements including the following:

• Low-cost fitness center memberships at Unum’s largest facilities. Offerings include personal training.
• Access to no- or low-cost preventive services and screenings like mammogram, X ray, colonoscopy, and $15 annual checkups.
• Annual fitness challenges including events like walking competitions that focus on team participation. Participants earn points they can use to purchase backpacks, bags, and other gear.
• Classes and health education. Lunch-and-learn sessions cover subjects such as diet, exercise, and caring for elders.
• Company cafeterias, managed by the vendor Aramark, are the “next big front here,” according to Malloy. Current efforts to provide healthier alternatives and more nutritional information will be enhanced, he says.

Across the country in Tulsa, Oklahoma, an energetic county wellness program is spreading the message about employee health to its own employees and to private businesses.

Working for Balance is “a comprehensive workplace wellness program designed to contain corporate health-related costs by helping companies promote positive changes in personal health practices among employees.” It was developed through a partnership of the Tulsa (County) Health Department, Oklahoma University Physicians, and the YMCA of Greater Tulsa.

Jill Almond is wellness coordinator for the Department and for the program. She explains that Working for Balance is structured around six focus areas: nutrition, physical fitness, weight management, stress management, disease prevention, and smoking cessation.

In October 2007 the program opened to serve the health department’s 300-plus employees. Before long, it became clear that private businesses were in the market for similar services as a hedge against rising healthcare costs.

Today, the expanded staff includes several nurses and dieticians. Depending on the needs of the client company, services can include one-on-one coaching with a nurse or dietician, tobacco-free worksite training, menu planning, establishment of wellness policies and exercise guidelines, and fitness programming, including the American Heart Association’s Get Moving walking plan.

Stress management is a particular focus. An outside vendor offers classes in progressive relaxation and exercises employees can do at their desks to reduce the levels of stress they carry through the day.

Working for Balance has been well received by county employees who earn points for participating that can be used to buy sports clothing or reduce their insurance rates. Participants also benefit from fitness assessments that measure everything from flexibility, balance, and cardio endurance to blood sugar and body mass index.

“When we started participation wasn’t very good,” recalls Almond. “Our first screening attracted eight people and the following year we had 80.” Numbers have continued to rise, she adds. Almond and her colleagues are currently working with Tulsa University researchers to measure the value and impact of the wellness programming.

One of the private worksites that’s taking advantage of the program is the Osage Million Dollar Elm Casino located near Tulsa. HR specialist Jenny Bentley oversees health and wellness for the casino’s 1,000 employees. “My director came from a company that had a wellness program; participants enjoyed getting healthier and being able to do it at work. So she added wellness into our budget.”

The casino found that Working for Balance offered a diverse and affordable program. When wellness programming was first offered, the casino anticipated (and budgeted for) about 60 participants, but about three times that many applied. Today employees eagerly participate in fruit-and-vegetable-eating competitions, health screenings, vision and hearing testing, smoking-cessation programs, and health fairs.

Tulsa Health Department employees serve as health mentors for casino employees and for other private businesses that use the program. They start with an initial weight and blood screening and offer the services of nurses and dieticians depending on the individual’s condition and interest.

Osage employees have a 5-K walking/ running club and a variety of on-site team sports, including volleyball, softball, and basketball. The casino provides water and fruit and the employees enjoy fun, competitive on-site activity, especially on Tuesdays and Thursdays, the slowest days of the week.

Says Bentley, “We’re working out plans for next year and we plan to include more family and community events including volunteering.” She adds that casino management is fully onboard with the wellness program and has been highly impressed with the level of excitement and engagement.

Although the initiative has been in place only since January, employees have already lost significant amounts of weight, lowered their blood pressure, worked with health mentors, and burned calories in friendly competition with co-workers.

With a doctorate in the field and more than 20 years of experience in the healthcare industry, Gregg Lehman has a solid perspective on the world of wellness. He is currently CEO of HealthFitness, a Minneapolis-based business that collaborates with employers to provide personalized solutions to reduce risks and change behaviors.

The company’s client list includes some of the most well-known corporate names in the country. Lehman also serves on the board of the Disease Management Association of America. Asked about the ironic increase in wellness programs in a shrunken economy, Lehman offers a hypothesis based on his experience and observations.

“During tough economic times when employers were forced to downsize, many wanted to offer programs to deal with stress management, keep employees physically fit, and help them focus on good diet, exercise, and tobacco cessation.”

They added these programs, says Lehman, as an added benefit to help sustain the remaining workers who were being asked to shoulder more responsibility than ever before. According to Lehman, employers that have chosen this approach “have weathered the recession well with engaged, healthier employees” as well as with financial savings.

Some companies, including HealthFitness clients like Eastman Chemical, have seen a return on investment of several dollars for every wellness dollar spent.

“If you’re deriving more savings than the cost of the program in a recession, it’s more a question of why wouldn’t you do it than why would you,” he adds. According to Lehman, even breaking even can be seen as a win, with healthier, more engaged employees as the tangible result.

What’s the future of worksite wellness promotion? Lehman anticipates more mobile phone applications and use of social media and electronic coaching. He also sees a continuation of the emphasis on meaningful incentives for successful implementation and sustaining engagement.

Lehman believes the key to making incentives work is custom applications rather than a one-size-fits-all approach. “The sweet spot we’ve found in the marketplace is between $100 and $300 in incentives per person per year over and above the cost of the program,” he adds.

The trend is to tie incentive dollars to co-pays or deductibles as long as individuals continue to participate in a company’s health plan.

Such policies help level the playing field and ensure that employees who take responsibility for their own health are not subsidizing those who are less accountable.

Another trend likely to continue is encouraging biometric screening to supplement self-reported findings through HRAs.

And Lehman anticipates that more companies will find ways to integrate their health and wellness programs into overall safety initiatives.

Long-term wins will come from a more integrated approach that also includes absence management, pharmaceutical, and wellness prevention programs—collectively known as population health management. “I like to call it the connection between health and human capital,” states Lehman.

Workplace health promotion is a valuable tool to build engagement and participation while helping to identify chronic conditions and prevent illness. Proponents say they’re in it for the long term, confident that a fitter, healthier workforce means a fitter, healthier company and a trimmer bottom line.