During a recent online course sponsored by RYAN Associates, four occupational health and wellness professionals discussed Workforce Health and Productivity Management. The following article features excerpts from that discussion.
The speakers are:
Stewart Levy, President, Health Promotion Solutions, Philadelphia, Penn.;
Mike Nordness, Manager, Wellness Works, Watertown Area Health Services, Watertown, Wis.;
Brenda Schmidt, President, Diversity Wellness, Phoenix, Ariz.;
Terry Sutterfield, Director, Corporate Business Development, Community Hospital Occupational Health Services, Indianapolis, Ind.
Q: What advice do you have for provider-based occupational health programs seeking to further extend their wellness and health promotion outreach to employers?
Mr. Levy: Recognize that the work site is a good place for these programs. There is a captive audience with repeat consumers and the necessary social support.
Mr. Nordness: Tailor services for each client – there isn’t a one-size-fits-all model – but also encourage all your clients to conduct a workforce health risk assessment (HRA) with incentives for participation. The HRA is the cornerstone of the program, and you want to get as close to 100 percent involvement as possible.
Ms. Schmidt: Fully integrate employee health and wellness into your occupational health program. Lay the foundation for success with program design and analysis to determine the real needs of the population.
Mr. Sutterfield: Position your program as a partner to companies that strive to be the employer of choice.
Q: What specific wellness-oriented business strategies have you seen produce positive results?
Ms. Schmidt: There is a great opportunity for occupational health professionals to have day-to-day contact with employees coming in for physicals, flu shots, drug screens, and other routine services. Professionals with the right training and resources have multiple opportunities for brief interventions, which have been shown to be effective in a non-threatening way. Tools and resources include motivational interviewing techniques designed to achieve changes in behavior, one-on-one coaching, and a variety of health education materials.
Mr. Sutterfield: We opted to answer the market call by forming Infinity Employer Health Solutions, a division dedicated to partnering with employers. Employers are looking for an organized system and services that complement their company culture and goals. With employers, we function as the face of the health system and a conduit to these services. The pillars of our program include occupational health clinics and onsite services, rehabilitation, and absence management programs. Health promotion has generated considerable activity within the health network for our own 10,000 employees, allowing us to demonstrate our ability in education, screening, coaching, employee assistance, disease management, and overall organizational effectiveness.
Mr. Nordness: We look well beyond the confines of the occupational health clinic. Our objective is to offer an integrated, total health and wellness management program. We work to create a relationship with our clients and their employees. We become part of a company’s team by broadening our scope.
Q: In your opinion, what specific wellness-oriented product lines have the greatest long-term potential in terms of provider revenue generation and improved workforce health?
Mr. Levy: One important thing is the disability and chronic disease you might be dealing with at the occupational health level and shifting the paradigm toward risk reduction and prevention. An investment in health and wellness addresses many of the chronic disease states and disabilities that are covered under healthcare costs for employers. Up to 75 percent of an organization’s healthcare cost is driven by their employees’ lifestyle-related behavior. The federal government has proposed incentives for employers to adopt work-site wellness programs, which may be very important as we move forward. But currently only 5 percent of employers allocate funds specifically for prevention and screening.
Mr. Nordness: A promising area is using occupational health as a portal to disease management service integration, which is a big benefit to companies.
Ms. Schmidt: Online, telephonic, or onsite health coaching (is promising). About 80 percent of our clients have an onsite health coach for four to 40 hours per week. We have found that support from a healthcare professional is the most effective way to achieve behavior change. Health coaches have to be extremely well-trained. All of our coaches are certified tobacco treatment specialists and certified in weight management counseling. They understand that goal-oriented changes build confidence – and it’s confidence that is really the key.
Q: How do you manage your finite internal resources in a cost-effective manner?
Mr. Sutterfield: We have tapped into our primary care physician group for additional expertise. We also have added a pharmacy-consulting group, which reviews formularies, benefit structure design and generic utilization and has the capability of putting pharmacy services onsite. We work closely with our management information systems team to put together a system to track and measure results and create models that will work onsite for our customers. Integration of management teams, the information system, various services, and the sales and consulting side of our business is the catalyst for real customer benefit.
Mr. Nordness: We get really creative in terms of whom we use and how we use them. We plug people in who are cross-trained within the occupational health area. We use nurses, aides, wellness specialists, etc., and since we are part of an integrated health system, we also have access to other skilled professionals such as dieticians and exercise physiologists. We can offer a broad range of expertise to companies without having to hire individuals for specific programs. We use existing equipment, such as Cholestech for lab testing, so we don’t incur a lot of additional cost.
Q: What do you recommend with regard to demonstrating the genuine value of and return on investment associated with wellness interventions?
Ms. Schmidt: At the end of the day, we need to show that these programs are effective. It requires data, which we acquire through biometric testing, health risk assessments, and comparisons to established metrics over time. You need to focus on the areas where the client is going to get the biggest bang for their buck. We use sophisticated predictive modeling assessment tools to accurately anticipate the onset of chronic disease within a five-year period for individuals. We can also report on the percentage of risk that is attributable to lifestyle management and the percentage of current modifiable risk. This gives the employee and the health coach actionable information.
Mr. Nordness: We want to help client companies realize that wellness is not an expense. Employers have tended to look at health care as a major cost driver. We promote it as a performance driver: How can we help your employees be better performers and how will that help control your costs? We track aggregate workforce data over time, placing employees in either high-risk or low-risk categories for overall health, tobacco use, weight, body fat, blood pressure, LDL/HDL ratio, triglycerides, glucose, and exercise. We compare average costs per employee, per year in high-risk versus low-risk categories. When those at higher risk shift into lower-risk categories over time, associated costs go down. You have to quantify potential economic benefits using numbers, percentages, and dollars whenever possible. Simple graphs and charts are one of the best ways to illustrate results.
Mr. Levy: One of the challenges with worksite wellness is getting enough of the right kind of employees involved. We don’t want to motivate the worried well and the gym rats. We need to retain those employees who are going to sustain behavior change. So, in addition to measuring cost-effectiveness, cost savings, and ROI, I recommend measuring participation rates and participant satisfaction; improvements in knowledge, attitudes, skills, and behaviors; changes in the workplace physical and cultural environment; and impacts on key productivity measures such as absenteeism, turnover and morale along with changes in biometric measures and changes in the health status of at-risk employees.
Mr. Sutterfield: We utilize an electronic medical records system that can be integrated with our customers’ human resource information management systems (for case tracking and reporting). The system provides an information portal for employers. When measuring outcomes, we jointly decide which key quality indicators we want to track. Our Highway2Health program is an example of this type of joint effort. (See related article.)
Q: What are your suggestions for obtaining genuine employee buy-in?
Mr. Levy: If everyone could access information on the web to stop smoking or lose weight, we would all be healthy. It takes a more personal relationship to help people modify their behavior. Employees appreciate regular communication: monthly newsletters, weekly health tips, consistent access to self-monitoring tools, and webinars… all educational materials should be bilingual.
Ms. Schmidt: We feel that customized communication is the key. For example, at a chicken processing plant, we found the most effective way to communicate with the employees was to put postcards under their windshield wipers. It can’t be a program pushed by human resources. It has to be something that the employees can get engaged in and excited about. It can’t look like a summary plan document. It has to have very clear program information, culturally competent messaging, and be branded for consistency. We use multiple mediums. About the time we find we are sick of communicating is when employees start to realize they have a wellness program Other avenues for communication include new-employee orientation, hallway demonstrations, mailing information to employees’ homes, email, staff meetings, and recognition events.
