Health and Productivity Survey 2010 V5 - Willis Towers Watson · beings wear out, lose motivation...

THE WILLISHEALTH AND PRODUCTIVITY SURVEY 2010

TABLE OF CONTENTS

ABOUT THE SURVEY 2

KEY FINDINGS 3

WORKSITE WELLNESS: THE VALUE OF EMPLOYEE ENGAGEMENT 4

SURVEY FINDINGS 7

WHAT THE FUTURE HOLDS 42

A web-based platform was used to collect,measure and analyze data. Completeresponses were received from 1,352organizations and an additional 597completed a portion of the survey questions,for a total of 1,949 participants. Allrespondents represent a cross-section ofsizes, industries and geographic locations.

Willis asked organizations to respond to thesurvey whether or not they currently offered awellness program. Those that did not wereasked if they plan to offer one, what theyperceive as barriers to doing so and what typeof support or information they would need toimplement such a program.

Those organizations offering wellnessprograms were asked to detail programcomponents, incentives, participation,vendor satisfaction and how program resultsare measured. A subset of 1,030 organizationsresponded that they currently offer acomprehensive wellness program,representing a good, although slightlydifferent, demographic cross-section. Thenumber of respondents is not consistent foreach question, since some participants didnot complete the entire survey.

ADDITIONAL INFORMATION

For additional information about the surveyor to share your comments, write to:

Willis AmericasHuman Capital Practice – North AmericaOne Glenlake Parkway, Suite 1100Atlanta, GA [email protected]

With respect to all charts and tables in thisdocument: Not all percentages equal 100% due to

rounding. A full technical appendix with all survey

data is available to Willis clients upon request.

ABOUT THE SURVEYNUMBER OF ALL RESPONDENTS WITH A EMPLOYEES RESPONDENTS WELLNESS PROGRAM

Fewer than 100 37% 15%101 to 500 34% 39%501 to 1,000 10% 15%1,001 to 5,000 12% 20%5,001 or more 6% 12%

n = 1352 n = 583

ALL RESPONDENTS WITH A GEOGRAPHIC REGIONS RESPONDENTS WELLNESS PROGRAM

Northeast region(NY, PA, MD, DE, NJ, CT, RI, MA, NH, VT, ME) 21% 20%

Southeast region(WV, KY, TN, NC, SC, VA, DC, GA, AL, MS, FL) 20% 19%

North Central region (MT, ID, WY, ND, SD, NE, KS, MN, MO, WI, IL, MI, IN, OH, IA) 32% 33%

South Central region(UT, AZ, CO, NM, OK, TX, AR, LA) 12% 12%

West Coast region(AK, WA, OR, CA, NV, HI) 8% 6%

Nationwide 8% 11%

n = 1352 n = 583

ALL RESPONDENTS WITH A INDUSTRIES RESPONDENTS WELLNESS PROGRAM

Construction 9% 6%Finance, Insurance, Real Estate 9% 11%Professional, Technical 7% 6%Government 5% 7%Health Care 13% 15%Manufacturing 18% 17%Not-for-profit 10% 9%Retail and Wholesale 8% 6%Services 8% 7%Transportation 2% 2%Other 11% 12%

n = 1352 n = 583

Willis North America n 2

KEY FINDINGSWELLNESS PROGRAMS

n Of those that participated in the survey,about half (43%) indicated that they hadsome type of wellness program. Of thosewith a wellness program:

• 57% describe their program as basic• 33% had an intermediate program• 10% had a comprehensive program

n The percentage of survey participantswho strongly agreed that their leadershipis committed to improving employeehealth significantly increased from 6% in2009 to 42% in 2010.

n About one-third of survey respondentsdid not agree that financial rewardsshould be used to encourage healthylifestyles; basically doubling the 15% thatdisagreed in our 2009 survey.

n Regarding wellness program participation:

• 47% indicated less than 50%participation in health riskassessments

• 39% indicated less than 50%participation in biometric screenings

• 35% indicated less than 25%participation in their physical activityprogram

• 39% indicated less than 25%participation in their weightmanagement program

n 44% of participants reported insufficienttime or not enough staff as the mostsignificant barrier to offering a wellnessprogram, followed by budget constraints(43%).

n Management support and having a stronginternal leader championing wellnesswithin the organization were rated thetwo most important factors in thesuccess of the wellness program.

ENGAGEMENT

Substantial opportunity exists foremployers in the area of buildingengagement.

n Only 28% of the organizationsresponding have a specific anddefined strategy in place to improveemployee engagement.

n 64% of respondents consider theirwellness program an important partof their overall engagement strategy.

n The vast majority – 80% – want toreward employees who are takingsteps toward health improvement.

n The top factors cited as necessary toimprove employee engagement inworksite wellness are increasingmarketing and communication withpotential program participants,setting more specific goals forachievement and more coordinatedefforts.

MEASURING SUCCESS

n 38% of survey respondents indicatedthat they did not have sufficient datato calculate ROI. The second mostcommon barrier, cited by 32% of therespondents, was not enough staffingor time to dedicate to this.

n Most employers seem to bemeasuring their wellness program’ssuccess by comparing health carecosts over time, trackingparticipation in the wellnessprogram and monitoring use ofspecific wellness program services.


Faster than a speeding train. Able to leap tall projects in a single bound.X-ray vision that can see through walls and predict the future. For manyAmerican workers, the skill set needed to succeed in today’s businessenvironment can feel like a strange hybrid of super-hero andprofessional athlete. The mantra in corporate America has become“Bigger, faster, better, MORE!”

Invigorated, confident, challenged, joyful and connected…how well dothese words describe your workforce? Depressed, exhausted, burnedout, hopeless and defeated…do these sound more familiar? The Way

We’re Working Isn’t Working. So says best-selling author Tony Schwartzin his recently published book. We have to agree. The relentless pursuitfor MORE: more market share, more profit, more shareholder value,

more and more work being done by fewer people paradoxically leaves us all with less and less. Demand isexceeding capacity.

“Organizations undermine sustainable high performance by forever seeking to get more out of their people.No matter how much value we produce today – whether it’s measured in dollars or sales or goods or widgets –it’s never enough” says Schwartz.1 Is engagement the secret elixir? Some studies seem to indicate it is.

According to the 2007-2008 GlobalWorkforce Study conducted by TowersPerrin, only 20% of the workforce isfully engaged, 8% are completelydisengaged and 71% fall “somewhere inthe middle.” Disengaged employees arenot only unhappy, but they routinelyshare their discontent with co-workers,infecting others with negativity.

WORKSITE WELLNESS:

THE VALUE OFEMPLOYEE ENGAGEMENT


According to the 2007-2008 Global Workforce Study conducted by Towers Perrin, only 20%of the workforce is fully engaged, 8% are completely disengaged and 71% fall “somewhere inthe middle.” Disengaged employees are not only unhappy, but they routinely share theirdiscontent with co-workers, infecting others with negativity. Moreover, the longeremployees stay with an organization, the less engaged they tend to become. Why shouldemployers care? Because increased employee engagement in work results in higheremployee productivity and loyalty. Companies with high employee engagement outperformlow engagement companies in many areas of business success. A meta-analysis of studies byGallup revealed that having a work environment that promoted positive employeeengagement was consistently associated with positive business outcomes, including reduced employee turnover, greater customer satisfaction, employee productivity andcompany profits.2, 3

If we accept the definition of energy to be “the capacity to do work,” then we must alsoacknowledge that the management of individual and organizational energy is a significantconcern and a worthwhile endeavor if you seek to have a high performing workforce. Energyand engagement are inextricably intertwined. It takes a partnership between individualsand organizations to achieve and maintain high engagement and high performance.Unfortunately, even when individuals understand this relationship and attempt to practicethese tenets, the need for balance, renewal and recovery are often viewed as weakness by theorganization or its leaders and dismissed, criticized or worse. Resilience is something to becultivated and rewarded. Human beings do not operate like machines that can be turned onand expected to operate 24/7. Without downtime and adequate rest and renewal, humanbeings wear out, lose motivation and become disengaged.

The core elements of worksite wellness programs are essential building blocks in managingpersonal energy and cultivating resilience. Regular physical activity has a profound effect onhow we feel and how much energy we have to invest, whereas a sedentary lifestylecontributes to a cycle of low energy. Every choice we make about what we eat and drink hasan immediate and in some cases, cumulative, longer-term impact on our energy levels. Thefrequency and timing of nutrient intake greatly affects our ability to fuel energy andperformance. Our daily food choices have an equally strong influence on our moods, healthand even how long we live. Sleep is critical both for renewal and as a preventive or protectiveelement of health. Many wellness programs are expanding to include education about thisimportant topic. An interesting paradox exists relative to tobacco, which is used by many tomanage stress, claiming that it relaxes them. However, physiologically the reverse is true:tobacco use impedes energy. Here again, making a difference takes a concerted effortbetween employees choosing healthy habits daily and a workplace culture that is supportiveof optimal health.

Relationships at work play an important role as well. The relationship with your directsupervisor greatly influences how engaged you are with your job – and how long you will staywith the company. “Career Wellbeing” is one element of overall wellbeing examined in thenew publication by Gallup authors Tom Rath and Jim Harter: “WELL BEING The FiveEssential Elements.”4 Some interesting, albeit concerning, information was revealed. Theyreported that the person we least enjoy being around is our boss. “Of all the categoriespeople ranked, from friends to relatives to coworkers to children, they rated the time theyspent with their manager as being the worst time of the day.”4 Time spent with one’s bossranked even lower than cleaning the house. “The most disengaged group of workers we haveever studied are those who have a manager who is simply not paying attention. If your


manager ignores you, there is a 40% chance that you will beactively disengaged or filled with hostility about your job.”4

Employers are missing an important engagement opportunityby not investing in training designed to assist managers andsupervisors in managing relationships along with the healthand productivity of the workforce. Our survey findings showthat currently only 5% of respondents offer such training.

Meaningful relationships with co-workers also contributegreatly to the satisfaction and level of engagement employeesfeel in their work. Positive relationships, both professionallyand personally, support resilience. The sense of teamwork orcommunity that exists when individuals feel valued for theircontributions and, more importantly, feel and display a mutualrespect among co-workers is described in the ancient Africanphilosophy known as “ubuntu.”5 The book ubuntu! by StephenLundin and Bob Nelson, offers many interesting insights, a fewof which include:

n Ubuntu is a philosophy that considers the success of thegroup above that of the individual – and espouses “We’reall in this together.”

n The first level of recognition is simply to value others forwho they are. This is the heart of ubuntu, and must alwayscome first.

n The second level of recognition is to value others for what

they achieve. This kind of recognition is what drives mostperformance.

n To engage another person in an authentic way releases themost powerful energy on the planet.

Could engagement flourish in this type of environment?Imagine the possibilities if the entire workforce understoodtheir personal value and how they contribute to the whole – if allemployees were respected and valued and in turn supported oneanother and spent their energy for the success of the group.

Engagement, it turns out, has a significant impact on our healthand vice versa. When our health is compromised, it’s difficult topositively engage in anything, work-related or otherwise.Although many factors contribute to our mental health status,being disengaged at work appears to be a significant risk factorfor an eventual diagnosis of depression. “On a more encouragingnote, as workers become more engaged, their physical healthimproves in equal measure. As employees’ levels of engagementat work increased, their total cholesterol and triglyceride levelssignificantly decreased.”4 The reverse was also true, asengagement went down, clinical risk values went up. Improvingoverall employee engagement may be one of the most important priorities to consider when planning worksitewellness programs.

Although this survey focused on engagementfrom a worksite wellness programperspective, it is important to view thisinformation in the context of overallorganizational engagement as the two areclosely linked. Our health impacts how wework, and how we work impacts our health.A positive work environment, one of the by-products of a successful wellness program,improves not only individual health, butorganizational engagement and, ultimately,productivity and business results. Employeeengagement may well be the quintessence ofoverall business success.

Cheryl A. Mealey, CHESNational Practice Leader Wellness [email protected]

ENGAGEMENT IS DEFINEDVARIOUSLY AS:

• Emotional involvement or commitment to theorganization, its values and goals

• Willing to “go the extra mile” for the company,expend discretionary effort toward the achievementof goals

• When employees feel positive emotions towardtheir work, find their work to be personallymeaningful, consider their workload to bemanageable and have hope about the future of their work

• A positive, fulfilling work-related state of mindcharacterized by three aspects: 1. Physical component, or vigor

(e.g., “At my work I am bursting with energy”); 2. Emotional component or dedication

(e.g., I am enthusiastic about my job”); 3. Cognitive component or absorption

(e.g,. I am immersed in my work”)


SURVEY FINDINGS

0% 10% 20% 30% 40% 50% 60% 70% 80%

Wellness Programin place

Plan to offer onein the future

No current program

PREVALENCE OF WELLNESS PROGRAMS

Large employers (1,000 or more employees)Employers under 1,000 employeesAll employers

75%

36%

43%

9%

11%

11%

53%

46%

16%

0% 10% 20% 30% 40% 50% 60% 70% 80%

WELLNESS PROGRAM TYPES

16%

8%

10%

40%

29%

33%

44%

63%

57%

Comprehensive

Intermediate

Basic

Large employers (1,000 or more employees)Employers under 1,000 employeesAll employers

TYPES OF WELLNESSPROGRAMS –DEFINITIONS USED FORTHIS SURVEY

BASIC: Just getting started witha wellness program, offer a fewvoluntary activities, such aslunch-and-learns, health fairsand team challenges. Operatewith minimal or no budget.

INTERMEDIATE: Have had awellness program for at leasttwo years. Have a designatedwellness committee or internalprogram coordinator. Offer mostof the components of a basicprogram plus health riskassessments, onsite biometricscreenings, health coachingand/or a wellness web portal.Provide some incentives forprogram participation and adesignated wellness budget.

COMPREHENSIVE: Offer mostof the components of anintermediate program plustargeted behavioral changeinterventions, have significantwellness incentive design. Offerprogram to spouses, trackingwellness program data year toyear and focused on evaluatingthe impact of the wellnessprogram.

PREVALENCE OF WELLNESS PROGRAMS

Slightly less than half of survey respondents currently have some type ofwellness program or plan to offer one in the future. Of those with wellnessprograms in place – slightly more than half have what they would describeas a “basic” wellness program. Employers with 1,000 or more employeesare more likely to have a program and more advanced program offerings.


“COLLECT NEEDS AND INTEREST ANDCULTURE DATA FIRST IN ORDER TOKNOW WHAT YOUR EMPLOYEES AREINCLINED TO PARTICIPATE IN AND HOWYOU CAN IMPROVE NOT ONLYEMPLOYEES, BUT THE ORGANIZATIONALCULTURE RIGHT FROM THE BEGINNING.”

(HEALTH CARE – NORTHEAST)

HOW DO ORGANIZATIONS GET STARTED?

Health care costs remain the driving force in theimplementation of worksite wellness programs, although therewas a notable decrease in all categories this year. 78% ofemployers reviewed their health care cost trends prior toimplementing a wellness program. A variety of other relevantinformation was reviewed when contemplating wellnessprogram implementation. The key items reviewed were:

n Health care cost trends – 78%, down from 92% in 2009

n Corporate goals and objectives – 39%, down from 63% in 2009

n Plan costs for chronic conditions – 34%, down from 50% in 2009

WHO CAN PARTICIPATE?

This year, slightly fewer spouses, dependents and spouses ofretirees were eligible to participate in wellness programs.Employee and retiree eligibility remained the same. As we haveseen in previous years, the programs of larger employers weremore likely to offer participation to spouses, dependents andretirees than those of smaller employers.

n Overall, 38% included wellness benefits for spouses, slightlydown from 43% last year

n 18% covered dependent children

WHAT RESOURCES ARE BEING USED?

The majority of survey respondents use their health insuranceresources and internal staff to help implement their wellnessprograms. Roughly half also indicated they use their insurancebroker/consultant as a resource.


0% 10% 20% 30% 40% 50% 60% 70%

IMPLEMENTATION BARRIERS

Not enough time/staffto dedicate to this

Budget constraints

Employees are invarious geographic

locations

Too few/small group ofemployees

No program yet — butplanning for the future

No interest in this typeof program from

employees

No interest in this typeof program from

management

Lack of support frommanagement

Do not perceive a needfor such a program

Lack of return oninvestment statistics to

justify expense

Fear that wellness inthe worksite will beviewed as intrusive

Legal/complianceissues a concern

High employeeturnover

All employersLarge employers (1,000 ormore employees)

44%

49%

43%

60%

24%

37%

23%

5%

21%

33%

21%

6%

11%

11%

11%

17%

10%

3%

9%

14%

9%

10%

6%

3%

6%

13 %

IMPLEMENTATION BARRIERSSTILL EXIST

The top barriers to implementing a wellnessprogram remain lack of time, limited staffingand budget constraints. In the currenteconomy, many organizations are still intenton doing more with less, which constrainsmaking wellness a higher business priority.

n Not enough time/staff to dedicate – 44%n Budget constraints – 43%

“WE NEED TO FOCUS ON ORGANIZATIONSURVIVAL BEFORE WE CAN FOCUS ONWELLNESS. A VERY TOUGH BUSINESSCLIMATE HAS PUT WELLNESS ON THEBACK BURNER. EMPLOYEES ARE TOOWORRIED ABOUT HAVING A JOB. STRESSIS AT AN ALL-TIME HIGH. MORALE IS AT AN ALL-TIME LOW.”

(MANUFACTURING – NORTH CENTRAL)


RESOURCES NEEDED TO IMPLEMENT WELLNESS

Additional staffing/time

More education aboutprogram benefits

Dedicated budget forwellness

Senior managementsupport for wellness

initiatives

Access to betterresources, programming

for wellness

Better return oninvestment

measurements

Not applicable

Better measurementsof improved employee

health

Better morale, trustamong employees

0% 10% 20% 30% 40%

39%

33%

30%

21%

20%

19%

18%

18%

13%

RESOURCES NEEDED TO BEGIN WELLNESS PROGRAMS

Fewer respondents this year (19%) than last (29%) reported thattheir organizations needed to see better return on investmentmeasurements to begin a wellness program. Additional staffingand time, more education about the benefits of wellness and adedicated wellness budget remain the leading factors inlaunching a wellness program.


10%

20%

30%

40%

0%

33%

20%

28%

20% 20%

27%

14%

10% 12%

7%10%

8% 9%

21%

7%

4% 7%6%

4% 4%3% 2%

Cash/giftcards

Loweremployeecost(premiumcontribution)for medicalplan

Noincentive

Raffle forlargerprizes

Accumulatepoints forprizes —onlinerewardstracking &deliverysystem

Additionalcontributionto healthaccount(health FSA,HRA, HSA)

Notapplicable

Accumulatepoints forprizes —tracking &redemptionhandledmanually

Smallerprizes foreachparticipant

Lowerdeductible,co-insuranceor co-pays

Paid time off

INCENTIVES FOR HEALTH ASSESSMENT TOOLS

HRAsBiometric screenings

WHAT HEALTH ASSESSMENT TOOLS ARE UTILIZED?

Typically, the most common type of health assessment programsoffered to employees are health risk assessment (HRA) surveysand onsite biometric screenings. Most often, they are providedto employees alone, but some organizations also offer them tospouses.

PROGRAMS INCLUDE VARIOUSINCENTIVES

For health risk assessments, the most common incentive is cashor gift cards followed by lower employee costs (premiumcontributions) for the medical plan. For health screenings, alarge group of respondents indicated that they did not offer anincentive for this program, a decision which may be related tothe costs of onsite workplace screenings. Offering a convenient,free worksite screening may be viewed as incentive enough foremployees to participate.

WINNING WITH WILLIS

Winning With Willis is our way of helping youreach your employees with accurate, relevantand actionable health information via anattractive, convenient website. This websitehas evolved to become a public accessresource center that can be viewed from anycomputer. We are proud to collaborate withthe U.S. Centers for Disease Control andPrevention (CDC) to include relevant,regularly updated content. Willis is committedto helping you increase your employees’personal commitment to their health andwell-being. WinningWithWillis.com is dedicatedto helping your employees develop positivebehaviors around nutrition, physical activityand tobacco use, prevention and cessation. To learn more, visit our site or talk with your Willis representative.


http://www.winningwithwillis.com/

DO INCENTIVES WORK?

Incentives continue to inspire substantially higher participation inboth health risk assessments and biometric screenings. This surveyfurther analyzed the types of incentives used and the reportedparticipation rates to determine the more effective incentives.Connecting HRA completion with health plan costs, such as lowerplan deductibles, employee costs or contributing to a health accountappears to be the most effective incentive approaches garneringhigher completion rates.


IMPACT OF INCENTIVES ON HRAs

Lower plan deductibles,co-insurance or co-pays

Lower employee cost(premium contribution)

for medical plan

Additional contribution tohealth account (health

FSA, HRA or HSA)

Accumulate points to earnprizes — online reward

tracking and delivery system

Accumulate points to earnprizes — tracking and

redemption handled manually

Paid time off

No incentive

Smaller prizes for eachparticipant

Cash/gift cards

Raffle for larger prizes

Not applicable

0% 10% 20% 30% 40% 50% 60% 70%

64%

33%

40%

63%

57%

49%

48%

48%

48%

47%

45%



for medical plan

Additional contribution tohealth account (health

FSA, HRA or HSA)

Paid time off



Cash/gift cards





No incentive

Not applicable

69%

67%

66%

63%

61%

50%

50%

49%

47%

38%

38%

0% 10% 20% 30% 40% 50% 60% 70% 80%

IMPACT OF INCENTIVES ON BIOMETRIC SCREENINGS


Weight management

Tobacco cessation

Physical activityprogram

Online wellness portal

Stress management

Drug counseling

Alcohol counseling

Health coaches

Financial wellness

Team- or individual-based behavior change

challenges/competitions

Personal fitnessassessments or

planning

50%

49%

48%

43%

39%

30%

30%

29%

24%

22%

20%

0% 10% 20% 30% 40% 50%

TYPES OF WELLNESS PROGRAMS BEING OFFERED

12%Worksite and/or peersupport groups

WHAT TYPES OF HEALTHYLIFESTYLE PROGRAMS AREOFFERED?

To promote healthy behavior, manyemployers offer weight management, tobaccocessation and physical activity programs aspart of their wellness strategy. This year wenoted a lower number of programs beingoffered, perhaps because so many of thosewith wellness programs (57%) rated theirprograms as “Basic.” The most prevalenttypes of programs offered are:

n Weight management – 50%n Tobacco cessation – 49%n Physical activity – 48%

Some less reported types of programsinclude:

n Team or individual behavior changechallenges/competitions – 22%

n Personal fitness assessment – 20%n Worksite and/or peer support

group – 12%


INCENTIVES OFFERED FOR BEHAVIORAL CHANGE

As noted previously, many organizations continue to include traditional behavioral changeprograms for weight management, physical activity and tobacco cessation in their wellnessprograms. To increase participation in these programs, the majority of organizations offerincentives, but the percentages are slightly down from last year’s survey. With limitedbudgets, many organizations may be using incentives just for health assessments or usingany available funding to provide additional program offerings.

10%

20%

30%

40%

0%

50%

Additionalcontributionto healthaccount(health FSA,HRA or HSA)

Loweremployeecost(premiumcontribution)for medicalplan

Accumulatepoints forprizes —onlinerewardtracking &deliverysystem

Accumulatepoints forprizes —tracking &redemptionhandledmanually

Raffle forlarger prizes

Smallerprizes foreachparticipant

Cash/giftcards

No incentive Notapplicable

3% 3% 6%4%

9%

5% 8%6%

11%

6%11%

6%

24%

19%

28%

24%26%

43%

Physical ActivityWeight Management

INCENTIVES FOR PHYSICAL ACTIVITY AND WEIGHT MANAGEMENT PROGRAMS

10%

20%

30%

40%

0%

50%

Paid time off

1%

Smallerprizes

Accumulatepoints formanualprizes

Additionalcontributionto healthaccount

Lower plandeductible,co-insuranceor co-pays

Raffle forlargerprizes

Accumulatepoints toearn onlineprizes

Cash/giftcards

Reimburse-ment ofcessationprogramexpenses

Free orreducedcosts fortobaccocessationaids

Premiumcontributionfor medicalplan

Noincentive

Notapplicable

1% 2% 2% 2% 2% 4% 7% 7% 8% 11%

24%

45%

INCENTIVES FOR TOBACCO CESSATION PROGRAMS


WHAT IS THE IMPACT OF THESE INCENTIVES?

Survey data was further analyzed to compare the types of incentives usedand the reported participation rates to better understand which types ofincentives had the greatest impact on participation. Linking weightmanagement and physical activity participation to an additional healthaccount contribution or offering paid time off seemed to be very effective,but few survey respondents are using these approaches.


FINDING THE RIGHTINCENTIVES

What type of incentive is mostinfluential in motivating people? Howmuch of an incentive is enough? Thebest strategy for your organizationultimately needs to be determined byyou, after consultation with youremployees. An incentive can getemployees to participate in yourwellness program, but it likely won'tmotivate a long-term behavioralchange in the majority of participants.

There is a big difference between“compliance” and “engagement.”Engagement and health improvementhappen as a result of a participantmaking an emotional connection to theconcept. True engagement happensmore as a result of strong leaders whoserve as role models and who send theright messages. It also happens as aresult of working daily in a culture ofhealth. Ultimately, motivation to doanything comes from within each of us.You may need to dangle a few carrotsto get people started, but the goal isto engage people in a true lifestylechange that is personalized enough tomeet their needs and helps them besuccessful over the long term.Encourage employees to makechanges, not for the money, but forthemselves, their loved ones and theirquality of life. Share success stories.Offer praise and peer support. Abalanced approach will likely yield thebest long-term results for yourprogram.

IMPACT OF INCENTIVES ON WEIGHT MANAGEMENT PROGRAMS

Paid time off



for medical plan

Additional contributionsto health account

(health FSA, HRA or HSA)

Accumulate points to earnprizes — tracking & redemption

handled manually



Cash/gift cards


Not applicable


No incentive

34%

13%

17%

33%

31%

31%

25%

24%

22%

21%

17%

0% 5% 10% 15% 20% 25% 30% 35% 40%


IMPACT OF INCENTIVES ON PHYSICAL ACTIVITY



for medical plan


Additional contributionsto health account (health

FSA, HRA or HSA)






Cash/gift cards

No incentive

Not applicable

0% 5% 10% 15% 20% 25% 30% 35% 40% 45%

44%

18%

25%

40%

35%

32%

30%

30%

29%

29%

26%

Paid time off

Not currently offering premiumdiscount incentive

Completion of a Health Risk Assessment survey

Participation in a worksite biometricscreening event

Considering this type of incentive for the future

Tobacco use

Participation in a health improvement program(such as tobacco cessation or weight loss)

Completion of a well-visit

Completion of age/gender appropriate preventivescreenings (mammogram, PSA, colonoscopy, etc.)

Health Risk Assessment score — improvements ormaintenance of healthy score

Completion of a health coaching program

Other, please describe

Meeting or maintaining targeted weight orbody mass index

Meeting or maintaining targeted bloodglucose levels

Meeting or maintaining targetedcholesterol levels

Meeting or maintaining targeted bloodpressure

Enrollment in a disease management program

57%

22%

15%

14%

12%

7%

7%

5%

4%

4%

3%

3%

2%

2%

2%

2%

0% 10% 20% 30% 40% 50% 60%

PREMIUM DIFFERENTIALS AS AN INCENTIVE

PREMIUM DIFFERENTIALS AS AN INCENTIVE STRATEGY

Some organizations provide lower health care premiums for individuals based on certaincriteria, such as not smoking or completing a health risk assessment questionnaire. Inparticular, among those organizations reporting that they offer this type of incentive:

n 22% base the premium difference on the completion of a health risk assessment surveyn 15% base it on participation in a worksite biometric screening eventn 12% base it on tobacco use status

While a large portion of the survey respondents donot offer premiumdifferential incentives,14% indicated that theywere considering them forthe future.


“FINANCIAL BENEFITS ARE WHATDRIVES OUR EMPLOYEES. THEY AREDOING GREAT WITH PREMIUMDISCOUNTS AND REDUCED/WAIVEDCOPAYS FOR PARTICIPATION INVARIOUS PROGRAMS.”

(HEALTH CARE – SOUTHEAST)

“LESSON LEARNED – WE MANDATEDCOMPLETION OF A HEALTH RISKASSESSMENT (IN ORDER TO HAVEHEALTH INSURANCE) IN YEAR ONE.THIS WAS TOO AGGRESSIVE FOR OURGROUP AND WAS MET WITHTREMENDOUS OPPOSITION.ULTIMATELY WE HAD TO BACK OFFOF THE MANDATE AND MAKE ITVOLUNTARY. NEEDLESS TO SAY, WEHAD LESS THAN A 10%PARTICIPATION.”

(GOVERNMENT – SOUTHEAST)

“WE ARE GOING TO SWITCH FROM A‘CARROT’ TO A ‘STICK’ METHOD TOREQUIRE ALL EMPLOYEES, EVENTHOSE RELUCTANT TO CHANGE, TOPARTICIPATE IN HEALTHIMPROVEMENT INITIATIVES.”

(FINANCE/INSURANCE/REAL ESTATE– NATIONWIDE)

5%

10%

15%

20%

0%

25%

30%

35%

40%

23%

9%

37%

18%

22%24%

7%

12% 12%

24%

Less than $10 $11 to $25 $26 to $50 $51 to $75 $76 or more

HOW MUCH OF MONTHLY PREMIUM DISCOUNT?

Employee onlyFamily

HEALTH CARE REFORM AND WELLNESSINCENTIVES — WHAT WILL CHANGE?

The use of financial incentives in workplace wellness or health managementprograms has been gaining momentum over the past several years. Thepassage of the Patient Protection and Affordable Care Act (PPACA) mayincrease the likelihood that employers will expand their use of incentivestied to participants meeting certain health standards. The legislation did notaffect the current requirements for wellness programs which continue toallow employers to tie employee costs to “health status factors” such as bodyweight or tobacco use, as long as other HIPAA requirements are met. Themaximum incentive employers can offer will now increase, with the currentHIPAA limit of 20% of the total cost of health coverage, growing to 30% onJanuary 1, 2014.

To ensure the success of this type of incentive strategy and to effectivelyintegrate it into their overall health management strategy, employers need toharness the power of workplace culture to drive employee engagement andhealth outcomes. Strong cultural support is critical because incentives bythemselves only net compliance. Employees may just play by the incentiverules and declare themselves “done” when the incentive requirement is met.Long-term success with wellness program engagement does not come fromcompelling people to jump through incentive hoops but from creating aculture of shared responsibility for health and using incentives strategicallyto accelerate individual change. As you evolve your health managementprogram and incentive strategy, work with your wellness program vendorsand your internal legal counsel to ensure that your program complies withHIPAA, ADA and other relevant laws and regulations.


COMMUNICATION APPROACHES

Emails

Printed materials —flyers, posters,

paycheck stuffers

Newsletters

Bulletin boards

Intranet sources

Online healthimprovement tools

Departmental staffmeetings

Wellness committeemembers pass alonginformation to their

departments or locations

Town hall meetings

Social networking —Twitter, Facebook, blogs,

etc.

Text messaging

0% 20% 40% 60% 80%

79%

0%

2%

59%

56%

47%

39%

36%

27%

25%

13%

VARIETY OF COMMUNICATIONAPPROACHES ARE USED

Communication and education are essential to successfullyengage wellness program participants. Organizations arerelying primarily on traditional methods, such as generaleducation campaigns, emails, print materials and newsletters.Less common communication approaches are text messaging,social media (Facebook, Twitter, blogs, etc.) and town hallmeetings. All of these methods can be part of a comprehensivecommunication campaign.

ASK THE EXPERTFeaturing Ame McClune, Director ofMarketing & Client Communications for the Willis National Human CapitolPractice

Q. How can employers use their wellnessprogram communication campaigns toactively engage more employees?

A. Wellness program communication effortstypically involve significant education andlong-term campaigns. Are you struggling tonot only push important information andtrying to change behaviors, but also tokeep employees engaged? Try these ideasto mix it up and help grab employeeattention:

n CREATIVE PRINT MAILINGS: Trysending traditional looking “invitations”to participate in events, or “thinking ofyou” cards to thank employees and showappreciation for participation and effortsto make healthy lifestyle changes.

n VOICEMAIL BLASTS: Consider usingyour c-suite to talk to employees once amonth or highlighting local employees togive information and encouragement.

n WELL PLACED FLYERS: Try newlocations, such as bathroom stalls, hangdoor hangers on frequently used doors,or identify unique locations specific toyour workplace.

n SIDEWALK CHALK: Write a briefmessage outside your front door soemployees can’t miss it as they enterthe workplace.

Making a commitment to trying a few newmediums may be the difference you need tocreate engaged and educated employees.


CONCERNS IN REACHING PARTICIPANTS

Employees spread out atvarious geographic

locations

High stress and lack oftime among employees

Employees withoutcomputer access at work

Employees concerned withinvasion of privacy/

confidentiality

Different employeeshifts/work hours

Reaching spouses anddependents outside the

workplace

Lack of trust/poor moraleamong employees

No significant concerns

Non-English speakingemployees

High turnover

0% 10% 20% 30% 40% 50% 60%

49%

9%

46%

45%

41%

30%

25%

22%

17%

12%

SPECIAL CHALLENGES REACHING CERTAIN EMPLOYEE GROUPS

To be successful, communications about the organization’s wellness program mustreach all individuals covered by the wellness program. Special communicationschallenges often add to the difficulty of sharing information. The leadingcommunications challenges were:

n Employees spread out at various geographic locations – 49%n High stress and lack of time among employees – 46%n Employees without computer access – 45%n Employees concerned with invasion of privacy/confidentiality – 41%

“DIRECT COMMUNICATIONWITH THE ‘HOLD OUTS’ AS OPPOSED TO GROUPEMAILS, ANNOUNCEMENTS,ETC. SEEMED TO GET ABETTER RESPONSE.”

(SERVICES – WEST COAST)


A 2010 survey conducted by the National Business Group on Health,indicated that nearly one-half (47%) of the 1,500 U.S. employeessurveyed said they use Facebook daily or weekly for personal reasons,while 45% use text messaging daily or weekly for personal reasons.Slightly more than one-third said they don’t use social media vehiclesfor personal reasons at all. However, when it comes to using socialmedia for business purposes, only 7% use Facebook and 16% use textmessaging. Additionally, about eight in 10 said they weren’t interestedin receiving information about their employer-provided healthbenefits, or tips on how to exercise, eat healthy or save money onhealth care via Twitter or text messaging. The majority of employeeswho participated in this survey seemed to prefer their employers stickto tried and true communication methods — mailings to home and e-mail.

If this is a strategy your organization is considering, it may be helpful to pilot the new way of communicating at a locationor with a department that has regular computer access. You may want to hold informal employee focus groups to gain amore accurate measure of their comfort with and/or interest in using these technologies for work-related information or ifthey would prefer another source. If possible, track whether employees are moving beyond digital “review” in which theyjust view a web page or e-mail, to performing “click-throughs” to access more information. Electronic communications mayassist you and your vendors in tracking which messages and images compel the greatest number of employees to seekadditional information.

SOCIAL MEDIA: A NEW COMMUNICATION VEHICLE FOR WELLNESS?

Marketing and communications for your wellness program should ideally go beyond how you typically communicate benefits andHuman Resource updates. Successful wellness program campaigns get employees’ attention. In today’s busy world, it often takessomething catchy or curious to grab and hold people’s attention. While many employees use social media in their personal lives,this trend has yet to build much momentum in the benefits and wellness areas. Social media tools such as blogs, Facebook pages,Twitter feeds, online message boards and podcasts can help communicate about wellness programs and improve the engagementlevel of participants if used in a strategic way with the right workforce demographics.

Mailing to my home

E-mail

Company Facebook page

Text messages

Twitter

Blogs

Linkedin

46%

52%

2%

0%

0%

0%

0%

PREFERENCES FOR COMMUNICATING HEALTHAND HEALTHY LIFESTYLES INFORMATION

ADDRESSING PRIVACY/ CONFIDENTIALITY CONCERNS

When promoting worksite wellness, employersare often challenged by the privacy andconfidentiality concerns of their employees.Communications about the program shouldclearly state for employees: What’s in it forthem – what are the benefits? Why should theyparticipate? Who is going to see their personalhealth information? Who might contact themand why? Another important strategy to

mitigate this common concern is to share the aggregate results fromprograms like health risk assessment and biometric screeningcampaigns. Let your employees know what your organization haslearned by looking at the big picture of employee health risks. Also,update them yearly on any changes or progress that is being madewithin the aggregate data and for the overall wellness program goals.Sharing a sample aggregate report in advance of program roll-out orannual health assessment campaigns with employees can be aneffective strategy to alleviate concerns about the organization havingaccess to personal health information. Employees will more likely beactive supporters of your program if they understand the value of itand the benefits to them personally, as well as to your organizationin the long term.


Source: National Business Group on Health, How EmployeesUse and Want to Use Social Media to Obtain HealthInformation, 2010.

ORGANIZATIONAL PERSPECTIVES

Leadership support is often touted as the essential element for long-term wellness programsuccess. As more and more employers are establishing worksite wellness programs, the ideathat having all management dedicated to facilitating optimal employee health as an integralpart of being an effective leader seems to be catching on. The percentage that stronglyagrees that leadership is committed to improving employee health increased from 6% in2009 to 42% in 2010. This year’s survey also found:

n Employees generally understand the correlation between their health and health carecosts.

n Management is generally committed to improving the work/life balance of itsemployees.

n Management mostly agreed that employee health is linked to reducing absenteeism andincreasing productivity.

n About one-third of survey respondents did not agree that financial rewards should beused to encourage healthy lifestyles; an increase from last year’s survey results whereonly 15% disagreed with that approach. This is double the 15% that felt that way in our2009 survey.

Research continues to illuminate the importance of intrinsic or personal motivation inrelation to successful long-term behavioral change. Some debate the value of such extrinsicor external rewards as financial incentives. Under the pressures of financial recovery,organizations may also be frustrated trying to balance using incentives and increasingoverall engagement in their worksite wellness programs.

0% 20% 40% 60% 80% 100%

Management believes that employee healthis linked to reducing absenteeism and

increasing productivity

Leadership in the company is committed toimproving the work/life balance of its employees

Management believes that financial awardsshould be used to encourage improvements

(such as being a non-smoker or losing weight)in employee health

Employees understand the correlation betweentheir health and health care costs

Leadership in the company is committedto improving employees’ health

ORGANIZATIONAL PERSPECTIVE Strongly agreeSomewhat agreeDi sagree

46%

30%

25%

18%

42% 49%

61%

44%

52%

45% 9%

18%

31%

21%

8%


No program

Flexible work schedule

Telecommuting

Extended family leave(beyond FMLA)

Compressed work week

onsite clinic oroccupational health nurse

Elder care resources

Job sharing

Other, please specify

Onsite child care

Subsidized child care

0% 10% 20% 30% 40% 50% 60%

Large employers (over 1,000 employees)All employers

WORK/LIFE PROGRAMS

48%

36%

37%

44%

20%

25%

19%

27%

14%

19%

13%

25%

10%

15%

7%

15%

6%

6%

4%

10%

3%

6%

MANAGEMENT PERSPECTIVE — HEALTH,PRODUCTIVITY AND WORK/LIFE BALANCE

Managers seem to understand that employee health status is linked toabsenteeism and productivity. Compared to last year’s survey, moremanagers are reporting an effort to improve the work/life balance of theiremployees. About half of the survey respondents offer some type ofwork/life program, as compared to about a third last year. This is anencouraging sign that employers increasingly recognize the need to helpemployees achieve such balance. Managerial support of these programsis critical to employee adoption.

The top three work/life programs offered by survey respondents were:

n Flexible work schedule – 37% (as compared to 26% in 2009)n Telecommuting – 20% (as compared to 12% in 2009)n Extended family leave (beyond FMLA) – 19% (as compared to

10% in 2009)

WORK AND REAL LIFE — THE DELICATE BALANCING ACT

Work is where we spend most of ourwaking hours and some of the mostimportant life issues find their way intoour work days. Many employees come towork struggling with issues, such asfinding or affording reliable child care,managing financial strains, dealing withaging parents or grandparents andnavigating the health system with theirown chronic health conditions. Coping withreal life can often feel like a full-time job initself. An organization focused on havinghealthy and productive employees shouldconsider resources and tools that allowemployees to balance their work and life ina way that will result in best outcomes inboth areas. True balance between thesetwo worlds may seem impossible, but howone deals with issues in each area fuelsone’s energy and focus in the other.Organizations can help employees find theright balance by encouraging managementto set a good example and to be clear withemployees about the boundaries for worktime and expectations. They can alsoencourage and highlight employees withhealthy hobbies such as biking, running orgardening.


PARTICIPATION VS. ENGAGEMENT — WHAT IS THE DIFFERENCE?

The old adage “you can lead a horse to water, but you can't make itdrink” captures the essence of participation versus engagement inworksite wellness. An incentive can draw additional employees toparticipate, but they may not be fully engaged in the program andoptimizing their potential benefits of participating over the long term.Unfortunately, many worksite wellness programs and their participantshave a very small percentage of long-term health behavior changes.Many of the typical wellness program elements, such as newsletters,health risk assessments and web portals are not compelling orsustaining enough to engage participants’ hearts, minds and time for very long.

Some of the most effective ways to drive both participation andengagement is to follow best practices for wellness program design,including engaging leadership, developing a healthy workplace culture,having a clear and simple incentive design, consistent communicationsand the strategic use of employee success stories. Certain types ofincentives may create a compliance mindset and reduce an individual’spersonal commitment or motivation to becoming healthier ormaintaining good health. It is essential to educate employees about therationale for the incentive, with an emphasis on shared responsibility,the goals of the program and the expectation of what is required of them.And, most importantly, remember that success does not come fromcompelling people to jump through incentive hoops but from creating ahealthy culture of shared responsibility and passion for optimal healthas well as using incentives strategically to accelerate individual change.

“OUR FUTURE GOALS INCLUDEIDENTIFYING A PROGRAM THATMORE EFFECTIVELY MEETS THENEEDS OF THE EMPLOYEES —ONE SIZE DOES NOT FIT ALL.VENDOR’S APPROACH IS TOONARROW. WE NEED ADDITIONALAVENUES IN ORDER TO ENGAGEA LARGER PERCENTAGE OF THEEMPLOYEE POPULATION.”

(MANUFACTURING – WESTCOAST)

“NOT ENOUGH TIME AND NOONE TO HELP COORDINATEDESIRED PROGRAMMING,EMPLOYEES LACK TIME ANDPUT THEIR OWN HEALTH LASTON THEIR PRIORITY LIST,MANAGEMENT DRIVING FORSHORT-TERM RETURN ON LONG-TERM PROGRAMS, DIFFICULTYREACHING EMPLOYEES & THEIRFAMILIES.”

(HEALTH CARE – NORTHCENTRAL)

“YOU CAN’T PLEASE EVERYONE. WE NEEDTO FIND OUT WHAT MOTIVATES PEOPLEINTRINSICALLY. SOME PEOPLE AREN'T EVEN THINKING ABOUT BEING HEALTHIER,SO NO DOLLAR AMOUNT OR MATERIALITEM IS GOING TO CHANGE THEIRMINDSET. ALSO, JUST KEEP OFFERINGPROGRAMS. SLOWLY MORE PEOPLE COMEAROUND. THERE IS DEFINITELY A COREGROUP OF REGULAR PARTICIPANTS, BUTYOU CAN REACH OUTSIDE OF THAT GROUP.HAVE VARIETY AND FLEXIBILITY. LETTHEM SET THEIR OWN GOALS. CONTINUETO OFFER ENCOURAGEMENT, AND SHARESUCCESS STORIES. IT'S AN UPHILLBATTLE, BUT STAY FOCUSED AND STRONGAND KEEP PUSHING FORWARD.”

(RETAIL/WHOLESALE – NORTH CENTRAL)


0% 10% 20% 30% 40% 50% 60%

We do not currently measure employeeengagement

We conduct our own internal survey of allemployees

We solicit feedback frommanagers/supervisors about the engagement

level of their respective departments

We have contracted with an externalorganization who conducts an annual survey

of our associates

51%

14%

29%

15%

MEASURING ENGAGEMENT

ORGANIZATIONAL ENGAGEMENT

Only a quarter of survey respondents indicated that they had a specific and defined strategyin place to improve employee engagement. Those that measure employee engagement do somost often with an internal survey. More than half (64%) of respondents noted that theyconsidered their wellness program to be an important part of their overall employeeengagement strategy. Having a defined strategic approach to engagement ultimatelyfacilitates a more comprehensive, sustainable worksite wellness program. Details of how anorganization will create engagement are an essential part of a long-term vision for employeewellbeing and should be outlined in an operating plan. Many companies’ plans start with thefundamentals of rebuilding trust, improving communication and other elements thatenhance career wellbeing.

Our organization hasa specific and definedstrategy in place toimprove employeeengagement.

28%

72%

Yes

No

We consider ourwellness program to bean important part ofour overall employeeengagement strategy.

64%

36%

Yes

No


WELLNESS PROGRAM ENGAGEMENT

When asked about their organization’s approach to wellness programengagement:

n Many were not sure or disagreed that it was OK to penalizeemployees who are not taking steps towards health improvement.

n Most agree that they want employees to be compliant with certainsteps to get a wellness incentive.

n A large majority agree that they want to improve employee healthand address health risks and reward those who are taking stepstowards health improvement.

n Most agree that their programs seem to attract the same, healthyemployees.

n Many were unsure if they had addressed employee healthimprovement through aspects of their worksite culture.

We want to reward employees who aretaking steps towards health improvement

We feel it is OK to penalize employees whoare not taking steps towards health

improvement

We have addressed employee healthimprovement through many aspects of our

worksite culture

We have offered some wellness programactivities but they seem to attract the same

healthy employees

We want to improve employee health and tooffer programs that address their personal

health risks

We want employees to be compliant with thesteps we have outlined to get the wellness

initiative

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

48% 32% 13% 3%4%

9%

15%

29%

65%

37%

13%

32%

41%

26%

30%

28%

23%

16%

6%

23%

19% 32%

21% 9%

10%

5%

3%

5%

2%

1%

AgreeSomewhat agreeNot sureSomewhat disagreeDisagree

WELLNESS PROGRAM ENGAGEMENT STRATEGY


Do you regularly(biannually, quarterly,etc.) meet with yourleadership team toprovide a program updatethat outlines programaccomplishments, successstories, challenges, statusupdates and/or financialimpact results?

62%

38%

Yes

No

LEADERSHIP ENGAGEMENT

It appears that, while the research continues to support theimportance of leadership engagement, this is an area where manysurvey respondents are not as focused. There are many opportunitiesand strategies that can be used to facilitate all levels of leadershipbecoming more involved to help champion an internal wellnessprogram.

Do you regularlyrequest from yourleadership team thatthey communicateprogram successstories, challenges,status updates and/orfinancial impactresults to theemployees?

25%

75%

Yes

No

Do you regularlyrequest that yourleadership teamand other levels ofmanagementparticipate inongoing wellnessactivities?

43%

57%

Yes

No

Do you conduct anyspecific trainingswith seniorleadership to helpfacilitate their buy-inand understanding ofthe employeewellness program?

16%

84%

Yes

No


WELLNESS COMMITTEE ENGAGEMENT

Another area that appears to hold great potential for the surveyrespondents as respects wellness programs is that of further engagingtheir wellness committee members. One of the most commonchallenges with a worksite committee is maintaining the momentumof the program, keeping members actively engaged and contributingto the sustainability of the program.

Do you have aninternal wellnesschampion/captain at each worksitelocation?

69%

Yes

No

Do you regularly rotatewellness committeemember functions oradministrative tasksamong team members?

85%

15%

Yes

No

Do you provide acknowledgementor appreciation to the wellnesscommittee team members for theircontributions to helping shape thewellness program (such as publicrecognition, appreciationletter/certificate, gifts, etc.)? 77%

23%

Yes

No


31%

EMPLOYEE WELLNESS ENGAGEMENT

Employee engagement is the focus of many worksite wellnessmarketing efforts, incentive designs and managementcommunications. Common strategies that survey respondentswere employing included providing an explanation of thewellness program in their new hire orientation process andincorporating fun wellness activities into their programs. Lesscommon approaches seem to be refreshing marketingstrategies and having a buddy system to attract newparticipants and encourage social support.

Employee morale appears to be somewhat influential whensurvey respondents were determining their wellness programdesign. Most indicated that they wanted the wellness programto be viewed as a perk and that they were focused on avoidingmajor employee backlash.

To improve employee engagement, a majority of surveyrespondents indicated that they needed additional incentives,more attractive programs to offer potential participants andstronger leadership support.

Measuring engagement in the wellness program also seems tobe an area of opportunity for many survey respondents. Mostindicated that it was too early to tell if they have improvedhealth risks among their participants or they simply are notgetting any valuable reporting on their programs.

Do you include anexplanation of thewellness program inyour new hireorientation process?

49%51%

Yes

No

Have you updated your marketing andcommunicationsstrategies since theprogram launch topromote your wellnessprogram to participantsand non-participants?

36%

64%

Yes

No

Do you have amentoring or“buddy system”component of yourwellness program tohelp attract newparticipants andencourage socialsupport?

8%

92%

Yes

No

Do you incorporate“fun” wellnessactivities or eventsto increase socialsupport and engagenew participants?

44%

56%

Yes

No

What level ofinfluence doesemployee moraleor employeeperception have inyour wellnessprogram design?

41%

41%

No influence or very little — we do whatis best for our company to save costs

Some influence — we try to avoid major employee backlash

Very influential — we want employees to view our wellness program as a “perk”

19%

“AS A UNIONIZED ENVIRONMENT,WE CAN MEASURE ENGAGEMENT BY THE NUMBER OF GRIEVANCES,OR LACK THEREOF.”

(HEALTH CARE – NORTHEAST)


Increasing marketing andcommunication with potential

program participants

Setting more specific publicgoals for achievement

More coordinated efforts

Addressing trust or moraleissues with employees

Personalizing messages torecruit program participation

TOP FIVE FACTORS NEEDED TO IMPROVE EMPLOYEE ENGAGEMENT IN WORKSITE WELLNESS

0% 10% 20% 30% 40% 50% 60%

56%

45%

44%

37%

33 %

Too early to tell

Don’t know/not getting anyvaluable reporting

Getting worse or increasing

Most seem to be improving

Little or no change

0% 10% 20% 30%

30%

26%

1%

24%

21%

OVERALL TREND WITH POPULATION HEALTH RISKS


BUILDING A CULTURE OF HEALTH

Each organization has a unique culture, yet many employers pursuesimilar strategies in their quest to build a culture of health. The topthree strategies remained the same as last year’s survey results. Anemployee assistance or work/life program was again the mostcommon offering identified by survey respondents. Postinginformation about healthy lifestyles and encouraging healthybehaviors followed closely as the second most popular strategy.Discounted memberships or reimbursements for fitnessmemberships and activities were third.

Training of managers and supervisors to support health andproductivity efforts was adopted by the fewest survey participants –a mere 5%. This is a slight increase from last year’s reported 4% andremains an important area, not only to reinforce a culture of health,but also to increase employee engagement in both the wellnessprogram and the organization as a whole.

TOP FIVE CULTURE OF HEALTH FEATURES

Promotes fun competitions, teamsfor physical activity and/or

weight/nutrition in the worksite

Provides employees withpedometers or other tracking

devices

Sponsors teams in communitywellness events such as fun

runs/walks

Covers tobacco cessation productsunder the pharmacy benefit

Has policies and procedures that supportoptimal health (tobacco, seatbelt use, flex

time for physical activity, etc.)

0% 10% 20% 30% 40% 50% 60% 70%

66%

59%

52%

46%

42 %


0% 20% 40% 60% 80% 100%

Flu shots

Health website — general

Periodic health fairs

Disease management

Nurse hotline — basicreference and referral source

75 %

80 %

46 %

56 %

40 %

49 %

40 %

62 %

37 %

46 %

TOP FIVE ADDITIONAL PROGRAM OFFERINGS

All employersLarge employers (over 1,000 employees)

ADDITIONAL PROGRAMS AND TOOLS AVAILABLE

As programs continue to develop and mature we expect to see evenhigher adoption of these strategies. Additional programs that weremost commonly offered include flu shots, health websites and health fairs.


Communications/marketingmaterials

Health improvement programvendor

Health coaching vendor

Worksite screening vendor(biometric screening)

Reward tracking and deliveryvendor

Health risk assessment vendor

Disease management vendor

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

VENDOR SATISFACTION

Not satisfiedSomewhat dissatisfiedSatisfiedSomewhat satisfiedVery satisfied

5% 8% 37% 32% 19%

4% 9% 37% 30% 20%

6%

4%

7%

63%

5% 10%

8%

10%

5%

7% 35% 25% 28%

34%

20%

25%

15%27%

25%

28%

24%32%

35%

38%

43%

CONTINUING SATISFACTION WITHWELLNESS VENDORS

Survey respondents that work with wellness vendors are mostlysatisfied with them. The majority of survey participants who usevendors indicated that they were satisfied, somewhat satisfied or verysatisfied. Very few noted that they were not satisfied. Worksite healthscreening vendors again won the highest satisfaction ratings.

“WHEN YOU START A PROGRAM,MAKE SURE YOU ARECOMFORTABLE WITH YOURHRA/BIOMETRIC VENDOR. IF YOUCHANGE AFTER TIME, YOU WILLNOT GET GOOD COMPARABLEDATA.”

(MANUFACTURING – NORTHCENTRAL)


PROGRAM MEASUREMENTS

More than half (63%) of survey respondents track absenteeism by employee and only10% reported that they are able to track or measure presenteeism or other productivitymeasures. Many health risk assessment survey instruments include questions that cancapture self-reported presenteeism and absenteeism.

When asked which measurements are actually used to gauge their wellness program’ssuccess, respondents reported the following top metrics:

n Comparison of health care claim costs over time – 44%n Participation in wellness programs – 41%n Use of wellness program services – 28%


Analysis of health care claim costs forwellness participants compared to cost

for non-participants

Disability and workers’compensation costs

Employee satisfaction

Utilization of wellness programservices

Participation in wellness program

Comparison of health care claimcosts over time

Survey of employees — self-reportedbehavior changes, knowledge increases

Return on investment

Absenteeism costs

Plan risk based on employee healthprofiles (comparing initial risk

assessments to periodic updates)

Number of employees assessed higherhealth care costs due to selected criteria

(example: tobacco use status)

Productivity improvement

0% 10% 20% 30% 40% 50%

44%

41%

28%

27%

18%

18%

16%

10%

10%

8%

7%

4%

PROGRAM MEASUREMENTS

Some less commonly usedmeasurements also point tomajor sources of potentialreturn on investment:productivity improvement(4%), number of high costemployees due to selectedcriteria such as tobacco usestatus (7%), comparing riskassessments to periodicupdates (8%) andabsenteeism costs (10%).


It appears that many of the survey respondents do not have adedicated budget for wellness or were not sure how much theyare spending on their program. Of those that were able toestimate their per-employee-per-year (PEPY) costs, themajority estimate that they spend less than $25 PEPY onexternal wellness vendors, internal staff time and wellnessincentives.

As can be seen in the charts on the following page, surprisingly,about half (53%) of survey respondents indicated that for theirmanagement, achieving a positive ROI was not a program goal.This is a jump from last year’s survey where approximately one-third of respondents indicated this was not a program goal.Most others believe their management expects to see a positiveROI within two to three years.

COST OF WELLNESS PER EMPLOYEE PER YEAR (PEPY)

45%

40%

35%

30%

25%

20%

15%

10%

5%

0%

Less than $25 $26 to $50 $51 to $75 $76 to $100 $101 or more

External wellness vendorsInternal staff timeWellness incentives

38%

43%

38%

17% 19% 19%

16%

13%

10% 10%

7%

11%

19%

21%

18%

Percent of medical claimsreduction in certain measures such

as chronic conditions or ER use

MEASURING ROI

7%

3%

2%

2%

1%

0%

Per dollar invested (example, areturn of $1.50 per $1.00

invested/spent)

Decreases in worker’scompensation or disability

costs

Increases in productivity

Reductions in absenteeism

Percent of pharmacyclaims reduction

0% 1% 2% 3% 4% 5% 6% 7% 8%

5%

10%

15%

20%

0%

25%

30%

0%

Less than$1.00

SAVINGS PER DOLLAR INVESTED

6%

17%

11%11%

$1.01 to$2.00

$2.01 to$3.00

$3.01 to$4.00

$4.01 ormore

Less than1%

1.01% to2%

2.01% to3%

3.01% to4%

4.01% ormore

0%

20%

16%

12%

8%

4%

9%

7 %7%7%

11%

SAVINGS AS A PERCENT OF CLAIMS

FEWER ORGANIZATIONSMEASURE RETURN ONINVESTMENT

While only 15% of respondents withwellness programs reported that theirorganizations measure ROI, 7% calculatedmedical claim reductions and 3%measured their return against dollarsinvested. For organizations that sharedthis information, the results are below.


Insufficient data

Not enough staffing/time todedicate to this

Vendor states HIPAA privacyconcerns regarding reporting


Measurements/methodsnot deemed reliable

No access to or budget for anintegrated data warehouse

Participant group too small tomeasure accurately/reliably

Not sure how to measure

Hard to determine influence ofwellness vs. other factors which

impact health care costs

Too early to measure return

No interest at this time

0% 5% 10% 15% 20% 25% 30% 35% 40%

BARRIERS TO MEASURING ROI

38 %

32 %

30 %

29 %

28 %

24 %

14 %

11 %

9%

3%

2 %

“$1.7 MILLION SAVINGS FROM2009 TO 2010 IN MEDICALPLAN — OVERALL WELLNESSFOCUS AND PLAN WERE LARGECOMPONENTS OF POSITIVEOUTCOME.”

(HEALTH CARE – SOUTHEAST)

The main barriers to measuring ROI were:

n Insufficient data – 38%n Not enough time/staffing to dedicate to this – 32%n Hard to determine influence of wellness vs. other factors

which impact health care costs – 30%


Participation, engagementin programs

Employee satisfaction

Medical claims trend

Absenteeism costs


Disability and workers’compensation costs

Population health riskfactors

Tobacco use rate

Weight loss

Productivity

41 %

6 %

11 %

12 %

14 %

15%

19%

22%

31 %

33%

0% 10% 20% 30% 40% 50%

CATEGORIES IN WHICH THE COMPANY HAS MEASURED AN IMPROVEMENT

A COMMON MYTH OF ROI

Everyone seems to be talking about ROI, whyaren’t you? Don’t be discouraged. The reality isthat many employers are not calculating ROIand may never have the resources orcomprehensive program dynamics to do so. Atrue return on investment (ROI) involvescalculating the net benefits (or savings minusprogram costs) as compared to the cost of theoriginal investment. Many worksite wellnessarticles and presentations cite the typical“3:1” ROI that can be achieved.

The true process of calculating ROI involvescomplex data requirements and analytical oractuarial evaluation. Published researchstudies on ROI have collaborated with, and paidfor, expert assistance to collect and analyzethe necessary data from sources such ashealth risk assessments, medical claims andabsenteeism. This type of data needs to becollected into a trusted data warehouse andanalyzed over time. Employers struggle withsuch issues as participation data collection,not having a large enough participant group tomake comparisons over time and not beingable to collect consistent data from the samevendor year after year. It can also be asignificant challenge to determine whatpercentage of savings or cost reductions areattributable purely to the wellness program asopposed to concurrent plan design changesand other cost containment strategies.

OTHER MEASUREMENTS ARE VALUABLE

While a true return on investment calculation may be difficult tocapture for most employers, respondents reported measuringimprovements in other metrics, many of which will ultimatelyresult in lower costs to the organization. The categories in whichorganizations reported a measureable improvement were:

n Participation, engagement in programs – 41%n Employee satisfaction – 33%n Medical claim trends – 31%n Weight loss – 22%n Tobacco use rate – 19%

Research studies have outlined the potential cost savings in theareas of absenteeism, disability, workers’ compensation andpresenteeism, yet very few of our survey respondents are able tomeasure these types of savings within their programs.

“INTRODUCED A SUMMER WALKINGPROGRAM ESTIMATING THAT ABOUT 1/3 OFEMPLOYEES WOULD SIGN UP. HAD OVER50% OF EMPLOYEES SIGN UP. AN EMPLOYEEFROM A NEARBY OFFICE CAME OVER ANDSTATED THAT SEEING ALL OF OUREMPLOYEES OUT WALKING OUR CAMPUSINSPIRED HER TO START WALKING!”

(NOT-PROFIT – NORTH CENTRAL)


Management support

Return on investment

Incentives

Strong partnershipwith vendor

Leadership of supervisorsand co-workers

Sustainability of program

Culture of health throughoutthe organization

Communication of program

Strong internal leader

25 %

43 %

44 %

49 %

56%

59%

60 %

63 %

67 %

0% 10% 20% 30% 40% 50% 60% 70%

KEY FACTORS FOR WELLNESS PROGRAM SUCCESS

LEADERSHIP REMAINS KEY FORSUCCESSFUL PROGRAM

While various factors must converge to create a meaningful wellnessprogram, management support and a strong internal leader were onceagain reported as the top contributors to program success. A cultureof health and effective communication are also noted as importantaspects of a successful program.

“HEALTH SCREENINGS FOUNDONE LEUKEMIA VERY EARLYAND TWO THYROID CANCERSALSO VERY EARLY.”

(INSURANCE – SOUTHEAST)

“TOBACCO USAGE HASDECREASED SIGNIFICANTLY.OUR PROGRAM COMPONENTS:POLICIES SUPPORT OURGOALS, PREMIUM INCENTIVESFOR BEING TOBACCO-FREE,AND ANNUAL QUIT WEEKINCLUDES COUNSELING,TRAINING AND A SUPPORTGROUP.”

(OTHER – NORTHEAST)


MEASURING THE “VALUE” OF YOUR INVESTMENT – VOI

Where’s my ROI? What is the ROI for a healthfair? Offering a fitness center discount?Conducting onsite biometric screenings? Anemployer is unlikely to calculate a true ROI onany single activity in the short term. In thelong term, however, the cumulative effect of amulti-component program can be determined.Your wellness program provider should beproducing reports on participation,satisfaction and, most importantly, programoutcomes that showcase health improvementand behavioral change. These are the outcomereports you should demand from the verybeginning of your program. Keep in mind thatyou will need at least two years of comparabledata from your vendor in order to startassessing your program’s overall impact.

Most worksite health promotion programs areput in place intending to generate costsavings but are often not planned nor built toproduce optimal results. In order to achieve apositive ROI, a comprehensive program shouldbe customized to meet your unique needs andculture. Realistically, you may be able toestimate ROI and demonstrate healthimprovement. Avoid focusing too heavily onROI or throwing around that term whendiscussing the potential impact of worksitewellness programs. Instead concentrate yourefforts on building the best program you canthat is customized to your needs and committo working with vendors that can effectivelyshowcase the value of your programinvestment (VOI) in realistic ways in the shortand long term.

DEFINING A SUCCESSFUL PROGRAM

Organizations define success in their wellness programs invarious ways. Some are focused on offering wellness programs toimprove morale and retain healthy, productive employees.Others target specific cost drivers within their health care costs.The most important factors influencing program success fromour survey respondents were:

n Management supportn Strong internal leader championing wellnessn Communication of program goals and componentsn Culture of health throughout the organization

Factors that seemed less important or neutral were:

n Return on investment statisticsn Strong partnership/satisfaction with vendors

“ONE OF OUR WEIGHT MANAGEMENTPROGRAMS IS SO SUCCESSFUL THATMANY OF THE PARTICIPANTS AREGETTING OFF ALL OR MOST OF THEIRPRESCRIPTION DRUGS, SEEINGIMPROVED BLOOD SUGAR, BLOODPRESSURE AND CHOLESTEROL. SOMETYPE II DIABETICS HAVE EVEN BEENABLE TO GET OFF THEIR INSULIN.”

(HEALTH CARE – NORTH CENTRAL)

THE POWERFUL IMPACT OF WORKSITEWELLNESS

The business case for wellness often hinges on health care costsavings and improving the productivity of a workforce.Regardless of industry or mission statement, all organizationsneed healthy, productive employees to get the job done and meettheir organizational goals with distinction. Wellness programscan change lives – can save lives – especially when healthproblems are detected before they become overwhelming. Thetrue impact of worksite wellness may be difficult to quantify butthe value of helping the workforce achieve optimal health isclear to the organizations that develop programs.


WHAT THE FUTURE HOLDSIt is hard to create passionate, engaged customers, students orpatients without passionate, engaged employees. Engagement in theworksite has become a broad and somewhat difficult concept todefine and cultivate. Organization leadership cannot dictateengagement merely with mission or vision statements or throughvalue statements; it must also grow organically one successful workgroup at a time.

By nature, most people want to contribute to something positive andbe proud of where they work and what they bring to an organization.Employee engagement involves capturing the heads and hearts ofyour employees to instill an intrinsic desire and passion for doingtheir best, giving their best and living their best. Engaged employeeswant their organization to succeed because they feel connectedemotionally and socially to its mission, vision and purpose.

The same holds true for worksite wellness. The best practicerecommendations to conduct employee needs assessment surveys,share success stories, involve all levels of employees in wellnesscommittees and have strong leadership support of the program allcontribute to employees feeling that their participation is vital to apositive culture of health in their workplace. Employees need tounderstand how they can grow with the organization, how theybelong, what they can contribute and what they can get fromengaging in worksite wellness. At a very basic level, managers caninfluence employees’ level of engagement in the wellness programby setting an example, sharing organizational expectations andproviding needed resources. More than this, they can energize theiremployees by showing them that they care about the health of theiremployees and the overall health of their organization.

As the economy recovers, employers are looking for innovative waysto deal with escalating health care costs, maintain employee moraleand drive positive organizational results. Worksite wellness, ifpositioned correctly, can provide a solid foundation for all of thesechallenges and lead to a more engaged, productive workforce.

For more information contact:Cheryl A. Mealey, CHESNational Practice Leader Wellness [email protected]


ACKNOWLEDGEMENTS

Survey research, production, editorial and technical work were provided by Paulette Callen, Lisa DesJardin, LeahFidler, Nancy Harris, Erech Meyers, Jennifer Price and Beth Stewart.

REFERENCES1 Schwartz, T. (2010), The Way We’re Working Isn’t Working. The four forgotten needs that energize great

performance. 2 Research Works. Partnership for Workplace Mental Health, Volume 1, Issue 2. June, 2009. 3 Harter, J.K., Schmidt, F. L., & Keyes, C.L.M. (2003). “Well-being in the workplace and its relationship to business

outcomes: A review of the Gallup studies.” 4 Rath, T., Harter, J., WELL BEING The Five Essential Elements. Gallup, 2010. 5 Lundin, S., Nelson, B., ubuntu! Pub. Broadway Books, 2010.

With respect to all charts and tables in this document: Not all percentages equal 100% due to rounding. A full technical appendix

with all survey data is available to Willis clients upon request.


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