Wp Ihr Employee Wellness 0305 (3)

Research paper

Employee Wellness

HR.COM Wellness Survey Study
“Wellness: What Flavor Do You
Prefer?”
Written by

Rod Reasen II, CEO
Healthiest Employer, LLC

www.hr.com | 1-877-472-6648 copyright © HR.com March 2012

WP_IHR_EmployeeWellness_0305.indd

Research paper

“Wellness: What Flavor Do You Prefer?”
Employee Wellness
In 2011, HR.com created a Wellness Advisory Board to assist the Institute for Human Resources:
Employee Wellness certification program with content. The Board elected to measure the
human resource community’s views on corporate wellness through a survey. This high-level
survey generated several expected results, with some new notable points. This whitepaper
addresses the respondents, questions and answers, and overall trends in the wellness market.

The 239 respondents were comprised of HR.com’s distribution list and the Advisory Board’s
network, and took place from November 2011 to January 15th, 2012. The survey was created
with 10 questions in multiple select, ranking, and yes/no answers. The respondents represented
an employee base of 1.8 million employees worldwide.
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Participating employers represented
all sizes. No single employer size
category dominated the response.
As Exhibit 1 indicated, employers
with fewer than 500 employees
represented 49% of the respondent
audience. It is promising to see this
segment getting more involved.

Additional facts:
• Average age of wellness
program is 4.5 years
• Average employee age is
40.13 years

Q1. What is your greatest challenge in getting results
from your wellness program?
Respondents were offered 15 choices to select their greatest challenge in getting results. When
considering the average respondent’s wellness program has been in existence for 4.5 years,
it is not surprising that engaging employees came in as the highest-rated challenge. This is a
common topic on our travel and speaking circuit on corporate wellness. There are several stages
of engagement that we need to understand.

Phase 1: Getting initial participation
When establishing a wellness initiative you should look for “champions” within the organization
who can influence others to participate. Additionally, offering some form of financial incentive
can help create initial participation. Items like gift cards, cash, premium discounts, and drawings
for large prizes draw interest. The obvious key, at this stage, is to get as much of your population
engaged in participation as possible. Surveys are frequently used to gauge areas of interest
along with motivating factors. It is important to understand what drives your population. Do
you have a diverse workforce of men and women, age, social demographics? Is your population
health minded, sedentary or obese? Make no assumptions. Whether referring to incentives
or areas of needed health change, your individual interests will not be appealing to everyone.
Sparking the attention and motivation of your team will involve a bit of investigative work on
your part. Your efforts at the beginning will pay dividends if you take the time to start right.


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Phase 2: Achieving on-going participation
This challenge can arise even in the first year. Personal interests or “what’s in it for me” drives
participants. If your wellness program’s participation is solely driven by financial incentives, then
you may need to continue offering these to keep your population’s attention. You may even
need to increase the amount to encourage greater participation in the future. Educating your
team members about the personal value of wellness may seem logical but many individuals
need your assistance in showing them how. You are uniquely situated to be able to offer the
support necessary for individuals to improve their own health. Developing a long-term strategy
at the beginning will help you follow a path toward success.

Phase 3: Desire for lasting participation
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While all organizations hope their workforce will immediately understand the personal benefits
of health, the reality is that most of us are stubborn and like to follow our own desires. As a
wellness practitioner, it is important to understand that your enthusiasm for personal health
is not always communicable. Getting lasting participation takes hard work, diligence, an
understanding of behavioral psychology, and knowledge of your population. “Give a man a
fish and you feed him for a day. Teach a man how to fish and you feed him for a lifetime.”

The personal benefits of being healthy far outweigh those of the employer; yet, so much of
corporate wellness is focused on employer benefits. The employer, government, and society
will ultimately benefit from individual personal health. To create lasting participation, employers
must direct their attention toward personal accountability and intrinsic motivation.

Teamwork is also highly important. Studies have shown that you are highly likely to resemble
the friends you spend time with. Thus, if your friends like to sit, eat potato chips, and watch
television you will likely begin doing the same. Subsequently, if you find yourself around
friends who exercise, eat right, and focus on health, you too will find yourself motivated to do
the same. You can be a positive or negative influencer on your team. The applicable point
is that teams can help each other by offering ideas, camaraderie, and a social dynamic that is
very powerful.

GOOD SIGNS: The four lowest scoring items include lack of interest by the HR team, lack of
c-suite interest, privacy and confidentiality concerns, and lack of energy/motivation. It was not
too many years ago that privacy and confidentiality ranked as one of the highest concerns of
employees. The cascade of information and perceived security of the data has softened the
workforce to be open to more disclosure.

Another item is certainly clear: the HR professional is interested and motivated to take corporate
wellness to the next level. They are now an advocate for the development and implementation
of a strong plan.

Interest and engagement are the two broad areas to be addressed. We discussed the
employee type above but cannot neglect one major constituent, leadership. Whenever you
read about or discuss corporate wellness this topic becomes paramount. As leadership goes,
so goes the organization. More than ever, employers see their strategic position evolving from
a supporting role to a leading one. The idea behind creating a healthy workforce needs to
move beyond a budget item. We need leaders who see the impact of health on society and
not just their bottom line.


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Employee Wellness
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Q2. Please rank the following statements that best describe
the objective of your workplace wellness program.
As corporate wellness initiatives grow in size and intensity, we wanted to discover what is
motivating employers to dig deeper. There is an increasing understanding that wellness goes
beyond offering a fitness center or bowl of fruit. There is also a newly discovered foundation
and belief that wellness does not have to be tied directly to healthcare claims to show positive
momentum and return. As you will see in this section, containing healthcare costs ranks 6th
whereas the creation of a healthy worksite environment ranked first.

Employers intuitively see the link between corporate wellness and the personal health of their
workforce. While certainly very important, claims reduction is now taking a backseat to the
overall health of the employee. Bravo!

Although ranked last on this survey, the desire to use wellness for recruiting and retention
benefits is moving up. We have had many discussions with employers who say this is one thing
that younger workers are asking about during the interview process. Take note employers.
Culture and environment are very important to this demographic.

There is also a growing trend to contemplate other outside effects on a population. Teamwork,
education about healthy lifestyles, and dependent inclusion are now considered norms when
establishing a corporate wellness program.


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Employee Wellness
Ranked only slightly behind healthcare costs is the idea of enhancing productivity. We see
this as one of the key issues among employers worldwide. Many in the wellness industry see
this as a national competitiveness issue. As a nation, we must concentrate on the health and
productivity of our workforces to remain the premier supplier of talent, intelligence, and labor.

Q3. Which of the following do you offer at your
organization? (Select all that apply)
There’s no shortage of options for this question, so we included the top areas with the most
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relevance (which include some new items that are trending in the marketplace). The results are
not overly surprising, but we do see some alarming tendencies.

ALARM BELLS RINGING:

Two of the areas we found most alarming are obesity education and tobacco cessation. By most
studies, including those by the Centers for Disease Control, these are two of the most pertinent
yet still aggressively out-of-control areas in American society. One in three US adults is obese,
costing employers $1,000 to $5,000 per obese employee. Tobacco use is still the leading cause
of preventable disease and illness in the United States. These are both controllable issues that
demand immediate attention.

The survey showed employers continuing to offer flu shots, wellness flyers, and other materials
but the time has come for stronger solutions. To have a sustainable wellness initiative, employers
must take action and move toward identification, mitigation, and prevention of health risk.

There were several positive areas showing encouraging results: nutritional education, weight loss
initiatives, healthy vending, and biometric screening. Biometric screening has been on the rise
for the last few years. This objective and statistically relevant information can be used to help
identify many areas of risk including hypertension, diabetes, and cardiovascular disease. Like
health risk appraisals, biometric screening provides actionable information on your population
as a whole. We see biometric screening becoming the linchpin for other wellness initiatives.


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Employee Wellness
Nutritional education and weight loss initiatives should go hand in hand but they are often
divorced of each other. Independently they are important but together they can become
powerful. Most individuals do not understand the difference between a protein, carbohydrate,
fiber or starch. The terms are familiar but ask one of your truck drivers if he is balancing his
diet or if he knows how. You have an opportunity to inform, educate, and train your folks how
to eat healthy. Experts agree that eating right and staying in motion are extremely important.
Obviously there is a tie to obesity.

As we move on we find healthy vending options as a natural progression toward this endeavor.
When it comes to vending, there are many good options to choose, including reducing the
cost of a healthy alternative, dramatically increasing the cost of unhealthy options, or entirely
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removing the unhealthy ones. Don’t be afraid to make a bold move.

Q4. What incentive types do you find “most effective”
in encouraging participation in your workplace wellness
program? (Select all that apply)
Our goal was to identify opinions from wellness: firsthand user and the HR community. There
are many thoughts, theories and studies about how to best incentivize employees to participate
in corporate wellness programming. Some folks believe financial incentives are THE best way,
while others passionately believe in social or intrinsic motivation.

While 239 respondents is not a comprehensive study, the information is nonetheless valuable.

On the chart you will see that premium discounts rated ninth overall, while giveaways, gift
cards and cash heavily outweighed the other options. One suggestion - know your population.
As mentioned earlier, behavioral economics teach us that people are self-motivated. Not that
they are motivated to get up and run three miles in 26 degree weather, but rather that they
are motivated by their own self interests. These interests range dramatically by region, culture,
social demographics and other environmental factors. To look at this chart and pick the highest
rated incentive for use in your population could be a major disservice to you and your team.


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Employee Wellness
Let’s look at a few of these:

Giveaways, gift cards, cash, and merchandise have been the staples of wellness programs.
What can we get someone to do for a ten-dollar gift card or t-shirt? Our society is riddled with
free offers, coupons and deals. Although they may work for a while, studies show that we
eventually become immune to their allure. Variety truly can be the spice of life when it comes
to keeping your employees’ attention. The counter objective to the above is that we also have
very short attention spans. With the average person losing focus after just 20 seconds it is no
wonder these types of incentives are still being deployed today.

We heard of an auto manufacturer giving a new truck away to the winner of a weight loss
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challenge. The challenge drew a bevy of attention and many in the organization did lose
weight. This type of offering can be effective when used to draw attention to the bigger
strategic goal.

Lastly, additional vacation time or paid time off is a way to reward any and everyone in
your organization. Drawings, big prizes, and contests draw upon our competitive spirit but
limit the number of winners. For those less interested in competing, this incentive becomes
very attractive.

Before choosing any incentives, employers should think through what behavior they are trying
to elicit. They must also consider the potentially destructive behaviors being conditioned.
For wellness to be sustainable, employers must work to create long-term motivation. Your
incentives should be thought of as a way to introduce and draw attention towards your strategic
objectives.

Q5. Have you had any internal discussions around how
healthcare reform will impact your business?
We wanted to learn if employers were discussing healthcare
reform as it pertains to their business. More importantly, we
were hoping to see how employers were looking at reform
through the lens of wellness initiatives. Healthcare reform
is certainly not a new talking point and one could argue that
the market is overwhelmed with this subject, which is one
reason we were surprised to find that close to half of the
survey respondents answered that they have not discussed
its impact.

Much could be said about the need to plan, prioritize and research, but we will leave that for
another day. As employers consider the changes ahead, we suggest seeking professional advice
for legality, structure, and future financial ramifications.

Several changes that affect corporate wellness include:
1. Small employers may have federal and state grant money available to help establish or
bolster wellness programming.
2. There are impending legal changes that would allow incentive amounts to grow by a
significant amount. Currently set at 20% we have seen proposals to move this as high
as 50%.


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Employee Wellness
3. Copayment changes on preventive services in 2018 may facilitate the need to review benefit
design and wellness programming.

4. “HIPAA’s five” standard based restrictions need to be adhered to legally.

Healthcare reform has already made its way into the health delivery system and benefit design.
As incentive rules are modified, we suggest employers take a close look at how they can use the
law to their advantage. The percentage of incentive will likely be increasing substantially thus
allowing employers to create glaring choices for employees who elect to be healthy. For those
employees who choose otherwise, the financial structure could be severe.
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This area of the law is very favorable to the employer giving them more control to structure their
health plan and wellness programming effectively. Overall, these are significant changes that
should be considered when developing an employer wellness strategy. We hope that employers
will take this to heart and begin having internal discussions within the year.

Q6. How do you anticipate healthcare reform affecting
your business?

For those who answered, “yes” to considering the business effects of healthcare reform, we
asked them to tell us how. We wanted to see if corporate wellness had finally moved beyond
healthcare cost reduction to become a standalone program. The results were encouraging.

Before we get into the positive aspects of this chart, let’s discuss the red bar. As mentioned from
question five, there is still a large extent of employers who have had little discussion. The above
shows that of the 125 employers from the original 239, only 12.9% or 17 have still had minimal
discussion around how this will affect their wellness programming.

Still, the majority suggest they will continue offering wellness programming. Another 11.11%
say they could actually begin increasing wellness spending and programming. Only a handful of
respondents suggested they may drop wellness altogether. A hopeful sign for both the wellness
industry and society as a whole.


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Employee Wellness
Looking at this question by itself may cause some to ponder. After cross correlating question
six with question two (Please rank the following statements that best describe the objective of
your workplace wellness program) things become clear. The apparent link is not the expected
relation to healthcare costs. It is the desire to create a healthy worksite. Furthermore, when
the two questions are linked what you find is that the majority of employers are focused on
individual health, education about being healthy, and the perpetuation of a culture of health.
Notice I did not mention healthcare costs.

Certainly driving down healthcare costs is important but fortunately these survey respondents
see the bigger picture. This is incredibly inspiring. Corporate wellness initiatives have
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existed for decades and there are many trailblazers who deserve our applause for laying the
groundwork. Without these folks it is hard to believe that the above employers would have
responded so favorably.

Corporate wellness is here to stay.

Q7. How do you measure the effectiveness of your
wellness program? (Select all that apply)
One of the touchiest subjects when dealing with corporate wellness programs is the discussion
of metrics, tracking results, and return on investment. Some would argue that this is not
something we should even be worried about. Others prefer key performance indicators
signalling a program’s effectiveness.

As a data collector and metrics driven organization, Healthiest Employer is focused on the proof
behind a theory. We understand that everyone calculates return differently, but see several
common denominators that are far less subjective than objective. The survey responses were
not all that encouraging. In fact, 27.84 percent of respondents say they don’t try to calculate
a return and an additional 10.8 percent say they guess. Hmmm.

Much could be said about which methods of calculation to use or what specific data is relevant
to calculate. We suggest starting. Most employers have access to three basic data sources:
claims, biometric data and health risk assessments. For those employers who are blessed
with additional access to information you may be seeing the aformentioned plus pharmacy,
employee assistance programs, disease management, workers compensation, abesenteeism,
and disability data.


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Calculating ROI: As mentioned before, there are many theories about the correct path to
calculate an accurate return on investment. Rudementary forms of calculation do exist. For
instance, organizations can compare year to year claims and pharmacy usage or spending.
Undoubtedly, it is nice to see these numbers drop from year to year. However, a cause and effect
scenario is not necessarily being produced. The reduction could easily have been driven by the
economic climate, turnover, eligibility or a host of other factors. Simply to state that a wellness
program was effective by just viewing these two metrics is at best naive.

A more precise method would be to use multi-year specific biometric and risk stratification
factoring across a specific static population. A mouthful and simply stated just means make
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sure you are comparing the same population set when looking at aggregate data. The issue
with most employers when reviewing aggregated risk factors is that they literally change daily.
Turnover is one of the biggest enemies to the calcualtion of corporate wellness return. By the
time the employer gets his report, the population has already changed. The key is to make sure
you understand this dynamic when building your hypothesis.

One should also consider which inputs to include. We believe there is enough core and pariphial
data to show a fairly dynamic picture. Using biometrics, pharmacy, claims, and absenteeism
data employers can get a snapshot of their current health status. By plugging in employee
assistance, disability, workers compensation, and health risk assessment data employers have
the ability to refine the picture. Think about it like putting the edge pieces around the puzzle.
The hard part is done but you still have to fill in the middle.

The argument here is to start tracking. Begin with where there is access to information and
build from there. The idea behind data collection is to find the story that the information is
telling. Like a puzzle, data in silos can only show a piece of the picture. The more pieces that
exist the more clear the story becomes.

As employers become more savvy about their data and what to look for in this arena we see
exciting things happening.

Q8. Where do you turn first for corporate wellness
advice? (Select only one)
The last five years have been a boon
to the wellness community. Employers
are adopting wellness initiatives at a
higher rate than ever before and thus
creating the need for resources to fulfill
the demand. We asked respondents to
tell us where they seek advice first. For
the brokerage community, the results are
very optimistic.

Respondents were asked several questions
that advisors may find quite encouraging.
For example, 63.18% say that engaging
employees is the greatest challenge they


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face in getting results from their wellness program (Exhibit 2). Who better suited to assist
the human resource professional than someone who already knows and understands how
employees think? The most encouraging number for advisors came from the 25.94% who
ranked the broker consultant as the “first place” they seek corporate wellness advice.

There is little question that healthcare reform has had its effect on the brokerage community,
but it seems this group is also doing a good job at transitioning into a new era. Another
question that showed renewed hope for the advisor was when we asked how healthcare reform
would affect the business. Only 1.43% of respondents said they would drop health coverage
while 11.11% said they would increase wellness spending (question 6). The overwhelming
majority said they would continue to offer both insurance coverage and wellness programming
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to their workforce.

When asked this same question, 47.70% (question 5) said that they have not discussed the
impact on healthcare reform. Additionally, respondents ranked “lack of time” as their third
greatest challenge in implementing a wellness program.

An opportunity undoubtedly exists for those in the business of giving advice. As advisors
continue to journey down these new roads of discovery, one thing is aptly apparent. Good
advice is always welcome.

Insurers should also take note of this question. As respondents look for ways to build and
improve their wellness programming they are seeking advice from you. One could argue that
the insurer has a major interest in seeing wellness grow, as it could immediately affect their
bottom line. Several insurers believe enough in this idea to offer guaranteed rates, with some
up to three years. Of course the employer will be required to follow a strict protocol but it could
be worth it.

Whatever the method, there are many resources on this topic. Information is available but it
takes some time to weed through, analyze, and choose the best approach.

Q9. What do you see as the biggest hurdle for a corporate
wellness program’s long-term sustainability? (Select one
response)
We addressed this previously under “incentives,” but it can’t be mentioned too often. For
corporate wellness to remain effective it must have a sustainability strategy. Employers realize
that short-term initiatives may get people moving initially, but they need them to keep doing so.
Corporate wellness is more of a marathon than a sprint.

Keeping employees engaged is the biggest hurdle to sustainability. For this survey the average


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age of wellness programs came in at 4.5 years. These employers are also seeing a plateau effect.
Many new employers are joining in and creating workplace initiatives but for those who have
been doing this a while we see a real issue. What happens when you level out? Do you start
from scratch? Hire a new wellness vendor? Start an onsite clinic? Go social or drop wellness
altogether? These are the questions that many employers are asking. As the chart suggests,
they don’t see healthcare reform or environmental factors getting in their way. Nevertheless,
leadership and engagement remain focal points for the wellness industry.

Engagement is not only an issue from the beginning but it remains an issue throughout the life
of a business. For an employer to stay moving it must consistently evaluate the effectiveness of
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current programming while predicting the areas to be addressed in the future. There is no set
it and forget it trigger with corporate wellness. The minutiae of the population evolve and so
must the programming.

We strongly believe that wellness works when individuals understand their role. Federal
government, local government, employers, and individuals are all responsible but no one is
more rewarded by good health than you and I.

Q10. Have you made any HR policy changes that support
wellness? If so what?
The role of HR in wellness is ever expanding. In fact, we see a new job function emerging in
mid- to large-sized employers; that of the wellness manager, coordinator, educator. We like
to call them “health promotion directors.” In recent years, the human resource professional
has been tasked with the enormous undertaking of creating, implementing and sustaining a
wellness initiative. Although many have performed remarkably, most have been doing so with
little to no training or the necessary time needed to fulfill this responsibility adequately.

We see new institutes, colleges and universities establishing training for this growing field.
Furthermore, we see a natural progression for wellness to appear in employee handbooks.
Items such as tobacco-free work policies; volunteerism, increased pre-employment screenings
and hiring practices are changing merging strategic wellness initiatives with policy.

Some employers have gone to the extreme of no longer hiring tobacco users. Others have
created a “no sharing policy.” If you have
the flu, a severe cold or other contagious
illness, stay at home and don’t share.
There is merit in understanding how to give
flexibility to your workforce to preserve
the health of the team. If you are serious
about creating a culture of health, then
you will inevitably make policy changes
to support your goals. Make sure you
seek appropriate legal advice and support
with any change you see suitable for your
organization.

The health and productivity field is by no
means a new idea or an unproven one.


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Employee Wellness
Yet, new ideas are budding and the space is growing rapidly. As the landscape of national
health continues to deteriorate, we see wellness, productivity and prevention rising. On behalf
of the Institute for Human Resources Employee Wellness certification program, we offer our
sincere congratulations to those of you who have entered the wellness journey and extend an
invitation to those pondering. Let’s make a difference together.

About the author:
IHR Research Paper

Rod R. Reasen II
Chief Executive Officer
Healthiest Employer, LLC

Mr. Reasen is no stranger to the wellness community. For over ten years he has worked hand in
hand with employers of all sizes to create unique trendsetting wellness programs. The Healthiest
Employers® award program was created to show the innovation taking place in corporate
wellness. The program has grown to nearly fifty U.S. cities and includes thousands of employers
representing nearly thirty million employees.

Healthiest Employer, LLC is a research and analytics firm focused on behavioral health and
wellness. They work directly with wellness vendors, brokers and insurers to assist with analytics
in the workplace.

Mr. Reasen holds two bachelor degrees in Marketing and Finance from Bob Jones University in
Greenville, SC and has been the featured speaker at multiple universities, wellness conferences,
forums and webcasts.

He has authored over thirty articles in leading journals, including The Boston Business Journal,
Employee Benefit Adviser Magazine and Inside the Minds – Employee Benefits Best Practices.
His wellness research has been helping employers reconsider the way they develop, deploy and
administer their initiatives.


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