Some
workplace health-promotion programs give no measurable return
on investment - leaving HR executives wary of implementing such
plans.
Other
HR execs feel that simply pitching the idea of a work-site wellness
program could place them in a vulnerable position with top management.
"The
reality is that poorly designed health-promotion programs don't
work," says David M. Hunnicutt, president of the Wellness
Councils of America in Omaha, Neb.
But
well-designed programs do, according to Gary Montrose, president
of Ashby, Montrose & Co. In Denver and Ron Z. Goetzel, vice
president of the Medstat Group in Washington.
"The
economic case for work-site wellness programs can be made,"
says Montrose, who co- authored Managing Health Care Demand.
Montrose points to an investigation conducted over the last several
years by Goetzel.
In
the evaluation of wellness programs involving 20,000 to 25,000
employees at New York City- based Citibank, Goetzel found a return
of $6.70 for every dollar the company invested. The findings
were based on a study of medical costs and absenteeism.
As
a rule of thumb, Goetzel says "health-promotion programs
save money if they are well- designed, well-implemented and well-evaluated.
But
HR executives must put in time and planning to achieve quality
results, Montrose adds.
Evaluation
is Key
For HR executives
to ensure their programs are producing measurable returns, evaluations
must be conducted, says Larry Chapman, spokesman for the National
Wellness Institute in Stevens Point, Wis., and chairman/senior
consultant for Summex Corp. in Seattle.
But Hunnicutt says
the majority of corporate health-promotion plans in the United
states don't even have formal goals or objectives.
An Office of Disease
Prevention and Health Promotion survey of work sites nationwide
found that while 80% offered health-promotion activities, less
than 20% actually had established formal goals and objectives
for their programs. And only 12% had a means of evaluating their
program's effective.
An ongoing evaluation
should be performed each year and additional periodic evaluations
should be conducted on an ad hoc basis, Chapman says. The latter
might be initiated by a variety of triggers; for example, a question
about how well an employer's program interfaces with those offered
by major managed-care vendors could prompt a periodic assessment.
However, evaluating
only the economic impact of these programs is shortsighted and,
ultimately, ineffective.
"In evaluating
a workplace health-promotion program it is important to examine
health outcomes and process outcomes - not just economic benefits,"
Goetzel says. Process outcomes are participation levels, employee
awareness about the program and employee satisfaction, he adds.
Unless health and
process outcomes are achieved, "you will not achieve the
economic benefits," he says.
But, Chapman adds,
program survival depends on addressing economic issues.
Chapman says wellness
programs should be designed to produce economic savings in each
of the following health related categories: health claims, absenteeism,
workers' comp and short-and long-term disability.
Broad
Perspectives
The actual task of
evaluating a work-site wellness program encompasses several different
elements.
It is important for
human resource executives to be very clear about what their programs
are to accomplish, says Hunnicutt. Is the program supposed to
contain or reduce medical care claims? Or is it there to improve
employee morale? What about reducing absenteeism?
"In examining
the costs of existing unhealthy behavior, it is often necessary
to look past immediate effects. However, it is [more] constructive
to take a broad-systems perspective on the problem," says
Montrose.
"A common risk
in thinking about work-site wellness challenges and initiatives
is 'impact myopia' - a tendency to look at only the nearest,
most immediate effects of possible interventions," he says.
"From a broad-systems
perspective one can see that work-site wellness programs have
a series of effects. For example, the use of health services
leads to expanded consumer satisfaction, which in turn leads
to more appropriate use of health services," Montrose adds.
A thorough evaluation should take all of this into account, he
says.
Such factors as direct
and indirect impact on productivity, health status, service utilization,
employee retention and family members should also be considered,
Montrose says.
Impact upon family
members is typically overlooked in tightly controlled evaluation
studies, he adds. Smoking or alcohol abuse by pregnant mothers,
for instance, may lead to the birth of a severely impaired child,
which could cost an employer or health plan hundreds of thousands
of dollars - an expense that could have been avoided with a well-designed
wellness plan.
In evaluating what
the company offers, HR execs must consider their alternatives
carefully, adds Bob Harmon, spokesman for the Washington-based
American College of Preventive Medicine and national medical
director of the Optum Division of United Healthcare in Minneapolis.
"HR execs need
to consider a number of different options. Which is best depends
upon the situation and upon such factors as how long they can
wait for the benefit to produce results and how much they can
afford to pay," Harmon says, adding a population profile
- what are the ages, genders and risk profiles of those who will
benefit from wellness - should also be conducted.
While each company
will have specific goals for its wellness evaluation, HR execs
can look at the characteristics of successful promotion programs.
One common characteristic is one-on-one counseling for high-risk
individuals, says Goetzel, who, along with Catherine Heaney of
Ohio State University, analyzed more than 40 separate evaluations
of workplace programs for the Centers for Disease Control and
Prevention in Atlanta.
"We found that
if they are done properly, these programs significantly improve
the health of the population over the long term. However, they
must include a component that is directed at people at the highest
risk," he says.
Various employers
may have different subgroups that may be identified as being
at high risk. The use of alcohol by young males could be a focus
at one company, while the postmenopausal health problems of females
could be the focus at another.
Strategic
Issues
But only addressing
the needs of high-risk individuals is insufficient. It is important
that the workplace's physical environment and the organization's
policies foster effective wellness programs.
"Too often only
individual behavioral changes are looked at," says Shari
McMahan, assistant professor at the University of California's
School of Social Ecology in Irvine.
For example, a smoking
cessation program will only succeed if it helps the individual
employee while promoting a corporate policy on nonsmoking. The
physical work environment also has to be modified with ashtray
removal, nonsmoking reminders, etc.
Similarly, a program
on violence prevention should expand beyond the boundaries of
a course on how to deal with disgruntled clients and fellow employees.
Physical barriers should be constructed to decrease the opportunity
for violence to arise. And corporate policies should promote
violence prevention.
"Wellness needs to be an integral part of the corporate
culture," concurs Chapman.
Indeed, the most successful
work-site wellness programs are linked to core business objectives,
says Hunnicutt.
"One reason wellness
programs get cut is that they are not seen as essential,"
he says.
An insurance company's
wellness effort illustrates his point. To help its 3,000 employees,
the company established an executive fitness center and a rigorous
prostate screening campaign.
But when the program
was evaluated, company officials discovered wellness needs were
coming from large numbers of women instead. The bulk of health-care
costs were related to child birth.
"That is where
the health need was in this organization," Hunnicutt says.
"Approach wellness just as you approach business planning,"
he says, adding a connection must be made between health promotion
and the core business. If the link isn't there, the wellness
program is probably lacking.
Many other subtle
benefits link good programs to bottom-line performance. Once
employees gain confidence in their ability to modify unhealthy
lifestyles, they will feel more confident about managing their
health. "This, in turn, will result in more appropriate
health-care utilization," Montrose says.
Other bottom-line
benefits will be employee satisfaction, loyalty and retention,
he adds.
As questions concerning
how to evaluate workplace health-promotion programs arise, health
promotion itself is being redefined, Goetzel says. It's no longer
about primary prevention or the establishment of a fitness center.
Successful wellness plans incorporate secondary and tertiary
prevention as well as demand and disease management programs.
At the same time,
health promotion in many corporations is seen as part of the
broader initiative known as health and productivity management.
"This is the
process of having diverse HR and benefits and organizational
entities work together to solve common problems," Goetzel
says. The process may include leaders from benefits, management,
disability and absence management, EAP, occupational health,
organizational development and employee relations, as well as
other corporate entities.
"Health promotion
is often a catalyst in the process. It brings people together
and introduces issues that apply to all," he says.
Evaluating
Cost
While assessing health-promotion
programs is an important task, it is one that should never consume
more than a modest portion of a company's budget.
In fact, companies
shouldn't spend more than 5 percent of the total amount budgeted
for health- promotion programs on their evaluation, says Ron
Z. Goetzel, who recently spoke on program evaluation at the American
Journal of Health Promotion's 9th Annual Art & Science of
Health Promotion Conference in Montery, Calif.
Being creative in
deciding how to obtain information will help HR executives limit
evaluation costs, says Larry Chapman, spokesperson for the National
Wellness Institute in Stevens Point, Wis. By using volunteers
or graduate students to conduct telephone surveys and follow
up analyses, evaluation costs can be reduced, he says.
Another way to evaluate,
Chapman says, is to ask participants directly. During the last
session of a wellness program, have employees address a stamped,
two-part mailer. Six months later the survey can be mailed to
participants, who will then return the self-addressed, stamped
envelopes.
Seven
Strategies
To apply a broad framework
to the evaluation of wellness activities, Larry Chapman, spokesman
for the National Wellness Institute in Stevens Point, Wis., suggests
HR executives use the following strategies:
1. Develop formal
objectives and be sure you are achieving them.
2. Look at participation;
that is, the size of the eligible population, the proportion
at high risk for various conditions and the number or proportion
who have taken part in the program.
3. Obtain direct feedback
from participants.
4. Monitor changes
in health-risk prevalence, focusing on areas such as tobacco
use and serum cholesterol levels. HR can also educate workers
on the benefits of using safety restraints in motor vehicles.
5. Categorize employees
by stages. At what stage is each employee ready to participate
in the program? In the evaluation of an exercise program, the
employee who has not considered doing moderate exercise at all
should be categorized differently than the employee who has committed
to start exercising within the next 30 days.
6. Examine the use
of health-care services. Consider including the costs associated
with absenteeism, disability payments and workers' compensation.
7. Consider using
cost/benefit derivations and net-present-value calculations.
