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What workers eat has moved 'front and center'
Health care costs have put wellness, including what employees eat, "front and center," according to Ben Kahn, assistant vice president of health and insurance programs at Portland, ME-based Unum, an employee benefits provider. "Now it's important to the CFO and the CEO, who are fighting health care costs," Kahn says.
Targeting employees who already have a chronic condition isn't enough; you also need to support healthy behaviors in individuals at risk of developing these conditions, says Kahn. "You have to stem the tide and look at lifestyle issues," he says. "Fifty percent of health care costs are driven by behavioral issues, such as smoking, diet, and physical activity level. So that's where a lot of industry investment is going."
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At Southfield-based Blue Care Network of Michigan, the affiliated HMO of Blue Cross Blue Shield of Michigan, an employee wellness program was implemented on Jan. 1, 2007, with healthy food as one focus, reports Pamela Reinert, RN, director of quality management. Ten items were identified as the unhealthiest in the company's cafeteria, which serves 1,300 employees, including deep-fried foods, French fries, and mashed potatoes. Prices for these items were raised by 25%. Likewise, prices were lowered by 25% for 10 healthy items such as salads, yogurt, vegetables, and fruit. "We are in the process right now of doing the calculations on the outcomes, but our cafeteria manager tells us that they have seen a shift to eating more healthy foods," says Reinert.
At Unum, the company's cafeteria has a "well-being" station that offers healthy food with eye-catching signs, lighting, and festive music. "With this change in their displays, we have seen significant decreases in dessert items purchased, and more fruits and fruit parfaits purchased," says Mike Booth, health programs manager.
At Blue Care, the company's six vending machines previously were filled with candy bars. Five of these were limited to four bars, with the price increased by 25%, and healthy snacks were added, such as Nutragrain bars and pretzels, says Reinert. A single machine was installed with only healthy foods — yogurt, apples, oranges, carrots, and celery — all sold at a reduced rate. "The addition of more healthy food vending machines will be determined at the end of the four-month pilot program," says Reinert. On "Healthy Mondays," Blue Care Network's offers additional healthy options with creative healthy salads and no desserts, she adds.
Two health fairs have been held for Blue Care employees, with healthy foods promoted through cooking demonstrations, healthy food recipes, education on caloric and fat content in foods, and brochures listing the food content of fast foods.
Unum employees can attend a monthly wellness program called "Your Health Matters," with ongoing programs run by nurse educators. Programs are given in a "lunch and learn" format and have covered obesity, musculoskeletal problems, diabetes, gastrointestinal and cardiovascular health, cancers, and smoking cessation.
"On occasion we also bring in outside vendors and local resources," says Booth. "We usually try to hit the lunch hour, and have also experimented with late afternoon hours." A registered dietitian comes onsite once a month to give individualized education to employees, such as understanding and using nutrition labels, dealing with cravings and binges, and controlling high blood pressure.
A variety of different methods are used to publicize the programs to employees, including a weekly newsletter, e-mails, monthly program calendars posted on the company's Intranet site, and direct marketing through café promotions in prominent campus locations.
At many companies, cakes and cookies were traditionally the only offerings at events or parties, but these food choices are changing. "We have worked with our food service provider to promote healthy alternatives when managers prepare for celebrations," reports Booth. "Now there is an option to offer some healthy choices as well." Managers and administrators now can order directly from the company's intranet site, which allows them to choose healthy selections such as fruit trays, frozen fruit bars, juices, water, yogurt parfaits, whole fruit, and numerous salads including grilled chicken caesar, salmon caesar, chef's, and garden salads.
It's very difficult to prove that healthy food selections lower health care costs or improve productivity, says Kahn. "Having said that, we feel pretty confident that if we give our folks the tools they need to live a healthier lifestyle, it will help the bottom line as well," he says. However, an employer can only provide the tools. At the end of the day, the worker is responsible for their own choices, says Kahn. "These are all voluntary programs," he says. You can offer someone an incentive to enroll in a disease management program, but whether or not they stick to the program is ultimately their decision, Kahn points out.
Since healthy foods were implemented as part of an overall wellness program, Blue Care is measuring success by tracking overall absenteeism rate and illness rate, as well as usage of certain prescriptions. "We will be tracking some aggregate health risk assessment information, but we will also consider the feedback and testimonials that we have received from the employees themselves," says Reinert. "It's normally two if not three years before you would get enough information to see [return on investment] on this. We are looking at improving health, and that is a longer time frame."
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