Wellness programs need their own Rx
Too often, employee participation lags
Employers are unreliable stewards of their workers' health. Most hospitals and other large employers offer wellness programs, but they struggle to engage the employees who need it most.
This dilemma is frustrating for employers. But increasingly, it is also becoming a public health issue, as the workplace is viewed as the primary site for addressing rising rates of diabetes, obesity and heart disease. Hospitals have an opportunity to be on the forefront of efforts to promote workplace health, wellness experts say.
"Employers are becoming more familiar with the connections between health and productivity," says Jason Lang, MPH, MS, team lead for workplace health programs at the National Center for Chronic Disease Prevention and Health Promotion at the Centers for Disease Control and Prevention. "They're getting much more involved in understanding that they need to do something. The question becomes, what are they going to do and how are they going to do it?"
CDC now has three distinct initiatives to help employers address wellness, two of them funded by the Affordable Care Act.
"Our overarching goals are to see an increase in the number of employers who are actively committed to employee health through health promotion and wellness programs, as well as for those who are building or enhancing the wellness options to do it with the highest quality possible," says Lang.
A recent study by the RAND Corp. in Santa Monica, CA, reveals the challenges. Employers reported low participation rates for disease management programs among at-risk employees. For example, on average, only 7% of smokers participated in smoking cessation programs and only 11% of people eligible for weight management programs participated.1
A comprehensive program that engages employees, offers substantial incentives and integrates all facets of employee health can produce much better results, says Michael Parkinson, MD, MPH, senior medical director of the UPMC Health Plan and Work Partners, a health and productivity service geared toward corporate clients. The University of Pittsburgh Medical Center has 90% participation in its wellness program.
"One reason a lot of wellness programs fail is because they believe one size fits all," he says. "Our health coaches walk the hallways and talk to people about the challenges they have."
Making wellness work
Wellness programs work. When employees participate, they achieve "statistically significant and clinically meaningful improvements" in their exercise frequency, smoking behavior and weight control, the RAND study found.
For example, continuous participation in a weight loss program for five years led to a 13% decrease in obesity and a 14% increase in the proportion of normal weight employees, RAND found.
But to get benefits from the program — healthier and happier employees — it is important to tailor wellness interventions to your workforce, says Soeren Mattke, MD, DSc, MPH, senior scientist at the RAND Corp. in Boston, managing director of the RAND Health Advisory Services and lead author of the report.
"The temptation is that managers impose a solution that fits their particular world view as opposed to the world view of employees," he says. "We saw in many cases management imposed an exercise-focused program in a manufacturing context where people are actually physically active just based on their job all day. The last thing they needed was an exercise program. Managers ignored that they had a terrible diet."
Disease management provides the greatest possible impact in improving health and reducing health costs, but the RAND study found only 16% of employees eligible for those programs participated.
Incentives can boost participation rates, RAND found. But Mattke cautions that designing an accessible and appealing program is more important than the value of incentives. (For tips on creating a wellness program, see box on p. 41.)
ACA creates new resources
Although RAND found the wellness programs had only a modest impact on short-term health costs, the workplace has become part of the national public health strategy to reduce rates of obesity and smoking, improve control of diabetes and asthma, and promote healthier lifestyles.
CDC offers free resources and consulting to boost employer efforts. In addition, the National Institute of Occupational Safety and Health (NIOSH) created four WorkLife Centers of Excellence to promote an integrated approach to employee health.
CDC's National Healthy Worksite Project provided intensive assistance to 104 mostly small and mid-sized employers in eight communities. To share resources, the agency provides online links to toolkits to promote healthy eating, physical fitness, and other health promotion programs at www.cdc.gov/nationalhealthyworksite.
More employers wanted the hands-on help starting a program, says Lang. "It was a demand we simply could not meet," he says.
So CDC also used $8 million in Affordable Care Act funds to develop Work@Health, a training program for 600 employers of all sizes to support comprehensive wellness initiatives. The program also provides up to $5,000 in seed money to employers. (www.cdc.gov/workathealth.)
Training could help employers make existing programs more effective, Lang says. "Virtually all employers are doing something with employee health and wellness. It could be a biometric screening, it could be a Weight Watchers program," he says. "But they tend to be a one-off intervention and they're very rarely integrated with one another or implemented in a way that we would deem comprehensive."
For example, in a pilot program, it became apparent that few employers have data on employee health needs or interests to shape their wellness programs, he says. "How can you make well-informed decisions about what to do and how to do it if you don't understand what's going on in the organization with your people and your work environment?" he says.
As hospitals develop wellness programs for their own employees, they have an opportunity to assist other employers as well, says Lang.
Hospitals can use existing resources, such as diabetes education, which can be tailored for a work environment, he says. "They're in a position to be a model for others in their communities around these issues," he says.
The workplace is the obvious place to reach American adults with messages and tools to have healthier habits, he says. That's why wellness was included in the Affordable Care Act, he says.
"Through the ACA, we've been able to get resources we previously did not have," Lang says. "That has allowed us to take more proactive and formal steps toward our program goals."
- Mattke S, Liu H, Caloyeras JP, et al. Workplace wellness programs study. RAND Corp, Santa Monica, CA, 2013. Available at www.rand.org/pubs/research_reports/RR254.html.