How do higher education employers compare to their corporate counterparts with the types of wellness benefits and incentives offered? A number of recent surveys provide context and data to help answer the question.
By Karla Hignite
Several national surveys of corporate health and wellness programs reveal a number of benefits and activities designed to motivate employees—for their own good and the productivity and efficiency of the workplace.
Cash or Credit
Types and amounts of incentives vary when it comes to encouraging employees to participate in wellness programming. Most popular are lump-sum cash rewards or gift cards, reductions in employee insurance premiums, and contributions to an employee health savings account. These rewards are often tied to specific actions, such as completion of a health-risk assessment (HRA) or a biometric screening. How well such financial incentives work is open to debate and depends in part on employees' perception of the rewards' value and appeal.
Yet, according to the 2013 National Survey of Employer-Sponsored Health Plans published by Mercer—using data collected from approximately 2,800 employers—use of incentives among large employers with staff numbering 500 to 4,999 doubled the rate of employees completing a health assessment (53 percent versus 27 percent with no incentive) and tripled the rate of employees completing a biometric screening (50 percent versus 17 percent with no incentive).
In whatever ways an organization attempts to encourage participation, active engagement of employees in improving their own health is the new norm for health management programs, suggests the report. Read also, "Get Well Soon" in the January 2014 issue of Business Officer magazine.
"Home" Health Care
Some employers are trying to promote participation through convenience. A growing trend among large employers in particular is establishing on-site health clinics to offer staff a wide spectrum of services such as walk-in immunizations, allergy shots, biometric screenings, pharmacy and lab services, health coaching, chronic disease management, mental health services, and employee-assistance program counseling-all without leaving work.
According to Towers Watson's 2012 Onsite Health Center Survey Report,—a poll of 74 employers representing 1.7 million workers—62 percent of respondents with an on-site clinic cited "enhance worker productivity" as their primary reason to provide this benefit, followed by the goal to "reduce medical costs" (56 percent).
The concept is straightforward: Eliminating employee visits to off-site providers saves employees time and increases the likelihood that they will keep up with the appointments and prescriptions they need to manage their health-further contributing to employee wellness and productivity. On-site care can also provide employers greater control over health-care costs through standardized charges negotiated with an on-site provider. According to the survey, in efforts to boost use of their clinics, some employers are either waiving or reducing co-payments for accessing care on-site.
The survey also found that biometric screening is a primary service offered through most on-site clinics, with 81 percent of respondents currently offering this, and another 10 percent with plans to do so within the next year. Likewise, companies have plans to boost wellness counseling, with 73 percent currently offering this service and another 19 percent with plans to do so in the next 12 months.
Other areas of significant planned growth include disease and chronic condition management (projected additional 17 percent beyond the current 48 percent) and care coordination/case management (projected additional 21 percent above the current 41 percent level). While only 8 percent of respondents currently offered telemedicine, another 28 percent indicated plans to put this in place during the coming year.
With regard to use of clinics, 32 percent of respondents currently allow spouses and children to use the clinic services, but in the coming year another 21 percent of employers plan to make services available to spouses, and 14 percent plan to offer them to children. The vast majority of on-site clinics are contracted through a third-party health services vendor (67.2 percent) versus directly employed by the organization (18.8 percent).
Spend to Save
Overall health-care spend per employee in corporate health-care programs has been on the rise, with the assumption that the investment will pay off. A study released in February 2013 from Fidelity and National Business Group on Health, based on responses from 120 companies, found that corporate spending on employee wellness-based incentives doubled from an average of $260 per employee in 2009 to the $521 per individual that employers planned to spend in 2013.
Among the health-improvement incentives employers are offering are:
- Smoking-cessation programs.
- Discounts for gym memberships.
- Newer options such as employer-sponsored fitness challenges (increasing 10 percent in 2013), and discounts for health food options in the company's cafeteria (increasing 9 percent in 2013).
In addition to offering more, employers are expecting more from their employees, suggests the study. While many provide rewards of some sort to staff who complete various health activities, like a biometric screening or health-risk assessment, some plan to require completion of a health-risk assessment (10 percent) or biometric screening (7 percent)—or individuals run the risk of being defaulted into a less attractive subset of the company's health plan. Three percent of employers indicated that failure to complete an HRA or biometric screening already results in loss of benefits.
The study also found that 41 percent of companies currently include, or plan to incorporate, outcomes-based metrics as part of their incentive program to give employers and employees alike a measurable goal for rewarding behavior or results in certain health categories, such as lowering cholesterol (30 percent) or blood pressure (29 percent), or reducing waist measurement (11 percent).
The Society for Human Resource Management's 2013 Employee Benefits survey, based on responses from more than 518 HR professionals within SHRM's membership, echoes many of the findings of other national benefits surveys.
With regard to preventive health and wellness benefits in particular, some of the less widespread wellness and prevention offerings being tested by employers include discounts for not using tobacco products (19 percent), on-site blood pressure machine (18 percent), standing desks (13 percent), stress-reduction programs (10 percent), on-site massage therapy services (9 percent), nap rooms (6 percent), and on-site vegetable gardens (3 percent).
In addition to providing an overview of benefits, the SHRM report examines trends in those offerings over the course of the past five years; the rapid growth in specific areas is illuminating. For instance:
- From 2009 to 2013, the percentage of employers offering health and lifestyle coaching grew from 33 percent to 48 percent.
- Rewards or bonuses for completing certain health and wellness programs nearly doubled from 2009 (23 percent) to 2013 (43 percent).
- Similarly, the number of employers offering discounts on employee health-care premiums in connection with completing a health-risk assessment rose from 10 percent in 2009 to 21 percent in 2013.
- Employers providing preventive programs targeted to employees with chronic health conditions grew from 30 percent in 2009 to 42 percent in 2013.
- While the percentage of companies offering smoking-cessation programs rose at a modest pace from 2009 (39 percent) to 2013 (44 percent), another 6 percent of respondents indicated plans to offer a program within the next year, representing the biggest uptick in the planned addition of prevention and wellness benefits.
Play or Pay
Increasingly, employers are recognizing the link between employee health and company performance and competitiveness, and are shaping their health and wellness programming to get employees in the game. As numerous national health-care surveys released in recent years indicate, one undeniable trend in employer-provided health plans is the move toward encouraging—sometimes requiring—employees to take greater ownership of their personal health, as evident in the rise in consumer-directed and high-deductible health plan offerings, rewards for "performance"-based health outcomes, and penalties for sitting on the sidelines.
According to the Aon Hewitt 2013 Health Care Survey, even as health-care delivery systems in general are moving in the direction of an individual consumer approach, employers maintain a vital role in promoting and facilitating increased participation in wellness and disease management. A top priority for employers in the next five years is finding that mix of incentives and disincentives that will empower sustained behavior change among employees in connection with their personal health and well-being, while mitigating the risks to employers of an unhealthy workforce.
KARLA HIGNITE, Ogden, Utah, is a contributing editor for Business Officer.
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