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Get Well Soon

Push your employees to take greater command of their health behaviors with wellness programming that helps to achieve cost containment.

By Karla Hignite

*Ever-rising health-care expenses are prompting college and university leaders to find new ways to reduce high-cost claims. The evolution toward sponsored wellness programs focused on prevention and healthy behaviors includes testing a variety of incentives to increase employee participation. One underlying message to employees is this: It's time to take care of your health—for your own good, and for the financial sustainability of the institution.

Highlighted in this article are several college and university approaches to employee wellness, related results, and advice for implementing a program that works.

Healthy Competition

A biometric screening, health-risk assessment, and annual wellness exam compose the core requirements that Washington and Lee University's 850 benefits-eligible employees must complete to accrue enough points to earn a $50 monthly discount on their health insurance premium. If spouses covered under the Lexington, Virginia-based university's health plan likewise meet the required point goal, the combined family discount bumps to $75 per month, explains Amy Barnes, executive director of human resources. Several years ago the university got a surprise: a 2 percent decrease in its premium instead of an anticipated 10 percent increase. "Instead of taking that funding back, our president and CFO were willing to take the savings and use this to fund the incentive we now offer employees," says Barnes.

Read An Online Extra

For a summary of recent surveys in the for-profit sector detailing employee wellness program enhancements, see "Corporate Context" Business Officer Plus at www.nacubo.org.

Washington and Lee's Live Well program is voluntary and is focused on driving participation through meaningful incentives and promotional efforts to encourage wellness activity throughout the year. The rollout of wellness offerings this year coincides with a new provider intent on creating a culture of wellness and helping the university drive down large-claim costs.

In addition to the insurance premium discount available to Washington and Lee employees, ample opportunities exist to earn points that place employees in contention for prize drawings at the end of the plan year for gift cards, a Kindle, or an iPad. Each of the three required components for the insurance discount (biometric screening, health-risk assessment, and annual physical exam) earns 1,000 points. To be eligible for the insurance discount and the prize drawings, employees must then earn an additional 250 points through any combination of approved activities.

Accepted activities run the gamut and include participation in physical challenges on or off campus, such as participating in a 5K run/walk, attending health-related education sessions, talking with a health coach about personal wellness goals, completing a dental or eye exam, engaging in community service, or even logging on to the employee wellness portal, says Anne Remington, the university's work-life coordinator. A total of 3,400 points qualifies employees to enter the drawing for the Kindle; 3,450 points nets a chance for the iPad.

Health Stats

Biometric screening is often part of employee health assessment and includes blood pressure, height, weight, body mass index score, and cholesterol and glucose reading.

—The Ohio State University

"Whereas before, employees could do the biometric screening and health-risk assessment throughout the year, we now encourage them to complete these early in the year, with a window for taking the health assessment by mid-November," notes Barnes. That's because data from the screenings and the health survey are used to create personalized health goals, which employees will update every two months to earn points. The goals can be simple and somewhat general, such as eating more whole grains, adds Remington. "Among additional tools available to employees are online trackers to calculate consumption of target foods like fresh fruits and vegetables," she adds.

The new structure launched this year is an attempt to encourage employees to engage in healthy behaviors early and often throughout the year, says Remington. Saving employees time is a priority.

Another new feature this year that is quickly gaining ground is the Pebble, an activity tracking device that can be worn on a shoe or hip area to monitor time, steps, or distance. Various sync points located around campus allow employees to conveniently upload their data wirelessly to the wellness portal so that they don't have to manually input their progress, notes Remington. Employees can then view their level of physical activity by day, week, or goal period. "This is especially great for facilities and dining services employees who are on their feet most of the day, because it's a convenient way for them to get credit for their physical activity," notes Barnes.

The Wellness Imperative

The University of Denver developed an employee wellness program some time back, but it lacked the cohesion to gain sufficient traction, notes Amy King, DU's director of human resources. Several years ago, she and others took a step back to consider what was needed to make the program successful. They recognized that despite a limited budget, the university would need to invest something to give it a fair chance of building a culture of wellness across campus.

  • Gaining support. King first sought the approval of senior administration officials. DU's "C suite" of leaders—including the chancellor, provost, and vice president for business and financial affairs-is a rather data-driven group, says King. Consequently, she pitched the idea in terms of overall cost impact to the university health plan. For starters, she gathered research indicating the financial benefits of keeping within their current category those employees who are at low risk of developing diabetes or heart disease, rather than allowing an environment of unhealthy behaviors that over time might move people into the moderate- or high-risk categories for these conditions.
  • Gathering resources. Senior leadership agreed to commit funding on a one-time basis to test various components to determine the best direction for the program, explains King. "We began by looking at our fringe benefits to see where we might redirect existing funds. For instance, the university's line item for child care and elder care was being used by fewer than 4 percent of employees, and even then not consistently." By cobbling together budget dollars from this underused service, she allocated $80,000 to the health initiative, which arguably would benefit the entire university population. Combined with funds from DU's insurance carrier, the total would allow HR to pay for a full-time employee focused on developing wellness-related programming and incentives.
  • Crafting program criteria. King's next step was to create a survey for administrators and key stakeholder groups, including the university's faculty senate president and president-elect, union president, and staff advisory committee presidents. "We asked all these leaders the same questions to gauge their understanding about health-care costs and impacts. We included questions regarding what they would consider 'palatable' surrounding requirements, such as having employees pay more if they chose not to participate in wellness programming." HR then compiled all survey responses and put the results back in front of top leaders, seeking confirmation regarding what they wanted done and how best to proceed, says King. "By doing this, we got all our top leadership on the same page regarding the shape and focus of our program."
  • Cause and effect. In the two years since the well@DU program launched, more than 75 percent of employees are participating, says King. For the first year, employees who completed a health assessment received a $150 discount on their annual health-care premium. If an employee's covered spouse or partner also completed the assessment, then the employee received a $250 discount. "The first year we chose to spread the deduction throughout the year so that each paycheck reflected the wellness credit, to reinforce the value of the benefit," explains King.

HR also rolled out new wellness-related programming, including group physical competitions as a means to engage teams of employees who could encourage each other to remain involved. High-value prizes included iPads, Kindles, and juicers.

For year two—this current academic year—HR upped the ante for participation. In addition to completing a personal health assessment, employees are required to complete a wellness exam with age-appropriate medical testing. Letters were sent to employees indicating the required health screenings, such as a mammogram or colonoscopy, they would need based on their gender and age. "These are preventive tests and screenings that are no cost to the employee," stresses King. "Knowing that only about 60 percent of employees are usually up-to-date on these preventive measures, we wanted to make sure this became part of the incentive."

Top Five Targets

The top five health issues for employees are obesity, diabetes, depression, asthma, and cardiovascular disease. —University of Denver

In exchange, the university also increased the perk. Employees completing the health assessment and physical exam, along with preventive screenings, receive a $250 discount on their health-care premiums and $500 if their spouses or partners also complete these requirements. One added catch: If an employee completes both requirements but his or her spouse or partner does not, the employee receives no discount, explains King. "This is our attempt to emphasize the importance of family members who are covered under our plans to take action as well, since their health is also important to the institution," she says. "Part of creating a culture of wellness is reinforcing the importance not only of healthy individuals but also of healthy families."

Health Share

For years it was Bernadette Melnyk's dream to bring together people from academic institutions throughout the country to learn from one another about best practices for improving population health. That vision was realized when the Ohio State University, Columbus, hosted the inaugural Building Healthy Academic Communities National Summit in April 2013. The gathering drew 300-plus leaders from more than 90 colleges and universities—evidence of the need for a more coordinated national effort around improving health and fitness, notes Melnyk, OSU's chief wellness officer, associate vice president for health promotion, and dean of OSU's college of nursing.

The summit was followed with the launch of the National Consortium for Building Healthy Academic Communities to maintain momentum of this group and provide an avenue to continue to build best practices, says Melnyk. The consortium has developed a series of webinars for the coming year, with plans for a second summit in 2015 at Stanford University, Stanford, California. (For more information, see www.healthyacademics.org.)

As for OSU, the institution has provided wellness services to its 23,000-plus university employees and their dependents since 1991, but in recent years it has overhauled the program. Some new areas of focus have fostered improvements.

  • Top-level tactics. "At many institutions, wellness is driven entirely out of the HR and benefit design function," says Melnyk. At OSU, high-level coordination takes place among Melnyk; Andraea Douglass, OSU's senior vice president and chief human resources officer; and Larry Lewellen, vice president of care coordination and health promotion at OSU's Wexner Medical Center. Together they have formed OSU's One University Health and Wellness Council, gathering leaders from across the institution with responsibility for any aspect of the health and wellness of faculty, staff, and students, explains Melnyk. "We've decided to develop a coordinated vision and implementation process, with each unit providing something of real value to add to the picture."
  • Health champions. Another layer of OSU's success is its wellness champions. "While you need top leaders serving as role models and providing support for a culture that makes it easy to engage, you can't implement this kind of program from the top down," argues Melnyk. "When you get people at all levels involved, your odds of success are much greater." This past year OSU implemented its wellness innovators program, asking for faculty and staff from across the university to spearhead and support health-related activities. That request produced 224 volunteers from across 65 units, providing a critical mass of people to help communicate the message and get people excited to participate. "In working with our wellness innovators, we try to develop a consistent message they can use to help us encourage our larger employee population to make one healthy lifestyle change each year," says Douglass. "When it comes to messaging, simple is better," she insists. "When you give people too many things to work on, it can get overwhelming."
  • Inventive incentives. OSU's Your Plan for Health program rewards the university's employees for taking steps to improve their health. Program services include biometric health screenings, personal health assessment, incentives and competitive challenges, health coaching, personal action planning and tracking support, care coordination for chronic conditions, and educational programming. This year, employees who complete a personal health assessment receive an annual $360 insurance premium credit for those enrolled in the Ohio State medical plan, with an additional $120 credit when an employee's enrolled spouse or same-sex domestic partner completes an assessment. Enrollment in the voluntary personal health assessment this year reached 97 percent, notes Douglass.

Completing the assessment does require obtaining basic health values (such as blood pressure, height, weight, body mass index score, and cholesterol and glucose readings) through a biometric screening. Employees are also encouraged to set a personal health goal for the year and engage in at least one university wellness challenge. Like Washington and Lee employees, OSU employees who participate in various wellness challenges can accrue points toward various prizes, including Amazon gift cards and a personal fitness tracking device, explains Douglass.

Whole Health and Wellness

The employee wellness program at North Iowa Area Community College (NIACC), Mason City, began as an initiative driven by the college's insurance provider. The program provided financial breaks on premiums for employees who participated, explains Shelly Schmit, NIACC vice president of institutional effectiveness and organizational development.

NIACC established additional funding for wellness programming in the college's general fund budget, with a lump sum of up to $100 available annually to employees who participated in various structured events and activities. The funding could be used for a variety of health-related purposes, including athletic shoes, weights, or co-pays, says Schmit.

  • Holistic health. Over the years, the college has expanded and evolved its program to a whole-mind-and-body concept, incorporating mental health and stress management components, and using aggregate data to structure programming. For instance, following a period of significant claims related to back injuries and pulled muscles, the college incorporated educational programming aimed at reducing these incidents. Recent years also saw an uptick in emergency room visits, so the college launched a campaign on the importance of establishing a relationship with a primary care doctor.
  • A look at longevity. NIACC has once again expanded its wellness vision by recently becoming a Blue Zones Project Worksite—the first institution in North Iowa to achieve the designation. The communitywide initiative to create healthier, happier, and more productive citizens is the brainchild of author Dan Buettner and is based on his research into the lifestyle habits of the world's longest-living people, to unlock the secrets of longevity and well-being, irrespective of genetics.  

As part of its worksite designation, NIACC completed an inventory of workplace changes it has instituted, including making headsets available to employees who spend hours each day on the phone, offering walking groups and book clubs, and adding space for community gardening. To date, about 70 NIACC employees have made personal pledges of healthy lifestyle changes that include making improvements in their diet and finding ways to reduce stress.

  • A culture of patience and persistence. The overall goal of the project is environmental change that allows healthy choices to become the easy choices, says Schmit. "This is not an overnight initiative, but one that will require a sustained and long-term approach to community wellness, recognizing the connection between lives of contribution and a decrease in chronic disease." Part of NIACC's comprehensive wellness plan is to continue to increase employee participation in individual Blue Zones profiles, in part because this is a good reinforcing health inventory that speaks to the effects that good and bad habits have on long-term health, notes Schmit.

She hopes to take NIACC's wellness efforts to the next level with some structured measurement of effects of the college program. "Our direction at this point is to broaden engagement of those disconnected employees, and to explore the link between employee health and employee engagement," she says. To do so, Schmit is working to tie the college wellness program to the institution's strategic plan as a way to prioritize and make evident the connection between employee health and institution mission.

Tracking Health

Making the connection between employee health and institution health-care costs is another growing priority for many colleges and universities seeking to maintain health benefits amid strains to institution budgets.

In addition to holding the institution's first annual 5K run/walk for students, faculty, and staff, this year the University of Denver is reaching out to family members with activities such as hands-on healthy cooking and nutrition classes, using the facilities and staff within the university's restaurant management program. University leaders are also hosting open forums for employees and their spouses and partners to help explain health-care reform and the potential impact for the institution as an employer-sponsored health plan. "We are using these forums as a venue to educate employees and family members on the reason we need to mitigate health-care costs and tying this into our wellness efforts as a means to keep cost increases low so that we can continue to offer a health plan," says King.

Staff Supports

Workplace changes include making headsets available to employees who spend hours a day on the phone, offering walking groups and book clubs, and adding space for community gardening. —North Iowa Area Community College

Some of the funding that DU's insurance provider allocates will now go toward developing and implementing a wellness program tracking system, says King. "We would like to monitor certain metrics that would shed light on the positive effects of our program. These might include reduced pharmacy needs as a result of healthier lifestyles," notes King. While a number of DU employees have anecdotally shared that they are no longer taking certain medications because of improved health conditions, King would like some hard data to back those testimonials so she can provide leadership with further evidence of the benefits of DU's wellness programming. Increased employee engagement and productivity are other metrics King would like to track, in part by comparing rates of absenteeism with improved health outcomes over time.

At this stage, university leaders are setting their sights on tackling their biggest health challenges. "We know that the top five issues for our employee population are obesity, diabetes, depression, asthma, and cardiovascular disease," says King. "While one approach would be to try to address all five, we understand that if we can dramatically decrease obesity, we have the potential to eliminate primary risks in these other areas." For instance, if someone is no longer obese, that often alleviates the likelihood of developing diabetes and can reduce depression, asthma, and cardiovascular risks, explains King.

Outcomes tracking is likewise essential to OSU. Currently a subgroup of the university's wellness council is assessing what the university should track from its claims data in order to demonstrate health improvement, notes Melnyk. This might include how many employees respectively are at an unhealthy weight, experience high blood pressure, continue to smoke, or exhibit symptoms of depression.

While Washington and Lee hasn't as yet set goals for specific health improvements, university leaders recognize that as more people get their screenings and become aware of their health issues, the institution may see an initial spike in visits and claims, notes Barnes. "Like everyone else, we ultimately want to reduce the number of large claims, but we realize it could take years for our wellness efforts to have that effect," adds Barnes. "We will be able to track health scores and risk factors from year to year to see whether we are impacting the health of participants. Ultimately, we believe that the program will help control costs."

Talk About It

Ideally, Washington and Lee would like reach 80 percent participation in its wellness program, says Barnes. The percentage of eligible employees who earned an insurance discount incentive has more than tripled, from 13.6 percent in FY11 to 44 percent in FY13.

With the rollout of new initiatives, the university is also trying to communicate with employees in new ways. "Part of our strategy has been to get on the agendas of division meetings early in the plan year. So, for instance, we secured time during a training workshop for dining services staff to take our message about employee wellness and opportunities for participation directly to front-line workers," says Barnes.

"We are also having luck with our group of wellness ambassadors—representatives from across the campus who can go back to their departments and show people how to use the employee wellness portal. And we are pushing information and blog posts via our faculty and staff portal and sending mailings direct to employee homes so that spouses can learn more."

Barnes notes that one of the biggest challenges for her staff relates to employee concerns about data confidentiality. "Even the personal fitness device is a point of contention for some who think we are monitoring their whereabouts and behaviors," says Barnes. "While these fears may seem misplaced, they are a reminder of the need for continued communication with employees about security of data and confidentiality of health-related information."

King concurs that trust is crucial. Once she gained approval from DU's top leadership to move forward with a revamped wellness initiative—and after she secured the buy-in of faculty, staff, and union leaders—she pressed ahead with outlining a broader communication plan. That was probably the most critical component of what HR did to ensure broad acceptance and participation, notes King.

Talking Points

The communication strategy has been to get on division meeting agendas, appoint wellness ambassadors to explain the wellness portal to colleagues, add blog posts to the faculty and staff portal, and send mailings to employees' homes so spouses can learn more. —Washington and Lee University

"When it came time to implement the program, we let these same leaders be the face of communicating the changes to their respective faculty and staff groups," notes King. While HR representatives accompanied leaders to their staff meetings, they intentionally stayed in the background as leaders conveyed the message to their employees to help them understand issues related to rising health-care costs, the need for a financially stable health plan to ensure that the university could continue to offer an employer-sponsored plan moving forward, and the impact of double-digit rate increases on merit increases. With leaders delivering messages directly to their employees, they were able to make forthcoming changes more palatable, argues King.

She attributes the positive result of little pushback from DU employees to two approaches: securing broad leadership buy-in and encouraging that the direct line of communication about the program flow from leaders to their employees. King's advice to others is to take time on the front end in planning your wellness program. "Although it may take significant effort to get stakeholders on board, if you get their support and then have them share the message and be the face of communication with employees, you will have a much greater chance for employee acceptance and participation."

Well Wishes

In talking with wellness leaders from across the country, it's clear that one universal challenge is program sustainability, says Melnyk. "It's relatively easy to get started, but at some point, interest typically peters out." One reason for this may be the lack of a critical mass of folks from across the entire organization to sustain enthusiasm and keep things fresh, suggests Melnyk.

Worth remembering is that it takes time and effort to adopt a healthy lifestyle change on an individual level or to transform your organization's wellness culture—and even more time and effort to make those changes stick, cautions Melnyk. "If you are looking for a quick win, you will be disappointed," adds Douglass. "You need to jump into this with both feet and be in it for the long run. And you can't pursue this for the cost benefit only. It has to be about promoting the health and well-being of your people."

"While employees understand that we are engaged in wellness for the financial return on investment—to keep their health-care costs down and institution costs under control—they also want to know that we are doing this because we care about our Buckeye family," says Melnyk. "We want people to be healthy and engaged in their work, and healthy and engaged outside of their work, and this is the consistent message we want to put forward."

KARLA HIGNITE, Ogden, Utah, is a contributing editor for Business Officer.

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Wellness Gains Favor

While rising health-care costs are a primary source of motivation for employers to enhance their staff wellness programs, the Affordable Care Act (ACA) offers employers additional permission to emphasize physical fitness and prevention through options to charge differential premiums to employees based on their participation in employer-sponsored health plans.

Several recent surveys also indicate that colleges and universities are paying increased attention to programs that serve the dual purposes of keeping employees healthy and productive while working toward health-care cost containment.

The Affordable Care Act Approves Activities

While uncertainty remains about a number of core provisions of the ACA, employer-sponsored wellness programs get a thumbs-up under the law. The rules (see www.gpo.gov/fdsys/pkg/FR-2013-06-03/pdf/2013-12916.pdf), jointly issued in June 2013 by the Internal Revenue Service, the Department of Labor, and the Department of Health and Human Services, would allow employers to offer outcome-based wellness programs with incentives (or penalties) of up to 30 percent of the cost of group health insurance coverage, up from the 20 percent previously allowed.

Additionally, for programs that include a smoking cessation component, the maximum reward (or penalty) could be as high as 50 percent of the cost of coverage. These new rules, which apply to insured and self-insured group health plans, make changes to the existing rules issued in 2006 under the Health Insurance Portability and Accountability Act of 1996 (HIPAA).

Surveys Assess Impacts and Incentives

To assess the impact of looming ACA requirements, CUPA-HR's 2013 Employee Health Benefits Survey of Higher Education (www.cupahr.org/surveys/benefits.aspx) included a new section of questions. Respondents were asked about specific changes made to their 2013 health benefits plans as cost-cutting measures in direct response to the ACA.

According to survey findings-representing 626 institutions-23 percent indicated they had either adopted or enhanced an existing wellness program, and another 19 percent said they had plans to do so in 2014. Separate from the ACA-specific questions, 51 percent of respondents indicated they already have a formal wellness program in place, with 37 percent noting they have dedicated staffing for those programs.

In concert with those numbers are findings from Sibson Consulting's inaugural College and University Benefits Study (www.sibson.com/publications/surveysandstudies/2013CUBSreport.pdf), which analyzed data from nearly 200 higher education institutions about their benefits programs. According to the survey, 55 percent had plans to include a wellness program as part of their health plan strategy for 2013. Already, wellness ranks as a priority, with approximately half of institutions in the study indicating that they offer weight-loss programs (55 percent), tobacco-cessation programs (53 percent), flu shots (53 percent), and health-risk assessments (49 percent), while nearly three quarters (73 percent) allow employees to use the campus fitness center.

 

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