If you’ve read my last two editorials, you understand that “wellness” is a term that means different things to different people, and that “program success” is equally ambiguous. Let’s say you launch a program consisting of health education tools, free screenings and incentives. Two years later you report a reduction in the percentage of tobacco users from 30% to 25% and the obese population from 50% to 48%. Have you succeeded? What if claims went up 20% during that time? What if you really didn’t see any meaningful health improvement, but you know you discovered previously undiagnosed high risks and claims came down 10%? Is that “success”?
A key part of measuring success is understanding how the stakeholders who made the decision to invest in a wellness program define victory. My observations suggest that organizations that assign the company wellness program oversight to clinically oriented individuals (a Medical Director, Chief Medical Officer, Health Promotions Specialist, Wellness Program Director, etc.) tend to view employees as patients and the workplace as a community. Organizations that assign the program to people responsible for managing costs, productivity, quality and ROI (CFO, Chief HR, head of “Total Rewards”) will generally view employees as human capital and define success in terms of throughput, an increase in productivity and cost reduction.
Is one of these views right and the other one wrong? Can they effectively co-exist? Will improvements in employees’ “happiness scores” or “risks for chronic conditions” resonate as the best use of capital in a company whose shareholders haven’t seen a profit in a year? Will an increase in profitability be viewed as a success if it came through employer’s shifting 20% of the total cost of healthcare to obese smokers who didn’t achieve outcomes-based goals? Is this a question for society, the health community or the Federal government to decide, or should organizations have latitude to run their business as they see fit as long as their program isn’t discriminatory?
We all have opinions and perceptions of fairness. Many subscribe to the “every kid gets a trophy” school of thought and to the belief that labeling winners and losers can cause permanent damage and erode the selfconfidence of individuals. Others believe strongly that it’s misleading to give every kid a trophy and call them a winner when they didn’t perform at the level others did in an event (and perhaps didn’t even put forth significant effort). You’ll hear them say “life just doesn’t work that way!”
I wonder if the battle that ensues over the rights and wrongs of health promotion programs is really rooted in these individual biases regarding fairness. Not to mention varying beliefs on whether it’s an employer’s obligation to help someone quit smoking, manage their depression or lose weight because they chose to hire them to work in their factory. What’s clear is that those who feel that the world will come into agreement or reach consensus on these issues may be forever frustrated that everyone doesn’t think about things the way that they do.
So does wellness work? Here’s another example of a company that would say “absolutely!”
One Bravo client who gave employees a chance to participate in a biometric screening to earn discounts off of their premium contribution achieved results that exceeded their expectations. First, they offered the screening to about 18,500 covered employees and their spouses who enrolled in the health plan. Because they didn’t have a budget for the program, and because they knew that fewer than 40% would participate without a meaningful financial consequence, they raised the employees’ portion of the insurance premium contribution by $90 per month. However, they gave employees a chance to earn back $100 per month as they achieved healthy outcomes or marked improvement in blood pressure, cholesterol, body mass index and tobacco use.
The hope was to see 95% participation, improvement in the biometric measures (compared to the baseline screening performed the previous year), participants earning a discount and the net of all incentives paid plus the cost of the program to be subsidized by the additional fees paid by non-participants and those who didn’t earn at least the $90 monthly discounts. By these accounts, the program was a success on every level.
- 99% participated in the screening
- 83% passed their blood pressure goal of 130/85 with another 4.2% passing based on an improvement based reasonable alternative
- 86% passed their cholesterol goal of an LDL <130 or a total cholesterol <200 with another 2.3% passing based on their improvement based reasonable alternative
- 50% passed the BMI goal of <27.5 with another 2.45% passing based upon an exception granted for low body fat percentage and 4.1% passing because they lost 10% or more of their weight in the past year or completed an alternative
- 73% were tobacco free or completed a cessation program
- 50.2% earned the $90 or $100 incentive and experienced $0 increase or -$10 compared to their 2014 cost Overall, the company collected about $5 million in surplus contributions from those who did not achieve the $90 or $100 level (with only 800 people experiencing the full increase in cost); this surplus completely funded the screenings, the result reports , administration of the incentives and a host of health improvement resources including tobacco cessation, health coaching and a high touch weight management program for those who wanted it
- 1,575 (82%) of people with high blood pressure (>140/90) in 2013 reduced it to a number below 140/90
- 616 (78%) of the people with LDL cholesterol >160 in 2013 reduced it by the time of the 2014 screenings
- 1,899 of the 3,489 people with two or critical risk factors in 2013 eliminated one or more of the risks by 2014; only 213 actually added a risk factor
- Claims data is still being analyzed by overall, trend was down and below national average
In this example, the clinical team and the finance team were both very pleased. The results were unprecedented. Did everyone share in the celebration? Of course not. Those who feel that individuals who did not participate, did not achieve a healthy outcome, did not document any improvement and did not consult with their own physician to obtain a waiver or determine a health goal that may be more appropriate for them had to pay more to participate in the employer sponsored health plan do not consider this program a success. Some will even call it a cost-shifting scheme (as if the health improvement would have happened without the use of financial consequences). While universal acceptance will never exist, more and more organizations are accepting the fact that results like these are real; they are within reach and they resonate with the majority of Americans. We are thankful for our customers who forge ahead in spite of doubt and disbelief in the market. With results like these, the majority of their employees are thankful as well.