1. Improved Morale – When the organizational culture begins to change as a result of your health promotion efforts, you and your staff members may actually begin to see and feel a new level of energy within the employer. Ultimately, one of the most ambitious goals of any comprehensive health promotion program is to attempt to influence the attitudes and actions of the organization’s most valuable resource — its staff members.
2. Reduced Turnover – As we all know, employee replacement costs can be quite high for any kind of employer. The effort and expense associated with running employment ads, reading applications, checking references, interviewing qualified candidates, hiring and training a new employee can be a serious burden on any employer. In light of the challenges that high employee turnover pose, many organizations are looking to health promotion programs as an additional perk that can help to prevent staff members from jumping ship.
3. Increased Recruitment Potential – In the midst of a very tight labor market, organizations are forced to pull out the stops in order to recruit new talent. In some instances, health promotion can prove to be a very valuable tool in sealing the deal.
4. Reduced Absenteeism – When an employee misses work in a employer setting, the entire organization is forced to absorb his/her responsibilities. Even in the event of the occasional absence caused by things like colds and the flu, work can back-up and tensions can build. Even worse is a long-term absence caused by a major health event that requires hospitalization and/or rehabilitation. By preventing certain types of illness caused by poor lifestyle habits, health promotion programs can play an important role in lowering rates of absence.
5. Health Care Cost Containment – Most organizations don’t start a health promotion program with cost containment in mind. However, cost containment for certain health problems should be considered a viable goal by many organizations.
6. Improved employee Health Status – One of the greatest advantages of a well-designed health promotion initiative is the promise of improved health. There is a growing body of evidence that suggests well-designed health promotion initiatives can successfully impact such behaviors as tobacco use, high-risk alcohol use, and more.

The Worksite Wellness Program management world is evolving rapidly. Each month, there are new research findings that support the premise that Worksite Wellness Programs and disease management have a long-term impact on healthcare costs. Many large organizations that started Worksite Wellness Programs three to five years ago are showing savings in health, disability, and workers compensation costs. Small to mid-size organizations are watching all this and wondering where to start with wellness.

Getting senior management support and budget approval is one of the challenges at the beginning of a Worksite Wellness Program. This is the case because Worksite Wellness Programs can be expensive, averaging $150-300 per employee per year in large organizations. Most of the savings are not realized for a number of years. This long-term investing is hard for organizations on the move.

The key to success for Worksite Wellness Programs is to take a strategic approach. Here are ten steps to consider when starting a Worksite Wellness Program.

1. Begin with senior management. Without senior management support, a health promotion strategy can fall flat. Begin with the health of your executive team and discover your wellness champions at the top of the employer.
2. Assess the problem. Look at your healthcare claims and analyze the trends. Which conditions are driving your medical, disability, and workers’ compensation claims and which are modifiable? What’s worked and what hasn’t thus far? What is the long-term impact of doing nothing?
3. Hold an initial wellness meeting. Invite your primary stakeholders both outside and inside the employer. Ask your broker to facilitate the meeting and invite primary health vendors including health, disability, Employee Assistance Program (EAP), fitness, and occupational nursing. Review claims and utilization information and identify primary areas of concern. Look at current offerings and see how they can be tailored to the needs of the population.
4. Look at both healthy and unhealthy staff members. Since 85% of claims are usually attributed to 15% of claimants, it is essential to reach those with the most costly conditions while also reaching workers who are at risk for developing preventable diseases in the future. Voluntary Worksite Wellness Programs such as lunchtime wellness seminars miss many of the workers who need them most. Look at initiatives that are population-wide or target intact workgroups. Wellness incentives help but do not motivate everyone.
5. Establish short-term goals for the Worksite Wellness Programs. Establish some realistic short-term goals based on your primary areas of concern. Are there any plan design changes that could have an immediate impact on spending? Are there some programmatic actions that could have immediate results?
6. Determine what staff members are thinking. Hold some focus groups to determine where workers are with wellness. What’s working? What isn’t? How much interest do workers have in the Worksite Wellness Programs? What obstacles and barriers are staff members experiencing when they try to change behavior?
7. Make sure you have a high-impact Employee Assistance Program (EAP). Your first wellness dollars should go into upgrading your Employee Assistance Program (EAP). A highly utilized Employee Assistance Program (EAP) can provide a foundation for all of your future wellness activities. A good Employee Assistance Program (EAP) is a trusted link to the hearts and minds of staff members. At no additional cost, the Employee Assistance Program (EAP) can provide needed follow-up coaching and personal attention for staff members who are working on modifiable health behaviors or involved in disease management initiatives. Nutritionists, fitness, pregnancy, and stress management specialists are all part of a high-value Employee Assistance Program (EAP).
8. Establish three to five year goals for healthcare savings and measure them. Get help from your broker and insurance carrier help you on long-term goals for your health, disability, and workers compensation plans. Establish program metrics that will help you to measure return on investment. Go beyond participation rates, completion rates and program satisfaction. Measure changes in readiness, changes in behavior, and changes in risk factors. Establish rigorous methods to measure healthcare savings over the long term.
9. Establish goals for organizational health. Look at the more intangible benefits of a wellness initiative and quantify them whenever possible. Include employee turnover rates, cost of new hires, employee morale, benefit satisfaction information, and employer of choice issues in setting goals. Establish ways to measure success in these areas.
10. Add specifics to your short and long-term plan. Include a Worksite Wellness Program strategy, a communication strategy, and a Worksite Wellness Program incentive strategy that will fit with your corporate culture. Focus on integration of related components along a health continuum with communications that are focused, simple, and human. Establish a budget that includes primary components such as consumer education, health promotion, health risk assessments, and regular biometric screens.

Employers can also benefit from Worksite Wellness Programs. According to recent research, employers’ benefits are:

• Enhanced recruitment and retention of healthy staff members
• Reduced healthcare costs
• Decreased rates of illness and injuries
• Reduced employee rates of absence
• Improved employee relations and morale
• Increased productivity

A U.S. Department of Health and Human Services report revealed that at worksites with physical activity initiatives as components of their Worksite Wellness Programs have:

• Reduced healthcare costs by 20 to 55%
• Reduced short-term sick leave by six to 32%
• Increased productivity by two to 52%

Thanks to modern medicine, life expectancy for Americans has continually increased. How much we enjoy these additional years, however, depends greatly on how we have lived our lives. If our quality of life is to remain high so that we can fully enjoy these extra years, we must practice good eating habits, be active and refrain from using tobacco products.

Furthermore, stress, distractions and the pressures of the job can take its toll on the employee, which makes it important that a Worksite Wellness Program is started. Today, all across America, Canada, Europe and Asia, top Worksite Wellness Programs are being used to help improve employee conditions at work and reduce the cost of worker healthcare.

Some of the top Worksite Wellness Programs currently in use today include:

Health Risk Assessments (HRAs)

Health Risk Assessment is a top Worksite Wellness Program currently in use globally. Organizations that implement it determine the safety and health concerns of workers by the assessment of appropriateness of the facilities and equipment against the needs of the staff members.

It can, for example, guide the employer into determining how much air quality within an office room affects the users and then help the assessment team to come up with the measures necessary to correct the problem. An HRA can also evaluate the level of exposure workers have to certain hazardous or dangerous materials and practices.

Immunizations

This isn’t always practiced in every country since there are regions where government sponsored immunization shots are available. However, it has also become an important component of the top Worksite Wellness Programs in many organizations in North America.

Immunization, flu shots, such as those used to combat flu, for example, are offered to workers for free.

Employee Assistance Programs (EAPs)

Employee Assistance Programs (EAPs) consist of a wide variety of services. It can range from providing educational resources to staff members regarding health issues to sponsoring health services and medical care. In many organizations, medical and insurance have also become a staple part of their benefits system.

Weight Management Programs

This is another Worksite Wellness Program that organizations use, particularly those that offer in-house commissary or cafeteria services. Instead of serving richer, high-calorie fare, cafeterias offer options for a healthier diet, usually in the form of low-calorie foods and sugar substitutes.

Employee Wellness Newsletters – Health Education Programs

One of the top Worksite Wellness Programs that organizations can implement is a self-powered tool using a newsletter to promote wellness, coupled with a visible campaign. The campaign may be done periodically and focus on a specific topic, such as tobacco use hazards, cancer, stress, carpal tunnel syndrome, safety in the worksite, etc.

The newsletter in itself can be an effective way to deliver information to staff members or members of an employer but it is far from perfect. Some staff members, for example, may not read the newsletter in its entirety or even pay attention to it. If the issues outlined in the newsletter are promoted through an active and highly visible campaign, it will be easier to maximize positive results.

Physical Fitness and Exercise Programs

Another top health promotion program for organizations is one that involves physical activities. Companies often sponsor physical fitness-related events such as marathons and employer sports initiatives to encourage staff members to remain fit or lose excess weight. In mid- to large-sized organizations, organizations may even pay for gym memberships or in-house physical fitness facilities.

Worksite Wellness Program Incentives

Some of the top Worksite Wellness Programs started by organizations involve incentive rewards. This involves employer-sponsored initiatives that reward staff members for achieving specific wellness goals. Participation in health campaigns and signing up for Worksite Wellness Programs are two of the most commonly rewarded schemes. Rewards can range from special recognitions to points (for bigger rewards) to specific gifts. In a few cases, cash may also be used.

However, incentive systems have had mixed reactions and levels of success. But it continues to be one of the top choices among organizations who are willing to modify it in order to fit their unique needs.

Group Activities

In many organizations, organizations take advantage of peer pressure in order to encourage workers to take part in Worksite Wellness Programs. This is currently one of the favorite worker Worksite Wellness Programs currently in use today and growing in popularity. Peer pressure is often leveraged to help promote competitions and to persuade staff members to be active in employer-sponsored health fairs.

Worksite Wellness Programs: The Good

• A sampling of return on investment for Worksite Wellness Programs: Bank of America: 600%; General Motors:370%; Pepsico: 300%; Citibank: 465%; and the Washoe County School District leading the pack at a whopping 1,560%. (Campbell,J., Wellness Improvement Experts, www.wellnessimprovementexperts.com, Albuquerque, New Mexico.)
• Companies with Worksite Wellness Programs have realized a 28% reduction in sick leave, a 26% reduction in adjunctive healthcare costs and a 30% reduction in disability and workers compensation costs. (Health Affairs, Volume 21, No.2, March, 2002.)
• The Washoe county School District in Northern Nevada realized a $15.60 return on investment for every dollar spent due to a 20% reduction in rates of absence. (Hardy,A. (2005). At the Top Of The Class. WELCOA’s Absolute Advantage Magazine, 5(1), 14-20.)
• Worksite Wellness Programs provide the structure, encouragement, incentives and ongoing support that many people need in order to make lifestyle changes.
• Employees also realize returns on their efforts. FiServ, a financial services technology employer, gave staff members who filled out a health risk assessment a significant discount on their health insurance premium. (Holland, Kelley, The New York Times, July 22, 2007.)

Worksite Wellness Programs: The Bad

The flip side of the argument centers on basic human rights. Do we want/need our employer to tell us to eat our veggies or lose 30 pounds? Some organizations are doing just that and at least one lawsuit has resulted because of it.
• Three hundred organizations have requested assistance from a national employment and labor law firm to institute more aggressive Worksite Wellness Programs.(Cornwell, Lisa, Associated Press, Albuquerque Journal, September 10,2007.)
• Clarian Health, based in Indianapolis, Will begin lowering employee paychecks by $10.00 for every employee who has a Body Mass Index (BMI) of greater than 29.9 because not enough staff members were utilizing their wellness services.(Cornwell, Lisa, Associated Press, Albuquerque Journal, September 10,2007.)
• Scott Rodrigues filed a suit against his prospective employer, Scotts Miracle-Gro, because he believed the employer’s antitobacco use policy violated his civil rights. The employer has a policy against hiring staff members who smoke and Mr. Rodrigues’drug screen was positive for nicotine.(Holland, Kelley, The New York Times,July 22,2007.)
• employee advocates are concerned that health discrimination may not be covered under the Americans with Disabilities Act.(Cornwell, Lisa, Associated Press, Albuquerque Journal, September 10,2007.)

Penalizing staff members by hitting them where it hurts the most,their pocketbook, does not appear to be a favorable approach to molding human behavior.
Such tactics may result in increased resentments and retaliation, primarily in the form of rates of absence and presenteeism (decreased productivity on the job.) Voluntary, incentive-based initiatives, such as the one in the Washoe County School District, can and do produce results. A positive attitude on the part of management along with an opportunity for staff members to have a stake in the decision-making may yield the greatest dividends to both employer and employee.The motivation and resolve needed to change unhealthy lifestyle habits can best be derived from the basic tenets of encouragement, respect and support.

The American Association of Family Physicians’ Web site, www.aafp.org, offers a recommended adult immunization schedule created by the Advisory Committee on Immunization Practices. This schedule, tiered by age and chances of exposure, recommends diphtheria, tetanus, influenza, pneumonococcal, hepatitis B, hepatitis C, measles, mumps and rubella, varicella and meningococcal vaccinations.

Ideas to incorporate prevention and early detection:

• Hold a wellness fair and invite organizations that provide screening services for such conditions as blood pressure, blood iron, cholesterol, body mass index (BMI) and diabetes.
• Offer educational materials about well-baby care and vaccinations.
• Choose healthcare coverage plans that include wellness check-ups and vaccinations.
• Offer onsite mammograms for staff members.
• Sponsor onsite flu vaccinations to coincide with flu season.

Instances of respiratory diseases, cancer and other illnesses can be reduced through tobacco use cessation efforts. tobacco use cessation initiatives can provide huge opportunities for improved health.

The American Cancer Society reports that tobacco use staff members cost organizations an average of $1,429 per smoker per year in increased healthcare costs over non-tobacco use staff members. Implementing a tobacco use cessation program costs an average of $45 per employee per year, saving organizations an average of $1,383 per year for each employee who quits tobacco use. Additionally, the American Cancer Society reports that smokers are absent from work 50% more often than nonsmokers. They are also 50% more likely to be hospitalized and have 15% higher disability rates. tobacco use decreases onthe- job productivity as well. Employees who take four 10- minute tobacco use breaks a day work more than a month less per year than workers who don’t take smoke breaks.

Places to start with tobacco use cessation initiatives:

1. Start a employer policy prohibiting tobacco use anywhere on the property.
2. Offer prompts/posters to support no tobacco use policy.
3. Policy supporting participation in tobacco use cessation activities during duty time (flex-time).
4. Offer counseling through an individual, group, or telephone counseling program onsite.
5. Offer counseling through a health plan sponsored individual, group, or telephone counseling program.
6. Offer cessation medications through health insurance.

Nutrition directly impacts nearly every aspect of physical and mental health. A healthy diet can help protect against such conditions as heart disease, diabetes, arthritis, stroke, certain cancers and depression. Obesity, which is among the most common conditions linked to diet, affects a record number of Americans.

The American Journal of Health Promotion estimates the cost of obesity to U.S. employer to exceed $12.5 billion in health care, sick leave, and life and disability insurance. Further, one study reports that obesity raises healthcare costs by 36% and medication costs by 77%. To offset the health risks of obesity and poor diet, many organizations have committed to helping staff members ensure proper nutrition and undertake weight control initiatives.

Popular nutrition initiatives:

Fruit and Vegetable Consumption
1. Offer healthy eating reminders and prompts to staff members via multiple means (i.e. e-mail, posters, payroll stuffers, etc.).
2. Offer appealing, low-cost fruits and vegetables in vending machines and in the cafeteria.
3. Offer cookbooks, food preparation, and cooking classes for staff members’ families.
4. Ensure onsite cafeterias follow healthy cooking practices and set nutritional standards for foods served that align with the U.S. Dietary Guidelines for Americans.
5. Offer healthy foods at meetings, conferences, and catered events.
6. Use point-of-decision prompts as a marketing technique to promote healthier choices.
7. Offer healthy cooking demonstrations that teach skills (i.e. fruit and vegetable selection and preparation).
8. Offer taste-testing opportunities at the worksite.
9. Offer employee-led campaigns, demonstrations or programs.
10. Offer local fruits and vegetables at the worksite (i.e. worksite farmer’s market or community-supported agriculture drop-off point).
11. Use competitive pricing (price non-nutritious foods in vending machines and cafeterias at higher prices).
12. Offer protected time and dedicated space away from the work area for breaks and lunch.
13. Make kitchen equipment available to staff members.
14. Offer an opportunity for onsite gardening if possible.

Sweetened Beverage Consumption
1. Make water available throughout the day.
2. Offer appealing, low-cost healthful drink options in vending machines and the cafeteria.
3. Modify worksite vending contracts to increase the number of healthy options.
4. Price non-nutritious beverages at a higher cost.
5. Use point-of-decision prompts to promote healthier choices.

Portion Control
1. Label foods to show serving size and/or nutritional content.
2. Offer food models, food scales for weighing and pictures to help staff members assess portion size.
3. Offer appropriate portion sizes at meetings, worksite events and in the cafeteria.

Nutrition initiatives in action

While many organizations address weight management through fitness initiatives, organizations are increasingly focusing on nutrition through separate programming. Recognizing the productivity boost and lowered medical expenditures that come with maintaining a healthy weight, many organizations may help pay for obesity treatments for staff members. For example, to improve the health of dangerously obese staff members, drug maker Wyeth reportedly pays for stomach-shrinking surgeries that carry price tags of up to $40,000.

A 2003 Society of Human Resource Management study shows that 24% of employers offer weight loss initiatives. In Ohio, Honda offers an onsite, registered dietitian who provides individual or group consultations on weight management. Body fat analysis and body mass index (BMI) measurements are available to staff members at any time.

At Grange Insurance’s Columbus headquarters, the cafeteria chef analyzes meals and provides staff members basic nutrition information, including Weight Watchers points. Many organizations partner with the American Cancer Society to offer nutrition information through the ”5-ADay” program, which provides employers free signage and educational materials about the importance of eating five servings of fruits and vegetables a day. The program also offers a fruit and vegetable ”frequency card” that gives staff members a free portion of fruit or vegetables after he or she has purchased a preset number.

Exercise reduces weight, lowers risks of heart attack and stroke, helps to control blood pressure and diabetes, and improves mood. Studies increasingly show that physical fitness may also help reduce the occurrence of certain types of cancer. Researchers at the Centers for Disease Control and Prevention (CDC) recently documented another major advantage: physical fitness improves the health of the nation’s medical care expenditures.3 According to the CDC, physically active individuals incur $865 less per year in medical costs than inactive workers.

Dr. Michael Moore, vice president and chief medical director at Nationwide Insurance in Columbus, maintains that physical fitness is the most effective tool in health maintenance. “If you could prescribe exercise in a pill, it would be the number-one prescribed treatment in the world,” he said. In step with Dr. Moore’s prescription, nearly one-third of U.S. employeres help staff members pay for gym memberships, according to an Associated Press report. Subsidizing gym memberships is just one way organizations encourage active lifestyles.

Popular Fitness Initiatives:

1. Allow access to on- and off- worksite gyms and recreational activities before, during, and after work hours.
2. Offer and encourage participation in after work recreation or leagues.
3. Offer cash incentives or reduced insurance costs for participation in physical activity and/or weight management or maintenance activities.
4. Offer shower and/or changing facilities onsite.
5. Offer outdoor physical fitness areas such as fields and trails for employee use.
6. Offer bicycle racks in safe, convenient, and accessible locations.
7. Offer onsite fitness opportunities, such as group classes or personal training.
8. Offer an onsite physical fitness facility.
9. Start initiatives that have strong social support systems and incentives, such as:
• Buddy or team physical activity goals
• Initiatives that involve workers and family
• Initiatives to encourage physical activity, such as pedometer walking challenges
• Explore discounted or subsidized memberships at local health clubs, recreation centers, or YMCAs
10. Offer flexible work hours to allow for physical activity during the day.
11. Support physical activity breaks during the workday, such as stretching or walking.
12. Host walk-and-talk meetings.
13. Map out onsite trails or nearby walking routes and destinations.
14. Have staff members map out their own biking or walking route to and from work.
15. Post motivational signs at elevators and escalators to encourage stair usage.
16. Offer exercise/physical fitness messages and information to staff members.
17. Offer or support recreation leagues and other physical activity events onsite or in the community.
18. Begin employee activity clubs such as walking or bicycling clubs.
19. Offer onsite child care facilities to facilitate physical activity.
20. Sponsor a bike to work day and reward staff members who participate.
21. Start a box and solicit fitness and health tips.