In recent years, the public has become more aware that healthy lifestyles are instrumental in preventing disease. At the same time, employers have begun to promote wellness programs because they can reduce real costs of absenteeism and insurance coverage. The challenge now is how to deliver a cost-effective and measurable prevention program to an entire employee population.
Reactive or Proactive
Historically, employers and health care carriers operate in a reactive mode, focusing on disease management and providing "wellness" services when a medical claim is recognized. In 2004, less then 5% of health care costs was spent on wellness and 75% was spent on chronic diseases.
To be successful, a health care program must have a proactive approach, focusing on individual risk factors not medical claims.
Prevention and wellness requires a proactive approach to the entire population -- not just those costing dollars today. When individuals at risk are left alone, sooner or later they will move into a higher risk category. The opportunity for prevention is missed once a claim is filed.
University of Michigan's Dr. Dee Edington's studies show that by decreasing risk factors, medical costs also decrease. Shifting from high-risk into a lower-risk group can save more than $3,000 per person per year.
The U.S. Department of Health and Human Services' Diabetes Prevention Program shows that a moderate diet and exercise program leads to weight loss of 5% to 7%, which lowers the incidence of Type 2 diabetes by 58%.
In a multi-year study involving more than 23,000 General Motors employees that was published several years ago, those who increased their heart rate through any type of activity, twice a week for 20 minutes, saved $300 per person per year in medical claims. Most participants did not even have any weight loss. Those who were obese and sedentary and did not participate increased their claims by $3,000 per year.
Internet-Based Programs
The Internet is by far the most powerful tool available for a disease prevention and wellness program. Yet, choosing a web-based program is not as easy as it seems. The following are traits of good programs.
Customized to the Individual Employee
The majority of tools available are built for one-size-fits-all and fail to personalize the message and integrate health coaching for employees who participate. Information must be brief, specific and provided quickly. The Internet is robust in the delivery of customized, tailored information and tools. True web-based developed systems are precision-built and deliver concise, tailored and specific information.
Simple To Use
Most disease and chronic conditions relate back to two drivers: nutrition and exercise. Before launching into a series of programs, however, employers must measure the employees' risk factors: weight, smoking, job satisfaction, exercise, social support, etc.
Twenty questions or fewer is recommended for a Web-based questionnaire to be completed. Research indicates that there are 12 factors responsible for most poor health, but most health risk assessments include 60 to 80 questions -- far too many to engage any employee. Many of these questions are related to medical issues or family history, and no amount of behavior modification or information can change those. So why ask them?
Engaging
Often health Web sites deliver "shovelware" -- throw-everything-at-the-wall-and-see-what-sticks information: The "7 ways to..." or "10 steps to..." newsletters. These magazine-type health information bytes or articles don't really help an individual achieve a goal, but preach what they "should" do. Most people don't hear information delivered in that manner. The majority of people know exactly what needs to be done; they just don't do it. Motivating. Change is hard, and when employees are facing many things to change, most won't even choose one. Focus needs to be on a little at a time. Changing one small thing can have a huge impact on health. Once a small step is achieved, self efficacy and empowerment increases.
Self-efficacy -- defined as confidence, judgment, personal competence or belief in ability to perform a given desired behavior -- has been shown to be the strongest predictor of participation in workplace exercise programs.
Successful lifestyle modification programs deliver tailored personal programs with regular contact, support and personal coaching. Connection with another person is a crucial element to building self-efficacy. Belief in the ability to change is estimated as 85% of whether one has success in lifestyle change.
Health coaching is about listening and supporting an individual's effort in change.
Privacy of Employee Wellness Records Must be Assured
Wellness programs should be provided by outside companies, other than the insurance carrier. Fear of retaliation somehow pervades when an assessment -- a long, highly personal questionnaire is given.
One carrier offered a free smoking cessation program to all 1.23 million employees insured; 23 people signed up. Another major carrier boasts 13% participation after three years. The national average is 20% participation the first year without incentives.
Internet tools can support health coaching through push technology and proactive tools. If designed correctly, participation rates can easily double the national average. Everyone wins with a program that ensures trust, is customized, provides specific information delivered a little at a time and applauds the small successes.
About Allyson Faist
Allyson Faist is president and CEO of MEDeCOACH, which uses Internet technology to deliver personalized health coaching. www.medecoach.com.
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