Posts from — July 2010

A Health Risk (Assessment|Appraisal}  is sometimes used in conjunction with a biometric testing. an HRA is a computerized assessment tool which looks at an individual’s family history, health status, and lifestyle.

An HRA seeks to identify precursors associated with premature death or serious disease and quantifies the probable impact for each individual.

An HRA instrument is derived from an understanding of the while a illness. Based on this understanding, useful prediction instruments may be constructed to assess the health risks of an individual. Individuals with a higher number of health risks tend to have more serious health problems over time.

Drawing attention to their health risks can help customers reduce risk factors which lead to the onset of unnecessary illness and subsequent premature death.

The questionnaire covers lifestyle habits (such as use of tobacco, seat belt use, and exercise) and physical measures (such as cholesterol, blood pressure levels, height, and weight).

For accuracy, it is vital to obtain direct measures of blood pressure, cholesterol and HDL-cholesterol. the HRA also provides recommendations and indicates what risks are modifiable. Kinds of measures to assess health risks are discussed under Screening Programs.

The impact of a health risk (assessment|appraisal} is much greater when it is given in-person, with immediate feedback to the customer. This also provides an opportunity to invite the customer’s participation in continuing health counseling and to gain their written consent to do pro-active outreach to them.

A health age may be computed based on the individual answers to the questionnaire and physiologic factors. the health age might indicate the individual to be younger or older than their chronological age.

HRA programs are one the most prolific types of wellness activities utilized by organizations. Continuing research on HRAs is examining the efficacy of this tool.

One of the large benefits of this tool is that it can provide an aggregate group report of a business and may be utilized as an evaluation tool.

Detailed information is available from the Society of Prospective Medicine (www.spm.org/desc.html) who publishes a handbook on HRAs.

The most common screening performed in wellness programs is heart health assessment.

The screening can include a written heart health test, blood pressure (BP) measurement, cholesterol/HDL-cholesterol test, glucose (blood sugar), weight, educational materials specific to diet, nutrition, exercise, cholesterol, smoking, and weight.

The health expert conducting the screening then provides a consultation and assists set objectives with the participant.

The backbone of wellness programming at the worksite is health testing. It is the first major activity a corporation ought to do when first beginning a wellness program.

Medical screening is often used coupled with the administration of a Health Risk (Assessment|Appraisal} .

The most effective way to screen is to utilize a health expert trained in wellness screening techniques and counseling to privately and individually assess participants.

This wellness specialist takes a brief health history and measures blood pressure and cholesterol. With computerized cholesterol desktop analyzers, results are acquired in about four minutes.

Immediate feedback, consultation, and educational materials are provided. for those identified at-risk, follow-up appointments may be scheduled at this time. the whole process takes about twenty minutes per individual.

The screening also provides an immediate opportunity to register participants in various health betterment programs based on their interests and identified health risks.

Medical screening could be done on an annual basis and used as a means of monitoring health risks within the worksite.

A health screening program needs to provide multiple opportunities for participation. the service must be provided for all the various shifts of a business. the screening program must be conducted in highly visible areas so the process can be observed.

Reluctant employees often like to be able to see what the program is about before they participate. When wellness screeners aren’t busy, they should perform outreach going to areas where employees gather and attempt to recruit employees.

When well-planned and promoted, medical testing can attract participation rates of 60 percent to 100 percent. These high participation rates have a positive impact on management producing support for further programming.

Objectives are broad-based statements about what the program is expected to do. the goal of the wellness program is to enhance the health of the individual and the organization. Objectives like mission statements provide direction in a program.   

Goals are specific and provide a means of measurement of the program to determine effectiveness. There are two kinds of objectives, process and outcome.    

Process goals state the activities that need to occur to achieve a desired outcome.

Examples of process objectives are –

• Number of participants screened

• Number of participants in and completing health improvement programs

• Satisfaction of program participants

• Number of participants who were medically referred and saw their physician

• Number of promotional activities

• Number of participants seen in follow-up

Example of outcome objectives are –

• Number of participants who improved fitness level

• Number of participants who decreased cholesterol level

• Number of participants who lost weight, body fat

• Number of participants who quit use of tobacco

• Number of participants with high blood pressure who reduced their blood pressure

• Number of participants whose initial level of alcohol consumption put them at-risk who are no longer at-risk

• Number of participants with risk factors who saw their doctor and are being treated for high blood pressure or cholesterol years later

Wellness committees are important in that they create a sense of ownership in the program, and facilitate various tasks involved in wellness programming at the workplace.

The committee ought to be composed of a cross-section of workers representing various occupations, levels, and subgroups with the organization.

A common mistake is filling the committee with the most health/fitness-conscious people  in the company. Don’t rely solely on volunteers to fill a committee. Be sure that your committee members have enough power in the company to run an effective wellness program.

The wellness committee is made up of workers from the workplace. It oversees the wellness program and assists carry it out.

The committee should meet about once a month to review the previous month’s activities and plan future ones. When the program is just beginning, the committee may meet weekly until things get going.

Committee members do not carry out medical procedures, counsel clients, or handle confidential medical information. Wellness specialists perform these tasks.

In general, the committee’s duties fall into three areas –  planning, promoting, and helping to run programs.

Planning the programs can include –

• Locating space for activities

• Planning and organizing worksite-wide events such as contests

• Reviewing reports prepared by the program staff and making recommendations

Promoting the program can include –

• Recruiting workers to participate in screening and health betterment programs

• Encouraging staff members to participate in follow-up counseling

• Organizing promotional strategies using newsletters, signs, bulletin boards, computers, and other media available within the workplace

Assisting to run the program can include –

• Establishing up equipment for various activities

• Helping to conduct worksite-wide activities

• Monitoring all activities and evaluating  the performance of the specialist staff

• Acting as wellness mentors to fellow workers

The size of the wellness committee will be dependent on the size of the organization. Choose members by asking day management to nominate or appoint employees.

Make an announcement through flyers, memos, and meetings to recruit potential members. Explain the purpose of the committee, duties and responsibilities, and the time commitment.

Recognize your wellness committee volunteers. Allow them to participate in programs at a lowered cost. Hold appreciation breakfasts/lunches/dinners.

Print names of committee members on company communications about the wellness program.

Purchase special T-shirts, caps, and buttons for them. Write letters to supervisors saying that you appreciate the member’s service. Develop awards certificates for members.

The following could be used as a guide for committee size –    

• Less than 300 employees   2 to 4

• 300 to 1,000 employees   4 to 6

• 1,000 workers or more   6 to 12

Effective wellness programs recognize the importance of building a supportive cultural environment. the workplace culture includes shared values/heartfelt beliefs about what is important. It includes social standards of expected and accepted behavior called “cultural norms.”

It includes colleague support from family, friends, and colleagues. This support can help one adopt healthy lifestyles. Tools are available to audit a corporation.

The long-term success of any wellness program is dependent on the corporate culture.

Some healthy culture signs in a company are –

• Staff Members communicate openly

• Leaders support diversity and opinion

• Employees have fun

• Policies support wellness

• Workers are encouraged to grow

• Workers work together as a team

• Employees’ skills and talents are matched to their jobs.

• Flexible work schedules are available

• Companys consider workers as their most asset

Effective wellness programs try to create healthy workplace climates. A healthy workplace climate is one which encourages teamwork, cooperation, and empowerment of the individual.

Individuals  have a sense of community, a shared vision, and a positive outlook. Policies promote and support wellness efforts within the workplace.

• Effective programs identify ways that business policies and organizational traditions encourage wellness.

• Effective programs work at the group and organizational level to build support for healthy lifestyle choices.

• Effective programs set clear target objectives and objectives for the health improvement of the worksite.

An initial medical testing can include a recent survey of employees’ interests as part of the assessment. Successful wellness programs are designed to meet the needs and interests of the employees.

The information you need to get from a recent survey depends on the scope of your program. A sample survey can be obtained in the HOPE Publications Web site.

If you plan to adapt this sample survey or develop your own survey, keep the following hints in mind –

• Ask mainly closed-choice questions, particularly when you’ll be sending the survey to a large number of staff members. Closed-choice questions provide specific options and are easy to tabulate. You might want to use a computer for data entry and analysis.

• Invite comments, suggestions and recommendations, or ask open-ended questions after the survey. Open-ended items are more challenging to summarize.

• Include a brief explanatory cover letter with the survey with the signature of the corporation president. Make certain to include a statement about confidentiality and anonymity.

• Ask a group of representative staff members to review the survey before it’s distributed. Find out when the questions will be understood by staff members and won’t be objected to.

• Include demographic information at the starting or end of the survey. Consider various ways that you could analyze the responses by demographic characteristics (gender, age, shift, site, department, etc.).

When considering who should get the survey, a simple rule is when you have under 500 workers, everybody should receive one. the public relations advantage of everybody receiving a recent survey can be significant.

Over 500 staff members, a sample of the work population will suffice. A sample saves on costs and time. You may want to consider consulting with a statistician to determine an appropriate sample size for your worksite.

Needs surveys are confidential and anonymous; they don’t request information that may identify a person.

Getting support from management is critical to the success of the program.

One way to do this is to survey managers (see forms) and conduct interviews with decision-makers in the organization. You can use the surveys here or make up your own.

If you decide to do your own, keep the survey short. It should not take more than ten minutes to complete.

The interview process can also serve as a means of educating management. Give concise fact sheets on the benefits of wellness programs for management.

When surveys and interviews are completed, tally the surveys and write brief summaries of the interviews. Give these reports to management.

Once completed present a brief executive summary to management. Highlight a few intriguing findings that may be used immediately to make decisions about the program.

Utilize charts and graphs to make your points. Prepare a detailed report for wellness committee members itemizing each response. Provide a short article about the survey in the company newsletter.

The higher the response the more exact and reliable the results. A minimum response of 40% to 50% is acceptable.

Robust wellness programs involve all employees, deal with all major health risks, offers options, and target both the employees and the worksite environment; provide periodic investigation of its results.     

Robust wellness programs emphasize follow-up and offers support for the staff member as long as he/she is employed. Studies have shown this approach to be highly successful. Key components are planning, implementation, and examination.   

Planning robust wellness programs involve performing a needs and interest assessment, appointing a wellness committee, picking  wellness providers, setting goals/objectives for the wellness program, marketing and advertising/promoting the program, and establishing procedures to ensure confidentiality.   

Implementation of extensive wellness programs consist of five major tasks –    

1   Medical screening and referral

2   Follow-up and counseling workers

3   Follow-up with doctors

4   Health improvement programs

5   Organizing worksite-wide activities.

Examination involves monitoring wellness programs to find out when it is working and to help you refine it. Measuring success shows what you’ve achieved, assists justify costs, and provides information for management to support continued programming.   

Extensive wellness programs involve all employees, deal with all major health risks, offers options, and target both the employees and the worksite environment; provide periodic analysis of its results.     

Comprehensive wellness programs emphasize follow-up and offers support for the staff member since he/she is employed. Studies have shown this approach to be highly successful. Key components are planning, implementation, and investigation

Planning extensive wellness programs involve performing a needs and interest assessment, appointing a wellness committee, choosing  wellness providers, establishing goals/objectives for the wellness program, advertising/promoting the program, and establishing procedures to ensure confidentiality

Implementation of robust wellness programs consist of five major tasks –

• Health testing and health risk (assessment|appraisal}

• Follow-up and counseling employees

• Follow-up with doctors

• Health improvement and illness avoidance programs

• Organizing worksite-wide wellness program activities.

Examination involves monitoring wellness programs to find out when it is working and to help you refine it.

Measuring success shows what you have achieved, assists justify costs, and provides information for management to support continued programming.

Initially introduced by Halbert Dunn in the 1950’s, wellness became a popular buzzword during the late 1970’s and received considerable academic attention in the 1980’s.     

Wellness programs for workers became more widespread during the following decade, and credible evidence for their economic viability began to be published.     

There have now been over 100 published studies on this topic and a number of systematic reviews.

Health risks increase costs.  Medical and health insurance costs escalate with both age and number of risks present.8,10   the number of risks is also strongly related to sick time absenteeism, Employee’s Compensation costs, short-term disability, and decreased productivity (”presenteeism”).

Early employee wellness programs were relatively basic and usually produced a return on investment (ROI) of less than one dollar for every dollar spent operating the program (ROI = <1 - 1).8

Such programs might  be characterized as “fun-oriented”.  Participation is entirely voluntary, and there is no particular focus on the reduction of in particular identified high risks.  

Interventions and activities aren’t customized, and there’s no emphasis on the management of health costs.  These programs are ordinarily site-based only, lack choices to address all of the major behaviorally-related health risks, and lack multimodal presentation.  

Minimal or no incentives are provided to staff members for participation, and services to spouses and family members are not available.  Most such programs lack meaningful analysis.  

More conventional programs are “activity-oriented” and have shown an ROI of between 1 – 2.5 and 1 – 3.5.8 These programs may have a greater emphasis on health and risk reduction, although the efforts are relatively broad and not personalized.  

They could have some generalized emphasis on health care cost management, although not necessarily aimed at specific high risks.  Most are site-based and voluntary, with spouses included only rarely.  

Modest incentives could  be utilized to encourage participation.  Formal examination could  be weak.

The newest and most economically viable programs are “results-oriented” and exemplify the health and productivity management model.  These programs consistently produce return rates of 1 – 4 or greater within a 12-24 month period.8  

Such programs are strongly focused on the reduction of namely identified high risks and the management of healthcare costs.  They’re normally voluntary, but use strong financial and other incentives to promote participation.  

They’re multi-component in nature (address all major risks), and have both onsite and virtual modalities of operation.  The interventions are highly targeted and individualized, and offered to spouses as well as employees.

For companies, the cost of providing health insurance for their workers is of excellent importance.  Those costs have been increasing at annual rates between 6 percent and 14 percent.

Chapman’s 2007 systematic review7 stated an typical reduction in health care costs of 26.5% then of worker wellness programs.  His review covered 60 of the most scientifically valid studies, with an typical of 3.77 years of study.

Absenteeism due to illness is another cost driver.  Chapman’s review7 reports an typical reduction in sick time of 25.3%.   Cost for Employee’s Compensation was lowered by 40.7%, and disability costs by 24.2%.

There is also an emerging literature on the costs of presenteeism (reduced productivity).11,13  In one study, every risk lowered through a wellness program yielded a 9% reduction in presenteeism (and a 2% reduction in absenteeism).11

Some businesses have achieved a zero% increase in health care costs across at least brief periods of time.10  Doing so requires 90-95% participation of the worker population in focused wellness programs, with 75%-85% of the workers falling into the low risk category.10     

Although comprehensive efforts to lower the risk status of those in moderate or high risk categories ought to be made, the needs of currently healthy employees ought to be addressed as well to avoid increases in risk-status.   

Given the size of the federal workforce, meaningful cost savings in the government’s contribution to medical insurance premiums for workers may be achieved if a majority of that population were participating in active wellness programs.     

In like fashion, improvements in absenteeism, employee’s compensation, disability, presenteeism, and turnover as a result of extensive employee wellness programs would yield substantial fiscal benefits for the government.   

References   

1   Aldana, Steven G.  (2001)   Financial Impact of Wellness Programs –   A Comprehensive Review of the Literature.   Am J Wellness 15(5) – 296-320.

2   Chapman, Larry.  (1998)   the Role of Incentives in Wellness.  The Art of Wellness  2(3) – 1-8.

3   Chapman, Larry.   (2003)   Biometric Screening in Wellness –   is it Really as Important as We Think?  the Art of Wellness  7(2) – 1-12.

4   Chapman, Larry.  (2005)   Meta-Examination of Corporate Wellness Economic Return Studies –  2005 Update.  The Art of Wellness, July/August, 1-15.

5   Chapman, Larry.   (2006)   Employee Participation in Corporate Wellness and Wellness Programs –   How Important are Incentives, and Which Ones work Best?   North Carolina Medical Journal   67(6) –   431-432.

6   Chapman, Larry, Lesch, Nancy, and Passas Baun, Mary Beth.   (2007)   the Role of Wellness Coaching in Corporate Wellness.   the Art of Wellness, July/August, 1-12.

7   Chapman, Larry.  (2007)   Proof Positive –   an Analysis of the cost-Effectiveness of Corporate Wellness.  Northwest Health Management Publishing, Seattle, WA.

8   Chapman, Larry.  (2007)   an In-Depth Look at the Economic Evidence for Rewarding Health Behavior Change.   Workshop presentation at the World Research Group “Rewarding Healthy Behaviors for Health Plans and Companys” Conference, Orlando, FL, January 23-24.

9   Edington, Dee.   (2001)   Emerging Research –   A View from One Research Center.  American Journal of Wellness 15(5) –  341-349.

10   Edington, Dee W.  (2007)   Health Management as a Serious Business Strategy.  Presentation at the World Research Group “Rewarding Healthy Behaviors for Health Plans and Businesss” Conference, Orlando, FL, January 23-24.

11   Pelletier, Barbara, Boles, Myde, and Lunch, Wendy.  (2004)  Changes in Health Risks and Be certain to work Productivity.   Journal of Occupational and Environmental Medicine, 46(7) –  746-754.

12   Pelletier, Kenneth R.  (2005)   A Review and Analysis of the Clinical and Cost-Effectiveness Studies of extensive Health and Disease Management (DM)Programs at the Worksite –  Update VI 2000-2004.  JOEM 47(10)1051-1058.

13   DeVol, Ross, Bedroussian, Armen, et. al.  (2007)  an Unhealthy America –   the Economic Burden of Chronic Disease.  Report released by the Milken Institute.   www.milkeninstitute.org.

14   Partnership for Prevention.  (2008) Investing in Health –   Proven Wellness Practices for Workplaces.   http – //www.prevent.org/images/stories/2008/investinginhealth_finalfinal.pdf.