By Kathy McKimmie

Wellness programs, health risk assessments and carrot-and-stick employee incentive programs to encourage healthy lifestyles have been around for decades. Their effectiveness has been mixed for many reasons, including their voluntary nature, the lack of a convincing return on investment and the inability of fully insured small employers to impact their current insurance rates.

Still, as health-care cost increases continue in the double digits, wellness continues to get attention from employers, providers and organizations seeking ways to keep employees healthy and improve productivity.

The Wellness Council of Indiana has been around since 1988, established to share information about what works among members, promote healthier lifestyles and certify workplace wellness programs. But it was always run by volunteers, says President Mike Campbell, until January of this year when it entered into a partnership with the Indiana Chamber of Commerce.

The chamber hired Chuck Gillespie as its first full-time program director. With its new resources and increased visibility, Campbell hopes the council's membership will grow to 500 over the next 18 months, and that it can boost attendance at the Council's 3rd Annual Wellness Summit on Sept. 27, 2011.

Campbell is managing partner, health and productivity, at Neace Lukens, Indianapolis. He sees wellness as one part of a strategic cultural change within the workplace, along with an emphasis on presenteeism, workers' compensation claims, health-care claims and attracting and retaining employees.

“Wellness today is in most cases ill-perceived and ineffective because it's tactical in nature,” says Campbell. Health-care costs go up and employers go down the wellness road trying to tackle smoking, obesity, diet and nutrition. “But that's tactical, not strategic. Why are you 350 pounds? If you go after the why, we'll get to the cure.”

Strategic efforts start at the top, says Campbell, by getting CEO buy-in. “The leader needs to take charge.” Where this happens, managers are held accountable for wellness in their annual reviews, and it's even built into hiring practices by stressing the importance to potential employees. “Those people who are not going to get on board with you on this, you can weed them out.”

Walking the Talk
Through its WorkingWell occupational health arm, the Franciscan Alliance (formerly the Sisters of St. Francis Health Services), has a long history of working with employers in the region to do blood draws and screenings and promote use of its online health risk assessment tool to promote wellness, decrease accidents and increase productivity.

But it's also leading the charge with its own employees. As regional wellness specialist with the Franciscan Alliance, Carlos Celis travels to five employee fitness centers at Northwest Indiana hospitals, helping employees set up individualized workout routines and encouraging everyone he meets to make exercise a habit.

In addition to free exercise consultation, monitored motivational wellness initiatives, such as 10,000 Steps, a holiday weight maintenance program, summer walking and biking mileage programs are offered. And for a small fee, employees can take part in yoga and Zumba classes (really taking off), receive massage therapy and participate in Weight Watchers at Work.

The exercise program doesn't operate in a vacuum. All employees are encouraged to participate in an annual blood draw and take an online health risk assessment to determine if they need to make changes to improve their health. There are five key areas where a good result can mean a reduction in health premiums – up to a maximum of $60 a month, says Celis. They are tobacco use, body mass index, glucose levels, blood pressure and cholesterol.

“New hires in the wellness program will automatically start receiving a wellness credit the first year and then in the following years their wellness credit will be dependent on their completion of the wellness requirements and if they reach their wellness biometric goals,” says Celis.

Incentives for Employees and Employers
Federal law allows employers to give employees a 20 percent discount off their insurance premium (“premium differential”) if they meet certain wellness criteria. That increases to 30 percent in 2014 and could potentially go to 50 percent.

The idea that the government has bought into is that cash (carrots) gives employees an incentive to get well and stay well.

“I believe in five years we'll see the option if you're overweight or you smoke you'll pay more or be on a lesser plan,” says Carla Cohen, employee benefits account executive, Braman Insurance Services, Merrillville. But for now, carrots, rather than sticks, are the preferred method of getting employees engaged.

Cohen has seen an upward trend in the use of wellness programs over the last year. “Most insurers pay for one free wellness screening a year,” she says. As a value-added convenience to utilize that benefit, Braman will bring a phlebotomist to the worksite, typically between 6 a.m. and 8 a.m., for a fasting blood draw for employees choosing to participate.

Employees get a report, comparing their latest results to past years if available. It's particularly valuable for people who rarely see a doctor. When one local company with a largely female workforce discovered that several employees were low in iron, dietary changes were suggested as a result.

Some wellness activities can be low cost or no cost. “The Biggest Loser” TV show has inspired some of Cohen's clients to start weight-loss programs, driven by employees who see it as a fun challenge rather than a traditional wellness program. Several area employers have weigh-ins, scheduled walks and fruit brought in as snacks.

Premiums for fully insured small employers are increasing about 20 percent this year, says Cohen, and there's little that can be done to see direct savings from a wellness program. Employees who indicate they smoked in the last 12 months, for instance, can result in the employer getting dinged by the underwriter due to increased claims risk. Even if the employer's wellness program is successful, it will not show up as improvement until the following year.

Craig Menne, vice president, General Insurance Services, Michigan City, echoes Cohen's comments about insured vs. self-funded employer control. The trend is continuing for employers to self-fund their health-care plan, adding a stop-loss policy. “The financial benefits become more immediate,” he says. “You have claims coming in and you're paying them.” For fully insured employers with wellness programs, wellness programs might help at renewal “a year down the road.”

“Most fully insured businesses have access to some sort of wellness offering,” says Menne, but he has found that use of the offering is relatively rare. Self-funded employers, on the other hand, have more financial incentive to reduce their claims, and some area employers have set up medical clinics and employ nurse practitioners so that employees can get onsite immunizations, some prescriptions, and receive counseling on health issues.

The employer's philosophy has a lot to do with its wellness efforts, says Menne. Some “own” wellness, others think “whatever employees do when they're not here is their own business.” That might lead some employers to give out a $50 gift card just for completing an online assessment and leaving it at that, while others will be more aggressive in having nurses make monthly follow-up calls to employees found to be at risk.

Both the state and federal governments have enacted legislation to encourage small businesses to provide wellness programs by offering financial rewards. Indiana's law, covering employers with two to 100 employees, was passed in 2007 and is funded through a cigarette tax. Fifty percent of the costs of a qualified employee wellness program can be claimed as a credit on an employer's state taxes.

Businesses must submit an annual application to the Indiana Department of Health before Oct. 1 of the tax year to be claimed (see www.wellnesstaxcredit.in.gov). Wellness programs must include weight loss, smoking cessation and preventive health-care services, and other requirements must be met. The department reports that 78 wellness plans were certified in 2010, out of 100 applications. Seventy-three were approved in 2009, 70 in 2008 and 54 in the first year of the program, 2007.

Mike Campbell questions the perceived value of the program among employers. “Let's look at the facts: 219,000 employers qualified to apply for the tax credit, and only 78 were approved.” And its existence may be sunsetted, he added, pending deliberations at the Statehouse.

At the federal level, Congress passed a $200 million program of grants to small employers as part of the 2010 Affordable Care Act. It was to go into effect this year but it didn't happen. And the law states that you can't have an existing wellness plan in place to qualify, only newly established plans could get grants – if it's ever funded.

This brings us back to the importance of organizational commitment and the CEO's buy-in if employees are to get involved in wellness. “The No. 1 incentive above everything else is belief that the CEO truly cares,” says Campbell. Compare that to the one in nine chance for change if your doctor tells you to shape up.