The concept of Wellness has been around for 25+ years, however most programs at the workplace fall short of full impact.
We will most likely agree that over the past five years, company profits have flattened, while healthcare costs have steadily risen.
Employers will need to find more innovative solutions to not only control costs, but instill employee accountability into their employee benefit plans.
According to the 2010 Towers Watson Employer Survey on Purchasing Value in Health Care Report, employer groups identified three concerns as the top challenges in maintaining affordable benefit coverage:
1. Employees' Poor Health habits,
2. Underuse of preventative services, and
3. High cost of catastrophic cases.
All three of the concerns listed above can be addresses and identified through properly designed wellness programs and certain incentive-based models, with a primary focus on outcome-based results.
Outcome-based results being the key word, it is important to first realize that a small number of claimants drive the largest percentage of claim dollars. Some of these "high claims" cannot be controlled, due to hereditary disease and/or uncontrollable injuries and illnesses, but a very large percentage of claim dollars can be controlled and often reversed.
Obesity and tobacco use are two of the major contributors to claim costs for just about any organization. These are also two of the more controllable drivers, and the proper implementation of robust wellness programs can begin to help control and contain costs in these areas.
The ultimate goal of a wellness program is to create and sustain a culture of heath within an organization. Once this culture has been realized, only then can healthcare costs begin to flatten or in many instances, actually begin to reverse.
With a large percentage of companies already having some form of a wellness program, the larger question becomes how to utilize and create systems that will actually accomplish the goal, and see a significant return on investment, which many wellness programs currently do not realize.
Before we discuss some of the parameters of successful programs, please note that according to The Harvard Business Review (Leonard L Berry, Ann M. Morabito, and William B. Baun, 2010), the ROI on comprehensive, well-run employee wellness programs can be as high as 6-1. If your business could purchase a product that generates a 6-1 ROI, you would most likely implement this product as quickly as possible.
For simplicity purposes, I will identify four levels to specifically designed to reduce trend.
Level One: Understanding, Supporting and Demonstrating the business value of workforce health. This is the beginning stage of building a healthy, productive workforce. By combining a set of employee incentives and activity-based results, strategies in this level are designed to implement a health insurance program that operates efficiently and lays the foundation for a High Performing Health Insurance program.
Level One Employee Responsibilities:
1. Mandatory biometric screenings and
2. Mandatory health risk assessments.
Level One Employer Responsibilities:
1. Formation of a Wellness Committee,
2. Achieve plan design adherence to high-performing results,
3. Demonstrate the organization's interest in employee well-being, and
4. Support employees' in managing their health and wealth.
Level Two: Establish business-focused goals to ensure that health investments deliver a health dividend - and begin to measure the program's success in producing targeted results. This is the second stage in building a healthy, productive workforce. By engaging employees' and promoting a culture of health, strategies in this level are designed to create a sense of shared responsibility and employee accountability for health and cost management.
Level Two Employee Responsibilities:
1. Health Promotion Programs,
2. Outcome-based results (first stage via rewards programs),
3. Voluntary preventative schedule, and
4. Use of information, resources and tools to support health promotion.
Level Two Employer Responsibilities:
1. Enhancement of Wellness Committee,
2. Changes in the work environment to encourage healthier behavior and support a culture of health,
3. Promote culture of shared responsibility and accountability, and
4. Create/Provide Health Resources Website.
Level Three: Designing programs that support transparency and create meaningful incentives for healthy behavior and choices. This is the first stage in outcome-based results. By establishing business-focused goals to ensure that health investments deliver a health dividend, strategies in this level are designed to rigorously measure the success of the program in producing targeted results.
Level Three Employee Responsibilities:
1. Care/Disease Management Programs,
2. Use of High-Performing providers,
3. Outcome-based results (second stage via rewards programs),
4. Use of Evidence-Based treatments, and
5. Health Advocacy/Coaching
Level Three Employer Responsibilities:
1. Further enhancement of the Wellness Committee,
2. Encouraging employees to assess their personal health risks,
3. Senior Management involvement/support, and
4. Disciplined execution.
Level Four: Designing programs that will drive the market towards better solutions that deliver more value for both employees and organizations. This is the second and final stage in outcome-based results. Strategies in this level are designed to align health benefit programs with rewards and business strategy, allowing businesses to create, achieve and maintain a competitive advantage.
Level Four Employee Responsibilities:
1. Mandatory Preventative Schedule,
2. Use of Centers of Excellence (E.g., Specialty Treatment Networks), and
3. Outcome based results (third stage via rewards program).
Level Four Employer Responsibilities:
1. Further enhancement of the Wellness Committee,
2. Further employee encouragement,
3. Further Senior Management involvement/support, and
4. Smoke free environment.
The Patient Protection and Affordable Care Act (PPACA) will position wellness at the forefront. Legislation will force companies to evaluate their policies and procedures in healthcare by virtue of the Medical Loss Ratios (MLR's). Make sure that the MLR's have a positive impact within your organization.
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