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ACA Pushes Preventive Care Wellness

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 Unless your health plan has "grandfathered" status, you are

already subject to the Affordable Care Act (ACA) requirement that preventive services (as defined on this government website) be included in your plan, and come without any employee deductible, copay or co-insurance provisions. (This assumes, of course, that you are large enough to be required to play or pay.)
Also, ACA boosted, from 20 to 30 percent the maximum incentive/discount you can give employees for participating in a "health-contingent" wellness program, beginning in 2014. (The percentage amounts refer to the cost of your employee-only health coverage.) A 50 percent incentive limit applies to smoking cessation programs. Health-contingent wellness plans require employees to satisfy specified health-related requirements (examples: achieving certain results on a biometric screening, or meeting targets for an exercise regimen) to earn the incentive benefit
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Many Programs Fall Short

So what makes a wellness program successful? A stark reminder of the fact many aren't successful was part of a comprehensive study published earlier this year by Rand Corporation.

Only 46 percent of employees who are offered wellness programs "undergo clinical screenings and/or complete a health risk assessment and of those identified for an intervention based on screening results a fifth or less chose to participate," according to the study.

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 Your goal is have a program which is well above those averages, and
delivers results. A Sibson Consulting "healthy enterprise" study found companies whose programs and policies place them in the top quartile of the firm's "wellness index" achieved these results relative to the rest of the companies surveyed:

37 percent less extended employee absences (4 percent of

employees vs. 6 percent)

9 percent lower annual per member per year health costs

($3,431 v. $3,769)

33 percent lower employee turnover (8 percent vs. 12 percent)

17 percent lower Workers' Comp costs (.74 percent of payroll vs. .89
percent) and

A 22 percent slower rate of increase in annual per member per year

health cost increases ($235 vs. $302)
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Patience Required
The first step is to give up any expectations you can turn unhealthy employee lifestyles and the resulting health problems around overnight. One researcher concluded it generally takes three to five years for a well-designed wellness program to achieve its full potential. The following tasks and wellness program components, developed by a group of employers and academics called the Change Agent Workgroup, are critical to success:

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 Develop and embrace an organizational vision of health. What would

having a very healthy workforce look like? What would the benefits be? Senior management participation and commitment. If you aren't involved personally, your employees are less apt to take it seriously. Workplace policies and the work environment. Lecturing employees to eat healthy foods, while having candy and high-calorie drink vending machines scattered around the workplace undercuts your message. Ditto with enabling employees to smoke at work. Diagnostics, informatics and health metrics. Use (or insist wellness program vendors use) objective scientific measurements to assess individual and group health, and progress towards improving it. Value-based plan design. Focus your attention and investment on highimpact program elements to get the most bang for your buck. Patient-centered medical homes/chronic care management. Strive to provide for employees with long-term conditions to receive medical care from a coordinated team of healthcare providers who can focus on helping the employee holistically.

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Behavior Change Support

In addition, Sibson Consulting encourages employers to incorporate easy-to-use behavior change support mechanisms in their wellness programs. These can include programs focusing on fitness, nutrition, smoking-cessation and health coaching. Programs should focus on optimal behavior, in a coordinated manner, from a holistic perspective. Without turning you into the equivalent of a mother hen to your employees, you should not limit the "optimal behavior" to the purely physical/medical realm. Instead, also include employees' intellectual, emotional, social and financial wellbeing "so the employee and the business can thrive," Sibson maintains. Finally, the design of effective wellness programs should reflect the demographics of your company. Recent research on the impact of gender and age with regard to participation in wellness programs should be taken into account (see sidebar).
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Consider Your Employee Demographics

A study published in the April, 2013 issue of the Journal of Occupational and Environmental Medicine titled "How age, sex and program components relate to employee engagement and health outcomes" offers useful insights for developing an effective demographically customized health promotion program. Among the findings:

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 Females and older employees are more likely than others to enroll.

Tangible (vs. cash) participation incentives such a T-shirt can actually

backfire and reduce enrollment.

Cash incentives don't guarantee active participation in programs after

employees sign up and take the money.

Biometric screenings boost the number of older employees who

enroll and participate in programs.

Using onsite "wellness champion networks" improves behavior

changes for older adults.

In female-dominated or gender-balanced workplaces, "special

strategies" may be required to get the men engaged in coaching programs.
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