WorkplaceWellnessProgramsStudy

CaseStudiesSummaryReport

ContractNumber:
DOLJ089327414

Preparedfor:
OfficeofPolicyandResearch
EmployeeBenefitsSecurityAdministration
DepartmentofLabor

OfficeofHealthPolicy
AssistantSecretaryforPlanningandEvaluation
DepartmentofHealthandHumanServices.

Preparedby:
RANDCorporation

April2013

Table of Contents
Summary.......................................................................................................................................................4
Introduction..................................................................................................................................................5
Background...............................................................................................................................................5
CaseSelection...........................................................................................................................................5
CaseStudyMethods.................................................................................................................................7
EmployerA:ALargeUniversity.....................................................................................................................9
Organization..............................................................................................................................................9
WellnessProgramDescription................................................................................................................10
EngagementStrategy..............................................................................................................................14
ProgramResults(DocumentedandPerceived)......................................................................................16
ProgramImpact......................................................................................................................................18
FutureDirections....................................................................................................................................20
Conclusion...............................................................................................................................................20
EmployerB:AStateGovernmentAgency..................................................................................................22
Organization............................................................................................................................................22
WellnessProgramDescription................................................................................................................22
EngagementStrategy..............................................................................................................................27
ProgramResults(DocumentedorPerceived).........................................................................................29
ProgramImpact......................................................................................................................................31
FutureDirections....................................................................................................................................34
Conclusion...............................................................................................................................................34
EmployerC:Alargeserviceorganization...................................................................................................36
Organization............................................................................................................................................36
WellnessProgramDescription................................................................................................................37
EngagementStrategy..............................................................................................................................41
ProgramResults(DocumentedorPerceived).........................................................................................44
ProgramImpact......................................................................................................................................46
FutureDirections....................................................................................................................................47
Conclusion...............................................................................................................................................48
EmployerD:AManufacturingCompany....................................................................................................51
Organization............................................................................................................................................51
WellnessProgramDescription................................................................................................................52
EngagementStrategy..............................................................................................................................55

ProgramResults(DocumentedorPerceived).........................................................................................58
ProgramImpact......................................................................................................................................59
FutureDirections....................................................................................................................................62
Conclusion...............................................................................................................................................62
AppendixA:DiscussionGuide.....................................................................................................................67
AppendixB:FocusGroupProtocol.............................................................................................................70

Summary

Thisreportdescribesfindingsfromfourcasestudiesofexistingworkplacewellnessprogramsina
diversesetofemployers.Theauthorsdescribecharacteristicsofwellnessprograms,useoffinancial
incentiveandengagementstrategies,facilitatorsandchallengestosuccess,andimpactofprograms.
Casestudieswerebasedondatacollectedthroughsemistructuredinterviewswithorganizational
leaders,focusgroupswithemployees,reviewofprogrammaterials,anddirectobservation.

Introduction
Background
Employershaveincreasinglybecomeinterestedinworkplacewellnessprogramstoimproveemployee
health,suchaswellnessscreenings,onsiteclinics,healthierfoodsoptionsincafeteriasandvending
machines,andgreateropportunitiesforphysicalactivity.1Further,manyemployerslooktohealthplans
toadministerandcoordinatewellnessprogramsand/orhealthscreenings.ThePatientProtectionand
AffordableCareActsupportstheseinitiativesthroughanumberofprovisionsintendedtoleverage
workplacewellnessprogramsasameanstoreducetheburdenofchronicdiseaseandcontrolhealth
carecosts.

Tobetterunderstandhowworkplacewellnessprogramsareimplementedandhowparticipating
employeesviewsuchprograms,weconductedcasestudiesoffouremployers.Thesecasestudiesare
partofalargerproject.Thisreportdescribesourapproachtotheselectionofcasestudysites,our
protocolfordatacollectionandsummarizesourfindingsforeachsite.Thisresearchwasconducted
undercontract#DOLJ089327414withtheDepartmentofLabor,aspartofalargerstudyofworkplace
wellnessprogramsthatisrequiredbytheSection2705(m)(1)ofthePublicHealthServiceAct.

Case Selection

Muchhasalreadybeenwrittenaboutwellnessprogramsimplementedbylarge,Fortune500companies
(e.g.,JohnsonandJohnson,GeneralElectric,andPepsiCo),butlessisknownabouttheexperiencesof
smallerfirms.Therefore,wefocusedontheexperiencesofcompanieswithatleast100workersbut
fewerthan50,000workers.

Wedevelopedasiteselectionprotocolthatcouldhelpusmaximizetheinformationalyieldbyensuring
diversityofselectedfirms.Weattemptedtorecruitsitesthatvaryalongthefollowingcriteria:

Companysize
Typeofemployer(heavyindustry,retail,servicesandgovernment)
Programorigin(homegrownversusofferedbyahealthplanorvendor)
Region
Employerrelianceonsubstantialfinancialincentivestopromotewellnessprogramparticipation
andbehaviorchange;wespecificallysoughtatleastonefirmthatusesrewardstiedto
achievementofhealthrelatedstandardsthatareclosetothecurrentlyallowedlimit.

Becausethereisnonationallyrepresentativedatabasesofemployerwellnessprograms,casestudy
candidateswereidentifiedbasedonpublishedinformation,suchascompanieslistedinthePartnership
forPreventionLeadingbyExamplepublications,highlightedinawardprograms(e.g.,WelcoaAwards
andC.EverettKoopAwards),featuredinnewspaperarticles,and/orreferredtousbyexpertson
worksitewellnessprograms,suchasacademics,benefitconsultants,managersofwellnessprogram

WorldEconomicForum.WorkingTowardsWellnessInitiative.
http://www.weforum.org/en/initiatives/Wellness/index.htm,accessedNov18,2009

vendors,andgovernmentofficials.Relyingonarangeofsourcesofinformationaboutworksitewellness
programshelpedusidentifytheprogramsthathavebeenlesshighlypublicized,aswellasthosethat
offersubstantialfinancialincentivestopromotewellnessparticipationandbehaviorchange.

Intotal,weidentifiedalistof34candidateemployersforthecasestudies.Siteswereclassifiedbasedon
ourselectioncriteriaandweselectedprimaryandbackupsitestoachievebalancedrepresentationof
ourselectioncriteria.Primaryselectedsiteswerecontactedbytheresearchstafftosecure
participation.Ifaprimaryselectedsitedeclinedtoparticipate,itwasreplacedfromthelistofbackup
sites.Atotalofnineorganizationswerecontactedtosecureparticipationfromfouremployers.

Twoprimarysitesagreedtoparticipateandtheothertwositeswererecruitedfromthebackuplist.In
addition,weuseddatathatwecollectedduringarecentsitevisitunderaseparatestudy,whichwasa
reviewofthewellnessprogramoperatedbyalargegovernmentagencyin2010.Table1summarizes
howthefoursitescoverourselectioncriteria.

Ofnote,wewereunabletosecureparticipationofasmallfirmwithlessthan1,000employees,even
thoughwehadidentifiedandcontactedthreecandidateorganizations.Representativesofthesefirms
feltthattheburdenofstudyparticipationwouldbetoohighfortheiremployees,company
managementwasreluctanttoparticipate,ortherenostaffavailabletohelpwithstudycoordination.

Table1:Characteristicsoffouremployersites.
Numberof
Employees

Industry

Region

EmployerA

3,500

Services

South

Program
Administration2
Employer;
healthplan

EmployerB

19,000

Government

South

Employer;
healthplan

Northeast

Employer;
healthplan;
vendor

Midwest

Employer;
healthplan;
vendor

EmployerC

EmployerD

4,800

9,000

Services

Manufacturing

FinancialIncentives[peryear]
Smoking:$50annualinsurance
premiumsurcharge
Smoking:Smokersrestrictedtolower
valuecoverageoption
Screening:$15reductionincopays
Screening:$20forcompleting
biometricscreening
HRA:$50forcompletingonlinehealth
assessment
Smoking:Upto$600premium
surchargeperyear
HealthGoals:$20forachieving
personalhealthgoals
Screening:Upto$2600annual
premiumdifferential3(forindividual
coverage)
HealthOutcomes:Upto$754annual
premiumdifferentialbasedon
biometricdataandsmokingstatus(for
individualcoverage)

Employersmaychoosetoadministerandmanagewellnessprogramsinternallyorpurchasewellnessservicesfor
theiremployeesfromtheirhealthplanorthirdpartyvendors.
3
EmployerDhasa$50weeklysurchargetoemployeescontributionstohealthplanpremiumsforemployeeswho
optoutofwellnessscreenings,whichtotals$2600annually.

Case Study Methods

Methods of Data Collection

Eachcasestudywasbasedondatacollectedthroughsemistructuredinterviewswithkeyinformants,
focusgroupswithprogramparticipants,reviewofrelevantdocuments,anddirectobservation.Alldata
collectionandanalysisprocedureswerereviewedandapprovedbyRANDsInstitutionalReviewBoard.

Wedevelopedasemistructuredinterviewprotocoltoguideexpertinterviews.Thequestionswere
informedbyaliteraturereviewandexpertconsultations.Theinterviewguideincludedalistofmajor
topicswithdiscussionprobesundereachsubheading,andisattachedtothisreportasAppendixA.We
conductedindividualinterviewswithwellnessprogramcoordinators,wellnessprogramstaff,human
resourcerepresentatives,accountants,workerrepresentatives,andseniorexecutives.Ifappropriate,
wealsointerviewedbenefitsconsultants,healthplanstaffandprogramvendorrepresentatives.

Eachcasestudyalsoincludedatleastoneemployeefocusgrouptogettheenduserperspectiveonthe
impactandeffectivenessofthewellnessprogram.Likethekeyinformantdiscussionguides,thefocus
groupprotocolwasinformedbytheliteraturereview.Focusgroupparticipantswereaskedtoprovide
verbalinformedconsent.Theprotocolincludedalistofmajortopics,withdiscussionprobesundereach
topic,andisattachedtothisreportasAppendixB.

Inadditiontodatacollectedthroughkeyinformantinterviewsandfocusgroups,researchersreviewed
relevant,publishedmaterialsaboutwellnessprogramsprovidedbysitesthemselves.Examplesofthese
materialsincludebrochuresdescribingtheprogramtoemployees,internalstudiesdocumentingthe
programseffectiveness,oranyliteratureprovidedtoworkerstohelpthemmakehealthierchoices(e.g.
nutritionguides).Finally,researchersalsocollectedinformationduringsitevisitsthroughdirect
observation,suchasdetailsonthebuiltenvironment,cafeteriafoodchoicesandaccesstoinformational
materials.
OMB Review

Oncethekeyinformantdiscussionguideandemployeefocusgroupprotocolweredeveloped,theywere
submittedforOMBclearance.TheOMBapprovedkeyinformantdiscussionguideandfocusgroup
protocolareincludedwiththisreportasappendices.
Site Visit Procedure

Weaskedeachsitethatagreedtoparticipatetonominateaprimarycontacttocoordinatedata
collection.ThesecontactsassistedwithrecruitingthekeyinformantsbyusingRANDprovided
recruitmentmaterials.Meetingswerescheduledwithupto12keyinformantsateachparticipating
employer,providingavarietyofperspectivesonwellnessprogrammanagement,implementation,and
perceivedoutcomes.

Torecruitfocusgroupparticipants,theorganizationalcontactssentinitialemailstogroupsof
employeesidentifiedaseligibleforthefocusgroupsbasedontheirparticipationinwellnessactivities.
Theorganizationalcontactsentfollowupemailsclosertothedatetoconfirmattendance.RAND
workedwiththeorganizationalcontacttoprovidethetextfortherecruitmentemails,which
emphasizedthatparticipationinthisstudywasvoluntary.Inthreeofthefourcasestudies,the
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organizationalrepresentativepreferrednottohelpwithfocusgrouprecruitment,thereforetheRAND
researchteamwasresponsibleforidentifyingeligibleemployeestoparticipateinfocusgroups.
Recruitmentwaslimitedtonomorethan12participantsineachgroup.

Thetimeanddateofeachsitevisitweredeterminedbasedontheavailabilityoftheorganizational
representativeandotherkeyinformants.Whenitwasnotpossibletointerviewallinformantsinone
visit,followupinterviewswereconductedbyphone.Thefocusgroupswerescheduledafterthe
interviewscheduleswerefinalized.Theresearchteamworkedwiththeorganizationalrepresentativeto
schedulethefocusgroupatatimethatwasacceptabletotheorganizationandlikelytobeconvenient
foremployees.

Theresearchersscheduledthesitevisitstotakeplaceoveroneortwodaysateachlocation,during
whichtimetheyconductedtheemployeefocusgroupsandmetwithkeyinformants.Sitevisitswere
conductedbyaRANDresearcherandaresearchassistant,whoassistedwithnotetaking.
Case Study Data Analysis

Thequalitativedatacollectedfromeachcasestudywereanalyzedthematicallybytheteamthat
conductedtherespectivesitevisit.Afterallinterviewsandfocusgroupsweretranscribed,researchers
reviewedthetranscriptstoensureaccuracy.Interviewandfocusgroupguideswereusedtofacilitate
datacoding,ensurecodingconsistencyacrosscasestudies,andproducecomparableindividualcase
studyreports.Suchanapproachtoqualitativedataanalysishelpedusensurethatsimilardataare
abstractedforeachcasestudy,whichisimportantforsynthesizinginformationacrossallfourcase
studiesandillustratingthemainstudyfindings.

Employer A: A Large University

wearetryingtocreate[aculture]ofpersonaldevelopmentandindividualenrichmentbyworking
collaborativelywithothergroupsoncampustojustpromotehealthylifestylesandidentifyingthetypes
ofareasthatseemtoberelevantandofinterestfromthefeedbackwehadbeenreceiving(Wellness
LeaderatEmployerA)

Organization
Background on the Employer

EmployerAisalargeuniversitylocatedinthesouth.Theuniversityofferseligibleemployeesvarious
benefitplans,includinghealth,dental,andvisioncoverage;itcontributestopremiumsbasedonstate
lawandrequirementsoftheStatesTeachersRetirementSystem.Tobeeligible,anindividualmustbe
appointedtoaregularfacultyorstaffpositionthathasananticipateddurationofgreaterthansix
months.Eligiblefacultyandstaffmaycovertheirspousesandeligibledependentchildren.

Employeehealthplansareofferedbytwomajorinsuranceproviders.Since2012,EmployerAhas
offeredfourtypesofplans,threeofwhichareadministeredbyProvider1,whichincludeanHMO(no
newenrolleesareaccepted),HSAOpenAccessPOS(ahighdeductiblePointofServiceoptionthat
replacedaformerPPOoption),OpenAccessPOS(anotherhighdeductiblePointofServiceoptionwitha
differentprovidernetworkthatreplacedaformerPPOoption).ThesecondprovideroffersanHMO(no
newenrolleesareaccepted,exceptforSeniorAdvantagePlan65+).Allplansarerequiredtoofferlow
tonocostalternativestoimproveoverallemployeehealthsuchassmokingcessationprograms,to
expandcommunicationandeducationeffortsaboutwellnessandprevention,andtoofferdiscounted
weightmanagementprograms.

Whiletheuniversitysystemgovernstheoverallstructureofemployeeandstudentbenefits,this
universitymadeadecisiontocreateitsownwellnessprogram.Housedat,andfundedby,theHuman
Resources(HR)Department,theschoolsemployeeandwellnessservicesprogramoffersservicestoall
staff,faculty,students,andevenretirees.Inadditiontothisemployersponsoredwellnessprogram,the
twoinsuranceprovidersalsoofferhealthandwellnesscomponentstoplanparticipants.

Basedontheinformationweobtainedduringourinterviews,themostpressinghealthissuesfor
universityemployeesandtheirdependentarehypertension,pediatricasthma,anddiabetes.Noactual
prevalencedatawereavailable.
Organizational Strategy

TwoindependenteventsledtothecreationoftheEmployerAswellnessprogram.First,in2005,the
universityidentifiedsmokingasamajorhealthconcern.Incollaborationwiththestudenthealthoffice,
theEmployeeAssistanceProgramcoordinatorappliedfor,andsubsequentlyreceived,asmallgrant
fromtheAmericanCancerSocietyintendedtoraiseawarenessofthenegativeconsequencesof
smoking.

Thesecondeventwasadecisiontoeliminateuniversityemployeesaccesstothecampusstudenthealth
clinicduetobudgetcutsin2006.Becausetheclinicwasapopularproviderofhealthserviceson
9

campus,theuniversityadministrationdecidedtosearchforalternativeservicesthatcanbeprovided
locallyusingexistingresources.Accordingtoaninterviewee,theuniversityadministrationsattogether
with[thedepartment]ofnursingand[thedepartment]ofnutritiontotalkaboutaprogramwhere
employeescancome.Maybenoteverydaylikeaclinic,buthowaboutfirstThursday,onceamonth.For
starters,letsseehowthatmightgo.Thatseemedrealisticandreachable.Consequently,auniversity
widetaskforcewascreatedtoidentifymajorhealthandwellnessrelatedareasofconcern.Thetask
forcefocusedonstressandworklifeissuesandchoseaproactiveapproachtryingtoempowerpeople
tochangetheirhabits,makebetterchoices,andfocusonhealthandwellness.In2008,theAssistant
VicePresidentofHumanResources(AVPHR)officiallyinitiatedthewellnessprogram.

Wellness Program Description

Program Development and Implementation

EmployerAsworksitewellnessprogramwasdesignedasanadditionalbenefittohelpfaculty,staff,and
studentsdevelopandmaintainhealthylifestyles,balancetheirwork/schoolandpersonallives,cope
withstress,andboostemployeemoraleandproductivity.Reductionofhealthcarecostswasnotamong
initialreasonsforcreatingtheprogram.Programgoalsofraisinghealthandwellnessawarenessare
alignedwiththeoverallmissionoftheuniversityinthatthewellnessprogramfocusesoneducating
programparticipantsabouthealthandwellness.

ThewellnessprogramisadministeredbyadepartmentwithinHumanResources,alsoresponsiblefor
oversightoftheEmployeeAssistanceProgram,Work/LifeResources,andPersonalEnrichment
Workshopsgearedtowardservingadiverseuniversityworkforce.Theprogramdirectorofthis
departmentoverseestheimplementationoftheworksitewellnessprogram,whichhastwoemployees
andusesseveralparttimeconsultantsandgraduatestudentstohelprunvariouswellnessactivities.
Data Collection

Beforethewellnessprogramwasimplemented,hypertension,pediatricasthma,anddiabeteswereseen
asthemostrelevanthealthrisks.Untilthefallof2011,thewellnessprogramitselfdidnotcollecthealth
riskdata;however,itstarteddoingsoaspartofthemonthlyHealthScreeningprogram.Accordingtoa
wellnessprogramemployeewhoconductsthesehealthscreenings,Imstartingtotrackscreeningdata;
definitelythehealthcoachingdataforbloodpressuresandweights.

Moreover,thewellnessprogramdirectorrecentlyvisitedtheofficeofInsuranceProvider1tolearn
moreabouttheplanswellnessprogramandreceivedasummaryofthemosttypicalhealthissuesthat
universityemployeesreportwhentheycalltheplansfree24/7hotline.Althoughthesedatawerenot
sharedwithus,anintervieweestatedthatthemostprevalentissueswerehighbloodpressure,
diabetes,andobesity.

Aspartofitsownwellnessprogram,Provider1collectshealthriskdatathattheuniversitydeemedto
bepotentiallygreatbutthesedataareaboutthehealthstatusofarelativelysmallnumberof
employees.Say,wemayhave2,000members[Provider1splan],butmaybe200ofthemagreedto
completetheformsandsuppliedtheirinformationtotheplan[However,eventhedataonthosewho
joinedtheprogram]havenotbeenmadeavailable.Andthatsbeenpartoftheconcernbecausewe

10

haveobviouslydealtwiththechallengeofrisinghealthclaims,premiums,andclaimscostWerenow
waitingforabigreportfromthem.
Program Costs

TheuniversityworksitewellnessprogramreceivesfundingfromtheHRDepartment.Toreducecost,it
leveragesoncampushumancapitalbyestablishingmutuallybeneficialcollaborationswithdifferent
academicdepartmentsanduniversityprograms/services,includingSchoolofNursing&Health
Professions,theCollegeofBusiness,SchoolofSocialWork,RecreationalServices,andthestudent
healthoffice.Forexample,graduatenursingandcounselingstudentsfunctionaswellnessservice
providers;nursingandnutritiongraduatestudentsandfacultygivelecturesonhealthandwellness
relatedtopics.Builtonthepremiseofmutuallybeneficialcollaboration,theuniversitywellnessprogram
isregardedasanexampleofhowawellnessprogramcanstrengthenoncampusrelationships.

Althoughwewerenotabletoobtainexactinformationonprogramcosts,fromtheperspectiveofthe
HRdepartment,relianceonthesepartnershipsimprovesefficiency.Accordingtoourinterviews,the
majorcostitemisthesalariesofitsdirectorandseveralemployees,whichareabout$200,000ayear.
Duetotheprogramspopularityoncampus,reputationamongtheinstitutionsofhighereducationin
thestate,andthegrowingimportanceofwellnessanddiseasepreventionasastrategyforloweringthe
stateuniversitysystemshealthcarecost,theannualbudgetofthewellnessprogramwasincreasedin
the2011/2012academicyear.Theexactnumber,however,wasnotprovidedtous.
Wellness Events and Activities

Theprogramoffersawiderangeofwellnessevents,suchaslecturesonhealthandwellnesstopicsand
individualizedhealthcoaching,andprovidesaccesstowellnessrelatedinformationbyleveraging
existingresourceswithintheuniversity.Wellnessactivitiesincludingyoga,meditation,andmassage
therapyareintendedtoreducestresslevels.Currently,therearetwelveongoingwellnessprograms,
events,andactivitiesoncampus;mostofthemareofferedatnocosttostudents,staff,andfaculty.
Thesewellnessprograms,events,andactivitiesareeitheradministeredbyhealthplan,outsidevendors,
ortheuniversityitself.

Programsadministeredbyhealthplans
InsuranceProvider1sProgram:Provider1swellnessprogramstartswithanonlinehealth
questionnaire.Basedontheresults,caremanagersprovideindividualizedrecommendations.
Theprogramorganizesitsactivitiesandresourcesintothreecategories:(1)Toolsandresources,
includingonlinehealthandwellnessinformation,aswellasdiscountsonhealthrelated
productsandalternativemedicinetherapies(e.g.,chiropractors,acupuncturists,massage
therapists,andregistereddietitians);(2)Healthguidanceandsupport24/7fromregistered
nurses;and(3)Healthmanagementfordiabetesandotherseriouschronicconditions,focusing
onprovidinghealthevaluationandconsultationtoassistinmanagingcondition,offering
conditionspecificeducationalmaterialsonprevention,selfmanagement,andlifestylefactors
tohelpimprovehealth).
InsuranceProvider2sProgram:Provider2offersapatientcenteredmodeloftotalhealth
program.Thediseasemanagementprogramsfocusonchronicmedicalconditionsandprovide
evidencebasedguidelinesforscreeningandtreatment;generalandtargetedoutreachand
reminderstomembers;patienteducationandselfmanagementtoolsandresourcesfor
memberengagementandcompliance;specialtyservices(e.g.,diabeticnurseeducators,and
11

ClinicalPharmacyServicestoimprovecholesterolcontrolformemberswithCAD);andphysician
feedbackregardingperformancemeasures.
Activitiesandprogramsadministeredbyoutsidevendors
YogaClasses:Onehouryogaclassesareofferedtofaculty,staff,andstudentsatacostof$14
perclass,or$10perclasswithadvancepaymentforseveralclasses.Theseclassesareheldon
campusattheUniversityCenterandemphasizestressreductionandrelaxation.
GuidedMeditation:Focusedonstressreductionandrelaxation,theseindividualmeditation
sessionsareofferedonFridaysbyappointmentonlyandareconductedatvariouscampus
locationsconvenienttoemployees,faculty,andstudents.
MassageServices:Tableandchairmassagesareavailableforacharge.Alicensedmassage
therapistcomesoncampusbyappointment.
WeightWatchers:WeeklyWeightWatchersgroupmeetingsareheldoncampus.New12week
sessionsstartthroughouttheyearandareusuallyscheduledduringlunchbreaks.Amonthlyfee
applies.
FreshandHealthyMealService:Thelatestadditiontotheuniversitywellnessprogramsisa
programadministeredbyalocalnonprofitorganizationthatpreparesanddeliversfreshmeals
thatmeetguidelinesoftheAmericanDiabetesAssociationdirectlytocampustwiceaweek.
Thisnonprofitalsoemploysateamofregistereddietitianswhoareavailableforconsultations,
education,andsupport.Adailyplanwiththreemealscostsbetween$21.49and$26.99aday
andisavailableforpurchasetouniversitystaff,faculty,andstudents.
EventsandprogramsadministeredbyEmployerA
WellnessWednesdays:Thisweeklyeventisdesignedtodisseminateinformationonbest
practicesinhealthandwellnessinasupportiveandeasytouseformat.Subjectmatterexperts
areinvitedtogivepresentationsonawiderangeofhealthandwellnesstopics.Manylectures
arevideorecordedandpostedontheprogramswebsiteandYouTube.Awebinarformatis
usedtoreducethecostofinvitingexternalspeakers,increasingthelikelihoodthattheywillbe
willingtoparticipate,andmakeiteasierforuniversityemployeesandstudentstoattendthese
lectures.
WalkingProgram:TheuniversitycollaborateswiththeStudentRecreationCentertoholda
monthlyeventdesignedtoencourageemployeesandstudentstoparticipateingroupwalking
duringthelunchhourandincorporatemorephysicalactivityintheirdailyschedules.Everylast
Wednesdayofthemonth,programparticipantsmeetattheRecreationCenterandtakescenic
routesaroundcampus.Accordingtooneoftheparticipants,theprogramalsoprovides
informationaboutdistancesandplacestowalkaround[campus]andthingsthatyoucando,
howmuchbenefityoucangetfromashortamount,and[ithelps]youtrackyourcalorieburn
andwhatyouvedone.
MonthlyHealthScreening:Thismonthlyevent,whichisconductedincollaborationwith
campusandcommunitypartners,offershealthscreeningandcoachingonavarietyoftopics,
suchasmaintainingahealthybloodpressureandcholesterollevels,theimportanceofinfluenza
vaccinations,andtherisksoftobaccouse.In2009,theprogramwasawardedauniversityaward
thatrecognizescosteffectiveideas.
WellnessonWheels:Forthoseemployeeswhofinditdifficulttoleavetheirworkplaceduring
theworkday,thewellnessprogramcancometotheiroffice.Healthscreeningandpersonal
coaching,massagetherapy,andguidedmediationsessionscanbescheduledatacampus
locationconvenienttoparticipants.Healthcoachingcanalsobedoneoverthephone.

12

SmokingCessation:FreshStartisanocost,fourphaseprogramdesignedbytheAmerican
CancerSocietyandadministeredeveryTuesdaybytheDepartmentofRespiratoryTherapy.Its
goalistoprovideessentialinformationandevidencebasedstrategiesproventohelp
participantsquitsmoking.

Role of Vendors and Partners

Outsidevendorsofferroughlyhalfofallwellnessprograms,events,andactivitiestouniversitystaff,
faculty,andstudents,suchasyogaandmeditationclasses,massagetherapysessions,leadWeight
Watcherssessions,andprovidefreshmealsoncampus.Mostofthewellnessactivitiesprovidedby
vendorsarepaidforbyprogramparticipantsthemselves.Theotherhalfisorganizedandconductedby
wellnessprogramstaff,universityfaculty,andgraduatestudents.Forexample,withrareexceptions,
lecturesaregivenbyuniversityfacultyandstaff;individualizedhealthcoachingisperformedbyapart
timewellnesscounseloremployedbythewellnessprogram;wellnessrelatedinformationiscollatedby
thewellnesscounselor,wellnessprogramdirector,andstudentemployees;andsmokingcessation
sessionsarerunbygraduatestudentsunderafacultymemberssupervision.
Changes to Physical Environment

Mostoftheenvironmentalchangesoncampusfocusonfoodenvironment.Besidesbringingthefresh
andhealthymealserviceoncampus,thewellnessprogramstaffisworkingonimprovingvending
machinesnackchoices.Accordingtoawellnessprogramrepresentative,werecentlyapproachedthe
AuxiliaryServicesaproviderforourvendingservicesandwereworkingwiththemonswitchinga
chunkofvendingmachinesovertoaHeartHealthylineofsnacksthattheycanstockthisspringThe
HeartHealthylineofsnacksoffershealthierchoicesthatmeetspecificguidelinesforfat,sugar,and
salt.

Whenitcomestophysicalenvironmentchanges,thewellnessprogramhasanumberofinteresting
ideasthathaveyettobeimplemented,includingthedecorationofstairwellsoncampus.The
implementationofthisidearequiresbuildinganewpartnershipwiththeSchoolofArts.Explainsone
wellnessprogramrepresentative:wewouldliketodoalittlecontest[amongartstudents]toget
peopleinterested,andproposingmaybefivetotendifferentdesignsthatcouldeventuallygoaround
thecampus.Moreover,focusgroupparticipantssuggestedthatitwouldbegreattohaveacampus
walkabilitymapthatshowswalkingroutesofdifferentlengthanddifficultylevels.
Alignment with Health Plan

Thetwoinsuranceplanprovidersofferfreehealthandwellnessprogramstoplanparticipantsdescribed
above.Thusfar,however,theinsurerswellnessprogramsarenotcoordinatedwith,orofficially
includedaspartof,theuniversityprogram.Accordingtoaninterviewee,whenProvider1initiatedits
wellnessprograms,theydidnotcomeoncampusandcommunicatedonlywithkeyHRrepsinthe
differentinstitutionsItalldependedontherepstohavethetrickledowneffect.Therewassomeonline
communication,butveryminimal,anditcamedirectlyfrom[Provider1].Andbecausethiswashandled
differently[atdifferentstateuniversityinstitutions],therewasntasystemwide
communication/marketingstrategythatwasconsistentacrosstheboard.Moreover,EmployerAdoes
notknowwhoisparticipatingintheplanswellnessactivities.

13

Engagement Strategy
Incentives

In2011,theuniversitystartedimposinga$50monthlyinsurancepremiumsurchargeonactive
employeesandretireescoveredbytheuniversityshealthplan,butnotdependentsandstudents,who
selfidentifiedthemselvesassmokers.Toavoidthissurcharge,tobaccouserscouldelecttoquiteither
byusingsmokingcessationproductsorbyparticipatinginasmokingcessationprogram.Whilethe
universitysystemprovidescoveragefordifferentsmokingcessationproducts,suchasnicotinegum,
lozenges,patches,andcertainprescriptionpills,employeeswhotakeadvantageofsmokingcessation
programsmayincuranominalfee,whichisnotcoveredbytheuniversitysystem.Thewellnessprogram,
however,offersfreesmokingcessationclasses.

Ifanemployeecoveredbyoneoftheuniversityshealthplancertifiesthats/heisanontobaccouser,
butitislaterdeterminedthats/hehasusedtobaccoproductsorstartedusingtobaccoproductsafter
thedateofcertification,s/hewillbesubjecttopaymentofthe$50surcharge,plusa10%penalty,for
eachmonthsincethecertification.Accordingtooneuniversityadministrator,thereareanumberof
peoplewhowentthroughthesmokingcessationprogramsandthesmokingcessationprogramwasthe
incentive.Wearenotgoingtochargeyou;theprogramisfree.Wearegivingyousomethingfreeto
saveyoumoney,$50amonth.

Universitywellnessprogramleadersgenerallydonotbelievethatparticipationinwellnessactivities
shouldbeincentivizedfinancially;rather,theyclaimthatthestrongestmotivatorshouldbethedesireto
behealthyandfit.Asawellnessprogramrepresentativeputit,whenitcomestochangingyourhealth,
therealmotivationhastobeinternal,andyouhavetowantit.Tohelpthem,weneedtobuildtheir
awareness,andthatswhatweretryingtopromotehere.Ifsomebodyforcedmetoparticipate,orif
peopleparticipatedtogetaniPodorsomethinglikethat,Idontknowhowgenuinethatparticipationis.
Ithinkthatsastruggleinthewellnessfieldingeneral.Asdescribedinthisquotation,theuniversity
programsgoalistobuildawarenessabouthealthylifestylesandtoprovideresourcesnecessarytohelp
employeesstayhealthyandfit.Onrareoccasionswhentokenincentivesareused,individualsare
enteredforachancetowinaprize.Freemassageswerecitedasthemostpopularprize.
NonFinancial Avenues to Increase Engagement

Convenienceandlinkagestocharityrelatedactivitiesarethetwononfinancialavenuesusedtoraise
thelevelofengagementattheuniversity.WellnessonWheelsisapopularwellnessactivitybecauseitis
convenient;participantscanscheduletheirappointmentsintheirownofficesorinnearbylocations.
Yogaandguidedmeditationsalsodonotrequireparticipantstotraveltoamaincampuslocationand
canbescheduledatatimethatisconvenienttoparticipants.

Themostpopularwellnesseventoncampusistheannual5kraceorganizedbyInsuranceProvider2for
allareacompaniesandtheiremployees,regardlessoftheirparticipationinProvider2smedicalplans.
Thiswalkbeginswithan8weektrainingpromotiontohelpemployeespreparefora5Krun/walk.The
universitytypicallyhasmorethan200participantsinthisactivity,whichnotonlypromoteshealthand
wellness,butalsoraisesmoneyforlocalcharitiesandcollectsnonperishableitemsforalocalfood
bank.Participantsalsoenjoythepicnicandmeetingtherepresentativesofvariouslocalcharities.

14

Communication/Marketing Strategy

EmployerAswellnessprogramhasamultifacetedcommunication/marketingstrategythattargets
faculty,staff,andstudents.Bycollaboratingwithitscampuspartnersandcosponsoringdifferent
wellnessrelatedactivities,thewellnessprogramisabletospreadthewordaboutitsservicesand
programsandencouragemoreactiveprogramparticipation.Accordingtoawellnessprogram
representative,usingcatchyprogramtitlesdrawspeoplesattentionandhelpsthemrememberabout
wellnessactivitiesofferedoncampus:Peopledoseemtogravitateandfindmoreappealingthose
programsthattheycanrememberthenames.Therefore,manyuniversitywellnessprogramshave
titlesthatarebothcatchyandinformative.

Besidescreatinghighqualityflyersthatareprintedincolor,distributedaroundcampus,andposted
online,thewellnessprogramhiredaninternfromtheCollegeofBusinesstotapewellnessevents,edit
them,andputthemonYouTubetostartFacebookandTwitteraccountsandtoappealtothewhole
campuspopulation,notjustfacultyandstaff.Currently,thereare21wellnessvideosonYouTubethat
highlightdifferentwellnessprogrameventsandactivities,includingawelcomemessagefromthe
universitysAssistantVicePresidentofHumanResources,yogaandmeditationclasses,andWellness
WednesdayPresentations,amongothers.ThesevideosarealsoairedontheuniversitywideTVstation.
Announcementsaboutupcomingwellnessactivitiesaremaderegularlyontheuniversityradiostation.
Finally,thewordofmouthisalsoused.Thewellnessprogramhiresundergraduateandgraduate
studentsasparttimestaffandpartnerswithvariousacademicdepartmentsthatencouragetheir
graduatestudentstoworkonprojectsthatareadministeredinpartnershipwiththewellnessprogram.
Thesestudentsactasinformalpromotersofthewellnessprogramamongthestudentbody,whichisthe
leastactivecampusconstituentwhenitcomestowellnessactivities.

Accordingtoabusinessschoolfacultymember,thewellnessprogramisverygoodatmarketing:[The
wellnessprogram]iseverywheretheyneedtobetopromotethis.They'reonemail,they'reatevents,
they'reatmeetings,theyareatconferences...Ithinkasfarastheofferings,theyareputtingouta
productthatismorethanadequate,comparedtoothers.AndIdon'tknowwhattheycoulddo,
realistically,thattheyaren'tdoing.
Leadership Support

Accordingtoourinterviewees,thereisalotofsupportforwellnessprogramsatthelevelofthe
universitymanagement.TheAssistantVicePresidentofHumanResourceswasfeaturedinapodcast
postedontheuniversitywebsiteandYouTubepromotingthewellnessprogram.Wewerealsotoldthat
theplanistobegindevelopingsomepodcastswherewehaveseniorexecutivescominginandtalking
aboutwellness.Wehaveapresidentwhoworksoutallthetime;wehavealotoftheseniorexecutives
whoarerunners.Ourpresidentwasamarathonrunner.

Moreover,theuniversitywellnessdirectorwasappointedtotheuniversitysystemwidesteering
committeethatischargedwithcreatingastrategicplantohelppromotehealththroughacompetitive,
coordinated,efficient,effective,accessible,andaffordablesystemofcareandreimbursementand
focusesonpatientcenterednessandwellness.Thisshowstheimportanceoftherolethewellness
programplaysatEmployerA,aswellastheuniversityswillingnesstohelpotherstateinstitutionslearn
fromtheirexperiencesofcreatingawellnessprogram.

15

Althoughthereisprogramsupportatthelevelofuniversityadministration,itdoesnotalwaystrickle
downtodepartmentmanagersandsupervisorswhosometimesareseenasbeingreluctanttoallow
employeestoleavetheirofficestoattendwellnessactivitiesduringthelunchbreak.Severalfocusgroup
participantsvoicedsuchconcerns.Forexample,onepersonmentionedthathermanagerisjustnot
lettingmecometothegym.IdonotknowwhythatsanydifferentthanifIweretogoto[the
departmenthead]andsit[inhisoffice]forfortyfiveminutes.Anotherfocusgroupparticipant
complainedthatitisacceptableforthepeopletotakesmokebreaks,[but]Imnotasmoker,so
smokingforfifteenminutes,chatting,oreventwentyminutes[isallowed],butIdontdoanyofthat.
Therewasconsensusamongfocusgroupparticipantsthattheuniversityadministrationcoulddomore
toreachouttomanagersandsupervisorsandaskthemtolettheiremployeesknowthatitsokayfor
themtoattendwellnessactivitiesandencouragethemtobeflexible.Oneemployeegaveanexample
ofhowsupervisorscanbeflexible:becauseourofficeisactuallyusuallybusierduringthelunchhour,
itswhenthepeoplegetoffandcomeseeus,[mysupervisor]askedmeifIwantedtotakeanhourin
themorningtogo[tothegym]insteadofatlunch.
Inclusiveness

Programparticipantsfeltthattheuniversitywellnessprogramoffersabroadrangeofwellness
activities.Asonepersonputit,almostanythingthatIcouldpossiblywantiseitheravailableorthey
wouldhaveavailable.Theprogramisconstantlyaddingnewcomponents,suchasthenonprofitfood
service,andislookingforinnovativeapproachestopromoteitsactivitiesamongfaculty,staff,and
students.Theprogramsemphasis,however,isonwellnessawarenessandeducation,aswellasstress
relief,butnotnecessarilyonphysicalactivity,teamsports,andgroupchallenges.

Program Results (Documented and Perceived)

Program Evaluation

Noevaluationstrategywasincorporatedintheoriginaldesignoftheprogramandnobaselinedata
werecollectedpriortoprograminitiation,makingaformalevaluationofprogramimpactdifficult.
Nonetheless,programevaluationiscurrentlyatthetopofthewellnessdirectorsagenda.Sherecently
askedtheCollegeofBusinesstoevaluatedifferentapproachestomeasuringtheimpactofworksite
wellnessprogramsinauniversitycontext.
Wellness Program Participation

Informationonparticipationmostlycomesfromobservationsofprogramstaffatthemoment.
Accordingtoawellnessprogramemployee,participationvariesbytheprogram:For[ourmonthly
healthscreenings],wetendtoseemoreofthefacilitiespeoplecomeout,youknow,thegroundspeople
whocleanup.ForWellnessWednesdays,weseemoreuniversitystaff.Wehaveasetgroupofpeople
thattendtocomeeverytime.Theyreallwomen.Weseementrickleineverynowandthen,butitall
dependsonthetopicreally.Foryogaandguidedmeditation,weseeallthree[staff,faculty,and
students].Formassage,thattendstobeallthree,butmainly,morefacultyandstaffbecausetheycan
affordit.Whenitcomestoconsistencyinattendance,WellnessWednesdaysandyogaclasseseach
haveadevotedgroupofparticipants.Wehaveasetgroupofaboutsixpeoplethatcome[toyoga
classes]faithfullyforyears,continuesthewellnessprogramemployeeweinterviewed.Thenumber
fluctuatesfrom10downto6.Theprogramwiththesmallestnumberofparticipantsisthenonprofit
foodservice,withonlytwoorthreepeoplewhosigneduptoparticipate.Thisprogram,however,was
16

therecentadditionthatwasbroughtoncampusonlytwoorthreeweeksbeforeoursitevisit.
ParticipationratesintheInsuranceProviderwellnessprogramshavenotbeensharedwiththe
universitywellnessprogramatthetimeofoursitevisit.

Relativetothetotalnumberofuniversityemployeesandstudents,thenumberofwellnessprogram
participantsremainssmall.Toboostprogramawarenessandparticipationrates,theuniversitywellness
programdecidedtoincreaseitssocialmediapresence,whichisassumedtoresonateparticularlywell
withthestudents.FacebookandTwitteraccounts,aswellasaYouTubechannel,werecreated.While
theYouTubevideothatintroducedthewellnessprogramwaswatched441timesduringthe11month
period,theuniversitywellnessprogramonlyhas36peoplewhoLikethemonFacebookand43
individualswhofollowitonTwitter,basedonMarch26,2012data.

Thewellnessprogramiscurrentlybuildingtheinfrastructuretotrackprogramparticipationin
educationalactivitieswithsigninsheetsandappointmentlogs.Oneofthestudentemployeesrecently
createdadatabaseofallindividualswhohaveeverparticipatedindifferentwellnessactivitiesby
enteringtheinformationfromsigninsheetsusedduringdifferentevents.Asmallscalesurveywas
conductedattheEmployeeBenefitsFair,whichshowedemployeespreferenceforindividualized
coachingsessionsandsmallgroupactivities.
Challenges to Participation

Weidentifiedfivefactorsthataffectstaff,faculty,andstudentparticipationindifferentwellness
activitiesattheuniversity.Eachofthesefivefactorscanbeconsideredasabarrierandasafacilitatorat
thesametime.

LocationandTiming:Theuniversityhasmultiplecampusesarounditshostcity,whichcanmakeit
difficultforpeopletoattendwellnesseventsatlocationsotherthantheirown.Manylecturesare
scheduledtobeginat11am,whichisnotconvenientforsomeemployees.Myonlyissue,explainsone
focusgroupparticipantisthatclassesareatelevenandthatjustdoesntwork.Noonissomuchbetter;
theyrenotexpectingyoutobeatyourdesk.Imanadminassistant,sotheyexpectmetobethere,
exceptforlunchhour.Moreover,fewwellnessprogramsareofferedafterbusinesshours,because
manyemployeesleavetheirofficesatfiveoclocktryingtobeattraffic.Bycontrast,individualizedhealth
coachingaspartofWellnessonWheelsprogram,massageservices,andmeditationclassesareall
offeredindifferentlocationsandatdifferenttimetoimproveaccess.

ProgramFocusonEducation:Theuniversitywellnessprogramemphasizeseducationbecauseitis
alignedwiththeoveralleducationalmissionoftheuniversity.Benefitingfromtheexpertiseofuniversity
facultyandgraduatestudents,thewellnessprogramcanofferawiderangeofhealthandwellness
lecturesandindividualizedwellnesscoachingactivitiesthatotherorganizationswouldhavetopayfor.
Atthesametime,however,physicalactivitiesandfitnesschallengesseemtobelesspromotedatthe
university.Severalfactorswerementionedduringtheinterviewsascontributingtothis.First,thereare
notenoughfacilitiesforpeopletocleanupaftertheyworkout.Second,facultyandstaffhavetopaya
feetousecampusrecreationalfacilities.Third,theagedifferenceamongwellnessprogramparticipants
maymakesomeofthemuncomfortable.Explainsonefacultymember,formanyofusofacertainage,
goingtothepoolwithpeoplewhoare18,19yearsoldisveryintimidatingYougo,IthoughtIlooked
prettygooduntilIwalkedinhere!

17

LeadershipSupportfortheProgram:Althoughleadershipsupportforwellnessbyuniversity
administrationisrelativelyhigh,directsupervisorsandmanagersseemtobesomewhatlesssupportive.
Ifanimmediatesupervisorissupportiveofhis/heremployeesparticipationinwellnessactivities,itis
morelikelythathisorheremployeeswillmakeanefforttopartakeindifferentwellnessinitiatives.
Managerswhodonotsupportwellnessordonotparticipateinsuchprogramsthemselvescancreatean
environmentwhereparticipationinwellnessactivitiesisviewedasadistractionthatimpedes
productivity,ratherthanimprovesit.

ProgramManagement:Theuniversityhasadesignatedofficethatrunstheprogram,whichhelps
coordinatewellnessinitiativeandresourcesoncampus.ItismanagedandfundedbytheHR
department,butservesalluniversityfaculty,staff,andstudents,whichmaybeconfusingtostudents.
Indeed,universitystaffsarethemostactiveprogramparticipants.Manyfacultymembersarenoton
campusonadailybasis,whereasstudentsmaynotrealizethattheprogramthatishousedattheHR
departmentisdesignedtoofferservicestothem.Moreover,retireeshavebeenrecentlyaddedtothe
listofprogramtargetpopulation,andthewellnessprogramiscurrentlysurveyingthemtoidentifytheir
needsandinterestsinparticipatinginwellnessactivities.Havingdiverseclientelemakesitdifficultfor
thewellnessprogramtoberelevanttoallitsclients.

ExposuretotheWellnessProgram:Theuniversitywellnessprogramusesdifferentmarketingavenues,
suchasfliersprintedincolor,programwebpage,announcementsattheuniversityradiostationand
televisionchannel,andstrongsocialmediapresence(FacebookandTwitteraccounts).Nonetheless,
accordingtooneprogramrepresentatives,thewellnessprogramstillhasnothitallfourcornersofthe
university.So,peoplereallydontknowthatitsthereandthatsoneofourbiggestchallengesisthat
peopledontknowwhatwedo.Tofurtherinformandengagefaculty,staff,andstudentsandto
accommodateemployeeswithinflexibleschedules,theprogramstartedusingsocialmediato
disseminateinformationabouttheprogram.Cosponsoringhealthandwellnesseventswith
RecreationalServicesalsoincreasesthewellnessprogramsvisibilityamongthestudentcommunityand
allowsfitnessfacilitiestopromotetheirservicesamongfacultyandstaffwhoarerequiredtopaya
nominalmonthlyfeetousethegymandotherfacilities.

Program Impact
HealthRelatedBehaviors:Theprogramdoesnotyethavenecessaryinformationtoevaluatethe
programimpactonhealthrelatedbehaviorsandhealthrisks,butitstartedcollectinghealthrelated
datarecently.Forexample,toevaluatetheimpactofindividualizedhealthcoachingsessions,awellness
programemployeecreatedadatabasewhereshelogschangesinbloodpressureandweightineach
individualprogramparticipantovertime.However,onewellnessprogramrepresentativesuggestedthat
itistooearlytoseetheimpactthisprogramhadonhealthstatusoftheprogramparticipants.Finally,
wearenotawareofanyevaluationsofthewellnessprogramsimpactonhealthcarecosts.

EmployeeSatisfaction:Tomeasureprogramsatisfaction,theprogramreliesonparticipanttestimonials,
whichsuggestthatitiswellreceivedandhasapositiveimpactonemployees.Accordingtoonewellness
programemployee,participantsoftentellherthathavingregularlyscheduledwellnessactivitiesforces
themtogooutandthengettheirexerciseforthatday.Shealsomentionedthatshegetsalotofe
mailsthanking[theprogramfor]themassagetherapyand[for]anythingthatcreatesrelaxation,such
asfreeguidedmeditationsessions.Anumberofuniversityemployeessharedtheirthoughtsinonline
podcastspromotingtheprogram.Herearesomeoftheircomments:[Thewalkingprogram]isavery
18

sociableexperience.Itisagreatwaytoburnstressandgetenergized.Italsohelpsgetcolleagues
outoftheofficeandmeetnewpeople.Whilethesetestimonialssuggestthatthisisawellnessprogram
thathelpsparticipantsfeelgoodandsocializewithcolleagues,theycannotbeusedtoformally
evaluatetheprogramsimpact.

Morale/Productivity/CorporateCulture:EmployerAswellnessprogramhasyettoformallyevaluateits
impactonemployeemorale,productivity,andcorporateculture.Itplanstouserecommendationsfrom
arecentlycommissionedstudy(seebelow)toidentifysomeorganizationalmetricsthatshouldbe
monitored.Nonetheless,participanttestimonialsseemtosuggestthatthewellnessprogramishelping
themboosttheirmoraleandproductivitylevels:Ihighlyrecommendguidedmeditation,saysone
wellnessprogramparticipantinarecordedmessage.Itdefinitelyassistsyouwithreturningtothe
workplaceandhelpsbeingmoreproductive,becauseyouarenotallowingthoughtsandconcernsto
interferewiththeproductivityofyourwork.

ReturnonInvestment:Leadersofthewellnessprogramaskedtheuniversitysbusinessschoolto
conductareviewoftheexperiencesofotheruniversitiesinthearea.Afacultymemberandagroupof
graduatestudentsconductedaliteraturereviewandanumberofindepthinterviewswithexpertsin
theschoolscitytobetterunderstandhowtheuniversitycomparestootherinstitutionsofhigher
educationintheareaandtoofferrecommendationsonhowEmployerAshoulddesignitsownprogram
evaluationstrategy.

ThestudyconductedbytheSchoolofBusinesshasfourmainfindings.First,therearentmany
organizationsthatlookattheevaluation;theylookatthedelivery,themarketing,andthedesignand
almostnoneofoursisterschoolsaredoingthat.Second,alotoftheexpertsevenquestionwhether
youshouldlookatROI.Itshouldbesomethinglikecompensationorhealthinsurancethatisjust
somethingyouoffertoattractandretaingoodemployees.Wedon'tevaluateourhealthinsurance[this
way],sowhyareweworryingaboutmakingacasetotheboardor[focusonwhether]thisprogrampays
foritself?Third,almostallthestudiesshowedthattherewasagoodfinancialreturn,anywherefrom
twodollarsto12dollarsperdollarspent,whichisprettysignificant.Buttherewerealotoflittle
interestinganomalies:often,thesicknessandaccidentratingsgoupdramaticallyafteryoufirst[starta
program],becausepeoplearegoingtothegymforthefirsttimeorthey'resuddenlyonbloodpressure
medication,sohealthcarecostsgoup...butovertime,thosetendtolevelout.Peopleputinawellness
program,andtheyexpectinayearweshouldseeourhealthinsurancecostsshoulddropby50percent,
andit'sjustnotthatsimple.Fourth,whenitcomestomeasuringprogramimpact,privacyissuescan
becomeahurdlebecauseit'sdifficulttogetpeopletogiveuppersonalinformationabouttheirweight
andhealthissues.

Basedonthestudyfindings,researchersrecommendedtofocusonmeasuringprogramparticipation
andsatisfactionandtotrackafewoutcomemetrics,suchasabsenteeismandsatisfaction.Participation
andsatisfactioncouldbemeasuredbysurveyingthosewhoparticipateintheprogramandaskingthem
aboutthereasonswhytheyparticipateandwhattheylike,andthensurveyingthosewhodidnot
participateandaskingthemwhytheydidnotparticipate,whatitwouldtaketoengagethem,andwhat
programstheywouldwanttopartakein.Whenitcomestooutcomemeasures,absenteeismwasthe
onlymetricthatthestudyauthorsfeltwasmeasurableandusefulfortheROIanalysisinauniversity
setting.Productivitywasdeemedimpossibletomeasuregiventhenatureoflaborattheuniversity,
whereashealthoutcomeswereruledoutduetoprivacyconcerns.

19

EffectofIncentives:Theeffectofhealthinsurancepremiumsurchargesforsmoking,theonlyfinancial
incentiveusedattheuniversity,hasyettobemeasuredformally.

UnintendedConsequences:Whilethewellnessprogramispopularamonguniversitystaff,manyof
whomdonothaveflexibleschedulesandcannotleavetheirworkplacetoattendawellnessactivity,
somestaffreportedstrainedrelationshipswiththeirimmediatesupervisorswhodidnotapprovetheir
participationinwellnessactivities.Oneemployeereportedthatshehadtocancelhercampusgym
membershipandsignupforamoreexpensivegymthatwasclosertoherhousesothatshecould
exerciseafterworkandonweekendsinsteadofherlunchbreak.

Future Directions
Accordingtoourinterviews,EmployerAsprogramwillcontinuefocusingonstressreductionandraising
wellnessawareness.Byleveragingthecampuspartnershipsandsupportoftheadministration,the
programplansonimprovingitsstudentoutreachstrategy.Whenitcomestotheintroductionofnew
programcomponents,numberoneonthelististhecollectionofHRAdatathroughstronger
relationshipswiththehealthplans.Thewellnessprogramdirectoralsoplanstoinvestfurtherin
programevaluationbyformalizingparticipationtrackingandoutcomedatacollection.Finally,thereis
aninterestincollaboratingwithotheruniversitysysteminstitutionsbycreatingaconsortiumtoshare
ideasandexperiencesandleveragetheexistingresources.

Conclusion
Tosummarize,EmployerAisawellnessleaderamonguniversitysysteminstitutionsthatoffersarange
ofwellnessactivitiesandeventsthatareavailableforstaff,faculty,students,andretireeseitherfreeof
chargeoratanominalfee.Theuniversitywellnessprogramisarelativelylowcost,partnershipbased,
homegrownprogramthatcreativelyleveragesrelevantexistingresources.Itnotonlybenefitsfromthe
talentsandexpertiseofuniversitystaffandfaculty,butalsoengagesgraduatestudents.Byleveraging
existingcampusresourcesandengaginggraduatestudentsintrainingasserviceproviders,the
universitywellnessprogramisabletoofferindividualizedwellnessactivitiesthatfitintothebusy
schedulesofuniversityemployeesandstudentsanddevelopeducationalprogramsthatshowcasethe
expertiseofitsfacultymembers.Thislowcostprogramnotonlyenjoyedthesupportofuniversity
administrationandwonauniversitywideaward,butalsohelpsgraduatenursing,nutrition,and
counselingstudentsgainprofessionalexperiencebyallowingthemtoprovidewellnessservicesand
obtainresearchexperiencebyconductingstudiesfortheirmastersthesesonworksitewellnessissues.

Theuniversityessentiallyhastwoseparatewellnessprograms:oneisadministeredandcoordinatedby
theuniversityandincludeswellnessactivitiesofferedbyoutsidevendorsandonethatisoperatedbyits
twohealthplans.Itisinterestingtonotethatwellnessprogrampersonneldonotconsidertheprogram
offeredbythetwohealthplansasbeingapartoftheuniversitywellnessprogram.Thereislimited
coordinationandcommunicationbetweenthetwoprograms,andthedatacollectedbythehealthplans
werenotsharedwiththeuniversityatthetimeweconductedthecasestudy.Whileparticipant
testimonialssuggestthattheuniversityoperatedwellnessprogramissuccessfulinreducingemployee
stressandincreasingtheirproductivity,thereisnoobjectiveanalysisofprogrameffectivenessinterms
ofparticipationratesandorganizationalandemployeeoutcomes.Availableparticipationdatadonot
suggesthighuptakerates,andprogrameffectivenesscannotbejudgedbasedsolelyonparticipants
20

testimonials.Evaluationoftheprogramsimpactonhealthstatusofuniversitystaffandstudents
requiresclosecollaborationwithhealthplanstoobtainclaimsandHRAdata,whichhasyettobe
established.

Moreover,theuniversitywellnessprogramisnotuniformlypopularoncampus.Staffaremorelikely
thanfacultyandstudentstoparticipateindifferentwellnessactivities.BecauseitisfundedbytheHR
unitandadministeredbytheemployeeandstudentservicesdepartment,thewellnessprogrammay
wanttoreachouttostudentsandemphasizeactivitiesthataremorelikelytoattractthem.Focusingon
physicalactivitiesandteamchallengesmaynotonlyhelpengagestudentsandbuildcloserrelationships
withRecreationServices,butwillalsoexpandarangeofcosponsoredwellnessprogramactivitiesthat
arecurrentlyfocusedheavilyoneducationandindividualizedscreeningandcoaching.Nonetheless,
offeringmorefitnesseventsmaycreateunnecessarycompetitionwithactivitiesofferedbythe
RecreationServicesprogram.

Employeeparticipationinwellnessactivitiesisnotalwayssupportedbytheirimmediatesupervisors.
Researchshowsthatsuccessfulimplementationofaworksitewellnessprogramrequiresstrong
managerialsupport.Thewellnessdirectoranduniversityadministrationshouldworkcloselywith
departmentmanagerstoexplaintheroleandthebenefitofthewellnessprogramandrequirethemto
providereasonablesupportfortheiremployeesparticipationinwellnessactivities.

Finally,whilecreatingsocialmediapresenceisimportant,thesuccessofthismarketingandoutreach
strategydependsonthenumberofpeoplewhoobtaintheprograminformationfromthesesources.As
ofnow,itappearsthattheimpactofusingsocialmediacouldbeincreased.

21

Employer B: A State Government Agency

TheworksitewellnessprogramatEmployerBwasdevelopedtoreduceemployeechronicdiseaserisk
factors,createamodelwellnessprogramthatcouldbereplicatedthroughoutstategovernment,and
demonstratethecriticalimportanceofafulltimewellnessdirectorpositiontodevelop,administer,and
evaluatetheprogram.(WellnessProgramAnnualReport)

Organization
Background on the Employer

EmployerBisastategovernmentagencyresponsibleforensuringthehealth,safety,andwellbeingof
citizens,andprovidingotherhumanservicesforpopulationsinneed.

EmployerBisandoneofthelargestemployersinthestate,withmorethan19,000employeesworking
in30agenciesandofficesand18facilities,suchashospitals,treatmentcenters,andresidentialschool
facilities.EmployerBsannualoperatingbudgetis$14billion.Manystaffworkinthestatecapital,but
othersarelocatedthroughoutthestateinregionalandcountyoffices.Themajorityofemployees(73%)
arefemaleandtheaverageemployeeageis45.Stateemployeesareeligibletojointheselfinsured
statehealthplan(SHP),whichprovideshealthcarecoveragetomorethan663,000individuals.Usingan
InsuranceProvidersnetwork,theSHPofferstwoPPOplans.Thebasic70/30planhashigher
copayments,coinsurancerates,anddeductiblesbutlowermonthlypremiums.Thestandard80/20plan
offersahighercoveragelevelbutalsohashighermonthlypremiums.Bothplansencourageemployees
tomakehealthierlifestylechoicesandbecomepartnersinaddressingtheirhealthcareneeds.

Thetotalmedicalcostforemployeeswasover73milliondollars.Thetotalcostofcoveragepermember
($3,933)ofemployeeswashigherthananyotherstatedepartment.Ratesofutilizationwere62.0
hospitaladmissionsand230.2ERvisitsper1,000members.Fortytwopercentofemployeeshada
chroniccondition,morethaninallotherdepartments,exceptfortheDepartmentofCorrection.
Hypertension(37.4%),diabetes(12.0%),andmentalhealth(8.0%)werethemostcommonconditions.

Wellness Program Description

Program Development and Implementation

EmployerBsWellnessProgramwaslaunchedasapartnershipbetweenthestateemployeehealthplan
andthestatespublichealthdepartmenttoestablishareplicablemodelofaworksitewellnessprogram
andcontainhealthcarecostsbyreducingriskfactors.Thedepartmentwasselectedtodevelopthis
modelprogramduetoitslargesize,diverseworkforce,highprevalenceofchronicdiseases,and
leadershipsupport.

Whencreated,thewellnessprogramhadaflatstructurewithtwolevelsoforganizationalhierarchy:the
departmentleveltoprovideoveralldirectionandstrategyandagency/facilityleveltoorganizeand
implementwellnessactivitiesontheground(seeTable2).Atthedepartmentlevel,thewellness
directorcoordinatedandevaluatedtheprogramduringhertenure.Wellnesscouncilmeetingsprovided
wellnessrepresentativestheopportunitytoshareideasandupdatesonupcomingactivities.Between
22

councilmeetings,regularcommunicationtookplaceviaemail.Sincethewellnessdirectorpositionwas
eliminatedin2011,theoversight,coordination,andcouncilmeetingsnolongeroccur.

Attheagency/facilitylevel,eachwellnessrepresentative,withthehelpoftheirwellnesscommittees,is
encouragedtofocusonthemostrelevanthealthrisksandorganizetheirownevents.One
representativedescribedthebenefitofthisdecentralizedstructure:Youweregivenopportunitiesto
havegroupchallengesbutwealwaysgottochoosehowwewantedtodoit,whatwewantedtodo.If
wedidntwanttodosomething,wedidnthaveto.Ifwewantedto,wecould.Ourparticulardivisionis
oneofthesmallerdivisions,sowewereactuallyabletodoalotofcustomizationandpersonalization
forourparticularmembers.Thewellnessrepresentativesandwellnesscommitteescontinueto
organizeeventsfortheirownagency/facility.

Table2:OrganizationalStructureofEmployerBsWellnessProgram
Position
Roles
DepartmentLevel
WellnessDirector
Coordinatesacrossagencies;
(thispositionwas
Chairsthewellnesscouncil;
eliminatedinFallof
Representdepartmentonvarioushealthandwellnessinitiatives.
2011)
Wellnesscouncil
Wellnessrepresentativesfromeachagency/facility;

Advisesonwellnesspolicyandprogramneeds.
Agency/FacilityLevel
Wellnessrepresentatives
Provideleadershiptotheagency/facilitywellnesscommittee;

Helpdevelopandimplementtheagency/facilityannualwellness

plan;

ReportwellnessactivitiestotheiragencydirectorandtheWellness

Director;

Makeupthewellnesscouncil.
Wellnesscommittees
Providewellnessprogramsandactivitiesineachagency/facility.

Theagencysprogramfocusesonchangingbothformalandinformalorganizationalpoliciesandwork
environmentstoincreaseworkplacesupportforwellnessandongoingevaluation.Tosupportthe
wellnessprograminfrastructure,EmployerBcreatedawellnesspolicy,whichauthorizedfourhoursper
personpermonthofworktimeforwellnesscommitteeworkandsixhourspermonthforthewellness
representativeateachagency/facility.Thepolicyalsoencouragesapprovalofflexibleworkschedules,
whenpossible,toallowparticipationinwellnessactivities.

Whiletheongoinggoalofthewellnessprogramistocreateasustainablewellnessinfrastructure
throughoutthedepartmentthatsupportsandpromotesemployeewellness,thewellnesspolicystates
theprogramgoalsareto:

1. Maintainagencywellnesscommittees,departmentwellnesscouncilandawellnessdirectorto
planandimplementwellnessprogramsthroughoutthedepartment.
2. Raiseawarenessamongemployeesregardingtheimportanceoflifestylebehaviorsthat
promotegoodhealthandprovideemployeeswithinformationandresourcesonhowtomake
changesthatreducetheirriskforchronicdiseases.

23

3. Promotechangestoworkplacepoliciesandenvironmentsthatencourageandsupport
employeesinbeingmorephysicallyactive,havingaccesstohealthierfood,avoidingtobacco
andmanagingstress.
4. Provideprogramsandactivitiesattheworkplacethatofferemployeesopportunitiestobe
morephysicallyactive,eathealthierfood,stopusingtobaccoandmanagestress.
5. Elicitongoingemployeefeedbacktoplanandimplementprogramsthatmeettheneedsand
interestsofemployees.
Data Collection

Duringtheirtenure,theformerwellnessdirectorusedtwomethodstoexaminedataonthehealth
statusofthedepartmentsemployeepopulation.First,basedonpublishedreportsfromtheSHP,the
Wellnessdirectoridentifiedthemostcommonchronicconditionsandutilizationpatternsamong
employeesandtheirdependents.Second,asurveyshowedthatthemostsalienthealthconcernswere
poordiet,weight,physicalactivity,anddepression.Inaddition,onefacilitypilotedahealthscreening
andcounselingprogram,RoadmaptoGoodHealth.Thispilotprogramcollecteddataonfacility
employeesthroughanonlinequestionnaireandheight,weight,glucose,andcholesterolmeasurements.
Program Costs

JointlyfundedbythedepartmentandSHP,thewellnessprogramwasformallyinitiatedwhenthe
wellnessdirectorpositionwascreatedin2004.Thetotalamountoffundingprovidedtotheworksite
wellnessprogrambetweenNovember2004andJuly2009wasto$678,456.Between2009and2010,
thewellnessdirectorpositionwassupportedbythePreventiveHealthandHealthServicesBlockGrant,
fundingprovidedbyCDCforstatestoaddresstheirownuniquepublichealthneedsinlocallydefined
ways.In2010,thewellnessdirectorpositionwastransferredtotheOfficeoftheSecretaryand
eliminatedin2011duetoalackoffunding.Giventhebudgetcuts,thewellnessdirectororganizedtwo
fundraiseractivitiesin2009and2010,whichgeneratedslightlymorethan$2,000inprofitandwere
usedtoprovidesmallincentivesandplanevents.
Wellness Events and Activities

WellnessprogramsandactivitiesatEmployerBareorganizedandadministeredeitherbythestate
healthplanorthedepartmentswellnessdirectorandWellnessCommittees.

Programsadministeredbythestateemployeehealthplan
WellnessServicesandCaseManagement:Thestateemployeehealthplanoffersvarious
preventionandcasemanagementservices;smokingcessationprogram;onlineweight
managementprogram;healthassessment;andconfidentialsupportforstress,depression,or
othermentalhealthissues.Preventionandcasemanagementservicesincludeeducational
resourcesandoneononenursecoachingtohelpmembersmanageachronicillnessormedical
event.Smokingcessationservicesincludeoneononetelephonesupport,webcoaching,and
freenicotinepatches,inpersoncounselingwithdoctororbehavioraltherapist,andreduced
costforsmokingcessationmedications.Thisstateprogramalsooffershealthcoachingwith
registereddietitians,nutritionists,personaltrainers,exercisephysiologists,weightloss
therapistsandhealtheducators.

Becausemostdepartmentinitiatedwellnessprogramactivitiesareorganizedandimplementedbyeach
agencyswellnesscommittee,theyvaryacrossEmployerB.Mostagency/facilityeventsfocusongroup
24

activities,suchaswalkingandteamnutritionchallenges.Someagencies/facilitieshaveintroduced
activitiestoreduceemployeestressandimproveworklifebalance.Examplesofwellnessactivitiesand
eventsinclude:

ProgramsadministeredbyEmployerB
EducationActivities:Educationinitiativesincludeposters,seminars,andbulletinboards.For
example,oneagencycreatedaposterthatpresentedanexplanationofbloodpressure,how
youmeasureit,whatthenumbersmean,whatindividualsshouldwatchfor,andwhatonedoes
tofollowupifconcerned.Anotherfacilityusesitsprofessionalstafftoprovidemonthlyhealth
lectures.Arecentpopularseminar,MommaAlwaysSaidEatYourVegetables,waspresented
bytheretirednursingdirector.Theselecturesaredesignedas30minutepresentationsduring
lunchtimesothatstaffwithonly30minutebreakscanattend.
WellnessFairs:Manyagenciesandfacilitiesholdannualwellnessfairstoprovideeducationand
screening.OneagencyhasconducteditsannualwellnessfairinconjunctionwithEmployee
AppreciationDaytomaketheeventmoreenjoyable.Thiswellnessfairincludedgamesand
activitiesanddonatedfruitsandvegetablesfromWholeFoods.Anotheragencyinvited
organizationsthatraisefundsforspecificinitiatives,suchasheartdiseaseandcerebralpalsy,to
participateinthewellnessfair.Thisprovidedemployeeswithanopportunitytotalkwith
organizationstheydonatemoneyto.
Walking/RunningEvents:Walkingchallengesareapopulargroupactivityacrossthe
department.Teamsareorganizedtoworkasagrouptoreachaspecificgoaloftotalmiles
walked.Forexample,theAppalachianTrailWalkrequiredteamstowalkthelengthofthe
AppalachianTrailfromSpringerMountain,GAtoMountKatahdin,ME.Thisdepartmenthad87
teamsthateachwalkedatotalof2,179miles.OtherwalkingchallengeshaveincludedWalkto
SanDiegoandLisbontoLondon.5Keventsarewalkingorrunningchallengesthathavebeen
usedtohelpthewellnessprogramraisemoneyforparticipatingwellnesscommittees.Funds
raisedarespentonsubsidizingclasses,repairingfitnessequipment,andpurchasingsmall
incentives.
IndividualizedWalkingProgram:Severalagenciesandfacilitieshavegroupsofindividualswho
walkoutsidetogetheronceaday.Thewellnessprogramhasdevelopedwalkingmapsforthea
localcollegecampusandthestatecapitalsdowntowndistrict.Thedesignatedwalksrangefrom
0.3milesto1.69miles.Foremployeesinotherlocations,thewellnessprogramprovidesalink
forindividualstocreatetheirownwalkingmaponitswebsite.Duringsummermonthswhenitis
hotandhumidoutside,dailyindoorlunchtimewalkingprogramsinthegymarescheduled.
ExerciseClassesandTeamSports:Weeklylunchtimefitnessclassesandfreeworkteamsports
areofferedatseveralagenciesandfacilities.Classesincludeyoga,Pilates,andZumbadanceand
cost$3$5perclass.Teamsportsincludevolleyball,basketball,andsoftball.
LineDancing:Duringthehearthealthmonth,oneagencyheldHippyHoppyHoppingHeart
HealthyMonth.Threedaysaweek,employeesmetintheparkinglotanddancedforanhour.
Asoneemployeedescribedit,EvenourdirectorcameoutandlinedancedwithusADJ,a
friendofafriend,mademeatape,andsowehadallthesecrazyoldsongsOndayswhenwe
couldntgooutsidebecauseitwasreallycold,rainy,orsnowingourDirectorallowedustoline
upinthehallway.
FruitandVegetable30DayChallenges:Employeesreceiveweeklyhealthyeatingnewsletters
andrecipesduringthechallengeastheykeepalogoftheirdailyservingsoffruitsand
vegetablestocompeteforsmallprizes.

25

WeightlossPrograms:Onsiteandonlinesubsidizedweightlossmanagementclassesare
availabletoemployees.
SwapShops:Oneagencyusesthemedswapshopsasanactivityfocusedonstressrelief.
Employeesbringunusedhouseholditemstoswapwithotheremployees.Anyitemsleftatthe
endofthedayaredonatedtoalocalcharity.OneoftheswapshopthemeswasLotionsand
Potions;employeesbroughtinlotion,shampoo,andperfumethattheynolongerwanted.One
intervieweedescribedthepopularityoftheseevents:Wellhavepeoplesolinedupatthedoor
thatwehadtobringthemoutintothehallwaytogetinjusttogettotheswapshop.
SpringFling:Toimproveemployeemoraleduringarecentfurlough,oneagencyheldaSpring
FlingFurloughCleanFridayevent.Employeeswereencouragedtocometoworkontheir
Furloughdaytocleantheirofficesandthenenjoyapicnicwithhealthyfoodsandmany
opportunitiesforexercise(e.g.,croquet,balls,weights,balloons).Asawellnessrepresentative
described,employeescleanedtheirofficethatwastheSpringCleanpart.ThentheFlingwas
thefactthatwewentoutsideandhadfun,andtheFurloughFreeFridaywasthattheylostten
hoursofpay,buttookthedayoutsideparticipatingintheevents.

Changes to Physical Environment

Changestothephysicalactivityandfoodenvironmenthavebeenmadeinseveralcampuslocations.A
policychangeallowsemployeestousefitnessfacilitiesthatwerepreviouslydesignatedas
resident/patientfacilities.Severalotheragencies/facilitiesfoundsmallroomstodesignateforemployee
fitness,withafewpiecesofexerciseequipmentorspacetoexercisewithfitnessvideos.Campus
walkabilitywasimprovedbycompletingafullpathofsidewalkstoallowemployeestowalka15minute
loopwithoutcrossingthestreet.

Toimprovefoodchoices,theagencyreviseditscontractwiththeOfficefortheServicesfortheBlind,
whichoperatesallvendingmachinesonthedepartmentcampus,torequirethevendortoofferatleast
fivehealthiersnacksineachvendingmachine.Whenoneagencylostitsvendingcontractwiththe
OfficefortheServicesfortheBlindbecausetheagencywastoosmalltohaveaprofitablevending
machine,itboughtitsown.Thewellnesscommitteestocksthevendingmachinewithhealthieroptions,
suchasgranolabars,FigNewtons,nuts,driedcranberries,raisins,bakedchips,andpopcorn.The
wellnessprogramalsobringsintheFarmeronMallProject,whichsetupalocalfarmertosellfresh
localproducetoemployeesonceaweek.Finally,thewellnessdirectorworkedwithacafeteriastaffata
localuniversitytoofferalowcostweeklyhealthlunchspecialandtoincreasetheavailabilityof
healthiermealsandsnacks.
Alignment with Health Plan

Startinginthelastdecade,thestatehealthplanbeganofferingwellnesspreventionprograms,
education,andresourcestoitsmembers.Moreover,thedepartmentwellnessprogramwaspartially
fundedbytheSHPandcreatedtosupplementandaugmenttheSHPadministeredwellnessactivities.
Theplaninitiatedwellnessprogramsandactivitiestypicallytargetindividualemployees,whereasthe
departmentwellnessprogramfocusesongroupactivities.However,therewaslimitedawarenessofthe
stateadministeredactivitiesbyourinterviewees.

ThestatehealthplanalsocollaboratedwithEmployerBtoconductapilotprogram,RoadmaptoGood
Health(seebelow),toincentivizeindividualizedhealthscreeningandcounseling,butonlyone

26

departmentfacilitywasinvitedtoparticipateinit.Thisfacilitywaschosenbecauseithadtheworst
healthindicatorsandthehighestriskfactors.

Engagement Strategy
Incentives

Thedepartmentswellnessprogramfocusesprimarilyongroupactivities,suchaseducational
lectures/classes,walkingchallenges,andannualwellnessfairs.Raffleincentivesandsmallexercise
equipmentgrantsweresometimesofferedtowellnesscommittees,ratherthanindividualemployees,
tofurtherincentivizeworksitewellnessactivitiesintheiragencies.Thesegroupincentiveswere
intendedtopromoteparticipation,ratherthanrewardtheachievementofaparticularhealthoutcome.
Groupincentiveswerespentonpurchasingexerciseequipment,pedometers,andotheritemsfor
wellnessactivities,suchasanaudiosystemforlinedancing.

Incontrasttolimitedincentivesthedepartmentswellnessprogramofferedforparticipation,theSPH
hasastatelegislatedbilltoencourageitshealthinsuranceplanmemberstomakehealthierlifestyle
choices.Thetobaccocessationcomponentofthisinitiativewasdevelopedtohelpmembersquit
smokingandtolowerthecostsassociatedwiththetreatmentofhealthconditionsassociatedwith
tobaccouse.Thisbillrequiresstateemployeesandtheireligibledependentstoattesttothenon
tobaccouseorstatethattheyqualifyforexemptionbasedontheirparticipationinatobaccocessation
programbeforetheycanselectthehighercoveragelevel(80/20)planratherthanthebasic(70/30)
plan.ThebillalsohasasecondprovisionthattargetsBMIlimitsofcoveredindividuals,whichhasyetto
beimplemented,accordingtoourinterviewees.

Incollaborationwiththestatehealthplan,onefacilitypilotedanincentiveofreducedcopayto
participateinahealthscreening.Staffreceiveda$15reductionincopaysforanentireyearfor
participatingintheRoadmaptoGoodHealthpilot.Oneintervieweenotedwhattheyweretryingtodo
wastogetpeopleintothedoctorproactively,likegointhereandfindoutwhatsgoingonthatyoucan
controlinsteadofgoingtourgentcare.Theprogramrequiredindividualstocompleteanonline
questionnaireandhavetheirheight,weight,glucose,andcholesterolmeasured.Staffwerethen
providedareportcardandmetwithamedicalprofessionaltoreviewtheresults.Anintervieweestated
thepilotwasextremelysuccessfulandpeoplewereveryappreciativeofthefactthat,youknow,the
stateaswellas[thefacility]wastryingtopartnerupanddosomethingfortheirhealth.
NonFinancial Avenues to Increase Engagement

Theagencyswellnessdirectorprovidedoversightsupportandcoordinationtothedepartmentand
facilitywellnesscommitteestoincreaseengagement.Thewellnessdirectorhelpedfacilitateactivities,
suchasthewalkingandfruitandvegetablechallenges,acrosstheentiredepartment,provided
resourcesforsmallequipmentincentives,andsuggestedactivitiesthatwereinlinewiththegoalsofthe
program.Shealsohelpedagenciesandfacilitiesshareanddiscussideasthroughthewellnesscouncil.

Toincreaseengagementofemployeesinspecificeventsandactivities,someagenciesandfacilities
providesmallgiveawaysforparticipatinginactivities.Forexample,onehasobtainedrestaurant
couponsorbottlesofwaterfromvendorstoraffleoffatevents.Anotheragencyorganizedapiefestat
thefinishlineoftheirHalloweenwalkingchallenge.Smallslicesofpieweregivenasatokenof
27

appreciationforemployeeparticipation,thankingthemforbeingapartofallthechallenges,
demonstratingthatyoudontalwayshavetogocoldturkeywithtreatsbutyoudohavetosavethem
forspecialeventsandyouhavetoexerciseyourheartbeforeyoueatit.Thesameagencyalsoinviteda
localicecreamtrucktocometotheirofficesduringahotsummerday.Theagencyclosedallbutone
buildingdoortoencourageemployeestousethelongestroutetotheicecreamtruck,placedwading
poolsintheyardonthewaytotheicecreamtruck,andhadexerciseequipmentavailableintheyard.
Communication/Marketing Strategy

Whiletheprogramhadawellnessdirector,theoverallcommunicationmessagesandstrategywereset
bythewellnessdirectorandthenadaptedtothelocalneedsofagenciesandfacilities.Oneinterviewee
emphasizedtheimportanceofongoingreinforcementfromthewellnessdirector:Whenyoure
working[twootherjobs]andyourestilltryingtokeepthewellnessthinggoing,itwasobviouslyjust
reallyhelpfultohavethoselittleremindersofthisiswhereweneedtogo.Thiscentralizedstrategyand
decentralizedimplementationallowedeachagencytoimplementatargetedcomprehensive
communicationpackage.Forexample,onefacilitynotedtheycantrelyonlyonemailtoadvertise
activitiessincemoststaffdonthaveemail.Healthcaretechsthattakecareofindividuals,their
supervisorsmayhaveemail,buttheydontandthatsabigworkingclassat[thefacility].Toreach
thesepeople,thewellnesscommitteedoesntrelyonjustonemodeofcommunication.Theyask
supervisorstopostflyers,makeannouncementsduringstaffmeetings,andputinformationonbulletin
boards.Forlargerannouncements,thedirectorofthefacilityoftensendsoutanemailtopromotethe
event.Anotheragencydistributesinformationandeducationtoemployeesthroughawebsite,including
postingrecordedWebinars.Finally,oneinpatientmedicalfacilityhasaWellnessTVshowwith
employeessharingtheirwellnessexperiencesandhowthewellnessprogramcanhelprelievestressand
stayphysicallyfit.TheshowfollowsaDavidLettermantypeformatwithasoundtrackand
commercialsandrunsonthefacilitystationsoemployeesandpatientscanwatchit.
Leadership Support

Althoughthestateprovidedsupportforthedevelopmentofthedepartmentswellnessprogramand
fundedthewellnessdirectorspositionfor6years,thispositionwasfirsttransferredtotheOfficeof
Secretaryandtheneliminatedduetostatebudgetaryshortages.Withoutthissupport,thewellness
committeesareprettymuchlefttotheirowndevicesandinvolvementwilldependonindividual
motivation.

Supportforthewellnessprogramfromvariousagencyleadersvariessignificantlyacrossagenciesand
facilities.Oneintervieweesaidhisfacilitydirectorhasbeenverysupportiveofmanywellnessactivities.
Thedirectorssupportwasthereasonwhytheprogramwasabletogettheexerciseroomandsome
equipment.Also,hewasthefirstoneinlineforthebloodwork[he]sentemailsout,encouraging
managerstomakesuretheirstaffweregiventhetimeofftoparticipate,andhasevenparticipatedin
oncampusWeightWatchersmeetings.Anotherintervieweewasmoreneutral.Shementionedthat
whileheragency/facilitymanagementisgenerallysupportiveofwellnessactivities,shedoesnotsee
thosefolksatthewellnesseventstheyhave.Finally,oneemployeeraisedaconcernthattheydont
havethesupportofupperlevelmanagement:Wewonastatewidecompetitionandnobodyin
managementevenacknowledgeditwecongratulatedourselves,butwehadnoonefrom
administrationsayjobwelldone,becauseIdontthinkthereisnecessarilyknowledgeofwhatwedoor
supportofwhatwedo,becausetheydontparticipateinit.

28

Inclusiveness

Employeescanparticipateinmanyactivitiesrangingfromindividualizedwalking,tofruitandvegetable
challenges,toeventswhereemployeescanswapunuseditemswithcolleagues.Whilethereisawide
rangeofwellnessactivitiesthroughoutthedepartment,becauseeachagencyorganizesitsownevents
andprograms,theprogramsofferedtoemployeesvarybyagency.However,allwellnesseventsand
activitiescanbegroupedintofourlargecategories:physicalactivity,nutrition,smokingcessation,and
stressrelief.Thesecategoriesmapontotheoverallwellnessfocusareasidentifiedinthedepartment
wellnesspolicy,whichhelpsensureadegreeofconsistencybetweendifferentdepartmentsagencies
andfacilities.

Toassessemployeeinterestsandpreferencesandsolicittheirinputonnewactivities,thewellness
directoralsoconductedannualemployeesurveysduringtheirtenure.Informationprovidedinthese
surveyshelpedthewellnessprogramdeterminethemostpopularactivities,betterunderstandhow
informationshouldbedeliveredtoemployees,anddeterminewhichwellnessresourcesandactivities
shouldbeaddedorcanceled.

Program Results (Documented or Perceived)

Wellness Program Participation

Annualemployeewellnesssurveysrevealedthatapproximatelyhalfofallthedepartmentsemployees
participateinworksitewellnessactivities.This50%participationratewasalsoconfirmedduring
interviewswithseveralwellnessrepresentatives.In2010,roughlytwofifthsofallparticipating
employeesdidsoatleasttwiceaweek.Individualwalking,groupwalkingchallenges,andorganized
fitnessclasseswerethemostpopularactivities.Morethanaquarterofallemployeesparticipatedin
healthyeatingwellnessactivities,suchasthefruitandvegetablechallenges.

Moreover,departmentemployeeshaverepresentedoverhalfofallthestategovernmentWalking
Challengeteams.Forexampleover1,500employeesparticipatedonteamsfortheSpring2011
challengeandwon8of9trophiesawarded.
Challenges to Participation

Severalbarrierstoparticipationemergedfromtheinterviews,focusgroup,andmostrecentannual
wellnessprogramreport.Themostcommonbarriersare:lackoffundingforwellnessactivities,difficulty
incommunicatingwithemployees,workschedulesandlocation,andlackoftimetoplanandto
participateinwellnessactivities.

LackofFunding:Althoughthewellnessprogramwasabletocreatenewfitnessareasinexistingspacein
facilitiesandagencies,thelimitedfundingmeantthattheywereoftencreatedwithoutairconditioning
orshowers,whichlimiteduptake.

Communication:Lackofemailorinternetaccessbymanyhospitalandtreatmentfacilityemployees
makesitmoredifficulttopublicizeeventsandactivitiestothisgroupofpeople.Lackofawareness
negativelyimpactsparticipationineventsandactivities.

29

DiversityofLocationsandSchedules:Inhospitalsandtreatmentfacilities,itisdifficultforshiftworkers
toparticipateinwellnessactivities.Someadministrativestaffcannotleavetheirphonesunattendedand
thereforehavedifficultyparticipatinginactivities.Otheragencieshavefounditdifficulttoinvolve
telecommutersinwellnessactivities.Oneintervieweedescribedherattemptstoinvolvethese
employees:Mystrategywastohavesomebodyontheteamwhowasremotesothatmaybethey
wouldhavesomeinsightintowhatwecoulddothatwouldmotivatethem.Butthatsveryhard,
becausetheyarealsoremoteforteammeetingsandsotheyfeelliketheyrenotreallypartofthe
team.Thiswellnesscommitteetriedtomotivateemployeesinanylocationandanyphysicalabilityto
participatebychallengingthemtowalksomewhereintheareatheylive,takeapicture,uploadthe
picture,andthenotherscouldguesswherethepicturewastaken.Wehavecomeupwithchallenges
wherewethoughtanyonecouldparticipate,buthadzeroparticipationinit.

LackofTime:Employeesalsoreportedlackoftimetoparticipateinwellnessactivities.Onewellness
representativedescribedthatsomeemployeesfounditparticularlydifficulttoparticipateinongoing
activities:Ivehadpeoplewantingtoparticipateinthingsandtheyjustcouldntbecausetheycouldnt
keepthetimeslotopenintheirschedule.Anotherwellnessrepresentativedescribedtheireffortsto
accommodatetheshort30minutebreakstaffhaveforlunch:Wevedonesomelecturesoncampusas
wellasgoingtospecificbuildingsthatrequesteditandwevehelditintheirconferenceroombecause
itshardImeanwhenstaffhave30minutelunchhours,iftheyrehavingtospendlike15ofitwalking
toandfromthemainswehaveabigcampus.
Facilitators

Severalfacilitatorswerealsoidentified,includingimplementationofthewellnesspolicy,annual
programimplementationevaluation,havinganengagedwellnessdirector,andtheprogramstructure
withwellnessrepresentativesandcommitteesineachagencyandfacility.

WellnessPolicy:Thewellnesspolicyencouragesapprovalofflexibleworkschedules,whenpossible,to
allowparticipationinwellnessactivities.Thiswellnesspolicyindicatestoemployeesthatthereis
managementsupportforparticipatinginwellnessprograms.Thepolicyalsoauthorizeswellness
representativestospendsixhourspermonthandwellnesscommitteemembersfourhourspermonth
ofworktimetoplanandimplementwellnesseventsandactivities.

ProgramEvaluation:Annualemployeesurveyshelpedthewellnessdirectorandwellness
representativesunderstandfactorsthatimpactparticipation(e.g.,timing,communicationaboutevents)
andthetypesofactivitiesandeventstheyareinterestedin.Forexample,resultsofthe2010survey
indicatedthatthemajorityofemployeespreferthatwellnessactivitiesbescheduledduringlunch.
Twentypercentofsurveyparticipantsindicatedthattheyequallyprefertoreceivewellnessinformation
throughlunchtimepresentations,emails,andonlineprograms.Themostcommonrequestsfornew
activitiesorresourceswerehealthiervendingselections,fitnessequipment,stressreducingactivities,
andwalkingchallenges.Aboutathirdofemployeesrequestedannualhealthscreeningtests,healthy
eatingclasses,andorganizedwalkingprograms.

EngagedWellnessDirector:Severalintervieweesreportedthatthepositionofawellnessdirectorwas
crucialfortheprogramssuccess.Accordingtooneofthem,byprovidingnecessarystructureand
directiontothewellnessprogramandcoordinatingcollaborationbetweenprograms,thewellness
directorwasabletobringsomuchenergytotheprogramandhasgiven[theagenciesandfacilities]
guidancetheyneededtosuccessfullyimplementtheprogramintheiragencies/facilities.
30


ProgramStructure:Whiletheprogramhadawellnessdirector,thetwolevelsoforganizational
structureprovidedthewellnessprogramwithoveralldirectionandstrategyatthedepartmentleveland
individualizedimplementationattheagency/facilitylevel.Wellnessrepresentativeswithineach
agency/facilityknowtheneedsoftheiremployeesandcanbettermakedecisionsonhowtouselimited
wellnessresourcestoensurehigherdegreeofparticipationandimpact.Forexample,knowingthat
manyemployeesenjoyedlinedancing,onewellnessrepresentativerequestedmoneyfromthewellness
directortopurchaseanaudiosystem.Shealsousedherpersonalcontactstopurchasetheaudiosystem
atadiscountandobtainfreemusicCDs.

Program Impact
AlthoughacomprehensiveevaluationoftheimpactofEmployerBswellnessprogram,whichincludes
healthriskassessmentandreturnoninvestmentanalysis,hasnotyetbeenconducted,thewellness
directorassessedagency/facilityprogramimplementationandselfreportedchangesinbehaviorduring
hertenure.

ProgramImplementation:Inanattempttoevaluatethewellnessprogramimplementationatthe
agency/facilitylevel,thewellnessdirectorconductedannualprogramaudits.Table3presentsthe
resultsofthe2010audit(thelatestdatacollectedforthe2011annualprogramreport).Almostall
agencies/facilitiesreportedthattheyprovidededucationtoemployees,andtwothirdsofferedfitness
classesorprovidedtobaccocessationresources.Overhalfprovidedweightmanagementprograms,
haveindoorfitnessareas,andorganizedwalkingclubs.Someagencies/facilitieshaveahealthyfoods
policy,heldhealthfairs,havehealthiervendingoptions,haveapolicysupportingphysicalactivity,
offeredhealthscreenings,andofferregularbloodpressurechecks.

Comparedtobaselinedatacollectedin2005,thelargestimprovementwasinthenumberof
agencies/facilitiesthatreporthavinghealthyfoodspolicy(0to18),offeringtobaccocessationresources
(3to24),offeringhealthyvendingselections(increasefrom10to17),andhavingindoorfitnessareas
(14to21).

Table3:PercentageofAgencies/FacilitiesReportingProgramImplementationActivitiesfor2010
(N=37)
Programactivities
Percentage
Providededucationtoemployeesonfourmajorriskfactors
92
Offeredfitnessclassesinthepastyear
65
Providedtobaccocessationresources
65
Providedweightmanagementprograms
59
Haveindoorfitnessareas
57
Havewalkingclubsorganized
51
Haveahealthyfoodspolicy
49
Heldhealthfairs
49
Reportedhealthiervendingoptionswereavailabletoemployees
46
Haveapolicysupportingphysicalactivityduringtheworkday
38
Offeredannualhealthscreeningtoemployees
24
Offeremployeesregularbloodpressurechecks
12
31

HealthBehaviors:Programimpactattheemployeelevelwasassessedusingtheemployeesurveys.
Between2006and2010,theproportionofemployeesreportingapositivehealthbehaviorchange(all
categoriesexceptfortobaccouse)wassignificantlyhigheramongemployeesparticipatinginworksite
wellnessactivitiesthanamongthosewhodidnotparticipateinanyworksitewellnessactivityduringthe
prioryear.

Figures1and2illustratethehealthbehaviorchangesinthepreviousyearreportedbydepartment
employeesbetween2006and2010.Roughlyhalfofallsurveyparticipantsannuallyreportedpositive
changesintheirwalkingactivitiesandeatinghabits(N=3,112in2010).Aquarterofparticipants
reportedgettingclosertohealthyweight.Oneintervieweedescribedthechangeinemployeebehaviors
andattitudes:Peoplethatneverexercised,thatwereextremelyoverweightyoucanseethe
differenceintheirlives,theiractivitylevels,andweightloss.Nowwhenwehaveluncheons,nooneis
complainingthatwedonthavedessertorthatwehavelotsofsaladsandsoup.Andonlyonefifthor
fewerparticipantsreportedimprovementsintheirabilitiestomanagestress.Between2006and2010,
566employeesreportedtheyhavequittobaccouse,and695reportedtheyhavereducedtheirtobacco
use.Thedownwardtrendofpositivehealthchangesandreducedtobaccousemaybeanindicationof
lesssupportforthewellnessprogramandactivitiesoracaseofdiminishingreturns.

Figure1:PercentofDepartmentEmployeesAnnuallyReportingPositiveHealthBehaviorChangesin
PriorYear(20062010)
60
50
40
30
20
10
0
2006

2007

2008

Walking,exercisingmore

Choosinghealthierfoods

Closertohealthyweight

Managingstressbetter

2010

Eatingmorefruits/Veg

32

2009

Figure2:NumberofDepartmentEmployeesReportingQuittingorReducingTobaccoUseinPrior12
Months(20062010)
300
250
200
150
100
50
0
2006

2007

2008

Stoppedtobaccouse

2009

2010

Reducedtobaccouse

EmployeeSatisfaction:In2010,30%ofagencyand44%offacilityemployeesratedtheirwellness
programasgoodorexcellent,whereas15%ofagencyand8%offacilityemployeesrateditas
poor(N=3,112).Overall,facilityemployeesappearmoresatisfiedwiththeirworksitewellness
programsthantheircolleaguesemployedbyagencies.

EmployeeMoraleandOrganizationalCulture:Severalintervieweesreportedthatthefocusongroup
wellnessactivitieshelpedemployeesdevelopteamspiritandsocialconnectivitywithinthe
agencies/facilities.Accordingtooneinterviewee,[thewellnessprogram]buildsteamspirit;oneofthe
reallypositivethingsIwouldhearbackwas,especiallyourlargeragencies,Thisisthefirsttimewesee
peoplethatworkdownthehall.Anditsfun.Youknow,Wegettoknowpeople.Thisreallyenhances
yourteam.Andyoufind,Oh,youdothat?Oh,well,Idothis.Youfindconnections,anditreallyisa
teambuildingwithoutthatbeingkindofstupidandartificial.Thisisamorenaturalwaytomeet.Were
comingtodothistogether,whichbringspeopletogetherin,tome,anormalway,asopposedtosome
artificialgamethatyouplay.Someintervieweesreportedthatemployeesbegandoingotherwellness
activitiestogetheroutsideofwork,includingcharitywalksandmountainclimbing.

HealthcareCostsandReturnonInvestment:Whilethewellnessdirectorevaluatedwellnessprogram
satisfaction,activities,andreportedhealthbehaviorchanges,theprogramhasnotexaminedtheeffect
onhealthcarecostsorthereturnoninvestment.

EffectofIncentives:EmployerBusesbothnonfinancial(competitioningroupactivities)andfinancial
incentives(lowercoverageplanifasmoker;reductionincopayforcompletinghealthscreening).
Althoughtherewasnodirectmeasurementoftheeffectofgroupactivitiesandraffleincentivesfor
groupparticipation,theseactivitieshavebeenpopular.Onewellnessrepresentativedescribeda
positiveeffectofgroupchallenges:therewasthebenefitofbeinginagroupanddoingsomethingasa

33

group,andmaybetryingtodobetterthantheothersoratleastasgood.Ithinktherewassome
excitementinthatforpeople.

Therequirementsofnotusingtobaccooractivelytryingtoquittobaccotoqualifyforthehigher
coveragelevel(80/20)healthplanwasinstitutedonJuly1,2010.Theeffectofthehealthplan
qualificationontobaccousehasnotyetbeenassessed.

AlthoughtherearenoquantitativeresultsoftheRoadmaptoGoodHealthpilot,anintervieweenoted
thatthe$15reductionincopaymadeitmoremanageablefinanciallyforemployeestogotothedoctor
onaregularbasisandnotuseurgentcare.Theintervieweealsodescribedseveralindividualsuccess
storiesofthepilotthatwerepresentedatasymposium.Onewomanfoundouthercholesterolwashigh
andhadborderlinediabetes.Basedonthetestresultsandmedicalconsultation,shewastoldtotrydiet
andexerciseorbeputonmedications.Andnow,sheslostlike70pounds.Imeanitsamazingand
sheskeptitoffHerA1CisgreatShedidnthavetostartanytypeofmedicationforherdiabetesher
levelswerebackdowntonormal.

UnintendedConsequencesofIncentives:Nounintendedconsequencesofincentiveswereidentified
duringtheinterviewsorfocusgroup.

Future Directions
FutureplansforEmployerBswellnessprogramincludeagencyandfacilitywellnesscommittees
continuingtoorganizeandsupportwellnessactivitiestotheiremployeesandpotentialpartnering
betweenagencies.Eventhoughcentralizedworksitewellnessactivitiesandeventsarenolonger
coordinatedatthedepartmentlevelbythewellnessdirector,manywellnessrepresentativesreported
theirwellnesscommitteeswouldcontinuemeetingonaregularbasisandoffervariouswellness
activitiestotheiremployees.Itwasalsosuggestedthatwellnesscommitteesmaystartpartneringwith
eachothertocosponsorwellnesseventsandsharetheirknowledgetoleveragethelimitedresources
thatmaystillbeavailablewithinthedepartment.Thelevelofpartnering,however,dependslargelyon
thepersonalitiesofwellnessrepresentativesandtheirlevelofcommitmenttoworksitewellness.

Conclusion
EmployerBswellnessprogrambeganwithsupportfromthestatehealthplantodevelopareplicable
modelofaworksitewellnessprogramandcontainhealthcarecosts.Theprogramwasoverseenbya
fulltimewellnessdirectorwhoprovidedleadership,direction,andsupporttowellnessrepresentative
andwellnesscommitteeineachagency/facility.Eachwellnesscommitteeorganizesthemajorityof
activitiesandeventsfortheiragency/facility.Althoughthistwotierprogramstructureallowswellness
committeestoprioritizeactivitiesforpreferencesoftheemployeesintheiragency/facility,itmayalso
createadisadvantageforemployeesworkinginagencies/facilitiesthatdonothaveanactivewellness
representativeandcommittee.

Thedepartmentswellnessprogramoffersawiderangeofwellnessactivities,withanemphasison
groupphysicalactivities,healthyeatinghabits,andstressrelief.Thewellnessprogramhasachieved
severalpolicychangesincludinganimplementationofwellnesspolicythatauthorizesofsixhoursand
fourhoursofworktimeforwellnessrepresentativesandwellnesscommitteestoorganizeactivities
34

withineachagency.Thewellnesspolicyalsoencouragesapprovalofflexibleworkschedulestoallow
employeestoparticipateinwellnessactivities.Althoughthereisadepartmentwidewellnesspolicy,not
allsupervisorsaresupportiveofemployeesspendingtimeonwellnessactivitiesduringnormalbusiness
hours.

Whiletheprogramhadawellnessdirector,severalprogramevaluationactivities,includingannualaudit
ofagencyactivitiesandanannualsurveyofemployeeinterests,participation,satisfaction,andimpact,
wereconductedperiodically.Evaluationresultsshowthatalmostallagency/facilityprogramsprovide
educationtoemployeesonmajorriskfactors,andmanyofferfitnessclasses,providetobaccocessation
resources,offerweightmanagementprograms,andhaveindoorfitnessareas.Employeefeedbackon
interestsandpreferenceshasbeenusedtoidentifyprioritiesforactivities.Since2005,approximately
halfofdepartmentemployeesparticipateinatleastonewellnessactivityeachyear.About20percent
ofthoseemployeesparticipateatleasttwiceaweekinawellnessactivity.Selfreporteddatahavealso
shownthatmanyemployeesimprovedseveralhealthbehaviors,rangingfrombettermanagementof
stresstoincreasedintakeoffruitsandvegetables.However,thesedatahavenotbeenlinkedto
participation,satisfaction,cost,oroutcomesdatatomeasureprogramimpactortoperformanROI
evaluation.

Whilethetwotierprogramstructure,theimplementationofthewellnesspolicy,thefocusonperiodic
programevaluation,andhavinganengagedwellnessdirectorhavebeenidentifiedasfacilitatorsof
programimplementation,lackoffunding,difficultypromotingevents,schedulesandlocationof
employees,andlackoftimetoparticipatewereperceivedtobebarrierstoactiveprogramparticipation.
Althoughthefulltimewellnessdirectorpositionhasbeeneliminatedandcentralizedworksitewellness
activitiesarenolongercoordinatedatthedepartmentlevel,wellnesscommitteesstillcontinueto
functionandmayevenstartpartneringwitheachothertocosponsorwellnesseventsandleveragethe
limitedresources.

35

Employer C: A large service organization

Wewantemployeestobehealthierandbetterinformedtoliveabetterlife,andatthesametimethe
reasonwearedoingthisasacompanyistocontrolcostsandimproveproductivity.
OrganizationalleaderatEmployerC

Organization
Background on the Employer

EmployerCistheU.S.subsidiaryofaglobalfinancialfirm.Thecompanysprimaryproductlinesinclude
lifeinsurance,mutualfunds,401(k)plans,longtermcare(LTC)insurance,andannuities.

EmployerCcomprisesoneofthelargestlifeinsurersintheU.S.andemploysapproximately4,894
individuals,themajorityofwhich,approximately3,742,arebasedinonecity.Otheremployeesworkin
asmallersitelocatedatanothersecondarysite,orforanationalnetworkofprofessionalsat
independentfinancialfirmsacrosstheU.S.Approximately50percentoftheemployeepopulationis
comprisedofwomen,withanaverageageoffortytwoandtenyearsofemploymentatEmployerC.
Aboutaquarter(26%)oftheworkforceisaged1829,whilethemajorityofemployeesarebetweenthe
agesof3045(37%)or4564(36%),andonepercentofemployeesareage65orolder.

EmployerCshealthplansvarybygeographiclocation.Thecompanyisfullyinsuredthrougha
recognizedprimaryinsurerofferedtoindividualsinthetwomainlocations,aswellasthoselocatedat
remotesitesregionally.TheprimaryinsurersoptionsincludeaHealthMaintenanceOrganization
(HMO),PreferredProviderOrganization(PPO),andahighdeductiblehealthplan(withhealthsavings
account).MorerecentlyatierednetworkPPOwithprovidersandmedicalgroupstieredbycostand
qualityhasbeenintroduced.Anothernationallyrecognizedinsurerisofferedoutsideoftheprimary
insurerscoverageareaandmainlyservesindividualsemployedbymembersofthenationalnetwork.
ThissecondaryinsurersplanoptionsincludePPO,ahighdeductiblehealthplan(healthsavingsaccount)
andanExclusiveProviderOrganization(EPO).

LeadersatEmployerCdescribelifestyledrivenconditions,likeoverweightorobesity,hypertension,and
stressasthemostcommonhealthriskfactorsamongemployees.Chronicconditionslikediabetesand
cancerwerealsocitedaspressingissuesamongtheemployeepopulation.Thecompanyswellness
activitieshaveprimarilytakentheapproachtoworktowardhealthcarecostreductionandimproved
healththrougheducationandbehavioralmodificationprograms,withasecondaryfocusondiseaseor
chroniccaremanagement.
Organizational Strategy: A Focus on Health and Wellness

EmployerCbegandevelopingtheirwellnessactivitiesin2007andofficiallylaunchedamultifaceted
wellnessprogramthroughouttheirU.S.firmsin2008.Themotivationtoimplementwellnessprograms
wasprimarilydrivenbyasenseofcorporateresponsibilityforstaffwellbeingandtheviewthat
wellnessprogramscanhavetangiblebenefitstotheorganizationinformofhealthcarecostsavings,
increasedemployeemoraleandimprovedhealthbehaviorsandoutcomes.

36

Asuppermanagementbecameconcernedbyrisinghealthcarecost,humanresourcesleaders
expressedenthusiasmabouttheprospectofbeingaheadofthecurveintheareaofworkplace
wellnesstocontrolcostswhilesimultaneouslyimproveemployeemoraleandproductivity.Onehuman
resourcemanagershared:[EmployerC]hasalwayshadarealfocusasviewingtheworkplaceasmore
thanaplacethatemployeescometowork,[wehave]astrategythatgoesfarbeyondwhatdoyoupay.
Weareviewedasacompanythathelpsemployeesbecomeengagedintheirownhealthandfeelbetter,
thishasalwaysbeenapartof[ourstrategy].Theideaofexpandingwellnessprogramswasseenasa
relevantnextstepthatcoincidedwiththeirvibrantworkculture.

Wellness Program Description

Program Development and Implementation

Todayswellnessprogramevolvedin2007whenEmployerCpartneredwiththecompanysprimary
healthplantoexamineclaimsdatatoidentifycostdriversand,inturn,developwellnessinitiativesto
simultaneouslycontaincostsandempoweremployeestomanagetheirownhealth.Oneorganizational
leaderexplained,Itwasntour[EmployerC]philosophytochangecostshiftingeveryyearwewanted
toencouragepeopletomanagetheirownconditions[and]showemployeesthatwe,asacompany,
careaboutthem.

TheHumanResourcesBenefitsDepartmentcreatedasmallwellnessteamcomprisedmainlyofhuman
resourcesleaderstodiscussideasandrolloutpilotprograms.Collectively,theydecidedpreventivecare
awarenesswouldbetheinitialwellnesspriority,soleadersresearchedmedicalstandardsfor
appropriatecareandminedclaimsdatatodeterminegapsinpreventivescreeningsamongtheir
employeepopulation.EmployerCthendevelopedmarketingmaterialsandcommunicationsto
encourageemployeestogetpreventivescreenings,likecolonoscopiesandmammograms,andinvited
healtheducatorsfromtheirprimaryinsurertoleadeducationalseminarsontheimportanceof
prevention.Oneorganizationalleaderrecallsthepositiveresultsoftheawarenessprogram:Wefound
ourclaimshadspiked.Whenwedugdeeperwefoundthecolonoscopyscreeningsincreased.Although
ourinitialcostswentuptheappropriatespendwentup.

Encouragedbythepositiveimpactofthepilotawarenessprogram,EmployerCbegantoofferadditional
services.Anonlinehealthquestionnaire,diseasemanagementprograms,andreimbursementsfor
attendingqualifiedgyms,wereamongthefirstcomponentsrolledout.Soonthereafter,in2008,the
companybroughtbiometricscreeningsonsitetoemployees,aquarterlybiometricsscreeningandhealth
coachconsultationprogram.

Currently,ateamofhumanresourcesrepresentativesatthecompanyoperatetheprogramanddevelop
communicationstrategiesinpartnershipwiththeprimaryinsurer.Thehumanresourcesteamalso
partnerswithEmployerCspropertymanagementgroup,representativeswithintheeventmarketing
department,andthecompanysfoodvendortodevelopandimplementvariouswellnessactivities.
Data Collection

EmployerCusesthreeprimarymethodstocollectdataonthehealthstatusoftheiremployee
population:biometricscreenings,onlinehealthriskquestionnairesandmonitoringmedicalclaimsdata.
Mostcommonly,dataarecollectedthroughtheonsitebiometricscreening,whichprovidesdataon
37

cholesterollevels,bloodpressure,bloodglucoseandbodymassindex.Second,thehealthrisk
questionnairesadministeredthroughinsurersprovideaggregateddataonhealthbehaviorrisksand
allowthehealthplanstoevaluatevariationsinrisksandbiometricmeasuresovertime.Datagathered
duringtheonsitebiometricscreeningareautomaticallylinkedandtransferredtoindividualemployees
onlinehealthriskquestionnaire;employeeswhodidnotreceiveascreeningcanmanuallyentertheir
biometricdata.Lastly,theorganizationreceivesaggregatemedicalclaimsdatafromtheirinsurance
carriersthatincludesinformationonhealthcareclaims,workerscompensationandprescriptiondrug
costs.
Identifying Employees for Participation

AllwellnessactivitiesofferedatEmployerCarevoluntaryanddonotrequirethatemployees
participate.Employeesareeligibleforparticipationinallprograms,regardlessoftheirhealthstatus,and
donotneedtomeetcertaincriteria(e.g.,haveacertainhealthrisk)toutilizeservicesorparticipatein
programs.Thoughthebiometricscreeningsareadministeredonsitethroughtheinsurer,employees
withotherinsurancecarriersarestilleligibletoparticipateintheprogram.Someemployeesmaytrigger
ahealthcoachingopportunityduringthebiometricscreeningandwillbeofferedtospeakwitha
healthcoach,oriftheyareparticipantsinHarvardpilgrimshealthplan,linkedtoongoingcoaching
assistancethroughtheirnursehotline.Theonlinehealthriskquestionnaire(administeredthroughthe
insurers)identifiesindividualswhomaybenefitfrombehavioralmodificationordiseasemanagement
programs,andthenlinksthemtoprograms,thoughtheyarenotrequiredtoparticipate.
Program Costs

Leadershiphaslabeledtheirbudgetaswellnessonashoestring.Nationwide,EmployerCallocates
approximately$800,000onwellnessprograms,whichtranslatestoapproximately$160peremployee.
Approximately,$214,000isdedicatedtofinancialincentivestiedtothebiometricscreeningswhich
entailsgiftcertificatesforparticipationinbiometricscreeningsorachievingspecificpersonalhealth
goals.Thenursehotlinecostsapproximately$75,000andgymmembershipreimbursementsandthe
healthyeatingprogramtogethertotalapproximately$80,000.Othercostsaredividedamongseveral
otherofferings,likeweightlossprograms,amicrositeforoffsiteemployees,educationalseminars,and
othergiftcardsorraffles(e.g.,rewardsfortheBusinessUnitChallenge).Theorganizationfullyfunds
incentivesforparticipationandachievinggoals,thenursehotline,andthereimbursementprogram,
whiletheprimaryinsurerfundsthebiometricscreeningfair,healthquestionnaire,andotheronline
educationalmaterialsandwebinars.
Wellness Events and Activities

EmployerCscomprehensivewellnessprogramisbrandedwithacatchyname,whichinvolvesawide
rangeofactivitiestoencourageemployeestobecomehealthierthroughofferingssuchasbiometric
screenings,educationalmaterials,competitivefitnessprograms,andweightlossprograms,someof
whichprovidefinancialincentivesforparticipationormeetingpersonalgoals.Theorganizationhasalso
improvedthephysicalworksiteenvironment,throughhealthierfoodoptionsandaccessonsitefitness
facilities,topromotehealthybehaviorsthroughouttheday.Acorporateintranetsitecombines
informationonwellnessactivitiesandeventsinoneplace.Belowisalistofthevariouswellness
initiativesofferedattheorganization.

38

Programsadministeredbyhealthplans(insurers)
BiometricScreening:Theprimaryinsurersponsorsaquarterlybiometricsscreeningprogram
thatprovidesasnapshotofanindividualshealth.Metricsinclude:cholesterol,bloodpressure,
bodymassindex,weightandheight.Individualswithcertainriskfactorshavetheopportunityto
discusspersonalhealthgoals,likeweightloss,smokingcessation,ordietmodifications.The
biometricscreeningprogramisoperatedbytheprimaryinsurerbutopentoallemployees.
HealthRiskQuestionnaire:Bothinsurersofferonlinehealthriskquestionnairestoplan
participants.Atcompletion,thequestionnaireproducesareportthattellstheparticipanttheir
healthstatusandmaylinkthemtoalifestyleordiseasemanagementprogramortelephonic
coachingassistancethroughthenursehotline.Datafromthebiometricscreeningare
automaticallyuploadedintoanemployeeshealthquestionnaire.
ReimbursementProgram:Participantsreceivea$400reimbursementformembershipto
qualifiedgyms,attendingasmokingcessationprogram,WeightWatchersmeetings,orqualified
nutritionalprograms.
PerformanceMatters:Inpartnershipwiththesecondaryinsurer,EmployerCdevelopeda
micrositeforprofessionalsemployedatvarioussitesthroughouttheU.S.throughthe
companysnationalnetwork.Thesitecontainshealthynewsletters,webinars,andaccessto
healthriskquestionnaires.Thecompanyswellnessteambrandedthisprogramwitha
meaningfulnamethatinstilledwithintheirsalesworkforcetheideathathealthandwellbeing
canincreasesalesandmotivation.

Programsadministeredbythirdpartyvendors
Healthyeatingprogram:Ahealthyeatingandlifestylemanagementprogramthatoffers
educationalinformationonnutritionandhealthyeating,personalizedphonesupportfrom
healthcoaches,andonlinetrackingtohelpparticipantsmonitortheireatingpatternsandhealth
improvementsisofferedtoemployees.Participantshaveaccesstoavarietyinteractivetools
includingsocialnetworkingtools,educationalandcookingvideos,andanonlinedatabaseof
recipesandmealplans.
NurseHotline:Avendoroffersatelephonicnursehotlinethatallowsplanparticipantsaccessto
registerednursestoreceiveconfidentialhealthinformationandadvice.Thoughallhealthplan
participantsareabletoaccesstheservice,individualswhotriggeredanopportunityforhealth
coachingorinterventionaredirectedtothehotline.Theservicesareavailabletwentyfour
hoursaday,sevendaysaweek.
WeightWatchers:WeightWatchersmeetingsareofferedduringlunchhouronsiteto
employeestoallowgreaterconvenienceforemployeeswhoaremembers.
ProgramsadministeredbyEmployerC
WellnessProgramNewsletters:Eachmonth,thewellnessprogramnewsletterisdistributed
electronicallyandthroughhardcopycirculation.Newsletterscovertopicsrelatedtostress,
healthyeating,andfitnessandaredevelopedbyEmployerCswellnessteam(Pleasereferto
Figure3).
HealthandWellnessSeminars:EmployerChasofferedavarietyofonsitelunchandlearn
seminars,atwhichspeakerspresentinformationonvarioushealthrelatedissuesrangingfrom
stressmanagement,smokingcessation,anddemonstratedstretchingexercises.Seminarsare
typicallysmallandinformalandhaveincludedguestspeakerslike,nurses,healthcoachesand
marathonrunners.Onehumanresourcemanagerexplainedtheirstrategyhasbeentooffer

39

programsonlunchhourtominimizeinterruption:Wetrytodoseminarsonlunchhourso
peoplefeelliketheyhavepermissionlunchhourseminarsworkbestwithschedules.
HealthWebinars:Webinarscorrespondingtohealthtopicsinthemonthlynewsletteraremade
availabletoemployeestowatchattheirleisure.Oneemployeesaidshepreferswebinarsto
seminarsbecauseyoucandothemwheneveryouhaveacoupleoffreeminutes.EmployerC
hasalsotransitionedfromofferinginpersonseminarsforsensitivehealthtopics,like
depressionorstress,towebinarstoprovideasenseofprivacytoindividuals.
BusinessUnitWalkingChallenge:Eachyear,businessunitsformateaminwhichmembers
trackandlogtheirdailystepsorstepequivalents.TheAmericanHeartAssociationsstep
equivalentconversiontoolisusedtotranslatevariousactivities(e.g.,laundryorhousecleaning)
intosteps.Theteamwiththemoststepsattheendofthesixweekchallengeisrewardedand
publicallyacknowledged.PreviousawardshaveincludedNFLticketsandgiftcertificates.
WorkYourWaytoa5K:Thisisa15weekrunninggroupthatmeetingsduringthelunchhour
foremployeeswantingtotrainfora5K.Expertrunnersandtrainerscometomeetwiththe
grouptoproviderunningtipsandassistwithtraining.
MarathonTrainingProgramandSponsorship:EmployerCisasponsorofamarathonandpays
entrancefeesforemployeesinterestedinrunning.Participantsintheprogramreceiveatraining
routineandcanattendrunningseminarswithnutritionistsandrunningcoaches.
TaketheStairsCampaign:EmployerCleveragedacitywidecampaigntoencourage
employeestochoosethestairs.Thecityprovidedtheorganizationwithpointofdecision"
signagetopostnexttoelevatorsandescalatorsencouragingemployeestotakethestairs.
Signagehascreativesloganslike,Notimetoexercisetoday?Youropportunityisnow!"
GlobalWellnessInitiative:TheBusinessUnitWalkingChallengewashighlyregardedintheU.S.
office,soofficesabroadhavedecidedtointroduceasimilarwalkingcompetitionand
educationalseminars.
SmokingCessationPrograms:Groupbasedsmokingcessationprogramsareofferedonsiteto
employees.Theseprogramsqualifyforthereimbursementbenefit.
AccesstoGymFacilities:Officesatthemaincityhaveonsitefitnessfacilitieswhichinclude
exerciseequipment,groupexerciseclassesandlockerroomswithshowers.Locationseither
haveapublicfitnesscenteroraprivatefacilityforEmployerCemployeesonly.Employeesare
reimbursedthecostofthegymmembershipthroughthereimbursementbenefit.
BikeRoom:Thewellnessteampartneredwithpropertymanagementtoconvertunusedstorage
spaceintobikeroomsatonelocation.Anotherlocationwasoriginallyconstructedwithbike
rooms.Showersandchangingroomsareavailable.
IncreasedHealthyFoodOptions:EmployerCpartneredwithfoodvendorstoimprovehealthy
optionsinthecompanycafeteriaandnegotiatedwithonsitefoodstorestoimprovehealthy
options.Atonesite,aseparatefoodstationwasintroducedtoofferhealthyhomecookedmeals
inlieuofaheartyhomecookedmealsstation.Atanotherofficelocation,wellnessleaders
negotiatedwithanonsitefoodstoretoofferhealthieroptions.Thestorepreviouslyoffered
cookiesandsodas,nowtheyoffercagefreeeggs,Greekyogurt,saladsandunbundlethelunch
boxessoconsumersareabletochoosehealthysideoptions,likefruit.Oneorganizational
leadermentionedofferinghealthyoptionsattheworksitewasaplantobuildacultureof
wellness,ourstrategyis[toencourageouremployees]toeatbetterandtherewerenohealthy
choicesinthecafeteria.So,weworkedwithourfoodvendorstohavesomesortofhealthy
choices.

40

CalorieLabelinginCafeteria:Theonsitecafeteriaclearlylabelscaloriesoncertainfood
productsandplacescalloutstickersonhealthyfoodoptions.PleaserefertoFigures4and5
forexamplesofcalorielabelingtechniques.

Alignment with Health Plan

LeadersatEmployerCconsidertheirpartnershipwiththeprimaryinsurerin2007thebeginningsof
theirwellnessprogram.Oneorganizationalleaderdescribedthemasastrongpartnerthatallowsus
toexecutethecoreoftheprogram.Priortotheircollaboration,managerswithinhumanresources
weregenuinelyinterestedinwellnessbutwerentabletostructureanintegrated,companywide
programwitharecognizablebrand.

Theprimaryinsurerisresponsiblefordesigningandimplementingthemajorityofprogramcomponents.
Theycoordinatethebiometricscreenings,providevariousonlineprograms,includingbehavioral
modificationanddiseasemanagementprograms,provideeducationalinformationandcommunications,
managedataonbiometricsandmedicalclaims,andevaluateemployeehealthoutcomesandcost
savings.Theprimaryinsureralsoactsasanadvisor,suggestingwaystoincreaseemployeeparticipation
(e.g.,developmarketingcampaigntopromotethehealthquestionnaire)andlinksEmployerCtoother
innovativewellnessactivities(e.g.,anursehotlineorhealthyeatingprograms)thatareadministeredby
outsidevendors.

Engagement Strategy
Incentives

EmployerbasedIncentives:Employeesreceive$20forcompletingthebiometricscreeningandare
eligibletoreceiveanadditional$20forachievingtheirpersonalhealthgoals(e.g.,losefivepoundsinsix
weeksorexercisethreetimesweeklyfortwomonths).Employeessettheirpersonalgoalsbasedon
theirhealthassessmentandotherpersonalneeds.Ifemployeeshavereachedtheirgoalsatthetimeof
thenextquarterlybiometricscreening,theyareeligibletoreceivethe$20reward.Otherincentives
includerafflesandforattendingthebiometricscreeningfairandticketstosportingevents(givento
winnersoftheBusinessUnitChallenge).

HealthPlanIncentives:EmployerCsphilosophyonuseofincentivesistoofferinterimrewardsto
encourageintrinsicmotivationwithattentiontocarrotsoversticks.Leadershipreportedthatthe
majorityoffinancialincentivesforwellnessactivitiesareusedprimarilytoencourageemployeesto
showuptogetbiometricscreeningdone,setgoalsandachievethosegoals.Employeesreceive$50
forcompletingtheonlinehealthriskquestionnaireofferedthrougheitherinsurerandcanreceivean
additional$50forsuccessfullycompletingalifestylemanagementprogramtiedtoindividualhealth
status.

ThoughmostincentivesofferedthroughEmployerCareinformofreward,asof2012,thecompany
implementedasmokerpenaltyforprimaryinsurerplanparticipants.Employeeswhoidentify
themselvesassmokersandreporttheydonotintendtoquitarerequiredtopaya$600premium
surchargeeachyear.Thesurchargeiswaivedforplanparticipantswhoenrollinasmokingcessation
programorreporttheywouldliketoquitsmoking.

41

NonFinancial Avenues to Increase Engagement

Focusgroupparticipantsreportedconvenienceandasenseofcamaraderiearethetwomostimportant
motivatorsforparticipationinwellnessactivities.Onefocusgroupparticipantsaidshewouldunlikely
attendWeightWatchersmeetingsiftheywerentofferedonsitebecauseofherdemandingschedule:
AtnightIdon'tgethomeuntilsixthirty,seveno'clock.Sohavingitatworkdefinitelyhelpsme,andso,
Ithinkitdefinitelyhelpsbeingatworkbecauseithelpsyoufeelbetter.Anotherrespondentstatedthat
shefoundtheeaseofonlineseminarsworkedwithherschedule,Ivelistenedtoacoupleofthem
becauseyoucandothemwheneveryouhaveacoupleoffreeminutesatyourdesk.Similarly,the
convenienceoftheonsitefitnessfacilityencouragessomeemployeestoexerciseregularly.One
respondentstatedthataccesstotheworkoutfacilityallowshimtoincorporateexerciseintohisdaily
routine,andprovidesanoutletforstressrelief:IdogodowntothegymandIfoundthatthat'sabreak
thatIcoulduse,butIalsofoundthatjusttheconvenienceofithelpedmeit'slikeyoudontwanttobe
thesedentarydaddoingnothing,soitwasagoodincentivethatway.However,otherfocusgroup
participantscomplainedthat[thebiometricscreening],thoughofferedonsite,canbeanuisancedue
tounpredictablewaittimes,whichhasdiscouragedparticipation:Iftheresalonglineitsnotworth
waitingfor.

Focusgroupparticipantsreportedthatperceivedsocialsupportandabuiltsenseofcamaraderieamong
coworkersareanimportantpartoftheirparticipationinwellnessactivities.Oneparticipantstated,I
definitelythinktheteamdynamicandthecompetitivenatureofit[BusinessUnitChallenge]tendsto
generatealotmoreexcitementandenergy.Ahumanresourcemanagersaidshenoticedthisteam
basedchallengewasthefirsttimesomanypeoplegotengaged:Onourteam,weralliedandgot
everyoneengaged.Shewaspleasantlysurprisedtofindprogramsallowedforindividualstosupport
eachother.Weallgodownto[getbiometricscreenings]together,shesaid,Ithappensatthe
managerleveltoo.Anotherparticipantreportedthatteamfocusedwellnessprogramsaremorelikely
tocaptureemployeesattentionthansmallmonetaryincentivesorshorttermprogramsorseminars
thatareeasytoforget:Itsacamaraderieandteambuildingthingiftheydidmoreofthoserather
thankindoftheseonetimespecialthatgetsmorepeopleoutandgoingand[is]encouraging.
Communication/Marketing Strategy:

EmployerCscommunicationstrategybrandstheirwellnessprogramsname,andutilizesmultiple
communicationchannelstoempoweremployeestopracticehealthybehaviorsandinformthemof
wellnessopportunities.Thebrandispostedonbulletinboards,onsignsinthecafeteria,andcompanys
intranetsitewhichenablesemployeestoconsistentlyseehealthrelatedmessagescorrespondingwitha
recognizablebrandthroughouttheirday.

Thecompanyalsofocusesonongoinghealthawarenesscampaignstoimproveemployeeengagement.
Theircampaigninvolvesthedeliveryofmultidimensional,focusedmessagingviaavarietyof
communicationchannelslikenewsletters,signage,calloutsonthecompanysintranetsiteandemails.
Onehumanresourcesmanagerstatedthattheyhavebeenincrediblysuccessfulwithkeeping
employeesengaged,weareconstantlyonnewwaysofgettingattention.Weknowtheyounger
generationscommunicatedifferentlyfromoldergenerations.Wewantwellnesscommunicationstobe
engaging.Oneexampleoftheirconsistentmessagingisthecompanysmonthlyhealthnewsletter
distributedviaemailandinprintwhichprovidestimely,relevanthealthrelatedinformationand
tips.

42

Leadership Support

Wellnessleadersconsistentlyreportedseniormanagementunderstandsthebusinesscasefor
workplacewellnessprogramandconsidersitastrategicpriority.Oneorganizationalleaderreported,
Wehavefullsupportofleadershipwhichhasbeenhelpfulforwellnessleadersastheyvedeveloped
theirprograms.[Managers]understandwhythismakessensefromabusinessperspective;[this]has
helpedcreateacultureofhealth.

Employeesreportedseniormanagersareactiveparticipantsinmaintainingahealthylifestyle
themselvesandsensetheyencourageemployeeparticipationinwellnessactivitiesingeneral,butwere
onlyabletorecallafewinstanceswhentheyreceiveddirectcorrespondencefromseniormanagement.
OnefocusgroupparticipantdescribedanacompanywideemailtheCEOsenttoencourage
participationintheBusinessUnitChallenge:Emailswentoutfromseniormanagementandthey
basicallysaid,look,becausewehaveallthesehealthprograms,yourhealthinsurancepremiumsarent
goingupasmuchastherestoftheindustry.Andbyparticipatingintheseprogramsbydemonstrating
thatwereahealthierpopulation,ourhealthinsurancepremiumsremainlower.Andsothatdidhelp
encouragepeopletoparticipate.Focusgroupparticipantsalsolargelyagreedthatseniorleaders
practicewhattheypreachbytakinginitiativetoimprovetheirownhealthandfitness,whichcultivates
asupportiveworkcultureasexplainedbyonefocusgroupparticipant:Theheadofmydepartment,I
knowhegoestothegymeverysingledayandIknowhetakestimeduringtheworkdaytogo,sothatto
mespeaksmore.Youseealotoftheminthegymwhenyouseethemworkingout,youknow,its
importanttothem,theyretakingthetimetodoit.Similarly,anotheremployeearticulatedher
enthusiasmasshewitnessedEmployerCsCEOcompeteinalongdistancebikerace,[EmployerC]
sponsorsthe[alongdistancebikeride].Iknowlastyeartherewasapictureof[TheCEO]ridingabike
whichIthoughtwasawesomeonhisseniorlevel,hesveryintobeingactive.

Althoughseniormanagementisactivelyinvolved,mostfocusgroupparticipantsreportedtheirdirect
supervisorswerelessinvolvedwithencouragingparticipationinwellnessactivities:[Mymanager]
doesn'thaveaproblemwithmeattending[wellnessactivities].It'slike,meetyourdeadlinesandIm
happy.
Inclusiveness

OfferingabreadthofprogramswithsomethingforeveryoneisacommonstrategyEmployerCusesto
engageawidevarietyofemployees.Employeescanparticipateinawidearrayofactivitiesfroma
marathontrainingprogramtoWeightWatcherstospeakingwithnursesviaatelephonichotline.
Offeringabreadthofprogramsallowsindividualsofallfitnesslevelsandhealthstatusestoengageina
programthatbestmatchestheirneeds.

EmployerCattemptstoincludeemployeesinthefeedbackprocessesonmanylevels.Managementasks
foremployeefeedbackevery18monthstoseethevaluetheemployeesplaceon[wellness]programs.
In2010,thehumanresourcesdepartmentsurveyedemployeeswhoparticipatedinacomponentofthe
wellnessprogramtogetfeedbackonprogramimprovementsandbarriersandmotivatorsfor
participation.Thisfeedbackallowsmanagementtounderstandtheemployeeperspective.Additionally,
employeesareaskedtofilloutasurveyimmediatelyaftertheyattendthebiometricscreeningand
wellnessfair.Ahumanresourcemanagerarticulatedthattheteamtakesfeedbackseriouslyto
implementchangesandmakecontinualimprovements.Forexample,employeeshadreportedconcerns
ofprivacywhilegettingtheirheightandweightassessedatthebiometricscreeningandwellnessfair,so
43

privacyscreensarenowplacedbetweenstations.Someemployeesperceivedtheirfeedbackas
valuable:Yeah,theydefinitelywanttoknow[ouropinion]everytimetheyaskforfeedback,yeah,on
asurvey.Actually,Ithinktheydoagreatjob,whileothersexpressedconcernthattheirfeedback
wasnttakenintoconsideration:thefirsttimeIprovidedfeedbackbutthenIdidn'tseeanything
change,soit'slike,whyamIwastingmytime?Anotherrespondentexpressedsimilarconcern:Ididn't
seeanythingchange.Iaskediftheycouldincludemaybesugarteststoo,andnothingchangedsoIdont
thinkIvebotheredrepeatingmyselfyeartoyear.

Program Results (Documented or Perceived)

Wellness Program Participation

Overall,approximately41percentofEmployerCemployeeshaveparticipatedinatleastonehealthand
wellnessactivityinthepastfiveyears(excludingthereimbursementprogram).Onethird(~1504)ofall
ofthetwomainlocationbasedemployeeshaveattendedbiometricscreeningsoneormoretimes,
whichisbasedonameasuredcountofhowmanyindividualsparticipateinthequarterlyevent.The
facilitiesmanagerreportedapproximately26percentof[maincity]employeesutilizetheonsitegym
facilitiesandatotalofsixtyindividualsutilizebikeroomsatthe[maincitylocations].Women(60%)are
morelikelytoparticipateinwellnessprogramsthanmen.

Duringthefocusgroup,manyindividualsreportedthebiometricscreeningeventwasthemostwell
knownwellnessprogramoffered.Employeesreportededucationalseminarsandtheonlinehealth
questionnairedontreceivealotofattentionorseemtogethighlevelsofparticipation.
Challenges to Participation

Whenaskedwhatspecificchallengeshinderparticipation,severalcommonthemesandbarriers
emerged.Thetopreportedbarriersamongemployeeswere:concernsofprivacy,logisticsandtiming,
andnegativefeedbackfromcolleagueswhichdiscouragedinterestinparticipation.Organizational
leadersidentifiedcommunicationandoutreachastheprimarychallengetoincreaseparticipation.

Privacy:Employeesexpressedconcernaboutprivacyduringthebiometricscreening:Itsthatbigopen
areakindofthing.Ifitwereprobablysetupalittlebitmorediscreetly,Ithinkpeoplemightbemore
inclinedtogo.Whileotherfocusgroupparticipantsexplainedprivacyofhealthdataisanissue:Its
thepersonalinformationreasonBecauseIknowtherespeoplewhohavesaidtheydontwanttheir
anybodytogetaccesstothatinformationortobeabletotrackitoryouknow,whatifthisultimately
endsupinmypersonalpremiumratherthanoverallcompanywideorsomethinglikethat.

LogisticsandTiming:Accesstoonsitebiometricscreeningswasreportedasdifficultbecauselineswere
oftenlongandavailabilityofhealthcoachesunpredictable.Oneemployeecommentedthatalthoughhe
wantedtocompletethescreening,thelongwaitdeterredhisinterestinparticipating:AttimesIve
beenintimidatedbythesheervolumeofthepeoplewhotakeadvantageof[thescreenings]andIthink
thehourscouldbeexpandedorspreadoutbetter.IknowIvegonetherelaterthannowandseeingits
goingtobealongwaitandturnedaround.

NegativeSpilloverEffect:Somefocusgroupparticipantshavewitnessedcolleaguessharingtheir
negativeopinionsofwellnessprogramstofellowcolleagueswithinthedepartment.Inparticular,one
44

employeerecountedtheexperienceofacolleaguesnegativeperceptionofbiometricscreenings,which
inturncreatedanegativespillovereffecttoothercolleagues:
Iactuallyknowsomebodyandsheactuallybodybuilds,sosheworksout.Andwhenshe
went[tothebiometricscreeningevent]shealmosthadafightbecausetheytoldherBMI
wasofftheroof,andshesatthereandtheyarguedbackandforthandfinallyshejust
walked away. She wasn't too happy, so now shes affected everybody around her. So
whenyouaskpeoplewho'venevergone[tothebiometricscreeningevent]theysay,oh,
noIdon'twanttogetthesametreatmentshegot.Soalreadytheresaperceptionthing
becausesomebodyhadabadexperience.

Communication:Fromorganizationalleadersperspective,nearlyallintervieweesconsidered
disseminatingwellnessinformationasaprimarybarriertoimprovingparticipation.Developing
communicationsforoffsiteemployees,mainlythesalesteamthroughthenationalnetwork,hasbeen
oneofgreatdifficulty:Wehaveachallengebecausewehaveindividualsinthefield,withsmallpocket
offices.Itsdifficulttogetthebiometricscreeningprogramoutthere.Onehumanresourcemanager
mentionedtheyhavebeenworkingtodevelopprogramstailoredtothespecificneedsofthesales
team,likeeatingontheroadandmanagingstress.
Facilitators

EmployerCleaderssharedanumberofenablersthathavehelpedmaketheprogramasuccess,
includinganengagedworkforce,managementsupport,thestrongpartnershipwiththeirhealthplan,
andanapproachtorewardemployeesforimprovingtheirhealth.

Engagedworkforce:Oneorganizationalleadercommentedthattheworkforcecompositionmainlya
higheducated,generallyhealthyworkforce,hasmadegeneratinginterestinwellnessmuchsimpler:
Wehaveahighlyengagedworkforce,wehappentobeunique.Ourprogramcouldbeduplicated
somewhereelse,butitwillbehardtohavethesameeffect...whatwedowouldbedeadonarrivalina
manufacturingplant.

PartnershipwithHealthPlan:EmployerChastakenmanyopportunitiestopartnerwiththeprimary
insurertoofferawidevarietyofprogramsandkeeptheoverallbudgetveryreasonable.Asone
organizationalleaderdescribed,havingagoodpartnermakestheprogramasuccess.Wecouldnt
havedoneitalone.

RewardBasedProgram:EmployerCleaderspridethemselvesonusingcarrotsoverstickstomotivate
employeestoengageinprograms.Overall,theprogramleadershaveavoidedtakingapunitive
approachtowellnessprograms;organizationalleadersconsiderrewardamoreeffectiveapproachto
maintainingasustainablehealthandwellnessculture.

SupportofSeniorManagement:Thestronginterestinimplementingwellnessactivitieswasfacilitated
bythefactthatleadershavebeenengagedandgenerallyinterestedinwellness.Seniorexecutives
participateinhealthactivitiesinavisiblewaytovalidatethatwellnessisanimportantcomponentofthe
companysculture.Thissendsastrongmessagetoemployeesthattheirparticipationcontributesto
loweringhealthcarecostsandthatthecompanyiswillingtoinvestinitsemployeeshealthandwell
being.

45

Program Impact
AcomprehensiveevaluationoftheimpactofEmployerCswellnessprogramhasnotyetbeen
conducted,thoughongoinganalysesofclaimsdataandbiometricsandasmallscaleevaluationofthe
healthyeatingprogram(atwelvemonthnutritionprogramadministeredbyathirdpartyvendor)have
offeredadocumentedpositiveimpactonemployeehealthrisksandbehaviorsandcostsavings.Our
interviewswithemployeesandwellnessleaderssuggestthatprogramsimproveemployeemoraleand
haveledtoanevolvingcultureofwellness.

HealthRisksandHealthBehaviors:Atrendanalysisofclaimsdata,conductedbytheprimaryinsurerin
conjunctionwithalargestateuniversity,foundthatindividualswhoparticipatedinbiometricscreening
andhavehadatleasttwofollowupsshowedimprovementsonavarietyofbiometricoutcomes.We
weretoldthatoftheamong1504employeeswhohavecompletedabiometricscreening,70percent
lostweight,80percentofindividualswithhypertensionloweredtheirbloodpressure,andwelloverhalf
of(65%)improvedtheircholesterollevels.Individualswerealsolikelytoimprovetheirhealthrelated
behaviors.Approximatelyhalfofindividualswhocompletedthebiometricscreeningreportedthey
stoppedsmoking(53%)andemergencyroomvisitsdecreased,from17percenteachyear,while
preventivecarevisitshaveincreased,rangingfrom1to4percent.

Aprepostevaluationfromtheoneyearhealthyeatingprogram,participantsshowedimprovedhealth
outcomes,whichonehumanresourcesmanagerarticulatedasunbelievinglycompellingevidence
aboutthepoweroffoodonourhealth.Approximately112individualsatEmployerCcompletedthe
program,ofwhichover50percentreducedtheirBMI,92percentreducedtheirbloodpressure,and83
percentimprovedtheirbloodsugarlevels.Allindividualsimprovedcholesterollevels(100%).

EmployeeSatisfaction:Mostleadersperceivethatemployeesarehighlysatisfiedwithwellness
offerings,wehaveseenaveryhighlevelofsatisfactionwiththeprogram.Mostparticipantsratetheir
satisfactionwithbiometricscreeninginthe90thpercentile.Leadersattributehighlevelsofsatisfaction
withtheprogramtothefactmanagementcaresaboutthem.

EmployeeProductivityandMorale:Focusgroupmembersreportedflexibleworkschedulestoexercise
improvesproductivity.Oneemployeewhousesthegymduringlunchbreaksaysitsimprovedher
energylevelandproductivity.IfeelreallyrefreshedandImkindofreadytogo.Idonthitthat2:00
wallifIgotothegym.WhenIdont,thenIpersonallynoticeadifference.shecommented.I
personallyfeelmoreproductive.Employeesalsoreportedtheyareawarethatthecompanyistaking
measurestoensuretheirwellbeingandgenerallycareabouthealth,whichinturnsbreedsimproved
attitudeandmorale.Onefocusgroupparticipantarticulated:Whenthepeopleareparticipatingin
these[programs]theymaybemorepositive.SoIjustthinkthemoralethatithasthepotentialtobring
aswell.Imean,itwasreally,itwasreallykindoffunwhenwehadthat,thebusinessunitchallengeand
alotofpeoplewereoutdoingthings,reallyexcited.

CorporateCulture:EmployerChasmadeaconcertedefforttoincorporatewellnessintothecompanys
strategicplantocreateavibrantworkplace:Weofferavibrantcultureandwedemonstratethatto
employeesthefactwehavethesewellnessprograms,supportvolunteerism,weknowthisisimportant
[toemployees].Craftinganatmospherethatsupportshealthhasbeenapproachedwiththemottoof
wellnessisanevolution,notrevolution.Oneleaderexplainedthisgradualtransition:Culturaland
behavioralchangetakestime.Youcantexpecttoshiftthingsfromoneyeartothenext]Cultural
changeisoneofthemostdifficultthingsinacompany.
46


Oneorganizationalleadersaidhewastransformedbythecompanyscultureofwellness,Iwalked
into[EmployerC]withoutpriorexperience[inwellness]Icameinasahugeskeptic.Inowbelieve
[wellnessprograms]canhaveanimpact,Iseeitqualitativelyandquantitatively.Ifnothingelse,itsthe
rightthingtodo.

HealthcareCosts:Theprimaryinsurerusesaproprietarymethodtoestimatethesavingsderivedfrom
thewellnessprogrambycomparingEmployerCshealthcarecostagainstanindustrybenchmark.The
evaluationshowedthatthecompanysaved$111permemberin2009,and$261in2010andthistrend
hascontinuedupward.LeadersatEmployerCsharedthatwellnessprogramsconstituteaninvestment
oflessonepercentoftheirtotalhealthcarecosts,buthasreducedmedicalexpensesbyapproximately
twotothreepercentagepointsbelowindustrytrendsince2009.(Industrybenchmarksweregenerated
fromthecompanysBenefitsConsultants.)Leaderswerenotabletopinpointtheexactsourcesofthe
savings,butnotedthatsavingsalignwithmeasurablechangesincareutilizationpatterns:Wenoticed
thesavingssincewevebegunwellnessinitiativesouremergencyroomvisitshavegonedown,andwe
areabovebenchmarkforallpreventivecarescreenings.

ReturnonInvestment:EmployerCreportsanROIforspendingontheworkplacewellnessprogramof
about2.5:1basedonhealthcarecostsavings,i.e.,withoutconsideringbenefitssuchasincreasedmorale
orimprovedproductivity.

EffectofIncentives:Althoughtherehasbeennodirectevaluationoftheimpactofincentiveson
employeebehaviors,manyfocusgroupparticipantsreportedthemonetaryincentiveinfluencestheir
decisiontoattendbiometricscreening:Youwalkinthere,youget$20.Imean,it'sfreemoney.
Similarly,managementacknowledgesthatincentivesofferedarerathermodest(e.g.,$20for
completingabiometricscreening)butaregenerallysuccessfulatcatchingemployeesattentions.
Conversely,employeesstatedthatmanywereunawareofthe$50incentivetheyreceiveforcompleting
theonlinehealthriskquestionnaireadministeredthroughthehealthplanoroptedtonotcompleteit
becauseitwaslogisticallyfrustratingortheyhadforgottenaboutit.

UnintendedConsequencesofIncentives:Nounintendedconsequenceswereidentifiedduring
interviewswithfocusgroupmembersoremployees,thoughonehumanresourcesmanagermentioned
incentivesmaybetrainingpeopletoexpectmoneysimplyforjustdoingwhatsrightwhichmay
decreasetheirlevelsofintrinsicmotivationtoimprovetheirhealthinthelongrun.

Future Directions
FutureplansforEmployerCswellnessprogramincludeeffortstoincreaseparticipationintheonline
healthriskquestionnaireandexploreuseofnonmonetaryincentivestomotivateemployees.First,the
wellnessdirectorattheprimaryinsurerandthecompanyswellnessteamplantodevelopatargeted
marketingcampaigntoincreaseparticipationintheonlinehealthriskquestionnaire.Byincreasing
participation,EmployerCwillhaveaccesstomorerobustdatatobetteridentifyhealthconcerns,which
willthendrivethetypesofprogramstheyofferinthefuture.Second,leadersplantoexplore
alternativeincentivestructuresisafuturepriority.Anorganizationalleadersharedthatthewellness
teamisconsideringalternativeincentiveofferings,likeofferingreductionsinhealthcarepremiumsor
noncashbenefitsthatrelatetohealthandwellness[or]likemoneydirectedtotheirfavoritecharity.

47

Conclusion
EmployerCswellnessprogrambeganasasmallscalepreventiveawarenessprogramandhasexpanded
toacomprehensivewellnessprogram,whichinvolvesvarioushealthandwellnessactivities,from
biometricscreeningstoaccesstoonsitefitnessfacilitiestomarathontrainingprograms.Thewellness
teamatEmployerCbegantheirprogrambyidentifyinggapsinmedicalclaimsdata(e.g.,lowratesof
screeningcolonoscopies)andhascontinuedtoinnovateandexpandofferingsaswellasdevelop
communicationanddisseminationstrategiestopromotehealthtotheiremployeepopulation.The
organizationleveragesoutsideresources,likethecitysstairscampaignandtheAmericanHeart
Associationswalkingchallengetoexpandtheprogramatlittletonocost.Theyhavebuiltapartnership
withtheirprimaryhealthplantoofferonsitebiometricscreenings,seminarsandinformational
materials,andimprovetheirmarketingandcommunicationcampaigns.Thispartnershiphasbeen
crucialforallowingEmployerCtoofferacomprehensiveprogramonwhattheyconsiderashoestring
budget.

Accordingtoourinterviews,theparticipationrateforanywellnessactivityisapproximately41percent,
andaboutonethirdofemployeesparticipateinthebiometricscreeningprogram,thoughfew
employeesreportedattendingseminarsorbeingawareofthehealthriskquestionnaire.Primary
barrierssuchasconcernsofprivacy,timelimitations,negativefeedbackfromcoworkers,anddifficulty
disseminatingwellnessinformationmaynegativelyaffectparticipationratesamongemployees.
EmployerCmakesaconsistentefforttosolicitemployeepreferencesthroughengagementand
feedbacksurveys,andovercomebarrierstoparticipationbydevelopingacultureofwellnessthrough
leadershipbuyinandconsistentmarketingcampaigns.

Thereisdocumentedevidencethattheprogramhasimprovedhealthoutcomes.Participantswho
completedabiometricscreeningshowhealthimprovementslikeweightloss,improvedbiometrics(e.g.,
improvedcholesterollevelsandloweredbloodpressure),andreductionsinsmokingrates.
Organizationalleadersalsoreporthealthcarecostsavingsandapositivereturnoninvestment.
However,thesepositiveoutcomesmaybeinpartattributabletoparticipatingindividualshighlevelsof
motivationtoimprovetheirhealth.Wedidnothaveaccesstotheevaluationmethodologies,and
thereforecannotverifythereportedimpacts.

PerhapsoneofmostprominentfeaturesofEmployerCsWellnessprogramisanorganizational
commitmenttocreateanatmospherethatprovidesworkerswithopportunity,socialsupportand
incentivestoimprovetheirhealth.Thecompanyhasbeenperceivedasbeingonthecuttingedgeof
workplacewellness,andplanstocontinuemakingimprovementsbyincreasingparticipationinthe
healthriskquestionnaire,therebyimprovingtherichnessofemployeehealthdata,andexploringnon
monetaryincentivesthatdriveandmotivateparticipationinwellness.

48

apshotoftheMonthlyNew
wsletterDistributedtoEm
mployerCEm
mployees.
Figure3:Sna

49


Figu
ure4:ImagessofCalorieLaabelsinEmplloyerCsOnsiteCafeteria

Figu
ure5:ImagessofCalorieLaabelsinEmplloyerCsOnsiteCafeteria

50

Employer D: A Manufacturing Company

Ourintentisnttojustshiftcosts,ourgoalistochangebehaviorandbuildawarenessThisprogramhas
notbeeneasy;itsinvasive.Butatthesametimehasitforcedindividualstotakeadifferentlookattheir
lifestyle?Yes.DoIfeelgoodaboutthat?Yes.
OrganizationalLeaderatEmployerD

Organization
Background on the Employer

EmployerDisalargemanufacturergeneratingmorethan$1billioninsaleseachyear.Theorganization
employsnearly9,000individualsinmanufacturingandservicecentersacrosstheUnitedStatesand
Canada.ThemajorityEmployerDsworkforceiscomprisedofmen(57%),withanaverageageof43
years.Theaveragelengthofserviceforanemployeeiseightyears.LeadersatEmployerDconsider
tobaccouseandlifestyledrivenconditions,likeoverweightorobesity,highcholesterol,and
hypertensionasthemostcommonhealthriskfactorsamongemployees.

Healthinsuranceplansareselfinsuredandadministeredthroughamajornationalprovider.Available
planoptionsincludeatraditionalPPOplan,aHealthReimbursementAccount,alsoreferredtoasa
HealthCareAccount(HCA),andaHealthSavingsAccount(HSA).Themajorityoftheworkforce,nearly
60percent,isenrolledintheHealthCareAccount.Approximately20percentparticipateintheHealth
SavingsAccountplanandtheremaining20%inthetraditionalPPO.Allthreeplansoffer100percent
coverageforpreventivecare,includingroutineannualexams,mammograms,paptestsand
colonoscopies,aswellasimmunizations.
Organizational Strategy: Making the Shift from Low to High Employee Engagement

Beginninginthemid1990s,organizationalleadersatEmployerDbecameincreasinglyconcernedabout
reininginrapidlyrisinghealthcarecosts.Inresponsetothisconcern,EmployerDcontractedwiththeir
healthinsurertoprovidevoluntaryonsitepreventivescreeningswiththegoalsofnotonlycontrolling
costs,butalsocreatingasustainablewellnesscultureandimprovingtheoverallhealthstatusof
employees.However,participationrateswerelowerthananticipated,hoveringaround20%.Oneleader
shared:Iwasinvolvedinthebusinesscasewiththepresidentaskingtoinvest[inpreventive
screenings]butbecausetheywerevoluntarywedidnothaveahighlevelofparticipation.Atthesame
time,theindividualswhoparticipatedinonsitescreeningswerealreadyhealthyhighlymotivated
thereforethiseffortseemedtohavelittletonobenefitforimprovinghealthandcontrollingcosts.

Whenthiseffortfailedtomeetitsintendedgoals,EmployerDbeganofferingeducationalseminars:
Wehadlunchandlearns;wewantedtomakesureouremployeeswerebeingknowledgeable
consumersand[teach]whyitisimportanttogetaphysical[exam].Organizationalleaderstappedinto
localresources,suchasprogramsandmaterialsofferedthroughlocalhospitalsortheirinsurer,but
participationremainedpoor.

In2009,overtenyearsaftertheinitiallaunchofwellnessactivities,EmployerDbegantoreevaluatethe
originaldesignoftheprogramandmadethedecisionthattogetpeoplesattention[they]neededto
havealittlebitofapocketbookeffect.Oneorganizationalleaderwasdeterminedtocurtailspiraling
51

healthcarecostsandreachedouttopublichealthexpertsattheCenterforDiseaseControl.After
learningthatthemajorityofspendingintheU.S.onhealthcarewasonlifestylerelateddiseases,he
proclaimed:
Itjustkindofclicked.Imean,thatwasmyepiphanyIvegottenallthediscountsIcan
possiblygetoutof[thecompanysinsurer]orthelocalhospitaloranythingelsesothe
only other lever left to pull is claimsyou know, I cant help a burn victimbut I can
certainly help somebody whos prediabetic from becoming diabetic by helping them
understandtheirhealthrisks.

Inparallel,therisingcostofcoverageprovidedthemotivationtoshifttoamoreassertivewellness
approach:Wehadjustcomeoffofayearinwhichwegota20percentincrease[inpremiums]because
ofunexpectedclaimswehadahighyearanditjustlookedlikeitwasgoingtobehigher.

Startingin2010,EmployerDmovedfromavoluntaryprogramthatencouragedparticipationthrough
outreachandeducation,toanoutcomesbasedincentiveprogramwithbuiltinpremiumdifferentials
basedonanumberhealthriskfactors.Thisshiftincreasedparticipationinonsitewellnessscreenings
frombelow20percentparticipationto99.8percent.

Wellness Program Description

Program Development and Implementation

Wellnessactivitiesfallprimarilyintotwocategories:datacollection(e.g.,biometricscreenings)and
interventions(e.g.,fitnesscompetitions).Anumberofindividualswithintheorganizationandthird
partyvendorscollaboratetodevelopwellnessstrategiesandprogrammingaswellasmanagedayto
dayoperations.

Atthecorporatelevel,aninternalteamofexecutivesandhumanresourcesleadersisinchargeofthe
wellnessprogramsstrategicdevelopment.ACommunicationsManagerproducescommunication
materials,enhancesonlinecommunications,andcoordinatesmessaging,primarilytomanufacturing
employeesacrossvarioussites.In2009,thecompanyhiredaWellnessCoordinatortoexpandwellness
activitiesandinterventionsandtocollaboratewithvendors.Atthesitelevel,humanresources
managersareresponsiblefordirectlycommunicatingtoemployeesandencouragingparticipation.To
supplementtheseefforts,somesiteshaveidentifiedemployeesaswellnesschampionstogenerate
enthusiasmandcommunicatehealthrelatedmessages,particularlytoemployeesintheproduction
fieldwhoaredifficulttoreach.

EmployerDcollectsdatathroughathirdpartyvendor,whichisresponsibleforadministeringthe
companysonsiteannualhealthscreening.Thevendorcompilestheresultsofthebiometricscreening,
whichprovidesmeasuressuchasbloodpressure,cholesterol,bodymassindex(BMI)and
tobacco/nicotineuse.Thevendorthenprovidesfeedbackreportsonfindingsonacompanywideand
sitelevel,andmailsemployeestheirindividualresultsfromthebiometricscreenings.Meanwhile,
EmployerDsinsurerlinksplanparticipantstoanonlinehealthriskassessment,educationalmaterials,
andnursehotlinesforatriskemployeesandisalsoresponsibleforcompilingdatafromthevendorto
setindividualpremiumratesbasedonbiometricscreeningdata.

52

Identifying Employees for Participation

AllwellnessactivitiesatEmployerDarevoluntaryanddonotrequirethatemployeesparticipate.
However,individualswhodonotparticipateintheannualscreeningsaresubjecttoaweeklypremium
surcharge(e.g.,wellnessadjustment)of$50,whichisappliedtotheirmedicalplancontributions.

Thedatacollectionvendoralsoidentifieshighriskindividualswhomaybenefitfrombehavioral
modificationordiseasemanagementprograms.Thevendorchannelsprofilesofhighriskemployeesto
thecompanyshealthplanadministrator,whothenlinksthemtoanursehotline.Althoughindividuals
arecontactedbyanurse,theyarenotrequiredtoparticipateinrecommendedinterventions.
Program Costs

ThewellnessbudgetatEmployerDisestimatedat$625,000peryear.Approximately$600,000is
allocatedforfeesassociatedwithservicesadministeredbythethirdpartyvendor.Servicesinclude
coordinatingscreenings,outreachtoemployees,datacollection[andreporting],administeringany
appealsfiledduetomedicalissues,andarrangingreasonablealternativesforindividualswhocantmeet
biometricbenchmarks.Theremaining$25,000isreservedforothermaterialsforwellnessinterventions
andsmallrewardsforparticipatinginorwinningthesecompetitions(e.g.,dufflebags,yogamats).
Wellness Events and Activities

EmployerDcurrentlyoffersawidearrayofwellnessinitiatives,includingweightlossprogramsand
fitnessactivities,andhasmademodificationstotheworkplaceenvironmenttoencouragehealthy
eatinganddiscouragesmoking.Manyoftheseprogramsarerelativelynew,havingbeenjustrecently
implementedorstillinexperimentalstageswiththeintentofrollingoutinthenextcalendaryear.
Belowisadetailedlistofthevariouswellnessinitiativesthecompanycurrentlyoffers:

ProgramsAdministeredbyHealthPlan
OnlineHealthRiskAssessment:Thereisanonlinehealthriskassessment(HRA)availableto
employeesthroughtheinsurerswebsite.TheHRAisvoluntaryandemployeesmustcomplete
theassessmentontheirowntime,butassistanceisavailableonsiteifrequested.If[an
employeeis]notcomputersavvyandwantssomehelpenteringdataintoahealthrisk
assessmentorsomethinglikethatwelldothat.In2009,completingtheHRAwasrequiredof
employeesduringtimeofopenenrollment,butduetologisticalchallengesanddifficulty
arrangingcomputertime,ithasbecomeavoluntaryoption;Toomanypeoplewerehaving
majorproblemswithityoudon'thavetodoitnow.
AccesstoOnlineResources:Therearenumerousresourcesavailableforemployeesonline
throughthehealthplanincludingBMIcalculators,caloriecounters,recipes,smokingcessation
resourcesandhealthsurveys.
SubsidizedGymMemberships:Healthplanparticipantsareabletojoinanumberofqualified
gymsfor$25.00permonth.

ProgramsAdministeredbyThirdPartyVendor
AnnualBiometricScreening:Since2010,EmployerDhasofferedannualonsitewellness
screeningstomeasuresover6,000employeesthroughouttheU.S.onanumberofbiometric
indicatorsincludingBodyMassIndex(BMI),bloodpressure,cholesterol,andtobacco/nicotine
use.EmployerDoutsourcesthisservicetothethirdpartyvendor,whocontractswithlocal
53

medicalstafftoadministerthescreenings.EmployerDarrangesnursestovisithomesof
employeeswhoworkremotely,mainlysalesrepresentatives,toconductthescreening.

ProgramsAdministeredbyEmployerD
TheBiggestLoser:Thisisaneightweekweightlosscompetitioninspiredbythetelevisionshow
TheBiggestLoser.Participantsweighinonabiweeklybasisandhavetheirprogress
monitoredthroughoutthedurationoftheprogram.Employeesareprovidedwithhealthy
recipes,linkstogymmembershipdiscountsthroughtheinsurerandotherinformationwith
healthrelatedtips.WinnersreceiveawardssuchasafreePaidTimeOffday,ahealthylunch,or
sweatshirts,aswellasanacknowledgementletterfromthecompanyspresident.
GettotheHeartoftheMatter!:Inthisprogram,employeesaregivenExcelsheetstotracktheir
walkingdistanceandroutines.Theorganizationalsopostsinformationalflyersinofficesand
sendsoutonlinewellnessblastswithhearthealthytipstoparticipants.
CommittoBeFit!:Thiseducationandfitnessprogramtargetsimprovingweightandblood
pressureoutcomesbybuildingawarenessaboutexerciseandnutrition.Employeesearnpoints
bymeetingtheirweeklygoalsforexerciseanddailyconsumptionofwater,fruitsand
vegetables.Employeescantrackpointsonlineorbypaper,whicharethenconsolidatedand
recordedbyawellnesschampion.Winnersareawardedwithahealthycookbookandatraveling
trophy.
OfferingHealthierAlternatives:EveryFriday,thecorporateofficetraditionallysetsupa
popcornmachineinthebreakroom.Morerecently,EmployerDhasbeenofferingapplesasa
healthieralternative:Wegettwoboxesofapples.Soanybodywhowantstogointherecan
havepopcornortheycangetanappleWevegottenbetter.Theyalsoofferahealthier
vendingmachinewithsaladsandsandwiches.However,employeesstatedthismachinedoesnt
attractemployeesbecauseitlacksfreshnessandiscostlyatthreedollarsfor[a]littlebitty
littlesalad.
LabelingVendingMachines:EmployerDusesvisiblepromptsonvendingmachinesintheform
ofstarstickersandposterstoidentifyandpromotehealthieroptions.Healthfuloptionsare
basedonfat,caloric,andsodiumcontent(Figure7).
EliminatingSmokingBreakRooms:Indoorsmokingbreakroomshavebeeneliminatedatmany
manufacturingplantsandsmokingisnowonlyallowedoutdoorsindesignatedareas.
Alignment with Health Plan

EmployerDhashadanongoingpartnershipwiththehealthplanforassistinginwellnessprogram
developmentandadministration.Whentheprogrambegan,theinsurerhelpedconductthevoluntary
screeningsandprovidededucationalseminarsandmaterials.However,participationwaslackingand
theseprogramsneverflourishedtotheextentanticipated,thereforeorganizationalleaderslookedto
othervendorstoexpandtheprogram.

ThepartnershipbetweenthethirdpartyvendorandEmployerDwasthecrucialstepforbuildingthe
wellnessprogramasitexiststodaywithafocusonresultsandhighemployeeengagement.The
vendorhasfullresponsibilityforadministeringtheonsitescreening,collectingdata,andproducing
feedbackreportsthatcomplywithnondiscriminationregulationsandprotectprivatehealth
information.Oneorganizationalleadershared,IknewearlyonIdidnotwantanyofmy[human
resource]peopledealingwithprivatehealthinformationIdontwanttoknowwhatpeopleshealth
risksare.Anotherorganizationalleaderarticulatedwealwayscommunicatethatwedontknow
results[ofthescreening].
54


Anotherimportantrolethevendorplaysistooverseetheprocessandprovidereasonablealternatives
foremployeeswhoarentabletomeetthebiometricbenchmarkssetbythevendor.Oneleader
explainedthatemployeescanreachoutdirectlyto[thevendor]Forexampleifawomanispregnant,
ifitisunreasonablefor[her]tomeetcertaingoals[she]canappealthetestresults.[Thevendor]hasa
verystructured,consistentstandardprocesstotakeindividualsthroughtheappealsprocess.Another
leaderemphasized,Wehighlyencourageindividualstocall[thevendor]ifanemployeethinksthe
measuresarentaccurate.

ThethirdpartyvendorssystemicapproachforscreeningemployeeshasallowedEmployerDtocollect
comprehensivedataonhealthrisksthatwillallowEmployerDtoevaluateoutcomesandbehavior
trendsovertime.OngoingdatacollectionwillallowEmployerDtoassessemployeesbehaviorsand
conditionsovertimeandtailorwellnessprogramsaroundthesespecifichealthrisks.

Engagement Strategy
Incentives

HealthPlanIncentives:EmployerDswellnessprogramstiefinancialincentivestoanemployee'sability
tomeetspecifichealthoutcomes,suchasbloodpressure,tobacco/nicotineuse,cholesterol,orbody
massindex(BMI),whichareassessedannuallyduringonsitescreenings.Employeeswhooptoutofthe
screeningspayapremiumsurchargeof$50perweek.Employeeswhocompletethescreening,butdo
notachievetherequiredstandards(orhealthgoals)haveanincreaseof$6.25to$12.504perweek
dependingonhowmanygoalstheydonotmeet.Employeeswhomeetallgoalsreceivea$2premium
crediteachweek.ThespecificcriteriaandpointsystemisoutlinedinFigure8.

EmployerbasedIncentives:Otherincentivesforwinningchallenges,suchasCommittobeFit!orThe
BiggestLoser,includenoveltiessuchasduffelbags,tshirts,cookbooks,ticketstothemeparks,andyoga
mats.Inaddition,employeesreceivePointsthroughtheinsurer,forcompletingahealthquestionnaire
orotherhealthsurveys,whichcanbetradedforavarietyofprizes(thoughmanyemployeesare
unawareofthisbenefit).
NonFinancial Avenues to Increase Engagement

Focusgroupparticipantsreportedthatsocialpressure,particularlyweighinsforTheBiggestLoser,
encouragesongoingengagement.Oneemployeecommented,Itsbetterwhensomeonesthere
weighingyou,notyourself.Shewentontosharehersuccessstory:

TheHealthInsurancePortabilityandAccountabilityAct(HIPAA)permitsemployerstoofferincentivesbasedon
outcomesofupto20%ofthetotalannualcostofcoverage.Thecostofcoverage(forasingleindividual)at
EmployerDisestimatedat$7096,thereforethemaximumoutcomesbaseddifferentialof$14.50perweek,or
$754peryear,isapproximately11%thecostofcoverage.The$50weeklysurchargeisbasedonparticipationin
screenings,notoutcomes,andthereforedoesnotfallunderHIPAAregulations.

55

Iwanttotrytodobettereverytimeformyself,youknow?Onceamonth,they'llhavea
birthday[party]bringcakesinandallkindsofgoodstuffIwalkedrightby[thecake]
andIsaidno,Igotaweighintomorrow,inthemorning.AndIwassoproudofmyself
thatmorningwhenIwenttoweighinbecauseIdidn'teatit.IsaidIdon'tneedit.Idon't
wantit.

Oneorganizationalleaderemphasizedtheimportanceofpeerpressureforengagementandimproving
health:Ifsomeoneisholdingmeaccountable,Immorelikelytofollowthrough,versusblowingitoff
andnotmakingitapriority.
Communication/Marketing Strategy

EmployerDutilizesmultiplecommunicationchannelstoinformemployeesofwellnessactivities.
Variousoutreachapproachesareconsiderednecessaryduetothediverseemployeepopulation,ranging
fromsalesrepresentativestocorporateleaderstomanufacturingworkers,whoarelocatedatmore
than30sitesthroughouttheU.S.andCanada.

Onelineofcommunicationisthewellnessportalonthecompanysintranet,whichisconsistently
updatedwithwellnessnewsandevents,gearedprimarilytoemployeesinthecorporateoffice.One
wellnesschampionexplainedthatshesendsemailswithafewexercisesorrecipestoalistservof
individualswhohavevoluntarilysignedup.Shebelievestheyarefrequentlyoverlooked:Wejustsee
theemails,andwhetheryoupayattentiontothem,whoknows?Otherwiseyouignorethem.

Mailings,likeweeklynewsletterswithhealthadvice,flyersannouncingupcomingcompetitionsor
noticesofannualonsitescreenings,arepostedinbreakroomsatthemanufacturingplantsanddropped
inemployeesmailboxes.Oneemployeesaidshenoticessomeoftheseannouncements,specifically
thatrecipesandnewslettersgetprintedoutandputonthebulletinboards,whilethemajorityof
focusgroupparticipantsdidntrecallseeingpostsorothercommunicationmaterialsregardingwellness.
Duringourvisitweobservedwellnessinformationandnewsletterspostedonbulletinboards.

Linemanagersareresponsibleforcommunicatingmessagesaboutwellness,particularlyduringteam
meetings:Alotofitiscommunicatedthroughourlittlehuddleonewastalkingaboutoneofthe
wellnessprogramsThatifyouwantedtosignup,gaveusthedatesandstuff,andthenwheretogoand
signup.Whileanotheremployeesharedthatwellnessnewsisrarelydiscussedduringherteam
meetings:noonereallyeventalksaboutthedifferentprograms.

Toimprovetheeffectivenessofwellnessmessaging,ateamoforganizationalleadersisintheinitial
stagesofdevelopingarecognizablebrandandlogofortheprogram,whichwillbeappliedtobothonline
andprintedcommunications.
Leadership Support

Priortothe2010restructuringofthewellnessprogram,leadersmettodevelopathorough
implementationandrolloutstrategy.Oneleaderarticulatedtheplanningprocessasfollows:
Theonethingwehavetohaveisalignmentamongtheleadershipteam.Thatswhywe
discussedthingssomuchtherearesomeculturesandsomecompanieswhereitsvery
muchmywayorthehighway.Thatsnotusandthatkindofcompanywouldimplement
thewellnessprogramalotdifferentlythanwedidandIkindoflikethewaywedidit.
56


Leadersdescribedthewellnessprogrambeingimplementedforawidevarietyofdifferentreasons.
Someleadershadthedesiretoimprovewellnesscultureandpromoteawarenessthatcanonlybe
measuredinsoftdollars.Anotherleadersharedthataddressingrisingcostswastopontheagenda
[we]hadadesiretoconserveactualspendingtherehastobeafinancialramification,especially[since
employees]arenotashealthyastheaveragepopulation.Anotherleaderarticulatedthatthewellness
programwasacorporateresponsibility,notonlytothesustainabilityofthecompany,butalsotothe
communityatlarge:Igrewupinthiscommunity,itsimportanttometohavejobsavailablewithinour
communityandforEmployerDtocontinuetobeviableasabusinessingeneralsowecancontinueto
employindividuals.

Messagesfromexecutiveleadershipprimarilycomefromthepresidentviaemailandhardcopyto
promoteahealthyworkcultureandadviseemployeesofupcomingscreenings.Lettershavepositive
andemployeefocusedmessages,suchaseveryonebenefitsfromhavinghealthyemployees,
preventivecareisfreeinall[health]plans,andhealth[shouldbe]atoppriority.

Focusgroupparticipantsgenerallyreportedthatbeyondhuddlemeetings,theirdirectsupervisorsare
toobusyandrarelydiscusswellnessactivitiesorencourageparticipationinprograms:Theydon't
knowanythingaboutitthey'reeverywhereelse.Althoughplantmanagersdonotactivelypromote
wellness,anemployeesharedthattheydoengageinactivities:Atourplant,wehaveseveral
[individualsin]managementthatactuallydoTheBiggestLoserandallthatstuff.
Inclusiveness

Organizationalleadershaverolledoutavarietyoffitnessactivitiesandprovideeducationalmaterials(as
detailedinWellnessActivitiessection),andallemployeesarewelcometoparticipate.However,
individualsinthemanufacturingplantoftenarenotabletoduetotheirinflexibleworkschedules:
NobodyevergetsoffatthesametimeThatsthethingwiththeladywho'sdoingwalkingatlunch.Her
lunchtimeisdifferentthanmylunchtime.Further,theseemployeesmissemailblastsanddonothave
readyaccesstothecompanysintranet.Althoughawidearrayofprogramsismeanttoimprove
inclusiveness,thesestructuralbarriersmayunintentionallylimitaccesstocertainprogramsand
messagesforthemanufacturingemployeepopulation.

Sincemanywellnessactivitiesarerelativelynew,theWellnessCoordinatorhasmadeinitialattemptsto
includeemployeesinthefeedbackprocesstoimprovefutureprogramming.Followingthecompletionof
TheBiggestLoserprogram,theWellnessCoordinatordistributedsurveystoemployeestosolicit
feedbackwiththegoaltoimprovefutureprogramming(Figure9).Duringthefocusgroupdiscussions,
whenemployeeswereaskediftheyrecalledseeingafeedbacksurvey,oneemployeeresponded:Yes
ontheonesurvey,theyasked,whichonesyouparticipatein?Whichonesdidyoufindmostuseful?
Butthissameindividualreportedshedidnotcompletetheform.Themajorityoffocusgroup
participantssaidtheydonotrecalleverseeingafeedbacksurvey,yetalonecompletingit.Thewellness
championresponsibleforcompilingresponsesfurthersupportedthisclaim:IknowIcollected[the
feedbacksurveys]intheoffice,andthereweren'tthatmanythatactuallydiditthere'snotthatmany
thatofferedsuggestions.

Althoughresponseratesarelow,employeesreportedtheybelievethecompanyvaluestheiropinions
andcaretoimprovewellnessactivities.It'sreallycomealongway[Companyleaders]arereally
lookingatwellness.
57

Program Results (Documented or Perceived)

Wellness Program Participation

EmployerDhassuccessfullymotivatednearlyallemployeestoparticipateinwellnessscreenings.
Thoughtheydonotformallytrackparticipationinmostwellnessactivities,theydotrackparticipationin
TheBiggestLoser,whichaccordingtofocusgroupparticipants,isthebestknownwellnessactivity.
Manufacturingemployees,whichmakeupthemajorityoftheemployeepopulation,havesignificantly
lowerparticipationratesthanemployeesatthecorporateheadquarters,whichcompriselessthanten
percentoftheemployeepopulation.Tenpercentofallemployees(n=629)participateinthisweight
lossprogram,andnearlyaquarterofthoseparticipating(n=140)areemployedinthecorporate
headquarters.Manufacturingemployeeshavesignificantlylowerparticipationratesthanemployeesat
thecorporateheadquartersmanufacturingemployeesthatparticipateintheseprogramsisDiscussions
withfocusgroupparticipantsalsorevealedthatotherinitiatives,suchasthoseofferedthroughthe
BCBSwebsite,subsidizedgymmembershipsandCommittobeFit!weresignificantlylesspopularamong
staff.
Challenges to Participation

Employeesdescribedrigidschedulesandmisalignmentofprogramswithhealthneedsaskeybarriers
forparticipatinginprograms.Organizationalleadersidentifiedcommunicatingacrossageographically
dispersedanddiverseworkforceastheprimarybarrierforimprovingemployeeengagement.

ProgramMisalignmentwithEmployeesNeeds:Manufacturingemployeeswork12hourdays,and
havebeenontheirfeetallday,anddidnotreportexerciseprogramsasaneffectiveapproachto
improvetheirhealth.Bycontrast,interviewswithorganizationalleadersrevealedastronginterestin
programsonphysicalactivityandtrackingtheprogressoftheseactivities.

Manufacturingemployeesexpressedastrongdesiretohaveincreasedaccesstohealthyfoodatthe
worksite.Theyreportedtheyfelttemptedbysnackmachineswhereunhealthyoptionsarereadily
availableandthehealthieroptionsarentfitforadog.Biscuits,gravy,andbaconweredescribedas
staplesduringbreakfastsocialsandcakesarebroughtintocelebratebirthdays.Onefocusgroup
participantsuggestedheavierfoodsbereplacedbybananasandangelfoodcakeduringpartiesand
fruitbeavailableratherthansnackfoodinbreakrooms.Oneparticipantsaidsometimessheishungry
atworkandherbestoptionistogetaSnickerssoshecanstayfull.

SchedulesofManufacturingWorkers:Employeesnotedthattheirschedulesdontallowthemto
participateinsomeactivitiesduetotheirworkschedule.Oneemployeedescribedthedifficultyin
coordinatinggroupactivitiesorworkouts:Westagger[schedules].Iwork8:30to5:15.We'vegotone
thatworks9:15to6:00.Soit'shardtryingtogetagrouptogetheratagoodtime.Anotheremployee
notedthatthecompanytriedtoencouragehealthyeatingbyprovidingdiscountsatSubwayduringthe
lunchhour,butshewasunabletotakeadvantageofthisbenefitbecause[she]couldn'tgettoSubway
andbackduringherallottedworkhourbecauseit'sallthewayacrosstown.Employeesalsoreported
thattrackingnutritionandactivitywereaburdensomeduetotheirirregularschedules:Itwasn'tlikeI
workMondaythroughFriday,youknow?Iforgottobringmy[tracking]paper.

CommunicatingtoDispersedPopulation:Fromorganizationalleadersperspective,disseminating
wellnessinformationisachallengetoimprovingparticipationinwellness.Developingcommunications
58

thatengageemployees,mainlyinmanufacturing,andtoalesserdegree,offsitesalesrepresentatives,is
afrustrationforleaders:Howcanwekeeptheprogramalive?oneleaderconcernedlyasked.We
havewellnesschampionsatsitestotrytoengageindividuals,butbecausethepopulationisso
dispersed,itsdifficult.Duetochallengesofcommunicatingwiththeiremployeepopulation,leaders
arelookingtovendorsforhelp:Weneedtopartnerwithavendorthatcanhelpusengageour
employeepopulation,specificallyouremployeesthatareofhigherrisk.Wehavetalkedtodifferent
vendorsonhowtocommunicatetoindividuals.
Program Strengths

EmployerDswellnessprogramhasachievedhighparticipationratesforonsitescreenings,and
encouragesparticipationinwellnessactivitiesthroughthesupportofseniormanagementanduseof
wellnesschampionstogenerateonthegroundexcitementamongemployees.

NonparticipationSurchargeMotivatesParticipationinScreenings:The$50weeklypenaltyforopting
outofonsitescreeningshasresultedin98.9%participation.Thisisasubstantialimprovementoverthe
20%participationrateinnonincentivizedscreenings.

SupportiveManagementCultivatingaCultureofWellness:ExecutiveleadersatEmployerDhave
strongpersonalinterestsinwellness:oneisaformermarathoner,othersmeetforlongdistancebiking
trips,andtheexecutivewellnesssponsorisanationallyrankedpowerlifter.Leadersviewwellnessas
therightthingtodoanditisadvocatedbytopleadership;Itsjustpartofourvaluesystem,one
leaderexplained.Aletterfromthepresidenttotheemployeepopulationreads:Wefeelthevalueof
goodhealthisundeniable.

InvolvingMotivatedStafftoImproveEngagement:TheWellnessCoordinatorselected24employees
acrossvarioussitestoactaswellnesschampions.Theseindividualsworkwithintheirdepartmentor
teamsencourageemployeestogetinvolvedinwellnessactivities.Onewellnesschampiondescribedher
role:Iemailthegroupthathassignedupforthewellnessprogram,andI'llattachafewexercisesor
recipes.Butjustkindofkeepeverybodykindofpumpedup,youknow?

Program Impact
Sincebiometricdatahasonlybeencollectedfortwoyears,acomprehensiveevaluationoftheimpactof
EmployerDswellnessprogramhasnotbeenconducted,thoughdatacompiledbythethirdparty
vendorprovidesfeedbackreportsthatallowleadersatEmployerDtoobservetrendsinhealthrelated
behaviorsfromthe2010and2011screenings.Discussionswithorganizationalleadersandfocusgroup
participantsyieldedmixedperceptionsofwellnessprogramming,withnotablevariationacross
employeetype;manufacturingemployeesreportedmisunderstandingsofwellnessprogram
components,anddonotconsidertheonsitescreeningaspartofthewellnessmission.

HealthRisksandHealthBehaviors:Thethirdpartyvendorcompilestheresultsofthescreeningsand
producesfeedbackreportsforEmployerDatthecorporateandsitelevel.Thedatafrom2012reveals
that58percentofemployeesatEmployerDpayawellnessadjustmentabovethebaselinepremiumand
in2011,atotalof47appealswerefiledtodisputetheresultsofthescreenings.

59

Datafrom2011and2012feedback5reportsaredescribedbelow:
Atotalof2000individualslost16,000lbs.
In2012,62%ofemployeeshadBMIof30orunderversus63%in2011.
In2012,77.7%mettheLDLcholesterolgoal,versus76.2%in2011.
In2012,81.5%metgoalforbloodpressureversus82.7%in2011.
In2012,62.5%hadnormalglucoseversus65%in2011.6
33individualsquitsmokingfrom2011to2012,whichtranslatestoaonepercentagepoint
decrease(32%to31%)inthetotalnumberoftobaccousersnationwide.

Focusgroupparticipantsrevealedthattheirownmotivationwasthemostimportantfactorfor
improvingtheirhealth,butprogramsserveasreminderstohelpthemtostayontrack.

EmployeeSatisfaction:Therehasnotbeenaformalevaluationtoassessemployeesatisfactionof
wellnessprograms,thoughfocusgroupparticipantsreportedtheyarepleasedwithwellnessprograms:
Ilikethewellnessthings,Ienjoyit.However,someemployeesreportedoverhearingcolleagues
complainoftheprograms:theydontwantnothingtodowith[thewellnessprograms]there'salotof
themouttherethatjustdon'twantnothingtodowithit.Youcouldn'tmotivatethemtodoit.

CorporateCulture:Interviewswithleadersandemployeesrevealedmixedopinionsaboutthewellness
cultureatEmployerD.OrganizationalleadersmadeitclearthatpartofEmployerDswellnessstrategyis
tocreateahealthyworkplaceenvironment:Weasanorganizationvaluewellness,thatsanincentive
Wehavetobeaplacethatpeopleareproudtosaytheywork.Organizationalleadersconsider
wellnessaspartofthenorm:Thereisalwayssomething[wellnessrelated]goingon,itseemslikeit
[wellness]hasbeenaroundforalongtime.However,somefocusgroupparticipantsreportedthat
wellnessisrarelymentionedordiscussed,asoneemployeecommented,Wedon'ttalkaboutitthat
often.

HealthCareCosts:EmployerDhasnotyetmadeanattempttodetermineprogramimpacton
healthcarecostandreturnoninvestmentsincetheprogramwasrevampedtwoyearsago.However,the
premiumdifferentialsincreasedemployeecontributionstocoverageby$1.2milliondollarsin2011,of
whichapproximately$625,000wasspenttorunthewellnessprogram.Oneleadershared,[We]want
tocoverthecostsoftheprogramwiththispremiumdifferentialbeyondthatitsaninvestmentinthe
[wellness]program.

EffectofIncentives:Theweekly$50premiumsurchargehasresultedinnearly100percentparticipation
inwellnessscreenings.Employeesreported,[We]alldoitbecause[we]don'twanttohavetopaythat
extra$50andit'sexpensive!Althoughthe$50surchargeincentivizesparticipation,focusgroup
membersdidnotreportpremiumdifferentialsasamotivatortochangetheirhealthbehavior;infact
manywereunawareoftheirownpremiumpayoutsorresultsfromthescreening.Someorganizational
leadersreportedtheyweremotivatedbythepremiumsurchargeknowingtheycouldsaveafewdollars
throughgoodbehavior.Anotherorganizationalleaderadmittedthepremiumsurchargewasatipping
pointtohelphimquitsmoking.

Datafrom2011and2012feedbackreportswerederivedfromscreeningsthatoccurredinFall2010and2011.
Thismeasureisnotincludedtodetermineemployeespremiumdifferential,butisreportedtoemployeesfor
educationalpurposes.
6

60

Focusgroupparticipantsreportedsmallrewardsdonotnecessarilyinfluencetheirdecisionto
participate,butdocapturetheirattention.Noveltiesliketshirts,duffelbagsandticketstothemeparks
wereperceivedasattractive:Itsnicegettingthoselittlerewards.Employeesreportednontangible
rewards,suchasafreeparkingspaceorpaidtimeoffwouldmotivatethemtoenrollorcomplete
programs.

UnintendedConsequencesofIncentives:Asdescribedabove(inCommunication/MarketingStrategy
section),broadbasedcommunicationstrategieshavebeenusedtoinformemployeesaboutwellness
screenings/premiumdifferentialsaswellastherolloutofwellnessactivities(e.g.,TheBiggestLoser).
Thethirdpartyvendorisprimarilyresponsibleforcoordinatingandcommunicatingmessagesabout
screeningsandpremiumadjustments,whilemessagesonwellnessactivitiescomefrominternal
sources,suchasdirectsupervisors,executivesandemployeechampions.Thesevariouscommunication
channelsappeartohaveunintentionallycreatedconfusionamongemployees.Duringthefocusgroup,
employeesdidnotrecognizewellnessscreeningsasacomponentofEmployerDscomprehensive
wellnessprogram.

Whenqueriedaboutwellnessscreenings,onefocusgroupparticipantresponded,Thatsnotthe
wellnessprogram,that'sourinsurance.Anotheremployeecommented,Thescreening,yeah,wehave
todoitforinsurance.Employeesperceivewellnessactivitieslikefitnesscompetitionsandnutritional
trackingasthewellnessprogram,whileconsideringthewellnessscreeningsasameanstoacquire
healthcoverage.Accordingtofeedbackfromfocusgroupparticipants,thepremiumadjustmentsmay
fallshortoftheirmissiontoraiseawarenessandspurbehaviorchange.

Anotherunintendedconsequenceofthewellnessprogramisthatthelocalmedicalstaffcontractedby
thevendorforhomescreeningswentbeyondtheircontractualdutiesandoutreachedtoseverelyhigh
riskindividualsinneedofurgentmedicalcare.Nursescalledindividualswho,basedontheirwellness
screenings,wereofparticularlypoorhealth.Thisoutreachmayhavesavedlivesorprevented
emergencyhospitalization:
thefirsttimewediditIthinkthereweresixpeoplethatgotphonecallsfrommedical
staff,thatwasnotpartofthecontractthatwehadwiththem,buttheycalledandsaid,
Wethinkyououghttogotothedoctorortothehospitalimmediatelybecauselooking
atyourbloodpressure,yourtriglycerides,youareinimminentdangerofaheartattack.
And,oneor twoofthose peopleactuallycameforwardand said,youknow,Iwentin
andIhadnoideaIdidntrealizeIwasonthevergeofaheartattack.

UnintendedConsequencesofIncentives:Judginghealthrisksacrosssitesorbyemployeetypeis
difficultbecausecomparativedataislimitedandnoformalanalyseshavebeenconducted.However,
initialdatasuggestaslightlygreaterburdenonmanufacturingworkerscomparedtocorporate
employees.Companywide,manufacturingemployeestendtohavepoorerhealthstatusandhealth
behavior,inparticularwithrespecttosmoking.Smokingisagoodexample,onlyabout11percentof
ourpeoplesmoke,whereasmanufacturingemployeeshavesmokingratesatabout30percent.
However,organizationalleadersarecarefultodrawtoomanyconclusionsandcanbetterunderstand
thesediscrepanciesasmoredatabecomeavailable.

Asecondunintendedconsequenceisthatincentivesbasedonoutcomesmaydemotivatethe
employeeswithparticularlyhighhealthrisksfromimprovingtheirhealthbecauseitmayseemtoo
difficulttomakechange.Organizationalleadersmentionedsomecomplaintstheyheardfrom

61

employees:ImnevergoingtomeettheBMIgoal,sowhyshouldItry?andifyou'reobese,you'renot
goingtowanttotryifyouhavetogetacertainlevel.

Future Directions
Inresponsetoconcernsofdeterringthehighestriskemployeesfromimprovingtheirhealth,starting
Fall2012EmployerDwillrecognizeprogressgoalsformakinghealthimprovements(e.g.,twopoint
decreaseinBMI)ratherthangoalsbasedsolelyonoutcomes(e.g.,requirementtomeetBMIof30or
below).Oneleaderarticulated,themovementtowardsprogressgoalsis[away]todrawpeopleto
action.Wedontwantourgoalstoseemunachievable.

Inaddition,organizationalleadersintendtoimproveemployeeengagement.Oneleadershared,
employeesaregenerallydisengagedfromtheresultsoftheirscreeningsweplantoworkwithvendors
tofigureouthowtoengageindividuals.Inthemoredistantfuture,oneleadersaidshewouldliketo
bringpeopleonsitefromahealthcoachingperspectivetomeetwithanindividualabouttheirresults,
becauseaccountabilityisimportant.

Conclusion
EmployerDswellnessprogrambeganovertenyearsagowhenthecompanypartneredwiththehealth
plantoimplementvoluntaryonsitewellnessscreeningsandeducationalprograms;however,these
programsneverachievedthelevelofuptakeneededtomakeasubstantialimpactonhealthrelated
behaviororrisinghealthcarecosts.In2009,organizationalleadersgrewincreasinglyconcernedwith
increasingpremiumsandtheoverallpoorhealthoftheiremployeepopulation.Executiveandhuman
resourcesleadersconvenedtodevelopacomprehensivewellnessstrategy,andresolvedtolooktoa
thirdpartyvendortoadministeronsitewellnessscreeningswithpremiumsurchargesforemployees
whodidnotparticipateormeetcertainhealthgoals.Inparallel,thecompanyrolledoutvarious
wellnessactivitiesfocusedonfitnessandimprovednutrition.

ThevendorisresponsibleforcollectingdataandproducingfeedbackreportsforEmployerD,whichhas
allowedthecompanytoobservehighlevelchangesinemployeehealthbehaviorsandoutcomesover
time.Dataarerelativelynew,andnoformalanalysisonimprovedbehaviororoutcomeshasbeen
conducted,butleadershaveobservedmixedresults.Thereissomeindicationofimprovedhealthrisks
(e.g.,reducedsmokingamongemployees),whileotheroutcomesseemtobeunaffected(e.g.,glucose
levels).Interviewswithemployeesrevealthatindividualshave,tosomedegreemodifiedtheirshort
termbehaviorasaresultoftheseprograms,orattheveryleastrecognizetheprogramsactasa
remindertobehealthy.

Costsavingsfromtheprogramhavenotbeencalculated;thoughfundsfromthepremiumsurcharges
payforthecostofwellnessprogrammingandsurplusfundsareallocatedtoapooltooffsetcostsof
medicalexpenses.Interviewswithemployeesandorganizationalleadersrevealthatprogramshave
helpedcreateacultureofwellness,particularlyamongexecutiveleaders.

Theperceptionsofwellnessprogrammingvaryacrossemployeetype;manufacturingemployees
reportedmisunderstandingsofwellnessprogramcomponents,anddonotconsiderthescreeningpart
ofthewellnessmission,butratheranecessityforbeeligibleforhealthcoverage.Further,employees
62

reportbarriersfortakingadvantageofallofthetoolsandresourcesaroundus.Forexample,
manufacturingemployeesareunabletoparticipateinwalkingclubsofferedduringthelunchhourdue
totheirrigidscheduleandthefacttheyareonthefeet12hoursadaymakestheseactivitiesless
appealing.Employeesopenlyexpressedtheirdesiretohaveincreasedaccesstohealthierfoodoptions
whileattheworkplace.

EmployerDhasimplementedanincentivebasedstrategywhichhasresultedinnearly100percent
participationinscreeningsandallowedforcomprehensivedatacollectiononemployeehealthrisksand
behaviors.Whileparticipationinscreeningsisremarkablyhigh,participationinwellnessprogramsis
lacking.Inordertocontinuouslyimprovewellnessprograms,EmployerDhasimplementedemployee
feedbacksurveysandleadersplantoworkwithvendorstofindcreativesolutionsforimproving
employeeengagement.Organizationalleadershavealsodecidedtoimplementincentivesformeeting
progressgoals,ratherthanoutcomesalonetoencourageallemployees,particularlythoseofhighest
risk,tomakeincrementalimprovementsintheirhealth.Thesecontinuousimprovementefforts,coupled
withthebackingoftopleadership,willallowEmployerDtostrivetodevelopawellnessprogram
focusedonknowingnumbersandmanagingrisks.

63

Figure
e6:WorkoutLogforEmplloyeesParticiipatinginCom
mmittobeFi
Fit!

64

Figure7:VendingMachinesLabeledw
withRedStarrstoIndicateeUnhealthyO
Options.

Figure8
8:Description
nofEmployerDsBiometrricOutcomessCriteriaand
dCorrespondingPointVallues

65


Figure9:Em
mployeeFeedb
backSurveyfforTheBiggeestLoser

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Appendix A: Discussion Guide

DiscussionGuideforKeyInformants

1.Backgroundontheemployer
a.Whendidyourcompanystartofferingwellnessprograms?
b.Whydidyourcompanymakethisdecision?
c.Hasyourwellnessprogrameverbeenmodified?Ifyes,whathasbeenchangedandwhy?
d.Areyouplanningonchangingitinthefuture?Why?Whynot?
e.Ifitisanawardwinningprogram,whatwasthereasonwhyyourprogramwontheaward?

2.Healthcoverage
a.Doesyourcompanyofferhealthcoveragetoitsemployees?
b.Whatplantypesdoesyourcompanyoffer?(PROBES:HMO,PPO,deductible,costs,etc)

3.Detailsofthewellnessprogram
a.Whodevelopedyourwellnessprogram?Isitprovidedthroughahealthplan(selfinsuredorfully
insured)ordirectlythroughyourcompany?Iftheprogramisadministeredbyanoutsidevendor,
whatcriteriawereusedtochoosethatprogram?Ifitisaninternalprogram,howwasitcreated?
b.Whatarethemaincomponentsofyourcurrentwellnessprogram?PROBE:Makesuretoask
aboutthefollowing:
Healthawarenessinitiatives(includinghealtheducation,preventivescreenings,andhealth
riskassessments).
Initiativestochangeunhealthybehaviorsandlifestylechoices(includingcounseling,
seminars,onlineprograms,andselfhelpmaterials).
e.Whywerethesecomponentschosen?Whataretheirgoals?
f.Couldyoupleasedescribeatypicalparticipantinyourwellnessprogram?PROBE:Age,gender,
healthstatus.

4.Supportiveenvironment
a.Whatefforts,ifany,havebeenmadeatthecorporateleveltosupporttheimplementationof
yourwellnessprogram?PROBE:CEOencouragement,participation;newworkplacepoliciesto
encouragehealthylifestyles,healthyeating,increasedphysicalactivity,andimprovedmental
health.

5.Programsatisfaction
a.Howhappy/satisfiedareyouremployeeswithyourwellnessprogram?
b.Haveyoueverformallyevaluatedsatisfactionwiththisprogram?Ifyes,whatdidyoufindout?
c.Whydoyouthinkyouremployeesarehappy/unhappywithyourwellnessprogram?
d.Whatcanbedonetofurtherincreasethelevelofprogramsatisfaction?

6.Participationrates
a.Whatdoyouremployeeshavetodotoparticipateintheprogram?
b.Howmanypeoplehaveparticipatedinyourwellnessprogramthisyear?
c.Howdoesthisnumbercomparetoprogramparticipationinpreviousyears?
d.Howmayprogramparticipationrateslookinthefuture?

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7.Use,typeandimpactofparticipationincentives
a.Whatstrategies,ifany,doesyourcompanyusetoencourageemployeeparticipationand
engagementinwellnessprograms?
b.Doyouofferanyfinancialrewardstoincentivizeparticipation?Ifyes,whataretheyandhowthey
arestructured?Aretheytiedtooutcomes?Ifnoincentivesareoffered,haveyoueverconsidered
offeringfinancialincentives?Why,whynot?
c.Ifyes:Foranemployeewithemployeeonlycoverage,onapercentagebasis,howdoesthe
amountoftherewardcomparetothecostofemployeeonlycoverage?
d.Aredependentseligibletoparticipateinthewellnessprogram?Ifso,howdoestheaward
amountcompare,onapercentagebasis,tothecostofthetotalpremiumforthecoverageunder
whichthedependentisenrolled?
e.Ifyouincentivizebasedonoutcomes,howdoyouhandleasituationwhereanindividualisnot
abletosatisfyahealthstandardduetoamedicalcondition?Whatisyouralternativestandardthat
theindividualemployeemaymeettoqualifyfortheincentive?
f.Ifyouhaveanalternativestandard,howdoyouinformeligibleindividualsaboutit?
g.Whatdoyouremployeesthinkabouttheseincentives?Haveyoureceivedanycomplaintsabout
them?
h.Whataresomeofthedownsidesofprovidingincentivesforwellnessprogramparticipation?
i.Haveyoueverchangedyourapproachtoincentives?Ifyes,when,whyandhow?

8.Programimpactonemployeehealthstatus
a.Hasyourcompanyevaluatedtheimpactofyourwellnessprogramonyouremployeeshealthand
healthbehaviors?{ifyes,goto(b);ifno,goto(d)}
b.Pleasedescribethisevaluationeffort:
i.Whoperformedtheevaluation?
ii.Howwasthehealthimpactofthewellnessprogrammeasured?Howwerechangestohealth
statusattributedtotheprogram?Whatdatawereexamined?
c.Whatimpact,ifany,wasyourprogramfoundtohaveonemployeeshealthandhealthbehaviors?
{gotoQ9}
d.Whatisyourmanagementsperceptionoftheimpactthewellnessprogramhasonemployee
healthandwellbeing?Whydoyouthinkso?

9.Costofprogram,perceivedandifavailabledocumentedreturnoninvestment
a.Hasyourcompanyevaluatedthecostorcosteffectivenessofyourwellnessprogram?{ifyes,go
to(b);ifno,goto(d)}
b.Pleasedescribethisevaluationeffort:
i.Whoperformedtheevaluation?
ii.Howdidyoumeasurethefinancialbenefitsoftheprogram?Didthecalculationinclude
reductionofmedicalcosts(eitherdirectpaymentsorinsurancepremiums),reduced
absenteeism,and/orincreasedproductivity?Howwerethesebenefitsattributedtothe
program?
iii.Howdidyoucalculatethecostsoftheprogram?Whatcostswereidentified?
c.Whatdidyourevaluationfindintermsofthenetcost,costeffectiveness,orreturnon
investmentofyourprogram?{gotoQ10}

d.Whatisyourmanagementsperceptionofthecostorcosteffectivenessofyourwellness
program?Whydoyouthinkso?

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10.Challengesencountered
a.Implementationofawellnessprogramcanbeunpredictable.Haveyouencounteredany
challengesordifficultieswhileimplementingtheprogram?Ifyes,what?Whydoyouthinkyouhad
theseproblemsduringtheprogramimplementation?
b.Howhaveyouresolvedthesechallenges?
c.Ifyouweretostartanewwellnessprogram,whatwouldyoudodifferently?

11.Plansforthefuture
a.Howdoesthefutureofwellnessprogramslooklikeinyourcompany?
b.Areyouplanningonmakinganychangestoyourprogram?
c.Howfrequentlydoyouupdateyourprogramorintroducenewcomponents?
d.Areyouplanningonchangingthewayyouincentivizeyouremployeestoparticipateinthe
wellnessprogram?

12.AnticipatedchangesduetotheAffordableCareAct
a.Doyouanticipateanychangesinyourwellnessprogramasaresultofthenewhealthlaw?

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Appendix B: Focus Group Protocol

OPENING
REMARKS&
PROCEDURE
(1minute)

CONSENT&
RULES
(2minutes)

Welcome.Mynameis___andthisismycolleague_____.Iamgoingtomoderate
ourdiscussiontonightand____________willtakenotessothatwearesurewe
accuratelyhearwhatyouhavetosaybutwillnotbeparticipatinginthediscussion.
Wereallyappreciateyourtakingthetimetocometothismeetingtodaytoshare
yourviewsandexperienceswithus.

Weareinterestedinlearningaboutyourexperienceswith,andopinionsabout,
wellnessprogramsofferedbyyouremployer.Employmentbasedwellnessprogram
initiativesaretypicallyaimedtohelpworkersstayhealthy,suchassmoking
cessationprograms,discountedgymmemberships,andhealthychoicesinthe
cafeteria.Weareinterestedinyourknowledge,andimpressionof,wellness
programsofferedby[NAMECOMPANY],whetheryouhaveparticipatedinanyof
theseprograms,andwhatyourexperienceswere.

ThisprojectisfundedbytheUSDepartmentsofLaborandHealthandHuman
Services.

Yourparticipationiscompletelyvoluntary,andyouareundernoobligationto
discussanythingthatyoudonotfeelcomfortablediscussingwithme/us.Wewill
keepallinformationyouprovideduringthediscussionconfidential.Wealsoask
thatyourespecttheconfidentialityofotherparticipantsbynotdiscussingtheir
commentsoridentitiesoutsidethegroup.Theinformationyouprovidewillhelpthe
DepartmentsofLaborandHealthandHumanServicesdeveloppoliciesregarding
wellnessprogramsthatemployersareoffering.Asrelevant,ourfinalreportmay
usequotesfromthefocusgroupsasillustrativeexamplesofperceptions,needs,or
concernsamongemployees.Wewillnotattributethesequotestoindividualsina
waythatmayidentifythem.

Weareaudiotapingourdiscussionsothatthoseofuswhoareworkingonthis
projectcanlistentoyourcommentslaterandmakesurethattheyareaccurately
represented.Wewilldestroythetapesoncethetranscriptshavebeencompleted
andchecked.Toprotectyourconfidentiallyontheaudiotape,pleasedontuseyour
lastnameorcallothersbytheirlastnameduringthediscussion.

Beforewegetstarted,Iwanttobesurethatyouarecomfortablewithparticipating
inthisfocusgroup.Ifyouhavedecidednottoparticipate,youmayfeelfreeto
leaveatthistime.Youmayalsoleavelaterifatanypointyoudecideyounolonger
wishtoparticipate.Yourdecisionaboutwhetherornottoparticipatewillnotbe
reportedtoanyone.

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GROUNDRULES
(2minutes)

Aswetalktonight,wedlikeyoutogiveusyourhonestopinionsandimpressions,
evenifyoudisagreewithsomeoneelse.Sincewewanttohearfromallofyou,and
wehavealottotalkabout,Imayneedtointerruptsomeonetokeeptoour
schedule.Itwillbeeasierforustoheartheaudiotapeifyouspeakup,trytotalk
onlyonepersonatatime,andidentifyyourselfbyyourfirstnamebeforeyoutalk.

Therearefoodanddrinksforallofyou,sopleasehelpyourselftothematanytime.
Makeyourselvescomfortableandfeelfreetogetupandgetmoretoeatanddrink
orusetherestroomsasneeded.Ourdiscussionwilllastanhourandahalf,andwill
endat[GIVETIME].

INTRODUCTIONS Letsbeginwithbriefintroductions.Illtellyouabitaboutusfirst.Iaman
(5minutes)
economistandOTHERPERSONisa____.

Now,wedliketohearabouteachofyou.Pleasetellusyourfirstnameandhow
longyouhavebeenwiththiscompany.

AWARENESSOF Areyoufamiliarwiththewellnessprogramsthatyouremployerisoffering?

WELLNESS
Whattypesofwellnessprogramsareoffered?
PROGRAMS

(5minutes)
Whichoftheseprogramsaretypicallyofferedaspartofyourhealthplanandwhich

areoffereddirectlybyyouremployer?

Howlonghasyouremployerofferedwellnessprograms?

PROGRAM
Haveyoueverparticipatedinawellnessprogramoractivity?
PARTICIPATION

(12minutes)
Ifyes,whatprogramsoractivitiesdidyouparticipatein?Howlongdidyou
participate?Didyouremainintheprogramfortherecommendedduration?

Ifno,whydidntyouparticipate?

Doesyourcompanyofferanyincentivesforwellnessprogramparticipation?What
typeofincentives?Whatdoyouthinkabouttheseincentives?Didtheincentives
influenceyourdecisiontoparticipate?

Hasyourworkplaceinitiatedanyenvironmentalchangesthatmayaffectyour
healthhabitsatwork?Examplesofenvironmentalchangesmayincludean
emphasisonusingthestairs,healthyeatingoptionsinthecafeteriaorvending
machines?Ifso,didyoualteryourbehaviorinresponsetothechanges?Howdid
youchangeyourbehavior?

71

EMPLOYER
SUPPORTFOR
PROGRAM
(5minutes)

BENEFITSOF
PROGRAM
(12minutes)

SUGGESTIONS
FOR
IMPROVEMENT
(6minutes)

GLOBALIMPACT
ASSESSMENT
(5minutes)

Isyourimmediatesupervisorsupportiveofwellnessprograms?Whathasheorshe
donetoshowsupport?Doesheorsheparticipateinwellnessprograms?

Areseniorcompanyexecutivessupportiveofwellnessprograms?Whathavethey
donetoshowtheirsupport?Doyouknowiftheyparticipateintheseprograms?

Whataboutyourcoworkers?Dotheyparticipateinwellnessprograms?Dothey
seemsupportiveofotheremployeeswhoparticipateintheseprograms?
Forthoseofyouwhohaveparticipatedinwellnessprograms,
Whatdoyouthinkabouttheprogramthatyouhaveparticipatedin?Whatdid
youlike/didnotlikeaboutit?
Havetheseprogramshelpedyouachieveyourpersonalgoals?Ifyes,whatwere
thegoalstheyhelpedyouachieve?
Haveyounoticedanyimprovementsinyourhealth,likereducedcholesterol
levelsorhealthierbloodpressurelevels,sinceyoubeganparticipating?
Doyougetsicklessfrequentlynowthatyouparticipateintheprogram?
Hasparticipationinthisprogramaffectedyourworkperformance?Ifyes,how?

Besidesthehealthbenefitswediscussed,arethereanyotherbenefitsassociated
withparticipatinginthewellnessprogram?

Howeffectivedoyouthinkthisprogramis/wasinhelpingimprovetheoverall
healthandwellnessofthepeopleworkinghere?

Arethereanydrawbacksassociatedwithwellnessprogramparticipation?What
couldbedonetomakethesedrawbackslesssignificant?

Forthoseofyouwhohavenotparticipatedinwellnessprograms,howshouldthis
programbechangedsothatyouwouldparticipateinit?

Ifyouwereresponsibleforwellnessprogramsinyourcompany,howwouldyou
changetheexistingprogramsothat:
morepeopleparticipateinit?
itismoreeffectiveinachievingitsgoals,suchashealthierbehaviororbetter
healthoutcomes?

Arethereanyimportantaspectsofhealthandwellnessthatarenotaddressedby
youremployersprogram?Ifso,whataretheseaspects?

Overall,howvaluableisthiswellnessprogramtoyou?

Ifyouwererecommendingyourjobtoafriend,wouldthewellnessprogrambea
sellingpoint?Whyorwhynot?

72