Wellness Carrots & Sticks

At the Council on Foreign Relations, a non-profit think tank based in New York, getting employees to leave their desks, stretch, or even duck out for a quick lunch can be an uphill battle. So to get heart rates rising and competitive juices flowing among its highly educated workforce, the Council’s wellness team crafted a “Stairwell Challenge.”

At each floor in the Council’s stairwells (six in New York and eight in the Washington, D.C. office) workers encounter an unmarked photo of a famous bridge, such as London’s Tower Bridge or the 16th century “Stari Most” in Mostar, Bosnia-Herzegovina. Next to the bridges are motivational statements like “Walking down improves strength and muscles.” The stair climber who identifies the most bridges correctly can win prizes that range from a coffee gift card to fitness accessories.

This creative fitness challenge is just one element of an overall wellness strategy the 300-person organization uses to keep workers healthy and health care costs under control. Like a growing number of companies nationwide, it uses incentive-based programs like the stair challenge, personalized health care tools, and health and fitness resources and discounts to encourage employees to take a personal stake in their health and ultimately, their health care costs. It’s a strategy that’s paying off. Last year the Council’s overall health premiums declined a half percent—savings it passed on to employees. By contrast, annual premiums for employer-sponsored family health coverage rose 4 percent nationally in 2012, according to a Kaiser Family Foundation survey.

Incentives for wellness programs

Using incentives—and sometimes disincentives—to motivate employees to improve their health isn’t just a fad; it’s soon to be part of the federal health law. Under a provision of the Affordable Care Act that goes into effect January 1, 2014,  employer health plans that offer reward-based wellness programs will be able to discount up to 30 percent from employees’ health benefit costs if they participate in a wellness program and/or meet specified health goals. The law gives the federal government the discretion to raise this amount up to 50 percent in the future. Employers seem to be getting the message. A survey of 1,800 organizations by human resources consulting firm Aon Hewitt found that the number of employers embracing wellness incentives programs increased to 54 percent in 2012, up from 49 percent two years earlier.

But employers must think beyond simply offering prizes to get employees motivated, something Arlington County, Virginia learned since starting its wellness program in 1994. Indeed, thinking creatively and preventatively about workplace wellness can net real results, says Katie Sweeney, Arlington County’s employee wellness manager.

“The programs that are most successful are group-oriented and have a relatively short time frame … they’re also the easiest to implement,” Sweeney says.

She points to Arlington’s “Maintain, Don’t Gain” program around the holidays, which featured healthy cooking demonstrations and a simple box for employees to check to track weight gain from week to week. This month, Arlington kicks off its “28-Day Yoga Challenge,” which encourages employees to reduce stress by taking free yoga workshops, trying yoga poses, and recording them in an online “Feel Great Tracker.” At the end of the month, participants who tried a pose for 20 out of 28 days qualified for free yoga classes.

In past years, Arlington has held pedometer challenges and a “HealthSmart Idol” competition where participants competed against each other to reach personal health goals.

Additionally, the county performs annual confidential health assessments and uses the resulting data to determine which wellness programs it offers.  In the past two years, Arlington has given employees a $40 one-time premium reduction for taking the voluntary assessment, but the county does not tie wellness program participation to ongoing premium reductions.  Wellness specialists visit worksites annually to take confidential blood pressure, glucose, and cholesterol screenings, among other measures. Today, 95% of the county’s 3,800 employees know their blood pressure readings, Sweeney says. The combination of these programs has helped decrease the county’s health costs.  In the fiscal year 2013, premiums for Arlington’s two health plans rose only 3% or not at all—a substantial reduction from the 5 to 11 percent increases the county had seen in past years.

Real change takes time

Though incentive-based wellness programs are growing in popularity, studies are still inconclusive about whether they work long term. A 2009 study by University of Pennsylvania researchers found that financial incentives got employees to stop smoking—and remain smoke-free—up to 18 months after they started the study. Still, another 2011 study by Carnegie Mellon researchers of overweight veterans found that financial incentives resulted in significant weight loss at first, but that participants regained weight after the intervention. And enticing workers with financial rewards worth more than $450 has little additional effect on participation rates in wellness programs, according to research by a St. Paul, Minnesota health management company.

“You have to change behavior intrinsically, and changing it over time can take years,” says Stephen Musgrave, president of the Wellness Council of Northeast Ohio. “It’s not accomplished by the whip—the whip is to be used only once you get your employees’ attention.”

As employers find their way in developing the most effective wellness programs for their workers, the mind-body connection to overall health is gaining prominence in programming, says Robert Duggan, author of “Breaking the Iron Triangle: Reducing Health-Care Costs in Corporate America.”   Duggan, an acupuncturist and co-founder of the Tai Sophia Institute in Laurel, Md., advises companies nationwide on wellness programs.

He says corporations are shifting their health care strategy from one that attends to workers’ piecemeal health problems to models that emphasize wellness and disease prevention.   That means workers can expect more in-house yoga classes, acupuncture, massage, and an emphasis on modest behavioral changes – like drinking more water and walking. Learning about how the body works and how it generates its aches and pains can make a significant dent in the $8,000 annually companies spend per employee on health care.

“We have a fair amount of research over the years showing that if you treat somebody and their symptoms go away, they’re not satisfied,” Duggan says. “Satisfaction is correlated when a patient says ”˜I’ve learned how to control my symptoms.’”