• The business provides no cost membership for active employees to Wellness Centers located at 8 U.S. sites (retirees pay a small fee).
• Workers at locations without a Wellness Center receive $240 to help cover the expense of a membership at a qualifying exercise facility.
• In 2003, the business provided flu immunizations to more than 11,000 employees, dependents and retirees at 70 on-Site locations.
• Motorola holds hundreds of health education classes each year for employees.

Employee Health Promotion Results:

• Among employees who regularly used on-Site Motorola Wellness Centers or an alternate exercise facility the business saved $3.93 for every $1 it invested, according to data from 2000.
• Participating employees cost $6.5 million dollars less in lifestyle-related healthcare expenses than non-participants.
• Employee Health Promotion participants experienced annual Healthcare cost increases of 2.5%, compared to 18% increases for non-participants.

Obesity, one of the fastest growing epidemics in America, is the most prevalent health risk among employees. Obese people are at a greater risk for several chronic diseases such as congestive heart failure, type 2 diabetes, stroke and hypertension. Facts:

• The prevalence of overweight and obesity has doubled since 1980.
• Two-thirds (66.3%) of the population is overweight or obese (using Body Mass Index as a measure); 32.3% are very overweight.
• Obesity has roughly the same association with chronic health conditions as 20 years of aging.
• More than 20% of very overweight employees have low morale, almost twice that of employees of healthy weights.
• Overweight and Obesity healthcare claims cost around $92 billion in 2002, 9.1% of all U.S. Healthcare expenditures.

Mental Illness

Often ignored or misdiagnosed, mental illness is one of the most disruptive health problems in organizations. It is unique in that its indirect costs (particularly presenteeism) are often higher than its direct healthcare costs. Facts:

• Approximately 20% of the U.S. population is affected by mental illness during a given year, with the most common form being depression; yet in 1997, only 23% of American citizens diagnosed with depression received treatment.
• In 2001 mental illness and substance abuse treatment cost more than $104 billion, comprising 7.6% of domestic Healthcare spending.
• Around 217 million days of work are lost annually due to productivity decline from mental illness and substance abuse disorders, costing $17 billion each year.
• Depression is one of the most costly workplace health problems, costing the U.S. $43.7 billion annually, including workplace costs for absenteeism and lost productivity.

Smoking

Though smoking rates have gone down slightly in the United States over the past decade, smokers still make up 21.1% of the population. For many organizations, restrictions on smoking in facilities means a greater loss of productivity during breaks, adding to the costs of the practice. Facts:

• The U.S. Center for Disease Control and Prevention (CDC) puts a $3,391 price tag on each employee who smokes: $1,760 in lost productivity and $1,623 in excess healthcare expenditures.
• Workers who use tobacco had about two times more lost production time (LPT) per week than employees who never smoked, a cost of $27 billion to organizations.
• An economic assessment found that a Healthcare plan’s annual cost of covering treatment to help people quit smoking ranged from $0.89 to $4.92 per smoker, whereas the annual cost of treating smoking-related disease ranged from $6 to $33 per smoker.
• The direct and indirect costs of smoking are estimated at $138 million per year.43 Finding Wealth Through Wellness 19 • Quitting smoking could decrease an individual’s Healthcare costs by $960 each year.
• Secondhand smoke costs the U.S. economy roughly $10 billion a year: $5 billion in estimated healthcare costs associated with secondhand smoke exposure, and another $4.6 billion in lost wages.
• From 1997-2001, tobacco use and exposure to tobacco smoke resulted in approximately 438,000 premature deaths in the United States, 5.5 million years of life lost, and 92 billion dollars in productivity losses annually.
• Smokers, on average, miss 6.16 days of work per year due to sickness (including smoking related acute and chronic conditions), while people that do not use tobacco miss 3.86 days of work per year.
• Each smoker who successfully quits lowers the anticipated healthcare costs associated with heart attack and stroke by an estimated $47 in the first year and $853 during the following seven years.

Civil Rights Act of 1991 – Provides monetary damages in cases of intentional employment discrimination.

This legislation authorizes people to sue organizations for improper treatment. Compensation can be in the form of actual damages such as lost or expected wages, compensatory damages for a situation that causes public embarrassment, or even punitive damages meant to send a message to a business for egregious or habitual violations. While these laws govern all business activities, there are even more stringent restrictions with regard to Healthcare problems. Most policies, communications and data collection regarding employee health are governed by the Health Insurance Portability and Accountability Act of 1996 (HIPAA). Under HIPAA organizations cannot deny eligibility for benefits or charge a higher premium on the basis of:

• Health status
• Medical condition (including both physical and mental sickness)
• Claims experience
• Receipt of medical care
• Medical history
• Genetic information
• Evidence of insurability (comprises activities such as riding a motorcycle, skiing, snowmobiling and other similar pursuits)
• Disability

However, because wellness programs may not incorporate healthcare treatment or be insurance related, and may instead be confined to behavioral initiatives, HIPAA’s nondiscrimination provisions do not completely apply. To address this, in 2001 the U.S. Department of Labor, the Internal Revenue Service and the U.S. Department of Health and Human Services jointly issued a proposed regulation to help clarify the lawful provisions of a “bona fi de Wellness Program” in the context of HIPAA’s existing language (See Box p. 14). Although the regulation is not yet final, organizations that comply with the measure will be viewed by the government as making a good-faith effort to avert discrimination in wellness programs. Comprehensive Employee Health Promotion Programs are still relatively new to corporate America and the legal implications of implementation and enforcement are not completely known. By their very nature, these programs potentially expose organizations to discrimination lawsuits, disengaged employees and negative public relations. However, organizations that make a good-faith effort to comply with current Healthcare-related laws, discover ways to engage employees, and communicate strategically, will be able to minimize these risks while finding plenty of room to develop a creative and effective Employee Health Promotion .

• - The total reward that may be given to an individual is limited. The departments invited comments on the appropriate level of the reward, suggesting that a limit of 10% to 20% of the total expense of employee-only coverage may be appropriate.
• - The program must be reasonably designed to promote great health or prevent disease for people in the program.
• - The reward must be available to all similarly situated people. More specifically, the program must allow any individual for whom it is unreasonably diffi cult due to a healthcare condition to meet the Employee Health Promotion standard (or for whom it is medically inadvisable to attempt to meet the Employee Health Promotion standard) an opportunity to satisfy a reasonable alternative standard.
• - All plan materials describing the terms of the program must disclose the availability of a reasonable alternative standard.

Source: U.S. Department of Labor Employee Benefits Security Administration As Northwestern Memorial’s Kathryn Krivy says, “The most fundamental failure in any Employee Health Promotion is not communicating. You need to tell people what you’re doing and why you’re doing it. You have to get employees engaged and teach them of what’s going on.” A properly started Employee Health Promotion is designed to save a business more money with improved participation. However, a business must match its focus on program design with an equally strategic investment in efforts to participate employees in the initiatives. Lay out your case – Despite widespread recognition of rising Healthcare costs, employees remain skeptical that the issue impacts business operations. In fact, only 53% of employees even believe what their business communicates about the subject.24 Organizations need to be more candid and forthcoming about the amount they spend on Healthcare and how that relates to larger budgetary constraints and potential investments. Says Motorola’s Saenz: “We share with employees that we have been able to maintain Motorola’s Healthcare spend trend below national average over the past decade due to their participation in our various Employee Health Promotion Programs. This transparency is necessary to keep reminding people the reasons for our conduct.” An effective strategy is to focus on the cost savings and central health benefi ts to the employee and not the business. By personalizing the information in this way, it establishes a win-win scenario rather than presenting the program as a sacrifi ce on the part of the employee. Information ought to be presented through multiple channels, constructed in a way that makes sense to all levels of employees, and offered to employees, dependents and retirees. Make it your own – Every Employee Health Promotion will be different, and ought to reflect the culture of a business. While program areas will be determined by analyzing employee health risks, the actual offerings ought to be shaped by the nature of the business. Younger, more active employee communities may be attracted by different programs than an older or technicaloriented employee. In Addition, a global business with mobile employees will have different needs than a business with one central location. As noted earlier regarding PepsiCo’s HealthRoads, one strategy is for organizations to brand their Employee Health Promotion Programs. Union Pacifi c Railroad (HealthTracks), General Motors (LifeSteps) and Caterpillar (Healthy Balance) all adopted this approach to help create recognition and a larger meaning around their efforts. Having a branded plan helps employees and other stakeholders see the larger goals/objectives of the Employee Health Promotion , rather than focusing on isolated offerings. Say it loud, say it proud – As a potential cost-saving plan, Employee Health Promotion Programs ought to be given the same executive support and internal responsibility as any comparable business effort. Organizations ought to not approach wellness as simply a preventive, financially-motivated program, but rather as an opportunity for the business to distinguish itself and become more competitive. Jeffrey Treem, analyst, Edelman Change and Employee Program Engagement Group, says that effective communication about Employee Health Promotion Programs ought to be integrated into existing business communication channels and vehicles. “This comprises executive communication to external stakeholders,” he notes, “because this sends a powerful message back to employees about the importance of the programs. Employee Health Promotion Programs ought to not be treated as merely an additional employee perk, but rather an innovative and strategic effort to decrease costs and create a healthier work environment.” Talk among yourselves – The most powerful champions of any Employee Health Promotion will be the participants. Organizations ought to discover ways to facilitate discussions about the program among employees. This could take the form of support groups, interactive media and the sharing of success stories. However, since Employee Health Promotion Programs touch on potentially private health problems, it is valuable communication remains positive and inclusive, while not pressuring employees. Discussion of wellness problems ought to be voluntary, though organizations may consider providing incentives for those willing to contribute. Motivation and information from peers is likely to carry more credibility and significance than messages from management.

Furthermore, discussions around Employee Health Promotion Programs can share personal success stories and provide business progress updates. Successful organizations not only use existing communications channels to generate discussion around activities, but also consider more interactive tools like message boards, forums, blogs and wikis. This helps personalize initiatives and authorizes for the sharing of best practices within the business. Many organizations engage healthcare professionals to advise in the construction, communication and support of the program. The use of outside authorities such as these will broaden the credibility of the Employee Health Promotion Programs as well as combat skepticism from employees who may view the business’s motives as merely selfserving. Another strategy available to organizations is to brand their Employee Health Promotion . This move can broaden the visibility and acceptance of the offering. Branded wellness programs are most common when organizations are also promoting an external campaign around Employee Health Promotion Programs. An example of this is PepsiCo, which launched its HealthRoads Employee Health Promotion internally along with a consumer campaign, Smart Spot, that puts special labels on healthier food and drink options. These efforts are more effective when they are not owned solely by the internal communications department, but rather when managers serve as leaders of, as well as participate in, Employee Health Promotion Programs within organizations. This establishes more immediate accountability and motivation.

Measurement is only useful if a business explicitly specifies what data would constitute success. Potential measures of success comprise:

• Participation rates
• Better employee engagement
• Lowering of risk status
• Lowering of direct health costs
• Reduced absenteeism
• Fewer disability claims

Motorola’s Saenz advises administrators of Employee Health Promotion Programs to track as many measures as possible from the start, even if management only needs one, because it is very difficult to retrieve data later. She notes that even if leadership begins by looking at participation rates, they will eventually want to know about reductions in claims and costs. Frequent assessment is the only way to build support among management and employees. Nearly half of organizations feel a lack of useful data is a top barrier to their ability to manage employee health, and at least 20% of organizations do not know how effective existing Employee Health Promotion Programs are regarding various outcomes. Organizations ought to lead utilization analyses annually and reevaluate Employee Health Promotion priorities based upon changes. In Addition, progress ought to be shared with the wider business community to build support for initiatives. Managers and executives throughout a business are likely to support a program that can prove increased productivity among employees. Effective Employee Health Promotion Programs are designed to be fl exible so they can respond to changes in both business goals/objectives and larger health variations.