Health Care and Insurance

Wellness working for Goodwill workers: Despite high turnover rates, program cuts costs

October 8, 2007

Why pay to get employees healthy if they're likely to leave in a few years?

That used to be the killer question for wellness and disease management programs. But that attitude is changing. And employers like Goodwill Industries of Central Indiana are a good example of why.

The not-for-profit, whose main mission is to help workers make a transition into other jobs, has enjoyed significant savings on health care costs even as it has ditched the employee-paid deductible on its health insurance, reduced co-pays for some prescription drugs, and had more people join its health insurance plan.

Goodwill's annual turnover rate is an intentionally sky-high 78 percent. But that hasn't been a problem.

While most employers grapple for control of skyrocketing health care costs, Goodwill saw its health insurance premiums drop 10 percent in the 12 months ended April 1, even as 20 percent more people joined its health plan.

"We asked, 'What can we control?'" said Keith Reissaus, Goodwill's vice president for employee and organization development, as he sat in his office at Goodwill's headquarters on West Michigan Street. "Our own behavior."

Indeed, Goodwill officials embraced wellness by extending one of the organization's core values. Just as Goodwill tells its workers they are responsible for their own personal and professional development-then gives them tools to help themselves-Goodwill did the same with health.

In 2004, Goodwill made most of its 2,200 employees take a health risk assessment. It not only asked them about health habits, but also whether they wanted to change those habits.

Those who said yes-and the habits they wanted to change-became the focus of Goodwill's wellness and pre- vention programming. They also got more attention from nurses and health coaches Goodwill uses to check up on employees. It calls such checkups "care management."

"That's how we were able to get to some of that low-hanging fruit very quickly," Reissaus said, adding, "We're really taking a heavy demand focus instead of a supply focus."

That's a key difference few employers adopt, said Ned Lamkin, president of the Indiana Employers Quality Health Care Alliance. But more need to let their employees drive their program, he said, and demand that their health insurers or administrators meet their needs.

"A lot of companies just shy away, for lots of reasons," Lamkin said. "They really pass off that responsibility to the health plans."

Goodwill started its wellness programs by spending $50 per worker per year. Now it spends $300 per worker, or about $600,000 total.

After 18 months, Goodwill was saving $2.50 in health care claims for every $1 it spent on wellness, prevention and disease management. Since April 1, when Goodwill hired Cigna HealthCare and intensified its programs, its savings have spiked up to $5 for every $1 invested, Reissaus said.

Goodwill's latest wellness program is the most employee-driven of all. Goodwill set aside $200,000 this year and told employees they could apply to receive some of that money in order to help them improve their health in some way.

The first grant, of up to $6,000, was awarded late last month to 12 employees at Goodwill's Greenfield retail store. It will subsidize their memberships and exercise coaching at Hancock Wellness Center.

The staff at the center will help each employee develop fitness goals. It will then report on their progress to Goodwill about every six months.

What reward they'll get if they meet their goals hasn't been determined. But a penalty for whoever loses the least weight is set, said Suzanne Panyard, manager of the 23-person Greenfield store. That person must wear the ugliest dress found on Goodwill's racks for a whole day.

"It's really wonderful that somebody in corporate America cares about the health of their employees," she said. Goodwill will deduct $10 every other week, or $260 a year, from Panyard's paycheck to pay for her membership.

A monthly membership at Hancock Wellness costs about $60 per month, or $720 a year.

Workers at Goodwill stores in Noblesville and Crawfordsville are soon to start similar programs, said Karma Anderson, manager of Goodwill's wellness and prevention program, which it calls Good Signs.

Ian Duncan, a wellness and disease management consultant, said Goodwill's employee-driven approach is something new.

"If you say, 'We're not going to force a program on you; we're going to let you tell us what you want,' that's a different approach," said Duncan, who is president of Solucia Consulting in Connecticut. "That is an intriguing thought."

But Goodwill also has more typical top-down programs, too. Its disease management program identifies workers with chronic illnesses, such as diabetes or asthma, who can rack up significant health care claims.

For example, Tina O'Neal, a Goodwill employee in New Castle, has received quarterly phone calls from health coaches for more than four years now. They ask her how she's handling her diabetes and managing her weight, give her tips, or send her booklets of information if she wants one.

Since O'Neal quit smoking two years ago, the health coaches ask her how she's doing staying away from cigarettes.

"They ask me how things are going," O'Neal said. "They ask me if I still hang around people who still smoke. Do you still have a craving? Yes, I can't lie to them."

Cigna, which administers Goodwill's self-funded insurance benefits, performs these regular checkups on more than 60 Goodwill employees. It focuses on workers with asthma, heart disease, lung disorders, low back pain and diabetes. Cigna also performs checkups for pregnant mothers and newborns.

After Goodwill hired Cigna in April, it reduced its co-pays on prescription drugs for chronic conditions to the same level as its generic co-pays, which is $10 percent. It also eliminated its $250 deductible.

O'Neal certainly liked the changes. She now pays far less for her twice-daily insulin injections.

"I like it because it helps a lot, especially with my diabetic medicine," said O'Neal, 46, who has worked at Goodwill seven years.

She said she had no insurance at her previous jobs and didn't bother to go for annual doctor exams or other preventive medicine. Now, she not only does annual exams, but also sees a doctor regularly to work on her weight.

"You reward people for being healthy and staying healthy," Reissaus said. "And it's wise dollars spent."
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