Are workplace wellness programs really working?
Even as employers increasingly embrace efforts to improve their workers’ health habits, health care spending continues to eat up a growing share of the economy as medical inflation continues to outpace the rest of the economy by the same margins it has for decades.
Which is why two Indianapolis organizations—one for-profit and one not-for-profit—are launching initiatives to help employers address worker health in a way that reaches outside the office and the clinic.
Novia CareClinics LLC, which operates on-site clinics for employers, is negotiating contracts with various counselors who help address the financial, psychological or substance abuse issues that often lie beneath the health problems doctors and nurses try to address.
Novia is gradually pitching that new constellation of services, which it calls Total Patient Experience, to its 85 clients.
From a different angle, Indianapolis-based Better Healthcare for Indiana has helped a group of businesses in a wide swatch around Terre Haute with their community-wide efforts to address health.
The group, known as Better Healthcare Wabash Valley, got going in February and now includes 25 companies. It has focused on reducing obesity and smoking in the entire population of six counties.
“This is really just an effort to identify drivers that will change health outcomes,” said Todd Foushee, chief operations officer at Novia. “If we can move the metrics a little bit forward, then we could end up with a healthy community.”
Both groups share the view that, to change individuals’ habits, employers have to start hitting the myriad factors that drive behavior, and yet often have little to do with either health care or the workplace—think personal financial problems and mental health issues.
That idea makes sense, according to research into the causes of Americans’ health status.
A 2002 study in the journal Health Affairs estimated that medical care contributed just 10 percent to the average American’s health status. Behaviors—the things wellness programs aim at—accounted for 40 percent of health.
Education levels, poverty rates and environmental conditions contributed another 20 percent toward health. The balance was due to genetics.
And while hard evidence mounts that wellness programs produce results for some individual companies—reducing the overall cost of care and slowing down employee absences and attrition—the wellness movement as a whole has yet to dent the galloping increases in both the price and overall spending on health care.
Health care costs have still grown about 2 percentage points faster than overall inflation the past 12 months—just as they have since 1983, according to the U.S. Bureau of Labor Statistics.
Health care use moderated during the economic downturn of the past five years. But the spending still amounts to a whopping 18 percent of the entire economy and is projected to reach 20 percent by the end of the decade.
If the United States has any hope of changing that trend, employers are one of the best agents to do it, according to Harvard Business School professor Clayton Christensen.
In the 2009 book “The Innovator’s Prescription,” Christensen and co-authors Dr. Jerome Grossman and Dr. Jason Huang wrote that “employers have a bigger stake in the health and productivity of their employees and employees’ families than any other entity or institution in our society.
“This is the basis for our belief,” they added, “that certain major employers will become much more assertive in guiding and even providing care for their employees. They will thereby create an infrastructure that other, smaller employers can then utilize.”
Foushee, Novia’s chief operations officer, works with employers who embrace Christensen’s idea. But even among them, Foushee recognized something different was needed after talking with the doctors Novia employs to treat patients in employer clinics.
Novia’s doctors spend at least 20 minutes in every visit with a patient—roughly double the national average for primary care physicians. The extra time started bringing up more of the root causes for illnesses.
For example, patients suffering from depression often have financial difficulties. Patients receiving pain medications might need physical therapy. Patients struggling to sleep may have a complicating mental health issue.
“Those everyday stressors, financial pressures for example, that could lead to depression,” Foushee said. “Depression could lead to overeating. Those are the ways these things are connected.”
Discovering such underlying issues is nothing new, Foushee admits. But what Novia wants to do that is different is to bring professionals to address those issues into its employer clinics.
Under this approach, if a physician discovers a patient has financial problems, for example, he or she could instruct one of the clinic’s health coaches to get the financial counselor with whom Novia has a contract on the phone right away.
Or Novia’s staff could schedule an appointment at the clinic in which the financial counselor, doctor and patient could all meet together—still just a few steps from the patient’s work station.
Foushee thinks it is imperative for employers to help workers get to the bottom of their health issues, because if they don’t, they face a wave of workers whose productivity will be dampened by poor health.
The rates of obesity in younger Americans is far, far higher than it was in their parents, suggesting that as those young people become the 30- and 40-something workers in plants and offices, an enormous number of them will struggle with obesity and its many complications.
Ken Baker, human resources director at packaging film manufacturer AET Inc. in Terre Haute, said that reality is already upon employers in his area. He has found that roughly half of all workers in his catchment area are obese, tobacco users or both. Those percentages are roughly double what they are in the Hoosier population as a whole.
“This pool of employees in the Wabash Valley is one of the unhealthiest in the United States,” said Baker, who also manages human resources for employees at AET’s four other work sites around the country. “It’s one of the unhealthiest in Indiana, and Indiana has a lot of problems.”
That’s a particularly big problem for manufacturers like AET, because they compete directly with lower-cost countries.
To no surprise, Baker said he has not had trouble getting employers to join the health care initiative: “The problem I have is finding healthy employees; everyone in this area has the same problem.”
That has not been true around the rest of Indiana, said Les Zwirn, executive director of Better Healthcare for Indiana. He has struggled to get employers to buy into his concept of bringing in all community stakeholders—including schools, restaurants, churches, child care centers, hospitals, politicians and others—to address the big factors contributing to unhealthy behavior.
“They haven’t been banding together,” Zwirn said. “They have to be visionary enough and they have to be patient enough to wait for years to see a return.”
Dr. Ned Lamkin, president of the Indiana Employers Quality Health Alliance, agrees with Zwirn’s vision for community-wide action by employers. But he said employers, especially small ones, don’t consider health care problems to be their problem.
“It’s a really hard pitch to get individual employers to designate either themselves or somebody within their organization to go to a bunch of meetings and figure this out. They don’t think it’s something that’s their responsibility to fix,” said Lamkin, who is also on the board of Better Healthcare for Indiana.
Even so, Lamkin concluded, “a local employer effort is going to have a hard time succeeding unless the general community takes steps to reduce obesity, to reduce chronic diseases.”•