Chapter 20

The Corporate Wellness Index

TYPES OF ORGANIZATIONS WHERE THIS METRIC IS APPROPRIATE

Any organization that spends 20 or 25 percent of its costs on people should probably consider this metric, as well as large organizations that have more than 1,000 employees. Organizations with corporate wellness programs should definitely consider tracking this measure to see if their efforts are making any difference. Even a small organization might consider an employee health analytic if the organization values health and wellness. I worked with the Jackson Hole Airport in Wyoming to help develop performance metrics, and one the team decided on was employee health. Airport CEO Ray Bishop is in amazing health, and his level of fitness is certainly that of someone at least 10 years younger. With only about 75 employees including all the Transportation Security Administration agents, Bishop wanted a comprehensive measure of employee health that would be easy to implement, so he elected to have employees go the web site Realage.com and enter data on their own lifestyle, family, and current health statistics. The three major factors that are assessed in Realage.com are family history and genetics, lifestyle (diet, exercise, sleep, etc.), and current health statistics like blood pressure and LDL/HDL ratio. Based on all this data, the web site computes your physical age versus your chronological age. By making use of this free web site, Jackson Hole Airport has a simple yet comprehensive analytic to use in assessing the health of its workforce.

Most organizations of any size pay for the health insurance of their employees. Even firms like Starbucks and UPS that have a mostly part-time workforce provide excellent health insurance for their employees. The healthier employees are, the less insurance will cost and the more productive employees will be. A healthy workforce boils down to huge cost avoidance. Employees will accomplish a lot more at work if they are fit and healthy like the guy Mike I mentioned earlier. Mike’s success was due to many things, but being healthy was certainly one of those factors.

HOW DOES THIS IMPACT PERFORMANCE?

If your organizational results are dependent on employees and their behavior, their health will impact your company performance. If you work for a hospital, airline, retailer, pharmaceutical firm, government, military, or even many manufacturing companies, you will no doubt find that the health of your employees costs you a great deal of money. Another important way health impacts performance is that you avoid losing key employees to sickness or even death. I recall working for a big aerospace client that had two of their top vice presidents die of heart attacks in one year. Both of these guys were in their fifties and had worked at the firm since college. The company had invested a lot of time and effort grooming them and turning them into high-performing executives, and now they were gone. The previous CEO was a major proponent of health who had only vegan food served in the executive lunchroom, exercised regularly, and did a lot to encourage health from all his employees. When he retired, the culture of the company moved away from a focus on health.

HALFHEARTED APPROACHES TO WELLNESS

If you examine most of the wellness programs in the corporate or government world, you’ll find that they include a minimal workout facility or discounts at a local health club, one healthy food choice option in the company cafeteria (which almost no one eats), exercise clubs like lunchtime walking or yoga, annual health screening and physicals, drug testing for new employees, Weight Watchers or similar programs, posters with tips on improving health, and online health assessments. The vast majority of employees don’t take advantage of any of these wellness programs. In fact, the ones who do are usually people who are already very healthy, or who don’t have a lot of work to do and can find time to participate in these activities at work. Most managers I encounter don’t even take a lunch hour, let alone find time to go to the company gym or walk with a bunch of others.

WHAT REALLY WORKS: TOUGH POLICIES

Radical and innovative approaches seem to be the ones that produce real results, even though most of these programs or approaches are controversial. Blue Cross Blue Shield of Maryland and Nationwide Insurance were among the first companies to have completely smoke-free workplaces. Smoking employees were given 90 days to quit and offered whatever counseling or help they needed. Blood tests make sure that there is no nicotine in their blood, so the company can verify that employees are actually quitting smoking.

Other companies were slow to follow Nationwide because of fear of lawsuits, but now it is common to find companies that refuse to hire smokers. There is enough data to indicate that smokers cost a company thousands more in health care costs. Most companies at least make smoking employees pay extra for health insurance and discourage them from smoking on company property. In the not too distant past it was common to see groups of smoking employees huddled outside of entrances puffing away. One of my clients built a shed hundreds of feet away from the buildings where employees had to go to smoke. The “smokehouse” was unheated and the cold and the distance made most employees really think twice about how badly they wanted to smoke at work.

ESAB, a company I worked with a few years ago, also has a radical approach that really works. Employees are given a very thorough annual physical and lifestyle assessment. Based on results, they are sorted into three categories: (1) extremely healthy, (2) average health, and (3) unhealthy or high-risk. Unhealthy or high-risk employees are not given company-paid health insurance. Those in the average health category get minimal coverage, and the extremely healthy employees get the best coverage, which pays for doctor visits as well as dental, vision, and family care, and so on.

The program has caused some major behavioral changes to occur in many of the employees. In fact, two of the executives were found to be in the unhealthy category even though they were avid exercisers, so they were on strict diets to try to reduce their blood pressure and bad cholesterol. The company offers all kinds of programs and assistance to help employees get healthier and then obtain company-paid insurance, and there are much higher levels of participation than in typical corporate wellness programs.

WHAT REALLY WORKS: IN-HOUSE HEALTH AND WELLNESS CENTERS

HHI Healthcare Solutions has a really innovative approach: on-site health and wellness centers for employees and their families. Employers pay for only catastrophic health insurance and run their own health centers that handle most of the medical needs of employees. HHI builds, staffs, and manages these on-site facilities, which often include full gyms and access to nutritionists, doctors, dentists, trainers, and full spa services. Rather than having to take a day off from work to get an annual physical or have a root canal, employees can see HHI doctors and dentists on-site and get back to work in a few hours. Employees can also get in a workout with a trainer at lunch, get a massage, or get a facial. HHI’s centers look much more like a spa or health club you might see at a Four Seasons or Ritz-Carlton than an industrial-looking rehab facility or clinic from the old days.

A common cause of absenteeism is having to deal with childcare or eldercare issues. Taking your mom or dad to the doctor, attending to an ill child, and other related issues force most people to take a few days off to deal with them. Realizing this, HHI centers often include both childcare and eldercare facilities so that you can bring both your dad and your daughter to work and know that they will be well taken care of.

The whole focus is on prevention, and the in-house facilities lead to increased levels of employee satisfaction, greater productivity, and savings of around 20 percent in hard dollars spent on health insurance. Real cost savings are much higher when you factor in all the time lost from work that’s spent dealing with health issues. SAS, regarded as one of the best employers in the United States, has compelling data that shows that it gets $1.41 back for every dollar it has invested in its on-site health center. HHI also has a sister company that gets prescription drugs from Canadian pharmacies, saving employers an additional 25 to 30 percent over what they would pay for prescriptions filled in the United States.

WHAT REALLY WORKS: HIRING THE RIGHT PEOPLE

More and more companies are finding that hiring people with the right values is a key to maintaining their culture. Disney’s philosophy is to hire the smile and attitude versus hiring for specific skills and knowledge. Southwest Airlines hires people with a good sense of humor, and Purina hires people who love animals. It is also possible and probably a good idea to hire people who value health and fitness. Some people really value wellness and do everything possible to be as healthy as they can; others do not.

An effective way of making sure that fitness and health are part of your culture is to attract and hire people who already embrace this as one of their personal values. Forward-thinking companies today use web sites and social media to communicate their culture to prospective employees so as to attract people who already embrace the same values as them. Purina has dramatically reduced its recruiting costs and improved its pool of qualified job applicants by communicating the company culture and values and only receiving résumés from individuals who already have the same values.

COST AND EFFORT TO MEASURE

This metric I would say is medium to high in cost and effort to measure. Of course, you can spend next to nothing and use the approach of Jackson Hole Airport and just have employees log on to Realage.com, but the data is subject to integrity problems since you are relying on employees to enter it themselves and to report what the web site calculated for their real age. To develop a metric that has good integrity, much of the data should not be based on self-reporting. We are all notoriously unreliable in recalling our own behavior, especially bad behavior. I read recently that according to a survey, about 65 percent of Americans report that they have a healthy diet. I also recall reading that about the same percentage of Americans are overweight, and that a third of Americans are considered obese. Seems to be a pretty big disconnect in this data. The approach to measuring health and wellness I am advocating in this book goes way beyond surveys and counting behaviors like people who signed up for the lunch walking program or annual 5K run. In order for your corporate health analytic to have any integrity, at least 40 to 50 percent of it should be made up of hard objective health measures like waist size, resting heart rate, and cholesterol ratios. In order to get this data people have to go somewhere for a physical and blood test, and that is expensive. However, they should be doing that at least once a year anyway, and insurance usually pays for all or most of an annual physical, so it may not end up costing a lot to get this data.

Aside from the cost factor, you may face a battle in gathering this data in the first place because of privacy laws (HIPAA). As long as individual employee data is not revealed there is nothing illegal or improper about getting group averages for body mass index (BMI), blood pressure, glucose, or other health metrics. In organizations with hundreds or thousands of employees there is usually less concern that someone will see their personal health data, but this might be a concern that requires some effort to overcome. I have a client who refuses to go in for a company physical because she does not want to be told that she has to lose weight and quit smoking.

HOW DO I MEASURE IT?

Regardless of your approach to employee health and wellness, it is important to have ongoing measures that provide feedback to management on the effectiveness of the entire effort as well as individual components. Most company scorecards do not include any measures of the health of their workforce, or if they measure anything at all, the metrics are pretty useless.

For example, one big corporation I consulted with measures the percentage of employees who get an annual physical at one of their quarterly health drives where a big van pulls into the company parking lot and runs tests on volunteering employees. The logic is that if employees get an annual physical they will receive information that might cause them to change their behavior and adopt more healthy habits. My brother gets an annual physical from his employer and routinely ignores all the advice provided and discredits the importance of metrics like blood pressure, BMI, HDL/LDL ratios, and other health stats that may show he is a heart attack waiting to happen. He pops his statin drug and hopes for the best.

Other useless metrics I’ve seen are the number of people participating in company wellness activities, such as exercise groups, weight loss or quit-smoking programs, or health fairs. Some very healthy people don’t participate in these programs and prefer to exercise at their own gym or at home; maybe they don’t want everyone at work to know they are in a weight loss program if that’s the case.

AltaMed Health Services Corporation, one of the largest independent Federally Qualified Health Centers, has a comprehensive employee health analytic on the CEO’s dashboard that includes individual metrics such as health risk assessment completion, EAP utilization, web-based sponsored wellness program participation, health coaching participation, biometric screenings completion (self-reported and performed on-site), and number of clicks on health information web sites. Targets for participation and/or completion of such components are set on a yearly basis to benchmark annual participation improvement rates.

Counting participation in wellness programs is fairly useless, so how do executives measure the impact of their efforts and the overall health of their workforce? The answer is a corporate health analytic. Just like your credit score is made up of many individual measures to provide an overall assessment of your credit worthiness, a corporate health analytic should consist of a mixture of metrics.

Constructing a good health or wellness analytic involves first deciding what factors you are going to include. An important and objective factor that should be measured is knowledge. A prerequisite to having a healthy lifestyle is knowing what to do and not do. Most of us know that smoking is bad, drinking and driving is bad, and eating too much red meat and saturated fat is bad, but I think it is shocking how little most people know about health and wellness beyond some basic facts. In fact, a popular segment on The Dr. Oz Show is the quiz on common health myths. Whenever I watch this segment, the audience—and often me, too—get about half of the questions wrong. There are many myths about health that come from old wives’ tales (chicken soup will help cure a cold), propaganda from advertisers (vitamin C in orange juice helps prevent colds, or high-fructose corn syrup and sugar are the same thing), or just from reading too much stuff on the Internet. Measuring people’s knowledge simply involves giving them a test that should focus on testing actual knowledge that people can use in daily life to live more healthily. For example, show four fast-food choices and ask people to select the one with the choices lowest in calories. A health knowledge test might cover a wide range of topics, such as diet, exercise, stress, diseases, common illnesses, psychological factors, and understanding key health statistics. Results from the knowledge tests are not only a good measure, but they also allow you to identify knowledge gaps in the workforce. These gaps can then be alleviated by offering training to improve employees’ knowledge of health.

A second dimension that should be included in a comprehensive wellness analytic is beliefs or perceptions. These are different from knowledge. These are attitudes about health that would be measured via an anonymous survey. You could create a series of statements and have people indicate the degree to which they agree or disagree with them. For example, some of the attitudes or perceptions might be things like:

• People who exercise extend their lives by exactly the same amount of time they spend exercising, so I would rather be doing something more fun.
• Diet and exercise just don’t work for me because everyone in my family is fat—it’s just genetics.
• Vegetarians always look pale, drawn, and unhealthy. Humans are designed to be carnivores.
• Wearing a seat belt makes it more likely you will die in a crash because you won’t be thrown free of the vehicle.

I’m sure you can think of dozens more of these statements that we have heard people espouse. A big part about changing attitudes or beliefs is getting people the knowledge that changes their minds. Even knowledge is often not enough, because beliefs and attitudes are entrenched and most people don’t radically alter them as a result of one article or training program. By getting a baseline on the health attitudes and beliefs of your employees you can develop a change management strategy for beginning to modify those beliefs.

The third dimension that might go into your health analytic is family history or genetics. Having a family history of diabetes or heart disease is not a guarantee that you will get these diseases, but you are probably more likely to get them if you are not extra careful. If everyone in your family is obese, you probably stand a greater chance of becoming that way than the typical person. If both your parents were alcoholics, you probably need to be a little more careful with your alcohol consumption than some of your peers. Genetics is one of the three factors assessed in the Realage.com analytic, but it is given less weight than lifestyle or current health statistics because genetics just show tendencies, not certainties. Just because your grandparents all lived well into their nineties is not a guarantee that you will do the same. Genetic data on large groups of employees might help an employer craft a wellness program around certain predispositions. I would recommend giving genetics a very small weight in your wellness index, because there is nothing you can really do about them, and if you wanted to leave this factor out entirely it would not be a big deal; I think you can still have a robust analytic without genetic data. This data is also subject to integrity problems, because respondents are relying on memory and whether they were even told about the health of their relatives. I just recently found out that my mom’s father died of heart disease in his late forties. Yet my mom is 87 and still going strong.

The fourth dimension is behavior. Behavior is a huge determinant of current and future health, but it is very hard to measure accurately. Some behaviors, like going in for an annual physical, are easy and quite objective. Others, like measuring what people eat or how much they drink, are probably very unreliable if we rely on people’s verbal reports. Most of us cannot remember all the details of what we eat on a daily basis. Behavior like anger or feelings of depression can only be measured via surveys or instruments. Some organizations have become more diligent in measuring behavior than simply relying on verbal reports. I mentioned my client, community health care leader AltaMed, earlier. Many of AltaMed’s employees are participating in the 10,000 steps program wherein employees are encouraged to walk 10,000 steps a day. Different departments are competing with each other on who can do the best, and the company is giving prizes to the winning team. Of course the real prize is that everyone will probably lose weight and improve their health. All participating employees must use pedometers, and their daily activity is tracked and recorded automatically on their computers. The company wellness director can get daily data on the percentage of employees who logged the 10,000 steps and the average number of steps per employee. This is only one behavior, but technology makes it much easier to get objective data. Of course, this method is not foolproof either. I know of someone who thinks the company wellness program is a joke and moves his pedometer back and forth all evening while doing 12-ounce curls with his other hand and watching ESPN. He goes back to work the next day with his 10,000 steps logged and the company nurse is continually puzzled that his weight continues to increase.

The final and most objective type of data to include in your wellness analytic is health statistics. This is data collected via blood sample, lab analysis, and testing done by doctors, nurses, or medical technicians. There are a wide variety of tests and procedures that might be done, and the comprehensiveness of the data might vary by the level of the employee. My dad was an executive at what is now Target and used to be Dayton Hudson. He got sent to the Mayo Clinic in Rochester, Minnesota, for a three-day physical every other year, so in three days Mayo collected lots of data and did lots of tests to assess my dad’s health. Even a one- or two-hour hour physical like the one I get results in statistics on close to 75 different variables. While this data is the most objective, it is also the most personal. People may prefer to go to their own doctor for a physical and not report the results to their employer. A guy I know seems to be in great health, but he is a binge drinker and does not want his employer to know this. Another guy I know smokes pot every day and does not want this information to get to his employer. To get around privacy concerns like this, many employers have agreed to only measure a dozen or fewer key health statistics like blood pressure, cholesterol, and BMI, although the last one is touchy for some folks, especially in light of recent reports on better ways to measure body fat (waist-to-height ratio) than BMI.

VARIATIONS

Some variations I have seen involve tracking a few simple health statistics such as absenteeism, disability claims, annual physicals completed, and participation in company wellness programs. The level of complexity of your health metrics depends a lot on how big the organization is, how much it pays for health insurance and absenteeism, and whether health is one of your core values. Even just tracking absenteeism is better than nothing, and this is a metric on which you can get lots of comparative data from others in your city or industry. What I would avoid is just tracking participation in company-sponsored wellness activities and programs. You might have very few people work out in the company gym or eat the healthy choice in the cafeteria, yet you could still have a very healthy workforce. They work out at home or at their own gym and bring their own lunch. I also think you can leave genetics out of the index without doing much harm, because this data is notoriously unreliable and nothing can be done about it.

FORMULA AND FREQUENCY

I would lower the weight of the lifestyle and behavior metrics if they are all based on self-report or interviews and questionnaires. I would also lower the weight of the behavior measures if the measures are counts of activities like participating on company wellness programs. In a company that gets a very low score for health literacy and knowledge and beliefs, I might put an initially high weight on these factors, since the first step toward changing behavior is changing knowledge and attitudes, and then with time gradually shift more of the weight to the outcome measures of behavior and health outcomes. The weights shown below are for a company where employees already have good beliefs and attitudes about health and know quite a bit about it:

TARGETS AND BENCHMARKS

Individualized targets for knowledge and beliefs would have to be set based on your baseline levels. Targets would not be set for genetics or family history, because nothing can be done to change them; they are just information that provides data on the overall health of the workforce. Comparative data and well-researched standards can be used to assess behaviors. For example, sleeping eight or nine hours a night would be green, six or seven hours would be yellow, and less than six would be red. Health statistics will also be easy to set target ranges for, since data exists for large populations about what good levels of blood pressure, glucose, and other factors look like. Of course, these target ranges change all the time with new research and often as a result of lobbying from pharmaceutical companies to sell more drugs.

BENEFITS OF DATA

In today’s world of tight budgets and reduced spending on any program that does not contribute directly to the bottom line, it is easy to dismiss wellness programs as something nice to do when there are extra profits to invest in things like this. In the last few years, most companies have severely cut budgets for training, travel, new software, and lots of other things viewed as nonessential. Wellness programs, if properly designed and executed, can bring an ROI as high as six to one, according to an article in Harvard Business Review.1 It would be difficult to find another investment with such low risks, such a high payback, and so many side benefits.

NOTE

1. Leonard L. Berry, Ann M. Mirabito, and William B. Baun, “What’s the Hard Return on Employee Wellness Programs?,” Harvard Business Review, December 2010.