State Efforts to Keep Employees Healthy:Employees Healthy:

Worksite Wellness Programs

Karen K. Shore, PhDKaren K. Shore, PhDCenter for Health Improvement

D b 10 2009December 10, 2009

Definition: WorksiteHealth Promotion Program

Emplo er initiati es to impro e health of• Employer initiatives to improve health of workers/their families

• Designed to avert disease and support prevention

Source: Baase, 2009

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Why the Workplace?Why the Workplace?• Concentrated group; share a common

d ltpurpose and culture• Communication is relatively straightforward• Supports available for employees to change

unhealthy behaviorsO i ti l h l t t i• Organizational norms help promote certain behaviors/discourage othersC ff i ti f ti i ti• Can offer incentives for participation

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Source: Partnership for Prevention, 2008

Benefits of Integrating Health P ti I t th W k lPromotion Into the Workplace

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Source: National Business Group on Health, 2005

Best Practices in Workplace pHealth Promotion

1 O i ti / 7 Eff ti l i d1. Organization/ management commitment

2. Incentives for employee ti i ti

7. Effective planning and implementation

8. Employee input in developing goals andparticipation

3. Effective screening and triage

developing goals and objectives

9. Wide variety of program offerings

4. Effective targeting of high-risk individuals

5. Evidence-based

offerings10. Effective communications11. Ongoing program

evaluationinterventions

Source: Partnership for Prevention, 2008

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p ,

Examples: StateW k i W ll EffWorksite Wellness Efforts

• California

N h C li• North Carolina

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Step UP – OverviewStep UP Overview• 3-year worksite wellness pilot program –

CA Department of Health Services (CDHS)CA Department of Health Services (CDHS) • Changes in policies, corporate culture,

physical environmentphysical environment• Program integrated:

– PreventionPrevention– Behavior change– Best and promising practices in workplace health

promotion

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Step UP in Action!Step UP in Action!

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Step UP – Program Componentsp g p1. Branding/promotion efforts2. Wellness website and

7. Healthy vending machine choices

“Monthly Fit Tips” 3. Weekly farmer’s market

within walking distance

8. Walking routes promotion9. Noontime wellness talks10. Exercise room improvements

4. Annual educational campaigns – blood pressure, body fat screening

10. Exercise room improvements11. Exercise buddy bulletin

board12 Employee worksite wellnessp y g

5. Stairwell improvements 6. Free cookbook with healthy

recipes

12. Employee worksite wellness committee

13. Nearby deli – healthier food choicesrecipes choices

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Step UP – Program Evaluation: I di id l O HRAIndividual Outcomes – HRAs

• Health Risk Assessments (HRAs) offered annually to employees

• Results 2007 vs. 2005:L i k l i i d– Low-risk employees – maintained or slightly improved health status

– High-risk employees decreased slightly – Employees reporting daily stair

use increased– Employees walking or biking at least once

a week increased– Employees responding “rarely/never” to daily fatty food intake

increased

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Step UP – Program Evaluation: I di id l O t SIndividual Outcomes – Survey

Employee survey (n=600)– 99% believed nutrition and regular physical activity

contribute to higher productivity93% felt it is important to have a worksite wellness– 93% felt it is important to have a worksite wellness program

– 92% wanted an employee wellness website– 89% were aware of Step UP program– 71% called the program “very” or “extremely” valuable– 50-75% reported participation and/or interest in– 50-75% reported participation and/or interest in

program components

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The Future of Step UPThe Future of Step UP

• Department of Public Health and the pDepartment of Health Services (formerly DCHS) adopted Step UP as a formal part of the organization

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NC State Health Plan –P j O iProject Overview

• North Carolina Institute of Medicine and CHI• North Carolina Institute of Medicine and CHI recommendations re: worksite wellness– Lessons learned from previous studies:Lessons learned from previous studies:

• Worksite wellness program interventions• Incentives for employee participation in p y p p

worksite wellness programs– Design of a wellness program for NC State

Health Plan members

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NC Wellness Program –G idi P i i lGuiding Principles

• Overarching goals:• Overarching goals:– A “healthier” workforce through

health risk reduction– Reduced rate of increase in

health care costs• All teachers and state employees eligible• Participation should be voluntary; positive

i ti f ti i ti hi t fincentives for participation, achievement of personal health goals

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NC Wellness Program –R d i (1)Recommendations (1)

• Program open to all state employees• Program open to all state employees• Vendor administration of HRA, confidential

reporting of results summary information onreporting of results, summary information on risk profiles to plan

• Ensure all members receive education re:Ensure all members receive education re: benefits of health behavior changes and how to access wellness program

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NC Wellness Program –R d i (2)Recommendations (2)

• Create an employee committee to review• Create an employee committee to review HRA content, confidentiality process, etc.

• Offer meaningful incentives for:Offer meaningful incentives for: – HRA completion– Post-HRA participation in risk-reduction p p

interventions• Offer options for HRA follow-up related to:

smoking cessation, diet and physical activity, and stress reduction

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NC Wellness Program –R d i (3)Recommendations (3)

• Establish participation and outcome goals• Establish participation and outcome goals – HRA completion = 80% of all state employees– Minimal migration of lower risk employees to higher g p y g

risk categories– Overall # of “high-risk” employees reduced by 5%/year

Longer range goal: 70% of employees either low or– Longer-range goal: 70% of employees either low- or moderate-risk

• Develop an evaluation plan for program p p p goverall and subcomponents

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The Future of HealthSmartThe Future of HealthSmart

• HRAs are voluntaryy

• For all except retirees, higher premiums for people with a BMI over 30 or who smokepeople with a BMI over 30 or who smoke, unless they enter into an approved weight reduction program or smoking cessation p g gprogram

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Worksite Wellness Incentives: P li O iPolicy Options

• Insurance premium discounts or rebates for• Insurance premium discounts or rebates for member participation in wellness programs

• Insurance premium discounts to group rates• Insurance premium discounts to group rates for employers with wellness programs

• Tax credits to employers for providing• Tax credits to employers for providing wellness programsSt t t ti f f b i• State contracting preferences for businesses offering wellness programs

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Legislative Options for Worksite Wellness: What Can You Do? S pport ellness programs in state p rchased• Support wellness programs in state-purchased health benefits and in state agenciesH b i d i ith l• Honor businesses and insurers with exemplary wellness programsD i t ll l t d t• Designate wellness-related events – e.g., “Health, Wealth, and Wellness Week”

• Create a worksite wellness resource center –information on best practices, return on

investment (ROI)investment (ROI)20

Resources• Baase, C. Principles of Integrated Health: A Path to Health Care

Reform. Testimony before the U.S. Senate HELP Committee. F b 23 2009February 23, 2009.

• Heaney CA, Goetzel RZ. “A review of health-related outcomes of multi-component worksite health promotion programs.” A i J l f H lth P ti 1997 11 290 308American Journal of Health Promotion. 1997;11:290-308.

• North Carolina State Health Plan. Making the Case for Worksite Wellness. Available at: htt // h / df/ M k th C dfhttp://www.shpnc.org/pdf/ww_MaketheCase.pdf

• Partnership for Prevention. Workplace Health Promotion: Policy Recommendations that Encourage Employers to Support Health I t P f Th i W k D b 2008Improvement Programs for Their Workers. December 2008.

• Woolf, Steven. “A Closer Look at the Economic Argument for Disease Prevention.” JAMA. February 4, 2009.

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Thank You!Thank You!If you have further questions please contact:If you have further questions, please contact:

Karen Shore PhDKaren Shore, PhDCenter for Health Improvement

(916) 930-9200( )kshore@chipolicy.org

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