by George DeVries

   It’s only March, yet 2007 has become a banner year for healthcare headlines as political leaders press for solutions to America’s healthcare cost crisis. Here in California, some of Governor Schwarzenegger’s early health policy discussions focused on a proposal to require California insurers to offer disease-prevention programs, such as smoking and obesity management, health screenings, and disease management to encourage healthier lifestyles and greater personal responsibility.

    But, many California insurers, agents, and employers are way ahead of the Governor. We’ve been championing wellness and disease prevention for more than a decade because we’ve seen the significant cost savings and positive health outcomes that result from these programs.
    The goal in 2007 and beyond should be to build on these successes by taking traditional wellness tools to the next level to achieve even greater cost savings while benefiting the lives of a broader population. Personal health improvement is the wellness strategy of the future. It may be the key that unlocks substantial rewards for your employer groups.
Personal health improvement programs incorporate the best of traditional wellness and disease management plans, while adding important new components, such as the following:

• Lifestyle interventions.
• A whole-population approach.
• Personal health coaching and employee accountability.
• Individualized health improvement tools.
• Incentives that engage more employees.

Lifestyle Interventions

   Over the past decade, science has proven that nothing affects our health more than our lifestyle choices. Yet, most insurers and employers focused primarily on health interventions for high-risk individuals. In 2004, a shift occurred with a landmark study titled, “Actual Causes of Death in the United States” published in the Journal of the American Medical Assn. The study named tobacco, poor diet and exercise, and alcohol consumption as the top links to cardiovascular disease, diabetes, cancer, obesity, high cholesterol, and high blood pressure.

   The study sparked many employers and insurers to recognize that they must do much more to encourage healthy living. Employers began to scrutinize medical research and large group studies about lifestyle interventions and personal health improvement programs. What they learned was compelling.

    For example, a 2002 study published in the New England Journal of Medicine demonstrated that lifestyle interventions achieved a 58% reduction in the development of diabetes among pre-diabetic people with a history of high blood glucose, obesity, inactivity, and fatty diets. These lifestyle interventions included exercise three times a week, a low fat diet, and weight loss of at least 7%. Participants who made these simple lifestyle changes had a far lower incidence of diabetes than did those in a control group who took a leading prescription drug for diabetes prevention.

    Employers also learned about impressive results among early adopters of lifestyle intervention plans. For example, The Savannah Business Group on Health implemented an intervention program to improve cardiac health through exercise, nutrition, weight management, smoking cessation, and other lifestyle changes. In 2005, the highest cardiac risk participants saw a 28.2% reduction in their propensity for developing coronary artery disease over the next 10 years.

    The Voluntary Employee Benefits Association recently implemented a lifestyle intervention program among its obese and overweight members. Eighty-five percent of participants achieved an average weight loss of 12 pounds and 27% lost enough weight to move down an entire NIH risk category.

    These kinds of examples, along with numerous published studies, are fueling demand for lifestyle intervention programs. In fact, more than 80% of large employers surveyed by PricewaterhouseCoopers in 2005 said that establishing lifestyle interventions with healthy living incentives is the most promising strategy for reducing claims and containing healthcare costs.

A Whole-Population Approach

   Disease management programs focus on managing the health of employees with chronic medical conditions. While these plans can spur substantial healthcare cost savings, they may not go far enough. Personal health improvement programs apply to the chronically ill as well as the healthiest employees. Their whole-population approach rewards healthy employees for their healthy behaviors and helps them learn new ones. It can also help detect risks in seemingly healthy employees, preventing them from migrating into a higher risk status. Equally important is that such programs can drive support for health improvement across the entire employee population.

Personal Health Coaching

   A recent report on National Public Radio chronicled the struggles of a mother who was trying to lose weight amidst work and family demands, and the daily temptations of fast foods, comfort snacks, and old habits. One of her biggest obstacles was a lack of support from family, friends, co-workers, and her employer.

   Given the stresses and distractions of our environment, it’s not hard to understand why so many Americans fail to lose weight, exercise, or change poor nutritional habits. In recognition of this situation, more health improvement programs are offering personal health coaches to give employees individual and ongoing telephone support. Besides acting as personal cheerleaders, these coaches help employees develop fitness and dietary goals and plans; implement stress management techniques; and stay motivated.

   Coaching programs have been so beneficial in helping employees achieve their health goals that 54% of the nation’s largest employers say they will offer health coaching by the end of 2007, according to a survey by the National Business Group on Health.

Individualized Health Improvement Tools

   Health plans and employers learned long ago that one size does not fit all when it comes to healthcare. Over the past decade, insurers have worked hard to tailor health plan components to drive participation and make employees accountable for achieving tangible health improvement results. The degree of customization can greatly affect a program’s success. Personal health improvement plans take customization a step further by providing employees with the following:

• Health risk assessments.
• Counselors to help them evaluate and set goals.
• Personal fitness training regimens.
• Dietary assessments and custom meal planning.
• Stress-busting techniques.
• Medication management.
• Regular sessions with personal coaches.

Incentives That Engage More Employees

   The biggest factor in the success of any employee wellness plan is participation. A typical employer struggles with participation rates of 20% or less. The good news is that more and more employers are achieving participation rates of 40%, 60%, and even 80%. For example, Fairview Health Services of Minneapolis reported participation rates of 80% in 2005 -- thanks, in part, to employee rewards, such as $25 gift certificates and store credits worth $50 to $100 for completing key program requirements.

   Health improvement programs include a broad mix of incentives that appeal to the widest possible audience. Incentives can include contests and cash prizes; free books, manuals and CDs on diet, exercise or stress management; lower health insurance costs; discounts on self-help products; free gym memberships; free weight loss and smoking cessation programs; end-of-year recognition and gifts; and bonuses for engaging in healthy activities and making healthy choices.

   But, incentives aren’t always the key motivator. In 2005, Florida Light and Power Company credited its 84% participation rate to the involvement of senior executives who worked out with other employees at the company gym and were seen participating in regular health screenings.

Helping Your Groups Choose the Right Health Improvement Plan Health improvement plans stand out as a shining example of a win-win strategy compared to other cost containment options, such as cost shifting and benefits slashing. Well-implemented health improvement plans have been proven to help employers control health costs. However, determining how much your groups might save is more difficult.

   An analyst at Brigham Young University estimated that for every dollar spent on health improvement programs, employers could save $3.50 in healthcare costs in the first three years. Watson Wyatt sources pegged it closer to $1.50 for every dollar spent in the first three years, with the ratio increasing to $3 to $1 between years five and 10.

   Meanwhile, companies large and small, from Johnson & Johnson to Coca Cola, report that they are saving thousands to millions of dollars -- thanks, largely, to these programs. These estimates typically don’t include savings from decreased absenteeism and increased productivity -- both of which are very real side benefits. According to a survey by the National Business Group on Health, participation in health improvement programs helped 20% of large employers increase worker productivity and decrease absenteeism, while 56% reported increased employee morale.

   As you review these plans with your groups, keep in mind the following:
• Whole population intervention is the key to reducing health claims. Conducting health risk assessments and screenings is the first key to identifying and mitigating risks. Having multiple employee engagement strategies helps ensure that high-risk members get the help they need and that healthy, low risk members don’t migrate to a higher risk status.
• Personal health coaching is a cornerstone of mitigating health risks mitigation. Coaches partner with employees in setting goals, exercising, and eating better. They provide ongoing support for employees throughout their successes and failures.
However, not all coaching programs are created equal. The best provide continuity with one personal coach, which allows employees to build a level of trust that is vital to success. Coaches should be registered or licensed dietitians, personal trainers, nurses, nutritionists, or certified health educators who can implement techniques for behavior modification and coaching that are proven to motivate each employee to success.

   Privacy protection is also paramount. Privacy has become a red flag as employers press for more personal health information on their employees. Most insurers bend over backwards to ensure that HIPAA privacy laws are not violated, but some go one step further by offering employees a written promise that their personal information won’t be viewed by management or used against them. Others contract with outside health coaching firms, which provide only composite information about the employee population at large.

   Sustained participation is vital. Many programs offer tremendous employee kickoff activities to stimulate high initial participation rates. But, sustained participation is really the key to long-range cost containment. Make sure that the programs you recommend include on-going employee challenges timed to seasonal events; nationally recognized health awareness days, such as the great American Smoke Out; or quarterly company-wide challenges, such as a Step it up Challenge, a fitness walk, or other health promotion activities.
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George DeVries is president and chief executive officer of American Specialty Health (ASH), a provider of complementary healthcare products and services. In 2002, the company launched its Healthyroads for Living program, which focuses on smoking cessation, weight management, and overall employee health improvement. This program is offered along with ASH’s complementary care benefit plans covering chiropractic, acupuncture, massage therapy, dietetic counseling, naturopathy, mental imaging, and relaxation benefits. ASH programs offer low-cost health benefits and cost-containment options. For more information, visit www.ashcompanies.com.