Every quarter, a HERO member is invited to comment on a particular topic derived from an analysis of the most current HERO Scorecard data. We’re pleased to share the most recent commentary from Jesse Hercules, CEO of Extracon Science. As mid-sized and small employers move rapidly to develop and enhance their employee health management programs, we turned to the Scorecard data to tell us about their experience and success with employee health management.
How much does employer size matter when it comes to employee health management? Specifically, can small employers, with their more limited resources, hope to achieve as much success with employee health management as larger employers? This commentary uses data from the HERO Scorecard to compare large, medium and small employers in their use of employee health management best practices.
For the purposes of this analysis, consider the following baseline data:
While the overall Scorecard results are important, it’s also instructive to look at how employers of different sizes compare on their average scores for the six sections of the Scorecard. For instance: Relative to large employers, small employers score lowest in the areas of Programs, Engagement Methods, and Measurement/Evaluation.
While these results support the perception that health promotion programs are more comprehensive among larger companies, it’s encouraging to note that small employers do achieve levels of leadership engagement as high as large companies.
Other noteworthy findings that are specific to small employers include:
Small employers offer fewer programs than larger employers. Health risk assessments, disease management services, and lifestyle interventions such as coaching are all less prevalent among small employers. However, these programs have become widely available from vendors on a remote basis, so small employers’ lack of usage seems more a matter of culture and priorities than necessity.
The low prevalence of onsite medical clinics among small employers reflects legitimate problems of scale – the fixed cost of a facility and full-time clinicians must be spread across a larger population to make sense.Small companies use fewer communication methods than large or medium companies, perhaps because fewer are needed to reach a smaller, less-dispersed workforce. However, companies of all sizes communicated a similar number of employee health management themes.
Small companies use health risk assessment (HRA) incentives at a rate similar to that of medium and large companies, but they’re less likely to use benefits-integrated incentives, such as an employee health plan premium reduction, which is now the most common incentive among large employers.
The most common HRA incentives provided by small employers are still cash or gift cards. Large, medium and small companies use incentives in similar ways for lifestyle management programs.
Unique Opportunities for Improvement
The Scorecard areas of Strategic Planning and Measurement/Evaluation seem to offer some of the best opportunities for improvement in smaller companies. Small organizations may find these processes easier to manage than large, complex organizations. For example, a strategic plan for employee health management for a small employer with one or two locations could be much more concise and targeted than a plan that must cover dozens of dissimilar sites across the globe for a large organization. Surveys and focus groups could also be easier to manage at a smaller organization, as it can be easier to get a representative sample in-person if there are fewer sites, and it will be easier to manage a smaller data set.
Scorecard results to date support the conventional wisdom that larger organizations tend to have more comprehensive programs for employee health management, even though there are relatively few programs–such as onsite clinics–that really require a substantial employee population. However, there is significant variation within each employer-size group and examples of employers of all sizes that have outstanding program results.
An earlier analysis of the entire Scorecard database demonstrated that higher best-practice scores are associated with better program outcomes. When the same analysis is performed on just the small employers in the HERO database–arraying respondents by score and dividing them into low, average and high-scoring groups of equal number–the same pattern emerges: the high-scoring group of small employers reported significantly better outcomes than the average or low-scoring groups. In fact, high-scoring small employers reported outcomes in terms of health risk reduction that were similar to high-scoring large and mid-sized employers.
While further study is needed with a more robust database of small employers, this analysis supports the assumption that, regardless of size, employers that follow best practices will achieve better program outcomes.
Readers interested in a case study on a successful, comprehensive employee health management program in a small employer setting should read “The Impact of Worksite Wellness in a Small Business Setting,” published in the February 2011 issue of the Journal of Occupational and Environmental Medicine, and accessible through the HERO website.
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