A Message From Our CEO

We are delighted to announce that HERO, in collaboration with the American College of Occupational and Environmental Medicine (ACOEM), American Cancer Society, American Cancer Society Cancer Action Network, American Diabetes Association, and American Heart Association, have released a joint consensus statement on the use of outcomes-based incentives in workplace wellness programs. The paper, “Guidance for a Reasonably Designed Employer-Sponsored Wellness Program Using Outcomes-based Incentives,” was published by the Journal of Occupational and Environmental Medicine (JOEM) on

Industry Voices: Effective Communication

LaVaughn Palma-Davis

We’re bombarded with messages to improve our lives. Emails, phone calls, TV and even smart phone apps and social media sites tell us how to be happier, healthier, and live better.
So there’s an abundance of competition when it comes to communicating the benefits and news of an employee health program. It’s a battle, but one that’s worth winning.

MHealthy is a comprehensive population health strategy that has been recognized both internally and externally for successfully providing high quality services and creating a culture of health at the University of Michigan (U-M).  Now in its fourth year, MHealthy has established a strong foundation for the future and is making measurable progress toward its long-term goals of improving the health status and quality of life of the UM community and helping to control health related costs. The level of health risks in U-M’s population is trending in the right direction.  Customer satisfaction is high, and MHealthy is achieving favorable health outcomes. U- M is also seeing a positive trend in both health care costs and self-reported absenteeism. 

Scorecard Quarterly Commentary: A Case for Including Spouses in EHM Programs

By, Dan Gold, PhD

There is evidence that comprehensive communications, the use of incentives and a strong culture of health can all help drive increased participation in EHM programs. An often overlooked element that also contributes to the long-term success of EHM programs, however, is the role of family support—specifically spouses. In fact, it’s missing from the term itself: “Employee Health Management”.

Health behavior research has found that other individuals and groups have a profound impact on an individual’s behavior, with spouses being a key influencer. Social support is not only a predictor of initial engagement, but also of long-term success. Spouse support has been associated with higher quit rates for tobacco users, and predicts weight loss adherence as well. While social support contributes to initial participation, its crucial role is in the maintenance of changed behaviors.

Given that a primary objective for most EHM programs is to reduce medical cost trend, it would seem even more important to include a group of members that is driving nearly a third of the health care costs of an organization.  Although spouses typically represent only about a fifth of covered members, average cost in an average population is about 30% higher for spouses than for covered employees, adding a greater opportunity for savings.

This analysis of HERO Scorecard data investigated the impact of including spouses in an EHM program. Specifically, it examined whether making key components of EHM programs available to spouses: 1) increased employee engagement; 2) improved the program’s likelihood to impact health; or 3) increased the program’s likelihood to demonstrate savings. The analysis also examined whether including spouses in an overall EHM strategy is associated with the use of other best practices (as demonstrated by higher best-practice scores). Because a key focus was on participation rates, the analysis was limited to employers offering, at a minimum, health risk assessments (HRA) and lifestyle management programs.

Including Spouses in EHM Programs
About two-thirds of all Scorecard respondents indicated that they include spouses in key components of their EHM program. Of those that offer both an HRA and a lifestyle management program, about three-fourths said that spouses are included.

Findings

*Of those that offered an HRA
**Of those that offered Lifestyle Management

[1] Responded in the affirmative to the following question: Has your organization taken steps to make key components of the EHM program available to benefit-eligible spouses/domestic partners or dependents (including service offered through health plans or community groups)?
Employers that included spouses in key components of EHM had a higher HERO score than those that did not (117 vs. 100). Both groups were above the database average of 94 because this analysis was limited to employers offering at least an HRA and lifestyle management, which drove up the average score for these subgroups.
While spouse involvement had only a minimal effect on average employee HRA participation rates (52% in programs that included spouses and 50% in those that didn’t), a more dramatic impact was seen in the behavior change programs. Employers that included spouses in key components of EHM reported employee participation rates twice as high as those that did not (28% vs. 14%).  The average employee participation rate in tobacco cessation programs was higher in EHM programs that included spouses as well (10% vs. 8%). As other research also suggests, these findings imply that social support likely has a greater impact on engagement in specific interventions than on initial participation.

*Of those who measured impact and/or outcome.

To assess the impact on health risks and savings, an analysis was conducted on two sets of questions. Respondents were first asked if they measured the impact of their program on health risks and/or medical costs, and if they did this measurement, what they found.
Among those that measured risk change, 88% of respondents that included spouses in their strategy reported at least some improvement in health risks vs. 81% of respondents that did not include spouses.  In addition, 70% of respondents that included spouses reported at least some improvement in medical trend vs. 64% of respondents that did not include spouses. While the magnitude of impact was not evaluated, the findings suggest, at least directionally, that there is a greater likelihood of program success if spouses are included.

Conclusions
While the evidence is supportive, it is important to note that the analysis was descriptive in nature and does not necessarily suggest causation. Other factors, not controlled for in the analysis, also likely influence the results. For instance, larger organizations are more likely to include spouses in their EHM strategies, and as reported in a past commentary, employer size is related to the HERO score.

However, the data support, at least directionally, that those organizations that include spouses in their overall EHM strategy were able to demonstrate increased employee participation, especially in the interventions that matter, as well as a greater likelihood of health improvement and medical cost savings.

While it was encouraging to see that including spouses in EHM strategy is becoming more of the norm, there is still a ways to go. Until we can move Employee Health Management to true Population Health Management, we will be limiting the potential impact of these programs.

Scorecard News

VERSION 4.0 OF THE HERO SCORECARD IN COLLABORATION WITH MERCER

The project to create version 4.0 of the HERO  EHM Best Practice Scorecard has launched!

Maintaining a leading measurement tool means keeping up with the industry changes.  To ensure the Scorecard remains current with industry direction HERO launched the Version 4.0 project.  The project, slated to take approximately 8 months, will address changing issues including measurement, and the special needs of micro businesses.  Additionally, the team will examine existing questions for relevance and update the questions or the answer selections as required. 

The project team is divided into work groups comprised of experts from across the industry, including individuals from employers, consultants, providers, insurers, universities, and individuals with expertise in key areas.  This mix of expertise brings the broadest perspective possible to ensure the Scorecard remains the most comprehensive measurement tool for Employee Health Management available.
When was the last time you took the Scorecard?  HERO recommends retaking the survey annually.

New Publications

Toward an Employee Health Management Research Agenda: 
What Are The Research Priorities?
AJHP The Art of Health Promotion July/August 2012
David Anderson, PhD
Melondie Carter, DSN, RN
Kristi Rahrig Jenkins, PhD
Terry Karjalainen, PhD
R. William Whitmer, MBA

Exerpt
As employee health management (EHM) programs continue to grow and mature, employers are increasingly interested in gaining a deeper understanding of contributing factors to EHM program success.  To lead in this effort, HERO has evaluated the current research, established new research priorities and created a strategic road map to guide our direction. This article will give you insight into the process HERO employed to determine what research priorities are most important to our members and the industry, consistent with the HERO mission.
Purchase this Article

Guidance for a Reasonably Designed, Employer Sponsored Wellness Program Using Outcomes-Based Incentives.
JOEM 54(7):889-896, July 2012
Excerpt
This Consensus Statement was prepared by a Joint Committee of the Health Enhancement Research Organization (HERO), American College of Occupational and Environmental Medicine (ACOEM), American Cancer Society (ACS) and American Cancer Society Cancer Action Network (ACSCAN), American Diabetes Association, and American Heart Association (AHA). This was reviewed and approved by the ACOEM Board of Directors in May 2012

Abstract
Objective: To provide guidance regarding appropriate use of outcomes-based incentives as part of a reasonably designed wellness program designed to improve health and lower cost while protecting employees from discrimination and unaffordable coverage.
Methods: The process included reviewing the literature, regulations, case studies, and other resources while developing consensus through numerous group discussions.
Results: We offer guidance on the elements of a reasonably designed wellness program that should be in place if outcomes-based incentives are deployed and identify strategies to help ensure that effective and fair programs are put in place and evaluated.
Conclusions: We strongly encourage employers using outcomes-based incentives as part of wellness initiatives to incorporate these elements of a reasonably designed wellness program and consider this guidance for the design, implementation, and evaluation of such programs. Download Article Free

THE FOLLOWING ARTICLE HAS BEEN ACCEPTED FOR PUBLICATION
Presenteeism According to Healthy Behavior, Physical Health, and Work Environment. 
Population Health Management (date pending)
Ray Merrill, PhD
Steve Aldana, PhD,
James Pope, MD
David Anderson, PhD
Carter Coberley, PhD.
R.William Whitmer, MBA
Studies subcomittee

Recent additions to the Think Tank library:
Three articles were recently submitted on Human Performance  by Jack Groppel PhD and Ben Wiegard, PhD. 

1. Biology of Human Performance
2. New Balance Association Increases Engagement and Energy Levels with Workplace Movement Program
3. A New Performance Paradigm

Research Update

R. Bill Whitmer MBA, Co-Founder HERO

The HERO Research Committee, along with several member organizations, has been actively advancing research designed to inform the employee health management industry and support the efforts of our member organizations. For this issue of HERO on Health, we’ll focus on

New Think Tank Members

Ohio State University
Launched in 2006, Ohio State’s Your Plan for Health (YP4H) is the university’s approach to providing benefits-eligible faculty and staff with the tools and resources that will empower them to become proactive in managing their own health. YP4H's primary focus is on helping faculty, staff and their families reach the healthiest state possible by offering a variety of programs and incentives for identifying and acting on health care conditions, promoting cost-efficient choices based on individual needs, and taking control of health care spending. YP4H services includes biometric health screenings, personal health assessments, health-related financial incentives, personal health coaching, care coordination for chronic conditions, the employee assistance program, education programming and much more.  http://nursing.osu.edu/

The Workplace Helpline
The Workplace Helpline is an industry leading Legal and Compliance Services Company, With a patent on its method and technology, HELPLINE has revolutionized the way that Professional Services are brought to carriers, brokers , TPAs and their employer group clients. Through insurance and financial services, HELPLINE provides legal and  compliance advice & counsel to thousands of employers in all 50 states. They range from the small to medium size firm in the private and public sectors to large organizations that have in-house legal and HR departments. HELPLINE’s “high touch” Relationship Management approach seamlessly integrates human contact with cutting edge technology and experienced professional expertise to answer and document responses to employers’ specific legal and compliance questions.
www.helpline-group.com

Tufts Health Plan
Tufts Health Plan is a nonprofit organization nationally recognized for its commitment to providing innovative, high-quality health care coverage. The plan offers members and employers an array of health management programs, which support evidence-based approaches to health and wellness
http://www.tuftshealthplan.com/