Finally, spring has arrived in the northern United States and with it the promise of growth and accomplishment. The spring edition of HERO on HEALTH features a very informative article authored by HERO Think Tank members, Vicki George and David Schweppes of Kaiser Permanente, entitled “Diagnostic and Evaluation Tools: Understanding the Health and Wellbeing of Populations.” In this Industry Voices column they identify several health measurement tools that are available to measure, analyze and evaluate the health of a community, organization and individuals for the purpose of improving that group’s health status. Very timely indeed as the HERO Health, Performance and Productivity Study Committee explores the relationship between individual health, personal and team performance, and organizational productivity.
We’re pleased to report that over 1,000 organizations have now completed the HERO EHM Best Practices Scorecard in Collaboration with Mercer at least one time. The HERO Scorecard database now provides an even richer source of information to identify the relationship between health management program practices and levels of program participation, population modifiable health risk reduction, and impact on medical costs. In this quarter’s HERO Scorecard Quarterly Commentary, “Engagement Methods,” author Steven Noeldner provides a thought-provoking analysis of the use of communications and incentives and their impact on participation, health improvement and reduced medical costs.
I hope to see you at the 2013 HERO Forum, September 24-26, at the Disneyland Hilton Hotel in Orlando, Florida. Visit us online to register or to download a printable registration form.
Good Health,
Jerry
INDUSTRY VOICES
Diagnostic and Evaluation Tools: Understanding the Health and Well-Being of Populations
by Victoria George and David Schweppe
Employers are increasingly concerned with the health and productivity of their workforce. They ask for answers to tough questions—how can I help my employees be healthier and more productive? What should our workforce health program focus on, and how do I know what interventions will work? Fortunately, there are tools employers can use to get information to answer these questions. The first step, however, is to use these diagnostic tools to identify the state of health and productivity within an organization at the community, environmental and individual levels.
Community Health
Assessing the health of a community gives insights into the types of activities that support the health of employees living in that community. One such tool that employers can use is the Gallup-Healthways Well-Being Index®, which surveys at least 500 U.S. adults on a daily basis on many health and well-being measures, including emotional health, physical health, healthy behaviors and work environment. Another useful tool is the County Health Rankings and Roadmaps produced by the Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute. The rankings, which exist for nearly every county in the United States, focus on factors that affect health, such as education, income, access to health insurance and healthy food and smoking and obesity rates.
Kaiser Permanente and its community partners use the Community Health Needs Assessment (CHNA), a web-based resource that allows employers a glimpse into understanding the community’s health based on publically available population health data. CHNA measures include: demographics, poverty levels, education, morbidity, mortality, health behaviors, number of children who receive free lunch at school and the overall community environment. Employer groups use assessments at the community level to inform and tailor the types of activities they might include in a workforce health program.
Workplace Health
Tools for assessing the health of a specific workplace focus on evaluating not just work environments, but organizational factors that can be critical to the success of the organization’s employee health management program. Among these tools are worksite audits such as the Lifegain Health Culture Audit, workplace culture surveys like the WELCOA Well Workplace Checklist and employee interest surveys. These tools aim to identify specific areas in which employers can target investments in time and resources to have the greatest impact on the health of their workforce. In addition, employers often conduct comprehensive surveys that cover a broad array of health practices, such as the Centers for Disease Control (CDC) Worksite Health Scorecard and the Health Enhancement Research Organization (HERO) Employee Health Management Best Practice Scorecard. The CDC scorecard focuses on health promotion interventions targeted at specific conditions as part of a comprehensive workplace health promotion program. The HERO scorecard is used to determine employer best practices by analyzing strategic planning, leadership engagement, engagement methods, program availability and measurement and evaluations. These types of comprehensive survey tools help employers identify and implement programs and policies such as a no-smoking policy, open stairwell campaigns, or initiatives to offer healthy food in vending machines and cafeterias to promote healthy behaviors at the work site.
Individual Health
Once an employer has taken a broader look at the community and work environment, the next step is to review the health of the employee population. Understanding the health conditions and risk factors within an employee population helps guide program offerings and track progress over time. The most common tools that enable employers to assess individual employees’ health statuses are health risk assessments such as HealthMedia Succeed®, StayWell® Health Assessment, and Wellsource® Personal Wellness Profile. These self-report tools provide the employee with a snapshot of his or her health and generate recommendations for improvement. In the process, they also give the employer an aggregate view of health risks and existing health conditions for their employees.
The use of clinical data can also be helpful for identifying areas where employers can focus on improving the health of an individual or an employee population. Often, this sort of data takes the form of claims reporting. However, at Kaiser Permanente, we are able to draw on an electronic medical record system to provide a variety of aggregate clinical reports that inform employers about lifestyle risks and preventive care (like BMI, cholesterol, blood pressure, smoking and preventive screenings) that could support their workforce health programs.
Kaiser Permanente is leading the way with measures to include reporting for employers on the percent of their employees who have had a flu shot or who meet exercise guidelines. At every primary care visit, patients are asked if they exercise and, if so, how many minutes per week. Their answers are then recorded in the medical record as a vital sign. Exercise as a vital sign will soon be available as an important factor for better understanding the health behaviors of an organization’s employee population, and is just one way that the variety of tools that support the evaluation of health and well-being of populations will continue to evolve and expand.
About The Author
Victoria George
National Executive Director Program Evaluation
Kaiser Permanente
About The Author
David Shweppe, MPH, CPHIMS
National Vice President
Customer Analytics and Reporting Kaiser Permanente
SCORECARD QUARTERLY
Engagement Methods
by Steven P. Noeldner, Ph.D., Partner, Mercer
The term “engagement” is widely used in employee health management; however, there are varying definitions of this term. While participation rates are sometimes used as a measure of employee engagement in health management programs, most experts agree that engagement involves much more than enrolling in programs and activities; it implies that individuals participate in meaningful ways that ultimately lead to behavior change and health maintenance or improvement.
To engage individuals in health-promoting activities, you must both educate them about the programs and encourage them to enroll and participate. The HERO Scorecard outlines best practices for employee engagement in two areas: communication and incentives.
Communication
The importance of effective communication for employee health management program success is often underestimated. For many organizations, communication begins and ends with a letter or newsletter article announcing the start of a new program. However, about two-fifths of respondents (43 percent) have an annual or multi-year communication plan and—not coincidentally—these organizations also reported significantly higher participation rates for the health risk assessment (54 percent) than those with no communication plan (26 percent). Pre-launch communication and regular communication with stakeholders were also associated with high health risk assessment participation rates (54 percent and 57 percent, respectively).
Because disease management and lifestyle management are typically targeted to individuals in need of these programs, it’s important to provide detailed information that not only informs, but also compels people to accept the invitation to participate. Higher-than-average participation rates were associated with respondents who received communications focused on purpose, components, value and deadlines for these programs.
Many organizations recognize that their communication efforts are not as effective as they could be, with only 9 percent of respondents saying their communication program was “very effective” at promoting employee engagement, while 44 percent said their communication efforts were “not very effective” or “not at all effective.” Either way, most organizations likely have an opportunity to improve their communication efforts by adopting best practices.
Incentives
The use of incentives to encourage participation and engagement is a widely used best practice. Respondents are most likely to provide an incentive to complete an HRA (85 percent) or to participate in a lifestyle management program (61 percent). However, just 27 percent of employers offering disease or condition management programs provide an incentive to participate. Because these programs are often provided through the health plan, organizations are less likely to actively promote them through communication initiatives and incentives, and instead rely on the health plan to engage members.
Health Risk Assessment
While cash or gift cards are still the most common incentive used to boost health risk assessment completion (40 percent), many employers are now tying completion of the assessment to lower health plan costs, most often a reduction in the premium (30 percent). A few provide either lower copays (1 percent) or lower deductibles (3 percent).
Contributions to health spending accounts (HSA, FSA, or health reimbursement account) were offered by 16 percent of organizations. The average value of incentives (across all types) was $214. For employers in this sample, higher incentives are linked to higher participation rates. Among respondents providing incentives valued at $75 or less, the participation rate was 39 percent. This increased to 64 percent among respondents offering incentives valued at $200 or more. While the great majority of incentives were considered rewards or positive incentives, 4 percent of respondents said that participation in the health assessment was required to enroll in the health plan, which could be interpreted as a penalty for non-compliance.
Disease/Chronic Condition Management
Only 27 percent of responding organizations provided incentives for participation in disease management programs. Of those that did, 11 percent offered cash or a gift card, 5 percent offered lower health plan costs, and 5 percent offered contributions to health spending accounts. The average value of incentives for disease management participation was $141. Not enough data was available to evaluate the relationship between the value of incentives and their association with participation rates.
Lifestyle Management / Behavior Modification
As mentioned previously, 61 percent of responding organizations offered some type of incentive to encourage participation in lifestyle management programs. The average value of the incentive was $162. Cash or a gift card was the most prevalent form of incentive (32 percent), followed by raffles (22 percent), token non-cash rewards (16 percent), lower health plan costs (15 percent), intra-company competitions (12 percent), and contributions to health spending accounts (9 percent). For those organizations that reported the value of their incentives as under $50, the average participation rate was 49 percent; among those offering incentives valued at $150 or higher, it was somewhat higher, at 57 percent.
Engagement Best Practices Related to Outcomes
One valuable application of the HERO Scorecard database is to compare the use of employee health management best practices to outcomes. While the Outcomes section uses a mix of quantitative and qualitative measures, it provides insight into how the responding organizations perceive their program outcomes. The comparison of scores for the Engagement Methods section to reported outcomes suggests that organizations that employed more best practices achieved higher levels of participation, greater risk reduction, and more positive medical trend cost experience than those organizations that employed fewer best practices. For example, a quarter of high-scoring respondents (25 percent) reported that their employee health management program has had a substantial positive impact on medical trend, compared to just 11 percent of respondents with average scores.
While the Engagement Methods section of the Scorecard focuses on communication and incentives, a broader view of best practices for EHM suggests that other program elements also contribute to optimal engagement in programs, including leadership support and culture of health, which are covered in other sections of the Scorecard. It’s important to remember that none of these elements stand in isolation from the others. Research evidence suggests that participation, program impact, and financial outcomes are subject to the effectiveness of most or all of the elements that contribute to engagement. For example, an incentive of the same type and value offered by an organization with an excellent communication plan and execution is likely to get better program participation and results than one that does moderately well at communicating the incentive and the employee health management program.
It is encouraging that scores for the Engagement Methods section are directionally associated with participation rates, health risk impact and self-reported financial outcomes. This supports the value of using the Scorecard to guide the development of successful employee health management programs.
About the Author
Steven P. Noeldner, Ph.D.
Partner & Sr. Consultant in the Total Health Management specialty practice of Mercer
HERO RESEARCH
HERO Research Study: Health habits tied to absenteeism and job performance
Following are articles and studies HERO members have contributed to the knowledge base for employee health management:
“Overall Well-being as a Predictor of Health Care, Productivity, and Retention Outcomes in a Large Employer”, Lindsay Sears, PhD, Yuyan Shi, PhD, Carter Coberley, PhD, James Pope, MD. Published in Population Health Management, March, 2013. This study, a first of its kind longitudinal study, looks at well-being at a Fortune 500 company and found that the employees’ self-reported overall well-being predicts future retention, productivity and healthcare costs and that improvements to employee well-being are linked to improvements in these outcomes.
“Money Talks When It Comes to Losing Weight Mayo Clinic Study Finds”, Steven Driver, MD. This study, presented at the Annual Scientific Session of the American College of Cardiology on March 9th, reported the findings of a study of 100 adult Mayo employees or their dependents that had BMI of 30 who were given a goal to lose 4 pounds per month over a one year period. Part of the group was given financial incentives to lose weight, while the other members were not. Dr. Driver’s message is this study indicates that “financial incentives can improve results and improve compliance and adherence”.
“A Role for Private Industry/ Comments on the Johnson & Johnson’s Wellness Program”, Fikry Isaac, MD, MPH. American Journal of Preventive Medicine 2013; 44 (ISI): S30-33. This commentary highlights the effectiveness of the Johnson & Johnson employee wellness program in a summary case study format. Referenced is a 2009 study of the program indicating that employees who felt that having an employer with a strong culture of health were three times more likely to take action related to their health.
HERO Members- HERO Annual Research Meeting Announced
HERO members will gather in Minneapolis on July 17th for a day-long meeting to discuss the latest finding in research in the field and identify research that is of high priority to employers as they strive to help improve the health of their workforce.
The HERO Research Agenda will be reviewed for updating based on what is happening in the marketplace. An updated agenda will then be produced and released on the HERO website this fall. We hope to see you there.
A Call to Join HERO Research Partners
Your organization is invited to join this prestigious group of organizations that have come together to provide funding for important HERO research projects.
Alere Bravo Wellness Eastman Chemical Company HealthFitness
Healthways Kaiser Permanente Plus One Health Management
Prudential Financial Staywell Health Management
University of Pittsburgh Medical Center
NEW THINK TANK MEMBERS
ADT
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Aetna
Aetna is one of the nation's leading providers of health care, dental, pharmacy, group life, and disability insurance, and employee benefits. They serve employers, individuals, college students, part-time and hourly workers, and government employees, and the community at large. Aetna is dedicated to helping people achieve health and financial security.
Engaged Health Solutions
EHS creates and delivers programs that connect with your employees and make a significant, lasting impact on their health and well-being. Our approach is different. It’s personal. And it transforms organizations. EHS connects with your people to create and deliver programs that make a significant, lasting impact on their health and well-being. Our education and face-to-face coaching services work to achieve the outcomes that your organization care about.
Gardant Global
Gardant Global, headquartered in Florida with offices in Washington DC Metropolitan area and the United Kingdom represents leading companies in distinct vertical markets by providing strategic planning, market capture, and revenue generation. Gardant’s primary focus is the area of Government, Healthcare, Technology and Professional Services.
Howard County Public School System
HCPSS is a K-12 public school district in Howard County, Maryland. We have over 52,000 students and 8,400 employees. The school system consistently ranks among Maryland's top school districts based on student performance on the Maryland School Assessments. We implemented a comprehensive employee wellness program, Commit To Be Fit HCPSS, in 2012.
INTERESTED IN MEMBERSHIP?
CONTACT Marlene Abels
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(952) 835-4257
You are invited to register for the following “HERO Learning Series” complimentary webinars.
Space is limited for each session.
The HERO EHM Best Practices Scorecard in Collaboration with Mercer™: Findings
June 19, 2013, 1:00 - 2:00 PM CT
Reserve your Webinar seat now at: https://www1.gotomeeting.com/register/313991416
Developing Highly Engaged Organizations that Improve the Quality of Human Life: Healthy, High-Performing Teams & Leadership
August 8, 2013, 1:00 PM - 2:00 PM CT
Reserve your Webinar seat now at: https://www1.gotomeeting.com/register/959560993
HERO Forum 13 for Employee Health Management Solutions:
September 24- 26, 2013, Hilton at Walt Disney World, Lake Buena Vista, FL
HERO Members - Only Events
Annual HERO Research Meeting
Wednesday, July 17th, Sofitel Hotel, Minneapolis, MN
Pre-Forum HERO Think Tank Roundtable:
September 23, 2013, Hilton at Walt Disney World, Lake Buena Vista, FL beginning at 2:00 PM ET
Finally, spring has arrived in the northern United States and with
it the promise of growth and accomplishment. The spring edition of HERO on HEALTH features a very informative article
authored by HERO Think Tank members, Vicki George and David Schweppes of Kaiser
Permanente, entitled “Diagnostic and Evaluation Tools: Understanding the Health
and Wellbeing of Populations.” In this Industry
Voices column they identify
several health measurement tools that are available to measure, analyze and
evaluate the health of a community, organization and individuals for the
purpose of improving that group’s health status. Very timely indeed as the HERO
Health, Performance and Productivity Study Committee explores the relationship
between individual health, personal and team performance, and organizational
productivity. 
