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A culture of health is spreading in corporate America. Instead of cutting health-care benefits and paring back programs to reduce costs, many forward-thinking employers are adding programs and services aimed at promoting employee health and wellness. Through comprehensive health and wellness strategies, employers are educating and empowering employees to take charge of their own health, manage chronic conditions and adopt healthier behaviors.

Companies speak of the culture of health as a paradigm shift, which they believe will reap a positive return-on-investment in the short and long term. It encompasses health programs and risk management, such as offering flu shots. The strategies are also longer term, focusing on providing the right care and treatment resources--in line with proven case management strategies--while preserving scarce and costly resources through wellness and prevention.

For Intel, the world's largest chipmaker and a leading manufacturer of computer, networking and communication products, the reasons behind its culture of health are multifaceted, including productivity concerns, the cost of health care and the issue of "presenteeism," meaning employees who are at work but not functioning at their optimal best. "Plus there is the fact that people can be more engaged if they are healthier and the company cares about their health," Adams adds.

A culture of health holds bottom-line appeal for companies struggling to deal with health-care inflation. According to Hewitt Associates, a human resources outsourcing and consulting firm, U.S. employers will see a 9.9 percent average increase in health-care costs in 2006, following a 9.2 percent increase in 2005. The answer, say many employers, is to provide the right benefit plans and programs, with a particular emphasis on healthy employees and employees who face some risks that have not yet materialized or worsened.

"Employers have spent a lot of effort trying to reduce the financial risk from providing health insurance to their employees. But the greater risk is what employees' health problems can cost them in the form of lost productivity at work or the total burden of illness. This is the risk they should manage, by reducing the overall health risks of their employees," says Sean Sullivan, president and CEO of the Institute for Health and Productivity Management.

Promoting health makes good business sense, a fact that is being embraced by top management at many employers. "When I presented the concept to the chairman, I never finished my presentation. Right away he said, 'I get it. It's the right thing to do for our people, and it's the smart thing to do for our business.' The chairman of the company is the project champion," says Joseph Checkley, global benefits director for American Standard Companies.

"This has become a business priority," adds Dr. Catherine Baase, global medical director of Dow Chemical. "We were able to put together a very well-detailed business analysis and business case for why health is inextricably linked to the profitability of the company."

ONE PIECE OF A LARGER STRATEGY

There are many approaches to managing health-care costs and promoting wellness, just as there are myriad needs among individual employees or specific employee populations. The common denominator in the health equation is engagement of employees who take greater responsibility for their current and future health state. Health coaching, utilizing case management activities and principles, encourages this type of approach.

"We have a strong shared-responsibility model," says Baase of Dow Chemical. "We believe that the responsibility for both the costs and the health outcomes is shared between individuals and the company."

The culture of health--like the practice of case management--does not seek to deny access to needed care resources. Rather, it emphasizes wellness, compliance with medication, healthier behaviors, disease management for chronic illnesses and other proactive programs to reduce demand. For example, by offering education and support to employees with chronic conditions such as asthma, companies believe costs and absences will be reduced. In addition, healthy employees are encouraged to undergo preventive screenings--such as testing blood glucose levels to assess the risk of diabetes--to avoid costly comorbidity complications and treatments in the future.

"As an employer and as a payer, we are taking on a challenge of how do we appropriately alter the demand for health-care goods and services," says Checkley of American Standard, which makes air conditioning systems, bath and kitchen products, and vehicle control systems.

"While we will continue to manage the supply side of the health-care equation, including discounted networks and plan design, we have very clearly shifted our focus to impacting demand."

To improve, manage and promote employee health, employers are offering a variety of programs. These include wellness programs for smoking cessation, weight loss or exercise promotion; disease management to offer support and education for those with chronic diseases; and behavior modification that supports a healthier lifestyle. (See article on page 26.)

"Employers in the know praise employee-focused, health risk management, corporate wellness and integrated case management efforts that unfolded long ago to improve employee health, well-being and productivity" says Les C. Meyer, health-care strategist and chairman of the IHPM's Health Management Strategic Advisory Council and its Employer Leadership Group.

Employee health and wellness programs are not stand-alone offerings, but interrelated parts of comprehensive strategies to educate and engage employees on many different levels, depending upon their personal needs. To manage these health and wellness tools, companies are using health risk appraisals and other assessments, which also help employees to understand the state of their own health.

For example, Lincoln Plating, the nation's largest finishing company, requires each of its 450 employees--from the CEO to a person on the manufacturing line--to undergo a quarterly health evaluation of such things as blood pressure, body weight and body fat percentages, and flexibility. Based on the assessment, personalized wellness goals are devised. "About 50 percent of the employees are encouraged by it; they like the attention and the opportunity to improve their health," says Tonya Vyhlidal, wellness manager for the company. "Another 20 percent are cautious, and then you have that other 30 percent who aren't really sure they want to buy into it."

WORD OF MOUTH

One of the most powerful tools in achieving employee buy-in is word of mouth, as success stories are shared. Vyhlidal gives the example of a 45-year-old employee who stopped using tobacco after 25 years and now is a wellness department leader at the company.

The culture of health seeks to manage future costs by anticipating the collective needs of an aging workforce, younger workers who have poor health habits and behaviors, and retiring baby boomers consuming resources in the future. "We're highly focused on providing health-care services through the continuum of health," says Lynn Zonakis, director, health strategy and resources for Delta Air Lines. "The population at Delta tends to

be a long-term, older population. For us, we understand very well that this population we have will also be utilizing retiree benefits for many years," she says.

To respond to the needs of its employee population, Delta developed a customized and dedicated care management program in 2004. It targets healthy individuals who may have certain risk factors, as well as those who have significant illnesses, to help them modify their risks and manage their conditions more effectively. In addition, it extends complex case management to employees who face more serious health issues.

While a culture of health makes good sense intuitively, there must be specific goals set and data to track and measure results. For example, Dow Chemical's corporate-level strategy on health is built around five "pillars," Baase explains. Under each of the five pillars--prevention, quality and effectiveness of care, health systems management, aligned incentives and advocacy--is a comprehensive set of metrics, short- and long-term objectives, and goals and activities.

Pitney Bowes, which provides mail-stream software, hardware and services, took data analysis a step further with predictive modeling to project future costs related to medical claims, disability and absenteeism. One finding was that, as expected, higher than average medical costs were incurred by those with chronic medical conditions, which pointed to the need for better medical compliance for these individuals.

It also found that "normal" health-care spending for a typical healthy employee was somewhere between $100 and $800 a year, covering such things as normal preventive screenings and doctor visits a couple of times a year for a few illnesses.

"Having no costs is not desirable, because people need some level of routine care, and not just preventative," explains Dr. Jack Mahoney, corporate medical director for Pitney Bowes. "We did a total redesign of our benefit program, redesigning all health plans so that preventative services are free or have a minimal co-payment. What we wanted to do was set up an atmosphere where we can preach that screenings are good, and then remove the cost barrier, plus make them available through on-site clinics and on-site screenings."

Offering comprehensive programs is one thing. Getting employees to participate is another. Employee support and involvement are critical if employers are to reap their desired short-term ROI and realize future savings in avoided costs and benefits consumption.

"Employee education and empowerment are the critical components," Zonakis of Delta says. "You need a plan design that is an incentive for the behavior, and then communicate how to use the program."

Managing employee health also means promoting healthy behaviors, and in many cases helping employees to change behaviors, such as stopping tobacco use, losing weight or taking up an exercise regime. To effect these changes, companies need to keep a high visibility so that the health message is reinforced. A proactive, individualized case-management strategy assists in the process.

Pitney Bowes, for example, has taken health promotion into the cafeteria, repricing its menu so that healthy foods are subsidized by the company while less healthy foods cost more.

"That means in the morning you can get a serving of oatmeal at a reasonable price. Fresh fruit costs only 50 or 60 cents. If you order food for a meeting, potato chips are not included. Bottled water is encouraged; you have to ask specifically for soda," explains Mahoney of Pitney Bowes. "It's a culture of health, and it has to start from the very top. You'll find the chairman of the company in the cafeteria, working his way through the salad bar. It's the kind of thing that when people see it they say, 'It's OK to do that, too.' ?

MINDY OWEN, RN, CRRN, CCM, is chairwoman of the Commission for Case Manager Certification. She is also principal of Phoenix HealthCare Assoc. LLC, based in Coral Springs, Fla.

March 1, 2006

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