Employee wellness programs have proven and documented positive returns for both employers and employees. Why, then, doesn’t the entire workforce participate? Theories and employee surveys suggest there are several reasons why an employee might not choose to participate in an employee-sponsored wellness program. Employers that address these head-on can encourage greater participation:
Employees think the employer is trying to learn about their health issues to somehow use that information against them.
They do not believe that Health Risk Assessments are reported in the aggregate and will not have their name associated with their individual results.
They are not interested in improving their health (most smokers understand that it's unhealthy, yet they are not ready to make the effort to quit).
Some employees do not need help and are already living a healthy lifestyle.
The company sends mixed messages: It encourages participation in the wellness program, yet still offers high-fat "junk" foods in the cafeteria and vending machines.
The company leaders don't participate, so employees don't believe it's important.
Employees believe the company saves money, but "what's in it for me?"
What exactly is a wellness program? Today, it can mean everything from a company gym membership to a simple smoking cessation program offered to employees, to a full-blown, structured program where employees can choose their areas to track, set their own goals, and have access to professional health coaches along the way. Structured programs offer the best way to track results, especially if you start with a Health Risk Assessment for each participant. As noted above, HRAs are conducted by third-party companies and report results only in the aggregate. The more you stress this to employees, the better.
Advantages to the Employer Whether or not they have made the move to invest in the health of their employees, most company leaders acknowledge that a healthier workforce will benefit them, and why not? According to the Wellness Council of America, results are impressive:
A company gains an average of $5.81 for every dollar invested in health management programs.
They reduce sick-leave absenteeism by an average of 26.8 percent.
They reduce health care costs by 26 percent.
They reduce worker's compensation and disability management claims costs by 32 percent.
Advantages to the Employee Likewise, employees are seeing the benefits of wellness programs. According to the Principal Financial Well-being index for American Workers, 62 percent of employees believe workplace wellness activities are successful in improving health and reducing risks (up from 55 percent in 2011).
American employees who are healthier approach their work with more energy and motivation. Here are some benefits they cite:
51 percent of participants say they work harder and perform better
59 percent say they have more energy and are more productive
Employees expect their employers to offer wellness programs
45 percent say that health-related programs encourage them to stay in their current position
43 percent say they miss fewer days of work as a result of wellness programs
Why, then, do 34 percent of employees refuse to participate in company-sponsored wellness programs? In addition to addressing the concerns listed above, two strategies can be very effective: offering incentives and inserting game mechanics.
The Role of Incentives Incentives can dramatically increase participation, as well as results. One study conducted by MED-STAT of Ann Arbor, Mich., documents an almost 250 percent increase in participation with the introduction of non-cash incentives. Incentives can help drive participation in the following areas:
1. Prevention, which can include the initial HRAs, as well as increased participation in events such as flu shot clinics and health fairs 2. Lifestyle changes such as smoking cessation, weight loss, and nutrition or stress management classes 3. Managing specific conditions, such as having access to nurse phone lines to manage treatment for conditions such as diabetes 4. Education, which includes intranet websites with program details and information that employees can access, Lunch & Learn sessions, and interaction with personal health coaches
Cash is not necessarily king when it comes to wellness incentives. Companies are finding non-traditional ways to encourage participation in their programs. AstraZeneca Pharmaceuticals invited employees in their Wilmington, Del., headquarters to participate in healthy cooking classes hosted by local celebrity chefs and to attend a health-tips seminar given by an Olympic runner. Employees accrue points for engaging in healthy activities that they can redeem for gift cards. A farmer's market is set up on site in the summer months to make it convenient and affordable to find fresh produce.
What types of incentives work? The best incentive is always the one that appeals to your audience! Involve potential participants in the reward selection process to make sure you’re offering something they consider valuable. Some ideas are:
corporate-identified merchandise such as tote bags and apparel (especially when used in exchange for registration)
reduced insurance premiums
increased company contribution to HSAs
additional benefits to their health plan
perks unique to the company (prime parking spots, preferred vacation times, etc.)
formal employee recognition by management and peers
one-on-one time with the CEO or other executives
reduced co-pay or deductibles
Wellness as a Game Gamification sounds like an intimidating term, but it simply refers to the practice of incorporating game elements in non-game applications to make them more fun and engaging. Especially for a generation of younger workers who grew up on video games, gamification is an effective educational strategy and is being used in many corporate applications, from sales incentive programs to consumer offers and reward & recognition programs. Incorporating game elements into a wellness program can increase enrollment and participation but also can be used to educate employees about specific conditions and courses of treatment, as well as help them understand the intricacies of their employee benefits program. Medical information is notoriously dry, boring, and can be confusing; the use of game components allows for the information to be broken into small bites the employee can comprehend and remember.
How big is gamification? M2 Research estimates the gamification market at $100 million and expected to grow to almost $3 billion in the United States alone by 2016. According to Lightspeed Research, 53 percent of Facebook users play games regularly and 19 percent consider themselves “addicted.” If we estimate the total Facebook users today at 500 million and count only the 19 percent who are "addicted" and play more than 30 minutes each day, Americans are conservatively spending 2.8 billion hours each day playing games on Facebook alone, not to mention the many other social networking sites that include games, games on smart phones, or in conjunction with the promotions mentioned earlier.
There's no question the popularity of online games is growing, but will that relate positively to your wellness program? It seems so: 15 percent of U.S. hospitals use at least one form of social media (such as internal social networking sites, Facebook, Twitter, YouTube, etc.), and 80 percent of web users/consumers look online for medical information, so incorporating games into the wellness program structure makes sense as the next engagement strategy.
If you don't want to start from scratch, several companies offer off-the-shelf games that are appropriate for wellness initiatives: Livestrong.com offers do-it-yourself games that can be used for families (Family Weight Loss Game), individual personalized brain-training games or food tracking, and fitness games to engage a neighborhood, civic organizations, or student groups. Companies can also find games that are designed to achieve specific goals: Humana Games for Health is a suite of online mobile games designed to keep both mind and body fit; Lit to Quit is an iPhone game for smoking cessation. As gamification for wellness programs continues to prove successful, we’ll likely see more companies developing these types of games.
The Rules of the Game Whether you design your own game strategy or use existing games, incorporating game mechanics into your wellness program is just one more tool that you can use to build a healthier workforce. Here are some tips to consider before you start constructing your gamification strategy:
Make it simple. Clear rules and a simple, point-based format that is consistent throughout the program will be easy to understand. Choose a game that will be familiar to your audience and ties in with the theme of your program or some company or program initiative. Likewise, make it easy for employees to track and monitor their own progress.
Make it interesting. Mixing in periodic challenges or competitions will keep the participants engaged. Present group activities where co-workers can connect with others (group walks at lunch breaks, team activities between departments, a company team participating in a local charity walk, etc.).
Make it social. It's not much fun to participate in a vacuum. Provide ways that employees can socialize to compare scores, exchange tips, and encourage one another. Just the knowledge that others will see their progress provides some motivation, but support and encouragement from peers also contributes to success.
Make it meaningful. Getting support (actual participation, not just lip service) from management can make all the difference. When employees see that a healthier workforce is a priority for management and that they are also participating, employees may see an additional value in joining in (and there's always that chance that the employee may get a little face-time with the boss during that walk-a-thon).
Make it measurable. Make sure you have strong reporting tools in place to gather data to determine how effective the game components are in increasing results or show where you need to adjust the game to achieve higher results.
The Role of Government and Legislation The Patient Protection and Affordable Care Act (Affordable Care Act) has a number of provisions intended to contain health care cost growth and expand health promotion and prevention activities, including start-up grants for businesses with fewer than 100 employees, resources for evaluating employer wellness programs, and expert aid for employers to develop and expand workplace wellness activities, such as tobacco-free policies, flextime for physical activity, and healthier food choices in the workplace.1 Other provisions championed by Sen. Tom Harkin, D- Iowa, include a 50 percent tax credit for companies that offer a comprehensive wellness program to their employees. Harkin said, "It simply makes sense to partner with employers and leverage the place where Americans spend the majority of their waking hours -- the workplace."
The health care reform law includes several provisions tied to health promotion, but in particular would allow employers to offer employees a premium discount of up to 30 percent (versus 20 percent currently) for positive lifestyle practices or participation in health promotion programs.
The Incentive Federation launched an Incentive Legislative Awareness campaign, lobbying in Washington, D.C., to increase awareness of the benefits incentive programs can bring to the corporate bottom line. The Healthy Workforce Act of 2009 offered tax advantages for safety and service awards (IRS Code 274(j)), with great success. The Incentive Federation is now hoping to encourage Congress to build on that success by enacting legislation offering tax advantages for wellness programs.
George Delta, executive director of The Incentive Federation, Inc., asserts the law advocates universal coverage but doesn't do much to address costs. Wellness programs reduce health care costs and help to motivate employees. If Congress authorizes employers to provide non-taxable tangible (non-cash) merchandise incentives, it will create the incentive for companies to maximize the benefits of their wellness programs and provide the environment to reduce costs.
While we're waiting for legislators to get it right, employers who want to maximize the benefits of their wellness programs today can do that by encouraging employee participation by addressing many of the points mentioned here.
Reference 1. A Review of the U.S. Workplace Wellness Market (prepared for the Office of Policy and Research, Employee Benefits Security Administration, Department of Labor, and the Office of Health Policy, Assistant Secretary for Planning and Evaluation, Department of Health and Human Services)