An ounce of prevention

In a classic scene from the Mel Brooks movie "Blazing Saddles," Slim Pickens' character yells at his outlaw posse to head off the good guys "at the pass." Harvey Korman's character, in Brooks' effort to parody his own parody, gives Pickens a menacing look and lets him know how much he hates that clich?(C) before punctuating his point by shooting Pickens in the foot.

Employers, employees, brokers, insurance companies, providers and even politicians are realizing the value of paying for some programs that actually help prevent people from getting sick as often or developing chronic conditions that require years of treatment -- of heading off health problems at the pass.

If overweight employees can be convinced to change eating and exercise habits and lose weight, they'll be at work more, they'll be more productive while they are there, and they will cut their chances of developing high blood pressure, heart disease and diabetes. If smokers quit smoking, their chances of developing asthma, cancer and a wide range of other ailments drop. Another old clich?(C) -- an ounce of prevention is worth a pound of cure -- is finding prominence as wellness and disease management programs gain a foothold in employer-sponsored offerings.

"If people live healthier lifestyles, it helps reduce health problems and keeps them more productive at work," says Sean Slovenski, president and CEO of Hummingbird Coaching Services in Cincinnati. "That costs companies less, and employees have a better life for themselves."

Wellness efforts

In an attempt to get the word to more employers and consumers, state and local governments and nongovernmental organizations are getting in on the act, sponsoring wellness days, encouraging exercise and spearheading smoking cessation drives.

For example, the Southern Nevada Health District and the Office of Chronic Disease Prevention and Health Promotion have put together a program called "Get Healthy Clark County." The program has an extensive Web site filled with information for employers, including downloadable wellness kits for human resources to use, including tobacco prevention, physical activity, nutrition and more.

The state of Arkansas' Web site features a wellness section with a worksite wellness toolkit, assessment tools, information on incentive programs and a lot more. In addition, it lists these seven elements of a comprehensive worksite wellness/health promotion program:

1. Health education, which focuses on skill development and lifestyle behavior change.

2. Supportive social and physical environments, including implementation of policies that encourage healthy behavior.

3. Integration. The worksite program must fit into the organization's structure.

4. Linkage to related programs like employee assistance programs.

5. Screening programs.

6. Support for individual behavior and follow-up interventions.

7. A way to determine how the program is working and ways to improve it.

The U.S. Department of Health and Human Services, in conjunction with the Centers for Disease Control, created the Steps to a Healthier US Cooperative Agreement Program to provide grants to communities across the United States. The grants are used to encourage lifestyle changes in populations deemed at-risk.

Austin, Texas, used its grant to partner with Capital Metro, the local transit authority, to implement a worksite wellness program, which includes consultations with dieticians and personal trainers, a 24-hour fitness center and personal assessments. Since 2003, Capital Metro has seen its health care costs rise much more slowly: 9.6 percent from 2004 to 2005, compared to 26.8 percent from 2003 to 2004. Absenteeism fell 44 percent from March 2004 to June 2006.

The federal program is working in other places, too, and it demonstrates that properly implemented and maintained wellness and disease management programs can drive down health insurance costs. That should be good news for brokers, because anytime they can demonstrate a cost savings, it keeps a client happy, which in turn keeps a client a client.

So how can brokers go about introducing one more thing to a client who already feels like he's paying for too much?

It's not easy, but it can be done.

Getting employers interested in wellness and disease management programs means brokers have to understand employers' pain. They have to know what the complaints are and be able to address them. Zachary Meyer says the issues employers are dealing with are three-fold:

1. Attracting and retaining talent

2. Cost trends

3. Productivity

"Attraction and retention of top talent is the No. 1 pain for employers in the mid- to small market," says Meyer, senior vice president of Ceridian LifeWorks in Minneapolis. "Offering a rich benefits package helps those companies compete."

The second pain has to do with making sure the top talent stays healthy, thereby keeping costs down. This is where disease prevention programs are prevalent. Keeping the talent healthy also weighs on the third pain: productivity. Sick employees are not productive employees, and small to mid-sized companies can't afford productivity losses, so wellness and disease management programs can go a long way toward helping the bottom line.

The problem is, small and mid-sized companies don't seek what they might really need.

"Smaller employers are not always looking for a complete solution," Slovenski says. "The reality is that it's more important for those companies to have a complete solution because one employee can affect health care costs more."

Lonny Reisman, M.D., the CEO of ActiveHealth in New York, agrees with the assessment that a complete solution is more effective. He says a wellness program and a disease management program should work in tandem in order to address the entire employee population. In most groups, it's a good bet there are both people who already have chronic conditions that need management and those who are at-risk and can be helped by a wellness program.

"Disease management and wellness management are totally different things," Reisman says. "We focus on both because any population will have the need for both. Disease management is much more complicated. A lot of programs are focused on one day at a time. Diseases aren't like that."

Cost containment

The final, or maybe the first, pain -- the one that will never disappear -- is cost. Can the cost of such programs be justified by more than the feeling of goodwill that may be generated?

Yes, say the experts. Common sense says that healthier employees cost less money to take care of, and the experience of the Austin transit authority is a real-world example of health care costs slowing way down. Technology has made it possible to track progress and measure success.

Online enrollment and tracking let providers give employers measurements they can use. Has 20 percent of the population moved from a high-risk position to at-risk or better? Did those 13 workers who enrolled in smoking cessation programs miss less work and visit the doctor less? The possibilities are nearly limitless.

"We can give process metrics on enrollment and achievement," Meyer says. "[Brokers] can use that to give an estimated ROI." And that is something employers can relate to.

"All an employer has to do is look around and see how many employees are smokers, how many are obese, how many are under stress, etc.," Meyer continues. Between the metrics provided and just looking around, the employer gets a gut check and an ROI check.

"There is skepticism about whether any of the programs save money," Reisman says. "We've done studies that show they do. This is more than just a sentimental thing. We're showing it's more than a nice thing to do."

So providers have done the research. Brokers have the luxury of using numbers that have already been gathered at the source. They can show an employer with 275 employees how the programs have worked at companies of similar size.

Participation

Even armed with numbers that show the programs work and with information about the preventability of many of the ailments that cost the most money, brokers still have some convincing to do. The question they will be faced with is this: "How do I know my people will stick with the programs?" The answer to that contains a couple of parts.

First, incentives drive participation. Whether it is a gift certificate to take the health assessment or paid days off for participation in a weight-loss program, an incentive to participate and stay active in a program makes a difference.

"Most research confirms it," Slovenski says. "And the body of research seems to grow weekly. You need to incentivize employees to get higher participation, and it needs to be tied to cash. Give them money in their pocket or off their premiums. The employer will get [the money it spends] back because it will spend less on health care and employees will be gone less."

But just offering the incentives might not be enough. That's where coaching comes into play. A program that assigns health coaches to participants is going to have the most success. Adults are very good at holding their children accountable for their homework, their chores and brushing their teeth, but those same adults aren't as accountable for their own habits, especially when it comes to exercise, nutrition or smoking cessation. They need a coach, and they need a coach who specializes in their needs.

Companies like Ceridian offer coaches to participants in specialized programs like weight loss. If someone calls in for weight management, Meyer says, that person gets a weight counselor. But coaches don't work very well without a relationship with the participant. That's why Ceridian, Hummingbird and other programs offer dedicated coaches.

"Your coach is with you as long as you are in the program," Slovenski says. "The participant gets to know the coach. He knows there's a follow-up coming on any commitment made."

Coaching is offered in person, on the phone, via e-mail or instant messaging, or through message boards. In whatever form it is offered, that coach becomes a participant's personal accountability officer, and that -- as much as anything else -- is what keeps employees on the right track to better health, which, in turn, turns offices into healthier places to be and keeps costs down.

Wellness programs also provide another avenue for holding consumers more responsible for their own health care in the consumer-driven model. This is one more way to keep those health savings accounts flush with cash for a real emergency down the road. Fewer trips to the doctor for recurring ailments leaves more money in an account that can grow and be taken along should a person change jobs.

"The consumer-driven model has switched cost and accountability to the consumer; the money is theirs," Meyer says. "There is an incentive to take care of themselves, and wellness programs help them do that.

"Plus, health and wellness expenses can be reimbursed through HSAs," so they get to participate in self-betterment programs with tax-advantaged dollars.

In the end, like it or not, it all boils down to a clich?(C): Head them off at the pass. The more potential health issues that are addressed before they become chronic problems, the less money gets spent later treating what could have been prevented. It may seem like a lot of work now, but brokers who do their absolute best to introduce these programs to their clients will create loyal clients and -- just maybe -- will keep clients from shooting themselves in the foot.