Posts from — October 2010

A Health Risk Appraisal (HRA)  is sometimes used paired with a health testing.  An Health Risk Appraisal (HRA) is a computerized assessment tool which looks at an individual’s family history, health status, and lifestyle.

An Health Risk Appraisal (HRA) seeks to identify precursors associated with premature death or serious illness and quantifies the probable impact for each individual.

An HRA instrument is derived from an understanding of the while a disease. Based on this understanding, useful prediction instruments may be constructed to assess the health risks of an individual. Individuals with a higher number of health risks tend to have more serious medical problems over time.

Drawing attention to their health risks can help patrons reduce risk factors which lead to the onset of unnecessary disease and subsequent premature death.

The questionnaire covers lifestyle habits (such as tobacco use, seat belt use, and exercise) and physical measures (such as cholesterol, blood pressure (BP) levels, height, and weight).

For accuracy, it is crucial to obtain direct measures of blood pressure, cholesterol and HDL-cholesterol.  The HRA also provides recommendations and indicates what risks are modifiable. Types of measures to assess health risks are discussed under Screening Programs.

The impact of a health risk assessment is much greater when it’s given in-person, with immediate feedback to the customer. This also provides an opportunity to invite the customer’s participation in continuing health counseling and to gain their written consent to do pro-active outreach to them.

A health age could be computed based on the individual answers to the questionnaire and physiologic factors.  The health age may indicate the individual to be younger or older than their chronological age.

Health Risk Appraisal (HRA) programs are one the most prolific types of wellness activities utilized by corporations. Continuing research on HRAs is examining the efficacy of this tool.

Among the big benefits of this tool is that it can provide an aggregate group report of a organization and may be utilized as an examination tool.

Detailed information is available from the Society of Prospective Medicine (www.spm.org/desc.html) who publishes a handbook on HRAs.

The most common screening performed in wellness programs is heart health assessment.

The screening can include a written heart health test, blood pressure measurement, cholesterol/HDL-cholesterol test, glucose (blood sugar), weight, educational materials specific to diet, nutrition, exercise, cholesterol, use of tobacco, and weight.

The health professional conducting the screening then provides a consultation and assists set goals with the participant.

The backbone of wellness programming at the workplace is biometric testing. It is the first major activity a corporation ought to do when first beginning a wellness program.

Biometric testing is usually used coupled with the administration of a Health Risk Assessment (HRA) .

The most effective way to screen is to utilize a health professional trained in wellness screening techniques and counseling to privately and individually assess participants.

This wellness specialist takes a brief health history and measures blood pressure and cholesterol. With computerized cholesterol desktop analyzers, results are acquired in about four minutes.

Immediate feedback, consultation, and educational materials are provided. for those identified at-risk, follow-up appointments may be scheduled at this time.  The whole process takes about twenty minutes per individual.

The screening also provides an immediate opportunity to register participants in various health promotion programs based on their interests and identified health risks.

Health screening may be done on an annual basis and used to monitoring health risks within the worksite.

A biometric screening program needs to provide multiple opportunities for participation.  The service should be provided for all the various shifts of a organization.  The screening program should be conducted in highly visible areas so the process could be observed.

Reluctant employees often like to be able to see what the wellness program is about before they participate. When wellness screeners aren’t busy, they should perform outreach going to areas where employees gather and try to recruit employees.

When well-planned and promoted, health screening can attract participation rates of 60% to 100%. These high participation rates have a positive impact on upper-level management producing support for further health promotion programming.

Objectives are broad-based statements about what the health promotion program is expected to do.  The goal of the health promotion program is to enhance the health of the individual and the organization. Objectives like mission statements provide direction in a health promotion program.   

Goals are specific and provide a means of measurement of the health promotion program to determine effectiveness. There are two types of goals, process and outcome.    

Process objectives state the activities that need to occur to achieve a desired outcome.

Examples of process objectives are -

• Number of participants screened

• Number of participants in and completing wellness programs

• Satisfaction of wellness program participants

• Number of participants who were medically referred and saw their physician

• Number of promotional activities

• Number of participants seen in follow-up

Example of outcome goals are -

• Number of participants who improved fitness level

• Number of participants who lowered cholesterol level

• Number of participants who lost weight, body fat

• Number of participants who quit use of tobacco

• Number of participants with high blood pressure (BP) who decreased their blood pressure (BP)

• Number of participants whose initial level of alcohol consumption put them at-risk who are no longer at-risk

• Number of participants with risk factors who saw their physician and are being treated for high blood pressure (BP) or cholesterol years later

Wellness committees are important in that they create a sense of ownership in the health promotion program, and facilitate various tasks involved in health promotion programming at the worksite.

The committee must be composed of a cross-section of personnel representing various occupations, levels, and subgroups with the business.

A common mistake is filling the committee with the most health/fitness-conscious individuals  in the company. Don’t rely solely on volunteers to fill a committee. Make certain that your committee members have enough power in the company to run an effective health promotion program.

The wellness committee is made up of workers from the worksite. It oversees the health promotion program and helps carry it out.

The committee should meet about once a month to review the previous month’s activities and plan future ones. When the health promotion program is just starting, the committee may meet each week until things get going.

Committee members do not carry out medical procedures, counsel clients, or handle confidential medical information. Wellness experts perform these tasks.

In general, the committee’s duties fall into three areas -  planning, promoting, and helping to run wellness programs.

Planning the wellness programs can include -

• Finding space for activities

• Planning and organizing workplace-wide events like contests

• Assessing reports prepared by the wellness program staff and making recommendations

Promoting the wellness program can include -

• Recruiting workforce to take part in screening and health promotion programs

• Encouraging workers to take part in follow-up counseling

• Organizing promotional strategies using newsletters, signs, bulletin boards, computers, and other media available within the workplace

Helping to run the health promotion program can include -

• Setting up equipment for various activities

• Helping to conduct worksite-wide activities

• Monitoring all activities and assessing  the performance of the expert staff

• Acting as wellness mentors to fellow personnel

The size of the wellness committee will be dependent on the size of the company. Pick members by asking day management to nominate or appoint staff members.

Make an announcement through flyers, memos, and meetings to recruit potential members. Explain the purpose of the committee, duties and responsibilities, and the time commitment.

Recognize your wellness committee volunteers. Allow them to participate in health promotion programs at a reduced cost. Hold appreciation breakfasts/lunches/dinners.

Print names of committee members on company communications about the wellness program.

Purchase special T-shirts, caps, and buttons for them. Write letters to supervisors saying that you appreciate the member’s service. Develop awards certificates for members.

The following can be used as a guide for committee size -    

• Less than 300 employees   2 to 4

• 300 to 1,000 employees   4 to 6

• 1,000 workforce or more   6 to 12

Effective wellness programs recognize the importance of building a supportive cultural environment.  The worksite culture includes shared values/heartfelt beliefs about what is important. It includes social standards of expected and accepted behavior called “cultural norms.”

It includes peer support from family, friends, and peers. This support can help one adopt healthy life choices. Tools are available to audit a company.

The long-term success of any health promotion program is dependent on the corporate culture.

Some healthy culture signs in a corporation are -

• Workers communicate openly

• Leaders support diversity and opinion

• Workers have fun

• Policies support wellness

• Workers are encouraged to grow

• Workers work together as a team

• Employees’ skills and talents are matched to their jobs.

• Flexible work schedules are available

• Companys consider staff members as their most asset

Effective health promotion programs try to create healthy workplace climates. A healthy workplace climate is one which encourages teamwork, cooperation, and empowerment of the individual.

Individuals  have a sense of community, a shared vision, and a positive outlook. Policies promote and support wellness efforts within the workplace.

• Effective health promotion programs identify ways that company policies and organizational traditions encourage wellness.

• Effective health promotion programs work at the group and organizational level to build support for healthy lifestyle options.

• Effective health promotion programs set clear target goals and goals for the health improvement of the workplace.

An initial health testing can include a recent survey of employees’ interests as part of the assessment. Successful wellness programs are designed to meet the needs and interests of the personnel.

The information you need to get from a recent survey depends on the scope of your wellness program. A sample survey can be obtained in the HOPE Publications Web site.

If you plan to adapt this sample survey or develop your own survey, keep the following hints in mind -

• Ask mainly closed-choice questions, particularly when you will be sending the survey to a big number of workers. Closed-choice questions provide specific choices and are easy to tabulate. You may want to use a computer for data entry and analysis.

• Invite comments, suggestions and recommendations, or ask open-ended questions at the end of the survey. Open-ended items are more challenging to summarize.

• Include a brief explanatory cover letter with the survey with the signature of the organization president. Make certain to include a statement about confidentiality and anonymity.

• Ask a group of representative workforce to review the survey before it is distributed. Find out when the questions are going to be understood by workforce and won’t be objected to.

• Include demographic information at the beginning or end of the survey. Consider various ways that you could analyze the responses by demographic characteristics (gender, age, shift, site, department, etc.).

When considering who should get the survey, a simple rule is when you’ve under 500 staff members, everyone should receive one.  The public relations advantage of everyone receiving a recent survey may be significant.

Over 500 workforce, a sample of the work population will suffice. A sample saves on costs and time. You could want to consider consulting with a statistician to determine an appropriate sample size for your workplace.

Needs surveys are confidential and anonymous; they don’t request information that may identify a person.

Getting support from executive management is vital to the success of the health promotion program.

One way to do this is to survey managers (see forms) and conduct interviews with decision-makers in the corporation. You can use the surveys here or make up your own.

When you decide to do your own, keep the survey short. It shouldn’t take more than ten minutes to complete.

The interview process can also serve as a means of educating management. Give concise fact sheets on the advantages of wellness programs for management.

When surveys and interviews are completed, tally the surveys and write brief summaries of the interviews. Give these reports to management.

Once completed present a brief executive summary to management. Highlight several intriguing findings that can be used immediately to make decisions about the health promotion program.

Utilize charts and graphs to make your points. Pull together a detailed report for wellness committee members itemizing each response. Provide a short article about the survey in the corporation newsletter.

The higher the response the more valid and reliable the results. A minimum response of 40% to 50% is acceptable.

Robust wellness programs involve all staff members, deal with all major health risks, offers options, and target both the staff members and the worksite environment; provide periodic investigation of its results.     

Comprehensive wellness programs emphasize follow-up and offers support for the worker if he/she is employed. Studies have shown this approach to be highly successful. Key components are planning, implementation, and examination.   

Planning extensive health promotion programs involve performing a needs and interest assessment, appointing a wellness committee, selecting  wellness providers, establishing goals/objectives for the health promotion program, advertising/promoting the health promotion program, and establishing procedures to ensure confidentiality.   

Implementation of extensive health promotion programs consist of five major tasks -    

1   Health screening and referral

2   Follow-up and counseling staff members

3   Follow-up with physicians

4   Health improvement programs

5   Organizing workplace-wide activities.

Investigation involves monitoring health promotion programs to determine if it is working and to help you refine it. Measuring success shows what you have achieved, helps justify costs, and provides information for upper-level management to support continued health promotion programming.   

Extensive health promotion programs involve all employees, deal with all major health risks, offers options, and target both the employees and the worksite environment; provide periodic examination of its results.     

Extensive wellness programs emphasize follow-up and offers support for the staff member if he/she is employed. Studies have shown this approach to be highly successful. Key components are planning, implementation, and evaluation

Developing comprehensive wellness programs involve performing a needs and interest assessment, appointing a wellness committee, picking  wellness providers, setting goals/objectives for the wellness program, advertising and marketing/promoting the wellness program, and establishing procedures to ensure confidentiality

Implementation of robust health promotion programs consist of five major tasks -

• Health testing and health risk assessment

• Follow-up and counseling employees

• Follow-up with physicians

• Health improvement and disease avoidance programs

• Organizing worksite-wide wellness program activities.

Analysis involves monitoring health promotion programs to find out if it’s working and to help you refine it.

Measuring success shows what you have achieved, assists justify costs, and provides information for senior management to support continued wellness programming.

Initially introduced by Halbert Dunn in the 1950’s, wellness became a well-liked buzzword during the late 1970’s and received considerable academic attention in the 1980’s.     

Wellness programs for staff members became more widespread during the following decade, and credible evidence for their economic viability started to be published.     

There have now been over 100 published studies on this topic and a number of systematic reviews.

Health risks increase costs.  Medical and health insurance costs escalate with both age and number of risks present.8,10   the number of risks is also strongly related to sick leave absenteeism, Employee’s Compensation costs, short-term disability, and lowered productivity (”presenteeism”).

Early staff member health promotion programs were relatively basic and usually produced a Return On Investment (ROI) of less than one dollar for every dollar spent operating the health promotion program (Return On Investment (ROI) = <1 - 1).8

Such wellness programs may  be characterized as “fun-oriented”.  Participation is entirely voluntary, and there’s no particular focus on the reduction of specifically identified high risks.  

Interventions and activities aren’t personalized, and there is no emphasis on the management of medical costs.  These health promotion programs are normally site-based only, lack choices to address all of the major behaviorally-related health risks, and lack multimodal presentation.  

Minimal or no incentives are provided to employees for participation, and services to spouses and family members aren’t available.  Most such health promotion programs lack meaningful evaluation.  

More conventional health promotion programs are “activity-oriented” and have shown an ROI of between 1 - 2.5 and 1 - 3.5.8 These health promotion programs may have a greater emphasis on health and risk reduction, although the efforts are relatively wide and not personalized.  

They may have some generalized emphasis on health care cost management, although not necessarily aimed at specific high risks.  Most are site-based and voluntary, with spouses included only rarely.  

Modest incentives might  be utilized to encourage participation.  Formal investigation might  be weak.

The newest and most economically viable wellness programs are “results-oriented” and exemplify the health and productivity management model.  These wellness programs consistently produce return rates of 1 - 4 or greater within a 12-24 month period.8  

Such wellness programs are strongly focused on the reduction of especially identified high risks and the management of health care costs. They’re generally voluntary, but use strong financial and other incentives to promote participation.  

They’re multi-component in nature (address all major risks), and have both onsite and virtual modalities of operation.  The interventions are highly targeted and individualized, and offered to spouses as well as workers.

For companies, the cost of providing health insurance for their staff members is of great importance.  Those costs have been increasing at annual rates between 6 percent and 14 percent.

Chapman’s 2007 systematic review7 reported an typical reduction in healthcare costs of 26.5% as a result of worker wellness programs.  His review covered 60 of the most scientifically valid studies, with an typical of 3.77 years of study.

Absenteeism due to disease is another cost driver.  Chapman’s review7 reports an average reduction in sick leave of 25.3%.   Cost for Employee’s Compensation was decreased by 40.7%, and disability costs by 24.2%.

There is also an emerging literature on the costs of presenteeism (reduced productivity).11,13  In one study, every risk reduced through a wellness program yielded a 9% reduction in presenteeism (and a 2% reduction in absenteeism).11

Some corporations have achieved a zero% increase in health care costs across at least brief periods of time.10  Doing so requires 90-95% participation of the worker population in focused wellness programs, with 75%-85% of the staff members falling into the low risk category.10     

Although robust efforts to lower the risk status of those in moderate or high risk categories ought to be made, the needs of currently healthy personnel ought to be addressed as well to avoid increases in risk-status.   

Given the size of the federal workforce, significant cost savings in the government’s contribution to medical insurance premiums for staff members can be achieved when a majority of that population were participating in active wellness programs.     

In like fashion, improvements in absenteeism, staff member’s compensation, disability, presenteeism, and turnover then of extensive staff member health promotion programs would yield substantial fiscal benefits for the government.   

References   

1   Aldana, Steven G.  (2001)   Financial Impact of Health Promotion Programs -   A Extensive Review of the Literature.   Am J Health Promotion 15(5) - 296-320.

2   Chapman, Larry.  (1998)   the Role of Incentives in Wellness.  The Art of Health Promotion  2(3) - 1-8.

3   Chapman, Larry.   (2003)   Biometric Screening in Health Promotion -   is it Really as Important as We Think?  the Art of Health Promotion  7(2) - 1-12.

4   Chapman, Larry.  (2005)   Meta-Examination of Corporate Wellness Economic Return Studies -  2005 Update.  The Art of Wellness, July/August, 1-15.

5   Chapman, Larry.   (2006)  Worker Participation in Company Wellness and Wellness Programs -  Just how Important are Incentives, and Which Ones work Best?   North Carolina Medical Journal   67(6) -   431-432.

6   Chapman, Larry, Lesch, Nancy, and Passas Baun, Mary Beth.   (2007)   the Role of Wellness Coaching in Company Wellness.   the Art of Wellness, July/August, 1-12.

7   Chapman, Larry.  (2007)   Proof Positive -   an Analysis of the cost-Effectiveness of Corporate Health Promotion.  Northwest Health Management Publishing, Seattle, WA.

8   Chapman, Larry.  (2007)   an In-Depth Look at the Economic Evidence for Rewarding Health Behavior Change.   Workshop presentation at the World Research Group “Rewarding Healthy Behaviors for Health Plans and Corporations” Conference, Orlando, FL, January 23-24.

9   Edington, Dee.   (2001)   Emerging Research -   A View from One Research Center.  American Journal of Health Promotion 15(5) -  341-349.

10   Edington, Dee W.  (2007)   Health Management as a Serious Company Strategy.  Presentation at the World Research Group “Rewarding Healthy Behaviors for Health Plans and Businesss” Conference, Orlando, FL, January 23-24.

11   Pelletier, Barbara, Boles, Myde, and Lunch, Wendy.  (2004)  Changes in Health Risks and Make certain to work Productivity.   Journal of Occupational and Environmental Medicine, 46(7) -  746-754.

12   Pelletier, Kenneth R.  (2005)   A Review and Analysis of the Clinical and Cost-Effectiveness Studies of comprehensive Health and Illness Management (DM)Programs at the Workplace -  Update VI 2000-2004.  JOEM 47(10)1051-1058.

13   DeVol, Ross, Bedroussian, Armen, et.  Al.  (2007)  an Unhealthy America -   the Economic Burden of Chronic Disease.  Report released by the Milken Institute.   www.milkeninstitute.org.

14   Partnership for Prevention.  (2008) Investing in Health -   Proven Health Promotion Practices for Worksites.   http - //www.prevent.org/images/stories/2008/investinginhealth_finalfinal.pdf.