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Finding the Right Carrot

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Wellness programs can translate into both cost savings for your organization and healthier lives for employees--if you can find the proper motivation.

Hospitals' increasingly aggressive efforts to encourage employees to lead healthy lives have been met with considerable media attention--and in some cases, controversy. Many studies, like one done by RTI International in Research Triangle Park, NC, and the University of North Carolina in Chapel Hill, suggest that employer-generated wellness programs can help participants take an active interest in their health and save organizations anywhere from $400 to $2,000 annually on health costs per employee. But finding the right incentives can be a challenge.

Senior leaders at Clarian Health, a five-hospital system in Indianapolis that employs more than 13,000 people, know firsthand about the attention such initiatives can generate. The organization designed a wellness program that increased health plan premium charges (up to $30 per pay period) for employees with risk factors--such as being a smoker, having a high body mass index or high blood pressure--that exceeded a set of metrics created by a team of physicians and based on national health data.

Legally, the system was allowed to do this under strict Health Insurance Portability and Accountability Act of 1996 wellness program guidelines, but it wasn't the prospect of legal difficulties or even the significant press attention that bothered Clarian executives--it was employees' focus on the penalties rather than the health system's message of personal accountability, says Sheriee Ladd, vice president of human resources.

To better anchor that message, the leadership at Clarian spent time talking with employees both in large groups and in one-on-one situations about prospective health plan and wellness ideas. Ultimately, the system decided to swap out the system of penalties for one that rewarded participation. To test the waters, the health system gave its employees a $100 credit toward their health plan deductible if the employees filled out a health risk assessment survey.

The move saw a 90 percent participation rate from employees. Inspired by that success, Clarian decided to take a different approach with the rest of its wellness strategy. In 2008, employees participating in the system's "Healthy Results for You" wellness program will get a $5 rebate on their health premium per pay period after completing an online risk assessment, plus an additional $5 per period for being a nonsmoker. Those who don't sign up on the wellness track are offered insurance, but must pay the same premium all year long and cannot participate in the incentives program.

In 2009, the health system will track blood pressure (it has to be 140/90 or lower), "bad" cholesterol (it has to be 130 or below), blood sugar or glucose (it has to be 120 or below), and body mass index (it has to be 29.9 or below). During 2008, Clarian will offer free screenings to employees so they can know their numbers and take steps to get in the normal zone to earn the incentives the following year, says Ladd.

"Healthcare organizations have the opportunity to [take care of their employees' health] more than anyone else," says Kenneth Kruger, president of the Healthcare Human Resources Consulting Consortium, LLC, in New York. A former vice president of human resources and labor relations at New York's Mount Sinai Medical Center, Kruger helped develop several programs that offered rewards for wellness at the 1,171-licensed-bed hospital. As more employees participated in the initiatives, Mount Sinai leaders realized their offerings were having a "two-prong effect" that benefited patient and organization alike, says Kruger.

"For example, if you do a blood pressure screening for your employees, not only is it a freebie for employees, the doctors have an opportunity to possibly get some patients out of it," he says.

Despite the often heavy incentives organizations offer for wellness participation, employees can also resist for another reason: privacy. Many employees simply don't want personal information about their specific health conditions to be visible to others. Clarian has taken steps to allay employees' privacy concerns by making sure personal information is coded--payroll will only see that an employee gets a deduction, but not why, Ladd says. "We're confident that we've protected employees' privacy very well." Ladd says.

-Corey Christman

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