Let's Get Physical

Do you remember the fitness craze of the 1980s when Americans bought the Jane Fonda Workout, spandex leotards became the rage, and fitness experts stretched their way onto our television screens?

Maybe the fashion and TV shows were laughable, but the idea behind the movement is alive in managed care. The latest wellness programs don't include leotards and legwarmers (thankfully), but wellness is no longer just a fashion statement or way of life. It has become a business model.

The terms "wellness" and "population health" are everywhere in managed care. In fact, I recently talked to a number of disease management experts about their expectations for 2008. A common subject was integrating wellness into disease management.

While wellness programs gain popularity, there are studies that show the benefits of one option, fitness programs. A Centers for Disease Control and Prevention-funded study of Healthways' SilverSneakers, a fitness program for Medicare Advantage beneficiaries, revealed healthcare costs increased at a smaller rate among SilverSneakers participants than a control group. The program for Medicare Advantage beneficiaries enjoyed savings in inpatient admissions.

Another recent study of Highmark, Inc., workers showed that a comprehensive employee wellness program resulted in a positive ROI. In fact, researchers found healthcare expenses per person per year were $160 lower for wellness program participants than non-participants, inpatient expenses were $184 lower per year for participants, and the estimated net savings from the program were $1.3 million, which produced an ROI of 1.64:1.

Studies like SilverSneakers and Highmark show the financial benefit for companies, but experts are also quick to point out that just providing gym membership discounts and stapling wellness posters in the employee lunch room doesn't cut it. Today's wellness programs offer tailored communications, incentives that lead to greater fitness, and utilize behavior change sciences.

I recently spoke to Ron Z. Goetzel, PhD, who co-authored the review of Highmark's employee wellness programs, about what is needed to create successful wellness programs. He gave me seven tips:

1. Health risk assessment--HRAs provide immediate feedback to program participants and highlight areas that need improvement, allow a company to reach out to people who need help, and provide an effective measurement tool. The rest of the wellness program is built upon the HRA foundation.
2. Good methods for triaging people into risk-reduction programs. 
3. Good incentives--"Incentive structures that seem to be working more effectively are those where you reduce participants' medical premiums if they engage in programs."
4. Theory-based behavior change methods--"There is a whole body of literature in the social-psychology domain that shows how to change people's behaviors more effectively than just telling people to change their behavior."
5. Tailoring communication to a person's preferred learning style, such as one-on-one coaching, mail, telephone or e-mail. "A program that doesn't engage a large proportion of the population in some form or fashion is not going to be successful."
6. Measurement and evolution by building metrics that allow you to access and fine-tune wellness programs. 
7. Leadership support--"[Leaders] need to model healthy behaviors. They can't say, 'everyone live a healthy lifestyle, I'm going to continue to live my unhealthy lifestyle.' "

New wellness programs go beyond reduced gym memberships that are commonly offered by employers. As more wellness studies show positive ROI, employers will demand these services. Managed care companies will either have to offer the services, contract with companies that do, or potentially lose business.

The question is then: Will your company get ahead of the wellness movement or will you get left behind much like the spandex leotard?

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Les Masterson is senior editor of managed care with HCPro, Inc. He may be reached at lmasterson@healthleadersmedia.com.