Building Participation and ROI in an Employee Wellness Program

Low employee participation has often been the pitfall for company wellness programs. Studies have found that less than a quarter of employees take part.

But just four months after the launch of the wellness program at Swedish Medical Center, a 1462-bed acute care hospital in Seattle, the hospital's Labor Management Committee shared a sparkling cider toast. Through a combination of a targeted communication strategy, a financial incentive, and a collaboration with a healthcare consulting firm, the hospital reached a 91% participation or "engagement" rate with employees.

July marked the deadline by which full-time employees had to have taken their first step toward health and wellness, either by completing an online wellness assessment, visiting their primary care physician, or stopping into the employee wellness clinic. At the beginning of the program, less than half of Swedish employees had a primary care contact .

The financial incentive was really a financial stick: Employees who didn't complete the first program step by July 1 faced a $50-per-month penalty.

"I think it's the natural balance of being reasonable, but the price is high enough that it's noticed," says program manager Mandy LeBlanc. "$50 a month is enough to think, 'Oh wow, that's a significant charge,' and especially in a struggling economy it incentivizes people to go through these reasonable hoops in order to save money."

By a second program deadline, November 1, employees had to have taken two steps or pay a penalty of $55 per month. The first step was to complete a wellness visit, carried over from July if they hadn't done so already. The second step: Know their numbers—height, weight, blood pressure—or show they had thought about these numbers in an online assessment.

Also by this deadline, employees had to earn 300 points via "health challenges." The challenges included taking a pledge to be tobacco-free or taking a tobacco-cessation readiness quiz, seeing a dentist, and getting a flu shot.

"I think the way we designed the program, the steps were meant to be easy and reasonable," says LeBlanc. "It's not like we were asking people to go nuts and all of a sudden have a healthy BMI."

As of November 1, engagement had jumped to 93.5%, which allowed Swedish to reduce its healthcare spending growth rate from 9% to 6.5%.

"We felt like this was not only a win for Swedish but for labor management, because we discuss cost of healthcare so often year after year," LeBlanc says. "This is something we really came together on, and in terms of discussing benefits, this was a victory we could really stand on that our program was working."

Steps to setting up a wellness program
The seeds of the employee wellness program began three years ago when Swedish Medical Center began providing resources to employers in its service area to set up wellness programs or health clinics for their employees. Swedish leadership realized that if they were in the business of setting up wellness programs, they ought to have one of their own.

One of the first steps was hiring a dedicated manager for the Swedish program. LeBlanc came to Swedish from the National Heart Association, where she had built a program to get people to walk for 30 minutes a day.

"So many companies build a wellness program where somebody in HR is tasked with it, but it's not really their passion or skill set," says LeBlanc, who has a background in communications. "I think it's important, in order to have these successes, that it's something a full-time employee is focused on."

Swedish's Labor Management Committee, which designed the wellness program, is composed of 15 members of the hospital staff. "So we designed this program hand-in-hand with labor. And due to that, we had our health and wellness champions in our labor teams, who would spread the word," LeBlanc says.

LeBlanc credits the targeted, regular, and diverse communications methods with Swedish employees as a major key to success. From regular information on the intranet to "mini-memo" emails to mailed newsletters to employees' homes, employees received a regular flow of information about health and wellness. Managers also had financial incentives to discuss the program with their direct reports.

Once employees began participating, though, they were rewarded with less communication. "What I didn't want to do was to make people feel inundated with too many messages from the organization," says LeBlanc. "We did not want to ... upset people and have them get sick of us."

Swedish also works with a wellness technology company, Limeade, that has technological capabilities. Limeade allowed LeBlanc to track whether employees had reached their targets, through regular reports from health records.

Limeade has developed smart phone apps transforming daily health and wellness activities into a game-style approach.  To help Swedish employees meet their targeted goals and earn points from daily behavioral changes, applications track everything from daily nutrition and physical activity to sleep and efforts to manage stress.

Besides the savings to healthcare costs, the wellness program has helped improve employee morale. Regular assessments have shown positive increases in how employees feel about their work. With Swedish Health System's recent moves to partner with Providence Health & Services, a larger system in the Pacific Northwest, LeBlanc says hospital leaders were worried that Swedish employees might feel less significant, but the assessments have shown they are actually taking a little more pride in their work.

Swedish executives are also seeing the return on investment from the wellness program. "I think [executives] will see through the financial results that this effort helps Swedish save money, which in turn could eventually result in improved benefits or better quality of life for Swedish employees," says LeBlanc. "When it comes to having to make these tough decisions about benefits, now we can come together and discuss how we can improve upon our success and increase engagement and participation."