Finding out causes of poor health, first step to cutting benefit costs

“It is like we are putting more and more people at the side of the river to pull people out, but nobody ever goes up stream to see why people are ending up in the river in the first place.”

There is a fundamental flaw in how employers — and the community at large, for that matter — are tackling the ever-growing problem of rising health-care costs, says Lydia Makrides.

Too much of the health-care discourse is focused on treatment of problems and illnesses instead of prevention, says the director of the Atlantic Health and Wellness Institute, and director of the school of physiotherapy at Dalhousie University in Halifax.

Rather than stopping the problems from happening in the first place, we’re spending ballooning sums of money on treatment.

“It is like we are putting more and more people at the side of the river to pull people out, but nobody ever goes up stream to see why people are ending up in the river in the first place,” she says.

For employers, harmful employee behaviour like smoking, poor diet and inactivity are driving benefit costs ever upward. The only real solution is to change unhealthy behaviour.

For a few years now, employers have been hearing that encouraging healthy living and ensuring a non-toxic workplace culture are the best bet for controlling health-care costs.

But still, they remain reluctant to spend the money on comprehensive health and wellness programs. Employers either won’t spend on something that won’t pay off next quarter, or they don’t believe the small but growing body of research which shows the substantial return on investment of wellness, she says. (For more on how wellness pays off, see page 6 story, “Health promotion ROI.”)

A growing number of senior managers say all the right things about employee health being a top priority, but they seldom follow through and commit the money necessary to implement a comprehensive wellness program. That’s about $150 per employee per year, says Makrides.

Earlier this month, the Atlantic Health and Wellness Institute launched a new four-year study to try and prove once and for all the concrete connections between unhealthy employee behaviour and employer health costs.

They’ll be going into workplaces and conducting thorough health screenings and collecting data about risk factors. For employees identified as at risk, plans to avoid the problem will be created and followups conducted to see how effective fitness and health promotion can be.

Hamilton-based Taylor Steel Inc., recently made the move toward health and wellness promotion. Mike Coughlan, vice-president of corporate administration explained that during a meeting with the company’s group health benefits broker last May, the conversation inevitably turned to cost containment.

Like most other organizations they had tried the usual things to keep costs down, but it was clear those tactics were no longer reasonable.

“I said we can’t just keep hacking and slashing. That is not fair to our employees and it is not in keeping with our culture and goals and objectives.”

The broker raised the possibility of wellness and health promotion and they decided to give it a try.

The company chose Burlington, Ont.-based Connex Health Consulting to develop a health and wellness program, a process that began with a preliminary health assessment. Of the 450 employees, roughly 50 per cent completed the assessment and from that the company learned its potential employee danger areas and opportunities for improvements to employee health including, weight management, improved nutrition, stress management and smoking cessation.

In September the company officially kicked off the Life Balance program with an information day. Six different information stations were set up on-site to explain to employees the wellness interventions that could be offered — initiatives to encourage stretching, better nutrition and stress management. A healthy snack was offered and employees received a sweatshirt with the Life Balance logo.

The kick off was held on consecutive Thursdays from 10 a.m. to 10 p.m. to ensure all employees, who work shifts, could attend. Offering it during company time ensured a high turn out, says Coughlan.

Right now only company-wide numbers are available, but later this fall, the company will offer screenings for cholesterol and blood pressure and they are considering ways to offer complete physicals so that employees can identify their own risk areas and develop personalized healthy living strategies.

Coughlan knows the move toward wellness is a long-term proposition. “There will not be an immediate payback,” he says. In fact, benefit costs could even go up if screenings reveal previously undiagnosed needs for medication. But Coughlan says he has no doubt that down the road savings will be realized through improved health and greater productivity. “If you are spending more money on drugs, hopefully that person will be at work every day,” he says.

Denise Balch, president of Connex Health Consulting, says employers are looking at between $150 to $200 per employee per year for a workplace health strategy, though that is wholly dependent on what the customer wants to include in the strategy. A company of 500 employees should typically spend in the range of $75,000 to $100,000 per year, she says.

To ensure optimum results and demonstrate the value of that investment, the first step in a wellness program has to be a health assessment and screening, she says.

It is possible to do a wellness program that is just education and promotion. But without the assessment at the start, it becomes very difficult to determine if the right initiatives are being offered to target the highest risks and if the initiatives are having any impact on employees, she says.

Screenings can be designed to cover a very broad range of potential problems or to focus on more specific problems — cardiovascular, respiratory, asthma, gastrointestinal. The choice usually depends on the unique risk circumstances of the workforce identified through the initial assessment, says Balch.

In the next year, ConnexHC hopes to develop an online stress and depression assessment, says Balch. “Generally the people who are in the roughest shape are not coming to a lunch-and-learn and they are not going to fill in a questionnaire.”

A recent study by wellness consulting firm Buffett Taylor and Associates indicates organizations doing assessments and screenings are a small minority.

A survey of about 430 Canadian employers, conducted in late 2003 and early 2004, shows less than 20 per cent are offering comprehensive wellness programs and just five per cent were conducting workplace health screenings. “That is virtually double what it was in 2000, but it shows we still have a long way to go,” says Ed Buffett, president and CEO of the Whitby, Ont.-based firm.

In almost every instance where employers balk at introducing a wellness program or a screening, it is either due to cost, or the senior leaders still have the attitude that employee health is not something employers should be involved with, he says.

A dearth of evidence has been a problem in generating more commitment from senior managers but that is changing, he adds. Recent research on wellness ROI by Buffett Taylor, taking into account everything from medical costs to lost productivity, found that for every dollar invested in a wellness program, the employer gets back $4.50.

Kendy Bentley, president of Calgary-based consulting firm Kendrith Bentley and Associates Ltd. and a workplace wellness instructor at the University of Calgary, also says she needs more evidence to make the case to employers.

Business leaders usually say they like the idea of a comprehensive wellness program, but they want to see numbers that take into account everything comprehensive wellness entails, says.

One part of employee wellness is health and fitness promotion. But an equally important part is the employer’s responsibility to create work environments that aren’t hurting employees and causing them psychological harm, which compounds physical problems. Much of the research doesn’t take into account things like work environment.

She doesn’t doubt comprehensive wellness programs go a long way to improving the health of employees, it’s just going to take some more evidence to get employers to feel the same way, she says.

“If we could get health and wellness to have as important a place as health and safety, we would have it made.” Everyone agrees people can die at work if the right safety measures aren’t in place, but few people yet understand that people can die from stresses of a toxic workplace. “No one gets fined because that man died of a heart attack,” she says.

Screening for health risks

Denise Balch, president of Burlington, Ont.-based Connex Health Consulting explains that usually in the weeks leading up to the health-risk screening, a newsletter is distributed to employees to raise awareness, educate them a little about why the screening is offered and make sure the right people attend. “You don’t want everybody to come, because you could get some who are just the ‘worried well.’ You want those who are at risk,” she says.

For example, risk factors for diabetes include a high-fat diet, lack of exercise and family history of diabetes, she says.

People who attend the screening complete a short self-assessment before seeing a nurse. With a diabetes screening, the nurses check height and weight and do a blood glucose screening. Anyone already diagnosed with diabetes is also encouraged to come to review what they should be doing to take care of themselves.

Anyone who attends and is identified as being in need of extra attention gets followup phone calls, says Balch. “We call and say, ‘Hey, remember we tested you, have you done anything about it?’”

This is one of the ways employers can see the effectiveness of the screening program. Employers will know, for example, how many people checked with a physician, how many made lifestyle changes, how many went on medication.

At one recent screening attended by 250 employees, 55 were referred for additional attention and two cases of diabetes were discovered, she says.

She says some employers are worried about privacy, but the privacy guidelines are clear: If the employer gets permission in writing to track results then those numbers can be looked at in aggregate, she says.

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