To achieve wellness program goals, employers should make healthier choices easier to access, and target populations that have chronic conditions. Encouragement from trusted leaders is seen as improving buy-in by sick population segments, and unions could in some ways be more effective than employers in achieving results, said a panel of experts at an Oct. 20 health care summit sponsored by the U.S. Chamber of Commerce.
Employer Makes Default Choices
If an employer makes a default health choice on the workers’ behalf, wellness programs can work better, said Paul Terry, CEO of HERO Health, a think tank on developing best practices in employee health promotion.
Successful wellness programs make the unhealthy choice the harder choice and the healthy choice easier to opt for. People prefer a curated experience, and a large number of untargeted choices creates confusion, Terry said.
An example of behavioral steerage is food: Some large employers have adopted a “farm-to-table” approach to cafeteria food, Terry explained. Cafeteria workers are retrained to prepare and actually cook real food instead of merely heating up prepackaged food.
Other wellness option include: (1) stationing a farmers market outside of the workplace; (2) giving employees wearable exercise monitors, with reminders during the workday to take a walk after they’ve been seated for two hours or more; (3) giving people the option of using stand up desks; and (4) providing on-site exercise facilities and workout options.
Terry used the term “paternalistic libertarianism” to describe this. The paternalistic sponsor says: “This diet or exercise program is what we think is right for you,” while the worker retains the freedom to accept or reject it.
Targeted Programs
Just as offering a plethora of choices won’t necessarily work, focusing on the dollar amount of incentives has shortcomings too.
Health care reform allowed employers to increase the amount of wellness incentives to 30 percent of health plan value. But employers are not drastically reducing employee premiums, copays and deductibles in response, because lavish rewards are not reducing health claims or big ticket health plan costs, according to Chris Mathews, vice president at the Segal Co.
Money incentives might help to achieve outcome or activity-based goals, but community support, communication through digital technologies, and encouragement from trusted leaders inside and outside of the employer were seen as more effective. Focusing programs was seen as key.
Mathews mentioned the strategy of a tightly focused wellness program that concentrates rewards and penalties on a targeted group: for example, noncompliant diabetics (instead of on the whole population). Under this strategy, the program targets only the fraction of workers who need it most.
He further noted that a union focused on noncompliant diabetics by: (1) educating diabetics; (2) linking them with physicians who are effective in treating that condition; and (3) making available data about physician outcomes to help diabetic workers pick the right doctor for their needs. Once the program runs its course, the program will move on to the next target population, Mathews said.
Loss Avoidance
“Penalties work better than rewards; they get people’s attention,” Mathews stated. The other speakers agreed: Loss avoidance motivates.
Jin Haag, practice leader for Towers Watson, suggested the following application of loss avoidance principles:
Example: An employer makes a $500 deposit in a wellness trust fund, but each 20-percent portion of that amount must be unlocked by participation in a wellness activity. So workers who skip participation will feel they are losing their property by opting out, thereby putting the loss avoidance principle to work for the wellness program.
Union-sponsored Programs
Wellness programs offered through unions may be hamstrung by having limited, fixed contribution levels, and little latitude to tinker with benefits that are set out in collectively bargained agreements. However, they also have a social component, sense of community and leaders that can motivate people, Haag said.
Labor leaders who have bought into wellness programs can serve as mentors; they get better buy-in because they are trusted and respected by union members, as opposed to business leaders who may be seen as not advocating for the worker, Haag said.
Mathews added that union-sponsored wellness program may have motivational advantages over employer-sponsored programs because if someone is abusing their health, everyone’s union dues are being wasted. That may makes the union or other workers more willing to urge the unhealthy individual to comply, or make the union member understand that if he abuses his health, he deserves penalties like higher premiums, deductibles and copays.