Featured Articles                                                   August 2010, Vol. III, No. 4
Six Ways to Drive Success in Wellness Programs

While employer wellness programs have spread rapidly in recent years, few firms implement comprehensive programs likely to make a meaningful difference in employees’ health, according to a new study by the Center for Studying Health System Change (HSC). Whether employer wellness initiatives are just a passing fad or make a real difference in workers’ health will likely depend on whether firms implement customized, integrated, comprehensive, diversified programs strongly linked to a firm’s business strategy and championed by senior leadership and managers throughout the company, according to industry experts interviewed for the study. Recommendations emerging from 45 interviews with wellness industry experts and representatives of benefits consulting firms, health plans, wellness companies and employers sponsoring wellness programs include:

  • Customize programs to suit the culture and situation of a particular employer. One- size-fits-all programs purchased off the shelf from health plans and wellness vendors are unlikely to make a significant impact either in participation or outcomes. Least likely to make an impact are programs consisting only of online HRAs and Web-based educational tools, with no individualized follow-up activities to engage employees.
  • Engage senior leadership in linking wellness to the organization’s business strategy. Organizations with successful programs tend to have senior leaders whose championing of wellness is tempered by reasonable expectations and accompanied by an ability to communicate clearly and honestly with employees about shared goals and responsibilities of health and wellness. In contrast, selling wellness to employees as initiatives for their sole benefit, or selling wellness in an environment of discord or financial turmoil, is likely to be futile. Mutual trust is key to effective wellness programs.
  • Provide effective, ongoing communication at several levels. In addition to strong messaging from senior leadership, successful programs tend to have both dedicated wellness staff and informal champions within the company who are able to raise awareness, boost enthusiasm and provide peer support. Communication must be both ongoing and updated to keep the message fresh and keep employees engaged. Effective communication typically cannot be outsourced to a vendor.
  • Produce programs that are comprehensive, integrated and diversified to stand the best chance of success. Behavior modification programs offered in isolation don’t have a strong track record. Participants who quit smoking or lose weight often revert to former behaviors. Without broader interventions to change the work environment and promote a culture of health, wellness programs are unlikely to make a lasting impact. Because most employers have diverse workforces and individual needs and preferences differ, wellness programs work best when they span a wide range of activities.
  • Use incentives judiciously. Most believe financial incentives are essential, but compelling exceptions exist. The consensus in the wellness industry was that substantial cash incentives are needed to achieve strong participation, and these incentives should be designed to incrementally reward discrete activities that improve or maintain health. However, some employers operate successful programs with minimal or no cash rewards attached and believe such rewards to be counterproductive in causing employees to focus on the incentive rather than on health.
  • Understand that ROI is uncertain and measurement poses many challenges. Employers should expect to invest in wellness for several years before achieving a positive ROI, if at all. Employers looking to wellness as a quick fix for high health costs are those least likely to see positive returns, as they are also the least likely to have undertaken the measures to gain true employee engagement in health. There are many challenges in accurately capturing ROI or alternative measures of impact, and because wellness programs are often implemented simultaneously with other benefit changes, isolating the impact of wellness programs on an employer’s cost trends may not be possible.

Get more information here.

Quotable: Break Down of Employee Health Programs

"From designing and deploying [employee health] programs and engaging and driving participation, to appropriately managing results, you have to handle all the issues. You have to do the design work very thoroughly on the front end. Developing the platform for data integration, research and development, continuous quality improvement and program development needs to touch on evidence-based programming tied directly to outcomes. You must also have multiple touch points offering a variety of population health management programs because some people respond more appropriately to Web-based coaching or educational tools. Some respond better to face-to-face types of health advising and encounters, and others respond very well to telephonic outreaches, effective employee communication campaigns, incentive management programs or population risk identification tools."
                                        — Gregg Lehman, HealthFitness.

Learn more about designing employee health programs.

Using Motivational Interviewing for Teen Alcohol Intervention

A brief, motivational talk in the emergency room reduced by half the chances that teenagers would experience peer violence or problems due to drinking, according to a study published in the Journal of the American Medical Association. According to the study's lead author, "Therapists used motivational interviewing, which is well-suited for adolescent development. It doesn’t preach or tell teens what to do, but allows adolescents to weigh the pros and cons of their choices in reference to their goals." Motivational interviewing (MI), with proper training, can be used effectively by healthcare providers as well those without a professional healthcare background.

Researchers offered help to 726 adolescents, ages 14-18, who reported they experienced aggression or had a drink of beer, wine or liquor at least two or three times in the past year. All patients in the study completed computerized screening questions regarding alcohol use and violence and were randomized into three groups: a control group receiving a brochure, or one of two groups receiving a 35-minute brief intervention delivered by a computer or a therapist in the emergency room.

A one-on-one talk with a therapist resulted in a 34 percent reduction in peer aggression. Teens who received only a brochure had a 16 percent drop in aggression over the next three months. The study showed similar drops in alcohol misuse after teens heard prevention messages delivered by a therapist or while using a role-playing computer program.

Violence and injuries are the leading causes of deaths among adolescents in the U.S. and the incidents are often fueled by alcohol. The U-M study showed ED interventions can also reduce alcohol-related problems by as much as 32 percent for six months. The talks with teens were more complex than a parent talking to a child about the dangers of drinking and how to avoid peer pressure. The therapists’ talks with teens also included role play exercises and tools to cope with risky situations that involve drinking or violence and referrals to community services. Authors say the computer screening worked well with teenagers because of their comfort with using technology. The computer program included animated role playing such as how to handle drinking and driving and conflicts with peers. The ED can be a prime location for reaching high-risk teenagers since many may skip school, consider themselves too old to go to a pediatrician, yet often do not have a primary care doctor.

Read the full article here.

Using Motivational Interviewing to Elicit Behavior Change
A health coach's use of motivational interviewing (MI) can pave the way to a partnership resulting in an individual's behavior change, explains Kristin S. Vickers Douglas, Ph.D., L.P., a clinical health psychologist at the Mayo Clinic and medical director of its EmbodyHealth coaching program. Frequently called upon to employ MI in her practice as well as train health coaches in the technique, Dr. Vickers Douglas describes the dimensions of MI and its value in determining and reacting to an individual's readiness to change.

Listen to the podcast here.

New Chart: Who's on the Medical Home Care Team?

The medical home care team provides patient-centered, coordinated and high-quality care for its members. We wanted to see which medical professionals besides the physician are players on the medical home care team.

Click here to view the chart.

Engaging Clients and Sustaining Motivation for Behavior Change

Question: How do you engage your clients and keep them motivated to change their behavior?

Response: It’s important to recognize the incentive and where the motivation is coming from, because it’s not the coach’s job to get them to change or to get them motivated. It’s a matter of trying to facilitate an individual doing what they want for themselves. You wouldn’t have a client, unless they’d been assigned or sent to you by an outside entity, who wouldn’t have some desire to work in some direction of change themselves. That is one of the conflicts that arises: if someone’s being told that they need to participate in a program because of a work indication or a third-party payor, and they have no desire to be there themselves, you can’t motivate them. You can’t give a patient motivation that they don’t have.

(Karen Lawson, M.D., program director for the health coaching track at the Center for Spirituality and Healing, University of Minnesota.)

Learn more about engagement and motivation in behavior change.

HCH Readers Save 10% on Coaching Resource

In Measuring Change: Evaluating Health and Wellness Coaching Performance, Outcomes and ROI, two health coaching thought leaders present their coaching ROI models and examine the impact of health and wellness coaching on behaviors and the bottom line. They also share anecdotal research that ties coaches' personal attributes to optimal outcomes — information that can influence health and wellness coach hiring strategies.

HealthCoach Huddle subscribers should use ordering code HCH to purchase this product at a special price!

Get more information on evaluating health and wellness coaching.

2010 Benchmarks in Health Risk Assessment Use

This white paper captures trends in the use of aggregate data from HRAs by 116 healthcare organizations to design and deliver health promotion and disease management interventions to targeted individuals in response to the Healthcare Intelligence Network June 2010 Health Risk Assessments e-survey.

Download complimentary white paper here.

Take HIN's third annual e-survey on Health Coaching.

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