Carrots and Sticks? How about personal accountability!
http://www.corporatewellnessmagazine.com/article-detail.php?issue=Issue%205&article=carrots-and-sticks?-how-about-personal-accountability!
Jim Pshock, President of Bravo Wellness
Dec 9, 2009
Over and over I hear the analogies of our trade, “It’s easier to attract bees with honey,” “You can lead a horse to water but you can’t make him drink” or “It’s better to motivate change with carrots than to punish a lack of progress with a stick.” Passionate wellness team members at numerous organizations desperately try to motivate employees who more often than not, simply don’t care. Perhaps they care, but just not enough to change behaviors.
Many employers already pay in excess of $6000 per employee per year for health benefits and it is growing. Too often, rather than appreciation – many employees are indignant, feeling that even the slightest increase in their payroll contribution, co-pays or deductibles are unfair. Employees feel like victims of the benefit plan rather than the beneficiaries. Do they have any idea that they are the only ones really capable of reducing the cost? It is widely accepted that 70 – 80% of all healthcare spending is spent treating conditions that are lifestyle driven and largely preventable. Employers who ignore this and continue to offer “one size fits all” health benefits are the real victims.
I recently attended an annual employee benefits meeting where a company introduced their annual plan changes. They used a different approach this year, no cost increases but your plan deductible was going to be tied to your lifestyle choices. Their $1250 deductible could be reduced to only $250 if they maintained cholesterol below 200, blood pressure below 140/90, body mass index below 30 and were a non-smoker ($250 per category). One employee, offended by the concept, stated “Is that the best you can do? It’s none of your business whether or not I smoke.” The company president quickly replied: “I’m not telling you that you cannot smoke. I’m telling all of your co-workers that they no longer have to pay for it!” – The room erupted in applause. A rapidly growing number of American workers are ready for this concept.
Employee lifestyle choices most certainly are an employer’s business. Health benefits are often the second highest expense on an organizations balance sheet! Suppose that your company provided group auto insurance instead of group health insurance. If you had a few employees who had five at-fault accidents each year, a DUI and several speeding tickets and that caused the rates for the entire company to go up 30% each year, the good drivers would be infuriated. They would demand a discount and they would demand that those responsible for the increase bear more of the cost. Health plans are really not that different.
Have you ever listened to the chatter that occurs before employee benefit meetings? “What are they going to do to us this year?” or “Here we go again, no raises and higher benefits cost.” Finally, employers are starting to respond with, “What have you done for yourself this year? Lose weight? Quit smoking? Get your diabetes under control? If the answer is “yes” you may not see an increase at all.” Reward those who never smoked and don’t need to lose weight with the best plan and/or lowest cost of all. After all, the only ones who can control costs are the ones who can avoid claims by making healthier choices. Even employees who don’t personally like this message rarely say that they think it’s unfair.
In this current age of entitlements, laziness and “victims” expecting a bail out because of their poor choices there are indeed glimmers of hope and success stories from those who have instead chosen to take personal responsibility and show some grit determination. Individuals who have maintained a high credit score can find unparalleled deals in this economy. Banks that didn’t cave into the sub-prime mortgage lending pressures are enjoying stability and strong reputations that can fuel growth. The only Detroit auto-maker to refuse a bail out is the only one now posting a profit! Well done Ford! History has taught us that doing for others what they can and should do for themselves never produces lasting success. This applies directly to your wellness plan as well.
Yes, many people need help. Yes, there are special circumstances that warrant intervention and exceptions. We need more coaching, more outreach, encouragement and support programs, but at the core of all of these initiatives is personal accountability. Employers should not feel guilty for expecting individuals to be a part of the solution or accept the consequences. This happens in performance reviews every day.
I recently presented to a group of about 50 insurance brokers. Following the meeting, dinner was served. And then – the largest piece of cheesecake I ever saw was placed before me. Those at my table jeered “Oh, the wellness guy can’t eat that!” and they watched to see what I’d do. I explained that my company doesn’t tell anyone what they can or cannot eat. The crux of our message is that if I choose to eat that cheesecake and I do nothing to burn the fat and calories off – my co-workers shouldn’t have to pay for it. The bell finally rang! They understood what results-based wellness incentives were all about.
If you are training an animal, you know that rewarding desired behavior causes repeat behavior. It also creates an expectation of a bonus “reward” for doing what they should be doing anyway. Remove the reward and the behavior usually stops. If instead you beat an animal into submission with a stick, you will see behavior change but you will often also see a broken spirit and resentment. The good news about your wellness program is that you don’t need a carrot or a stick. With adult human beings, try communicating the problem, suggesting solutions, listening to feedback, soliciting alternative ideas that accomplish the same goal and executing a strategy. Seek understanding, not consensus (and certainly not a unanimous decision). Tying employee costs to their healthy choices actually works.
Every organization is a little different and cultures must be respected, but the cultures can also change. Given a chance to be a part of the solution and an expectation to make meaningful lifestyle changes, many employees will rise to the occasion and surprise the skeptics.
The wellness plan that Safeway has implemented has been getting a lot of publicity lately. The following link to ABC News will show the video that Good Morning America recently aired:
http://abcnews.go.com/video/playerindex?id=8144123
Bravo Wellness has been at the forefront of implementing programs such as this. We have a great deal of flexibility in designing plans that fit each company’s culture and goals. The technology that we have developed can help employers navigate and comply with the regulations surrounding these types of outcome-based wellness programs.
Contact us today to find out how we can help your organization: 1-877-66-BRAVO or info@bravowell.com
By Sen. Tom Harkin (D-Iowa)
Washington, DC - With the Senate health committee convening daily to craft a comprehensive health reform bill, the basic outline of this landmark legislation is now clear.
Yes, it will ensure access to affordable, quality care for every American. But, just as important, it will hold down health care costs by creating a sharp new emphasis on disease prevention and public health.
As the lead Senator in drafting the Prevention and Public Health section of the bill, I view this legislation as our opportunity to recreate America as a genuine wellness society - a society that is focused on prevention, good nutrition, fitness, and public health.
The fact is, we currently do not have a health care system in the United States; we have a sick care system. If you’re sick, you get care, whether through insurance, Medicare, Medicaid, SCHIP, community health centers, emergency rooms, or charity. The problem is that this is all about patching things up after people develop serious illnesses and chronic conditions.
We spend a staggering $2.3 trillion annually on health care - 16.5 percent of our GDP and far more than any other country spends on health care - yet the World Health Organization ranks U.S. health care only 37th among nations, on par with Serbia.
We spend twice as much per capita on health care as European countries, but we are twice as sick with chronic disease.
How can this be so? The problem is that we have systematically neglected wellness and disease prevention. Currently in the United States, 95 percent of every health care dollar is spent on treating illnesses and conditions after they occur. But we spend peanuts on prevention.
The good news in these dismal statistics is that, by reforming our system and focusing on fighting and preventing chronic disease, we have a huge opportunity. We can not only save hundreds of billions of dollars; we can also dramatically improve the health of the American people.
Consider this: Right now, some 75 percent of health care costs are accounted for by heart disease, diabetes, prostate cancer, breast cancer, and obesity. What these five diseases and conditions have in common is that they are largely preventable and even reversible by changes in nutrition, physical activity, and lifestyle.
Listen to what Dr. Dean Ornish told our Senate health committee: “Studies have shown that changing lifestyle could prevent at least 90 percent of all heart disease. Thus, the disease that accounts for more premature deaths and costs Americans more than any other illness is almost completely preventable, and even reversible, simply by changing lifestyle.”
It’s not enough to talk about how to extend insurance coverage and how to pay for health care - as important as those things are. It makes no sense just to figure out a better way to pay the bills for a system that is dysfunctional, ineffective, and broken. We also have to change the health care system itself, beginning with a sharp new emphasis on prevention and public health.
We also have to realize that wellness and prevention must be truly comprehensive. It is not only about what goes on in a doctor’s office. It encompasses workplace wellness programs, community-wide wellness programs, building bike paths and walking trails, getting junk food out of our schools, making school breakfasts and lunches more nutritious, increasing the amount of physical activity our children get, and so much more.
I am heartened by the fact that the major players in this endeavor - Democrats and Republicans alike - all “get it” when it comes to prevention and public health. We all agree that it must be at the heart of reform legislation.
As President Obama said in his speech to Congress earlier this year: “[It is time] to make the largest investment ever in preventive care, because that’s one of the best ways to keep our people healthy and our costs under control.”
No question, comprehensive health reform is an extraordinarily ambitious undertaking. But what makes me optimistic is that all the major groups are playing a constructive role, including those that opposed the 1993-94 heath reform effort. Everyone agrees that the current system is broken.
Winston Churchill famously said that “Americans always do the right thing - after they’ve tried everything else.” Well, we’ve tried everything else, and it has led us to bad health and the brink of bankruptcy.
Comprehensive health reform legislation is our opportunity to change the paradigm. We are going to extend health insurance to every American. And we are going to give our citizens access to a 21st century health care system - one that is focused on helping us to live healthy, active, happy lives.
Sen. Tom Harkin (D-Iowa) is a senior member of the Senate Health, Education, Labor and Pensions Committee and chairs the Senate panel that funds medical research and health care.
Staying Healthy
Eight Tests That Could Save Your Life
Matthew Herper and Robert Langreth 05.21.09, 4:20 PM ET
No modern doctor would have been surprised at Franklin Delano Roosevelt’s death from a cerebral hemorrhage in 1945. His blood pressure was 260 over 150 millimeters of mercury–double the normal level.
Blood pressure, measured by how far pulses of blood in your arm push up a column of mercury, is one health-related number everyone should worry about. But it’s on a very short list. If you’re healthy and trying to stay that way, the important tests are few and relatively low-tech: Measure your cholesterol, step on a scale, check for signs of a small number of cancers and tell your doctor if you feel depressed.
This advice may run contrary to what might be characterized as “test madness”–the tendency of doctors and patients to want to test in all sorts of ways, using dozens of parameters that purport to measure how well your internal bodily engine is running. More are proposed and touted by entrepreneurs all the time–such as exotic new genetic tests and whole-body scans. They claim they will spot disease before symptoms arise. But most have no data proving that taking the test will improve your health or lengthen your life.
“There are five things that can happen with a screening test, and four of them are bad,” says B. Ned Calonge, the Colorado doctor who is chairman of the U.S. Preventive Services Task Force, a government-sponsored expert panel that evaluates preventive tests. Tests can indicate you have a disease you don’t. They can tell you don’t have a disease you do, leading you to ignore symptoms. They can spot a slow-growing disease you might be better off not knowing about. And they can waste money with unhelpful information.
Conclusion: Before you take an exotic test, talk to your doctor about whether taking it will really improve your health.
The Preventive Services group takes a conservative approach and tries to cherry-pick the few tests likely to lead to better health. Its list of recommended screening tests for healthy adults provides the basis for ours; we’ve added an overall calculator for heart risk and waist circumference, which many cardiologists believe may spot risky amounts of abdominal fat. A bone density screening and bad-cholesterol screening are also suggested.
Most of our tests screen for the risk of heart disease and stroke. Cardiovascular disease slays 800,000 Americans a year, 60% more than cancer, the runner-up killer. Heart disease put the whole idea of risk-screening on the map. The Framingham Heart Study, which has followed 5,000 patients in Framingham, Mass., for half a century, established blood pressure and cholesterol as risk factors way back in 1961.
Routine blood panels done by doctors often include dozens of obscure numbers. Finding out many of these lab numbers might not hurt, but there’s not a lot of proof they’ll help you in the long run. If you do enough tests, one will be high just by chance–causing unnecessary anxiety and yet more tests.
In cancer, pap smears have dramatically reduced the rate of cervical cancer, and randomized trials have shown mammograms prevent deaths. But recent studies showed prostate-specific antigen (PSA) may lead to prostate surgeries without saving lives, because prostate cancer is such a slow killer; it might be worth it if you have a family history of the disease or some other reason to worry. Diabetes mostly kills through heart disease, so wait to get tested until your blood pressure or cholesterol is already high. Women over 65 should watch their bone mineral density, and everyone should look out for signs of persistent sadness that could mean clinical depression or other mental illness.
Health is not just about the numbers. Too often, “the abnormality on the screening test has become the disease,” says Peter Bach, a pulmonologist and epidemiologist at Memorial Sloan-Kettering Cancer Center. Equating the number with the disease can lead to problems. In one big study diabetics who had their blood sugar lowered all the way back to normal died sooner than those who had it lowered somewhat less. So stick to treatments that have been proved in clinical trials.
Click here: http://www.forbes.com/2009/05/21/life-saving-tests-lifestyle-health-tests_slide_9.html?thisSpeed=30000
May 10, 2009
Congress Plans Incentives for Healthy Habits
WASHINGTON — In its effort to overhaul health care, Congress is planning to give employers sweeping new authority to reward employees for healthy behavior, including better diet, more exercise, weight loss and smoking cessation.
A web of federal rules limits what employers and insurers can do now.
Congress is seriously considering proposals to provide tax credits or other subsidies to employers who offer wellness programs that meet federal criteria. In addition, lawmakers said they would make it easier for employers to use financial rewards or penalties to promote healthy behavior among employees.
Two Democratic senators working on comprehensive health legislation, Max Baucus of Montana, the chairman of the Finance Committee, and Tom Harkin of Iowa, have taken the lead in devising such incentives.
“Prevention and wellness should be a centerpiece of health care reform,” said Mr. Harkin, who regularly climbs the stairs to his seventh-floor office on Capitol Hill.
The White House agrees. One of President Obama’s eight principles for health legislation is that it must “invest in prevention and wellness,” a goal espoused in almost identical words by Republican senators like John Cornyn of Texas and Orrin G. Hatch of Utah.
Frank B. McArdle, a health policy expert at Hewitt Associates, a benefits consulting firm, said, “Wellness and prevention programs have become a mainstream part of the benefits offered by large employers, and it’s virtually certain that Congress will include incentives for such programs” in its bill. The goals of such programs are to help people control blood pressure, fight obesity and manage diabetes and other chronic conditions.
Under Mr. Harkin’s proposal, employers could obtain tax credits for programs that offer periodic screenings for health problems and counseling to help employees adopt healthier lifestyles. Programs could focus on tobacco use, obesity, physical fitness, nutrition and depression, he said.
Growing numbers of employers have adopted wellness programs after finding that they can lower health costs and increase the productivity of workers. Financial incentives include gift certificates and premium discounts or surcharges.
Critics say that holding people financially responsible for their health behavior is potentially unfair and that employers have no business prying into their employees’ private lives.
Lewis Maltby, president of the National Workrights Institute, a research and advocacy group, said financial rewards and penalties were often a form of lifestyle discrimination. “You are supposed to be paid on the basis of how you do your job, not how often you go to the gym or how many cheeseburgers you eat,” Mr. Maltby said.
But federal officials insist that the rewards and penalties can be used in an ethical way.
Ethics experts at the National Institutes of Health have developed guidelines for assessing workplace wellness programs. In the current issue of the journal Health Affairs, the experts, Steven D. Pearson and Sarah R. Lieber, say the unhealthy behavior of some employees can affect co-workers by driving up costs for the group as a whole.
“The core ethical justification for penalty programs is that employees should be held responsible for voluntary actions that cause harm to others,” they write. But, they add, employees should be exempt from penalties when it is “unreasonably difficult or medically inadvisable” for them to meet a particular goal or standard.
In setting up wellness programs, employers must navigate a maze of tax, labor and insurance laws.
If, for example, an employer pays the cost of gym membership for employees as part of a wellness program, the payment is often counted as taxable income to employees.
Helen Darling, president of the National Business Group on Health, which represents 300 large employers, said, “We would like Congress to change the law so it would not be taxable income if an employer provides a benefit to help employees stay healthy.”
Employers who reward healthy behavior may also run afoul of a 1996 law intended to prevent group health plans from discriminating against people because of their health status or medical history.
If an employer offers financial incentives to employees for lowering cholesterol, losing weight or stopping smoking, the amount of such rewards generally may not exceed 20 percent of the cost of coverage.
Many employers would like to offer larger incentives, and many in Congress want to let them do so.
Wellness programs seen as key benefit: Survey
By Joanne Wojcik / Business Insurance
March 18, 2009
Employers are stepping up communication with their employees about wellness and
employee assistance programs available to them and are not planning to make significant
cuts in the budgets for those programs, according to a survey.
“Despite pressure to reduce costs in many other areas of operations, 45% of respondents
report increasing their wellness communications to highlight available services that can
assist employees with issues brought on by the economic downturn,” said Ruth Hunt, a
principal in Buck Consultants’ communication practice in New York, in a statement.
Ms. Hunt co-directed the survey with Barry Hall, Buck principal and global wellness leader,
during the Fourth Annual Employer Health & Human Capital Congress, which was held in
Washington last month. The survey was conducted interactively involving 200 audience
members attending one of the meeting’s general sessions.
“Our findings suggest that wellness has ‘come of age’ as a vital benefit offering, especially
during financially difficult times,” Mr. Hall said in the statement. He said 53% of survey respondents reported an increase in the use of wellness services since the financial crisis began.
Among other survey findings:
- 19% plan to increase spending on wellness programs
- 59% have experienced no budget changes, but are anxious about the possibility of having
to make cuts in the future.
- Among those expecting cuts, 78% said those involving wellness programs will be no
greater than any reductions affecting other corporate spending areas.
Before the conference, Buck conducted a separate survey of 52 employer delegates to
examine the culture of health—the creation of a workplace culture that promotes healthy
lifestyle choices—in today’s workplace.
Those findings include:
- Only one-third of respondents report having a culture of health today, while 87% intend
to pursue this philosophy for the future.
- Measuring outcomes is the top priority for enhancing wellness programs among 56% of respondents.
- 47% of respondents reported the biggest barrier to achieving a culture of health in their
organizations was getting a commitment from top management. Neither survey results were formally published.
http://www.businessinsurance.com/cgi-bin/printStory.pl?news_id=15757
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