Common thread -  the way you prepare - and control - your budget for a health promotion program is vital to its success.

1. Top-down wellness budget

Depending on the size of your organization and wellness program, you could have full budget responsibility or might need to work with a C-level who’s budgeting professionalise.

Regardless of the arrangement, you’re likely to face one of two distinct challenges -  a top-down budget or a zero-based budget.

A top-down budget is when you’re given a finite dollar amount and told to run the wellness program within the limit. When that’s the case, here are three vital questions to ask -

• Does this limit include money set aside for staff member incentives and future programs?

• Should we keep long-tenured health promotion programs that keep going up in price, and

• Does Benefits/HR have to deliver all education about the wellness program, or is there additional funding to hire staff?

2.  Zero-based wellness budgeting

In zero-based funding, you submit to upper-level management an itemized list of the wellness programs/features you want and the cost of each. Best practices -

• Rank health promotion programs by priority (health-risk assessments should be at or near the top)

• Indicate which expenditures are fixed and which are variable, and

• List ways to incorporate existing resources (like an EAP program) for a better return on investment.

3. Estimating wellness ROI

On average, health promotion programs normally take at least 18 months to break even. After three years, you should see savings.

If not, it’s time to take a fresh look at the health promotion program design.

In Washington, lobbyists have spearheaded a push for Congress, the DOL and IRS to crack down on “punitive” wellness programs.

In particular, the groups seek to limit health promotion programs in which employees’ share of their medical costs are directly tied to their willingness to participate in a health promotion program.

HIPAA’s non-discrimination rules prohibit corporations from creating negative financial incentives for staff members with health risks.

For example, you can’t raise someone’s premium share because he or she smokes. What you are able to do is offer a discount when someone completes a tobacco use cessation program.

Reason -  the law does allow for financial incentives to personnel who willingly participate in wellness programs.

The watchdog groups seek greater regulation to make sure incentives and discounts are used only as rewards for healthy behavior, not as a thinly veiled form of discrimination against high-risk employees.

That’s a enormous increase from four years ago, when just 28% of smaller corporations offered such wellness programs.

There’s more to come, too. Fifteen% of respondents that didn’t currently have a disease management component to their health plan hope to add one by 2011.

The highest-demand disease management (DM) programs are for diabetes, asthma and heart disease.

Source -  Small Company Benefits Survey, PDR Consulting Group, 9/1/2008.

In order to be effective, the health promotion program must meet participants’ individual medical and psychological needs, not to mention your own organization’s need to control long-term health costs.

Precisely how wide-reaching should the program be? After all, it doesn’t make sense to pay for services your personnel don’t want or can’t use.

Mary Beth Chalk of Resources for Living suggests that obesity programs could be broken down into four tiers of employee need, from which your organization’s ROI can also be measured.

Tier 1 -  Education

Tier I workers struggle with weight management problems but don’t need a health Coach.  Instead, they could benefit from a self-directed program that provides weight-management related materials online, targeted mailing, and/or access to nurse call line.

Exactly how to measure Return On Investment -  utilization. Do workforce click on the Web site? Do they return to the site regularly? Do individuals  use the nurse line? Your health promotion program provider should provide you detailed use stats.

Tier 2 -  Clinical supervision

When the staff member has been diagnosed as obese - a Body Mass Index (BMI)  score over 30 is obese, over 35 is clinically obese - he or she’d do better working with a health coach in a clinically supervised wellness program.

Three keys to getting maximum results -

1. Periodically have participants rate their relationship with their health Coaches. Not everybody clicks, so a change might  be in order.

2. Coordinate your disease management care with your worker assistance program (EAP)services. Reason -  Inability to control weight is often closely tied with mental health issues - and one can adversely affect the other.

The more closely your EAP and obesity program managers work together, the higher the chance for success.

3. Beware of the fade-out effect. A lot of staff members in weight-loss programs get off to a excellent start and then fall back into old habits. People  should re-commit to the program after three sessions, four months and nine months.

To measure ROI, look at utlization, goal achievement and lowered presenteeism. of course, presenteeism is notoriously difficult to measure with reliable dollar figures. So how can you overcome that problem?

• Start with employees’ salaries. Let’s suppose one participant earns $40,000 annually.

• Ask employees to self-report how energetic and productive they feel on the job, on a percentage scale. Then have supervisors estimate the employee’s productivity and split the difference. for this example, let’s assume it averaged to 50 percent.

• Collect scores again six months and one year into the program and then multiply the difference by salary.  The result is your estimated productivity Return On Investment.

In the example above, when the worker earning $40,000 improves from 50 percent to 75 percent after one year, the productivity related Return On Investment is $10,000.  

Tier 3 -  Medical management

At this level, the obese employee needs a higher level of care than a wellness coach can offer.  The employee has chronic health conditions related to obesity - like diabetes, high blood pressure, and/or sleep apnea - and needs a doctor case manager.

In particular, the employee needs to set up regular visits with the physician and create a treatment plan.

To measure Return On Investment, start with the lower-tier criteria, then track quarterly and year differences in FMLA or compensated absences, and prescription drug costs. Then compare it to the per-participant cost of the obesity program.

Tier 4 -  Morbid obesity

At this level, the staff member has been diagnosed as morbidly obese - Body Mass Index (BMI) over 40 - and is considered a potential candidate for gastric bypass surgery.

Return On Investment (ROI) is measured through ongoing health claims in addition to the previous criteria.

Create Exemplary Management Support

In the most successful Health Promotion Programs, upper managers lead their corporations by example.  And they work to ensure that the senior management structure not only allows, but actively encourages their staff to participate.

Organize a Health Promotion Advisory Team

Wellness committees serve as the eyes, ears, arms and legs of the wellness program, representing peers ideas and concerns, and assisting reshape the organizational culture toward health.

Conduct an Assessment of Financial and Human Assets and Liabilities

Successful Wellness Programs are built upon a foundation of information, including claims review, demographic analysis of the workforce, upper management and employee surveys, health risk data, history of organizational wellness, and health benefit plan design.

Develop Obviously Reported Vision, Mission and Outcomes

Establish a clear vision of wellness program direction, expectations and measures to answer the questions, “Where are we going and how’ll we know when we get there?”

Create a Extensive and Strategic Health Promotion Program

A multi-component plan ought to consist of strategically developed and implemented awareness, lifestyle change, and supportive environment programs, in addition to policies and activities that target appropriate health risk behaviors and needs of the workforce.

Identify an Incentive and Reward Strategy

Incentives show the organizational commitment to the wellness program and motivate individuals to participate. Incentives vary widely from program to program, but can include such things as time off, reduction in health insurance premiums or co-pays, cash incentives, discounts to gyms, free pedometers, etc.

Communicate to Employees

Your wellness program must be simple and concise, use an identifiable brand, and rely on a variety of media to communicate with personnel and managers.

Evaluate Outcomes

Evaluate health promotion program participation, satisfaction levels and behavioral change. You could want to track the number of workers’ compensation claims, productivity, turnover morale and absenteeism.

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Wellness Program - Management Support.

Create Exemplary Management Support

Goal -  A Health Promotion Program established into the organization’s culture.

Focus - Develop support and excitement for the health promotion program from all levels of the corporation -  executive management, mid-level management, and grass-roots employees.

Obtaining senior management’s buy-in is essential to launching an effective health promotion program.  The workers must understand that senior management is supportive of the health promotion program.

Actions -

Develop an Executive Management Executive Team to determine high-level decisions - positions that must be included are the Chief Executive Officer, Chief Operating Officer, Chief Financial Officer, Communications Officer, and other appropriate division-level managers and wellness program professionals, as necessary.

The Senior Level Management Executive Team will -

• Communicate to all levels of senior management about the health promotion program and drive the integration of the Wellness Program as a part of the business culture.

• Ensure that organizational resources are available for health promotion program planning and implementation.

• Be sure to encourage staff members to participate and to assist in “recruiting” other staff members, get the momentum going, and keep it growing.

• Share success stories within the company, and continue to elevate the perceived value of participation.

Organize a Health Promotion Advisory Team

Goal - Create a working committee that consists of personnel and essential functional parts of the company.

Focus -  to assist in reshaping the organizational culture to support employee-wellness activities by serving as messengers and supporters for the health promotion program.

Health Promotion Advisory Committees serve as an essential part of the infrastructure of your Health Promotion Program.  The team members are the eyes, ears, arms, and legs of the health promotion program.

They represent their coworkers by sharing ideas and concerns about the health promotion program.

Actions -

The Health Promotion Advisory Committee will -

• Make sure to work with upper-level management and the Health Promotion Program coordinator in the design, implementation, and investigation of the health promotion program.

• Develop methods to enhance the acceptance and success of the activities of your Wellness Program by encouraging staff member ownership of the health promotion program.

• Hold periodic meetings to keep the committee informed of upcoming plans and events and to provide feedback to the health promotion program coordinator about their thoughts, ideas, and suggestions, and those of their coworkers.

• Recommend policy and environmental changes that are aimed at bettering the safety and health of staff.

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Wellness Program - Vision and Mission.

Goal - Develop a baseline of information and identify human and organizational needs.

Focus -  Review a variety of information to better understand past and current conditions regarding healthcare utilization, organizational culture, demographic overview, and wellness programs.

Data collection plays an important role in planning, monitoring, and evaluating  a wellness program. It’ll also set the baseline for continued and future investigations of wellness program efficiency, effectiveness, and feasibility.

Actions -

• Claims review (health care, pharmaceutical) -

• What have been the 10 most costly major disease categories in each of the past five years? What are the number of claims and dollars compensated for each?

• What have been the 10 most costly therapeutic classes of drugs in each of the past five years? What are the number of claims and dollars compensated for each?

• What have been the 10 most frequently prescribed and filled therapeutic courses of drugs in each of the past five years? What are the number of claims and dollars compensated for each?

• Demographic analysis of staff member population (may include dependents) -

• List your number of employees, by gender, for each of the past five years and the percentages of males and females by age groups.

• Think about any other factors that may have affected the health of your workers and their use of the health care system.

This may include mergers, acquisitions, workplace trauma, staff member strikes, layoffs, early retirement offers, etc.

Management survey -

• Conduct surveys of mid-level management to understand their concerns and measure their level of interest and buy-in.

• Employee-interest survey -  Gather information to determine what the workforce want and to measure the level of participation, satisfaction, and “success” of any previous activities.

Risk data (health-risk assessments) -

• Is there any data from health-risk appraisals over the past five years?

Participation in similar activities -

• List and describe all wellness programs that have been implemented over the past five years, including participation rates.

Design of the health plan, and anticipated changes -

• Have there been any significant changes in the health plan’s design in each of the past five years, like a change from an health maintenance organization to a PPO, increased co-payments or deductibles, or increased staff member contributions?

Develop Clearly Reported Vision, Mission and Outcomes

Goal -  Establish a clear vision of health promotion program direction, expectations, and measures.

Focus - Establishing a vision, mission, goals and goals to keep your Wellness Program focused toward its desired outcomes. It will answer the questions, “Where are we going?” and “How’ll we know when we get there?”

Actions -

• Identify two to five obviously stated objectives. Be sure that your wellness program is capable of having an impact in the area desired, and be sure that you are capable of measuring that impact.

Example Goal - Employees having access to healthier food options

• Establish two to five measurable objectives that especially state what your wellness program is going to accomplish, by when, how, and how it will be measured.

Example Objective -  Modify all vending machines to include 50% healthy food options.

• Identify several activities that’ll help you reachyour objective. Activities are very specific.

Example Activity - Make certain to work with vending machine owners to identify healthy food choices and restock with 50 percent of items that are healthier food choices.

• Identify who’s going to do what, by when, and what resources are needed.

Example Detail -  the Program coordinator will contact XXX Vending Company by September 30.

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Wellness Program Incentives.

Create a Comprehensive and Strategic Wellness Program

Goal -  A extensive Wellness Program plan.

Focus -  Development of a plan that consists of a selection of awareness, lifestyle change, and supportive environment program, policies, and activities that will target risk behaviors, needs, and interests of workforce.

Your Wellness Program ought to provide an integrated, strategic approach specific to the needs, objectives, and culture of your business, designed throughout an annual cycle.

It’ll be imperative that you review and revise existing policies governing such areas as smoking, vending machines, and the staff cafeteria. Moreover, it is useful to examine what company health promotion or health-promotion activities are offered under your existing health-benefit plan.

Actions -

• Create activities based on your wellness program goals and the specific needs of your personnel. Focus on those topics that are of greatest interest to your personnel and the greatest needs of your corporation, in that order. Prevent topics with narrow appeal.

• Keep it simple. Design the wellness program so it’s easy for the participants to understand and track. Let personnel focus their learning efforts on their own behavior, not on the rules and regulations of the wellness program.

Likewise, simplify the wellness program administration. Let people  record their own activities when possible; create a mixture of self-reported activities along with verified activities.

• Integrate a combination of activities to include awareness, educational, and behavior elements. Link the activities throughout the year to allow for desired behavior repetition.

• Pick activities that every staff member can participate in.

Examples -

• Challenges -  Activities that focus on practicing a desired behavior and continue for 4-8 weeks and focus on specific topics (such as physical activity, nutrition, or stress management).

• Learning experiences (seminars, videos, classes) -  One-time activities that last for a relatively short time and focus on a specific topic; these can precede “challenge activities” to prepare participants for behavior change.

• Behavior changes (such as tobacco use cessation) -  Interventions may or might not be offered at the worksite; individuals ought to be encouraged to make lifestyle changes that they wanted to make even without the incentive.

• Illness management (support and education groups for diabetes and hypertension) -  These may  be provided or supported by the company through disease-management providers, or by community, health, or religious companies.

• New skills (first aid, cardiopulmonary resuscitation) -  These could  be provided or supported by the corporation, or by community, health, or religious organizations.

• Screenings, wellness assessments, physical exams -  A wellness assessment provides the company with aggregate data that could be used in health promotion program planning and examination; preventive screenings and physical exams could be encouraged by awarding credits to workers.

• Program support (membership or leadership in wellness committee or challenge team) -  Reward those who work with you to help make your Wellness Program a success.

• Community events -  Reward participation in events like the Heart Walk or March of Dimes Walk; limit the number of these events that could be counted toward the annual total, and be selective about which events you allow to be counted.

Develop an Incentive Strategy

Goal -  to motivate and reward employee participation and completion.

Focus - Develop a sense of interest in participation and completion of wellness activities.

Providing incentives and rewards will send an important message to the employees that the company is committed to bettering their health and will share the rewards that these changes will bring. It also plays a significant role in arousing individuals to participate.

Actions -

• Identify through personnel what incentives they value most.

• Identify what incentives the organization can provide.

• Integrate your incentives into your benefits strategy.

• Ensure that every participant who achieves a goal receives some recognition.

• Give participation incentives.

• Prevent offering incentives for the “best” or the “most.”

• Avoid rewards for biometric changes.

• Use incentives to promote your Wellness Program, through logos and branding.

Examples -

Compensated time off, reduction in health insurance premiums or co-pays, cash incentives, discounts to fitness centers, free pedometers, etc.

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Health Promotion Program Communication.

Goal -  Increase awareness of and participation in the Health Promotion Program.

Focus -  Promote the Wellness Program to staff members to encourage participation in activities and benefits.

A well-designed communications strategy is paramount to successful health promotion program awareness and participation. Even a “world class” health promotion program design won’t succeed when nobody knows that it is available or how to get involved.

Workers who do not get involved in the health promotion program should be doing so because they choose not to participate, not because they did not know about how, when, or where to participate.

Actions -

• Conduct a Resources and Communications Audit to identify internal and external resources available to support your Health Promotion Program, in addition to knowing how information are going to be disseminated.

• Keep the wellness program simple and concise -  easy to peruse about, understand, and act upon.

• Build the brand; be sure it’s something that workforce can identify with. Add the brand to T-shirts, water bottles, mouse pads, stress balls, etc.

Use a selection of media -

• Print - handouts, fliers, posters, banners, paycheck inserts, newsletter articles, bulletin boards, literature racks, post cards.

• Electronic - Web, intranet, e-mail, closed-circuit TVs, sign lines, audiovideo productions.

• Staff meetings and business events; word of mouth.

• Use existing channels of communication - what works best in your business - and be sure to know about all points of contact and systems of distribution.

Timing for communications -

• Prior to activity to create awareness and to educate.

• During activity to stimulate participation.

• After an activity to report results.

• Between activities to maintain momentum and interest.

Consistency of communications -

• Use branding; maintain a consistent look, feel, and tone of messages.

• Maintain this consistency throughout the wellness program.

Surveys and forms -

• Collect information.

• Disseminate information.

Robust wellness programs focused on changing lifestyle behavior have been proven to yield a $3 to $6 return on investment for each dollar invested. It takes about three to five years after the initial wellness program investment to realize these savings.

Ninety-three percent of USA companies offer some kind of health promotion program for their personnel, but is it the right type?

Primary Kinds of Wellness Programs

Programs focusing on illness management. These wellness programs monitor and treat specific diseases. Disease management follows the 80/20 rule -  80% of health care costs are spent on 20% of staff.

Disease management is reported to have a $7 to $10 return on investment within a year.  The 20% of personnel requiring the greatest medical expenditures today are typically not the same 20% who’ll cause the greatest health care expenses a year or two down the road.

Programs focusing on health enhancement and risk management. These wellness programs focus on lifestyle behavior change, and offer a $3 to $6 return on investment within two to five years, according to a 2004 report issued by the National Business Group on Health.

It is imperative that you note that a $3 to $6 return on an entire employee population produces a higher sum savings than does illness management.

Good Data Drives Good Company Decisions

• Based on more than 120 scientific research studies, the National Corporation Group on Health stated that, within five years of health promotion program implementation, overall benefit-to-cost ratios (return on investment) of -

• $3.48 in lowered health care costs per dollar invested.

• $5.82 in lower absenteeism per dollar invested.

• A 2003 evaluation of one large USA corporation found that simply assisting employees control their blood pressure alone can save $547 per person annually.

• Johnson and Johnson claims to have saved $38 million in healthcare costs for its workers between 1995 and 1999 by promoting healthy life choices.

Healthcare costs lowered $224 per staff member each year (averaged over four years), and this rate improved over time.  The company found most benefits in the third and fourth years after wellness program initiation.

• A 2004 Univ. of Michigan study of 23,500 General Motors staff members showed that nonexercising staff members claimed at least $100 more per year in healthcare costs than exercisers.

The research study  also reported that obese, sedentary personnel who started exercising at least twice a week decreased their costs by an typical of $500 a year.

• The Washoe County School District in Nevada estimated that, in a single year, it spent $300,000 on direct costs associated with obesity and $1 million for gastric-bypass surgeries. It instituted a weight-loss program that paid workers $10 per pound lost, up to 25 pounds.

Program participants missed three fewer workdays a year, producing a cost savings of $15.60 per program dollar spent.

Staff Time
Building a successful Wellness Program requires staff time in addition to money. Some larger corporations may spend 20 hours per week for three to six months preparing all the steps prior to launching a Wellness Program.
Company Costs
Monetary costs can fluctuate widely, depending on whether the company compensates all costs, the personnel pay all costs, or the costs are shared.
A 1992 study indicated that 28% of corporations spent $5 or less per staff member, and 19% spent between $6-10 per staff member.
The Health Promotion Council of America estimates the cost per staff member to be between $100 and $150 a year for an effective wellness program that produces a return on investment of $300 to $450. A sample expenditure for various levels of wellness programs include -
Program Type
A minimal (largely paper) wellness program          $1 - $7         

A moderate health promotion program
A medium wellness program with a few activities       $16 - $35            

A fairly comprehensive wellness program             $36 - $75      

A very extensive, effective wellness program       $76 - $112            

Another increase of 12-15% is expected in 2005. General Motors expects to spend $5.6 billion on health costs in 2005, or 40% more than it earned in profits in 2004.

• More research shows that poor diet andphysical inactivity are major drivers of increases in healthcare costs for employers.  The number of obese adults has doubled since the 1970s.

• The rise in obesity has a significant impact on healthcare costs. on average, 2002 healthcare costs for an obese person were $1,244 higher than for a person with a healthful weight.

• Obesity is causing rapid increases in type 2 diabetes and contributes directly to a 65 percent increase in diabetes treatment from 1987 to 2002. Almost $1 of every $5 spent on healthcare in the USA is for a individuals with diabetes.

Treating employee health care as an investment, rather than a cost, can yield long-term dividends

• At least 50% of your organization’s healthcare costs are driven by the lifestyle related behaviors of your workforce, like smoking, poor diet, and lack of exercise.

• In the past 10 years, the annual return on investment for Wellness Programs has been as much as $6 saved for every $1 spent, doubling the return on investment of earlier wellness programs.

• The typical reduction in health-plan costs, sick leave, disability costs, and workers’ compensation is more than 25% for well-designed Health Promotion Programs.

• Fit workers are more productive workers, with fewer sick days, fewer accidents, higher morale, and lower job turnover.

Employers who integrate wellness in their overall objectives find they experience lowered absences, better morale, lowered health risks, and lowered healthcare costs.

The purpose of this guide to is to encourage and help you launch your own Health Promotion Program. If you already have a wellness program, but are not receiving the results you expected, perhaps some ideas and best practices in this toolkit will help you and your staff reap the benefits of a healthier workforce.

At least 50 percent of healthcare expenditures are lifestyle-related, and accordingly, potentially preventable. Yet despite the $5,000 an average business spends on healthcare per staff member each year, most businesss are spending less than 5 percent of that on biometric testings and prevention.

The most extensive meta-evaluation of Wellness Program studies shows something very exciting! It shows that Wellness Programs aren’t only effective at assisting to reverse the rising spiral of health care costs, but these wellness programs are also becoming more effective.  The average cost-benefit ratio has increased from 1 - 3 for earlier wellness programs to 1 - 6 today.

Simply put, the typical reduction in health care costs, sick leave, disability costs, and workers’ compensation is more than 25% for well designed health promotion programs.

Corporate wellness provides a long-term approach for helping keep staff members well.  The single most crucial thing you can do for your staff members is to start a Health Promotion Program now.

Many of us create objectives that seem beyond reach and we can’t seem to stick to a specific health promotion program for an extended period of time.  

With the numerous struggles that prevent us from reaching our optimum individual wellness, many of us would welcome the assistance and guidance of a specialist wellness coach.  

A wellness coach is a trained professional who works with person to help them to reach their wellness objectives by developing and implementing personal health promotion programs.  

A wellness coach is highly educated and generally maintains advanced degrees in areas such as Exercise Physiology, Occupational or Physical Therapy, Athletic Training, and Nutrition.  

A wellness coach sets achievable goals for the client, holds them accountable, and acts as a guide, motivator, and support system for that individual.  They focus on behavioral change by using individually designed health promotion programs to meet the unique needs of the client while offering creative solutions to help them achieve their goals.  

In order to fully understand the role of a wellness coach it is crucial that you understand the various factors that involved in overall wellness.  The five major components of wellness are health risks, physical activity, stress management, weight management, and nutrition.  

A wellness coach focuses on each of these areas of wellness while meeting the specific needs of the client whether they’re attempting to lose weight, get in shape, reduce stress, or quit smoking.  

They evaluate a person’s needs based on a highly scientific study known as a Health Risk Appraisal (HRA) .  After a wellness coach has determined the specific needs of the client, he or she’s able to create the wellness program, set achievable objectives for that individual, and monitor them while they reach success.  

Wellness coaches focus on physical health as well as mental and emotional health for create a balance in the patron’s life.  They not only work on assisting the patron with their current wellness issues, but they assist the patron to maintain their individual health by creating future objectives in their health promotion program.  

Every individual has unique needs and time constraints that require attention in different ways.  A wellness coach provides convenience with their services by working with patrons in a variety of ways.  

The customer and coach may use telephone meetings, e-mails and instant messaging (electronic coaching), face-to-face interactions, or a combination of these various forms of communication.  

Although electronic coaching is becoming the most well-liked method due to its lower cost and efficiency, each client may select the method or methods will work best for them.  

The wellness coach is available 24 hours a day through web-based communication to make it even more convenient for the patron to reach his or her objectives.  

Wellness coaches offer the kind of assistance that fits the needs of each client in order to make it easier for the client to embrace their personal health promotion program.  

Based on the convenience, knowledge, and assistance that is offered by a wellness coach, it is easy to see why more people  are taking advantage of these coaches to assist them in achieving their ultimate wellness goals.