Companies large and small are using wellness programs in an effort to reduce healthcare costs while improving the health of their employees. The pieces of these programs have been around for a while, but companies are learning more about them and becoming more assertive in convincing their employees to get involved. Many are opting for help from wellness brokers who provide tools, materials, and an online application to bring it all together.
Stacey Verdino, associate human resources director at Amicus Therapeutics, Emma Fogt, nutritionist and wellness consultant, and Steven Chinn, vice president of compensation, benefits and HR services at Novo Nordisk, will speak Tuesday, September 23, on a panel “Innovative Employers: Helping Your Employees Help You,” with Mike Makowsky, medical director at New Jersey Manufacturers, moderating. (See sidebar, page 29, for details on the Princeton Chamber’s fourth annual Healthcare Symposium).
Verdino had the idea of implementing a wellness program at Amicus about two years into her nine-year tenure, and finally got it going with the help of a human resources colleague in 2011.
The Amicus people started it by themselves, in their own way, with no help from an outside vendor. “It was all participation-based,” Verdino says. “The first year we implemented the wellness program, it was all about having fun and introducing employees to fun things about learning to stay healthy.”
To blast off the homegrown program, Verdino and her colleague looked at the calendar, where different months are highlighted for awareness of a disease or health condition, and they planned educational programs based on this calendar.
For brain health month, for example, they took advantage of the zombie craze, and, in addition to learning more about diseases that affect the brain, like Alzheimer’s and Parkinson’s (both diseases that Amicus studies as part of its biopharmaceutical work on rare and genetic diseases), they had a zombie shooting gallery. “Because you have to shoot a zombie in the brain to kill it,” she explains. So they put the zombie video game on a big screen in the large conference room and, she joked, “We are the O.K. Corral of zombies.”
During May, which is typically skin cancer awareness month, they gave out little packets of sunscreen and lip balm and hosted a talk on the dangers of sun exposure and tanning beds. It was probably in the mid to upper 90s, she said, and they did that one as a lunch-and-learn. “We did it at lunchtime to lure them with healthy food,” she says. “No more cookies at our lunches, just fruit platters.”
The first year the focus was entirely on making it fun. “You could come if you wanted to; we didn’t tie it to anything,” Verdino says. “We wanted it to be something that employees are naturally inclined to want to do without there being any kind of financial incentive initially.”
While all the fun and games were going on, they started interviewing different wellness providers that could partner with Amicus. But what they were looking for was someone a little unusual, says Verdino, “someone who was forward thinking enough to share our interest in doing monthly things that were a little out of the norm and wanting to make it fun and engaging so that employees wouldn’t feel like it was a burden.”
As wellness was just coming on the scene, most of the companies they talked to seemed too “cookie cutter-ish” for Amicus. “They just didn’t have the imagination we had,” Verdino says, explaining that most companies would do a biometric screening, then a webinar on the health awareness topic of the month. Or they might do flu shots or hold a clinic to check people’s cholesterol and glucose. But that was it.
A biometric screening is a 36-panel blood test that tests red and white cells, hemoglobin, blood glucose, and hematocrit, and calculates body mass index using weight, height, neck, and waist measurements. The result of the biometric screening is an aggregate report of how healthy a population is. “You won’t know anything specific about a person’s medical issues,” Verdino says.
The first wellness company they selected did the biometric screenings, but otherwise left them holding the bag. One of the things Amicus had to take care of was its walking program. Each employee had a pedometer and an icon representing them on a huge map of Italy in the lobby. The problem was each icon had to be physically moved as the data came in. “I think the visual was what really got people going,” Verdino says, noting that everybody had an icon disguise, for example, Charlie Chaplin or Frank Sinatra. “Nobody knew who was who until the big unveiling at the awards ceremony.”
Amicus decided on a three-year plan. By the beginning of 2012 it started year one of the formal wellness program, in which it tied participation to financial incentives. That first year, if an employee participated in a biometric screening and a health risk assessment (which focuses on personal medical history and lifestyle issues, for example, asking the participant about tobacco use, nutrition, physical activity, stress, and other behavioral conditions that have been shown to be significant predictors of future risks), then Amicus would make a contribution to that employee’s health savings accounts.
“Our mission in 2012 was to increase awareness of personal and corporate health risk factors and provide tools for a healthier work environment,” Verdino says, noting that the goal was to create a foundation and establish baselines for individual wellness and what people needed to focus on. They also created a “Be Well” working environment, with Benny the Bee as Amicus’s wellness mascot.
From that 2012 baseline the 90-employee company learned some interesting things. Whereas 30 percent of employees thought they were in great health and only 1 percent saw their health as poor or below average, the actual scores indicated that 68 percent were in great health but 7 percent were at high to very high risk for developing long-term health issues.
That year the program had both individual and corporate incentives; if the company was able to improve its average wellness score by 2 points, then there would be a healthy barbecue event the following spring, and if by 3 or more points, a “wellness floating holiday.” For individuals, a 2-point improvement meant a $50 company contribution to the person’s health savings account and a 3-point or more improvement, a $100 contribution.
In 2013 the program got a little more complicated. Points were assigned for participation in a variety of health-promoting activities: for example, attending educational events or medical testing, getting a flu shot, annual exams, race participation, quitting smoking for a day, talking to a health coach, or serving healthy food at meetings.
These points were tied to Amicus depositing money in an employee’s health savings account. Amicus set aside $1,500 in eligible funding for each employee; of this, $750 was funded up front in January, another $300 for completing the screening and risk assessment, and the remaining $450 depended on wellness participation points.
Not so satisfied with its first vendor, Amicus eventually found a company — Well Works in West Chester, Pennsylvania — that Verdino says “was ahead of its time.” But maybe not quite as much as Amicus. “We put them through the ringer and helped get them more forward-thinking,” she says. “They were ready but didn’t have companies forward thinking enough to do it with them.”
One important tool for creating a healthy work environment at Amicus was working with the chef to provide more healthy lunch choices. The company also put healthier snacks in its vending machines — baked chips and fruity items. “We did leave some of the bad stuff but priced it outrageously,” Verdino says.
The company has since replaced the vending machines with candy bowls, which have come to serve an interesting purpose. Verdino says, “You can tell by the number of times we fill the candy bowls how stressed the organization is.”
They have also encouraged the use of the stairs and, of course, walking and use of their on-site gym.
“As the program evolves, it has gotten where people need to do a little more every year to earn the money we give them,” said Verdino. The first year they just had to do the biometric screening, then the screening plus events and going for preventive doctor visits and dental checkups. Today they log into each of these on the Well Works website to get points.
The data from the screenings and assessments provide guidance on the types of educational programs Amicus’s employees need, rather than relying on something more random like the disease of the month. After that first screening, they found that their population was relatively healthy, with a median age in the mid-40s, but, says Verdino, “they had the typical cholesterol, blood pressure, diabetes, laziness/inactivity/couch potato issues.”
“We found out that in the first real year we had people who didn’t exercise enough, but were on the fence about wanting to make changes,” she says. They also realized that 25 percent of the workforce had high to very high-risk cholesterol issues, were overweight, had bad eating habits, were not getting their recommended daily allowance of fruits and veggies, were consuming too many carbs, and were drinking too much. This led the company to tie wellness activities to opportunities to earn incentives.
Along with the wellness program, Amicus adopted a “self insured” insurance approach. The company pays for medical claims up to a certain point, after which a “stop loss” carrier pays the rest.
This change will enable the company to make comparisons among data for different years. Because not all companies do biometric screenings the same way, they have not been able yet to do an apples-to-apples comparison to see what effects the wellness program has had. But now they will be able to compare claims data from last year to this year to see whether they have made progress in their managed disease states.
Verdino cautions the bean counters not to expect an immediate return on investment. “It takes three to five years to see a change because you are changing mindsets and habits,” she says.
The next step for Amicus in the development of its wellness program will mean a big change for employees. “We are going to start challenging them to look at their overall health and make changes to their overall health,” Verdino says. “It seems to be best practice with most wellness companies that you definitely want to evolve from being participation-based to outcome-based — because the whole reason why you are doing a wellness program is to get people healthy.”
If outcomes change — for example, by losing weight or lowering cholesterol — claims should go down, she says. This means that premiums would not go up as much, and the company should see some return on its investment in wellness.
Sometimes, of course, concessions will have to be made regarding outcomes. For example, obesity might be caused by something that is not within an individual’s power to fix, and with a doctor’s note, they have to figure out a work around. But even if cholesterol runs high in a family, a person can get a prescription for medications to lower cholesterol, says Verdino. Another adjustment had to be made for a body builder who was in great shape but whose weight fell into an unhealthy range because of his high muscle-to-fat ratio.
This year Amicus has told its employees that the biometric screenings would constitute a baseline, with the goal of seeing improvements to areas in unhealthy ranges in 2016. Verdino notes that many conditions that are big claims drivers, like cholesterol, diabetes, and high blood pressure, can all be managed with diet, exercise, and medication.
Verdino, a Bordentown resident, began college at Mercer County Community College, then transferred to Rutgers as a psychology major. Because she didn’t know what she wanted to be, she says, she dropped out and went to work for 17 years in various companies, first as a receptionist and eventually as an executive assistant.
At Rhodia, she was supporting the human resources director and eventually did work for him. This prompted her to return to Rutgers and finish a degree in human resources. “I did it nights, weekends, and summer — four years of geekdom, when I had no life,” she says, noting that she finished in 2006 and has just started back to get a master’s degree. After Rhodia, she moved to ITXC as a human resources office manager, then to Amicus.
While the quantitative value of the Amicus wellness program has yet to be calculated, there is anecdotal evidence that Verdino has seen of an attitudinal change. “The culture here and the mood and the excitement around the wellness program and how it has changed people’s mindfulness” has impressed Verdino. “That in and of itself has increased employee engagement. I think they are more thoughtful about their overall health, and it’s something I’m pretty proud of,” she says.
Emma Fogt: From Work Culture To Wellness Culture
Emma Fogt, a Pennsylvania-based registered dietitian and “Innovative Employers” panelist, consults on corporate wellness workshops and does speaking engagements on the power of self-care and corporate wellness.
She looks at wellness from the perspective of corporate culture. “When you are talking about corporations, I think the best way to decrease healthcare costs is to look at the wellness culture — by looking at the big picture of that culture, which includes work environment, company values, and everything around their attitudes, goals, and norms,” Fogt says. “It is my philosophy that we address wellness within that work culture, not so much one-on-one through individuals.”
Sometimes for a small company, a team event can make a big difference. For a company that makes cables for television transmission, she ran a corporate culinary event for 12 people whose mission was to create a healthy meal from soup to dessert. They were divided into teams and each allocated a recipe to create in the kitchen. After one hour the group ate the meal together.
“This is a small example of a health and wellness event that can make a big difference to a company,” Fogt says. “During team building people get to know each other on a more personal level, and leaders can emphasize their support of a wellness culture — we’re not just interested in you producing cables for us; we’re interested in you as a whole person as well.” This event also gives employees healthy eating skills to take home with them.
Another type of event she has developed is getting a group of women leaders in an organization to come together for triathlon training. “What is involved with that is a commitment to a season — it can be 10 weeks — to reach the goal of that one morning to be able to run, bike, and swim a triathlon,” Fogt says.
During that period women have opportunities to train together or to work individually. “Many of the women in the group had never run a triathlon; and it was empowering and exciting for them,” she says, explaining that many worked in stressful, high-powered positions and the strong friendships they established with other women outside of work were very important. They realize, says Fogt, “wow, I can create a group of fun, like-minded individuals that I can be friends with and rely on as sounding boards.”
“They are benefiting from so much more than losing weight or decreasing blood pressure,” she says. “They may be gaining more in the sense of having a community of wellness for mind and body, and relationships — all those things involved in a holistic viewpoint of health and wellness.”
Fogt suggests that for big corporations, engagement strategies “that are a little more forward thinking” are very important. These might include online competitions as well as creating social networks through the company, for example, via a lunchtime walking group. “Unfortunately,” she says, “only a small percentage of company people become the wellness champions — only 20 percent are the ones really into health and wellness. The question is how to get everybody on board.” Part of the solution, she says, is to make it visual; bring it into the stairwells and out into the open.
Fogt grew up Jamaica Plains, a Boston suburb, where her physician father was a principal investigator and researcher, and her mother a painter.
Always good at sciences, looking for a service-oriented field, and knowing that, as an extrovert, she needed to be with people, she pursued a bachelor’s degree in nutrition at the University of Vermont and completed a one-year dietetic internship at Brigham and Women’s Hospital.
She spent 1988 to 1992 doing research on obesity and the nutrition of the critically ill at the Center for the Study of Nutrition Medicine at Beth Israel Deaconess Medical Center in Boston, which did cutting-edge research on Fen-Phen and insulin resistance. At Boston University she got a master’s degree in communication, which she says nourished the creative side that is so important in healthcare and wellness.
After moving to Pennsylvania for her husband’s job, she earned an MBA focused on healthcare management at Eastern College in Gladwyne, Pennsylvania, and then taught at a nursing school. In 2002 she opened a private practice, Nutrition for Kids, Teens, and Families, where she did one-on-one sessions for ages 2 to 18, specializing in failure-to-thrive babies, obesity, and gastrointestinal issues like celiac disease. “I would see a baby, then be facing an 18-year-old and talking about sports nutrition,” she says. “It was fascinating and awesome to have that different variety in one practice.”
In 2011, with her children grown, she closed down her practice and become a consultant on health and wellness. To support her growing practice, she has just written a book, “Having Your All,” which talks about how self-care leads to an energized, empowered, and effective life; in the book she covers the five power habits of self-care: sleep, eating, stress, passion and purpose, and movement. “I knew I wanted to do something bigger,” she says. “Now I can work full on.”
NJM’s Makowsky: Using the Carrot
New Jersey Manufacturers’ wellness programs date back to the 1990s, says Mike Makowsky, the medical director at the West Trenton-based firm. Back then, these comprised nurses at two out of its three sites who provided basic care like flu vaccines and first aid. Over the years things evolved toward more preventative programs, including mammograms on site and smoking cessation, open to employees, spouses, and dependents.
Then two years ago, NJM added another dimension, via Keas, a social media program that allows employees to set health goals for themselves and compete on teams to achieve modest rewards (a kea, is a large species of parrot known for its curiosity and playfulness). The program provides education about wellness and allows employees and their families to take quizzes and quests to earn points that can be used for incentive prizes.
A quiz might be a series of questions on what would be included in a low-sodium diet. A quest might be a challenge for the coming week to eat breakfast five out of seven days and also to be involved in a 20-minute exercise program for three days. Employees track their progress on the computer, and numbers are calculated at the end of the challenge and compared to other people’s. Prizes, he says, are usually $50 cash cards, but sometimes items like socks and baseball caps.
“We are very pleased because we have had 60 to 65 percent engagement by our employees, which is more than any other wellness program provided,” he says.
In the first part of 2014 NJM had vendors come in and do biometric screenings, whose numbers were recorded and entered into Keas, and 41 percent of employees participated. “The employees got reports on risk; and it gives us objective evidence of where we can target our wellness programs,” Makowsky says. They found that body mass indexes were signaling risk, and in response NJM will have more wellness programs directed to weight reduction and nutrition counseling.
Now in the second part of the year, NJM has begun to do health risk assessments, which are available through Keas. If employees do both the biometric screening and the health risk assessment, they will have $100 directly deposited into their accounts. He says about 44 percent of employees participated, as compared to the industry standard of 30 to 35 percent. NJM plans to continue the biometric screening and risk assessment every year, and over time they will see whether they can reduce cholesterol counts and BMIs.
When they did their first health risk assessment two years ago, they were surprised to learn that over 10 percent of their employees were smokers, and since then NJM has been active in providing a tobacco-free workplace and supporting it with a smoking cessation program.
Makowsky notes that NJM is still in the “carrot phase,” offering incentives to encourage people to make lifestyle modifications and reduce their health risks. Many companies have moved on to assuming that employees will participate and applying the “stick,” where the consequence of nonparticipation and not achieving goals means paying a higher percentage of their healthcare premiums. NJM has no immediate plans to do that.
Makowsky grew up on Long Island, and both of his parents died when he was very young. He says he wanted to be a doctor as long as he can remember, and first worked in a hospital during junior high school, as an orderly. He went to SUNY Buffalo in premed and went to medical school at Indiana University at Purdue.
His internship and residency, in internal medicine, were at St. Vincent’s Hospital Medical Center in New York City, and then he completed a two-year fellowship in nephrology at New York Hospital and Memorial Sloan Kettering. Then he was on the staff at Sloan Kettering, eventually burning out from working intensively with the terminally ill.
So, when someone offered him an opportunity involved more in prevention than treating people at the end stage of a disease, he took it. His position was with Mobil Oil in occupational medicine, and he spent three years in Saudi Arabia. “A good part of occupational medicine is preventing injuries and illnesses, and I learned a great deal.”
When he returned to the United States, he joined Union Carbide as assistant corporate medical director. After five years he joined ICI Americus, a chemical company in Wilmington, Delaware, as assistant corporate medical director and was involved in wellness programs as well as writing safety data sheets and responding to toxicology and hazardous waste problems.
Then he returned to clinical medicine, as medical director of the occupational medicine at Iowa Methodist Medical Center. His next move was to Trenton to become medical director of corporate health programs at Capital Health. After 10 years there, he came to at NJM, where he has been medical director for about eight years.
Makowsky, who is responsible for the wellness programs at NJM and is also involved in the business units and in the medical aspects of workers compensation claims, says he is especially proud of introducing the Keas program, because it has enabled NJM to get more employees involved who haven’t been involved in the past. “We offer many onsite programs such as Weight Watchers, aerobic dance, and zumba, but that often attracts the same employees,” he says. “Keas has broadened the number of employees and made the level of engagement much higher.”
“It is too early to say that wellness programs are reducing healthcare costs, but I know that wellness programs are good for companies,” says Makowsky.