The Corporate Wellness Program management world is evolving rapidly. Each month, there are new research findings that support the premise that Corporate Wellness Programs and disease management have a long-term impact on medical costs.

Many large employers that started Corporate Wellness Programs three to five years ago are showing savings in health, disability, and workers compensation costs. Small to mid-size employers are watching all this and wondering where to start with wellness.

Getting senior management support and budget approval is one of the challenges at the beginning of a Corporate Wellness Program. This is the case because Corporate Wellness Programs can be expensive, averaging $150-300 per employee per year in large employers.

Most of the savings are not realized for a number of years. This long-term investing is hard for employers on the move.

The key to success for Corporate Wellness Programs is to take a strategic approach. Here are ten steps to consider when starting a Corporate Wellness Program.

1. Start with senior management. Without senior management support, a health promotion strategy can fall flat. Start with the health of your executive team and discover your wellness champions at the top of the business.
2. Analyze the problem. Look at your medical claims and analyze the trends. Which conditions are driving your medical, disability, and workers’ compensation claims and which are modifiable? What’s worked and what hasn’t thus far? What is the long-term impact of doing nothing?
3. Hold an initial wellness meeting. Invite your key stakeholders both inside and outside the business. Ask your broker to facilitate the meeting and invite key health vendors including health, disability, Employee Assistance Program (EAP), fitness, and occupational nursing. Review claims and utilization information and identify key areas of concern. Look at current offerings and see how they can be tailored to the needs of the population.
4. Look at both healthy and unhealthy staff members. Since 85 percent of claims are usually attributed to 15 percent of claimants, it is essential to reach those with the most costly conditions while also reaching employees who are at risk for developing preventable diseases in the future. Voluntary Corporate Wellness Programs such as lunch and learns wellness seminars miss many of the employees who need them most. Look at initiatives that are population-wide or target intact workgroups. Wellness incentives help but do not motivate everyone.
5. Set short-term goals for the Corporate Wellness Programs. Set some realistic short-term goals based on your key areas of concern. Are there any plan design changes that could have an immediate impact on spending? Are there some programmatic actions that could have immediate results?
6. Determine what staff members are thinking. Hold some focus groups to determine where employees are with wellness. What’s working? What isn’t? How much interest do employees have in the Corporate Wellness Programs? What obstacles and barriers are staff members experiencing when they try to change behavior?
7. Make sure you have a high-impact Employee Assistance Program (EAP). Your first wellness dollars should go into upgrading your Employee Assistance Program (EAP). A highly utilized Employee Assistance Program (EAP) can provide a foundation for all of your future wellness activities. A good Employee Assistance Program (EAP) is a trusted link to the hearts and minds of staff members. At no additional cost, the Employee Assistance Program (EAP) can provide needed follow-up coaching and personal attention for staff members who are working on modifiable health behaviors or involved in disease management initiatives. Nutritionists, fitness, pregnancy, and stress management specialists are all part of a high-value Employee Assistance Program (EAP).
8. Set three to five year goals for medical savings and measure them. Get help from your broker and insurance carrier help you on long-term goals for your health, disability, and workers compensation plans. Establish program metrics that will help you to measure ROI. Go beyond participation rates, completion rates and program satisfaction. Measure changes in readiness, changes in behavior, and changes in risk factors. Establish rigorous methods to measure medical savings over the long term.
9. Set goals for organizational health. Look at the more intangible benefits of a wellness initiative and quantify them whenever possible. Include employee turnover rates, cost of new hires, employee morale, benefit satisfaction information, and employer of choice issues in setting goals. Establish ways to measure success in these areas.
10. Add specifics to your short and long-term plan. Include a Corporate Wellness Program strategy, a communication strategy, and a Corporate Wellness Program incentive strategy that will fit with your corporate culture. Focus on integration of related components along a health continuum with communications that are focused, simple, and human. Establish a budget that includes key components such as consumer education, health promotion, health risk assessments, and regular biometric screens.

Employers can also benefit from Corporate Wellness Programs. According to recent research, employers’ benefits are:

• Enhanced recruitment and retention of healthy staff members
• Reduced medical costs
• Decreased rates of illness and injuries
• Reduced employee absenteeism
• Improved employee relations and morale
• Increased productivity

A U.S. Department of Health and Human Services report revealed that at worksites with physical activity initiatives as components of their Corporate Wellness Programs have:

• Reduced medical costs by 20 to 55%
• Reduced short-term sick leave by six to 32%
• Increased productivity by two to 52%

Thanks to modern medicine, life expectancy for Americans has continually increased. How much we enjoy these additional years, however, depends greatly on how we have lived our lives. If our quality of life is to remain high so that we can fully enjoy these extra years, we must practice good eating habits, be active and refrain from using tobacco products.

Furthermore, stress, distractions and the pressures of the job can take its toll on the employee, which makes it important that a Corporate Wellness Program is implemented. Today, all across America, Canada, Europe and Asia, top Corporate Wellness Programs are being used to help improve employee conditions at work and reduce the cost of worker medical.

Some of the top Corporate Wellness Programs currently in use today include:

<h3>Health Risk Assessments (HRAs)</h3>

Health Risk Assessment is a top Corporate Wellness Program currently in use globally. Organizations that implement it determine the safety and health concerns of workers by the assessment of appropriateness of the facilities and equipment against the needs of the staff members.

It can, for example, guide the business into determining how much air quality within an office room affects the users and then help the assessment team to come up with the measures necessary to correct the problem. An HRA can also evaluate the level of exposure workers have to certain hazardous or dangerous materials and practices.

<h3>Immunizations</h3>

This isn’t always practiced in every country since there are regions where government sponsored immunization shots are available. However, it has also become an important component of the top Corporate Wellness Programs in many employers in North America.

Immunization, flu shots, such as those used to combat flu, for example, are offered to workers for free.

<h3>Employee Assistance Programs (EAPs)</h3>

Employee Assistance Programs (EAPs) consist of a wide variety of services. It can range from providing educational resources to staff members regarding health issues to sponsoring health services and medical care. In many employers, medical and insurance have also become a staple part of their benefits system.

<h3>Weight Management Programs</h3>

This is another Corporate Wellness Program that employers use, particularly those that offer in-house commissary or cafeteria services. Instead of serving richer, high-calorie fare, cafeterias offer options for a healthier diet, usually in the form of low-calorie foods and sugar substitutes.

<h3>Employee Wellness Newsletters – Health Education Programs</h3>

One of the top Corporate Wellness Programs that employers can implement is a self-powered tool using a newsletter to promote wellness, coupled with a visible campaign. The campaign may be done periodically and focus on a specific topic, such as tobacco use hazards, cancer, stress, carpal tunnel syndrome, safety in the workplace, etc.

The newsletter in itself can be an effective means to deliver information to staff members or members of an business but it is far from perfect. Some staff members, for example, may not read the newsletter in its entirety or even pay attention to it. If the issues outlined in the newsletter are promoted through an active and highly visible campaign, it will be easier to maximize positive results.

<h3>Physical Fitness and Exercise Programs</h3>

Another top health promotion program for employers is one that involves physical activities. Companies often sponsor physical fitness-related events such as marathons and business sports initiatives to encourage staff members to remain fit or lose excess weight. In mid- to large-sized employers, employers may even pay for gym memberships or in-house physical fitness facilities.

<h3>Corporate Wellness Program Incentives</h3>

Some of the top Corporate Wellness Programs implemented by employers involve incentive rewards. This involves business-sponsored initiatives that reward staff members for achieving specific wellness goals. Participation in health campaigns and signing up for Corporate Wellness Programs are two of the most commonly rewarded schemes. Rewards can range from special recognitions to points (for bigger rewards) to specific gifts. In a few cases, cash may also be used.

However, incentive systems have had mixed reactions and levels of success. But it continues to be one of the top choices among employers who are willing to modify it in order to fit their unique needs.

<h3>Group Activities</h3>

In many employers, employers take advantage of peer pressure in order to encourage workers to participate in Corporate Wellness Programs. This is currently one of the favorite worker Corporate Wellness Programs currently in use today and growing in popularity. Peer pressure is often leveraged to help promote competitions and to persuade staff members to be active in business-sponsored health fairs.

<h3>Corporate Wellness Programs: The Good </h3>
• A sampling of ROI for Corporate Wellness Programs: Bank of America: 600 percent; General Motors:370 percent; Pepsico: 300 percent; Citibank: 465 percent; and the Washoe County School District leading the pack at a whopping 1,560%. (Campbell,J., Wellness Improvement Experts, www.wellnessimprovementexperts.com, Albuquerque, New Mexico.)
• Companies with Corporate Wellness Programs have realized a 28 percent reduction in sick leave, a 26 percent reduction in adjunctive medical costs and a 30 percent reduction in disability and workers compensation costs. (Health Affairs, Volume 21, No.2, March, 2002.)
• The Washoe county School District in Northern Nevada realized a $15.60 ROI for every dollar spent due to a 20 percent reduction in absenteeism. (Hardy,A. (2005). At the Top Of The Class. WELCOA’s Absolute Advantage Magazine, 5(1), 14-20.)
• Corporate Wellness Programs provide the structure, encouragement, incentives and ongoing support that many people need in order to make lifestyle changes.
• Employees also realize returns on their efforts. FiServ, a financial services technology business, gave staff members who filled out a health risk assessment a significant discount on their health insurance premium. (Holland, Kelley, The New York Times, July 22, 2007.)

<h3>Corporate Wellness Programs: The Bad</h3>
The flip side of the argument centers on basic human rights. Do we want/need our employer to tell us to eat our veggies or lose 30 pounds? Some employers are doing just that and at least one lawsuit has resulted because of it.
• Three hundred employers have requested assistance from a national employment and labor law firm to institute more aggressive Corporate Wellness Programs.(Cornwell, Lisa, Associated Press, Albuquerque Journal, September 10,2007.)
• Clarian Health, based in Indianapolis, Will begin reducing employee paychecks by $10.00 for every employee who has a Body Mass Index (BMI) of greater than 29.9 because not enough staff members were utilizing their wellness services.(Cornwell, Lisa, Associated Press, Albuquerque Journal, September 10,2007.)
• Scott Rodrigues filed a suit against his prospective employer, Scotts Miracle-Gro, because he believed the business’s antitobacco use policy violated his civil rights. The business has a policy against hiring staff members who smoke and Mr. Rodrigues’drug screen was positive for nicotine.(Holland, Kelley, The New York Times,July 22,2007.)
• employee advocates are concerned that health discrimination may not be covered under the Americans with Disabilities Act.(Cornwell, Lisa, Associated Press, Albuquerque Journal, September 10,2007.)

Penalizing staff members by hitting them where it hurts the most,their pocketbook, does not appear to be a favorable approach to molding human behavior.
Such tactics may result in increased resentments and retaliation, primarily in the form of absenteeism and presenteeism (decreased productivity on the job.) Voluntary, incentive-based initiatives, such as the one in the Washoe County School District, can and do produce results. A positive attitude on the part of management along with an opportunity for staff members to have a stake in the decision-making may yield the greatest dividends to both employer and employee.The motivation and resolve needed to change unhealthy lifestyle habits can best be derived from the basic tenets of encouragement, respect and support.

The American Association of Family Physicians’ Web site, www.aafp.org, offers a recommended adult immunization schedule created by the Advisory Committee on Immunization Practices. This schedule, tiered by age and chances of exposure, recommends diphtheria, tetanus, influenza, pneumonococcal, hepatitis B, hepatitis C, measles, mumps and rubella, varicella and meningococcal vaccinations.

<h3>Ideas to incorporate prevention and early detection: </h3>

• Hold a wellness fair and invite organizations that provide screening services for such conditions as blood pressure, blood iron, cholesterol, body mass index (BMI) and diabetes.
• Offer educational materials about well-baby care and vaccinations.
• Choose medical coverage plans that include wellness check-ups and vaccinations.
• Offer onsite mammograms for staff members.
• Sponsor onsite flu shots to coincide with flu season.

While stress cannot be eliminated from life, or even from the workplace, coping skills can be developed with relative ease. Stress management skills lead to reduced absenteeism and more effective, more productive staff members. Because stress has been shown to contribute to such physical conditions as ulcers, high blood pressure and stroke, stress reduction has a direct impact on improving physical health.

Studies have shown that heart patients who attend stress management initiatives have 42% lower medical costs. Other studies have documented a 50% reduction in medical services use when stress management initiatives are employed. Further, Employee Assistance Program (EAP) experts estimate that 20% of any workforce is affected by personal problems that can influence work performance.

<h3>Stress reduction tactics to consider: </h3>

• Offer onsite yoga or meditation classes.
• Organize support groups among staff members.
• Sponsor stress management classes during the workday.
• Offer an employee assistance program that includes both counseling and referral.
• Offer onsite counseling for staff members in the case of a work-related trauma, such as the death of a co-worker.

The old adage “an ounce of prevention is worth a pound of cure” is particularly relevant to when applied to preventive measures taken during pregnancy, when a few extra ounces of birth weight can save a child’s life. During pregnancy, simple precautions can help avoid catastrophic results; giving up tobacco use, for instance, drastically reduces the risk of miscarriage and pre-term labor.

The March of Dimes reports that if all women took adequate folic acid before conception and during pregnancy, the number of babies born with a neural tube defect could drop by as much as 70%. The physical and emotional benefits of proper prenatal care to a mother and child are underscored by a strong business case for offering prenatal wellness benefits. Nationwide’s Chief Medical Director, Dr. Michael Moore, estimates costs to care for one baby delivered prematurely could approach $500,000.

<h3>First steps in fostering a prenatal program: </h3>
• Invite the March of Dimes to present information about prenatal health at an employee brownbag lunch or breakfast meeting.
• Hold prenatal care information classes for interested staff members at lunchtime.
• Offer educational materials about the effects of alcohol, drugs and tobacco use on an unborn child.
• Offer incentives for adopting healthy lifestyles during pregnancy.
• Offer prenatal initiatives and education as part of the business medical package.

Instances of respiratory diseases, cancer and other illnesses can be reduced through tobacco use cessation efforts. tobacco use cessation initiatives can provide huge opportunities for improved health.

The American Cancer Society reports that tobacco use staff members cost employers an average of $1,429 per smoker per year in increased medical costs over non-tobacco use staff members. Implementing a tobacco use cessation program costs an average of $45 per employee per year, saving employers an average of $1,383 per year for each employee who quits tobacco use. Additionally, the American Cancer Society reports that smokers are absent from work 50% more often than nonsmokers. They are also 50% more likely to be hospitalized and have 15% higher disability rates. tobacco use decreases onthe- job productivity as well. Employees who take four 10- minute tobacco use breaks a day work more than a month less per year than workers who don’t take smoke breaks.

<h3>Places to start with tobacco use cessation initiatives: </h3>

1.    Establish a business policy prohibiting tobacco use anywhere on the property.
2.    Offer prompts/posters to support no tobacco use policy.
3.    Policy supporting participation in tobacco use cessation activities during duty time (flex-time).
4.    Offer counseling through an individual, group, or telephone counseling program onsite.
5.    Offer counseling through a health plan sponsored individual, group, or telephone counseling program.
6.    Offer cessation medications through health insurance.

Nutrition directly impacts nearly every aspect of physical and mental health. A healthy diet can help protect against such conditions as heart disease, diabetes, arthritis, stroke, certain cancers and depression. Obesity, which is among the most common conditions linked to diet, affects a record number of Americans.

The American Journal of Health Promotion estimates the cost of obesity to U.S. business to exceed $12.5 billion in health care, sick leave, and life and disability insurance. Further, one study reports that obesity raises medical costs by 36% and medication costs by 77%. To offset the health risks of obesity and poor diet, many employers have committed to helping staff members ensure proper nutrition and undertake weight control initiatives.

<h3>Popular nutrition initiatives: </h3>

Fruit and Vegetable Consumption
1.    Offer healthy eating reminders and prompts to staff members via multiple means (i.e. e-mail, posters, payroll stuffers, etc.).
2.    Offer appealing, low-cost fruits and vegetables in vending machines and in the cafeteria.
3.    Offer cookbooks, food preparation, and cooking classes for staff members’ families.
4.    Ensure onsite cafeterias follow healthy cooking practices and set nutritional standards for foods served that align with the U.S. Dietary Guidelines for Americans.
5.    Offer healthy foods at meetings, conferences, and catered events.
6.    Use point-of-decision prompts as a marketing technique to promote healthier choices.
7.    Offer healthy cooking demonstrations that teach skills (i.e. fruit and vegetable selection and preparation).
8.    Offer taste-testing opportunities at the workplace.
9.    Offer employee-led campaigns, demonstrations or programs.
10.    Offer local fruits and vegetables at the workplace (i.e. workplace farmer’s market or community-supported agriculture drop-off point).
11.    Use competitive pricing (price non-nutritious foods in vending machines and cafeterias at higher prices).
12.    Offer protected time and dedicated space away from the work area for breaks and lunch.
13.    Make kitchen equipment available to staff members.
14.    Offer an opportunity for onsite gardening if possible.

Sweetened Beverage Consumption
1.    Make water available throughout the day.
2.    Offer appealing, low-cost healthful drink options in vending machines and the cafeteria.
3.    Modify worksite vending contracts to increase the number of healthy options.
4.    Price non-nutritious beverages at a higher cost.
5.    Use point-of-decision prompts to promote healthier choices.

Portion Control
1.    Label foods to show serving size and/or nutritional content.
2.    Offer food models, food scales for weighing and pictures to help staff members assess portion size.
3.    Offer appropriate portion sizes at meetings, workplace events and in the cafeteria.

<h3>Nutrition initiatives in action</h3>

While many employers address weight management through fitness initiatives, employers are increasingly focusing on nutrition through separate programming. Recognizing the productivity boost and lowered medical expenditures that come with maintaining a healthy weight, many employers may help pay for obesity treatments for staff members. By way of example, to improve the health of dangerously obese staff members, drug maker Wyeth reportedly pays for stomach-shrinking surgeries that carry price tags of up to $40,000.

A 2003 Society of Human Resource Management study shows that 24% of employers offer weight loss initiatives. In Ohio, Honda offers an onsite, registered dietitian who provides individual or group consultations on weight management. Body fat analysis and body mass index (BMI) measurements are available to staff members at any time.

At Grange Insurance’s Columbus headquarters, the cafeteria chef analyzes meals and provides staff members basic nutrition information, including Weight Watchers points. Many employers partner with the American Cancer Society to offer nutrition information through the ”5-ADay” program, which provides employers free signage and educational materials about the importance of eating five servings of fruits and vegetables a day. The program also offers a fruit and vegetable ”frequency card” that gives staff members a free portion of fruit or vegetables after he or she has purchased a preset number.

Exercise reduces weight, lowers risks of heart attack and stroke, helps to control blood pressure and diabetes, and improves mood. Studies increasingly show that physical fitness may also help reduce the occurrence of certain types of cancer. Researchers at the Centers for Disease Control and Prevention (CDC) recently documented another major advantage: physical fitness improves the health of the nation’s medical care expenditures.3 According to the CDC, physically active individuals incur $865 less per year in medical costs than inactive employees.

Dr. Michael Moore, vice president and chief medical director at Nationwide Insurance in Columbus, maintains that physical fitness is the most effective tool in health maintenance. “If you could prescribe exercise in a pill, it would be the number-one prescribed treatment in the world,” he said. In step with Dr. Moore’s prescription, nearly one-third of U.S. businesses help staff members pay for gym memberships, according to an Associated Press report. Subsidizing gym memberships is just one way employers encourage active lifestyles.

<h3>Popular Physical Fitness Initiatives: </h3>

1. Allow access to on- and off- worksite gyms and recreational activities before, during, and after work hours.
2. Offer and encourage participation in after work recreation or leagues.
3. Offer cash incentives or reduced insurance costs for participation in physical activity and/or weight management or maintenance activities.
4. Offer shower and/or changing facilities onsite.
5. Offer outdoor physical fitness areas such as fields and trails for employee use.
6. Offer bicycle racks in safe, convenient, and accessible locations.
7. Offer onsite fitness opportunities, such as group classes or personal training.
8. Offer an onsite physical fitness facility.
9. Start initiatives that have strong social support systems and incentives, such as:
• Buddy or team physical activity goals
• Programs that involve workers and family
• Programs to encourage physical activity, such as pedometer walking challenges
• Explore discounted or subsidized memberships at local health clubs, recreation centers, or YMCAs
10. Offer flexible work hours to allow for physical activity during the day.
11. Support physical activity breaks during the workday, such as stretching or walking.
12. Host walk-and-talk meetings.
13. Map out onsite trails or nearby walking routes and destinations.
14. Have staff members map out their own biking or walking route to and from work.
15. Post motivational signs at elevators and escalators to encourage stair usage.
16. Offer exercise/physical fitness messages and information to staff members.
17. Offer or support recreation leagues and other physical activity events onsite or in the community.
18. Start employee activity clubs such as walking or bicycling clubs.
19. Offer onsite child care facilities to facilitate physical activity.
20. Sponsor a bike to work day and reward staff members who participate.
21. Start a box and solicit fitness and health tips.