Introduction
2006–07 Survey of Wellness Programs at Business Roundtable Member Companies

Ask any group of chief executive officers (CEOs) to name their companies’ greatest asset and they will almost always say, “Our employees.” As business leaders and as people, CEOs understand the importance of having a qualified, productive and engaged workforce — so it is no surprise that Business Roundtable’s 2006–07 Wellness Survey reveals “healthier employees” as the number one reason cited by member companies for having a corporate wellness program.

But U.S. employers also remain the largest source of health insurance coverage for nonelderly Americans. So, as benefit costs continue to rise faster than the rate of inflation, it also makes sense that “lower cost of benefits” runs a close second in the survey as a reason to invest in employee wellness.

Less than a decade ago, these two goals might have seemed to be at cross purposes. As benefit premiums soared by double digits year after year, health plans sought to contain costs by offering options that tightly managed how, where and from whom workers could receive care. Coupled with that approach, a number of companies recognized the potential benefits of prevention as a strategy to help workers be healthier and, therefore, reduce their use of the health care system. Companies hired wellness directors, set up on-site fitness centers and thought seriously about how they could help their workers maintain their health.

Although many companies and employees embraced the wellness ideal and services, the success of managed care as a cost containment tool proved limited. After the initial savings, health plan costs began to rise again — the result of inflation and employee demand for plans that allowed wider access to providers and services.

From those lessons learned, however, a new approach is emerging — one that encourages employees to take greater responsibility not only for their well-being but also for how their health dollars are used. At the leading edge of this trend, Consumer-Driven Health Plans (CDHPs) combine high-deductible health care coverage with Health Savings Accounts (HSAs) to provide employees with the financial incentive to make thoughtful day-to-day health care decisions while shielding them from catastrophic costs.

Coupled with their CDHPs — and in some cases in advance of them — many companies are taking a new look at wellness. Once largely a standalone enhancement, wellness is becoming fully integrated within companies: with other corporate health and safety initiatives, with health benefit plan designs, and with the corporate culture. As companies are giving employees the opportunity to direct their own health care choices, they are equipping their people with the tools they need to make the most of that opportunity: education, intervention, outreach and support — along with incentives to take full advantage of these opportunities.

About this Report

Business Roundtable's membership consists of CEOs from 160 of the United States’ largest companies, with a combined workforce of more than 10 million employees. As a 10-year followup to the 1997 report, Quality Health Care Is Good Business: A Survey of Health Care Quality Initiatives by Members of The Business Roundtable, the Roundtable’s Health and Retirement Task Force wanted to learn how member companies are using health and wellness initiatives to support the health of their employees while addressing rising health benefit costs.

With the support of Business Roundtable member CEOs, in late fall 2006 the Roundtable sent comprehensive questionnaires regarding corporate health promotion and wellness initiatives to the appropriate wellness, medical or benefits director at each member company. Mailings were followed up with e-mails, telephone calls and, where necessary, re-mailings to ensure that the questionnaire reached the right person and was returned in a timely way. We received an unusually high rate of 76 responses, of which all but one reported having wellness programs either fully under way or in active development.

Surveys included quantitative (multiple-choice) questions, with space for additional responses or elaboration, and open-ended questions, which invited respondents to describe in detail their signature programs, communications initiatives, return on investment and, significantly, how their programs have changed over the past five years. Based on this input, we identified companies with illustrative trends or promising practices and followed up in extended telephone interviews with program spokespeople at these companies.

Because of the limited size of the population surveyed, this report does not present full numerical results or attempt detailed statistical analysis. Instead, we use the numbers for general observation purposes to suggest trends within the member population, and we freely combine the data, open-ended responses and interviews to present what we believe is an accurate and instructive picture of how Business Roundtable’s member companies are advancing the state of the art in workplace wellness today.

Overview of Survey Results

Wellness at Business Roundtable Member Companies

Many Business Roundtable member companies have longstanding wellness programs: Of the 73 wellness initiatives reported, more than half have been in operation for at least five years, and 42 percent have existed for more than 10 years. A notable number of other companies have recently launched wellness initiatives: Twenty percent of the respondents’ programs were created within the past one to two years, and several other companies reported that they plan to have new programs up and running this year.

Current program offerings run the gamut from standbys, such as on-site flu shots (97 percent), health fairs and on-site screenings (91 percent), on-site workout facilities (73 percent), and organized employee walks or other challenges (66 percent), to increasingly popular tools such as health risk assessments (80 percent), nurse/health advice lines (84 percent) and online resources (72 percent).

Shifts in Focus

Interestingly, the open-ended and interview responses revealed that several companies with longstanding programs, including such wellness pioneers as Aetna Inc., CIGNA Corporation, Corning Incorporated, IBM Corporation, Northwestern Mutual Life Insurance Company and Texas Instruments Incorporated, have recently revamped or refocused their programs into integrated, branded, companywide initiatives focused on helping employees take responsibility for their health and be more effective consumers of health care. Companies with new or developing programs reported starting directly with a comprehensive consumer-based model, and in some cases, the wellness program actually was created to support the implementation of a CDHP.

In the process of such changes, lines between health plans and wellness are increasingly blurred. Many companies are reinforcing that relationship with the use of financial incentives or consequences tied directly to their health plan premiums or health-related savings accounts. Strategies such as health risk assessments (HRAs), once introduced as part of the wellness program, have become integral tools for identifying employees who need preventive or condition management programs and getting them the health system services they need.

Similarly, the focus of many programs has moved from maintaining general health and wellbeing to identifying, managing or reducing specific (and potentially costly) health risks. Targeted interventions, such as disease management (82 percent), tobacco cessation (74 percent) and weight management programs (85 percent), have become common. Again, financial incentives and consequences are used to engage employees at high risk, and data are used to track outcomes.

Employees are getting the message that they can be effective partners in improving their own health and well-being. For those who participate in CDHPs or any health plan that emphasizes consumerism, this speaks loud and clear to their own bottom line. “With consumerism, when employees are responsible for their initial medical care costs, they are more interested in, ’How can I take care of myself?’” observes Sharon Klun, manager of work/life initiatives at Accenture Ltd.

For their part, employers expect to see that sense of shared responsibility take hold across their companies. “We trust that the culture of wellness and personal responsibility that we’ve nurtured over the years will continue to serve us well,” says Bridget Schulz, assistant director, benefits at Principal Financial Group. “As long as we’re providing the tools and resources, when employees are ready, they will use them.”

Trends and Strategies

Based on the numbers, open-ended responses and interviews with representatives from approximately two dozen companies, a number of emerging strategies bear additional discussion.

These strategies fall into three broad categories:

1. Create a culture of wellness within the company. Along with integrating wellness with other corporate initiatives, companies are exploring more effective ways to communicate health care consumerism, benefits and wellness; make wellness opportunities available and accessible across the employee population; increase employee participation and ownership; and build management accountability for the health goals of the organization.
2. Focus on the health of each employee. Companies are developing tools and approaches to target health risks, offer customized interventions, and empower employees to manage their own health and wellness.
3. Build the business case for wellness. Business Roundtable’s member companies are tracking costs and return on investment (ROI), working with vendors to measure ROI, and developing other measures of wellness program effectiveness.

This report presents summaries of these trends along with snapshots of some of the strategies at work at member companies.

Public Policy Implications and Actions

This report highlights an important aspect of America’s health care system — the commitment of U.S. businesses to offer benefits and services that help their employees lead healthier lives and make wise use of health care services. Business Roundtable members have taken the lead in developing innovative benefits and programs that promote wellness, prevent disease and manage chronic conditions to help employees maintain the best possible quality of life while becoming effective stewards of health care resources.

At the same time, Business Roundtable recognizes that the U.S. health care system needs improvement that will require the combined determination of both the private marketplace and public payers of health care. First and foremost is the goal that all Americans have access to affordable, quality health care coverage.

In addition, federal policymakers need to address certain policy issues to accelerate change and improve health outcomes. A 21st-century health care system should be powered by technology and driven by evidence-based performance and healthy lifestyles.

Most important, we need to foster greater involvement of individual Americans in their own health care. Business Roundtable believes that every person has two responsibilities: to make the choices that support his or her own health, including participating in wellness, prevention and any necessary chronic care programs, and to have health insurance coverage that, at a minimum, offers catastrophic benefits.

To accomplish these goals, the Roundtable supports the following policies and initiatives:

• Release information from the public and private sectors quantifying the critical importance of healthy lifestyles, disease prevention, care management and health promotion programs. Individuals who engage in healthy lifestyles, participate in efforts to prevent disease and follow the recommended treatment for their chronic conditions can improve their health and reduce their long-term costs. Information on the importance of these efforts to improving health care should be widely available.
• Support incentives for wellness initiatives. Tax incentives should be expanded and public health programs enhanced to encourage companies to offer health and wellness programs for employees and to expand options for individuals who do not have access to these programs in the workplace.
• Preserve and protect the laws that provide the foundation for employer-sponsored health care. The Employee Retirement Income Security Act of 1974 (ERISA) is the foundation on which most employers offer health coverage to their employees. ERISA enables employers to create health plans that are tailored to the needs and desires of their own employees. ERISA plans are federally regulated, allowing employers to create the plan, or plans, that best serves the needs of their current and retired employees without the impediment of complying with 50 different sets of state regulatory requirements. Without ERISA there would be significantly less health care coverage and fewer healthy workers in America’s workforce.
• Expand private plan options to permit greater choices and flexibility in the design of consumer-centric health benefits. Although progress has been made in improving the design and use of HSAs and other CDHPs, additional legislative changes should be enacted that enhance the benefits of these plans by permitting more flexibility.
• Promote and reward quality and efficiency through the use of health information technology. Adopting a uniform, nationwide health information system will improve the patient experience and increase positive health outcomes while realizing significant savings in health care costs for both individuals and businesses. 
• Make accessible actionable cost and quality information about health care services. Private and public efforts at the local, state and federal levels should be expedited to provide Americans with the information they need to make wise decisions about health care services available in their communities. Such efforts must include data from both public and private plans so that consumers can make accurate evaluations based on the best information available.

We hope that the private-sector initiatives described in this report will serve as a catalyst for change in public policy — encouraging federal, state and local policymakers; business leaders; and most important, individual employees to become effective advocates for preventing disease and promoting health in the workplace, at home and in every aspect of American life.

Strategy: Create a Corporate Culture of Wellness

“Our offices are all confronted with the same question: How can we tweak the employee value proposition and use wellness to give our employees a really great work experience?”
—James Corry, Ph.D., wellness director, MetLife, Inc.

In recent years, companies have begun to think big about wellness: how to move it from a standalone program to one that supports the overall goals of the company, even above and beyond the bottom line of health care costs. And although almost 40 percent of the companies that responded to this survey reported yearly wellness budgets of $200,000 or more and 20 percent spend at least $1 million annually, the big thinking is not limited to the size of the program. Wellness professionals — along with the CEOs who champion their programs — understand that changing behavior starts with changing the culture that supports it.

Of course, many of Business Roundtable’s member companies have nourished a culture of wellness for years or even decades. Recently, though, even these leaders have revamped and rebranded their programs, formed partnerships with other internal health-related corporate services, and reached out to previously underserved employee populations. Perhaps most important, some Roundtable members have devised innovative ways of keeping management and health professionals explicitly accountable for the well-being of company employees and their communities.

Following is a look at some of the approaches that member companies are successfully using to build a companywide commitment to wellness.

Integration

“We are proud to be a leader in consumer-directed health care benefits. Naturally, we want our employees to understand this and integrate it into their own way of life.”
—Mary Bianchi, director, work/life programs, CIGNA

Several Business Roundtable member companies have pulled together two or more of their health-related initiatives with the shared mission of enhancing the health of their workplace and employees. The strategy has many benefits. It clarifies functional responsibilities and reporting relationships; it expands the resources a company can bring to bear on health-related activities as well as the reach of those efforts; it promotes the sharing of data and ideas to improve quality and manage costs; and it allows the company to align its health-related programs and activities to support clear, companywide goals.

Most of the respondents with integrated programs have branded those programs as well, increasing the impact of their communications while helping employees understand how various initiatives work together to support health at the company.

Although they share some elements, programs at the following member companies illustrate some of the many forms that integration can assume:

• CIGNA’s Healthy Life model is based on using health care consumerism to drive behavior change and address health care costs by providing an integrated range of programs and services to all employees. Launched in fall/winter 2006, the program combines health care consumerism resources with health and fitness tools, including HRAs and biometric screenings. “We have created an ongoing dialogue of health at our company. We really want employees to use the information we give them, put it into practice and act on the successes we’ve seen in our own organization,” says Mary Bianchi, director, work/life programs.
• MetLife created a total health and productivity model by bringing all of its health vendors together to create a comprehensive, coordinated care system across the health spectrum. MetLife worked with its health plans, condition management, employee assistance program (EAP) and other vendors to facilitate referrals among the vendors, including those who normally compete with each other. Wellness Director James Corry, Ph.D., created a system to track intervendor referrals and used quarterly conference calls with vendors to keep the effort focused. “It was a little hard for some of them at first — especially if they needed to refer to a competitor,” says Corry. “But at the end of the day, they are all trying, and we are pleased with their effort.”
• The Dow Chemical Company has launched a comprehensive corporate health strategy, which addresses primary prevention and health promotion, quality and effectiveness of health care, health system management, and health-related legislation at the national and state levels, says Catherine Baase, M.D., global director, health services. The company’s integrated approach combines the health and outreach elements of the company, including occupational health, health promotion, human resources benefits and organizational effectiveness, safety, industrial hygiene, corporate communications, government affairs, and risk management, with a stated and measurable corporate commitment to improving the health of Dow’s employees, their corporate environment and their communities.
• Union Pacific Corporation identifies links between health conditions and safety risks through a series of innovative periodic reports that integrate incident, lost work time and other safety data with wellness assessment data. “We saw that certain health conditions and behaviors, such as tobacco use, correlated with safety, which helped us target interventions at specific worksites,” reports Marcy Zauha, director of health and safety.
• Schering-Plough Corporation is integrating its existing wellness programs under the Healthy Steps brand and adding HRAs, a multicondition disease management vendor and other programs in a comprehensive initiative to support employee health. “As a health care company, we wanted to have a program that says we are serious and committed to the health of our employees and their families,” says Teri Pazos, senior benefits manager. “This is really a very strong concern of our CEO.”
• Humana Inc. initiated MOCHA (More Options and Choices for Humana Associates) in 2000 to develop and evaluate consumer-choice health plans and related products. “As associates became more informed health care consumers, we expanded our wellness programs to reinforce the connection between lifestyle behaviors and health,” reports Elona DeGooyer, consultant, human resources. Toward that end, Humana developed internal programs and external partnerships to reach its goals to encompass multiple dimensions of wellness, encourage participation and goal attainment with incentives, and pilot innovative programs the company can introduce into the marketplace. “We use a multilayered approach to wellness program design to provide a variety of services and resources that address the broad definition of wellness,” DeGooyer writes. “We incorporate traditional benefit programs and components from our consumer-choice medical plans and use site-specific opportunities to create a unique and comprehensive program.”
• Texas Instruments (Live Healthy), Corning (Total Health), IBM (Healthy Living Rebates) and Verizon Communications (HealthZone) are among the other Business Roundtable member companies that have brought some or all of their health-related initiatives together under one brand.

Corning: Total Health Continuum

Corning was one of the early major companies to integrate services on an organizational level. In 1999, the company pulled together counseling and support services/EAP, workers’ compensation, health and safety, corporate medical services, and employee benefits under one department with common objectives and goals.

Together, the units devised a health care continuum under the Total Health brand based on level of risk, ranging from health promotion and risk reduction on the low end, through acute conditions and chronic conditions at the mid range, to disabling conditions and catastrophic conditions on the high end.

“We populated the continuum with our existing programs, then we added any programs we needed to fill the gaps,” recalls Deborah Lauper, director of compensation, integrated health and employee benefits. “Our 10,000 Steps walking program went into the health promotion box at the low-risk end, and our complex care management, cancer resources services and transplant services were at the other extreme.” The result is a progression of interventions that clearly defines the connections among interventions and their impact on the employee population and on the bottom line.

Corning’s team also used a data warehouse to integrate medical, dental, pharmaceutical, disability and other data from all sources, then used the information to fine-tune programs and management. “For example, we asked what we could learn from how we treat occupational health cases that would help us manage nonoccupational cases more effectively. And we saw that we had 19 different EAP programs around the country, so we decided to integrate them into a single carveout that would help us manage costs and make sure people get the most appropriate care.”

In 2006, Corning took the program a giant step further with the deployment of 24/7 wellness teams at three pilot sites. At each location, existing safety teams expanded to include a nurse, representatives from human resources, plant leadership and other employees who have an interest in health. Local teams received a user-friendly data dashboard that helps them target their local health and wellness needs and measure their performance. “It’s taking the integrated health approach to the grassroots level,” explains Lauper.

Communications

“Once you start communicating, you can’t stop.”
—Tom Coogan, director of employee benefits, Case New Holland Inc.

As health plans and wellness programs become integrated, complex and proactive, companies are assigning communications a more strategic role. In many programs, including Texas Instruments’ Live Healthy initiative and Corning’s Total Health, communications has an identified seat at the table. “Our corporate communications department is key to what we do,” declares Linda Moon, manager of wellness and health management at Texas Instruments. “We try to involve them from the front end, to help us start thinking through how things will be perceived, what we want to be careful about, what we want to emphasize. It’s their specialty — why not utilize it?”

Communicating about Consumer-Driven Health Plans

“This is the first wave of getting associates to understand health care and be more accountable for how they use the consumer-driven health plan program. To do that, we really felt we needed to educate our associates around wellness and help them understand more about their own health and well-being. Everything the team looked at directed us to a decision to redesign our communications initiative around wellness.”
—Frank LaPlaca, director, benefits, Office Depot, Inc.

Several Business Roundtable member companies have developed communications strategies based on health care consumerism to support the rollout of their CDHPs.

• Northwestern Mutual credits the company’s high CDHP participation levels at least in part to its incentive-based communications strategy. When the company introduced its consumer-driven plan three years ago, “We decided that brown bag presentations and infrequent screenings were not enough, so we revamped our program to include four- to 12-week campaigns and focused on nutrition and exercise,” reports Jessie Schwade, health services consultant. Among the popular activities: a consumerism scavenger hunt, which had employees scurrying to look up information on existing company programs, such as the fitness center, a self-care guide and a health clinic.
• American Electric Power Company, Inc., also credits communications for the favorable employee response when the company introduced a CDHP option in 2006. “We believe the rollout was a success as the result of an extensive communications campaign that included more than 400 face-to-face meetings,” writes Karen Jenkins, senior human resources associate.
• Office Depot has launched a three-year communications strategy, including a Web site, 12-month health calendar, self-care manual, and other integrated programs and tools, to support the company’s changing benefit platform, including a new CDHP/HSA. “As in any organization, associates are looking at this pretty much as buying insurance, a benefit that they are ’entitled’ to. We are trying to change that outlook to one of awareness and understanding of how to use this product,” says Frank LaPlaca, director of benefits.

Several more Business Roundtable member companies also have integrated their communications tools and programs with their CDHPs. Others, including ArvinMeritor, Inc., currently are designing consumer-based communications strategies to support planned CDHP rollouts.

Case New Holland: Communicating CDHPs

Communications are critical when rolling out a CDHP, says Tom Coogan, director of employee benefits, Case New Holland. “This is one of the most important decisions our employees have to make. We wanted to give them the tools to help them do this.”

Case New Holland worked with outside consultants to build a set of four CDHP options that address the specialized needs of the company’s workforce and lay the groundwork for an integrated wellness program. Focus groups at the start of the planning process in 2005 served both planning and communications goals, says Coogan. “They sent employees the message that they would have to be involved in making the right purchasing decisions and in changing their lifestyles to keep from paying more in the future.”

Communications strategies also included a series of newsletters explaining various aspects of the plan, followed by test groups to make sure employees were understanding the communications.

Prior to the first open enrollment period in 2006, Coogan and his team held meetings at multiple times at each plant location — mandatory for employees, with spouses welcome — to explain features of each plan. Employees also could access an online decision tool customized for Case New Holland’s CDHP designs that let them calculate which of the four options was the best cost value given their needs.

Coogan continues to use the quarterly newsletter to provide additional information about the health plans. These, along with frequent communications from the disease management and other wellness programs also initiated in 2006, are starting to bring about the culture change Coogan sees as essential.

“There’s really nothing unique about what we’re doing,” he observes. “Employers need to plan thoroughly, do a good job with communications, be serious about disease management and choose the right vendors. The concept is really quite simple. You just have to do it.”

Communicating about a Health-Focused Culture

Business Roundtable member companies also use communications strategies to increase participation and engagement in health and wellness initiatives. Following are a few of their noteworthy ideas.

• Humana uses its benefits enrollment period to reinforce the wellness strategy that is communicated throughout the year to associates, reports Deborah Triplett, director of associate benefit programs, human resources. “Just prior to benefits enrollment, we train approximately 200 associates (all levels) to serve as MOCHA Mentors — helping peers locate resources and resolve issues and be program champions,” she writes. “For the past two years, we have provided wellness program information to this group in addition to the human resources consultants and benefits specialists. This year we also produced a special consumerism wellness message from [healthful living advocate] Dr. Michael Roizen at our MOCHA to Market meetings and developed a podcast to explain key aspects of the wellness program.” Humana’s associates also can participate in pilots of new wellness products developed by the company before those products are offered to consumers.
• Texas Instruments brands every item having to do with health with its Live Healthy logo. Bottled water available at the company also sports the Live Healthy logo plus rotating wellness program messaging.
• Eastman Chemical Company uses a number of creative tactics to deliver health messages to employees, including Bathroom Briefs — flyers posted on the insides of restroom stalls. New flyers are posted every two weeks.
• CSX Corporation is using strategic communications to lay a strong foundation for its new integrated wellness program. “Direct, person-to-person communication is vital,” reports Ken Glover, director, health and ergonomics. “Division wellness coordinators meet with management and union employees on a regular basis.”
• General Motors Corporation’s Life Steps Wellness Program uses lifestyle-based approaches to communicate awareness and educate its diverse employee populations, writes David Siegel, M.D., M.P.H., assistant director, health care operations and programs. Each program topic provides information, skill building and group support and tracks individual employees’ health behaviors and outcomes.

For example, a deer hunting module featured an expert hunter who shared information on deer density trends and information about the Bovine TB virus while health educators shared nutritious venison recipes, walking program how-tos, proper lifting techniques to load the deer onto a truck, and warning signs of a heart attack. Golf conditioning focused on core stretches and exercises to generate power and performance, along with healthful food choices for a golf outing and relaxation techniques to improve performance.

Texas Instruments: Reaching Out to Families

Texas Instruments has a longstanding culture of including employees’ families in the company’s health and wellness activities. “Families always have been welcome at our Texins Activity Centers,” notes Linda Moon, manager of wellness and health management. “Spouses have full access to our aerobics, nutrition and other programs, and our spring break and summer camps for kids reinforce healthy activities and foods.”

Moon and her team also have been careful to communicate with spouses about the company’s health benefits. “We know that women make most of a family’s health care decisions — and our employee population is 70 percent male. That means we need to reach out to the spouses as well as our employees.”

In a focus group for spouses, the company probed for information on how spouses receive health benefit information and if they knew where to go to get what they needed. “We learned a lot of things we never would have known if we had not taken the opportunity to seek information from the spouse,” she observes.

For example, “We learned that spouses sometimes don’t get information we distribute at the worksite because the workers forget to bring it home. And mailing it to employees at home doesn’t solve the problem because spouses don’t open each other’s mail.” As a result, mailings now have an inclusive address, such as “family of.” Envelopes are clearly identified as benefit information so they will not be tossed as junk mail.

Spouses also reported that they could not access benefits information on the company’s Web site from their homes because the site was protected by a firewall — a problem solved by moving the information to an accessible location.

Employee benefits communications regularly feature photos and stories of families — including success stories from employees reporting how their spouses support their wellness. “They’re all part of who we are and what we do,” says Moon.

Targeted Strategies to Promote Employee Buy-In and Participation

“We have very high participation levels, probably due to our communications strategy and incentives. We also felt it was important to keep our programs simple and accessible to all levels of participants (not just reward the daily joggers).”
—Jessie Schwade, health services consultant, Northwestern Mutual

Employee participation in health and wellness programs is an essential component of a company’s culture of wellness and contributes to the success of its health programs and interventions. Business Roundtable member companies have devised numerous strategies to reach out to their employee populations, provide them with appropriate wellness opportunities, encourage their participation and, in the process, allow them to embed their own philosophies of wellness within the corporate culture.

Incentives

Incentives have been recognized for some years as an effective strategy to increase participation in health and wellness assessments and activities. Of the survey respondents, 69 percent indicated that they use some kind of program incentives, such as money rewards; logo athleticwear, pedometers or other gear; public recognition; or other positive feedback measures. Benefit designs, including CDHPs that tie financial consequences to health care choices, behaviors or outcomes, are another typical form of positive — or in some cases, negative — incentives.

Several Business Roundtable member companies have taken the lead in exploring new incentives, applying incentives in new ways, or effectively integrating their incentive programs with the company’s mission or philosophy. Following are some examples.

• Northwestern Mutual gave employees an incentive to get to know their new self-care manuals by randomly hiding $50 gift certificates in some books before distributing them to employees.
• IBM built on its successful smoking cessation rebate with its Healthy Living Rebate program. Today, the program also includes a Physical Activity Rebate to reward participation in a personalized program through the company’s Virtual Fitness Center, and a Preventive Care Rebate to reward employees who take steps to identify their preventive care needs and personal health risks through completion of online personal health records and other activities.
• Humana’s HealthMiles program from Virgin Life Care makes it simple for associates to earn gift cards for being active, tracking results and reaching goals. Steps recorded on a pedometer are automatically downloaded via USB port, and biometric data are captured at a health kiosk. Ease of use has resulted in increased participation, higher activity levels and body mass index (BMI) reduction, reports Elona DeGooyer, consultant, human resources. In addition, Humana’s MOCHA Wellness Account rewards participation in a range of nonfitness programs, including clinical and lifestyle change programs, ergonomics, wellness Webcasts and healthy behavior campaigns. “Wellness awareness and participation have increased significantly since the introduction of the program a year ago,” writes DeGooyer.
• Aetna’s Healthy Lifestyles incentive program encourages employees to access preventive care, complete their HRAs, join Weight Watchers, participate in and keep track of physical fitness activities, and participate in appropriate disease management programs.
• Caterpillar Inc. uses a differentiated pricing strategy to encourage employees to make healthy food choices in company cafeterias. Lunch for Less offerings tempt employees with nutritious, lower-cost favorites, such as a chicken breast sandwich for $1.99 or a fourvegetable selection for less than a dollar. “Employees can still get a double cheeseburger, but they’ll pay more,” says Michael L. Taylor, M.D., Caterpillar’s medical director for health promotion.
• Owens Corning Inc. added a tobacco-free discount program in 2005. Employees qualify for a $40-per-month discount on their health plan premiums if they pledge to be tobacco-free for the entire year or, if they use tobacco, attempt to quit and become part of a smoking cessation program.

FedEx Express: A Small Incentive Program with a Big Return

Retinopathy is a common complication of diabetes. Untreated, it can lead to blindness, but it can be successfully treated if it is detected early with a simple eye exam. So when data revealed that only about half of the people with diabetes in the company’s employee population received retinopathy screenings, “we knew we had to find a way to get more people to take the exam,” reports Beth Casteel, managing director of employee benefits, health and communications for FedEx Express, the largest operating company of FedEx Corporation.

In considering options for incentives, “our number one priority was to keep it simple,” she adds. “If it is too complicated, people will toss it away.”

Cash was the simplest possible incentive, the team decided. The team also elected to designate the cash as a partial return of the copayment for the tests, which makes it nontaxable to the employee.

To receive the payment, an employee simply needs to participate in the diabetes disease management program and take two important exams: a blood sugar test that indicates the presence of diabetes and the dilated eye exam. There are no additional forms to fill out — although the tests are performed by two different providers and covered separately by FedEx Express’ medical and vision plans, the company’s data warehouse integrates the claims data from both vendors.

“People automatically receive a letter signed by me, along with a check for $50,” says Casteel.

Thanks to the incentive, of the employees in the diabetes disease management program in both 2005 and 2006, participation in retinal eye exams jumped from 55 percent in 2005 to 100 percent the following year. Emergency room visits related to diabetes dropped 13 percent, inpatient admissions dropped 7 percent and the cost of a diabetic episode dropped 75 percent.

“It’s a small program; that’s the key,” concludes Casteel. “It’s something every employee understands.”

Although wellness and health promotion initiatives are voluntary at most companies, some benefit designs call for mandatory participation. For example, the preferred Provider Option at Office Depot requires an HRA for all enrollees.

Western & Southern Financial Group is using premium surcharges and wellness programs to encourage associates to change unhealthy lifestyles. Its self-funded health plan includes a health premium surcharge for associates who have used tobacco during the preceding 12 months and a tiered scale of surcharges for associates whose BMI exceeds 27. The company’s plan offers allowances for smoking cessation programs and medical treatments for obesity, and it provides an on-site weight management program that includes counseling, healthy nutrition and exercise. Associates who lower their BMI or discontinue tobacco use are eligible for rebates of the surcharges.

Currently one-third of Western & Southern employees are paying the tobacco surcharge, and about 40 percent pay a weight surcharge.

Strategy: Create a Corporate Culture of Wellness cont.

Availability and Accessibility

“Our observations and survey data tell us that many employees felt too busy to set aside time to attend to their health needs — particularly for wellness services that are often seen as elective. So we’ve been making conscious efforts to bring these services to our employees.”
—Jeanette Fuente, vice president, wellness, Merrill Lynch & Company, Inc.

Business Roundtable member companies make the logical connection between how many employees participate in wellness activities and how easy it is for employees to use the services.

Of the companies that responded to the 2006–07 Wellness Survey, 73 percent have an on-site fitness center in at least one location, 57 percent have an on-site employee health clinic, 97 percent offer on-site flu shots, 81 percent offer brown bag lunches or other on-site education, and 91 percent offer a health fair or on-site screenings. Almost half of Business Roundtable members that responded to the survey offer wellness activities at every worksite.

Companies that do not have wellness facilities at every site use a variety of strategies to reach distant employees, including subsidizing the cost of membership in a local health facility (27 percent) or paying all or part of the cost of local weight management, smoking cessation or other wellness programs (36 percent).

Member companies also take care to reach their covered populations, including families of employees and retirees. Of the survey respondents, 39 percent say they extend wellness services to employees’ families, 68 percent to part-time employees and 41 percent to retirees. For many Business Roundtable member companies, on-site health and wellness services are deeply embedded in the corporate culture. For example, Texas Instruments opened its first Texins fitness center in the 1960s and now runs state-of-the art centers, open to employees and their families, in three of the company’s major locations. “The centers stemmed from our employees wanting a convenient outlet to live a healthy lifestyle,” reports Linda Moon, the company’s manager of wellness and health management. “Many of our company’s leaders are members of the fitness centers, working out there and setting that example.”

Corporate leaders also regularly work out at Principal Financial Group’s seven advanced fitness centers, two at corporate headquarters in Des Moines and five at other company sites. Principal’s centers are the focus of the companywide fitness program, which includes screening, coaching, goal setting and other activities. “We started 20 years ago with one person to run the first fitness center — now we have nine people whose sole responsibility is wellness,” reports Bridget Schulz, assistant director, benefits.

On-site fitness also is an integral part of the corporate culture at The Boeing Company, where fitness centers at 34 locations receive more than 1 million employee visits annually.

Schering-Plough provides on-site medical facilities at its major sites. In addition to performing evaluations for return to work and other occupational services, the standalone facilities provide urgent care to employees along with a comprehensive menu of physical examinations and screenings. “Services are free and convenient for employees,” says Teri Pazos, senior benefits manager. An on-site pharmacy at the company’s Kenilworth, NJ, facility, operated by the company’s health plan vendor, fills prescriptions for employees. Schering-Plough prescription products are available through the medical plan with no copayment.

Business Roundtable member companies report using various approaches to offering wellness activities at their plants, including full professional staffs; partnerships with local vendors; volunteer wellness committees; and offering discount memberships in local gyms, smoking cessation programs or weight management groups.

Integrated health and wellness programs at many companies include unified organizational structures for setting goals, managing programs and working together throughout the corporation. Other companies with health or wellness programs at diverse sites have various strategies for maintaining communications and bringing their efforts together. Following are some examples.

• DuPont’s Global Health Team, consisting of the company’s regional medical directors and competency leaders in areas such as EAP, prevention and wellness, and occupational medicine, meets regularly to set policies, share ideas and develop tools.
• FedEx Corporation has a Health Task Force with directors responsible for health programs or benefits from the corporation’s separate operating units, such as FedEx Express, FedEx Ground and FedEx Kinkos. “Our goal is to develop an overarching health care strategy without changing the benefit structures of the individual companies,” reports Beth Casteel, managing director of employee benefits, health and communications at FedEx Express. “Companies also learn from each other and adopt practices from others that make sense for their own populations.”
• Navistar International Corporation is among the Business Roundtable member companies that bring their local volunteer wellness leaders together for an annual Wellness Summit. “At this event our executives share their passion for wellness and discuss how it makes good business sense,” reports Dawn Weddle, wellness manager. “It keeps everyone energized and focused.”

Merrill Lynch: Bringing Wellness to the Employee

Merrill Lynch provides on-site clinics that offer a broad menu of services at its seven home office locations, including company headquarters at the World Financial Center in New York. Services vary by location but include preventive screenings, fitness facilities, flu shots and other medically indicated immunizations, nutrition and smoking cessation counseling, and primary and specialized medical care, including a healthy back clinic, sports medicine, travel medicine and dentistry.

To make the on-site services as easy to use as possible, employees can use the company’s electronic scheduling service to arrange most appointments from their desks.

Branch offices are offered a free smoking cessation program and discount memberships at local fitness centers. In addition, the company offers on-demand assistance from its corporate wellness office to set up wellness programs at other sites. “People at our smaller locations will learn of something we offer at a home office and say, ’We’d like to have this, too,’” says Jeanette Fuente, vice president, wellness. “They’ll get the branch manager to sign off on it, and I’ll work with them to make it happen.”

Fuente maintains templates of most of the company’s existing wellness programs that she can share with the branch offices. “I don’t exactly have a turnkey kit, but I can draw on memos and planning communications and help them customize programs by location to make it their own without reinventing the wheel.” Fuente also works with national vendors and partners, such as the American Heart Association, that have local offices that can work with the Merrill Lynch sites to set up screenings, health fairs or educational services.

Other services, such as nutrition counseling, and some health seminars are available to off-site offices by phone or Webex. “I’m trying to do some things that reach everyone if they are available and interested and if it is cost neutral,” she says.

Although computer-based tools, such as e-mail counseling, have their place in her program, Fuente believes that a personal connection — even if only by phone — is essential. “Technology is a wonderful thing, but the motivational factor is missing — the human touch is what really gets results for some people.” 

Technology

Business Roundtable member companies with multiple sites increasingly look to technology to bring wellness to their distant employees.

“Because our population is so diverse geographically, most programs are available virtually (via either Web or phone) or at facilities in close proximity to McGraw-Hill locations,” writes Danielle Shanes, director of benefits planning and design at The McGraw-Hill Companies. “For example, we offer discount gym memberships to more than 1,500 fitness clubs nationwide but sponsor very few health facilities. When we conduct educational sessions, the venue is Web and telephone based so that the maximum number of employees can participate.”

Dow’s local health professionals and “health contacts” serve as a network of liaisons and primary health promoters to each work location, says Catherine Baase, M.D., global director, health services. In addition, the company uses a variety of technologies to communicate with its dispersed workforce, including video commercials on internal TVs or computers, CDs for use by salespeople while driving, an interactive feedback tool on the company’s global Web site, and informal highlights by leaders on company broadcasts.

Sun Microsystems and IBM are two Business Roundtable member companies that use customized virtual fitness centers to motivate and track employees’ progress toward fitness goals. In addition, several companies use Webinars to deliver wellness programming to their far-flung workforces.

Accenture: Delivering Wellness to a Virtual Workforce

Several Business Roundtable member companies have numerous small sites, but most of Accenture’s employees have limited company worksites. “Many employees are consultants, often on the road, who work directly with clients, and others work out of their homes,” says Sharon Klun, manager of work/life initiatives. “When they join the company, most Accenture employees receive laptops (which provide a great degree of flexibility), and they become part of a virtual workforce — even if they are in an Accenture office.”

Two years ago, when an employee poll indicated wellness as the top priority, the human resources team thought hard about how to deliver the programs to a workforce that was, in large part, virtual.

To get the program moving quickly, the team created a Work-Life Web portal that brought together existing online resources that responded to the needs of Accenture’s employee population. “We wanted to be sensitive to the needs of different levels of ability and activity, so we looked for programs that offered lots of choices — tennis, gardening and canoeing, as well as running and walking,” says Klun. This program evolved over the next two years into the current online wellness program, which includes an HRA and other tools as the framework for the wellness and health management program.

To give employees shared goals in a virtual world, the company offered its employees the President’s Challenge, an online physical activity program sponsored by the President’s Council on Physical Fitness and Sports. Over time, the company identified other programs with online models that met the identified needs of employees, and it offered gift certificates, pedometers and water bottles as incentives that employees could use to manage their health while on the go.

“We also identified new and better ways to deliver programs and information that our employees wanted and needed,” says Klun. Among their creative ideas:

• Conference calls on seasonal topics, such as holiday weight management in January
• Wellness education that employees can download to their MP3 players
• Water bottles with a watertight niche to hold an MP3 player while working out
• “Did you know …” messages recorded on the company’s phone system so employees hear information about benefits and wellness instead of “hold” music

In 2007, the company also added components of consumerism to its health care benefits options and is including information to support better health care decisions in its communications efforts.

“Our high-performance workforce constantly challenges us to stay visionary, especially in the areas of wellness and other areas of work and life,” says Klun. “We really want to meet and exceed their expectations.”

Reaching Diverse Populations

Throughout the United States and around the world, Business Roundtable member companies have adopted other strategies to make wellness programs available and accessible to their varied employee populations. For example:

Shift Workers: At General Motors, the UAW-GM LifeSteps program has developed organizational, educational and psychological strategies and best practices to deliver a wellness program in a manufacturing environment, according to David Siegel, M.D., M.P.H., assistant director of health care operations and programs. Among the strategies: identifying ideal times for health screenings in a multishift population, strict confidentiality of records, company union and community support, programs tailored to different shift audiences, employee participation as program leaders, and a final reminder that “the program must be fun.”

Global Workforce: “MetLife is using its domestic seasonal flu campaign as a vehicle to gain competency in the global arena and as a pilot for a corporatewide intervention should there be a pandemic,” writes James Corry, Ph.D., wellness director. “Many employees of MetLife’s newly acquired Travelers Life and Annuity unit are located in parts of the world where we have concerns about avian flu,” he adds. “We’re doing a good job of flu education in the United States, so we want to apply that model to meet the needs of our employees and our clients in other parts of the world.”

Similarly, DuPont’s Global Health Team has developed standardized protocols for 19 different occupational health processes for its plants throughout the world, covering such issues as determining fitness for duty, modified work programming and health surveillance for hazardous agents, says Sol Sax, M.D., chief medical director. Protocols include clear process maps, methods and procedures, and they take into account cultural differences and sensitivities, says Sax. Implementation plans currently are being created by a global team of subject matter experts, he reports.

Dow translates its annual global physical activity program into 10 languages for implementation in more than 30 countries, says Catherine Baase, M.D., global director, health services.

Aging Population: “As an insurance company, MetLife looks ahead to anticipate demographic trends and emerging risk areas. One obvious demographic challenge we see is an aging workforce that is getting ready to retire, and this is certainly true in our company,” notes James Corry, Ph.D. The company has adopted multiple strategies to keep its older workers healthy and engaged until the age of normal retirement and even longer. It also has invested millions of dollars in research on aging issues, particularly Alzheimer’s disease, through the company’s foundation.

At SAS Institute Inc., “our programs have changed in many ways over the past five years as the age of our employee population continues to rise,” observes Jack Poll, director, recreation and employee services. SAS has modified many of its fitness programs to accommodate the needs of aging workers and their families, including adding water-based activities to sports and fitness offerings.

Case New Holland’s CDHP benefits include an option specifically designed for people close to retirement, according to Tom Coogan, director of employee benefits. The plan directs unused employer-funded dollars into workers’ HRAs.

Corporate Change: Duke Energy, DuPont, MetLife and FedEx Corporation are among the Business Roundtable member companies that are making efforts to integrate their health and wellness cultures with those of recently acquired companies.

Corporate Leadership and Accountability

“Advancing the health of our employees is one of the most important things we need to do for our people as well as for the good of our organization. So it is reasonable that our bonuses should be tied to our success in making that happen.”
—Catherine Baase, M.D., global director, health services, Dow

Business Roundtable member companies have long understood that their leaders play a critical role in establishing a culture of wellness, and many maintain strategies to engage top management on an ongoing basis. For example:

• Navistar’s Executive Wellness Council regularly brings together the company’s 10 top corporate leaders, including the CEO, the chief financial officer, presidents of its four business units and executive vice presidents, to set the strategy and provide visionary leadership for its program. Council members are quoted in the employee wellness newsletter, present fitness awards at company ceremonies and challenge employees to beat their performance in company-sponsored fitness challenges. “We are fortunate to have executives who truly believe in the business case for health and wellness, and we want our employees to know that,” says Dawn Weddle, wellness manager.
• Principal Financial Group’s chairman and CEO, Barry Griswell, set a companywide example of healthy choices when he made a public commitment to lose pounds. “We made a big event of it,” recalls Bridget Schulz, assistant director, benefits. “Wellness isn’t a hard sell at Principal — it’s a top-down belief.”
• Employee support for the disease management program at Xerox Corporation got a strong boost when Roger LaDue, the president of UNITE HERE! Local 14A, spoke publicly about how the program had improved his life. “The union sent a personal letter to every union member and Roger did a Webinar telling how the program had helped him and his wife lose weight and lead healthier lives,” recalls Lawrence Becker, director of benefits and human resources policy at Xerox. “His message was extremely effective because it came from the heart — from the person our employees had chosen to be president of their union.”

Top executives at many Business Roundtable member companies also are visible on national and local platforms on behalf of public policies that support employee health and wellness, including serving on the Roundtable’s own Health and Retirement Task Force.

Several Business Roundtable member companies have adopted strategies for reinforcing accountability for health improvement initiatives, as well as tools to measure the results of those efforts. For example:

• Corning combines and distills data from its integrated programs into companywide and plant-level dashboards that show performance at a glance on measures such as HRA participation, aggregate risk levels, use of preventive services and productivity data. Plant-level 24/7 Wellness Teams will use the dashboards to evaluate local programs and see how their plants measure up to companywide performance.
• Union Pacific’s Health Index measures the progress of local management in achieving action plans drawn up by its work units to achieve health improvement goals, reports Marcy Zauha, director, health and safety. The Health Index includes mandatory measures — such as rate of participation in the company’s HRA, behavior modification programs and educational programs — as well as extra-credit measures, such as community outreach. Local units earn points cumulatively throughout the year, with interim results tabbed on scorecards that are discussed in monthly safety calls with the company’s regional vice presidents.

Dow: Taking Responsibility for Performance

As part of its integrated health strategy, Dow has adopted innovative approaches and tools for holding the corporation, its leaders and its health professionals accountable for health improvement performance. For example:

• Tying bonuses of health professionals to employee health improvement. In 2005, Dow’s team of health professionals elected to base 20 to 40 percent of the personal portion of their annual variable pay on achievement of a set of companywide and regional goals within their own employee populations, such as frequency of physical activity and reductions of risk factors, including obesity and tobacco use. Using Dow’s health assessment program as the keystone, the company’s 130 to 170 health professionals worldwide also work with the company’s local health plan vendors to provide education, run promotions and market their available programs to their employee populations.

• Healthy Environment Index. In 2007, Dow’s health team introduced the Healthy Environment Index, which helps company facilities measure their progress on companywide and local human and environmental health metrics, such as the tobacco use policy, access to physical activities and availability of healthy food in the cafeteria.

• Health Message Map. Developed as a tool to help local company leaders understand and explain the importance of health measures, the message set illustrates the company’s intersect with human health and provides details — for example, ways the company supports health in nearby communities and how the company’s products support public health, plus awards and recognitions the company receives for its initiatives.

• Leadership training. Dow incorporates several hours of health awareness training within its formal leadership curriculum, along with business case analyses on why supporting health is important to the company.

Dow also is participating in pilot research programs at 12 U.S. sites, focusing on the ways to improve the organizational environment, including supporting employee health and the effectiveness of leadership training in promoting the success of corporate health goals.

“People are our core asset. We have a stated commitment to advance the health of our employees and our communities as well as the public through our products,” says Catherine Baase, M.D.

Using the Company’s Unique Resources to Advance Health Goals

Many Business Roundtable member companies tap into their products, promotional capabilities and other resources to educate and motivate their employees toward more healthful lifestyles. Following are a few of their popular initiatives.

McGraw-Hill offers a robust calendar of employee Lunch and Learns — 90-minute sessions that many times feature the company’s authors, who speak and answer questions on topics related to health and other work-life matters, reports Danielle Shanes, director, benefits planning and design. Recent sessions include Dr. Edward Abramson’s Body Intelligence, Perry Christenson’s Family 360 and Robert Brooks’ Raising Resilient Children. Employees participate via Web conference, with the audio delivered over the phone and the presentation on their computers. Sessions also are recorded and accessible to employees for six to 12 months on the company intranet. Employees who participate in the sessions given by company authors receive free books.

“As a diverse health care company, Abbott Laboratories has many products and resources that support healthy living activities,” writes Roberta Finkler, manager, wellness. Among these are diabetic supplies and nutritional products that support disease management programs. Abbott now covers these company-made supplies at 100 percent, as well as other Abbott drugs, says Finkler.

Office Depot’s employee health initiatives get great promotional mileage from the company’s national sponsorship of NASCAR driver Carl Edwards and his racing team, reports Daisy Vanderlinde, executive vice president of human resources. Edwards, who is well known around the circuit for his personal commitment to physical activity and other healthy lifestyle choices, signed a statement encouraging healthy lifestyles in the recent annual enrollment newsletter sent to all Office Depot employees.

Edwards’ letter read, in part, “The importance of health and wellness can’t be overstated, particularly in our nation today where we are facing a crisis in terms of individual health and in the health care industry. As someone who is personally a strong advocate of health and wellness, I want to convey that message to you as well. … We all operate in the same high-pressure, fastpaced world, whether we spend our days behind a desk, at a cash register, assisting customers in a retail store, or behind the wheel of the No. 99 Office Depot Ford Fusion. Live your life in a way that helps you be both physically and emotionally healthy. Why? It’s your health.”

To support its healthy nutrition efforts, Alcoa Inc. created the Healthy Living Cook Book, with submissions from employees, writes Melissa Miller, manager, relocation and work life benefits. The cookbook was given free to all employees attending a company health fair.

General Mills, Inc.: Healthy Employees to Healthy Consumers

General Mills recently transformed a successful weight management program into an ongoing national consumer campaign, reports Karen Seal Grafe, manager, health and wellness communications.

“In 2004, we launched our program for our employees, ’Lose 10 Pounds in 10 Weeks,’ in partnership with the Mayo Clinic,” recalls Grafe. The program included speakers and activities to engage employees with a BMI of 25 or greater in losing weight in a healthy, sustainable way, using what Grafe calls “that boring but proven formula — exercise more and eat less.”

Of more than 1,300 program enrollees, 443 enrollees lost weight, with an average per-person loss of 6.7 pounds.

Several of the employees saw the potential for bigger things. “They said, ’Hey, we’re a food company — why don’t we do this for our consumers, too?’” says Grafe. Champions of the idea included the company’s chief marketing officer, Mark Addicks, who helped get the ball rolling.

In 2005, the company launched its consumer promotion, “Brand New You,” a 10-week, Webbased program featuring popular General Mills products, such as Yoplait yogurt, Progresso soups and Cheerios cereal, that provides consumers with information, motivation and strategies they can use to maintain a nutritious and enjoyable diet while attaining a healthful weight.

Another General Mills promotion, EatBetterAmerica.com, engages consumers with food, recipes, fitness and community strategies for healthful nutrition and lifestyles. “We play down our own brands and invite people to create their own more healthful versions of favorite recipes,” says Grafe. The company also has an endorsement tie-in for 12 healthful brands with the new Best Life Diet by Bob Greene, the popular author and personal trainer to Oprah Winfrey.

“We’re a big brand company,” observes Grafe. “We want to put a coordinated, good health face on our foods.” 

Strategy: Target Interventions to Employee Needs

“Today, we are more focused on identifying and lowering health risks. In the past, our programs were geared toward the entire population. While we still have programs for everyone, we are more focused on moving individuals to lower risk levels.”
—Keith Winick, wellness coordinator, Prudential Financial

As companies expand and integrate their programs and build them into their corporate culture, they also are becoming more strategic about how they use wellness to support the health of their employees. Although some companies have always made efforts to involve the workers who could benefit most from their programs, it was not uncommon for programs to appear to be “preaching to the choir” — filling their fitness centers with the already fit. Programs typically promoted broad goals such as physical activity, healthier eating and stress reduction.

Today, Business Roundtable member companies are skeptical about the one-size-fits-all approach. Serving workforces that are among the world’s largest and most diverse, they draw on aggregated claims data, HRAs and other advanced tools to identify risks or conditions that are prevalent within their employee populations, such as tobacco use or diabetes, and/or those risks and conditions that account for the highest medical benefit costs.

Companies also have become skilled at customizing their interventions for individual employees — timing offers of help to quit smoking, for example, based on an employee’s readiness to change, then providing telephone counseling and other personalized support to employees who have made the commitment. Personal self-care and health improvement services, such as nurse lines, health coaching, and telephone and online support for tobacco cessation and other behavior change programs, also are popular options within Business Roundtable members’ programs.

As a result, companies believe their programs are becoming more effective at keeping workers healthy and productive while showing more measurable results in containing costs for the population’s most expensive conditions. Following is a summary of the approaches and tools that Business Roundtable members are using to target their wellness programs.

Health Assessments and Screenings

Online or written HRAs have become a popular tool for companies — and their employees — to identify conditions that have the potential to become problems and provide targeted interventions. Of the member companies that responded to the Wellness Survey, 80 percent offer some kind of health assessment.

 Many Business Roundtable members use instruments provided by their health plan or another vendor, in some instances branding them with the company logo or otherwise customizing the assessment for their own use. Other companies have developed their own assessment or other screening tools from scratch. Employers typically make their HRAs available through the company’s wellness Web site, although some companies offer them at their health fairs. Most HRAs cover the employee’s medical history, current physical condition and lifestyle choices, such as frequency and duration of physical activity. Many Business Roundtable members similarly use biometric screenings, such as blood pressure, heart rate or other data, performed either separately or in conjunction with HRAs. Roundtable companies also encourage the use of other preventive screenings, such as mammograms to detect breast cancer and PSA tests for prostate cancer, through strategies that include providing first-dollar coverage in their benefit plans or making the screenings available on-site.

Companies use the results of their assessments and screenings to classify employee risks and target interventions. A common strategy is to place employees in high-, medium- or low-risk groups and offer help in moving from a higher- to a lower-risk category.

Based on results, companies also may offer employees with identified risks the opportunity to join a disease management program or receive lifestyle change support such as tobacco cessation or weight management coaching. Companies that conduct assessments or screenings in person may offer help on the spot, using the results as a teachable moment to drive behavior change. Several companies report making dramatic, life-saving interventions when assessments or screenings revealed imminently dangerous conditions, such as extremely high blood pressure or the possible presence of a tumor.

Most HRAs are voluntary, although companies typically offer a cash reward, medical plan premium discount or other kind of incentive for completing the assessment. Several companies use the assessment as the portal for enrollment in the wellness program itself. HRAs also are mandatory in some health benefit plans. Participation rises as employees become familiar and comfortable with the tools. Several Business Roundtable companies with well-established programs say that participation rates in their HRAs and screenings consistently top 80 percent.

Companies are aware of employee concern about the privacy of their personal information and are prepared to respond when questions arise. For example, Jessica Muhlenberg, Applera Corporation’s manager of benefits, reports that the privacy issue was at least part of the reason for low participation when the company first offered its HRA in late 2005. “Our employees are very concerned about disclosing personal information,” she writes. “We focused on the confidentiality of their HRA results this year, and participation jumped.”

Following are some of the ways that members of Business Roundtable are using assessments and screenings to support the health of their employees.

• General Mills’ in-house health services staff developed the General Mills Health Number Screening tool, a personalized, “live” version of an HRA, writes Karen Seal Grafe, manager, health and wellness communications. At on-site health fairs, employees answer questions on 10 lifestyle factors, including physical activity, tobacco use, nutrition, seat belt use, alcohol use and stress. Company health professionals then measure employees’ blood pressure, cholesterol, BMI and fasting blood sugar and give employees their health numbers on the spot. Those whose numbers indicate risks receive referrals to information, personal health coaching, local clinics or other resources.
• At CIGNA’s Healthy Life Expo, employees complete biometric screenings, engage in discussions with the company’s resource representatives and put together an action plan for personal health, reports Mary Bianchi, director, work/life programs. CIGNA stages the expo at more than 10 company locations.
• W.W. Grainger, Inc., offers ergonomic evaluations, including carpal tunnel screenings, by company health center nurses as part of its extensive program of on-site screenings.
• Principal Financial Group provides on-site screenings for blood pressure, blood sugar and cholesterol at all locations with 20 or more employees. Employees at smaller sites receive screenings in their physicians’ offices and are fully reimbursed. All employees fill out HRAs and set goals online.

In addition to — or in conjunction with — their other assessment and screening strategies, some companies have invested in predictive modeling software tools to target and respond to employee health risks.

Caterpillar: Assessing Risk and Readiness to Change

Caterpillar’s custom-designed HRA gets much of the credit for the “best in class” results of its tobacco cessation program, says Michael L. Taylor, M.D., the company’s medical director for health promotion. Caterpillar’s program, which is provided by a national vendor, has achieved a four-year quit rate of 35 percent.

Along with standard information on current tobacco use, Caterpillar’s HRA captures data on an employee’s readiness to change risky behaviors such as smoking. This makes intervention much more efficient, says Taylor. “We’re doing a better job of screening people and a better job of moving along people who are ready to quit,” he says. “We don’t unleash our efforts before they’re ready.”

For smokers identified as being in the precontemplation stage — not even thinking about quitting — efforts are deliberate, but low key. “We ask if they are ready to make a quit attempt and send them information to move them along.”

“It’s difficult to claim that we are more effective at moving the precontemplators, but we do work hard at it,” Taylor observes. “Then, when they let us know they are ready, we invite them into the program.”

Caterpillar’s HRA collects longitudinal data as well, which Taylor also finds helpful in measuring the success of the tobacco cessation program. “Most programs can’t measure their quit rates for more than a year, but we can track the outcomes for our employees long term,” he says. “We set the standard because we have better data.”

Online Strategies

“Our Web portal is an opportunity to look beyond sick care. It has trackers and modules that allow you to proactively take better care of yourself, not just in a crisis.”
—Pascale Thomas, director, benefits, Verizon

Over the past decade, the computer has evolved from a passive communications tool for delivering wellness messages and benefits enrollment materials to the active center of a company’s integrated health strategy.

Of the Business Roundtable member companies that responded to the survey, about threefourths say that they use the Web to provide wellness services to their employees. Most of these companies have branded health or wellness home pages on their corporate intranets that serve as portals to all of their internal programs, with links to vendors and other resources. Some companies have built their own sites, while others have partnered with WebMD or other vendors to design customized sites.

Within that broad reach, online resources also provide virtually limitless options for targeting wellness interventions to employees — from assessing risk, to customizing and delivering programs to targeted employees, to motivating, facilitating and tracking participation. Following is a summary of some of the ways Business Roundtable companies are using virtual resources to customize and focus their programs.

Branding and Supporting a New Program

• Verizon partnered with WebMD to create a customized, cobranded portal, Verizon Health Zone. The portal was launched in May 2006 in tandem with a health improvement program for management employees that provides seamless and coordinated access to the company’s health-related benefits and services, including integrated data from key health care vendors. “Prior to this, we had several points of entry for health information and myriad programs that were not coordinated,” writes Audrietta Izlar, manager, benefits. “These programs did not allow for clear messaging or effectiveness measurement against our health claims experience.”
• Office Depot’s three-year communications strategy to launch its new CDHP benefits platform also has a Web site as its centerpiece. In its first year, the site will focus on health, bringing together all the company’s wellness initiatives, health benefits enrollment information and tools, plus interactive features and links to engage employees and keep them coming back, says Frank LaPlaca, director, benefits. Next year, LaPlaca plans to add a “wealth” component, with information on company-sponsored retirement accounts, stock programs and related benefits. “Eventually the Web site will be an access point to total compensation and benefit information,” says LaPlaca.

 Aetna: Web-Based Communications for an Integrated Strategy

Aetna’s wellness program has “transitioned from a paper-based model to a Web-based, online model,” writes Dick Watson, senior benefits consultant, wellness strategy and fitness operations.

Aetna’s wellness programs are complemented by an innovative engagement strategy known as the Healthy Lifestyles incentive program. Employees access the program through a home page that is part of the company’s transaction-based application, so employees can reach it as part of their normal business activity, explains Watson. The page also links to other Aetna resources, such as Aetna Navigator, worksite fitness centers, DocFind and employee work/life assistance sites.

“Our communications tactics reflect a friendly style and an employee-centered focus,” he continues. The Web site features reader-friendly text and formatting with links to additional information, including electronic “postcards,” question-and-answer documents, and the human resources knowledge base of program and policy details.

In addition, Aetna’s weekly communications strategy moves employees electronically along a continuous process from registration and health assessment to documenting goals, completing healthy living programs and preventive screenings, and tracking physical activity. The company tracks employee registrations and program use to determine the impact of monthly communications and can send just-in-time messages to areas with low rates of participation.

“Our communications strategy fits into an overall initiative to give employees the tools necessary to build excellence and accountability for their health and well-being,” concludes Watson.

Establishing a Local Presence for Corporate Programs

Business Roundtable members use the Web to support and connect with their wellness programs at distant sites. For example:

• Navistar’s wellness effort includes teams of local volunteers who help implement programs at the plant level, with guidance from corporate wellness leaders. More than half the teams have their own Web sites, reports Dawn Weddle, wellness manager.
• Merrill Lynch connects wellness champions at the company’s small local worksites with the Web sites of national vendors and partners, such as the American Heart Association. “It helps our people identify people they can work with locally to set up their own on-site programs,” explains Jeannette Fuente, vice president, wellness.

Providing Employees with Personal Health Management Tools

Several members of Business Roundtable, including Verizon and IBM, offer Web-based Personal Health Records (PHRs) that employees can use to enter their family medical histories, allergies, current medications and other information that affects their health.

Verizon is populating its PHR tool with claims data from selected health plans and the prescription drug administrator, retroactively from 2004. “This gives employees a greater opportunity to control their own health care because it provides a lot of information that normally doesn’t exist in one secure place,” explains Pascale Thomas, director, benefits.

For example, the program helps employees prepare for a doctor visit by drawing on their data to generate questions to ask during the visit. The program also can alert employees if there is an industry update about their medication. “This is a smart tool. The more you use it, the more it knows you and can help you,” adds Thomas.

IBM: Virtual Fitness Based on Readiness to Change

IBM’s Virtual Fitness Center (VFC) offers each of the company’s 130,000 active U.S. employees a personal wellness experience based on the employee’s own readiness to change. The VFC is integrated with IBM’s Healthy Living Rebate incentive programs and is accessed through the company’s Wellness for Life Web portal.

“We wanted to reach everyone, not just the regular exercisers, so we built the program around behavior change,” explains Megan Turner, health promotion program coordinator.

On the portal, employees can assess their own readiness to make improvements in areas such as stress, physical activity, weight management, nutrition and smoking based on the stage-ofchange model developed by Dr. J.O. Prochaska. “We translated our Physical Activity-Nutrition Rebate incentive into readiness as well — for example, whether your goal is to exercise four times a week or two times, you get to choose which options you are ready to adopt,” says Turner. “We focused on physical activity because it affects so many other health behaviors, like weight management and stress, as well as physical conditions, like heart disease and diabetes.”

Employees also can access an online workbook that uses the 12 principles of the stage-ofchange model to guide employees through five stages of readiness. “We worked with Prochaska to put the workbook online,” recalls Turner. “We went beyond the typical assessment — having people determine the stage they were in, but then saying, ’Here’s what will help you be successful when you are in that stage.’”

On the VFC, employees are able to log their activities, check their progress toward goals, access support resources and learn about upcoming fitness programs.

IBM employees further personalize their wellness experience by creating a Personal Wellness Vision during the company’s registration process, says Turner. “We wanted to put our employees in the driver’s seat and make the process a little more personal. People can pick a variety of lifestyle behaviors to work on — looking better, feeling better, spending more time playing with the kids.” When employees log onto the Wellness for Life portal, they reach a personal home page that refers to their vision, asking questions like, “How do you see yourself in three months? How confident are you that you will accomplish this?”

“Last year, our focus was how employees could be better consumers of health care and better informed about their decisions,” adds Turner. “This year, we’ve moved on to the next level: How can you take better control of your habits and be successful at it?”

Disease Management Programs

“Our surveys tell us that employee satisfaction with our disease management programs is high. Once people get into the programs, they can really see a difference.”
—Lawrence Becker, director, benefits and human resources policy, Xerox

Disease management programs are an increasingly popular strategy to reduce the prevalence and complications of chronic or complex conditions such as asthma, diabetes and coronary heart disease, contributing to improved quality of life while reducing the high costs associated with these conditions.

Program designs vary, but most incorporate personal coaching and education, based on best practice treatment guidelines for the disease. Employees who are identified as having the condition or as being at risk are encouraged to receive timely and appropriate medical treatment, comply with prescribed treatments, and make lifestyle changes that may reduce the severity of the conditions or help prevent complications.

Of the Business Roundtable member companies that responded to the survey, 82 percent say they offer a disease management program or self-care tool. Disease management programs typically are offered as part of the benefits package by health plan providers or as carveout programs from other vendors. Although diabetes management is the program most frequently mentioned in the survey, some companies have begun covering many other conditions, including chronic pain, cancer and lower-back pain.

• Abbott’s Custom Care Coordination program is a coordinated treatment approach for chronic conditions such as coronary heart disease, cancer and lower-back pain. Offered through Abbott’s health plan vendors, “the program can improve quality of life by preventing flareups and complications and minimizing symptoms through oversight of all treatments,” writes Roberta Finkler, manager, wellness. Custom Care Coordination services can include supportive care, education, helping patients find community resources or helping members better understand their treatment plans, adds Finkler. “As the team of nurses interacts with Abbott members, they assess the whole situation and connect members to the appropriate Abbott resources and programs like employee assistance programs [EAPs]. This type of integration is not usually seen with disease management programs offered.”
• Caterpillar worked with a local provider to create its own programs to manage diabetes and coronary heart disease. “We wanted a program that focused on conditions that were problems in our own populations and that evidence showed could be prevented by making lifestyle modifications and other strategies,” says Michael L. Taylor, M.D., medical director for health promotion. Taylor and the local hospital crafted their own program, which draws on a multidisciplinary team that includes a nurse, dieticians, a social worker and a health educator with an exercise physiology background. The program is telephone based to serve the company’s workforce in plants across the United States. Taylor tracks the program’s performance on process measures such as use of screenings and clinical outcomes.
• FedEx Express integrates data from disease management and other vendors to track results and design improvements to its programs. Based on data showing that few participants in the diabetes management program were receiving dilated eye exams to detect a common but preventable complication of the condition, the company created an incentive that substantially increased use of the screening (see sidebar, page 16).

Many companies include disease management strategies in their integrated health and wellness programs. For example, Corning identifies chronic disease management on the company’s Health Care Continuum. ExxonMobil Corporation, Schering-Plough, Owens Corning and Pactiv Corporation are among the companies that report that they have recently added or plan to add disease management components to their wellness programs.

Although participation in disease management programs usually is voluntary, some companies offer incentives for participating. For example, along with a $200 medical premium reduction for taking an HRA, McKesson Corporation offers additional incentive dollars to employees who complete a health improvement or disease management program.

Texas Instruments: Managing Risks beyond Disease

Like many companies, Texas Instruments contracts with an outside vendor to identify employees to participate in disease management programs and deliver the appropriate services.

“What makes us uncommon is that our identification is not based on costs alone — but on a combination of costs and potential risks based on a variety of factors, including employees’ use of medical and pharmacy services and disability data along with their diagnosis,” says Linda Moon, manager, wellness and health management. “As a result, we can identify employees whose utilization might not be in the highest cost range, but their combination of medical conditions might put them at higher risk.”

On the other hand, she notes, some employees diagnosed with diabetes may be managing their diseases well, so they would not be identified to participate in the program. “These people would not be high risks, so why would we spend that money?

“We also don’t focus solely on disease,” adds Moon. “Our program is more behavioral or holistic. For example, people with some conditions tend to have certain comorbidities — like diabetes is often seen with cardiovascular disease. Our program is about identifying employees on the basis of total health risks for all diseases and reaching out to talk about their quality of health in all those areas.”

Moon notes that many people with multiple risks or conditions already are aware of what they can do to improve or manage them. “So the issue isn’t determining what they should be doing, but determining why they’re not doing it. That takes a skill set that digs deeper than ’did you keep your doctor’s appointment?’”

Changing behavior at that level also is an opportunity to engage with the family, especially the spouse. “There may need to be changes in the family’s lifestyle involving diet or exercise. Or both the employee and the spouse should know what questions to ask the doctor,” says Moon.

Texas Instruments considered designing its own disease management program along these lines but was pleased to find a contractor who shared its philosophy, says Moon. “We don’t identify the condition, we identify the people who need help.”

Support for Healthier Lifestyles

“We look upon food service as a health promotion opportunity, not a dining experience.”
—Michael L. Taylor, M.D., medical director for health promotion, Caterpillar

For many companies, programs aimed at lifestyle improvements, such as increasing physical activity, managing weight, quitting smoking or reducing stress, have been traditional points of entry into wellness, and they remain among the most popular offerings. Of the Business Roundtable companies that responded to the Wellness Survey, 85 percent offer a weight management program, 74 percent offer a smoking cessation program, 73 percent offer an on-site workout facility, 66 percent offer organized wellness activities that promote physical exercise, and 47 percent provide on-site massages or another stress-reduction program.

As companies become more sophisticated about tracking the costs associated with these lifestyle-related conditions as well as the effectiveness of interventions, they also are increasingly creative in how they design their programs — using HRAs, predictive modeling and other tools to identify high-risk populations; using incentives, readiness to change and personal goalsetting strategies to encourage participation; providing personal coaching, tracking and other approaches to customize interventions and feedback; and closely integrating their programs with the corporate culture. Following is a sampling of ways that Business Roundtable members have added their signatures to healthier lifestyle programs.

• In Navistar’s companywide challenge, Trucking Across North America, employee teams from 26 company sites use a Web-based tracking tool to track their physical activity for 13 weeks. Employees use a pedometer to add up miles walked or run to a virtual destination. They get credit for all forms of physical activity from gardening to running, and receive bonus miles for other beneficial activities like community service or getting a flu shot, according to Dawn Weddle, wellness manager. Plenty of incentives and rewards keep the competition interesting; the winning team also keeps a traveling trophy for the year along with a letter of congratulations from the CEO.
• Sprint Nextel turned its weight management initiative into a highly successful teambuilding event, reports Collier Case, director, health and productivity. Approximately 3,200 employees signed up for a 10-week program that combined friendly competition, weightloss goals and physical activity. Employees assembled four-person teams, registered online and tracked their workouts. Most teams also had weekly weigh-ins, reports Case. Every employee who participated received a sports bottle, and teams that met their goals were eligible for eight cash drawings of up to $100 for each team member. “People appreciated the opportunity to do something different,” says Case. “They had just been through a merger, and this changed their focus a little bit, giving us a good reason to get out and take a walk, feel healthier and lose some weight.”
• Caterpillar formed a partnership with its food service vendor to provide healthier choices in its employee cafeterias and vending machines. “Up to this point, their job was managing the dollars and cents and the quality. Now, they are part of our change model, and their job is to provide healthier alternatives,” says Michael L. Taylor, M.D., medical director for health promotion. Caterpillar also made corporate food service a division of its integrated Healthy Balance program. Company cafeterias now offer nutritious Lunch for Less entrees at lower prices and supported by signage. The vendor also provides nutrition labeling and uses more healthful ingredients. “We did this before it became popular,” reports Taylor. “We told our vendor this would become a competitive advantage for them and it has — now they are replicating it with other companies.”
• Boeing’s telephonic tobacco cessation program uses Web integration and special programming to help employees control their weight while they attempt to quit smoking, reports Michael Brennan, wellness programs manager. “Our program serves all employees at all sites globally, and we continue to attract at least 2,000 new registrants annually,” he writes. Boeing also pays one-third of the cost of employees’ participation in a pilot Weight Watchers enhanced-for-business program. “So far, the results have been impressive,” writes Brennan.
• SAS provides an extensive on-site services program that saves employees and their families time and money on necessary daily errands and amenities, reports Jack Poll, director, recreation and employee services. Popular offerings include a hair salon, skin care services, massage therapy, dry cleaning, alterations, car detailing, a podiatrist and a bakery.

Accenture: Bringing Work-Life Benefits Home

Accenture offers a menu of creative programs to help its consultants maintain a healthful balance in their work and personal lives. “Our company always has been interested in having our employees succeed personally as well as professionally,” says Sharon Klun, manager of work/life initiatives. “And when you look at the long-term effects that mismanaging wellness can have on your health, it makes a compelling argument for providing that kind of benefit.”

Most of Accenture’s employees are consultants who work irregular hours and spend considerable time on the road, so the company extends backup dependent care services to children as well as elders, spouses and domestic partners. Services are available 24/7, says Klun. “A consultant might need child care at midnight while working on a report, so we think the service is a good investment in our people and the business. We encourage people to use the resource in ways that are valuable to them.”

Accenture’s holistic approach extends to career management and planning — especially career on- and off-ramps. For example, the company’s Future Leave program allows employees to bank a percentage of their salary to self-fund planned sabbaticals of up to three months. Accenture continues to fund the employee’s medical insurance during the sabbatical. Employees come back after dealing with what was important to them.

“Research tells us that top performers often value work-life balance more than compensation,” says Klun. “Organizations need to think differently about where they’re looking for answers. Work/life and wellness strategies provide healthy ways to help employees manage stress, take care of themselves, manage their lives and stay engaged in growing a successful organization.”

Strategy: Make the Business Case for Wellness

“We don’t consider it a cost because the net effect is to improve health, reduce overall health care costs and improve productivity impacting the bottom line.”
—Deborah Lauper, director, compensation, integrated health and employee benefits, Corning

Wellness programs can involve a substantial investment. Of the Business Roundtable member companies that responded to the Wellness Survey, almost 40 percent spend more than $200,000 annually on their programs, and 20 percent spend at least $1 million.

Most companies that offer wellness programs believe that their investment pays generous returns, both financially and in terms of valuable intangibles, such as employee health and satisfaction. “We track the effectiveness of our program by evaluating the use of our programs by our employees and the feedback we get for our programs,” says Jack Poll, director, recreation and employee services, SAS.

When it comes to estimating an ROI in terms of dollars and cents, however, many companies find the calculation harder to make. Although costs, such as salaries, vendor fees, facilities, equipment, assessment tools and volunteer time equivalents, are readily known, the value of improved health status is harder to reduce to numbers.

Jeanette Fuente, Merrill Lynch vice president of wellness, sums up the situation faced by many wellness professionals: “Although the program recognizes that promoting health and preventing disease save money through reduction in health claims costs, increased productivity and reduced absenteeism, it is difficult to systematically estimate those savings because of the complexity of accurately quantifying the savings from health behavior change, averting illness, early detection of disease or saving a life.“

Still, Business Roundtable member companies are making significant efforts to track the ROI of their wellness programs, advancing the state of the science as they make a strong case for their programs. They include a growing number of companies that accompany launches of new or refocused integrated health plans with initiatives to track and analyze data that help them target at-risk employee populations, deliver appropriate services, and evaluate and refine their programs.

Calculating Dollar Return on Investment

Business Roundtable member companies use qualitative as well as quantitative program measures to place real dollar values on their program results. Following are some of their strategies.

• MetLife estimates the 10-year cost savings effect of regular exercise on reducing cardiovascular risk. An initial profile of 200 randomly selected fitness center members showed that 65 percent had low or no risk of cardiovascular disease, while 35 percent were in the high-risk category, writes James Corry, Ph.D., wellness director. Over time, the proportion of participants in the low- to no-risk categories increased to 90.4 percent, while the percentage of employees in the high-risk category dropped to less than 10 percent. With annual medical costs estimated at $1,166 for employees in low- or no-risk groups and $3,803 for higher-risk employees (those with three or more risk factors), MetLife estimated a savings of $1.38 million per year by improving the risk profiles of nearly 2,100 members in its fitness centers at the time of the study. Against annual fitness program costs of $550,000, this resulted in an estimated ROI of 2.52 for the fitness program, reports Corry.
• Corning measures ROI for programs in which the company has baseline costs and some years of data, reports Deborah Lauper, director of compensation, integrated health and employee benefits. “For example, our disease management program ROI is 3.7:1 over a twoyear period, measuring health care costs for the participating group and tracking year after year. “Each program is measured separately and not always related directly to cost,” adds Lauper. “We determine if the risk factors are improving from year to year and can quantify the estimated health care costs of various risk groups.”
• Prudential tracks ROI based on the use of its on-site clinics, wellness programs, flu shots and ergonomic workstation assessments, writes Keith Winick, wellness coordinator. “Our return on investment for 2005 was approximately $4 million.” The company will track shortand long-term benefits costs for employees who participate in the HRA, its wellness programs or both.
• With a self-funded, self-administered health plan, Western & Southern has its entire medical and prescription cost details, reports Laura Hauter, associate director, benefits department. The company is tracking medical and prescription drug costs related to its weight, diabetes and tobacco cessation programs and is in the process of measuring the return based on a net decrease in health care expenses.
• Navistar estimates the potential cost avoidance savings for seven key wellness programs, including disease management, its health club subsidy and its Trucking Across North America fitness incentive campaign at $6.2 million. “If we were to reach 100 percent participation, these savings could reach $19 million,” reports Dawn Weddle, wellness manager.
• W.W. Grainger annually reviews its companywide claims history. The company targets programs such as disease management to address conditions associated with the greatest claims costs. The company plans to track those claims going forward to evaluate the impact of the program. W.W. Grainger also uses cost avoidance to evaluate the impact of some programs, such as carpal tunnel screenings performed by its health center nurses.
• Principal Financial Group has begun tracking ROI for its health screening and disease management programs, according to Bridget Schulz, assistant director, benefits. “We have had only one year since we’ve implemented health screenings, so the ROI is not positive yet at 0.51.” Looking only at claims and not measuring lost productivity, ROI for disease management is 2.71, she reports. Principal does not look at every component of other programs and services, but it does look at some individual metrics. The company also looks at aggregate cost compared to savings, says Schulz.
• Verizon’s integrated program, launched in May 2006, includes methodology for measuring ROI by tracking reduction in health risks over three to five years.

Aetna: Returning the Investment in Fitness

Aetna measures ROI for its wellness programs using medical claims data and productivity studies using data from the Work Limitations Questionnaire, according to Dick Watson, senior benefits consultant, wellness strategy and fitness operations. In 2004, the company conducted a formal investigation of the relationship between health care costs and employee participation in Aetna’s on-site fitness center during the previous year.

In the study, an Active Participating Group (fitness center participants who exercised two or more times a week) and a Total Participating Group (fitness center participants regardless of frequency of exercise) were each matched with a control group of fitness center nonparticipants by age, gender, state, job family code and medical product class. General Two-Sample T tests were used to compare the means for the Active Participating Group and the Total Participating Group to their respective matched control groups.

The study concluded that regular, active participation in Aetna’s on-site fitness centers was associated with lower combined medical and pharmacy costs during 2003. On average, the Active Participating Group experienced total combined costs that were $28.30 lower per member per month than the matched control population, for an annualized savings of $340 per member. The Total Participating Group also showed a trend toward lower costs compared with the control group of nonparticipants. “Based on the results of this study, the ROI for the physical fitness component of the Healthy Lifestyles program is 3.4:1,” Watson reports.

Working with Vendors

“Consistent with one of MetLife’s core values — People Count — we engage our vendors to address health issues across the entire health spectrum, from high-level wellness to acute disease to chronic conditions.”
—James Corry, Ph.D., wellness director, MetLife

Business Roundtable member companies are turning to disease management and other vendors to provide ROI and other cost-benefit metrics. Although this approach relieves the company of the burden of tracking and analyzing data, it may not always give the company a comprehensive, consistent or precise picture of the impact of the program.

“We work continuously with our vendors to evolve useful, accurate cost-benefit metrics,” writes James Corry, Ph.D., wellness director, MetLife. “Given our health and productivity goals, however, these measures are not always perfect in capturing the full business impact of our health enhancement programs.

“For example, our vendors typically report on cost savings attributed to reduced use of medical services, more cost-effective drug selections or the use of equally effective but lower-cost alternative medical procedures. The cost-benefit ratios reported for medical savings alone have ranged from 1:2 up to 1:7.85,” observes Corry. Adding reliable measures of productivity would make these estimates even more impressive.

Following is a sampling of ways that Business Roundtable companies work with vendors to track ROI.

• Sprint uses an integrated hierarchy of vendor-reported ROI for its complex case management, disease management and behavior change programs and for its HRA, according to Collier Case, director, health and productivity. The programs have produced results of up to 7.86 ROI, he reports.
• Abbott’s Custom Care Coordination program resulted in a $2.5 million cost avoidance, most significantly with coronary artery disease and cancer care, and affected the overall health care cost trend by 1.5 percent, reports Roberta Finkler, manager, wellness. Abbott measures ROI by evaluating medical trends by disease state as well as comparing baseline illness costs to post-program costs.
• “Verizon is beginning to review methodologies for disease management programs with our key health vendor partners,” reports Audrietta Izlar, manager, benefits.
• Xerox has negotiated 2:1 return guarantees with its disease management vendors, reports Lawrence Becker, director, benefits and human resources policy. Guarantees include a sliding scale of penalties. “They are sharper below 1:1 and go away above 2:1,” reports Becker.
• Union Pacific has just completed a data warehouse to track relationships among health management program participation and claims costs, disability costs and productivity costs. The company also has done lifestyle claims analyses as well as a series of studies to determine relationships between safety and health risks, according to Marcy Zauha, director, health and safety.

Business Roundtable companies also partner with outside resources, including leading researchers, to provide data, program design or other support to determine ROI. For example:

• Navistar recently partnered with researchers at the University of Michigan and plans to track ROI data for the coming year, reports Dawn Weddle, wellness manager.

Dow: Targeting ROI

Dow tracks three primary financial outcomes: cost per employee for medical benefits, presenteeism and absenteeism, writes Catherine Baase, M.D., global director, health services. To track presenteeism and absenteeism, the company uses annual survey data from a statistically random sample of employees from each country. Presenteeism is assessed using the Work Limitations Questionnaire. For both presenteeism and absenteeism, the company uses average salary as a proxy for financial impact.

In addition to the economic measures, Dow also tracks employee health status. Considering just the top three target risks of obesity, tobacco and physical activity, Dow trends from a 2004 baseline showed that in 2006, the company experienced a 14 percent reduction in its high-risk population and a 4 percent increase in the low-risk group.

Improving employee health status has significant value, Dow has found. In a study, “Estimating the Return-on-Investment from Changes in Employee Health Risks on The Dow Chemical Company’s Health Care Costs,” published in the Journal of Occupational and Environmental Medicine, the company estimated that reducing each of 10 risk factors by just 1 percent per year would result in an ROI of 3:1 — an estimated savings of more than $50 million in just the health benefits plan costs over the 10-year period.

“It is important to note that this ROI estimate assumes the only benefit is changes in direct dollar expenditures for health care,” adds Baase. “We also expect that health risk reduction would result in indirect dollar savings of about the same magnitude, therefore increasing the ROI. The estimate also did not account for any intangible benefits, such as morale or recruiting.”

Among its analyses of individual programs, Dow assessed the ROI of its internal “health advocacy” case management efforts by using disability guidelines to calculate lost days saved by supporting employees’ return to health and return to work. “Across our U.S. sites in 2006, we estimate a savings of more than $6 million,” writes Baase.

Other Measures to Track Program Effectiveness

Business Roundtable companies also use outcomes and other metrics to measure how well their programs are serving their employee populations.

• In addition to its ROI studies, Aetna measures the effectiveness of its programs through productivity studies using self-reported data; risk reduction studies using biometric data from health assessments and screenings; self-efficacy questionnaires using before-and-after results of selected wellness interventions; and literature-based savings based on participation in wellness interventions, according to Dick Watson, senior benefits consultant, wellness strategy and fitness operations.
• Eastman Chemical Company measures the impact on risk levels after participation in a face-to-face coaching program. Before-and-after risk levels are assessed, and a statistical significance test is run against the outcomes, according to Amanda Dean, human resources representative.
• Case New Holland tracks the number of employees who stop tobacco use at six-month and one-year intervals. The program has been in effect since October 2006.
• CIGNA uses individual program metrics including participation, costs, goals achieved, weight loss, HRA scores, multiple employee surveys on benefits and behavior change, biometric screening data, and results of incentives for enrollment and participation in disease management programs, reports Mary Bianchi, director, work/life programs. The company will analyze data from claims and outcomes post-intervention.
• The wellness program at DuPont’s Pioneer facility supports four key company market channels: maximum employee engagement/capability; attraction and retention of a worldclass workforce; quality, efficiency and sustainable affordability of health care; and the safety goal of zero occupational injuries or illnesses. To measure wellness program impact on the quality health care channel, Pioneer applied a three-tiered metric approach: Tier 1 — program payroll as a percentage of revenue; Tier 2 — health care cost trend; and Tier 3 — health care benchmarks, such as use of generic versus brand name prescription drugs, inappropriate visits to the emergency room, use of preventive screenings and change in employee health status.
• IBM’s goal is to measure success at four levels, reports Megan Turner, health promotion program coordinator. The levels are penetration as a measure of participation; behavior change, such as increased physical activity or improved nutrition; health risk reduction or maintenance of low-risk status; and cost savings for the company, including lower health care costs and improved productivity.
• Sprint’s cost-benefit measures include calculating and evaluating total medical costs, tracking changes in risk factor distribution and use of HEDIS® (Health Plan Employer Data and Information Set) metrics, reports Collier Case, director, health and productivity.
• Principal Financial Group is collecting baseline data for a dashboard to track costs, participation and results, says Bridget Schulz, assistant director, benefits.
• Corning uses dashboards to measure and compare year-to-year progress at each company location. Measures include risk factors, productivity, participation levels, use and program spending, reports Deborah Lauper, director, compensation, integrated health and employee benefits.

Merrill Lynch: Putting a Value on Savings

“Our wellness programs are supported by existing medical clinics and staff,“ says Jeanette Fuente, vice president, wellness.

“We monitor clinical outcomes and, to the extent possible, follow up with employees found at screening programs to have treatable conditions, such as skin cancer, breast cancer, high blood pressure or high blood cholesterol. [We follow] how health promotion programs impact employees’ health risks. We also estimate time saved as a result of offering programs and services on-site.”

In one demonstrated ROI, a survey of more than 1,500 Merrill Lynch employees who participated in health promotion, wellness and clinical care programs in 2004 found an average per-employee savings of more than four hours of productivity. Estimating 20,000 visits and an average salary of $40 per hour, the company arrives at an estimated savings of $3.2 million for the year.

“Keeping employees healthy is good business, and it contributes to the company’s bottom line — not only in health dollars saved but in positive corporate image, increased employee morale, and enhanced recruitment and retention,” says Fuente.

Acknowledgments

We thank these Business Roundtable member companies for participating in the survey.

Abbott Laboratories
Accenture Ltd.
ADP
Aetna Inc.
Air Products and Chemicals,
Inc.
AK Steel Corporation
Alcoa Inc.
American Electric Power
Company, Inc.
American Express Company
Ameriprise Financial
Applera Corporation
Arch Coal, Inc.
ArvinMeritor, Inc.
Avery Dennison Corporation
Bechtel Group, Inc.
The Boeing Company
Case New Holland Inc.
Caterpillar Inc.
Ceridian Corporation
The Chubb Corporation
CIGNA Corporation
Convergys Corporation
Con-way Incorporated
Corning Incorporated
CSX Corporation
Deere & Company
The Dow Chemical Company
Duke Energy
DuPont
Eastman Chemical Company
Eaton Corporation
Ernst & Young, L.L.P.
ExxonMobil Corporation
FedEx Corporation
Fluor Corporation
FMC Corporation
General Mills, Inc.
General Motors Corporation
Humana Inc.
IBM Corporation
Liberty Mutual Group
The McGraw-Hill Companies
McKesson Corporation
Medco Health Solutions, Inc.
Merrill Lynch & Company,
Inc.
MetLife, Inc.
National Gypsum Company
Navistar International
Corporation
New York Life Insurance
Company
Northwestern Mutual Life
Insurance Company
Office Depot, Inc.
Owens Corning Inc.
Pactiv Corporation
Peabody Energy Corporation
PPG Industries, Inc.
Principal Financial Group
Prudential Financial
SAP America, Inc.
SAS Institute Inc.
Schering-Plough Corporation
Southern Company
Springs Global US, Inc.
Sprint Nextel
The St. Paul Travelers
Companies, Inc.
State Farm Insurance
Companies
Sun Microsystems
Texas Instruments
Incorporated
Union Pacific Corporation
Verizon Communications
W.W. Grainger, Inc.
Western & Southern Financial
Group
Weyerhaeuser Company
Wyeth
Xerox Corporation
YRC Worldwide Inc.

We thank the following people for providing interviews or extensive written contributions to the narrative portion of this report.

Catherine Baase, M.D.,
global director, health services, The Dow Chemical Company

Lawrence Becker, director,
benefits and human resources policy, Xerox Corporation

Mary Bianchi, director,
work/life programs, CIGNA Corporation

Michael Brennan, wellness programs manager, The Boeing Company

Collier Case, director,
health and productivity, Sprint Nextel

Beth Casteel, managing
director, employee benefits, health, and communications, FedEx Express, an operating unit of FedEx Corporation

Tom Coogan, director,
employee benefits, Case New Holland Inc.

James Corry, Ph.D, wellness
director, MetLife, Inc.

Amanda Dean, human
resources representative, Eastman Chemical Company

Elona DeGooyer, consultant,
human resources, Humana Inc.

Ralph Fader, staff
consultant, benefits, Verizon Communications

Roberta Finkler, manager,
wellness, Abbott Laboratories

Jeanette Fuente, vice
president, wellness, Merrill Lynch & Company, Inc.

Ken Glover, director, health
and ergonomics, CSX Corporation

Karen Seal Grafe, manager,
health and wellness communications, General Mills, Inc.

Laura Hauter, associate
director, benefits department, Western & Southern Financial Group

Karen Jenkins, senior human
resources associate, American Electric Power Company, Inc.

Audrietta Izlar, manager,
benefits, Verizon Communications

Sharon Klun, manager,
work/life initiatives, Accenture Ltd.

Frank LaPlaca, director,
benefits, Office Depot, Inc.

Deborah Lauper, director,
compensation, integrated health and employee benefits, Corning Incorporated

Melissa Miller, manager,
relocation and work life benefits, Alcoa Inc.

Linda Moon, manager,
wellness and health management, Texas Instruments Incorporated

Jessica Muhlenberg,
manager, benefits, Applera Corporation Connie Orzech, manager, benefits programs, Office Depot, Inc.

Teri Pazos, senior benefits
manager, Schering-Plough Corporation

Jack Poll, director, recreation
and employee services, SAS Institute Inc.

Sol Sax, M.D., chief medical
director, DuPont

Bridget Schulz, assistant
director, benefits, Principal Financial Group

Jessie Schwade, health
services consultant, Northwestern Mutual Life Insurance Company

Danielle Shanes, director,
benefits planning and design, The McGraw-Hill Companies

David Siegel, M.D., M.P.H.,
assistant director, health care operations and programs, General Motors Corporation

Michael L. Taylor, M.D.,
medical director for health promotion, Caterpillar Inc.

Pascale Thomas,
director, benefits, Verizon Communications

Deborah Triplett, director,
associate benefit programs, human resources, Humana Inc.

Megan Turner, health
promotion program coordinator, IBM Corporation

Daisy Vanderlinde, executive
vice president of human resources, Office Depot, Inc.

Dean Vonderheide, assistant
vice president and director of the benefits department, Western & Southern Financial Group

Dick Watson, senior benefits
consultant, wellness strategy and fitness operations, Aetna Inc.

Dawn Weddle, wellness
manager, Navistar International Corporation

Keith Winick, wellness coordinator,
Prudential Financial

Marcy Zauha, director, health
and safety, Union Pacific Corporation

Carole Zompa, senior
benefits advisor, FedEx Express, an operating unit of FedEx Corporation