As employers, governments have to tackle rising health care costs for their employees. But the need to stay competitive in the job market means that employers can't pass along too much of the cost, or employees will look for new jobs with better benefits. The solution? Have healthier employees. But it isn't always that easy to convince employees to change their habits.
The National Association of State Personnel Executives (NASPE) put together a white paper (PDF) last year detailing the challenges employers face and the practices they pursue to keep employees healthy. The survey found that managing disease and chronic conditions, and implementing wellness programs were at the top of the list of important issues facing health plan administrators.
With a little up-front investment, according to the paper, governments could have employees that will incur lower health care costs. This could also potentially lead to less sick leave and more productivity. Some studies have suggested that healthy employees are even more motivated in the office than their less-healthy counterparts.
Anyone, regardless of health status, can benefit from health programs focused on wellness and prevention, and states are implementing these programs via carrots or sticks. So far, success is hard to measure, but this isn't stopping states from encouraging employees to take an active role in their health.
Providing incentives is one way to entice and reward employees for developing healthy habits. Take a health assessment? Earn some money. Take a walk with coworkers during lunch breaks? Win some comp time. By offering incentives, these governments-as-employers hope that small awards go a long way.
For example, in Rolla, Mo., absenteeism was a major problem. The city financed a prevention program in which documented physical activity could earn employees up to one hour of comp time per week and gym membership reimbursement. In addition, employees could earn a $5 bonus per pay period for completing health assessments. Between 2008 and 2009, the city's absenteeism dropped by nearly 1,000 hours.
In West Virginia, the state is working to improve employee health by encouraging employees to complete preventative screenings and assessments. The state's "Improve Your Score" program provides employees with financial incentives if they receive a green or yellow score on their post-assessment report card, indicating good or relatively good health. Anyone receiving a red report card is told to see their doctor. In Arkansas, employees who complete an annual health screening and track their fruit and vegetable intake, tobacco use and physical activity could earn up to three extra vacation days a year.
Conversely, some states offer disincentives to employees, like higher premiums. Last year in Alabama, state employees' insurance premium rose from $25 to $50 a month. Employees are given the opportunity to receive a $25 discount by getting their cholesterol, body mass index (BMI), glucose and blood pressure screened. Those who completed screenings and are deemed at-risk are asked to see a doctor (for free) in order to receive the discount. Not following through with the doctor means an undiscounted premium.
One year later, the rules have changed a bit. Now, employees automatically receive the discount if their checkup put them in a "not at risk" category. If they're found to be at risk, they have three options to receive the discount: get a statement from a doctor saying that they've been counseled on health risks or that they have a medical condition that prevents them from improving risk factors; participate in or complete a state wellness program; or show reported improvement in risk factors through self-management.
In a number of states, a similar premium discount program is offered, but it focuses on tobacco use. In Kansas, those who self report that they do not use tobacco products receive a premium discount of $40 per month. Those who are tobacco users can sign up for a tobacco cessation program, involving activities like talking to a coach to discuss quitting strategies, allowing them to receive the premium discount.
So which method ends up being more successful: The carrot or the stick? (Surely, the carrot would taste better, one would think.) It turns out that success in either case can be hard to measure, and it depends on how it's measured. It could be determined by the number of participants, overall savings for the state or better health for employees.
"It's very fuzzy," says Leslie Scott, NASPE's director. "The challenge is ... that you really don't know what you're saving. You can't count how many strokes you've prevented." And Scott says the things that can be counted, for example a decline in claims for certain health problems, require many years of data to provide significant information -- something a number of programs don't yet have. Defining success by the number of participants can also be difficult. In many cases, says Scott, "Initially, there's a lot of participation and then that participation dwindles."
West Virginia Public Employees Insurance Agency Director Ted Cheatham told NASPE writers in the white paper that the state's "Improve Your Score" program had 16,000 participants and paid out $750,000. But it is unclear how effective the program was in changing habits, with Cheatham quoted as saying that assessment results were all over -- greens turned into reds and vice-versa. As a result, the program changed to provide employees with lower premiums if they improve their assessment scores.
In the case of Arkansas' vacation "carrot," the program was originally intended to increase physical activity, fruit and vegetable intake, cut down on tobacco use and increase health screenings. "The main thing we wanted to see the behavior changes is because we know that translates into healthier outcomes down the road," says Becky Adams with the state's Department of Health. The Centers for Disease Control and Prevention featured research showing that the Arkansas program produced results in increasing employee's fruit and vegetable consumption.
Does bringing out the stick work better or more consistently? In Kansas, where employees are asked to report on tobacco use, the state had 2,875 employees enrolled in the tobacco cessation program last year. The program has a quit rate of 39.1 percent after six months. Dustin Moyer with the Kansas Health Policy Authority says that this success rate is higher than typical avenues employees might pursue to quit smoking.
While wellness and preventative programs' success may be hard to measure so far, it is fair to say that any push -- be it tied to an incentive or disincentive -- is a push in the direction of cost containment and healthier employees.
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