Alla tua Salute! 2007

Second annual corporate wellness awards share more best practices from local companies who’ve found ways to managee rising health care costs

Story by Sean Fitzgerald

How about making hand sanitizers more accessible to employees to help prevent the spread of germs in the workplace. Or providing a communal stock of vitamin C tablets for employees to take on a regular basis.

The two ideas cited above are simple approaches to improving the health of a company’s workforce, both introduced by a local employer named one of B2B’s 2007 Alla Tua Salute! award winners. After a successful inaugural year recognizing and honoring local companies for their wellness efforts, B2B reprised its Alla Tua Salute! awards this year to a higher number of area companies nominated for the award.

Alla Tua Salute – from the Italian expression “to your health” – was created last year to spawn a competitive environment among employers in the Fox Valley to become known as a healthy place to work. Why?

Because the economics of health care in the United States have been and will continue to be in a state of crisis until American patients learn to better manage their own health, and learn to consume health care products and services in an intelligent, cost-effective manner. That may sound too strict an indictment of ourselves, our family members, friends and neighbors.

But the fact of the matter is that after almost two decades of managed care and a couple generations of reliance on employer-based health care insurance, the average American health care patient is so far removed from the actual costs of care it’s difficult to make smart health care decisions. After years of trying to identify solutions to the issue of increasing health care costs, it’s become evident that fostering an environment where patients act as engaged consumers of health care and ultimately become the master of their own health lies in the hands of employers.

Many of the Fox Valley area employers who submitted nominations for the 2007 Alla Tua Salute! award have already come to such a realization, and have acted accordingly by implementing employer-based health and wellness benefits geared toward keeping their workforce healthier, have fewer absences from work, become more productive, and spend less money on health care. As a result, some of these companies have kept health care insurance premiums at an even rate in recent years without having to modify the structure of their benefits.

How can your company reach that level? Stay tuned.

A natural progression
The most resounding message from our 2006 award – won by Miles Kimball Co. of Oshkosh – and its corresponding article was this: If your company doesn’t employ some sort of wellness program already, a good place to start is with a health risk assessment.

Health risk assessments, or HRAs for short, provide data on each individual employee relative to cholesterol levels, body mass index, blood pressure, blood sugar levels and nicotine and alcohol intake. This snapshot of information isn’t intended to single out individual employees, and by federal law, can’t be used against employees to raise their individual premiums or as a means for discharge.

Typically, a third party can conduct the HRA among employees, gather the data and present the results to each individual employee in order to offer assurance of confidentiality to staff and serve as a legal buffer for the employer.

The employer typically receives composite results for the entire workforce who took the HRA – without any specific information identifying which employee received a particular score – so that the company as a whole can identify what the greatest health risks are within the organization and develop measurable goals for improving those risks. Onsite HRA can typically be conducted for between $50 to $100 per person.

All too often though, an employer will take the initial step and expense to provide HRAs for employees, but then shelve the results and not take any further steps to improve wellness. While all of our panelists agree the HRA is a sound first step, it’s only intended as a tool for providing a measurement, or benchmark for health. Employees can use the data from an HRA to pinpoint areas of their personal health and lifestyle that require targeted attention, and an employer can evaluate the group results to determine new programs that might benefit a large group of high or medium-risk employees.

“A health risk assessment is not wellness in itself, but it’s what you do with the information,” said Dan Morrill, an employee benefits consultant with The Starr Group in Oshkosh.

The results from HRAs – particularly when an individual employee compares results from year to year – help quantify in very real terms the improvement of one’s health. If a company can get a handle on those kinds of health improvements, it can gain a clear picture of the return on investment of its wellness dollars.

“We have so many companies spending a lot of money on these things, and they don’t have any way of measuring the impact of the money they’re spending,” said David Brand, a group/employee benefits specialist with FirstChoice Insurance Agency in Oshkosh.

The two winners of B2B’s 2007 Alla Tua Salute! Award have a history over the past five years offering HRAs to employees. But it’s what they do with those results, as well as a variety of other creative wellness initiatives, that prompted our panel of judges to select Miller Electric Manufacturing Co. and 4imprint for this year’s corporate wellness award.

“The thing I like about both of them is their exuberance for what they’re doing,” Brand said. “They get it out in front of their employees – they talk about it.”

Miller Electric
In the mid-1990s, employers of all sizes recognized rising health care costs weren’t just a one-time anomaly, but that it was going to become a regular, annual occurrence.

Many sat by, idly waiting with baited breath to discover the amount of the increase for the next year’s group health insurance premium. Only a small number of employers took action to do something about it.

Miller Electric Manufacturing Co. in Appleton was one of those employers, establishing a workforce-based wellness committee 10 years ago to promote more healthy living among employees. It wasn’t much at the time – the committee had a small budget and met just six times a year. But it was a start, and it laid the foundation for what has become a strong program embraced by management as well as employees throughout the company.

Every new employee who starts on the job at the manufacturer of industrial welding equipment is required to take a health risk assessment with the first 90 days of employment, said Patty Leiker, the health and benefits manager for Miller Electric. Existing employees take an HRA every two years.

“As part of our culture here, health is important,” Leiker said.

Miller Electric changed the format of its HRA from 2002 to 2004, so comparing the results would be akin to comparing apples to oranges. But it’s maintained the same HRA format since 2004, and is just beginning to see measurable results. Even more telling of the success of its wellness initiatives is the medical claims data it’s reported in recent years.

The company experienced a 25 percent increase in the claims it paid from its self-insured medical fund from 2002 to 2003, but in the next year it saw a 10 percent drop, and from 2004 to 2005, it faced only a 2 percent increase, Leiker reported. Claims data was not yet available for 2006 medical expenses.

The company – which supports about 1,300 employees in the Appleton area - began contracting with an on-site health coach through Ingenuity First two years ago to consult with each employee about three to four weeks after taking their HRA. The health coach – who’s on site about 32 hours a week - receives and maintains the employee’s individual HRA results in a sealed file unavailable to company management.

Those results then become the basis for the health coach to develop a plan of action for employees to improve their health through simple goals, such as drinking more water each day, taking the stairs rather than an elevator, or logging their daily nutritional intake.

“He’s very motivated to get our people to take baby steps (toward improving their health),” Leiker said.

As an incentive, employees achieving these behavior-changing habits for a period of three months or longer can earn points toward receiving paid time off.

That’s an intelligent approach to changing what’s truly at the core of exorbitant health care costs – that is, unhealthy lifestyle behaviors, said Michael Bina, a partner with Intellectual Marketing, a Green Bay-based research and marketing company with a special focus on health care. Modifying those behaviors, Bina said, might seem like an impossible task to an employer, but breaking that transition down to a number of manageable goals makes it a much more realistic endeavor.

“The way I like to see these programs set up is not to punish the high-risk people, but to give them small, achievable steps to get to improvement,” Bina said.

Miller Electric has maintained an on-site nurse for the past three years, also contracted through a third-party health care provider. The nurse provides regular blood pressure screenings, provides group sessions on nutrition and other health care topics, and acts as a first point of contact for employees who have questions about their own health but are perhaps reluctant to visit a clinic. At the beginning of this year, the nurse began providing a 10-minute stretching program for employees to exercise at the beginning of their shift.

Bringing a nurse onsite has become a growing trend among employers.

“There’s a lot of people that don’t have relationships with doctors,” said Morrill, who added that individuals not regularly using health care may be more willing to schedule an appointment with on on-site nurse. “For these people, any contact with the health care system is a step in the right direction.”

In addition, Miller Electric offers onsite flu shots, onsite first responder and CPR training, an onsite employee assistance program, and ergonomic evaluations of workstations. All company properties went smoke free in 2005, meaning employees aren’t even able to go outside during their regular 10-minute break for a cigarette. To help out employees who did smoke, the company offered a comprehensive smoking cessation program at no cost. The result - almost 30 employees have quit smoking altogether.

4imprint
Promotional marketing firm 4imprint in Oshkosh has built its human resources on the philosophy that satisfied, productive employees who don’t lament coming to work each morning is an effective approach to long-term profitability. The company is a two-time recipient of B2B’s annual Best Place to Work award, and its health and wellness initiatives are as creative and genuine as the rest of its employee benefit programs.

Among the first comments from our panel – one which had consensus across all three judges – is the hand sanitizer and vitamin C capsules the company provides for employees at each entrance to the building.

“Those are all teeny little things that can make a huge difference,” Bina said.

Morrill concurred, indicating that he plans to recommend this simple plan of action to each of his clients.

“Both of those together (the hand sanitizer and vitamin C) probably cost about $100 for the year, and if you can prevent just one employee from getting sick or from transferring their germs to another employee, then your return on investment is substantial,” Morrill said.

4imprint has been offering employees the chance to conduct a health risk assessment each year since 2002. 4imprint employees aren’t required to take an HRA – as is the case at Miller Electric – but those who do can receive a company reimbursement for 50 percent of the cost toward a health club membership, exercise classes, or the purchase of in-home exercise equipment, said Mary Curtin, vice president of administration at 4imprint. In 2006, about 60 percent of employees elected to take the HRA.

For the past few years, the 300-employee company has taken cumulative HRA results and used that data to tailor wellness programming toward employee needs.

“We took a look at the top three issues from the HRAs to try to determine where we could impact the most,” said Curtin. She cited a result from a recent HRA that indicated a surprisingly high number of employees hadn’t received tetanus shots in the last 10 years, so the company provided employees with onsite tetanus shots at no cost. It conducts a similar onsite clinic with flu shots once each year as well.

One day this past January, the company rented and brought into the office a bone densitometer for a half day and encouraged employees to take a no-cost osteoporosis screening. 4imprint holds a weekly classes at its offices after work hours for Pilates and yoga – employees still have to pay a nominal $24 fee for an eight-session course, but can use their wellness reimbursement if they took an HRA. An onsite Weight Watchers class has been meeting during lunch or after work for three years now, Curtin said.

Like Miller Electric, 4imprint has enlisted the assistance of a contracted nurse and wellness coach to visit the office regularly. Both the nurse and wellness coach provide regular guidance to employees on nutrition and exercise, and also help detect early warnings signs of health concerns. Curtin said staff visits with the nurse – coupled with recent HRA results – helped several employees identify that they have Type 2 diabetes, a diagnosis they likely wouldn’t have made otherwise.

“Whatever cost we’ve spent on HRAs and wellness pales in comparison to the costs we may have faced if those employees weren’t able to properly treat their diabetes,” Curtin said.

Other employers of note
Moraine Park Technical College in Fond du Lac had conducted a written self-assessment of personal wellness in the past – essentially, a written HRA, rather than drawing blood and testing it for cholesterol, triglycerides or nicotine, for example. But the college plans to abandon the test in the future because it felt employees weren’t as honest as they could be about the state of their health.

“That’s the flaw of self-assessment – because everyone is going to assess themselves in their favor,” Bina said.
Morrill agrees, noting assessments where the patient’s blood is drawn and lab tested for biometric data is necessary to give a complete and honest illustration of one’s health. Overall, he thought the college’s WellTech program include a number of components that have it on the right track.

“They are trying. This, to me, has the potential to be a great nomination down the road,” Morrill said.

The Oshkosh Area School District nominated its wellness initiative which has been in place since 1991. Both Bina and Brand noted that while the program was average in regard to what many private businesses sponsor for wellness, it’s groundbreaking for public education, which is often regarded for having some of the most expensive health insurance benefits of any industry.

“This could be a model for how school districts conduct wellness,” Bina said.

All told, the term “health insurance” in itself is a euphemism, Morrill points out, because such products are used more definitively as sickness insurance or as injury insurance.

What’s necessary to overhaul health care in the U.S., Brand believes, is to change each individual’s mindset of healthy living. Steps need to be taken along the way – not only to improve individual health now – but also to ensure it’s improved in the future. That’s the only way to drive bottom line results for medical claims spending in years to come.

“It’s like doing maintenance on a wooden boat – you don’t wait until the boat leaks to begin doing regular work on it,” Brand said.