The Effectiveness and Participation in Wellness Programming New

The Effectiveness and Participation in Wellness Programming
The Effectiveness and Participation in Wellness

Programming:
A Recommendation for An Empirical Research Report
December 15th, 2014

Research Team
Hannah Forkel
&
Cassidy Helms
Table of Contents
EXECUTIVE SUMMARY:
STUDY OBJECTIVES
PREVALENCE OF WORKPLACE PROGRAMS

FIG. S.1 FROM KAISER SURVEY OF EMPLOYEE SPONSORED HEALTH BENEFITS, 2012
FIGURE S.2 FROM MEDICAL EXPENDITURE PANEL SURVEY, 1998
4
5
6
EVIDENCE FOR PROGRAM IMPACT
FIG. S.3. FROM RAND HEALTH WORKPLACE WELLNESS PROGRAM STUDY, 2012
KEY FACILITATORS TO A SUCCESSFUL PROGRAM
7
7
DISEASE MANAGEMENT AND LIFESTYLE MANAGEMENT
RETURN ON INVESTMENT
FIG. S.4 FROM RAND HEALTH WORKPLACE WELLNESS PROGRAM STUDY, 2012
INDIANA SPECIFIC SOLUTION SUPPORT
9
10
FINANCIAL INCENTIVES
CURRENT STATE OF WELLNESS PROGRAMS FOR EMPLOYEES AT THE UNIVERSITY

OF SOUTHERN INDIANA
11
METHODS
12
SUBJECTS
INTERVIEWS (APPENDIX A)
CONSENT (APPENDIX B)
OBSERVATIONS
12
13
13
13
RESULTS
13
DISCUSSION
14
CONCLUSIONS AND RECOMMENDATIONS
15
APPENDICES
17
APPENDIX A - INTERVIEW QUESTIONS TO HUMAN RESOURCES DEPARTMENT

APPENDIX C PARTICIPANT CONSENT FORM
17
19
REFERENCES
21
Executive Summary:
This empirical research report investigates the characteristics of workplace wellness
programs, their prevalence, their impact on employee health, the resulting medical cost and the
key facilitators in a successful program. The study explains how participation in a wellness
program is typically associated with lower health care costs and decreasing health care use. Due
to employees health improving, there is an overall positive affect on the companies who offer
such programming.
With happier employees, the companies saw many positives within their return on
investments. Financial incentives drove participation and more employee involvement caused an
increase in participation by word of mouth. The employees who were satisfied with the
programming and saw results were more likely to share with their coworkers their success stories
and therefore, other employees would then become involved.
Workplace wellness gives employees access to programming at an age when
interventions can still greatly change the long-term health of employees. Typically, these
programs do not work yet data is not regularly being collected to discern how this can be
corrected. Wellness programming has grown into a six billion dollar industry according to the
New York Times, yet surveys completed show the response to programming is considered
somewhat effective.
The Affordable Care Act encourages wellness programming and raises legal limits on
penalties and allows employers to, for example, raise premiums of tobacco users 50 percent.
Employers misunderstand research and believe that any program is effective but the key is welldesigned programs. Employers cannot continue to only focus on lifestyle and weight
management in their programming but rather calculate what the employees need and have a wide
variety of programs.
Study Objectives
This report addresses the following questions:
What are the characteristics and prevalence of current workplace wellness programs?
What are the participation rates in current university wellness programs?
What is the impact and effectiveness of a successful wellness program?
In what ways is the current university wellness program achieving t
How can program effectiveness be improved regarding participation rate and apathy of
employees toward wellness?
Prevalence of Workplace Programs

RAND Survey Research Group conducts general population surveys. The general population
consists of elderly, Medicaid recipients, and families with small children, etc. They plan, collect
data and then provide data analysis on surveys.
According to the RAND Employer Survey conducted for this study, approximately half of US
employers offer wellness promotion initiatives, and larger employers are more likely to have
more complex programs. Programs of this scale often include wellness screening activities and
preventative intervention. The following graph, figure S.1, shows the percentage of companies
offering different wellness programming both large scale and small.
Fig. S.1 From Kaiser Survey of Employee Sponsored Health Benefits, 2012
Preventive interventions target employees with risk factors for chronic disease and improving
disease control in employees suffering from chronic conditions. Employers will typically offer
specific intervention management programs such as nutrition and weight loss, smoking, overall
fitness, alcohol and or drug abuse, stress management, and health education concerning specific
conditions.
The following chart, figure S.2, shows how these chronic conditions effect healthcare cost.
Figure S.2 From Medical Expenditure Panel Survey, 1998
Evidence for Program Impact

Of the employees who participated in the programming, fewer than half, according to RAND,
undergo clinical screening. The employers screened for:
Diabetes
Asthma
Coronary Artery Disease
Heart failure
Depression
Cancer
COPD/Emphysema
Back Pain
When comparing the wellness program effects on significant and clinically meaningful
improvements in exercise frequency, smoking behavior and weight control, the observations
showed low employee participation in programs according to RAND. The following illustration,
figure S. 3, illustrates these findings.
Fig. S.3. From RAND Health Workplace Wellness Program Study, 2012
Key Facilitators to a Successful Program

According to RAND, the studies they completed on the different types of wellness programs
found the following factors to aid in the assistance of a successful program:
Broad outreach and clear messaging from organizational leaders.
Making wellness activities convenient and accessible for all employees.
Making wellness an organizational priority among senior leaders.
Leveraging existing resources and building relationships with health plans to expand
offerings at little to no cost.
Approaching wellness with a continuous quality improvement attitude, and solicit

feedback from employees to improve programs.
Disease Management and Lifestyle Management

According to RAND, management of disease programs will have many short term benefits
whereas lifestyle management programs provide more long term benefits. The short term risks
showed that intervention avoided risks with heart disease, diabetes, emphysema, heart attack,
amputation due to diabetic complications and pneumonia. The long term effects of lifestyle
management programs assisted in the avoidance of pre-diabetes, cancer and hypertension.
Return on Investment
Typically, employees participate in lifestyle management programs but the bulk of these
healthcare cost savings come from disease management programming. According to RAND, out
of the employees that participated, 87% participated in lifestyle management programs and 13%
participated in disease management programs. The following figure, illustration S. 4, shows the
return on investment according to the type of programming.
Fig. S.4 From RAND Health Workplace Wellness Program Study, 2012
Indiana Specific Solution Support

According to RAND Health, sponsored by the U.S. Department of Labor and the U.S.
Department of Health and Human Services, a comprehensive analysis of 42 published studies of
worksite health promotion programs showed that companies that implemented an effective
wellness program realized significant cost reductions and financial gains, including:
An average of 28% reduction in sick days
An average of 26% reduction in health costs
An average of 30% reduction in workers compensation and disability management claims
An average $5.93 to $1 savings-to-cost ratio.
Within this study, 92% of the companies with a wellness program in place agreed that these
programs are effective, and 47% reported the programs are very or extremely effective. In
addition, 44% of employers agree they are able to offer lower health insurance premiums as a
result of their wellness program, and 61% agree they have a healthier workforce as a result of
having a wellness program in place. The DuPont Corporation decreased disability days at its
Tennessee plant by 14% after instituting a wellness program, saving almost $120,000 annually.
Financial Incentives
Employers understand that employees who participate in wellness programs take a more active
role in their healthcare, which makes an impact on the bottom line as well as health outcomes.
The following chart, Figure S.5, calculates employees who were asked, Which of the following
would incentivize you the most to complete a wellness program? The results of the
questionnaire found that direct financial incentives are valued more than riskier incentives.
FIGS.5 From RAND Health Workplace Wellness Program Study, 2012
10
Current State of Wellness Programs for Employees at the University

of Southern Indiana
Presently, there are three wellness programs available to full-time employees of the University of
Southern Indiana:
Time to Get Fit
Anthem Wellness Programs
Wellness Programs for Employees electing Lumenos CDHP/HAS
Time to Get Fit is a program organized directly through the Human Resources department of
the University of Southern Indiana, that gives employees the option of one paid hour of
participating in the exercise options outlined in the program which include:
Walk/Jog/Swim/Bike/Stairstep Program, Climb Mt. Everest Program, lunch time aerobics,
other fitness activities sponsored by the Employee Wellness Committee , USI Fitness Center
usage and activities , University intramural events occurring during working hours , independent
exercise activities conducted on campus , and USI Physical Activities Center usage. The
remaining two programs are offered through Anthem, an outside wellness provider, to those who
are already receive their health coverage from Anthem Blue Cross Blue Shield and include
services such us: The 24/7 Nurse Line, ConditionCare, Future Moms, MyHealth Advantage,
MyHealth Coach, Healthy Lifestyles, ComplexCare, Comprehensive Medical Management.
Potential problems that are seen in each of the programs have to do with the obvious
exclusions that each possess. Time to Get Fit does not support or cover any exercise options that
are outside of the immediate campus of the university. While employees come from many areas
of the Evansville metropolitan area, the program only supports exercise as it is done within the
11
limits of the university. Expansion of this program to wellness centers could increase employee
participation by offering more convenient locations and services for improving wellness, The
Anthem wellness programs have the obvious exclusion of all employees that are not covered by
Anthem Blue Cross Blue Shield health insurance.
Methods
In order to accurately determine the effectiveness of university wellness incentives and programs
our study will include a combination of both interview and observation of our subjects. Both will
be conducted after the study subjects have read and signed the proper consent forms. Interviews
will be conducted in order to hear the direct opinions of the subjects on the effectiveness and
convenience of the wellness program in which they participate and how they would feel better
equipped to participate if there was any need for improvement. Observations will be conducted
in order to add credibility to the participants motivation and participation in the said program.
Before any of these research procedures are conducted, participants will be informed of the
extent of the procedures, the risks, the benefits, and their obligations regarding this study.
Subjects
Subjects for this study will be those employees who are directly involved in the wellness
programs (providers and participants) offered by the university as well as those employees who
are not involved. Observations and interviews conducted on those who are involved in the
wellness programs will also be varied by age as much as possible to determine the amount of
awareness and interest in the program by age. Study subjects who are not involved in the
wellness programs offered by the university will also vary in age to make the sample of subjects
congruent on both the participating side and non-participating side of the study and will only be
12
interviewed to ascertain the reasoning for not participating in the offered programs and if there
was any additional conditions or incentives that could be added to persuade them to begin
participation in the universitys wellness programs.
Interviews (Appendix A)
Consent (Appendix B)
Observations
Observations will be made in a structured manner, based on specific behaviors that have
been previously decided are pertinent to the goal of this study. These behaviors might include:
the interactions made between the subject and others during the activity, amount of time spent
doing the activity, what types of activities are performed, and the amount of time spent
performing the activity in compared to the amount of time total spent at the facility.
Results
The study produced evidence for changes in programming in all workplaces. The
University of Indiana can be preemptive in their programming by better calculating their
employees health and participation by making changes. The ultimate goal is participation
because across the state there are significant health issues and chronic conditions that could be
prevented.
The University of Southern Indiana can greatly benefit from financial advantages of these
preventative programs. There is limited information of the differential impact of different
incentive types for both employees and employers. Employees benefit from healthier lifestyles
and employers benefit from lowered health care costs over time. This information is not properly
13
quantified at this time. Questions that arise with further research can be answered with proper
data collection to help optimize incentives. The research we completed is only a fragment of the
bigger collection of information that can be and should be gathered.
Discussion
After contacting Human Resources at the University of Southern Indiana conclusions
about employee participation cannot be made due to the confidential relationship between
Human Resources and university employees. However, additional investigation can be done
among the general pool of university employees to determine awareness and participation in
university wellness programs.
Feedback from the Human Resources department does indicate an interest in more that
just physical wellness as the statement was made by Donna Evinger, Director of Human
Resources, We have resources available in the dimensions of emotional, intellectual, spiritual,
occupational, environmental, social/cultural, physical, and financial health. Also, in regard to
incentives, personal well-being is the number one incentive she sees for participation in
university wellness programming. Financial and work-related incentives only apply to full-time
university employees.
Benefits are not seen as limited to employee participants, and the university is seen as
benefitting from such programs with a reduction in sick leave, injury, illness, and health
insurance costs.
In respect to the study, the wellness programming offered by Human Resources seems to
have all of the necessary goals and benefits of a successful wellness program. The question our
14
study plans to answer in greater depth is whether or not there is enough participation and
awareness in order for this programming to meet its goals and if not, how the programming
could potentially be improved.
Conclusions and Recommendations

Our project combines statistical information, research into the University of Southern
Indianas fitness programming and Indiana specific issues that demonstrates the need for
effective programming. The wellness programs put in place by workplaces, according to our
study and other research studies, shows an improvement in employee health. Even though
employee engagement in programs remains limited, incentives can greatly increase employee
involvement and further research is needed to see the long-term effects, both intended and
unintended.
A clearer picture will emerge as more information becomes available. The employers
commitment to long-term benefits for employees is crucial in order to contain health care costs.
The more information that can be collected, the better employers can ensure affordability of
coverage. The components of typical wellness strategies includes screening, preventative
interventions, and health promotion benefits.
Consistent with prior research, lifestyle management programs reduce the common risk
factors among employees. The results for these types of changes are critically important and can
be substantial overtime. The employers willingness to restructure programming is equally
necessary. Leadership support and changes to corporate policies in ineffective programming
needs to be regularly addresses. If a program does not work or ceases to work, restructuring must
be considered and implemented.
15
Changing benefit design can encourage healthy behaviors because of the imbedded
incentives as part of the health care coverage and incentives offered directly. The biggest
obstacle employers face is the engagement of employees. Surveys confirm that participation
remains low and in order to promote uptake, incentives are crucial. Small incentives cannot be
calculable in the span of participation rates, but a large incentive such as $100 per year off costs
of healthcare is more measurable.
In order to see what and who is participating at the University of Southern Indiana in
programming, there needs to be a larger scale study completed. Other comparable workplaces to
the University of Southern Indiana, who have already completed empirical research, should also
be consulted. Employees should be directly connected to their role in remaining healthy so they
should be considered when making effective programming.
The long-term impact of the University of Southern Indianas programming needs to be
measured starting in 2015, if no research is currently available. Once this information is
collected, it can be examined more thoroughly. A broader sample can allow generalizations of
results to a larger population of employers. Investing in the health of the workforce does produce
positive effects but they need a specific measurement completed.
16
Appendices
Appendix A - Interview questions to Human Resources Department
1.
Tell me about the different wellness programs you have.

a. What are their requirements?
b. What are their benefits?
c. What are the incentives?
2.
Do you know what the employee participation rate is in university-sanctioned wellness
programs? If so, could you share that rate?

3.
Do you collect participator feedback on each of your wellness programs?
4.
What type, if any, of feedback have you gotten?
5.
What strengths and weaknesses do you see in the current execution of the wellness
programs for USI employees?

6.
Do you have any future plans for improvement or implementation in the existing programs?
Ideas for new programs? If so, and you can share them, what are these plans, generally speaking?
17
Appendix B Employee Participant Interview Questions

1. Tell me about how you view wellness.
2. How do you personally achieve wellness?
3. Do you participate in any wellness programs offered at the University of Southern
Indiana?
4.
If so, is the program you participate in offered through the university?

a. What is its benefits?
b. What are the incentives?
c. What are the requirements
d. Do you feel that the benefits and incentives justify the requirements?
5. If not, do you see a need for wellness programming at an institution such as this
university?
6. Have you ever been asked for your feedback on wellness programs offered at the
University of Southern Indiana?
7. How do you feel that you would be better served as a university employee through either
on campus or off campus wellness programming?
18
Appendix C Participant Consent Form
University of Southern Indiana

Effectiveness and Participation in Wellness
Programming
You are invited to participate in a research study on the wellness programs offered by the Human
Resources department of the University Southern Indiana This study is being done by Cassidy Helms and
Hannah Forkel under the supervision of Dr. Melanie Lee. Cassidy Helms can be reached by e-mail at
chelms2@eagle.usi.edu or by phone at (812) 486-7048. Hannah Forkel can be reached by email at
hforkel5@gmail.com or by phone at (812) 215-0330.For questions about your right as a research
participant or to discuss problems, complaints, or concerns about a research study, or to obtain
information, or to offer input, contact the University of Southern Indiana Office of Sponsored Projects
and Research Administration, 8600 University Blvd., Wright Administration Rm. 104, Evansville, IN
47712-3596, 812-228-5149 or by email at rcr@usi.edu. We ask that you read this form and ask any
questions you may have before agreeing to be a part of this study.
Purpose: The purpose of this study is to accurately assess the effectiveness of university wellness
programs and to recommend possible improvements that could attract and better serve university
employees.
Procedures : Research procedures can include any of the following: the interview of the participant
regarding why they do or why they do not participate in university wellness programs, observation of a
study participant who also participates in a university sanctioned wellness program during participation,
and a follow up interview to the observations taken during the physical activity.
Time Commitment: The time commitment for this type of study can vary depending on the participants
involvement in a university wellness program. Time dedicated to being a study subject could range from
1-3 hours including interview and observation time.
Risks and Benefits: The risks for are very minimal due to the minimal amount of personal information
required as well as the minimal amount of time required to be a participant in the study. Possible risks
could include discomfort in answering questions about why you do or do not participate in university
wellness programs and how you would improve what programs are already in place through the Human
Resources department. Also, discomfort could arise while being observed during exercise.
The benefit of this study would be the improvement of university wellness programs for employees and
overall improvement of employee health.
Confidentiality: Efforts will be made to keep your personal information confidential. All data-containing
files will be stored on a flash drive that will be kept in a locked location during the research period and
19

also during the data analysis period. Upon the conclusion of data analysis and the publishing of research
findings, the researchers will destroy the drive containing any individual identifiers. Research data will
never uploaded to any file sharing drive or service and will not ever be uploaded to an email account.
However, absolute confidentiality cannot be guaranteed. The above measures will be taken to ensure that
all precautions were taken to ensure your identity will be held in confidence to in the event that the study
may be published and in databases in which your information will be stored.
Compensation: There will be no monetary compensation for participating in this study.
Volunteering for the Study: Taking part in this study is voluntary. You may choose not to take part in
this study or leave at any time during the study. Leaving the study will not result in any penalty or loss of
benefits to which you are entitled. Your decision whether or not to participate in this study will not affect
your current or future relations with the researchers.
Alternatives to taking part in the study: As mentioned above, there is no obligation to participate in
this study and you have the choice to not participate in the proposed study or leave the study at any point
in which you feel that the benefits of the study are being outweighed by the personal risks.
Participants Consent: I have read the information provided to me. I have had all my questions answered.
Based on the statements listed above, I give my consent to participate in this research study. I agree to
take part in this study.
Participant signature: _____________________________________________
Date:______________
20
References
111th Congress (2010). Patient Protection and Affordable Care Act.
Aldana, S. G., R. M. Merrill, et al. (2005). "Financial impact of a comprehensive multisite workplace
health promotion program." Preventive Medicine 40(2): 131137.
Baicker, K., D. Cutler, et al. (2010). "Workplace wellness programs can generate savings." Health Affairs
29(2): 304311.
Centers for Disease Control and Prevention (2010). "Chronic Disease Overview. 2011." As of March 11,
2013: http://www.cdc.gov/chronicdisease/overview/index.htm
Hochart, C., and M. Lang (2011). "Impact of a comprehensive worksite wellness program on health risk,
utilization, and health care costs." Popul Health Manag 14(3): 111116.
KFF/HRET (2012). Employer Health Benefits: 2012 Annual Survey. Menlo Park, Calif; Chicago, Ill: Kaiser
Family Foundation/Health Research and Educational Trust.
http://ehbs.kff.org/pdf/2012/8345.pdf
Mercer (2010). National Survey of Employer-Sponsored Health Plans: 2009 Survey Report. New York.
U.S. Department of Health and Human Services (2004). Prevention: a Blueprint for Action. Appendix F
Incentives for Healthy Behavior. Washington, DC. As of July 28, 2011:
http://www.health.state.mn.us/divs/hpsc/hep/transform/resourcebook/preventiontab18.pdf
U.S. Department of Labor. "FAQs about the HIPAA Nondiscrimination Requirements." As of April 6,
2011: http://www.dol.gov/ebsa/faqs/faq_hipaa_ND.html
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