Organizations are struggling with the transition from a commute-to-the-cubicle, 20th century Industrial Age environment where work is performed during set times in centralized locations to one that affords more control over when and where work is performed. As a result, many are also struggling with wellness programs, finding that staff lack the time in their daily schedules for sustained physical activity, as shown by the recently released 2013 Global Workplace Health and Wellness Report. The findings of the survey 378 organizations in various industries and a link to the report can be found in this Forbes article, Employees Don’t Have Time for Wellness Initiatives.
The survey’s finding that lack of time for exercise is a major obstacle for wellness programs is hardly surprising. The Industrial Age work style consumes most of people’s waking hours and energies in minimum 8-hour-long “shifts” and time sucking, stressful commutes. All involving prolonged sitting that studies show adversely affect health status. Then when they get home mentally exhausted, it’s more inactivity and collapsing onto the couch, often with take-out food. And we wonder why as a society we’re getting fatter and sicker.
Achieving wellness requires exercise. And sustained exercise done at least daily takes time. The implication to be drawn from the Global Workplace Health and Wellness Report is wellness isn’t so much as a “workplace” issue as a personal time management and lifestyle issue.
The good news is organizations have 21st century Information and Communications Technology (ICT) at their disposal to help alleviate the time crunch. ICT allows staff to work most any place and time, affording them more control over their personal schedules to engage in exercise programs in their own communities chosen by them and their health care professionals. While organizations clearly have a stake in the health of their members, health is ultimately an individual lifestyle choice. Making the right choice for health requires organizations provide their members sufficient control over their work schedules to exercise that choice.
Insurance no matter what variety assumes two kinds of risk. First, the underlying peril that could result in a covered loss, such as a windstorm or a fire in the case of homeowners insurance. Second, human hazards that can increase the risk of loss. For example, there’s moral hazard (such as filing a fraudulent claim to collect on the insurance by setting one’s house on fire) and morale hazard. What’s morale hazard? This definition is a good one:
A term used to describe a subjective hazard that tends to increase the probable frequency or severity of loss due to an insured peril. Morale hazard, as contrasted with moral hazard, does not imply a propensity to cause a loss but implies a certain indifference to loss simply because of the existence of insurance. For example, an insured’s attitude may be indifferent if a loss occurs because they have insurance. (Emphasis added)
The emphasized part is directly applicable to and has major implications for health insurance. In the context of health insurance, a clear example of morale hazard would be the failure to engage in health promoting behaviors and lifestyles. For instance, an individual with a family history and propensity to develop cardiovascular disease eating an unhealthy diet and not regularly exercising. Granted, that individual may not want to have a stroke or heart attack. But if they have the attitude that they can shift the risk of costly medical care should that happen to their health plan, they may be less motivated to adopt a lifestyle to help head off those eventualities.
As one strategy to stem rising costs, health plans must strike a balance between providing people the peace of mind that comes with having coverage for potentially financially ruinous medical costs while also motivating those they cover to take responsibility to avoid them.
This becomes especially critical starting this October, when health plans in the individual market must begin pre-enrolling applicants for coverage beginning January 2014 regardless of medical condition or history. No longer will plans be able to practice risk avoidance to control claims costs, rejecting those deemed too risky to cover or charging small employers higher rates based on the medical condition of their employees.
That leaves mitigation of morale hazard as their only remaining form of risk management. Large employers as well as smaller ones are looking to so-called “workplace wellness” programs as a form of addressing morale hazard, including contingent wellness programs that provide employees economic incentive to engage in health promoting behaviors to reduce the likelihood of their incurring major medical costs. Whether such programs have a meaningful impact remains to be seen given mixed outcomes such as reflected in this 2011 survey and a study published this week in Health Affairs.
With limited financial incentives available to both plans and employers to reduce morale hazard, it will likely take a big shift in societal attitudes to achieve a measurable reduction. For example, viewing both personal health and health coverage as a common social good that should be respected and preserved. If the resources to pay for health care are shared and finite – and they are – we should regard them as a societal asset that should be preserved. That change in outlook will also require us to re-examine our values and strive for balance in our lives that supports preserving our individual and collective health.
Knowledge workers earn their livings analyzing, abstracting and communicating. In today’s Information/Internet economy, all too many knowledge workers needlessly do so working under legacy Industrial Age 8-5 office schedules, spending even more time each day relatively immobile than sleeping. Add to that another 1-3 hours spent sitting in a daily commute to a central office location. Month after month, year after year of this occupational lifestyle sets the stage for the development of preventable chronic conditions such as diabetes, hypertension and obesity that drive the health cost curve and the health insurance crisis.
But that’s not all. Lack of physical movement can also dull the knowledge worker’s most important tool: their brain. This Sacramento Bee article cites research linking physical activity to the brain’s ability to perform learning and memory tasks.
The clear conclusion to be drawn is sustained exercise could produce dividends for organizations by not only lowering their healthcare and insurance costs, but also the added bonus of better and more creative thinking. For knowledge organizations, affording workers control over their schedules and time for sustained exercise probably is likely the most cost effective “workplace wellness” program going. A key program component is ditching outmoded Industrial Age commuting and office hours and becoming a more virtual organization and maximizing the use of Information and Communications Technology (ICT). Knowledge work can be done anywhere, and some of the most creative thinking happens during and after sustained exercise. That requires freeing up time for it every work day by getting people out of their cars and cubicles.
In November, the U.S. Department of Health and Human Services (HHS) issued a proposed rule governing wellness programs offered as part of employer-sponsored health plans for plan years beginning January 1, 2014. The proposed rule is aimed at boosting incentive for large employers to increase the health status of their employees since large employers will be continue to be regarded as discrete risk pools under the Patient Protection and Affordable Care Act, whereas small employers will be collectively treated as a single risk pool.
In addition to the traditional participatory wellness programs such as discounts on fitness club memberships, health assessments and seminars, the proposed rules create an enhanced incentive for employers to offer health contingent wellness programs. The contingency? Employees must adopt a lifestyle changes and health improvement plans designed to help them reach target biometric goals such reducing weight, body mass index (BMI), blood pressure, or cholesterol levels. If they hit the prescribed targets, the proposed rule would allow employers to reward the employee with a payout of up to 30 percent of the cost of the employee’s health coverage for the plan year, an increase over the current 20 percent permitted under rules adopted in 2006.
The rulemaking’s preamble suggests HHS believes the increase in the maximum reward is necessary to boost participation in contingent wellness programs. It cites a 2010 survey by NBGH and TowersWatson in which just four percent of responding employers reported offering financial incentives for maintaining a BMI within target levels. Only three percent did so for maintaining targets for blood pressure and cholesterol levels. Based on these numbers, increasing the maximum award level alone isn’t likely to produce a significant increase in the number of employers and employees participating in contingent wellness programs.
However, if such programs were joined with affording employees greater control over when and where they work, participation could increase substantially and employers would see a potentially large payoff in improved employee health status and reduced medical utilization. Schedule control eliminates the “I don’t have time” excuse for not engaging in health promoting behaviors such as regular exercise and getting sufficient amounts of sleep. If employers want employees to take responsibility for their health, they must give them the means to adopt healthy lifestyles and avoid the daily sedentary (and hardly health promoting) routine of commuting to and from and sitting in a centralized office. Plus they would likely enjoy the added bonus of crisper and more creative thinking and better ideas from employees getting plenty of sleep and exercise thanks to having more control over their work schedules.
SAN FRANCISCO – September 12, 2012 – With the upcoming presidential election hinging on health care and the economy, analysis shows that poor health and its impact on productivity costs the U.S. economy $576 billion per year. This is according to estimates by the Integrated Benefits Institute (IBI), a nonprofit health and productivity research organization.
In addition to showing the entire financial burden of poor health, IBI researchers found that 39 percent—or $227 billion—is due to lost productivity associated with poor health. Lost productivity results when employees are absent due to illness or when they are underperforming due to poor health (“presenteeism”—when employees are at work but not performing at their peak).
This is a staggering number and clearly indicates Americans need to change how they work and live to achieve healthier and more balanced lives. The status quo harms their quality of life as well as the fiscal health of their employers.
Aon Hewitt’s survey shows a growing number of employers are beginning to link incentives to a result, as opposed to simply participating in a program. Of companies that offer incentives, 58 percent offer some form of incentive for completing lifestyle modification programs, such as quitting smoking or losing weight. About one-quarter offer incentives for progress or attainment made towards meeting acceptable ranges for biometric measures such as blood pressure, body mass index, blood sugar and cholesterol.
* * * * *
“Employers know that eight health behaviors, including risks such as lack of physical activity and failure to complete recommended preventive screenings, drive 15 chronic conditions that lead to higher medical costs and increased absence from work. An effective incentive strategy rewarding those who take action to improve their health is fundamental for improving health and reducing cost,” said Stephanie Pronk, clinical health improvement leader for Health & Benefits at Aon Hewitt.
Rather than offer incentives for healthy lifestyle choices, employers seeking measurable gains in the health status of their workforces and decreased medical utilization for preventable conditions should afford employees more control over their schedules in order to free up time for exercise and adequate sleep. One of the biggest reasons employees don’t exercise is lack of time — largely due to the outdated expectation that they must commute to an office five days a week in order to perform their jobs. It effectively chains workers to their cars and their desks most of their waking hours and is a prescription for employee sickness, not wellness. This situation cannot be rectified with any amount of “wellness” incentives. Instead of trying to bribe workers to take better care of themselves, employers should treat them as adults and give them more responsibility and control over their schedules as long as they get their work done. How? By adopting a Results Only Work Environment (ROWE).
In today’s business world, there are plenty of things to be sick about. Urgent deadlines (even when some aren’t urgent), constant interruptions (how many times do you need to hear about Steve’s weekend?!), way too many meetings, endless politics that waste precious energy that could be aimed at the actual work – not to mention an all-around lack of sleep. These reasons, and so many more, can lead to workers who are just plain miserable.
So when we say that the workplace is full of “healthcare” issues, we mean a bit more than benefits. The health of any office is tied to a number of factors beyond the doctor’s office, and it would seem that even the best insurance plans can’t protect against the evils of limited vacation time or long commutes.
ROWE presents a true workplace wellness program that can get real results, reducing health care utilization. It goes beyond gym membership subsidies (not beneficial if people don’t have time to go there) and symbolic gestures like award certificates for serving healthy snacks at meetings.