Wellness

Workplace Wellness

Dr. RookeDr. Jennifer Rooke is a Board-Certified Occupational Medicine Specialist who uses her knowledge and experience in Lifestyle Medicine to provide an effective workplace wellness program that will improve the health of employees and produce a healthy return on investment for employers. Call 404-769-3928 for more information and a workplace consultation. This is a wellness program that works!!! 

Most employers have three sets of health-related costs – the cost of workers compensation premiums, the cost of health benefit plans, and the cost of lost productivity due to poor employee health. When the full cost of emiceberg-and-healthcare-costs1ployee health is analyzed, the first two direct costs are just the tip of the iceberg. Loss of productivity from absenteeism and presenteeism have a far greater economic impact on a business. The impact of absenteeism is obvious, employees are not doing the work that they are paid to do, but presenteeism may be a new term to you. Presenteeism means that employees are present at work but their productivity is impaired by one or more health conditions or social problems. The resulting poor work performance  may cost an employer as much as 4 times the direct costs of doctor visits and medications. You can see from the chart below that some health conditions cost employers more than others. An effective workplace wellness program improves employee health and produces return on investment (ROI) by targeting the underlying causes of the costliest health problems.

Top 10 Doctor Diagnosed Health Conditions by Annual  Medical, Drug, Absenteeism and Presenteeism Costs/1000 Full Time Workers
total cost od care

You can see from the chart above that the 7 health conditions that cost employers the most financially are:
Depression and anxiety
Chronic pain – arthritis, back, neck and other pain
Obesity
Gastroesophageal reflux (GERD) also known as indigestion
Allergies
Cancer
Hypertension

The good news is that all of these health conditions are related to lifestyle and are preventable and reversible with a well designed workplace wellness program. The bad news is that most current workplace wellness programs focus mostly on getting employees to exercise, advising them to just eat less of the Standard American Diet that is causing the health problems in the first place, and screening them for disease management with medications. These strategies are ineffective because they do not address the underlying causes of these conditions.

The Rand Report on Workplace Wellness sponsored by the U.S. Departments of Labor
and Health and Human Services and released in May 2013 found that the
Exercise guyaverage participant in current wellness
programs did not have any significant weight loss. After 3 years of participation the average 5’4″ woman weighing 165 pounds lost an average of 0.9 pounds a year and the average 5’9″ 195 pound man lost 1 pound. Seriously! 3 pounds lost after 3 years of effort!?!

An April 2013 University of California study for the state legislature analysed dozens of existing studies of workplace wellness programs and found that participating in work-based wellness programs did not lower blood pressure, blood sugar or cholesterol and rarely led to weight loss.

It is not surprising then that less than half of employees participate in the wellness programs offered by their employers. Only 46% of employees get a wellness physical exam or complete a health risk assessment (HRA). Far fewer participate in fitness (21%), smoking cessation (7%), weight loss (10%) or disease management programs (16%).obamacare-logo_full Participation rates are expected to increase in 2014 when the Patient Protection and Affordable Care Act (Obamacare) allows employers to shift health care costs to employees and penalize then financially for not participating in wellness programs or achieving desired health outcomes. This is unfair to employees if employers choose to implement “wellness” programs that are not effective. Employers have to chose programs that actually make employees well and produce ROI not only to the employer but to the employees who spend time and effort to participate.

Employers surveyed for the Rand Report were unaware of the ineffectiveness of their workplace wellness programs. They “overwhelmingly expressed confidence that wellness programs” would reduce costs. Only about half had actually evaluated program impacts and only 2% reported actual savings estimates. Only one company had requested an assessment of cost trends from it’s health plan. Analysis of cost data suggested that participation in a wellness program over 5 years was associated with lower health care costs and decreased health care use which resulted in a total average annual cost saving of $157, this was not statistically significant. This analysis did not take absenteeism and presenteeism cost savings into account, but even so, if the average employer spends $521.00img-roi per employee on vendor costs and program incentives, no math is needed to see that there is no ROI.

The myth of ROI from wellness programs stems partly from a January 2010 Health Affairs article “Workplace Wellness Programs Can Generate Savings,” Professor Katherine Baicker estimated that medical costs would fall about $3.27, and absent day costs would fall by $2.73 for every dollar spent on wellness programs. Those figures have been widely quoted by wellness vendors in their sales promotion materials but there has been no evidence from actual wellness programs to support these figures. On July 24 NPR Marketplace program Professor Baicker, walked back from those predictions saying “it’s too early to tell.” Johnson & Johnson, the most renowned state-of-the art award-winning workplace wellness program will not disclose it’s ROI numbers or the overall cost of its wellness program. Safeway the company that inspired the incentives/penalties in Obamacare has actually seen increased cost trends since their wellness program started in 2009 and have not released recent ROI reports.

One of the reasons for lack of significant health improvements from wellnresults is the exercise. Myth of exercise Most programs are based on the exercise myth that people are overweight and have health problems because they are lazy and don’t get enough exercise. If you do a random survey of the overweight people you know, you may be surprised to find that most are walking or going to a gym or work in a job with high physical demands. The problem is not lack of exercise but that exercise alone does NOT produce weight loss. The average person quits after about 8 weeks of no results on an exercise program. Those who stay with the program may be fitter and believe they are healthier but if arteries are still clogged by atherosclerosis they are still at risk for a costly heart attack or stroke.

Another reason for no ROI is screening for diseases to treat with medications. Screening based on the US Preventive Service Task Force guidelines is necessary but unnecessary screening increases costs and employees may actually be less productive after they start certain medications. Lipitor-may-increase-diabetes-riskCholesterol lowering statin drugs are good example, the FDA warns that these drugs may increase the risk of diabetes, memory loss, mental confusion, forgetfulness, muscle damage and liver injury. If they prevented heart attacks, the benefits may outweigh the risks but a 2008 study found that over 2/3 of the people hospitalized for heart attacks had cholesterol levels within the normal range. This is because a high cholesterol level is really just a warning sign that your arteries are clogged by atherosclerosis, but you can have atherosclerosis with a normal cholesterol level.  When an employee is found to have a high cholesterol level the first step should NOT be a drug that may give them diabetes and impair mental function, it should be a Lifestyle Intervention that is scientifically proven to improve mental and physical function by reversing atherosclerosis and increasing blood flow to the brain, heart and all body parts. This is the low-cost approach that produces real wellness and ROI.

Choices concept.Choices have consequences, asking employees to take responsibility for their health and pay for their poor health choices is not a bad idea, but they may also be paying for the poor choices of their employers. If an employer chooses an ineffective wellness program that produces 1 pound of weight loss a year, no real health improvement and more medications, then it is unfair to penalize an employee for not participating or not achieving expected health outcomes. Employers who plan to penalize employees for their health choices have to be sure that the wellness programs that they chose is worth the time, effort and cost of participation.

geico geko 2There are effective workplace wellness programs: the program at GEICO is an example. In 2010 the Physicians Committee for Responsible Medicine (PCRM) conducted a study at GEICO headquarters that focused on changing the eating habits of employees. The average participant in this study lost 11 pounds in 22 weeks. A more recent geographically diverse study of GEICO workers in 10-cities produced an average weight loss of 6.4 pounds in 18 weeks.Cant out exercise bad nutrition At an average of 0.4 pounds per week the 195 pound man in the Rand study who only lost a pound a year would have lost 20 pound a year and be in the normal BMI range in the second year of the program, without added exercise. If he was a manufacturing and production worker he may have been getting enough physical activity at work and did not need to add more. If he was an office worker that was not getting physical activity he would be encouraged to start an exercise program to maintain his weight loss. An exercise program is ideal for weight and heath maintenance but NOT for weight loss or disease reversal

2013-06-16 12.13.02Advanced Lifestyle Medicine offers a comprehensive 12-week workplace Lifestyle Intervention that includes evidence-based nutrition, stress management, relationship skills and fitness assessments with activity prescriptions. The intervention is followed by monthly follow-up sessions to help employees sustain healthy habits. The program interfaces with primary care physicians because participating employees are usually able to stop diabetes, blood pressure and cholesterol medications or reduce the number medications needed; it’s a wellness program that works.  If you want to know more about our program please call  404-769-3929 for a complementary workplace

 

ce consultation. 

References
Loeppke, R, et. al. Health and Productivity as a Business Strategy: A Multi-employer Study JOEM 51(4):411-428, April 2009 http://www.ncbi.nlm.nih.gov/pubmed/19339899

Mishra, S,  et. al. A multicenter randomized controlled trial of a plant-based nutrition program to reduce body weight and cardiovascular risk in the corporate setting: the GEICO study, European Journal of Clinical Nutrition (2013) 67, 718–724; doi:10.1038/ejcn.2013.92; published online 22 May 2013 http://www.nature.com/ejcn/journal/v67/n7/full/ejcn201392a.html

Ferdowsian HR, Barnard ND, Hoover VJ, Katcher HI, Levin SM, Green AA et al. A multicomponent intervention reduces body weight and cardiovascular risk at a GEICO corporate site. Am J Health Promot 24: 384–387.

Sachdeva, A, et al. Lipid levels in patients hospitalized with coronary artery disease: An analysis of 136,905 hospitalizations in Get with the Guidelines, American Heart Journal – January 2009, 157 (1) 111-117.

Consumer Updates: FDA Expands Advice on Statin Risks, Apr 12, 2013, DHHS, FDAwww.fda.gov/ForConsumers/ConsumerUpdates/ucm293330.htm‎