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Description

Your supervisor, the Wellness Director, asked you to review preliminary results for a pilot study that the campus pharmacy completed. The primary objective of the pilot study was to provide a unique patient-centered care management and wellness program to promote healthy lifestyle behaviors. The voluntary pilot study aimed to improve personal health and quality of life, prevent cardiovascular disease, and contain costs associated with the disease. The participants in the pilot study had to be employed at Employer A, enrolled in one of Employer A’s health plans, and have an existing diagnosis of high blood pressure or high cholesterol. Your supervisor would like you to make meaning out of the data set identifying and describing the main themes. She would also like you to include an overview of the method you used to analyze the data and a description of why this method was appropriate.

HWC 670 – Research Methods and Program Design
Qualitative Analysis Project Data Set
1: All of the following are tools we use in the CVRRP to help you meet your personal health goals.
Please check the top 3 that help you the most.
(Respondents were allowed to choose multiple responses)
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2: If there are other responses to Question 1, please list them here:
Response
The pharmacist has been great to work with!
There are so many advantages to this program – I have found the following to be valuable: educational
materials, lifestyle journal to keep me on tract, one-on-one meetings to discuss the positives /
negatives, medications at no cost is a great benefit along with the automatic refills, cholesterol testing
to see if my numbers have improved.
The support group meetings, educational materials and the medication counseling were in my opinion
extremely important. To me the no cost medications, automatic refills of medications and the exercise
facility at no cost did not factor into my decision to join this group.
The behavioral/lifestyle suggestions are also very helpful.
All are tops, but the #1 is the Exercise Facility!!! The Lifestyle Journal is also a plus, in that it keeps me
on track with what I eat and is also a good reminder for me to eat healthy!
Its difficult to choose only three – the combination of all of the above has been essential to a healthier
living style.
Pedometer, home blood pressure monitor, Lifestyle journal, support group meetings, and especially
referral to other healthcare professionals
With tools like the pedometer, blood pressure monitor, the journals, etc., I can visually see what is
going on with my health.
Fitness facility (though should be expanded to the YMCA), auto refills and the one-on-one meetings in
conjunction with the BP monitor and log all help. It’s really the integration of all of these basics that
provide the accountability that makes the program effective.
While I would have filled the prescriptions myself, it was the medications at no cost that put me over the
hump to join the program.
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3: Have you improved your communication(s) with your doctor and/or other healthcare professionals
since you started the program?
(Respondents could only choose a single response)
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4: Please describe if/how the pharmacist that you are working with in the CVRRP helps you meet
your personal health goals.
Response
The pharmacists are terrific!! They are ready and willing to answer questions and have been helpful.
Encouragement, personal evaluation of health goals, positive outlook
The one one one meetings help keep me on track with my goals and stay focused.
The accountability factor is major part of the program. I have been encouraged through discussions. I
could call at any time with a question and get the answer almost immediately. Manyy healthcare
decisions were made because of the guidance given.
not working with a pharmacist
Due to the one-on-one nature of the program and the meetings, I felt my particular needs and
circumstances were very well met and used inorder to craft a program that would specifically work for
me.
They’ve helped with alternate medicines and have been available for any consulting
They are great. No problems. I love the fact that they call me about my refills instead of me having to
call them. Avoids running out over weekends, etc. like used to happen previously.
Not using them
They challenge and encourage me. I have a heightened sense of responsibility when I know that I will
be talking with them.
I tend to drift off schedule, and just by receiving educational email messages on the importance of
exercise and eating healthy, and the monthly newsletters are such a major benefit in training me to be
more cautious!!! I also love the recipes!!!
Assists me in making better chioces and gets me motivated for the next step.
He is knowledgeable, resourceful, caring, competent, and kind. I look forward to our meetings, whether
my program is going fine or if I am in a slump.
It is always such a pleasure to meet one on one – everyone is positive, offer suggestions and make you
realize that it is possible to be healthier. It is helpful to be encouraged, showing you the numbers (cholesterol, BP, weight, etc) and giving suggestgions on how to make it better and not sending you out
the door wondering what to do or what I need to do to reach a goal. They are good at keeping me on
track with the meds I need to take. I don’t “forget” to take them now. They listen to my concerns even if
it feels like a silly question. That is so important.
They help make sense of my medications and what they are doing; they provide excellent sounding
boards for concerns and ideas about my illness, and offer thoughtful, helpful feedback. They are
golden; they keep me informed and motivated.
The pharmacist was instrumental in me taking my diabetes more seriously and referring me to an
amazing and excellent endocrinologist.
They are great. Very helpful,they are not judgemental also. I really enjoy talking with them. They can be
very encourging. They listen even when its not to do with program.
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Breaks down everything in language I can understand.
Helps me to better understand my condition and what i need to be doing for better health.
Personal meetings help keep me on track and they give supportive ideas and encouragement
They have been fantastic and cooperative. It is reassuring to know that someone is monitoring your
meds and intervening when appropriate.
The individual counseling helped me.
The one-to-one meetings that include medication counseling as well as the individualized lifestyle
program are synonymous for me. While I have not turned the corner to apply all I’ve learned to my
lifestyle, I have noticed a definitive change in my understanding of how it all works together and what
“m doing that needs to change, where before starting the program I was ignorant of how certain bad
choices were really affecting my health.
The pharmacist were so encouraging made me want to follow the program.
Helped determine best med. combination at the best cost; i.e., switching from two meds. to one
combination med.
It nice to meet with someone periodically who is aware of your goals and gives you the support you
need to continue on. Even tho something you get off track they are there to help you find out what
happen and how to get back on track. I personaally need the structure ,I know i can count on them to
give me the best direction and suggestions because they make it all about me!
Constant re-enforcement is the key. Having someone to talk to certainly helps.
Encouraging me to keep trying.
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5: Please describe if/how the Program, in general, is helping you meet your personal health goals.
Response
The program has been very helpful in light of all the other health issues I have encounter. My health
issues have made it more diffcult to keep up with execersise program.
The program has kept me on track and always thinking about what I’m doing and what I am eating.
By encouragement, accountability, education and the tools to use to help meet my goals
It has educated me and made me more aware of what I need to do to stay healthy as I age.
While I have been physically and emotionally challenged this year, being on the program kept me “incheck”. I think that if I had not been in the program, the “stress” related issues would have made my
eating portions and frequency become even higher and more unhealthy. Therefore, while I did not
really decrease my weight, I have (during most time periods) increased my exercise and made
healthier food choices.
I am more aware of my blood pressure and the effect of my weight on these readings. I’ve noticed how
much better I feel when I am active – not in the gym but around the house when I increase my walks or
do some type of exercise.
Being more awear of my bad habits EATING all the wrong things
Makes me more accountable to myself. I think twice if I want to stray from the program.
Due to the program and the ability to use my specific circumstances, I am much more conscientious
about my exercising, eating and sleeping habits. Also, because of the one on one nature of the
meetings, I felt I had to be accountable for what I was doing. This was very motivating for me.
This has sent me on the right track in personnel wellness. This most evident in my exercise level and
proper eating. I’ve made very good strides the past couple of years.
Since November 1, 2009, I’ve lost more than 20 lbs. and my blood pressure is now under control. My
next goal is to lose about 5-10 more pounds and possibly get off of blood pressure meds altogether.
Great program has really made me chug my lifestyles
I am probably alive because of the program. That is the best personal health goal I can imagine and I
don’t know where I would be without this program. The information, instruction, and personal
accountability has all led to improvements in my health.
Yes, I would definitely say that the program is helping me to meet and work at good personal health
goals.
Lets me know what I can and can’t do to meet my goals and gives me more info about losing weight.
Keeps it real. Keeps me honest to myself.
Although it is a slow process, the program keeps me focused and aware of the benefits of a purposeful
lifestyle on general health. With emphasis on several aspects (nutrition, sleep, exercise, goal setting,
etc.)the program gains strength and creates stamina for the user. Telling participants to “lose weight” or
“get some exercise” are useless unless the big picture is in focus. The components of CVRRP provide
an anchor of stability as you set and achieve healthy lifestyle changes.
Just knowing that I will be meeting one on one – keeps me on track – I found myself thinking about how
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much this program does to help keep me healthy therefore, I feel I should do my best in order for the
program to work for me. My personal favorite is the fact that I went from a wellness score of 79% to
90% in one year!
Having regular contact with someone other than my physician (who I don’t particularly care for) keeps
me on track and motivated.
Because of the monthly meetings with Jessica I have been able to take control of my diabetes, lower
my A1c considerably, lose 20 pounds, and have a mentor and advocate for me at all times.
My personal goal has not been met. I have had great many prolbems with my knee and family. But I
still have been trying.
While I may not always follow it to a “T” I am aware of what I need to do.
Pays for my medication (very important). The one on one meetings and log book help to make me
accountable.
Helps in accountability toward a healthy lifestyle which makes us more productive at work. Our roles at
CU are very stressful, and this program provides a mechanism to deal with those issues.
The program got me started on the right track. The journal help keep me accoutable and allowed me to
keep track of my progress.
The ease of obtaining medication and knowledge of MY own health has opened the door for me to
learn the difference between good and bad habits and to make incorporate better choices into my daily
routine so that they now are part of my habit.
Increased my exercise activity.
The program made me aware of many danger factors of my body – I was headed for a train wreck.
Keeps me aware of the lifestyle changes I need to continue to follow in order to maintain my health
goals.
I have had alot of obscales to over come in my life last year but this program has kept me mindful of
taking care of me will help me take care of others and i never thought of it that way before. I may not be
as active as i want but i get at least 30 minute a day activity as well as being more conscious of what i
eat even if it is not so good choice for me that means extra some kind of activity. If i have a not so
active day i say to myself there is always tomorrow. I really enjoy being a part of this program because
it helps me to set obtainable goal and not only keeping my body health but my mind as well.
I was able to reduce weight and cholesterol levels during the first 6 months. Increased requirements at
work have forced elimination of gym visits and now I am afraid all my positive gains are lost, and I must
start over.
Makes me realize that there are a lot of things that can come together to help make me be healthier.
I’m disappointed that I haven’t done better.
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6: Please provide any suggestions that you have that would help to improve the Program.
Response
More literature on specific subjects such as food preparation for diabetics.
I think the program is doing very well. The program staff is readily available for questions and is very
supportive. Many options for an individual to access and work into the program.
Great program.
I feel this is a great program for employees or anyone who needs a little help getting on the right path
for healthy living.
Probably would have liked to see some “group” exercise opportunities. I work well when under group
presssure to comply.
For me more one on one guidance with specific menu choices to help bring my blood pressure down. I
need someone to say, No, don’t eat that because… eat this because it does this for you, etc. Once I
started eating better I wanted to move more which brought the pressure into a better range.
none
Program staff was very personable and helpful. They could explain so much to me that helped me to
understand the dynamics of a lot of health issues. So the knowledge and personable-ness that he
brought to this program were wonderful. However, the organization and process are such that others
can carry it on very well. It is set up to be able to be continued and expanded. All of this is very
commendable.
Perhaps more frequent visitis after one is furhter along in the program
Continuing with supploementing the cost of the meds and the fitness center memberships should be
continued at some level. As I understand, that might be discontinued. How about if we consider a 50%
cost reduction for fitness centers and meds?
I really the independent style, I do think monthly meetings throughout the program should br used, it
makes us more accountable.
Open it up to the larger campus community, including spouses of the employees.
I personally love the cooking classes!!! Would love to have more on cooking and preparing healthy
dishes! I would also love to participate with a group after work Exercise Class!
Bring in a nutritionist and a trainer and have personal fitness and eating programs available.
No suggestions come to mind. My participation has been a blessing! Thank you.
Everything about this program is excellent. it is such a benefit to each person who has the opportunity
to participate – it is a wonderful incentive to get a person on track AND keep you on track to a healty
body and mind. Thank you for the opportunity.
If I could improve anything it would be to make it a requirement to attend 2-4 support group meetings.
Often it has just been one or two of us meeting. Despite the small group I always learn healthy tips,
ideas, and recipes.
If a support group could be offered at multiple locations on campus.
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This is a very important program that is really helping me. I can’t think of any way you could make it
better. Thank you.
I think YOU are doing all that you can do. It’s really up to use to impliment it.
Continue program with no cost medication. Thank you for all your guidance and positive support.
Group meetings on the west side of campus
Would like a discounted fee or support to the YMCA if that is closer to your home and where we are
able to work out.
If the lifestyles journal could become electronic I believe I would rely on it more as my life is lived on the
go and I’d prefer it to be more mobile. I LOVE the accountability of the journal and ease of use but once
I forget or find it too bulky to take it with me, the routine is broken and I start to beat myself up for not
using it and it takes more effect to start again…again. 🙂
Find a way to help lose weight.
I thought the program was very balanced – I cannot think of any suggetions at this time.
Continue no cost exercise facility as long as the individual remains involved in the program — including
after the first year.
Monthly meeting throughout the program rather than only the first few months. In my situation, added
workload has forced me make a decision about job vs personal health and well being,,, unfortunately I
opted for Job. It is a debate I continually have with myself and also with my spouse. I dont know if I
would have benefitted from some type of counselling or not…. to help me prioritize my goals and
perhaps find some compromise. For me it was an either or decision…it was probably correct for the
short term but i worry about the long term ramifications.
Just make the diagrams in the journal a little bigger.
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Workplace Wellness Programs Study
Case Studies Summary Report
Contract Number:
DOLJ089327414
Prepared for:
Office of Policy and Research
Employee Benefits Security Administration
Department of Labor
Office of Health Policy
Assistant Secretary for Planning and Evaluation
Department of Health and Human Services.
Prepared by:
RAND Corporation
April 2013
Table of Contents
Summary ……………………………………………………………………………………………………………………………………. 4
Introduction ……………………………………………………………………………………………………………………………….. 5
Background …………………………………………………………………………………………………………………………….. 5
Case Selection …………………………………………………………………………………………………………………………. 5
Case Study Methods ………………………………………………………………………………………………………………… 7
Employer A: A Large University……………………………………………………………………………………………………… 9
Organization ……………………………………………………………………………………………………………………………. 9
Wellness Program Description …………………………………………………………………………………………………. 10
Engagement Strategy ……………………………………………………………………………………………………………… 14
Program Results (Documented and Perceived) ………………………………………………………………………….. 16
Program Impact …………………………………………………………………………………………………………………….. 18
Future Directions …………………………………………………………………………………………………………………… 20
Conclusion …………………………………………………………………………………………………………………………….. 20
Employer B: A State Government Agency …………………………………………………………………………………….. 22
Organization ………………………………………………………………………………………………………………………….. 22
Wellness Program Description …………………………………………………………………………………………………. 22
Engagement Strategy ……………………………………………………………………………………………………………… 27
Program Results (Documented or Perceived)…………………………………………………………………………….. 29
Program Impact …………………………………………………………………………………………………………………….. 31
Future Directions …………………………………………………………………………………………………………………… 34
Conclusion …………………………………………………………………………………………………………………………….. 34
Employer C: A large service organization ……………………………………………………………………………………… 36
Organization ………………………………………………………………………………………………………………………….. 36
Wellness Program Description …………………………………………………………………………………………………. 37
Engagement Strategy ……………………………………………………………………………………………………………… 41
Program Results (Documented or Perceived)…………………………………………………………………………….. 44
Program Impact …………………………………………………………………………………………………………………….. 46
Future Directions …………………………………………………………………………………………………………………… 47
Conclusion …………………………………………………………………………………………………………………………….. 48
Employer D: A Manufacturing Company ………………………………………………………………………………………. 51
Organization ………………………………………………………………………………………………………………………….. 51
Wellness Program Description …………………………………………………………………………………………………. 52
Engagement Strategy ……………………………………………………………………………………………………………… 55
2
Program Results (Documented or Perceived)…………………………………………………………………………….. 58
Program Impact …………………………………………………………………………………………………………………….. 59
Future Directions …………………………………………………………………………………………………………………… 62
Conclusion …………………………………………………………………………………………………………………………….. 62
Appendix A: Discussion Guide……………………………………………………………………………………………………… 67
Appendix B: Focus Group Protocol ………………………………………………………………………………………………. 70
3
Summary
This report describes findings from four case studies of existing workplace wellness programs in a
diverse set of employers. The authors describe characteristics of wellness programs, use of financial
incentive and engagement strategies, facilitators and challenges to success, and impact of programs.
Case studies were based on data collected through semi‐structured interviews with organizational
leaders, focus groups with employees, review of program materials, and direct observation.
4
Introduction
Background
Employers have increasingly become interested in workplace wellness programs to improve employee
health, such as wellness screenings, onsite clinics, healthier foods options in cafeterias and vending
machines, and greater opportunities for physical activity.1 Further, many employers look to health plans
to administer and coordinate wellness programs and/or health screenings. The Patient Protection and
Affordable Care Act supports these initiatives through a number of provisions intended to leverage
workplace wellness programs as a means to reduce the burden of chronic disease and control health
care costs.
To better understand how workplace wellness programs are implemented and how participating
employees view such programs, we conducted case studies of four employers. These case studies are
part of a larger project. This report describes our approach to the selection of case study sites, our
protocol for data collection and summarizes our findings for each site. This research was conducted
under contract #DOLJ089327414 with the Department of Labor, as part of a larger study of workplace
wellness programs that is required by the Section 2705(m)(1) of the Public Health Service Act.
Case Selection
Much has already been written about wellness programs implemented by large, Fortune 500 companies
(e.g., Johnson and Johnson, General Electric, and PepsiCo), but less is known about the experiences of
smaller firms. Therefore, we focused on the experiences of companies with at least 100 workers but
fewer than 50,000 workers.
We developed a site selection protocol that could help us maximize the informational yield by ensuring
diversity of selected firms. We attempted to recruit sites that vary along the following criteria:
ï‚·
ï‚·
ï‚·
ï‚·
ï‚·
Company size
Type of employer (heavy industry, retail, services and government)
Program origin (“home‐grown” versus offered by a health plan or vendor)
Region
Employer reliance on substantial financial incentives to promote wellness program participation
and behavior change; we specifically sought at least one firm that uses rewards tied to
achievement of health‐related standards that are close to the currently allowed limit.
Because there is no nationally representative databases of employer wellness programs, case study
candidates were identified based on published information, such as companies listed in the Partnership
for Prevention “Leading by Example” publications, highlighted in award programs (e.g., Welcoa Awards
and C. Everett Koop Awards), featured in newspaper articles, and/or referred to us by experts on
worksite wellness programs, such as academics, benefit consultants, managers of wellness program
1
World Economic Forum. Working Towards Wellness Initiative.
http://www.weforum.org/en/initiatives/Wellness/index.htm,accessed Nov 18, 2009
5
vendors, and government officials. Relying on a range of sources of information about worksite wellness
programs helped us identify the programs that have been less highly publicized, as well as those that
offer substantial financial incentives to promote wellness participation and behavior change.
In total, we identified a list of 34 candidate employers for the case studies. Sites were classified based on
our selection criteria and we selected primary and backup sites to achieve balanced representation of
our selection criteria. Primary selected sites were contacted by the research staff to secure
participation. If a primary selected site declined to participate, it was replaced from the list of back‐up
sites. A total of nine organizations were contacted to secure participation from four employers.
Two primary sites agreed to participate and the other two sites were recruited from the back‐up list. In
addition, we used data that we collected during a recent site visit under a separate study, which was a
review of the wellness program operated by a large government agency in 2010. Table 1 summarizes
how the four sites cover our selection criteria.
Of note, we were unable to secure participation of a small firm with less than 1,000 employees, even
though we had identified and contacted three candidate organizations. Representatives of these firms
felt that the burden of study participation would be too high for their employees, company
management was reluctant to participate, or there no staff available to help with study coordination.
Table 1: Characteristics of four employer sites.
Number of
Employees
Industry
Region
Employer A
3,500
Services
South
Program
Administration2
Employer;
health plan
Employer B
19,000
Government
South
Employer;
health plan
Northeast
Employer;
health plan;
vendor
Midwest
Employer;
health plan;
vendor
Employer C
Employer D
4,800
9,000
Services
Manufacturing
2
Financial Incentives [per year]
Smoking: $50 annual insurance
premium surcharge
Smoking: Smokers restricted to lower
value coverage option
Screening: $15 reduction in copays
Screening: $20 for completing
biometric screening
HRA: $50 for completing online health
assessment
Smoking: Up to $600 premium
surcharge per year
Health Goals: $20 for achieving
personal health goals
Screening: Up to $2600 annual
premium differential3 (for individual
coverage)
Health Outcomes: Up to $754 annual
premium differential based on
biometric data and smoking status (for
individual coverage)
Employers may choose to administer and manage wellness programs internally or purchase wellness services for
their employees from their health plan or third‐party vendors.
3
Employer D has a $50 weekly surcharge to employees’ contributions to health plan premiums for employees who
opt‐out of wellness screenings, which totals $2600 annually.
6
Case Study Methods
Methods of Data Collection
Each case study was based on data collected through semi‐structured interviews with key informants,
focus groups with program participants, review of relevant documents, and direct observation. All data
collection and analysis procedures were reviewed and approved by RAND’s Institutional Review Board.
We developed a semi‐structured interview protocol to guide expert interviews. The questions were
informed by a literature review and expert consultations. The interview guide included a list of major
topics with discussion probes under each sub‐heading, and is attached to this report as Appendix A. We
conducted individual interviews with wellness program coordinators, wellness program staff, human
resource representatives, accountants, worker representatives, and senior executives. If appropriate,
we also interviewed benefits consultants, health plan staff and program vendor representatives.
Each case study also included at least one employee focus group to get the end user perspective on the
impact and effectiveness of the wellness program. Like the key informant discussion guides, the focus
group protocol was informed by the literature review. Focus group participants were asked to provide
verbal informed consent. The protocol included a list of major topics, with discussion probes under each
topic, and is attached to this report as Appendix B.
In addition to data collected through key informant interviews and focus groups, researchers reviewed
relevant, published materials about wellness programs provided by sites themselves. Examples of these
materials include brochures describing the program to employees, internal studies documenting the
program’s effectiveness, or any literature provided to workers to help them make healthier choices (e.g.
nutrition guides). Finally, researchers also collected information during site visits through direct
observation, such as details on the built environment, cafeteria food choices and access to informational
materials.
OMB Review
Once the key informant discussion guide and employee focus group protocol were developed, they were
submitted for OMB clearance. The OMB approved key informant discussion guide and focus group
protocol are included with this report as appendices.
Site Visit Procedure
We asked each site that agreed to participate to nominate a primary contact to coordinate data
collection. These contacts assisted with recruiting the key informants by using RAND‐provided
recruitment materials. Meetings were scheduled with up to 12 key informants at each participating
employer, providing a variety of perspectives on wellness program management, implementation, and
perceived outcomes.
To recruit focus group participants, the organizational contacts sent initial emails to groups of
employees identified as eligible for the focus groups based on their participation in wellness activities.
The organizational contact sent follow‐up emails closer to the date to confirm attendance. RAND
worked with the organizational contact to provide the text for the recruitment emails, which
emphasized that participation in this study was voluntary. In three of the four case studies, the
7
organizational representative preferred not to help with focus group recruitment, therefore the RAND
research team was responsible for identifying eligible employees to participate in focus groups.
Recruitment was limited to no more than 12 participants in each group.
The time and date of each site visit were determined based on the availability of the organizational
representative and other key informants. When it was not possible to interview all informants in one
visit, follow‐up interviews were conducted by phone. The focus groups were scheduled after the
interview schedules were finalized. The research team worked with the organizational representative to
schedule the focus group at a time that was acceptable to the organization and likely to be convenient
for employees.
The researchers scheduled the site visits to take place over one or two days at each location, during
which time they conducted the employee focus groups and met with key informants. Site visits were
conducted by a RAND researcher and a research assistant, who assisted with note‐taking.
Case Study Data Analysis
The qualitative data collected from each case study were analyzed thematically by the team that
conducted the respective site visit. After all interviews and focus groups were transcribed, researchers
reviewed the transcripts to ensure accuracy. Interview and focus group guides were used to facilitate
data coding, ensure coding consistency across case studies, and produce comparable individual case
study reports. Such an approach to qualitative data analysis helped us ensure that similar data are
abstracted for each case study, which is important for synthesizing information across all four case
studies and illustrating the main study findings.
8
Employer A: A Large University
“…we are trying to create [a culture] …of personal development and individual enrichment by working
collaboratively with other groups on campus to just promote healthy lifestyles and identifying the types
of areas that seem to be relevant and of interest from the feedback we had been receiving…” (Wellness
Leader at Employer A)
Organization
Background on the Employer
Employer A is a large university located in the south. The university offers eligible employees various
benefit plans, including health, dental, and vision coverage; it contributes to premiums based on state
law and requirements of the State’s Teachers Retirement System. To be eligible, an individual must be
appointed to a regular faculty or staff position that has an anticipated duration of greater than six
months. Eligible faculty and staff may cover their spouses and eligible dependent children.
Employee health plans are offered by two major insurance providers. Since 2012, Employer A has
offered four types of plans, three of which are administered by Provider 1, which include an HMO (no
new enrollees are accepted), HSA Open Access POS (a high deductible Point of Service option that
replaced a former PPO option), Open Access POS (another high deductible Point of Service option with a
different provider network that replaced a former PPO option). The second provider offers an HMO (no
new enrollees are accepted, except for Senior Advantage Plan 65+). All plans are required to offer low‐
to‐no‐cost alternatives to improve overall employee health such as smoking cessation programs, to
expand communication and education efforts about wellness and prevention, and to offer discounted
weight management programs.
While the university system governs the overall structure of employee and student benefits, this
university made a decision to create its own wellness program. Housed at, and funded by, the Human
Resources (HR) Department, the school’s employee and wellness services program offers services to all
staff, faculty, students, and even retirees. In addition to this employer sponsored wellness program, the
two insurance providers also offer health and wellness components to plan participants.
Based on the information we obtained during our interviews, the most pressing health issues for
university employees and their dependent are hypertension, pediatric asthma, and diabetes. No actual
prevalence data were available.
Organizational Strategy
Two independent events led to the creation of the Employer A’s wellness program. First, in 2005, the
university identified smoking as a major health concern. In collaboration with the student health office,
the Employee Assistance Program coordinator applied for, and subsequently received, a small grant
from the American Cancer Society intended to raise awareness of the negative consequences of
smoking.
The second event was a decision to eliminate university employees’ access to the campus student health
clinic due to budget cuts in 2006. Because the clinic was a popular provider of health services on
9
campus, the university administration decided to search for alternative services that can be provided
locally using existing resources. According to an interviewee, the university administration “sat together
with [the department] of nursing and [the department] of nutrition to talk about a program where
employees can come. Maybe not every day like a clinic, but how about first Thursday, once a month. For
starters, let’s see how that might go. That seemed realistic and reachable.” Consequently, a university‐
wide task force was created to identify major health and wellness‐related areas of concern. The task
force focused on stress and work‐life issues and chose a pro‐active approach trying to empower people
to change their habits, make better choices, and focus on health and wellness. In 2008, the Assistant
Vice President of Human Resources (AVPHR) officially initiated the wellness program.
Wellness Program Description
Program Development and Implementation
Employer A’s worksite wellness program was designed as an additional benefit to help faculty, staff, and
students develop and maintain healthy lifestyles, balance their work/school and personal lives, cope
with stress, and boost employee morale and productivity. Reduction of healthcare costs was not among
initial reasons for creating the program. Program goals of raising health and wellness awareness are
aligned with the overall mission of the university in that the wellness program focuses on educating
program participants about health and wellness.
The wellness program is administered by a department within Human Resources, also responsible for
oversight of the Employee Assistance Program, Work/Life Resources, and Personal Enrichment
Workshops geared toward serving a diverse university workforce. The program director of this
department oversees the implementation of the worksite wellness program, which has two employees
and uses several part‐time consultants and graduate students to help run various wellness activities.
Data Collection
Before the wellness program was implemented, hypertension, pediatric asthma, and diabetes were seen
as the most relevant health risks. Until the fall of 2011, the wellness program itself did not collect health
risk data; however, it started doing so as part of the monthly Health Screening program. According to a
wellness program employee who conducts these health screenings, “I’m starting to track screening data;
definitely the health coaching data for blood pressures and weights.”
Moreover, the wellness program director recently visited the office of Insurance Provider 1 to learn
more about the plan’s wellness program and received a summary of the most typical health issues that
university employees report when they call the plan’s free 24/7 hotline. Although these data were not
shared with us, an interviewee stated that the most prevalent issues were high blood pressure,
diabetes, and obesity.
As part of its own wellness program, Provider 1 collects health risk data that the university deemed to
be “potentially great… but these data are about the health status of a relatively small number of
employees. Say, we may have 2,000 members [Provider 1’s plan], but maybe 200 of them agreed to
complete the forms and supplied their information to the plan… [However, even the data on those who
joined the program] have not been made available. And that’s been part of the concern…because we
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have obviously dealt with the challenge of rising health claims, premiums, and claims’ cost…We’re now
waiting for a big report from them.”
Program Costs
The university worksite wellness program receives funding from the HR Department. To reduce cost, it
leverages on‐campus human capital by establishing mutually beneficial collaborations with different
academic departments and university programs/services, including School of Nursing & Health
Professions, the College of Business, School of Social Work, Recreational Services, and the student
health office. For example, graduate nursing and counseling students function as wellness service
providers; nursing and nutrition graduate students and faculty give lectures on health and wellness‐
related topics. Built on the premise of mutually‐beneficial collaboration, the university wellness program
is regarded as an example of how a wellness program can strengthen on‐campus relationships.
Although we were not able to obtain exact information on program costs, from the perspective of the
HR department, reliance on these partnerships improves efficiency. According to our interviews, the
major cost item is the salaries of its director and several employees, which are about $200,000 a year.
Due to the program’s popularity on campus, reputation among the institutions of higher education in
the state, and the growing importance of wellness and disease prevention as a strategy for lowering the
state university system’s health care cost, the annual budget of the wellness program was increased in
the 2011/2012 academic year. The exact number, however, was not provided to us.
Wellness Events and Activities
The program offers a wide range of wellness events, such as lectures on health and wellness topics and
individualized health coaching, and provides access to wellness‐related information by leveraging
existing resources within the university. Wellness activities including yoga, meditation, and massage
therapy are intended to reduce stress levels. Currently, there are twelve ongoing wellness programs,
events, and activities on campus; most of them are offered at no cost to students, staff, and faculty.
These wellness programs, events, and activities are either administered by health plan, outside vendors,
or the university itself.
Programs administered by health plans
 Insurance Provider 1’s Program: Provider 1’s wellness program starts with an online health
questionnaire. Based on the results, care managers provide individualized recommendations.
The program organizes its activities and resources into three categories: (1) Tools and resources,
including online health and wellness information, as well as discounts on health‐related
products and alternative medicine therapies (e.g., chiropractors, acupuncturists, massage
therapists, and registered dietitians); (2) Health guidance and support 24/7 from registered
nurses; and (3) Health management for diabetes and other serious chronic conditions, focusing
on providing health evaluation and consultation to assist in managing condition, offering
condition‐specific educational materials on prevention, self‐management, and lifestyle factors
to help improve health).
 Insurance Provider 2’s Program: Provider 2 offers a patient‐centered model of total health
program. The disease management programs focus on chronic medical conditions and provide
evidence‐based guidelines for screening and treatment; general and targeted outreach and
reminders to members; patient education and self‐management tools and resources for
member engagement and compliance; specialty services (e.g., diabetic nurse educators, and
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Clinical Pharmacy Services to improve cholesterol control for members with CAD); and physician
feedback regarding performance measures.
Activities and programs administered by outside vendors
 Yoga Classes: One‐hour yoga classes are offered to faculty, staff, and students at a cost of $14
per class, or $10 per class with advance payment for several classes. These classes are held on
campus at the University Center and emphasize stress reduction and relaxation.
ï‚· Guided Meditation: Focused on stress reduction and relaxation, these individual meditation
sessions are offered on Fridays by appointment only and are conducted at various campus
locations convenient to employees, faculty, and students.
ï‚· Massage Services: Table and chair massages are available for a charge. A licensed massage
therapist comes on campus by appointment.
 Weight Watchers: Weekly Weight Watchers group meetings are held on campus. New 12‐week
sessions start throughout the year and are usually scheduled during lunch breaks. A monthly fee
applies.
ï‚· Fresh and Healthy Meal Service: The latest addition to the university wellness programs is a
program administered by a local nonprofit organization that prepares and delivers fresh meals
that meet guidelines of the American Diabetes Association directly to campus twice a week.
This nonprofit also employs a team of registered dietitians who are available for consultations,
education, and support. A daily plan with three meals costs between $21.49 and $26.99 a day
and is available for purchase to university staff, faculty, and students.
Events and programs administered by Employer A
ï‚· Wellness Wednesdays: This weekly event is designed to disseminate information on best
practices in health and wellness in a supportive and easy‐to‐use format. Subject matter experts
are invited to give presentations on a wide range of health and wellness topics. Many lectures
are video recorded and posted on the program’s website and YouTube. A webinar format is
used to reduce the cost of inviting external speakers, increasing the likelihood that they will be
willing to participate, and make it easier for university employees and students to attend these
lectures.
ï‚· Walking Program: The university collaborates with the Student Recreation Center to hold a
monthly event designed to encourage employees and students to participate in group walking
during the lunch hour and incorporate more physical activity in their daily schedules. Every last
Wednesday of the month, program participants meet at the Recreation Center and take scenic
routes around campus. According to one of the participants, the program also provides
“information about distances and places to walk around [campus] and things that you can do,
how much benefit you can get from a short amount, and …[it helps] you track your calorie burn
and what you’ve done.”
ï‚· Monthly Health Screening: This monthly event, which is conducted in collaboration with
campus and community partners, offers health screening and coaching on a variety of topics,
such as maintaining a healthy blood pressure and cholesterol levels, the importance of influenza
vaccinations, and the risks of tobacco use. In 2009, the program was awarded a university award
that recognizes cost‐effective ideas.
ï‚· Wellness on Wheels: For those employees who find it difficult to leave their workplace during
the workday, the wellness program can come to their office. Health screening and personal
coaching, massage therapy, and guided mediation sessions can be scheduled at a campus
location convenient to participants. Health coaching can also be done over the phone.
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ï‚·
Smoking Cessation: FreshStart is a no‐cost, four‐phase program designed by the American
Cancer Society and administered every Tuesday by the Department of Respiratory Therapy. Its
goal is to provide essential information and evidence‐based strategies proven to help
participants quit smoking.
Role of Vendors and Partners
Outside vendors offer roughly half of all wellness programs, events, and activities to university staff,
faculty, and students, such as yoga and meditation classes, massage therapy sessions, lead Weight
Watchers sessions, and provide fresh meals on campus. Most of the wellness activities provided by
vendors are paid for by program participants themselves. The other half is organized and conducted by
wellness program staff, university faculty, and graduate students. For example, with rare exceptions,
lectures are given by university faculty and staff; individualized health coaching is performed by a part‐
time wellness counselor employed by the wellness program; wellness‐related information is collated by
the wellness counselor, wellness program director, and student employees; and smoking cessation
sessions are run by graduate students under a faculty member’s supervision.
Changes to Physical Environment
Most of the environmental changes on campus focus on food environment. Besides bringing the fresh
and healthy meal service on campus, the wellness program staff is working on improving vending
machine snack choices. According to a wellness program representative, “we recently approached the
Auxiliary Services – a provider for our vending services ‐ and we’re working with them on switching a
chunk of vending machines over to a Heart Healthy line of snacks that they can stock this spring…The
Heart Healthy line of snacks offers healthier choices that meet specific guidelines for fat, sugar, and
salt.”
When it comes to physical environment changes, the wellness program has a number of interesting
ideas that have yet to be implemented, including the decoration of stairwells on campus. The
implementation of this idea requires building a new partnership with the School of Arts. Explains one
wellness program representative: we would like to do “a little contest [among art students] to get
people interested, and proposing maybe five to ten different designs that could eventually go around
the campus.” Moreover, focus group participants suggested that it would be great to have a “campus
walkability map” that shows walking routes of different length and difficulty levels.
Alignment with Health Plan
The two insurance plan providers offer free health and wellness programs to plan participants described
above. Thus far, however, the insurers’ wellness programs are not coordinated with, or officially
included as part of, the university program. According to an interviewee, when Provider 1 initiated its
wellness programs, they did not come on campus and “communicated only with key HR reps in the
different institutions…It all depended on the reps to have the trickledown effect. There was some online
communication, but very minimal, and it came directly from [Provider 1]. And because this was handled
differently [at different state university institutions], there wasn’t a system‐wide
communication/marketing strategy that was consistent across the board.” Moreover, Employer A does
not know who is participating in the plans’ wellness activities.
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Engagement Strategy
Incentives
In 2011, the university started imposing a $50 monthly insurance premium surcharge on active
employees and retirees covered by the university’s health plan, but not dependents and students, who
self‐identified themselves as smokers. To avoid this surcharge, tobacco users could elect to quit either
by using smoking cessation products or by participating in a smoking cessation program. While the
university system provides coverage for different smoking cessation products, such as nicotine gum,
lozenges, patches, and certain prescription pills, employees who take advantage of smoking cessation
programs may incur a nominal fee, which is not covered by the university system. The wellness program,
however, offers free smoking cessation classes.
If an employee covered by one of the university’s health plan certifies that s/he is a non‐tobacco user,
but it is later determined that s/he has used tobacco products or started using tobacco products after
the date of certification, s/he will be subject to payment of the $50 surcharge, plus a 10% penalty, for
each month since the certification. According to one university administrator, there are “a number of
people who went through the smoking cessation programs…and the smoking cessation program was the
incentive. We are not going to charge you; the program is free. We are giving you something free to
save you money, $50 a month.”
University wellness program leaders generally do not believe that participation in wellness activities
should be incentivized financially; rather, they claim that the strongest motivator should be the desire to
be healthy and fit. As a wellness program representative put it, “when it comes to changing your health,
the real motivation has to be internal, and you have to want it. To help them, we need to build their
awareness, and that’s what we’re trying to promote here. If somebody forced me to participate, or if
people participated to get an iPod or something like that, I don’t know how genuine that participation is.
I think that’s a struggle in the wellness field in general.” As described in this quotation, the university
program’s goal is to build awareness about healthy lifestyles and to provide resources necessary to help
employees stay healthy and fit. On rare occasions when token incentives are used, individuals are
entered for a chance to win a prize. Free massages were cited as the most popular prize.
Non‐Financial Avenues to Increase Engagement
Convenience and linkages to charity‐related activities are the two non‐financial avenues used to raise
the level of engagement at the university. Wellness on Wheels is a popular wellness activity because it is
convenient; participants can schedule their appointments in their own offices or in nearby locations.
Yoga and guided meditations also do not require participants to travel to a main campus location and
can be scheduled at a time that is convenient to participants.
The most popular wellness event on campus is the annual 5k race organized by Insurance Provider 2 for
all area companies and their employees, regardless of their participation in Provider 2’s medical plans.
This walk begins with an 8‐week training promotion to help employees prepare for a 5K run/walk. The
university typically has more than 200 participants in this activity, which not only promotes health and
wellness, but also raises money for local charities and collects non‐perishable items for a local food
bank. Participants also enjoy the picnic and meeting the representatives of various local charities.
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Communication/Marketing Strategy
Employer A’s wellness program has a multi‐faceted communication/marketing strategy that targets
faculty, staff, and students. By collaborating with its campus partners and co‐sponsoring different
wellness‐related activities, the wellness program is able to spread the word about its services and
programs and encourage more active program participation. According to a wellness program
representative, using catchy program titles draws people’s attention and helps them remember about
wellness activities offered on campus: “People do seem to gravitate and find more appealing those
programs that they can remember the names.” Therefore, many university wellness programs have
titles that are both catchy and informative.
Besides creating high‐quality flyers that are printed in color, distributed around campus, and posted
online, the wellness program hired an intern from the College of Business to “tape wellness events, edit
them, and put them on YouTube…to start Facebook and Twitter accounts…and to appeal to the whole
campus population, not just faculty and staff.” Currently, there are 21 wellness videos on YouTube that
highlight different wellness program events and activities, including a welcome message from the
university’s Assistant Vice President of Human Resources, yoga and meditation classes, and Wellness
Wednesday Presentations, among others. These videos are also aired on the university‐wide TV station.
Announcements about upcoming wellness activities are made regularly on the university radio station.
Finally, the word of mouth is also used. The wellness program hires undergraduate and graduate
students as part‐time staff and partners with various academic departments that encourage their
graduate students to work on projects that are administered in partnership with the wellness program.
These students act as informal promoters of the wellness program among the student body, which is the
least active campus constituent when it comes to wellness activities.
According to a business school faculty member, the wellness program is very good at marketing: “[The
wellness program] is everywhere they need to be to promote this. They’re on email, they’re at events,
they’re at meetings, they are at conferences…I think as far as the offerings, they are putting out a
product that is more than adequate, compared to others. And I don’t know what they could do,
realistically, that they aren’t doing.”
Leadership Support
According to our interviewees, there is a lot of support for wellness programs at the level of the
university management. The Assistant Vice President of Human Resources was featured in a podcast
posted on the university website and YouTube promoting the wellness program. We were also told that
the plan is to “begin developing some podcasts where we have senior executives coming in and talking
about wellness. We have a president who works out all the time; we have a lot of the senior executives
who are runners. Our president…was a marathon runner.”
Moreover, the university wellness director was appointed to the university system‐wide steering
committee that is charged with creating a strategic plan to help promote health through a competitive,
coordinated, efficient, effective, accessible, and affordable system of care and reimbursement and
focuses on patient‐centeredness and wellness. This shows the importance of the role the wellness
program plays at Employer A, as well as the university’s willingness to help other state institutions learn
from their experiences of creating a wellness program.
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Although there is program support at the level of university administration, it does not always trickle
down to department managers and supervisors who sometimes are seen as being reluctant to allow
employees to leave their offices to attend wellness activities during the lunch break. Several focus group
participants voiced such concerns. For example, one person mentioned that her “manager is just not
letting me come to the gym. I do not know why that’s any different than if I were to go to [the
department head] and sit [in his office] for forty‐five minutes.” Another focus group participant
complained that it is acceptable for “the people to take smoke breaks, [but] I’m not a smoker, so
smoking for fifteen minutes, chatting, or even twenty minutes [is allowed], but I don’t do any of that.”
There was consensus among focus group participants that the university administration could do more
to reach out to “managers and supervisors and ask them to let their employees know that it’s okay for
them to attend” wellness activities and encourage them to be flexible. One employee gave an example
of how supervisors can be flexible: “because our office is actually usually busier during the lunch hour,
it’s when the people get off and come see us, [my supervisor] asked me if I wanted to take an hour in
the morning to go [to the gym] instead of at lunch.”
Inclusiveness
Program participants felt that the university wellness program offers a broad range of wellness
activities. As one person put it, “almost anything that I could possibly want is either available or they
would have available.” The program is constantly adding new components, such as the nonprofit food
service, and is looking for innovative approaches to promote its activities among faculty, staff, and
students. The program’s emphasis, however, is on wellness awareness and education, as well as stress
relief, but not necessarily on physical activity, team sports, and group challenges.
Program Results (Documented and Perceived)
Program Evaluation
No evaluation strategy was incorporated in the original design of the program and no baseline data
were collected prior to program initiation, making a formal evaluation of program impact difficult.
Nonetheless, program evaluation is currently at the top of the wellness director’s agenda. She recently
asked the College of Business to evaluate different approaches to measuring the impact of worksite
wellness programs in a university context.
Wellness Program Participation
Information on participation mostly comes from observations of program staff at the moment.
According to a wellness program employee, participation varies by the program: “For [our monthly
health screenings], we tend to see more of the facilities people come out, you know, the grounds people
who clean up. For Wellness Wednesdays, we see more university staff. We have a set group of people
that tend to come every time. They’re all women. We see men trickle in every now and then, but it all
depends on the topic really. For yoga and guided meditation, we see all three [staff, faculty, and
students]. For massage, that tends to be all three, but mainly, more faculty and staff because they can
afford it.” When it comes to consistency in attendance, Wellness Wednesdays and yoga classes each
have a devoted group of participants. “We have a set group of about six people that come [to yoga
classes] faithfully for years,” continues the wellness program employee we interviewed. “The number
fluctuates from 10 down to 6.” The program with the smallest number of participants is the nonprofit
food service, with only two or three people who signed up to participate. This program, however, was
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the recent addition that was brought on campus only two or three weeks before our site visit.
Participation rates in the Insurance Provider wellness programs have not been shared with the
university wellness program at the time of our site visit.
Relative to the total number of university employees and students, the number of wellness program
participants remains small. To boost program awareness and participation rates, the university wellness
program decided to increase its social media presence, which is assumed to resonate particularly well
with the students. Facebook and Twitter accounts, as well as a YouTube channel, were created. While
the YouTube video that introduced the wellness program was watched 441 times during the 11‐month
period, the university wellness program only has 36 people who “Like” them on Facebook and 43
individuals who follow it on Twitter, based on March 26, 2012 data.
The wellness program is currently building the infrastructure to track program participation in
educational activities with sign‐in sheets and appointment logs. One of the student employees recently
created a database of all individuals who have ever participated in different wellness activities by
entering the information from sign‐in sheets used during different events. A small‐scale survey was
conducted at the Employee Benefits Fair, which showed employees’ preference for individualized
coaching sessions and small group activities.
Challenges to Participation
We identified five factors that affect staff, faculty, and student participation in different wellness
activities at the university. Each of these five factors can be considered as a barrier and as a facilitator at
the same time.
Location and Timing: The university has multiple campuses around its host city, which can make it
difficult for people to attend wellness events at locations other than their own. Many lectures are
scheduled to begin at 11 am, which is not convenient for some employees. “My only issue,” explains one
focus group participant “is that classes are at eleven and that just doesn’t work. Noon is so much better;
they’re not expecting you to be at your desk. I’m an admin assistant, so they expect me to be there,
except for lunch hour.” Moreover, few wellness programs are offered after business hours, because
many employees leave their offices at five o’clock trying to beat traffic. By contrast, individualized health
coaching as part of Wellness on Wheels program, massage services, and meditation classes are all
offered in different locations and at different time to improve access.
Program Focus on Education: The university wellness program emphasizes education because it is
aligned with the overall educational mission of the university. Benefiting from the expertise of university
faculty and graduate students, the wellness program can offer a wide range of health and wellness
lectures and individualized wellness coaching activities that other organizations would have to pay for.
At the same time, however, physical activities and fitness challenges seem to be less promoted at the
university. Several factors were mentioned during the interviews as contributing to this. First, there are
not enough “facilities for people to clean up after they work out.” Second, faculty and staff have to pay a
fee to use campus recreational facilities. Third, the age difference among wellness program participants
may make some of them uncomfortable. Explains one faculty member, “for many of us of a certain age,
going to the pool with people who are 18, 19 years old is very intimidating… You go, “I thought I looked
pretty good until I walked in here!”
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Leadership Support for the Program: Although leadership support for wellness by university
administration is relatively high, direct supervisors and managers seem to be somewhat less supportive.
If an immediate supervisor is supportive of his/her employees’ participation in wellness activities, it is
more likely that his or her employees will make an effort to partake in different wellness initiatives.
Managers who do not support wellness or do not participate in such programs themselves can create an
environment where participation in wellness activities is viewed as a distraction that impedes
productivity, rather than improves it.
Program Management: The university has a designated office that runs the program, which helps
coordinate wellness initiative and resources on campus. It is managed and funded by the HR
department, but serves all university faculty, staff, and students, which may be confusing to students.
Indeed, university staffs are the most active program participants. Many faculty members are not on
campus on a daily basis, whereas students may not realize that the program that is housed at the HR
department is designed to offer services to them. Moreover, retirees have been recently added to the
list of program target population, and the wellness program is currently surveying them to identify their
needs and interests in participating in wellness activities. Having diverse clientele makes it difficult for
the wellness program to be relevant to all its clients.
Exposure to the Wellness Program: The university wellness program uses different marketing avenues,
such as fliers printed in color, program webpage, announcements at the university radio station and
television channel, and strong social media presence (Facebook and Twitter accounts). Nonetheless,
according to one program representatives, the wellness program still has not “hit all four corners of the
university. So, people really don’t know that it’s there and that’s one of our biggest challenges is that
people don’t know what we do.” To further inform and engage faculty, staff, and students and to
accommodate employees with inflexible schedules, the program started using social media to
disseminate information about the program. Co‐sponsoring health and wellness events with
Recreational Services also increases the wellness program’s visibility among the student community and
allows fitness facilities to promote their services among faculty and staff who are required to pay a
nominal monthly fee to use the gym and other facilities.
Program Impact
Health‐Related Behaviors: The program does not yet have necessary information to evaluate the
program impact on health‐related behaviors and health risks, but it started collecting health‐related
data recently. For example, to evaluate the impact of individualized health coaching sessions, a wellness
program employee created a database where she logs changes in blood pressure and weight in each
individual program participant over time. However, one wellness program representative suggested that
it is too early to see the impact this program had on health status of the program participants. Finally,
we are not aware of any evaluations of the wellness program’s impact on healthcare costs.
Employee Satisfaction: To measure program satisfaction, the program relies on participant testimonials,
which suggest that it is well‐received and has a positive impact on employees. According to one wellness
program employee, participants often tell her that having regularly scheduled wellness activities “forces
them to go out and then get their exercise for that day.” She also mentioned that she gets “a lot of e‐
mails thanking [the program for] the massage therapy…and [for] anything that creates relaxation, such
as free guided meditation sessions.” A number of university employees shared their thoughts in online
podcasts promoting the program. Here are some of their comments: “[The walking program] is a very
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sociable experience.” “It is a great way to burn stress and get energized.” It also helps “get colleagues
out of the office and meet new people.” While these testimonials suggest that this is a wellness program
that helps participants “feel good” and socialize with colleagues, they cannot be used to formally
evaluate the program’s impact.
Morale/Productivity/Corporate Culture: Employer A’s wellness program has yet to formally evaluate its
impact on employee morale, productivity, and corporate culture. It plans to use recommendations from
a recently commissioned study (see below) to identify some organizational metrics that should be
monitored. Nonetheless, participant testimonials seem to suggest that the wellness program is helping
them boost their morale and productivity levels: “I highly recommend guided meditation,” says one
wellness program participant in a recorded message. “It definitely assists you with returning to the
workplace and helps being more productive, because you are not allowing thoughts and concerns to
interfere with the productivity of your work.”
Return on Investment: Leaders of the wellness program asked the university’s business school to
conduct a review of the experiences of other universities in the area. A faculty member and a group of
graduate students conducted a literature review and a number of in‐depth interviews with experts in
the school’s city to better understand how the university compares to other institutions of higher
education in the area and to offer recommendations on how Employer A should design its own program
evaluation strategy.
The study conducted by the School of Business has four main findings. First, “there aren’t many
organizations that look at the evaluation; they look at the delivery, the marketing, and the design…and
almost none of our sister schools are doing that.” Second, “a lot of the experts even question whether
you should look at ROI. It should be something like compensation or health insurance that is just
something you offer to attract and retain good employees. We don’t evaluate our health insurance [this
way], so why are we worrying about making a case to the board or [focus on whether] this program pays
for itself?” Third, “almost all the studies showed that there was a good financial return, anywhere from
two dollars to 12 dollars per dollar spent, which is pretty significant. But there were a lot of little
interesting anomalies: often, the sickness and accident ratings go up dramatically after you first [start a
program], because people are going to the gym for the first time or they’re suddenly on blood pressure
medication, so healthcare costs go up…but over time, those tend to level out. People put in a wellness
program, and they expect in a year we should see our health insurance costs should drop by 50 percent,
and it’s just not that simple.” Fourth, when it comes to measuring program impact, privacy issues can
become a hurdle “because it’s difficult to get people to give up personal information about their weight
and health issues.”
Based on the study findings, researchers recommended to focus on measuring program participation
and satisfaction and to track a few outcome metrics, such as absenteeism and satisfaction. Participation
and satisfaction could be measured by surveying those who participate in the program and asking them
about the reasons why they participate and what they like, and then surveying those who did not
participate and asking them why they did not participate, what it would take to engage them, and what
programs they would want to partake in. When it comes to outcome measures, absenteeism was the
only metric that the study authors felt was measurable and useful for the ROI analysis in a university
setting. Productivity was deemed impossible to measure given the nature of labor at the university,
whereas health outcomes were ruled out due to privacy concerns.
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Effect of Incentives: The effect of health insurance premium surcharges for smoking, the only financial
incentive used at the university, has yet to be measured formally.
Unintended Consequences: While the wellness program is popular among university staff, many of
whom do not have flexible schedules and cannot leave their work place to attend a wellness activity,
some staff reported strained relationships with their immediate supervisors who did not approve their
participation in wellness activities. One employee reported that she had to cancel her campus gym
membership and sign up for a more expensive gym that was closer to her house so that she could
exercise after work and on weekends instead of her lunch break.
Future Directions
According to our interviews, Employer A’s program will continue focusing on stress reduction and raising
wellness awareness. By leveraging the campus partnerships and support of the administration, the
program plans on improving its student outreach strategy. When it comes to the introduction of new
program components, number one on the list is the collection of HRA data through stronger
relationships with the health plans. The wellness program director also plans to invest further in
program evaluation by formalizing participation tracking and outcome data collection. Finally, there is
an interest in collaborating with other university system institutions by creating a consortium to share
ideas and experiences and leverage the existing resources.
Conclusion
To summarize, Employer A is a wellness leader among university system institutions that offers a range
of wellness activities and events that are available for staff, faculty, students, and retirees either free of
charge or at a nominal fee. The university wellness program is a relatively low cost, partnership‐based,
home‐grown program that creatively leverages relevant existing resources. It not only benefits from the
talents and expertise of university staff and faculty, but also engages graduate students. By leveraging
existing campus resources and engaging graduate students in training as service providers, the
university wellness program is able to offer individualized wellness activities that fit into the busy
schedules of university employees and students and develop educational programs that showcase the
expertise of its faculty members. This low‐cost program not only enjoyed the support of university
administration and won a university‐wide award, but also helps graduate nursing, nutrition, and
counseling students gain professional experience by allowing them to provide wellness services and
obtain research experience by conducting studies for their masters’ theses on worksite wellness issues.
The university essentially has two separate wellness programs: one is administered and coordinated by
the university and includes wellness activities offered by outside vendors and one that is operated by its
two health plans. It is interesting to note that wellness program personnel do not consider the program
offered by the two health plans as being a part of the university wellness program. There is limited
coordination and communication between the two programs, and the data collected by the health plans
were not shared with the university at the time we conducted the case study. While participant
testimonials suggest that the university‐operated wellness program is successful in reducing employee
stress and increasing their productivity, there is no objective analysis of program effectiveness in terms
of participation rates and organizational and employee outcomes. Available participation data do not
suggest high uptake rates, and program effectiveness cannot be judged based solely on participants’
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testimonials. Evaluation of the program’s impact on health status of university staff and students
requires close collaboration with health plans to obtain claims and HRA data, which has yet to be
established.
Moreover, the university wellness program is not uniformly popular on campus. Staff are more likely
than faculty and students to participate in different wellness activities. Because it is funded by the HR
unit and administered by the employee and student services department, the wellness program may
want to reach out to students and emphasize activities that are more likely to attract them. Focusing on
physical activities and team challenges may not only help engage students and build closer relationships
with Recreation Services, but will also expand a range of co‐sponsored wellness program activities that
are currently focused heavily on education and individualized screening and coaching. Nonetheless,
offering more fitness events may create unnecessary competition with activities offered by the
Recreation Services program.
Employee participation in wellness activities is not always supported by their immediate supervisors.
Research shows that successful implementation of a worksite wellness program requires strong
managerial support. The wellness director and university administration should work closely with
department managers to explain the role and the benefit of the wellness program and require them to
provide reasonable support for their employees’ participation in wellness activities.
Finally, while creating social media presence is important, the success of this marketing and outreach
strategy depends on the number of people who obtain the program information from these sources. As
of now, it appears that the impact of using social media could be increased.
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Employer B: A State Government Agency
The worksite wellness program at Employer B was developed to “reduce employee chronic disease risk
factors, create a model wellness program that could be replicated throughout state government, and
demonstrate the critical importance of a full‐time wellness director position to develop, administer, and
evaluate the program.” (Wellness Program Annual Report)
Organization
Background on the Employer
Employer B is a state government agency responsible for ensuring the health, safety, and well‐being of
citizens, and providing other human services for populations in need.
Employer B is and one of the largest employers in the state, with more than 19,000 employees working
in 30 agencies and offices and 18 facilities, such as hospitals, treatment centers, and residential school
facilities. Employer B’s annual operating budget is $14 billion. Many staff work in the state capital, but
others are located throughout the state in regional and county offices. The majority of employees (73%)
are female and the average employee age is 45. State employees are eligible to join the self‐insured
state health plan (SHP), which provides health care coverage to more than 663,000 individuals. Using an
Insurance Provider’s network, the SHP offers two PPO plans. The basic 70/30 plan has higher
copayments, coinsurance rates, and deductibles but lower monthly premiums. The standard 80/20 plan
offers a higher coverage level but also has higher monthly premiums. Both plans encourage employees
to make healthier lifestyle choices and become partners in addressing their health care needs.
The total medical cost for employees was over 73 million dollars. The total cost of coverage per member
($3,933) of employees was higher than any other state department. Rates of utilization were 62.0
hospital admissions and 230.2 ER visits per 1,000 members. Forty‐two percent of employees had a
chronic condition, more than in all other departments, except for the Department of Correction.
Hypertension (37.4%), diabetes (12.0%), and mental health (8.0%) were the most common conditions.
Wellness Program Description
Program Development and Implementation
Employer B’s Wellness Program was launched as a partnership between the state employee health plan
and the state’s public health department to establish a replicable model of a worksite wellness program
and contain healthcare costs by reducing risk factors. The department was selected to develop this
model program due to its large size, diverse workforce, high prevalence of chronic diseases, and
leadership support.
When created, the wellness program had a flat structure with two levels of organizational hierarchy: the
department level to provide overall direction and strategy and agency/facility level to organize and
implement wellness activities on the ground (see Table 2). At the department level, the wellness
director coordinated and evaluated the program during her tenure. Wellness council meetings provided
wellness representatives the opportunity to share ideas and updates on upcoming activities. Between
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council meetings, regular communication took place via email. Since the wellness director position was
eliminated in 2011, the oversight, coordination, and council meetings no longer occur.
At the agency/facility level, each wellness representative, with the help of their wellness committees, is
encouraged to focus on the most relevant health risks and organize their own events. One
representative described the benefit of this de‐centralized structure: “You were given opportunities to
have group challenges…but we always got to choose how we wanted to do it, what we wanted to do. If
we didn’t want to do something, we didn’t have to. If we wanted to, we could. Our particular division is
one of the smaller divisions, so we were actually able to do a lot of customization and personalization
for our particular members.” The wellness representatives and wellness committees continue to
organize events for their own agency/facility.
Table 2: Organizational Structure of Employer B’s Wellness Program
Position
Roles
Department Level
Wellness Director
ï‚· Coordinates across agencies;
(this position was
ï‚· Chairs the wellness council;
eliminated in Fall of
ï‚· Represent department on various health and wellness initiatives.
2011)
Wellness council
ï‚· Wellness representatives from each agency/facility;
ï‚· Advises on wellness policy and program needs.
Agency/Facility Level
Wellness representatives
ï‚· Provide leadership to the agency/facility wellness committee;
ï‚· Help develop and implement the agency/facility annual wellness
plan;
ï‚· Report wellness activities to their agency director and the Wellness
Director;
ï‚· Make up the wellness council.
Wellness committees
ï‚· Provide wellness programs and activities in each agency/facility.
The agency’s program focuses on changing both formal and informal organizational policies and work
environments to increase workplace support for wellness and ongoing evaluation. To support the
wellness program infrastructure, Employer B created a wellness policy, which authorized four hours per
person per month of work time for wellness committee work and six hours per month for the wellness
representative at each agency/facility. The policy also encourages approval of flexible work schedules,
when possible, to allow participation in wellness activities.
While the ongoing goal of the wellness program is to create a sustainable wellness infrastructure
throughout the department that supports and promotes employee wellness, the wellness policy states
the program goals are to:
1. Maintain agency wellness committees, department wellness council and a wellness director to
plan and implement wellness programs throughout the department.
2. Raise awareness among employees regarding the importance of lifestyle behaviors that
promote good health and provide employees with information and resources on how to make
changes that reduce their risk for chronic diseases.
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3. Promote changes to workplace policies and environments that encourage and support
employees in being more physically active, having access to healthier food, avoiding tobacco
and managing stress.
4. Provide programs and activities at the work place that offer employees opportunities to be
more physically active, eat healthier food, stop using tobacco and manage stress.
5. Elicit ongoing employee feedback to plan and implement programs that meet the needs and
interests of employees.
Data Collection
During their tenure, the former wellness director used two methods to examine data on the health
status of the department’s employee population. First, based on published reports from the SHP, the
Wellness director identified the most common chronic conditions and utilization patterns among
employees and their dependents. Second, a survey showed that the most salient health concerns were
poor diet, weight, physical activity, and depression. In addition, one facility piloted a health screening
and counseling program, Roadmap to Good Health. This pilot program collected data on facility
employees through an online questionnaire and height, weight, glucose, and cholesterol measurements.
Program Costs
Jointly funded by the department and SHP, the wellness program was formally initiated when the
wellness director position was created in 2004. The total amount of funding provided to the worksite
wellness program between November 2004 and July 2009 was to $678,456. Between 2009 and 2010,
the wellness director position was supported by the Preventive Health and Health Services Block Grant,
funding provided by CDC for states to address their own unique public health needs in locally defined
ways. In 2010, the wellness director position was transferred to the Office of the Secretary and
eliminated in 2011 due to a lack of funding. Given the budget cuts, the wellness director organized two
fundraiser activities in 2009 and 2010, which generated slightly more than $2,000 in profit and were
used to provide small incentives and plan events.
Wellness Events and Activities
Wellness programs and activities at Employer B are organized and administered either by the state
health plan or the department’s wellness director and Wellness Committees.
Programs administered by the state employee health plan
ï‚· Wellness Services and Case Management: The state employee health plan offers various
prevention and case management services; smoking cessation program; online weight
management program; health assessment; and confidential support for stress, depression, or
other mental health issues. Prevention and case management services include educational
resources and one‐on‐one nurse coaching to help members manage a chronic illness or medical
event. Smoking cessation services include one‐on‐one telephone support, web coaching, and
free nicotine patches, in‐person counseling with doctor or behavioral therapist, and reduced
cost for smoking cessation medications. This state program also offers health coaching with
registered dietitians, nutritionists, personal trainers, exercise physiologists, weight loss
therapists and health educators.
Because most department‐initiated wellness program activities are organized and implemented by each
agency’s wellness committee, they vary across Employer B. Most agency/facility events focus on group
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activities, such as walking and team nutrition challenges. Some agencies/facilities have introduced
activities to reduce employee stress and improve work‐life balance. Examples of wellness activities and
events include:
Programs administered by Employer B
ï‚· Education Activities: Education initiatives include posters, seminars, and bulletin boards. For
example, one agency created a poster that presented an explanation of blood pressure, how
you measure it, what the numbers mean, what individuals should watch for, and what one does
to follow up if concerned. Another facility uses its professional staff to provide monthly health
lectures. A recent popular seminar, “Momma Always Said Eat Your Vegetables,” was presented
by the retired nursing director. These lectures are designed as 30‐minute presentations during
lunchtime so that staff with only 30‐minute breaks can attend.
ï‚· Wellness Fairs: Many agencies and facilities hold annual wellness fairs to provide education and
screening. One agency has conducted its annual wellness fair in conjunction with Employee
Appreciation Day to make the event more enjoyable. This wellness fair included games and
activities and donated fruits and vegetables from Whole Foods. Another agency invited
organizations that raise funds for specific initiatives, such as heart disease and cerebral palsy, to
participate in the wellness fair. This provided employees with an opportunity to talk with
organizations they donate money to.
ï‚· Walking/Running Events: Walking challenges are a popular group activity across the
department. Teams are organized to work as a group to reach a specific goal of total miles
walked. For example, the Appalachian Trail Walk required teams to walk the length of the
Appalachian Trail from Springer Mountain, GA to Mount Katahdin, ME. This department had 87
teams that each walked a total of 2,179 miles. Other walking challenges have included “Walk to
San Diego” and “Lisbon to London.” 5K events are walking or running challenges that have been
used to help the wellness program raise money for participating wellness committees. Funds
raised are spent on subsidizing classes, repairing fitness equipment, and purchasing small
incentives.
ï‚· Individualized Walking Program: Several agencies and facilities have groups of individuals who
walk outside together once a day. The wellness program has developed walking maps for the a
local college campus and the state capital’s downtown district. The designated walks range from
0.3 miles to 1.69 miles. For employees in other locations, the wellness program provides a link
for individuals to create their own walking map on its website. During summer months when it is
hot and humid outside, daily indoor lunch time walking programs in the gym are scheduled.
ï‚· Exercise Classes and Team Sports: Weekly lunch time fitness classes and free work team sports
are offered at several agencies and facilities. Classes include yoga, Pilates, and Zumba dance and
cost $3‐$5 per class. Team sports include volleyball, basketball, and softball.
 Line Dancing: During the heart health month, one agency held “Hippy Hoppy Hopping Heart
Healthy Month.” Three days a week, employees met in the parking lot and danced for an hour.
As one employee described it, “Even our director came out and line danced with us…A DJ, a
friend of a friend, made me a tape, and so we had all these crazy old songs…On days when we
couldn’t go outside because it was really cold, rainy, or snowing…our Director allowed us to line
up in the hallway.”
 Fruit and Vegetable 30‐Day Challenges: Employees receive weekly healthy eating newsletters
and recipes during the challenge as they keep a log of their daily servings of fruits and
vegetables to compete for small prizes.
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ï‚·
ï‚·
ï‚·
Weight‐loss Programs: Onsite and online subsidized weight loss management classes are
available to employees.
Swap Shops: One agency uses themed “swap shops” as an activity focused on stress relief.
Employees bring unused household items to swap with other employees. Any items left at the
end of the day are donated to a local charity. One of the swap shop themes was “Lotions and
Potions;” employees brought in lotion, shampoo, and perfume that they no longer wanted. One
interviewee described the popularity of these events: “We’ll have people so lined up at the door
that we had to bring them out into the hallway to get in…just to get to the swap shop.”
Spring Fling: To improve employee morale during a recent furlough, one agency held a “Spring
Fling Furlough Clean Friday” event. Employees were encouraged to come to work on their
Furlough day to clean their offices and then enjoy a picnic with healthy foods and many
opportunities for exercise (e.g., croquet, balls, weights, balloons). As a wellness representative
described, employees “cleaned their office – that was the Spring Clean part. Then the Fling was
the fact that we went outside and had fun, and the Furlough Free Friday was that they lost ten
hours of pay, but took the day outside participating in the events.”
Changes to Physical Environment
Changes to the physical activity and food environment have been made in several campus locations. A
policy change allows employees to use fitness facilities that were previously designated as
resident/patient facilities. Several other agencies/facilities found small rooms to designate for employee
fitness, with a few pieces of exercise equipment or space to exercise with fitness videos. Campus
walkability was improved by completing a full path of sidewalks to allow employees to walk a 15‐minute
loop without crossing the street.
To improve food choices, the agency revised its contract with the Office for the Services for the Blind,
which operates all vending machines on the department campus, to require the vendor to offer at least
five healthier snacks in each vending machine. When one agency lost its vending contract with the
Office for the Services for the Blind because the agency was too small to have a profitable vending
machine, it bought its own. The wellness committee stocks the vending machine with healthier options,
such as granola bars, Fig Newtons, nuts, dried cranberries, raisins, baked chips, and popcorn. The
wellness program also brings in the “Farmer on Mall Project,” which set up a local farmer to sell fresh
local produce to employees once a week. Finally, the wellness director worked with a cafeteria staff at a
local university to offer a low cost weekly health lunch special and to increase the availability of
healthier meals and snacks.
Alignment with Health Plan
Starting in the last decade, the state health plan began offering wellness prevention programs,
education, and resources to its members. Moreover, the department wellness program was partially
funded by the SHP and created to supplement and augment the SHP‐administered wellness activities.
The plan‐initiated wellness programs and activities typically target individual employees, whereas the
department wellness program focuses on group activities. However, there was limited awareness of the
state‐administered activities by our interviewees.
The state health plan also collaborated with Employer B to conduct a pilot program, Roadmap to Good
Health (see below), to incentivize individualized health screening and counseling, but only one
26
department facility was invited to participate in it. This facility was chosen because it had the worst
health indicators and the highest risk factors.
Engagement Strategy
Incentives
The department’s wellness program focuses primarily on group activities, such as educational
lectures/classes, walking challenges, and annual wellness fairs. Raffle incentives and small exercise
equipment grants were sometimes offered to wellness committees, rather than individual employees,
to further incentivize worksite wellness activities in their agencies. These group incentives were
intended to promote participation, rather than reward the achievement of a particular health outcome.
Group incentives were spent on purchasing exercise equipment, pedometers, and other items for
wellness activities, such as an audio system for line dancing.
In contrast to limited incentives the department’s wellness program offered for participation, the SPH
has a state legislated bill to encourage its health insurance plan members to make healthier lifestyle
choices. The tobacco cessation component of this initiative was developed to help members quit
smoking and to lower the costs associated with the treatment of health conditions associated with
tobacco use. This bill requires state employees and their eligible dependents to attest to the non‐
tobacco use or state that they qualify for exemption based on their participation in a tobacco cessation
program before they can select the higher coverage level (80/20) plan rather than the basic (70/30)
plan. The bill also has a second provision that targets BMI limits of covered individuals, which has yet to
be implemented, according to our interviewees.
In collaboration with the state health plan, one facility piloted an incentive of reduced copay to
participate in a health screening. Staff received a $15 reduction in copays for an entire year for
participating in the Roadmap to Good Health pilot. One interviewee noted “what they were trying to do
was to get people into the doctor proactively, like go in there and find out what’s going on that you can
control instead of going to urgent care.” The program required individuals to complete an online
questionnaire and have their height, weight, glucose, and cholesterol measured. Staff were then
provided a report card and met with a medical professional to review the results. An interviewee stated
the pilot was extremely successful and “people were very appreciative of the fact that, you know, the
state as well as [the facility] was trying to partner up and do something for their health.”
Non‐Financial Avenues to Increase Engagement
The agency’s wellness director provided oversight support and coordination to the department a…
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