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Description

Your supervisor, the Wellness Director, stopped by your office this morning and asked you to review a list of “Future Directions” that have been identified by key campus wellness stakeholders as areas to focus on to enhance the wellness program. She would like you to review the list, and pick one to pitch at the next Human Resources department meeting. She would like your pitch to include four parts: an introduction or overview to the potential program, a needs assessment survey, a fieldwork data collection plan, and focus group questions.

The Future Direction Pitch should be approximately 5 pages not including appendices and prepared following AMA (American Medical Association) guidelines.

INTRODUCTION

Describe the wellness program enhancement that you are proposing for Employer A (Page 9 in attached PDF). Why is the program enhancement important for the campus?

NEEDS ASSESSMENT SURVEY

Create a 20 question needs assessment survey for the program enhancement you are proposing for Employer A (Page 9 in attached PDF). Describe your target population, plan for collecting the data, timing of survey implementation, and the audience you will share your findings with. Attach the needs assessment survey as an appendix to your paper.

FIELDWORK DATA COLLECTION

Describe what your fieldwork data collection plan would entail. How would you find out how the proposed program is being received by the campus or target population. What type of field research would provide valid and credible information that cannot be obtained from other data collection sources? Attach the fieldwork data collection instrument(s) as an appendix to your paper.

FOCUS GROUP

Develop 10 focus group questions centering on the program enhancement you are proposing. Provide the purpose of the focus group(s), when the focus groups would take place (prior to program implementation, during, or after), your target audience(s), how you would find/recruit participants, would you provide incentives, who will moderate the focus group(s), and provide your data analysis plan? Attach the focus group questions as an appendix to your paper.

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
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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
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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.
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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
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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.
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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
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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.
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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
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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
10
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
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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 and
facility wellness committees to increase engagement. The wellness director helped facilitate activities,
such as the walking and fruit and vegetable challenges, across the entire department, provided
resources for small equipment incentives, and suggested activities that were in line with the goals of the
program. She also helped agencies and facilities share and discuss ideas through the wellness council.
To increase engagement of employees in specific events and activities, some agencies and facilities
provide small giveaways for participating in activities. For example, one has obtained restaurant
coupons or bottles of water from vendors to raffle‐off at events. Another agency organized a pie fest at
the finish line of their Halloween walking challenge. Small slices of pie were given as a token of
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appreciation for employee participation, “thanking them for being a part of all the challenges,
demonstrating that you don’t always have to go cold turkey with treats but you do have to save them
for special events and you have to exercise your heart before you eat it.” The same agency also invited a
local ice cream truck to come to their offices during a hot summer day. The agency closed all but one
building door to encourage employees to use the longest route to the ice cream truck, placed wading
pools in the yard on the way to the ice cream truck, and had exercise equipment available in the yard.
Communication/Marketing Strategy
While the program had a wellness director, the overall communication messages and strategy were set
by the wellness director and then adapted to the local needs of agencies and facilities. One interviewee
emphasized the importance of ongoing reinforcement from the wellness director: “When you’re
working [two other jobs] and you’re still trying to keep the wellness thing going, it was obviously just
really helpful to have those little reminders of this is where we need to go.” This centralized strategy and
de‐centralized implementation allowed each agency to implement a targeted comprehensive
communication package. For example, one facility noted they can’t rely only on e‐mail to advertise
activities since most staff don’t have e‐mail. “Healthcare techs that take care of individuals, their
supervisors may have e‐mail, but they…don’t and that’s a big working class at [the facility].” To reach
these people, the wellness committee doesn’t rely on just one mode of communication. They ask
supervisors to post flyers, make announcements during staff meetings, and put information on bulletin
boards. For larger announcements, the director of the facility often sends out an e‐mail to promote the
event. Another agency distributes information and education to employees through a website, including
posting recorded Webinars. Finally, one inpatient medical facility has a Wellness TV show with
employees sharing their wellness experiences and how the wellness program can help relieve stress and
stay physically fit. The show follows a “David Letterman‐type” format with a soundtrack and
commercials and runs on the facility station so employees and patients can watch it.
Leadership Support
Although the state provided support for the development of the department’s wellness program and
funded the wellness director’s position for 6 years, this position was first transferred to the Office of
Secretary and then eliminated due to state budgetary shortages. Without this support, the wellness
committees are “pretty much left to their own devices” and involvement will depend on individual
motivation.
Support for the wellness program from various agency leaders varies significantly across agencies and
facilities. One interviewee said his facility director has been very supportive of many wellness activities.
The director’s support was the reason why the program was “able to get the exercise room and some
equipment.” Also, “he was the first one in line for the blood work…[he] sent e‐mails out, encouraging
managers to make sure their staff were given the time off” to participate, and has even participated in
on campus Weight Watchers meetings. Another interviewee was more neutral. She mentioned that
while her agency/facility management is generally supportive of wellness activities, she “does not see
those folks… at the wellness events they have.” Finally, one employee raised a concern that they don’t
have the support of upper level management: “We won a statewide competition and nobody in
management even acknowledged it…we congratulated ourselves, but we had no one from
administration say job well done, because I don’t think there is necessarily knowledge of what we do or
support of what we do, because they don’t participate in it.”
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Inclusiveness
Employees can participate in many activities ranging from individualized walking, to fruit and vegetable
challenges, to events where employees can swap unused items with colleagues. While there is a wide
range of wellness activities throughout the department, because each agency organizes its own events
and programs, the programs offered to employees vary by agency. However, all wellness events and
activities can be grouped into four large categories: physical activity, nutrition, smoking cessation, and
stress relief. These categories map onto the overall wellness focus areas identified in the department
wellness policy, which helps ensure a degree of consistency between different department‘s agencies
and facilities.
To assess employee interests and preferences and solicit their input on new activities, the wellness
director also conducted annual employee surveys during their tenure. Information provided in these
surveys helped the wellness program determine the most popular activities, better understand how
information should be delivered to employees, and determine which wellness resources and activities
should be added or canceled.
Program Results (Documented or Perceived)
Wellness Program Participation
Annual employee wellness surveys revealed that approximately half of all the department’s employees
participate in worksite wellness activities. This 50% participation rate was also confirmed during
interviews with several wellness representatives. In 2010, roughly two‐fifths of all participating
employees did so at least twice a week. Individual walking, group walking challenges, and organized
fitness classes were the most popular activities. More than a quarter of all employees participated in
healthy eating wellness activities, such as the fruit and vegetable challenges.
Moreover, department employees have represented over half of all the state government Walking
Challenge teams. For example over 1,500 employees participated on teams for the Spring 2011
challenge and won 8 of 9 trophies awarded.
Challenges to Participation
Several barriers to participation emerged from the interviews, focus group, and most recent annual
wellness program report. The most common barriers are: lack of funding for wellness activities, difficulty
in communicating with employees, work schedules and location, and lack of time to plan and to
participate in wellness activities.
Lack of Funding: Although the wellness program was able to create new fitness areas in existing space in
facilities and agencies, the limited funding meant that they were often created without air conditioning
or showers, which limited uptake.
Communication: Lack of email or internet access by many hospital and treatment facility employees
makes it more difficult to publicize events and activities to this group of people. Lack of awareness
negatively impacts participation in events and activities.
29
Diversity of Locations and Schedules: In hospitals and treatment facilities, it is difficult for shift workers
to participate in wellness activities. Some administrative staff cannot leave their phones unattended and
therefore have difficulty participating in activities. Other agencies have found it difficult to involve
telecommuters in wellness activities. One interviewee described her attempts to involve these
employees: “My strategy was to have somebody on the team who was remote so that maybe they
would have some insight into what we could do that would motivate them. But that’s very hard,
because they are also remote for team meetings and so they feel like they’re not really part of the
team.” This wellness committee tried to motivate employees in any location and any physical ability to
participate by challenging them to walk somewhere in the area they live, take a picture, upload the
picture, and then others could guess where the picture was taken. “We have come up with challenges
where we thought anyone could participate, but had zero participation in it.”
Lack of Time: Employees also reported lack of time to participate in wellness activities. One wellness
representative described that some employees found it particularly difficult to participate in ongoing
activities: “I’ve had people wanting to participate in things and they just couldn’t because they couldn’t
keep the time slot open in their schedule.” Another wellness representative described their efforts to
accommodate the short 30‐minute break staff have for lunch: “We’ve done some lectures on campus as
well as going to specific buildings that requested it and we’ve held it in their conference room because
it’s hard – I mean when staff have 30‐minute lunch hours, if they’re having to spend like 15 of it walking
to and from the mains – we have a big campus.”
Facilitators
Several facilitators were also identified, including implementation of the wellness policy, annual
program implementation evaluation, having an engaged wellness director, and the program structure
with wellness representatives and committees in each agency and facility.
Wellness Policy: The wellness policy encourages approval of flexible work schedules, when possible, to
allow participation in wellness activities. This wellness policy indicates to employees that there is
management support for participating in wellness programs. The policy also authorizes wellness
representatives to spend six hours per month and wellness committee members four hours per month
of work time to plan and implement wellness events and activities.
Program Evaluation: Annual employee surveys helped the wellness director and wellness
representatives understand factors that impact participation (e.g., timing, communication about events)
and the types of activities and events they are interested in. For example, results of the 2010 survey
indicated that the majority of employees prefer that wellness activities be scheduled during lunch.
Twenty percent of survey participants indicated that they equally prefer to receive wellness information
through lunch time presentations, e‐mails, and online programs. The most common requests for new
activities or resources were healthier vending selections, fitness equipment, stress reducing activities,
and walking challenges. About a third of employees requested annual health screening tests, healthy
eating classes, and organized walking programs.
Engaged Wellness Director: Several interviewees reported that the position of a wellness director was
crucial for the program’s success. According to one of them, by providing necessary structure and
direction to the wellness program and coordinating collaboration between programs, the wellness
director was able to bring “so much energy to the program and has given [the agencies and facilities]
guidance” they needed to successfully implement the program in their agencies/facilities.
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Program Structure: While the program had a wellness director, the two levels of organizational
structure provided the wellness program with overall direction and strategy at the department‐level and
individualized implementation at the agency/facility‐level. Wellness representatives within each
agency/facility know the needs of their employees and can better make decisions on how to use limited
wellness resources to ensure higher degree of participation and impact. For example, knowing that
many employees enjoyed line dancing, one wellness representative requested money from the wellness
director to purchase an audio system. She also used her personal contacts to purchase the audio system
at a discount and obtain free music CDs.
Program Impact
Although a comprehensive evaluation of the impact of Employer B’s wellness program, which includes
health risk assessment and return on investment analysis, has not yet been conducted, the wellness
director assessed agency/facility program implementation and self‐reported changes in behavior during
her tenure.
Program Implementation: In an attempt to evaluate the wellness program implementation at the
agency/facility level, the wellness director conducted annual program audits. Table 3 presents the
results of the 2010 audit (the latest data collected for the 2011 annual program report). Almost all
agencies/facilities reported that they provided education to employees, and two‐thirds offered fitness
classes or provided tobacco cessation resources. Over half provided weight management programs,
have indoor fitness areas, and organized walking clubs. Some agencies/facilities have a healthy foods
policy, held health fairs, have healthier vending options, have a policy supporting physical activity,
offered health screenings, and offer regular blood pressure checks.
Compared to baseline data collected in 2005, the largest improvement was in the number of
agencies/facilities that report having healthy foods policy (0 to 18), offering tobacco cessation resources
(3 to 24), offering healthy vending selections (increase from 10 to 17), and having indoor fitness areas
(14 to 21).
Table 3: Percentage of Agencies/Facilities Reporting Program Implementation Activities for 2010
(N=37)
Program activities
Percentage
Provided education to employees on four major risk factors
92
Offered fitness classes in the past year
65
Provided tobacco cessation resources
65
Provided weight management programs
59
Have indoor fitness areas
57
Have walking clubs organized
51
Have a healthy foods policy
49
Held health fairs
49
Reported healthier vending options were available to employees
46
Have a policy supporting physical activity during the workday
38
Offered annual health screening to employees
24
Offer employees regular blood pressure checks
12
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Health Behaviors: Program impact at the employee level was assessed using the employee surveys.
Between 2006 and 2010, the proportion of employees reporting a positive health behavior change (all
categories except for tobacco use) was significantly higher among employees participating in worksite
wellness activities than among those who did not participate in any worksite wellness activity during the
prior year.
Figures 1 and 2 illustrate the health behavior changes in the previous year reported by department
employees between 2006 and 2010. Roughly half of all survey participants annually reported positive
changes in their walking activities and eating habits (N=3,112 in 2010). A quarter of participants
reported getting closer to healthy weight. One interviewee described the change in employee behaviors
and attitudes: “People that never exercised, that were extremely overweight…you can see the
difference in their lives, their activity levels, and weight loss. Now when we have luncheons, no one is
complaining that we don’t have dessert or that we have lots of salads and soup.” And only one‐fifth or
fewer participants reported improvements in their abilities to manage stress. Between 2006 and 2010,
566 employees reported they have quit tobacco use, and 695 reported they have reduced their tobacco
use. The downward trend of positive health changes and reduced tobacco use may be an indication of
less support for the wellness program and activities or a case of diminishing returns.
Figure 1: Percent of Department Employees Annually Reporting Positive Health Behavior Changes in
Prior Year (2006‐2010)
60
50
40
30
20
10
0
2006
2007
2008
Walking, exercising more
Choosing healthier foods
Closer to healthy weight
Managing stress better
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2009
2010
Eating more fruits/Veg
Figure 2: Number of Department Employees Reporting Quitting or Reducing Tobacco Use in Prior 12
Months (2006‐2010)
300
250
200
150
100
50
0
2006
2007
2008
Stopped tobacco use
2009
2010
Reduced tobacco use
Employee Satisfaction: In 2010, 30% of agency and 44% of facility employees rated their wellness
program as “good” or “excellent,” whereas 15% of agency and 8% of facility employees rated it as
“poor” (N=3,112). Overall, facility employees appear more satisfied with their worksite wellness
programs than their colleagues employed by agencies.
Employee Morale and Organizational Culture: Several interviewees reported that the focus on group
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