Larry Chapman’s Blog

Results-Driven Worksite Wellness

Employee Wellness Industry Trends for 2020

Saturday, February 15th, 2020

Source: Wellable

What is this about?

This just-released 53-page summary report based on a national sample of 92 health insurance brokerage professionals surveyed in 2019 focuses on their perceptions about important trends affecting employer investment in employee wellness programs along with key decision issues.  Conducted by Wellable, a leading wellness program vendor, the report provides a useful snapshot of the brokerage and benefits field about how they view current employer attitudes about wellness and well-being programming. The benefits professionals surveyed were primarily from Massachusetts, Texas, and California with a few from other states.  The survey respondents work primarily with employers with 250 to 1,000 employees and three-quarters of respondents had more than 5 years of experience in the benefits field.

A few of the major findings contained in this report include:

  • Increased investment is likely in disease management, financial wellness, flu shots, free healthy food, gym reimbursement, health coaching, health education/literacy, health fairs, mental health, mindfulness & meditation, stress management/resilience, telemedicine, tobacco cessation, weight management, and wellness challenges.
  • Decreased investment is likely in biometric screening, health risk assessments, fitness classes and onsite or near-site clinics.
  • The top 5 growth areas in employee wellness in 2020, in their order of likely magnitude, will be:

1st  Financial wellness

2nd Telemedicine

3rd Stress management & resilience

4th Mental health

5th Mindfulness & meditation

  • A “deep dive” is offered on financial wellness and mental health interventions.
  • 82% of employers are perceived to be significantly or somewhat influenced by the measurement of the wellness program’s ROI.
  • 80% of employers are significantly influenced by the rising cost of benefits.
  • Pricing is the top criteria for evaluating wellness vendors.

Why is this important?

This well-done industry survey report of the brokerage community provides a credible and useful picture of emerging trends in employee wellness.  It identifies the likely growth areas and the employer decision factors that are influencing programming choices.  The report forecasts some of the likely ebbs and flows of programming for the near turn and provides very useful insights for program planning.  This report allows you to answer the question of …:what are the likely newer trends affecting employee wellness in 2020 and beyond?”

What can you do with this document?

  • First, look through the 53-page report and focus on the issues that are most important for you.
  • Next, put a short “sound bite” together of the report’s key findings (see above) and determine who you should send it to.
  • Then, at a minimum send it to your HR and benefits staff.
  • Then, determine whether the reported trends are likely to be reflected in the employee groups you are working with.
  • Then, decide how else you can use this information to help employees and management staff understand the changing needs of employees and their family members.

In summary, this document contains a useful set of insights from the perspective of the brokerage community on how they see their employer clients approaching employee wellness in 2020 and in the years ahead. Remember – there will always be ebbs and flows around the various targets and interventions that are used in our field.  We have a tendency historically to downplay certain issues and then later to resurrect them.  This survey data reflects a constantly changing and very dynamic aspect of our collective pursuit of employee wellness and well-being.

(Everyone can now download these documents regardless of membership status.)

Click here to download this document

If you have any problem downloading the article or tool go to the membership section of our website and search by the topic or name of the document.
I hope this tool helps you reach your wellness programming goals!  Drop me a note and let me know if you found it to be helpful.

Loneliness in the Workplace: 2020 Cigna National Survey

Saturday, February 1st, 2020

What is this about?
This just-released 2-page summary infographic and 57-page full report based on a national sample of 10,000 U.S. employees surveyed in 2019 focuses on their perceptions of loneliness and social isolation.  Conducted by the large market research firm Ipsos and funded by Cigna, this landmark report involves the use of the UCLA Loneliness Scale that uses a 20-item online survey.

A few of the major findings contained in these two documents include:

  • 61% of employees surveyed reported…”feeling lonely.”
  • The 2018 survey found that 54% of those surveyed reported …”feeling lonely”, which when compared to the 2019 results is a 13% proportionate increase.
  • 24% of employees surveyed say their mental health is “fair” or “poor.” (CDC reports that 20% of Americans will experience a mental illness in any given year.)
  • Americans reporting “good mental health” is down 5-percentage points from 2018 (76% vs. 81%).
  • Younger generations are lonelier than older generations. Nearly eight in 10 Gen Zers (79%) and seven in 10 millennials (71%) are lonely, vs. half of boomers (50%).
  • Men (46.1%) are lonelier than women (45.3%).
  • People who report that they don’t have good relationships with their coworkers (53.7%) are 10 points lonelier than those who do (43.7%).

Why is this important?
These 2 reports provide a credible picture of an emerging national health problem.  Often referred to as the “loneliness epidemic” is has contributed to a renewed interest in employee mental health among U.S. employers. This information is important because it highlights a newly emerging wellness need of U.S. employees and because it has a variety of productivity, job performance and health cost implications.

What can you do with this document?

  • First, skim the 2-page infographic summary and create a separate document for emailing.
  • Next, determine what individuals and groups you should send the infographic to and who should receive the full report.
  • Then, share this information with your HR and benefits staff.
  • Then, look for an opportunity to address loneliness and social isolation in your wellness program.
  • Then, decide how else you can use this information to help employees and management staff understand the needs of employees and their family members.

In summary, this document contains a useful summary infographic and the full report of a major survey of U.S. employees focused on loneliness and social isolation. This area represents a newly emerging challenge for employee health and well-being initiatives.

Click here to download this document

If you have any problem downloading the article or tool go to the membership section of our website and search by the topic or name of the document.
I hope this tool helps you reach your wellness programming goals!  Drop me a note and let me know if you found it to be helpful.

National Health Costs 2018 & 2019

Wednesday, January 15th, 2020

What is this about?
These two articles capsulize recent major patterns in U.S. health care costs for 2018 and 2019.  The two articles are full of data on patterns and trends in employer health costs and provide a very useful backdrop for examining national and employer health cost trends.

Some of the major findings contained in these two documents include:
In 2018:

  • National health care costs went up 4.6% to $3.6 trillion or 17.7% of our GDP.
  • That represents $11,172 for each of the 326.6 million individuals in the U.S.
  • Cost of private health insurance increased at a rate of 5.8% while Medicare cost increased at a rate of 6.4%.
  • Cost of private health insurance increased 3 times the rate of growth in the Consumer Price Index (1.9%).
  • Hospital care consumed 38.7% of all personal health care expenses and is the largest single element.

In 2019:

  • The average annual premium for single employee health plan coverage rose 4% to $7,188.
  • The average annual premium for family health plan coverage rose 5% to $20,576.
  • Covered workers provided 18% of the cost for single coverage and 30% of the cost of family coverage.
  • 61% of workers are in plans that are completely or partially self-insured.
  • The average deductible for single coverage was $1,655 and $2,271 for family coverage.

Why is this important?
These 2 reports provide a national backdrop for employer health benefit cost trends and since employee health plan cost is one of the primary reasons employers establish employee wellness programs it is important for reference purposes in the justification and funding of these programs.  Health benefit costs are somewhat complex to understand and are difficult to effect without utilizing specific strategies in an employer wellness program.

What can you do with this document?

  • First, skim the 2 articles to get a sense of the content and data categories.
  • Next, determine what type of information can be utilized in your own program justification and budgeting and by your benefits staff.
  • Then, share this information with your HR and benefits staff.
  • Then, decide how else you can use this information to help employees and management staff understand their health benefits better and specifically the role the wellness program plays in their long term management.

In summary, this document contains 2 major peer-review articles that highlight national and employer-specific patterns in health care costs for 2018 and 2019.  They provide a useful set of comparison points for analysis of individual employer health benefits experience.

Click here to download this document

If you have any problem downloading the article or tool go to the membership section of our website and search by the topic or name of the document.

I hope this tool helps you reach your wellness programming goals!  Drop me a note and let me know if you found it to be helpful.

New Guidelines for Prevention of Cardiovascular Disease

Wednesday, January 1st, 2020

What is this about?
The American College of Cardiology (ACC) and the American Heart Association (AHA) have issued a new set of guidelines for the primary prevention of Cardiovascular Disease (CVD).  These recommendations provide an important background context for workplace wellness programming efforts to prevent heart disease among working Americans.  These guideline recommendations represent the best science we have to date to help reduce one of our most important causes of morbidity, premature mortality and healthcare utilization.

Major recommendations contained in this document include:
• A team-based care approach, including physicians and other clinicians, is effective for prevention of CVD (strong recommendation; high-quality evidence). Clinicians should evaluate the social determinants of health that affect individuals to inform treatment decisions (strong recommendation; moderate-quality evidence).
• Adults aged 40 to 75 years being evaluated for CVD prevention should have a 10-year ASCVD risk estimation and a clinician-patient risk discussion before starting pharmacological therapy, such as antihypertensive therapy, a statin, or aspirin (strong recommendation; moderate-quality evidence).
• Adults should be routinely counseled in health care visits to optimize a physically active lifestyle (strong recommendation; moderate-quality evidence).
• For adults with type 2 diabetes mellitus, lifestyle changes such as improving dietary habits and achieving exercise recommendations are crucial. If medication is indicated, metformin should be used first (moderate recommendation; moderate-quality evidence), followed by consideration of a sodium-glucose cotransporter 2 (SGLT-2) inhibitor or a glucagon-like peptide 1 receptor (GLP-1R) agonist (weak recommendation; moderate-quality evidence).
• All adults should be assessed at every health care visit for tobacco use and tobacco use status recorded as a vital sign. Those using tobacco should be firmly advised to quit and assisted using a combination of behavioral interventions plus pharmacotherapy (strong recommendation; high-quality evidence).
• Low-dose aspirin should not be administered on a routine basis for primary prevention of ASCVD among adults aged 70 years or older (strong recommendation against routine use, moderate-quality evidence).

Why is this important?
This issue is important for 3 major reasons.  First, heart disease claims usually represent 10% to 17% of total health claims costs for most actuarially-sound working populations. This represents a significant savings potential if we can reduce the incidence of new heart disease by reducing the prevalence of relevant health risk factors.   Second, educating employees about these guidelines will likely help diffuse this knowledge more quickly through the health care system.  It is generally recognized that newer prevention science is usually slow to diffuse through the practitioner community. By educating employees we are likely to help primary care practitioners (PCPs) become aware and knowledgeable about the new guidelines. Third, the guidelines include the importance of lifestyle choices in the prevention of CVD, which helps support participation in employer wellness programs and the adoption of healthy lifestyle choices.

What can you do with this document?

  • First, read the document to get a sense of the content and reasoning behind the guidelines.
  • Next, determine where in your current programming this information could be utilized.
  • Then, determine which of your program interventions should include this information first.
  • Then, decide how else to include the information to help employees assimilate and use it with their PCP.
  • Finally, make sure that any speakers, trainers, coaches or screening staff are aware of this information and appropriately reinforce its use.

In summary, this document contains a new set of guidelines for the prevention of CVD.  Employee wellness programs can play a major role in dissemination of this information in working populations.

Click here to download this document

If you have any problem downloading the article or tool go to the membership section of our website and search by the topic or name of the document.

I hope this tool helps you reach your wellness programming goals!  Drop me a note and let me know if you found it to be helpful.

Recommended Low-Cost Wellness Resources

Thursday, December 5th, 2019

Source: Chapman Institute

What is this about?
Budget is usually a major challenge for most employee wellness programs.  Since employee wellness and well-being programs are completely discretionary or “optional” in terms of management decision-making around resource allocation, it makes it very hard to adequately fund these kinds of programs.  Employee wellness professionals usually must work hard to secure adequate vendor budgets. The Connections document in this edition of the newsletter is a vetted listing of no-cost or low-cost wellness program resources that can be used to stretch your employee wellness vendor budget and enhance your program’s effectiveness. The key to low-cost wellness resources is getting them to the employees (and family members) that need them and can use them.  How well we do that has a lot to do with how much value they bring to our programming effort.

Why is this important?
This issue is important for three major reasons.  First, our limited program budgets need to be stretched with good wellness resources. You can do that by careful use of the resources identified in this Solution Set document.  Second, our employee wellness programs need to address the widest range of health and wellness issues we can.  The topical or issue “richness” of our programs is important in meeting the needs of our target populations. Low-cost wellness resources can add that “richness”.  This Solution Set document identifies 57 different resources across 16 different topic areas that have been recommended either by the Chapman Institute or various WellCert graduates. (Actual contributors are recognized) The third reason this is important is that senior managers usually want to know if our programs are efficient at utilizing resources and that we are not wasting money.  When we carefully integrate no cost or low-cost resources into our employee wellness or well-being program it provides an opportunity to demonstrate our efficient management of resources.  It’s like saying…“Look how careful we are at using budgetary resources – we will use any additional funds you might want to give us to real advantage.”

What can you do with this document?

  • First, look the document over to get a sense of the range of topics and interventions that are recommended.
  • Next, see if you are already using any of these resources. For those you are using make sure they are made available in a way that is likely to get to the right person at the right time.
  • Then, determine which of the remaining resources/interventions in the document table offer the most potential to help enhance the topic “richness” of your program and fill any recognized gaps.
  • Then, decide for those resources or interventions you are considering using, how you plan to make them available to those who are likely to need them. The more “friction” you can take out of the process by making them easy to access the better.
  • Then, once you have made the no-cost or low-cost resource available to your group write up a brief notice of the new program activity (pointing out its low-cost nature) and circulate it to key managers and your employee advisory members/wellness champions. If you do this 2 or 3 times a year the message od good budget stewardship will get across.
  • Finally, take a look at least once a year at the list to see if new needs have arisen that can be met by any of these low-cost resources.

In summary, this document contains a large number of low-cost resources recommended by colleagues to help enrich your employee wellness/well-being program and to make it more effective at meeting the needs of your population while helping senior management feel better about the wellness budget and program.

Click here to download this document

NOTE: You will need to have an active WellCert Membership in order to download this document.

I hope this tool helps you reach your wellness programming goals!  Drop me a note and let me know your thoughts and if you found it to be helpful: [email protected].

Assuring Long Term Behavior Change – Crossing the “Chasm”

Friday, November 15th, 2019

Source: Chapman Institute

What is this about?

First, the good news… employer wellness programs have been proven to help people change their short-term wellness behaviors.  Now, the bad news… those same wellness programs have been shown to be pretty poor at helping people change their long-term wellness behaviors.   For our purposes, we will define “short-term” as 1 – 6 weeks and long-term as 6+ weeks.  We obviously need to help people make as many long-term wellness behavior changes as possible if we want health improvement and economic return.

In the WellCert Program, we refer to this phenomenon as the “chasm” between short-term wellness behaviors and long-term wellness behaviors. It is vital for employee wellness programs to help all participants “cross the chasm” and move from doing wellness over short periods of time to doing that same behavior over long periods of time. The long-term wellness behaviors that become long-term habits enable individuals and wellness programs to gain the higher order results of wellness programming.

These higher order results include HRA improvements, health status or biometric improvements, health risk mitigation, lower disease incidence and prevalence rates, lower health care utilization and claims cost, and positive ROI.  But without getting more people to adopt healthy habits and positive wellness behaviors over the long term we are not likely to realize the full potential of results that wellness programming potentially provides.

 Why is this important?

 This issue is absolutely critical to the future of the field of worksite wellness and it is also critical for the future competitiveness of our employee and employer communities.  This Solution Set document identifies 14 possible strategies that employers can use to help assure that their employee wellness programs help more people get “across the chasm”, and successfully adopt long term wellness habits. If we want more than just the lower order results from our employee wellness efforts (knowledge change, attitude change, readiness to change, and short-term behavior change), we have to use these strategies to secure those desired higher order results (long term behavior change, health status changes, health risk changes, improvements in disease and condition prevalence, health care utilization changes, health care claims changes and VOI and ROI). Without meaningful results our programs are not likely to be around over the long haul.

What can you do with this document?

  • First, look the document over to get a sense of the range of strategies that are recommended.
  • Next, examine your current wellness programming initiative for the present use of these strategies. Eliminate those strategies you are already using, but before you do that make sure they are now being deployed in an optimal way.
  • Then, determine which of the remaining strategies offer the most potential to help participants …”cross the chasm.”
  • Then, decide how you will introduce each of the applicable strategies into your program.
  • Then, begin the process of introducing the various strategies.
  • Then, determine how you are going to measure the effects of the various strategies on key metrics.
  • Then, monitor the metrics to observe the change.
  • Then determine your next steps.

In summary, this list of specific programming strategies for helping employee participants to ..”cross the chasm” and adopt more long term wellness habits is designed to significantly enhance the effectiveness of your employee wellness effort and to produce both more lower order and higher order program results.

Click here to download this document

NOTE: You will need to have an active WellCert Membership in order to download this document.

I hope this tool helps you reach your wellness programming goals!  Drop me a note and let me know your thoughts and if you found it to be helpful: [email protected].

Getting management to be serious about Wellness

Tuesday, November 5th, 2019

Source: Chapman Institute

What is this about?

Unfortunately, most employee wellness programs in the U.S. are both under-funded and relatively ineffective.  They also tend to be more tactical in nature with limited strategic or business value.  A recent article in JAMA documented the ineffective nature of the typical employee wellness program using an admittedly elegant research design.1 The unfortunate reality is that the management of most U.S. companies is not very serious about wellness or wellness programming.  As a field, we need to help them see the strategic potential and strategic importance of employee wellness programming. This is particularly important for the average employee and the average employer.
1 Song, Z., and Baicker, K., Effect of a Workplace Wellness Program on Employee Health and Economic Outcomes, JAMA, Vol. 321, Number 15, April 16, 2019, 1491-1501.

Why is this important?

This is also important for the future of the field of worksite wellness. This Solution Set document is designed to provide a draft of a brief email for use in polling your senior management team on their perceptions about the strategic value and nature of employee wellness.  The draft email is designed to focus your executive teams’ attention on your current employee wellness efforts and to raise the question of desired results.  It is important because it is intended to get senior management’s attention and provoke them to action.  Without a catalyzing email like this one, they are likely to continue the “same old – same old” approach that has not produced much in the way of meaningful results. The bottom line is – what have we got to lose?

What can you do with this document?

  • First, look the document over to get a sense of what it attempts to do.
  • Next, review the entire process with your supervisor and get approval to proceed. Don’t forget to brief your “champion” if he/she is not your supervisor.
  • Then, decide if any of the draft text in the email should be modified and make the changes.
  • Then, determine which managers should receive the email.
  • Then, decide when you would like a response. Be sensitive to their work pressures, vacations, travel etc.
  • Then, send the email out.
  • Then, monitor the responses around the requested date.
  • Then, follow-up with any late respondents and summarize the responses.
  • Then determine your next steps.

In summary, this draft email is intended to get senior management’s attention and to catalyze a re-examination of your employee wellness program effort with the potential of upgrading your current programming efforts and helping your organization get more serious about their employee wellness initiative.

Click here to download this document

NOTE: You will need to have an active WellCert Membership in order to download this document.

I hope this tool helps you reach your wellness programming goals!  Drop me a note and let me know your thoughts and if you found it to be helpful: [email protected].

Proposal for Wellness Program Redesign

Friday, November 1st, 2019

Source: Chapman Institute

What is this about?

Unfortunately, most employee wellness programs in the U.S. need to be redesigned for greater effectiveness, but few wellness coordinators know how to make a simple redesign proposal “pitch” to their senior management team.  The proposal they put forward needs to be seen as feasible and logical for senior management to endorse it. Another part of the challenge is making the redesign process robust enough to produce a stronger redesigned wellness program without getting too much into the “weeds” and losing your senior managers’ attention.  This requires a carefully balanced approach and a little finesse.

Why is this important?

 This Solution Set document is designed to provide a sample of a brief proposal for redesigning your employee wellness program.  It is important because it is intended to get senior management’s attention and provoke them to action.  Without a catalyzing event/proposal like this, they are likely to continue the “same old, same old” approach that has not produced much in the way of results.

What can you do with this document?

  • First, look the document over to get a sense of how it positions the key organizational issues around a possible program redesign.
  • Next, decide if any of the statements or redesign planning steps contained in the draft document should be modified. (You may be proposing a new wellness program versus a redesign of an existing wellness program.)
  • Then determine which employees should be involved in the redesign project and add them to the proposal.
  • Decide who should facilitate or lead the effort.
  • Then, show the proposal to your supervisor or senior management “champion” to get their feedback and approval to proceed.
  • Then, distribute the proposal through the appropriate “chain of command” channels with a requested date for feedback or a decision.
  • Follow-up with your principal contacts at the appropriate time.

In summary, this sample proposal for requesting a redesign of your employee wellness program is intended to help your management staff re-examine the way your organization is approaching employee wellness and well-being and to improve the effectiveness of your programming effort.

Click here to download this document

NOTE: You will need to have an active WellCert Membership in order to download this document.

I hope this tool helps you reach your wellness programming goals!  Drop me a note and let me know your thoughts and if you found it to be helpful: [email protected].

Solution Set #13 – Sample Request for Health Plan Claims Analysis

Sunday, September 15th, 2019

Source: Chapman Institute

What is this about?

Employer health benefit costs are headed up again. Estimates range from 6% to 9% or higher annual increases for 2020 renewals.  For larger organizations, a health plan claims analysis of their employee wellness program is certainly desirable.  Yet few wellness professionals know much about how to request a valid health plan claims analysis.  In this edition of Connections, we provide a sample health plan claims analysis request. You can use this document to help prepare your own request. This sample request applies primarily to employers with several thousand employees that are concentrated in a few health plans and have a clear definition that separates “participants” from “non-participants.”

Why is this important?

This Solution Set document is designed to provide a template for your health plan claims request.  It is important because it establishes the technical parameters for the effort and helps contain the analysis to those issues that are relevant.  A critical issue in health plan claims analysis is how very large or catastrophic claims costs are handled.  This issue confounds most of the peer review articles that have been published in the field and creates non-random bias which unfairly prejudices these analyses.  It is not fair to expect a garden variety employee wellness program to have a significant effect on the rare and very large catastrophic claims of employees and family members.  The important econometric assumption recommended here is the use of the conventional attachment points associated with individual stop-loss reinsurance as a way of more fairly adjudicating what claims expense should be included in the analysis.  This becomes even more important when considering the highly skewed distribution of typical employer claims patterns. The analysis needs to be conducted in a reasonable business-based manner in order to appropriately guide business decision-makers.

What can you do with this document?

  • First, look the document over to get a sense of how it positions the key technical issues of the health plan claims analysis.
  • Next, decide if the proposed position on those technical issues is appropriate for the analytical expectations of your senior managers. (Note: This is where the use of a survey of senior managers such as the one included under Solution Set #1 – Quick Senior Management Survey on Wellness becomes critical.)
  • Then, determine which of these technical issues needs to be modified for use in your request and then adapt it to the specifics of your own health plan situation.
  • Also, remember that the sub-populations to be studied (“Participants” and “Non-Participants” should each have a minimum size of 1,000 individuals to assure the actuarial credibility of any analytic results. Some actuarial techniques can be used with smaller populations but are limited.
  • When you have received the raw data from your health plan, go ahead and do the summary analysis of savings and costs and make the comparison with the total direct cost of your employee wellness program to derive ROI (Return-on-Investment).
  • Don’t forget to conduct an analysis that answers the question of whether any other variable or factor could have accounted for the observed change in expected health plan claims cost between participants and non-participants. If no other alternative explanation is identified, then it is reasonable to propose that the attribution of the observed change is likely due to the effects of your employee wellness program.  It is also advisable to look for any intermediate results (i.e., participation, risk prevalence changes, screening results, morbidity changes, etc.) to help establish attribution and to help document the “cause and effect” relationship of your wellness program to employee health plan cost.

In summary, this sample request for a health plan claims analysis can be used to examine the effects of an employee wellness program on an employee’s health plan claims cost experience and is critical in establishing the primary economic effects of the program on a particular workforce

Click here to download this document

NOTE: You will need to have an active WellCert Membership in order to download this document.

I hope this tool helps you reach your wellness programming goals!  Drop me a note and let me know your thoughts and if you found it to be helpful: [email protected].