Over the last three months, I've questioned the validity of health risk assessments and the ability of biometric-screening data to powerfully track wellness program performance. This has prompted many readers to ask, "So what do you suggest instead?" If you think that tracking wellness program performance, return-on-investment and cause-and-effect is impossible, think again.
If your wellness vision is something like, "To effectively compete in our market by having the healthiest employees," and your wellness strategy and programs are the vehicle that will help you reach this vision, then the mission you need to be on is to change the things that improve employee health. A healthy, balanced scorecard borrows a tool from Dr. Robert Kaplan and David Norton, who developed the performance management strategy to help companies track their progress towards their corporate vision. We've found that the same tool, applied specifically to a company's wellness strategy, produces equally valuable results.
Driving toward wellness results
If your wellness vision is the destination and your wellness strategy is the vehicle, the healthy scorecard is the dashboard that tells you how fast you're going, how much fuel is left, and other critical data about how your vehicle's performance. Chart 1 illustrates the relationship between these elements.
You want to see the most important information with the least effort, see what's important (when it's important) and make sure that warning lights and important indicators are working properly and tell the truth about what's going on with the vehicle. If you're lucky enough to have a navigation system as part of your dashboard, you want it to be easy to read, give you directions well in advance and change your route as traffic arises or when new and better routes become available.
With that analogy in mind, what should our wellness program's balanced scorecard, or dashboard, look like? Chart 2 summarizes my view on how the ideal scorecard should appear to any company serious about getting results.
Health status is a measure of how healthy employees are, on average. It might comprise an index of factors, but it should not be a summary of health failures like biometric screening results or HRA answers. As I've argued before, if you had to choose a single metric to best describe the positive side of health status, it would certainly be fitness levels. Other elements of the Health Status Index might be things like strength, flexibility, the ability to climb 10 flights of stairs or other similar indicators. Health habits are the leading indicators of future health status. We know that 70% of our health is driven by habits and the environment, and we are confident of which habits have the biggest impact. We know, for example, that frequency of exercise, quality of diet, hours of sleep and the use or non-use of tobacco and alcohol are the health habits that explain most of our non-genetic health outcomes. If all four of these can be tracked - technology increasingly is making this possible - then you can create an index of health habits. Currently, the most powerful health habit - daily exercise - can be quite accurately tracked. There is an increasingly strong body of data showing that exercise - much more than health risk factors such as obesity, hypertension or cholesterol - predicts future health outcomes and health care costs.
Satisfaction is a measure of how happily employees are participating in the programs. It's one thing to force employees, it's quite another to have them enjoying the opportunity to participate as a benefit offered by their companies. Done right, wellness can have wonderful spin-offs for employers in terms of how it expresses their message of care to employees, not to mention how it can improve overall engagement levels. To measure satisfaction, we like to use the single, powerful statistic that Fred Reichheld calls "The Ultimate Question:" How likely is it that you would recommend our wellness program to a friend, work colleague or family member?
When asked to score their answers on a one-to-10 scale, 10 being "very likely" and one being "not likely at all," Reichheld says we can calculate the net promoter score. The NPS is the number of people who answer nine or above (promoters) less the number of people answering six or below (the detractors) and it ignores the sevens and eights (the passives).
Why does satisfaction matter? Ultimately, if employees are not satisfied or excited by the program (so much so that they would recommend it to their friends and families), expect that future participation will decline.
Return on investment is a measure of the overall impact of the wellness strategy compared with the costs of implementation. Because of all the complexities of calculating a reliable ROI, I'll address this measure in a future column. For now, suffice to say that without a credible and sizeable ROI, you should not continue to invest in employee wellness. Like everything else that employers do, it should add value, not just be the right thing to do. Fortunately, effective wellness programs can satisfy both goals.
Last but not least, we get to the warning lights, measures that indicate that we are failing to improve the health of employees. Many readers wrote to me asking, "Do you see no value in biometric screening data or HRAs at all?" If there is a place for that data, it is here, in the warning lights section of the dashboard.
Absenteeism, health risk factors and health care costs are indicators of our failure to improve or maintain the health of employees. They are good warning signals and deterioration in their levels is a very worrying sign. Similarly, reductions in these measures can be seen as one of the welcome byproducts of improving employee health. They should be a nice bonus and not the key measure of health, since the real ROI comes from the productivity that results from improvement in positive health much more than it comes from reductions in these symptoms of our health failures.
If you're a practitioner that just can't let go of HRAs and biometric screens, I hope that I've at least given you some perspective on where the data from these tools belongs on a healthy dashboard. When relegated to their useful roles as a measure of how we're failing, and when better measures of success are included and given priority, such as health habits and positive measures of health, the dark side of these tools also become a little less worrying. -A.S.
Contributing Editor Andrew Sykes is chairman of Health at Work. He is a qualified actuary, a licensed health insurance broker, an HIAA managed health professional and an accomplished speaker on the topic of consumer-directed health care and wellness. He can be reached at andrew@hatwork.com.
Over the last three months, I've questioned the validity of health risk assessments and the ability of biometric-screening data to powerfully track wellness program performance. This has prompted many readers to ask, "So what do you suggest instead?" If you think that tracking wellness program performance, return on investment and cause-and-effect is impossible, think again.
If your wellness vision is something like, "To effectively compete in our market by having the healthiest employees," and your wellness strategy and programs are the vehicle that will help you reach this vision, then the mission you need to be on is to change the things that improve employee health.
A healthy, balanced scorecard borrows a tool from Dr. Robert Kaplan and David Norton, who developed the performance management strategy to help companies track their progress towards their corporate vision. We've found that the same tool, applied specifically to a company's wellness strategy, produces equally valuable results.
Driving toward wellness results
If your wellness vision is the destination and your wellness strategy is the vehicle, the healthy scorecard is the dashboard that tells you how fast you're going, how much fuel is left and other critical data about your vehicle's performance. The chart, "Destination: Wellness vision," (above right) illustrates the relationship between these elements.
You want to see the most important information with the least effort, see what's important (when it's important) and make sure that warning lights and important indicators are working properly and tell the truth about what's going on with the vehicle. If you're lucky enough to have a navigation system as part of your dashboard, you want it to be easy to read, give you directions well in advance and change your route as traffic arises or when new and better routes become available.
With that analogy in mind, what should our wellness program's balanced scorecard, or dashboard, look like? The chart "The wellness dashboard," (lower right) summarizes my view on how the ideal scorecard should appear to any company serious about getting results.
Health status is a measure of how healthy employees are on average. It might comprise an index of factors, but it should not be a summary of health failures like biometric screening results or HRA answers. As I've argued before, if you had to choose a single metric to best describe the positive side of health status, it would certainly be fitness levels.
Other elements of the Health Status Index might be things like strength, flexibility, the ability to climb 10 flights of stairs or other similar indicators.
Habits are leading indicators of future health
Health habits are the leading indicators of future health status. We know that 70% of our health is driven by habits and the environment, and we are confident of which habits have the biggest impact. We know, for example, that frequency of exercise, quality of diet, hours of sleep, and the use or non-use of tobacco and alcohol are the health habits that explain most of our non-genetic health outcomes. If all four of these can be tracked - technology increasingly is making this possible - then you can create an index of health habits.
Currently, the most powerful health habit - daily exercise - can be quite accurately tracked. There is an increasingly strong body of data showing that exercise - much more than health risk factors such as obesity, hypertension or cholesterol - predicts future health outcomes and health care costs.
Satisfaction is a measure of how happily employees are participating in the programs. It's one thing to force employees, it's quite another to have them enjoying the opportunity to participate as a benefit offered by their companies.
Done right, wellness can have wonderful spinoffs for employers in terms of how it expresses their message of care to employees, not to mention how it can improve overall engagement levels.
To measure satisfaction, we like to use the single, powerful statistic that Fred Reichheld calls "The Ultimate Question:" How likely is it that you would recommend our wellness program to a friend, work colleague or family member?
When asked to score their answers on a one-to-10 scale, 10 being "very likely" and one being "not likely at all," Reichheld says we can calculate the net promoter score. The NPS is the number of people who answer nine or above (promoters) less the number of people answering six or below (the detractors), and it ignores the sevens and eights (the passives).
Why does satisfaction matter? Ultimately, if employees are not satisfied or excited by the program (so much so that they would recommend it to their friends and families), expect that future participation will decline.
Return on investment is a measure of the overall impact of the wellness strategy compared with the costs of implementation. Because of all the complexities of calculating a reliable ROI, I'll address this measure in a future column. For now, suffice to say that without a credible and sizeable ROI, you should not continue to invest in employee wellness. Like everything else that employers do, it should add value, not just be the right thing to do. Fortunately, effective wellness programs can satisfy both goals.
Beware the warning lights
Last but not least, we get to the warning lights, measures that indicate that we are failing to improve the health of employees. Many readers wrote to me asking, "Do you see no value in biometric screening data or HRAs at all?" If there is a place for that data, it is here, in the warning lights section of the dashboard.
Absenteeism, health risk factors and health care costs are indicators of our failure to improve or maintain the health of employees. They are good warning signals, and deterioration in their levels is a very worrying sign.
Similarly, reductions in these measures can be seen as one of the welcome byproducts of improving employee health. They should be a nice bonus and not the key measure of health, since the real ROI comes from the productivity that results from improvement in positive health much more than it comes from reductions in these symptoms of our health failures.
If you're a practitioner that just can't let go of HRAs and biometric screens, I hope that I've at least given you some perspective on where the data from these tools belongs on a healthy dashboard. When relegated to their useful roles as a measure of how we're failing, and when better measures of success are included and given priority, such as health habits and positive measures of health, the dark side of these tools also become a little less worrying.
Contributing Editor Andrew Sykes is chairman of Health at Work. He is a qualified actuary, a licensed health insurance broker, an HIAA managed health professional and an accomplished speaker on the topic of consumer-directed health care. He can be reached at
