You've been thinking about introducing a wellness program and finally feel like you've developed a solid business case. You walk in to your manager's office and barely get these words out of your mouth, "I'd like to talk about wellness ... ," when you hear a combination of: "We don't have the money for it ... you have better things to work on ... only the healthy will use it ... ." You meekly head back to your desk and put your wellness presentation up on the shelf. Is this you? If yes, let the "tree of healthy" be your green thumb of wellness success.

The tree of healthy being is not a wellness program; quite simply, it's a graphic approach to illustrate the success you can have with wellness using the current and future resources at your disposal; success does not require a full-blown wellness program and can be as low key as you want/need it to be.

So, how do you determine what your tree of healthy being looks like?


Roots, trunk and branches

Imagine the roots and trunk of any tree. They serve as the basis from which a tree grows and maintains its stability in the ground. From a wellness perspective, the roots and trunk of your tree are everything you have at your disposal to develop and maintain a wellness program. This could include top management support, internal resources, health and welfare carriers, available funds, any employee data and/or health-based metrics. As with any tree, the depth and stability of its root structure will dictate how healthy and tall your tree will grow.

Now imagine a tree's branches. Each wellness opportunity resides on a separate branch, with the lower branches representing those opportunities that will be easier to implement and maintain. The branches could include everything from medical insurance plan design opportunities to carrier/vendor education and tools to third-party wellness vendor assistance.

To better illustrate this concept, here's an example of how a tree of healthy being was planted and grown for a corporation struggling to introduce employee wellness.

From a roots and trunk perspective, there was no executive interest in offering a corporate wellness program. As such, there were no funds budgeted for wellness. But members of the benefits staff thought there would be value, the medical insurance carriers offered free wellness education and medical insurance plan reporting was available to enable the benefits staff to understand the most prevalent chronic medical conditions within the organization. This represented the company's tree of healthy being root and trunk structure.

With help from the company's benefits broker/consultant, the following branches were implemented in year one:

Branch 1. Modify medical insurance program plan design and improve employee communication. With the belief that an ounce of prevention is worth a pound of cure, employee benefits communication was increased to tout the new free preventive care opportunity (required because the company offered nongrandfathered medical insurance plans). As more employees went for their physicals, the expectation was that between taking better care of themselves, plus learning whether they had a propensity for chronic conditions, there would be a reduction in health insurance costs and an increase in employee productivity.

Branch 2. Evaluate and address onsite company food and fitness offerings. In an effort to provide healthier employee food and fitness opportunities, onsite vending machines were filled with more nutritious foods. Plus, the benefits staff was able to negotiate a corporate membership rate for employees at local fitness facilities.

Branch 3. Increase medical insurance carrier education. Upon reviewing aggregate employee health data from the medical insurance carriers and recognizing a high incidence of stress and diabetes, the benefits staff spoke with the carriers about offering greater employee education on understanding and managing these diseases (in addition to the targeted disease management they provided). Examples included healthy hints in the company's newsletter and providing specific information about these diseases at the company's health fair. The expectation was that health insurance costs would be positively impacted through this increased education about avoiding and managing these diseases.

Since the current root structure couldn't handle any more branches at the present time, the following items - branches four through six - are under consideration for future years:

Branch 4. Offer employee health risk assessments and screenings (including participation incentives). To get a better understanding of the health risks associated with the population now and into the future, the benefits staff will recommend introducing health risk assessments and biometric screenings. To gain the best participation possible, some form of incentive would be recommended.

Branch 5. Develop and roll out basic wellness program offerings. Using the results of the health risk assessments and biometric screenings (plus the aggregate employee health data), the benefits staff recommends introducing vendor-sponsored, tailored wellness programs that will assist in improving employee health and productivity. This could include weight management and smoking cessation programs.

Branch 6. Work with a third-party wellness vendor to develop and roll out a custom wellness program (including metrics). As more data is gained from the employee population through the various options included on the lower branches, consider working with a vendor who can help develop and manage custom wellness offerings, including providing incentives, tracking progress and generating reports in different key areas, allowing for continued improvement of the company's health insurance program.

Once the tree of healthy being was completed, the benefits staff approached management with this visual and methodical representation of a wellness program within the organization.

Based on the depth and breadth of the company's roots, branches one through three were proposed under the guise that costs and disruption would be minimal, but the potential for positive cost and productivity improvement was significant. Because wellness was presented in such an organized format, not only did management listen, but branches one, two and three were approved with an opportunity for a follow-up conversation in year two regarding branches four through six.

In addition to being an effective way to speak with management about wellness, it also keeps the benefits staff grounded as the structure of the tree of healthy being doesn't allow you to get ahead of yourself - you won't introduce an initiative on a higher branch until the root development enables you to.

Contributing Editor Ed Bray, JD, is director of employee benefits for Hawaiian Airlines. He holds a bachelor's degree from Providence College and completed his JD at the Western New England University School of Law and his MBA at Auburn University.



Incentive consensus

Several leading health careadvocacy groups are helpingadvance the use of outcomes-based incentives in worksite wellness or health management programs that are encouraged by the Patient Protection and Affordable Care Act. The guidance, published last month in the Journal of Occupational and Environmental Medicine, is intended to help ensure that worksite wellness programs using such incentives are fair to all employees and improve health results. The guidance incorporates research, practical application, policy perspectives and a set of basic considerations for employers seeking to maximize the health improvement results of their incentive programs. Participating organizations inlcude the Health Enhancement Research Organization, American College of Occupational and Environmental Medicine, American Cancer Society, American Cancer Society Cancer Action Network, American Diabetes Association and the American Heart Association.

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