Most employer-sponsored wellness programs are stuck, says Dr. Dee Edington, founder & CEO of Edington Associates LLC. The health management expert explains that many in the wellness field have not looked beyond biometrics and poorly aligned incentives. Implementing a successful wellness program starts with awareness, but with time and experience, employers "are expanding their program beyond health risks to address the whole person - behavioral psychology, physical health, social well-being and career well-being," explains Gina Payne, national director of wellness at CBIZ Employee Services.

EBN profiles three progressive employers - Nationwide Insurance, Heartland Health and Cerner Corporation - who have developed strategic and innovative wellness initiatives that succeed in part because benefits and business leaders have ingrained wellness as a core part of their business strategy and culture.


Wellness is on their side

"At Nationwide, our brand promise is that 'we are on your side,' and we take that very seriously. That's a promise that we make to our members." The company believes it's important to "live that brand promise for our associates as well," explains Kathleen Herath, associate vice president health and productivity at Nationwide Insurance.

Each year, Nationwide's wellness leaders ask employees to participate in two programs of their choosing. Based on the completion of those programs - not on the outcome - the company rewards participating employees and spouses with discounts on the cost of health care coverage. Even employees not currently enrolled in a company-sponsored health plan can receive rewards in their HSA or HRA.

The company uses an interactive health assessment to engage employees in programs that could help them improve their health. If a participant indicates that they suffer from depression, domestic violence or financial stress, the online questionnaire will have an EAP counselor reach out to the participant directly if they give permission. That way, the onus isn't on the employee to seek help.

"We can really get the right program in the right hands for people right when they need it," explains Herath.

The assessment also gives recommendations based on outcomes reported, and the age and gender of the participant. For instance, it could recommend a weight loss or nutrition program, stress management, heart healthy coaching or diabetes coaching, depending on the information input. For healthy participants, the assessment may recommend preventive care, such as an annual physical or flu shot.

Herath believes employers need to help people get past barriers to participate in wellness. If someone is afraid they might lose their house, then they may not be concerned about how many steps they take each day. That's why the assessment directs employees to mental health or financial counseling to ease their minds, so that they can participate in the more fun aspects of program.

And Herath makes sure participants have fun. For example, the company asked employees to do 100 sit-ups for one wellness challenge and held a contest for the funniest place employees did sit-ups that day. Later the company posted the silly and inspirational photos on its fitness social networking site.

The company hosts a wellness challenge about every quarter, which is usually a food or walking challenge. The healthy holiday challenge engages participants early in October so they hit the hectic holiday period in a good place. The challenge focuses on a single topic such as weight gain or stress.

"For pretty much every benchmark and trend, Nationwide is ahead of it in terms of participation, engagement and claims cost," says Jason Lee, senior population health consultant at Optum. For all health metrics, Nationwide's population is better than the U.S. average. But its biggest success story is for untreated hypertension. About 7.5% of Nationwide's population used to suffer from untreated hypertension, well above the U.S. average. Now, it's 3.6%, which is well below norms.

With such great results, Nationwide employees inspire their colleagues by sharing real-life successes. Through the social media platform Yammer, Nationwide has a well-being group, weight and fitness and Fitbit groups, and even a group that shares healthy recipes. Many of these groups started organically by employees.

"Their stories are so much more compelling than anything we could write. We simply put the program in their hands and let them tell their stories," explains Herath. For instance, wellness organizers always talk about the importance of working out and staying fit while traveling. During a business trip, one employee, beleaguered after a long day of meetings, remembered this advice and dragged herself to the hotel gym. Her dedication paid off when the hotel closed the gym early so that President Obama could use the facilities. She ended up running on a treadmill alongside the president. After that experience, the employee exclaimed, "I will never miss a chance to work out while traveling!"

In addition to sharing successes, Nationwide leaders find unique ways to encourage employees to take small steps in the right direction. It encourages employees to wear their pedometers and measure how far they walk, then asks: Could you do a little bit better tomorrow? The company doesn't demand employees walk 10,000 steps right off the bat.

During another initiative, the wellness team handed out small cards detailing employees' benefits information. On one side, they reminded employees that yearly physicals and dental checkups were free, and on the back they offered a short message on oral health: "Just floss the teeth you want to keep and skip the rest."

Herath says the campaign was concise, but worked because "it makes people think, and it was manageable."

For Saint Patrick's Day, the organization suggested eating green leaves instead of green beer. For Cinco de Mayo, it reminded employees that a commercial margarita has 600 to 800 calories and 400 grams of sodium, which makes up 1/4 of their daily recommended salt intake. By providing small nuggets of health information at relevant times, Nationwide has engaged employees and families, and encouraged them to improve their health, one step at a time. "It's too overwhelming to do everything, but it's not enough to do nothing," says Herath.


Improving employee and community health

Named a wellness winner in the 2013 Edington Next Practice Awards, Heartland Health's initiative directly touches the lives of their caregivers and families.

"Our initiative is to improve the health of community, and what better place to start than with the caregivers of the organization, our employees," says Laney Taylor, manager of compensation and benefits at Heartland Health.

The integrated health delivery system offers employees two onsite wellness facilities with free trainers, as well as educational opportunities, such as stress management classes. Its participation-based wellness program energizes staff to participate in wellness. Employees earn quarterly prizes credited through a passport program that rewards points to participants for activities such as attending classes and each day they exercise.

Moreover, employees who are tobacco-free or below a certain body mass index receive premium reductions. Employees with a higher than healthy BMI can earn the incentive by participating in a reasonable alternative, such as using the wellness facilities twice a week. The company has also piloted a Fitbit initiative so that employees who log a certain number of steps can count them toward their reasonable wellness alternative.

Heartland Health aims to make wellness more convenient, and with the Fitbit program employees can exercise with their families or use the onsite facilities. The company also pays the gym membership cost for employees who don't live near the main campus and onsite facilities.

Heartland also involves the larger community. Every year, the company co-sponsors the Pound Plunge. During the 12-week weight loss challenge, it offers activities like kickball and Zumba to employees and to the wider community. The event has had as many as 2,500 participants. Going into the ninth year, Pound Plunge participants collectively have lost 100,000 pounds of weight.

Heartland also has dietitians on staff who offer cooking classes and sample healthy recipes in their cafeterias several times a month, then share the recipes with employees. The wellness leaders have also worked with the company's dietary department to list all nutritional and dietary information on food sold in its cafeterias. It offers fresh fruit at no markup, has eliminated fryers and vending machines contain only water, healthy fruit drinks or diet soda.

Prior to the Super Bowl, Heartland sent a short video to employees and families suggesting healthier snack alternatives for the festivities and posted the video on YouTube and Facebook. The company also broadcasts employee success stories about weight loss or preventive care on Tuned In, its TV station shown on sets around the campus. Employees share stories, and some are featured as the wellness member of the month. Stories are also shared in the company newsletter.

Taylor credits "sharing the stories [as] one thing that has made our program so successful, because [hearing] about someone who has a significant life change is motivational to others."


Cerner Corporation's 'living lab'

Cerner is a health care information technology corporation that has built on a robust wellness program since 2006. The program incentivizes employee participation, activity and outcomes. Participants can earn premium reductions and HRA reimbursements by completing wellness evaluations, biometrics, and annual and demographic-specific screenings. Employees also receive points if they measure in a healthy range, as well as if they show a 5% or 10% increase toward that healthy range.

"It's our job to meet them where they are and move them to the healthy side," says Arielle Bogorad, director of worldwide benefits and wellness at Cerner Corporation.

Wellness leaders take a holistic view of healthy living and deliberately separate "health care" into two words and concepts.

"We believe that there has been too much of an emphasis on reactive health care and not enough on proactive health," says Bogorad.

For example, the employer has partnered with MyBrainSolutions, as "part of our larger behavioral health strategy," says Bogorad. The vendor provides tools, games and assessments to help employees build resilience and cognitive recall, improve focus and reduce stress.

Cerner leaders consider mental health an integral part of its wellness program even though mental and stress concerns are not among the highest risks for its employee population. Though mental health issues were number nine on its population's list of top health issues, well over half of their highest utilizers of medical care also have a stress-related health issue. Though this issue is present in the workplace, it may not always be obvious.

Last year, "on the care side, we added therapists to our onsite clinics. On the 'get well' side, we did a value benefit design concept around generics of anxiety and depression drugs, which we cover at 100%," explains Bogorad. The company has also built a strategic and innovative maternity program to help employee and community mothers have healthy pregnancies, births and easier transitions back to work.

"Our associates understand how they are players in our living lab and how they're helping to contribute to Cerner's overall future," says Bogorad.

The company brings farmers' markets onsite by partnering with local vendors to bring fresh produce directly to their employees and asks their health vendors to create and demonstrate healthy recipes with those fresh ingredients that employees can recreate at home.

Cerner tracked 1,800 people on its health plan from 2007 to 2011 and found that 75% had either maintained the same amount of overall health risk factors or reduced their risks, despite aging five years.

Bogorad believes "that is a testament that we're having an impact on the health status of our overall population."

These results reflect in the bottom line as the company's health plan spending has been on a negative cost trend since 2009 without resorting to cost shifting. Most recently, Cerner had a 6.8% decrease from 2011 to 2012, and a 4.5% decrease from 2010 to 2011.

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