Putting Wellness Online

Web-based solutions can augment other efforts to get employees to lead healthier lives.

By Jennifer Taylor Arnold Aug 1, 2009
0809cover.jpgAs health insurance providers, the leaders of Blue Cross and Blue Shield of Louisiana (BCBSLA) have always recognized the value of good health. But​ until recently, executives at the Baton Rouge-based company hadn’t found an effective way to encourage its 1,700 employees to practice what they preach. "We used to do little things here and there—health fairs and screenings," says Eileen Wilcox, director of human resources for BCBSLA.

That changed in 2005, when Wilcox proposed rolling out an employee wellness program with a full suite of online tools. The following year, BCBSLA introduced an easy-to-use web site that offers health risk assessments (HRAs), support and education modules, reporting capabilities, and convenient access for employees across the state.

Today, BCBSLA has nearly 100 percent participation in the wellness program. According to Wilcox, the company has seen a 5 percent drop in turnover as well as significant reductions in workers’ compensation and long-term disability expenses. In addition, BCBSLA employees have shed more than 7,000 pounds since the program’s inception.

New Tools for Old Ills

For more than a decade, employers have looked for ways to stem escalating health insurance costs by encouraging employees to adopt healthier habits. Today, as costs continue to rise and health authorities warn of obesity and diabetes epidemics, more companies are offering programs to help employees lose weight, start exercising, quit smoking and become better-educated health consumers.

Traditional wellness programs rely on hard-copy handouts, instructor-led classes, and coaching in person or by telephone. All are difficult to deliver when employees work at multiple sites, and they can be quite costly. Today’s web-based solutions can deliver the same information to a limitless number of employees, 24 hours a day, from any location with Internet access and for a fraction of the cost.

Online solutions aren’t the total package; rather, they are one part of a coordinated wellness program. BCBSLA’s online wellness tools, provided by HealthMedia, based in Ann Arbor, Mich., include online HRAs, a smoking-cessation program, and modules on nutrition, exercise, and weight and stress management. In addition, the company offers an employee gym, some instructor-led programs and quarterly meetings with on-site wellness coaches. "Different things work for different people," says Wilcox.

Still, online programs offer many advantages to traditional approaches, and they meet the needs of modern workforces. Minneapolis-based retail giant Target recently launched an employee health and wellness initiative that includes online tools provided by RedBrick Health, also of Minneapolis. "It’s important to have choices," says John Mulligan, Target’s vice president of pay and benefits. "The online piece is very important to our young team member population. That’s what they’re used to, that’s where they go first. We need to meet them where they are."

Expanding Delivery

Scalability is one of the most obvious benefits of online delivery. In the past, health and wellness initiatives were often limited to employees at headquarters. Companies with multiple sites or with large numbers of field or remote employees found it difficult to distribute, collect and track information. Plus, paper-based information must be stored and continually updated, a major challenge in the rapidly changing health field.

At Johns Manville, a Denver-based building supplies manufacturing and marketing company, managers recently decided to offer employees an HRA tool, a questionnaire that measures a participant’s current health status. With 7,000 employees in the United States, Europe and China, scalability and accessibility were critical. Johns Manville chose online tools provided by Wellsource, based in Portland, Ore. "While not all of our employees have their own computers at work, all of our plant locations are equipped with computer terminals for employees to use," says Barbara Schane, Johns Manville’s manager of compensation and benefits. "We did not believe that offering paper-based HRAs would increase participation enough to justify the additional expense."

The ability to provide custom information is another advantage. Many web-based wellness programs can populate a report of current health issues, recommended goals and action plans based on the results of an employee’s HRA. This capability separates these web sites from countless other sources of health and wellness information already on the Internet. "Otherwise, there’s a huge menu to wade through," says Kyle Rolfing, chief executive officer of RedBrick Health.

Technology may also make typically expensive high-touch interventions, such as instructor-led education and coaching, more affordable. According to HealthMedia, the web-based personal coaching it offers effectively simulates a face-to-face or telephone coaching experience for about one-fifth of the cost. And, as part of its comprehensive program, Target is offering health education and coaching on a variety of topics via web-based video links, provided by MD Health Evolution, a healthful-living program developed by a Stanford University-trained internist.

"Web programs, if implemented right, offer a tremendous advantage in cost of delivery," says Ted Dacko, president of HealthMedia. They have higher participation rates, he says, and participants enjoy "privacy and convenience."

Improving Benefits

Experts agree that participation rates are major markers of wellness programs’ effectiveness. The participation rate drives success, says Reuben Polk, president of Wellsource. You want at least 50 percent participation, he advises. To really reap the benefits, however, "strive for 70 percent."

Those benefits can include higher morale, increased productivity, reduced absenteeism, and fewer workers’ compensation and disability claims, as BCBSLA leaders have seen. Over time, an effective wellness program may even translate into lower health insurance costs, though experts caution that it takes at least three years to realize those savings.

While it is possible to see these effects with an offline approach, technology makes it easier to identify and quantify results. Many online wellness programs offer robust reporting, allowing employers to stratify and compare and contrast aggregate data in a few keystrokes. This allows sophisticated analyses such as tracking a disease management module’s effect on participants’ key disease markers or identifying a hidden issue that puts many employees at risk.

Intercare Insurance Solutions, a privately held insurance brokerage and consulting firm based in San Diego, has only 45 employees in three locations. But managers were still surprised by the aggregate results of its employees’ HRAs. "Smoking was one of our top risk factors," says Beth Taylor, who oversees Intercare’s online wellness program, provided by Wellsource. Taylor says that before analyzing the HRA data, she would not have recognized tobacco use as an employee health issue. "Now, we’re planning a cessation program."

Many employers drive participation rates with incentives ranging from direct cash payments and paid time off to points that accumulate and can be redeemed for prizes. "You’re asking people to take more accountability and responsibility for their health," says Rolfing, but "you need to reward them." BCBSLA has recently adopted incentives: Employees who choose not to complete certain aspects of the wellness program will now have to contribute toward the costs of their health insurance. Accurately tracking participation and incentives for a paper-based program can easily become an administrative headache; most online wellness solutions offer incentive management functions that simplify the process and reduce errors.

Ensuring HIPAA Compliance

All data collected in an employer wellness program are considered protected health information and subject to Health Insurance Portability and Accountability Act (HIPAA) regulations. Web-based programs report only aggregate data so that individual results cannot be connected to specific employees. Before partnering with any web-based solution provider, employers should ask how employees’ information is protected and should verify that the provider’s site is HIPAA-compliant.

Providing wellness tools through a web-based third-party provider may actually help alleviate employees’ privacy concerns. "It’s tough for employers [to collect health data]; there’s this Big Brother aspect," says Polk. Experts say this explains the relatively low use of online wellness tools offered by health insurance carriers. Insurance companies have "had them forever, [but] no one uses them," says Taylor. "People don’t trust their insurance carrier; they think they will use the information against them."

For this reason, some web-based wellness vendors advise against co-branding wellness sites. While many types of off-the-shelf HR technology can be tailored to an employer’s looks, some see that as a liability in this arena. "We encourage employers to co-brand on the landing site with employer-specific messaging," says Polk. "After that, we encourage them not to. The employee needs to feel very safe that the information is not getting back [to the employer]."

Solutions for All Sizes

Online wellness offerings vary widely, as do their costs. The Cincinnati-based web site SparkPeople provides one simple—and free—way to offer basic online nutrition and support for physical activity. This open-access site provides a forum for individuals and groups to set health goals, track progress and share experiences through bulletin board postings and blogs. Employers can create private teams and invite employees to join by e-mailing a hyperlink.

According to Jenny Uhlmansiek, corporate category brand manager for SparkPeople, the site has accumulated 970 teams with more than 90,000 team members since its founding in 2000, and interest is increasing. "Recently, we’ve seen a lot of companies looking for ways to add value with little to no cost," says Uhlmansiek.

More-sophisticated solutions with capabilities such as online HRAs, disease management and support modules, and reporting capabilities operate under the software as a service model, charging users a per-employee, per-month fee for a contracted period, usually one to three years.

One distinction: Some vendors charge on the basis of the client’s total number of employees, while others charge just for the employees who participate. Depending on participation rate, the difference can be dramatic. Schane reports that Wellsource’s willingness to charge per participant vs. per employee was one of several determining factors in Johns Manville’s vendor selection process. Depending on the selected modules and the site’s capabilities, the per-employee orper-participant monthly cost can range from $20 to $50.

Since these programs are web-based, they require no internal support from companies’ information technology departments and do not require complex implementation. Once a vendor is selected, programs can be up and running in less than a week.

And while the subject matter may be special, the vendor selection process should not be. "The criteria should be exactly the same as when you’re buying personally delivered programs," says Dacko. "It’s all about results, not bells and whistles." Don’t be distracted by graphics or design; instead, ask for data that demonstrates the program’s impact on specific metrics like absenteeism, turnover and health care costs. Dacko also cautions that the number of web site hits is not valuable; the value of online tools lies in participation rates and outcome measurements.

Health and wellness programs are a true win-win: Employers can boost productivity, attract and retain workers, and realize insurance claim cost savings, while employees can improve their health and reduce out-of-pocket health care costs. Now, with the availability of web-based technology, companies of every size and budget can realize the benefits for themselves and their employees.


The author is a freelance writer based in Baltimore.

Web Extras

SHRM toolkit: Wellness

Web site:RedBrick Health

Web site:HealthMedia

Web site:Wellsource


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