The global corporate wellness market is expected to be $72 billion by 2023, TCU Neeley School of Business Dean Homer Erekson told the audience at the TCU and UNTHSC School of Medicine and TCU’s Neeley School of Business Annual Healthcare Forum Dec. 5.
The reasons are obvious – employers are seeking to increase productivity and reduce their health care costs.
“At the same time, medicine is moving from a model of taking care of sick people to a more preventative care model to keep individuals healthy. For a company to perform well, as an organization, it needs healthy people,” Erekson said. “But what does a successful program look like?”
That was the topic of the forum: “The Dollars and Sense of Health Care.”
Dr. Stuart D. Flynn, dean of the new medical school, moderated a panel that included Mae Centeno, vice president of the Chronic Care Continuum at Baylor Scott & White Health and a graduate of Texas Christian University; Dr. Paul Hain, market president for North Texas Blue Cross and Blue Shield of Texas; Matt Dufrene, vice president of Blue Zones Project in Fort Worth; and Dr. Thomas Bettes, regional managing physician for Lockheed Martin Corp.
The secret to encouraging wellness in the workplace is that there really is no secret, the panelists said in various ways. It’s a matter of hard work. And, they said, measuring wellness as a component of ROI is difficult.
Flynn asked Hain to begin with a definition of wellness.
“I think the World Health Organization does a nice job of contextualizing wellness for us in saying, it’s not just the absence of disease, it’s really the presence of emotional well-being, physical well-being, spiritual well-being,” Hain said. “To me, it really means … the ability to actually reach your full human potential.”
Important steps in that process, panelists said, are well-known: having a personal physician, getting regular checkups, exercising and eating properly. The issue is how to nudge employees toward participation in maintaining their own health.
Hain said that, depending on the source, medical care and access to the health care system makes up between 20 and 40 percent of a person’s wellness.
“So that leaves a whole lot outside of the health care system — social economic determinants of health, how you go about your daily activities. Are you moving in a natural manner?” he said, citing studies that say “motion, the ability to actually move yourself, to get a little bit of exercise every day, whether it just be walking briskly, predicts mortality like virtually nothing else.”
Businesses want to know how to encourage that.
He says his opinion is that employers can offer help to employees, “but they can’t cure them.”
An example from Blue Cross Blue Shield.
“We have experimented with paying people’s gym memberships,” Hain said. “Guess what we found out? We paid for everybody that already had a gym membership.” Nobody else wanted to participate.
“Then we put in a nice walking path in our building and started to encourage people to walk. And the president and I would start to hold meetings there by walking. And, really, what we did was give passion to everybody to go walking during the day, in this eighth of a mile layout we had among or conference room. Turns out that is wildly successful,” Hain said.
There are fits and starts in helping people to practice healthy lifestyles, he said.
If the emphasis is return on investment, most of that is chronic disease management and getting people to see their doctors and follow the doctors’ advice.
“But if you’re really talking about having a healthier workforce, you have to do a lot of different things, and you have to work with your community,” Hain said. “That’s why I think the Blue Zones have been so important, because once you start to transform your community, you’re getting to that other 60 percent of where people live.”
Music to the ears for Dufrene, vice president of Blue Zones Project in Fort Worth.
Blue Zones project is an innovative approach to community health, he said, and began in Fort Worth when the city, Texas Health Resources and the Fort Worth Chamber of Commerce decided that community health had to be addressed in a proactive way.
Blue Zones takes its name from a study of five places in the world where people were not only living longer but also living healthier lives. Those five regions were marked on the global map with blue-colored graphics.
What the studies found, Dufrene said, was that genetics accounted for only about 25 percent of longevity. Behaviors ¬
made up the rest, including total environment, physical fitness, diet and social and spiritual connections.
“For the last five years, Blue Zones project has been working across our whole community,” he said. “The idea is Blue Zones project needs to be in all the places where people spend the majority of their time.”
That’s work places, including schools for students, restaurants – most Americans eat out four to five times a week – homes and grocery stores.
“A lot of us here know what’s healthy,” he told the audience, “and it’s just a matter of us making the decision or not. But that’s not the case for all the residents of Fort Worth. So, clearly letting people know and educating them about what the healthy choices are is really important as well.”
Dufrene said there have been some dramatic improvements in Fort Worth.
Gallup and Sharecare track and analyze the factors in The Gallup-Sharecare Well-Being Index, which encompasses more than just physical health and economic indicators. The survey also measures how Americans feel about and experience their daily lives across five elements of well-being: purpose, social, financial, community and physical, Gallup says in its description of the program.
Dufrene said that in 2014, Fort Worth was near the bottom of large urban areas surveyed. In five years, the city has risen from 185th to 58th while the national trend overall was declining.
“So we’re backing that national trend in terms of overall well-being. But even from a more dramatic standpoint, we’re seeing a 17 percent increase in exercise. We’re seeing a 31 percent decrease in smoking. So we’re seeing dramatic improvements, not just for the overall community, but in the individual lives as well,” he said.
Staying healthy is one issue, but another is dealing with health care costs involving patients with chronic disease.
Centeno, of the Chronic Care Continuum at Baylor Scott & White Health, said literature suggests that about 40 percent of the population has core-morbid conditions, such as hypertension or diabetes.
Baylor Scott & White Health started its wellness program in 2007 and in 2012 began requiring an annual preventive screening that allowed the organization to identify its highest-risk population.
Since 2012, Centeno said, Baylor Scott & White took sodas out of vending machines and focuses on healthy eating, mobility, stress management, weight management, group exercise and walking paths.
“And in five years, our health care spent per member per month has been flat. And I think that that is a huge accomplishment. That equates to $125 million in savings just from premium,” she said.
“We’ve seen a 27 percent reduction in patients, family members, and employees having an admission and a readmission, and a 22 percent reduction in emergency department use. We’ve improved access. We’ve improved our communication,” Centeno said.
“It’s a partnership between the employee and the employer and the community because health care is not an individual issue. It’s really a community issue,” she said.
Bettes, of Lockheed Martin Corp., noted that the company has more than 100,000 employees across the world and is a company that is used to communicating by messaging.
“We’re a wellness program that utilizes messaging,” he said. “We’re well suited to it. But it’s hard to keep everybody spread around the world on the same page on a lot of things.”
Lockheed uses an outside contractor – Optimum Health – for its wellness program.
“So there’s nothing, per se, that we’ve invented about wellness programs,” he said.
“You really want to do three things. You want to increase the health, wellness of your population. You want to reduce costs.
And you want to affect the business outcome,” he said.
“The first two items are pretty much related. If you have healthy employees, you have lower health care costs,” Bettes said.
Echoing Centeno, he said it is harder to show that a wellness program pays for itself because there are so many variables, especially in a company as diverse as Lockheed.
In January, Lockheed went to a high-deductible health insurance plan and made some health savings accounts available to employees.
“We didn’t invent anything here,” Bettes said, “but we’re able to incentivize participation and certain health initiatives by offering incentives through contributions to the health savings account. That’s not a trick or anything. A lot of people do that.”
The result has been “a pretty high participation,” he said, not only in the health savings accounts but also in health survey response.
“We have personalized messaging that sends out messages to people, reminders, to live healthy and do certain things, and we have biometric screening. If you participate in one or all three of them, you get a pretty significant contribution to your health savings account,” he said.
Fort Worth is the biggest single location for Lockheed, and its partnership with Blue Zones in the city has been important.
“It compliments everything we do with our other wellness programs,” Bettes said. “We made significant changes to our menu items, our cafeterias, vending machines, walking paths, things like that.”
And, he said, to have a successful wellness program required leadership at the top and he singled out Mayor Betsy Price as “the very best example of that in the whole world.”
Lockheed also sees wellness as an advantage in finding science, technology, engineering and math workers in its competition with Silicon Valley and high-tech companies in Austin and around the country, he said.
“It’s been shown many times that [to] that population, especially younger ones, lifestyle is very important. They want to feel that their company supports their healthy choices and supports their lifestyle,” Bettes said. “It’s important to attract and retain people of that generation. That’s just a fact.”