If you drop a big wellness program into your small business, your employees will think you've lost your mind. A small business offers more of a family atmosphere than a big workplace. Thus, the approach can and must be different − and creative.
Big Wellness Needs To Comply With Federal Privacy Regulations
A big wellness program comes with a long list of growing regulations and liability issues. Wellness programs that incorporate secondary prevention (screening and intervention) and tertiary care (disease management) are in the business of practicing medicine in the eyes of the U.S. Federal Government and its regulatory agencies (in my opinion).
If the latest zombie movie or Stephen King novel didn't scare the hell out of you, try sitting in on one of the hundreds of webinars that address "being in compliance with HIPAA, GINA and PPACA" with your wellness program. There are an increasing amount of federal regulators and trial attorneys watching workplace wellness practices.
A small business may want to lower healthcare cost as much as possible. But there should be more interest in helping people improve health, productivity, and enjoyment of their work and life. And there is no need to become a paralegal to promote wellness at your small workplace.
For starters, let's do away with the old, big wellness program tools...
- No Health Risk Appraisals (HRA)...
- No big $$ incentives...
- No coaches calling individuals...
- No big $$ spend. FREE is the right price...
- No federal privacy regulations to comply with (because you don't need to collect or track information or offer incentives)...
- No distractions or big time commitments for management (think simple)...
- No special certifications, credentials, training, designations, etc., needed for staff (keep thinking simple).
The 7 Common Questions Small Business Owners Ask Me About Wellness Programs
Q #1. What should a wellness program look like for a small workplace?
A. A communication-based, content-rich program that taps into free local, state, and national wellness resources. Team up with other small workplaces in your community and work together. And then piggy-back local events and venues. You can tap into billions of dollars of free wellness resources, and still avoid all the hassles, pitfalls, and penalties of meeting confusing federal confidentiality and discrimination compliance regulations.
Q #2. You don't like big wellness programs do you?
A. Not so much, does it show? I certainly don't like them for small workplaces with two to 500 employees. For one, the incentive schemes are untenable because they don't work over the long term. And the incentives will draw federal regulators to you like honey draws bears. Second, the big wellness programs are insanely expensive. Both big wellness and small wellness programs can now be implemented for free.
Q #3. If we can't target people at high risk, how can we ever control healthcare costs?
A. You don't need to "target" people for them to improve their life. In a smaller workplace, it's easier to improve the culture for everyone. Besides, your healthcare cost risks are dispersed to the greater population or you're paying for excess risk to pick it up.
A wellness program will not help with your healthcare costs much. And, although, healthcare costs can be impacted more by wellness for big, fully self-funded workplaces − it never should have been the reason for wanting people to be well. That's just like saying we needed people to use email in order to lower telephone costs. It happens anyway, and the new technology is adopted because it's intuitively more productive.
Q #4. Doesn't it make sense for a wellness program to prove it is controlling healthcare costs?
A. No. For a few years, (earlier in my career) I ran a healthcare claims payment operation for group health plans. Paying claims is an accounting process not a health research process. To use claim codes in health behavior research is a tricky and very expensive process. The reports you end up with are works of art in statistical mining and extrapolation. It's nearly impossible to tie cause to effect.
That said, some good studies have been done -- and low and behold guess what they found? Healthier people are less expensive. It's up to the underwriters and actuaries to determine if a population warrants an increase or decrease in healthcare costs − not the wellness program coordinator. So focus on keeping and getting people healthier, and the costs will be what they are. Guessing what the theoretical savings might be doesn't make it so.
Q #5. Why is so much emphasis in wellness put on "risk factors?"
A. Here's what's going on... the quickest way to lower health care costs in a huge, fully self-funded workplace is to screen for all major chronic diseases that may be on the horizon. Then intervene with the high risk people aggressively, and pay extra attention to those with multiple risk factors in an effort to remove one or more of those risk factors.
Use huge incentives, mild intimidation, and dead fish wrapped in newspapers if you have to. You'll defer most, and avoid some, expensive disease events that were about to happen. But, as I've said many times, that is not wellness, it's secondary prevention − or primary care, the practice of medicine. Although a big workplace may be able to justify practicing medicine to some extent, in a small workplace people can self-identify risk factors and be referred to the appropriate medical personnel for help.
Q #6. Doesn't the employer or their vendor need to know exactly who has health risk?
A. No. What shall you do with that information? Say it's your star engineer, or software writer, a person that gives the organization a competitive advantage. You can't treat them differently than anyone else. What if they are obstinate about their poor lifestyle?
Imagine your highest risk person is your most valuable employee. You could kill the golden goose if you start focusing on a specific person. Besides, once you try to reach out to a specific person you come under all the privacy regulations coming to big wellness programs. Build a supportive environment that encourages people to talk to the healthcare provider about any self-discovered health issue. And make the public domain, health awareness enhancing tools available.
Q #7. What do you mean by "communication-based" wellness program?
A. Instead of using a HRA (data driven) as the basis for the program, we use a content model (information driven). I don't think most people understand the concept of relative risk (50% less or more) because we don't tell them compared to what. That's another story. Don't get me started. I am a real risk guy (3 out of 1,000). A concept even a C+ student can understand.
We think good health is a good product to sell. Instead of harping on people about risk factors, we talk a lot about more energy... better sleep... greater independence... more physical strength... flexibility... satisfying and healthful food... social connections... and a longer and productive life. And then we tell them about the self-responsibility it takes to get there. And why they're worth it. It's a great story that people find attractive and workable. And at the end of the day, we all love a great story.