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Working Well

With healthcare costs soaring and employees suffering from an increasing number of stress- and lifestyle-induced maladies, some employers are turning to corporate wellness programs to keep their people healthier, happier, and more productive. And in many cases, it seems to be working.

At SAS, a software company headquartered in Cary, N.C., an employee might start her workday by dropping off her child at one of two onsite daycare centers. If she’s feeling under the weather, she can go to the campus healthcare center to see her doctor before heading to her desk. At lunchtime, she might head to the gym for an aerobics class, to the pool for a swim or perhaps to a workshop on finding assisted living for an aging parent. If the employee is a nursing mom, she can use a comfortable lactation station during the day to nurse or pump in private. And if she works later than she expected, she can stop by one of several cafeterias to buy a takeout dinner — maybe a half tray of lasagna and some fresh veggies from the salad bar — to bring home.

SAS, a private company with nearly 10,000 employees worldwide and more than 4,000 in Cary, is almost unrivaled in its proactive use of wellness programs to create a culture that values employees and helps them to achieve work-life balance. For example, when the company set out to launch its fitness program, “We put all the reasons why people don’t exercise up on a wall and, one by one, tried to eliminate all of them,” says Jack Poll, the recreation and employee services manager who looks after a complete fitness center and several outdoor athletic fields.

More companies are beginning to follow SAS’s lead. They want to make their people healthier. But they’re also looking for ways to acknowledge that employees are more than what they do from 9 to 5. They want to encourage their employees’ outside interests and show them that their personal life and values are respected on the job. They also want to provide support and solutions for those who struggle with personal issues that could be stressing them out and distracting them from doing their best work.

There are several explanations for the interest in corporate wellness programs and for this new corporate point of view. But the primary motivation, it appears, has its roots somewhere near the intersection of health, fitness and the cost of insurance.

Sick and Tired

America has perhaps never been less healthy. According to the Centers for Disease Control, approximately 65 percent of U.S. adults are overweight, and 30 percent of those people are obese. One in 10 (about 25 million people) suffers from chronic illnesses severe enough to limit his or her activity. Correctable conditions like obesity, poor nutrition and smoking (and failure to be screened regularly for things like diabetes or high blood pressure) are leading causes of chronic illness.

The CDC categorizes such lifestyle-related diseases as highly preventable. Left unchecked, however, they’re costly, accounting for more than 75 percent of what this country spends on healthcare each year.

It should come as no surprise, then, that as Americans have gotten heavier, healthcare costs have soared. According to the Centers for Medicare and Medicaid Services ( www.cms.hhs.gov/statistics/nhe/default.asp?), total health expenditures rose from $246 billion in 1980 to $1.7 trillion in 2003. Expenditures per capita rose to $5,670 in 2003, more than doubling from $2,738 in 1990. The Institute on the Costs and Health Effects of Obesity, in Washington, D.C., reports that obesity alone costs corporate America more than $13 billion a year in healthcare claims, absenteeism and lost productivity.

To make matters worse, Americans are also working longer hours, often in sedentary jobs. All that time spent in front of the computer and away from family and activities is hurting our bodies and minds. Inactivity contributes to a variety of major diseases, including colon cancer, diabetes and hypertension. Musculoskeletal ailments, which may arise from repetitive stress or excessive time spent in sedentary, static postures, have become common.

Our mental health is suffering, too. David Hunnicutt, PhD, president of the Wellness Councils of America, a nonprofit organization in Omaha, Neb., estimates that 20 percent of managers in corporate America are depressed.

Rewriting the Work Contract

It’s easy to see these broad trends trickling down into individual companies. Blue Cross and Blue Shield of Texas, for example, estimates that five out of eight of its employees are overweight or obese. David Dahlke, a corporate wellness manager at the company, reports that two of the top reasons employees go to the doctor are for repetitive stress ailments, such as carpal tunnel syndrome, and “those ill-defined conditions that usually have to do with stress, like stomachaches and headaches.”

“The new issue in the workplace isn’t absenteeism, it’s ‘presenteeism,’” observes Renee Moorefield, CEO of Wisdom Works Group, a wellness consulting firm in Boulder, Colo. “People show up to the office,” she explains, “but they work at a reduced capacity because they’re burnt out or depressed or have personal issues distracting them.”

One more motive in the drive toward wellness is less easily measured than health insurance and disease, but no less important. “There’s a new contract emerging between companies and employees,” asserts Moorefield. The prospect of lifetime employment used to drive employee loyalty and give people a sense of shared values and mission with their companies, she explains. (Remember when there was such a thing as the company song?) But after several cycles of layoffs that began in the 1980s, and the frequent job-hopping that so many people did during the Internet boom, it’s become clear, says Moorefield, “that companies can’t be loyal for a lifetime, and employees won’t be either.”

Currently, only 53 percent of Americans feel that their company’s values are consistent with their own, according to a recent study by the American Business Collaboration, in Watertown, Mass. But competitive companies still want to be seen as good places to work, and they are looking for ways to communicate that. Meanwhile, Moorefield observes, “People want to bring more of their spiritual and ethical selves to work. They want an outlet for their creativity. They’re willing to take a lower salary to focus on family and physical and emotional health. And they’ll choose an employer that shares these values over one that doesn’t.”

Putting a Value on Wholeness

The corporate wellness programs coming into favor these days acknowledge that an employee might also be an active community volunteer who’d like a flexible schedule, or a baby boomer concerned about an aging parent who lives alone, or a young mother worried about finding quality childcare. These programs also recognize that people who are always scrambling to meet deadlines are less likely to pay attention to what they eat for lunch, how little they exercise or when they’re overdue for a physical.

Moorefield and others say that a good wellness program can bring a company’s values closer in line with employees’ personal values, which fosters morale and boosts loyalty. And she might be right. In a survey of large companies, conducted by the National Business Group on Health, in Washington, D.C., 56 percent said they saw employee morale improve after they launched fitness programs. In a separate survey commissioned by the American Association of Occupational Nurses Inc., more than 50 percent of employees said a health and wellness program would provide a strong incentive for them to stay at their current jobs.

The best wellness programs look at employees holistically, and they tend to their career goals as well as their values and their mental and physical well-being. A comprehensive wellness program might offer weight-loss and smoking-cessation groups; health and fitness assessments; workshops on life issues such as paying for college or caring for an older parent; various coaching and counseling services; plus, access to a fitness center, walking and running clubs — even healthier vending machine and cafeteria options.

Among the largest companies in the United States, 95 percent offer some sort of wellness initiative, according to Hewitt Associates. But Hunnicutt warns that many of these programs are fairly basic: They might be nothing more than a monthly newsletter with wellness tips, or a perk like weekly chair massages.

“These types of programs are a good way to get started,” Hunnicutt says, “but they don’t generate concrete outcomes.” He says it’s harder to count the number of companies offering the broader, more well-rounded approach to wellness that he prefers, but he observes, “In the past 15 months, I’ve seen more changes in health promotion than I’d seen in the previous 15 years.”

Planning a Program

Hunnicutt, who advises companies on how to set up a wellness program, prefers what he calls a results-oriented approach to wellness. He likes to see companies set measurable goals, like trimming absenteeism and turnover, or keeping health-insurance costs at a certain level, and then build a broad wellness program to meet them.

SAS, for example, has kept its employee turnover below 5 percent a year, about a quarter of what it is at other tech companies. And Gale Adcock, manager of corporate health services at the company, says the health center alone, with four doctors and 10 nurse practitioners, saves the company about $1 million a year in insurance costs and lost productivity. “Any time employees use our doctors instead of going outside, they don’t file an insurance claim, which keeps our premiums down,” she explains. “And we estimate that a trip to an outside doctor can take two hours out of the day. But if nothing is seriously wrong, we can have employees back at their desk in 30 minutes.”

While the breadth and depth of SAS’s program is something to shoot for, it’s important to remember that the company started modestly and built up gradually over 28 years. Adcock, for example, started with one nurse practitioner (no doctors) in a small office.

The Container Store, a Dallas-based retail chain that has won recognition for being a good employer, launched its first serious wellness effort in 2004. The company has tried to make the program broad in its philosophy and has given it measurable goals (reducing insurance claims enough to keep insurance costs flat). But with only one person dedicated to wellness full-time, the company decided to get its program started with a single, high-profile effort that it could build on as the human resources staff learned more about wellness and about what employees were likely to respond to. The idea was that focusing on one activity would also give the wellness director a chance to build interest and excitement among employees scattered across 34 stores nationwide.

That first project was a yearlong challenge, where employees earned points toward prizes that included $500 health reimbursement accounts — sums they could use toward their share of their health-insurance premiums or for health-related items like gym memberships or eyeglasses.

Employees earned points by taking part in companywide contests meant to turn them on to healthy habits. One had them drink more water for eight weeks; another had them walk, run or bike more. They could earn additional points by doing active volunteer work, going to the gym, joining a weight-management group, getting a physical or doing an online health assessment, which asked questions about smoking, weight and even whether a person wore a seat belt regularly.

About 800 out of 3,000 employees took part, according to Rene Morris, who oversees the wellness program. And she expected 400 to do well enough to qualify for prizes. The cost of getting it up and running: about $30,000. This year, Morris plans to offer more exerting physical challenges — her experience last year suggests that her relatively young employees are up to it — and add elements that focus on overall well-being, such as a smoking-cessation program.

Measuring Impact

Most of the studies done on wellness programs measure both investment and results. And for well-done programs the impact is real: Hunnicutt estimates that these companies will see at least three dollars in savings for every dollar they spend on wellness. But if the employees don’t see clear health and monetary benefits for themselves, even a well-planned program is likely to falter for lack of popular support.

“If an employer saves 10 percent on insurance costs, that savings can go back to the employee,” says LuAnne Heinen, director of the Institute on the Costs and Effects of Obesity. The company can cut the employees’ share of the costs, too, or spend more on care for nonpreventable illnesses.

Some employers try to directly tie employees’ insurance savings to healthy behavior. Highsmith, a library-supplies distributor in Fort Atkinson, Wis., launched an incentive-based wellness program after it saw its health-insurance costs spike 53 percent in one year. One of the company’s ongoing initiatives is to give employees who keep on top of their health a discount on their insurance. To qualify for the discount, employees can’t smoke, must get tests from their doctor that are appropriate to their age and gender, and take the annual company-offered physical.

Eighty-three percent of employees go for the discount. And with the aggregate information collected during the physicals (they can’t see an individual employee’s results) Highsmith can create programs that zoom in on its workforce’s most widespread health problems.

For a program to succeed, employees have to see more than bottom-line results, though. Particularly if they are putting in a personal effort by exercising, eating healthier or instituting other healthy habits, they expect to see a change in themselves. And in a best-case scenario, they do.

At Highsmith, after the company discovered that high cholesterol and high blood pressure were common problems, they focused on educating employees about how to improve these conditions. Between 2000 and 2004, the number of employees at risk for each condition fell by more than 50 percent, allowing both employer and employees to breathe a sigh of relief.

To combat companywide obesity, Blue Cross and Blue Shield of Texas began offering low-cal entrées like grilled salmon in the company cafeteria, at a lower price than the usual meat-and-potatoes options. And it launched an eight-week challenge program similar to The Container Store’s that focused specifically on weight loss. By the end of that program, its 3,000 employees shed a combined two-and-a-half tons. “Some lost 10 to 12 pounds and some lost in the 20-to-25-pound range,” says Dahlke.

And, coming full circle, what’s good for the employees is usually good for the employer, too. At The Container Store, Morris knows of a handful of employees who lost more than 25 pounds as a result of that challenge program. She says, “I’ve had a lot of feedback from employees who say they feel better and have more energy [and as result] I have to assume that we’ll find that absenteeism is down and they’re at work more.”

The tangible benefits such as savings on health insurance are what compel most companies to look into wellness programs. But this dynamic of mutual appreciation — companies valuing and supporting their employees as loyal high performers and employees crediting their employers with making them healthier and less stressed — often proves to be an even more meaningful payoff in the long run.

Once again, SAS is a case in point: “One of the most important things at a technology company is to have a culture where people are innovative. But people don’t create when they’re worried about something that’s going on in their personal life or at home. You have to be feeling pretty good in order to have good ideas flowing,” notes Laura Wallace, manager of work-life programs at SAS. “We understand that, and inherent in our wellness program is the message that it’s not just about an employee’s role or position. What matters to us is the whole person.”

Eileen P. Gunn, a freelancer based in Brooklyn, N.Y., writes frequently about careers and work-life topics.

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