Health Promotion Blog

At the end of the day, is it worthwhile to ban smoking on the premises at your company?

It depends on the steps you take to support staff attempting to kick the habit, finds a recent published study .  The Journal of Tobacco Policy and Research found that smokers do, truly  take more sick days than their non-tobacco use colleagues.

And even when the smoker is in relatively good overall health (i.e., isn’t obese, does not have chronic medical conditions), he or she is still likely to have higher healthcare costs than a comparable non-smoker over the last three years.

Exactly how does a tobacco use ban fit into the cost equation? When the smoker quits, healthcare costs even out.

But if the individuals only refrains from use of tobacco on the job â.” but continues puffing away at home â.” the company sees little to no healthcare cost decrease.  The research study  found similar patterns for absenteeism.

Bottom line –  A workplace tobacco use ban in combo with a tobacco use cessation program gets results. A tobacco use ban alone normally doesn’t.

In the last few years, there’s been a rising trend for public companys â.” not just private organizations â.” to ban tobacco use. Here is what your colleagues are doing.

What’s New in Benefits and Compensation recently surveyed 374 of our readers from both the private and public sectors to determine their organization’s policy on permitting staff members to smoke on-site and hiring smokers in the first place. Here is what we found -

o  11% have developed a policy of hiring only non-smokers

o  17% allow personnel to smoke offsite, but ban it on all organization property

o  39% restrict use of tobacco to designated areas outside the building

o  30% allow smoking anywhere outside the building, and

o   3 percent allow smoking in break rooms or other indoor areas.

Public employers get aggressive

While much of the publicity about no-hire policies for smokers centers on private corporations, it’s actually public companys in certain states who have been the most aggressive of late.

For example, Florida is one of the states at the forefront of the movement. Sarasota County lately became  the third Florida county to take a no-hire stance for control health care costs.

New hires must take a drug test that detects nicotine and sign a pledge certifying that they haven’t smoked in the past 12 months.

The ban won’t affect current staff, but the county has undertaken use of tobacco cessation programs aimed at employees’ wallets.

Non-smokers pay less for coverage through various incentives and the county covers the cost of participating in smoking cessation programs.

The reason why Florida public corporations can take these steps –  the state supreme Supreme Court has ruled that refusing to hire smokers doesn’t break discrimination laws.

But your state laws may vary, so proceed with caution before considering similar policies.

Quitting smoking at any age can improve a person’s health.  And believe it or not, older workers often fair better with smoking cessation than younger workers.

As reported by the Journal of American Medicine, Duke Univ. reseearchers tracked 573 older patients over 10 years. They found that just 16 percent of those who joined the use of tobacco cessation program later returned to use of tobacco.

Previous research has found young smokers who try to quit have a 35 percent to 45 percent relapse rate within two years.

Given that staff members nationwide are retiring later and the cost of retiree health care is sky high, you may want to keep attempting with smoking cessation programs, even for the oldest staff members on your health plan.

In this recession economy and out-of-control staff member debt, many companys who don’t have automatic 401(k) enrollment have seen participation drop.

Here’s how one small company in Arizona cleverly tied 401(k) education to employees’ other financial concerns. Rather than simply holding its usual 401(k) open enrollment education meeting, it held a “financial health fair.”

Stressed 401(k) importance

How it worked –  on the same day the company’s 401(k) provider sent a plan rep to discuss the retirement plan, the company also arranged for a qualified financial planner to talk to personnel.

The financial planner went first. She began the session by pointing out that she wasn’t affiliated by any method with the management of the 401(k) plan.

That was vital both for the company’s legal protection under ERISA and for building trust with staff. She then discussed why it’s vital for individuals  to take part in the 401(k) plan, and offered attendees budgeting tips and basic strategies for cutting their debt.

The financial planner’s talk cut to the heart of a few major issues that hurt both worker salary satisfaction and 401(k) participation. Numerous studies show that the No. 1 reason many people  avoid 401(k) participation is that they feel they can’t sacrifice any part of their entire paycheck and still survive financially.

The second part of the session was the standard 401(k) enrollment presentation from the vendor. End result – Workers were more attentive and there was a noticeable uptick in both new 401(k) enrollments and salary contributions from already-enrolled workers.

The event was such a smash that the corporation plans to make the Financial Health Fair a regular part of 401(k) enrollment. While the financial planning advice is generic (the corporation may add third-party personal finance planning as a voluntary benefit in the future), it’s also timely.

The 401(k) signup appeal comes while the financial planning tips are still fresh in employees’ minds and they’re motivated to do something to help themselves.

Looking for incentives to get overweight personnel to buy into a wellness program? A recent published study  suggests many personnel are even willing to pay much â.” or all â.” of the cost themselves.

Roughly 35% of firms with wellness programs focus on providing staff members with convenient access to losing weight resources.

A poll of 1,352 staff members by the Strategies to Overcome and Prevent Obesity Alliance found that many individuals  would gladly chip in for the cost of the health promotion program if they believed it would help them lose weight. What staff members want -

o  confidential support and counseling

o  Access to a professional nutritionist or personal trainer, and

o  on-site fitness programs.

Until lately, only big companies were able offer such health promotion programs as part of their wellness benefits.   But the fastest growth of these health promotion programs in the last two years has been in smaller firms (sometimes with as few as 50 full-time employees).

The majority of firms split the cost with workers. Normally, workers pay up to about 25 percent of the cost. But some plans are fully employee paid.

Studies show that roughly five percent of workers drive about 80 percent of your health benefit costs.

No shocker here –  Smokers and obese personnel are the highest risk group for developing the sorts of chronic health problems that send costs through the roof.

A small, but quickly growing number of companys are taking desperate measures to avoid the costs associated with these employees.  The step could be broken down into three levels of aggressiveness and potential risk/reward.

Level one –  the employer installs a health promotion program in which non-tobacco use staff members and those who commit to maintaining a healthy weight receive financial incentives that lower their share of monthly insurance premiums.

Level two –  the business disqualifies job candidates who smoke or are significantly overweight from hiring consideration. Alternatively, some firms require new hires to undergo a health risk appraisal as a condition of being hired.

Level three –  the business docks pay or fires staff members who fail to control their lifestyle-related health risks. Example –  A business called Clarian Health has sent notifications to staff members that beginning in 2009, staff members who smoke or chew tobacco will be charged $5 per paycheck.

Are these strategies legal? at level one, the answer is a qualified yes. health insurance portability and accountability act (HIPAA)s non-discrimination rules permit such incentives under a few conditions.

Health Promotion incentives walk a fine line in terms of HIPAAs non-discrimination rules. It’s legal to reward staff members for wellness participation but its illegal to punish those who fail to improve their health.

Example – If an staff member follows a weight-loss program in good faith but fails to lose weight, you can’t withhold the incentive. In like manner, when an staff member fails repeated tries to quit tobacco use, you’re still legally obligated to give them another shot next year.

Likewise rememberthat, by law, the size of the reward or penalty under your wellness program cant exceed 20% of the total cost of coverage.

The other two are still largely uncharted waters in the courts. Corporations considering these policies should proceed with extreme caution. Remember that the question of “can you do it” (i.e., is it legal?) is different from “should you do it?” (i.e., is it good business?)

Health promotion programs come in all shapes and sizes. But regardless of plan design there are five common components that set the successful wellness programs apart from the rest.

At their core, wellness programs require constant monitoring and periodic adjustments.  The wellness programs that get mediocre results are the ones that are left to run on autopilot. That’s why it’s critical to -

1. Know thine enemy You have to know what’s driving your biggest claim costs on your health care plan – both among staff and their dependents.

2. Create realistic expectations. With wellness, what an corporation gets will nearly always depend on how much it spends, how well it plans and how well it sustains communications with participants and the provider.

3. Maintain strong communications.  The health promotion programs that achieve the greatest success are those which are communicated aggressively from the get go and are sustained. Repetition is your friend when doing worker education.

4. Integrate wellness with other benefits. Real-life experience has shown that you should consider your staff member assistance programs (EAPs) an extension of the health promotion program. You should also consider issues like absenteeism, disability and worker’s compensation to be pieces of the wellness puzzle.

5. Practice what you preach.  The key to ensuring staff member buy-in is for upper management to lead the wellness program by setting a positive example. If upper-level managers are unwilling to participate and address their own health issues, don’t expect many staff to take the wellness program seriously.

Here’s more evidence that wellness programs pay for themselves -

Over the last two years, one organization in five has seen significant betterment in employees’ health status â.” and began to stabilize their costs â.” as reported by one study.

Among firms noting improvement, almost two-thirds (64%) feature health promotion programs offering incentives for healthier lifestyles.

Here are three twists on traditional incentives that’re getting good results -

1. Health coach outreach

A lot of firms require workers to work with an individual wellness coach to get a discount on monthly premiums or earn cash incentives.

The most common set-up –  on a regular basis, the worker must set up appointments with and report to (either over the phone or face to face) his or her wellness Coach.

But experience has shown there’s often a high dropout rate.

Individuals  get off to a great begin â.” and they’re enthusiastic about the incentive â.” but once they realize there’s some effort involved, they lose interest.

The good news –  Firms have found a simple-to-arrange alternative that keeps people  on the right track. Rather than requiring staff to contact the wellness Coach, a growing number of organizations require participants to take calls from the wellness Coach.

Potential result –  Fewer folks fall off the wagon. There’s no outreach effort involved, and the health coach keeps individuals  accountable.

2. Nutritional education/therapy

A newer â.” and cost-effective â.” feature in the battle against worker obesity –  offering an worker nutrition-education program administered by a specialist nutritionist.

Just 11 percent of companies â.” 18 percent  of large employers and 7.5 percent of small to medium ones â.” have such wellness programs, according to SHRM’s most recent benefits survey.

Even fewer offer (via their EAPs) nutritional therapy for people  with eating disorders. But available data on these health promotion programs shows they usually pay for themselves.

The stronger the firm’s emphasis on teaching healthy eating, the faster and more dramatic the reduction in major health claims.

Common plan features –  lunch and learns featuring healthy food options, giving out nutrition-linked gift cards and extending obesity-prevention incentives to people ’s family members.

3. Aggressive smoking cessation

A small, but quickly growing number of companys are taking more assertive measures to avoid the costs associated with employees who smoke.

The step could be broken down into three levels of aggressiveness and potential risk/reward.

Level one –  the corporation installs a health promotion program in which non-use of tobacco employees and those who commit to maintaining a healthy weight receive financial incentives that lower their share of monthly premiums.

Level two –  the company disqualifies job candidates who smoke from hiring consideration. Alternatively, some firms require health risks assessments as a condition of being hired.

Level three –  the company docks pay or fires employees who fail to control their lifestyle-related health risks.

Example –  Clarian Health made news last fall for sending notice to employees that as of Jan. 1,  2009, people  who smoke or chew tobacco would begin be charged $5 per paycheck.

Are these strategies legal? at level one, the answer is a qualified yes. health insurance portability and accountability act (HIPAA)s non-discrimination rules permit such incentives within limits.

In a nutshell, it’s legal to reward personnel who quit smoking but illegal to punish those who attempt and fail. When an worker tries but fails to quit smoking, you’re still legally obligated to give them another shot next year.

Also keep in mindthat, by law, the size of the reward or penalty under your wellness program can’t exceed 20 percent of the total cost of coverage.

At levels two and three, it remains to be seen if such policies would hold up in court. Proceed with caution.

Health Testing:
• Blood pressure
• Breast cancer Testing
• Skin cancer Testing
• Diabetes Testing
• Cholesterol Testing
• Eye exams
• Body-fat Testing
• Flu shots
• Posture screening, spinal analysis
• On-site child immunizations
• Prostate cancer screenings
• Fitness Testing
• Depression Testing

Fitness Ideas:
• On-site fitness center or exercise room
• Walking and/or running club (during lunch hour or breaks)
• Bike rack on premises (so employees can ride to work or during lunch)
• Mind/body classes (yoga, tai chi) programs
• Team sports (volleyball, basketball, softball)
• Host an exercise equipment swap

Lifestyle Change or Behavior Change Programs:
• Tobacco cessation
• Weight management programs
• Substance abuse programs
• Fitness activity
• Stress management programs

Prevention and Safety Programs:
• Back-injury prevention and training
• Ergonomic education
• Hand-tool safety programs
• Fire safety programs

Awareness, Health Education, and Support Programs:
• Lunch-and-learn or brown-bag wellness seminars (see your EAP for a list)
• Nutrition and diet information, plus provide healthy food alternatives in your vending machines and cafeteria, and provide food storage and preparation facilities to encourage healthier eating
• Prenatal care programs
• Work / Life Balance programs
• Elder care programs
• Cancer survivor support groups
• Financial education

Stress-Reliever Programs:
• Laughter bulletin board where employees can post jokes and cartoons (in good taste)
• Visiting massage therapist
• Stretch breaks
• Group lunches or celebrations

Disease Management Programs:
• Back pain
• Asthma
• Diabetes
• Depression
• Cancer
• Obesity
• Hypertension
———-
John Bates

Employee Health Services
• access to an EAP
• worksite medical services
• worksite medical examinations
• health risk testing and counselling:
• blood pressure,
• blood cholesterol ,
• blood glucose clinics,
• thyroid.
• bone density testing,
• prostrate
• encourage self-exams – breasts, testicles
• medical surveillance Programs
• immunizations and flu vaccinations
• disability case management
• active rehabilitation
• return to work Programs
• self-care education (see health living Programs)
• disease management information and presentations:
• diabetes,
• stomach disorder,
• arthritis,
• asthma,
• allergy,
• pain control,
• foot and back care Programs,
• chronic tiredness,
• migraines
• health on-line with continuous learning/reminders/tips
• daily/weekly/monthly email tips or news bulletins
• excercise appraisals
• safety and health fairs
• hand-washing tips and reminders
• visiting your doctor guide – tips to efficiency
• links and information on help lines