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Employee Wellness for Hospitals & Healthcare: What's Different - Transcript

We have a straightforward agenda for today. We'll start out by talking about how employee wellness is different for healthcare organizations. So if you're an integrated health system, hospital or clinic, this is why a cookie-cutter wellness program isn't for you. Then we'll talk about some best practices for employee wellness in a healthcare organization. These are things we've learned over 7 years and tens of thousands of healthcare employees we've had in our programs. We'll also talk about how some healthcare systems are using employee wellness to spread health in their community. Then we'll wrap up & review. You can see my contact information here - in case you have questions after the presentation or want my team to follow up with you.

This webinar is bought to you by Extracon. Extracon is a wellness platform company. Since 2007 we've provided healthcare systems and other employers with a technology platform that connects the pieces of their employee wellness program. We are the glue that sticks together data from their health assessment and biometric screenings, onsite and online programs, and incentives. We run the technology so our employer clients can focus on running a great, hands-on employee wellness program. That means we've gotten a good look inside a lot of employee wellness programs, and we've gotten to see what works and what doesn't work. That's why I'm here today to talk with you about what's different in healthcare, and what the best practices are for running an employee wellness program in a healthcare organization.

Our healthcare customers include Methodist LeBonheur Healthcare, Indiana University Health, Southeastern Health, Community Hospital, University of California at San Francisco, Highmark Blue Cross, Sutter Health, Edward Hospital, OSF Saint Luke Medical Center, and many more. Our customers are using Extracon's technology to help them run better employee wellness programs.

Let's talk about what's different for you as wellness leaders in healthcare organizations. The first thing is - you have a bigger problem to deal with. Here's a recent headline from Time magazine: Who are the least heathy employees? Hospital workers. The article is based on a study done by Truven Healthcare, under the leadership of Dr. Mike Taylor who is one of the leading researchers on employee wellness. The study found that hospital workers are more likely to be diagnosed with chronic conditions like asthma, obesity and depression. The chart at lower right, from the study, shows that if you're a healthcare organization, you have fewer healthy employees and more employees with multiple health risks and conditions. Not surprisingly, these less healthy employees require more healthcare. Hospital employees were more likely to use the emergency room, and more likely to be admitted to a hospital than other kinds of employees. And it's not just regular emergencies and admissions. They are more likely to be admitted to the hospital because their conditions like ashthma, diabetes, depression, congestive heart failure, hypertension, and musculoskeletal disorders aren't being managed well enough. Those types of chronic conditions, if managed well, are less likely to result in a hospital stay. As the employer, it's costing you a lot of money as well. You're paying about 9% more for healthcare per employee than other employers are paying. Truven concluded that for a health system with more than 10,000 employees it can save over $1mm for each 1% reduction in health risks. If you'd like a copy of the Truven study, I can email it to you - just send me a message after the presentation. (NBGH 2014 webinar is source for “other programs” comparisons). So why do hospital workers less healthy than other employees? Some of the reasons are ones we already know. Hospital work is stressful, since lives are at stake every day. The shifts are long, often 12 hours or more. Many employees work the night shift or a swing shift to keep the hospital running 24/7. Workers are scarfing down any food they can get while on shift - often the most unhealthy fast food is the most convenient.

But some of the reasons are a little surprising. Hospital workers have a LOWER rate of preventative screenings than employees of other firms. You'd think they would get screened more often, but the study says that's not the case. Hospital employees have a lower rate of cholesterol screening, and lower rates of screenings like colonoscopies, mammograms and pap smears. And one reason may be that hospitals are lagging behind other kinds of employers in implementing wellness programs. These two graphs were put out by the American Hospital Association, in a whitepaper that they titled “A Call To Action”. The point of that whitepaper, and these graphs, is that health systems are behind the curve in adopting employee wellness programs. Some examples: 79% of hospitals offer smoking cessation, compared to 93% of other employers. 23% of hospitals offer a nurse helpline, compared to 87% of other employers. Only 47% offer biometric screenings - that's up to 75% for other employers. Only 37% offer health coaching, compared to 70% for other employers. And employee participation is relatively low in the programs that are offered. The biggest group of hospitals is seeing 10% to 29% participation in even one wellness program. This indicates a need to change the culture, the incentives, or both.

So that's the bad news. But there's also some good news. You have the people, the capabilities and the expertise to run the BEST employee wellness program in town. Do you remember that chart on the last page, showing that the biggest group of hospitals had like 10-20% participation? We work with hospitals that have gone from there up to 90%+ participation. Those are the best practices we'll be sharing. You can do this. You have nurses, doctors, and other health professionals on your staff. You have the equipment on hand to do biometric screenings. You have primary care to diagnose and treat things like high blood pressure or high cholesterol. You have all kinds of capabilities that traditional employers don't have - even when they sign up with a wellness vendor. You can have a top-shelf, best of breed wellness program. So now let's talk about what goes wrong in a traditional employee wellness program, and how you can use your unique healthcare capabilities to do better.

Traditionally, employee wellness and healthcare have been run separately. Employers and wellness vendors have provided the services on the left. Things like health risk assessments, biometric screenings, wellness programing, health coaching, disease management, and incentives. And then healthcare providers and health systems provided the services on the left - primary care, specialist care, emergency departments, inpatient care, prescription medications, surgical procedures, and more. But I think of these two fields as being, in effect, twins that were separated at birth. These are two sides of the same coin, things that belong together. It's just an accident of history that they have been kept separate. The bottom line for an employer - whether it's a hospital like you or a factory, is to have healthy, productive employees. Right? That's an employer's bottom line. But that's not what healthcare has been providing. What the healthcare system was designed to do was to diagnose and treat the patients that walk in the door. And that's absolutely, positively, not the same thing. As a healthcare organization, you can do everything on this page. You may need to buy some training to turn a PRN nurse into a biometric screener. You may need some training to turn a nurse into a great health coach. You may need to buy some technology to deliver a health assessment and keep track of your data and incentives. But you can provide all of these things for your employees, and you can do it in a much more integrated way than it's being done at other employers. You can put the two puzzle pieces together. So why is that important?

Since employee wellness has traditionally been separate from healthcare, there are some gaps that cause a lot of problems for employers. The first is when the health risk assessment or biometric screening detects a need for primary care. So maybe the biometric screening shows that a patient has high blood pressure. Or type II diabetes. Or maybe the health assessment finds out that a person is supposed to have a colonoscopy or mammogram and hasn't had one. Employee wellness has a bad history of dropping the ball here, since it has been kept separate from healthcare. So the wellness program tells the patient to see a doctor, but it doesn't actually happen. If nobody is coordinating the two sides, the primary care visit often doesn't happen. There's a second gap as well. After a healthcare visit happens, there's usually a prescription medication or some other other care plan. So if you have high blood pressure, or high cholesterol, or diabetes, you're going to get a prescription for that. Or maybe the care plan includes something else, like lifestyle change or physical therapy. The second big gap happens when the employee doesn't follow the care plan.

How big is this problem? The CDC estimates estimates that 30% of prescriptions are never filled. And even if they get started, rates of medication adherence drop after the first six months. As a results, only 51% of Americans treated for hypertension are adherent to their long term therapy. So if you take every employee that's been diagnosed with hypertension and put them in a room, you'd find that only about half are taking their medications. And it's about the same for cholesterol with statins. About 25% to 50% of patients discontinue statins within one year of treatment indication. And you'd see similar trends for type II diabetes medications, and many others. So you see there's a huge problem here that is not being addressed by traditional employee wellness nor is it addressed by traditional healthcare providers.

So again, what's different for you as a healthcare organization. You can run the employee wellness program, and you deliver healthcare. You can run a better program in-house than what you can buy from an employee wellness vendor, because you can put the two halves of the puzzle together and keep employees from falling through the gaps. So now let's move on to Best Practices.

The first and most important best practice we've seen in working with healthcare organizations is to run your own program. Don't just buy a cookie-cutter program from an outside wellness vendor. To do it right, you need to own your program. Second, Connect the Dots. We've seen a lot of programs lose impact because the program isn't able to connect the dots between the health assessment, the biometric screening, primary care, online and onsite programs, and incentives. If you don't have a way to connect the dots, employees will fall through the cracks. Third, Measure Outcomes. You can't manage what you don't measure. If you want a population with less health risks over time, less high blood pressure, less high cholesterol, less obesity - you have to start measuring your progress and adjusting your program. Fourth, Build the Culture. We looked at the fact that hospital employees are less likely to use preventive services or participate in a wellness program than other kinds of employees. That's why you need to change the culture. Culture change is not a mystery, it's not expensive, it is something you can do if you work at it. But it will never happen if you ignore it. We will talk about how it's done.

Here's the first of the four key Best Practices for healthcare organizations doing employee wellness. And it's really simple. Own your Program. It starts with top-level support. This was one of the main findings of the HERO Scorecard study, which looked at results of employee wellness programs over the long term. Programs with support from CEO's and CFO's produced much better results, even when adjusted for budget and incentives. If the program is only supported by the employee benefits department, you have a problem. You will also need a designated, full-time wellness leader. This is someone who's job description is to make design decisions about the program, run the program, and be responsible for the results of the program. For most hospitals and health systems, wellness will be the person's fulltime job. There is no substitute for having someone who's fully committed to the success of your program. Employee healthcare represents 4% of revenues at a typical hospital. Any other cost that large has people dedicated to managing it. And of course, you'll want to use your nurses to do biometric screenings and health coaching. You may need some technology to manage the data for you, but you already have the most important thing - the people to do screenings and coaching. Primary care is very important to your wellness program. As a healthcare organization, you have primary care in-house and you can make your primary care the easiest and most convenient choice for your participants. And one of the cornerstones of an effective employee wellness program is a strong network of volunteers who will help you get the word out about your wellness events and initiatives, lead teams in Challenge programs, and answer basic questions about the program for employees. So when we talk about running your own program, it means your people are doing all these things.

The second best practice is to Connect the Dots. This is VERY closely related to running your own program. You see, the #1 reason to run your own program is it makes it possible to connect the dots. So if you do a screening, you need to make sure participants don't fall through the cracks. So here's the visual. If you're doing a screening and someone has high blood pressure, you want them to walk out of that screening with an appointment already made to see a doctor - preferably one of your primary care docs. And an appointment to talk with a health coach afterwards to make sure they filled their prescription and are following their care plan. Speaking of health coaches, you want your coaches to know what the participant's health assessment answers were, what their biometrics were at baseline, and whether they've improved. If coaches are asking participants to improve lifestyle behaviors like physical activity and nutrition, the coaches need to see what participants are logging each day. When you're running wellness programs, you want the data to see if the right participants are joining the programs, and if the ones who do show improved biometrics the next year. Right? You need to connect from the biometric screening, through participation in various programs, to the next year's biometrics to see which of your programs are working. For example You need to know which of your smokers complete a smoking cessation program and got a certificate. Which sedentary people became active. Who lost weight and who how long they kept it off. Participants want to know exactly how to earn your incentives, which steps they've already completed and what to do next. If you're managing population health, there are a lot of dots to connect! This is where modern information technology really shines. A good wellness platform can be the glue that connects all these different programs together, and lets you run reports that make sense of it all. Here at Extracon, this is the big value we provide to our clients. You can't do this in your EMR. And you can't really do it using a bunch of Excel spreadsheets. You need a wellness platform to really connect the dots.

So I'd like to put them together with an example from one of our customers. This is a large health system in the mid-south with more than 10,000 employees. They have moved from an outsourced program to running their own program over the last 4 years, and it's made a huge impact in their wellness program success. Let's talk about where they started. They had been using the free health assessment offered through their health plan administrator. Did you ever get something for free, and realize you'd gotten about what you'd paid for? They only got about 20% to do the health assessment, even with a $150 incentive. Most people who needed coaching weren't getting it, since the health coaches had to rely on the HRA for information, and the HRA was completed by only 10 or 20% of the people. And the only data the employer could get was aggregate data - the data looked about like the graph you're seeing onscreen. So they couldn't connect the dots from the HRA to anything else. They ran quite a few onsite programs, and as you can imagine there was a lot of data floating around in Excel. The program administrator spent a lot of time chasing Excel spreadsheets, trying to make all the numbers connect and add up. But the really scary thing was how the screenings were run. They used a well-known outside screening firm, and paid good money for the screenings. So here's how the screenings worked. The person would come in and step on a scale, get their blood pressure taken, and get a finger stick for cholesterol and blood glucose. And here's what kills me. The screening nurse would take an ink pen, and write the numbers down on a piece of paper. Then the employee would take that piece of paper in their hand and literally walk out the door with the only copy of the data. That's what the cartoon shows. The data literally walking out the door. So they couldn't connect the dots from the screening data to anything else. They couldn't connect the dots, because they weren't running their own program.

Then they had a revelation. We're the #1 health brand in our city. We can do this better, and we have to start now. So they started by bringing their HRA in-house. Now they get individual-level data. They changed the communication strategy and incentives as well. The result: they moved HRA completion up from 25% to just over 94% and are actually spending LESS in incentives. And the HRA can direct participants to local resources provided by the hospital. So if a participant reports on the HRA that they haven't had their cholesterol checked in several years, the HRA can point them to the onsite health clinic for employees as a place to get that test accomplished. Or if they answer the depression screening or alcohol use questions in a certain way, the HRA can point them to the EAP - employee assistance program. They started doing their own biometric screenings. So the data doesn't walk out the door anymore! So again, they have the data now to do the right referrals to primary care, to wellness programs, and to health coaching. So if a participant tells the screener that they smoke, and says they would like to learn more about smoking cessation programs available through the hospital - they have a way to make that followup happen. And if the participant complete the program, the participant can upload their certificate and earn an incentive. They are running onsite programs like Walking Challenges and Diabetes Prevention Programs - and the data goes into the central database, so it's ready to connect to everything else. Next year will be their second year running their own program on our Extracon platform, and that's when the fun really starts. We'll be able to connect data from last year's HRA and screenings, though participation in programs, to the new year's HRA and screenings. In other words, we will be able to see whether the right people are joining programs, and whether the programs produce long-term changes in health risks and biometrics. And we can see where people are falling through the gaps and how to make sure they get the services they need. Which brings us to our next best practice.

Measuring outcomes is a key best practice. If we're going to bother connecting all those dots, we need to connect them to something solid, like measurable health outcomes. It's not enough to say we had 80% participation, or even 100% participation. You want to say we made a meaningful change in the health of our population. So here are some key things you can do. First, you need high rates of completion on Health Assessments and Biometrics. That's just the required first step. If only 1/3 of your people are completing the HRA and biometrics - you really have no idea what the other 2/3 of your population is doing. Once you have a solid data stream of biometrics from year to year, you can start to look for trends. If you're doing a good job, your results can look like the chart shown here - health risks going down each year. Fewer people with high cholesterol, high blood pressure, fewer smokers, etc. And you can laser in on program effectiveness. Let's say you had an optional diabetes prevention program. Did the people who completed the program improve their biometrics by more than the people who didn't do the program? If you measure outcomes, you can adjust your program to make sure it's working well.

Great employee wellness programs change the culture at the worksite. We know that hospital employees are underperforming when it comes to health habits, screenings, and managing their health conditions. The culture is to put yourself last, and not take care of your health. How do we change that? I'm going to tell a story on one of my customers, a large healthcare system in the Midwest. They had a longstanding wellness program with health assessments, biometrics, and other components. But they were finding it persistently hard to change the culture. Employees thought their job was to sacrifice their own health and wellness to serve the patients. They put themselves last every day, and weren't taking advantage of the wellness program. So they had a wellness program in place, but it wasn't changing the culture. How is that possible? Let's start with a simple definition of culture. Culture is what we see others do.

And it turned out the their wellness program was basically invisible. They had policies, procedures and programs in place. They had good rates of participation in things like health assessments and biometrics. They were paying out a lot in incentives. But every one of these things is INVISIBLE to the average employee. The average employee cannot see others do these things. These kinds of program simply DON'T have the ability to change the culture. If these are all the programs you have, employees do not SEE EACH OTHER living a healthy lifestyle. And culture is what we see others do. So what can we add to start changing the culture?

This is a big topic, and if you're interested we do a whole webinar on culture change. So this is just a summary. But if you want to change the culture, you need to add a set of wellness programs that meet these criteria: Participation is Visible. For example in Team Challenge programs, participants often wear pedometers or wristbands to show they are in the game. And on the Challenge website, they can see who else is in the program and send them a Friend request. Line managers need to lead by example. One of the biggest downfalls of employee wellness programs is when an employee wants to participate, but they are afraid their immediate supervisor will think wellness is interfering with getting the job done. If you want to change the culture, you need line managers leading by example. We've found one of the best ways to accomplish this is to ask line managers to lead a team each year in a wellness Challenge program. When your line managers are leading by example, you can start changing the culture. Third, programs need to let people recruit their peers, and let peers hold each other accountable. This is something we learned from employee safety - where employees are expected to hold their co-workers to the practices of wearing safety equipment and using checklists. In wellness, we've again found that team competitions are a great way to get people to recruit their peers into healthy behavior and into making commitments. So my friend John asks me to join a walking challenge - but only if I can commit to walking 10,000 steps a day for the team. See how that works? Your programs should be done together with others. That lets people influence their peers in a positive direction. That's also a feature of Team Challenge programs. Culture change also requires a diligent effort to find the success stories and publicize them. This can be done as part of your wellness platform's social networking features, as well as something you can do in your wellness newsletter, wellness blog and other places. You want your wellness success stories to be some of the most well-known employees in your organization. So we're an advocate of using Healthy Challenge programs to start changing the culture. But anything you do that hits these six points will work as a culture change initiative. We have a whitepaper called “Just Add Engagement” that shows the kinds of results and health impacts these kinds of programs can give you, and I'd encourage you to take a look.

So we've spent most of this hour talking about how to run a great wellness program for your own employees. And I know that most of you are going to find it a pretty big job just to make that happen. But some of you already have a strong wellness program. And that's when you can take the next step, and reach out to your community. When you have a great employee wellness program inside your organization, you've got a working process that you can take to local employers. Think about it. If you as a healthcare organization can run a complete wellness program, that closes the gaps and connects the dots - why would your local employers want to buy from anyone else? In your community, right now, there are all kinds of employers who are hearing the buzz about employee wellness - and feeling the pain in their budgets when health costs go up every year. But the market is full of noise right now. They can find 100 wellness providers on a list from their broker or a Google search. But there aren't any real brand names that stand out- there's not a vendor that's local, comprehensive and trustworthy that the average employer can find and work with. And that's where you come in, as a healthcare organization. If you're one of the two or three main hospitals or largest clinics in your community, you have the local presence, the brand recognition, and the trust of the employer and employees. We've worked with a number of health systems on these kinds of projects - from Sutter Health in California, to Indiana University Health, to Southeastern Health on the East Coast, to Methodist Healthcare here in Memphis. In each case, the health system has a growing business taking its successful employee wellness program to local employers. They use the same Extracon platform to connect the dots, run programs and manage the data - but it's their brand on it, and their people running the program.

So we're seeing healthcare organizations moving from left to right as shown here on the chart. They start out by going to employers with what I call a services sell. Here are the services they do, mainly clinical. Flu shots, biometric screenings, onsite clinics. Then they put some processes and technology in place so they can really start managing the whole employee wellness program. So they are doing the health risk assessment, the health coaching, and keeping track of all the program and incentive data. They've become a wellness vendor. And finally, the destination is employee wellness that's integrated with healthcare. That's the model we've been talking about for the last hour - connecting the dots, closing the gaps, and making it all work together. At that point the healthcare system has a better, more effective wellness program than any of the traditional wellness vendors. They have a competitive advantage and they can be the wellness program of choice for employers. That's a big deal, and not just for the revenue from wellness services. It makes you the healthcare provider of choice for employers with good health plans. So you're getting more and more of the kind of patients you want, which can drive revenue and market share for your whole hospital. And it reinforces your relationship with the community in a positive way. You're not just treating illness, you're spreading good health.

So I want to bring this back to a summary. We started off by showing that healthcare systems today have the biggest need for prevention and wellness. Healthcare employees are sicker than any other group of employees, use more medical care, are hospitalized more often, and do less prevention than any other industry or SIC code. Hospitals are behind the curve in adopting employee wellness, and employee participation is relatively low in the programs that exist. But healthcare systems are not the problem. In fact, you have all the elements of a solution, right in your grasp. You have the personnel and equipment to do anything in employee wellness yourselves - in house. And more importantly, since you can also do healthcare, you can close those gaps between employee wellness and healthcare. You can do what no other wellness vendor can do - offer a complete solution. Then we talked about best practices for employee wellness in a healthcare organization. First, you have to own your program and use your own people. That enables best practice #2, connecting the dots. When a screening shows a need for primary care, you need to be able to make sure the person gets the care they need. When primary care makes a treatment plan, you need a way to check in and make sure the treatment plan is followed. You need the data from all your onsite and online programs to connect with your HRA and screening data, so that you can measure outcomes and determine which programs are working. If you want to connect the dots, it takes a combination of good management practices, and strong information technology from your wellness platform. Then we talked about how to address the problem of low participation in health programs by building the healthy culture you are looking for. The key is running visible, team and social programs where line managers and other participants can lead by example and get their peers involved. Finally we talked about what you can do after you develop a strong internal wellness program. You can take that working model and implement it at employers all over your community. Because you can do healthcare as well as prevention, you are in the unique position to give other employers the same kind of integrated wellness program that you can implement for your own employees. This is not just a source of short-term revenue, it's also a long-term way to build relationships with the kind of patients you really want in your health system.

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