Saturday, January 26, 2008

Workplace Wellness Programs: Motivating Employees to Live Healthy

A recent Wall Street Journal article--Wellness Programs May Face Legal Tests: Plans That Penalize Unhealthy Workers Could Get Tighter Rules--discusses the US Department of Labor’s decision to curtail the ability of employers to motivate workers to kick unhealthy habits by making health insurance more expensive for unhealthy workers than for their colleagues.

Workplace wellness programs--which focus on illness prevention and chronic disease management through self-maintenance--are one key ingredient for healthcare cost control. Healthier employees tend to be happier, more motivated and more focused, which benefit their employers through reduced healthcare-related expenditures, improved productivity, lowered absenteeism and fewer on-the-job accidents. While “sticks and carrots” can help convince some employees to adhere to their wellness plan and lead healthier lifestyles, it will be ineffective or even harmful for some due to powerful psychological, physiological and situational factors. These strong internal and external influences will affect the wellness market by giving credence to the legal issues in article and by stressing the judicious use of incentives and disincentives.

Even most presidential candidates agree that wellness programs are essential for controlling healthcare costs. Employer-based wellness programs have been shown to have substantial return on investment through increased productivity and reduced absenteeism, by promoting employee health & safety and organizational effectiveness, and by reducing expenses through lowered sick-care utilization. For example:
  • The Leapfrog Group reported that many of the largest U.S. employers, with 54% of them now offering some version of health coaching to employees.
  • The US Dept. of Health and Human Services reported that: (a) a Johnson and Johnson’s wellness program yielded an estimated savings of at least $1.9 million through decreased medical costs, reduced sick leave, and increased productivity; (b) city employees insured by the City of Mesa, Arizona revealed a significantly greater decrease in health care costs of employees who participated in a mobile worksite health promotion program, as opposed to employees not participating. Health care costs decreased 16%, resulting in a $3.6 savings for every dollar spent on health promotion services; and (c) the return on investment enjoyed by five large companies, as a result of their health promotion and disease prevention activities, ranged from $2.05 to $6.15 per employee.
  • The Small Business Wellness Initiative found that businesses that invest $1 in workplace wellness can often reap $3 to $5 in savings through lowered healthcare costs, decreased absenteeism and decreased workers’ compensation claims.
  • The Texas Coalition for Worksite Wellness reported that the average cost of adding prevention and wellness services to a private health insurance program is typically $50 to $85 per person. Yet, every dollar invested in worksite health promotion yields $3.50 to nearly $6 in savings through reduced absenteeism, increased productivity and decreased health care costs.
  • And a wellness program at IBM returned $3 in healthcare savings for every $1 spent on wellness.
Despite these convincing numbers, workplace wellness programs ought to be cautious in their use of rewards and punishments for motivating employees to lead healthier lifestyles. There is good reason for the Department of Labor’s recently issued regulatory guidelines rejecting the use of incentives and disincentives that make health insurance more expensive for unhealthy workers than for their colleagues. I’ve identified the following three reasons why such tactics are unrealistic and won’t work for many employees.

1. Addiction (and compulsion). As mentioned in the article, smoking (as well as drug and alcohol) addiction is due to the influence of a powerful complex of biological and psychological factors. For many people, counseling (and medications) is required, and numerous relapses are common. Instead of simply punishing smoking, those addicted ought to be rewarded initially for participating in counseling to deal with the physical and psychological causes of their addictions. For employees whose health would improve if the curtailed their use of alcoholic beverages and recreational drugs, the same strategy should be offered, assuming they are not breaking company policies.

Similarly, certain compulsions, such as the drive to persistently overeat, are driven by powerful physiological, mental and emotional influences. As with addictions, weight loss typically requires counseling, family/peer support, and even medications or other medical procedures (e.g., gastric bypass or band). Our culture makes matters worse by promoting unhealthy diets through commercials and fast-food companies selling high-carb and high-fat foods and beverages. If we’re serious about reducing obesity, our society also should focus on changing these maladaptive cultural influences.

2. Hopelessness/Helplessness, Depression, and Denial. Some people lack the optimism and confidence to change their unhealthy lifestyles. Feelings and perceptions of hopelessness and helplessness are part of their personalities, which have been created by their personal experiences, attitudes and emotions. People who don’t believe they can succeed are not motivated to change, of course. Likewise, lonely or depressed people aren’t going to change their lifestyles in order to extend their lives because the prospect of living longer in chronic emotional pain isn’t very motivating. And when confronted with the knowledge that their health risks can kill them, many people tend to deny it because the idea is just too emotionally painful to acknowledge. So, threat of death isn’t a powerful motivator for many. In fact, the odds are nine to one that a person will fail to make substantial lifestyle changes, even if facing probable death!

Compelling discoveries in the fields of cognitive science, linguistics and neuroscience, however, are helping us understand how “reframing” the issue is essential. For example, people are more motivated to change if they can have a vision of “joy of living” rather than a “fear of dying,” since joy is a more powerful motivator than fear. This kind of reframing changes the mental structures that shape one’s view of the world, and it typically requires psychological counseling (individual and/or group). It may take months of counseling to the break through the thoughts and feelings that block one’s motivation to change. [Reference]

Sticks and carrots alone will not motivate these people to change; and some sticks may even lead to denial. Instead, they must first believe they can succeed in making the necessary changes in their lives and they must have a mental framework in which the prospect of a longer life brings them joy. Their initial incentives, therefore, ought to be focused on getting them involved in the counseling they need.

3. Time and Money (Resource) Constraints. Many employees have work, family and other demands that consume their time and make lifestyle change difficult. What they need is help with time management and developing wellness plans that take their busy schedules into account. Some have serious money problems, which prevent them from buying more healthy foods, a gym membership, prescribed medications, diagnostic tests, etc. s Sticks and carrots will be useless until these time and financial issues are resolved.

In conclusion, using incentives and disincentives fails to motivate many employees to live healthier lives. Wellness programs, therefore, ought to focus on providing the risk assessment, feedback and counseling necessary to deal with the emotional, attitudinal and resource blocks that prevent employees from making positive changes. Rewarding these people for participating in such counseling make sense, but punishing them for failing to improve their health is foolish and worthy of criticism by the Labor Dept. Not until these employees have attained a more positive psychological/emotional state will they be motivated to change. Only then does is make sense to reward them for achieving biologic benchmarks (e.g., weight, cholesterol levels, blood pressure, etc.) and behavioral goals (e.g., diet, exercise, non-smoking, reduced alcohol consumption, medication compliance, etc.).

In my next post, I discuss how a "whole-person integrated care" model addresses the particular needs of people with different personalities and levels of motivation.


Anonymous said...

This is a great article. I realize it is very important to have wellness awareness in workplace because lots of disease are from work place too.


Alex Liu
How To Become A Millionaire

Robin said...

If for no other reason than cost savings, the government ought to put in place a program that rewards companies participation in wellness program/s. The reward could be a tax incentive/reduction based on percentage of all employee participation thereby eliminating the current legal conflict being bandied about.

Unknown said...

This doesn't mention the millions who live with some for of chronic illness - from the mildly annoying to the debilitating. By making healthcare services a punitive measure, it forces these employees to decide between lowering their short term costs (for insurance) and raising their long term costs because of failure to seek medical care and treatment options. Furthermore, symptoms are usually invisible, employers are clueless about how this impacts employee motivation, satisfaction and performance. An essential part of any wellness program should be offering short term coaching to help people ith chronic illness that waxes and wanes manage their deliverables and continue to be productive.

Fiona Gathright said...


Just a note to tell you, from the perspective of a corporate wellness professional, this is a great and thought-provoking entry.

I've added your blog to my blogroll.

Best, Fiona Gathright

Anonymous said...

While your comments about the complexity of behavior change are correct and thoughtful, the regulations you support are too rigid. As you correctly point out, what works to change behaviors will vary by person. While carrot-and-stick approaches, by themselves, may not change behaviors, they can be essential tools in many cases, and the right percentage incentives are often unknowable in advance. Why three government agencies believe that a 20% limit is indisputably the right incentive limit is beyond me. Sometimes, the right answer may be no financial incentives, but sometimes, it may be 40%, or 50%, or even a complete foregiveness of health care premiums for a period of time. The caregiver should have the maximum flexibility to provide carrots.

That being said, I concur with your point that the use of "sticks" or punishments to change behavior when medical conditions and behaviors are either beyond someone's control or require major interventions that evidence limited control by the individual is inappropriate. At Pitney Bowes, we favor carrots rather than sticks.

Your argument that every carrot is really a stick for the people not receiving the carrot is true, but, as long as health care premiums are not punitively high for those not receiving the incentive, then I do not see a moral issue. If an average health plan participant should pay 6% of their income for health care in a community-rated environment, but those who engage in healthy behaviors pay 3%, I see no moral issue. The reason this can work is that, over time, the person not receiving the incentive will share in the benefit of lower overall costs and be able to pay less. This future benefit for even those who do not get the incentives was not addressed in any writing supporting the regulations.

Dr. Steve Beller said...

I thank everyone for their comments!

Here’s my reply to good points Mike just raised.

The field of psychology has proven without a doubt that positive rewards can be a powerful factor in helping motivate people to change their behaviors; and the same case can be made for punishment in certain situations. So, I do recognize the potential of incentives in general.

My problem has to do with the indiscriminate use of sticks and carrots in workplace wellness programs. That is, no matter how much the financial gain or loss, incentives will not be effective for types of employees if, for example, they have addictions, feel hopeless & helpless, are in fear-based denial, are stressed out by life events they find overwhelming, and/or lack the resources and support they need to comply with a plan of care. For others, the gains or losses must be great enough have the power to influence lifestyle change. So, for some of them, a savings of 3% of income (as Mike suggests) may not be adequate, while others would be motivated by a 1% savings, and still others need no monetary incentives. It’s true, nevertheless, that as the “loss experience” (utilization rates) decline for a company, all employees—those with healthy AND unhealthy lifestyles—would all benefit over time from lower insurance costs.

It is for these reasons that I suggest we focus on using wellness coaching/counseling, and the use of comprehensive mind-body assessments, to deal with the underlying reasons why sticks and carrots don’t motivate certain employees to live healthier lifestyles. In this regard, as I said in the original post, their initial incentives ought to be focused on getting them involved in the wellness counseling they need, even if they haven’t demonstrated lifestyle change.

Note that I’ll be discussing these issues in detail in subsequent posts.

Anyway, this all still begs the question about what to do with an employee who is so psychologically impaired that s/he will not take advantage of the wellness counseling despite the incentives and health risks & problems. Here we’re talking about someone who is likely mentally handicapped (lack the intelligence or insights to understand the situation), committed to self-destruction, drowning in despair, frozen with fear, psychiatrically disturbed (e.g., paranoid, psychotic), etc. It seems to me that human recourses and/or EAP personnel ought to be working with these employees to get them the help they need to help get them ready, if possible, for wellness counseling. But, just like the other employees who for whom coaching/counseling is necessary for them to make positive lifestyle changes, requiring they pay more for health insurance than healthy employees doesn’t make sense to me.


Anonymous said...

Hi Steve,

Thank you for the response. With respect to individuals who have behavioral health issues, your comments are well-taken.

At Pitney Bowes, we use a 10-visit confidential EAP consultative model to enable medical professionals to make the most informed judgment as to the right treatment program. Financial wellness incentives or penalties are really not in play in these situations, even in cases in which there is an accompanying physiological condition that could be addressed by financial carrots.

The point I made is that, under the right conditions, financial incentives can drive healthy behaviors, especially in combination with other prevention or treatment strategies. An arbitrary 20% ceiling reduces the available tool kit.


Dr. Steve Beller said...

Hello again Mike,

Pitney Bowes' wellness model is on the right track by tying its EAP’s sick-care professionals with its well-care program. This is an example of what I call the “integrated care” component of a high-value health promotion program (see this link ). It is something all large companies should consider doing, even though many companies--including just about all small to mid-size to companies--would likely have to outsource (much of) it.

And I agree that there need not be a problem with the judicious use of incentives (financial or otherwise) in a way that does not discriminate against those failing to achieve biometric benchmarks (e.g., BMI, weight, cholesterol, blood pressure levels) or behavioral objectives (e.g., diet and exercise levels) due to psychological or physical factors.

A caveat, however, is that the vast majority of individuals may, in fact, be impaired by such powerful influences, which may explain, in part, why the number of employees actively participating in workplace wellness programs tends to be quite small (around 20-25% enrolled with fewer than 10% completing program requirements), regardless of whether sticks and carrots are used (see references below).

Note I’ve begun examining this issue at at this link ), and will continue to post about it over the next few weeks.


7-35% (with a “best fit average” of 25%) enrolled in the program with around 8% completing program requirements and 4% earning maximum financial rewards. Available at this link .

20% of OSDH employees are participating in an online/telephone-based health and wellness program, utilizing health mentors while working on a personalized wellness plan. The Oklahoma State Department of Health (OSDH) Employee Wellness Program. Available at Available at this link .

20% employee participation in at least two wellness activities during the year. T2001 Healthy Workplace Awards--Michigan Fitness Foundation. Available at this link .

25% participation in wellness programs. Vermont Council on Physical Fitness and Sports. Available at this link .

MRadcliff said...

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Anonymous said...

Hi, this is a very useful article on Workplace wellness. Every company should implement such programs for the wellness
of the employees

Anonymous said...

Very interesting subject.
I have found that communication with your team direct from the manager has a tremendous effect on motivation. It makes them feel included and also updated, like there are no secrets. I hold monthly meetings with my staff to go over our teams performance compared with our KPI's. And I ask them for reasons why they think our performacne is the way it is, whether that be good or bad, not looking for excuses but instead trying to find out if there are any underlying issues that management may not be aware of.

Anonymous said...

Hi there, Great article, I realize that it is quite old now but I still want to comment.

Health begins in the minds of people. I have seen so many cases where people get physically sick when they are worried or burnt out. It actually has happened to me, too...

There are some great people in Switzerland who have started up a service called Workplace Angels. Check it out on There is a free forum on

Best regards

concerned nutritionist said...

Nice post! It is a fact that some workplace makes there employees fat. Sitting behind the desk can get boring and eating sugar-loaded snacks can be quite tempting. Healthy lunch choices don't come by so often. As a result, bellies grow bigger and legs grow fatter.
It's a good thing that these so-called "Workplace Wellness Programs" are being implemented. Thus, employees are constantly reminded to keep their health in check.

David Brett said...

I just came across to your blog and reading your post. It is very interesting story.It's no secret that small businesses in the US are being throttled by health care and workers comp costs. It seems that just about every small business I know has reduced their workforce to just family members. A large percentage of companies that typically would employ small numbers of people have reduced themselves to just family run operations to avoid the costs of health care and workman's comp insurance and also to avoid the risk of a workman's comp claim. Of course the economy is a big part of this but the dampening effect of these exorbitant expenses make a lot of businesses just not work in a less than dynamic economy.For those companies that are surviving and also retaining their employees, reducing these costs is a fundamental concern. When it comes to reducing health care costs employee wellness programs are a businesses best friend. Healthier employees means less health care costs, reduced absenteeism, and a reduced risk of workman's comp claims. In fact recent studies are showing returns on investment of three to fifteen dollars for every one dollar spent on a workplace wellness program. These returns are typically seen in under eighteen months according to recent surveys.accident at work.

Unknown said...
This comment has been removed by a blog administrator.
Unknown said...

Great post! It's nice to see someone who can see the importance of a wellness program. I've actually been looking for a worksite wellness program in New York, NY, but I just don't know anything about what makes a program good or not. Do you have any suggestions or ideas? Thanks!

Unknown said...

Great post! It's nice to see someone who can see the importance of a wellness program. I've actually been looking for a worksite wellness program in New York, NY, but I just don't know anything about what makes a program good or not. Do you have any suggestions or ideas? Thanks!