There is a movement in our area to provide intensive wellness services for individuals who are high risk. These are people that primarily fall in to the obese bucket or have a cluster of health factors called metabolic syndrome. While true that these folks need assistance to accomplish better quality of life and reduce the risk of cardiovascular disease or diabetes, we need to “change the conversation around health.” 1
The primary emphasis for most companies to use the high risk method is because individuals with five or more risk factors (i.e. high risk) typically account for more than twice the medical costs as compared to healthy individuals. 2
What we typically see are programs that provide a premium discount or incentive if individuals pass a health screening. For example, if individuals meet a specific score or have fewer than three risk factors for metabolic syndrome, they receive a premium discount of 20%. These employees are deemed healthy and are essentially done for the year. They can come back next year to the screening to get their discount. The employees that do not meet the guidelines are asked to participate in intensive classes or health coaching and must lower their risk by one factor within a specified time period (10-12 weeks).
Again, while we should provide assistance to individuals that have health concerns, we ignore our healthy and moderately healthy people at the risk of gambling that these individuals will forever maintain an optimum level of wellbeing. Extensive research points to the contrary. Dee Edington, Ph.D., leading researcher from the University of Michigan and author of the book Zero Trends makes a valid argument to spend the majority of resources on engaging all employees. In his research he found that programs that primarily target high risk end up losing the wellness battle over time because healthy people eventually will slip in to a state of worsening health as we age. In essence, we may help ten individuals reduce their risk for metabolic syndrome this year; however next year we may find twelve new individuals that were not high risk and now have metabolic syndrome. Edington argues that the best bang for the buck is to get the highest engagement possible and keep the healthy people healthy. He also argues that just keeping moderately and unhealthy from getting worse is a win!
So what is the moral of the story? Make sure you spread your resources evenly. Offer the services for all employees regardless of risk state. Design your program to encourage your people to engage throughout the year and not just give them a free pass once they meet screening guidelines. Wellness is about a shift in culture. It will take all individuals within an organization to be successful. It is time to change the conversation around health in this country. Let’s do it right!
1 Edington, Dee W; Zero Trends, Health Management Research Center, University of Michigan
2 Edington, AJHP, 15(5): 341-349,2001
by Lisa Henning, Executive Wellness Consultant
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