A four letter word. I used to think it was one of THOSE four letter words. You know the $*#% kind. As soon as you hear it you recall nightmares of high school math assignments, aptitude tests and dreaded STATS 101. I am not a mathematician nor a statistician. I have had my fair share of exposure to data however. In getting through graduate physical therapy school, data was unavoidable. After a time I learned to embrace data for what it really is; information. Hopefully, information that is useful. Information that you track for success or failure, savings or cost; or decide to make changes or not. Corporate wellness programs are not short on data that can become confusing quickly. Here is my perspective on simple and effective data you can collect and use on your own to help your wellness program succeed.
“In wellness, you don’t have to challenge the data to invalidate it. You just have to read the data. It will invalidate itself.” I wish I could recall where I heard this quote. I have heard variations of this theme over and over. We see it all the time. Studies will come out to show one thing and then a few years later other ones come out to show they were wrong. One great example is ROI (return on investment) in corporate wellness. Just a few years back studies were claiming ROI as high as 16:1 over 5 years. Then it dropped to 5:1. The Minnesota Department of Health had an outside study done in 2012 and it was concluded that the ROI was $3-6 per dollar spent1. The story keeps changing with all kinds of numbers and even losses. We hear less about ROI and more about health care savings.
If you are reading this, you are likely stuck between a rock and a hard place (CEO, CFO or whoever is asking that you validate your wellness plan). Showing that a corporate wellness program benefits the bottom line can seem difficult. In addition, most wellness program directors want to know that the programs are really helping employees as well. That change is being made.
Your program may have started like this: HR tells you corporate has decided to start some wellness programs to help company morale. It is now your job to create it. You network with friends and colleagues. You search online. You go to a conference on worksite health and wellness. You start to follow what others do: biometric screening, weight loss and nutrition speakers at lunch, company walks and yoga on Thursdays. You track participation. Biometrics are only done once a year. Insurance premiums are only calculated once a year. How do you know if people are getting “better before then? Now what? It is all you have, so you just go with it. This may be your situation and it may not, but here are some of my recommendations.
WHAT DATA TO COLLECT
You can collect useful data yourself. Most of which your company will already have or have access to it. If budgeting allows there are many companies that will do the data mining for you. This can be costly, so if you are just starting or have a small wellness program that will not be an option. With some footwork and collaborating with human resources, IT or database people in the company you may be surprised by the information you can get.
First thing, I recommend that information you collect be anonymous and transparent; as well as simple and non-intrusive. Employees are becoming ever skeptical of companies using personal health status to penalize them2. So the last thing you want to do is go around asking for direct personal information. Start by looking for these types of data:
- Company demographics – Numbers of employees, employee ages, gender, types of job or position. Try the HR department. This should be your source for some basic demographics of who works at the company, how old they are, how long they have been there, what kinds of jobs there are and more. This information will be useful to track percentages of employees that participate and to compare other data to it.
- Employee health and wellness culture – personal health assessments (PHAs): activity levels, sleep quality, stress levels, exercise, knowledge, habits, diet, needs, wants. Getting an idea of the overall health and wellness of your company can be easier than you think. Starting with personal health assessments that employees fill out themselves can give you tons of information. You have to be sure you use a tool that captures what you want. Often, questionnaires can be found in PDF format with a quick Google search. You may need to spend a small amount to get help creating one or purchasing the survey. The information you get is simple and does not require an MD or PhD to interpret. The hard part will be tallying the results. Using a tool like Survey Monkey or other e-survey tools can do this for you. Your company may already have permission to use one or an IT person could assist. This information should give you a snap shot of the basic wellness culture of the company. You can use this information immediately to locate areas of need. Plus most major health risks can be well established with this data.
- Productivity, sick day usage and turnover – How this is tracked will be different per company, but every successful company will track productivity. Tracking productivity will let you know how effective employees are at work. Get this grouped by how the company commonly groups employees. This may be by division, sector or facility. That way, as you make changes you will be able to watch productivity within groups. Do the same for sick day use and turnover.
- Employee risk of injury – Safety and workers compensation information: on the job injuries, number of injuries, injuries per area, and types of injuries. Corporate wellness programs should always coordinate with the safety department. For many this will be a new concept. The goals of these departments are very similar. If there are common injuries happening that will affect employee wellness. You need to know this! Are there certain groups of employees that get hurt often? What kind of injuries do they have? Areas of repetitive injury, high pain or accidents could be targets for wellness and safety programming.
- Company physical environment/exposure – physical set up of company facilities, amenities, areas of concern, ergonomics, areas of exposure (light, cold, heat, sun, etc). A part of wellness at any company is going to be things like comfort, ergonomics, amenities or lack of these things. What employees are being exposed to harsh conditions? What conditions are there? What changes could be made in these areas? Are employees comfortable at work? Even something as simple as the building temperature or lighting could affect how an employee feels and how productive they are.
- Health Insurance and Workers Comp claims – number and types (preventative care, emergency care, surgery, what body areas?) of claims being filed, costs of claims and premiums. Again, this should be information accessible from HR. You don’t need specific claims of individuals. That could be in violation of HIPAA laws. Global information about number of claims, size of claims for both the health plan and workers compensation is very helpful data. Look for trends in usage according to age groups, division, facility, etc. Are there many claims for small costs or less claims for more expensive costs? How often the Emergency Room is accessed vs an Urgent Care or family doctor? How have these changed over time? Another helpful thing to look at is company premiums over time.
DATA THAT MAY NOT BE HELPFUL
Quizzify founder Vik Khanna stated “the fetishization of health data and the belief that data can predict disease has been the result of misdirecting narrative that a technology-loving society has been eager to embrace”. It would be my recommendation that you not pay for any service to get data until you have at least gathered what you can on your own. Then branch out based on the information that may be lacking.
The majority of a corporation is not going to need biometrics, body mass indexing, body composition, EKG, Carotid Artery Screening, Bone Mineral Density Screening and some other common screens. The data you collect on your own can help you identify risk groups that may benefit from these services, but not everyone needs it. Some aspects of data can seem cool, like a new smartphone. Someone comes in and gives a great pitch on how their service will give you great data. What they won’t tell you is that most screenings don’t have a return on investment and numbers don’t typically motivate people to improve.
There is some data that is just flat out unreliable. Take BMI for instance. All this is, is a ratio of height to weight. So what happens when you have a tall muscular (athletic) person? How about a tall marathon runner? The first will have a high BMI and the second will appear “unhealthly” low. How about cholesterol? In May of 2016, Kaiser Permanente published results of a study that total cholesterol compared to good cholesterol to predict cardiovascular risk could be widely overstated.3 What about glucose testing? Well, are there many employees with diabetic risk? Is a large proportion of your workforce overweight, over the age of 40, family history of diabetic and inactive? If not, why pay to get it tested?
It would be much better to use wellness resources to encourage employees to create relationships with their own health care providers. Let the professionals do their job and decide on what tests should be used. Well, you say the health insurance plan will reduce premiums if we offer screening. Well, if employees access preventative care as appropriate, that should also reduce premiums. Use the data you already have to evaluate if you need to more data. Don’t just spend money to get more data that won’t tell you anything new.
IDEAS ON LOOKING AT THE DATA
As I mentioned above, getting data company wide instead of for each individual by name will help you in a couple of ways. Employees will have less fear about the information being used against them. It will also help prevent you from inadvertently targeting individuals. Global data will help keep using the information simple. This will help in the primary goal of getting an idea of the company culture towards wellness and health.
Using the data you get from the personal health assessments (PHA) will give you a place to start off immediately. Look for common themes. This will give you a picture of the overall wellbeing of employees. Chronic diseases related to poor eating, tobacco products and lack of activity are one of the largest drains on national economy.4 Even with the surveys being anonymous, as long as you have a couple key demographic questions within the survey, you will be able to see company risk towards health risks. Ask at least gender, age range and company position/area as part of the PHA. You will be able to create target groups based on that data. Let’s say you get surveys back and notice that more women age 35-40 categorize themselves as sleep deprived; or many more employees in “production line” complain of constant back and neck pain. Maybe you see employees aged 55+ are the least active. You should also see themes like a certain % of all employee that smoke, or would like to stop smoking, or classify themselves as overweight. Would this type of information be useful? Not only will it show you areas that need help, you can track them over time for change. It will just depend on the type of questions you have in the PHA.
You will want to ask employee attitudes about health and wellness. Do they feel they understand what each are? Do they want help? Would they participate in a wellness program? What would they want out of a wellness program? This will help you see what the company culture. This will help you tailor the types of programs and activities to be used. If only a small portion shows real interest, then start small. If many people state they just want help with gym memberships and nothing else that would be nice to know before you schedule a whole year of activities.
Now bring in company data (everything else listed above except PHA) and compare it to the groups you established with your PHAs. This is where you will see company benefit from the wellness programs. Here is an example. With the data from the PHAs you established a few large target groups. The largest of which is production areas A,B,C. The employees in these areas rated themselves as having low physical activity, high stress, poor sleep quality and less healthy than average. Go to the company data for areas A,B,C. You should be able to look at sick days, productivity ratings, turnover, safety and insurance information for A,B,C. What kinds of injuries are occurring, insurance claims and workers comp data? Coordinate with your Safety department and start working with this large group based on the data you have. Then track the trends. If you see sick days decrease, productivity increase and on the job injuries decrease then you know you are making a difference that is saving lots of money. This is the type of data that also will help to show decreased spending and/or increased profit by the company.
You could do the similar in all kinds of ways. Maybe you just got some new data from management that productivity is really low in the main call center and they want solutions. You go back to your data treasure trove and look for trends in this same employee group. Maybe you find they have the highest health insurance claims, or they have the highest job dissatisfaction. It could any combination of things. You would have real answers for these solutions.
It could even be as simple as looking at past trends of health insurance claims. If you notice that claims have been increasing for chronic conditions such as back pain, arthritis or diabetes what does that alone tell you? Is that a healthy company culture? I would say not. You start some programs to address this and look at the information 6 month later and then a year later. You notice an increase in claims! Then you notice the dollar amounts. It is actually less per claim. What does this tell you? Employees are accessing care for preventative measures more. Would that be positive change? Yes. This exact kind of study was recently published in the Journal of Preventative Medicine in June of 2016.5
COMPANY BENEFIT FROM INVESTMENT
Let us shift our thinking to company benefit. This will be anything that shows reduced spending or increased profit for the company right? We would all love it if corporations were 100% altruistic. You could just go sit down with the CEO and state that employees are happier and the company culture is changing. You show that participation in wellness programs has increased every quarter. The CEO gives you pat on the back and says “that is great, lets increase your budget 20%”. In some instances, this might actually happen. However, most corporations (CEO, boss, management, whoever) will want to see that the money that is spent on wellness is benefiting the bottom line. Companies pay large dollar amounts to get numbers run and tracked because they often spend even more money on all the wellness benefits and health insurance premiums. Maybe you can help first.
Here are some things to look at:
- As already mentioned above, get familiar with the health and workers comp insurance information for your company. Track trends along with your other data in the target groups you have established. If you see overall claim dollars going down this is an indicator that health costs should go down for the company. You should be able to verify this by the premium being paid (that is if the company plan does not change drastically). Tracking workers comp data is also huge. This can be very costly for companies. The National Safety Council estimates the average aggregate cost of one work related injury was $38,000 in 2015.6 The cost of one Off-the-job injury has been estimated at $10,000 (this does not take into account motor vehicle injuries).6 If you show a direct relationship to your efforts and reductions in workers comp claims or premiums that is money saved! (do the math – your programs reduce back sprains by 5 incidences and 3 on the job injuries over 90 days = average of $164,000 saved not to mention the below):
- Get familiar with company productivity data. Improved productivity directly relates to company cost of its product or service. If productivity increases then profits should also increase. So even though productivity is not a direct savings in health care cost, if you can relate your wellness data to increased productivity in any way then your programs are causing increase in profit.
- You need to get familiar with employee costs for sick leave and turnover. When employees are off sick it puts strain on productivity. If many employees are off sick frequently it puts a huge strain on productivity, and/or increases costs for temporary employees. There is a huge cost to find and train new employees. There is a decrease in productivity from losing more experienced employees. There is also additional expense in finding and training new workers. Look at the data to find areas of high sick leave use, ideas of why and track how that changes with wellness participation. If the sick leave is due to injury vs illness (back pain vs cold) then you should work alongside Safety. If you can show trends in reduced sick leave use that is in direct relation to productivity (and possibly reductions in health care access). This would be similar for any turnover trends. What areas have the highest turnover? If you have been working to improve employee satisfaction and can show turnover has dropped that will also directly affect productivity and reduce costs associated with hiring.
- One other thing to consider is the cost of employees working while sick vs taking a day or two to get better. Taking time off may actually save the company money if the employee can come back better and stronger.7 Presentism (working when not really effective) can result in errors, burnout, chronic health conditions and many other issues causing a drain on a company.
The bottom line really is that you should be relating changes seen from wellness programs to specific company costs. What about tracking participation in wellness programs? This may be helpful. However, participation alone is not enough to show company benefit from a wellness program. All participation is at the end of the day is COST. Corporate does not like cost. Think about it. The more people that participate the more money the company has to put out to cover it. Be it biometric tests, gym memberships, incentives, etc. It all costs money. So unless you can relate all that participation to benefits of the company’s financial situation it is not that useful.
HELP WITH DATA
At some point, you may need some outside help with gathering or understanding the data. There is no shortage of consulting companies both big and small. I am one of those small ones. Just gather as much as you can on your own first. Start to understand it before you higher all kinds of consultants. This will better understand your company and its culture. It will help you identify what needs your company has. Maybe no one understands on the job injuries at the company and you need help getting started. Maybe you can’t find a personal health assessment that embodies everything you want to know. Maybe the program has been going for several years and is now too big to handle on your own. These could be reasons to get outside help. Knowing your companies numbers will be useful in identifying the type of help you need. If you just need help with one aspect of your data why would you hire a large data company that wants to look at everything? If you just need help understanding employee injury what good is biometric screening going to do? Wouldn’t you want a niche consultant like a physical therapist (plug!) or similar? If you are a company that is going through a great deal of growth and change, then an all-inclusive data analysis company may be the right choice.
Ok, we made it that far. This is a good place to stop. Typically I try to weave some humor into my blogs. Sorry, this was a big subject, so thank you to those that have read to the end! Remember, just start looking at the data yourself. No matter how basic the information is, just start somewhere. It is imperative that you get to know the company culture on wellness. This will require some surveying and footwork. As you move along you will find connections that will be very useful. Information like I have presented above will guide you in creating a better wellness program!
Please also see my other blog post about Biometric vs. Biomechanical data and what you may be missing! – The Corporate Bio-Bandwagon
Please get in touch if you have any questions.
Resource Links (Footnotes):
- http://www.health.state.mn.us/divs/oshii/worksite/about.html Minnesota Dept of Health
- https://www.shrm.org/resourcesandtools/hr-topics/benefits/pages/wellness-incentives-backlash.aspx Society for Human Resource Management