How Alliance Employers Are Creating Healthy Employees

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The Alliance recently held an event with Dr. Jessica Grossmeier to cover the best practices employers can use to engage more healthy employees.

After her presentation, Dr. Grossmeier answered questions from the audience. Then Alliance was joined by two employer panelists – Jake Nolin of Rice Lake Weighing Systems and Wendy Whitehead of Kwik Trip – to explain their challenges and successes in engaging more healthy employees.

The following is an abridged version of that Q&A.

How do you motivate unengaged employees to focus on becoming healthy employees?

Grossmeier: What we’re finding from the research is relying less on extrinsic motivators, like incentives, and relying on building intrinsic motivation. There’s a lot of research building intrinsic motivation: helping other people, learning how to connect one’s well-being with what’s important to them out in the world.

Essentially, getting to their reason for getting out of bed in the morning. What matters most to folks are questions related to purpose and value, and when you start to look at those questions, you know those different motivations for people and can connect healthy employees with their larger purpose. Research shows this works – I’ve seen this demonstrated in worksites around the “what’s your why” initiatives.

And so, you start to see employees sharing their “why,” – doing this in videos, newsletters, whiteboards, etc. It helps employees express themselves in different ways and tap into what matters most to them as individuals. I could give a whole hour presentation dedicated to the research on this, but I’ll leave it at that for now.

Based on your research, which communication channels are best to engage more healthy employees?

Grossmeier: What we’ve learned is that a one-size-fits-all communication strategy for your population is not effective. One of the most effective things that we’re seeing – and it’s one of The 10 Best Practices – is to take your whole population and try to break them into different groups.

For example, if you’re in an education setting, you’ve got teachers, faculty, and other staff supporting them, and they all engage differently. You need to use a targeted communication strategy to create messages using language that works for them. In other words, the messaging might need to be different for different groups.

Plus, how you deliver the message matters. Some people like email, some people don’t. Some people would rather see posters at the workplace, or they might want something sent to their home, so it really takes three things:

• A great understanding of your population
• Breaking down the population into subgroups
• And then understanding how to communicate most effectively with them

If you have employee champion networks, you could use those types of relationships to understand how different pockets of employees respond to certain communications.

Communication companies and marketing vendors do this really well, and they can help you with this strategy.

Do you have any specific examples of how senior leadership can participate and show support for encouraging more healthy employees?

Grossmeier: I mentioned role-modeling earlier, and it’s so important. We see leaders that say, “unplug during your vacation,” or “I don’t want to see any emails this weekend,” but then they’re breaking their own rule and using email all the time – day and night and on vacation. I think it’s really important for leaders to pay attention to how they’re communicating employee health and well-being offerings but also walking the walk themselves.

For example, I had a boss that every once in a while would say, “you know, the water’s great today. It’s absolutely perfect for rowing. Can we reschedule our call?” That said to me, “Wow, health and well-being is really important to my leader. He’s taking time out of his workday to go and hit the water during the workday!” And that kind of gave me permission to take a walk during my lunch hour.

Leaders can also take a look at policies and how those are being translated into the workplace. Flex-time is something that we’ve seen be extremely effective. Just looking at adjustments to allow employees to mold their work schedule to fit health and well-being into their day is important.

We’re also seeing more and more employers allowing employees to participate during paid work time in some of these offerings, and I think that’s really important.

Those are just a few strategies, and if you go to the handout for this session there there’s more detail on how leaders can support more healthy employees.

We’ve talked a lot about engaging healthy employees, but what about engaging their families and spouses?

Grossmeier: My husband carries our primary health insurance, and his company has quite a few offerings for a healthy employee population. As a spouse who’s in this field, I’m always asking what’s available to me. And the interesting thing is, as much as this employer is doing to invest in programs and services, there’s no communication to spouses about what those are.

I would love it if an employer would send me some information on what is available to me. When you are dealing with older males, part of it is getting the information into the home and specifically allowing for the spouse to figure out how they can access those services. Many times, the partner in the household is the one that’s responsible for the family’s health and well-being, and they can be a strategic ally for you to get your own employees engaged. They need to know how to access their health benefits, though.

It starts with understanding how to contact people; you need good, up-to-date contact information. And it can be a part of benefits enrollment – having an opt-in where the spouse can agree to allow text messages or home mailings. That’s one easy strategy.

You could also show them everything available to them using some sort of portal, but you have to explain to them specifically how to access the information because sometimes it’s really confusing.

Beyond reaching the family, it’s about creating offerings that are designed for the whole family to participate. A super easy one that’s been used in the past is on-site health fairs and well-being fairs. A family-friendly event provides information in a celebratory atmosphere, and you can come get a flu shot, find out what your blood pressure is, see the programs and services available to you, etc.

What are some specific performance metrics that employers can use across multiple vendors?

Grossmeier: Make sure you have a measurement evaluation strategy for your initiatives that do not rely solely on vendor reports. It’s easy to fall into that because they’re offering reporting, but it can become a challenge when you change vendors or the vendor changes – whether via merger or their platform changes – and you could lose access to your data. Therefore, having a measurement evaluation strategy that is intentional and separate from your vendor is necessary.

But when it comes to things like participation and engagement it’s a bit more challenging. One of the hardest but most effective things you can do is develop an integrated system that allows the data to flow from these different partners into a data warehouse. If it’s just participation data points, they can create a HIPAA-friendly space where somebody in the organization can collect that data and pool it all together and start to look at how many people are participating in more than one thing. Then they look at the overlaps between exposures to different programs.

An even better strategy is to have an independent third party who specializes in data warehousing and integration do that integration for you. It’s a very resource-intensive strategy, but it’s probably the best way if you anticipate changing vendors over time.

You can also get a sense of if employees like what they get, and this is where employee surveys can be really helpful. Questions like “Do you feel like your manager or supervisor supports your health and well-being?” Ask employees to share their testimonials and stories about what’s effective.

Do you see digital health products being a major player in improving healthy employee populations?

Grossmeier: One that most intrigued me was an organization that offers assessments so employees can know how they’re doing in terms of their ergonomic setup. They offer musculoskeletal conditioning programs that they can do one-on-one via video. So, I think a lot of specialized offerings are popping up to help bring about better access, but this is a challenge if you have an employee population that doesn’t have a computer or strong internet.

If you have an on-site offering with a kiosk, folks can take advantage of those digital offerings. I do think digital offerings are here to stay, so now the challenge is two-fold:

• Ensuring people feel comfortable with the technology
• Ensuring their privacy is being protected

Any thoughts about how to engage employees in their mental health and well-being?

Grossmeier: Yes, there’s a free resource for emerging best practices and case study examples with the six best practices to encourage mental health and well-being. Here’s the top few:

• Raise awareness.
• Normalize the conversation and destigmatize.
• Integrate when possible. For example, combine weight management solutions with mental and emotional well-being solutions for emotional eating.

Thank you Dr. Grossmeier. Wendy and Jake, we’ll now turn our attention to you. Would you mind summarizing how you design health benefits to improve employee engagement and well-being?

Nolin: We started our journey a long time ago with a fully insured health plan, and year after year of double-digit cost increases made us finally change in 2015.

When I think about how we engage our employees and the things that we do well, health care consumerism is at the top of the list. We got it wrong at the beginning – we thought “what’s in it for the organization?” The question you need to ask is “how can this benefit our employees?”

The 2nd thing is Direct Primary Care – we wanted to have good, “old fashioned” health care. We didn’t want 15-minute appointments. We wanted ongoing, long-term visits. Some of our providers make house calls. In fact, one just filled a prescription at 9pm last night. That commitment to our employees is what we want and need.

Human resources is extremely well-versed in our benefits and subject matter experts in our health plan. We have a 3^rd party – Alethius – for care navigation and work with The Alliance on contracted care to shape our network design.

The focus on long-term health outcomes is good for our employees, our organization, and our communities. We’re always looking ahead. A truism we use in training and coaching is “Those who need it most, want it least.” When you’re talking about engaging employees in their health care, how can you reach out and engage that person?

Whitehead: We had a well-being program for some time where you got a gift card for participation. We transitioned it to be engagement-focused and outcomes-based, so participants can earn points for up to $1,100 or $3,100 as a family toward their health care premiums.

We use health risk assessments and biometric screenings to see where employees are at with cholesterol, blood pressure, BMI, etc. There are a wide variety of ways employees can earn points towards those incentives: COVID vaccine, annual dental cleaning, mammograms, maternity management program, vision exam, flu shot, sleep challenges, mindfulness challenges, minutes of physical activity – we look at the risk assessments to help guide what we use to offer points.

We also have a diabetic management program. We’re offering free diabetes medication to those employees using our new vendor. It’s not just free insulin, either. It’s other medications, too, because not everyone who has diabetes needs insulin. In order to qualify, they are required to complete tasks like: engaging with a diabetes specialist, logging their glucose, logging their weight, taking pictures of their food to ensure they’re complying, etc.

Our non-incentive well-being programs include free employee health clinics and bringing mammograms, skin cancer screenings, and blood pressure clinics on-site for free.

On campus we have clinic providers engage with our employees to participate in those screening events. We also try to educate our employees in the form of videos. And because we utilize so many vendors, we have a care navigation program that offers employees a single point of contact.

What are some specific tactics you use to incentivize your employees to help them become more engaged in employee health and well-being?

Nolin: We have three different types of incentives:

1. Cedar Ridge Health Center is our no-cost Direct Primary Care clinic. It offers acute care, chronic disease management, and wellness. We’re also able to do in-office procedures. There is absolutely no cost to employees at the health center, including prescription medications and durable medical equipment for use (crutches, blood pressure cuffs, etc.) Don’t underestimate the value of no-cost. Our employees really appreciate it and can’t believe they don’t have to pay more on the health plan to utilize these services – including their spouses and children on the plan. It’s a really great benefit.
2. We offer a 15% discount off the employee contribution cost if the adult members on the plan go to the health center at least once a year. And for remote employees – any physical exam, well-being exam, general appointment will satisfy that requirement. We have a 97% participation rate. And beyond that, we haven’t had an employee cost increase in 7 years.
3. Unique benefit plan design: we have special contracts – so our members can go with no deductible or coinsurance to get a procedure done at tier 1 provider for us. We’re not paying people $500 to do this, but if they do it at a Tier 1 provider there’s no cost to them. We have up to 5 tiers – with Tier 5 being out-of-network – so that’s another way we incentivize more healthy employees.

Whitehead: We have free diabetic medications for those that engage with the diabetes management program, and we have a health premium discount, both of which I already mentioned.

We have two health plan options: a low-deductible plan and a high-deductible plan with health savings account.

With the low deductible health plan, they’re able to use all the services at our Kwik Trip health center services for free. We don’t charge them a penny. However, the high-deductible health plan does have a co-pay to comply with HSA rules, but it’s as low as legally possible.

We also started offering cash incentives for those that use Centers of Excellence for colonoscopy, MRI, knee replacements, etc. And we’re rewarding employees for shopping; choosing low-cost, high-quality providers.

Both of your organizations are self-funded health plans which gives them the flexibility to offer them Direct Primary Care clinics at no or low-cost care. What kind of adoption have you seen from your employees in terms of your clinics?

Nolin: We stumbled a little bit out of the gate, but we changed health partners to Neopath Health, and they have been a fantastic partner. It really boils down to the providers. Right now, we have a doctor, an MD, and a PA each at 40 hours per week. There’s plenty of access. We didn’t want our members to have to wait. We have about 85% utilization of our available appointments.

Another thing is we changed was 20-minute appointments to 30 or 60-minute.

We’re continuing to add services and try to find innovative ways to use the clinic. Currently, we do occupational medicine, pre-employment drug testing and physicals, post-accident physicals, and some minor acute care for worker’s compensation.

It’s been great. I’ve said it before and I’ll say it again, for every dollar we put into the health clinic we get at least one – if not two – or more back in savings.

Whitehead: The interesting thing that Kwik Trip does is that the clinics are not just utilized by coworkers on our health plan. We let coworkers who are not on our health plan use them, too. Our workforce is predominately part-time, so they don’t qualify for our health plan, and we’re leveraging our clinic as a recruitment and retention tool for our organization.

The ROI is really the savings and redirected care, so it’s hard to put a number on it. We’re currently working with our vendors to get more finite numbers. About 50% of employees engage with our clinic at least once per year to 18 months. It’s a benefit that’s very easy for us to communicate here in La Crosse, but outside of our headquarters it’s more challenging.

We do offer primary care, acute care, preventative care, physical therapy – which has saved quite a bit of costs on worker’s compensation, and we added behavioral health. We found out people in our community just couldn’t access this benefit – they were waiting six or more months to see someone. So very quickly, we’ve reached our capacity with behavioral health counseling, so we’re looking to add more counselors and a remote/virtual health option.

How do you sell your ideas of improving healthy employee engagement your leadership?

Nolin: I don’t have to. Our benefits are our 3rd highest cost. Our owner and president, as well as our CFO, are very engaged and it’s very important to them – not just from a financial standpoint but they care about their employees. Fortunately for me, it’s not hard.

Whitehead: As far as “selling” our ideas, I’m lucky because we’re a family-owned company. And a few of them are physicians, so the family that owns us is aware of the challenges of health care and managing population health, so they’re open to these ideas. Still, with other members of leadership it can be more challenging, but a lot of it is tying it back to our work culture and of course, tying it to ROI when possible.

Wendy, you have a lot of diversity in where your employees live and what they do. How do you best communicate with them?

Whitehead: We have to do a lot repeatedly and hope it sticks. We’ve partnered with our safety champions out in retail and production areas. Safety is a huge initiative here, so we partnered with those teams to turn those safety advocates into well-being champions as well, so we have people out in our stores communicating with everyone in their area. When it’s from HR, nobody’s really reading it. When “Bob” sends it – someone they know – they are more prone to reading and listening to the information. We’ve also created short videos and we push them out to employees through our learning management system.

Sometimes we see an employer offer a single lunch-and-learn and call it day. When they don’t see the changes they were hoping for, they kind of throw their hands up and think, “So what now?” What does ongoing communication look like for you to make engagement stick?

Nolin: We provide a binder with many resources, and we’re out on the floor reinforcing it. We make all of our decisions by late summer for the next year. We go to extraordinary lengths for our employees every year to help educate them, and that includes utilizing Zoom with COVID. We have individual meetings with every new hire, so we’re setting the right tone from the beginning when they’re making those selections.

We also offer meetings with spouses. Spouses are very difficult to access and educate, and as a result, they become one of our largest cost claims. The education either isn’t sinking in or isn’t making its way home. For example, they’re going out and getting knee replacements done at non-preferred places. We send education materials to their homes and encourage members to talk to their spouses. We wrap it up with a total compensation statement that goes out with W2’s.

We have a phenomenal marketing department that’s very engaged. They help us with our materials, and we spend a lot of time and effort on education and information distribution. We use a refrigeration magnet with the email addresses and phone numbers they need to access that care navigator, and it’s really been a great little tool. We also send emails, booklets, and direct mail.

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