Employers must take ownership of employee wellness motivation

Health insurers are busily brewing up new and better health plans with a strong wellness and disease prevention components to tempt employers that provide health insurance, but those plans could be doomed to mediocrity if employers aren't giving employees the motivation and support to participate in wellness initiatives. That's the upshot of a new survey of more than 3,000 U.S., employees and their dependents from the nonprofit National Business Group on Health (NBGH) in Washington, D.C., and the consulting firm Hewitt Associates in Lincolnshire, Ill.

Employees know how to get healthy, but "knowledge does not equal action," said Cathy Tripp, principal and West Group business leader for Hewitt, at a recent press briefing. "Employees are clearly in the driver seat, but we're not sure that they know where to go."

The survey found that 84 percent of employees believe that making smart choices in daily life leads to good overall health; 72 percent related good health to obtaining regular preventive care; 36 percent, good genetics; 36 percent, good doctors; 29 percent, healthy living and work environment; 28 percent, positive attitude; and 16 percent, enough money to pay for expensive care. However, the more sustained commitment that making smart choices involves, the less likely employees are to make them. Sixty-five percent of employees said they were "great" or "good" at getting preventive screenings, and 60 percent said they were "great" or "good" at knowing their "numbers" (e.g., weight, blood pressure, cholesterol). Yet only 50 percent described themselves as "great" or "good" at healthy eating, and the number dropped to 47 percent for regular exercise.

Employee participation in health programs is relatively low, but satisfaction is high "once they are in," said Joann Hall Swenson, principal and health engagement leader at Hewitt. The three programs with the highest participation rates are: biometric screenings, 61 percent participation; online health information tools, 53 percent; and health-risk questionnaires (HRQs), 41 percent. A slightly different mix of programs achieved the highest employee satisfaction rates: biometric screenings, 91 percent satisfaction; on-site health clinics, 83 percent; and on-site physical fitness programs, 78 percent.

Internal motivators can be just as effective as financial motivators in incenting employees to take healthy actions, said Hall Swenson. "Many employers presume that offering cash incentives in exchange for participation, or cash takeaways if they don't participate, will generate the best results. But the results from our survey show that employees are equally motivated by both intrinsic factors and the use of incentives or penalties." For example, 48 percent of employees would complete an HRQ without any incentive "just because it's the right thing to do"; 29 percent would participate in an HRQ for an incentive, and 28 percent would complete it to avoid a penalty.

Intrinsic motivators "still work, but aren't quite as effective" when activities are harder to do, noted Hall Swenson. For example, "44 percent of employees would participate in a wellness or health improvement program offered by their employers just because it is the right thing to do compared with almost a third or 32 percent who would participate if there were incentives and 30 percent who would participate under the threat of a penalty," she explained.

Health plans need to work with employers to ensure that employees are offered a strong mix of mix of intrinsic and extrinsic motivators. Some of those motivators can come via plan design, but the employers have a role to play too because they have direct control over their employees' health environment. "Employers should facilitate employee efforts to lead a healthier lifestyle," said Hall Swenson. "The new frontier is removing barriers to people taking healthy actions." For example, employers can offer healthy food choices in cafeterias or vending machines, making it more convenient for employees to make good choices for their health. - Caralyn