Can incentives change consumer health choices? Innovative incentive programs may well help individuals overcome the inertia that limits engagement in wellness programs, disrupting the trade- offs people make when pursuing health care goals. Consumer incentives: Is now the time? There is widespread agreement that unhealthy behavior is costly to employers, publicly funded health care programs, and families. What’s not clear is how to change those behaviors and at what cost. In many ways, the US health system has been hamstrung by its inability to know how best to change, reduce, or eliminate the unhealthy behaviors of its citizenry—it’s a major dilemma for employers. An example (some HR executives may be familiar with the data): Each smoker costs a company an additional $3,8. The high prevalence of cigarette smoking and tobacco related morbidity and mortality in people with chronic mental illness is well documented. This review summarizes results from studies of smoking cessation treatments in people with schizophrenia, depression, anxiety disorders, and post-traumatic.Make a smoke-free worksite a priority Just about everyone is familiar with the health risks linked to tobacco use, including lung cancer, COPD, heart disea. The company is planning a smoking- cessation program, but results have historically been modest, with few managing to stop permanently. But might incentives increase the success rate?
If so, what types and how much? What’s more, the lack of consistency around which types of incentives work best, if at all, may constrain action: The HR department is hard pressed to recommend a solution that’s widely supported by objective data. Why is this important? Employee ill- health is expensive. Many employers are actively trying to manage health care costs by encouraging employees to take steps to maintain or improve their health. Worksite wellness programs are a convenient vehicle for employers to support wellness efforts, covering things from health promotion and preventive screenings to specific programs for workers who already have a medical condition. Some variant of workplace wellness programs can be found in over 9. US companies with 2. In 2. 01. 1, investment in health improvement programs was estimated at around 2 percent of companies’ medical spend. But can employers persuade workers, whose customary lifestyles may include a lifetime of bad habits, to be less “couch potato” and more “self- starter”—and exercise more, eat healthier, and stop smoking? Many are turning to using incentives to target such things as immunizations, annual screenings, and medication compliance to provide the extra nudge that some need to bridge the gap between good intentions and decisive action in managing their health. Even a once- healthy person, when diagnosed with a chronic condition, may choose to become non- compliant with their medication and treatment almost 5. So how effective is the use of incentives to engage employees in employer- sponsored worksite wellness programs? While a great variety of incentive types (such as cash, cash equivalents, and cost sharing) and approaches to incentive program design are being experimented with, it is not clear if incentives improve health or just add costs. Based upon a review of the literature, this report weighs the available evidence on the use of incentives and their potential to drive employees’ participation and achievements in health management programs. The impact and effectiveness of using incentives is not well understood. What’s widely assumed is that they work; what’s unclear is what types of incentives produce the targeted return. Incentives are a link between the present state and what employers hope to achieve. Can incentives become a lever by which the status quo is disrupted and new possibilities emerge? Even though the use of incentives is widespread, the frontiers of incentives remain largely unexplored. Conceived and executed in innovative ways, incentives hold the potential to “move the needle” in shaping consumer behavior in such diverse areas as chronic health management, prescription medication compliance, uptake of generic alternatives, and achievement of personal milestones—and to underpin self- directed care as health care transforms into a more efficient, patient- centered system of care. As employers jockey to secure a competitive and productive workforce and gear up for the 2. Affordable Care Act (ACA) of 2. Provisions in the ACA greatly enhance employers’ ability to reward their employees with incentives. The opportunity has never been greater for employers, health plans, and incentive management vendors to explore creative ways of taking advantage of the provisions and drive new, innovative programs that could reduce costs associated with individuals’ lifestyle and compliance choices. Perhaps the timing is right to break worksite constraints around wellness programs for employees. Pairing incentive strategies with rapidly developing digital technologies such as m. Health holds the potential to drive fundamental changes to the wellness paradigm. So do approaches such as using gamification in health care and changing the financial relationships between individuals and their providers. Incentives may well play a considerable role in migrating employees to the next generation of worksite wellness programs, thus breaking out of a “one size fits all” presumption that has shown mixed results and garnered skepticism in many C- suites. Incentives are a link between the present state and what employers hope to achieve. Background: The experiences, the constraints. Not all employers are pursuing worksite wellness. But many larger companies are making considerable investments in health management programs to address their employee population’s health and rein in growing health care costs. The results are all over the place. Despite the fact that around 6 in 1. ROI) of worksite wellness programs,6 the number investing in such programs is steadily rising. Workplace health promotion, illness prevention, and disease management programs have been shown to be effective in modifying health risk—at least in the short term. But the big challenge for employers is to sufficiently motivate employees to participate. Data suggests that only around 2. Many employers identify the lack of employee engagement and low participation levels as being their greatest challenge in managing health care costs. Some employers have turned to using incentives, in particular financial incentives, as a tactic to drive participation in worksite wellness programs and to ultimately engage employees. Only around 2. 0 percent of a company’s eligible population may become involved in company- sponsored programs. Constraint one: The cost of health care. As employers seek to manage the growth of health care costs and pursue high- value outcomes for their investment, being able to predict likely health care expenditures and to make informed decisions about where to invest scarce resources may unlock considerable value. Managing or reducing common and costly risk factors through worksite wellness programs and incentives to help employees make healthy lifestyle choices is growing in popularity. And while experts debate the cost- effectiveness of regular screening programs, such programs, if carefully chosen, are considered to be cost- effective and potentially cost- saving. Chronic disease accounts for 7. US deaths. 1. 4 Diet, activity patterns, and tobacco and alcohol use have been associated with a “substantial proportion of preventable deaths,”1. Despite this, since 2. US health care spend has been directed toward the promotion of healthy behavior and illness prevention. According to one study representative of the national population, around 8. US working population has at least one chronic disease or is overweight. Employers’ impulse to keep their workforce healthy through prevention and wellness programs is understandable—health- related productivity loss is a major concern for employers, who not only pick up the majority of the cost of purchasing insurance coverage but also deal with the fallout of ill health, including medical and pharmaceutical costs, absenteeism, presenteeism, and short- and long- term disability claims. An average of $2. Chronic conditions such as depression and anxiety, obesity, arthritis, and back and neck pain are the major causes of productivity loss. Cost constraints are always central to an employer’s view about health care. A view of wellness as an investment, accompanied by a methodology that is widely used in industry with a measurable ROI, is a constraint that restricts the unexplored possibilities of such programs. Constraint two: The role of wellness programs in recruiting and keeping talent. Eight in 1. 0 employers surveyed say they are committed to providing health benefits to retain and attract talent and improve job satisfaction. In a 2. 01. 2 study examining employers’ predisposition toward benefits strategies, Deloitte found that the majority of respondents anticipated maintaining health benefits for their employees but foresaw changes to their programs. Most did not plan to drop employee coverage; rather, they anticipated using defined contribution plans to shift more accountability to employees for cost control and quality. Most employers in the survey intended to change their benefits strategies in the next three to five years by increasing employee cost- sharing (6. When asked if they anticipated investing further in wellness programs or otherwise, half (5. The constraint here is value: the intrinsic impact of wellness programs on employee morale, presenteeism, and productivity, and the success of the organization’s recruitment and retention efforts directly attributable to wellness program investments. How value is measured on the people side of the enterprise is a constraint that forces every employer to second- guess the role, scope, and likely impact of wellness benefits. Constraint three: Regulation. The ACA of 2. 01. The ACA outlines a central role for employers in offering incentives to promote wellness and greatly expands employers’ ability to reward their employees with incentives. The ACA increases the maximum permissible reward (which can be an adjustment to premiums, copayments, or deductibles) from 2. January 2. 01. 4 (see sidebar, “Facilitating a focus on workplace wellness”). A Guide to Helping Your Employees Quit Smoking. WHY Should Employers Be Involved? There are six main reasons for employers to support smoking cessation in the workplace: improved employee health; increased productivity; reduced costs; enhanced job satisfaction; effective setting; better corporate image. Improved Employee Health. You cannot put a dollar value on good health. Good health is an invaluable resource. As an employer you need to invest in the health of your employees - they are your organization's most important asset. Employees who do not smoke take fewer sick days, go on disability less often, and are less likely to retire early because of poor health. Most people want to quit smoking. Increased Productivity. Helping employees quit smoking is good for business. On average non- smokers take fewer sick days than smokers. Non- smokers can be more productive because they do not take the unscheduled smoking breaks that some smokers do. Employees who smoke may also take longer breaks than non- smoking employees. Because of new municipal bylaws and stronger provincial legislation smoking is no longer allowed in most workplaces. This means that employees must go outside to smoke a cigarette, often to a designated smoking area and sometimes they must leave the premises completely. Because it now takes more time for employees to reach a place where they can smoke this translates into longer breaks. It also costs employers to pay for and install commercial ashtrays outside as well as to clean the ashtrays and the surrounding area. Reduced Costs. Supporting employees to quit smoking is an investment worth its return. If employees who smoke are helped to quit, employers will see less loss of skills, knowledge and corporate memory due to premature death and early retirement. Many companies that have offered smoking cessation activities to their employees report positive results. According to the Canadian Lung Association, smoking cessation support is a sound economic investment and is especially profitable when offered over the long term (five or more years). We have put a lot into hiring, training and keeping our world- class employees. It is a business imperative to have them healthy, and at work. Refer to Section V: Tools For Employers and Others Who Promote Health in the Workplace for a formula to calculate some of the costs of smoking in the workplace. The Hard Costs of Smoking A report from Cancer Care Nova Scotia estimates unscheduled smoke breaks cost Nova Scotia employers $2. Nova Scotia economy more than half a billion dollars annually in direct health care costs and productivity losses due to premature death and missed work days. Smoking costs New Brunswickers an estimated $1. New Brunswick employers. Another national study found that smoking costs Canadians $9. Employees are our most important assets, and we don't want them to break down, or lose time. We began to learn that this meant avoiding accidents, but also avoiding personal crisis, health crisis, financial crisis and so on. According to a national survey that Statistics Canada carries out for Health Canada on a regular basis, fewer people are smoking, and those who do smoke are smoking less. The majority of people who smoke want to quit. Several studies show that a large majority of both smokers and non- smokers would rather work in a smoke- free environment. Another Health Canada study shows that many smokers would welcome smoking cessation programs offered by their employers. When employees are healthy and have a strong sense of personal well- being, there is an improvement in their morale and the overall quality of the work environment. In this environment, employees are more productive and feel a greater sense of loyalty. Effective Setting. Workplaces and homes are the two environments that can have the greatest effect on people's health. Workplaces in particular are an ideal setting to help people quit smoking for several reasons: Many people spend a good part of their time at work. Workplaces have access to a large number of people on a regular basis. They have the opportunity to reach a high number of smokers on an ongoing basis. Workplaces have access to some groups that would be hard to reach otherwise, such as different minority groups, and people who do not visit doctors and other health care professionals regularly. Workplaces are convenient places for people to get information and support for quitting on an ongoing basis. Workplaces can provide the supportive social environment necessary for quitting smoking. Smokers who want to quit, and recent ex- smokers can get support from other employees, and from others who promote health in the workplace. Smoking bans in workplaces encourage employees who smoke to cut down or quit, and help those who are already smoke- free to stay that way. Employers can make a difference. People try to quit when they are presented with opportunities and options, and are more likely to succeed when they have support. By providing and publicizing cessation activities, and offering a smoke- free working environment, employers and others who promote health in the workplace can help employees to quit smoking. Better Corporate Image. Workplaces that care about the health of their employees portray a positive image within the workplace and the larger community. A better image helps to attract and keep talented workers. Workplaces that comply with non- smoking legislation are respected in the community. Those that go beyond these requirements by offering cessation support display an even greater commitment to the health and welfare of their employees. Some workplaces take a comprehensive approach to workplace health, and include tobacco reduction as part of a larger workplace health promotion strategy. Workplaces that are committed to the health of their employees become workplaces of choice. Peer Pressure, Peer Power. Peer support is very effective. One young woman who works full- time at the Irving Paper mill in Saint John was the lone smoker in her work group that included mostly older men (many of whom were ex- smokers). The good natured and well- intentioned peer pressure they exerted was the final push she needed to take advantage of the company's cessation supports, and she was able to quit smoking. It is Never too Late to Quit. People may be more apt to change their health behaviours at this time - - so they can enjoy this new and well- deserved stage of their lives more. They have hired the whole person and should be involved in individual health issues.. Lots of people have picked up the habit at work - non- smoking bans are recent - it was often a way to socialize. According to the Canadian Tobacco Use Monitoring Survey (CTUMS) carried out by Health Canada in 2. Canadians aged 1. Canadians feel that smoking should not be allowed in any area of a workplace, either inside or outside. Canadians feel that smoking should be allowed only in designated outdoor smoking areas of the workplace. Canadians report some sort of smoking restrictions at their workplace and 5. For more information about smoking trends in Canada, refer to Health Canada's Canadian Tobacco Use Monitoring Survey (CTUMS) atwww. The Stakes Are High with Employee Health. The Manitoba Lotteries Corporation (MLC) is not gambling on its employees' health. When the smoking bylaw was introduced in the City of Winnipeg on July 1, 2. But, believing that employee health and wellness was a sure bet, MLC seized on the opportunity to make this positive change and it became 1. Winnipeg businesses. The corporation employs about 2,0. Winnipeg - Club Regent and Mc. Phillips Street Station. With other locations across the province, including a head office, MLC has a mix of full- time, part- time and casual staff in varied positions including housekeeping, food and beverage, sound and lighting, sales, warehousing, and also employs dealers, groundskeepers, and office staff. The majority of the workforce is young and a fair number of employees smoke. Before all sites became smoke- free, smoking was permitted at the casinos in designated areas of the bars, restaurants and on the general gaming floors in specified areas. Before the smoking ban came into effect, a lot of communication took place with staff members. One of the venues for discussion included the semi- annual . The ban itself, and what it would mean for the staff, including the anticipated financial repercussions to business, were all discussed. The corporation admitted that a ban would mean a drop in revenue, at least in the short term, but that it would do its best to ensure that jobs were not lost. The rationale for why the casinos were following the city's lead and imposing the voluntary ban was also spelled out: MLC wanted to protect the health of its workers and clients, and it wanted to retain its standing as a good corporate citizen within the community. The disability manager and safety consultant for the corporation says the company believes it made . After consulting with their benefit provider, coverage for quit aids was included under the existing Blue Cross Extended Health plan. Available resources and self- help materials were promoted through posters, the company newsletter, the company intranet, in the lunchroom, at staff meetings, and at the training centre library. A wellness program was also started around the same time that was modeled on the Health Canada Corporate Health Model approach and focused on comprehensive employee wellness issues. Before the program began, an employee health needs assessment was carried out. Communications were transparent, varied, and included a variety of channels, including face- to- face meetings with management, to ensure that employees were kept in the loop every step of the way. Potentially difficult issues, such as the drop in business and the effects that could have on the workers, were not avoided as areas for discussion.
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