By Wendy Gammons

With a debate raging over how to reform the American health care system – and how to control costs – it is important to note that lifestyle choices have a substantial impact on health as well as health care costs.

The U.S. Centers for Disease Control and Prevention reports that at least 50 percent of individual health status and associated health care costs are directly related to individual behaviors.

While health care cost control strategies are often centered around factors such as the extent and scope of health insurance, point-of-use cost sharing, and provider incentives, it is clear that strategies targeting individual behaviors have a large potential to rein in the rising cost of health care.

As Bob Soroosh, from Affinia Group, told Ann Arbor Business Monthly in August, “What we need is a total paradigm shift, from react and repair to predict and prevent.”

Robust employee wellness programs can effect behavior changes in ways that help to bend the health care cost curve. In 2007, Larry Chapman, senior vice president of WebMD, conducted a formal meta-evaluation of 60 peer review articles on the economic return of 18 worksite wellness programs. He reported cost-benefit ratios of between 1:6.3 and 1:14.5, depending on the type of program.

Many employer groups experience significant reductions in disability and worker compensation costs and substantial improvements in employee productivity attributable to worksite wellness programs.

The City of Gainsville, Fla., is one example of a local government that has seen benefits from its commitment to wellness programs. Since the city first implemented wellness programs for its 1,800 active employees in 1992, the city has consistently held health care costs below the national average for organizations with 1,000 to 4,999 employees, and the city’s insurance premiums are consistently among the lowest in the nation. In 2003, the city was recognized with the first Gold Well City USA Award from the Wellness Councils of America.

LifeQuest, the city’s employee wellness program, offers virtual and on-site activities and resources at no cost to Gainesville employees, retirees, and their families. City officials report that a key component to the success of LifeQuest is convenience. LifeQuest fitness centers, where employees can meet with athletic trainers and exercise physiologists, are located within walking distance of each of the city’s 15 municipal facilities. LifeQuest also offers presentations on a variety of health promotion topics as well as health screenings and nutrition counseling.

LifeQuest operates 24 hours per day, seven days a week. This feature is most helpful for shift and off-site workers, such as public safety personnel and those who work in the electric, gas, streets and parks departments. From the employer’s perspective, employees may use the program without disrupting critical job functions.

Kathryn Parker, a nutrition consultant for the city, acknowledges the need for union support in developing and implementing successful municipal wellness programs.

“Lack of union support is the number one pitfall of public employee wellness programs,” she told the Center for State and Local Government Excellence in Washington, D.C. “Without union leaders behind your program, you will not achieve significant levels of employee participation.”

Likewise, the grocer Safeway reports that its Healthy Measures wellness program has helped to keep employee and corporate health care costs flat over a four-year period. This comes at a time when the average American employer experienced a 38 percent increase in health care costs.

Safeway CEO Steven Burd, founder of the Coalition to Advance Healthcare Reform, said he learned from the insurance industry: reward “good” behaviors. In 2005, Safeway designed an incentive system to reduce health care use. Employees receive discounts off a base level premium for each of four tests that they pass. Target areas include tobacco use, weight, blood pressure and cholesterol levels.

Burd said that Safeway wants to stress personal responsibility through its Healthy Measures program. And it seems to be working. The obesity and smoking rates for employees are roughly 70 percent of the national average.

Effective wellness programs must plan a wide variety of interventions because individual risk factors for illness and disease vary. These factors include the modifiable (e.g., poor diet, lack of physical activity) and non-modifiable (e.g., age, gender, family history).

Dee Edington of the University of Michigan, one of the first scientists to study the relationship between risk factors and health care costs, believes employers need to do all they can to “keep the healthy healthy.” Without intervention, over time people tend to move from lower risk groups to higher ones. The greatest wellness opportunity is to help those at low risk maintain their healthy lifestyles.

A 2004 study by the Health Management Research Center at the University of Michigan shows that individuals with one risk factor spent 1.8 times as much on health care as those with zero health risks. Those at medium risk (two to three risk factors) spent 2.8 times the amount, and those with four to five health risks spent 3.7 times as much.

Some employers are using confidential personal health assessment questionnaires – normally completed online by employees (and often spouses and retirees) – to determine risk factor data. Participants receive a comprehensive report immediately upon completion of the questionnaires. Aggregate reports received by employers are helpful for program planning purposes.

Well-designed employee wellness programs work closely with health plan carriers. Most health plan carriers offer personal health assessments and a variety of intervention techniques to help subscribers and their family members lower their health risks by changing behaviors and using the health care system more effectively.

The MIIA Health Benefits Trust, in partnership with Blue Cross Blue Shield of Massachusetts, offers a personal health assessment that can be accessed at www.emiia.org or www.bluecrossma.org. Groups in the MIIA Health Benefits Trust are entitled to participate in the Well Aware wellness program. Well Aware, integrated with Blue Cross Blue Shield, offers members a menu of services and resources designed to keep healthy people well and to improve the health of those who are ill, while also helping subscribers to use the health care system more effectively.

Wendy Gammons is MIIA’s Wellness Coordinator.