One of the lessons I frequently relearn in life is that people do not want unsolicited advice. An example that most parents can relate to is that my 6-year-old daughter does not want my help tying her shoes, even when we’re running late. Similarly, most employees — and certainly their dependents — do not believe they need to change how they manage their health.
This is why Penn State’s moderately structured, but poorly executed, wellness program failed so disastrously. The recent New York Times article about the program reports that “[a]fter weeks of vociferous objections by faculty members” University President Rodney A. Erickson—not the human resources leadership—announced it was abandoning the $1,200 annual surcharge levied against employees who refused to meet certain requirements. Those requirements included filling out a health risk assessment (HRA), participating in a biometric screening, and getting a medical check-up.
Human resources professionals’ fear of this type of outcome prevents many potentially meaningful and engaging wellness programs from even being introduced. To overcome this inherent resistance to wellness, broad employee understanding and support of the program is a prerequisite. The administrators at Penn State failed to attain this goal. Wellness — like any major change — cannot solely be a top-down effort, launched with a letter from the president, especially at consensus-driven academic institutions.
At Penn State, the outcome could have been successful if leaders had built a consensus prior to launching that wellness programs can save lives, reduce costs and improve performance. This is not the type of organization where decisions can be defended by saying: “This program is the one recommended by our health insurer.”
Building consensus for better outcomes
Through consensus-building, Miami University in Ohio successfully launched its voluntary health risk assessment, biometric screening and doctor visit program in 2010 and transitioned to a premium discount program in 2011. Premium discounts started at $15 per month and increased to $45 per month in 2013. More than 85 percent of the covered faculty and dependents participate in the program, and age-specific preventive screenings have increased substantially. The top three factors contributing to Miami University’s success are communication, consistency, and C-suite and departmental manager support.
Penn State struggled with breakdowns in all of these areas, driving the unfortunate outcomes they experienced. While shortcutting the consensus-building process, the university’s administrators did not ask for adequate feedback, the incentive design they used was abrasive, and the health risk assessment, though well intentioned, raised significant privacy concerns throughout the organization.
Health risk assessments aren’t new. Eighty-three percent of large employers use HRAs, according to a recent survey of HR professionals by bswift, and they are the most frequently incentivized wellness programs of large employers in 2013. The questions, however, haven’t changed much in two decades. The time for “old-school” questionnaires is past. Better approaches leveraging biometrics and social interactions that engage employees to share their information and request assistance with their health needs would be more meaningful and valuable for all stakeholders. And employers are heading in that direction: seventy-seven percent of large employers use biometric tests and the majority of large employers who offer incentives do so for completing biometric tests.
Balancing rewards and penalties
Penn State administrators also deployed a fatally flawed incentive strategy. Penalties, though more motivating than reward, also are significantly more emotionally charged. My 6-year-old daughter’s response to being able to stay up an extra 10 minutes is much more benign than her outrage at being sent to bed 10 minutes early. Likewise, penalties in wellness programs are more likely than rewards to spark outrage, especially when the surcharges are so significant.
Penn State did initially consider alternate cost-containment strategies such as artificially inflating employees’ premiums by 35 percent and then offering a discount to those willing to participate in the wellness program. Instead, administrators said they felt that the $100 monthly surcharge was more transparent. It’s also likely that the human resources staff at Penn State feared raising premiums, even if they could sell wellness as a way to avoid those cost increases for the university and employees.
Successfully navigating the changing waters
As human resources professionals advance their wellness program designs to improve employee engagement, health outcomes and financial returns, they need to remain attuned to managing organizational change. Both the organization’s cultural starting point and the pace of change that organization can manage are critical.
These issues should never be thought of as barriers to wellness program success, but rather currents that must be navigated to achieve healthy outcomes.
Brad Wolfsen is executive director of Exchange Solutions for bswift, a Chicago-based human resources software and services firm.