Striving for a Healthier America Through Availability and Uptake of Workplace Wellness Programs in the Small Business Community

Transcription

1 Striving for a Healthier America Through Availability and Uptake of Workplace Wellness Programs in the Small Business Community December 14, Convening Highlights The Trust for America s Health (TFAH) in collaboration with the Small Business Majority (SBM) convened a variety of stakeholders from government, business, public health, unions, insurers, insurance brokers, and small business owners to explore and discuss opportunities and challenges for increasing the uptake of and participation in workplace wellness programs by small businesses. One of the primary purposes of this dialogue was to review policy tools and potential avenues for ensuring workplace wellness can be advanced, in particular through opportunities available through implementation of the Affordable Care Act (ACA). The following summary identifies challenges and opportunities to increase uptake of workplace wellness in the small businesses community and introduces a logic model to engage key stakeholders to ultimately further these efforts. Workplace Wellness and Small Business: The Current Landscape Workplace wellness is not a new concept. Large employers have embraced and invested in workplace wellness programs for many years seeing a strong return on investment (ROI) in having a healthy workforce that can help stem rising health care costs and boost employee productivity. However, the landscape for small businesses provides a stark contrast to the large employer community. Many factors contribute to this contrast, including, but not limited to, the following: Lack of Data: Lack of research and gaps in data resulting in an absence of a strong case for support (including ROI) to small employers to offer workplace wellness programs; Lack of Awareness: Small business owners, in addition to employees of these businesses, lack awareness about the benefits of workplace wellness programs; Lack of financial incentives: Multiple, credible studies over many years on large company wellness programs suggest that when there is a measurable ROI and financial incentives for either or both the employer and employee, wellness programs work. There is no such option currently for small employers. Lack of Resources: At this time, there is limited support and resources for small employers to identify and to implement workplace wellness programs effectively. Additionally, unlike many larger businesses, many small businesses offer no or limited insurance coverage that could include workplace wellness programs (and workplace wellness is not a substitute for insurance); Variability Among Size and Workforce Makeup: Small businesses vary greatly in size and in the makeup of their workforce; as such, there is a deficit of effective adaptable and scalable models. Emerging Opportunities to Improve Uptake The ACA promotes a strong vision for prevention and wellness. There are several emerging opportunities that can be seized and leveraged as key parts of the law are implemented to improve the uptake of effective and evidence-based small business workplace wellness programs, including:

2 Health Insurance Exchanges (Exchanges) 1 : Expands access to insurance through a marketplace for individuals, small businesses and the self employed. As many small employers do not currently offer health insurance benefits to employees, the exchanges fill that gap and also provide an opportunity for further incentives for workplace wellness. Expanded coverage and increased incentives for workplace wellness complement new coverage requirements through ACA that emphasize prevention in the clinical setting. Prevention & Public Health Fund - Community Transformation Grants: State and community-based grants aimed at working with multi-sector stakeholders to improve physical activity and nutrition and decrease tobacco use throughout the country. Healthy Worksites Program: Through the Centers for Disease Control and Prevention (CDC), an effort aimed at engaging small to mid-size employers in workplace wellness programs and efforts. National Prevention Strategy (NPS): Convened and led by the Surgeon General with 17 federal agencies the NPS provides a comprehensive approach to prevention and wellness focused on where we live, work, learn, play, and pray. Health insurance carriers/vendors: Working with the aforementioned stakeholders, existing insurance carriers/vendors can develop or continue to develop wellness products and provide more tools, resources, and opportunities to adopt wellness programs in their current marketplaces as health care reform implementation continues. The Small Business/Workplace Wellness Logic Model The convening participants focused on the need to develop and illustrate the vital role of multi-sector stakeholders to address challenges to successfully create and expand workplace wellness programs within and among small businesses. From this dialogue, a logic model, shown below, was developed to illustrate how the many aspects of workplace wellness fit together and what the specific roles of stakeholders to increase uptake in wellness programs. The model begins with Individual Choice, and the Workplace Environment, and then addresses issues associated within the Community Context, which includes access to health care, education, transportation, etc. The model puts forth an Integrator Function to advance the role of key stakeholders in workplace wellness. These stakeholders are represented in the Agents of Change section of the logic model, which includes the community, government, health care system, and non-profit sector. 1 The ACA includes a provision that requires states, by January of 2014, to create health insurance exchanges that allow small businesses and consumers to review and compare qualified health insurance options to enable the selection and purchase of health insurance. Should a state not create its own exchange, the ACA provides that the federal government will operate one in the state. 2

3 Challenges Ahead in Advancing Change As outlined above, key challenges in the current small employer community must be overcome in order to successfully advance the contributions of key stakeholders (illustrated above) in improving the take-up rate of wellness programs. The following is a brief snapshot of key challenges (and with them opportunities) identified from convening participant discussion: Successfully Engaging Small Business Owners in Workplace Wellness Given the lack of data, translational models, awareness, and the absence of existing workplace wellness program evaluation for small businesses, research efforts that address these gaps, including program evaluation, must be available. Messaging is needed to educate and engage small employers to act, and to make the case for return on investment. Offer small employers guidance and incentives to offer wellness programs as a tool for employee recruitment/retention. Increasing Employee Engagement in Wellness and the Role of Employers With the variety of small business work environments, including shift workers, teleworkers, etc., employers must provide strong leadership at all management levels to make health promotion and wellness a priority and increase employee awareness of wellness programs and benefits. Small business owners must leverage their ability to easily engage their employee base and also provide incentives for participation. They should evaluate the effectiveness of programs and information should be used to make improvements. Advancing Policies to Promote Workplace Wellness Uptake Rates As stated above, as states move towards the ambitious task of implementing health insurance exchanges by January 2014, and work to ensure fundamental health insurance options are offered 3

4 to individuals and small business owners, an avenue also exists to make a compelling case for workplace wellness offerings/incentives and bring them to scale. Build on the experience of existing exchanges (e.g., Ohio, Massachusetts, Connecticut, etc.) to leverage the best practices/lessons learned to ensure workplace wellness options are available and that small business owners are informed of those offerings. Engage key partners, including insurance brokers and local community-based organizations, which have reach and resources to the small employer community. Coordinating Collaboration and Communication Among Key Stakeholders Many small employers lack resources and tools (including lack of knowledge of existing resources within their communities) to successfully incorporate workplace wellness into their business environments; an opportunity exists to leverage existing infrastructure and organizations (e.g., Community Transformation Grants, Healthy Worksites Program, local chambers of commerce, insurance carriers, brokers, etc). Small business workplace initiatives should be intertwined within the community, in order to be engaged with and to complement local prevention efforts. On the ground leadership can be tapped to form and fortify creative partnerships at the local/community level to develop and share workplace wellness best practices, tools and resources, and coalesce around other community level opportunities such a parks, safe streets, transportation, etc. Looking Ahead: Conclusions and Next Steps In conclusion, the convening discussion revealed that while small business workplace wellness is a complex issue with challenges to overcome including the need for additional research to ensure that evidence-based approaches are utilized, many opportunities exist to change the landscape for small employers. Insurance carriers/vendors can develop or continue to develop wellness products and provide more tools, resources, and opportunities to adopt wellness in their current marketplaces. Further, as the exchanges are developed at the state and federal level, a unique opportunity exists to bring workplace wellness into these evolving efforts and to integrate resources through new and existing programs including those described above. As part of our continuing efforts in this regard, TFAH and SBM will identify and explore opportunities to integrate workplace wellness programs into the exchanges, such as: Encouraging insurers to include evidenced-informed wellness services in their exchange products and provide employers rewards/discounts for use of wellness services; Providing workplace wellness services and programs through exchanges (that have a positive track record through existing exchanges) including services available through the community; Making accessible to the exchanges readily available workplace wellness toolkits and resources ; Educating exchanges to partner with insurance brokers (who have existing client relationships and are trusted by small employers) on the business case for workplace wellness programs to ensure effective information and tools are available through Exchanges and accordingly insurance offerings; and Establishing a workplace wellness advisory group to engage with and inform exchanges on the development and offerings for wellness and health promotion programs through the exchanges. Additionally, spurring collaboration with key partners from business, insurance, public health, the community among other sectors is essential. For example, the CDC, DOL, and the SBA should explore working with the National Association of Insurance Commissioners on effective workplace wellness models. The further development and dissemination of tools and resources, including messaging, will help to continue to define the value proposition to better engage small employers and their employees. TFAH and the Small Business Majority will continue to look for opportunities to work with and to engage with partners in pursuit of these common objectives to ensure all people have access to healthy environments where they work, live, learn, play, and pray. 4

5 Convening Participant List December 14, 2011 Name Title Organization Jason T. Andrew Insurance Broker Stone Meadow Benefits Paul Bonta Tom Carter Associate Executive Director, Policy and Government Affairs Vice President, Sales and Broker Relations American College of Preventive Medicine Kaiser Permanente Health Plan Paul Cotton Director of Federal Affairs National Committee for Quality Assurance Ron Goetzel Katie Jones Research Professor and Director Policy Analyst, Office of Chronic Disease Prevention Institute for Health and Productivity Studies, Rollins School of Public Health, Emory University Maryland Department of Health and Mental Hygiene Karen Kalantzis CEO & Majority Owner Corporate Network Services Tom Mason President Alliance for a Healthier Minnesota Todd McCracken President & CEO National Small Business Association Caitlin McDevitt Mary Meeker Marcie Memmer Legislative Assistant Benefits Specialist Director, Division of Nutrition and Physical Activity National Federation of Independent Business American Federation of State, County and Municipal Employees Union, AFL-CIO Indiana State Department of Health Suzanne Mercure Consultant and Project Director National Business Coalition on Health Stephen Miller Manager/Editor, Online Content Compensation and Benefits Society for Human Resource Management Mari Ryan CEO/Founder AdvancingWellness Kenneth D. Smith Lead Program Analyst National Association of County and City 5

6 Health Officials Andy Spaulding Patty Starr Director, Viridian Center for Community and Worksite Health Senior Director Health Insurance & Benefits Viridian Health Management Council of Smaller Enterprises Julielynn Wong Health Policy Resident American College of Preventive Medicine Observers Rex Cowdry Jason Lang Elena Lynett Senior SHOP Advisor, Office on Health Insurance Exchange/Center for Consumer Information and Insurance Oversight Team Lead, Workplace Health Programs Senior Employee Benefits Law Specialist Centers for Medicare and Medicaid Services, Department of Health and Human Services National Center for Chronic Disease Prevention, and Health Promotion, Centers for Disease Control and Prevention, Department of Health and Human Services Office of Health Plan Standards and Compliance Assistance, Employee Benefits Security Administration (EBSA), Department of Labor Meredith Olafson Attorney Advisor Small Business Administration Consultants Abby Dilley Katie Horton Vice President of Program Development/TFAH Consultant Research Professor, Department of Health Policy/TFAH Consultant The RESOLVE Team George Washington University Chrissie Juliano Program Manager The RESOLVE Team Small Business Majority Rhett A. Buttle National Outreach & Government Affairs Director Small Business Majority 6

7 Terry Gardiner Vice President, Policy & Strategy Small Business Majority TFAH Jackie Britz Health Policy Analyst Trust for America s Health Lauren Ferguson Office Manager, Grants Administrator and Executive Assistant to the Executive Director Trust for America s Health Karen Hendricks Director of Policy Development Trust for America's Health Jeff Levi Executive Director Trust for America's Health Courtney Pastorfield Policy Development Manager Trust for America s Health Sue Polis Outreach Manager Trust for America s Health March 13,