Employer Finds Small Steps Can Create Wellness Program Success

When you are a health care insurance provider, one may expect your company to be a model for good employee health, but at one time, that wasn’t so for Blue Cross and Blue Shield of Tennessee (BCBSTN).

The company acquired OnLife, a wellness company, in 2006, and began offering its services to employees. But, as Catherine Bass, director for analytics and reporting for OnLife, tells PLANSPONSOR, a bomb threat in 2008 was the jumping off point for a more comprehensive wellness offering.

“There was a bomb threat to one of [BCBSTN’s] Chattanooga buildings, and employees had to evacuate,” she explains. “Traveling down the stairwell, Vicky Gregg, president and CEO at the time, noticed people were struggling physically to get down the stairs; they were panting. Outside they were lighting up cigarettes while still out of breath. She thought, ‘How are we going to get our constituents to take care of employees’ health when we don’t take care of our own?’”

At the same time, BCBSTN was experiencing double-digit growth in health care costs each year, and there was a high percentage of overweight employees—more than 50%, which was higher than the 31.1% adult obesity rate in Tennessee. “Controlling costs and helping employees on their personal journey to wellness and living healthier was our goal when we started our wellness program in 2008,” Tyler Sanderson, director of Total Rewards at BCBSTN, tells PLANSPONSOR.

In addition to offering a health assessment, BCBSTN allowed wearing tennis shows in its dress code, employee activities are tracked via an online portal, wellness coaching is offered online and on site, and the company started incenting good behaviors. “It really made wellness a part of what employees do and not just something that happens once per year,” Bass says.

In 2009, the company also put together a different health plan package. “This is when high-deductible health plans (HDHPs) started becoming more popular with employers,” Bass says. “A lot of BCBSTN’s enrollment was in the preferred provider organization (PPO) option, which was a huge cost for the company. The health plan package was restructured to make it more attractive to choose the HDHP option. The company’s theory was that people will take more ownership of costs and what they are paying with more visibility of costs up to the deductible.” Take-up of the HDHP option increased from 10% in 2009 to 38% in 2013.

However, to help employees out, the company offered an employer contribution into a health savings account (HSA) of $750 per year for single, and $1,500 for family. “It was a strong signal that the company is committed to doing what is best for employees,” according to Bass.

At the time, construction of one building to house all Chattanooga employees was in process. Sanderson says the building includes walking work stations, at which employees can plug in their laptop to walk while listening in on webinars, for example. It also includes walking trails both outdoors and indoors and an onsite fitness center right in front. He adds that in the cafeteria, healthier choices are the most economic for employees. “We are giving folks choices and education to help them make healthy choices,” he says.

A BCBSTN employee told PLANSPONSOR, “If we did not have a gym on campus, I would not work out. Because we do, I go down on lunch break and get on the treadmill, or I can jog outside. Workout facilities are accessible, and the staff in the gym are knowledgeable.”

In 2010, BCBSTN introduced its Actiped program. Every employee was given a free pedometer and the company introduced an incentive program. A website tracks how many steps they have and how they are on-track to reach their goals. Employees receive points for steps and for doing activity inside as well as outside of the work-based wellness program, such as participating in Weight Watchers, dong group exercise at gyms, and participating in marathons, Bass explains. These points translate into dollars, and the maximum incentive is $200 per quarter. “For example, if employees take 40,000 steps per quarter, they get 10 points, outside events are 15 points each, and if they go to all onsite fitness classes, they can get 200 points.” Health coaching and watching educational videos also earn points.

BCBSTN encouraged each employee to set a goal of 10,000 steps per day, but what it found is that even moderate walkers (those who completed less than 5,000 steps per day) created big results. About 67% of employees participate in the Actiped program, Sanderson says. When the company looked at average claims costs of non-participants, it was $520; for moderate walkers it was $377, and for those who recorded more than 10,000 steps per day it was $155.

“This shows you don’t have to make huge strides, just moving is what it’s about,” Sanderson says. In addition, participants had fewer emergency room visits and inpatient hospital stays, and their body mass index (BMI) was lowered. And, as if walking was making employees want to be healthy in other ways, participants reported a likelihood to smoke was less and to eat the recommended amount of fruits and vegetables.

Bass notes that normal activity among participants was about 2,500 steps a day, but even that was enough to see benefits. “It is a lesson for other employers to set small, achievable goals in their wellness programs. I’m sure they would love to have all the other bells and whistles—a cafeteria, a fitness center—but they can get results by doing something as simple as encouraging employees to walk,” she says.

Since starting its wellness program in 2008, BCBSTN has been able to keep its costs fairly neutral—going from double-digit cost increases each year to a flat trend by 2012. The company also measures the return on investment (ROI) of its wellness program, something surveys have found only about one-quarter of employers do.

Bass says the company measures costs per member per month (PMPM) and has found members who do not do any components of the wellness program cost $476 PMPM; those who do at least one component cost $354 PMPM; two components lowers the cost to $260 PMPM and three lowers cost to $241 PMPM. “Again, this shows a little extra makes a big difference for both employers and employees,” she notes.

BCBSTN also measures employee engagement with the wellness program. In 2008, 26% participated in the wellness program; currently, 98% participate—an impressive number, considering most employers cite participation as the biggest wellness program challenge. According to Sanderson, communication is the top reason for such a high participation rate, followed by the incentives. One of the things the company does to motivate employees to participate is to promote the success stories of people losing weight, Bass adds. Life-sized posters, with a summary of an employee’s story and before and after pictures, are placed in the gym.

Sanderson says employees have reported a 56% improvement in their activity levels; 26.7% quit smoking; and nearly 47% improved their nutrition. Today, only 6% of BCBSTN employees are smokers. However, although their health was getting better, employees continued to report high stress.

So, the company has been working in the last year and a half to alleviate stress by offering yoga classes and massages with costs supplemented by the company, as well as adding a financial wellness program. Employees can learn how to budget and how to utilize all the resources and benefits offered by BCBSTN. The Foundation for Financial Wellness, a nonprofit organization based in Colorado, helped the company implement its financial wellness program.

“Like most things in life, this is a journey,” Sanderson says. “It’s not something for which employers will have a positive ROI in the first year. But, what we see is satisfaction and engagement of employees, and that’s a very tangible and important outcome of wellness programs.”