Sunday, February 28, 2010

Understanding and Using Your Drug Data to Drive Wellness Program Decision Making

A myriad of health problems are treated with pharmaceuticals and in many cases, the use of prescription drugs keeps people from needing more expensive treatments. Surveys show approximately half of the population has taken a prescription drug in the past month (you can find some interesting statistics in this report by the CDC). More troubling for those that budget for such things, prescription drug expenditures have risen more rapidly than any other health costs.

Roughly 20% of our association’s current health plan expenses are for prescription drugs. Digging into that data, I noticed we had a significant number of people taking medication for high blood pressure. One of the first things we offered staff as part of our wellness program was free blood pressure checks. I also expected this might reduce the number of office visits paid for by our health plan because people wouldn’t incur a visit just to have their blood pressure checked.

It was a good start. In 2005, however, our prescription drug coverage skyrocketed 39%. Back to the data; I figured I needed to know more about our staff’s needs. Digging through the utilization reports from our carrier, I looked up each of the drugs that showed up on a report and calculated their contribution to our total drug cost. Doing so gave me a better picture of our association’s health profile. We made adjustments.

Of course, the report continues to change over time. For instance, I have noted a decline in people using sleep aides and taking medication to treat high blood pressure. We’re also filling fewer prescriptions to treat thyroid conditions. I have a report that was run last October in front of me now. Here are some things that jump out:

  • We have 39 plan participants taking cholesterol lowering
  • 20 people take proton pump inhibitors to reduce gastric acid production and treat conditions like ulcers and reflux
  • 11 people are taking antidepressants
What does the data tell me this time? Emphasizing weight loss and exercise like we’re doing with our Biggest Loser program and Healthy Activities campaign should help. It also may be time to hold another gastric health seminar.

More broadly, it's clear to me that any wellness program should take prescription drug use into account. Beyond just giving us an organizations' health picture, we can use it to help our staff be better informed consumers and do our part to help them avoid preventable noncompliance (under- or over-dosing, dangerous drug interactions, etc.). Simply put, the role of pharmaceuticals has risen so dramatically that it would be foolish not to.

Monday, February 22, 2010

Biggest Loser -- Our First Team Challenge

Our first Biggest Loser Team Challenge is finally in the books. From the smiles and laughter, I think it's safe for me to say it was a lot of fun. True Athlete Performance planned and executed the whole event for us. They have experience running high school sports combines, so putting 11 teams through three challenges in two hours was a walk in the park for them.

The activities were all things the participants could do dressed in their casual Friday attire. We did tell folks to wear tennis shoes. For the next challenge, I've also suggested that women wear sports bras. (Unfortunately, I hadn't thought of that before this challenge.)

We declared first, second and third place with bragging rights being the prize. It would be fun to have material prizes for the challenges and the team with the greatest percentage of weight loss each week. Let me know if you have any suggestions for inexpensive, but meaningful prizes.

Here are the descriptions of the challenges from Matt Diener, my primary contact at True Athlete Performance. He brought two people with him -- Josh and Alex, so they had one individual running each station. Matt also runs our boxing and functional training classes.

Ladder Relay Challenge:

Fitness Components Tested: Speed, Agility, Quickness, Coordination

For the ladder relay challenge, team members completed a footwork drill through a 15 foot speed ladder, sprinted 5 yards around a cone, and then ran back to tag the next participant. Total team times were recorded and then averaged in order to determine the overall winner.

The drills included:

  • Doubles (2 steps in each box)
  • Bunny Hops (1 jump in each box)
  • 44s (2 steps inside and 2 steps outside each box)
In each of these drills, the goal was to keep your feet moving quickly while staying under control to make sure the drill was done correctly.

Vertical Jump Challenge:

Fitness Components Tested: Total Body Strength, Total Body Power

For this challenge, participants from each team stepped onto a JumpPad and jumped as high as they could from a basic standing stance. The JumpPad measured the time each participant was off the ground, computing a vertical jump distance in inches. The total distance for each team was added and averaged in order to determine a winner. Proper use of the upper body, core strength, and lower body strength/power are key essentials for this drill, which is why it measures total body power.

Foam Roller Balance Challenge:

Fitness Components Tested: Balance, Coordination, Core Strength, Ankle/Knee Stability

This was probably the most difficult challenge of the three. The challenge began with one person balancing on a half foam roller. The next person in line then handed them another foam roller. Once the first person put it down in front of them, they moved on to the next roller, while the second person began to balance on the first roller. Each time a new roller was passed forward, the first person could move forward and a new person started. The goal of the challenge was to see which team could get the highest number of players standing on foam rollers at the same time. Each team was awarded 2 falls/slips, after which they had to start over and try again. Although difficult, this challenge was a great test of teamwork and strategy in addition to balance and core strength.

Sunday, February 21, 2010

Hope or Fear – What motivates people to change?

Most health communications are fear based. My colleague, Amy, mentioned this to me last week and, after some consideration, I think she’s right.
For me, it’s the reason I don’t smoke. When I was in elementary school, a teacher showed us a video with pictures of cross slices of lungs from people that smoked and those that didn’t. The smokers’ lungs looked like black, moldy, Swiss cheese. Who wants to do that to themselves?
Certainly, fear can be a good deterrent, but is it a good motivator for people to make and sustain major lifestyle changes?
According to Alan Deutschman, author of Change or Die, probably not. He says that the odds are nine to one against an individual being able to change when given this ultimatum. If this is true, and the fear of death only motivates one in ten people to change, maybe fear-based health communications aren’t the best way to deliver the message.
Think about it. You’re overweight. You’ve tried every diet in the book, but you’ve never been able to get to a desirable weight and stay there. Someone gives you a brochure like this – Do You Know the Health Risks of Being Overweight? It alarms you, of course (you knew the risks already), but you don’t believe you can change your lifestyle enough that it will make a difference. Deutschman sums it up perfectly:
“When a person is demoralized and feels a sense of hopelessness and powerlessness about a seemingly impossible situation, then the common responses are depression and defeatism or denial and defense.”
He proposes three keys to change. First you need to form a new, emotional relationship with a community that inspires and sustains hope. Second, use these new relationships to help you to learn, practice, and master the new habits and skills that you need. Third, build on the new relationships to help you learn new ways of thinking about your situation and your life.
How to make this work in real life, then; now THAT is a pretty tall order. Most of us don’t have the resources that they have on the Biggest Loser, this isn’t a residential program, and we don’t have Jillian and Bob. At my association, we are bringing in experts -- nurses, nutritionists, trainers -- but people probably aren’t spending enough time with them individually to build a relationship.
I wonder, will the relationships they form within their teams be enough to inspire them? Are we providing enough opportunities for people to learn and practice the new skills and habits they’ll need to lose weight and sustain that weight loss?
The ultimate goal, of course, is that our particpants transcend the fear and avoidance mindset and embrace a more healthful approach to their wellbeing. Much to do, but I think we are on our way.

Thursday, February 18, 2010

Snowmageddon Derails Weight Loss Efforts

Snowmageddon derailed our weight loss efforts. Our 96 Biggest Losers only lost a combined total of 7 pounds during Week 4 when they were snowed in at home. They started off with a 146 pound weight loss during Week 1 and that dropped to 133 pounds Week 2, and 92 pounds in Week 3. I am expecting to see a weight loss of about 100 pounds a week, so this is disappointing.

The snow also forced us to reschedule our first Team Challenge twice. It's now set for tomorrow at noon. Hopefully that will help to re-energize everyone.

We also arranged to have Amy Barnes come speak to our staff on March 10th. Amy lost 340 pounds. She is now a motivational speaker and health and wellness consultant. She was featured on the cover of October’s Oxygen Magazine, NBC Today Show, Fox News, Fox and Friends, EXTRA!, and she was just in New York filming Dr. Oz. I'm confident that she'll inspire everyone. I just wish she was coming sooner.

Thursday, February 11, 2010

Wellness Program Incentives: A Look at Whole Foods' New Results Oriented Program

I’ve been interested in wellness incentives for a while and the debate over Whole Foods new discount program is fascinating. Some folks clearly just love to hate John Mackey, Whole Foods CEO, probably not unrelated to the op-ed he wrote for the Wall Street Journal last summer. After we separate the message from the messenger, however, maybe there are some things that most could agree on.

Here’s what is posted on the Whole Foods Site about the program. It is part of a larger Program called Health Starts Here.
The Team Member Healthy Discount Incentive offers increased discounts for full- and part-time Team Members (enrolled in the company’s medical plan) who do not use nicotine products and satisfy certain healthy biometric criteria for blood pressure, total cholesterol (or LDL) levels and Body Mass Index (BMI). Team Members already receive a 20 percent discount on purchases at Whole Foods Market stores as an employment benefit, but now, those who voluntarily opt to participate in the incentive plan could receive up to an additional 10 percent discount. (From what I’ve read, you can have your screenings done at Whole Foods for free or have them done by your doctor and submit the results - JgM.)

The media focus has been on BMI and I agree that it is an incomplete measure of “health.” BMI makes no distinction between body weight from muscle and body weight from fat. Consider this; using only BMI as a measure, most professional athletes would be considered “overweight.” And even if we could agree on BMI as a measure, there are also studies that show that the current definitions of “obesity” and “overweight” are imprecise predictors of mortality risk (in fact, some studies show that older women with a low BMI have an increased mortality risk).

In part, I think people are reacting badly to the concept of a "pay for results" type of wellness program. Wellness programs that incent behavior by providing discounts to people that complete a health risk assessment are touted as non-intrusive and respectful. Critics say that if you pay for results, you’re invading the employee’s privacy and discriminating against people that aren’t “naturally thin.”

I ask this question, then; how is this different from our pay for performance programs? Some organizations pay people for the results they achieve (someone who earns a commission would be on the far end of this scale). Sometimes, through no fault of their own, their "numbers" aren’t so good (I’m sure anyone who works in real estate can relate to that in this economy), so they don’t make as much. Other organizations pay for behaviors -- they have a robust 360 degree feedback program and reward people for “how” they go about their work.

Of course, most programs fall somewhere in between. Is it undesirable, then, for companies to exert the same discretion in encouraging employees to maintain a healthy lifestyle? When we separate the message and the messenger, do we really object that much?

A business is seriously looking at how the health of its employees impacts the bottom line; they are not raising deductibles and copays to cut costs and are encouraging their employees to live healthier lives. According to this report published by the World Economic Forum, less than half of employees work for organizations that actively promote health and well-being. Fewer still work for organizations that see wellness as a strategic tool that can add real value to growth and bottom-line performance.

It sounds to me like Whole Foods is making workplace wellness essential (not a “nice” to do), and a central part of their business strategy. Now that’s encouraging. Is it perfect? From the outside, I have no idea, but I think we should consider this some more before we condemn the approach.

Wednesday, February 10, 2010


Today is Wednesday, February 10, 2010 and tomorrow our Biggest Loser participants are supposed to report their Week 4 weights. Our office has been closed since 2:00 last Friday (along with everything else in the DC area) because of the blizzard and hazardous road conditions. I’m a little worried that our Biggest Losers are doing what I’m doing – baking, cooking, eating and drinking. I just posted this note of encouragement.

I know this has been a tough week to lose weight. I feel like we’re living the Little House on the Prairie Long Winter. There is nothing like a bowl of warm chili and a glass of red wine on days like this; and I don’t know about you, but I’ve had plenty of time to bake. Shoveling snow certainly counts as exercise, but my walk to Reston Town Center was dangerous, so nix walking for awhile.

What can you do?

1. Modify your goal. Maybe your goal this week is to maintain your weight loss from the last three weeks. Eat those comforting meals, but keep the portions small. There is nowhere to rush off to, so take your time and enjoy each bite.

2. Try a Fit TV workout. A little belly dancing could be a nice escape right now and you don’t have to worry about looking silly in front of anyone.

3. If you’re lucky enough to be able to walk to a store like I am, pick up a copy of this month’s Shape Magazine. There is a dream body workout that you could do at home and a diet you can stick to and love article that lays out some nice meal options. I’ve read Shape magazine for years to help keep me motivated.

4. If you have power, and I assume you do if you’re reading this, check out some online resources to support you in your weight loss. We’ve listed some on ASHAnet. Use those as a jumping off point and then post others that you find helpful to share with the group.

Stay warm and stay the course!


Biggest Loser -- Weekly Weigh-Ins

We are requiring all the participants to weigh-in weekly and report their weight confidentially via our intranet. Although public humiliation can be motivational, we decided to deviate from the show in this respect.
We have good doctor’s office type scales in both our men’s and women’s locker rooms, but we used a basic digital scale at the initial screenings since it was easy to move. Afterward, we put it in the HR area for people to use for their weekly weigh-ins. We told everyone that they could weigh themselves on any scale they chose, but the bulk of folks have been using the scale in HR. By Week 2, it started to bow and crack. We quickly replaced it with another scale and we’re hoping this one holds out. We should have purchased a heavy duty scale with a high maximum weight to use for the program. Oops! Chalk that up as our second lesson learned.
LifeWork strategies is keeping the “official” numbers for our participants. Small prizes will be awarded to the individual man and woman with the highest percentage of weight loss and to the team with the highest percentage weight loss based on their records. However, everyone is self reporting their weight weekly and we are declaring a weekly team winner.
Participants agreed to report their weights by noon each Thursday and every Friday we find ourselves having to track down a handful of folks that didn’t report. The team leaders have been great about following up with folks and it’s really only a couple of people that aren’t doing what we expect, but it’s driving me crazy. Do you have any suggestions for how we can get everyone to report their weight on time?

Biggest Loser -- Baseline Screenings

We have an ongoing relationship with LifeWork Strategies an affiliate of Adventist Health Care. They have done our on-site screenings for years and our staff trusts them. We contracted with them to handle all the screenings and most of the education for our Biggest Loser program.

Our initial screenings went well with one exception – the physical fitness tests. We decided to use the Presidential Challenge Adult Fitness Test minus the mile walk. The nurses weren’t well calibrated on what they counted as a sit-up and a push-up, so I don’t think people got a very realistic picture of their strength. If we do this again, I’ll have trainers come in and administer the strength tests. We’ll chalk this up as our first lesson learned the hard way.

I also would have liked to have done the mile walk or a VO2 Max Test. A VO2 Max Test measures an individual’s ability to transport and utilize oxygen during exercise. It is a reflection of how fit the individual is, but I can’t imagine administering it for 99 people.

Our initial assessment included the following:

· Weight


· Body Fat

· Waist Circumference

· Push-Ups

· Sit-Ups

· Flexibility

· Blood Pressure

· Lipid Panel

· Glucose

Each individual met one-on-one with a nurse and received a written report with the results about a week after the assessment. At that time, people also to set individual goals for themselves. We’ll be doing a pared down assessment at the midpoint of our 12 week program and a full assessment at the end. The biggest expense of our program is the blood work. The lab work alone runs $35 per blood draw.

Biggest Loser -- Team Selection Process

A benefit of our wellness program that I did not anticipate was the team building effect. We only have 250 employees, all but five of us are in the same building, and we work a lot in teams, but still people tend to get to know the folks they work closely with and not others. When we started offering the exercise classes, we received feedback that people appreciated getting to know their coworkers and this had a positive effect on their work. (I take four early morning classes at work each week and can vouch for the fact that you get to know the people you shower and dress with pretty well.)

Of course, the TV show is team based, and that’s the model we are mimicking. We wanted to keep the teams small enough that it was not too challenging for them to plan to meet. We decided on eleven teams of nine. First, I recruited team leaders. They had a special role to play.
Team Captains agreed to:

  • Participate in a meeting to choose their team
  • Serve as the team’s cheerleader and check in with each team member at least once per week
  • Remind team members about activities (HR sent appointments to all participants) and pass along information if a team member does miss an activity
  • Assure all team members post their weight weekly and submit their homework
  • Coordinate the one hour session with a trainer each team receives
  • Encourage folks to maintain their food diaries
  • Alert HR to any issues/concerns they become aware of
We also suggest some optional activities. For example, arranging for the team to eat or exercise together and arranging for the team to review their food diaries together and do some meal planning.

The next hurdle was actually selecting the teams. First, I asked all participants to forward any special requests to be placed on a team with someone to me. I put everyone’s name on an index card and noted their requests on the back of the card. Now what? I didn’t want the HR staff to put the teams together; and I didn’t want to traumatize anyone by having them be picked last like I was in elementary school when we played pickup games.
I arranged a meeting for the team leaders and had them pull a number out of a hat when they entered the room. They took turns selecting their team members based on the number they selected. 1 – 11 and then 11 – 1. A couple of the team leaders sent someone as a proxy, so I instructed them that they had to choose themselves in the first round. Before we got started, I had everyone raise their right hand and repeat after me, “On my honor, I pledge not to disclose the order in which people were picked, and not to divulge who wanted whom on their team.”

As the team leaders selected someone, they flipped over the card and noted any special requests. Most were worked out as we went, but we reviewed them again at the end and made a few final swaps. The whole process took 30 minutes. It went so fast I doubt anyone even focused on who was picked last.

Biggest Loser -- The Pledge

When we announced our Biggest Loser program, I had no idea what kind of participation we would get. Would 10 people sign up (or even 50)? In any event, 99 greatly exceeded my expectations and our budget.

I was thrilled, but a little concerned when I starting hearing that some folks signed up, but weren’t really committed. Probably not too surprising; this can happen when people have no "skin" in the game.

We addressed this with our exercise classes by charging folks $5 per class, but we didn’t want to charge staff for participating in the Biggest Loser. Instead, we drafted a participation "pledge" that everyone had to sign before participating in the initial screening. While a couple of people chose not to sign it, the group as a whole did so gladly; the pledge has given us a little leverage when we need to remind folks to enter their weekly weight. It has worked pretty well so far...


I have the good fortune of being the human resources director for an association in the DC area. I am passionate about health and wellness and my labor of love has been to help to develop a comprehensive wellness program for our 250-person staff.
We started off simply in 1994, with monthly blood pressure checks, annual flu shots, and a small exercise room. As it grew, we added educational programs (including an annual wellness fair), additional health screenings and Weight Watchers at work. Later, we established a wellness advisory team to help the human resources staff research and market organization-wide wellness initiatives.
In 2007, we built a new building, which included a fitness room with exercise equipment and a group activity room. In 2008, we started offering classes – cardio weight training, kickboxing, functional training, yoga, Pilates and Zumba. Our aim was to encourage not just participation, but also retention. Staff signed up for an eight-week session of a class and paid $5 per class; the association subsidized the rest of the cost. Participation was so high that we eventually had to expand our classes to our lunchroom. (We currently have 58 staff members enrolled in at least one exercise class per week.)
While we were very excited about the level of participation, there were still more employees that we were hoping to reach. Not too surprisingly, human nature is often the biggest single barrier to starting a wellness program; people are overwhelmed and think that they are too sedentary and overweight to even begin.
In this case, anyway, television offered us a way forward. We decided to kick off a Biggest Loser program in January 2010 -- 99 staff members signed up to participate! We are in the early stages of our first big weight loss effort; we are looking for ways to enhance our initial plan and taking note of things that don’t work.
I thought our experience might interest others (I started sharing on Twitter, but need more than 140 charcters). Welcome to my blog and to my first blog post.