Sunday, October 24, 2010

Smoke Free and Vending Machine Free

I just read The Great Banana Challenge in the WSJ and I’m left thinking, why bother? We have a pretty comprehensive wellness program in our office and we tried putting some healthier snacks in our vending machines and they didn't sell. Why? People who eat healthy generally bring their food from home, they plan ahead, they don't make many impulsive vending machine purchases. What's one of the first things people are taught in a nutrition education program? -- carry healthy snacks with you and stash some at your desk. There are Lara Bars in my purse and containers of flax seed and cinnamon at my desk to stir into the plain greek yogurt I bring from home. I can't tell you the last time I bought food from a vending machine (and the last time I did, I'm sure I wanted something junky I don't normally keep around).

The article in the WSJ also mentions the price of the fresh fruits and vegetables -- $2.50 for a banana. OK, I can't imagine wanting a banana so bad that I'd pay $2.50 for it. Actually, I can't imagine wanting a banana at all since Kristin Wood ruined them for me during our Eat Like an Athlete program. When is it appropriate to eat a banana? -- after completing a marathon or century bike ride. So, for me, that's never. But, I digress.

Has anyone asked whether people that eat fresh fruits and vegetables want to get them from a machine? I enjoy picking out a variety of fresh apples at the farm market, but a red delicious apple in a vending machine holds no appeal to me. Or maybe the question is, will people that eat out of a vending machine buy fresh produce if it's available?

I've been looking on line to see if someone has developed a profile of who purchases food from a vending machine. There has been quite a bit of research done on vending machines in schools, but nothing I've found about vending machines in workplaces. Although it looks like the National Automatic Merchandising Association is conducting somesurveys now. According to this literature review,33.8% of vending machines were in office environments in 2006.

As it stands, why do we even have vending machines in our office? They're full of food we don't want our staff to eat and it's the vending machine company that's making money on the sales. If we took them out all together, people would at least have to walk across the street to buy a bag of chips and they'd get some exercise.

We're a smoke free property. How about a junk food vending machine free property too?

Sunday, October 17, 2010

Diabetes Education and Support in the Workplace

We are currently running our first condition specific wellness program -- an eight week program for people that are diabetic, pre-diabetic or have family members that are diabetic, or pre-diabetic. We have 31 people participating. Diana Levin, designed the program when she interned with us and Lifework Strategies last summer.

Prior to the start of the program, we offered A1C Screenings which I talked about here. A1c is a blood test that checks the amount of sugar (glucose) bound to hemoglobin. It is used to diagnose diabetes as well as check the long-term control of blood glucose levels in people with diabetes. Any employees who had an abnormal result received a phone call from a physician's assistant at Lifework Strategies who offered coaching and next steps. People that have an abnormal A1c result were also referred to our diabetes education program. In addition, Lifework Strategies went back through our Biggest Loser blood test results and contacted staff members with high glucose levels and suggested they participate in this program. I believe Lifework Strategies efforts were critical in getting people to participate in our program.

We assembled a nice package of information for each participate and distributed them at a kick off that was combined with the first of four educational sessions.

  • Overview of Diabetes and Exercise
  • Nutrition and Learning to Control Your Blood Sugar
  • Diabetes Problem Solving, Reducing Risks, and Products for Diabetes
  • Supporting Family with Diabetes
These informational sessions are supplemented by weekly peer discussions groups. We recruited three volunteers from the program participants to lead these sessions. Their role is to facilitate the groups getting together and to prompt discussion.

We are participating in the DC Step Out: Walk to Fight Diabetes to close out the program. We intentionally set a very modest fundraising goal of $100 because our primary objective is to celebrate the close of our program and what we've learned together about diabetes. I'm pleased to say that we've already raised $335 and we're hoping to bring in some additional pledges before the event. I think this is going to be a great finale to our program and we'd love for you to join our team. The walk begins and ends at Nationals Park on October 23, 2010 and you can choose a 2 mile or a 5 mile route. 

Here's a good article about why and how an employer can get involved in helping their employees manage diabetes -- Fighting the 'Stealth Scourge'.

Update 10/23/10: Six of us completed the 5 mile DC Step Out: Walk to Fight Diabetes. It was a beautiful fall morning and a nice walk from Nats Park to Eastern Market and back. We raised $510.

Wednesday, October 13, 2010

Selecting a New Health Plan Using a Systematic Decision-Making Process

Guardian has provided our health insurance coverage since 2004. We have been happy with them, but we're hearing rumors that they are getting out of the health insurance business and we certainly don't want to be the last ones on a sinking ship. We worked with our broker, Mark Sager at Alliant, to put our health insurance out for bid this year.

A colleague, Karen Niles, had introduced some of us to the Kepner-Tregoe approach to decision making and we decided to use it in selecting a new health insurance carrier. The approach helps decision makers use weighted objectives to guide decision making, evaluate alternatives against objectives, and document recommendations by showing the structured thinking behind the decision.

In this case, the objective was pretty obvious -- Choose a new insurance company to partner with and provide health insurance coverage to the ASHA staff and retirees. Mark brought us bids from three insurance companies to consider -- United Health Care, Aetna, and Carefirst.

We solicited feedback from everywhere we could think of... we posted a notice to the staff and our retirees that we would be making a change and asked them to share any experiences they had with the carriers we were considering, we posted questions on Facebook and Twitter, asked for feedback from our current and former billing and flex plan administrators, and wellness partners. We also did a fairly extensive internet search. We captured all this on printed out emails, index cards and reports and hung it on a bulletin board. We wound up with an overwhelming amount of feedback. I met with a colleague in research, Mike Jeffries. Mike mentioned Edward Tufte's work and he suggested that we cut out all the extraneous information, so I spent a little time with a pair of scissors, some tape and a highlighter. This made a surprisingly big difference. (I wish I had a before picture so that you could see the difference.)

We used this feedback to brainstorm our objectives. Then we broke the objectives into musts and wants and determined what we would use as an indicator for each factor. We met with each of the carriers to determine if they could meet all of our musts. United Health Care and Aetna made it through this first round of screening.

We had a long list of wants and we spent a Friday afternoon weighting them. Because the list was so long, we categorized the wants and then grouped them on note cards organizing them from most to least important by category. This helped us to assign weights using a scale of 1 to 10 with 10 being the best satisfier. All this information was entered into a spreadsheet. United Health Care and Aetna came back in to meet with us a second time and we explored each factor and scored the carriers as to how well they satisfied each want. The process was somewhat tedious and continued via email after the meetings. It forced us to make sure we were comparing apples to apples and helped us to maintain a perspective that went beyond our liking one companies' presentation more than the other. Here's the spreadsheet.

Quotes 2010

You can see that United came out on top -- 1694 to 1681. This approach allowed us to distinguish the best satisfier from two very good options. We also checked references for United and Aetna and did a detailed cost comparison.

In addition to aiding us in making a decision, our approach conveyed our priorities to the carriers and that we are interested in creating a long term partnership. I look forward to working with the team at United Healthcare.