Transcript – Episode 31

Fred Dunayer:                 Welcome to the SCORE Small Business Success Podcast, Been There, Done That. To get free mentoring services, as well as to see the wide variety of resources available for small businesses visit our website at www.score.org or call 800-634-0245. Now here’s your host, Dennis Zink.

Dennis Zink:                     Episode Number 31, Employee Wellness. Fred Dunayer joins me today in our studio as co-host, SCORE mentor and our audio engineer. Good morning Fred.

Fred Dunayer:                 Good morning Dennis.

Dennis Zink:                     Our guest today is Bob Merberg with Paychex. Welcome to Been There, Done That.

Bob Merberg:                  Thanks very much Dennis. Great to be here.

Dennis Zink:                     For over twenty years, Bob Merberg has been helping employees get healthier while advancing his organization’s business objectives. As Employee Wellness Manager at Paychex, a program which he oversees, Bob has won the Best Employer for Healthy Lifestyles Awards six times from the National Business Group on Health. Last year the Institute for Health Care Consumerism selected Bob as Health Care Consumerism Super Star for his accomplishments in the realm of wellness empowerment. Super, Bob. That’s awesome.

Bob Merberg:                  Thanks Dennis. I’m very proud of it.

Dennis Zink:                     Why should a company commit to wellness?

Bob Merberg:                  There are a lot of reasons. Companies, Dennis, commit to wellness for a variety of reasons customized to the individual  company’s circumstances. I think that the main thing we see is that companies understand that healthier employees are more productive at work; more productive and often have healthier lives at home as well.

Productivity issues for employees takes different forms. In some cases it’s lower absenteeism. Sometimes it means less presenteeism. If any of your listeners are not familiar with presenteeism, presenteeism is time when you’re at work but your productivity is compromised for health related reasons. Think of someone who is working with a migraine headache or lower back pain.

Increasingly, I think that we’re seeing that employers also appreciate how wellness can enhance employee engagement, employees’ commitment to their work and to their employer. There are some other things like recruitment and retention. I think that these days many employees are coming to the workplace expecting to have a wellness program available to them, so it’s something that they look for and the mark of a good employer.

I think one of the things that sometimes often gets overlooked in discussions of employee wellness, Dennis, is that it’s really beneficial for everyone in our society. I think that everyone would agree that a healthier population would be a good thing. In order to have a healthier population in the United States or in any country, employers have to be involved and have to step up because work is such an important part of everyone’s life and a big part of where we spend most of our time.

Dennis Zink:                     Bob, how do companies measure the success of their programs? Is it absenteeism? Is it productivity? Do they typically put in metrics?

Bob Merberg:                  There’s a lot of discussion, Dennis, about how a large percentage of employers do not measure the success of their wellness program. I think that a lot do. I’d say … There’s some data on it, and actually I don’t … I’d be a little bit concerned about not citing that data quite as precisely as I’d like to.

I think that as an employer sets out to consider whether their program is working and what metrics to look at they have to consider, and this is something that really needs to be decided in advance, why are you doing your program? I mentioned a few things a couple minutes ago at the outset of our discussion. If I’m doing a program to improve employee engagement, then I need to use my employee engagement data or some measure of it to measure the success of the program. If I’m interested in reducing absenteeism, then yes, I’d look at people who participated in the program and are absentee rates improving, are presenteeism rates improving. That’s something that can be determined with questionnaires.

I know a lot of employers are interested in health care costs. That’s been a tough nut to crack, especially amongst small employers. Employers generally should measure the success of their program and the metrics have to be based on the company’s motivation for doing the program to begin with.

Dennis Zink:                     What are businesses actually doing currently to promote wellness?

Bob Merberg:                  There’s a wide range of programs that employers are offering, usually dictated by their own circumstances, their resources that are available to them, and their objectives. Some of the things that we most typically see are things like nutritional counseling and brown bag sessions for health topics like nutrition, as I mentioned, stress, back pain. Flu shots is one of the most popular and common employee wellness programs. Weight management programs, biometric screenings, which include things like screenings for cholesterol and blood pressure and body weight or BMI. A lot of employers offer coaching to help their employees achieve their goals related to wellness, like getting more fit, eating more healthfully.

Then there are some things … When I look at some of the data recently from a survey done by the Kaiser Family Foundation and they divide up all the things that employers are doing, small employers and large employers, they also include things like wellness newsletters which are being offered by actually thirty-three percent of the small employers they’ve looked at. Web based resources. That includes things like information and assessments and interactive programs.

Smoking cessation, or I should say tobacco cessation, because a lot of people use tobacco in other forms other than cigarettes, is a common program. A couple of others, gym membership discounts are common. Depending on the size of the employer, maybe onsite fitness facilities. Very small employers are not too likely to have that. Health risk appraisals, which are a questionnaire in which the employee is asked a series of questions about their health and given some feedback on what they’re doing well and what their opportunities for improvement are.

Dennis Zink:                     What does it typically cost per employee for a company to have a wellness program?

Bob Merberg:                  A company that’s trying to do a robust wellness program, maybe about one hundred to … When I think about a larger employer, it would probably go up to about five hundred dollars per employee (per year). It varies widely, especially based on whether the employer is contributing incentives for participation or for achievement.

You know, Dennis, I think the important thing is that a wellness program for a small or even a medium sized employer doesn’t have to cost much at all. It even can be done with almost no expense other than the investment in the people who help organize it. I’m a little bit reluctant to say that because I think that employers should invest in wellness and that it’s a good investment and you can always do more in wellness with more resources, but there are so many things that employers have available to them that they can often access for free or that they’re already paying for if they’re working with a health plan. They should definitely turn to their health plan and leverage those resources.

Local YMCAs, local hospitals often have programs available or are willing to send people to help out. The American Heart Association or Lung Association are usually very eager to come and assist an employer with their wellness program and they have a lot of resources available to them. There’s a lot that can be done with little expense at all.

Fred Dunayer:                 Bob, that was quite a list of services that you mentioned. I think that’s really valuable. I realize that establishing a cost number for something like that when you’ve got an a la carte selection is a little difficult to do, but when you talked about five hundred dollars, is that per year per employee?

Bob Merberg:                  Yes. Thanks for the clarification. That’s per year. Again, that is usually something I think that you would see for a larger employer. Per employee is actually not; and I work for a larger employer; that’s usually not how we quantify the expense. Sometimes what you’ve seen and the way it’s measured in a survey that’s done by the National Business Group on Health, which is an association that supports large employers, is based on what percentage of an employer’s overall health care expense is committed to wellness.

Usually what you would see is that it’s about one and a half to two percent of their overall expenditure for health care. I think that’s an important perspective because you hear one hundred dollars, two hundred dollars and up per employee per year, that sounds astronomical. But when you think about what employers are spending for health care, then that amount of money that’s spent on wellness and prevention actually is really just a sliver of that chart.

Dennis Zink:                     It sure is. What kind of incentives do companies offer to employees for different things? Let’s say I’m twenty pounds overweight or something or fifty pounds, what kind of incentives would I have?

Bob Merberg:                  We’re seeing the full gamut of incentives. My own belief, Dennis, is that if you’re twenty pounds overweight that your best incentive is feeling better, is maybe living longer, helping to prevent disease, having more quality time with family or to commit to whatever it is you want to commit to.

We do know that financial incentives are popular. For the small and medium employer, those incentives are often going to take the form of what I think of, for lack of a better word, like trinket incentives. I wouldn’t necessarily give you an incentive for losing weight, but I might give you a tee shirt for participating in a program. I might give you a gift card because you committed to train for a half-marathon or something. I think that for a small or medium sized employer a trinket incentive like a tee shirt, a gift card for participating, deliver value. That value is largely in energizing people around the program and around the offering.

Certainly in recent years there’s been an increase, and, Dennis, this might have been what you were thinking about when you asked the question, in what’s called outcomes based incentives, which is where the employee would receive some financial return for achieving a biometric measurement. For example, losing weight or getting their BMI into a healthy range, perhaps would lead to a discount on their health care coverage, their medical coverage costs. Or perhaps being above that range would lead to a surcharge. We see that with BMI and with blood pressure and with tobacco use as well.

I personally have not really been sold on the value of those programs. They’re very controversial. I have not seen any evidence that they actually help people achieve better health. They’re also right now getting caught in a bit of a regulatory net where there’s a lot of questions about them. Employers who are doing some of those programs have been sued. They’ve gotten a lot of bad publicity.

My take on it, and I’m really just sort of speaking for myself here and some other people in the wellness industry who take this position as well, we do know from a study that the Kaiser Family Foundation did, that seventy percent of employees, a little bit more than seventy percent of employees really do not believe that it’s right for an employer to penalize people based on a health factor such as blood pressure or BMI.

Wellness really has to be something positive. When we think about those goals that I mentioned earlier, engagement, recruitment, retention, that’s not going to work if you’re doing something that your employees hate, that your employees think you’ve got no business doing. I really encourage employers to keep their wellness program positive.

Dennis Zink:                     I would think that to some extent employees might feel that there’s an invasion of privacy that you’re going to look at my blood pressure and my cholesterol and I’m an employee there, but really I don’t know that I want an internal exam.

Bob Merberg:                  Yeah. I think employees definitely do view that as an invasion of privacy. That’s why their take on it is negative. I think that’s mostly true when that program is being … When the employees feel that they’re being coerced to participate in that program.

Where I work at Paychex, we’ve offered onsite health screenings. We’ve done it for more than ten years, actually since before I got into the role, and it’s strictly voluntary. We still get more than forty percent of our employees participating and they like it. They appreciate that information. Now if I started penalizing them because their blood pressure was a little bit too high, I don’t think that they would like it so much.

Privacy is an important thing. Employers will tell employees, and I’ve certainly found it to be true that employers are not looking at individual’s health factors. They’re not looking at blood pressure measures. There are usually third parties that are involved to do this and larger employers get aggregate information. Certainly in today’s world, employees are a little bit skeptical about how that information will be handled. While it’s regulated, I think that a little bit of skepticism is appropriate.

Dennis Zink:                     We hear a lot about large employers’ wellness programs. How do wellness programs differ for a smaller employer?

Bob Merberg:                  I think that they can be a lot different for a smaller employer. To be quite honest, Dennis, I’ve worked with some smaller employers, especially in my own community in Rochester, New York, where Paychex is based, and some of the best programs that I’ve seen have been done by smaller employers.

I think that they have a lot of advantages because they’re doing friendly walking clubs, yoga classes, and they have a sense of community to their wellness program. That’s an important part of wellness. That really goes to social support, and feeling connected at work is an important part of wellness. They’re doing things like bike rides, sports teams of course, healthy pot lucks; all those things that really when you step back and look at it is a very holistic view of wellness. It’s not just physical, but it’s about connectedness. It’s about feeling happy and whole and liking your job and maybe including family, which some of the smaller employers do as well.

The smaller employers, like every employer, have some challenges when it comes to wellness but also some advantages as well, especially if they’re all working in one place. The communication is better, so it’s easier to let people know about what’s happening in wellness. Obviously there are challenges if you have truck drivers or remote workers. The feedback lines are better, so the employer has a better idea of how their wellness program is being received and what people want.

There’s more influence of culture, I’d say. If I’m an employer of twenty people, for example, and the person who’s leading that company, say the CEO or the proprietor, or whatever it might be, is encouraging people to go out for walks, is walking with them, is organizing them to do a bike ride on weekends, that will be very, very powerful, and it’s actually harder to do in a large employer setting.

Finally, larger employers are very focused on what I think of, Dennis, as a conventional model, which includes these online health risk appraisal questionnaires, onsite screenings, telephonic coaching and incentives. To be as positive as possible, I’d say that there have been mixed results to those. The smaller employer I think has a greater ability to be agile and to be innovative and to try new things.

Fred Dunayer:                 Bob, is there any overlap between what a wellness consultant would do and workplace safety? The reason I ask, I’ve got an example. My stepson just went to work for a company that has a factory and in this factory it’s extremely hot. They provide water and what not, but he came home after his first day very ill from the heat. I’m just wondering if there is overlap and if wellness people ever get involved in looking at the work environment itself to see if there’s anything they can do to promote health for the employees.

Bob Merberg:                  Fred, that’s a very forward looking question and a really astute one. By the way, I’m sorry to hear that your stepson had that experience with his own health in that work environment. I’ll tell you the truth, in my own position as Wellness Program Manager, I’ve very recently been given responsibility and oversight as well for safety, ergonomics and workers comp. I’ll just let you know up front I’m on the learning curve and some of those things are a little bit complicated and I’m in an environment where it’s mostly knowledge workers as opposed to a manufacturing environment. Manufacturing safety is much more complicated.

What I’ve been finding is that there is definitely an interest in integrating wellness with safety and occupational health. I have not yet found perfect models for how to do that, which might be partially because it does differ so much from employer to employer. In fact, the National Institutes of Occupational Safety and Health have a campaign, it’s called the Total Worker Health Program, that’s all about integrating wellness and safety and the work environment. Of course, Fred, as you know the work environment goes even far beyond things like the ambient environment, the temperature and those sorts of physical conditions. There’s also the psychosocial environment, which goes to some of the things we talked about like stress and so forth.

In answer to your question, I think that there’s a lot of interest in integrating those things and I think that’s the way it should be. Wellness consultants should certainly be paying attention to the work environment, but I don’t think that there are any easy solutions or formulas right now or perfect models for exactly how to do that.

Dennis Zink:                     Bob, let me ask you in a typical business what person, what role should have the responsibility for their wellness program?

Bob Merberg:                  Probably the person in my role I’d say. It differs, again, from employer to employer. I know I’m going to start sounding like a broken record, but that’s the truth about wellness, is formulas are probably something to be wary of. In a small or medium sized employer setting, usually what I see, Dennis, is that it is someone in Human Resources or Benefits, if Benefits is separated out a little bit, who has responsibility for wellness in addition to a host of other responsibilities. That’s common and that works as long as that person is really committed to wellness.

I think that the most important thing is that the person who’s driving wellness is passionate about wellness. That doesn’t mean that they have to be lean or they have to be a marathon runner or a vegetarian or anything like that, but I do think it helps if they’re committed to this idea that people can lead healthier lifestyles and that there’s benefit to it for themselves and for the employer.

Depending on the size of the employer, there might be times when it’s just an employee in any role who steps up, who has that commitment and wants to drive it with their peers. In a small enough employer, if I think about being an employer with twenty employees, if the President of that company, the CEO, the proprietor or whatever they may call themselves, can drive that wellness, that certainly the ideal.

As we get into larger employers, I think it’s really good to have a dedicated wellness person such as myself and even larger, like when we get into global companies, to have a team. There is a role for committees. Probably the best role for committees is in those employers that maybe don’t have the resources to have a dedicated person and there’s enough grassroots support where people want to get involved and work as a team.

Dennis Zink:                     Bob, with wellness I tend to think of two main components that are probably a big percentage of any wellness program, that being weight management, which has to do with nutrition, and exercise. I would think those are two of the main components. Let’s look at nutrition first. What can employers do to promote good nutrition?

Bob Merberg:                  Those are both important components of wellness. There are a number of things that employers can do. Those would include things like offering low-cost healthy food options in vending machines and to promote healthy food if refreshments or lunches, for example, are served at meetings.

One of the things that we’re really seeing an upsurge of that I think is fabulous is employers partnering with local community supported agriculture organizations, which is basically a pool of local farmers that will deliver weekly shares of their produce directly to the work site. We’ve been doing this. Employees love it. It helps make sure that there’s fresh produce being delivered ultimately to their table. It makes it really easy for them and it connects the employer to the community as well.

Dennis Zink:                     Okay. On the second part of the question, what are some ideas for promoting physical activity in workplaces where most employees may be sedentary?

Bob Merberg:                  I think one of the simplest things to do is to start creating walking groups. That’s a group that will go out on a regular basis, often at lunch, for a walk. Employers should just jump in and do this. This is where employers need to be cautious about getting caught up in analysis and data and planning. Just do it. Employees want to move. They’re wired to move ultimately. They might not always feel that way.

Employers can offer ideas for where to walk around the workplace. If there’s a large space … I know this is something that local health agencies will do, actually help map out routes. Having bike racks available if the employer is in a bikeable location can be helpful. Anything the employer can do to support active commuting via walking or biking can be helpful.

Then of course onsite classes. You can connect with a local yoga instructor and if you can find the space, actually conduct a class once or twice in the evening, for example, after work, or during work if it’s possible, and deliver the experience right then and there.

Fred Dunayer:                 For what it’s worth, Bob, I know that some technology is on the horizon … I believe that already some Smart Watches … Maybe Apple is doing this, that they have an app that runs on your watch that every hour it gives you some sort of chime to get up and walk around.

Dennis Zink:                     I had that on my computer for years just as a program. Also standing desks are a big thing too these days. Can you comment on that?

Bob Merberg:                  Yeah. Standing desks are very popular, and even treadmill desks. If you’re not familiar with the treadmill desk or some of your listeners aren’t, and I’ve known even some smaller employers who have done this … The treadmill desk is a work station where the person is on a treadmill, but lest you have any visions of the treadmill at the gym going at ten miles an hour, these treadmills are designed to go no more generally than one and a half to two miles an hour, so it’s very, very slow.

Here at Paychex we’ve actually installed four of them at various sites. You can conduct work while just slowly moving. You can be on a phone call. What it does, it’s not a workout. It’s not supposed to be a workout. But we’ve all been hearing lately how sitting is the new smoking, that there’s just tremendous harm that can be done by sitting all day without a break that can’t be undone by working out in the evening. Having people use treadmill work stations is really a perfect way of allowing them to get some movement without them having to take time away from their work.

Fred Dunayer:                 Bob, how would somebody go about finding a wellness consultant and evaluating their qualifications?

Bob Merberg:                  There are a number of organizations out there that can refer an employer to a wellness consultant or a wellness vendor that provides services. There’s one called Welcoa, W-E-L-C-O-A. I think that their website is welcoa.org. There’s another one called the Health Enhancement Research Organization. They could certainly point any employer in the right direction.

I think that when seeking a wellness consultant or a wellness vendor there are some things that employers should be watchful for. One is being presented with realistic expectations. Any consultant that says that they’re going to generate a return on investment of seven to one or twelve to one, that’s not realistic.

An employer should made sure that a consultant has great references from other clients that have achieved what they wanted to, that the consultant is connected with wellness products and programs, we’ve mentioned a bunch of things, that the employer wants and the employees want, and that the objectives are clearly discussed. Again, for a lot employers who offer health benefits, their health plan is also often going to be a good starting point.

Dennis Zink:                     What are some future trends? What’s it going to look like in the future?

Bob Merberg:                  We touched on a couple of things that are taking off right now. That’s the use of wireless activity trackers like Fitbit, and mobile apps especially. I think that we’re seeing a greater emphasis on the different dimensions of well-being that include things like stress and financial wellness and on measuring these things in ways that are not strictly about health care costs, which is really the old model, but looking at engagement recruitment.

One of the things that I’m most committed to, that I haven’t mentioned is some of the psychosocial components to the workplace that influence wellness. Just recently we saw a study that showed that people who work long hours, more than fifty-five hours a week, have a thirty-three percent greater risk of stroke and a thirteen percent greater risk of coronary heart disease.

Other things that have been shown to affect wellness are things like having little control over the demands of your job, job insecurity, rewards, work/family conflict. These are things that have been attended to quite a bit in other economies in the world. I think that’s really an important part of the future of wellness, and I do think that we’ll get there and that we’ll see that it’s really in the end, at the core of how an employer can influence the wellness of its employees. It’s by those things, with the work environment and the job condition.

Fred Dunayer:                 Bob, if there was one thought that you would want our listeners to come away from this podcast remembering, what would it be?

Bob Merberg:                  I think that the one thought would be to do wellness, to not get caught up in the paralysis of analysis, and to always make it positive, never coercive, and customize it to the needs and desires of the specific employee population.

Fred Dunayer:                 Bob, thank you for being our guest today on Been There, Done That and enlightening our listeners on wellness.

Bob Merberg:                  Thank you both so much. It’s been a wonderful experience.

Fred Dunayer:                 Thank you Bob.

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