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Neurology Now:
doi: 10.1097/01.NNN.0000359090.10808.95
Department: Penny Wise

Wellness in the Workplace: How and why to take advantage of preventive care coverage

PHILLIPS, LISA

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Conrad Bley had been working as a car washer for UPS for three years before he dropped in on one of the company's wellness fairs. He didn't feel too bad but was wondering about the tight feeling in his chest. One of the first things he did was get his blood pressure checked. It was 198/122.

“It was through the roof,” Bley, 57, says.

He was sent to the hospital for a thorough evaluation. There, his doctor told him his condition probably would have turned into a stroke.

The UPS wellness fair “helped save my life,” he says. “My blood pressure was caught in time.”

With evidence mounting on the importance of diet, exercise, and other healthy lifestyle choices in preventing stroke and other chronic diseases, it may be time for you to check into whether your workplace or insurance plan offers resources for preventive care.

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A RANGE OF BENEFITS

Resources can be as simple as online health guides or as luxurious as on-site massages. According to the 2008 Employee Benefits Survey by the Society for Human Resource Management, 72 percent of human resource professionals indicated that their companies offered wellness resources, and 58 percent reported their organizations offered wellness programs.

Insurance plans typically offer some level of wellness benefits as well. According to a 2002 survey by America's Health Insurance Plans (AHIP), an industry group, all of the 194 plans participating in the survey offer “wellness or health-promotion programs.” Other common benefits include 24-hour nurse phone lines, stress-reduction programs, and chronic disease self-management programs.

“It's in everyone's best interest that patients take care of themselves and have healthier lifestyles,” says Robby Zirkelbach, a spokesman for AHIP.

Wellness programs typically start with a health risk assessment (HRA) and health screening. Participating employees take a survey on their existing medical conditions, lifestyle, family history, risk factors, medications, and readiness to take on healthier habits. Screening tests include cholesterol, body mass index (BMI), blood pressure, blood glucose level, and other standard measurements of vital function. These tools can help employees identify what they need to work on. Many plans help them take the next step through programs for smoking-cessation, weight management, and physical fitness. Some programs offer sessions with a personal health coach or a nurse and discounts at health clubs.

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NEUROLOGICAL DISEASE

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Constantine Moschonas, M.D., the medical director of Four Peaks Neurology in Scottsdale, AZ, says any effort to encourage people to live a healthier lifestyle has the potential to ward off increasingly complex medical problems. For example, exercise and nutrition programs that fight obesity also help prevent adult-onset diabetes, a condition that dramatically increases the risk for stroke.

“These programs promote simple changes in behaviors: exercise, diet, living a healthier lifestyle,” Dr. Moschonas says. “It takes a huge burden down the line off the entire health care system.”

One employee assistance program, called Concern: EAP, even offers “Maintain Your Brain” seminars that promote mental acuity and Alzheimer's awareness. Created by the Alzheimer's Association, the seminars have particular appeal to workplaces with older employees, says Denise Elbert, manager of client services at Concern: EAP.

“It's designed to give you information on how your brain works and how to play games and do different things in order to keep yourself sharp,” Elbert says.

Wellness programs can also help people with chronic neurological diseases manage their condition. Colleen Fegan, who has multiple sclerosis (MS), works part-time as a patient-access liaison for Advocate Health Care, a network of hospitals and doctors in Barrington, IL. Advocate's workplace wellness plan, Healthe You, gives a $10 per paycheck bonus to every employee who undergoes a basic health screening twice a year. Because Fegan, 52, treats her MS with steroids, which increase the risk for osteoporosis and high cholesterol, she welcomes the additional incentive to monitor her bone density and cholesterol levels.

“Knowing those numbers is encouraging,” she says. “I'm able to look out for myself.”

For patients with Parkinson's disease, physical fitness classes and health club membership discounts can be crucial resources, and they are often part of wellness programs. Lisa Shulman, M.D., a professor of neurology and co-director of the Parkinson's Disease & Movement Disorder Center at the University of Maryland School of Medicine, says evidence shows that patients who exercise regularly can delay the onset of disability in Parkinson's disease.

“I encourage patients to think about opportunities they may have to access a gym or some sort of wellness center,” she says.

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BEYOND THE BASICS

Many employee assistance programs (EAPs) go beyond health resources, offering seminars and counseling for stress reduction, financial problem solving, and life management skills. These programs can be invaluable to employees struggling to cope with a disabling or terminal neurological condition. Marcy Russell, director of human resources for Psomas, a Silicon Valley engineering company, remembers how, in a previous job with Hughes Aircraft, a 35-year-old coworker who was recently diagnosed with amyotrophic lateral sclerosis (ALS, or Lou Gehrig's disease) sought help from a multifaceted EAP.

“He needed psychological, legal, and financial help,” Russell says. “He became very angry because there was nothing he could do about the disease, so he needed anger management skills. His wife needed to know how she was going to earn a living. He needed to figure out how his family would make it when he was gone. The EAP was quite helpful.”

Some plans offer health care premium discounts for people who undergo an HRA, stop smoking, or lose weight. Others offer points for walking, working out, fitness classes, and other kinds of physical activity; the points can be exchanged for movie tickets, spa certificates, and other gifts.

Phil Smeltzer, the strategy leader for the wellness programs offered by Humana, a health insurance company based in Louisville, KY, says sometimes the best incentive for participants is friendly competition. Humana's Virgin Health Miles program is designed to get previously inactive people to wear a pedometer and take the surgeon general's recommended 10,000 steps a day (approximately a half hour of physical activity). Smeltzer has seen participants urge each other on and set up departmental contests at work. “It brings a sense of humor and fun to the process,” he says. “And that causes better engagement.”

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FISCAL FITNESS

Employers and insurance companies may be motivated to offer wellness programs out of concern for their bottom line. “We want a healthy workforce,” says Jan Park, a registered nurse and the wellness program manager for the city of Charleston, SC. “It improves quality of life, increases morale, decreases sick days, and helps to control medical costs. Seventy-five cents out of every health care dollar in the U.S. is spent on chronic disease. We're trying to shift the balance toward preventive care.”

Measurements of cost-effectiveness have been difficult to come by, says Jenna Williams-Bader, the product development manager for the National Committee for Quality Assurance (NCQA), a non-profit that recently began to accredit for organizations that offer wellness programs to employers, health plans, and unions.

Instead, NCQA's criteria focuses on risk reduction: whether the percentage of participants with no significant risk factors (obesity, smoking, sedentary lifestyle) increases over time. What makes a wellness program successful in reducing risk factors? Williams-Bader says two factors stand out: support for the program in the company's leadership, and communication between the program and the employees.

“If employees don't know the program is going on, it's less likely to be successful,” she says.

Some employees may be worried that the results of screenings done by insurance companies will be used to raise premiums. But Robby Zirklebach of AHIP says that's not the purpose of wellness plans. “Health plans go out of their way to make sure there are protections in place,” he says.

Having an employer or an insurance plan with good wellness resources is, of course, no magic bullet, especially for people who are at risk for or are coping with a neurological disease. Dr. Shulman says the patients who will benefit the most from these programs are the ones who know the most about their condition.

“Research shows that individuals who are more knowledgeable and active participants with their physicians in clinical decision-making are likely to do better over time than individuals who don't understand the disease,” she says. “The differences between uninformed and informed consumers of health care matter as much as writing the correct prescription. Informed consumers who are partners in their disease management provide a more accurate history and are more likely to receive the best options for management from their physician. In addition, new therapies are more likely to be implemented effectively.”

That advice has held true for Colleen Fegan since her diagnosis of MS five years ago. “In any chronic disease, the patient is the driver of the outcome,” she says. “It's great to have supportive tools offered on the job, but the real job is taking advantage of them.”

©2009 American Academy of Neurology

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