Health management is an ongoing process that helps individuals become aware of the impact upon both short- and long-term health in their everyday decisions.
Wellness programs are usually focused upon short bursts of interaction with an individual on a strictly voluntary basis. Participation rates tend to be very low. Interventions can include screening, health fairs, and data gathering questionnaires. Often, wellness programs are local initiatives that come under the umbrella of a health management program.
Below is a description of terms to help understand the differences.
- Participation levels. High levels of participation are a necessity to reach individuals at high risk for increased health care needs and costs. Sustained participation in excess of 90 percent is necessary to have the desired cultural impact and return on investment by reaching those at low and high risk. Wellness programs typically involve people at low risk for health care needs and cost because of the voluntary nature of the program and thus appear to be healthier than non-participants. Better health and lower health care costs aren’t due to the program, but rather the fact that healthier people self selected to participate—thus selection bias. Wellness programs rarely start off with more than 30 percent participation and fall off from there.
- Population. Health management programs are designed to support behavior change in all members of the population—from young to old—in all stages of health. Wellness programs mostly appeal to those already taking an interest in doing something about their health or those in the action stage of change.
- Serial Feedback. Simply stated, serial feedback is giving the same message over and over until it sinks in and changes behavior. Coca-Cola does it and so does every major advertiser and politician for that matter. Serial feedback is one of the basic tools of a successful program. Wellness programs usually don’t provide serial feedback.
- Proven Return (ROI). Comprehensive health management programs have been measured, and the ROI is there, ranging from 200 percent to more than 900 percent. Wellness programs haven’t been studied as extensively and can’t show the return.
- Culture Change. To impact the health and resultant cost to an organization, there needs to be a culture change. Well-thought-out programs like Healthy Balance produce culture change; individuals are encouraging others to make the right choices. Culture change isn’t achievable in most wellness programs because of the low participation rates and lack of incentives.
- Change to Better Health. Direct and indirect measurements have shown the health of the group improves in a program. Wellness programs almost always start with healthier individuals, and significant change often isn’t realized.
- Short Term ROI. Short-term return on investment relates to the avoidance or reduction on dollars to be spent on health care within the next one to two years. Strategies to help reduce these costs are different from long term because short-term strategies are directed at individuals in whom the disease process is already underway in many instances. Short term helps direct people to the proper level of care, rather than using the emergency room as frequently.
- Long Term ROI. Getting a person to start an exercise program, diet, or quit smoking will have some short-term cost savings, no doubt. However, the real savings are usually three or more years later when lung cancer, diabetes, hip or knee replacement, back surgery, emphysema, etc., are avoided or postponed. Behavior changes that result in long-term savings are often different from behavior changes that result in short-term savings—and so are the strategies and motivators that bring about those changes.
- Staged Interventions. Everyone isn’t at the same stage of change when presented with the opportunity or suggestion that they should change. People change behaviors by passing through a series of stages before they actually modify their behavior, especially if the behavior is ingrained. Comprehensive health management programs determine the stage the person is in and present the individual with as personalized information as possible, as well as motivators appropriate for that particular stage of change.
- On-Going Education. Frequent, scientifically valid communication targeted to the individual that’s relevant to him or her is crucial in a multi-discipline approach to changing behavior and culture. The individual must understand what’s in it for them. Information and facts not well founded in science and proven wrong soon after they’re communicated will only cause doubt regarding program credibility.
For more information on Caterpillar’s award-winning health management program, Healthy Balance, visit www.cranegilmore.com. IBI