Labor/Management Collaboration Led to Wellness Success

By Stephen Miller In 2012, Swedish—the largest nonprofit health care provider in the Greater Seattle area—sought to create a wellness program that would motivate its employees to improve their health and well-being, and curb rapidly rising health care costs. Improving employee preventive care statistics was a critical first goal for Swedish, as earlier efforts to engage employees in wellness programs had yielded lackluster results: over the prior three-year period (2009-2011), only 50 percent of Swedish employees had completed a preventive care exam. On April 16, 2012, Swedish launched its new initiative, dubbed “Wellness Works,” to 11,000 of its union and nonunion employees (the program is administered with wellness provider Limeade). “The process was a collaborative effort throughout, from fashioning the incentive with our labor management committee, to providing Limeade with the necessary inputs to craft a Swedish-branded, fully integrated, simple and engaging user-experience—both for employees and administration—and creating the targeted communications to keep employees on track with program goals,” Mandy LeBlanc, the Wellness Works program manager at Swedish, told SHRM Online. Attributes for Success HR and benefits managers at Swedish attribute the program’s success to the following key actions: Identify goals. “We’ve found that health care workers actually tend to be less healthy than employees in other types of organizations because we are driven by caring for others’ well-being and often forget to care for ourselves,” said Laura Boyd, director of compensation and benefits at Swedish. What management wanted foremost was to improve employee preventive care engagement. To that end, the program was designed “to support, maintain and improve the health of all of our employees, while managing our health care costs,” explained LeBlanc. Implemented a financial incentive aligned with goals. “Our health care costs were soaring out of control and becoming unsustainable. We wanted employees to have some skin in the game and realize that we are all in this together. So, we collaborated with our labor management committee to create an incentive they felt was acceptable,” said Cary Natiello, director of HR and labor relations at Swedish. Historically, employees at Swedish have not been required to pay a premium for their employee-only medical care coverage. In a meeting with the labor management committee, it was decided that to continue this perk, employees would have to meet the basic requirements of the Wellness Works program: • Full-time employees choosing not to participate in the requirements of Wellness Works would be asked to pay a health care premium of $25 per two-week pay period ($600 annually).• Employees meeting the requirements would not have to pay the wellness program opt-out premium charge, and would continue to receive medical care coverage without having to pay any portion of the premium.• To avoid having to pay the wellness opt-out premium, employees needed to earn 300 of 400 possible points within a specified time. During the first phase, employees were asked to complete a preventive care exam—either with a primary care physician (100 points) or through Swedish’s Employee Health & Wellness Clinic (50 points)—and a well-being assessment (50 points) to earn a minimum of 100 points by July 1, 2012.• To accumulate the additional points necessary, they needed to (by Nov. 1) get a flu shot (50 points) and TDAP—diphtheria, tetanus, pertussis—vaccination (50 points), have a dental exam (50 points), get and report their height, weight and blood pressure (50 points), and either be tobacco-free or complete a readiness to quit quiz (50 points). The financial incentive to comply with the wellness program requirements will increase, with the wellness opt-out premium rising to $55 per month in 2013 and then to $60 per month in 2014. Involve union representatives. Facing rising health care costs as other employers, the company’s HR, benefits and wellness program executives worked closely with labor representatives to design the Wellness Works program, which required that costs be shared with employees. Labor representatives were involved in negotiating the incentives for participation, and an agreement was reached with the labor management committee as described above—the key point being that employees would continue to get employee-only medical care coverage without a premium if they complied with the basic requirements of Wellness Works. Next, union (and nonunion) managers were given early access to the program, so they could become familiar with its use, obtain answers to any questions and serve as “Wellness Champions” introducing the program to employees throughout Swedish Medical Center’s five hospital campuses and 22 clinics, and promoting employees’ “buy-in” on the program requirements. Provide a user-friendly online platform. The selected online platform had to be able to do the following: • Integrate with all existing health/wellness resources.• Verify and track rewards for incentivized program activities.• Be easy for both employees and program managers to use. Limeade, the program vendor, manages data streams from a variety of parties—preventive care exams, dental care, flu shots/TDAP vaccinations and the tobacco cessation program—to verify participation and manage rewards. The vendor manages the data flows to payroll, also, to ensure that employees received appropriate incentives. Create a robust communication program. Swedish communicated with employees both digitally and via print communications delivered to their homes. Importantly, communications were targeted (rather than mass distributed) to those who had yet to complete a required task by a specific deadline. Ongoing communications were created to ensure continued engagement throughout the year, not just in the weeks after program kickoff. The goals of driving healthier behavior combined with a cultural shift toward self-care and wellness were clearly communicated throughout all aspects of the program. Among the results:

• Within the first 10 weeks of launching Wellness Works in April 2012, 87 percent of benefits-eligible employees had obtained a preventive care exam and completed a well-being assessment.• At the five-month mark, 91 percent of employees completed the preventive actions necessary to continue to receive free employee-only medical care coverage.

Swedish was anticipating a rise of 9 percent in health care costs during 2012. Based on year-end 2012 projections, it anticipates reducing this amount by 2-5 percent and remaining below the national cost trend for the next couple of years. “The percentage of employees completing a preventive care exam shot from an average of 50 percent during the prior three-year period combined to 91 percent within the first five months of launch. While it’s impossible to say exactly how great an impact we’ll see from a health care cost savings perspective, over time we anticipate a reduction of approximately 3 percent from our annual health care cost increase,” said Boyd. “Moving forward, if we continue at this rate, we expect that health care costs will remain below the national cost trend.” “Looking back, it’s easy to see how all the factors driving success fell into place,” added LeBlanc. “The process was a steady collaborative effort throughout, from fashioning the incentive with our labor management committee to crafting a Swedish-branded, fully integrated, simple and engaging user-experience—both for employees and administration—and creating the targeted communications to keep employees on track with program goals.” Stephen MillerCEBSis an online editor/manager for SHRM.