Fitness professionals are poised to benefit from employers’ battles against surging healthcare costs.
R. was carrying 311 pounds on her 5-foot-8-inch frame when she had blood work done at a “Know Your Numbers” workplace event. The results were so grim that the staff volunteered to take her to the hospital. When the doctor told R. that she might not have lived much longer had she not come in immediately, R. realized she owed her life to her employer, Clayton Homes. “Thanks for the wake-up call,” R. said. “I’m now 60 pounds lighter, I feel 10 times better, and I will continue this battle and lose more weight. I thank God, my family and [the company I work for] for caring enough to let me stay here a little longer. They really do care. I’m living proof.”
Q. was recovering from weight loss surgery and could barely walk when he joined the workplace health club run by Plus One Health Management. “With a bit of determination and staff help, I’m doing more and more,” Q. said. “I’ve more than doubled my treadmill speed since I started. It took a lot of willpower and determination to get the courage to start exercising. I don’t have and never have had a ‘gym body.’ Everyone seemed to make it look so easy to exercise, [but for me] it was an effort to get over my embarrassment and shyness. This has been an amazing journey with setting goals and then surpassing them.” Q. has lost over 120 pounds.
Stories like these will become more common as more American employers realize that promoting workplace health is a worthwhile investment. While motives may primarily be financial, workplace wellness programs have the potential to transform many lives in the years ahead—a trend that bodes well for fitness professionals.
The National Business Group on Health estimates that the corporate wellness market will grow 18% over the next 5 years. This puts the fitness industry in a perfect-storm position to create or embrace the opportunity. The major factors catalyzing this storm are rising disease and disability among Americans and relentless annual increases in healthcare costs.
The typical U.S. employee is not doing well. “About 67% of the workforce is overweight or obese, and there has been a 36% hike in healthcare spending associated with obesity in recent years,” said John Harris, chief wellness officer for Healthways Inc., in an interview in WELCOA News & Views (WELCOA 2010; FAWI 2008; WSJ 2011). Researchers estimate that the annual cost attributable to obesity among full-time employees may be as high as $73.1 billion, counting employee medical expenditures, lost productivity and absences from work (Yang & Nichols 2011).
Despite historically high unemployment, more than 140 million Americans had jobs at the end of 2011, according to the Bureau of Labor Statistics. That makes the workplace a powerful venue for conveying a wellness message, particularly as employers struggle to rein in healthcare costs (BLS 2012).
This article examines forces driving worksite health promotion and shares expert opinions on trends, including suggestions on how, as a fitness professional, you can best position yourself to inspire working Americans to achieve higher levels of well-being.
Inactivity is a leading contributor to the chronic diseases adding to an ever-growing burden of healthcare costs in the United States. This points to a clear and compelling opportunity for fitness professionals. The facts:
- Inactivity, smoking and poor nutrition are responsible for 70% of all chronic diseases (O’Donnell 2012). The leading chronic conditions for adults aged 18–64 are hypertension (30%), cholesterol disorders (20%), respiratory diseases (19%) and diabetes (12%) (RWJF 2010).
- Chronic diseases are responsible for 84% of all healthcare costs (RWJF 2010).
- In 2010, U.S. healthcare spending reached $2.6 trillion, $8,402 per person and 17.9% of the nation’s gross domestic product (CMS 2011).
- In 2009, 145 million people—almost half of the population—had a chronic condition (RWJF 2010).
- The 28% of Americans with two or more chronic conditions are responsible for two-thirds of healthcare spending (RWJF 2010).
More emphasis on prevention and effective disease management is essential, not only to improve American health, but also to reduce costs to governments, businesses and individuals. Fitness professionals are poised with the training and skill to help make these changes happen.
Worksite health management and promotion programs are in demand because employers are highly motivated to contain healthcare costs. “Several companies have gone under because they can’t afford health care,” said Margie Kidd, MBA, senior health outcomes consultant with Willis Group in Knoxville, Tennessee. “Starbucks spends more on health care than on coffee beans.”
Employers in 2010 spent an average of $10,387 per employee on health care, according to the 2011 Towers Watson/National Business Group on Health survey of large-sized corporations (TW & NBGH 2011). (Some big corporations pay less because they have more leverage to negotiate vendor prices and they have resources to provide on-site medical, fitness and restaurant facilities.)
Medium- and small-sized companies are also craving solutions. More than 95% of all businesses in the U.S. have fewer than 500 employees (FNBC 2012). Managing healthcare expenses is even more challenging and costly for smaller companies than it is for larger ones. “The small employer is the least served. Economies of scale work against [small companies],” said Tom Sabia, vice president of products, services and business development at MediFit in Norwalk, Connecticut. “We need to find better ways to serve them.”
While you may already have the tools to help, you must be able to make a business case to profit-minded employers. “All companies are focused on cost—cost containment, cost reduction, cost-sharing and cost avoidance,” said Brian Schonfeld, director of wellness services at BaySport Inc. in Los Gatos, California.
The largest cost to businesses is the soaring rate of health insurance premiums. Between 2000 and 2010, the cost of the average annual health insurance premium in America rose by 114%. Employers have passed on a large percentage of these costs to employees: during that same time period, workers’ contributions to premiums rose 147% (KFF & HRET 2011). Employers are also moving toward high-deductible health plans that shift even more costs to workers.
These trends are important because no matter how costs are reallocated, employees and employers share a growing incentive to improve their health in order to reduce their exposure to crushing medical expenses. “I call it the one-two punch of healthy living,” said Steven G. Aldana, PhD, chief executive officer (CEO) and founder of WellSteps in Salt Lake City. “One: it’s your money. Two: you have every reason to improve your health.”
Surging costs encourage people to take more responsibility for their health, agreed Barbara Reindl Pjevach, senior vice president of marketing and administration for Medforma in St. Paul, Minnesota. “If you have more personal accountability and less reliance on an insurer, then employees who are healthier will pay less [in insurance premiums] and will pay more attention,” Pjevach said. “You pay for who you are. You are also motivated to be healthier.” Aldana noted that some employers who are moving to high-deductible plans are also beginning to offer wellness programs, which is what he advises when consulting for companies.
As health costs drive the demand for worksite wellness, a growing body of research is showing that well-designed, comprehensive programs give businesses a positive return on investment (ROI). In a large meta-analysis of methodologically rigorous studies on the effects of wellness programs on healthcare costs and absenteeism, investigators found that every dollar spent yielded an average savings of $3.27 in medical costs and an average savings of $2.73 in absenteeism (Baicker, Cutler & Song 2010).
“A more realistic ROI estimate is probably in the neighborhood of 2:1 as opposed to 3:1, which is still mighty good, in my opinion, given the return on most investments,” said Ron Z. Goetzel, PhD, a professor and director of the Institute for Health and Productivity Studies at Emory University and a vice president at Thomson Reuters in Washington, DC.
While a 2:1 payoff sounds like a great selling point, bear in mind that it takes wellness programs 3 years to produce the typical ROI, said Andrea Krakower, MS, program manager for wellness development and promotion at Scripps Health in San Diego. Three years “does not align with the way most organizations track financial outcomes,” Krakower observed. “Therefore, a program may be eliminated before it has a chance to demonstrate a return.”
Companies want measurable results to ensure they are getting a satisfactory ROI—a significant challenge, as there are no industry-wide performance standards for workplace wellness because the field is so new. “It’s the Wild West in health promotion today. There needs to be some common understanding,” said Michaela Conley, MA, CEO and founder of HPCareer.net and Health Promotion LIVE, based in Baltimore.
Aldana noted that many health promotion vendors are making promises they cannot keep. This makes it difficult for employers to know which vendors to choose and puts more pressure on vendors to deliver documentable outcomes.
Despite these challenges, some best practices are emerging from companies that have received a good ROI on comprehensive wellness programs. Aldana said those programs usually have these features in common:
- strong leadership support
- worksite policies and environments that support healthy behaviors
- behavior-change programs (health risk assessments, campaigns, interventions, biometric screenings)
- participation-incentive programs
- good evaluation
Many experts also recommend that companies analyze their medical claims and develop individualized programs based on need. “Neither small nor larger companies can simply throw a wellness program at the wall and think it will stick,” said Pjevach. “We’re talking about engaging people in changing their personal and individual daily habits to do something a little healthier tomorrow than they did yesterday. Companies need to communicate fairly regularly to try to get employees to make a series of small, healthier changes.” For more information on best practices, see the NIOSH website in the sidebar “Resources: Employee Health Management.”
If, as a fitness professional, you want to get in on the growing workplace wellness trend, you will need to be educated and credentialed in health promotion and the components of wellness, behavior change, health coaching, psychology and communications. “Health education and marketing are key parts,” Sabia said, so do not assume you can make it on fitness skills alone.
You also will have to adjust to different realities in workplace fitness, especially if you are working for large corporations. “One important difference in corporate fitness [compared with] commercial fitness is that our measurement for success is based on utilization,” said Grace DeSimone, national director of group fitness at Plus One Health Management in New York City. “It’s not enough that we encourage employees to join the fitness center; we need to engage, educate and help them get results—and they do.” Kidd agreed: “If I can show that 60% of the company will participate in the program, that has weight.”
It’s important to get used to the idea that fitness alone is not the goal, but is part of an integrated answer. “Fitness is a piece of the good-health pie,” said Aldana. “It’s not the only solution. . . . There are other things that people do all day for their good health. [Fitness pros] must understand the package of what are really the causes of disease and that it’s influenced by a variety of things and not just fitness.”
Experts agree that the demand will be for a more highly trained professional with fitness certification/education as a baseline and additional training in health promotion, behavioral medicine and/or chronic disease management. Specificity is key. Evaluate your skill set in terms of delivering outcomes based on needs and within an integrated approach. Understand that resources exist to treat different people differently. Think through what it means to deliver a specific program for arthritis or diabetes.
As a workplace fitness professional, you will need to broaden your understanding of how people define fitness. “We ask people to define what it means to be fit,” Sabia said. “Some only want to climb two flights of stairs. Others know fitness can help stress.”
Krakower agreed: “The goal is not flat abs. When working in wellness, you have two clients—the individual with whom you work and the organization. The goal of corporate wellness programs is to maximize employee satisfaction and engagement, while managing costs associated with health plans, workers’ compensation, productivity, etc. It’s essential to provide programs that help employers meet their targets and help employees meet their personal health goals, which go beyond fitness.”
Many wellness professionals got their start in fitness but have broadly expanded their backgrounds to develop a full-time career in worksite health promotion.
“Generally speaking, employers are looking for someone with a bachelor’s degree in a behavioral health–related field,” said Conley, whose jobs website has 25,000 users. “The momentum is more toward a holistic mind-body integrated approach—a high-growth area is hospitals.”
Aldana added, “If you want to do anything in disease, chronic disease or prevention, you’ve got to open up your training to more than just fitness.”
Worksite health promotion is a vast field with jobs as small as teaching a class at a corporate site and as large as running national programs. “The opportunity for fitness professionals to grow their careers . . . is incredibly exciting,” said Krakower. “Somehow ‘incredibly exciting’ even seems like an understatement.”
“Expand your toolkit,” Krakower added. “If the only tool in your toolbox is Pilates, Pilates is [your] answer to everything. While Pilates is a wonderful practice, it’s not the only thing that will help people improve their health.”
For more, see “How to Become a Corporate Fitness Professional” at www.ideafit.com/fitness-library/how-to-become-corporate-fitness-professional; “Corporate Wellness—Programming for Profit” at www.ideafit.com/fitness-library/corporate-wellness-programming-profit; and “Fitness and Wellness Intertwine: A Major Industry Arises” atwww.ideafit.com/fitness-library/fitness-and-wellness-intertwine-major-industry-rises.
Workplace wellness programs have broad diversity, from size of role (part-time to executive) to choice of location (small-, medium- or large-sized company) to type of industry (sedentary, active, youthful or older population, or a combination of all). Almost three-fourths of the employers offering health benefits provide at least one of the following programs: weight loss, gym membership discounts or onsite exercise facilities, smoking cessation, personal health coaching, nutrition or healthy-living classes, Web-based resources for healthy living, or a wellness newsletter (KFF & HRET 2011).
“We’re working on sit/stand workstations, energy breaks, onsite education, healthy and mindful nutrition, and ergonomics,” DeSimone said. “Additional training in areas of specialization like ergonomics or moving from training to group training creates a well-rounded professional.”
Other experts point out that more small- and medium-sized companies are seeking physical activity programming that does not require an onsite facility and uses few resources—such as walking programs or movement activities like Pilates or yoga that can be held in a conference room.
Americans need help. The workplace is a powerful location for delivering tools and support to reach people who may not otherwise learn about and experience health improvement. While a discussion of workplace wellness may involve a dry analysis of cost factors and measurable outcomes, the underlying goal is the same: saving and improving lives. Fitness professionals are uniquely positioned to build transformational relationships between people and their jobs.
Christine Rutherford, group exercise instructor with BaySport and manager of the Philips Lumileds Lighting Fitness Center in San Jose, California, shared a story that sums it up: “One of my regular students pulled me aside one day and said she had something to share with me. Her doctor had warned her that if she did not do some type of exercise to manage her weight and blood pressure, her life would probably be shortened. She was 53 years old and had never exercised in her life prior to coming to my classes, ever—not even a bike ride. Having classes available during the workday, close by, and so inexpensive, made it almost impossible to pass up. When she started taking lunchtime classes, she saw almost immediate positive results in her weight, blood pressure and sleep. She has made her exercise class at lunch part of her daily life, and it’s now her ‘favorite habit.’ She just had to tell me.”
You—and every fitness professional—can ignite that change in a person’s life.