There doesn’t seem to be much dispute
about healthcare costs being a burden on employers and employees. Chronic
disease alone costs the United States more than $1 trillion annually. The U.S.
spends an additional $277 billion per year just to treat seven of the most
common diseases (cancer, diabetes, hypertension, stroke, heart disease,
pulmonary conditions and mental illness) (DeVol et al. 2007). “People are
suffering from preventable chronic diseases,” says Richard Carmona, MD, MPH,
FACS, chairman of the Partnership to Fight Chronic Disease (PFCD) and the
former U.S. surgeon general. “Not only does that suffering affect our nation’s
overall health, but also our productivity” (PFCD 2007).

About 100 years ago U.S. life expectancy was largely based on our
ability to manage infectious diseases and public health conditions (Anderson
2007). Conditions improved when the healthcare system poured money and
attention into the search for solutions. About 50 years ago, the focus turned
to treating acute, noninfectious illnesses such as heart attacks (Anderson
2007). The result: significant improvements in episodic care delivery and
survivability. Now the major reason for mortality and morbidity in the U.S. and
other industrialized countries has become chronic disease. Just 3 years ago,
133 million people—almost half the U.S. population—had at least one chronic
condition (Anderson et al. 2005).

Public health officials spent money to solve the infectious and
acute illness problems after
they had become an issue. Rather than watch history repeat itself—as money is
spent in reaction to
problems such as worker absenteeism, “presenteeism” (below-par on-the-job
performance due to illness), low productivity and the need for treatment—it
makes sense for corporations to look for a solution to the current health
crisis before the
economic burden becomes untenable. The system needs to change from an
acute-care focus to one of primary, secondary and tertiary prevention. Fitness
professionals are among the first line of defense. This article explores the
hard statistics that support work-based health, fitness and wellness programs
and offers advice from people who are currently working to help thousands of
employees and employers better their health and bottom lines.

Dollars and Sense

So is health a good business investment?
Ross DeVol of the Milken Institute thinks so. In fact, he believes an
investment now will add billions of dollars in economic growth over the next
few decades. The Milken Institute Study of 2007, for which DeVol was the
principal author, recommends “more incentives to promote prevention and early
intervention, and a renewed national commitment to achieve a ‘healthy body
weight’” (PFCD 2007). Should corporations focus on preventing and treating
chronic disease? Is that where the biggest cost savings lie?

There is no shortage of research that supports work-based health
initiatives. In a 2-year study done by Life Time Fitness and Medica Health
Insurance, members who exercised decreased their average healthcare claim costs
by 33.6% on a per-member, per-month basis, including a 13% decrease in
physician claims and a 9% decrease in prescription claims (Business Wire 2007).
In a study conducted by Capital BlueCross and Pennsylvania Blue Shield at
Berk-Tek, a manufacturer in New Holland, Pen­nsylvania, employees who attended
a single on-site workshop on self-care (no exercise involved) and then received
a copy of the “HealthyLife Self-Care Guide” showed an 18.4% reduction in
physician office visits and an almost 20% decrease in emergency room visits. A
12-month outpatient savings per employee of almost $40 added to the good
results (Powell 1997).

So it would seem that corporate participation in employee
wellness, no matter how small, has a positive impact. Whether it’s a booklet in
the late 1990s or an on-site wellness facility a decade later, companies that
invest in wellness programs reap savings, increase productivity and improve
employees’ health. For example, a recent review of health promotion and disease
management programs found a significant return on investment, with
benefit-to-cost ratios ranging from $1.49 to $4.91 (median of $3.14) in
benefits for every dollar spent on the program (USDHHS 2003).

Make Your Case

By using facts and figures, you can help
a company switch from its prevailing inefficient response system to a
cost-effective preventive one that has employees attaining and maintaining
higher levels of health. To remain viable, for-profit businesses must show a
profit. When you approach a company with a proposal to offer a wellness or
fitness program, it makes sense to keep this obvious statement in mind. If you
can show a decision maker how prevention and early intervention (and late
intervention if you specialize in disease management) can save money, you will
be talking the “language of business.”

Brenda Loube, MS, and Sheila Drohan, MPA, jumped on the corporate
wellness wagon before it was considered a career path. Back in the early 1980s,
Loube and Drohan took on the challenge of starting their own company. With her
experience as the founder of the cardiac rehabilitation program at Georgetown
University Hospital in Washington, DC, Loube found a potential business partner
in Drohan, who was the director of health and fitness at the National Capital
YWCA. “Sheila and I saw that disease prevention through fitness and health
might be a better path,” says Loube. “Since people spend a majority of their
time at their jobs, it made sense for us to go where people were—at work. We
sought advice from companies with wellness/fitness programs and then put
together our presentation, making a case for on-site employee wellness and from
that got three corporate contracts. From those initial contracts Corporate
Fitness Works was born.” With Loube as president and Drohan as chief executive
officer (CEO), the company has grown to over 50 locations in 16 states and
Washington, DC.

When making the case for on-site wellness, Loube believes that
companies today focus more on bottom-line benefits than they did 25 years ago.
“Companies now see wellness/prevention programs as a necessity, not a luxury.
Whether we work through human resources, benefits, facilities or sourcing, the
key is to provide them with both the human and financial benefits and reasons
for instituting a worksite wellness program. With this data, they can develop
the business case that the CEO will need to make an informed decision.”

The Details

Now that you see the number crunching and worth of working in corporate wellness, there are
a few considerations unique to the corporate setting. Jennifer Kakita, the
owner of Las Vegas Corporate Wellness, gives some pointers. “After you’ve made
the initial contact with a company, tour the facility,” she says. “Get an idea
of the work environment the employees endure on a daily basis so you can create
a program most suited for that environment. For example, if most employees are
at desks, you will need to include exercises and stretches with that in mind.
Then meet with your contact person to provide an outline of your tailored
program.”

Kakita also recommends making everything custom and “official.”
“Discuss the company’s budget needs and constraints and create a program to fit
those parameters,” she says. “It is very important to have a legal consultant
draw up a contract signed by both parties so that there is no dispute later on.
Also, be sure to have a waiver for every participant and a contract with any
independent subcontracted trainers who work on your behalf. Carefully choose an
insurance carrier who is going to cover a corporate wellness program, as some
insurance carriers require a separate policy.”

In addition to this practical advice, Kakita gives some
image-enhancing suggestions. “Get professionally created brochures and business
cards. And be persistent! It’s your job to show the company why they need your program and how it is
going to benefit them.”

Linda Freeman, who owns Guru Fitness in Green Bay, Wisconsin, has
been a subcontracted consultant to a variety of companies (for this type of
work you would report your earnings on a 1099 form) and has a few thoughts on
image, too. “The corporate world will expect an in-house wellness specialist to
possess professional skills of dressing, grooming, manners and the ability to
put together written materials with good grammar and punctuation.”

Add to Your Skill Set

If your resumé combines fitness and medical training, you will be in an excellent position to
deal with corporations. Patty Carothers, RN, MS (in sports medicine), has a
resumé that includes group fitness instructor and director, continuing
education credit provider and nurse care manager. Currently employed by Alere
Medical as a remote nurse-healthcare coach, Carothers works telephonically with
workers who are dealing with chronic diseases. “Our job is to keep utilization
costs down by keeping people out of the emergency room and out of the hospital.
In my experience, disease management companies are leaning toward wellness
programs for insured members. Just as we coach on chronic conditions and the
wellness aspects of each (i.e., smoking cessation, exercise, diet,
immunizations, body mass index information), companies are looking to expand
this coaching to nonchronic populations. I am seeing a trend toward insurance
companies using nurse-healthcare coaches such as myself to offer fitness
training, nutritional counseling and lifestyle coaching.”

Grace DeSimone, the national director of group fitness and
special projects for Plus One Holdings of New York City, agrees that a
combination of skills is an advantage when trying to work in corporate fitness.
“Someone wishing to get into this field should possess the ability to conduct
educational, motivational and coaching programs with groups,” she says. “That
person should also have a handle on chronic conditions, and how lifestyle can
positively impact those conditions. Another skill would be to look at
next-generation programming—people are looking for the tools and information
with which to educate their families and enhance their lives.”

On-Site Employment

What if you aren’t looking to start your
own business, yet want to be in the field of corporate wellness? In that case
you might consider becoming an employee at an already-established on-site
center. Corporate Fitness Works markets itself as a consulting and management
company that works with a variety of clients to create custom programs. Margie
Kidd is the senior health and wellness director for the on-site fitness center
at Clayton Homes. Based in Maryville, Tennessee, Kidd has been a direct
employee for about 3 years. She serves an employee base of more than 1,600
people and speaks with enthusiasm about the benefits of her job. “Our corporate
office is a tobacco-free campus with a restaurant that serves a 100% healthy
menu,” she says. “We offer group sports and classes, including 15-minute work
breaks throughout the day. We also offer assessments, sports training,
reimbursement for race and community intramural events, weekly wellness
luncheon seminars, health screenings, personal training, weight loss programs
and reduced-rate massages.”

Kidd says a corporate wellness center differs from its retail
cousin in that it can impact the employee’s entire
lifestyle. “With an on-site facility, many of the reasons that keep people from
exercising are eliminated, such as time, convenience and expense,” she says,
adding that the possibilities are very positive in nature. “More and more
companies [face] high healthcare costs and low productivity, and are turning to
fitness professionals to keep their employees healthy and happy. Some of them
are paying for employee memberships at local gyms, but an increasing number are
building their own facilities. This means there are opportunities for facility
managers, personal trainers, group fitness instructors, exercise physiologists,
nutritionists, massage therapists and even nurses.”

Make the Transition

“Go for it!”
That’s the advice Bill Sonnemaker, MS, founder and CEO of Catalyst Fitness in
Atlanta, Georgia, and 2007 IDEA Personal Trainer of the Year, offers to
professionals who want to join the corporate fitness world. “Many studies
suggest that 80% of the market is untapped, and I would venture to say that a
great majority is made up of workers who sit all day. You have a captive
audience!”

Sonnemaker says that “demonstrating need and benefit to upper
management” is one of the biggest hurdles to overcome. “You need to make sure
you are versed on the terminology and problems that businesses face, and
familiarize yourself with tax laws, legislation and incentives as they relate
to corporate wellness programs, ” he advises.

Even with the research and preparation time involved in getting
started, Sonnemaker believes that the right time to enter the field of
corporate wellness is now.
“At present there is little to no regulation, and individuals who are
knowledgeable, competent and possess good people skills will almost surely be
known as pioneers in this field,” he says. He recommends certification by an
accredited organization. “And a college degree would also be of benefit, especially
as the trend toward industry regulation continues. I believe that insurance
companies will start offering [benefits] only to individuals and companies who
meet a defined set of knowledge, skills and abilities.”

SIDEBAR: Government and Public Support

Currently, wellness benefits for employees who use an off-site fitness facility are taxed as additional income
while on-site use is not. Introduced several times, and most recently in the
110th Congress of 2007–2008, the Workforce Health Improvement Program
(WHIP) Act would “eliminate this inequity, allowing for the balanced tax
treatment of health club memberships as an employee benefit” (IHRSA 2007).
While it has yet to be passed, the WHIP Act (H.R. 1748/S.1038—lead sponsors
Rep. Zach Wamp and Sen. John Cornyn) has the support of 44 Democrats and 66
Republicans (at the time of publication) (IHRSA 2007).

Focusing on the medical angle,
Rep. Gerald Weller introduced the Personal Health Investment Today Act (H.R.
5479/245), which would amend the Internal Revenue Code to treat certain amounts
paid for exercise equipment and physical fitness programs as amounts paid for
medical care. Again, it has yet to pass even with bipartisan support, but it
has been referred to the House Committee on Ways and Means (GovTrack.us 2008).

A third bill (S.1753/H.R.
3717), which is strongly supported by Health Promotion Advocates (a 501c4
nonprofit organization created to integrate health promotion concepts into
national health policy and all aspects of society), would provide a tax credit
to employers for the costs of implementing wellness programs (NCPPA 2007).

SIDEBAR: The Hard Facts

The following facts and stats will help you make your case
when you create your PowerPoint presentation to market your services to target
companies.

  • There
    is a $1.3 trillion total impact on the economy from seven chronic
    diseases—cancer, diabetes, hypertension, stroke, heart disease, pulmonary
    conditions and mental illness. Of this amount, $1.1 trillion is attributed to
    lost productivity (DeVol et. al. 2007).
  • It
    is projected that by 2023 there will be a 42% increase in cases of the seven
    chronic diseases, which will cost $4.2 trillion in treatment and lost economic
    output (DeVol et. al. 2007).
  • Lowering
    the rates of obesity could produce productivity gains of $254 billion and avoid
    $60 billion in treatment expenditures annually (DeVol et. al. 2007).
  • In
    2004, the U.S. spent 85% of every healthcare dollar on people with chronic
    conditions (www.silverbook.org/fact/1334).
  • In
    2002, the U.S. spent 53% more per capita ($5,267) than the next highest
    country, Switzerland ($3,446), and 140% above the median industrialized country
    ($2,193) on health care, with comparable outcomes (Anderson et al. 2005).
  • Chronic
    diseases are responsible for 7 out of 10 deaths in the U.S. (PFCD 2007).
  • The
    economic toll of chronic disease for developing and developed nations around
    the world is estimated at approximately 3% of gross domestic product, globally
    (PricewaterhouseCoopers 2007).
  • The
    world now has more people who are overweight than people who are hungry
    (PricewaterhouseCoopers 2007).
  • According
    to the World Health Organization, the U.S. is the world’s fattest nation, with
    over half of adults overweight or obese. But China and India are growing fatter
    at a faster pace. By 2015, the number of overweight and obese adults in China
    and India will grow by 66% and 44%, respectively (PricewaterhouseCoopers 2007).
  • More
    than half of multinational corporations in a 2006 survey expect to introduce or
    expand corporate wellness programs over the next 5 years
    (PricewaterhouseCoopers 2007).
  • One-third
    of multinational corporations are rolling out comprehensive wellness programs
    in multiple countries, while another 17% are rolling out a single wellness
    program in multiple countries (PricewaterhouseCoopers 2007).
  • Presenteeism
    (days employees are at work but performing at less than full capacity because
    they are ill due to chronic disease) is increasingly viewed as an important
    contributor to employee health costs. The January 2008 Journal of Occupational and Environmental
    Medicine
    reports that workers with moderate to severe obesity
    annually cost $1,800 (about $500 higher than for other workers) in
    presenteeism, based on an hourly wage of $21 (Gates et al. 2008).
  • More
    than 60% of American adults don’t get the recommended amounts of physical
    activity, and the majority of the U.S. population has a poor diet (CDC 2002).
  • In
    2006, the average annual premium costs for insurance-covered workers were
    $4,242 for an individual, including both the worker and the employer
    contribution, and $11,480 for a family of four (KFF 2006).

SIDEBAR: Field Notes

There are many opportunities for those wishing to enter
corporate wellness that complement personal training and group instruction.
Here are some recommendations from those already in the field.

Engage
in Grassroots/Political Activism.
The International Health, Racquet
& Sportsclub Association (IHRSA) encourages fitness professionals to
advocate on behalf of healthy lifestyles; for example, by lobbying their
congressional and senatorial representatives to work for tax reform that will
encourage participation in wellness and fitness programs. To this end, IHRSA
(http://cms.ihrsa.org) has developed the Grassroots Initiative.

Develop
Your Public-Speaking and Coaching Skills.
If you can get up in front
of a group of people as an instructor, you can use this skill to make
presentations to business decision makers and offer workshops to groups of
employees.

Make
Phone Calls and Just Ask.
As Grace DeSimone, national director of
group fitness and special projects for Plus One Holdings of New York, says,
“Seventy percent of our business is managing facilities and/or staff on-site. I
would advise a person looking to work in this field to call me! We have
positions open from coast to coast.”

Add
to Your Skills.
Whether you are attracted to physical therapy,
lifestyle coaching, nutritional counseling, massage therapy, nursing,
chiropractic, disease management, family counseling, healthy cooking, marketing
and promotion or writing for a business audience, there are many ways you can
learn additional skills to make yourself appealing to a company.

Start Small and Focus on
Your Reputation.
Offer your services to a company that has just a few
employees, as it’s easier to see what does and doesn’t work and quickly make
adjustments. To gain experience, find a top-notch trainer in your area who has
experience working with companies and inquire about internship or mentoring
opportunities.

Alexandra Williams, MA, thinks of the three
Rs when writing about corporate wellness: Respect, Results and Revenue, and
hopes all three will come to everyone who pursues a career in helping companies
get healthier.

References

Anderson, G. 2007. Chronic conditions: Making the case
for ongoing care. Johns Hopkins Bloomberg School of Public Health.
www.fightchronicdisease.org; retrieved Jan.18, 2008.

Anderson, G., et al. 2005. U.S. still spends more on
health care than any other country. Health Affairs (July/Aug.). Johns Hopkins
Bloomberg School of Public Health.

Business Wire. 2007. Individuals who conduct regular
exercise achieve lower health care costs says new study by Medica and Life Time
Fitness. www.businesswire.com; retrieved Feb. 21, 2008.

Centers for Disease Control and Prevention (CDC). 2002.
HHS urges community partnerships to improve physical activity.
www.cdc.gov/od/oc/media/pressrel/r020501.htm; retrieved Feb. 21, 2008.

DeVol, R., et al., 2007. An unhealthy America: The
economic burden of chronic disease—charting a new course to save lives and
increase productivity and economic growth. Milken Institute.
www.milkeninstitute.org; retrieved Feb. 21, 2008.

Gates, D.M., et al. 2008. Obesity and presenteeism: The
impact of body mass index on workplace productivity. Journal of Occupational & Environmental Medicine, 50
(1), 39–45.

GovTrack.us. 2008. H.R. 245: Personal health investment
act of 2007. www.govtrack.us/congress/bill.xpd?bill=h110-245; retrieved Feb.
21. 2008.

International Health, Racquet and Sportsclub Association
(IHRSA). 2007. Workforce Health Improvement Program (WHIP) Act.
http://cms.ihrsa.org; retrieved Feb. 21, 2008.

Kaiser Family Foundation (KFF). 2006. Data spotlight.
www.kff.org/charts/012907.htm; retrieved Feb. 21, 2008.

National Coalition for Promoting Physical Activity
(NCPPA). 2007. The activity advocate: On the Hill.
www.ncppa.org/Activityadvocate.asp; retrieved Feb. 26, 2008.

Partnership to Fight Chronic Disease (PFCD). 2007. Milken
Institute study: Chronic disease costs U.S. economy more than $1 trillion
annually. www.fightchronicdisease.org; retrieved Jan. 17, 2008.

Powell, D.R. 1997. Implementing a self-care program:
Effect on employee health care utilization. AAOHN Journal, 45 (5).

PricewaterhouseCoopers. 2007. CEOs take on wellness as
corporate strategy; rising costs of chronic diseases hurting corporate profits
and productivity. www.pwc.com; retrieved Feb. 21, 2008.

U.S. Department of Health and Human Services (USDHHS).
2003. Prevention makes common “cents.” www.aspe.hhs.gov/health/prevention/;
retrieved Jan.19, 2008.