Gaining employee (and dependent plus retiree, where applicable) “ownership” – a strong commitment to and high levels of engagement in EHM efforts — is a key essential when it comes to optimizing results.  How many employees enroll, actively participate, and persist in both participation and behavior change, is the major factor in determining the size of cost reductions and productivity/performance improvements achieved, and thereby the return on investment realized.

Achieving total employee engagement is anything but simple.  It is affected by a wide range of factors, affecting employer and employees, themselves, and the kind of relationship existing between them.  The extent of employee trust in their employer, commitment to their job and getting results, confidence in successful results for themselves and their family, as well as the range of program offerings and incentives offered for participating in them will make big differences.  The following list of ideas offers some options.

1.  Choose a Good Name – the name workforce health management may have been a good one for consultants or suppliers to use when selling employers on the idea, but it is not a good one for the employer to use in selling the idea to employees.  They rarely like being “managed”, and may think they are being managed enough already.  Moreover, since it is their private information, and personal behavior that are involved, they may feel great concern about you even knowing about such things, much less managing them.

Successful program names should emphasize what the employees, themselves, will get out of participating.  “Healthy Living”, “Simple Steps to a Healthier Life”, and one of my favorites “Healthy Lifestyle Rewards” are good examples, but these and any others that might be imagined should be checked first for trademark infringement risks.  Representatives of employees in focus groups, or the entire workforce may also contribute ideas, perhaps in a contest to name the program, in order to create a sense of ownership and uniqueness up front.

2. Involve Employees Throughout – asking for and using, plus making sure employees know you are using their ideas on particulars of the strategy up front and regularly once begun is another good approach.  This can be especially helpful relative to sensitive issues such as information privacy and security, as well as any incentives planned.  Enabling employees to participate in decisions can save you from overlooking some key factors, or making big mistakes, as well as promoting their sense of ownership in the overall strategy.

3. Enable Choices – employees will almost always respond more positively and commit more enthusiastically to personal behavior changes if they have some choices about which and how.  Enabling them to choose their own program, if they are (as most will be) likely targets for more than one intervention.  Giving them a choice of incentives, and options for qualifying for these can be particularly helpful.  Blue Shield of California, for example, offered its employees a way to qualify for rewards by meeting any 8 out of 10 criteria.

4. Offer Incentives – though this adds to costs, it also adds significantly to participation, and it shows that you appreciate the value that employees’ health behavior changes can contribute to your bottom line, not merely to their own health and life quality.  Incentives have been shown to boost average participation from as low as 10-20% to as high as 80-90%.  Using a sharp pencil helps – to be sure the amount of incentive payments offered will not threaten the overall gains achieved, of course.  Consumer-Directed Health Plans with health spending accounts already owned by employees can offer significant incentives without adding to costs.  And they may give employees a sense of ownership with respect to their overall health and healthcare spending.

5. Recognize the Personal Gains Employees Achieve – this should add little to costs, but promoting employees’ and their families’ awareness and appreciation of how much they are gaining through participation can enhance both recruiting and retaining them in programs.  Offering a log or diary, plus charts of personal health and life quality — including personal financial gains, such as fewer lost days with less than full pay, savings from not buying cigarettes, etc. – is likely to stimulate more enthusiasm than reports of reduced labor costs or health insurance premiums for the employer.

6. Promote “Teamness” – if you already have a strong team culture, perhaps offering team-based performance evaluation and bonuses, or “flat” management structures, this will help by itself.  But promoting team competitions over pounds lost, miles walked, even incentives for team participation, can help as well.  Any recognition or rewards that fall at the team level will tend to promote both “peer pressure” on reluctant participants, and peer support to aid in overall achievements.  Logan Aluminum in West Virginia, for example, operates with a “team concept” culture that has helped it achieve significant improvements in employee health and operating costs.

7. Paying for Performance – can be the safest and most effective incentive for at least some employees, those who are most confident in their own ability to succeed in changing their behavior and health/risk status.  This is far safer, in terms of federal regulations, than is paying for participation, health behavior or status change, and can be geared directly to proven financial benefit.  It is also likely to be cheaper, since rewards are only paid after proven gains have been achieved.

8. Participate as Employer – if the employer shows its own commitment to employees’ health by making changes in working conditions that help promote health and productivity, that will show it is serious about it, and recognize that it is part of the solution vs. part of the problem.    The Jackson Kelly law firm, for example, modified employees’ workstations to be ergonomic, changed to indirect lighting and implemented a “white noise” program to calm its often hectic work environment. [C. Good “Wellness Matters” (Case Study) Wellness Councils of America 2005]

Visible championing of the EHM program and participation in it by the CEO and other executives, as well as managers and supervisors can promote similar responses in employees.  Mike Huckabee’s visible exercise efforts and loss of over 100 pounds provided a major stimulus in the “Healthy Arkansas” program for state employees and schoolteachers, for example.  Seeing executive take the stairs vs. elevators, choose healthy meals in the cafeteria, and otherwise clearly indicate support for the program can go a long way.

9. Share Gains with Employees – a pay-for-performance system, for example, can amount to an explicit “gainsharing” method for doing so.  Or you can offer explicit examples of sharing in gains when recruiting participants.  It may be safer, of course, to pay rewards unexpectedly after gains occur, in order to avoid disappointment among employees if gains are not as large as hoped.  The Jackson Kelly law firm, for example, once it learned that it got a 21% decrease in health insurance premium after years of double-digit increases, forgave the dependent share of premiums for three months as its way of sharing its gain.

10. Share the Firm with Employees – the ultimate example of employee ownership and gainsharing is illustrated at Cianbro Corp. in Pittsfield, Maine, where the formerly Ciancette-brothers-owned company became totally employee owned in 2004.  The firm’s “Healthy Lifestyle Program”, uses employee wellness teams to help design programs, and has 86% of eligible employees participating. Its annual premium increases have remained significantly lower than the industry average since it initiated its program, and it is one of few construction firms planning to actually add employees in 2008.

Any one or mix of these ten ideas should make a measurable difference in employers’ ability to attract and retain employees in the first place, as well as in recruiting and sustaining them as participants in workforce health management programs.  Clearly, each employer will have to consider the likely cost vs. benefits of each when choosing which and how many to try, but these ten offer at least a good place to begin considering ways to promote the success of EHM programs.