A Culture of Health

There's no easy cure for escalating healthcare costs, which one recent study predicts will climb another 9 percent this year. But some experts say creating a culture of health can make a difference and point to several corporate examples as proof. By Andrew R. McIlvaine You could be forgiven for feeling a twinge of envy at the lavish wellness center enjoyed by employees at the Mayo Clinic's Rochester, Minn., campus. The 115,000-square foot, five-story facility includes two swimming pools, a landscaped courtyard, acres of state-of-the-art exercise machines, yoga studios, workout rooms and even a demo kitchen where chefs show employees how to cook healthy, delicious meals. The Dan Abraham Healthy Living Center, as it's called, also has a large staff of experts on hand who conduct classes on stress reduction, swimming, pilates, yoga, strength training, nutrition and weight management, self-defense . . . the list goes on. Employees who wish to use the center pay a $27 monthly fee, but if they're frequent users, that fee is reduced to $17 per month, says Dr. Kerry Olsen, a professor at the Mayo Clinic's medical school and a member of its wellness executive committee, which helped plan and now oversees the four-year-old center. Mayo's facility didn't come cheap, of course. The organization spent north of $20 million building and equipping it. Yet it's still a relative bargain, says Olsen. When you consider that we spend $300 million annually on employee healthcare, we think it's a small investment, he says. A good portion of the cost was covered by a donation from a former Mayo patient named Daniel Abraham, founder of Slim-Fast Foods Co., for whom the center is named. He wanted to give something back to our employees in gratitude for the care he received, says Olsen. The center isn't intended to appeal just to your average gym rat. Instead, it's designed to lure people who don't ordinarily go to health clubs, says Olsen. Fifty percent of the people who've joined never belonged to a gym before, and 50 percent are overweight, he says. We're reaching out to the broad base of Mayo employees who look like the rest of the world -- who are struggling with the same issues of stress, weight and inactivity. Approximately 16,000 of the 30,000-plus people who work at Mayo Clinic-Rochester have become members so far, and the center has about 4,000 users per day, says Olsen. We understood that we can make the biggest impact on people's health by addressing lifestyle behavioral changes, he says. And with this center, I think we've hit a home run. Last year, the Mayo Clinic was one of

16 organizations to be awarded the Platinum Award for Best Employers for Healthy Lifestyles by the Washington-based National Business Group on Health. The award recognizes companies that the NBGH believes do a stellar job of promoting healthy work environments and encouraging employees to choose healthier lifestyles. Award-winners such as the Mayo Clinic may be bright spots amid what continues to be a somewhat grim scenario for healthcare costs and trends. According to Towers Watson's 16th annual healthcare-costs report, entitled Employer Survey on Purchasing Value in Health Care, employers are paying 36 percent more for healthcare than they did just five years ago, while the share paid by employees has grown by 45 percent over the same period. The short-term outlook for bringing these costs down doesn't look promising: Costs this year are expected to rise by 9 percent, according to PricewaterhouseCoopers. One of the great unknowns, of course, is the impact that the Patient Protection and Affordable Care Act will have. Supporters of the healthcare-reform law say it will start bringing costs into line by the middle of this decade, when its most far-reaching statutes go into effect. Opponents say it will only make things worse, driving costs up further still while increasing taxes and possibly leading to care-rationing. This is assuming, of course, that the law survives the constitutional challenges being brought against it in court by a number of state attorneys general and efforts by Congressional Republicans to repeal it. Amid all the wrangling, the destruction wrought by some of today's most deadly and expensive chronic conditions -- including cardiovascular disease, Type 2 diabetes and certain types of cancers -- continues to spread. According to the American Heart Association, the costs of cardiovascular disease -- including treatment and loss of productivity -- will exceed $1 trillion per year by 2030. Type 2 diabetes is expected to cost $500 billion per year by 2020. What's especially galling is that in many cases, these diseases are preventable. The workplace can be an excellent place to attack them. Consider research that finds the social networks formed at work -- formal and informal, online and face-to-face -- can play very important roles in influencing people's health behaviors. Harvard University's Dr. Nicholas Christakis and his associates discovered, for example, that if one worker at a small firm stops smoking, his or her colleagues have a 34 percent chance of quitting. They found that a person in a social network is

20 percent more likely to quit smoking if someone else in that network quits, even if the two don't know each other. Meanwhile, they found that a person's risk for obesity increases 37 percent if their spouse is obese, 40 percent if a sibling is obese and 57 percent if a friend is obese. Wellness programs, financial incentives and high-deductible health plans have long been touted as solutions for improving workforce health. But costs have continued to rise, and part of the problem is that too many companies take a scattershot approach to health promotion -- a tactic that fails to engage employees, says Dr. Ronald Loeppke, vice chairman of U.S. Preventive Medicine, a Jacksonville, Fla.-based healthcare-consulting firm. Health promotion needs to be part of a comprehensive, integrated business strategy -- you can't just be focused on the sickest

10 percent of employees, you also need to seriously engage the other 90 percent, because it's just as important to keep the healthy people healthy, he says. Creating a healthy workplace requires a culture of health, says Loeppke, in which company leaders are visibly engaged in the effort, healthcare providers and wellness vendors are aligned with the company's goals for health outcomes, proper incentives are in place to help motivate employees to live healthier and the message of health improvement permeates every corner of the workplace. Other experts concur with Loeppke about the importance of culture. In his book Zero Trends: Health as a Serious Economic Strategy, Dee Edington, a highly regarded expert on wellness and director of the University of Michigan's Health Management Research Center, writes We know that if individuals are to make a sustainable behavior change, they must be in an environment that supports that change. If someone changes a behavior and then returns to the same unhealthy environment that caused or aggravated the behavior, the chances are pretty good that they will return to their original behavior. What does a culture of health look like? As of now, there are no specific benchmarks for creating such an environment. However, a closer look at some of the NBGH's Platinum Award winners, which represent the cream of the crop from among the total of 66 companies honored last year, may offer the next-best thing. The winners exemplify what it means to have a culture of health, says LuAnn Heinen, who oversees the NBGH's Institute on Innovation in Workforce Well-being, which chooses the winners. What really distinguishes these companies is that they have a fully integ