Worksite Wellness and Maine's 10 Elements of Essential Public Health Services at the Local Level
By William McPeck, MSW, CWWPC, Chairman, Maine Council for Worksite Wellness
Introduction
As part of Maine's effort to promote and develop a local public health infrastructure and system, Maine State Government has divided the state into 8 public health districts. Each district, through a District Coordinating Council (DCC), is charged with developing a district wide public health plan. The DCC is also responsible for coordinating the development and implementation of public health services within the district. Select members from each DCC serve as the core membership of a Statewide Coordinating Council (SWCC) which serves as an advisory body to the Maine Center for Disease Control and Prevention within the Maine Department of Health and Human Services.
It is interesting to note that when this framework was set-up by the Public Health Workgroup, employers were not viewed as potential stakeholders in the process. Employers were not listed as possible members of either the SWCC or a DCC despite the significant impact an employer can have on the public health of a local community. To help guide the development of the local public health infrastructure and services, Maine CDC is directing the DCCs to follow the National Association of County and City Health Officials' 10 Elements of Essential Public Health Services at the Local Level. When I first reviewed these services, I was struck by how similar they were to the elements found in successful worksite wellness programs. This white paper will identify each of the 10 essential services and then examine how employer sponsored worksite wellness program elements relate to that service.
Essential Service #1: Monitor Health Status to Identify Community Health Problems. Employers monitor employee health status in several ways:
* OSHA requires employers who have employees in certain types of jobs or who perform certain duties to establish, for those employees, a medical surveillance program.
* Large and medium size employers can analyze their health, disability and workers'compensation data as a way of monitoring employee health status and to identify health related problem areas.
* Use of a health risk assessment (HRA) tool has become a standard feature in employer sponsored worksite wellness programs. Having employees complete an HRA allows the employer, at an aggregate level, to identify health risks and problems within their employee population. The employer can stratify the aggregated risk data for the employees in the same way a community can stratify the community's health risks.
This service also addresses the identification of community assets that support the local public health system, along with the establishment and use of population health registries. As part of the worksite wellness planning and design process, employers can identify both internal and external resources that might be utilized within their wellness program. Employers who are fully insured or self-insured often have access to a disease management (DM) program. Today, DM programs are often part of a standard offer from health insurance companies. Disease registries are often utilized by health insurers as part of their DM programs. In addition, employers pursuing value based purchasing and health care quality based initiatives may require participating health care providers to maintain disease registries.
Essential Service #2: Diagnose and Investigate Health Problems and Health Hazards in the Community.
This service relates to screenings and epidemiological investigations to identify patterns of diseases and injuries, as well as environmental hazards and other threats. Data collection and analysis are standard components in today's planning and design processes for successful worksite wellness programs. Employer focused data sources routinely considered include:
* Health claim utilization reports
* Employee Assistance Program (EAP)utilization reports
* Disability claims data * Workers' compensation data
* Sick time, paid and unpaid time off
* Productivity/performance data
* Employee interest surveys
Employers frequently review their injury data as part of their safety program. Environmental hazards and health hazards are also examined as part of an employer’s environmental health and safety program. Either as part of their health risk assessment (HRA) process or as a stand alone service, many employers offer their employees’ worksite based biometric screening programs. These screenings generally include height, weight, BMI (body mass index), cholesterol and blood sugar levels.
Essential Service #3: Inform, Educate and Empower Individuals and Communities about Health.
This service is about health information, health education and health promotion activities designed to reduce health risk and to promote better health. The core of a worksite wellness program today is about informing, educating and empowering individuals to reduce their health risks and to promote better health. Many programs are also empowering employees to value consumerism and quality through the adoption of consumer directed health plans and value based purchasing.
Health education and health promotion specialists were key in getting today's worksite wellness efforts underway. Employers routinely offer awareness, education and behavior/lifestyle change programs in an effort to inform and educate employees and their dependents. As the costs associated with healthcare continue to rise, employers are seeking to empower employees to be better healthcare consumers through the adoption of consumer directed health care benefits, quality and value based purchasing initiatives.
Essential Service #4: Mobilize Community Partnerships to Identify and Solve Health Problems.
This service includes identifying potential stakeholders who can contribute to or benefit from public health initiatives, building new and working with existing coalitions and commencing and facilitating partnerships and strategic alliances. Just as in a community health initiative, worksite wellness initiatives need to identify who the program's stakeholders will be. Will it be all health plan members, just employees, just high risk employees or some other sub-group of employees?
Employers provide support to community groups and coalitions through either active participation, financial support or both. Worksite wellness coordinators often form coalitions or councils to support their efforts. Currently, a statewide worksite wellness council and four regional worksite wellness councils exist in Maine. Networking, resource sharing and professional development are the core functions of a worksite wellness council. Since many worksite wellness programs operate on a shoestring budget, if any budget at all, partnerships and strategic alliances become critical.
Significant numbers of worksite wellness initiatives are conducted in partnership with the employer’s insurance carrier. Worksite wellness programs also engage in strategic partnerships with community based non-profit organizations, especially for the delivery of educational programming at the worksite. Employers also help to sponsor many community events related to the social and economic conditions associated with long term health.
Essential Service #5: Develop Policies and Plans that Support Individual and Community Health Efforts.
This service includes the development of policies and systematic community level planning for health empowerment and public health emergency response. Policy development and systematic planning are essential components of a successful worksite wellness program. Best practice models include the development of an annual wellness program operating plan. This plan provides the program’s roadmap for the year, and also serves as the standard against which progress is measured. Have the goals set in the plan been achieved? If not, why not? Employers establish various types of policies, including wellness related policies which may include: policies regarding the use of flextime, smoking, vending machine contents and the provision of food at meetings and company events.
Essential Service #6: Enforce Laws and Regulations that Protect Health and Ensure Safety. While employers obviously do not enforce laws and regulations, they do enforce their own policies and the provisions of any negotiated collective bargaining agreements.
Essential Service #7: Link People to Needed Personal Health Services and Assure the Provision of Health Care When Otherwise Unavailable.
It would not be unusual for an employer's HR representative to assist or advocate for an employee on a health benefits related issue. Today, often due to availability/access issues, an increasing number of large employers are establishing their own on-site health clinics to assist employees with preventive, acute care and chronic disease management issues.
Essential Service #8: Assure a Competent Public and Personal Health Care Workforce. Just as in the public sector, it is in an employer's best interest to assure that it has a healthy and competent workforce. Many employers have internal training and development units. Employers too small to sustain their own training unit have an abundance of community resources to draw upon. While a national standard for worksite wellness coordinators does not currently exist, the number of certification type programs for worksite wellness coordinators is on the rise. When hiring a worksite wellness coordinator, employers can also look for certification from either the American College of Sports Medicine (ACSM) or a CHES (Certified Health Education Specialist) designation or eligibility.
Opportunities for continuing education in worksite wellness continue to rise as well. More and more conferences are being held that specifically focus on worksite wellness or they devote a significant portion of their agenda to topics related to worksite wellness. As worksite wellness programs transition from the traditional programs of the past to the employee health and productivity programs of the future, greater attention is being paid to the issue of program quality. Today, we are seeing more and more programs that are results driven, as opposed to being activity driven. Thanks to the marvels of today’s technology, employers can get their worksite wellness coordinators initially trained and keep them up to date through distance learning and virtual community type opportunities.
Formal degree and certificate programs in worksite wellness are available via the Internet's World-Wide-Web. Worksite wellness coordinator continuing education is also available via Webinar and teleseminar. Since wellness coordinators can and do learn from each other, a number of Web sites and listservs exist where coordinators can meet and share their needs, wants, successes and failures.
Essential Service #9: Evaluate Effectiveness, Accessibility and Quality of Personal and Population Based Health Services.
Program evaluation is also a core component in today’s successful worksite wellness programs. Worksite wellness coordinators are taught to incorporate evaluation strategies into all levels of their program design. Worksite wellness evaluation strategies generally encompass four areas:
* Financial results such as ROI, VOI and cost benefit
* Performance and outcome results
* Program results such as outputs and impact
* Cultural results including climate and cultural changes
Essential Service #10: Research for New Insights and Innovative Solutions to Health Problems.
Employers are no strangers when it comes to participating in research. Much like the other areas of business management and operation, worksite wellness has been the subject of extensive research as well. Much of this research has been carried out by academic institutions of higher learning. Historically, most of the research has been conducted with large employers.
As larger numbers of small employers enter the worksite wellness arena, a new line of research will open up which focuses on the small employer. Initial research efforts will examine the applicability of current research strategies, methodologies and measures to the small business. Once researchers are satisfied with their small business research strategies, methodologies and measures, new research efforts will begin to examine all aspects of wellness within the small business community.
William McPeck, MSW, is currently Director of Employee Health and Safety for Maine State Government. Nationally certified as a Worksite Wellness Program Consultant, Work-Life Professional, Holistic Stress Management Trainer, Wellness Inventory Coach and Retirement Preparation Coach, Bill also serves as a Mentor Coach for the Wellness Team Coaches of Wellness Strategies, LLC a New England based employee wellness consulting firm. Bill’s personal Website is www.williamcmcpeck.com and his employee wellness blog is www.squidoo.com/employeehealthandwellness.
