This week Fred, Luis, and I review the Employee Wellness programs and the opportunity that the COVID19 pandemic has offered businesses and employers to re-think the employee health.
Our weekly question and answer session with Fred Goldstein, Dr. Luis Saldana, and Nick van Terheyden, MD on our COVID Insights to Action Discussion webinar that takes place live every Wednesday at 4pm ET You can register here. You can also find our training modules and services available to help businesses, education facilities, and employers get their employees, staff, customers, and students back to work and school safely in the context of COVID19
Raw Transcript
Fred Goldstein
Hello everyone, and welcome to this week’s COVID insights to action discussion group. I’m Fred Goldstein with accountable health and daily health. I’m joined here by our two esteemed physicians, Dr. Louis saadani and Dr. Nick van Terheyden. And this week, we’re going to be discussing the issue of employer wellness programs and get into what are they do they work as well as the issue of how does COVID potentially impact those, and what should people be considering? So, perhaps I’ll kick it off a little bit and maybe open up a little bit about wellness programs, then we can get into some of the ideas, Luis and Nick about how they might be impacted. So typically, you’ve seen these programs set up by employers to improve the health of their employees, it’s been an effort to go upstream and say, if we can keep our employees healthier, reduce their potential risks, we can go ahead and then obviously have a more productive workplace, happier and healthier employees, and also reduce our overall medical benefits spend. These programs typically include things like health risk appraisal to identify potential risks. Oftentimes, there are 11 biometrics, they’ll get some blood work, they’ll get some weight, they’ll get your height, your your blood pressure, etc, and use those to identify what you might be at risk for and what you might have. And then they typically have follow along programs such as things around exercise and diet, making sure you get your annual physicals and your flu shots, etc. So they’ve been around for a long time, there have been a lot of questions about whether or not and how they benefit organizations. But a vast majority of companies use some type of this program like this or have it supplied by their their health plan, whether that’s through an insurance company, or they’re self insured, and bring in some outside health plan or program to do this. So I guess perhaps start off maybe Luis, what are your general thoughts? As a physician, as you look at these things?
Luis Saldana
Well, I think, to put it in the context of the times we’re in now, really, the way I look at these type of programs is how can you reduce the negative impact of the workplace, on people’s health, that is the work that they’re doing that, you know, that the sitting is the new smoking, that type of, you know, that type of thing that comes from work, right, because that’s that that’s related to the, to the workplace in the workspace. So that was all turned upside down with COVID certainly, and that shifted everybody, folks that weren’t used to work at home, too, all of a sudden working from different locations and their offices. So that brings in all kinds of variables. And I think probably changes the game in terms of as we look at the landscape of these programs and what they need to offer and all that stuff. The other side of that and the other impact on that is the explosion of wearables and and you know, kind of the ability to, you know, just digital health in general digital health tools in general which would include telehealth, for mental, you know, for mental health for various different reasons, you know, you know, ideally should should should reduce the barrier to getting, you know, resources that you that you need for that. So it really may be a different kind of a menu of items, maybe what what would what these employers maybe offer in the future, but it’s I think it’s changing the game just based on COVID.
Nick van Terheyden
So I, you know, what this reminds me a lot of this the, the challenges that came alongside the Industrial Revolution. So, you know, we moved from localized activities into these highly concentrated factories, workers, all living in, you know, relatively poor housing, they sort of expanded in large amounts to provide sort of dormitory towns, and there was this big sort of change in the environment for the workplace. And what happened at the time was there was more disease more death more, you know, negative outcomes as a result of, you know, a number of impacts, and what that launched was a whole sort of public health approach to this, that took, you know, a broader look, tried to bring in some regulations and improved the overall setting and environment. And this feels very much like that, we’ve sort of been pushed into this environment where suddenly, you know, people are being put out into the home and you go, well, the home safe, not so much, I think we’ve we’ve got different sort of challenges, and we’re not, you know, reviewing it, we don’t have the sort of circumstance to go supervise, you know, impose, and also no real way of knowing how people are getting along, it’s very hard. I mean, one of the things that really struck me about zoom, I met somebody that I’d been zooming with for a long time, I discovered they were really tall, I have no idea, you think there’s always metrics, you just don’t get in this interaction. So I think there’s going to have to be, you know, a big change in the way that we approach this the virtualization of care and consideration. But I’ve got to call the end with channeling my Jerry Maguire here and say, Show me the data of this. So I think it’s really important. And you know, companies are going to say the same thing. They want to see the data that says, Well, this is valuable, you know, I introducing things. And my senses in talking to you, Fred, about this. You’ve seen a lot of this where not not so much, right. I mean, there’s I think there’s good intentions, as there often is, but it’s not coming out that way.
Fred Goldstein
Yeah, if you look at wellness programs, in general, or employee health improvement, in general, there have really been only two major random control trials of these programs run out of the group at Harvard. And they looked at I think one of the employer groups was in Iowa, the state employees or something, and actually had individually in other words with Costco individuals assigned randomly to groups to participate in these programs. And ultimately, they showed no return on investment. So there’s no financial savings associated with the program. And in fact, there was minimal changes to health behavior improvement. And it was only I believe, remember, right in two areas, and they were small. And so the question becomes, what you typically see with these programs, is they get to attract and they enroll those who are more likely to change, you’ve got selection bias right off the start. And so that’s why it’s fascinating. I think the other issue that you raised Luis, which is really an interesting one is you talked about workplace safety. And so did you, Nick from back in the days. And what COVID is, in essence done is sort of merged this concept of workplace safety and the health of my employees in the workplace with this idea of health improvement and a wellness program. And I think people are looking at that more one, how do you create that safe environment? And to how do we now provide these types of services in what’s probably a hybrid model? Many companies are putting their offices up for sale, they’re not going to bring everybody back. They’re going to do a two day back and two days away. And so you’ve got this issue that you raise, Nick, how do you know what’s going on out there? How do you help individuals? and Louis, you touched on the technology? I would just I was just reading an article. The University of Mississippi Medical Center has is one of the two centers of excellence for telehealth HHS centers of excellence in the country. They went from 12,000 to 131,000 telehealth visits last year, year to year. And they they were monitoring people with diabetes putting in things their home as you talked about. And so we’ve got this technological jump we know there’s been a huge jump is Nick you and I’ve talked About in the mental health arena, huge amounts of stress, anxiety, depression in the community, because of the disease, what it’s done, how it disjointed our abilities to communicate and, and relate to individuals. And and those are things I think that employers really need to look at is how do you overall look at? Yes, there’s the COVID issue, then there’s these broader issues that are raised by COVID and raised by how we now operate as a company. And how do you create those communications, those abilities to use technology to measure to try to get some result, as you’ve talked about, Nick?
Nick van Terheyden
Yeah, you know, I want to add one additional thing that I’ve seen, that sort of troubles me a little bit around this, which is, you know, there’s, there’s good intentions, you know, people have moved to virtual worlds and virtual engagement. But what I’ve seen a number of companies do is put in surveillance software that says, you know, how much time you’re spending on the keyboard, you know, are you engaged? And I’m troubled by that, because first of all, it puts a layer in, you know, has people concerned about this, they’re trying to play to it. And secondly, it’s sort of, I questioned the, the effectiveness of this, both from a work standpoint, but also from a health standpoint, you’ve now got that data, there’s a part of me, this is great, you can listen into people’s voices and start to detect that you know, that they’re unhappy. We’ve seen clear data that allows for that. But I’m really troubled by the idea that a company’s doing that in any form, and then maybe dressing it up as health or wellness, which, you know, for me, that isn’t. So there’s a really fine line here, because you’re not I don’t think the incentives are completely aligned is my, I guess, my underlying point?
Luis Saldana
Yeah, and I think I think a lot of what you’re saying making, it really lines up with what Fred talked about, with the return on investment, I think the focus on a lot of the digital health tools has been around measurement around getting data, think about sleep, you know, people monitoring their sleep, does that help your sleep? Not most people know, right, if you if your life, your measure your sleep, I was like, you’re gonna help yourself. So I think we’ve got where we were better at the measurement of an issue than the actual improvement of that issue. You know, I’m saying and, and so the wearables and all the other digital tools, move ahead on that side, without the inner intervention, what are the interventions to keep up with that monitoring piece of it? And I think that’s what’s really missing from the, you know, kind of these ROI things,
Fred Goldstein
you raise a fantastic question and point that I brought up numerous times, is, you want to intervene for something that’s an impactful risk, that you can do something about, you want to assess, and measure, something that you have a program for something that you can change, something, you know, is gonna make a difference. And a classic example of that is in genomics, we’re going to genetic tests, you know, give our employees or individuals go get a genetic test, well, you may get a genetic test that shows you a slightly higher risk for Parkinson’s. But what can you do about it other than stress out, potentially? And so as you talked about Nick, and Louise, have you created an environment that actually hinders what it is you’re trying to do? And so I think is, as we look at these things, we have to make sure we always keep that employee in the front and center of what it is we’re trying to do with the program. Because at the end of the day, they’ve got to feel comfortable in it, and be willing to participate. And if you’re just measuring crazy stuff, you’re going to end up with a bunch of people who said, I don’t want to do that.
Nick van Terheyden
It’s funny, you bring that up, Louis, about measuring because I you know, I’m terrible for that. I’m a quantified guy. I love measuring things. But yeah,
Fred Goldstein
my quantified self for to
Nick van Terheyden
thinking about that. And, you know, I’m pretty sure that I increased my blood pressure in the fact I couldn’t measure it all the time. So I think you’re exactly right.
Fred Goldstein
Yeah. And and so you know, when you think about this, especially from a COVID perspective, and given the touchy nature of mental brain health, as you like to refer to it, Nick, or mental health, behavioral health, and the amount of stress that individuals have, appropriately identifying, and appropriately intervening for that is a tough one. We are seeing some pretty good studies showing that, that behavioral health approaches done via telehealth are as effective as done face to face in many cases, as long as they’re using evidence based, you know, approaches cognitive behavioral therapy or things like that. And so I think that’s going to be something we’ll see more of, but the question becomes, how do you non intrusive Simply identify that within your employee population so that the individuals can reach out or know they should be reaching out for help.
Nick van Terheyden
I think it’s not just non intrusively, I think it’s with, you know, the genuine concern that this is for your benefit, it’s not just the my benefit, and let’s pick up on, you know, one of the points that you made at the beginning, which is, you know, this is going to improve product. If this is improving productivity, you’re just trying to squeeze more juice out of the the lime or lemon in this particular instance. And, you know, so it’s the alignment of incentives, that says, I really do care. And maybe one of the things that I get out of COVID here is that there’s been more of a pivot away from this sort of pure production kind of approach, we’ve seen some of the decrease in value in human factors, you know, we looked at who were our essential employees, I’m willing to bet that a year ago, not a single person would have ever said, supermarket employees, but boy, did they become, you know, essential workers, and, and they’re not on great wages. And, you know, they have some pretty rough environments. But I’m hoping in the same way that I saw a piece from the NIH Director saying, Please don’t let all of this scientific progress, go to waste, and say, Well, now we’re outside of the pandemic, you know, we just carry on as normal, this is our opportunity to really effect real change. And for me, the next steps around COVID are not well, that’s the pandemic over it’s what do we learn from that? What were the benefits of some of the things that we changed? And how can we start to think about our workforce who are not in offices, but are at home? And how we deliver better wellness, better working environments that, you know, support them? In? What is an increasingly challenging environment?
Fred Goldstein
Yeah, when you think about that, you know, also, so you have individuals who came to an office in certain places, no, Rei was building this beautiful office out in Seattle, you know, they had all kinds of outdoor spaces, and ultimately, they decided not to reopen it, but they were trying to create an environment that was conducive to their employees being happy and joyful and healthy. Are there things that employers may want to think about? For folks that are working in their home? Are there things that employers should supply them with? Right, consider, you know, it’s another thing to be sitting in your kitchen all day long, or like I am in the corner of this sunroom, you know, doing work all day in front of zoom. And so it’s a different environment that needs to be considered, you also raise this thing of essential workers. And I know, there was a fascinating study that just came out that showed there at 55% greater risk for getting in fact, right. And so they’re living with that every day. And whether whether they know it, because they see it amongst their peers and themselves, or they know it, because they’ve seen the data that is now in in a study and they study it that’s got to be a stressor, and tends to be individuals who don’t necessarily, you know, maybe from lower socio economic groups, etc, who have to get out and go work. And so how do we deal with that? I think it’s something that you have to look at your employer base, both from those that are away, and those that are there, and and consider both and ensure you have adequate resources.
Nick van Terheyden
Right. And, you know, what COVID did was amplified, that it sort of exposed, you know, much more of that we would never really considered it. So it is the sort of opportunity, the question is, how do you approach that with, you know, sensitivity to the challenges that come with this, you know, fine line between, you know, I’m squeezing the maximum productivity to genuine caring, and I think you do that, my view, I, you know, maybe a little bit of a personal view, but I really think you have to have independent support and advice in this. Having your HR department sort of involved. The challenges people’s credibility and my view, because it’s, whoever’s paying the fee as it were, is that’s where the focus of attention is. So having external advisors, and having people you know, for me, it’s like having a virtual health officer that really sort of provides that oversight and starts to give some credibility in the same way we saw With COVID-19, right?
Fred Goldstein
Yeah, exactly, I can give you a classic example of coming in as an outsider and looking at a program that was actually run at a university healthcare system. And I got a contact from the broker who said, Hey, they have an internal program to help their employees with diabetes. And they help manage those employees across their healthcare system. And they’re claiming that they saved a million dollars last year, the program is run by an internal department, literally. And I said, Send me the report. I’ll take a quick look at it that night, I reviewed it. And the next day, I wrote them a two page document that said, Here are all the reasons why that data you’re looking at is not correct. And they said, Oh, my gosh, Fred, would you be willing to get on a call with the department and our and their HR person and the broker and go through this. And by the time we finished the call, the the department had agreed that every point I had raised was correct. And the HR department literally cancelled an internal program, because it was not working. But they had presented data to show as if it was, and that’s why, as you said, bringing in somebody from the outside who can look at this with some expertise, whether it’s the medical expertise as a, as a fractional medical officer, that a lot of companies just can’t afford, or don’t, you know, don’t have the resources for that, or looking at the broader benefits package and programs themselves that are trying to intervene to help your employees. It’s really fascinating. And we’ve touched a little bit on this, Nick, this whole idea of incentives and penalties. And typically programs have an annual flu shot program. And they’re bringing the flu shots on site, and getting people to do them. And oftentimes, there’s an incentive associated with it. Obviously, in a healthcare system, it may be a little different, because they may mandate that flu vaccine for their employees or clinical employees, etc. But for normal employer, you’re not but we are hearing this idea of do we mandate the vaccine? Do we incent the vaccine? What are your thoughts on that?
Nick van Terheyden
Yeah, so I have to tread lightly here. You know, I have, I think I’ve been very clear, in in all the channels that I talk in the, you know, my confidence in the science, in the process of developing the vaccines that, you know, certainly occurred in an accelerated form, but the history and all of the research and people that have contributed to this is vastly in excess of anything you consider nine months, 12 months, whatever you want to think it’s more like a 15 to 20 year contribution to get us to where we all and even longer than that with some of these other vaccines that use traditional or more classical platforms for vaccination. And I have said repeatedly, you know, utmost confidence, in fact, I’ve been fortunate to get the first two doses, and in fact, in my family almost across the board, that said, you know, I’m deeply respectful of the country that I am a, essentially a visitor, or I’m not sure how to classify them, I’m not not born here. You know, and that seems to be a really strong defining element. And one of the things that’s attractive about is, is that freedom of choice, you know, the lack of imposition, you know, we have a bill of rights. And, you know, that sort of drives a lot of the behavior and you know, that part of the innovation that takes place here, so compelling people to do things, is a big step here. And there’s not a lot of places we do, I mean, you know, we compel people to go below 70 miles an hour on, you know, most of the roads, I think, maybe that’s 75 in some places, but, you know, so there are some laws, but forcing people to do things or take things is, you know, a real challenge. So with all that said, You know, I think we need as many people as possible to be resistant to the COVID-19. All the source code the to virus, that causes covid, 19. To get to that point, you, you essentially have two basic options, you either get infected with it. And I can tell you, that is a really bad idea you don’t want that doesn’t matter how old how young you are, everything we know suggests that that’s not a disease that you want to get. Even for the people that are lucky and have no symptoms. We’re seeing some troubling data about long COVID especially in the younger generation. So you’re either unlucky and you get it or you get vaccinated. Those are essentially the two choices. Well, to get to whatever Have a level we require, that gives us essentially, it diminishes the instance and we stop seeing this disease requires a relatively large percentage of the population. And if they’re not going to get it, then vaccination is the only other challenge. So we have to do everything we can to encourage it. I know you’ve talked about this, Fred, where there is opportunities to incentivize. So I’ve seen paying people, you know, additional vacation, certainly making it available, I think it’s, it’s certainly there’s no cost, but making it available, making time available for people that struggle to get time, I would say even transportation, one of the things I saw was pop up capabilities, because you know, great, I have a car, not everybody does, you know, public transportation and so forth. And then the other thing that I think is essential in this is to address the resistance in a, you know, calm, you know, factual basis. So, why are people resistant? But I would start with the basic question that I have with all folks in this sort of areas, what you to get the vaccine, that would probably be the most important question at the outset? Or what will persuade you that it’s safe enough that, you know, we’d encourage you to get it. But I think incentives are really the main course of action. And one final thing to say is, it’s very hard, if not impossible to say you must have something that hasn’t been formally approved. It has what’s you know, everybody’s now knows the term EU a and emergency use authorization. That’s not formal approval. for general use, it’s an emergency use authorization, and at some point, it will move to, you know, full authorization, but we’re not there so compelling people to take something that’s only been emergency authorized, probably a little bit challenging. What do you think?
Fred Goldstein
I think you’re right on target, I think it’s really about incentives, mandating it as a mistake. And so what we’re seeing is you talked about is, you’ve got this idea of a lot of companies a couple hours off of do it pay bonuses, or you get a vaccine, we’ll give you 50 bucks, $100, one of the hospitals is a bonus of $500. So I think those are really good ideas to help people, you see Israel with its green pass, that lets you go into places and I think you’re gonna see more of that, you know, you want to go to the basketball game or to cheerleading competition, or whatever it might be, you know, show that you’ve got a vaccine may be a great way to incent other individuals. And you raised a fantastic point, Nick. And that is, one of the ways you may best help your employees is to understand those specific instances like transportation, when maybe they can’t get there. And you’re seeing this all over the country, where certain individuals are scurrying into places that are in, you know, in lower socio economic group communities where they’ve set up these vaccination sites. And they’re running in there from some other place 4050 miles away, to get vaccinated, because the individuals within that community don’t have a means to get to the site. So we as employers should be considering, can I help them get there? Do I need to help arrange something for them as a way to help your own employees get vaccinated, it’s a critical issue. And I’ve seen that happening around the country, unfortunately, we really need to look at this from an equity approach, and find the best ways. And I know I was watching that one video we talked about, or a news story out in California, where they set up a big FEMA site, or National Guard site, and they were walking the streets. And it goes back to my old Community Health days with my disease management company with on the ground nurses and coordinators, and they were out in the community. And that’s what we need to do. We need to take the take the health to the folks, so they don’t necessarily have to try to figure out some way to get there.
Nick van Terheyden
Yeah, I think that’s a great point. So you it’s, it’s about having the resource inside that thinks that way. Not everybody thinks that way. don’t always see things through the same lens, and then having the adaptability and the experience that you can then apply that says, hey, these are some of the things that you can do that are supportive, that, you know, will allow folks to get to those places and be able to access the resources that have been provided. I mean, I think the great news is let’s be clear. You know, even a few weeks ago, we certainly wouldn’t have been talking this way because there was a challenge. the accessibility of this vaccine has been somewhat limited. We didn’t have enough of the resource. And it’s clear we have resource I’ve seen it open up in another States they’ve dropped the age, you know, I think wide open, you know, somewhere in the April timeframe possibly May. That’s incredible. I mean, it really is we are in good shape. And we want as many people as possible to be accessing and getting that vaccination. I’m feeling good about it not feeling compelled, but actually wanting to get in line. Again, the good news I’ve seen is that we’ve seen more, and even the outgoing administration has come out and said clearly, well, not clearly, but they have said and should get, or you should feel, you know, appropriately empowered to go get that vaccination. That’s incredibly important. There’s a whole segment of the population that pays tremendous attention to those leaders. And we have to recognize that and acknowledge that they need to hear it from their leaders, to feel confident we all like to belong to tribes, right and seeing our tribes say, this is a good thing. I think it’s helpful. Absolutely.
Fred Goldstein
What we’ve come up on the top of the half hour again, another great session, Nick, unfortunately, Dr. Sol donya had to drop off. But we’ll be back again next week with another COVID insights to action discussion group. We should have the ideas out where we talk about next week, and if you have any thoughts or comments, please feel free to share them with us. We thank you so much for joining us and hope you have a wonderful rest of your week.
