We have known for decades that smoking is unhealthy. Every state in the union has some form of a smoking ban. So, offering a smoking cessation program for employees is a slam-dunk, right? Not exactly. Instead of asking when employers can add a smoking cessation (or any health-contingent) program, ask: should they?

What started with discounted gym memberships evolved into strategy discussions to decrease health care costs, improve productivity and reduce absences. Employers added health risk assessments, biometric screenings, disincentives and incentives to change unhealthy behavior.

Today, critics of wellness programs question the return on investment — the buzzword for most C-suite executives. But has the emphasis on ROI clouded the real issues contributing to the failure of employers’ wellness strategies? Has the pressure from increasing health care costs resulted in missed elements that are essential to launching a new program?

By looking at the strategy of adding a smoking cessation program, employers can discover key facets to consider before implementing any program.

Smoke and mirrors

Few human behaviors have produced clearer evidence of health risk than smoking. The Centers for Disease Control and Prevention report the adverse effects of cigarette smoking account for nearly one in five deaths in the U.S. each year. When comparing smokers to non-smokers, studies show smoking increases the risk for coronary heart disease, stroke, cancer and chronic lung disease.

For all the scientific evidence, employers still must factor in the human element, as well as a dose of reality, for the success of a smoking cessation or other health-contingent program. Employers need to take a hard look in the mirror.

Four key areas for consideration are 1) the employer’s intent, 2) the workplace culture, 3) communication, and 4) the employer’s definition of ROI.

The best place to start when considering a smoking cessation or other health-contingent program is an honest assessment of the intent behind implementation. Is the intent a cost-shifting strategy? Or is the action a true attempt at changing employees’ unhealthy behavior?

Understanding the employer’s intent helps pave the path for a better outcome. Potential results could include employee morale issues or retention and recruitment challenges. The employer should acknowledge that possibility and decide if the intent outweighs the outcome.

On the flip side, the response could be a positive one, manifested by greater employee appreciation. Effective communication can be instrumental in engineering a positive outcome. Communications is the foundation for success in health-contingent programs.

Employers should examine their communication capabilities before activating a new program. Are communication channels already in place? Would employers strain existing resources with the increased communication activity? Are other resources available?

Without necessary adjustments, extensive lead-time or the need for added communication channels could delay the program’s implementation.

An important synergy exists between the culture of the workplace, the employer’s intent and the way the employer communicates. If the employer rarely reaches out, employees are more prone to skepticism when introduced to a new smoking cessation or other health-contingent program — even when the employer has the best of intentions. Communicating regularly and with transparency is a critical component of acceptance.

Provide support

A workplace devoid of supportive leadership promotes an environment in which employees perceive change as an attack on front-line workers. Add something as personal as health behavior and resistance is likely. Employers need to develop strategy that is consistent with the workplace environment. If the culture fosters mistrust and suspicion, the program strategy will undoubtedly fail.

The final consideration is the employer’s definition of ROI. Are ROI expectations reasonable? Does the employer have established metrics for measurement? Executives or employers focused solely on ROI can contribute to unrealistic expectations. For example, an expectation of a decrease in medical claims in the first year of a program is one that is unlikely to materialize.

Employers need to establish metrics for measurement that are both specific and realistic. Instead of an ROI of decreased tobacco use, a possible metric could be a specific percentage of smokers reporting non-use of tobacco for seven days, then a higher specific percentage at 90 days.

With the right metrics, employee benefit advisers can empower their clients with better negotiating tools for renewals.

Employers and their advisers can have all the legal answers and mechanics for implementing a health-contingent program. However, all their plans can go up in smoke without considering the employer’s intent, the workplace culture, communication and the expected ROI. With a hard look in the mirror, employers can see what they need to encourage a healthier workforce. EBA

Taylor, CWPM, is director of health and productivity at Alliant Insurance Services in Newport Beach, Calif. Reach her at btaylor@alliantinsurance.com.

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