Wellness programs are a difficult task for benefit advisers. When working with large employers, clients are more demanding than ever for the most innovative and tailored approach possible. When working with small employers, there’s still the matter of convincing the client it’s worth the price. But when getting down to it and deciding which wellness plan to offer clients, advisers say the most important features are easy-to-use educational tools for employees, return-on-investment and overall program cost, according to findings from EBA’s first wellness survey.

The survey also found that working with a client to implement a wellness program is tough, with the biggest challenges being an overall wellness culture transformation, developing employee wellness engagement programs and ROI. This might be one of the reasons nearly 32% of survey respondents, don’t offer programs to their clients at all.

EBA heard from nearly 150 readers on the topic of wellness — two thirds of those surveyed are brokers, 19% identified as consultants and 14% said they have another role in the industry including third-party administrator or carrier representative.

EBA also asked advisers what vendors they work with. Given a list of companies compiled by the National Committee for Quality Assurance, the five most popular vendors EBA respondents use, in alphabetical order, are Cigna Behavioral Health, HumanaVitality, Interactive Health Solutions, OptumHealth Care Solutions and WebMD Health Services.

Most important features

The wellness survey asked what attributes make up a good wellness vendor’s plan. Survey respondents say the most important factor to their clients is an easy-to-use educational tool. Yet, more than half (54%) of those polled called it “somewhat” or “very” challenging to implement. Jamie Debenham, vice president of employee benefits at Brooker Insurance Agency in Strongsville, Ohio, agrees this is difficult. “Maybe because [the vendors and employers] try and bite off more of the apple all at once,” he says. “They try to educate around everything. In my perspective, a wellness program should be a work in progress and add programs over the years so you don’t overwhelm the employees.”

There’s a clear opportunity for advisers to counsel clients with the reasoning Debenham suggests, or work closely when selecting a vendor in the first place to mitigate the difficulty of educational programs, given the level of importance.

The second most important component of a wellness program, ROI, is one of the most challenging to implement with 76% of respondents saying it’s “somewhat” or “very” difficult or challenging. In fact, 41% alone called it “very” difficult.

The frustration is also evident when the survey asked readers to discuss any open-ended issue related to wellness. “My clients see the value, offer incentives, but I can’t see where they are feeling any ROI,” one respondent wrote. “Just the right thing to do. With health care costs rising so quickly, but ROI is difficult to measure in terms of dollars.”

Independent wellness consultant Bart Sheeler, who previously worked for wellness vendor Nurtur, defines ROI as “the end result of a successful program.” The simple version in determining that result is to make employees aware of their health and well-being status and then you’ll see improvement, according to Sheeler, adding that savings will come, but in time and only if the program is robust. “More important is to understand the culture of the company’s employees. What motivates them — is it incentives, team challenges, recognition?” he explains. “Find the right message that resonates with the employees.”

Overall wellness program budget and cost was the third most important component to benefit advisers. While likely a concern to all employers, smaller ones are more frugal, according to Tom Schuetz of Group Services Inc. in Davenport, Iowa.

He says it falls on the broker to show them where wellness can affordably fit in. “They think of it as an extra expense,” he says. “Part of our responsibility is to look at their full benefits spend and rethink how to implement wellness, like redirect funds from somewhere else.” They can come from a contribution change, modification to a consumer-driven health plan or conversion of some employer-sponsored benefits into voluntary benefits, he says as a few examples.

Following is a list of all of the components EBA readers ranked in the survey, in order of importance for their clients:

1. Easy-to-use wellness educational tools

2. Return-on-investment in the  wellness plan

3. Program budgeting and costs

4. Employee engagement in the program

5. Overall wellness culture transformation

6. Health coaching

Sheeler had a reaction to the list. “They want easy-to-use and they want ROI, but just as telling is what they didn’t have as much interest in, like understanding the wellness culture and employee wellness engagement,” Sheeler says. “There’s still a disconnect between understanding what’s required to run and sustain a successful wellness program and what’s expected as the outcome, like ROI.”

Top vendors

Of the 24 wellness vendors on NCQA’s list, Cigna Behavioral Health, HumanaVitality, Interactive Health Solutions, OptumHealth Care Solutions and WebMD Health Services rose to the top as the most commonly used in the survey audience. Sheeler says this list doesn’t surprise him because they’re some of the “top level” vendors out there.

Three of the five vendors are connected to a large insurance carrier, as Cigna and Humana’s names imply. OptumHealth Care Solutions is owned by UnitedHealthcare. This could be because wellness, while talked about by advisers as an option for all clients, is still predominantly used by larger employers, according to Sheeler and industry experts.

Sheeler says the distinction between a wellness vendor that’s run by an insurance carrier and one that’s independent is that the insurers tend to focus on wellness as a resource. In other words, an option to have on-hand for interested medical benefit groups. But, “all three of those carriers are providing excellent tools and resources for their member companies,” he notes.

He continues: “The biggest difference between the carrier-promoted programs and the third-party vendor-related programs are the management, counseling, the advising that goes on behind the scenes versus providing the resources … the third-party vendors get much more involved with the implementation and the strategy behind running a wellness program.” Anecdotally, he says that gap is closing a little bit, a trend to watch.

The tough part

It’s crucial to select the right vendor. Sheeler’s compiled the following list of 10 essential wellness program ingredients that brokers should look out for when selecting a vendor:

1. Online platform with a member portal

2. Accredited health risk assessment (HRA)

3. Individual risk reporting

4.Educational and goal-setting tools

5. Incentive design and management tools

6.Team challenges for employees

7. Activity and event tracking

8. Communication plan with leadership support

9. Administrative management dashboard

10. Group reporting to track progress

While knowing the vendors and key players in the space is important, “it’s more important to follow the recipe of necessary ingredients for a successful wellness program,” Sheeler says.

When rating the components of wellness programs, EBA survey respondents said the most challenging element was wellness culture transformation (84%), followed by ROI (76%), developing employee engagement programs (76%), wellness program cost (67%), creating educational tools (54%) and health coaching (47%). Even that last item on the list, health coaching, had nearly half of respondents saying it’s “somewhat” or “very” difficult.

Sheeler says a big reason for the challenge is that employers focus on the lower premiums when they should be focused on what well-being actually is — individual health improvement. He says it’s important for advisers to counsel clients that this is not a one-step solution, it’s a process. “Everyone wants to plug in a wellness program and push a button and get savings,” Sheeler continues. “You can’t skip the steps.”

Brooker Insurance Agency’s Debenham says he has wellness programs in place for many of his clients. He recently conducted a successful wellness vendor selection, alongside one client, that he recommends as a process other advisers should try — he sat down with them as they interviewed vendors. 

“We interviewed two or three different vendors and they decided to go with a more exercise-focused program,” he explains. “There was a particular vendor that offered a fitness and nutrition program. There was another that went with the more fully comprehensive wellness program, with biometric screenings and HRAs surrounding weight-loss. They went with the less traditional option of the fitness and nutrition program.”

While some advisers may think their clients prefer a single, solid recommendation on a vendor provided to them without the hassle of sitting through the interview process, Debenham says involving them in the selection is better because they truly get a taste for the options. “Yes, my job is to know the marketplace and bring them to my clients … yes, I know my clients well, but I say, ‘I’d rather have you see two or three of them and you can decide,’” he says.  Clients and their leaders could turn out to be more invested in the program when included in the selection, something Sheeler pointed out as a crucial factor in overall wellness success.

The hold-outs

In EBA’s wellness survey, nearly 32% of respondents say they aren’t working with any wellness vendor, or don’t know if their clients are working with a wellness vendor. While employer hesitancy to follow through on a program could be one reason this percentage is so high, Sheeler thinks it’s actually higher and he has a few ideas as to why.

“I think it’s even less brokers not doing wellness,” he says. “One reason is that the wellness business model is different and most brokers are not yet ready to roll up their sleeves and become wellness experts, maybe because you can’t make as much money on it as you can with your regular book of business?”

However, he says it’s important benefit advisers get to know the wellness realm not only as a value proposition to clients but also a “defensive play — another broker who understands this part of the business could come around any time and steal the client away.”

“I think there’s a tremendous opportunity for wellness at the small- and mid-sized level,” he says. “Now that the tools are available to offer programs, there’s an opportunity for brokers to work with their clients to improve overall health and well-being.”

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