Analysis: US trends in corporate healthcare

What happens in the US no longer waits ten years to cross the Atlantic and manifest itself as a surprising new trend in the 51st state.

Global business, global economics and global corporations have led to global ideas and global business practices. Trends in the US are reaching us ever faster and healthcare is no exception.

In the US, cost control is the accepted mantra with ever more inventive ideas being tried to control what, for US business, is a sizeable millstone around the necks of almost all corporations. At this point, we cannot just sit back, think fondly of the NHS and lurch towards “ostrich time”.

A survey from the US Duke University in December 2007 found that obesity is placing an increasingly heavy burden on workplace productivity and company finances. This in turn is fuelling the cost of workers compensation (the US equivalent of employers’ liability) claims and expanding the risk of traumatic workforce injuries. It found that obese workers filed twice as many compensation claims, lost 13 times more working time from work-related illness or injury than their slimmer co-workers and generated seven times the medical cost.

The traditional background to the picture is cost control via brokers and insurers and elaborate cost containment systems to enable employers to monitor their spend on drugs, hospitals, procedures etc in the hope of achieving better value for money.

But, and it truly is a big but, is this all that can be done? This fundamental question has been asked in the US with some results which will impact the UK.

The biggest change in US healthcare strategy for some time is the realisation that companies have a financial incentive in being proactive in encouraging their employees to change their behaviour and live a healthier life

The Willis EB Wellness Survey 2007 reported that “the expected return on investment is at least 3:1 in medical claims over a three-year period where a comprehensive wellness programme has been initiated. The return is much higher when savings from disability, absenteeism and presenteeism are included”‘

This fundamental shift from “people are our greatest asset” to “healthy people make healthy and profitable companies” has led to an array of initiatives both carrot and stick in nature.

Employers are gravitating towards initiatives which are aimed at increasing employee responsibility for their health and behaviour. This has become more of a consumer driven healthcare model. Employees are being expected to become more accepting of their individual responsibility for healthcare costs while employers are accepting their unique place in being able to influence their employees’ behaviours.

The effects of wellness have expanded into: healthcare and insurance plan design; communication; health initiatives; management responsibilities; and incentivisation.


From a pure cost containment point of view this has taken the form of involving the employees in the financial consequences of healthcare decisions. Where traditionally neither doctors nor patients have had much incentive to keep costs down, involving patients/consumers in the financial consequences of healthcare decisions is an increasingly popular and effective option for employees. Options being utilised include: higher excesses on health plans; discounted excesses on health plans where the employee is part of the company wellness initiative; flexible spending accounts; and specialist clinical reviews to validate treatment.


There is a general trend towards technology solutions as a way of advertising the benefits of wellness, reinforcing the change of culture within the business and creating the wellness brand awareness.

Branded web portals, online programmes, personal health records and personal fitness programmes are just some of components of the “wellness page” applicable to each individual aimed at increasing visibility. Brokers and specialist software houses are providing off the shelf co-sponsored and white label solutions.


Wellness programmes are becoming more focused as specific health improvement exercises rather than general fitness incentives such as gym membership, stop smoking campaigns, health fairs and healthy workplace food options.

The following options are becoming more widely available in addition to health coaching and disease management initiatives: cholesterol monitoring; blood pressure monitoring; diabetes and glucose monitoring; biometric screening; body mass index monitoring; colonoscopies; and mammograms.


For wellness in its broadest sense to work, the consumers must know what its aims are, must have a stake in its success and know the fundamentals of what is available under the programme.

Companies in the US are going one step further than this by rewriting company policies to articulate the culture of optimal employee health and reinforcing the message using management commitment.

Incentives are being extended beyond the consumer to the managers and supervisors as required goals in their performance reviews. Giving management a financial stake in the success of the initiative is seen as a driver to success and also ensures that data collection / result evaluation is built in to the procedures of the business.


Most employees need to be incentivised to engage in a wellness programme. Incentives are accepted as being perhaps the most important driver for success for any wellness initiative.

The 2007 Willis EB Wellness Survey 2007 found that incentives around lower excesses and lower employee healthcare contributions were the most effective form of encouragement. Points to earn prizes and store discounts were also highly regarded by the respondents.


The return on investment of good health management has been quantified and we are in the position where we can learn from our US cousins and start to get the message across to our clients that employee health matters.

Looking into 2009/10, I can see that early adopters of the US trends will, in the long run, have a happier and more profitable business.


Richard Reid is the founder of Pinnacle Proactive, Specialising in the Employee Assistance ProgramStress ManagementStaff Retention & Absenteeism. Take a Proactive Approach to Growing Your Organisation & its People. For more info visit


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