Fight for your employees’ health

Benefits Canada’s 2015 Healthy Outcomes Conference shows how employers can encourage healthy behaviours while containing costs

10 steps to improved health: lessons learned from Chronic disease prevention and rehabilitation

Some populations are healthier than others. Can Canadians change their basic health behaviours relating to diet, alcohol, smoking and physical activity?

Epidemiologists’ research has found that four unhealthy behaviours account for 80% of the chronic disease burden and mortality in Canada and around the world. But Canadians living with a range of chronic diseases can learn to improve their health with the following 10 steps.

1. Maintain a healthy weight

Think about process instead of outcome when thinking about weight, said Dr. Paul Oh, medical director and scientist, cardiovascular prevention and rehabilitation program, with the Toronto Rehabilitation Institute.

“If losing weight is based on the scale, sometimes, you feel like a failure.” You have to really focus on what it means to be healthy, he continued. “Fit trumps unfit no matter what your body weight.”

2. Lower your cholesterol

Drugs such as statins can be helpful by reducing the production of cholesterol in the liver and encouraging the transportation of LDL back from plaques in blood vessels and other depots, says Oh. You can significantly lower your cholesterol through a combination of lifestyle

3. Eat your fruit and veg daily

Try the DASH diet (Dietary Approaches to Stop Hypertension), which focuses on consuming more fish, fibre, nuts, seeds, fruits and vegetables. Studies show it can decrease blood pressure by as much as 11/6 millimetres of mercury (which is as effective as any medication).

“Diet is not about taking things away,” said Oh. “The Greek word diaita means a way of living, a way of life.”

4. Control your glucose levels

“If you have diabetes or not, normal glucose is the goal,” explained Oh. “That is the single goal for everybody.”

5. Lower your blood pressure

Having an arbitrary threshold for high blood pressure (usually 140/90) is helpful, but it could be doing us a disservice, he said. Some patients with high blood pressure may be able to avoid taking medications and simply lower their blood pressure through diet. A recommendation such as the DASH diet might be all they need, Oh added.

6. Limit alcohol

“If you don’t drink, don’t start,” said Oh. “And if you drink a lot, drink less.” A healthy amount of alcohol is one drink per day for women and two drinks per day for men.

7. Quit smoking

Don’t stop the campaigns to quit smoking, and make sure employers continue to offer smoking cessation programs, said Oh. If a person quits, his or her risk of cardiovascular disease decreases. And while some people may feel they’re too old to give up their cancer sticks, it’s never too late to quit, he added.

8. Manage stress

There’s a difference between stress and strain, explained Oh. Strain occurs when we take a stressor and repeat it over and over, making it real in our heads. “We all need stress,” he said. “Strain, we don’t need.” He advised developing ways to manage stress, such as breathing deeply for 30 seconds.

9. Get enough sleep

Sleep is a needed part of a healthy life, so make sure you’re getting about seven to eight hours a night. And, if you have sleep apnea, seek help, because it can elevate blood pressure and increase your risk of stroke, Oh added.

10. Get moving

Physical activity is one of the secrets to longevity, said Oh. “The fitter you are, the lower the risk of dying or developing heart disease.”

Just 1% of the world’s population behaves in a healthy way, he noted. But our actions make a difference. “Every day, health is a choice, and we can choose. Be part of that 1%.” changes and medication.

Creating a Culture of Health at Unilever Canada

Unilever’s Sustainable Living Plan includes a goal to help employees take action to improve their physical, mental and nutritional well-being.

“We want our employees healthy, happy and engaged at work and at home,” said Laura Murray, North American wellness and Canadian benefits manager with Unilever Canada.

The plan began in 2011. At that time, Unilever already had many good programs in place: a smoking cessation program, a fitness reimbursement program and a flexible working policy. However, they weren’t aligned under one program, which made it difficult for employees to find information and understand the focus, Murray explained.

So, in 2012, Unilever created a three-year campaign to help employees focus on their health. It started by making employees aware of their personal health, giving away $150 Visa gift cards to employees who completed a health risk assessment (HRA).

By the next year (2013), employees’ awareness had increased, and Unilever added more to the program. That year, employees got a $75 Visa gift card for completing the HRA and a further $75 discount on their medical plan rates if they also started at least one defined healthy action (e.g., get health coaching via phone or personal counselling through the employee assistance program).

By 2014, Unilever had shifted away from the initial gift card incentives. Employees had to complete the HRA and complete at least one healthy action. If they did, they received a $150 discount on their medical plan rates.

The company also started talking about healthy employees being part of its business model, Murray explained. “We recognize that focusing on your health not only benefits the employee individually but also better enables them to meet the demands placed on them every day and better positions us to meet our objectives. That resonated with the leadership as it wasn’t only about reducing costs, it tied directly to business growth.”

From 2012 to 2014, Unilever saw a decrease in the per person medical plan costs relating to their highest health risks, and annual medical plan increases have consistently been lower than the average 8% seen in the market. The HRA results also showed an improvement in employees’ risk factors.

This year, Unilever launched a sustainable high performance (SHP) training program in Canada and the U.S. The program teaches participants how to maintain their energy levels throughout the day and into their home lives. To date, almost 2,000 employees have received training. Unilever’s incentive program also moved to a web-based platform that allows employees to track their activities, nutrition and sleep, and create both individual and team health challenges.

Murray emphasized that a health and wellness plan isn’t going to happen overnight. “It takes time; you have to change slowly,” she said. “You also need leadership engagement, and the focus needs to be incorporated into the business rather than a stand-alone benefits initiative.”

Understanding chronic disease and patient assistance programs for plan members

Chronic diseases (such as rheumatoid arthritis) affect many Canadians, and the drugs to treat these conditions can be costly. Government programs don’t cover all drugs or costs, so employers—and, sometimes, employees—have to foot the bill.

That’s where patient assistance programs (PAPs) can help. These programs are administered via hospitals, health charity/ advocacy groups or pharmaceutical companies, and are funded by pharmaceutical companies.

The features of a PAP will vary by company and by drug within a specific company, explained Suzanne Lepage, a private health plan strategist. “They’re designed to meet patient needs or requirement of the disease or specific drug [e.g., if a drug requires a certain exam before and after taking the drug because of potential adverse events.] They fill in the gaps in the healthcare system.” However, a PAP usually includes the following:

  • Connecting the patient with treatment (e.g., co-pay assistance)
  • Direct patient support (e.g., online tools or training in person or by phone)
  • Risk management (e.g., if a new drug has potentially severe side effects, Health Canada may require the manufacturer to set up a risk mitigation program as a condition of approval) and compliance (based on Health Canada requirements)
  • Reimbursement support (e.g., co-ordinating reimbursement)
  • Medication administration support (e.g., home infusions, if the patient lives in a remote area)
  • Success support (e.g., patient coaching and medication adherence)
  • Medication administration (e.g., drug dispensing).

According to a 2012 BioAdvance Patient Survey, 86% of respondents with a PAP improved in their ability to work, and 58% said the program helped them miss fewer days of work.


Managing employee wellness in a unique corporate environment

Mountain Equipment Co-op (MEC) doesn’t have a wellness program—not in the traditional sense of the term, said Abbie Hodgson van Essen, the company’s compensation and benefits manager. What it does have is a really strong culture. “Wellness has [grown] and continues to grow organically,” she explained.

With an average employee age of 34 in the retail stores and 44 in the head office, employees at MEC are active and passionate about outdoor activities, “but not everyone is a mountain climber,” Hodgson van Essen added.

The corporate culture at MEC encourages thinking outside the box and homegrown employee initiatives. For example, the co-op originally had an interest-free computer loan program, but employees brought up the idea of adding some of the bigger outdoor items—such as bicycles and boats—to it. Last year, MEC gave out loans of $400 to $3,000 per loan to 164 employees—55 loans for computers, 99 for bikes and 13 for boats.

To create a similar culture, companies need to consider what their why is, said Hodgson van Essen.

  • Why do you do what you do?
  • What is your organization’s why?
  • Does your team’s why correspond to your organization’s?
  • Do you link what you are doing each day with your purpose and with your why?

She believes companies need to look at their initiatives and go back to their purpose. “If you’re not checking in on that constantly, you’re wasting your time,” she said. “Are you stepping forward, or are you spinning your wheels?”

A lot of the big goals generated by our why can feel too big or unattainable, said Hodgson van Essen, adding they need to be broken down into bite-sized goals.

One goal the co-op had was to reduce the duration of long-term and short-term disability and provide greater support to employees. “We wanted people back to active and productive work, happy and not off on leave,” she said. So MEC got involved in the claims and reminded everybody— the employer, insurer, physicians/healthcare providers and employees—about their responsibilities.

HR and the MEC management teams took action. “We educated, coached, and got and stayed involved in the claims,” says Hodgson van Essen. “We kept a connection with those employees who were on leave; we continued to remind everyone of their responsibilities in the process.”

The result? Disability and sick leave durations were reduced by approximately 30%.

One of MEC’s next goals is to support the sandwich generation—those caring for young children as well as aging parents—since the co-op is starting to see absences and requests around this. MEC is asking questions and learning about what the options could be, she said. “This issue is not going away tomorrow, and we want to learn about how we can best support our employees when they need it most.”


What an Employer Can Do to Maintain a Healthy, Productive Workforce and Manage Healthcare Costs
Stephen Loh, director, health solutions, Shoppers Drug Mart

With one in 12 Canadians living with diabetes, it’s prevalent in the workplace. How do you create a successful diabetes management program?

  • Help employees know their numbers (e.g., blood pressure, cholesterol).
  • Build an incentive or nudge to encourage participation.
  • Change the co-pay on diabetes drugs as a reward.
  • Determine the barriers to accessing diabetes medications and why adherence has been a problem.
  • Identify a champion.
  • Ensure a collaborative approach.

Challenging Workplace Perceptions
Adam Marsella, senior external affairs manager, Novo Nordisk

The medical community may recognize obesity as a chronic disease, but do employers and private benefits plans see it that way? Currently, only onequarter of private health plans in Canada cover anti-obesity medications. How do you overcome the barriers to managing obesity as a chronic disease?

  • Get rid of the stigma—obesity is a visible disease, so people are stigmatized.
  • Understand what leads to obesity.
  • Ensure employers are using the services they have to help employees (e.g., a registered dietician through the employee assistance program).
  • Make sure the workplace isn’t part of the problem (e.g., longer hours, shorter lunches, stress).

Challenges and Opportunities
Peter Gove, innovation leader, health management, Green Shield Canada

Studies show employers typically offer benefits plans to attract and retain employees and to reduce absenteeism and disability claims. But how do you integrate a benefits plan with a health program?

  • Don’t look at a health plan in isolation; incorporate absences and absence statistics.
  • Focus on the purely preventative aspects of the plan (e.g., a dental plan with preventative services covered at 100%) and communicate to employees the value of prevention.
  • Avoid the shotgun approach—target your employee population.


Mitigating obesity-related illness in the workplace

Sleep Country Canada wanted to help its employees eat right. In July 2012, the company approached its employee assistance program provider and came up with an online health risk assessment (HRA). The incentive for employees to do it was a $50 gift card and the chance to win an iPad. Twelve percent of employees participated.

The top risk factor the HRA identified was nutrition, followed by weight management and exercise, explained Heather Ricketts, national manager of employee and labour relations with Sleep Country.

“These are all changeable through lifestyle modification,” she said, so the risk could be managed with behaviour changes. Ricketts said the company knew about half of the employee population (once it was educated and the communication campaign was repeated a few times) was ready to make changes. The goal then was to get workers to eat healthy, reduce their alcohol intake, stop smoking and exercise more.

One of the reports generated from the company’s HRA indicated the level of participants’ readiness to change for specific lifestyle issues. “Our chart showed that more than half of our population was ready for change within the next six months,” Ricketts added.

To encourage those behaviour changes, Sleep Country created a Biggest Loser Challenge. The criteria to win was the combination of a loss of 10% of body weight and 18 pounds.

Employees who qualified could win the grand prize: a trip for two to the Caribbean without having to use vacation days. Second prize was an iPad, and third prize was $250 cash.

The challenge had 135 participants, losing a total of 899.27 pounds and 3.14% of their body weight. There were 11 employees who lost more than 10% of their body weight and more than 18 pounds. The challenge winner lost 33 pounds—her name was drawn from those 11 employees.

Employee testimonials were a big part of the communications to other employees, Ricketts explained. Many of the diet changes employees made carried over to their dependents at home.

She said employers need to get commitment from the leadership team for a health and wellness program, assess the company’s readiness to change, communicate to employees and provide incentives.


Improving engagement through employee wellness

Bruce Telecom began its wellness journey in 2011. That year, the Buffett National Wellness Survey found 72% of organizations offered wellness initiatives. However, in the Sanofi Healthcare Survey from the same year, only 23% of employees indicated their employers were promoting or providing wellness programming.

Looking at these statistics, Bruce Telecom wanted to make sure its employees were educated about wellness, said Jackie Arnold, HR manager with Bruce Telecom. “We wanted to ensure the ‘right’ programming so what we delivered was going to be a benefit to people and lead to better outcomes.”

The initiatives consisted of group programming (e.g., yoga and bootcamp classes, lunch and learns), a health risk assessment and one-on-one sessions with an on-site wellness consultant (on a voluntary basis, employees could talk to the consultant about losing weight, starting an exercise program, managing stress and other issues).

The company has also held some ad hoc events during work hours, such as a morning omelette bar and a crock-pot dinner, where employees paid $10 and made a healthy meal to take home for dinner that night.

To ensure employees were aware of the initiatives and engaged in participating, the company did a lot of outreach—for example, starting a private Facebook page to show the fun opportunities the wellness program provided and keep employees excited.

Employee engagement is important, said Arnold, because organizations with high engagement levels have lower absenteeism and turnover, fewer safety incidents, higher productivity and higher profitability.

The results of the program proved positive. From 2011 to 2014, there was a 1.08-day improvement in sick days, a 17.8% reduction in health claims per employee, a 10% reduction in drug claims per employee and an 8% increase in overall employee engagement. The total cost savings was $136,000.

“When you have productive employees, you’ll get the cost savings,” Arnold added.

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