Emma Upton is a research intern here at HERO (Spring 2021) and just finished her Senior year at NC State University studying nutrition with a minor in sports science. Emma has a strong passion for helping people, which is why HERO’s mission really stuck out to her. Her work with HERO focused on small and midsize business initiatives, which is why she was interested in writing a commentary around this topic. Aside from her internship with HERO, Emma is involved in many extracurriculars and was a university ambassador at NC State. In her down time, Emma enjoys spending time with friends and family and cooking healthy recipes.
Introduction
Health and well-being in the workplace should be a unified and universal goal for all employers. However, much of the research and recommendations on workplace health and well-being best practices are directed towards large organizations (≥5,000 employees). This is a problem if the goal is to improve the health and well-being of all employees in the workforce given that 99.9% of employees work for organizations with <1,000 employees.1
The aim of this commentary is to assess the discrepancies in health and well-being practices between small and large organizations.1In order to achieve this aim, data were explored from 1,301 unique organizations that completed the HERO Health and Well-being Best Practices Scorecard in Collaboration with Mercer© (HERO Scorecard) Version 4 between 6/23/2014 and 12/31/2020 and provided data on organization size. Organization size is used to group organizations into small (<500), medium (500 to <5,000), and large (5,000+) organizations for benchmarking purposes. Further, this commentary aimed to further breakdown the small organization category to evaluate differences in health and well-being practices between organizations of <50, 50 to <200 and 200 to 500 employees.
Discrepancies by Organization Size
The HERO Scorecard consists of 200 points and organizations that achieve a score of > 125 points are considered to be in the best practice category. Approximately 22% of completers of the HERO Scorecard rank in the best practice category, with the majority of these organizations being in the large size category.2 Further, there is an overall stepwise relationship found between organization size and total score, where the average scores for large, medium, and small organizations were 108, 93, and 74 respectively. Table 1 provides a comparison of section scores by industry size. While small organizations scored lower than medium and large organizations in all sections, the largest discrepancies were found in the programs and participation strategies sections where there was an 11-point difference between small and large organizations.
Table 1. Average Section Scores from Version 4 of the HERO Scorecard by Employer Size
| Section (# of Employees) (points possible) |
<500 (n=459) |
500 to <4999 (n=554) |
5000+ (n=290) |
| Strategic Planning (20 points) |
9 | 10 | 12 |
| Organizational and Cultural Support (50 points) |
22 | 23 | 25 |
| Programs (40 points) |
16 | 23 | 27 |
| Program Integration (16 points) |
3 | 5 | 6 |
| Participation Strategies (50 points) |
17 | 23 | 28 |
| Measurement and Evaluation (24 points) |
7 | 9 | 11 |
| Total Score (200 points) |
74 | 93 | 108 |
Diving Deeper into the Small Organizations
In an attempt to better understand the level at which these discrepancies arise, the small size category was further broken down into groups of <50, 50 to <200 and 200-500 employees. Table 2 provides a comparison of scores between organizations in these three size categories. A stepwise relationship was noted again when comparing the total scores, with an 11 point difference between organizations with <50 employees and organizations with 200-500 employees. Similar results were found when comparing the section scores for programs, program integration, and participation strategies between these size categories, with the greatest discrepancy seen in the programs section. However, similar scores across all size categories were found when comparing scores achieved in the strategic planning, organizational and cultural support, and measurement and evaluation sections.
Table 2. Average Scores among Small Organizations
| Section (# of Employees) (points possible) |
<50 (n=66) |
50 to <200 (n=166) |
200-500 (n=238) |
| Strategic Planning (20 points possible) |
9 | 9 | 9 |
| Organizational and Cultural Support (50 point possible) |
22 | 21 | 22 |
| Programs (40 points possible) |
11 | 17 | 17 |
| Program Integration (16 points possible) |
3 | 4 | 4 |
| Participation Strategies (50 points possible) |
14 | 17 | 18 |
| Measurement and Evaluation (24 points possible) |
6 | 7 | 7 |
| Total Score (200 points possible) |
64 | 75 | 77 |
As mentioned, organizations with <50 employees scored on average 6 points lower in the programs section than organizations with 200-500 employees. Table 3 shows the differences in responses between organizations of <50, 50 to <200, 200 to 500 employees for each question in the Programs section of the Scorecard.
Table 3. Program Comparison by Employee Size (<50, 50 to <200, 200-500)
| Section (# of Employees) | <50 (n=66)* |
50 to <200 (n=171) | 200 to 500 (n=238) |
Q16. Which of the following approaches do you use to assess the health of the individual/population?
|
None: 43.1%
1 approach: 15.4% 2 approaches: 20.0% 3 approaches: 13.8% 4 approaches: 4.6% 5 approaches: 3.1% 6 approaches: 0.0% |
None: 24%
1 approach: 18.7% 2 approaches: 21.1% 3 approaches: 16.4% 4 approaches: 12.3% 5 approaches: 7.0% 6 approaches: 0.6% |
None-22%
1 approach: 21.8% 2 approaches: 16.8% 3 approaches: 21.0% 4 approaches: 11.8% 5 approaches: 5.5% 6 approaches: 0.8% |
Q17. Does your organization promote biometric screenings in any of the following ways?
|
None: 59.1%
1 way: 34.8% 2 way: 3.0% 3 way: 3.0% |
None: 45.6%
1 way: 38.6% 2 way: 11.7% 3 way: 4.1% |
None: 36.1%
1 way: 40.8% 2 way: 15.5% 3 way: 7.6% |
| Q18. Do you have a referral and follow-up process for those individuals whose biometric screening results are out of the normal range? | Yes: 27.3%
No: 13.6% |
Yes: 33.9%
No: 19.3% |
Yes: 38.2%
No: 25.6% |
| Q19. Does your organization provide health behavior change programs that are offered to all individuals eligible for key elements of the health and well-being program, regardless of their health status? | Yes: 43.9%
No: 53.0% |
Yes: 62.6%
No: 36.3% |
Yes: 65.0%
No: 34.2% |
Q20: If yes, how are these health improvement programs delivered?
|
None: 56.1%
1: 15.2% 2: 18.2% 3: 6.1% 4: 4.5% |
None: 38.6%
1: 17.5% 2: 19.9% 3: 12.3% 4: 11.7% |
None: 35.7%
1: 16.4% 2: 20.2% 3: 14.7% 4: 13.0% |
Q21: Are any of the following features incorporated into one or more of these health improvement programs?
|
None: 68.2%
1: 13.6% 2: 9.1% 3: 9.1% |
None: 51.5%
1: 18.7% 2: 12.3% 3: 17.5% |
None: 47.9%
1: 16.8% 2: 15.5% 3: 19.7% |
| Q22: Does your organization offer any individually targeted lifestyle management services that allow for interactive communication between an individual and a health professional or expert system, whether through coaching, seminars, web-based classes or other forms of intervention? | Yes: 31.8%
No: 65.2% |
Yes: 54.4%
No: 45.6% |
Yes: 55.0%
No: 44.1% |
Q23.What types of interventions are provided by the targeted lifestyle management program(s)?
|
None: 69.7%
1: 7.6% 2: 12.1% 3: 3.0% 4: 4.5% 5: 1.5% 6: 1.5% |
None: 45.6%
1: 15.2% 2: 13.5% 3: 10.5% 4: 7.6% 5: 6.4% 6: 1.2% |
None: 45.4%
1: 11.8% 2: 16.4% 3: 9.2% 4: 6.7% 5: 5.5% 6: 5.0% |
Q24: Does your organization provide any of the following resources to support individuals in managing their overall health and well-being?
|
None: 34.8%
1: 18.2% 2: 16.7% 3: 15.2% 4: 4.5% 5: 0.0% 6: 3.0% |
None: 9.9%
1: 19.3% 2: 18.7% 3: 16.4% 4: 9.9% 5: 10.5% 6: 8.8% |
None: 6.7%
1: 17.6% 2: 20.6% 3: 18.1% 4: 12.6% 5: 13.9% 6: 4.6% |
Q25: Does your organization offer a disease management (DM) program — whether through the health plan or a specialty vendor — that addresses any of the following conditions?
|
None: 66.7%
1: 4.5% 2: 0.0% 3: 4.5% 4: 3.0% 5: 1.5% 6: 3.0% |
None: 39.8%
1: 1.2% 2: 4.1% 3: 2.9% 4: 2.9% 5: 5.3% 6: 6.4% |
None: 41.6%
1: 4.6% 2: 2.5% 3: 3.8% 4: 3.8% 5: 6.3% 6: 2.9% |
| Q26. Does your organization provide or use any electronic consumer tools to assist participants with managing their health data, utilizing their health resources or tracking benefits? | Yes: 37.9%
No: 56.1% |
Yes: 56.7%
No: 42.1% |
Yes: 54.6%
No: 44.1% |
Q28. Has your organization taken any of the following steps to manage employee disabilities?
|
No: 66.7%
1: 15.2% 2: 10.6% 3: 6.1% 4: 0.0% 5: 1.5% 6: 0.0% |
No: 33.9%
1: 18.7% 2: 17.5% 3: 15.8% 4: 5.8% 5: 3.5% 6: 1.2% |
No: 29.0%
1: 14.3% 2: 23.5% 3: 17.2% 4: 8.4% 5: 2.9% 6: 2.9% |
*Significantly different than 50 to <200 and 200 to 500 size organizations in all program questions
Additionally, when completers were asked subjectively how effective they thought their programs were, there was a stepwise relationship between the <50 group and the other groups, specifically for those who don’t offer health promotion programs. While there was a stepwise relationship in all the questions in the programs section, when asked subjectively how effective employers thought their programs were, there were smaller differences.
Opportunities to Improve Health and Well-Being in Small and Midsize Businesses
Given the discrepancy in scores between small and large organizations, guidance is needed on appropriate steps small organizations can take to benefit the health and well-being of their employees. Out of this need, HERO has launched a small and midsize business initiative that seeks to bring leaders and experts in this space together to explore how small to mid-size organizations can leverage available resources to advance health and well-being initiatives.
It is worth noting that the data presented here are from Version 4 of the HERO Scorecard. The recently released Version 5 of the HERO Scorecard includes many important changes to reduce potential penalization of small organizations. These changes included removal of questions, changing response options to existing questions, adding questions related to new and emerging practices, changing score distribution between sections, and using a capping method for several questions when scoring. Specifically, when it came to the scoring, points were moved towards the organizational and cultural support and strategic planning sections and were moved away from the programs and participation strategies sections. Further, the capping method was used on 10 questions. For questions that use this method, full points will be awarded when an organization indicates that a pre-selected number of practices from the question responses are being implemented. Using this method will hopefully enable small organizations to receive points for implementing best practices even if it is not feasible to offer/perform all practices.
While these changes may equal the playing field for organizations of varying sizes, further work is needed to explore appropriate recommendations to improve health and well-being initiatives of small and mid-size organizations, as the recommendations provided to large organizations may not be appropriate and/or feasible.
