HERO Scorecard International Benchmark Report: Focus on Puerto Rico

The international version of the HERO Health and Well-being Best Practices Scorecard in Collaboration with Mercer© (International HERO Scorecard) helps employers learn about best practices that advance workplace health and well-being and determine the extent to which their programs incorporate these best practices. The International HERO Scorecard is intended for use in any country and benchmark data are provided for countries from which at least 20 responses have been collected. This commentary is based on benchmark data from Puerto Rico, a US Commonwealth, and insights from Barbara Carbonell Burgos (a health management senior associate for Marsh Saldaña serving employers in Puerto Rico) and Dr. Diego Ramirez (Health Management LAC Regional Leader at Mercer Marsh Benefits).

Like many US employers, companies based in the US Commonwealth of Puerto Rico invest in workplace wellness initiatives for several reasons. Rising healthcare costs are a significant concern, particularly since Puerto Rico has been experiencing a significant loss of its younger citizens due to migration from the island to the US mainland, lower birth rates, and higher mortality rates.1 This more than decade-long trend has accelerated the average age of the Puerto Rican workforce resulting in a higher concentration of health risks and chronic conditions. There is also a desire to offer health and wellness services as part of a comprehensive set of benefits to attract and retain skilled workers. Employers in Puerto Rico recognize the need to support preventive strategies and health promoting behaviors and rely heavily on health insurance providers for health education and awareness raising activities.

The International HERO Scorecard is useful to employers in Puerto Rico because it reinforces the need to use a more strategic approach and to more effectively engage leaders in supporting health and well-being (HWB) initiatives. It is currently being used as an awareness raising tool to help employers identify new ways to support their HWB efforts. Initial benchmarking data emerging from Puerto Rico indicates early adopters of the International HERO Scorecard may not be representative of the practices of all employers in Puerto Rico. Companies included in the Puerto Rico benchmark represent organizations from some of the highest paying industries including manufacturing (35%), financial services (15%), hospitals and clinics (5%), technical/professional services (15%), among others (15%). This differs from labor statistics indicating the largest industries in Puerto Rico are elementary & secondary schools (8%), restaurant/food services (7%), and hospitals (6%).2 Organization size ranges from 20 to almost 700 employees, representing predominantly non-union (95%) employees with an average age of 42 years and 57% male.

Only 45% of companies from Puerto Rico responding to the International Scorecard say they have a written strategic plan for their HWB initiatives, and most written objectives focus on participation in programs (78%) or employee satisfaction/morale (67%). Since most employers in Puerto Rico invest in HWB initiatives to address health care costs or to attract and retain employees, it makes sense that the most commonly used data sources informing strategic planning are medical/pharmacy claims (50%) and employee satisfaction/morale (50%). Absence data (45%) is another leading data source informing strategic planning, but only 33% of companies with a strategic plan include written objectives for reductions in absenteeism. When it comes to using data for measuring and evaluating their HWB initiatives, companies primarily rely on employee morale/engagement (55%), healthcare utilization/cost (40%), and absence (25%) data. These are the same data sources most commonly used in strategic planning, indicating alignment between written objectives and evaluation activities.

When it comes to providing organizational and cultural support for workforce HWB, the strongest practices include providing policies that support behavioral or mental health (75%) and a tobacco free work environment (75%). Built environmental supports are largely focused on safety (75%), which aligns with employer use of absence data to inform their strategic plans. The majority of companies report only modest leadership support for HWB, with 40% reporting they have none of the leadership supports assessed on the HERO Scorecard. Additonally, 55% of companies say they do not involve employees or get their input to guide their HWB offerings.

Most companies in Puerto Rico are likely to leverage their health plans to provide HWB services to their employees. The most frequently reported programmatic offerings include Employee Assistance Program (80%), targeted programs to support chronic condition management (70%), onsite or near-site medical clinic (40%), and legal/financial management assistance (40%).

Although participation goals are one of the most commonly reported objectives in strategic plans for the organizations that have them, most of the participation strategies recommended to employers are not being implemented by Puerto Rico companies. The most commonly reported participation strategies are use of year-round communications (60%) and multiple communication channels for targeted populations (55%). Only 20% of companies report using financial incentives to encourage participation in HWB programs and the majority do not use social strategies (50%), technology-based resources (65%), or targeted communications to leaders/influencers (84%).

In conclusion, companies in Puerto Rico that complete the International HERO Scorecard have many opportunities to strengthen their programmatic offerings, organizational supports, and strategic planning activities in support of employee HWB.


This commentary was authored by Jessica Grossmeier, PhD, MPH and based on data from the Q3 2019 HERO Scorecard International Benchmark Report.


  1. Abel JR and Deitz R. The causes and consequences of Puerto Rico’s declining population. Federal Reserve Bank of New York Current Issues in Economics and Finance. 2014;20(4): 1-8.
  2. US Census Bureau. Vizbuilder data on Puerto Rico economy. 2017. Available at: https://datausa.io/profile/geo/puerto-rico/#economy Accessed August 8, 2019.


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