Authored by Niki Hunt, M.Ed., RD, LDN, CHES; Senior Health Education Consultant, Geneia
Nicole Hunt is a senior health education consultant for Geneia. She earned a Bachelor of Science degree in Sports Nutrition and Nutrition/Dietetics from Mansfield University of Pennsylvania and received a Master of Education degree in Health Education from Penn State University. She is a Registered Dietitian licensed in Pennsylvania and a Certified Health Education Specialist through the National Commission for Health Education Credentialing (NCHEC). Nicole has previous experience working as a certified personal trainer and her professional interests include worksite wellness and weight management.
Published studies support the use of benchmarking data from the HERO Health and Well-being Best Practices Scorecard in Collaboration with Mercer© (HERO Scorecard) to identify employer practices associated with superior outcomes.
Previously published HERO Scorecard Commentaries have discussed the connection between having a formal strategic plan for employee health and well-being programs and the reported success of those programs, including higher participation rates, better health outcomes, and improved health care cost containment (Grossmeier, 2015; Serxner, 2013). As stated in the 2015 commentary, an effective strategic plan requires written goals that extend beyond participation and satisfaction metrics to determine the impact of the program over time (Grossmeier). The 2013 commentary reported that organizations with effective strategic plans were more likely to experience health improvement and medical plan cost savings (Serxner, 2013). Thus, effectively setting the stage for health risk change involves the development of a strategic plan with defined goals and objectives to measure impact in these areas.
Strategic Planning Practices Remain Relatively Stable
A year has passed since the last analysis. This commentary considers how employer practices have changed over time and seeks to confirm the relationship between strategic planning practices and observed program outcomes. Data analysis was conducted using data from 555 organizations that completed the HERO Scorecard V4 through June 30, 2016. Similar to the 2015 analysis, 56% of these employers report that they have a formal, written strategic plan in place. It could consist of a long-term plan, an annual plan, or both. Of the organizations with a strategic plan, about two thirds (66%) reported having written objectives for health risk change.
Associations between Strategic Planning and Reported Outcomes
Of the organizations that responded to the strategic planning questions, 205 of them also provided information on reported outcomes from their health and well-being efforts. Nearly 21% of respondents with written objectives report significant health risk improvement and 49% report a slight improvement (see chart below). In comparison, only 6% without written objectives note significant improvement and 22% report slight improvement. Not surprisingly, 46% of employers without objectives have not attempted to measure change in health risk. While we cannot infer causation from this analysis, it stands to reason that organizations with focused goals for their programs will be more intentional about tracking progress toward their goals over time and so may also make necessary quality improvements if expected outcomes are not being achieved.
A similar number of HERO Scorecard respondents provided feedback on their medical plan cost trends, we again found a positive relationship between strategic planning and outcomes. Of those with written objectives for health risk change in their strategic plan, 19% report substantial positive impact on medical trend, i.e., greater cost savings than the cost of the employee health and well-being program. Over 25% report a small positive impact, i.e., savings less than the cost of the employee health and well-being program, with the remaining organizations reporting no impact or did not measure impact. These findings are consistent with published research demonstrating a link between health risk change and medical cost trend, which demonstrates health risk improvement is one potential contributor to reduced or flatter medical cost trends over time.
Despite the importance of strategic planning and measurement of objectives, a significant opportunity remains for employers to adopt these recommended practices. Forty four percent of respondents do not have a formal written strategic plan. Of those with a written strategic plan, one third of them do not have written objectives for health improvement. Moreover, nearly half (49%) of the respondents that do not have written objectives, have not attempted to measure impact, and over a quarter (26%) with written objectives for health risk change have also not measured impact on medical cost trend.
Implications for Practice
Though strategic planning encompasses a variety of objectives, improvement in health risk and positive impact on medical cost trend represent perhaps the most meaningful markers of program effectiveness and return on investment.
It is not surprising that without written objectives for health risk change, employers are less likely to measure outcomes related to health status or medical cost trend. Findings from the current analysis support the importance of a formal strategic plan with measurable objectives for health risk change, since it is associated with improvements in health risk as well as positive impact on medical trend.
A formal strategic plan should define what outcomes are important to the organization and what measures will be used to determine success. Improvement in health risk and health care cost savings are strong indicators – but certainly not the only indicators — of an effective, results-oriented employee health and well-being program. Employers are more likely to experience success if they have a written, strategic plan for employee health and well-being over multiple years, and they develop specific objectives for health risk change. The HERO Scorecard can provide guidance for employers on the types of goals to include in a strategic plan, data sources that might be used to evaluate achievement of goals, and reasonable benchmarks that have been achieved by other organizations.
This commentary is based on data from the HERO Scorecard Benchmark Database through June 30, 2016.
Grossmeier J. (September 2015). Got strategy? Despite link to outcomes, many employers lack a strategic plan for health and well-being. 2016 HERO Scorecard Report, pages 33-35. Available at: www.hero-health.org/scorecard
Serxner, S. (January 2013). Strategic planning-a path to greater impact. 2014 HERO Scorecard Report, pages 10-11. Available at: www.hero-health.org/scorecard