In this Expert Interview, AdvancingWellness CEO Mari Ryan and Bryan Noar discuss A recent research report that provides valuable information that is useful in building a business case for worksite well-being programs. Bryan is the VP of Strategic Partnerships at Self Help Works.
Mari Ryan: Welcome to the Workplace Well-being Essentials Series. I'm Mari Ryan, I'm the CEO and founder of Advancing Wellness. It's my pleasure to welcome you today to this expert interview, where we explore topics that impact employee well-being. My guest today is Brian Noar.
Brian is the Vice President of Strategic Partnerships at SelfHelpWorks. SelfHelpWorks is an organization that provides the missing link in wellness. It is a convenient, low-cost way for employers to successfully eliminate the stubborn, deeply ingrained, unhealthy habits that resist standard behavioral modification techniques. Their video-based online interventions are evidence-based, highly effective, and easy to implement, and participants love them. Brian, thank you so much for being here today.
Brian Noar: You’re welcome, Mari, it’s good to be with you.
Mari Ryan: Thanks. For many years employers have implemented wellness programs with the expectation that health care costs would be reduced. We all know that behavior change is hard and that it can take years, literally years, for healthcare costs to reflect the changes in behaviors that might come from wellness and well-being programs. Over time there is been this expectation about return on investment, which has been very hard for employers to achieve. In spite of that, worksite health promotion professionals and well-being professionals have sometimes found it difficult to be able to build that business case, or the budgetary resources that they are requesting. Recently, your company, SelfHelpWorks, published a report that outlines some of the lifestyle and health behavior that represents the key cost drivers for employers. I’m curious, Brian, why this report and why now?
Brian Noar: That’s a great question, Mari. Actually, it started several years ago when I first came to work at SelfHelpWorks, about seven years ago. We had a very large client, a wellness vendor, very nationally known – I can’t mention their name because of our NDA as part of our contract – but they came to us and at that point in time they had just been doing business with us a very short while, a couple of years, and they said, look, we want you to look at some numbers that we’ve got and we think we made some mathematical errors. Can you take a look? What they had done is they had compared the annual health risk assessments of about 60,000 participants who had gone through one or another of our online programs and by comparing the back-to-back health risk assessments they had some very significant reductions in health risks for these individuals. They didn’t really believe that the programs could be that effective. So, they asked us to look at their math. Of course after we did that and proofed out the math we said do you mind if we use these numbers, and they said sure.
At that point in time I was actually in charge of our marketing side of things. So, I did up some slides and we incorporated it into our presentation about how these folks had reduced health risks. Then, every time we presented, the prospect would say well, what does this mean in terms of dollars? For instance, with tobacco it’s a very difficult issue to deal with, but to be able to say here’s a real life situation where a third of the people had reported quitting smoking and remained quit, someone would say what does that mean in terms of dollars?
I started trying to look into the literature and find out the dollar cost per employee of these very difficult to break behaviors. I couldn’t find the right information anywhere. I found a lot of things about what behaviors cost at a national level, but I couldn’t find anything that reduced it down to an employee level. I’m actually a CPA by profession, so, of course for me this was a big personal challenge to try and produce accurate representative rather than misrepresentative numbers.
Anyway, long story short, our team, over a period of a couple of years, started to deep dive into the literature, trying to specifically find studies that isolated the cost of different behaviors down to a per person, per adult individual level, rather than a national level. We had a hard time doing this, but eventually we found enough information -- and I want to be clear here, we are not scientists. This isn’t what I’m talking about, a thorough scientific literature review. We did it initially for our own purposes, but eventually once we got the numbers together, I started working up the numbers on what this would mean to a company, and they were so incredibly astounding, we said, you know, this was produced initially for our own internal use, but it is something that the entire healthcare and wellness industry needs to know because every time someone like a broker looks at a solution, or a C-suite, they say what does this mean in dollars. It seems that it’s been very difficult for the person in the wellness department, or the broker, or the consultants to say here’s what these behaviors mean in terms of dollars.
We brought out our report and just made it available to the industry, showing the cost of these kind of behaviors.
Mari Ryan: That’s really helpful because it’s always great to have these kinds of resources. I’m curious, when you looked at the costs, were they just healthcare costs or were they productivity impact costs as well?
Brian Noar: That’s a great question. The hard part was trying to find both because one of the issues is -- and forgive me, I haven’t looked at the latest numbers -- typically an employee stays around on average about three and a half years with the employer. If you are only looking at healthcare, it takes a while for an unhealthy behavior to manifest and become a healthcare cost situation. A lot of the studies say there is no ROI for lifestyle management, which I understand; however, when you take productivity into account, the numbers are pretty staggering.
For example, and again, these are statistical averages done on a nationwide basis, but if you look at the statistical averages based on the mathematical calculations per 100 employees, the six behaviors that drive most chronic diseases and health care costs are costing an employer around $340,000 per year, per 100 employees.
I did not say 100 unhealthy employees just based on the total population. Of that $340,000 per year, about 180,000 of that is in lost productivity. That is staggering because you get lost productivity – and I’ll give you a good example. A smoker, and this comes from a study, by the way that was done by Ohio State University and was published in a peer-reviewed journal, so very high quality study, they actually followed smokers around and they found that on average a smoker costs their employer about $5800 per year.
Some of that is depending on salary, so it’s really a range from about $3000 a year to $12,000 a year, but on average lost productivity costs over $3700 per year. That’s huge. That’s absolutely enormous and that comes from unauthorized smoke breaks, staring at the computer for another minute before break time because you just can’t help yourself, you’ve got to have a cigarette. We’ve worked with tobacco addiction for years, by the way, so we understand why that happens.
When you look at the productivity costs of these different unhealthy lifestyles, they are very expensive. Look at obesity, tobacco, alcohol use. Obviously, any HR manager who knows what Monday morning absenteeism is like, or after Monday night football, Tuesday morning absenteeism, these all have a huge cost to them.
Mari Ryan: Absolutely. Is there anything specific in the report that helps build the business case? Certainly, some of these productivity numbers, is there anything else that you found in your report that you would like to share?
Brian Noar: What we did in this report, Mari, we focused around saying that was our whole purpose was, what is going to help someone make a good decision on whether or not to implement a wellness program because it always comes about, yeah, I understand we need to do stuff for healthy employees, and everyone intrinsically knows that they should take care of employees and that healthy employees will be better for the organization, but the hard costs on this. We actually went about finding the prevalence of each of these behavioral issues. I’d like to mention them because there are six that drive the majority of chronic disease and conditions, and that’s obesity and unhealthy eating, tobacco use, too much alcohol, physical inactivity, stress, and poor sleep. Those are the six that I’m talking about. What we did is we went and found the prevalence of each of those within the adult population. The average annual increase in health care costs, and the average annual lost productivity of those. By being able to do that, you start to be able to draw up some calculations and find out what the cost is to an organization.
Then, we also added to this report insights as to … just interesting things. For example, it’s very encouraging at first blush that the smoking rates have gone down. In fact, we were in the middle of doing the report and according to the CDC, 15.5% of the adult population smoked. We were just about to publish, and then they changed their site and said, no, now the latest census says it’s 14% smoke, which was great news. But then, if you have a look at vaping, guess what’s happened … vaping nicotine has shot way up and also, you’ve got chewing to take into account.
So, we’ve tried to combine all of this, we’ve added some insights. We also took a look at diabetes. I mentioned earlier on that I’m a CPA by profession. I had a 20 year hiatus where I actually went into the nutritional industry through some health issues of my own. One of our main, big focus was dealing with diabetes because it’s mainly a lifestyle disease for most people. It is incredibly expensive, it is increasing in huge, huge rates. It’s so expensive, between working from a pre-diabetic to them progressing to an undiagnosed diabetic, and then diagnosed. The cost are so expensive for a self-insured employer, it’s scary. We also took a look at diabetes and put diabetes statistics into that report.
Mari Ryan: Excellent. It sounds like it’s got some great details that are worth pursuing. I’m curious, when you are speaking with employers and senior leaders, how concerned are they about, in particular, these healthcare costs and these productivity costs?
Brian Noar: Both, and it depends on who you speak to. It’s interesting, the productivity costs speaks for itself. What’s interesting is, speaking with some brokers, they told me that the employers don’t care about productivity. I said, what are you talking about? To pay people to come to work and not do the work that you are paying them for … of course they care about it. The broker said it’s not that they don’t care about the productivity, what they care about is they don’t believe that lifestyle issues cause a loss in productivity.
Well, that study from Ohio State shows in the case of a smoker very clearly what happens, and these other studies that we ferreted out I think will also give the good business case on the productivity side of things.
Employees themselves care about productivity. If you’re on a line in production in a manufacturing firm, someone’s on the production line, one person keeps taking breaks for whatever reason, everyone else has to pick up the slack. The whole team suffers. So, at the employee level there is an issue. At the management level, the managers have got the whip being cracked saying your team needs to be productive. Then at the C suite level -- I want to address this, if I may, part of the issue in producing this report and deciding to make it available to the whole industry is that – I mentioned I was a CPA. Well, I used to sit on the board of directors of a fairly large company. I remember as a young man being invited to sit on the board and we have this very seasoned board member. The first thing he did was he gave me this little booklet, and he said look, as a board member of a company you are subject to all sorts of fiduciary responsibilities and you need to read this. So I read the book and it scared the living bejeebus out of me, to be honest, about all the things that I could get sued for, but one of the big issues is you’ve got to handle the company’s money and make good decisions that are best for the shareholders. I want to be clear on this; best for the shareholders, not best for the employees.
So, for a small company that has 10 or 12 people, the owner, and the sole owner, they can do what they want, but as soon as you’ve got multiple shareholders or larger companies you’ve got that fiduciary responsibility to spend every company dollar wisely. So that’s why we figured we need to put some tools in the hands that the board of directors, C-suite, everyone else who is a senior decision-maker would now have a business case to be able to say, oh, this is strong.
Mari Ryan: That’s great. Very useful tool. Behavior change is hard. What can employers do to help their workforce adopt healthy lifestyles? I know behavior change is a big part of the work that you do.
Brian Noar: Well, it certainly is, and I’m pleased you asked me that question. One of the biggest mistakes that I see is that companies try and implement a one-size-fits-all wellness program. Go out on the street and look at the next 10 people who walk past you. They don’t all look the same, they are different shapes and sizes, different in every respect, and guess what, the way they think, the way they behave and act is completely different. I’m going to give you a very stark example here. I’d used to be obese. Fortunately I’m not anymore, but when I was a little kid I remember being so unbelievably intimidated, and I was a very good swimmer, by the way, I was incredibly intimidated to get into a swimsuit because all these rolls of fat would cascade over the swimsuit and all the kids used to tease me. So, I didn’t want to swim, but I was a very good swimmer.
That’s an example of what happens when you implement a one-size-fits-all wellness program. One is the easiest things to do is you do subsidized gym memberships, or an on-site fitness facility, or something like that, and you build a challenge around it and you get everybody all excited to go to the gym, and you think you’re building morale and everyone’s going to go and do team workouts and all the rest of it. Guess what? The folks who love the gym, who love to work out are now getting a free benefit that they would have been willing to pay for anyway, but now it’s coming out of company budget. But, the very people who you want to help, the people who are out of shape, the people who may not look fit, may be embarrassed to be seen in fitness clothes, or not doing as well, so they feel alienated.
This is an area of sensitivity. It is absolutely critical in any kind of an employee wellness program to meet your people where they are at and find the different types of interventions, activities, et cetera, that fit each segment of people.
The hardest one to deal with is the behaviors that have an emotional component to them. I can speak with some authority on this because I’d used to be obese. I went through all sorts of teasing growing up. I remember my teenage years and how difficult they were because the other kids in high school -- and by the way, I grew up in a country with very little obesity, in central Africa -- the other kids would take it out on me at all costs because of my weight. I would go home in tears as a young boy to my mom and I would say I’m so fat. She would say I love you as you are and then she would say try to eat less. And I would try, and try, and try to eat less, but guess what? There was this voice in my head that said Brian, you need to eat more, you need to eat more, you need to eat more.
Well, now that I am in the industry I am, I understand what was going on. We don’t just have one part to our brain, we have three parts to the brain. We have our thinking part of our brain, we also have our emotional part of our brain, and we also have the reptilian, or the survival part of the brain. They all work together. What happens is when you develop the habit either for comfort or for pleasure, and you keep repeating that behavior over and over, it develops narrow pathways within the emotional part of the brain and your brain literally sends you subconscious signals that says I need to do this habit to survive.
Now, when you are working with your health coach and the coach is saying try not to have that second helping and try and stay away from pizza and stay away from candies, and all these things that have helped build this neuro-pathway and make you comfortable, now that you are being told not to do that, that part of your brain starts firing off saying, feed me, feed me, feed me, and you are saying, but I don’t want to see you and it makes you less comfortable you’ve got this never-ending cycle and eventually you can’t take the discomfort anymore and you break down and you eat, or over-eat, or binge, or whatever. That applies to food, alcohol, tobacco -- believe it or not, even things like insomnia have a cycle like that, and stress.
So, it is absolutely important for an employer to not only look at the standard behavior modification techniques, but also to bring in interventions that have a cognitive side where the emotional side of things is taken care of. I think that’s a big answer and a missing link within wellness.
Mari Ryan: Thank you for sharing your personal experience with that. I’m sure that was very difficult and probably has taken you years to be able to work through that situation from what could have been considered a traumatic experience as a child.
Brian Noar: You’re welcome, and I would just hope that someone who would hear or see this just take that to heart and understand that each individual is different and don’t cast judgment. Just meet them where they are at, find appropriate solutions for them where they are at, and help them fix their problem.
Mari Ryan: Such sage advice; thanks so much for sharing that. I’m curious, are there any other insights that you would like to share in your report that our audience might be able to benefit from?
Brian Noar: Let me think about a couple; here’s one that I was pretty shocked at when we were doing the research. When we think of alcohol, we think of alcoholism, right? Alcoholism affects about 6% of the adult population. So it really doesn’t affect a big portion of your workforce, but there’s another type of alcohol issue that most folks overlook, which is binge drinking. I think these numbers are going to shock an awful lot of your audience. One in six of adults within the workforce binge drink. Not once a year, Mari, four times a month. That’s a weekly binge drinking and binging is defined as seven drinks or more – that is scary. If you think of what that does to productivity in the workforce, it’s scary. So that one is one that we talk about in the report.
Another one is physical inactivity. Most people think of physical inactivity as not getting enough exercise. Well, 25% of the workforce is pretty much 100% sedentary. They may walk to their desks, they look for the space in the parking lot that is closest to work so that they don’t have to walk far, they will do whatever they can to avoid exercise and that’s a very scary one that we talk about a little bit.
Another one is poor sleep. Most people don’t know it, but if you have a look at people who get less than six hours of sleep a night, the mortality rate from six hours or less asleep is about 13% from all causes. That is absolutely huge and the kind of chronic diseases that happen due to not enough sleep are enormous. So. I think that is something that needs to be looked at.
We also talk about stress and tobacco and a bunch of other things in the report.
Mari Ryan: It looks like there are a lot of great insights in that report, so thanks so much for sharing that. If our audience wants to obtain a copy of this report, where can they find that and where can they get in touch with you?
Brian Noar: The report is available from SelfHelpWorks and you can go to our website and find it there, but the easiest way is a direct link to the report, Mari, and why don’t we just put it on the screen? I think that’s going to be the easiest way. It’s the special report on the behavioral costs, they can download it. there’s no charge. All I do ask is that they share it around and that together we educate everybody in this fine country of ours about just how damaging these behaviors are and how badly there is a need to go and help employees who are struggling with them to get over them.
Mari Ryan: Thanks for the great work that you are doing, for publishing this report, and making this information available so that many of us have it at our fingertips. Thanks again for sharing your insights and experience with us today. Thanks, Brian.
Brian Noar: You are quite welcome, and thanks for having me on, Mari.
Mari Ryan: My pleasure.
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