James Pshock is a well-established thought leader in the area of workplace wellness. He is the president and founder of Bravo Wellness, whose mission is to deliver exceptional services and products to organizations seeking to help their workforce achieve optimal health through incentives. His experience in the health insurance and wellness industry spans over two decades. James is an Ernst & Young Entrepreneur of the Year Award winner, and is also a committee member of HERO, an advocacy group for the advancement of workplace wellness.
1) The recent documentary, Fed Up, presented evidence that lobbyists potentially have garnered a narrative regarding obesity to be too heavily focused on activity, resulting in a lackluster focus on nutrition and food intake. In parallel, there seems to be an abundant focus on physical activity with regards to workplace wellness in comparison to other areas of behavior change. In your opinion, why do you think that is?
I am not sure I completely share this observation, although it’s true most programs are activity-based (in the sense that many programs involve activities, like taking part in a step challenge or watching an instructional video) and I think in many ways it’s because activities can be measured, and because these programs are relatively easy to implement. Whereas, with food, we can think back to second grade when your mom sent you to school with an apple in your lunchbox, and you would trade it for a Twinkie, and she would never find out. You can educate people. You can give them the food, but it doesn’t mean they are actually going to eat it. And, plus, you have the complexities of allergies, and food preferences, and people who just don’t like the taste of what you’re telling them to eat.
Focusing on nutrition can open a Pandora’s Box. If you’re going to go down that path of telling someone what they ought to be eating, then you’re going to have to be willing to deal with a lot of personalization and accommodations, which is no easy feat. We tend to focus more on the “why” than the “what”, and sharing the message of personal accountability for your health… this empowers the individual with a directive, but also the power of autonomy to achieve it.
2) In a 2014 New York Times article about Workplace Wellness the author contends that programs that focus on lifestyle change potentially do not reduce costs but move them from the employer to the employee. Putting aside there is evidence to refute this claim as factual, where does the responsibility of the company end and the responsibility of the employee start?
There are a lot of deep issues loaded in this question, everything from an entitlement mentality to employees who recognize health insurance as a “benefit”. Almost any company was not founded on the premise of being a health insurance provider. Insurance is meant to be a benefit. Yet, so many people just kind of have an entitlement mentality that really shelters them from understanding the true cost. Most people are unaware of the role that they individually play in determining what that cost is. Dental insurance is a great example. Historically, dental insurance has had 100% coverage for preventative services and something like 50% coverage for restorative or repair services. Look at the statistics. The result has been a phenomenally high rate of prevention because the benefits are typically pretty inadequate for major restorative services. People take better care of their teeth. Prescription utilization versus generic utilization is another good example. For years organizations asked people to use generics and told them how much money the company would save if they used generics, but it was not until employees saw a pretty dramatic difference between the co-pays for generics versus the co-pays for branded drugs that companies began benefiting from the shift in consumerism to utilizing more generic drugs.
A final example is pension plans versus 401(k)s. For decades, the norm was to have a pension plan and your employer would pay you after you retired. And, as that shifted to a 401(k) model – you put money away, we’ll match it – it shifted the responsibility for post-retirement security to the individual versus the expectation that the company I work for is going to take care of me regardless of how I behave.
I believe we are just on the forefront of that happening in health insurance, where it’s not a cost shift thing. It’s simply shared responsibility. And, as that message of shared responsibility takes root, there are people who are going to say, “Well, you just shifted the cost to the people who refused to do anything about their personal health or their preventative risks.” And you could absolutely look at that and say, “I guess that’s one way to look at it.” But, the lens we look at it through is really more in line with the concept of transparency and shared responsibility. And for those who have a hard time accepting responsibility, they will likely be resistant to this change because their perception skews towards entitlement.
3) For a small to midsize business (SMB) with limited resources, how does a SMB choose what aspect of wellness to focus on and what role does a company like Bravo Wellness play in that decision making process?
There is a value in having some type of wellness program regardless of the size of your organization. However, when you talk about the concept of workplace wellness, it is important to note that it is enormous and complex. For example, you might be looking at something as basic as smoking and say, “Well, you’re going to add years to the end of your life if you quit. Don’t believe us? Here, we can show you all these studies of morbidity rates improving if you stop smoking.” But smoking is not the problem, in this case it is a symptom of severe depression. I mean the last thing on their mind is living longer, and we are discussing morbidity. We are making all these assumptions that what is important to us is important to them.
There is not a one size fits all unfortunately. What I have seen is that where you might see fantastic results in one environment, you take that exact same program and put it in a different company, with a different environment and culture, and it could fail. An environment that is based on teamwork, and very collectively working towards common goals adopt things differently than siloed organizations. Bravo Wellness helps organizations think through what they are trying to accomplish. What has been surprising for me is how many companies want a wellness program, but have no idea what they’re trying to accomplish. If your goal is to try to be recognized as the “healthiest employer in your city”, what does that mean to you? Your health related costs are going up 20% a year but the health of your organization has vastly improved, that might be what you are after. An assessment needs to be done of the organization: What are they trying to solve for? How will they handle those issues that will appeal to the broadest number of people? If further down the road they still have some people who aren’t making any good choices, how will they pivot?
4) The definition of wellness coined in 1995 by Anspaugh, Hunter, & Mosley talks about wellness in the context of the workplace as ‘a composite of physical, emotional, spiritual, intellectual, occupational, and social health’; Given the complexity of what constitutes one’s “wellness” is it even realistic to expect workplace wellness programs to encompass all the components of wellness? Or is it suitable to assume that programs should focus on maximizing efficacy by doing a few things really well in concert with other wellness providers (outside of work)?
How wellness is defined and how you start to educate your population, you treat this as a mission. I like the fact that we’re not just saying wellness means the five biometrics mandated by legislation. Like in our case, we’re limited somewhat in that by way of regulation we really only have five things that we can tie into and have contingent incentives or penalties against. That doesn’t mean in any way we are not trying to identify other risks, educate people, and equip them to take positive action for their emotional health, spiritual health, and other things that could really have a profound impact in their life. You should put it all out on the table. Where you’re going to focus your actual interventions, after all my experience on the TPA side as a buyer of wellness programs, and then our experience in the last six years facilitating them …I have landed on saying: educate and equip, provide the tools and resources, but reward people for results, not how they chose to get there.
An important consideration is the privacy aspect of wellness, employer’s limitations on asking certain wellness questions (even if well-intended), let alone obvious legal exposure regarding spirituality and things of that nature …there’s certain angles here that no employer, after they talk to their attorney, are going to be willing to do or should do for that matter.
5) Looking back at your extensive experience in the industry, what are the key elements that contribute most to the success of a corporate wellness program? Have there been any surprises?
The sole message of equipping people versus mandating how they need to get to “wellness”, the right tools, and a focus on results is what I have become more and more convinced is critical. Trust throughout the entire organization is also important. There needs to be transparency, so the employer can share the true cost of benefits. For example, a company says, “We get charged $1,100 a month from Blue Cross. We’re paying 80% of it. But, we are willing to pay up to 90% of it if you do these things.” It is eye-opening for a lot of employees who had no idea how much the employer was already paying on their behalf and what they were basically getting for free. And that certainly adds to their acceptance of responsibility, as well as better buy-in which is at the heart of success of any wellness program that is used as a tool to improve some aspect of employee well-being.