Another effect of the lagging economy: Recent research shows cash-strapped employees are cutting back on preventive healthcare measures.

More people are trading nutrition for processed and fast foods, and scaling back the amount of time they spend exercising.

So now’s a great time to refocus on preventive health care. If your company already has a wellness program (or is thinking of starting one), it’s a good idea to consider adding these features:

Claims checks and on-site screenings

Some wellness programs pinpoint at-risk employees by relying solely on the employees’ honesty in responding to health assessments. But let’s face it, employees aren’t always honest with themselves when it comes to their health. As a result, their answers on health assessments aren’t exactly accurate.

A better way to gauge workers’ health: Use a combination of data to determine who is at risk for chronic conditions. Example: Some companies use on-site health screenings and past claims history to assess if an employee is at-risk.

This approach has been found to significantly increase the amount of at-risk employees who are spotted.

Wellness consultants

Wellness program consultants are assigned to a company to help develop its wellness strategy, plan promotions, interpret reports and gauge the overall success of the wellness program.

Benefit: By keeping a close eye on a company’s wellness program, consultants can tweak and fix problems before they become out-of-control cost drivers.

Cross-trained coaches

Wellness coaches take a big-picture approach to helping employees with various lifestyle-related health issues.

Example: Smoking. There are a significant number of people who won’t try to quit smoking simply because they’re concerned about gaining weight.

But a cross-trained coach will help an employee quit smoking, while also making sure he or she makes smart nutritional choices to avoid the all-to-common weight gain that immediately follows kicking the habit.

What’s worked to improve your company’s wellness program lately? Let us know in the Comments Box below.

Slip and fall accidents.

The causes are easy to spot:

• Icy or snowy sidewalks, steps, etc.
• It’s dark when employees leave, so there’s less viability when employees are heading home, and
• Wet floors — either from the water and mud that gets dragged in on workers’ shoes or from trying to clean salt tracked in from outside walkways.

But preventing these seriously expensive injuries takes some stick-to-itiveness. Here are some ways HR and benefits pros can help make sure they don’t run up high medical bills:

• Make sure someone (preferably your facilities manager) conducts a safety survey regularly, both within and outside your facility to identify hazardous areas
• Have the person any problems immediately, and
• Keep a paper trail of all inspections and corrections to prove your company made a good faith effort to correct hazards — which will help avoid a lawsuit if someone got hurt.

Three advantages to spending more on health care: Reduced turnover, improved productivity and higher sales. Check out the healthcare strategy this business used to benefit from them all.

For years, Burgerville, a restaurant chain based in Vancouver, WA, offered limited health coverage to hourly employees.

Result: Just 3% of hourly workers were enrolled.

But when an employee survey showed health costs were employees’ No. 1 concern, the company decided to switch up its coverage and pay 90% of healthcare premiums for hourly employees who worked at least 20 hours per week.

Under this new plan, individual hourly workers can enroll in a health-maintenance organization for $15 per month with no deductible. A worker and spouse pay $30 per month, and family plans cost $90.

Result: Burgerville’s healthcare bill skyrocketed from $2.1 million per year to $4.1 million. But its turnover rate dropped to 52% from 128% in one year. And having to replace and train fewer workers led to huge cost savings. Now, 98% of the company’s eligible hourly employees are enrolled in the health plan.

Because employees must work 20 hours to qualify for the plan, they now work harder to qualify for more hours, which are assigned based on performance, Burgerville’s Chief Executive Jeff Harvey told the Wall Street Journal.

Result: Sales rose 11% in one year.

Only 28% of employees today say their overall health is excellent — down from 34% six years ago, found The State of Health in the American Workforce, a study just published by the Families and Work Institute.

The study also shows that men’s overall health is declining faster than women’s.

But the most troubling stat: Nearly half (49%) of employees admitted they hadn’t engaged in regular physical exercise in the last 30 days. And 22% of those workers hadn’t exercised rigorously at all in the last 30 days.

With employers more concerned — and active — than ever with trying to trim healthcare cost increases by getting employees to live healthier, this does not come as good news.

Two reasons employers’ efforts aren’t paying off:

• One in four workers continue to smoke, despite growing incentives to join smoking cessation programs, and
• Stress levels are rising — 40% of employees say they feel stressed regularly.

Most common treatments

• High blood pressure (21%)
• High cholesterol (14%)
• Diabetes (7%)
• Mental health (4%)
• Heart conditions (3%)

Four congressional committees have approved healthcare-reform bills. Here’s what’s been OK’d so far.

The approved stipulations are sure to be blended with and modified by other bills being considered, but here’s what’s on the table right now

• How much it’ll cost: $1.5 trillion spread over 10 years.
• How it’ll be paid for: $500 billion from cuts in Medicare and Medicaid, $580 billion in taxes, $200 billion in employer penalties for not providing coverage.
• Employer requirements: Except for small businesses — with annual payrolls of less than $500,000 — employers must provide health coverage.
• Employee requirements: Must have coverage or face a tax penalty, with exemptions for hardship.
• Who’s eligible for subsidies for coverage: Starting on 2013, those with incomes of up to 400% of the poverty level.
• What types of benefits coverage will provide: Hospitalization, doctor visits, prescriptions; no denials for preexisting conditions.
• How plans can be chosen: A National Health Insurance Exchange.
• Government plan: Available through the exchange.
• Uniform changes to Medicaid: The program will be available to all with incomes up to 133% of the poverty level, instead of leaving eligibility requirements up to the state.

President Obama’s plans for healthcare reform could have some nasty tax consequences for employees.

Congress is looking for ways to raise more than $1 trillion in new tax revenues to finance health care for the uninsured. At the top of the list: several proposals that would cut employees’ take-home pay 9% to 14%, depending on their household income and tax situation. Several of the plans under consideration would require Payroll to treat as taxable income:

• health insurance premiums
• dental premiums
• vision premiums
• flexible spending account deposits, and
• health reimbursement arrangement contributions.

Right now, employees don’t pay taxes on these benefits because they’re deducted from their paychecks on a pre-tax basis.

Specifically, the proposals the Employer Council on Flexible Compensation reports are under consideration include:

• capping this proposed group health tax exclusion at $6,800 for individuals and $17,240 for group coverage in 2013
• imposing the cap on all workers with group coverage, or
• imposing the cap only on those earning more than $100,000 per year (married couples, more than $200,000) per year.

For more info
To see how the proposals might affect your own paycheck, go to www.nohealthbenefitstax.com and click on “Worksheet: How the health tax impacts your paycheck” on the right-hand side of the screen.

You’ll enter data such as income and tax status; employer’s benefit contributions; and pre- and post-tax benefit contributions. The spreadsheet will show your take-home pay (as entered) as of today, then calculate how much it could decline under each of the proposals. Another chart shows the increase in employer FICA, based on the values entered.

The cost to insure the average family in the U.S. last year was $16,771 when coverage was obtained through an employer, according to a report by benefits consulting firm Milliman, Inc. And worker contributions to that coverage have been going up.

Some of the key numbers from the report:

• About 170 million Americans get their health insurance through an employer.
• Healthcare costs, via premium payments and out-of-pocket medical expenses, now eat up 14% of the average household income of about $50,000.
• Costs went up an average of $1,162 per family this year from the average of $15,609 last year.
• Employers’ contribution to workers’ monthly premiums increased by 5.4% over the past year, but employees’ contributions went up 14.7%.
• Employers paid an average contribution of $9,947 per worker. Employees paid an average of $4,004 in premiums and an additional $2,820 in out-of-pocket expenses.

A glimmer of good news: The report showed that costs are rising but not quite as rapidly as they had in prior years.

Click here to see the full report.

Previous efforts to push wellness in the workplace were met by objections — and occasional lawsuits — from employees and advocacy groups who said “wellness” was just another term for “invasion of privacy” and an attempt to control employees’ lives outside the workplace.

Rumblings out of Washington indicate, however, that the White House — with help from a friendly Congress — would like to change some of the rules on wellness mandates if the changes will lower healthcare costs.

What’s coming — what’s changing
The Administration has sent several proposals to Capitol Hill and asked members of Congress to consider the ideas, such as giving employers tax credits for:

• programs that offer periodic screenings for health problems
• counseling to help employees adopt healthier lifestyles
• smoking-cessation programs
• treatment of obesity
• physical fitness
• nutrition
• treatment of depression

To allow employers to fully implement such programs, without penalty or fear of lawsuits, the Administration would have to overcome some legal obstacles. For instance:

• A 1996 law prevents group health plans from discriminating against people because of their health status or medical history. Charging those people higher premiums or denying them the rewards that healthy people might get could be considered “discriminatory.”  That’ll have to be changed.
• If an employer offers financial incentives to employees for lowering cholesterol, losing weight or stopping smoking, the amount of such rewards generally may not exceed 20% of the cost of health coverage. Under current laws and tax codes, employers who want to offer greater rewards can’t do so. The Administration and Congress are looking at loosening those rules and letting employers decide the limits of the rewards.

President Obama vowed that he and Congressional Democrats will push through a healthcare bill by summer.

First, the President and Congressional leaders say the overall point of the legislation is to create a public healthcare system that covers 46 million uninsured Americans. Early volleys and opposition from Republicans center on:

• a stipulation that would cap the employer tax deduction for providing employee insurance
• how the system will be funded and how much it will increase the deficit
• whether such a system would undermine the traditional private system of insurance and care

Who’ll pay for it?
How to pay for the estimated $1.5-trillion cost over 10 years?  Congressional estimates point out that the tax exemption for benefits annually costs the government  between $246 billion $297 billion — money that could be used to fund a government-run program.

Most proposals, however, don’t call for completely doing away with the tax exemption, but rather limiting it, a move that could raise $700 billion over 10 years, according to consultants from the Lewin Group.

On top of limiting tax deductions for employers and employees, among the proposals floating around Capitol Hill are plans to raise taxes on alcohol, soft drinks and foods high in fat and salt. Health advocates in Congress are saying that’ll create a double benefit of raising money and encouraging better eating habits.

Congressional leaders say they’ll hammer out a bill by July and get action on it before the August recess. The goal: to have a final plan effective Jan. 1.

The full proposal from Congress is summarized in a report authored by Sen. Max Baucus (D-MT), Chair of the Senate Finance Committee.

The bad-news numbers on wellness come from HR consultant Hewitt Associates, which asked employers that have various wellness programs to gauge employee participation.

• Only 4% of smokers took part in employer-sponsored smoking-cessation programs.
• Just 5% of overweight employees signed up for weight-reduction programs.
• One out every 10 employees who suffered from chronic ailments such as diabetes, asthma and heart disease took part in programs designed to address those problems, meaning of course that 90% of eligible employees ignored the programs.

What did work
Why didn’t those employee-sponsored programs work? The reasons are varied and complicated. So probably the better approach is to look at employers whose programs did work, in that they got decent participation and good results.

To learn about that, HR Morning conducted its own survey of 1,174 HR managers to ask about whether they linked wellness to health care and whether they were successful. The HR execs who said they had some success pointed to health-risk assessment as the key — and getting employees to understand that assessments were in their best interests, and not just a way for the company to save money.

That matches some other research by Hewitt that indicates companies have a lot more success with wellness when it starts with a health-risk assessment, in which the employee answers questions about his or her health and gets back a report on which health problems need to be addressed and how to address them.

Compare the low participation rates above with these tied to health-risk assessments:

• According to Hewitt, 55% of workers who completed a health-risk assessment say they’re taking the recommended action.
• 35% said they plan to take action.
• Only 10% of employees don’t plan to take action to improve their health, based on the health-risk assessment feedback.

Warning
Here’s a warning, though, about what makes health-risk assessments unsuccessful: The companies that got the worst results usually:

• Required employees to complete the assessment. That is, when the assessments were mandatory, employees pushed back by refusing to follow the recommendations of the assessments.
• Emphasized the money-saving aspect. When employees perceived the assessment was just another way to increase employer profits, failure was almost guaranteed.