As their wellness programs mature, employers often discover that many of the elements impeding their ability to realize a return on their investment exist beyond the walls of their worksite.

External factors such as the cultural and socioeconomic makeup of an employer's workforce, the availability of local health and wellness resources, and the level of cooperation of benefits providers can play significant roles in determining the relative effectiveness of wellness initiatives, wellness experts said.

Some external barriers to wellness success can be addressed during the planning and design stages of a program's adoption, experts said. One critical issue employers should make an effort to address up front is the extent to which their health insurance providers are folded into the program's financial and philosophical structure.

Ann Clark, founder and CEO of San Diego-based ACI Specialty Benefits Corp., said many employers neglect to negotiate with insurers for considerations such as premium discounts based on wellness benchmarks, plan coverage for any specialists they intend to incorporate in their wellness program, and third-party access to claims and costs data.

“What happens a lot is that the employer goes to the insurer after the fact and asks for a discount or some other consideration, but it's too late then,” Ms. Clark said. “Part of the whole 'executive buy-in' concept needs to be bringing in your broker and a financially strong-minded executive like the CFO to negotiate with the insurance company. It's like any other hard-nosed business transaction. You have to negotiate your percentages and agreements up front.”

%%BREAK%%

Other peripheral impediments are likely to be revealed a year or two after a program's implementation, most commonly in the form of gaps in participation or sluggish performance in the reduction of costs. More often than not, experts said, these issues are a reflection of an overly broad approach to a program's delivery of wellness resources and communications that fails to account for cultural disparities and socioeconomic limitations among employee subgroups.

“There's the first generation of what employers are doing around wellness, which is to do the health risk appraisal to measure the predominant risks of your population, do your biometric screenings, build your intervention programs and then measure your outcomes,” said Laurel Pickering, president and CEO of the New York-based Northeast Business Group on Health. “The next generation is one in which employers become even more targeted in meeting the needs of their populations.”

For example, many employers' wellness and health promotion programs rely heavily on Web-based portals as an inexpensive, easy-to-manage central point of contact for employees, as well as the program's primary means of gathering participation and performance data and assessing health outcomes.

“They're fabulous tools, but if you've got a workforce that doesn't have regular access to a computer, or doesn't have the necessary computer skills to use these tools, they're not going to participate in the program,” said Mari Ryan, chair of the Worksite Wellness Council of Massachusetts and CEO of Advancing Wellness L.L.C., both based in Watertown, Mass.

%%BREAK%%

Poor performance in participation and health outcomes also often reflects a lack of accessible wellness resources outside the workplace, including primary phyicians, specialist services and urgent care facilities, as well as healthy food sources, gyms and outdoor fitness centers, experts said.

An examination of the demographics of an employee subgroup with low participation rates, coupled with focus groups of voluntary surveys, can help an employer determine how its program can be modified to account for gaps in the availability of wellness resources outside the workplace.

“There's a variety of different aspects that can influence participation, and without participation you're not going to be able to generate any of the outcomes you're looking for,” Ms. Ryan said. “The issue is whether or not those elements are predominant enough that you would need to make modifications or accommodations within the program.”