Every year a list of the 10 “fattest” states comes out, and it’s always depressing. A non-profit health-promoting organization, “Trust for America’s Health” (or TFAH), ranks states by high-risk health conditions, such as obesity and inactivity. Not surprisingly, the two go hand-in-hand. The state of Mississippi was #1 in both. Other statistics noted in state reports, such as incidence of diabetes and hypertension, can be related to low physical activity as well. Other alarming statistics show that percentages of bad trends show significant increases over the years, such as Arkansas’ increase in rates of obesity going up more than 80% since 1995.
Leaders of a mid-ranked state decided to do something about this, specifically the state of Nebraska. Officials reasoned that if they and the state government employees could start turning their own health around and lead by example, the health of the entire state could improve. This resulted in a concerted effort by the state of Nebraska in instituting an initiative they called “The Wellness Plan” in 2009. At the time the state ranked #32 in highest level of inactivity (this figure was an average from the years 2006-2008). The state enlisted the help of a third-party health-and-fitness management company to oversee the nearly 14,000 employees throughout the 93 counties across the state.
Nebraska had been providing 79% toward the premium employees paid for health-care services. The plan that was provided offered very few preventative-care options, and as a result of rising claims and costs for disease management rather than prevention, costs were rising and funds were quickly running out. This was the incentive for creating a program that would not only offset these costs but could save money in the long-run.
In order to get the program off the ground, a massive educational campaign was implemented beforehand. The main goals of the program were to:
- Provide premium incentives for employees who meet wellness-program criteria.
- Increase preventive adherence with an effective communication strategy.
- Reduce health-care costs by building a culture that promotes and encourages healthy lifestyles.
The criteria included choosing the Wellness Plan and then obtaining a biometric screening (such as blood pressure reading, blood sugar, etc.) and taking a health-risk assessment questionnaire online. Additional activities included participating in a walking incentive program (tracking steps with a pedometer with prizes for individuals or teams) or an online activity-logging program (for any type of physical activity).
Another part of the program that led to its success was the implementation of “Wellness Champions.” These were like a type of “team captain” or team leader who acted as a voice for groups within the state’s employees and agencies (remember there are 93 counties throughout the state). They offered feedback to the providers as well as communicated to their co-workers and led by example by practicing the healthy behaviors that are part of the program.
Not the least part of the program’s success was the fact that the Nebraska governor at the time, Dave Heineman, placed a high level of importance on this campaign due to the fact that he is a fitness enthusiast and a “Wellness Champion” himself. He went so far as to reward walking-program participants with a visit and a photo in the State Capitol with high-step achievers getting a personal photo with him. He also recognized participants’ testimonials on how they have improved their health by putting them up in the hallways of the Capitol and on an official state website along with sending them a letter and certificate to mark their achievements.
While these are external rewards for participating in healthy behaviors, the statistics offer another reward – reduced health-care costs. For example, in 2010-2011 the return on investment of this program was that for every $1 spent, $2.70 was returned in health-care savings based on an independent review of claims data. And the participant satisfaction, measured through surveys, indicated a high level along with the health outcomes, such as that the 11.3% who were previously high risk for low levels of physical activity, now exercised more than two days per week.
The last rating that Nebraska received in the TFAH scale for physical inactivity was #26 (2013). This is a pretty significant change for the better. Although the Wellness Plan focused on just the employees of the state government, the hope is that their success would transfer to the public sector as well. A walking program is encouraging because it is something that is easy enough for anyone to do. If more people became “Wellness Champions” and spread the news that the quality of life (and savings on health care) is a direct result of a few simple changes, the competition for the states with the highest levels of inactivity could turn out to be a race for the one taking the most steps – literally and figuratively.