The success of any wellness program rests on the active involvement of at least 80% of all employees and spouses. But lack of participation is just one of the potential pitfalls that cause wellness programs to fail.

The most avoidable pitfall is investing in the wrong type of wellness program — some companies don't even know they have options!

Types of programs

There are three types of wellness programs:

1. Awareness-oriented.
2. Activity-oriented.
3. Results-oriented.

All three types work toward the same end — a healthier workforce, higher productivity and lower health care costs.

Nevertheless, they are quite different, and not being aware of the differences may lead to a program's failure or premature termination.

Awareness-oriented programs provide information and resources, as well as an environment in which employees learn about healthy lifestyle choices.

Such a program might offer limited active interventions, but most emphasize education and awareness exclusively.

Participation rates typically are low, as awareness-oriented programs are most appealing to individuals already living healthy lifestyles.

Awareness-oriented wellness programs struggle to reach critical mass and therefore are unlikely to seriously affect your health care costs.

Activity-oriented wellness programs combine an awareness component with a focus on getting the workforce to participate in activities that directly affect individual health.

Activity-oriented wellness programs offer interventions like walking programs, weight-loss challenges, aerobics classes, discounted or free gym memberships. Most of these programs offer some form of participation incentive.

This approach will most likely lead to some health care cost savings, but it takes a minimum of three years before such programs typically demonstrate positive return on investment, or merely break even.

Results-oriented wellness programs are in a class by themselves and have the potential to produce significant ROI over a short period of time if combined with strong incentives.

Results-oriented programs focus on the desired outcome — measurable behavior changes achieved by coaching employees toward healthier lifestyle choices — rather than on participation only.

Awareness- and activity-related components are fully integrated into this approach.

Going for results

Despite the advantages, less than 5% of all companies offer results-oriented wellness programs. Why?

One reason might be misunderstandings concerning the legal issues raised by the Health Information Portability and Accountability Act.

There are indeed some legal considerations related to HIPAA, but a results-oriented approach can fit within the legal guidelines. HIPAA clearly defines the five conditions that a results-oriented (bona fide) wellness program has to meet:

1. The total reward is limited to 20% of the total health care premium.

2. The program must be reasonably designed to promote good health or prevent disease.

3. Eligible employees must have the opportunity to qualify for the reward under the program at least once each year.

4. The award must be available to all similarly situated individuals.

5. The plan materials describing the terms of the program must disclose the availability of a reasonable alternative standard for employees who are physically or medically unable to meet the requirement to receive the incentive.

To take advantage of the effectiveness of a results-oriented wellness program, consider using personal health improvement objectives, rather than inflexible health standards as referenced in HIPAA.

For example, a health standard could require all employees to achieve a BMI of less than 28 to qualify for the results-oriented incentive, but a personal health improvement objective would be tailored to the individual's health risk profile to address the most pressing needs first.

Using personal health improvement objectives gives employees the freedom to choose which of their health risks they want to address first and the level of progress they believe is feasible.

Combine personal freedom with basic medical guidelines for recommended levels of health improvement, and you have created an environment that is flexible and promotes employees' accountability for their own health.

Using proper medical guidelines for setting personal health improvement objectives also is important to ensure a consistent and fair payout of the health improvement incentives to employees who succeed in reducing or eliminating their own health risks.

Avoiding companywide health standards is likely to increase program acceptance and produce better health outcomes, which equals greater health care cost savings.

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Contributing Editor Michael Puck, SPHR, is the director of human resources for a midsize manufacturing company in Tennessee, author of "Healthcare Cost Management — The High Road" and the founder of http://www.8020wellness.com.