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Dena Pflieger, Global Health Promotion Leader, Dow Chemical

Managing Dow Chemical's corporate wellness and productivity management programs means coordinating activities for 40,000 employees across dozens of countries. But Dow is pushing ahead nonetheless with an aggressive effort to improve employee health, curb unhealthy behaviors, and increase productivity. And it's working. Here, Dow's Global Health Promotion Leader Dena Pflieger talks about the company's efforts.

PHP: Draw a distinction between corporate wellness and productivity management.

DP: I think both terms are a little limited because they're both workforce oriented. We like to think in terms of a broad health strategy rather than whatever term is in vogue. If you're trying to influence your workforce, you need to remember that they've got a lot of influences off the job that are equal to and perhaps more powerful than anything that we can do at the workplace. It's critical to look to the community to see what sort of change or impact you might have there as well. And don't forget about families, either. In many cases, certainly here in the U.S., family members, not employees, represent the larger share of health care costs.

PHP: What are the major elements of Dow's health care strategy?

DP: We focus on four key areas where we think we can make a difference:

  • Preventive health. This encompasses things like weight management programs, health screenings, and tobacco cessation. These are the "no-brainer" programs. The payback is so obvious and substantial, which is why lots of companies do them. Think about it: if you've got an employee who uses tobacco and you're not helping him quit, you're passing up an opportunity to enable him to lead a healthier lifestyle, as well as improve the company's overall medical spend. It's important not to wait until someone presents with a health claim or condition before providing him or her support.
  • Quality and effectiveness. We don't like to think of Dow as being just a payer, but an active partner in the health care system. Dow won't ever get sick and need surgery, but if one of our employees does, we want to do more than just pay for it. We want to help him get the most appropriate, effective care available. So we take on responsibility to help the system get better. To make sure it does, we share quality data with our employees to help steer them and their families to the best care. It also gives providers an incentive to improve and may help them rationalize related investments.
  • Health care system management. Dow wants to support doctors and hospitals in their efforts to adopt more intelligent health information technology (IT) systems. Some of the biggest problems in health care today are what I think of as being very fixable, if we had better management systems in place. We actually build requirements into most of our contracts that health systems and providers move in the right direction in this regard.
  • Advocacy. Finally, we're very active in terms of trying to influence public policy and to help improve the health of communities. We work with key health-related organizations at state, national, and global levels to support legislative changes that support prevention by, for example, lowering barriers to care or eliminating copayments. We also support legislation that encourages employers to play a positive role in health promotion and invest in quality initiatives.

PHP: Dow has facilities, large and small, all over the world. At what size facility can you be active in terms of health promotion?

DP: We're active even where we have one employee. It's a company requirement that every employee has access to health promotion services. For instance, we might have a single staffer working from a virtual office in South America or Iowa. Someone on our staff is responsible for making sure that that employee can receive information that's relevant for her and that she has access to services like preventive health programs or screenings. We reach employees where they are.

PHP: Talk to me about something that really works.

DP: Having a comprehensive strategy and a culture of health. The reality is that it's not any single resource, policy, or initiative that works. It's the combination of efforts and a long-term, strategic, and well-integrated program that adds the greatest value. It's making sure that you are addressing individual as well as cultural needs—at the worksite and in the community.

In terms of an activity that works and that can easily be replicated elsewhere, we have a few "Dow Health Days" throughout the year that focus on a specific issue. For instance, Dow No-Tobacco Day, Walk at Dow Day, and Dow Preventive Care Day. The great thing about these one-day observances is that they create a spark globally, are low cost, and can be easily localized. Participation and energy are very high. It's a great way for employees—especially more remote ones—to feel connected back to the bigger corporate family and have some fun and develop camaraderie with their coworkers. Feedback is universally positive.

We also have one 44-day program every year that focuses on either promoting physical activity, weight management, or building resiliency to stressors. It's called "The 12 Percent Solution" because 44 days is 12 percent of one year. The concept is that we do fairly intensive outreach to participating employees during those 44 days to get them to start to adopt healthy behaviors and find success. For our recent weight program, more than 5,000 people registered. While it isn't an end-all, it's a great way to get started.

Both the 12 Percent programs and the Dow Health Days are beneficial because they spark interest and change at both an individual and cultural level. They also feed very well into other resources or benefits and more substantial behavior change services like personal and group counseling and peer-support groups. So, these work in playing a special role in the larger strategy, but they can't succeed as one-off programs. For smaller companies, these types of activities can be a good place to start, as long as they don't stop there.

PHP: Does Dow target employees for help with particular issues?

DP: We have an intranet site for employees and an internet page for their families and retirees to tap into resources on a variety of topics. We also work with our health plan to do targeted outreach. A few examples of this are disease management and case management programs.

Our most valuable opportunity to target the unique needs of employees is through our Health Assessment Program. It starts right from the beginning. New employees do a health risk assessment, followed by counseling and referral as appropriate. We help employees set goals and match them with resources and then follow up. Participation in the Health Assessment Program continues throughout an employee's career at Dow, so we can regularly support their specific needs. As a result, our staff can get to know specific employees and reach out to people to say, "Hey, I know you've been trying to quit smoking. Dow No Tobacco Day is coming up, why don't you use that as a starting point?" It's all about connecting the pieces.

PHP: How do you measure return on investment (ROI)?

DP: We don't do formal ROI. We do track the costs of our program and know that the projected savings exceed the costs, but that's not the point. The big issues for us are improved health, customer satisfaction, and health care costs. We're moving in the right direction on all three fronts, especially in the area of improved health. We have very aggressive targets in areas like glucose control, body mass index, physical activity, tobacco cessation, blood pressure control, and so on. Our 10-year targets are for 10 percentage point improvements in each area for both high and low risk.

PHP: Did I hear that right? 10 percentage points? Not 10 percent?

DP: That's right: 10 percentage points. We believe in audacious goals and ones that will deliver measurable value to the company. For example, about 20 percent of Dow employees smoked in 2004. We're committed to getting that number down to 10 percent by year 10.

PHP: How are you doing so far?

DP: We're getting there. The decline to date has been 23 percent among tobacco users since 2004, which is terrific. For many of the other issues we're on track toward goal. Weight is another tough issue to make progress on, but we're moving the dial there, too. We're making progress and moving in the right direction while the rest of the country is moving in the opposite direction, so it's a little like swimming upstream, but we feel good about our progress to date.

PHP: I understand that a portion of your compensation is tied to those audacious goals you talked about. Do you think that's a good model for others in your field?

DP: Yes, a portion of our Health Services staff's performance award is linked to achieving those health risk reduction targets for the population over which we have responsibility. There are also some specific goals and outcomes that align with that target. The criteria are very specific and they should be.

Aligning the performance award with the population for which you're responsible makes a lot of sense. For our site staff, it's the people they "touch" with their consultations and deliverables so it gives them a chance to connect their day-to-day work more closely with the big-picture goal.

We regularly debate the value, scope, and fairness of the incentive process internally and tweak it as needed, but overall we're very happy with it. I think it's helped us realize some tangible improvements in how we plan and implement and in our ability to make an impact on employee health.

PHP: How does Dow work to advance the health of the communities in which it operates?

DP: There are a lot of different pieces to that puzzle. Sometimes it means working with other employers to coordinate initiatives with health plans or hospitals. It might also mean arranging for a seminar for local physicians about improving medication adherence. Right now, in central Michigan we're working as part of a community health collaborative to encourage media, employers, providers, schools, and community organizations to reach out directly to consumers to encourage them to ask questions when they go to the doctor. It sounds like a small thing, but it's a real issue. People go to the doctor and aren't prepared or confident to ask appropriate questions, even though they ask questions everywhere else. The written materials are available for free from the Agency for Healthcare Research and Quality.

PHP: Dow is a big company. Do you think a small organization can have a robust and effective health promotion strategy?

DP: It actually might be easier. You could probably make things happen faster. I've seen this in our smaller sites. They can have more success creating a culture that emphasizes health because people know each other and create a kind of social pressure that is hard to make happen among a group of 40,000 employees spread over several countries. I'd also recommend to small employers that they check out what's available from many of the national health organizations. For example, the Centers for Disease Control has done a great job of reviewing what works and providing recommendations on where to invest worksite health promotion dollars.

PHP: What's changed since you started 10 years ago?

DP: I think what's changed at Dow—and maybe industry-wide—is that wellness and productivity management are becoming more evidence- and value-based, as opposed to instinct-based. And that's a good thing. Back when we started, we might do things because they sounded fun. Our programs were called "Up with Life!" Now we report to the directors of the board; have a comprehensive, global strategy; and measure outcomes. We're challenged to think strategically and be just as cost-effective as any other division of the company and, as a result, I think we've had more success keeping people healthy.

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