The Challenge:

Cianbro's team members work in 15 states on the eastern seaboard. Team members work long hours, often seven days a week. Their daily commute to work can be anywhere from 30 to 90 minutes each way. The workforce is aging -- the population over 65 will increase 8% by 2025. Cianbro's average team member age is 41. With many team members even older than that, we are starting to see the effect of at-risk behavior on our team members.

Heart attacks, strokes, cancer, and other debilitating diseases are taking our loved ones. Obesity is expected to overtake tobacco use as the leading cause of preventable death in America. Further, health care costs in the United States represent more than 14% of GNP, or $1.45 trillion per year. From 1990 to 2000 healthcare costs doubled from $700 billion to $1.4 trillion.

All these factors have contributed to the creation of our Wellness Program. We must take control!

The Solution:

Peter Vigue, President of Cianbro, started a push in the 1980s to create a culture focused on the safety and health of team members. Today, Peter champions the same culture change with wellness. Driven by a strong belief in doing the right thing, Pete has empowered the Human Resources team to create a wellness program. Improving team members’ quality of life and reducing risky health behavior is the company's way to address burgeoning health issues and high costs for medical premiums. You can't have a healthy company without healthy team members.

The safety philosophy of “zero injuries and preventing accidents before they happen” works the same for wellness. At Cianbro, the medical plan focuses on a claims prevention program rather than a claims paying system.  With that objective in mind, wellness is an integral part of Cianbro's strategic plan.

Exercising, eating properly, losing and controlling weight, lowering blood pressure and cholesterol, managing stress and diseases and being tobacco free are the order of the day at Cianbro.

Cianbro wants to become the healthiest company in America. Toward that end, we have a program in place designed to make wellness both attractive and rewarding for our team members. We are committed to establishing a healthy work environment. Cianbro offers health awareness information and incentives through:

• The Healthy LifeStyle Program with personal health coaches 
• Wellness on Worksites (WOW) bullets
• Monthly Wellness Matters newsletter
• Safety meeting discussions
• Lunch and Learns 
• Healthy menu choices for in-house meetings and vending machines 
• Health clinics and screenings 
• A tobacco-free workplace
• Quit Tobacco Today Program and tobacco cessation classes 
• Daily stretching.

Participants in Cianbro's Wellness Programs are rewarded by improved health and quality of life, discounts on medical coverage with the Healthy LifeStyle Program, and support for some wellness activities during company paid time. But perhaps the best reward of all is that our people are losing weight, quitting tobacco, reducing their cholesterol and blood pressure, exercising, and taking control of their health!

What is The Healthy LifeStyle Program?

The Healthy LifeStyle Program is the center of Cianbro’s Wellness Program. The program guides participants toward optimal health behaviors by identifying risks and providing the education and coaching necessary to achieve a healthy lifestyle. Focus is on major preventable health risk behaviors - tobacco use, nutrition, obesity, exercise and controllable, measurable health risks such as blood pressure and cholesterol levels. Additional components include childhood activity and nutrition, wise health care utilization, self-care, preventive screening education and other areas which team members have a specific interest.

Health coaches provide ongoing counseling at follow-up interviews and track progress over time, utilizing Cianbro Wellness Tracking Software. The ultimate goal of the intervention is to improve the overall health status of participants, their quality of life, and productivity at work while reducing the need for, use and cost of health care both in the long and short term.

Credits:

Not only will participants gain a healthy lifestyle, you can also save money on medical premiums by qualifying for the following credits. Each credit is earned individually by the Team Member and their spouse (if applicable). 

Participating Credit: Participation means calling a health coach to complete an initial Health Risk Appraisal (HRA), identifying and committing to eliminate controllable at-risk behaviors, setting health related goals and objectives and scheduling and keeping face-to-face follow-up appointments. Telephone appointments are only used as back up if a face-to-face appointment cannot be made.

Healthy Living Reward: To qualify for this credit, participants must meet three of the four health risks listed below. These measurements are required to be updated once a year (except for cholesterol which is every three years). The Healthy Living Reward cannot be earned without first qualifying for the Participating Credit.

• Body Mass Index (BMI) less than 27.5 
• Blood Pressure both numbers less than 140 over 90*
• Total Cholesterol less than 200 and HDL greater than or equal to 40
• Tobacco-Free for 12 months or more

*If one blood pressure reading within the last year is 140/90 or higher, then two good blood pressure readings within the last year are required and must be less than 140/90 to qualify.

Step 1:  Complete a Health Risk Appraisal (HRA) with a Health Coach

The HRA is a list of questions related to the participant’s current lifestyle and health problems.  The team member is weighed and measured.  His or her blood pressure is checked and cholesterol is taken.  These procedures will determine eligibility for the Healthy Living Reward.  The information that is gathered is confidential, and remains with the health coach at Occupational Medical Consulting.

Step 2:  Set a healthy goal

Participants and their health coach will decide which at risk areas to focus on.  They will set long term goals and short term “target behaviors” to help achieve goals.  Participants will leave their meeting with a summary of risks, a risk score, and targets to serve as a guide between appointments.

Step 3:  Follow-up

During their appointment, participants receive a follow-up date and have the opportunity to schedule a follow-up appointment with their health coach. Team members meet with their health coach face-to-face at their jobsite. Spouses meet at other designated locations (within a reasonable distance from home). Telephone appointments are used only as back-up. Appointments must be completed on or before the follow-up date. It is the participant’s responsibility to schedule and keep follow-up appointments.

Risk Score:

The American Heritage Dictionary defines risk as "the possibility of suffering harm or loss". The Behavioral Health Risk score is based on studies that indicate that certain behaviors put us at an increased risk for developing preventable health problems such as heart disease, cancer, or Type II diabetes. Risks that have the most potential to do harm and the greatest potential to be prevented are scored the highest. These are called "behavioral risks" because they are closely tied to lifestyle behaviors that can be changed in order to reduce the potential for damage to health.

When a participant meets with a health coach, their health risk score is calculated in part on measurements (blood pressure, cholesterol, weight and height, tobacco use). A participant falls into the low risk category (less likely to develop chronic disease) if their risk score is under 50, medium risk category if their risk score is between that and 100, and high risk if their risk score is over 100.

The credit for the Healthy Living Reward in the Healthy LifeStyle Program is based on a participant’s risk in tobacco use, body mass index, blood pressure and cholesterol. Listed below are each of these criteria and the associated risk score:

Tobacco free for a year
Risk Score: Tobacco use 30 points

Smoking kills 3 jumbo jet loads of people each day! The U.S. Surgeon General and the Centers for Disease Control and Prevention provide a wealth of information on the potential health risks created by tobacco smoke. These risks include:

• Coronary artery disease, including angina and heart attacks
• High blood pressure, blood clots, aneurysms, and strokes 
• Cancer (especially in the lung, mouth, larynx, esophagus, bladder, kidney, pancreas, and cervix) 
• Chronic lung disease -- emphysema, chronic bronchitis 
• Pregnancy related problems, including miscarriage, premature labor, low birth weight, and risk for SIDS (sudden infant death syndrome) 
• Delayed wound healing 
• Tooth and gum diseases; decreased senses of taste and smell
• If you use smokeless tobacco for a long period of time, you have many of these same risks, plus a 50 times greater risk for oral cancer.

Body Mass Index (BMI) at or below 27.5
Risk Score: Overweight – 20 points, Seriously Overweight - 30 points

A body mass index (BMI) of less than 27.5 indicates that you are at a healthy weight (those less than 18.5 are considered underweight, however). If your BMI is between 27.5 and 29.9, you may be overweight. A BMI of 30 or more indicates you may be seriously overweight.

According to the Centers for Disease Control and Prevention, being overweight or obese may raise the risk of illness from high blood pressure, high blood cholesterol, heart disease, stroke, diabetes, certain types of cancer, arthritis and breathing problems. As BMI increases, so does the risk for health problems and it is also associated with an increased incidence of high cost health care claims.

Blood Pressure below 140/90 mm Hg
Risk Score: High Blood Pressure – 20 points

High blood pressure is the direct result of narrow arteries occurring naturally or by plaque buildup within the arteries which makes it considerably harder for blood to flow through them, increasing the pressure inside. When this happens your heart becomes strained, and blood vessels may become damaged. Changes in the vessels that supply blood to your organs like kidneys, brain and heart could be negatively affected.

Total Cholesterol below 200 and HDL (good) Cholesterol at or above 40
Risk Score: High Total Cholesterol – 20 points, Low HDL Cholesterol - 10 points

When you have high cholesterol, you may develop fatty deposits in your blood vessels. Eventually, these deposits make it difficult for enough blood to flow through your arteries. Your heart may not get as much oxygen-rich blood as it needs, which increases the risk of a heart attack. Decreased blood flow to your brain can cause a stroke.

HDL cholesterol acts as a scavenger, picking up excess cholesterol in your blood and taking it back to your liver for disposal. The higher your HDL level, the less "bad" cholesterol you'll have in your blood. In addition, HDL may have other protective effects on your heart and blood vessels, including antioxidant, anti-inflammatory and anti-clotting effects.

Results:

We have built the Healthy LifeStyle Program to help team members and spouses become aware of their at-risk health behaviors. We partner a health coach with them to turn these risks around and limit health care costs. Participants reap the benefits of good health by saving money on medical costs, and also earn additional credits toward medical premiums.

The following graph compares the change in behavior risk level for participants in the Healthy LifeStyle Program who joined the program between January 2003 and December 2008 (blue bars) and where they are December 2008 (red bars). Medium risk levels have reduced while those in the low risk category has increased.

By offering a way to work on at-risk health behaviors, and with our team's participation, Cianbro can continue to offer a robust medical plan. Without the help of our team members, costs might rise and quality might decrease. We all have a responsibility to be good consumers of our company benefits. Working together, we can control health care costs and keep them affordable. The following graph illustrates Cianbro’s trend of total health costs in comparison to the national trend.