Promoting a packaged wellness program to clients once a year or reminding them that they have access to their insurance carrier's complementary wellness Web site is all well and good, but Brandon Guest is taking the process a little deeper at his South Carolina benefits consulting firm. Just as charity begins at home, wellness begins at work for Horne/Guest employees.

When Guest and company Wellness Coordinator Nikki Barthelemy decided last spring to ramp up their existing employee wellness program, which then consisted of an online program with occasional fitness challenges, they instituted a "5% Challenge" in the style of "The Biggest Loser" that urged employees to lose 5% of their body weight. The first change was elimination of the second breakfasts brought by visiting vendors.

"It's a culture change. Vendors want to do something nice for you, but you've just got to get across to them that, hey, there are other things you can do besides bringing us donuts and bagels," says Guest, who's not afraid to pull out the trash can when necessary.

The results speak for themselves. During the 13-week challenge, Horne/Guest employees lost 186 pounds. Customers are noticing a change, too, and it's got nothing to do with physical appearance.

"If you're happy when you're talking to the customer, it'll show in your voice, and you will be happy. The customer will then send me an e-mail and say, 'You've got great customer service,'" says Guest. "I get a lot of those e-mails, it's amazing ... I'm getting more positive customer service feedback than I've ever gotten before in my life."

Cultural development

Horne/Guest started offering WellnessWorks, an online wellness program through United Benefit Advisors, to their 27 employees several years ago. The program includes a system that rewards points for completion of activities such as a health risk assessment and exercise programs. After a certain number of points, employees are rewarded with cash bonuses or money contributed to their HRAs.

After Guest realized they weren't getting the results that he wanted to see from the online program alone, he worked with Barthelemy to up the ante with the 5% Challenge.

"I wanted to see people actually working out, hear about them talking about running and losing weight and see them eating properly," he says. "I just wanted to bring it to a much higher level in the company."

Throughout the challenge, Barthelemy stressed accountability, holding a weekly weigh-in after Monday morning staff meetings. Consultant and co-owner Mark Combs says the biggest benefit of the program is the new office culture.

"Wellness is really about culture change, and changing the culture is a difficult thing to do. It's not something that happens overnight," says Combs, who recently wrote a book on employer-based wellness. "The example that I give clients is that in our break room, there is no sign that says you cannot come in here and eat pizza, hot dogs and Big Macs. But I can tell you that no one would ever, ever do that."

Ken Garrison, who won the challenge by losing nearly 16 pounds in three months, was psyched to get active by playing basketball and running. "I thought it was a pretty good idea," he says. "I wanted to get back into the habit of exercising, so this was just a little extra motivation."

People are coming into work with "a livelier step" and are visibly less stressed, says Guest. "I think it had more of an impact than I thought it would. I'm very pleased with the results."

Ideas and incentives

When looking for new ways to approach wellness in-house and with clients, Barthelemy says she draws inspiration from UBA's online wellness forum. Lately, people have been asking about the best way to use incentives to increase participation. "Sometimes you get stuck in one direction and it works, so you don't change," she says. "But with the forum, people throw out ideas and ... bam, it takes off."

Horne/Guest started a new challenge, the "Take Five Fruit & Veggie Challenge," in early August, bringing in a certified trainer and nutritionist to speak with the staff. Employees earn points by eating at least 125 cups of fruits and vegetables a month. Forty-six points by the end of the year earns them $300 toward their HRA.

Other challenges include a five-week boot camp at the local fitness center. If employees attend enough classes, Guest will pay for the camp.

Maintaining the momentum of the 5% Challenge, employees also can earn $20 for each additional pound lost over a six-week period. Even those who are already physically fit can participate by submitting their own proposal to Barthelemy.

"It might not be weight, it could be a host of other issues," says Guest. "It could be smoking, it could be drinking, it could be all kinds of things. It's hard to get people to open up to me about that, so that's why I have the wellness program to do it."

By the end of the year, employees can earn as much as $500 toward their HRA by participating in the wellness program, getting a physical, taking a health risk assessment and completing enough activities to earn at least 46 points out of a possible 68.

Because people do what they're incentivized to do, spreading out the wellness budget to increase the number of incentives offered is a great way to boost a wellness program, says Dr. Michele Dodd, vice president of health and wellness at ComPsych. Establishing a point system that distributes a dollar amount over a period of time is "maximizing the benefit by having employees really engaged in the program and also really earning the points," she says.

It's all about creating a healthy culture of energetic people within the organization, says Combs, who weighs 45 pounds less than during his college football days. "I don't want anyone working here who doesn't want to be better than they are now," he adds.

Barthelemy is quick to connect better health with saving money. "Health risks drive the health care costs; that's why we're so passionate about it here in the insurance industry," she says. "We know that if we can keep people healthy, we can keep their costs down."

Healthy equals happy

There's no chicken-or-the-egg debate when it comes to customer happiness, says Guest. "If you have happy customers, you've got to start with happy employees ... and I think it's hard to be positive and happy if you don't feel good and if you're not healthy," he says.

Guest makes no secret of his desire to gain market share from competitors, and he says the way to do that is through superior customer service: "[If] we don't have a lot of issues going on ourselves in our own lives, we can then go and help solve the problems that our customers have. So I guess my desire to create a better company is the reason why I wanted to do wellness."

Guest has lost about 20 pounds in the process, and customers are taking notice. When they comment on his weight loss, he takes the opportunity to discuss Horne/Guest's wellness program. With the positive results right in front of them, customers often respond with, "We need to do that!"

Horne/Guest client Heritage Trust Federal Credit Union started its own online wellness program for 200 employees in 13 locations across South Carolina about five years ago. Jim McKenrick chairs the company wellness committee and works closely with Horne/Guest consultant Steve Love, who sits in on wellness committee meetings and attends company events. "I see him out in the community a lot, and he's very involved in wellness," says McKenrick. "He's just been very, very helpful with taking our wellness program to the next level."

Heritage Trust has four fitness challenges a year, as well as a monthly newsletter and online seminars. The wellness committee uses an anonymous quarterly report to identify and target risk factors to focus on in the future, says McKenrick. Because their employees are at a high risk for obesity-related illnesses, the company is currently in the middle of its own "Biggest Loser" competition, with 80 employees participating.

Of the 200 employees, 78 participate in an HSA that Heritage Trust reimburses with a deductible deposit of $500 for an individual, $1,000 for someone with one dependent or $1,500 for a family. Money is deposited twice a year, in January and July, and employees must register on the wellness Web site and have a certain number of points to receive it.

The goal is to have all 200 employees registered on the wellness Web site, which costs a manageable $2.85 a month per participating employee.

The benefit of working with Horne/Guest is "immeasurable," says McKenrick, adding that their program could go up against any nationwide.

When a client starts a wellness program, the Horne/Guest graphic design team will create and distribute all employee communications, including custom posters that promote the program within the office. The service is free for accounts of more than 50 employees - and worth the price, says Combs.

"Our approach as a broker is to provide more value than our competition. And generally we do that [by reducing] sales person compensation. Salespeople in our business historically walk away with a lot, a lot, a lot of money. Our philosophy on it is, I would rather [our] services sell us than a big, fancy high-ticket sales guy," he says.

That's the direction the market is going, says Glenda Devechio with Swerdlin & Company, a Georgia benefits firm. It's time for brokers and consultants to be more involved on a regular basis rather than just at renewal time. "You have to get involved and hand-hold all the way through," she says. "We promote less cost for the employer, and obviously that translates into less commission for us. [It's a] new role; you need to be prepared to be a consultant. Those days of just getting 5% commission across the board are not there anymore," she says.

Barthelemy regularly attends clients' wellness committee meetings and keeps a constant flow of e-mail communication. For some, she is the wellness committee. "I'm basically the wellness program, the wellness coordinator, the wellness champion all in one, so it's up to me to get in there and penetrate the population and hope they'll get involved," she says.

Doing an overall wellness plan design for an employer is a "tremendous amount of work" says Devechio. "Significant claims cost savings may be realized from some of the new cutting-edge programs. [This] requires an employer to act outside of their comfort zone. It is our responsibility to assuage their concerns ... by helping them see the long-term effects."

Follow the leader

Once a client is onboard, what helps ensure success? For one thing, it takes a commitment from senior management, says Guest. If they're not promoting and consistently talking about the program, it's not going to go far.

"Online programs can be good, but I'm not so sure they're as effective as personal leadership by your senior management in engaging employees in showing the true desire and interest to change their behaviors," he says.

Tim Suchecki, national practice leader for integrated employee benefits at Reliance Standard Life Insurance Company, says senior management involvement is "where the rubber hits the road" in building an effective wellness program.

Suchecki recalls a 2,000-life employer where the president of the company recently lost 60 pounds. "That sort of commitment is what helps benefits managers find a couple of dollars per employee per month, which is what it takes to begin a wellness program and then continue the energy around getting the employees engaged," he says.

Heritage Trust follows such a philosophy. When putting together their wellness committee, McKenrick says they made an effort to find people who are not only passionate about wellness, but also hold strategic titles within the organization and "can get something done." The committee consists of managers, HR department employees and members of the credit union's marketing team.

Also, it's important to be flexible with wellness programs and not focus too heavily on one category, such as weight loss. If one of the owners of the company weighs 450 pounds and isn't interested in talking about weight loss, "don't even go there, because you're never coming from the point of integrity," says Combs.

Smoking cessation is another example. "If you're preaching smoking cessation, yet all your upper management doesn't pay attention to that, then what you do is, you totally erode trust and it's just not going to work," says Combs. "You're better off putting your efforts somewhere else."

Dodd does wellness surveys for her employers to find out what people are interested in doing. The surveys focus on areas such as nutrition, exercise and smoking cessation.

"The most effective programs are ones that look at what people are really interested and motivated in doing and what they need to do as a population," she says.

As for employers who doubt they'll benefit from starting a wellness program -"we're community rated" and "it'll take years to see financial returns" are common retorts - Guest says they're missing the point. "The point is not that your health care costs are going to go down, or may even be less. That's just a byproduct of what the real benefits of having a healthy workforce are all about," he says.

Sure, costs may go down in two, three, four years time, but the real benefit is what it does to your workforce. "We are a people-company, we work with other people so we have to be very positive and outgoing when we do that," says Guest. "You can do that if you're healthy."