Greetings card company Hallmark is one of a growing number of US companies adopting innovative approaches to wellbeing, in response to rising costs. Noel O’Reilly investigates.
For employers in the UK, probably the most eye-catching aspect of the company’s healthcare programme is that it offers financial rewards of up to $400 (£255) to employees who maintain healthy weight, blood pressure and cholesterol levels.
However, the programme’s reach is much broader than simply offering employees financial incentives. Hallmark takes a long-term strategic approach to encouraging employees to start and to maintain healthy behaviour. UK companies struggling to sustain health promotion and wellbeing programmes beyond the initial launch could learn from this.
In 2008, Hallmark realised that its healthcare costs were spiralling and becoming a critical risk to its business. So, since then, it has shifted its healthcare insurance from a self-insured basis to a fully insured one, in order to reduce the risk of higher-than-expected healthcare claims from employees.
Hallmark Health Rewards
The company revamped its wellbeing strategy and, in 2011, it introduced Hallmark Health Rewards to all employees on its healthcare insurance plan. The programme promoted personal health and wellbeing to employees.
The objective was to cut the costs of company-provided healthcare by encouraging healthy behaviour among staff and thus reducing health claims. The programme also supported employees in making cost-effective healthcare choices. To measure the impact of the programme, metrics were developed to track data on employee wellbeing over time.
The shift to Hallmark Health Rewards was enabled, in part, by the company’s heritage and culture.
Hallmark makes and sells greeting cards and it turned over $3.8 billion (£2.4 billion) in 2014. The company employs around 3,000 employees in its headquarters in Kansas City and has 2,400 staff who take advantage of this programme. Hallmark was founded by Joyce Clyde Hall in 1910 and remains privately owned. Since its launch, it has taken a paternalistic approach to employee welfare and it has invested in corporate responsibility initiatives. Women represent 38% of Hallmark’s senior managers and the organisation also offers flexible working to employees alongside other family-friendly policies.
Hallmark has taken responsibility for employees’ welfare from its early years, based on the motto that happy staff equal productive staff. Employees have been offered an onsite food service, after-work softball, family picnics, and, in the 1990s, the company organised employee wellbeing in three areas: food; medical clinics; and fitness and recreation.
Linking employee engagement to employee wellbeing
However, Hallmark Health Rewards represented a step change, linking wellbeing to employee engagement, and using technology, tools and resources to motivate employees to improve their health and adopt more cost-effective healthcare. The emphasis was on preventive health measures to cut the risk of ill health.
“Having a comprehensive approach, as well as a great tool to manage and fulfill our wellness incentives has been a huge step forward in furthering our culture of health,” says Sally Luck, director of corporate services.
“We knew we needed to take action to mitigate healthcare costs. We were already offering a lot of services, but we needed more structure, better branding and better communication regarding the tools and resources we could provide.
“At that time, we also introduced our Hallmark Health Reward Portal which provided many opportunities to learn and earn points for various healthy behaviours. We are very happy with overall participation levels, and were surprised that around two out of three participants chose gift cards over paycheck credits. Employees are looking to reward or treat themselves for their hard work in earning points.”
The programme was led by HR but integrated into the company’s culture, and supported by comprehensive marketing and branding. A multi-disciplinary oversight team was set up with executive-level support, and made accountable for results. Members of the group were drawn from medical and food services, fitness teams, employee benefits, marketing and corporate communications. The company also developed a close relationship with health benefits providers in order to find costeffective solutions.
Perhaps the most striking aspect of Hallmark Health Rewards, from a UK perspective, is the use of financial incentives to encourage employees to achieve wellbeing goals. Incentives, and sometimes penalties, have been used by a number of large US companies, most notably pharmaceutical company Johnson & Johnson, to encourage employees to adopt healthier behaviour or to quit unhealthy habits, such as smoking.
We would like to be better able to target specific locations with educational and screening opportunities based upon need and to improve engagement in some of the locations with lower participation – Sally Luck, director corporate services, Hallmark
The challenge of corporate wellbeing programmes is to sustain employee commitment over the long term and to encourage the engagement of more reluctant employees, who are often those most in need of a healthier lifestyle. Hallmark tackled this problem by adopting long-term strategic planning, whereas many UK wellbeing programmes are more ad hoc.
The first three years, from 2011 to 2013 focused on “building accountability” and the emphasis was on educating staff, setting goals, encouraging participation and reducing the risk of ill health. Employees were urged to know their vital health numbers, such as body mass index (BMI), and to make better decisions as consumers.
In 2013, the programme promoted the principle of “prevention pays” and, in 2014, the slogan was “reduce your risks”. Health screening was encouraged for a range of health risks, and individuals were able to identify problems before they became chronic and often before they were aware of their illness.
Annual wellness visits were offered to screen adults for blood pressure, diabetes, cholesterol, skin problems and obesity. Women were advised to be screened for cervical cancer, human papillomavirus, breast cancer and bone density, and men over age 50 were advised to be screened for prostate cancer. There was also an immunisation schedule and vaccinations offered onsite for a range of infections including diphtheria, chicken pox, shingles, influenza and pneumonia.
Sustainability and achieving outcomes
In the last two years, the emphasis has been on putting a comprehensive wellbeing programme in place that is focused on sustainability and that introduces the principle of outcomes-based results to employees.
Communication and leadership were key factors in engaging employees. Employee champions, referred to as “Hallmark health ambassadors”, are drawn from senior levels of the organisation. They help publicise the programme through emails in different divisions, supporting events, informal influence and assisting onsite OH nurse advisers.
“Our onsite occupational health nurse’s role has evolved into a much more wellness/prevention focus than in years past,” says Luck. “They plan and conduct our health fairs, screenings, flu-shot clinics and educational sessions. And they are masterful at health coaching.”
OH advisers have a role in coaching employees, and in helping to organise educational events such as “lunch and learn” sessions where therapists, dietitians and doctors give talks on various health topics. The communication strategy has tailored the message to different populations, headquarters and field staff. Channels deployed included the website, email, events pages, company TV and online video, computer demos, stand-up meetings, corporate and divisional forums, newsletters and displays. One of the most progressive aspects of the programme is the use of technology to help employees monitor their own health goals, and to engage them in wellbeing through personalised health tools on a new health portal. This has the potential to enable the company to collect data and develop an aggregate risk profile of the company’s employees. No individual data is collected as the company is committed to upholding the privacy principles of the US Health Insurance Portability and Accountability Act.
“We would like to be better able to target specific locations with educational and screening opportunities based upon need and to improve engagement in some of the locations with lower participation,” says Luck. “We are already targeting communications through our Hallmark Health Rewards portal. For instance; those who have completed only one or two activities or haven’t completed the health assessment will receive a different message than someone who is fully engaged.”
While many UK companies have adopted some of the interventions above, the principle of rewarding employees for adopting healthy choices is alien to most UK employers, and the fairness and validity of using financial incentives in wellbeing programmes has also been debated in the US.
However, since the financial incentive programme began in 2011, 82% of eligible employees have earned health rewards. People can be rewarded with up to $400 for participating in health and wellbeing initiatives, such as biometric and blood tests, physician check-ups, health assessments, and educational activities such as attending “lunch and learns” and completing workshops on its online portal. Around one-third ($150) of this incentive is earned by achieving or making progress toward healthy BMI and blood-pressure measures.
The company uses its subsidiary employee recognition company, Hallmark Business Connections, to administer the Hallmark Health Rewards Portal and to serve on the wellness oversight team. One of the ways in which the creative talents of Hallmark is utilised is in sending Hallmark Health greetings cards to inform staff when they have reached goals. The reward is in the form of gift cards or a health credit on their salary to help onset health insurance costs.
So has Hallmark’s health programme succeeded in transforming the wellbeing of its staff? There have been steady increases in physical activity, healthy food sales and participation in health education. However, it has proved more challenging to get employees to receive preventive care.
Hallmark’s journey is perhaps only beginning. Next steps include: better data integration and programmes targeted to groups with specific health risks; better engagement of field staff and outlying locations; more work on the online portal engagement; a continued emphasis on emphasis on preventive care; building accountability for health results; and reducing health risks. One other plan that has resonance in the UK is the aim to build relationships with primary care physicians, which is reminiscent of the introduction of the fit note to GP practices and the new Fit for Work service.
With demographic and lifestyle issues creating increasing risks of ill health, Hallmark’s programme is likely to remain a priority for years to come.
“At Hallmark we have a long history of health and wellbeing,” says Hall. “It is an important aspect of both our employment brand and our consumer brand and is deeply ingrained in our culture. It is the right thing for us to do now and in the future.”