Montana Dept. of Public Health Expands Successful Worksite Walking Program

Submission Date: July 2020

Entry Type: Case Study

State/Territory Submitted on the Behalf of: Montana

States/Territories Involved: Montana, North Dakota

Funding Source: CDC, NACDD

CDC Funding:

Yes

CDC Funding (Specified):

Other CDC Funding

Public Health Issue:

Approximately 127 million Americans live with a musculoskeletal condition. These conditions have an associated cost of treatment, care and lost wages totaling more than $213 billion annually.¹ Narrowing to arthritis specifically, this chronic disease affects one in four Americans and causes significant disability.² Similarly, more than one in four adults in Montana, 27%, have arthritis.³ Of Montanans with arthritis, half have activity limitations and nearly a quarter have arthritis-related joint pain.³

The negative consequences of arthritis extend beyond the individual. They lead to absenteeism, distraction and lost productivity at work. In fact, 172 million workdays are lost due to arthritis and other rheumatic conditions.²

Research recommends self-efficacy and self-management programs, such as Walk with Ease, for management of osteoarthritis.⁴ Likewise, physical activity has been proven to improve arthritis symptoms.⁵

As such, the National Association of Chronic Disease Directors (NACDD) is supporting the Montana Department of Public Health and Human Services, Chronic Disease Prevention & Health Promotion Bureau (CDPHP Bureau) in their effort to recruit partners that will increase the adoption of Walk With Ease (WWE) in workplaces across Montana. The WWE program can benefit those living with arthritis by reducing pain, improving balance and strength, and building confidence in one’s ability to be physically active.⁶ These individual benefits can also translate to employer benefits, including decreased absenteeism, increased productivity while at work, decreased health care costs, and increased job satisfaction.

1. American Academy of Orthopedic Surgeons. (2016, March 1). One in two Americans have a musculoskeletal condition: New report outlines the prevalence, scope, cost and projected growth of musculoskeletal disorders in the US. ScienceDaily. www.sciencedaily.com/releases/2016/03/160301114116.htm
2. Arthritis Foundation. (2018, December 20). What Americans Don’t Know About Arthritis May Surprise You. https://www.arthritis.org/about-us/news-and-updates/what-americans-don-t-know
3. Barbour KE, Moss S, Croft JB, et al. Geographic Variations in Arthritis Prevalence, Health-Related Characteristics, and Management — United States, 2015. MMWR Surveill Summ 2018;67(No. SS-4):1–28. DOI: http://dx.doi.org/10.15585/mmwr.ss6704a1
4. Kolasinski SL, Neogi T, et al. 2019 American College of Rheumatology/Arthritis Foundation Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee. Arthritis Care & Research 2020; 72 (2): pp 149–162 DOI: 10.1002/acr.24131
5. 2018 Physical Activity Guidelines Advisory Committee. 2018 Physical Activity Guidelines Advisory Committee scientific report. Washington, DC: US Department of Health and Human Services, 2018.
6. Arthritis Foundation. About the program. https://www.arthritis.org/health-wellness/healthy-living/physical-activity/walking/walk-with-ease/wwe-about-the-program

Project Objectives:

As written in NACDD’s Year 4 work plan, the project objective guiding this effort is “By 9/29/20, build on successes of the Work@Health Program and the State of Montana employee workplace wellness program by implementing Walk With Ease, an evidence-based intervention, as a sustainable component of worksite wellness efforts in at least five Montana employers and/or partner organizations.”

Anticpated outcomes for this project include:

– sustainable supports for arthritis appropriate, evidence-based intervention (AAEBI) dissemination and delivery;

– sustained delivery of AAEBIs;

– documentation of processes, challenges and lessons learned; and

– increased reach of individuals with AAEBIs.

Program Action:

Since 2015, the Montana Health Care and Benefits Division has offered the self-directed version of WWE in the established state employee wellness program.  Employees are offered a health insurance premium discount as a financial incentive to participate in and complete the program. Evaluation of self-reported data from participants revealed walking levels increased significantly among participants, while pain and fatigue decreased among those with moderate or severe pain at the start of the program.¹ In the first year, WWE was offered to only employees with arthritis, however, in subsequent years, it was offered to all State of Montana Benefit Members who wanted to participate in a low-impact physical activity program.

In 2019, NACDD began providing the CDPHP Bureau financial support to build on the successes of Work@Health^® and the State of Montana employee worksite wellness efforts, which included offering WWE as described above. Since then, NACDD has collaborated with the CDPHP Bureau to help increase the availability of WWE in employers across Montana. The CDPHP Bureau has done so by building upon existing partnerships formed during Work@Health^® and through other efforts to recruit employers and partners.

The CDPHP Bureau began by compiling a list of contacts and scheduling meetings to introduce WWE. To assist with explaining the program and benefits of adopting it as a physical activity component of workplace wellness efforts, both to employers and for employers to recruit employees, the CDPHP Bureau compiled a kit of marketing materials.

As more employers and partners engaged, the CDPHP Bureau formalized their onboarding process for new partners, offering each new site a start-up kit. Kits includes WWE participant books that were purchased using NACDD grant funding, marketing supplies, access to the WWE participant portal (described below), and other items to support the launch of their first WWE session. Additionally, the CDPHP Bureau offers technical support throughout the process to entice employers to implement the program.

1. Silverstein RP, VanderVos M, Welch H, Long A, Kaboré CD, Hootman JM. Self-Directed Walk With Ease Workplace Wellness Program – Montana, 2015-2017. MMWR Morb Mortal Wkly Rep 2018;67:1295-1299. DOI: http://dx.doi.org/10.15585/mmwr.mm6746a3

 

Data/Other Information Collected:

The CDPHP Bureau agreed to capture participant data to help document the Return on Investment and Value on Investment of supporting employees’ participation in WWE to their employers. This is happening through several avenues.

Prior to becoming involved with NACDD, the CDPHP Bureau worked with the University of North Dakota, Energy and Environmental Resource Center (EERC) to develop a WWE participant portal. Participants use the portal to register and report their weekly walking minutes. The CDPHP Bureau also uses the portal for collecting pre/post-tests from participants and the six-month follow-up questionnaire. In the spring of 2020, the updated WWE participant portal was launched for the self-directed WWE sites to use. The WWE participant portal now includes the weekly emails that are automatically sent from the portal. This enhancement has streamlined the delivery of the self-directed WWE program.

In addition to their participant portal, the CDPHP Bureau tracks the number of new participants and completers in the NACDD-created WWE evaluation tool. The CDPHP Bureau added two columns to that tool to provide the employer name and employer type, demonstrating the range of employers they have engaged.

The CDPHP Bureau is very data-driven and is in ongoing conversations with their state benefits managers to try and access data so that a comparison can be made between WWE completers and non-participants.  Potential data points being considered include productivity, absenteeism, health care usage/insurance claims, employee assistance program usage and workers’ compensation claims. The CDPHP Bureau is also in the process of adding a couple questions about absenteeism and productivity to their pre/post-tests and six–month follow-up survey to document the impact of WWE on employer metrics. The questions being added are those that were used as part of the evaluation being done of a similar employer-oriented WWE effort in Philadelphia.

Impact/Accomplishments:

To date, the CDPHP Bureau’s efforts have been fruitful. Since 2015, they have enrolled over 6,700 employees across multiple employers as WWE participants. Over 1,000 of the participants have been engaged since the CDPHP Bureau began working with NACDD.

All WWE participants have the opportunity to complete a voluntary pre-test, post-test, and a six-month follow-up survey. All three-assessment questionnaires are identical as a mode of comparison. There are four measurable outcomes in the questionnaires: 1) pain and fatigue levels; 2) current physical activity level; 3) self-efficacy to exercise; and 4) physical limitation. The data highlights that the participants who complete the self-directed WWE program have a significant increase in their weekly walking minutes and other physical activity, a decrease in fatigue levels and a reduction in moderate to severe pain levels. The CDPHP Bureau uses the data gathered from the assessment tools to promote self-directed WWE to potential employers by showing the benefits WWE has on employees.

Beyond the number of participants, the CDPHP Bureau has figured out a successful model for engaging employers and partners from different industry sectors, of various sizes and in geographic locations across the state. Examples of participating employers include the state government, county governments across the state, local health departments, a quality improvement organization, school districts, hospitals, and a community health center.

The CDPHP Bureau sees the value of working with partners with connections into groups of organizations where employers are members, and to integrating WWE into other employer wellness efforts. This approach is more advantageous than cold-calling employers to participate in WWE. Partners include:

• Montana Blue Cross, Blue Shield (BCBS): The organization has agreed to promote WWE, linking 24 employers to the broader effort. BCBS added WWE as a worksite wellness program to their menu of health and wellbeing programs that employers’ members can participate in. BCBS offers health and wellbeing programs as part of plan coverage. The programs help employees live healthier and save on health care costs. The CDPHP Bureau is hopeful that a subset of the 24 employers will begin rolling out WWE in the second half of 2020.
• Regional Health Districts: The Worksite Wellness Coordinator for the Chronic Disease Prevention and Health Promotion Bureau has agreed to integrate WWE as an evidence-based physical activity strategy for the 13 Chronic Disease Health Regions that are supported. Each chronic disease region is tasked with working with three local employers around physical activity, nutrition, tobacco-free, and/or breast-feeding strategies. As of March 2020, 10 out of the 13 Chronic Disease Health Regions are offering the WWE program to local employers.
• Diabetes Prevention Program: The CDPHP Bureau is working to link evidence-based interventions by partnering with community-based organizations, who are recognized Diabetes Prevention Program (DPP) providers, to market WWE as a physical activity component of the DPP lifestyle change program. DPP providers are also being targeted to implement WWE to their own employees. To date, seven DPP providers have agreed to roll out WWE to their own employees.
• The CDPHP Bureau is engaged in ongoing conversations with Montana Veterans Affairs to implement the WWE program. Montana Veterans Affairs has recently received approval to pilot the WWE group option in several of the homes of veteran throughout Montana. Over time, the CDPHP Bureau’s goal is to continue to have the WWE program offered to Montana veterans and eventually offer the self-directed WWE to the Montana Veterans Affairs’ employees.

Another worksite the CDPHP Bureau is working with is a large school district. The school district is currently piloting the self-directed WWE as a worksite wellness program to employees at a high school, with the potential to expand to all schools in the district in the subsequent semester.

Challenges/Lessons Learned:

The CDPHP Bureau has had to overcome several challenges, beginning with their initial approach. Building on the success that NACDD had previously, working with purchasers coalitions, the project team initially planned to partner with local business influencers’ purchasers coalitions in Montana to implement WWE as a worksite physical activity program to their members. Lack of initial interest from the original targeted group of business influencers in Montana led the team to shift their approach to other partners and stakeholders with a new aim of marketing WWE as a physical activity component of worksite wellness efforts.

But the challenges did not stop after redirecting their efforts to focus on new partners and stakeholders. While working with partners is a strategic business decision it does present challenges as it relates to waiting on each organizations’ timeframes and decision makers. Additionally, challenges are compounded by continual changes of contact and leadership. Despite these obstacles, the CDPHP Bureau has kept in communication with each prospective partner to ensure that WWE continues to be on their radar.

As the CDPHP Bureau expanded their outreach, staff realized they needed to better “sell” WWE’s ease to implement and its benefits to employers and employees, so they worked to improve the promotional materials used during their meeting and those they left behind with prospective partners. As such, the CDPHP Bureau developed or enhanced the following tools:

• Walk With Ease —A Worksite Physical Activity Program infographic (developed by the NACDD),

• Walk With Ease Fact Sheet,

• CDC Morbidity and Mortality Weekly Report Walk With Ease Self-Directed Workplace Wellness article,

• Walk With Ease Quick Start handout,

• The Effects of a 6-Week Walking Program on Work Place Activity Limitation journal article to provide to the employers to promote the Walk With Ease (self-directed format), and

• WWE participant flyers to help employers market/promote WWE to prospective employees.

While not an unexpected challenge for the CDPHP Bureau, the weather could prove problematic for some if it’s not considered. Montana is known for snowy, bitter cold winters, so it was expected that participation would be lower during winter season. The staff anticipated the dip in the winter season and planned for an uptick in the spring, when nice weather returns.

The experience in Montana demonstrates that flexibility is necessary as collaborating with stakeholders and partners to create a common agenda can be challenging.

Next Steps:

The CDPHP Bureau plans to continue outreach to business influencers who have the power to affect wellness-related purchase decisions of employers. In addtion, they will continue to support those who have already engaged. They would like to see all employers and partners expand their enrollment and sustain the effort by offering WWE as a covered benefit.

Finally, the CDPHP Bureau plans to continue working toward accessing more data that will further support the business case for WWE as an effective, low-impact physical actvity worksite wellness program for most employees, including those with arthritis or other chronic conditions.

Program Areas:

Worksite Health

State Contact Information:

MT
Lisa Erck, MS
National Association of Chronic Disease Directors
843.882.3015
eerck@chronicdisease.org

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