Many participants reported challenges with engaging employees in their own health. To overcome barriers such as geographically dispersed populations, culturally diverse workers and lack of motivation or interest, plans identified the need for all levels of leadership to "buy in" to the VBHC concept.

Plan representatives discussed communication and education techniques to engage employees:

• Carefully select the sources and vehicles for delivering messages
• Try to engage all levels
• Motivate people to take action by using a variety of techniques
• Begin educating early in a worker's tenure. 

They also stressed the need to think creatively and to use personalized communication methods such as one-on-one communication through champions at the worksite.

"A conglomeration of different types of communication is needed and sometimes throwing stuff at the wall to see what sticks," the report says. "This is what we have to do, and if it costs a little more initially, in the end it will help us get through to folks."

Although using health care data is important, few organizations are proficient in gathering and monitoring data and measuring outcomes to help them develop health care strategies. As a starting point, focus group representatives suggest preparing a general picture of a plan's health status to understand where costs are originating and the issues that have the greatest impact on worker health. Several representatives whose organizations monitor data are encouraged by favorable outcomes and hope to use data to drive future decisions.

"Our health care costs were growing just like everybody else's and a lot of it was in the area of certain diseases," one representative said. "Ten percent of the population was driving 90 percent of the costs. So we introduced a disease management program to target cost-driving diseases, and we have done a ton of analysis of our data that shows we have bended the curve in our health care costs."

Annual health screenings are viewed as an important first step to building a healthier and more productive work environment. Additionally, many focus group representatives report using value-based benefit design to encourage participants to manage chronic conditions so emergency room visits and hospitalization can be avoided.

Forty-six representatives of multiemployer and public employer health plans participated in the focus groups, part of the Foundation's ongoing, multi-step project to provide practical ways for multiemployer and public employer plans to integrate value-based strategies. The project is funded in part by a grant from Pfizer Inc.