A Hawkeye at Heart for Health

It stands to reason that Iowa City, Iowa, is a healthy city.

The small but urban community is supported by a major university, surrounded by miles of rolling farm fields; the ideal picture of clean living in America’s heartland.

And that’s largely true. But as Joni Troester discovered when she began working at the University of Iowa, building a culture of health and wellness was anything but a given at her alma mater in Hawkeye Nation.

Currently the interim assistant vice president of benefits, health and productivity at the University of Iowa, Troester is in charge of developing and sustaining a culture of health and wellness at an institution with more than 23,000 employees. Creating a wellness program that provides measurable value for both the individual and the organization is no small task. Thankfully, Troester is well-trained.

Troester holds three degrees from the university. She began pursuing a bachelor’s degree in exercise science in 1984 and left the university in 1989 with a master’s degree in the same field. She returned in 2009 to pursue an MBA at the Henry B. Tippie College of Business. In all, those nine years spent learning in Iowa City transformed her interest in health into an ability to develop employee wellness programs that, unlike some plans being hawked these days, yield measurable results.

“I knew going in that I wanted to work supporting people’s health and well-being, especially from a corporate aspect,” Troester said. “It was initially all about working with people and trying to help them improve in terms of their own health and wellness, but as I learned more, it turned into: How do we work collaboratively to develop systems and cultures within organizations to support people?”

After completing her first master’s degree, Troester took a position at St. Luke’s Hospital in nearby Cedar Rapids. Her initial role combined health promotion — an early iteration of wellness that was new at the time — and some cardiac rehabilitation. The experience she gained there led to an opportunity to return to her alma mater in 1997 to work within the department of family medicine providing health education and health promotion to its primary-care patients.

“What I noticed when I began working there was that a lot of our primary-care patients were also employees of the university,” Troester said. “So I began to have conversations with family medicine leadership and our central human resources department about launching an initiative for employees around health and wellness.”

Those conversations eventually grew into a wellness pilot program that launched in 1999.

Troester’s partnership with HR grew closer, eventually leading to her transitioning from a health role to an HR role in 2003. In 2005 she became the director of organizational effectiveness, health and productivity.

“Initially I was responsible for wellness and then I assumed some responsibility for the preventive-type services that HR wanted to implement around workers’ compensation,” Troester said. “Gradually, as people transitioned, had the opportunity to grow the scope of the program and align it around benefits and health management services. It’s about looking at it as a strategic initiative for HR and I was fortunate to have a great team supporting these efforts on campus.”

These efforts grew into the liveWELL brand that launched in 2006. By leveraging both internal and external partnerships, Troester and her team have provided the university with a combined cost savings and cost avoidance of up to $3 million annually. Based on a Truven Health Analytics study, the program yields an annual return on investment of 2.37. This number represents the total financial gains of the wellness program divided by the total cost to deliver the program.

It’s clear her efforts have been successful. LiveWELL has been recognized for its positive influence with the Healthy Iowa Award and by being named a Fit-Friendly Worksite by the American Heart Association, and most recently a 2015 recipient of the C. Everett Koop National Health Award – Honorable Mention. Troester herself was the recipient of the 2015 Heart of HERO Award. The Health Enhancement Research Organization— a nonprofit dedicated to employee health management — assigns the award to an individual who has made an impact on multiple aspects of that person’s organization’s employee health management program as well as the surrounding community.

She says the secret to her success is being proactive.

“Oftentimes institutions spend a significant amount of time on managing chronic conditions when they really need to concentrate on the big picture of lowering risk in their at-risk population and sustaining healthy behaviors,” Troester said.

Collaboration Is Key

To exert change in an organization as large as the University of Iowa, with just over 31,000 students, different departments had to work together on wellness. There was just no other way.

Sibson Consulting, a benefits and HR consulting firm, conducted a study in 2011 into the value of a healthy campus, and the University of Iowa was one of 71 institutions of higher learning to participate. The firm’s research showed that there are three practices that lead to a successful wellness program, the first of which is strategic support. Having strong leadership from a program leader or committee helps increase the odds that a shared wellness vision can be achieved, the study found. And strong leadership is just what the liveWELL program had from the start.

“I think it’s important for us to look at the initiative from a systems view,” Troester said. “How do we engage our partners and look for opportunities where all of us can benefit? We’ve been fortunate enough to have excellent partnerships on campus with our recreational services department, our health science colleges and our university hospitals and clinics.”

At the University of Iowa, engagement began from within. From its inception in 1999, the pilot program that would become liveWELL was based on an integrated model driven by HR that encompasses health services; disability assistance; long-term disability; organizational effectiveness; workers’ compensation; insurance provider relationships; safety; recreational services; environmental health; and risk management. Representatives from these departments formed a management advisory board tasked with developing goals and initiatives in the areas of behavioral health, healthy campus nutrition, physical activity and outcomes analysis,” Troester said.

For example, as a result of the discussions, the Healthy Campus Nutrition Advisory Group was formed by the vice president of student services and the vice president of human resources in 2011. The advisory group developed an educational campaign focused on identifying foods that are low in fat and sodium and made with whole grains and fruit juice. Foods that meet these criteria are labeled with a UChoose label for easy identification by university staff and faculty.

But having representatives from these different areas of the instutition make university-wide decisions was not enough. Employees needed a voice.

“The other piece that we feel very strongly about is: How do we collaborate with our faculty and staff more directly?” Troester said.

The first step was to create a wellness ambassador group composed of 130 volunteers who would serve as local champions for health and wellness within their department, Troester said. This grassroots effort allowed HR to work collaboratively with employees on campus.

In addition, employees are surveyed annually on areas of interest related to personal health and wellness. Three questions were added to the end of the Personal Health Assessment survey so the liveWELL team could collect information for planning purposes on an annual basis.

These personal health assessments are the foundation of the liveWELL program and have been well-received by faculty and staff. According to the 2015 liveWELL year-end report, 73 percent of employees completed a personal health assessment that year, up from 61 percent in 2009.

 “It’s important for us to understand what our employees’ wants and interests are, not just where their health risks lie,” Troester said. “Our model is about using partnerships to achieve success and develop a culture of wellness at the University of Iowa.”

Value Vision Over Data

As wonderful as a culture of wellness is, the same question looms large over any organization’s efforts to keep employees healthy: What’s the bottom-line value? Employers want to know that they are gaining something for their efforts and investments, and it typically comes down to money. Fortunately for Troester and her liveWELL program, she has a solid answer.

A 2014 study of employee members in the University’s UIChoice health plan showed positive financial returns for those engaged in health and well-being services that year. Participants had lower adjusted average annual claim costs of $307.50. They also experienced a 7 percent lower health care cost trend overall from 2010 to 2013. For comparison, the U.S. Centers for Medicare and Medicaid Services anticipates out-of-pocket spending to increase to 5.7 percent by 2021.

“I am very proud of the health and wellness services offered through human resources,” said Kevin D. Ward, interim vice president for human resources at the University of Iowa. “These programs have had a significant impact related to improved health and quality of life for our faculty and staff. Services have also contributed substantially to our health care cost containment efforts.”

As important as health cost reduction is to an organization, Troester is equally if not more proud of her efforts to keep her eye on the big picture. And in this case the big picture is the community beyond the university’s campus.

In early 2015, the University of Iowa obtained a Blue Zones Worksite designation. The Blue Zones Project is an initiative by Healthways — a well-being improvement company — to turn communities into hotbeds of healthy choices. By hosting health fairs and other educational opportunities generating awareness of the cause, the University of Iowa is building momentum for the cause in the Iowa City community as well as sharing practices that have worked to keep their employees healthy.

“I believe that it’s all about looking at the big picture for important things that we can do to stay focused on where our efforts are directed in terms of our growth and development and how we can continue to innovate and achieve results for the University that we have thus far,” Troester said.

This story was updated Feb. 10 to reflect corrections to the LiveWELL program and the university’s Blue Zones Worksite designation.