Alere Health’s Tom Underwood is attacking the health care crisis Featured

8:00pm EDT October 26, 2010

On one ordinary day earlier this year, the leaders from 20 Texas companies met and discussed the challenge of building a culture of health within their respective businesses.

Tom Underwood and his team at Alere Health LLC brought these clients together to help solve the health care crisis that is plaguing corporate America.

During this meeting, competition didn’t matter. Competition can’t matter when obesity rates are rising and companies are spending more on health care than ever before. It can’t matter when businesses lose productivity because of absenteeism and when poor lifestyle choices cause 40 percent of premature deaths.

“This is one area where the competitive nature between two companies tends to dissolve and people say, ‘We have a health care spend problem, but we also have a people problem,’” Underwood says. “You look around your company, and many leaders are seeing the effects of unhealthy choices, and they want to make an impact, and they want to help, but they don’t know where to begin.”

Enter Underwood. As CEO, his 3,800-employee company provides health support services to help people lead healthier lives.

“My biggest challenge is to alter the course of the health care trends corporate America is facing today,” he says. … “My biggest challenge is helping other business leaders like myself recognize their role in altering those health care trends today.”

He says that it may seem daunting, but you can be successful in this challenge if you can identify the problems and solutions, get others involved and encourage employees along the way.

“Sometimes we as leaders look at it and say we can’t,” he says. “It’s so easy to look at the health care reform and the health care debate and say … ‘It’s so big and so national that I, as an individual business leader, can’t move that needle.’

“The reality is … by focusing and caring about the individuals that we’re responsible for, overall, if we get enough leaders to do this, we will move the health care needle and improve the health of our employees,” Underwood says. “Don’t be intimidated by the national health care reform. Start at home. Start at your own company and begin building a culture of health.”

Identify problems and solutions

The first step in building a culture of health in your company is to identify the main issues.

“This applies to any type of problem you’re trying to solve,” Underwood says. “The first thing you need to focus on is (identifying) the problem that you want to solve — very clear and focused and consistent in terms of what is the problem.”

For example, he says that if you want to improve the health of your employees because you care about them deeply, then define that as the problem. If you’re spending too much on your company’s health care so you want to reduce your expenses, then that’s your issue. Whatever it is, use data to help you reach your conclusion — you can start by looking at your health care expenditures, but then go further.

“Some other data points they should look at to understand their problem is look at trends — what has been their health care trend over the last three to five years and then forecast that out,” he says.

Also look at your company’s absenteeism, as the causes behind employees not being at work are often health-related. On the other side of that, look at people who are coming to work but who are unproductive and distracted because they’re sick or they have a sick loved one at home.

“What you see is productivity being impacted,” Underwood says. “Remove the challenge, and productivity improves.”

Knowing what you’re facing is only half the battle. Next create a plan to solve the problem.

“Once you understand the problem, then you have to identify what the solution is, and you have to be passionate about both understanding the details of it and understanding the overall plan,” he says.

“Have milestones between current state and future state so that you can actually measure progress along the way and also track deviation. You can’t just look at future state. You have to look at interim milestones, and it’s extremely important that as you obtain those interim milestones that at appropriate times you celebrate.”

Throughout the process, make sure that you show employees that you believe in the changes taking place.

“The next thing you have to have is an unnatural confidence,” he says. “Even if [employees] don’t have that confidence, your confidence will instill confidence in them over time.”

But you also need to be grounded in reality.

“You have to be realistic about the enormity of the problem and the challenges you’re going to face,” Underwood says. “You’ve got to face the brutal facts of where you’re starting from and where you need to be and all the challenges associated with it. One of the mistakes some of us leaders make is you have the unnatural confidence, but you’re blind to the reality of the starting position or you’re blind to the set of challenges you’re going to face as you overcome this. It can be very disheartening.”

Find a balance to help you, and you’ll find it in data and by being on the front lines.

“It’s amazing what the people on the ground know and understand and see every day,” he says. “If you’re talking to them, you’ll know and see, as well. If you’re not, if you don’t have that forum and communication channel, it’s easy to set lofty goals and not understand why you’re not making progress on it. It’s starting with the facts and keeping the facts alive and real and understood day in and day out.”

When a problem and solution are identified, then you have to be prepared to put financial resources into your initiative.

“Many businesses look at it as, ‘This is an additional cost,’” he says. “In this economic environment, let’s be honest, funding new programs is difficult to rationalize and justify in many cases. But if you look beyond the short-term horizon, what you’ll see is those kinds of impact, and so it’s an investment that pays and has a fairly short return on investment.”

The potential results can speak for themselves.

“Some of the things that we do know is over $3 are saved for every $1 spent on wellness programs,” he says. “We also know that absenteeism, that those costs are decreased by over $2 for every $1 spent. The kind of data a CEO or business leader needs, they probably have them at their hands, but they may need to look at them slightly differently.”

Get everyone involved

With a goal and plan in place, then you have to rally the troops, and like most things in leadership, building a culture of health starts at the top, but it goes further than that — you have to involve others.

“Identify the group that’s going to move this forward,” he says. “One mistake that some CEOs tend to make is they think they can will this into their organization on their own — ‘If I believe in it, if I’m passionate about it, if I’m focused, then I can make this happen.’ The reality is … you have to have a forum or group that takes it and moves it forward.”

At Alere, Underwood has a group of values ambassadors to help him. Of his 3,800 people, he says about 75 make up this group.

“Leverage a larger group of passionate, focused people who will volunteer to make this happen,” he says.

But how do you know which employees should be a part of this initiative?

“It’s very similar to anytime you want to initiate something within your company,” Underwood says. “If you want to adjust your culture, if you want to introduce new products, if there’s a new idea, you’ve got to identify the people who can identify with the cause, who can identify with what you’re trying to accomplish and relate to it.”

The key is passion.

“Passion is the one thing that you can’t replace,” he says. “You can’t create passion. You can instill knowledge, you can instill incentives, you can instill a lot of things into a group of people, but the passion you can’t. You’ve got to be adept at identifying the people that have a lot of passion for what you’re trying to accomplish, and then enlist them. Then they’ll enlist others. It’s a bad term, but it’s almost a pyramid scheme — find the people and have them find similar people who have the passion.”

You also want to make sure that all of your managers from the top down to the ground level see the importance.

“If it doesn’t go to the bottom of the organization, what we’ve found is it’s not as effective,” he says. ... “The front-line manager must understand the impact of healthy choices and help create that environment because they are the first line to the general population, so if they’re not buying in and they’re not incented and they’re not measured on the impact they have on their employees, then the program falls short. It’s a top-to-bottom, bottom-to-top commitment that creates that environment.”

Underwood does this by measuring his managers in this area.

“The most straightforward way to do it is by embedding these types of measurement tools into the performance appraisal system,” he says. “When people are measured on the participation rates of their people in the team challenges or the team activities, when those types of metrics are built into the performance appraisal system, it’s amazing how people follow.”

Encourage employees

Underwood says that if you look at the amount of tools available to people and the obesity rates in America, it indicates that people aren’t going to take the initiative on their own.

“There are two things you need to focus on,” he says. “One is enrollment in these programs, and the second is engagement in these programs. One without the other doesn’t work. You have to get people enrolled and engaged in programs that will help them make healthy choices.”

You can do this through negative or positive manners. Negative ways include mandating employees to pay more for their coverage if they engage in riskier behaviors, such as smoking or not exercising.

But positive ways would be encouraging participation in healthy programs through incentives and recognition. For example, one of Alere’s clients, Procter & Gamble, has a blue-plate program, where healthy food options in the cafeteria are served on blue plates, and leadership walks around and gives small incentives and attaboys to the people eating off of the blue plates. It encourages people to make the healthy choices because they might get recognized by top leadership for doing so.

Another way to encourage employees is through team-based programs. Alere has team programs internally throughout the year to encourage healthy behavior.

“It’s real important that you don’t force-fit teams,” he says. “Don’t pit one division or one group against another. There will be a natural tendency for groups to form along those lines but also encourage them to cut across divisional lines.”

For example, one such program had teams compete to log the most active minutes. With a common passion for bicycling, several employees across multiple divisions and ranks created their own team because of their shared interest, so let those natural teams form.

Then, for every 10 minutes of activity, they earned points, which are recorded and published on a weekly basis.

“The competitive spirit of most people, they want to know how they’re doing and how their team is going versus others,” he says. “It’s extremely important to publish highlights and create the fun atmosphere.”

The competition lasts about eight weeks, and winners received small prizes, such as gift cards. After its completion, another similar program will launch, such as one that encourages employees to know and improve their vital health stats or one that encourages employees to eat fruits and vegetables.

The key is to keep encouraging people to try new things and incentivizing them so they’ll get involved.

“Anything we can do to get people active — it doesn’t really matter what the incentive is or what got them out there,” Underwood says. “What’s important is that we got them out there.”

How to reach: Alere Health LLC, (800) 456-4060 or