Total Worker Health

Healthier Workforce, Healthier Bottom Line

Programs that focus on total worker health are becoming an integral part of the way companies manage employee safety and workers' comp costs.
By: | July 11, 2016 • 6 min read

Wellness programs started catching on around a decade ago as a way for human resources to reduce medical costs and absenteeism. Typical programs included weight loss competitions, daily step goals or smoking cessation assistance.


Eventually, it began to catch on that healthier workers are also less prone to injury.

That led to what you might call “Wellness 2.0” … a combined wellness and safety program experts call “Total Worker Health.”

Deteriorating Health

When trucking company Tradewinds Transportation LLC updated its equipment and safety gear, it also added a wellness program.

Its workers’ compensation program saw clear benefits. Tradewinds’ experience mod fell to .71 from 1.01 in the decade since the wellness and safety program was first introduced.

Heather Hayes, operations manager, Tradewinds Transportation

Heather Hayes, operations manager, Tradewinds Transportation

The company’s annual workers’ comp premium fell to $98,000 from $122,000 — even as payroll, truck fleet and headcount tripled.

But the greatest gains started to show up two years ago when Tradewinds beefed up its safety program with an addition of a wellness program as an employee retention tool, said Heather Hayes, operations manager at Tradewinds.

Hayes was researching the causes behind the industry’s driver shortage when she found shocking statistics: Truck drivers live about 16 years less than the average employee; about 85 percent have hypertension and 80 percent are obese.

“Their deteriorating health was scary, statistically,” Hayes said. “And we were only contributing to the cause of the problem.”

Tradewinds looked everywhere for opportunities to improve. It built a walking trail around their Oregon office. It switched kitchen offerings to more healthy, grab-and-go options such as fruits, eggs, nuts and yogurt.

“Their deteriorating health was scary, statistically. And we were only contributing to the cause of the problem.” — Heather Hayes, operations manager, Tradewinds Transportation

Drivers received water bottles and rice cookers to take on the road so they could avoid the rest stop standard fare, like 72-ounce sodas and cheeseburgers. A nutritionist surveyed the most frequently visited truck stops to create a list of healthy options.

They also received resistance bands and on-the-road exercise programs. Each driver got a pedometer and information guide which told them how many loops walked around the truck equals a mile.

Employees received diet and exercise education, healthy recipes and mindfulness classes for stress management. They even allow drivers to bring kids along for short stints to help with their work/life balance.


During the 12-week pilot program, drivers lost an average 13 pounds.

Research conducted by the National Safety Institute found that after two years on the wellness program, those drivers who initially ranked in the “high risk” group fell to “medium risk” and stayed there.

Those initially labeled “medium risk” dropped to “low risk.”

“Once they learn it, they cannot unlearn it,” Hayes said. “Employees did not return to their old habits.”

Drivers quit smoking and lost weight; one employee lost more than 80 pounds. In an industry that has an average annual turnover rate of 110 percent, Tradewinds’ is 17 percent, and its experience mod continues to fall.

The program is so successful that Tradewinds now offers it year round.

Whole-Person Approach

The U.S. National Institute for Occupational Safety and Health (NIOSH) created a Total Worker Health program in 2011 and offers its template and research for companies to start their own.

Deb Fell-Carlson, a policyholder safety and wellness adviser at SAIF, Oregon’s not-for-profit, state-chartered workers’ compensation insurance company, said she sees companies using wellness to reduce workers’ comp costs in a big way.

“There’s no reason wellness and safety can’t come together. It’s more efficient and you can make your programs more effective.” — Tom Heebner, senior vice president/risk consultant, HUB International

SAIF issues almost half of the policies in Oregon and provides coverage to more than 600,000 workers. Fell-Carlson helps clients, including Tradewinds, combine safety practices with wellness program to offer a total worker health program.

Pinnacol Assurance, based in Colorado, studied the effect its wellness offerings had on clients’ costs and found that for every $1 invested in a worksite wellness program, companies saved $2 in medical costs and productivity improvements.

Approximately 97 percent of participants in Pinnacol’s workplace wellness program reported improvement in employee safety.

Workplace wellness helps employees achieve better health in seven key areas: cancer, coronary, fitness, nutrition, safety, stress and weight management.

Addressing certain health risk factors, such as smoking, obesity and diabetes, can reduce the risk of workplace injuries in less than a year, according to Pinnacol research.

“People who enjoy work are less likely to file workers’ comp claims.” — Ron Z. Goetzel,vice president, consulting and applied research, Truven Health Analytics, and senior scientist, Johns Hopkins Bloomberg School of Public Health

For example, obese workers can cost employers $5,000 more each year than their non-obese peers. When an obese worker is injured, it takes five times longer than their peers for them to return to work.

A 2007 Duke University study found maintaining healthy weight not only is important to workers but should also be a high priority for their employers given the strong effect of BMI on workers’ injuries. It recommends companies create work-based programs targeting healthy eating and physical activity.

Ron Z. Goetzel, VP, consulting and applied research; Truven Health Analytics; and senior scientist, Johns Hopkins Bloomberg School of Public Health

Ron Z. Goetzel, VP, consulting and applied research; Truven Health Analytics; and senior scientist, Johns Hopkins Bloomberg School of Public Health

Morale is a factor too. Research shows when employees like going to work and like their co-workers, it actually makes a difference in workers’ comp costs, said Ron Z. Goetzel,vice president, consulting and applied research at Truven Health Analytics, and senior scientist at Johns Hopkins Bloomberg School of Public Health.

Simply put, said Goetzel, “People who enjoy work are less likely to file workers’ comp claims.”

Focusing on the whole person makes sense. Participating employees are more alert, healthier and engaged in their jobs.

That correlates to less obesity, alcohol consumption, smoking, depression and poor control of biometric values, which in turn correlates to fewer safety incidents and fewer claims, he said.

“This whole movement from traditional health wellness programs has enlarged into the area of organizational health,” Goetzel said.

Busting Silos

Risk managers may struggle to quantify how well the wellness program works at reducing workers’ compensation costs.

To convince upper management, risk managers must start with a diagnostic assessment, Goetzel said. Create a big picture view of how employers are paying for the health and safety of workers.

Wellness programs of the past were typically the domain of HR. But risk managers working together with HR on a wellness program have much to gain.

“The challenge is making that case and then drawing the resources from those individual silos to come together to approach it as total population health management,” said Philip Swayze, director of health and performance at HUB International.

Tom Heebner, senior vice president/risk consultant, HUB International

Tom Heebner, senior vice president/risk consultant, HUB International

For example, if the HR team changed the way it financed health benefits, it might not think to tell risk management. But knowing about it can help risk managers anticipate fluctuations in workers’ comp.

“Potentially, if they changed to a larger deductible, then it may incentivize employees to file claims elsewhere,” Swayze explained.

“It’s hard for folks to cross over and be collaborative with groups they don’t normally collaborate with,” said Tom Heebner, senior vice president/risk consultant at HUB International. Heebner provides workers’ compensation reduction guidance to his HUB clients.

“There’s a wall thrown up pretty quick when you try to get performance statistics or wellness statics from the human resource side,” he said. That’s due to fear of health privacy laws.


Chances are these two groups provide different training on that same topic, and they don’t talk or collaborate and tie things together, he said.

“There’s no reason wellness and safety can’t come together. It’s more efficient and you can make your programs more effective.”

Once you decide on a program, how well you communicate to your employees may determine its success. Employees need to understand what is being offered, how to sign up, and how it will benefit them.

“All you want to do is get some small wins,” Heebner said.

Juliann Walsh is a staff writer at Risk & Insurance. She can be reached at [email protected]

More from Risk & Insurance

More from Risk & Insurance

Exclusive | Hank Greenberg on China Trade, Starr’s Rapid Growth and 100th, Spitzer, Schneiderman and More

In a robust and frank conversation, the insurance legend provides unique insights into global trade, his past battles and what the future holds for the industry and his company.
By: | October 12, 2018 • 12 min read

In 1960, Maurice “Hank” Greenberg was hired as a vice president of C.V. Starr & Co. At age 35, he had already accomplished a great deal.

He served his country as part of the Allied Forces that stormed the beaches at Normandy and liberated the Nazi death camps. He fought again during the Korean War, earning a Bronze Star. He held a law degree from New York Law School.


Now he was ready to make his mark on the business world.

Even C.V. Starr himself — who hired Mr. Greenberg and later hand-picked him as the successor to the company he founded in Shanghai in 1919 — could not have imagined what a mark it would be.

Mr. Greenberg began to build AIG as a Starr subsidiary, then in 1969, he took it public. The company would, at its peak, achieve a market cap of some $180 billion and cement its place as the largest insurance and financial services company in history.

This month, Mr. Greenberg travels to China to celebrate the 100th anniversary of C.V. Starr & Co. That visit occurs at a prickly time in U.S.-Sino relations, as the Trump administration levies tariffs on hundreds of billions of dollars in Chinese goods and China retaliates.

In September, Risk & Insurance® sat down with Mr. Greenberg in his Park Avenue office to hear his thoughts on the centennial of C.V. Starr, the dynamics of U.S. trade relationships with China and the future of the U.S. insurance industry as it faces the challenges of technology development and talent recruitment and retention, among many others. What follows is an edited transcript of that discussion.

R&I: One hundred years is quite an impressive milestone for any company. Celebrating the anniversary in China signifies the importance and longevity of that relationship. Can you tell us more about C.V. Starr’s history with China?

Hank Greenberg: We have a long history in China. I first went there in 1975. There was little there, but I had business throughout Asia, and I stopped there all the time. I’d stop there a couple of times a year and build relationships.

When I first started visiting China, there was only one state-owned insurance company there, PICC (the People’s Insurance Company of China); it was tiny at the time. We helped them to grow.

I also received the first foreign life insurance license in China, for AIA (The American International Assurance Co.). To date, there has been no other foreign life insurance company in China. It took me 20 years of hard work to get that license.

We also introduced an agency system in China. They had none. Their life company employees would get a salary whether they sold something or not. With the agency system of course you get paid a commission if you sell something. Once that agency system was installed, it went on to create more than a million jobs.

R&I: So Starr’s success has meant success for the Chinese insurance industry as well.

Hank Greenberg: That’s partly why we’re going to be celebrating that anniversary there next month. That celebration will occur alongside that of IBLAC (International Business Leaders’ Advisory Council), an international business advisory group that was put together when Zhu Rongji was the mayor of Shanghai [Zhu is since retired from public life]. He asked me to start that to attract foreign companies to invest in Shanghai.

“It turns out that it is harder [for China] to change, because they have one leader. My guess is that we’ll work it out sooner or later. Trump and Xi have to meet. That will result in some agreement that will get to them and they will have to finish the rest of the negotiations. I believe that will happen.” — Maurice “Hank” Greenberg, chairman and CEO, C.V. Starr & Co. Inc.

Shanghai and China in general were just coming out of the doldrums then; there was a lack of foreign investment. Zhu asked me to chair IBLAC and to help get it started, which I did. I served as chairman of that group for a couple of terms. I am still a part of that board, and it will be celebrating its 30th anniversary along with our 100th anniversary.


We have a good relationship with China, and we’re candid as you can tell from the op-ed I published in the Wall Street Journal. I’m told that my op-ed was received quite well in China, by both Chinese companies and foreign companies doing business there.

On August 29, Mr. Greenberg published an opinion piece in the WSJ reminding Chinese leaders of the productive history of U.S.-Sino relations and suggesting that Chinese leaders take pragmatic steps to ease trade tensions with the U.S.

R&I: What’s your outlook on current trade relations between the U.S. and China?

Hank Greenberg: As to the current environment, when you are in negotiations, every leader negotiates differently.

President Trump is negotiating based on his well-known approach. What’s different now is that President Xi (Jinping, General Secretary of the Communist Party of China) made himself the emperor. All the past presidents in China before the revolution had two terms. He’s there for life, which makes things much more difficult.

R&I: Sure does. You’ve got a one- or two-term president talking to somebody who can wait it out. It’s definitely unique.

Hank Greenberg: So, clearly a lot of change is going on in China. Some of it is good. But as I said in the op-ed, China needs to be treated like the second largest economy in the world, which it is. And it will be the number one economy in the world in not too many years. That means that you can’t use the same terms of trade that you did 25 or 30 years ago.

They want to have access to our market and other markets. Fine, but you have to have reciprocity, and they have not been very good at that.

R&I: What stands in the way of that happening?

Hank Greenberg: I think there are several substantial challenges. One, their structure makes it very difficult. They have a senior official, a regulator, who runs a division within the government for insurance. He keeps that job as long as he does what leadership wants him to do. He may not be sure what they want him to do.

For example, the president made a speech many months ago saying they are going to open up banking, insurance and a couple of additional sectors to foreign investment; nothing happened.

The reason was that the head of that division got changed. A new administrator came in who was not sure what the president wanted so he did nothing. Time went on and the international community said, “Wait a minute, you promised that you were going to do that and you didn’t do that.”

So the structure is such that it is very difficult. China can’t react as fast as it should. That will change, but it is going to take time.

R&I: That’s interesting, because during the financial crisis in 2008 there was talk that China, given their more centralized authority, could react more quickly, not less quickly.

Hank Greenberg: It turns out that it is harder to change, because they have one leader. My guess is that we’ll work it out sooner or later. Trump and Xi have to meet. That will result in some agreement that will get to them and they will have to finish the rest of the negotiations. I believe that will happen.

R&I: Obviously, you have a very unique perspective and experience in China. For American companies coming to China, what are some of the current challenges?


Hank Greenberg: Well, they very much want to do business in China. That’s due to the sheer size of the country, at 1.4 billion people. It’s a very big market and not just for insurance companies. It’s a whole range of companies that would like to have access to China as easily as Chinese companies have access to the United States. As I said previously, that has to be resolved.

It’s not going to be easy, because China has a history of not being treated well by other countries. The U.S. has been pretty good in that way. We haven’t taken advantage of China.

R&I: Your op-ed was very enlightening on that topic.

Hank Greenberg: President Xi wants to rebuild the “middle kingdom,” to what China was, a great country. Part of that was his takeover of the South China Sea rock islands during the Obama Administration; we did nothing. It’s a little late now to try and do something. They promised they would never militarize those islands. Then they did. That’s a real problem in Southern Asia. The other countries in that region are not happy about that.

R&I: One thing that has differentiated your company is that it is not a public company, and it is not a mutual company. We think you’re the only large insurance company with that structure at that scale. What advantages does that give you?

Hank Greenberg: Two things. First of all, we’re more than an insurance company. We have the traditional investment unit with the insurance company. Then we have a separate investment unit that we started, which is very successful. So we have a source of income that is diverse. We don’t have to underwrite business that is going to lose a lot of money. Not knowingly anyway.

R&I: And that’s because you are a private company?

Hank Greenberg: Yes. We attract a different type of person in a private company.

R&I: Do you think that enables you to react more quickly?

Hank Greenberg: Absolutely. When we left AIG there were three of us. Myself, Howie Smith and Ed Matthews. Howie used to run the internal financials and Ed Matthews was the investment guy coming out of Morgan Stanley when I was putting AIG together. We started with three people and now we have 3,500 and growing.

“I think technology can play a role in reducing operating expenses. In the last 70 years, you have seen the expense ratio of the industry rise, and I’m not sure the industry can afford a 35 percent expense ratio. But while technology can help, some additional fundamental changes will also be required.” — Maurice “Hank” Greenberg, chairman and CEO, C.V. Starr & Co. Inc.

R&I:  You being forced to leave AIG in 2005 really was an injustice, by the way. AIG wouldn’t have been in the position it was in 2008 if you had still been there.


Hank Greenberg: Absolutely not. We had all the right things in place. We met with the financial services division once a day every day to make sure they stuck to what they were supposed to do. Even Hank Paulson, the Secretary of Treasury, sat on the stand during my trial and said that if I’d been at the company, it would not have imploded the way it did.

R&I: And that fateful decision the AIG board made really affected the course of the country.

Hank Greenberg: So many people lost all of their net worth. The new management was taking on billions of dollars’ worth of risk with no collateral. They had decimated the internal risk management controls. And the government takeover of the company when the financial crisis blew up was grossly unfair.

From the time it went public, AIG’s value had increased from $300 million to $180 billion. Thanks to Eliot Spitzer, it’s now worth a fraction of that. His was a gross misuse of the Martin Act. It gives the Attorney General the power to investigate without probable cause and bring fraud charges without having to prove intent. Only in New York does the law grant the AG that much power.

R&I: It’s especially frustrating when you consider the quality of his own character, and the scandal he was involved in.

In early 2008, Spitzer was caught on a federal wiretap arranging a meeting with a prostitute at a Washington Hotel and resigned shortly thereafter.

Hank Greenberg: Yes. And it’s been successive. Look at Eric Schneiderman. He resigned earlier this year when it came out that he had abused several women. And this was after he came out so strongly against other men accused of the same thing. To me it demonstrates hypocrisy and abuse of power.

Schneiderman followed in Spitzer’s footsteps in leveraging the Martin Act against numerous corporations to generate multi-billion dollar settlements.

R&I: Starr, however, continues to thrive. You said you’re at 3,500 people and still growing. As you continue to expand, how do you deal with the challenge of attracting talent?

Hank Greenberg: We did something last week.

On September 16th, St. John’s University announced the largest gift in its 148-year history. The Starr Foundation donated $15 million to the school, establishing the Maurice R. Greenberg Leadership Initiative at St. John’s School of Risk Management, Insurance and Actuarial Science.

Hank Greenberg: We have recruited from St. John’s for many, many years. These are young people who want to be in the insurance industry. They don’t get into it by accident. They study to become proficient in this and we have recruited some very qualified individuals from that school. But we also recruit from many other universities. On the investment side, outside of the insurance industry, we also recruit from Wall Street.

R&I: We’re very interested in how you and other leaders in this industry view technology and how they’re going to use it.

Hank Greenberg: I think technology can play a role in reducing operating expenses. In the last 70 years, you have seen the expense ratio of the industry rise, and I’m not sure the industry can afford a 35 percent expense ratio. But while technology can help, some additional fundamental changes will also be required.

R&I: So as the pre-eminent leader of the insurance industry, what do you see in terms of where insurance is now and where it’s going?

Hank Greenberg: The country and the world will always need insurance. That doesn’t mean that what we have today is what we’re going to have 25 years from now.

How quickly the change comes and how far it will go will depend on individual companies and individual countries. Some will be more brave than others. But change will take place, there is no doubt about it.


More will go on in space, there is no question about that. We’re involved in it right now as an insurance company, and it will get broader.

One of the things you have to worry about is it’s now a nuclear world. It’s a more dangerous world. And again, we have to find some way to deal with that.

So, change is inevitable. You need people who can deal with change.

R&I:  Is there anything else, Mr. Greenberg, you want to comment on?

Hank Greenberg: I think I’ve covered it. &

The R&I Editorial Team can be reached at [email protected]