Rural Healthy Community coalition links worksite wellness and health reform for smallest employers: A simulated work-site wellness add-on for insurance exchanges

Background: In wellness as in coverage, the smallest employers are neglected. Can this be addressed under health reform? A community-based coalition in rural Maine, Somerset Microwellness (SMW), addressed administrative and market barriers to workplace wellness for very small businesses (<10) by designing and simulating a wellness add-on for insurance sold through Exchanges. SMW offers a tailored mix of worksite and community activities, with some services pooled to lower fixed costs and protect confidentiality. Financial incentives simulate tax credits and insurance rebates. Method: The project (1) defined a micro-worksite wellness add-on to insurance, (2) developed metrics for evaluating employee participation in a hybrid employer-community program, adapting an evidence-based large business scorecard --Health Enhancement Research Organization (HERO)/Mercer and (3) enrolled microbusinesses. Maine Health Access Foundation funding simulated financial incentives, which were paid to employers that met the targets. Results: With a 100 employee target, SMW enrolled 19 businesses, comprising 73 employees and 11 family members, in the first 6 months. 90% of employees reported no previous wellness activity; 80% were contemplating health changes or considering more. By the six month point 2/3 of the worksites had developed written work plan for wellness and all had participated in at least one activity. One unexpected opportunity: employers needed help with environmental/ policy activities -- posting smoking policies (13% at start) and annual fire drill (27% at start). Conclusion: Community-based worksite wellness, including metrics-based incentives, is feasible and acceptable to microbusinesses and is ready for testing as an insurance add-on.