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There are multiple determinants to health. And you do want to address as many as you can through your work site wellness program, correct?Essentially, in the workplace setting, employee health is determined as a function of individual practices, organizational practices and the greater community in which the organization resides. In order to approach employee health holistically then, the workplace wellness program must address these three levels.Individual Health DeterminantsResearchers estimate that the individual determinants of health account for up to an estimated 40% of how healthy an individual is. At the individual level, biology, genetics, age and gender all impact individual health. Researchers estimate that these physiological determinants of health account for approximately 10% of how healthy an individual is.Researchers have also found that an individual’s experiences in childhood impact how healthy they are in adulthood. Experiencing trauma in childhood adversely influences how healthy they are in adulthood.Individual lifestyle factors, personal health practices and coping skills also play a significant role in how healthy an individual is. Researchers estimate that these could account for up to 40% of how healthy an individual is.The traditional approach to worksite wellness has typically focused on individual health and lifestyle factors and personal health practices in particular.Organization Determinants of HealthResearchers have clearly established that a person’s health is also determined by social and economic factors, as well as individual factors. These are commonly classified as the social determinants of health. Research has estimated that the social determinants of health account for between 15 – 40% of how healthy the individual is.Management practices in the workplace contribute significantly to employee health and wellbeing. Management practices can either contribute to or detract from employee health and wellbeing.The work environment clearly influences and impacts the health and psychosocial wellbeing of employees. There is extensive evidence on the connection between the workplace and employee health and wellbeing. Many workplace conditions profoundly influence employee behavior, health and wellbeing.If the workplace is unhealthy, why would we ever expect employees to be healthy? It is for this reason that effective, successful 21st century worksite wellness programs focus just as much on organizational health, as they do individual employee health.Community Determinants of HealthEmployees and employers do not exist in isolation. Both are influenced by the community in which they live, work, play and operate. Typical community determinants of health include the physical environment (air quality, water quality, sanitation, etc.), the social environment and the cultural environment. Included in the environment is access to healthcare and social services.While healthy employees are good for an employer, healthy work places are good for the community. Being seen as a great place to work is good for the employer, but also good for the community. The more great places to work there are in the community, the healthier the community will be.Through corporate social responsibility type initiatives, employers are also contributing to the health of the community.Worksite wellness in the 21st century is more than just a focus on the health status of employees. Worksite wellness encompasses programming and interventions at the organizational and community levels as well.

There are countless books and courses on marketing and how to do it properly. You’ve probably read or attended some yourself. But, do you feel like you have a good grasp of marketing?Do you fully understand all the processes involved and how to best apply them to your company? When all the cards are on the table, most small-to-medium businesses don’t. Or at the very least, they understand these concepts.What Is Business Marketing?
Everything a business does, everything you do to sell products and services – is marketing. Every decision you make, if it’s about how to put your products or services in the hands of consumers, is business marketing.The foundations of marketing are relatively easy to explain and understand. But mastering these essential concepts can mean the difference between success and failure.You don’t have to micromanage all marketing that your business does. In fact, it’s probably a good idea to hire a professional. However, that doesn’t replace the need to have a solid knowledge of marketing strategy. Business owners should always have a proactive role in their company’s marketing tactics.Essential Components of a Good Marketing Strategy
Not all marketing concepts will apply to every business. Some will be more relevant than others, but as an entrepreneur you should be familiar with all of them.Inbound Marketing
Think of inbound marketing as your workhorse.It’s a set of marketing tactics designed to maintain a steady influx of customers into your sales process. This isn’t about pushing your brand to generate leads or direct conversion.Inbound marketing uses various channels in creative ways to reach as many people as possible. Tools such as SEO optimization and social media channels are ideal for this type of marketing. The goal is to drive high volumes of quality traffic that can convert through brand engagement in the long run.Direct Marketing
If inbound marketing is your workhorse, think of direct marketing as your racehorse.Direct marketing includes sales tactics designed to produce an instant response. Things like calls to action in online or broadcast media fall into this category.Regardless of what else you do, direct marketing is an important part of any marketing strategy. It allows you to instantly measure success or failure based on response rates.Knowing how people are responding to one offering versus another is crucial.Outbound Marketing
This is where the rubber really meets the road.In outbound marketing, you’re reaching out to prospects and basically saying “buy from me.” This is typically what people think of when they hear the word marketing.Outbound marketing includes sales calls, print ads, broadcast ads, door-to-door sales and much more. Any activity in which you’re reaching out to potential customers with an offering figures into this definition.Though a staple in countless marketing strategies, it’s not very effective. It’s hard to figure out if it’s really working and people are getting savvier and blocking the majority of this type of marketing.Content Marketing
This is the new-old way to market.Most smart businesses realize that people are OK with marketing, as long as they get something in return. For example, if you create great content, consumers will be happy to hear from you.Therefore, every channel you have should start by giving value in return for your customers’ attention.Social Media Marketing
It is inescapable, omnipresent, and pervasive.Marketing is about getting attention. If you can’t get people’s attention, you have no one to market to.The biggest attention vacuums nowadays are social media platforms. It goes without saying that any marketing strategy that doesn’t include social media, is off to a bad start.Start with Solid Foundations
Each of these components has its own place in the puzzle. Some may be more important to your business than others. But only by understanding them all can you find your way out of the marketing madness.Don’t be a passive business owner. Take charge of your marketing strategies and stop wasting resources on marketing that doesn’t deliver.

The Affordable Care Act (ACA) mandates that health insurance companies pay for preventive health visits. However, that term is somewhat deceptive, as consumers may feel they can visit the doctor for just a general checkup, talk about anything, and the visit will be paid 100% with no copay. In fact, some, and perhaps most, health insurance companies only cover the A and B recommendations of the U.S. Preventive Services Task Force. These recommendations cover such topics as providing counseling on smoking cessation, alcohol abuse, obesity, and tests for blood pressure, cholesterol, and diabetes (for at risk patients), and some cancer screening physical exams. BUT if a patient mentions casually that he or she is feeling generally fatigued, the doctor could write down a diagnosis related to that fatigue and effectively transform the “wellness visit” into a “sick visit.” The same is true if the patient mentions occasional sleeplessness, upset stomach, stress, headaches, or any other medical condition. In order to get the “free preventive health” visit paid for 100%, the visit needs to be confined to a very narrow group of topics that most people will find vert constrained.Similarly, the ACA calls for insurance companies to pay for preventive colonoscopy screenings for colon cancer. However, once again there is a catch. If the doctor finds any kind of problem during the colonoscopy and writes down a diagnosis code other than “routine preventive health screening,” the insurance company may not, and probably will not, pay for the colonoscopy directly. Instead, the costs would be applied to the annual deductible, which means most patients would get stuck paying for the cost of the screening.This latter possibility frustrates the intention of the ACA. The law was written to encourage everyone – those at risk as well as those facing no known risk – to get checked. But if people go into the procedure expecting insurance to pay the cost, and then a week later receive a surprise letter indicating they are responsible for the $2,000 – $2,500 cost, it will give people a strong financial disincentive to getting tested.As an attorney, I wonder how the law could get twisted around to this extent. The purpose of a colonoscopy is determined at the moment an appointment is made, not ex post facto during or after the colonoscopy. If the patient has no symptoms and is simply getting a colonoscopy to screen for colon cancer because the patient has reached age 45 or 50 or 55, then that purpose or intent cannot be negated by subsequent findings of any condition. What if the doctor finds a minor noncancerous infection and notes that on the claim form? Will that diagnosis void the 100% payment for preventive service? If so, it gives patients a strong incentive to tell their GI doctors that they are only to note on the claim form “yes or no” in response to colon cancer and nothing else. Normally, we would want to encourage doctors to share all information with patients, and the patients would want that as well. But securing payment for preventive services requires the doctor code up the entire procedure as routine preventive screening.The question is how do consumers inform the government of the need for a special coding or otherwise provide guidance on preventive screening based on intent at time of service, not on subsequent findings? I could write my local congressman, but he is a newly elected conservative Republican who opposes health care and everything else proposed by Obama. If I wrote him on the need for clarification of preventive health visits, he would interpret that as a letter advising him to vote against health care reform at every opportunity. I doubt my two conservative Republican senators would be any different. They have stand pat reply letters on health care reform that they send to all constituents who write in regarding health care matters.To my knowledge, there is no way to make effective suggestions to the Obama administration. Perhaps the only solution is to publicize the problem in articles and raise these issues in discussion forumsThere is a clear and absolute need for government to get involved in the health care sector. You seem to forget how upset people were with the non-government, pure private sector-based health care system that left 49 million Americans uninsured. When those facts are mentioned to people abroad, they think of America as having a Third World type health care system. Few Japanese, Canadians, or Europeans would trade their existing health care coverage for what they perceive as the gross inequities in the US Health Care System.The Affordable Care Act, I agree, completely fails to address the fundamental cost driver of health care. For example, it perpetuates and even exacerbates the tendency of consumers to purchase health services without any regard to price. Efficiency in private markets requires cost-conscious consumers; we don’t have that in health care.I am glad the ACA was passed. It is a step in the right direction. As noted, there are problems with the ACA including the “preventive health visits” to the doctor, which are supposed to be covered 100% by insurance but may not be if any diagnostic code is entered on the claim form.Congress is so polarized on health care that the only way to get changes is with a groundswell of popular support. I don’t think a letter writing campaign is the correct way to reform payment for the “preventive health visits.” If enough consumers advise their doctors that this particular visit is to be treated solely as a preventive health visit, and they will not pay for any service in the event the doctor’s office miscodes the visit with anything else, then the medical establishment will take notice and use its lobbying arm to make Congress aware of the problem.COMMENT: Should there not be an agreement up front between both parties on what actions that will be taken if said item is found or said event should be seen or occur? Should their be a box on the pre-surgical form giving the patient the right to denying the doctor to take proper action (deemed by whom?) if they see a need to? Checking this box would save the patient the cost of the procedure, and give them time for a consult. If there is not a box to check, why isn’t there one?There are two separate questions posed by the checkbox election for procedures. First, does a patient have a legal right to check such a box or instruct a physician/surgeon orally or in writing that he does not give consent for that procedure to be performed? The answer to that question is yes.The second question is does it serve the economic interest of the patient to check that box? For the colonoscopy, in theory the patient would get his or her free preventive screening, but then be told the patient needs to schedule a second colonoscopy for removal of a suspicious polyp. In that case, the patient would eventually have to pay for a colonoscopy out of pocket (unless he had already met his yearly deductible), so there is no clear economic rationale for denying the physician the right to remove the polyp during the screening colonoscopy.But we are using the much less common colonoscopy example. Instead, let’s return to preventive care with a primary care doctor. Should a patient have the right to check a box and say “I want this visit to cover routine preventive care and nothing more”? Certainly. There is way too much discretion afforded physicians to code up whatever they want on claim forms such that two physicians seeing the exact same patient might code up different procedures and diagnostics for the exact same preventive health screening visit.When I expect to receive a “zero cost to me” preventive screening, I do not imply that I am willing to accept a “bait and switch” change of procedure and payment due to the doctor from me. The “zero cost to me” induces consumers to go to the office visit; it is actually paid for out of the profits earned by the health insurance firms to whom consumers pay monthly premiums. Consumers need to hold doctors financially accountable for their claim billing practices. If you are quoted a “zero price” for a visit, the doctor’s office better honor that price, or it amounts to fraud.It is all too easy to find any little old thing to justify billing a patient for a sick visit instead of a wellness visit. However, it is up to the patient to prevent that kind of profiteering at his or her expense.It would be wonderful if HHS would give carriers the proper code or specify that other diagnostic codes cannot negate the preventive screening code used for a wellness visit. That is not happening now. DHS has been bombarded with so many questions and suggestions for health care reform that the department has a fortress like mentality. So realistically, consumers cannot expect DHS to address the coding issue for preventive health screenings any time soon. That leaves the full burden to fall on each consumer to ensure the doctor’s billing practices match the patient’s expectations for a free preventive health office visit.I investigated the web site http://www.healthcare.gov/news/factsheets/2010/07/preventive-services-list.html and discovered some inconsistencies. For example, the site purports to list the services covered under the “preventive health” coverage benefit, yet it omits the annual physical exam. Also, the site states that colorectal cancer screening are provided for people age 50 or older. However, I have been advised in writing that United Healthcare will cover preventive screening colonoscopies for people under age 50. In essence, that government web page is a good start to learn about preventive health care benefits, but a better source would be each consumer’s own health insurance carrier. For those with temporary insurance or who are without any insurance coverage, unfortunately, the preventive health benefit of the ACA will not have any practical consequence.Where will the money come from for the preventive health screening visit to a primary care doctor as well as the screening colonoscopy? We have to look at different scenarios. If the patient indeed has preventive health screenings with no other medical diagnoses, then the patient will be charged $0 for these services, and they will be paid for by the insurance carrier. The insurance carrier will pay these costs out of its operating income or profits. There is simply no other source for payment. The government has not offered to pay the insurance companies for these services.If the patient is hit with various medical diagnostic codes during these preventive health screenings, then he or she will pay his customary charge for the primary care doctor’s office visit and the contract-negotiated price for the diagnostic colonoscopy. In that scenario, the consumer will be paying most of these costs, although the visit to the primary doc may be limited up to any applicable copay amount.It is not a big shock or surprise to say preventive health care is going to be borne by health insurance carriers. The extent to which these carriers can pass along costs to consumers through higher rates depends on the degree of competition in their markets. Ehealthinsurance.com advises me that for the vast majority of states, the insurance carriers have NOT been able to shift these costs onto consumers through higher rates. That may change in 2013 or 2014. However, the trend is clearly moving in the direction of more power for consumers, more options and carriers available to supply health insurance in their states, which means greater competition and lower prices.For additional sections of this article, please see http://www.michaelguth.com