ENTRY FROM: The Top 100 Health Promotion Professionals

Nominee: James Smith

It's Only Wellness When It Works!

I attended Texas A&M University, where I earned Bachelor’s degrees in Kinesiology and Nutrition, and a Master’s Degree Clinical Exercise Physiology. I am a Registered and Licensed Dietitian, with extensive training in adult weight management. I have several years of experience in personal training, and have earned recognition as a Board Certified Specialist in Sports Dietetics (CSSD), the NSCA's Certified Strength and Conditioning Specialist (CSCS) and Certified Personal Trainer (CPT), as well as the ACSM's Certified Personal Trainer. I have served as a Clinical Dietitian in the United States Navy, I have worked as a Health & Productivity Manager for a manufacturer in the Southeaster United States, and I currently work as a Wellness Consultant for a large Employee Benefits Consulting firm in the Carolinas. I decided to seek a career in the Allied Health Professions to make an impact on the chronic diseases afflicting our country, namely heart disease, diabetes and obesity. In retrospect, the most useful thing in my career has been to learn from my surroundings and apply them at the next level. My education and clinical experience has been very helpful in my career, but learning about project management, human resources functions, employee benefits and compliance issues have been the most helpful. If anything, WELCOA's 7 Benchmarks validated my experiences.


As a clinical dietitian and commissioned officer in the United States Navy, I also served as the Command Fitness Leader.  During that time, my primary achievement was earning the Navy and Marine Corp Achievement Medal for graduating a majority of the Fitness Enhancement Program members and having the highest passage rate of the Physical Fitness Assessment recorded to date.

While working as the Health & Productivity Manager at Trane, Inc. our facility was recognized by the American Heart Association and earned Fit Friendly Company status at the Platinum Level for two consecutive years.  We implemented annual Health Assessments and Biometrics, Health Coaching, an Ongoing Walking Program, an Ongoing Weight Watchers program, a Tobacco Free Campus with Tobacco Cessation reimbursement, and installed a Subway Franchise in the factory itself.  We conducted several pilot programs for hypertension and diabetes, and completed a Six Sigma project called Healthy Lifestyles, which was recognized as Project of the Year for the documented success in exercise adherence and weight loss.  During the duration of the LifeSteps Wellness Program, we improved STD and WC (decreased the number of cases, the total cost, the length of claims, and the average cost of case), we decreased absenteeism, and we had high engagement in all programs including Health Coaching, resulting in high rates of adherence to standards of care.

At Benefit Controls, we advise our clients to implement similar programs with the added recommendation of onsite clinics and health contingent incentives. Our efforts have yielded results.  Not only has Benefit Controls earned the Healthiest Employer of Charlotte, eight of our clients have been Healthiest Employer Finalists, another client was recognized as the Healthiest Employer of Charlotte and two clients have been recognized as Fit Friendly Companies at the Platinum level.  I have also been fortunate enough to have acheived WELCOA Faculty status for several years now.

Our data-driven, clinical, health contingent approach is very effective, reproducible and scalable; our poorest-performing wellness clients actually experience the prevailing medical trend.  Our approach is to start with a strong incentive structure, which is linked to employee benefits in the form of premiums discounts, so it is framed as an incentive.  Afterwards, we layer on participation requirements such as ongoing walking programs, annual biometrics and a certain number of visits to the onsite clinic.  After a few years of providing the right tools and making success the path of least resistance (i.e., doing wellness for employees, not to them), incentives are then available for meeting certain health contingent goals, but we are lenient and accept improvement over time.

We consistently achieve greater than 80% participation in biometrics and clinic visits.  And while the time frame may vary, within two years we typically see that within the high risk population within any particular risk factor (blood pressure, cholesterol, blood sugar) that 40% to 60% of those members are able to successfully control their risk by getting it down to moderate risk.  When looking at aggregate risk, 80% to 90% lower their risk or maintain it (i.e., keeping the healthy folks healthy). 

We get executive buy-in in the form of a budget, an incentive structure, an investment in the clinic and ongoing communication.  We are data driven to the extent that we use a data warehouse the create business intelligence and actionable information from biometrics and claims data… and many other data sources.  Not only can we track participation, but we can track improvement in single risk factors, aggregate risk, certain cohorts and even target gaps in care.  Everything is integrated by virtue of branding, communicating and alignment with a single incentive structure, as opposed to an ad hoc "whack a mole" approach, which is easy to communicate and comprehend, makes program implementation and management relatively easy, and ensures a high level of participation and employee satisfaction.


Over the course of my career as a clinician, program manager and consultant, I have helped patients, I have managed teams and I have provided community support.  But I have had the most impact in organizations that have allowed me to assist them with my clinical knowledge and program management experience.  The lessons I try to share are to start strategically with the end in mind, to strive for best practices not just benchmarks, to systematize and operationalize health and wellness processes into the daily work flow, to make success the path of least resistance, to bring wellness tools to the worksite, to simplify the health message, to communicate abundantly, to do wellness for the employees and not to them, and to create a culture of support and accountability.

Personally, I stay abreast of best practices and compliance issues; I am always willing to learn from my clients.  I try to maintain healthy habits, so I walk my dogs at least three miles every day, and I go hiking on my vacations.  I eat well (lean meats and fish, limit red meat, focus on whole grains, beans, vegetables, fruit and low fat dairy) and maintain a healthy weight. I am tobacco free and limit my use of alcohol. 

If I had any advice for professionals who want to have a successful career in employee wellness, it would be to seek out relevant education and experience.  For Health Professionals, in addition to degrees and credentials, knowledge and experience in Human Resources, Benefits and Compliance is crucial, as is the ability to plan and execute in an environment that isn’t always friendly to interruptions for wellness activities.  For business professionals with those skill sets, acquiring enough clinical knowledge or credentials will be next to impossible, so credentials in worksite wellness will be essential.  Then, wellness programs must be treated like any other business endeavor (e.g., an operating plan, budget, analysis, management, etc.).


We are leaders in wellness strategy, data analytics, onsite clinic implementation and health contingent incentives.  We have over 80 clients with onsite clinics, most commonly staffed with nurse practitioners… we even hired a medical director to provider ongoing oversight when a clinic vendor went out of business and other vendors couldn’t step in to continue clinic operations.  To illustrate the power of installing onsite clinics and later adding health contingent incentives, we had a clinic in place with 80% participation (two visits a year for an $800 incentive) yield no health improvement, only to turn around and maintain participation and achieve significant risk reduction, but only when the same incentive was applied to achieving results. 

The culture changes when employees know the employer cares, and when the employer offers valuable tools and wants everyone to use them, and when participation is voluntary and confidential.   This is reinforced when the employers listens to and accommodates employee concerns, when quality healthcare is accessible at work, when benefits stay the same (or get richer) without increasing employee contributions, and when there is no targeting or finger pointing.   These clinical, health contingent programs have averaged a trend of 2.6% or less over the last four years, and over half have annual trend of <4%.  The worst performance in this group of clients is a 6% trend.



The most promising opportunities on the horizon are health information exchanges, analytical tools, peripheral devices, and onsite clinics/pharmacies that can blend lifestyle coaching, risk management, telemedicine and a “medical home” into a worksite wellness scenario.  And if Minute Clinics and/or Walmart get into the clinic business in such a way that it’s a deliverable to the employer community, then it might be cheaper to get retail healthcare and we’ll all spend our own money instead of filing a claim… price transparency will be available, bundled services and accountability will become the norm, equilibrium can be attained, and healthcare might just become affordable!

However, when assessing threats to the industry, my perception is that the most overarching threat to employee wellness as it stands now is the complex healthcare laws, the loopholes and the EEOC/ADA challenges.  Many leaders are taking a wait and see attitude or are experiencing analysis paralysis.    In my opinion, the next most prevalent risk endemic in many enterprises is the lack of willingness to invest in wellness, such as onsite clinics, something that in my mind is clearly beneficial and for which the value exceeds any concerns about the return on investment.  And finally, the undercurrent of the toxic culture that employees bring with them when they clock in, combined with a lack of willingness to be counter-cultural and fight the good fight (e.g., the lack of positivity in the wellness program, but also the lack of clear values such a as tobacco free campus) is the root of the problem.

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Hi James, All the best with your contest entry. Your achievements, innovation and leadership in Workplace Wellness within your organization is most impressive. Congratulations! I would love to connect with you offline to chat more about your programs and services as I am seeking interested and talented Workplace Wellness Professionals like yourself as guest presenters/facilitators for our online Ambassador Certification program. Additionally, I would most welcome a case study of your organization's successes for a KWC International White Paper on Workplace Wellness Perspectives, Best Practices, & Case Studies that we are currently developing. With permission, these papers will also become case studies for our soon to be launched Certification Program providing further recognition to your amazing successes. Please contact me at if either of these opportunities are of interest to you. I look forward to connecting in the near future! Lisa Kelly

Lisa K. on 10/09/2014

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