Leadership And Employee Support For A Tailored Approach To Health: Nabholz Construction

CDC Workplace Health Resource Center - Make Wellness Your Business

Nabholz Construction is a national commercial contractor offering a full range of construction, industrial, civil, environmental, and specialty services. The health and safety of its employees are vital to its success. Nabholz’s approach to employee wellness focuses on removing barriers to health care, starting with a tailored and family-oriented approach to care. The core of the program is a medically trained wellness team that works across locations to get to know all employees, promote wellness, and provide compassionate care to help employees and their spouses improve their health habits. Leadership support and widespread trust by employees have been central to the wellness program’s success.

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Nabholz Construction: At A Glance
Locations: Headquartered in Conway, AR, with 13 additional offices in Arkansas,Kansas, Mississippi, Missouri, and Oklahoma
Size: Approximately 399 employees at headquarters in Conway, and 732 employees at other locations
Industry: Construction, industrial, civil, environmental, and specialty services
North American Industry Classification System (NAICS) Sector: Construction

The History Of Wellness At Nabholz

In 2007, Nabholz shifted to self-funded health insurance to reduce rising health care costs. Nabholz leaders hired Jayme Mayo, PA-C (Certified Physician Assistant), as the Wellness Director. The initial program took a group or “one size fits all” approach, with lunch-and-learns and wellness events, such as 5K walks/runs. However, participation by employees was low. Mayo found the program offerings did not motivate employees. She decided she needed to take an individualized approach to behavior change. Nabholz leaders and Mayo then worked together to redesign the program.

Workplace Health Awards
  • Healthiest 100 Employers in America, 2017 (No.25), 2016 (No.58) (sponsored by Springbuk)
  • Corporate Health Champion, State of Oklahoma, 2017 (sponsored by Champions of Health)
  • Kansas City Healthiest Employers, 2017 (sponsored by Kansas City Business Journal)
  • Fit Friendly Worksite, 2016 (Platinum Level) (sponsored by the American Heart Association)
  • Workplace Wellness Certification, 2016 (Platinum Level) (sponsored by Kansas City Chamber of Commerce)
  • Certified Healthy Oklahoma Business, 2016 (sponsored by Oklahoma State Department of Health, Oklahoma Academy for State Goals, Oklahoma State Chamber, and Oklahoma Turning Point Council)

A Wellness Program Tailored To Employee Needs

The Nabholz wellness program provides individual support for employees and spouses to make lifestyle changes. The program brings health care into the workplace with on-site wellness testing, a medical clinic at headquarters, and a dedicated medical team.

Nabholz provides on-site wellness testing twice a year for employees and spouses on its health insurance plan. The medical team screens employees and spouses for cholesterol, blood sugar, blood pressure, obesity, and nicotine—all major drivers of health insurance costs. They recently added screening for thyroid levels and prostate cancer (for men). Nabholz pays 100 percent of the employee-only health insurance premium if employees and their spouses take part in the health survey and wellness testing. If the employee or spouse does not participate, the employee pays 30 percent of the employee-only insurance premium. As soon as the employee and their spouse complete wellness testing, Nabholz pays the full employee-only insurance premium. For each outcome that meets or exceeds Nabholz targets, employees can earn an annual gift card. They can earn as much as $400 if they meet all outcomes, and spouses can earn up to $100. Wellness testing results are the starting point for personal support from Nabholz’s wellness team. Led by Mayo, the team includes a doctor, personal trainer, medical assistant, and dietitian. The team works at Nabholz’s Medical & Wellness Center, located at headquarters. The Wellness Center includes exam rooms, consultation space, and a fitness center. The team also travels to all Nabholz sites to support employees and their family members as individuals, working to understand their lives, motivations, and challenges, to provide education and  specific steps to improve health.

Nabholz Contruction Wellness team

The Nabholz wellness team at the Medical & Wellness Center. From left: Samantha Thomas (Personal Trainer), Destany Stephens (Medical Assistant), Jayme Mayo (Physician Assistant and Wellness Director), Phil Stone (Physician), Daniela Utrera (Dietitian).

Almost all eligible employees take part in wellness testing: 99 percent completed testing each year between 2010 and 2017. Nabholz employees’ health also has improved. In 2011, 34 percent of employees who completed testing had biometric outcomes that met Nabholz targets in four or more categories. By 2017, this increased to 82 percent of employees (figure 1).

Since 2010, Nabholz saw its annual health insurance premiums increase an average of 1.6 percent, lower than the national average of 3.7 percent annual increases from 2010 to 2017.1 At the same time, its plan benefits stayed the same. Chief Executive Officer Greg Williams noted, “We’ve controlled costs much better than we thought. We’ve seen our employees buy in to the program. We’ve seen them see it as a benefit, and we are seeing a dollar return for our investment. It’s been a great investment for the company.”

Nabholz also removes barriers to care by giving employees more access to care, incentives for preventive care, and reimbursements for wellness. Vendor clinics are available at no cost to families on Nabholz health insurance, and they can get appointments within 24 hours of a request. There are five vendor clinics in Arkansas and four in Oklahoma, all close to Nabholz sites. Nabholz holds monthly $100 gift card drawings for employees who have a yearly wellness exam (spouses can be in  drawings each quarter). Employees and spouses with proof of routine preventive care (e.g., dental cleaning, mammogram, colonoscopy, skin cancer screening, or eye exam) are entered in a $50 gift card drawing every three months, with an entry for each case of preventive care.

Nabholz also reimburses employees and spouses (up to $150 each per year) for work boots, athletic shoes, activity trackers, gym memberships, or nicotine cessation.

Figure 1

1Mercer. Mercer survey shows employers face a 4.3 percent increase in 2018 US health benefit cost, highest since 2011, but trend stable. [cited 2018 May 9]. Available from: https://www.mercer.com/newsroom/mercer-survey-shows-employers-face-increase-in-health-benefit-cost-in-2018.htmlexternal icon.

Nabholz Targets For Biometric Outcomes

Nabholz established targets for select biometric measures. For each outcome that meets or exceeds Nabholz targets, employees and spouses can earn gift cards.

  • Body fat: ≤25 percent for men; ≤32 percent for women
  • Waist circumference: ≤40 inches for men; ≤35 inches for women
  • Tobacco: nicotine-free
  • LDL cholesterol: ≤130 mg/dL
  • HDL cholesterol: ≥40 mg/dL
  • Triglycerides: ≤200 mg/dL
  • Blood pressure: ≤130/85 mmHg
  • Blood glucose: ≤110 mg/dL and ≤6.5 percent A1C

Leaders And Employees Support And Trust The Program

How Leaders Support The Wellness Program

Mayo said much of the program’s success comes from having leaders’ support through regular communication, financial commitment, and program participation. Mayo reports directly to Williams, allowing her to communicate easily with him about any program challenges or needs. Nabholz leadership supports the program by giving Mayo money for the medical team, medical equipment, fitness space and equipment, and space for the wellness clinic to comply with privacy and confidentiality through the Health Insurance Portability and Accountability Act of 1996 (HIPAA).

Nabholz leaders take part in the program and know that they need to be role models for wellness. “Active participation is the big key. They see us participate in line at the wellness screenings, they see us at the training events, and they see us turn in our paperwork just like everybody else,” said President Jake Nabholz. Nabholz’s midlevel leaders, such as the construction superintendents, also see themselves as role models.

How The Wellness Team Earns Employee Trust

The Nabholz wellness team listens to employees and builds relationships with them. To do this, they communicate clearly, use employee feedback to shape the wellness program, incorporate wellness into work, and provide personal and thorough care for employees and their families.

When I had my physical, I was overweight, high cholesterol, high blood pressure. At that time, I made the decision… I’m going to go strong with this wellness program. Since then until now, I’ve lost 90 pounds.
~ Ron, Superintendent

The wellness program has definitely increased my work performance. I’ve lost 25 pounds and doing that has made me faster at my job and better at my job.
~ RJ, Carpenter

Clear Communication Breaks Down Barriers

Clear communication is essential to building employee trust in the Nabholz wellness program. The team makes sure employees know that their medical history, medical conditions, and biometric results are confidential. The team also lets employees know how to focus on their health and the benefits of wellness. Team members emphasize that suggestions for the program are welcome, and feedback will not affect working at Nabholz.

To support clear communication, the team has addressed the needs of its Spanish-speaking employees, especially those for whom English is a second language. Nabholz hired Daniela Utrera, a dietitian, who is fluent in English and Spanish. Utrera has gained and kept the trust of Spanish-speaking employees. She makes sure employees know about the benefits of the wellness program across the language and cultural barriers. With her help, all of Nabholz’s Spanish-speaking employees participate in wellness testing and are more interested in resources to stay healthy.

Employee Feedback Shapes The Program

The wellness team works to make changes to the program based on what employees tell them. At first, employees did not speak up, but with clear communication that the wellness team wanted employee feedback, they started to give it. For example, Nabholz’s decision to reimburse employees for their work boots came from an employee suggestion, because employees need good work boots to support their joints, back, and posture.

The Wellness Team Brings Wellness To All Employees

Nabholz Wellness team

The wellness team builds relationships with employees to provide individually tailored support for employees to develop healthy habits and improve their overall health. At top, Jayme Mayo (at right) consulting with an employee about his recent physical activity levels. At bottom, Mayo (at right) seeing an employee at Nabholz’s Medical & Wellness Center.

The workforce covers many states and job sites, so team members make regular job site visits. Superintendents like these visits, because it is helpful for Mayo and her team to check on employees without hurting their workflow.

Many Nabholz employees spend a lot of time on the road, and the wellness team supports their wellness needs. David, a Crane Operator, is on the road 80 percent of the time. He said, “I’d set up a time with my doctor and then, ‘Well, hey, you gotta be in California….’ OK, I gotta call the doctor, I can’t get in … it starts getting late in the year, and I haven’t done it. But I could call Jayme … and she got ahold of a clinic up there, ‘Hey, run down there, do your wellness, they’ll send me the results, we’re good to go.’ A lot of the guys had to do that in my division, because we were gone all the time.”

We can’t have a successful program if it consisted of us just staying behind our computers in our office all day. We have the freedom, and the blessing from our leadership to go travel … our job is to go build relationships with people. And I think once they realize we’re people too, we’re not just someone pointing at them, pointing our finger telling them to go to the gym, [that] they need to eat their fruits and vegetables […] once they understand that we’re real and that we’re invested in them, they’re much more likely to be engaged in our program, because they trust us, and they’re going to trust the program.

~ Samantha Thomas, Personal Trainer

Personal Care For Employees And Their Families

The Nabholz wellness team also earns employee trust in its approach to engaging with and caring for employees. The team learns about employees and how they are doing, rather than trying to “fix” employees’ health. The team books fewer appointments per day so that each employee gets personal care. Family members can also be seen at the Nabholz clinic, so families can work on better health and wellness together. The wellness team also follows up with employees to see if they have been able to make changes, and provides support as needed. Wellness team members have gone to the grocery store with employees, helped them assess the foods they keep at home, and accompanied employees on doctor’s visits.

Employees commented on having personal cell phone numbers of wellness team members and feeling encouraged to call and ask questions at any time.

Nabholz Employees Trust the Wellness Team’s Approach

Here […] they’ll talk to you like how are you feeling and stuff like that and it’s like they treat you like a person instead of just trying to rush you through.
~Tracy, Mechanic

I mean, when they [the wellness team] work with so many guys, you see other people getting results, why would you not trust them? … This dude lost 100 pounds, this other dude lost 30 pounds … he quit smoking, he quit this … you can tell, they honestly care about people.
~ RJ, Carpenter

When I started getting healthier, my wife saw the changes in me … [she] wanted to have those same changes herself. So she started doing wellness testing with our primary care physician to see what’s going on, and now we work together to try to help each other out, and it’s because of what Jayme started within me.
~ Nathan, Computer Numerical Control Operator, Cabinet Craftsman

Challenges And Future Plans

It can be difficult to reach employees at many job sites, on the road, and not connected to digital communication. To address these challenges, the team uses many methods. The medical team mails newsletters to employees’ homes, shares information on social media, makes phone calls to job site superintendents and uses posters and bulletin boards at job sites. Additionally, the team uses direct communication during visits to Nabholz job sites and office locations. Leaders also promote wellness during their “Around the World” tours, visiting every site and meeting all employees.

As Nabholz hires new employees, the challenge for the wellness team will be to earn the trust of each new individual. The wellness team will share the benefits of the wellness program with new employees and their families. The team will also get to know each new employee, building relationships to promote trust and encourage program participation.

Advice For Other Employers

Williams and Mayo advised employers to look at aggregate health insurance claims data to see what is driving costs and decide where to focus wellness efforts. Williams suggested that leaders give both financial and physical resources to support wellness.

To ensure employee trust, Williams recommended hiring people with health and wellness expertise who can build relationships and connect with employees. He also stressed that employers should make the program fit their organization’s specific needs.

Mayo added that whether an organization uses a wellness team, a wellness champion, a wellness committee, or some combination to support a wellness program, these teams or individuals need to be able to “get in there and shake the bushes and get something started on their own.”

Recommendations For Action

The CDC Workplace Health Resource Center (WHRC) is a one-stop shop for organizations to find credible tools, guides, case studies, and other resources to design, develop, implement, evaluate, and sustain workplace health promotion programs. Visit https://www.cdc.gov/WHRC to find more case studies of workplace health programs in the field.