Using a Social Capital Framework to Explore a Broker’s Role in Small Employer Wellness Program Uptake and Implementation

Abstract

Purpose:

Small employers, while motivated to implement wellness programs, often lack knowledge and resources to do so. As a result, these firms rely on external decision-making support from insurance brokers. The objective of this study was to analyze brokers’ familiarity with wellness programs and to characterize their role and interactions with small employers.

Design:

Using a newly developed common interview guide (20 questions), protocol and analysis plan, 20 interviews were conducted with health insurance brokers in Illinois, Minnesota, North Carolina and Washington in 2016 and 2017. In addition to exploring patterns of broker interactions and familiarity by segment, we propose a framework to conceptualize the broker-client relationship using social capital theory and the RE-AIM model.

Methods:

Interviews were transcribed, summarized and a common codebook was established using DeDoose. Themes were identified following multi-rater coding and structured within the framework.

Results:

Participating brokers reported having a high to moderate familiarity with wellness programs (65%) and a majority (80%) indicated that they have previously advised their small business clients on the availability and features of them. Further, we find that brokers may help eliminate barriers to resources and act as a connector to wellness opportunities within their professional network.

Conclusion:

New initiatives to promote small employer wellness programs can benefit from examining the influence of brokers on the decision-making process. When engaged and supported with resources, brokers may be effective champions for employer wellness programs.

Keywords

workplace wellness health communications interventions

Get full access to this article

View all access options for this article.

References

National Small Business Association. Workplace wellness programs in small business: impacting the bottom line. Published 2012. Accessed May 28, 2019. https://nsba.biz/new-nsba-report-wellness-programs-impact-bottom-line/

WP BrandStudio. Employee well-being is an important small business priority. The Washington Post. Published 2018. Accessed May 28, 2019. https://www.washingtonpost.com/brand-studio/wp/2018/12/04/kaiserpermanente-employee-well-being-is-an-important-small-business-priority/?utm_term=.702a80736b5a

Small Business Majority. Small business attitudes in California on wellness programs | Small Business Majority. Published 2015. Accessed May 28, 2019. https://smallbusinessmajority.org/our-research/healthcare/small-business-attitudes-california-wellness-programs

Centers for Disease Control and Prevention. CDC Workplace Health Resource Center. Centers for Disease Control and Prevention. Published 2019. Accessed May 28, 2019. https://www.cdc.gov/workplacehealthpromotion/initiatives/resource-center/index.html

Internal Revenue Service. Incentives for nondiscriminatory wellness programs in group health plans. 2013:33157–33192. Accessed May 28, 2019. https://www.federalregister.gov/documents/2013/06/03/2013-12916/incentives-for-nondiscriminatory-wellness-programs-in-group-health-plans

Small Business Majority. Healthy business, healthy community workplace wellness challenge launching today in Missouri | Small Business Majority. Small Business Majority. Published 2017. Accessed May 28, 2019. https://smallbusinessmajority.org/blog/healthy-business-healthy-community-workplace-wellness-challenge-launching-today-missouri

Hannon

Hammerback

Garson

Harris

Sopher

. Stakeholder perspectives on workplace health promotion: a qualitative study of midsized employers in low-wage industries. Am J Heal Promot. 2012;27(2):103–110. doi:10.4278/ajhp.110204-QUAL-51

Linnan

Cluff

Lang

Penne

Leff

. Results of the Workplace Health in America Survey. Am J Heal Promot. 2019;33(5):652–665. doi:10.1177/0890117119842047

The Kaiser Family Foundation. 2013 Employer Health Benefits Survey. Published 2013. Accessed May 28, 2019. https://www.kff.org/report-section/ehbs-2013-section-12/

10.

Harris

Hammerback

Hannon

, et al. Group purchasing of workplace health promotion services for small employers. J Occup Environ Med. 2014;56(7):765–770. doi:10.1097/JOM.0000000000000174

11.

The Kaiser Family Foundation. Small Group Market Rating Reforms. The Henry J. Kaiser Family Foundation. Published 2017. Accessed May 29, 2019. https://www.kff.org/other/state-indicator/small-group-market-rating-reforms/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D

12.

United States Bureau of Labor Statistics. Distribution of private sector employment by firm size class. Published 2019. Accessed January 21, 2020. https://www.bls.gov/web/cewbd/table_f.txt

13.

Marquis

Long

. Who helps employers design their health insurance benefits? Health Aff (Millwood). 2000;19(1):133–138. Accessed May 28, 2019. http://www.ncbi.nlm.nih.gov/pubmed/10645079

14.

Hammerback

Hannon

Parrish

Allen

Kohn

Harris

. Comparing strategies for recruiting small, low-wage worksites for community-based health promotion research. Heal Educ Behav. 2018;45(5):690–696. doi:10.1177/1090198118769360

15.

Conwell

LJ.

The role of health insurance brokers: providing small employers with a helping hand. Issue Brief Cent Stud Health Syst Change. 2002;(57):1–4. Accessed January 21, 2020. http://www.ncbi.nlm.nih.gov/pubmed/12387276

16.

Karaca-Mandic

Feldman

Graven

. The role of agents and brokers in the market for health insurance. J Risk Insur. 2018;85(1):7–34. doi:10.1111/jori.12139

17.

O’Brien

Harris

Beckman

Reed

Cook

. Standards for reporting qualitative research: a synthesis of recommendations. Acad Med. 2014;89(9):1245–1251. doi:10.1097/ACM.0000000000000388

18.

Glasgow

Vogt

Boles

. Evaluating the public health impact of health promotion interventions: the RE-AIM framework. Am J Public Health. 1999;89(9):1322–1327. doi:10.2105/AJPH.89.9.1322

19.

Coleman

. Social capital in the creation of human capital. Am J Sociol. 1988;94:95–120. doi:10.2307/2780243

20.

Nahapiet

Ghoshal

. Social capital, intellectual capital, and the organizational advantage. Acad Manag Rev. 1998;23(2):242–266. doi:10.2307/259373

21.

Granovetter

. The strength of weak ties. Am J Sociol. 1973;78(6):1360–1380. doi:10.2307/2776392

22.

Kilduff

Krackhardt

. Interpersonal Networks in Organizations: Cognition, Personality, Dynamics…- Martin Kilduff, David Krackhardt—Google Books. Cambridge University Press; 2008. Accessed January 21, 2020. https://books.google.com/books?hl=en&lr=&id=aUWxfSaXfiIC&oi=fnd&pg=PA13&dq=Kilduff,+M.,+and+Krackhardt,+D.+(2008).+Interpersonal+networks+in+organizations:+Cognition,+personality,+dynamics,+and+culture.+&ots=1mzAo95G3W&sig=CuBx2DSUfpZ0YoFBFzuVEEdzWgU#v=on

23.

Uphoff

Luniversity

. Understanding social capital: learning from the analysis and experience of participation. 2000. Accessed May 28, 2019. https://www.ircwash.org/sites/default/files/Uphoff-2000-Understanding.pdf

24.

Seghers

Manigart

Vanacker

. The impact of human and social capital on entrepreneurs’ knowledge of finance alternatives. J Small Bus Manag. 2012;50(1):63–86. doi:10.1111/j.1540-627X.2011.00344.x

25.

Lee

. Social capital as a source of business advantages for a woman entrepreneur in the context of small-size business. Asian Soc Sci. 2015;11(12):155. doi:10.5539/ass.v11n12p155

26.

Petrou

Daskalopoulou

. Social capital and small business competitiveness: evidence from cross-section tourism data. J Knowl Econ. 2015;6(4):946–967. doi:10.1007/s13132-013-0166-3

27.

Molina-Morales

Martínez-Fernández

. Social networks: effects of social capital on firm innovation. J Small Bus Manag. 2010;48(2):258–279. doi:10.1111/j.1540-627X.2010.00294.x

28.

Cooke

Wills

. Small firms, social capital and the enhancement of business performance through innovation programmes. Small Bus Econ. 1999;13(3):219–234. doi:10.1023/A:1008178808631

29.

Ståhl

Åborg

Toomingas

Parmsund

Kjellberg

. The influence of social capital on employers’ use of occupational health services: a qualitative study. BMC Public Health. 2015;15(1):1083. doi:10.1186/s12889-015-2416-8

30.

National Association of Health Underwriters. NAHU. NAHU Website. Published 2020. Accessed January 24, 2020. https://nahu.org/

31.

SocioCultural Research Consultants

Dedoose Version 8.0.35, web application for managing, analyzing, and presenting qualitative and mixed method research data. Published 2018. Accessed January 21, 2020. https://www.dedoose.com

32.

Boyatzis

. Transforming Qualitative Information: Thematic Analysis and Code Development. Sage Publications; 1998.

33.

Tinsley

HEA

Weiss

. Interrater reliability and agreement. In: Tinsley

HEA

Brown

Tinsley

, eds. Handbook of Applied Multivariate Statistics and Mathematical Modeling. Elsevier; 2000:95–124. doi:10.1016/B978-012691360-6/50005-7

34.

Lombard

Snyder-Duch

Bracken

. Content analysis in mass communication: assessment and reporting of intercoder reliability. Hum Commun Res. 2002;28(4):587–604. doi:10.1111/j.1468-2958.2002.tb00826.x

35.

Bradley

Curry

Devers

. Qualitative data analysis for health services research: developing taxonomy, themes, and theory. Health Serv Res. 2007;42(4):1758–1772. doi:10.1111/j.1475-6773.2006.00684.x

36.

National Association of Insurance Commissioners. State Licensing Handbook (2013). Published 2013. Accessed May 28, 2019. https://www.naic.org/prod_serv/STL-HB-13.pdf

37.

Wellness Council of America. WELCOA—Workplace Wellness Certifications, Trainings and Resources. Wellness Council of America. Accessed January 24, 2020. https://www.welcoa.org/

38.

Cummins

Doherty

. The Economics of Insurance Intermediaries. J Risk Insur. 2006;73(3):359–396. doi:10.1111/j.1539-6975.2006.00180.x

39.

Harris

Cheadle

Hannon

, et al. A framework for disseminating evidence-based health promotion practices. Prev Chronic Dis. 2011;9:e2. doi:10.5888/pcd9.110081

40.

The Kaiser Family Foundation. Broker Compensation by Health Insurance Market. State Health Facts. Published 2018. Accessed January 16, 2020. https://www.kff.org/health-costs/state-indicator/health-insurance-broker-compensation/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D

41.

National Association of Health Underwriters. Why work with an agent. Accessed January 16, 2020. https://nahu.org/looking-for-an-agent/why-work-with-an-agent

42.

Linnan

Leff

Martini

, et al. Workplace health promotion and safety in state and territorial health departments in the United States: a national mixed-methods study of activity, capacity, and growth opportunities. BMC Public Health. 2019;19(1):291. doi:10.1186/s12889-019-6575-x

Supplementary Material

Please find the following supplemental material available below.

For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.

For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.

0.00 MB

0.08 MB