Nelnet Case Study: Total Well-Being Lowers Health Care Costs

The Challenge

Nelnet LogoIn 2005, Nelnet held its first annual health assessment and identified weight management, high blood pressure, high cholesterol, and tobacco use as their biggest risk factors. While these risk factors were well within the industry average, Nelnet recognized that as a self-insured company, high health care costs caused by unhealthy lifestyles directly affect its bottom line.

The Solution

Initially, Total Well-Being looked closely at two issues—the high risk factors affecting the employees and the employees’ willingness to change.

Total Well-Being identified weight management, high blood pressure, and high cholesterol as the biggest risk factors that employees were willing to change. As a result, the Nelnet action plan focused on reducing these risks.

To motivate employees, Total Well-Being worked with Nelnet to reward a different healthy behavior each quarter. Each successfully completed activity was tied to a Reward Program on, powered by Mayo Clinic EmbodyHealth. Once an employee earned enough points, they were given a reward for their healthy behavior such as a donation to their health savings account. For example, Nelnet encouraged healthy eating by implementing Weight Watchers at Work, updating vending machines to include healthier snacks, and creating a 5-A-Day Challenge where employees were rewarded for consuming five or more fruits and vegetables each day. To encourage exercise, Total Well-Being partnered with Shape Up the Nation, a team-based exercise, weight loss, and walking competition. Additionally, Nelnet implemented a “Take the Stairs” campaign and “Walking Wednesdays” where an executive leader would lead each walk.

Tobacco use was the remaining high risk factor at Nelnet, but employees did not show a willingness to change in this area. Therefore, Total Well-Being approached tobacco use slowly and sensitively, making small changes over time to help employees develop an interest in changing their current habits. In year one, focus was placed on promoting the online portal containing health tips and information about the dangers of using tobacco. A “Tobacco-Free Campus in 2009” goal was set and communicated to motivate employees while ensuring them plenty of time to make the change. In year two, Nelnet made the Mayo Clinic Tobacco Quitline available to employees and provided free nicotine replacement (patches, gum, lozenges) for those enrolled. The following year, prescription strength cessation drug coverage was added and employees were reimbursed for out-of-pocket expenses. And finally, a $30/paycheck incentive was provided for associates who are either tobacco free or are signed up with Mayo Clinic Tobacco Quitline.

The well-being program includes an annual health screening and health assessment along with lifestyle coaching, self-care initiatives, gym membership reimbursement, nutrition education, a tobacco quit line, and a pedometer walking program among other initiatives.

The Results

Despite significant increases in health care costs across the country in the last few years, Nelnet’s medical costs have decreased 10%. In just three years, Nelnet has implemented a consumer-driven health plan and a robust wellness program, resulting in a 42% reduction in high cholesterol, a 7% reduction in obesity, a 15% reduction in blood pressure, and an 32% reduction in tobacco use.

These efforts have not only helped reduce our medical costs, but more importantly have encouraged our employees to live healthier lifestyles.

Weight Loss Weight Loss Declines from 67% in 2005 to 62% in 2008 - Industry average 65%

High Cholesterol High Cholesterol Declines from 36% in 2005 to 21% in 2008 - Industry average 38%

High Blood Pressure High Blood Pressure Declines from 66% in 2005 to 56% in 2008 - Industry average 67%

Tobacco Use High Blood Pressure Declines from 22% in 2005 to 15% in 2008 - Industry average 20%


Nelnet was featured in a 2008 issue of Forbes magazine as a result of their recent success.

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