Wellness Programs : Health Promotion Programs Economic Considerations.   

Initially introduced by Halbert Dunn in the 1950’s, wellness became a well-liked buzzword during the late 1970’s and received considerable academic attention in the 1980’s.     

Wellness programs for staff became more widespread during the following decade, and credible evidence for their economic viability began to be published.     

There have now been over 100 published studies on this topic and a number of systematic reviews.

Health risks increase costs.  Medical and medical insurance costs escalate with both age and number of risks present.8,10   the number of risks is also strongly related to sick time absenteeism, Employee’s Compensation costs, short-term disability, and reduced productivity (”presenteeism”).

Early employee health promotion programs were relatively basic and generally produced a Return On Investment (ROI) of less than one dollar for every dollar spent operating the health promotion program (Return On Investment (ROI) = <1 - 1).8

Such health promotion programs may  be characterized as “fun-oriented”.  Participation is entirely voluntary, and there is no particular focus on the reduction of in particular identified high risks.  

Interventions and activities aren’t personalized, and there’s no emphasis on the management of medical costs.  These wellness programs are normally site-based only, lack choices to address all of the major behaviorally-related health risks, and lack multimodal presentation.  

Minimal or no incentives are provided to employees for participation, and services to spouses and family members are not available.  Most such health promotion programs lack meaningful analysis.  

More conventional health promotion programs are “activity-oriented” and have shown an Return On Investment (ROI) of between 1 - 2.5 and 1 - 3.5.8 These health promotion programs might have a greater emphasis on health and risk reduction, although the efforts are relatively wide and not personalized.  

They might have some generalized emphasis on healthcare cost management, although not necessarily aimed at specific high risks.  Most are site-based and voluntary, with spouses included only rarely.  

Modest incentives might  be utilized to encourage participation.  Formal examination might  be weak.

The newest and most economically viable health promotion programs are “results-oriented” and exemplify the health and productivity management model.  These health promotion programs consistently produce return rates of 1 - 4 or greater within a 12-24 month period.8  

Such wellness programs are strongly focused on the reduction of specifically identified high risks and the management of medical costs. They are generally voluntary, but use strong financial and other incentives to promote participation.  

They are multi-component in nature (address all major risks), and have both onsite and virtual modalities of operation.  The interventions are highly targeted and individualized, and offered to spouses as well as workers.

For organizations, the cost of providing health insurance for their staff is of excellent importance.  Those costs have been increasing at annual rates between 6% and 14%.

Chapman’s 2007 systematic review7 stated an average reduction in healthcare costs of 26.5 percent then of staff member health promotion programs.  His review covered 60 of the most scientifically exact studies, with an average of 3.77 years of study.

Absenteeism as a result of disease is another cost driver.  Chapman’s review7 reports an average reduction in sick leave of 25.3%.   Cost for Employee’s Compensation was reduced by 40.7%, and disability costs by 24.2%.

There is also an emerging literature on the costs of presenteeism (reduced productivity).11,13  In one study, every risk reduced through a wellness program yielded a 9 percent reduction in presenteeism (and a 2 percent reduction in absenteeism).11

Some organizations have achieved a zero% increase in healthcare costs across at least brief periods of time.10  Doing so requires 90-95% participation of the worker population in focused wellness programs, with 75%-85% of the personnel falling into the low risk category.10     

Even though extensive efforts to lower the risk status of those in moderate or high risk categories ought to be made, the needs of currently healthful workers ought to be addressed as well to avoid increases in risk-status.   

Given the size of the federal workforce, significant cost savings in the government’s contribution to medical insurance premiums for staff can be achieved if a majority of that population were participating in active health promotion programs.     

Likewise, improvements in absenteeism, worker’s compensation, disability, presenteeism, and turnover as a result of comprehensive worker health promotion programs would yield substantial fiscal benefits for the government.   

References   

1   Aldana, Steven G.  (2001)   Financial Impact of Health Promotion Programs -   A Robust Review of the Literature.   Am J Health Promotion 15(5) - 296-320.

2   Chapman, Larry.  (1998)   the Role of Incentives in Wellness.  The Art of Health Promotion  2(3) - 1-8.

3   Chapman, Larry.   (2003)   Biometric Screening in Wellness -   is it Really as Important as We Think?  the Art of Wellness  7(2) - 1-12.

4   Chapman, Larry.  (2005)   Meta-Analysis of Employee Wellness Economic Return Studies -  2005 Update.  The Art of Wellness, July/August, 1-15.

5   Chapman, Larry.   (2006)  Staff Member Participation in Employee Wellness and Wellness Programs -  Exactly how Important are Incentives, and Which Ones work Best?   North Carolina Medical Journal   67(6) -   431-432.

6   Chapman, Larry, Lesch, Nancy, and Passas Baun, Mary Beth.   (2007)   the Role of Health Promotion Coaching in Employee Wellness.   the Art of Wellness, July/August, 1-12.

7   Chapman, Larry.  (2007)   Proof Positive -   an Analysis of the cost-Effectiveness of Employee Wellness.  Northwest Health Management Publishing, Seattle, WA.

8   Chapman, Larry.  (2007)   an In-Depth Look at the Economic Evidence for Rewarding Health Behavior Change.   Workshop presentation at the World Research Group “Rewarding Healthful Behaviors for Health Plans and Businesss” Conference, Orlando, FL, January 23-24.

9   Edington, Dee.   (2001)   Emerging Research -   A View from One Research Center.  American Journal of Wellness 15(5) -  341-349.

10   Edington, Dee W.  (2007)   Health Management as a Serious Company Strategy.  Presentation at the World Research Group “Rewarding Healthy Behaviors for Health Plans and Companys” Conference, Orlando, FL, January 23-24.

11   Pelletier, Barbara, Boles, Myde, and Lunch, Wendy.  (2004)  Changes in Health Risks and Make sure to work Productivity.   Journal of Occupational and Environmental Medicine, 46(7) -  746-754.

12   Pelletier, Kenneth R.  (2005)   A Review and Analysis of the Clinical and Cost-Effectiveness Studies of robust Health and Disease Management (DM)Programs at the Workplace -  Update VI 2000-2004.  JOEM 47(10)1051-1058.

13   DeVol, Ross, Bedroussian, Armen, et.  Al.  (2007)  an Unhealthful America -   the Economic Burden of Chronic Illness.  Report released by the Milken Institute.   www.milkeninstitute.org.

14   Partnership for Prevention.  (2008) Investing in Health -   Proven Health Promotion Practices for Worksites.   http - //www.prevent.org/images/stories/2008/investinginhealth_finalfinal.pdf.