Initially introduced by Halbert Dunn in the 1950’s, wellness became a popular buzzword during the late 1970’s and received considerable academic attention in the 1980’s.
Wellness programs for workers 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 health insurance costs escalate with both age and number of risks present.8,10 the number of risks is also strongly related to sick leave absenteeism, Employee’s Compensation costs, short-term disability, and decreased productivity (”presenteeism”).
Early staff member wellness programs were relatively basic and generally produced a Return On Investment of less than one dollar for every dollar spent operating the wellness program (Return On Investment = <1 - 1).8
Such wellness programs could be characterized as “fun-oriented”. Participation is entirely voluntary, and there’s no particular focus on the reduction of in particular identified high risks.
Interventions and activities are not customized, and there is no emphasis on the management of health costs. These health promotion programs are generally 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 wellness 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 may have a greater emphasis on health and risk reduction, although the efforts are relatively broad and not customized.
They may have some generalized emphasis on health care cost management, although not necessarily aimed at specific high risks. Most are site-based and voluntary, with spouses included only rarely.
Modest incentives could be utilized to encourage participation. Formal evaluation could be weak.
The newest and most economically viable wellness programs are “results-oriented” and exemplify the health and productivity management model. These wellness 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 health care costs. They’re typically voluntary, but use strong financial and other incentives to promote participation.
They are multi-component in nature (address all major risks), and have both on-site and virtual modalities of operation. The interventions are highly targeted and individualized, and offered to spouses in addition to workers.
For businesses, the cost of providing medical insurance for their workforce is of great importance. Those costs have been increasing at annual rates between 6 percent and 14 percent.
Chapman’s 2007 systematic review7 announced an typical reduction in healthcare costs of 26.5 percent thus of worksite wellness programs. His review covered 60 of the most scientifically accurate studies, with an typical of 3.77 years of study.
Absenteeism due to disease is another cost driver. Chapman’s review7 reports an typical reduction in sick time of 25.3 percent. Cost for Employee’s Compensation was reduced by 40.7 percent, and disability costs by 24.2 percent.
There’s also an emerging literature on the costs of presenteeism (reduced productivity).11,13 In one study, every risk decreased through a health promotion program yielded a 9% reduction in presenteeism (and a 2% reduction in absenteeism).11
Some businesses have achieved a zero% increase in health care costs across at least brief periods of time.10 Doing so requires 90-95% participation of the employee population in focused wellness programs, with 75%-85% of the employees falling into the low risk category.10
Despite the fact that robust efforts to lower the risk status of those in moderate or high risk categories must be made, the needs of currently healthy employees must be addressed as well to avoid increases in risk-status.
Given the size of the federal workforce, meaningful cost savings in the government’s contribution to medical insurance premiums for staff members may be achieved when a majority of that population were participating in active wellness programs.
Similarly, improvements in absenteeism, employee’s compensation, disability, presenteeism, and turnover so of comprehensive employee health promotion programs would yield substantial fiscal benefits for the government.
References
1 Aldana, Steven G. (2001) Financial Impact of Wellness Programs – A Robust Review of the Literature. Am J Wellness 15(5) – 296-320.
2 Chapman, Larry. (1998) the Role of Incentives in Wellness. The Art of Wellness 2(3) – 1-8.
3 Chapman, Larry. (2003) Biometric Screening in Health Promotion – is it Really as Important as We Think? the Art of Health Promotion 7(2) – 1-12.
4 Chapman, Larry. (2005) Meta-Investigation of Worksite Wellness Economic Return Studies – 2005 Update. The Art of Wellness, July/August, 1-15.
5 Chapman, Larry. (2006) Employee Participation in Worksite Wellness and Health Promotion 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 Wellness Coaching in Worksite Wellness. the Art of Wellness, July/August, 1-12.
7 Chapman, Larry. (2007) Proof Positive – an Analysis of the cost-Effectiveness of Worksite 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 Companys” 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 Business Strategy. Presentation at the World Research Group “Rewarding Healthful Behaviors for Health Plans and Corporations” Conference, Orlando, FL, January 23-24.
11 Pelletier, Barbara, Boles, Myde, and Lunch, Wendy. (2004) Changes in Health Risks and Be certain 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 Illness Management (DM)Programs at the Worksite – 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.
