Let’s review case studies that consider the ROI of these programs.

The first case study we will discuss was conducted in 2002 The first case study we will discuss was conducted in 2002. Highmark initiated the Highmark Wellness Program, a comprehensive health-promotion program that included health risk assessments, smoking cessation and nutrition coaching, fitness and nutrition classes, and stress reduction. All components of the program were offered free of charge to employees, and additional components were added in subsequent years. Between 2002 and 2005, 9666 employees participated in the program. This study compared 1892 of these workers with the same number of matched workers who did not participate. Reference Naydeck BL, Pearson JA, Ozminkowski RJ, Day BT, Goetzel RZ. The impact of the Highmark employee wellness programs on 4-year healthcare costs. J Occup Environ Med. 2008;50(2):146-156.

In multivariate models, total healthcare expenditures increased more slowly for participants than for nonparticipants. Participants reaped savings totaling $176.47 per year in healthcare expenditures compared with nonparticipants (P=.037); the greatest difference was seen in inpatient expenditures, with average savings of $181.78 per person per year (P<.0001). Reference Naydeck BL, Pearson JA, Ozminkowski RJ, Day BT, Goetzel RZ. The impact of the Highmark employee wellness programs on 4-year healthcare costs. J Occup Environ Med. 2008;50(2):146-156.

The graphs depict the differences in inpatient and outpatient costs over time for participants and nonparticipants. Of note, annual pharmacy costs were also lower for participants, increasing by $212 between 2001 and 2005, compared with an increase of $285 for nonparticipants. The researchers noted that Highmark’s per-person investment of approximately $139 per year in the wellness program was much lower than their healthcare expenses for treating illness. Reference Naydeck BL, Pearson JA, Ozminkowski RJ, Day BT, Goetzel RZ. The impact of the Highmark employee wellness programs on 4-year healthcare costs. J Occup Environ Med. 2008;50(2):146-156.

The second case study features Volvo’s Health for Life Program, which was initiated in North America in 2004 to encourage employees to establish and maintain healthy lifestyles. Importantly, the global chief executive officer of Volvo became a champion of the program, and this support had a strong influence on regional management. State-of-the-art fitness centers were built at several North American locations, and an award was instituted to recognize sites with the best health-promoting efforts. The program employs both mail and telephone counseling along with a variety of on-site classes and coaching sessions. In addition, incentives are offered to employees who participate. To date, 80% of eligible Volvo employees have participated in health risk assessments. Reference Grossmeier J, Terry PE, Cipriotti A, Burtaine JE. Best practices in evaluating workplace health promotion programs. Am J Health Promot. 2010;24(3):TAHP-1–TAHP-9.

The graph shows the reduction in health risks, based on annual health risk assessments, for program participants. Since the launch of the program, the net health risk reduction has resulted in an 8% improvement in the following health risk areas: alcohol use, back care, safe driving, nutrition, physical activity, tobacco use, stress management, weight management, and mental well-being. Reference Grossmeier J, Terry PE, Cipriotti A, Burtaine JE. Best practices in evaluating workplace health promotion programs. Am J Health Promot. 2010;24(3):TAHP-1–TAHP-9.

In multivariate regression models, medical costs for nonparticipants increased by 5%, whereas those for participants decreased by 3%. The medical-only costs savings were $249 per participant per year. In addition, Volvo’s total healthcare costs increased at a slower rate. Overall, the Health for Life Program was associated with total savings of $3.1 million, with program costs recouped within 2 years after initiation. Reference Grossmeier J, Terry PE, Cipriotti A, Burtaine JE. Best practices in evaluating workplace health promotion programs. Am J Health Promot. 2010;24(3):TAHP-1–TAHP-9.

The American Heart Association (AHA) endorses workplace wellness The American Heart Association (AHA) endorses workplace wellness. Use this slide and the following slide to demonstrate the increasing importance being paid to wellness programs by national healthcare organizations such as the AHA. Health promotion in the workplace is considered to be an integral component of maintaining and improving the health of our nation. The AHA has issued a position statement on workplace wellness programs in which they outline the rationale for employer implementation of these programs. The overriding premise is that workplace wellness programs can assist employees in maximizing their own health and well-being. The AHA maintains that wellness programs are important for addressing the increasing prevalence of chronic conditions among employed individuals in the United States. Programs aimed at addressing rising obesity rates and sedentary behavior are warranted given their implication in other diseases such as type 2 diabetes and hypertension.   Reference American Heart Association. Position Statement on Effective Worksite Wellness Programs. http://www.heart.org/idc/groups/heart-public/@wcm/@adv/documents/downloadable/ucm_301692.pdf. Accessed November 4, 2010.

There is an additional incentive for employers and employees to embrace wellness programs. The NCQA and URAC provide an accreditation process for organizations that offer wellness and health promotion services.1,2 Accreditation is valuable for employers because it ensures that the health plans and vendors offering these services are evaluated on the quality of their programs according to evidence-based requirements.1,2 The accreditation process for the NCQA and URAC is rigorous and provides concrete evidence to employers and their workforce that the wellness and health promotion services are of the highest quality.1,2    References National Committee for Quality Assurance (NCQA). Wellness & Health Promotion Accreditation: Demonstrating Value to Employers and Workers. http://www.ncqa.org/Portals/0/Programs/Recognition/WHP_Flyer_5_3_10.pdf. Accessed November 4, 2010. URAC. Health Management: Comprehensive Wellness Accreditation. http://www.urac.org/docs/programs/URAC_Wellness_Brochure.pdf. Accessed November 5, 2010.

We’ll conclude with best practices for wellness programs.

Studies have shown that programs implemented using a “best practices” formula are most successful. Best practices involves including certain elements in the design, evaluation, and evolution of a program.1 The current and subsequent slides offer a suggested set of best practices for wellness programs. The first step is to know the population for whom the program is being designed. Such knowledge can be gained through medical claims, self-report, and on-site biometric screenings.2 As discussed earlier, visible leadership support is vitally important to program success.2 The program should encourage everyone to become healthier, including those with low, medium, and high health risks (primary, secondary, and tertiary prevention).2 Data should be used to identify health risks, tailor programs, and personalize communications with the goal of maximizing participation.2 References Serxner S, Gold D, Meraz A, Gray A. Do employee health management programs work? Am J Health Promot. 2009;23(4):1-8. Rosen M, Spaulding T. Best practices for wellness programs. Occupational Health & Safety Web site. http://ohsonline.com/Articles/2009/07/01/Best-Practices-for-Wellness-Programs.aspx?p=1. Accessed August 29, 2010.

Communications should be compelling, so as to generate interest and create awareness. Incentives should be appropriate to foster enrollment. Programs should address factors that influence each participant’s behavior, and take into account potential comorbid influences such as depression. As discussed earlier, a culture of health supports worker health not just during classes or workouts but throughout the workday and over the course of the program. Tracking and evaluating the results of the program allows for the adjustments needed to ensure its continued success. Reference Rosen M, Spaulding T. Best practices for wellness programs. Occupational Health & Safety Web site. http://ohsonline.com/Articles/2009/07/01/Best-Practices-for-Wellness-Programs.aspx?p=1. Accessed August 29, 2010.

In summary, costs to employers and employees for health insurance and healthcare have increased. One factor associated with this increase is the cost of treating chronic illness, which is highly prevalent among US workers. The costs to employers are not measured merely in increased costs for health insurance but also in employees’ lost work time (absenteeism) and reduced productivity while at work (presenteeism). Workplace wellness initiatives offer a variety of solutions to the challenges posed by chronic conditions. The literature and the cases described herein have shown that these programs can reduce the direct costs of healthcare for both employers and employees, increase worker productivity, enhance corporate goodwill, and engender the loyalty of employees toward their employers.