by Larry Chapman MPH Senior Vice President WebMD Health Services (206) Does Wellness Work?: A Look at the Evidence for Worksite Wellness AWC Wellness Academy Wenatchee, WA April 17-19, 2007

Agenda Do Wellness programs improve health? Do Wellness programs reduce health costs? Do Wellness programs save money? What will Wellness programs look like in the future?

Program Model Main Features Primary Focus First, Wellness comes in different “flavors” Usual Percent Participation 15% - 29% 30% - 65% 66% - 98%

Do Wellness programs improve health? Source: Art of Health Promotion Newsletter, Vol. 1, No. 3, 1997 Answer: “Yes” for most types of Wellness Programs

Health risks are related to health costs Percent Higher Annual Health Plan Costs Health Plan Cost Source: Goetzel RZ, et. al. (1998, October). The relationship between modifiable health risks and health care expenditures: An analysis of the multi-employer HERO health risk and cost database. JOEM, 40(10): N = 46,000+ X 3 years

When health risks change costs change Source: Updated from Edington, et. al., (1997, November). The financial impact of changes in personal health practices. JOEM, 39(11), p Annual Per Capita Health Care Costs

What drives health care cost? Supply-Side Factors (outside the individual)  Extent and scope of insurance coverage  Point-of-use cost sharing  Geographic access to services  Size of discounts Supply-Side Factors (outside the individual)  Regional or local practice patterns  Provider incentives affecting diagnosis and treatment decisions Demand-Side Factors (inside the individual) Age Sense of responsibility for personal health Clinical risk factors Current morbidity Self-efficacy Gender Personal health behavior Attitudes about personal health and health care use.

Do Wellness programs save money?

Study inclusion criteria Multi-component programming Workplace setting only Reasonably rigorous study design Original research results Examines economic variables In peer review journal Use comparison or control group Use statistical analysis Must be replicable approach At least 12 months in duration

Meta-Evaluation criteria 1.Quality of research design 2.Sample size 3.Quality of baseline delineations 4.Quality of measurements 5.Appropriateness and replicability of interventions 6.Length of observational period 7.Recentness of experimental period

Example of Meta-Evaluation criteria #2 Sample size

Summary of 2007 findings Source: Proof Positive: An Analysis of the Cost-Effectiveness of Worksite Wellness, Sixth Edition, 2007.

Peer Reviewed C/B studies C/B Ratio Study Number Bank of America Blue Shield of CA Duke University Citibank City of Birmingham Coors DuPont General Foods General Motors GlaxoSmithKline Indiana BCBS Johnson & Johnson Life Assurance Nortel Prudential Travelers Union Pacific Washoe County Source: Proof Positive: An Analysis of the Cost-Effectiveness of Worksite Wellness, Summex Health Management, Sixth Edition, 2007.

Summary of C/B results C/B Ratio Study Number Source: Proof Positive: An Analysis of the Cost-Effectiveness of Worksite Wellness, Summex Health Management, Sixth Edition, Average C/B Ratio = 1:5.81 Red = Health plan savings only

Summary of C/B results C/B Ratio Study Number Source: Proof Positive: An Analysis of the Cost-Effectiveness of Worksite Wellness, Summex Health Management, Sixth Edition, Average C/B Ratio = 1:5.81 Red = Health plan savings only Blue = Health plan and sick leave savings

The rate of return is driven by the participation rate 50% 100% Cost/Benefit Ratio Participation Rate ● ● ● ● ● ● ● ● ● ● ● ● 1:10.0 1:20.0 ● ● 1:5.0 Source: Proof Positive: An Analysis of the Cost-Effectiveness of Worksite Wellness, Summex Health Management, Sixth Edition, 2006.

Another very important study Number of HRAs in 6 Years ( ) P = 13,048 NP = 13,363 Average Annual Savings P-NP Controlled for: Age Gender Bargaining status Plan type Site Baseline claims Source: Serxner, et.al., The Relationship Between Health Promotion Program Participation and Medical Costs: A Dose Response, JOEM, 45(11), November,

Lifetime Health Costs Perspective BirthDeath Annual Health Costs Without Wellness With Wellness 65

Model Features Focus Future of Wellness programming

Referrals HRA Personal Report Telephone Coaching and Mail Messaging PCP Summary Online E-HealthIncentives for Wellness Communications Kit “Virtual” Wellness Infrastructure for the Future

Summary of key points There are a large number of health improvement and economic return studies now in the literature. They are of differing quality and rigor. However, all of them with a few exceptions document positive findings, but with different magnitudes. They have been conducted in a wide variety of industries and settings with varying size work groups. The more rigorous the evaluation effort the greater the health effect and economic return. The higher the participation levels the greater the health effect and economic return. Studies are now being reported in other developed nations that parallel US study findings. There are a number of programming strategies that will enhance the economic return from these types of programs. Therefore, Yes - Wellness programs do work.

Questions?