Does Wellness Work?

: A Look at the
Evidence for Worksite Wellness
AWC Wellness Academy
Wenatchee, WA
April 17-19, 2007
by
Larry Chapman MPH
Senior Vice President
WebMD Health Services
(206) 364-3448
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?
 First, Wellness comes in different “flavors”
Health and
Program Quality of
Traditional Productivity
WorkLife
Model Management

Fun activity focus Mostly health focus Add productivity

No risk reduction Some risk reduction Strong risk reduction
No high risk focus Little high risk focus Strong high risk focus
Not HCM oriented Limited HCM oriented Strong HCM oriented
All voluntary All voluntary Some reqd activity
Main Site-based only Site-based only Site and virtual both
No personalization Weak personalization Strongly personal
Features Minimal incentives Modest incentives Major incentives
No spouses served Few spouses served Many spouses served
No evaluation Weak evaluation Rigorous evaluation

Primary
Morale-Oriented Activity-Oriented Results-Oriented
Focus

Usual Percent
Participation
15% - 29% 30% - 65% 66% - 98%
Do Wellness programs improve health?
Answer: “Yes” for most types of Wellness Programs

Source: Art of Health Promotion Newsletter, Vol. 1, No. 3, 1997

 Health risks are related to health costs

Depressed 70%

Stressed 46%

Blood Sugar
35%

Obesity
21%

Smoker 20%

High BP 12% Health Plan Cost

No Exercise 10%

0% 20% 40% 60% 80%

Percent Higher Annual Health Plan Costs
N = 46,000+ X 3 years

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):843-
54.
When health risks change costs change

Annual Per Capita Health Care Costs

$8,000 Low Risk Individual

$7,000
$6,000 High to Low
$5,000
$4,000 High Risk Individual
$3,000
$2,000
$1,000
$0
YR. 1 YR. 2 YR. 3 YR. 4 YR. 5

Source: Updated from Edington, et. al., (1997, November). The financial impact of
changes in personal health practices. JOEM, 39(11), p. 1037-1046.
 What drives health care cost?

Supply-Side Factors Supply-Side

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

Define Wellness Programs

Define Study Inclusion

Criteria

Conduct Literature Search

Select Studies

Apply Meta-Evaluation
Criteria

Book Article
Proof Positive Produce Summary Meta-Evaluation of Economic
Return Studies
Publications
 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
Points Criteria Sub-Components
5 Sample size > 50,000
4 Sample size from 25,000 to 49,999
3 Sample size from 10,000 to 24,999
2 Sample size from 1,000 to 9,999
1 Sample size  999
1 bonus For controlling for sample attrition
Summary of 2007 findings
Study Parameter Averages & Totals
(N=60)
Average study years 3.77
Observational years 226.3
Year Reported (median) 1995
# of Study Subjects 552,339
# of Control Subjects 200,259
Average # of Program Targets 5.1
% Change in Sick Leave -25.3% (26)
% Change in HCs -26.5% (27)
% Change in Workers’ Comp -40.7% (5)
% Change in Disability Mang. -24.2% (3)
C/B Ratio 1:5.81 (22)

Source: Proof Positive: An Analysis of the Cost-Effectiveness of

Worksite Wellness, Sixth Edition, 2007.
 Peer Reviewed C/B studies
Bank of America
Blue Shield of CA
Duke University
Citibank
City of Birmingham
Coors
DuPont
20 General Foods
General Motors
18 GlaxoSmithKline
Indiana BCBS
16 Johnson & Johnson
Traditional Life Assurance
14
Nortel
Newer Programs Prudential
12
Travelers
Outliers
C/B 10 Union Pacific
Washoe County
Ratio 8
6

0
#1 #2 #3 #4 #5 #6 #7 #8 #9 #10 #11 #12 #13 #14 #15 #16 #17 #18 #19 #20 #21 #22

Study Number

Source: Proof Positive: An Analysis of the Cost-Effectiveness of Worksite Wellness,

Summex Health Management, Sixth Edition, 2007.
 Summary of C/B results
Red = Health plan savings only

20

18

16

14

12 Average C/B Ratio = 1:5.81

C/B 10
Ratio 8
6

0
#1 #2 #3 #4 #5 #6 #7 #8 #9 #10 #11 #12 #13 #14 #15 #16 #17 #18 #19 #20 #21 #22

Study Number

Source: Proof Positive: An Analysis of the Cost-Effectiveness of Worksite Wellness,

Summex Health Management, Sixth Edition, 2007.
 Summary of C/B results
Red = Health plan savings only Blue = Health plan and sick leave savings

20

18

16

14

12 Average C/B Ratio = 1:5.81

C/B 10
Ratio 8
6

0
#1 #2 #3 #4 #5 #6 #7 #8 #9 #10 #11 #12 #13 #14 #15 #16 #17 #18 #19 #20 #21 #22

Study Number

Source: Proof Positive: An Analysis of the Cost-Effectiveness of Worksite Wellness,

Summex Health Management, Sixth Edition, 2007.
 The rate of return is driven by the
participation rate
Cost/Benefit Ratio

1:20.0
●
●

1:10.0 ●
● ●
● ●
1:5.0 ● ●
●
● ● ●
●

50% 100%
Participation Rate
Source: Proof Positive: An Analysis of the Cost-Effectiveness of Worksite Wellness,
Summex Health Management, Sixth Edition, 2006.
 Another very important study

$700
$607 $625
Average Annual Savings P-NP

No Activities
$600 $543 Activities
$500
$391
$400 $344
P = 13,048
$300 NP = 13,363
$200 $173
$83 Controlled for:
$100 Age
$0 Gender
$0 Bargaining status
0 1 2 3+ Plan type
Site
Number of HRAs in 6 Years (1992-1997) Baseline claims

Source: Serxner, et.al., The Relationship Between Health Promotion

Program Participation and Medical Costs: A Dose Response, JOEM, 45(11),
November, 1196-1200.
Annual Health Costs
Lifetime Health Costs Perspective

Without Wellness
65
With Wellness

Birth Death
 Future of Wellness programming

Health and
Quality of Traditional or
Productivity
Model WorkLife Conventional
Management

Fun activity focus Mostly health focus Add productivity

No risk reduction Some risk reduction Strong risk reduction
No high risk focus Little high risk focus Strong high risk focus
Not HCM oriented Limited HCM oriented Strong HCM oriented
All voluntary All voluntary Some reqd activity
Features Site-based only Site-based only Site and virtual both
No personalization Weak personalization Strongly personal
Minimal incentives Modest incentives Major incentives
No spouses served Few spouses served Many spouses served
No evaluation Weak evaluation Rigorous evaluation

Focus Morale-Oriented Activity-Oriented Results-Oriented

 “Virtual” Wellness Infrastructure for the Future

Incentives for Wellness Online E-Health

HRA

PCP Summary

Personal
Report
Email and Mail
Messaging

Referrals

Telephone Communications
Coaching Kit
 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?