Employee Health Promotion

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 employees became more widespread during the following decade, and credible evidence for their economic viability started 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 time absenteeism, Employee’s Compensation costs, short-term disability, and decreased productivity (”presenteeism”).

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

Such wellness programs may  be characterized as “fun-oriented”.  Participation is entirely voluntary, and there’s no particular focus on the reduction of specifically 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 typically site-based only, lack options to address all 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 examination.

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

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 could  be utilized to encourage participation.  Formal examination 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 namely identified high risks and the management of medical costs. They are usually 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 in addition to staff members.

For companies, the cost of providing medical insurance for their staff members is of excellent importance.  Those costs have been increasing at annual rates between 6 percent and 14 percent.

Chapman’s 2007 systematic review7 stated an average reduction in healthcare costs of 26.5% thus of staff member wellness programs.  His review covered 60 of the most scientifically accurate 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 typical reduction in sick time of 25.3%.   Cost for Employee’s Compensation was decreased 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 decreased through a wellness program yielded a 9% reduction in presenteeism (and a 2% reduction in absenteeism).11

A number of businesses have achieved a zero% increase in healthcare costs across at least brief periods of time.10  Doing so requires 90-95% participation of the staff member population in focused wellness programs, with 75%-85% of the workers falling into the low risk category.10     

While comprehensive efforts to lower the risk status of those in moderate or high risk categories should be made, the needs of currently healthy personnel should 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 members can be achieved if a majority of that population were participating in active health promotion programs.     

Similarly, improvements in absenteeism, staff member’s compensation, disability, presenteeism, and turnover thus of extensive employee health promotion programs would yield substantial fiscal benefits for the government.   

References   

1   Aldana, Steven G.  (2001)   Financial Impact of Health Promotion Programs –   A Extensive 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 Wellness  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-Evaluation of Employee Wellness Economic Return Studies –  2005 Update.  The Art of Wellness, July/August, 1-15.

5   Chapman, Larry.   (2006)  Employee Participation in Company Wellness and Wellness Programs –  Precisely 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 Company Wellness.   the Art of Wellness, July/August, 1-12.

7   Chapman, Larry.  (2007)   Proof Positive –   an Analysis of the cost-Effectiveness of Company Health Promotion.  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 Healthy 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 Health Promotion 15(5) –  341-349.

10   Edington, Dee W.  (2007)   Health Management as a Serious Business Strategy.  Presentation at the World Research Group “Rewarding Healthy 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 Make 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 Disease Management (DM)Programs at the Worksite –  Update VI 2000-2004.  JOEM 47(10)1051-1058.

13   DeVol, Ross, Bedroussian, Armen, et.  Al.  (2007)  an Unhealthy 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 Wellness Practices for Worksites.   http – //www.prevent.org/images/stories/2008/investinginhealth_finalfinal.pdf.