byLarry Chapman MPHSenior Vice President

WebMD Health Services(206) 364-3448

Does Wellness Work?: A Look at the Evidence for Worksite Wellness

AWC Wellness AcademyWenatchee, 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?

Fun activity focusNo risk reductionNo high risk focusNot HCM orientedAll voluntarySite-based onlyNo personalizationMinimal incentivesNo spouses servedNo evaluation

Mostly health focusSome risk reductionLittle high risk focusLimited HCM orientedAll voluntarySite-based onlyWeak personalizationModest incentivesFew spouses servedWeak evaluation

Add productivityStrong risk reductionStrong high risk focusStrong HCM orientedSome reqd activitySite and virtual bothStrongly personalMajor incentivesMany spouses servedRigorous evaluation

Quality ofWorkLife

TraditionalHealth and

ProductivityManagement

Morale-Oriented Activity-Oriented Results-Oriented

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

70%

46%

35%

21%

20%

12%

10%

0% 20% 40% 60% 80%

No Exercise

High BP

Smoker

Obesity

Blood Sugar

Stressed

Depressed

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):843-54.

N = 46,000+ X 3 years

When health risks change costs change

$0$1,000$2,000$3,000$4,000$5,000$6,000$7,000$8,000

YR. 1 YR. 2 YR. 3 YR. 4 YR. 5

Low Risk Individual

High to Low

High Risk Individual

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

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?

Define Wellness Programs

Define Study InclusionCriteria

Conduct Literature Search

Select Studies

Apply Meta-EvaluationCriteria

Produce SummaryPublications

ArticleMeta-Evaluation of EconomicReturn Studies

BookProof Positive

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

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)

Summary of 2007 findings

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

Peer Reviewed C/B studies

0

2

4

6

8

10

12

14

16

18

20

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

Traditional

Newer Programs

OutliersC/B Ratio

Study Number

Bank of AmericaBlue Shield of CADuke University

CitibankCity of Birmingham

CoorsDuPont

General FoodsGeneral MotorsGlaxoSmithKline

Indiana BCBSJohnson & Johnson

Life AssuranceNortel

PrudentialTravelers

Union PacificWashoe County

Source: Proof Positive: An Analysis of the Cost-Effectiveness of Worksite Wellness, Summex Health Management, Sixth Edition, 2007.

Summary of C/B results

0

2

4

6

8

10

12

14

16

18

20

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

C/B Ratio

Study Number

Source: Proof Positive: An Analysis of the Cost-Effectiveness of Worksite Wellness, Summex Health Management, Sixth Edition, 2007.

Average C/B Ratio = 1:5.81

Red = Health plan savings only

Summary of C/B results

0

2

4

6

8

10

12

14

16

18

20

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

C/B Ratio

Study Number

Source: Proof Positive: An Analysis of the Cost-Effectiveness of Worksite Wellness, Summex Health Management, Sixth Edition, 2007.

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

$0

$344

$83

$391

$173

$607

$543

$625

$0

$100

$200

$300

$400

$500

$600

$700

0 1 2 3+

No Activities

Activities

Number of HRAs in 6 Years (1992-1997)

P = 13,048

NP = 13,363

Avera

ge A

nnu

al Savin

gs

P-N

P

Controlled for:AgeGenderBargaining

statusPlan typeSite 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.

Lifetime Health Costs Perspective

Birth Death

An

nu

al H

ealt

h

Costs

Without Wellness

With Wellness65

Fun activity focusNo risk reductionNo high risk focusNot HCM orientedAll voluntarySite-based onlyNo personalizationMinimal incentivesNo spouses servedNo evaluation

Mostly health focusSome risk reductionLittle high risk focusLimited HCM orientedAll voluntarySite-based onlyWeak personalizationModest incentivesFew spouses servedWeak evaluation

Add productivityStrong risk reductionStrong high risk focusStrong HCM orientedSome reqd activitySite and virtual bothStrongly personalMajor incentivesMany spouses servedRigorous evaluation

Quality ofWorkLife

Traditional orConventional

Health andProductivityManagement

Morale-Oriented Activity-Oriented Results-Oriented

Model

Features

Focus

Future of Wellness programming

Referrals

HRA

Personal Report

Telephone Coaching

Email 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?