Having worked in the healthcare field now for nearly two decades, it is frustrating to read articles claiming that there is not a return on investment for employers helping their employees achieve better health. Remember when people—including many in the medical community—said smoking and chewing tobacco weren’t bad for you? We have come full circle with some in the medical community declaring that employer wellness programs that encourage a healthy lifestyle and help manage chronic conditions according to clinical guidelines “show little benefit.”
A study recently published in JAMA and highlighted in a New York Times article last week, “Employee Wellness Programs Yield Little Benefit, Study Shows” is one such study that declares wellness programs fail to positively impact health outcomes and costs. If that headline seems out of place, the University of Chicago used even stronger language: “Workplace wellness programs fail to improve health, study finds.”
Oddly enough, the same authors published a meta-analysis in Health Affairs in 2010, titled “Workplace Wellness Programs Can Generate Savings,” in which they found that “medical costs fall by about $3.27 for every dollar spent on wellness programs and that absenteeism costs fall by about $2.73 for every dollar spent.”
The previous study noted that “most studies lack an adequate comparison or control group,” and this newer study attempted to correct those issues, applying stronger research methodologies. As a randomized controlled trial, it should begin to definitively answer the question of ROI; unfortunately, it just raises more questions.
There are three major issues with this study on wellness outcomes.
- Wellness Vendor – Was this a best-in-class wellness vendor or the lowest bidder?
- Length of study – Over what period of time was the study, and did it allow time to capture reductions in health risk factors across the population?
- Return on Investment – Were the right metrics actually tracked?
When examining any wellness study or even evaluating a vendor you want to make sure they check all of the boxes in terms of consumer engagement strategy, clinical expertise, and scalability. The program must be an engaging experience for employees that delivered in the right channel (digital, face to face, etc.) at the right time, with the right call to action.
Clinical expertise, the most critical component of any wellness program, makes sure the recommendations, programs, and offerings are all clinically appropriate and personalized for the member (NCQA and URAC accreditations are the gold seal for the industry).
Wellness vendors have to be scalable for national workforces. Retail workforces are especially tricky because a critical component in many wellness programs is the digital experience. These digital programs are hard to deliver in industries where the employees are not all behind a computer screen or on their smart phone for work, so if you don’t have a viable solution for those retail workers on the floor that’s going to significantly impact the findings of the study.
The recently published JAMA study took place over an 18-month period, which many wellness experts would argue is insufficient to determine a holistic return. Medical costs would typically go up in such a short time frame, mostly based on already existing risk factors. A clinically accredited program would recommend participants get the necessary screenings based on their age and gender; if the program recommended a woman get a mammogram that resulted in an early diagnosis of an aggressive cancer, for example, the cost would have gone up during that 18 months for the procedure to treat her, but the member’s life would have been saved.
Many studies and books have been published that counter the beliefs of the wellness naysayers. One of the most comprehensive and popular with over 30 years of research is Dr. Dee Edington’s Zero Trends. After looking at many corporate wellness programs for decades Dr. Edington developed the Natural Flow model, which assumes we all develop risk factors as we age that can be categorized into three buckets: low, medium and high risk.
Once a baseline is established, any successful risk reduction can be tied directly to quantifiable savings for absenteeism, presenteeism and pure medical costs. When wellness studies are published, one should validate that it was able to track the gamut of risk factors and show what happens to the risk pools over a meaningful amount of time.
In summary, wellness programs should always have a return on investment when implemented correctly. If studies are to conclude meaningful findings, they may want to look over multiple employers using a variety of wellness vendors over a substantial period of time and apply the findings to proven methodologies. To come out and say wellness programs don’t work is a big claim, and that type of rhetoric is not only discouraging but potentially harmful. This study only proved that questionable wellness programs on difficult populations might not show ROI in a short timeframe.