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

Program Model
Quality of WorkLife Traditional Health and Productivity Management

Main Features

Fun activity focus No risk reduction No high risk focus Not HCM oriented All voluntary Site-based only No personalization Minimal incentives No spouses served No evaluation

Mostly health focus Some risk reduction Little high risk focus Limited HCM oriented All voluntary Site-based only Weak personalization Modest incentives Few spouses served Weak evaluation

Add productivity Strong risk reduction Strong high risk focus Strong HCM oriented Some reqd activity Site and virtual both Strongly personal Major incentives Many spouses served Rigorous evaluation

Primary Focus

Morale-Oriented

Activity-Oriented

Results-Oriented

Usual Percent Participation

15% - 29%

30% - 65%

66% - 98%

Do Wellness programs improve health?

Answer: Yes for most types of Wellness Programs

Major Intervention Area Hypertension Stress mang Multi-component Weight control Nutrition Cholesterol Exercise Safety belt HRAs Alcohol HIV/AIDS

Rank Based on Quality of the Research Plus Qualitative Descriptor 1 (Conclusive) 2 (Acceptable) 3 (Indicative to Acceptable) 4 (Indicative) 5 (Suggestive to Indicative) 6 (Suggestive to Indicative) 7 (Suggestive) 8 (Suggestive) 9 (Suggestive) 10 (Weak to Suggestive) 11 (Weak)

Number of Studies Reviewed

32 64 36 46 16 10 52 14 11 25 11

Percent with Rigorous Research Designs (%) 44% 76% 69% 48% 56% 40% 37% 71% 54% 24% 27%

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

Health risks are related to health costs

Depressed Stressed Blood Sugar Obesity Smoker High BP No Exercise

70% 46% 35% 21% 20% 12% 10% 20% 40% 60% 80%

Health Plan Cost

0%
N = 46,000+ X 3 years

Percent Higher Annual Health Plan Costs

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):84354.

When health risks change costs change

Annual Per Capita Health Care Costs

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

Low Risk Individual High to Low High Risk Individual

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 (outside the
individual)

Supply-Side Factors (outside the

Age
individual)

Extent and scope of insurance coverage Point-of-use cost sharing Geographic access to services Size of discounts

Demand-Side Factors
(inside the individual)

Gender Personal health behavior Attitudes about personal health and health care use.

Sense of responsibility for personal health Clinical risk factors

Regional or local practice patterns

Current morbidity
Self-efficacy

Provider incentives affecting diagnosis and treatment decisions

Do Wellness programs save money?

Define Wellness Programs

Define Study Inclusion Criteria

Conduct Literature Search

Select Studies

Apply Meta-Evaluation Criteria

Book
Proof Positive

Article

Produce Summary Publications

Meta-Evaluation of Economic Return Studies

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 5 4 3 2 1 1 bonus Criteria Sub-Components Sample size > 50,000 Sample size from 25,000 to 49,999 Sample size from 10,000 to 24,999 Sample size from 1,000 to 9,999 Sample size 999 For controlling for sample attrition

Summary of 2007 findings

Study Parameter
Average study years Observational years Year Reported (median) # of Study Subjects # of Control Subjects Average # of Program Targets % Change in Sick Leave % Change in HCs % Change in Workers Comp % Change in Disability Mang. C/B Ratio
Source:

Averages & Totals (N=60)

3.77 226.3 1995 552,339 200,259 5.1 -25.3% (26) -26.5% (27) -40.7% (5) -24.2% (3) 1:5.81 (22)

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 General Foods General Motors GlaxoSmithKline Indiana BCBS Johnson & Johnson Life Assurance Nortel Prudential Travelers Union Pacific Washoe County

20 18 16 14 12

Traditional Newer Programs Outliers

C/B 10 Ratio 8
6 4 2 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 4 2 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 4 2 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

Average Annual Savings P-NP

$700 $600 $500 $400 $300 $200 $100 $0 0 1 $83 $0 $344 $391

$607

$625 $543

No Activities Activities

P = 13,048 NP = 13,363

$173
Controlled for: Age Gender Bargaining status Plan type Site Baseline claims

3+

Number of HRAs in 6 Years (1992-1997)

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

Annual Health Costs

Without Wellness With Wellness

65

Birth

Death

Future of Wellness programming

Model
Quality of WorkLife Traditional or Conventional Health and Productivity Management

Features

Fun activity focus No risk reduction No high risk focus Not HCM oriented All voluntary Site-based only No personalization Minimal incentives No spouses served No evaluation

Mostly health focus Some risk reduction Little high risk focus Limited HCM oriented All voluntary Site-based only Weak personalization Modest incentives Few spouses served Weak evaluation

Add productivity Strong risk reduction Strong high risk focus Strong HCM oriented Some reqd activity Site and virtual both Strongly personal Major incentives Many spouses served 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 Coaching

Communications 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?