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

1. 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

2. 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?

3. First, Wellness comes in different “flavors” Program Model Main Features Primary Focus 15% - 29% 30% - 65% 66% - 98% Usual Percent Participation

4. Do Wellness programs improve health? Answer: “Yes” for most types of Wellness Programs Source: Art of Health Promotion Newsletter, Vol. 1, No. 3, 1997

5. Health risks are related to health costs Health Plan Cost 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.

6. When health risks change costs change Annual Per Capita Health Care Costs Source: Updated from Edington, et. al., (1997, November). The financial impact of changes in personal health practices. JOEM, 39(11), p. 1037-1046.

7. 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 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. Demand-Side Factors (inside the individual)

8. Do Wellness programs save money?

9. 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

10. Meta-Evaluation criteria • Quality of research design • Sample size • Quality of baseline delineations • Quality of measurements • Appropriateness and replicability of interventions • Length of observational period • Recentness of experimental period

11. Example of Meta-Evaluation criteria #2 Sample size

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

13. 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 14.5 C/B Ratio 6.3 3.0 Study Number Source: Proof Positive: An Analysis of the Cost-Effectiveness of Worksite Wellness, Summex Health Management, Sixth Edition, 2007.

14. Summary of C/B results Red = Health plan savings only Average C/B Ratio = 1:5.81 C/B Ratio Study Number Source: Proof Positive: An Analysis of the Cost-Effectiveness of Worksite Wellness, Summex Health Management, Sixth Edition, 2007.

15. Summary of C/B results Red = Health plan savings only Blue = Health plan and sick leave savings Average C/B Ratio = 1:5.81 C/B Ratio Study Number Source: Proof Positive: An Analysis of the Cost-Effectiveness of Worksite Wellness, Summex Health Management, Sixth Edition, 2007.

16. The rate of return is driven by the participation rate Cost/Benefit Ratio 1:20.0 ● ● ● 1:10.0 ● ● ● ● ● 1:5.0 ● ● ● ● ● ● 100% 50% Participation Rate Source: Proof Positive: An Analysis of the Cost-Effectiveness of Worksite Wellness, Summex Health Management, Sixth Edition, 2006.

17. Another very important study P = 13,048 NP = 13,363 Average Annual Savings P-NP Controlled for: Age Gender Bargaining status Plan type Site Baseline claims 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.

18. Lifetime Health Costs Perspective Annual Health Costs Without Wellness With Wellness 65 Birth Death

19. Future of Wellness programming Model Features Focus

20. “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

21. 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.

22. Questions?