Well­ness now, value later

Work­place pro­grams have ben­e­fits, though not in the short run

Modern Healthcare - - OPINIONS / COMMENTARY - So­eren Mat­tke and Kristin Van Busum So­eren Mat­tke is a se­nior sci­en­tist at the not-for­profit RAND Corp. and man­ag­ing di­rec­tor, RAND Health Ad­vi­sory Ser­vices. Kristin Van Busum is a health pro­ject as­so­ciate at RAND.

Across the coun­try, work­place well­ness pro­grams are mak­ing Amer­i­cans health­ier, pay­ing qual­ity-oflife div­i­dends for mil­lions of par­tic­i­pat­ing work­ers now and into the fu­ture. Em­ploy­ers are screen­ing work­ers for dis­eases, pay­ing for health club mem­ber­ships and pro­vid­ing in­cen­tives to en­cour­age health­ier life­style choices.

This is a good thing. But it’s just not good for the rea­son many em­ploy­ers and lots of other peo­ple think it is.

In re­cent years, em­ploy­ers have no­ticed that di­a­betes, heart dis­ease and other con­di­tions his­tor­i­cally viewed as “curses of old age” were emerg­ing more fre­quently in the work­ing pop­u­la­tion and driv­ing up the cost of health cov­er­age.

But there was a so­lu­tion, creative en­trepreneurs as­serted. As those dis­eases were partly caused by un­healthy life­styles, well­ness pro­grams that of­fered weight man­age­ment, smok­ing ces­sa­tion, and fit­ness pro­grams would re­duce health risks, make em­ploy­ees health­ier and con­trol cost. A win-win. Clever mar­ket­ing and count­less suc­cess sto­ries drove the de­vel­op­ment of a $4 bil­lion in­dus­try that is sup­ported by about half of all U.S. em­ploy­ers. Even the nor­mally skep­ti­cal aca­demic world joined the band­wagon: A 2009 re­view by Har­vard econ­o­mist Kather­ine Baicker stated that well­ness pro­grams re­turned $3 in health­care sav­ings and $3 in re­duced ab­sen­teeism cost for ev­ery dol­lar in­vested.

Our re­search tells a dif­fer­ent story. We re­cently com­pleted the largest as­sess­ment of work­place well­ness pro­grams to date and found that well­ness pro­grams do in fact re­duce health risks, like smok­ing and obe­sity.

But re­sult­ing cost sav­ings could not be de­tected, es­pe­cially when com­pared to the costs of the pro­grams. The study, which in­cluded al­most 600,000 em­ploy­ees and de­pen­dents at seven em­ploy­ers, found that pro­grams are not likely hav­ing im­me­di­ate ef­fects on the amount em­ploy­ers spend on health­care cov­er­age for their em­ploy­ees, and it may take a num­ber of years to de­tect any ef­fect on costs.

Our re­sults sug­gest that pro­gram par­tic­i­pa­tion led a quar­ter of the smok­ers to kick the habit. Pro­grams also in­creased num­bers of

As work­place well­ness pro­grams have sus­tain­able and clin­i­cally mean­ing­ful ef­fects on health risks over time, we should see lower rates of chronic dis­eases and thus re­duc­tions in health­care costs.

nor­mal weight per­sons by 50%. How­ever, the aver­age an­nual sav­ings over five years amounted to $157 per em­ployee, while typ­i­cal pro­gram costs are around $150 per em­ployee each year.

That cost wipes out the an­tic­i­pated sav­ings for em­ploy­ers run­ning well­ness pro­grams.

So why does bet­ter health not yield div­i­dends? The prob­lem is twofold. First, not ev­ery smoker will de­velop lung can­cer; in other words, not ev­ery­one with a health risk will de­velop a dis­ease.

Sec­ond, it takes a long time be­fore a risk fac­tor like obe­sity leads to the de­vel­op­ment of a costly dis­ease like di­a­betes. But em­ploy­ers have to cover the cost for ev­ery pro­gram par­tic­i­pant and have to cover it to­day. Thus, preven­tive in­ter­ven­tions, like work­place well­ness, can save money but only if the risk is high in re­la­tion to the cost of the in­ter­ven­tion, and it seems that well­ness pro­po­nents were overly op­ti­mistic about how quickly and strongly health ben­e­fits trans­lated into sav­ings.

But there is hope. As work­place well­ness pro­grams have sus­tain­able and clin­i­cally mean­ing­ful ef­fects on health risks over time, we should see lower rates of chronic dis­eases and thus re­duc­tions in health­care costs. Af­ter all, the pri­mary rea­son to in­vest in well­ness pro­grams is to im­prove health, and the ev­i­dence ap­pears that well­ness pro­grams do this quite well.

In the near term, work­place well­ness pro­grams are re­duc­ing waist lines. In the long run, they might even help im­prove em­ploy­ers’ bot­tom lines.

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