Do Wellness Programs Work - Chapman 2007

8/13/2019 Do Wellness Programs Work - Chapman 2007

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byLarry Chapman MPHSenior Vice President

WebMD Health Services206) 364-3448

Does Wellness Work?: A Look at theEvidence for Worksite Wellness

AWC Wellness AcademyWenatchee, WA

April 17-19, 2007


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Agenda

Do Wellness programsimprove health?

Do Wellness programsreduce health costs?

Do Wellness programssave money?

What will Wellnessprograms look like in thefuture?


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Fun activity focus

No risk reduction

No high risk focus

Not HCM oriented

All voluntary

Site-based onlyNo 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 onlyWeak 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 bothStrongly personal

Major incentives

Many spouses served

Rigorous evaluation

Quality of

WorkLife Traditional

Health and

ProductivityManagement

Morale-Oriented Activity-Oriented Results-Oriented

ProgramModel

Main

Features

PrimaryFocus

First, Wellness comes in different flavors

Usual Percent

Participation15% - 29% 30% - 65% 66% - 98%


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Do Wellness programs improve health?Major

Intervention

Area

Rank Based on Quality of theResearch Plus Qualitative

Descriptor

Number ofStudies Reviewed

Percent withRigorous

Research

Designs (%)

Hypertension 1 (Conclusive) 32 44%

Stress mang 2 (Acceptable) 64 76%Multi-component 3 (Indicative to Acceptable) 36 69%

Weight control 4 (Indicative) 46 48%

Nutrition 5 (Suggestive to Indicative) 16 56%

Cholesterol 6 (Suggestive to Indicative) 10 40%

Exercise 7 (Suggestive) 52 37%Safety belt 8 (Suggestive) 14 71%

HRAs 9 (Suggestive) 11 54%

Alcohol 10 (Weak to Suggestive) 25 24%

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

Answer: Yes for most types of Wellness Programs


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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


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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 ofchanges in personal health practices. JOEM, 39(11), p. 1037-1046.

Annual Per Capita Health Care Costs


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What drives health care cost?

Supply-SideFactors (outside theindividual)

Extent and scopeof insurance

coverage

Point-of-use costsharing

Geographic

access to

services

Size of discounts

Supply-SideFactors (outside theindividual)

Regional orlocal practice

patterns

Providerincentives

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

healthbehavior

Attitudes

about

personal

health and

healthcare

use.


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Do Wellness programs save money?

Define Wellness Programs

Define Study Inclusion

Criteria

Conduct Literature Search

Select Studies

Apply Meta-Evaluation

Criteria

Produce Summary

Publications

Article

Meta-Evaluation of Economic

Return Studies

Book

Proof Positive


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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 controlgroup

Use statistical analysis Must be replicable approach

At least 12 months in duration


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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


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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



1 Sample size 999

1 bonus For controlling for sample attrition


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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 ofWorksite Wellness, Sixth Edition, 2007.


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Peer Reviewed C/B studies

0

2

4

6

8

10

1214

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/BRatio

Study Number

Bank of AmericaBlue Shield of CADuke University

CitibankCity of BirminghamCoors

DuPontGeneral FoodsGeneral Motors

GlaxoSmithKlineIndiana BCBS

Johnson & JohnsonLife Assurance

NortelPrudentialTravelers

Union PacificWashoe County

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


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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/BRatio

Study Number


Average C/B Ratio = 1:5.81

Red = Health plan savings only


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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/BRatio

Study Number


Average C/B Ratio = 1:5.81

Red = Health plan savings only Blue = Health plan and sick leave savings


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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



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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

Average

AnnualS

avingsP-NP

Controlled for:AgeGenderBargaining statusPlan typeSiteBaseline claims

Source: Serxner, et.al., The Relationship Between Health Promotion

Program Participation and Medical Costs: A Dose Response, JOEM, 45(11),November, 1196-1200.


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Lifetime Health Costs Perspective

Birth Death

AnnualHea

lth

Costs

Without Wellness

With Wellness

65


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Fun activity focus

No risk reduction

No high risk focus

Not HCM oriented

All voluntarySite-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 voluntarySite-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 activitySite and virtual both

Strongly personal

Major incentives

Many spouses served

Rigorous evaluation

Quality ofWorkLife Traditional orConventional

Health and

ProductivityManagement

Morale-Oriented Activity-Oriented Results-Oriented

Model

Features

Focus

Future of Wellness programming


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Referrals

HRA

Personal Report

TelephoneCoaching

Email and MailMessaging

PCP Summary

Online E Healthncentives for Wellness

Communications Kit

Virtual Wellness Infrastructure for the Future


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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 differentmagnitudes.

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 economicreturn.

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 returnfrom these types of programs.

Therefore, Yes - Wellness programs do work.


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Questions?

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