Maximizing the Return on Health Improvement Programs

Wellness programs are increasingly popular with employers and employees.  A chart at the bottom of the page shows the behaviors most employers will target with these programs in 2015, in an effort to improve health and curb costs.  But employers should not expect to get the spectacular returns on investment (ROI) that many studies of health promotion programs can deliver.

A recent academic review looked at ROI assessments conducted on 51 workplace health promotion programs.* The conclusion was that the less rigorous the study, the higher the alleged ROI is “proven” to be.  Conversely, the more thorough the study, the lower the ROI estimate.  In other words, a superficial analysis is likely to overstate the results, so don’t cut corners when projecting or stating the financial rewards of your program.

Here’s an example.  Make sure you don’t base your analysis on short-term results.  If average employee weight loss over the course of a year is significant, but the analysis fails to adjust results for subsequent weight gains by program participants, the study results lack validity.  Similarly, studies that fail to incorporate data from program drop-outs, or studies that compare data from program participants to non-participants, can lead to deceptive conclusions.

In the review of studies, those applying only a rudimentary analysis claimed ROI of about 232 percent.  Programs that were subject to closer scrutiny on average found a 26 percent ROI.  Bottom line: when you are designing a wellness program, temper your ROI expectations and model your program on those that have stood up to thorough, objective review.

Ingredients of Success

According to the Wellness Councils of America, successful programs:

  • Garner support from the top leaders. “CEOs who communicate the wellness message clearly and frequently” have more effective wellness initiatives.  They also need to be willing to model the healthy behaviors promoted by the program, and use their clout to directly involve a variety of people in the organization to take charge of different facets of the initiative.
  • Are managed by a cohesive wellness team. Saddling a single individual with responsibility for running the wellness program is a bad idea because that person can burn out in that role, or take a new position in the organization, requiring the designation of a successor who will be starting from scratch.
  • Incorporate performance data collection. As noted, most studies lacking statistical rigor, when conducted by people with an interest in showing a positive result, are wildly unrealistic.  An organization called the Validation Institute has been created to raise the standards of “population health” studies to help organizations determine whether they are making real progress or not.
  • Use performance data to assess program outcomes. Outcome categories can cover a broad array of success indicators, based on program goals.  They can include participation rates, participant satisfaction with the program, improvements in knowledge, attitudes and behaviors, changes in biometric measures (for example, BMI, cholesterol, and blood pressure levels, risk factors (identification of and focus on individuals at greatest risk of acute medical problems), corporate culture, productivity, and return on investment.
  • Create a “supporting, health-promoting environment.”  This involves such things as the contents of vending machines at the worksite (for example, junk food undermines efforts to promote good nutrition), attention to workstation ergonomics, aggressive injury-prevention policies and sensitivity to employment conditions that cause high levels of employee stress.
  • Have an annual operating plan. Such plans should include measurable objectives linked to the company’s strategic priorities, implementation timelines, and designation of roles and responsibilities for the accomplishment of enumerated objectives.  In addition, these plans should address marketing strategies to promote the wellness program and evaluation procedures to assess progress towards goal achievement.
  • Use appropriate health interventions. Appropriateness of possible wellness program components may vary by organization, based on employee demographics.  Intervention variables include which health issues to address, how they will be addressed, incentives and disincentives for participation or outcomes, and whether the program should be offered only to employees or their families as well.  Note: Under the Affordable Care Act, program incentives and penalties can only be based on one of the following two measurements: participation or outcomes (such as biometric results).

What is an appropriate health intervention?  The answer to this question has evolved in recent years, based on employee complaints made to the Equal Employment Opportunity Commission (EEOC).  Many of these complaints relate to what employees say are abusive or discriminatory program design elements.  Bottom line: Don’t go overboard.  Make sure program goals are realistically achievable, and not punitive for those who fall short.

Guidelines to strike the right balance were enunciated by the EEOC in a recent case, EEOC v. Orion Energy Systems. The ruling emphasized the importance of program flexibility and alternative standards for employees with health conditions that minimize their prospects for success.  Otherwise, the employer could be in violation of the Americans with Disabilities Act. The program cannot appear to be an effort by the employer to cut health benefit costs by penalizing unhealthy employees.  It must reflect a genuine effort to improve the health of all employees.



Source: National Business Group on Health 2015 Health Plan Design survey


*Baxter et al, “The relationship between return on investment and quality of study methodology in workplace health promotion programs,” American Journal of Health Promotion, June 2014


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