Ten Questions Publicly Traded Company Boards Should Ask about Employee Wellness

The Board reviews a company

health promotion program

As follow-up to this post about the peer-reviewed evidence linking company-sponsored employee wellness programs and total shareholder return (TSR), the Population Health Blog offers ten questions that these companies' boards of directors should consider when reviewing the topic with their management team:

1. Does the company have a wellness, health promotion, disease prevention or condition management program in place?  If not, why not?  If it does, what is the vision and strategy?

2. In addition to internal measures of "return on investment," are the costs of the program(s) worth the impact on total shareholder return (TSR) and will this pass muster with the due diligence of activist investors?

3. Do other companies competing in the same industry have wellness, health promotion, disease prevention or condition management programs? How have they fared?

4. Have the program(s) been subject to external review, such as Mercer, C. Everett Koop or CHAA? 

5. If the company is self-insured, what are the expectations about the impact of the program(s) on health insurance claims expense?

6. Is the programs' impact on recruitment, morale or productivity being assessed?  How, and can the results be subject to an internal audit or to third-party outside review?

7. How are regulators' and employees' concerns about discrimination or privacy being addressed?

8. Does a "Chief Health Officer" exist?  If not, why not?  If yes, does the job description include any oversight responsibility of employee health?

9. Who on the board can act as a lead in providing the necessary oversight of any of these programs?

10. Is low-cost, scalable digital technology "mHealth" being leveraged? How?

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The Link Between Corporate Wellness Programs and Total Shareholder Return

While employer-sponsored wellness, health promotion and disease prevention programs have been linked to "human capital," talent recruitment and retention, improvements in employee morale, reductions in absenteeism, reductions in presenteeism and bending the curve of claims expense, should shareholders care?

After all, according to President Obama's latest State of the Union Address, corporate America's pursuit of profits have resulted in greater automation, less competition, loss of worker leverage and "less loyalty to their communities." According to that narrative, employees are just another commodity on the road to total shareholder return.

Well, according to an expanding body of peer-reviewed scientific literature, shareholders should care.

The latest example of why is this publication by Ray Fabius and colleagues that appeared in the January issue of the Journal of Occupational and Environmental Medicine.

First, some background.  The Corporate Health Achievement Award (CHAA) was created by the American College of Occupational and Environmental Medicine (ACOEM) to recognize companies' workplace health and safety programs.  It relies on a thousand point-based assessment system of multiple standards in four categories of 1) Leadership, 2) Healthy Workforce, 3) Healthy Environment (including Safety) and 4) Organization.  Many of the companies that have participated in CHAA are household names.

In this study, the authors tracked the stock market performance of companies that applied for the CHAA from 1997 through 2014.  As the Population Health Blog understands it, all the privately held companies as well as those that scored 175 or lower in Organization and lower than 350 combined in the Workforce and Environment categories were excluded from the analysis. Of the remaining publicly companies, those scoring at or above the 37.5 median percentile in the four categories described above (defined as high CHAA achievers) were placed in six hypothetical stock portfolios of 5 to 22 companies.  The authors then mapped out what would have happened with a January 2001 investment of $10,000. As each year passed, new high scorers were added to "rebalance" the portfolios, while the stock of repeat high scorers were added.

The results? While the benchmark Standard and Poor's (S&P) return over the study period was 105%, the portfolios easily exceeded that with returns that ranged from just from over 200% to 333%. 

This study builds on other studies that used the CHAA as well as other wellness award programs including Mercer's HERO Employee Health Management Best Practices Scorecard and the C. Everett Koop National Health Award.

Now that's total shareholder return.

In another demonstration of why peer-review is so important, Dr. Fabius and his colleagues correctly point out that correlation is not the same as causation. As a result, there is no evidence that importing wellness programs into other companies will translate into better stock performance. In addition, elementary statistics tells us that corporate wellness and TSR won't necessarily correlate over shorter periods of time for individual companies.

Bottom line? The PHB doesn't think investors in public companies are necessarily interested in "causation" as they are in market signals. It stands to reason that a commitment to company wellness is an important signal about where to put their money. 

Which raises three questions....

1) This was raised by Fabius et al: should investors or regulators demand that companies publicly report whether they have employee wellness programs?

2) Should companies invest in a "Chief Health Officer?"

3) Why isn't corporate wellness part of the national conversation about capitalism in America?

Coda: For additional reading, see this link on the ten questions about employee wellness that should be asked by boards of directors.

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