Tuesday, January 19, 2010

An Important Health Affairs Article on Savings from Workplace Wellness Programs

None other than healthcare Obamacon rock star David Cutler has an article on the prestigious Health Affairs web site assertively titled “Workplace Wellness Programs Can Generate Savings.” Anyone interested in or in the business of worksite wellness should not only read it, they should email the link, twitter the link, download it and provide printed copies to your co-workers, your customers and your bosses. The enthusiastic Disease Management Care Blog even gave a copy to the DMCB spouse. While her excitement was inexplicably muted, the DMCB is confident that with time, she'll come to appreciate its findings.

Here’s why. Lead author Katherine Balcker, co-author Zirui Song and Dr. Cutler scoured the world’s published scientific literature on worksite wellness and pulled out a surprising number of studies (32 of tem) from an equally surprisingly wide array of employer settings, including financial services, manufacturing, school districts, universities, municipalities, utilities, telecommunications, energy, pharma and consumer product manufacturers. What was not surprising was multiple components of these programs. The majority were kicked off with a Health Risk Assessment (HRA) by an array of initiatives, including self-help education materials, individual counseling, group sessions and incentives that attacked a variety of health concerns with a special emphasis on the twin lifestyle issues of tobacco abuse and weight gain.

When the economic ‘difference in difference’ (pre-post changes over time in an intervention group versus the pre-post changes over time in a control group) are added up across the studies, the workplace wellness programs not only lead to a workforce with lower health care costs, but those savings exceed the cost of delivering the program at a rate of $3.27 for every $1 spent. And if, as a regular reader of the DMCB, you are leery of studies that are non-randomized and could be compromised by a self-selection bias, the authors noted nine of the 32 studies were randomized and showed a return on investment (ROI) of $3.36 for every $1 spent. To ice this cake, the authors also reported on the monetized impact on absenteeism for the 12 studies that had those data and found a ROI of $2.73.

Balcker et al do an excellent job of being transparent about the limitations of their study. Since only programs that are successful would be expected to appear in the scientific literature, there could be a publication bias. Since only larger employers generally have such programs, there is only limited information on whether this would work for small employers. Costs are easy to detect, while savings, especially over the long haul, may be more prone to errors in measurement. All in all however, there is a considerable body of literature from a wide variety of settings that support the economic case for implementing wellness programs in the worksite.

There may be two additional implications:

The DMCB is unaware of the current status of the call for a moratorium on the prohibition of collecting family history information in HRAs under the Genetic Information Nondiscrimination Act (GINA). The finding that the use of HRAs in the workplace prior to the implementation of this part of GINA is associated with savings is another reason for the Administration to reconsider and allow HRAs to collect the information. Family history is an important part of addressing risk, increasing health and reducing cost.

The authors correctly point out that large employers can afford the up front investment costs in worksite wellness and that that is often out of reach of small businesses. Given the degree of savings, however, the DMCB wonders if health insurers should think seriously about offering this in their small business market. It'd be a logistical challenge, but the return on investment could be quite attractive, it's worth further study and there could be a distinct competitive marketing advantage.

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