Knowing What’s Working and What’s Not: Evaluating Your Company’s Wellness Efforts

How do you know if your wellness program is effective? That depends on several things: the maturity of your program, the type of services and activities your wellness program includes, and most importantly, what you are trying to accomplish.

A few years ago, ROI (Return on Investment) analysis was introduced as a guideline for measuring wellness program impact. While several methodologies for estimating ROI have been introduced, unfortunately a reasonably efficient and accurate method is not available. ROI is purely a financial measure. How much did I spend, and what did it produce. For wellness, the desired outcome is typically lower healthcare costs. Thus, a wellness program that lowered healthcare costs by $3 for every dollar invested would yield a 3:1 ROI.

However there are too many variables that affect potential financial measures to clearly attribute the outcome to any one source. Was a plan introduced with a higher deductible or higher premiums? Was a more aggressive pharmacy plan, disease management program, EAP or other change implemented, and what percentage of the population participated in each? Where there changes to the workforce through mergers, layoffs, massive retirements, or other changes that would have significantly affected demographics or healthcare utilization decisions?

Another challenge of trying to use ROI methodology is measuring the total impact of an effective wellness program. Research clearly reports that a healthier population is more productive, incurs lower costs related to disability and workers’ comp claims, and have lower turnover rates. Can an employer accurately attribute improvement in those areas to its wellness programs? Yes and no. The cost of such analysis and the lack of control of other influencers make an employer-specific evaluation unfeasible. However, if an employer’s population is large enough (500 or more employees), estimates of impact can be created using modeling.

Numerous studies have been published in recent years that evaluate financial outcomes in a variety of areas – healthcare costs, pharmacy costs, productivity, disability, etc. – and relate those costs to the risk status of a population. Risks are generally defined in lifestyle and clinical terms, such as obesity, high blood pressure, high cholesterol, physical inactivity, poor diet, tobacco use, and stress. Research clearly shows that costs follow risks. In other words, those at highest risk incur the greatest costs and are least productive.

Why? Because risks are indicators that a person either has or is likely to soon develop a chronic health condition such as diabetes, coronary artery disease, congestive heart failure, or chronic obstructive pulmonary disease. The U.S. Centers for Disease Control and Prevention estimate that as many as 70% of all health care dollars are spent on chronic diseases, and that number is growing.

Rather than only evaluating your wellness program as a whole using a single metric, you will benefit from evaluating each component of your wellness effort. Below are recommendations from the Principal Wellness Company for measuring each element of your wellness program.

Year Round Wellness Program (insert YRWP Sample Materials picture where appropriate within this section)
A primary purpose of a Year Round Wellness Program is to assist every eligible person at every risk level – those at high risk should move to moderate or low risk, those at moderate risk should move to low risk, and those at low risk should remain at low risk.

National health organizations, such as the American Heart Association and American Diabetes Association, set recommended values for blood pressure, cholesterol, LDL, HDL, triglycerides, glucose, and A1C. The Centers for Disease Control and Prevention assign risk status for weight based on body mass index (BMI), physical activity, diet, tobacco use and other behaviors. The purpose of these identified risk levels is to communicate severity with a goal of helping individuals improve their health. Some of these recommended levels have changed over the years as new research indicates a more or less aggressive approach to a risk.

Another use of risk data is to compare risk status of a population with certain costs. Since 1980 the University of Michigan Health Management Research Center, under the leadership of Dr. Dee Edington, has conducted extensive research on the relationship among costs and risks. Risk data have been collected on more than two million individuals. Rather than establishing stratified levels for each area of risk, the research team has assigned a single value that may or may not align with that identified by the associated national health agency. Thus for any of the 15 factors, a person is classified as either at risk or not at risk. Risk status is defined based on the number of risks, not on the severity of one or more risks. Risk status is defined as low (0-2 risks), moderate (3-4 risks), or high (5 or more risks).

In 2008 PWC collected data on 47,227 first-time participants. Using the University of Michigan’s definition, 57% were at low risk, 30% were at moderate, and 13% were at high.

Preventive Screening Services (insert At-Home kit sample pictures where appropriate in this section)
The purpose of preventive screening is to identify those with unknown risks and to refer them to appropriate resources for intervention. Those resources may include the care of a physician, a health coach, or another healthcare or wellness professional. Individuals who are at borderline risk should be encouraged to take personal action independently or as a participant in their employer’s wellness program. Since the desired health outcome is dependent on the participant’s actions following the screening event, it is not expected that a significant health risk shift will occur just because of participation in a screening. The success of screening events should be evaluated on the percentage of those who are newly identified with severely elevated health risks (high blood pressure, glucose, cholesterol, etc.) and referred to health care professionals for treatment, and on how well the screening events are organized and managed.

Health Coaching
Individuals at moderate-to-high risk status may be encouraged to work with a Health Coach to reduce their risk and improve their health status. As many as 50% to 60% of those in a population with typical demographics may qualify for Health Coaching. The actual number of people who opt in to the program is dependent on several factors, including the use of an incentive, how well the program is communicated, and the employees’ relationship with their employer. Health coaching services can best be evaluated by changes in the participants related to health status, self-perceived ability to reduce their risks and improve their health, and intent to continue to improve the health after completion of the health coaching program. It would also be appropriate to evaluate the health coaching experience – professionalism, convenience, and responsiveness.

When individuals are engaged in the Year Round Wellness Program, it is expected that more people will stay at low risk or migrate from high/moderate risk downward, than will move from low/moderate risk upward.

Evaluation should be based on the changing health risk status of a cohort population, i.e., the same people should be compared over time. A baseline of risk data should be established when a wellness program is initiated, and future risk status should be compared back against baseline. In other words, comparison made three or four years into a program should be made relative to the risk data collected when the program began. Year-to-year comparisons do not provide the data needed to establish trends, nor do they accurately account for long-term program impact.

Online Wellness Resources
Internet tools can be useful in communicating information about your program, and efficiently collecting information from participants. However, keep in mind that the Internet is only a tool. By itself it will not produce behavior change. One of the problems with Internet-based programs is low engagement rates. If your portal is an important part of your program offering, are you effective in driving use of your Web site? Once there, can users easily find the information they needs, such as an online health risk assessments, scheduling tools, medical self-care information, and educational information? Is the information from credible, reliable sources, and is the site information updated on a regular basis?