Traditionally, wellness programs have been quite predictable. Your employees take a health risk assessment and participate in biometric screenings. These will stratify participants into a given health risk category. Health coaching often follows. And there is usually some amount of incentive tied to the completion of the aforementioned activities.
When an organization speaks with a wellness vendor, they want to know the program’s return on investment. This is naturally an important piece of information for any C-level executive. ROI is a logical metric to track, but it may not be feasible with respect to wellness.
The problem with ROI is it’s difficult to tie participation in lifestyle management or wellness programs to medical claims reduction. Those who say they can are usually the companies who offer such programs.
Here are some reasons why ROI is difficult to prove:
- Often biometric screenings require additional testing from false positives,
- Discovery of diseases that may cost more in the short run to treat,
- Overtreatment – such as procedures leaving the member worse off than if nothing had been done, and
- Overscreening.
Biometric screenings, while great at informing employees of their numbers, often create further costs through unnecessary follow-up testing. Al Lewis & Vik Khanna discuss this in their book, Surviving Workplace Wellness. Do we really need to get our cholesterol numbers tested each year? The United States Preventive Services Task Force, an independent group of national experts in prevention and evidence-based medicine, only recommends testing every 5 years, and only for certain at-risk groups. More can be read about this in the somewhat-controversial RAND 2013 study on the efficacy of traditional workplace wellness programming.
Another pitfall to using ROI as proof of a wellness program’s effectiveness is that the program is typically comparing participants to non-participants. By nature, people who voluntarily enroll in the program are already more motivated than those who opt out, so the ROI will immediately be skewed by this self-selection bias.
People do not change because they receive a $50 gift card. They change their health behaviors because they want to improve their health for themselves or their family. No amount of biometric screenings, health coaching, or financial incentives will move the needle for people who simply are not ready to change or do not want to. The not-so-fun part of this realization is those employees who don’t have the motivation to make improvements in their health are likely the ones costing your organization the most money, in more than just medical claims.
It is critical to look at why your organization is pursuing wellness. If the primary reason is to save money, that is unfortunately not realistic. “You can’t make the argument that you’re going to save money today on something that won’t happen for 25 to 30 years,” Al Lewis says. “It’s no different than how you treat your family; you wouldn’t think you’re producing happy, healthy children by dragging them to the pediatrician all the time. You do that by creating an environment in which they flourish,” he continues.
If you are trying to save money for your organization, you can look at where your high claims are and see if you’re able to affect any of the people making those claims. Perhaps consider a disease management program.
But overall, the effectiveness of any wellness program or initiative should go back to culture. Does the commitment to wellbeing start at the top? Are your employees better off than they were before? Do they feel valued and engaged? When evaluating effectiveness, begin with these types of questions.
What does an organization do with this new information? As discussed in the A New Era For Wellness blog, the traditional wellness focusing on physical health might be setting us up for failure. Try thinking outside of that “traditional wellness” box.
First, ask your employees what type of wellness initiatives they’d like to see! If you don’t, you may see very low participation or worse, your employees may feel like they are being forced to do something they don’t want to do. Maybe their wellbeing can be improved by finding a group discount at a local gym, offering healthy snacks in vending machines, offering discounts on child care through a partnership with a local provider, or perhaps it’s a half PTO day for service in the community or flex hours - whatever your environment allows. Do what works best for your population to keep your employees happy and healthy, because your people are your greatest asset!
