In Defense of Corporate Wellness Programs

In Defense of Corporate Wellness Programs

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A recent blog on HBR.org proposed to deliver “The Cure for the Common Corporate Wellness Program.” But as with any prescription, you really shouldn’t swallow this one unless all your questions about it have been answered. As a physician, a patient, and a businessman, I see plenty to question in Al Lewis and Vik Khanna’s critique of workplace wellness initiatives.

With their opening generalization that “many wellness programs” are deeply flawed, the authors dismiss a benefit enjoyed by a healthy majority of America’s workers. Today, nearly 80% of people who work for organizations with 50 or more employees have access to a wellness program, according to a 2013 RAND study commissioned by the U.S. Department of Labor and the U.S. Department of Health and Human Services.

It’s not clear whether the authors are intentionally dismissing or simply misunderstanding the wealth of data that shows how wellness programs benefit participating employees. The RAND study summarizes it this way: “Consistent with prior research, we find that lifestyle management interventions as part of workplace wellness programs can reduce risk factors, such as smoking, and increase healthy behaviors, such as exercise. We find that these effects are sustainable over time and clinically meaningful.”

Lewis and Khanna, however, don’t focus on such findings. Instead, they question the motives of a company for even offering a wellness program, which they slam as an “employee control tool” and “a marketing tool for health plans.” And, in perhaps the most baffling statement of all, the authors suggest that workplace wellness initiatives are “trying to manipulate health behaviors that are largely unrelated to enterprise success” (emphasis mine).

Let’s consider that piece by piece. What are the behaviors that corporate wellness initiatives are trying to influence? According to the RAND study, the most common offerings — available in roughly 75% of all wellness initiatives — are on-site vaccinations and “lifestyle management” programs for smoking cessation, weight loss, good nutrition, and fitness. In short, companies want to reduce the risk that their workers will get the flu, develop lung cancer, or suffer from the many debilitating conditions linked to overweight and a sedentary lifestyle. How could these initiatives be deemed “largely unrelated” to the company’s success?

I beg to differ, and there’s plenty of data to back me up. Many companies may have instituted workplace wellness programs initially as a way to reduce health care costs. However, a growing body of research suggests that nurturing employee health and wellness has a significant impact on productivity — which, as we all know, has a direct bearing on company profitability. Consider this paper by Harvard researchers who reviewed 36 studies of corporate wellness programs. The researchers reported that for every dollar large employers spent on wellness programs, they saw company medical costs fall about $3.27. But even beyond that payoff in health, the study found a comparable payoff in productivity: For every dollar spent on wellness programs, the companies’ absenteeism-related costs fell about $2.73.

Good health “plays a large role in employee productivity,” says a research study by the Milken Institute, an economic think tank. The institute’s researchers concluded that common chronic diseases (including cancer, diabetes, and heart disease) are responsible for $1.1 trillion in lost productivity annually in the U.S. economy. They attributed those losses both to absenteeism and to “presenteeism,” when employees come to work too unwell to do their jobs.

The RAND report says its research “confirms that workplace wellness programs can help contain the current epidemic of lifestyle-related diseases, the main driver of premature morbidity and mortality as well as health care cost in the United States.” If Lewis and Khanna think that such achievements don’t having bearing on enterprise success, we’ll just have to agree to disagree.

What I do agree with are the authors’ recommendations that employers follow the USPSTF screening guidelines for generally healthy adults and their advice to tread lightly on promoting annual physical exams. Over-screening drives up health care costs, increases the likelihood of unnecessary treatment, and can even do more harm than good. And I certainly can’t quibble with their recommendation to ask employees what they want: Some of the best wellness programs I’ve seen stem from tight feedback loops between management and employees that lead to popular and effective wellness programming.

But I’m profoundly troubled by the authors’ intimation that corporate wellness programs are more about control or manipulation than about enhancing employees’ health. After working on wellness programs with hundreds of business leaders for the past eight years, I’m convinced that most of them truly want to support their workers’ well-being for three overarching reasons:

Humanity. Yes, it exists in the C-suite, despite what cynics say. Executives at America’s largest companies believe investing in the health and wellness of their employees is simply the right thing to do.

Fiscal responsibility. These leaders are under great pressure to rein in soaring health care costs, and they rightfully see wellness programs as one way to do that.

Perspicacity. Insightful executives look for every competitive advantage they can harness, and that’s what healthier employees represent. “Employers are recognizing that good health is a total business issue, and a lack of it affects workforce performance,” says a recent Towers Watson study. “Most now point to establishing a culture of health as their top priority and an essential factor for success.”

It may sound clever to ask executives the question that Lewis and Khanna pose: “Are you doing wellness to your employees or for your employees?” But neither choice seems ideal. In the many well-run companies that I work with, I see conscientious leaders doing wellness with their employees — a shared mission to cultivate a healthier workforce for everyone’s benefit.

Rajiv Kumar, MD, is founder and CEO of ShapeUp. This post originally appeared in the HBR Blog Network.

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37 Comments on "In Defense of Corporate Wellness Programs"


Member
Brian Welch
Jul 22, 2015

Personally, I think the wellness industry has almost as many buzzwords as the IT industry. The one I like best is “engagement.” If my company bought a wellness program, a measurement of success would not be filling out a health questionnaire (HRA). I’m in a Linkedin group and someone posted a link recently to an article with the title: When it comes to Corporate Wellness, Real ROI Stems from Behavioral Changes. Why is this even being discussed at this point? When did filling out a questionnaire become a measure of a program’s success?
To me, (and that’s an important part of this. I’ve been wrong before, just don’t let my wife know that) what is lacking is any sort of game plan to get the people that most need wellness programming involved in the wellness program and doing what they need to do to improve their health.
When you are dealing with people that we are supposed to make healthier, unless it’s stopping smoking, nobody wants to be part of the “fat group.” Nobody wants people to know they’re diabetic. Instead of separating people by “high risk” groups because of weight, separate people by age. People don’t mind being a part of “the wiley veterans.” High cost from chronic disease states doesn’t start until a person starts to get to be close to 40 years of age. I live near Washington DC, and when I was a kid, George Allen was coach of the Washington Redskins. They called themselves “The Over the Hill Gang” and every male over 35 just loved it.
That’s just one example of an idea to get people involved and get past their reservations of taking part in the program. When I look at websites or forums that give advice about wellness programs, it’s always the same “get senior management to buy in” or “make wellness part of the company’s culture.” The amount of articles and writings about analyzing data trends and integrating technology just seems endless. Just today, I read an article about how to maximize the ROI for your wellness program. The main point of what they recommended was measuring ROI as “soft ROI,” which they defined as “the degree to which employees become more energized and excited to go to work each morning.” I have no idea how you would measure that, but it sounds more to me like another buzzword to confuse the situation.
I’m not saying stuff like that doesn’t have its place. But it’s not the heart of the matter. Instead, what I would love to have some insight into is how I can convince a Type 2 Diabetic who wakes up at 2:00 AM with a sugar craving to not eat that cookie or bowl of ice cream? How can I convince a 55 year old man or woman to take a walk or go to the gym after work when they’re tired? If you can do that for people- not every person- then you have a successful wellness program, then you’re really helping people. That is a corporate wellness program worth defending.

Guest
Grady Grazny
Jun 13, 2014

It’s important to look at Corporate Wellness pragmatically, rather than as one big entity that is either “positive” or “negative”. Like any program, it’s about using the tools and supplies in the best way possible.

Check out this blog for a good take on it:

http://blog.newlinemedical.com/corporate-screening-save-money-save-lives/

Guest
Mar 30, 2014

Of course, other things being equal they would prefer thin healthy people but as you point out other things are rarely equal. thank you for your post.

Guest
john
Feb 26, 2014

Check sources rather than these time-wasting blogs. By far, most wellness success numbers come from EMPLOYERS, not vendors; however, Khanna, Lewis, and others scrambling to make a living with easy cynicism (through glorifying problems rather than creating solutions) avoid that simple fact.

You don’t need numbers for the obvious, but the numbers are there. We knows as a nation unhealthy behavior is costly. Cost to U.S. employers exceeds $200 billion per year in absenteeism, presenteeism and lost productivity. (American Mental Health Association). Cost annually associated with “potentially preventable” chronic diseases — $1.5 trillion (CDC). You think continued poor lifestyle choices will improve those numbers?

We should give up on advocating better understanding and practice of healthier living at home and at work because some program haven’t worked? And why haven’t they “worked?” Look closely at how they were implemented or, all too often, dumped into the workforce as one email, a couple of posters, and one workshop. Gee, I guess all program are futile.

Towers Watson, McKinsey, Harvard, Gallup, and many others have surveyed hundreds of employers here and around the world to confirm the obvious, summed up by McKinsey: “embrace the reality that organizational health propels performance.”

TW aggregated 600 North American EMPLOYERS (not wellness vendors)with hundreds of thousands of employees to find that the top 25% companies exemplifying wellbeing had:
 –1.8 fewer days absent per employee
 –11% more revenue per employee
 –28% higher shareholder returns
Numbers from employers, NOT wellness vendors.

And then there’s this: forget numbers. Try common sense and cause-effect life experience. Moving toward a healthier nation is common sense.

Thinking of “corporate wellness” is small minded — it’s personal and professional wellbeing we need to address as a society, as families, as employers, coworkers, and individuals. Obvious to anyone who has worked with employee groups, personal life directly impacts professional work.

When we stop this ridiculous obsession with “gee, what’s wellness? is there ROI? does wellness matter? oh look, a program failed! wow, those marketers of wellness lied! (a real first in American business)” and stop labeling “corporate wellness” as if it’s some separate thing that only exists 8 to 5, then we can move on with trying and refining evolving solutions. We will gain a healthier attitude (which includes how we support-promote salt-fat-sugar addiction throughout life, starting with children — a national addiction with profits that dwarf all wellness programs combined, globally.

More self-responsibility, more employer responsibility, more food industry responsibility (and honesty), better results.

The downside of actual progress: it’ll put many bloggers and authors out of business, but nobody will miss them. They’ll need to get a real job. Perhaps in the fast food industry.

Guest
Feb 24, 2014
Guest
John Smith
Feb 24, 2014

But Vik, they have nothing to report. They are social platform, basically a glorified game platform. Riding a trend of social this and that until they fade away.

Guest
Feb 25, 2014

“Nothing to report…glorified game platform…fade away.” The futility of workplace wellness in 8 words.

Thanks, John.

Guest
Al Lewis
Feb 23, 2014

And in ShapeUp’s defense, they did announce their success getting 0.86% (not a misprint) of Highmark’s employees to shift at least temporarily from one weight category (obese or overweight) to overweight or healthy.

However, that 0.86% success rate does not include whatever Highmark employees shifted in the other direction, since selective use of data is a ShapeUp and industry trademark. http://www.shapeup.com/resources/highmark/

As you can tell from this posting omitting Baicker’s retraction and Mattke’s actual opinion of his own work, one thing ShapeUp excels at is selective citation of data.

Even so, we must congratulate them on a wellness industry record: the smallest improvement (0.86% of employees shifting weight categories before counting failures and recidivists) ever meriting a press release.

Guest
John SMith
Feb 25, 2014

I wonder the time period. Since 95% of people (or more) regain the weight, rather than 0.86% is the real number .043%? Sorry if I sound cynical……

But at least it is fun? As you are coerced into these programs? Yikes.

Guest
Feb 23, 2014

I just love it that there are peeps more iconoclastic and curmudgeonly and snarky than me.

Guest
Al Lewis
Feb 23, 2014

thank you

Admin
Feb 22, 2014

Gang. I dont think this is that complicated. The TL:DR version of that Pepsi study is
1) Intensive management of the already chronically ill saves health care costs pretty much immediately (if done right) and results in better health outcomes
2) Aggressive screening of the well, especially for low level “cancers” and subsequent over-treatment increases costs way more than they save and probably on average decrease average health (especially for those getting false positives
3) Attempts to get the couch potatoes to work out & stop smoking don’t save health care costs but probably make them better, more productive employees. And probably improves their health way down the road when all the beach counters have stopped counting.

So we should be figuring out what programs do #1 well, we should stop doing #2 and we should not get too too upset if Shape Up and a bunch more like them make money selling #3!

Now can those of us not selling books on the topic (even if THCB is a promoter_ go back to the areas of health care where we really are doing something wrong!

Guest
Feb 23, 2014

Good summary.

Guest
Lisa Schaffner
Feb 22, 2014

Dr. Mattke,

In your comments, you noted “…we took many steps to reduce it (for the wonks: matching based on propensity scores, difference-in-differences design and individual fixed effects)…” to describe how the study design attempted to control for bias.

However, the following statement was made in the presentation slides from the 2013 Academy Health Annual Meeting (available: http://academyhealth.org/files/2013/tuesday/caloyeras.pdf), “Propensity score matching did not balance all observables.”

As a fellow wonk, I would like to be able to see how the treatment and comparison groups differed with respect to study variables. Unfortunately, neither a table describing the characteristics of each group was provided in the Health Affairs article. I would also like to see a summary of modeling results, including coefficients, confidence intervals and p-values. Is there a publication that contains that information for the PepsiCo study? If so, would you mind directing me to it? Thank you.

Guest
Al Lewis
Feb 22, 2014

There are many excellent comments in this thread (and given who is doing the commenting, I’d expect nothing less).

The problem with wellness is the massive amount of lying and innumeracy about numbers. This is an institutionalized process, starting with Ron Geotzel, who decided to give an award –ironically named after C Everett Koop — to a company, Health Fitness Corporation, that admitted falsifying the data in order to win that award.

If you want to support wellness, stop lying. Just say (like comments suggest) that done right, employees appreciate it and it’s good for them. Don’t misquote people and don’t make up numbers in support of your arguments. The numbers don’t add up but that doesn’t mean that a company shouldn’t want to do these programs. Companies do tons of things where the numbers don’t add up, usually for excellent reasons. (Rorer stopped making its most profitable drug, Quaaludes. The numbers went the other way, but theirs was clearly the right call.)

Just once, I’d like to see a wellness vendor say, “the whole industry makes up numbers but there are other reasons to do it.”

Guest
Soeren Mattke
Feb 22, 2014

With all the references to our work, I am almost compelled to weigh in.

1. Can lifestyle management programs improve health?

Our data suggest yes, if they are well executed. The results reported in our 2013 report are pretty robust (http://www.rand.org/pubs/research_reports/RR254.html), but probably not generalizable to all programs, as they were derived from a highly committed group of employers with substantial experience in wellness. At the same time, we see many poorly designed programs that won’t have much of an effect. Further, I disagree with Al Lewis who asserts that you findings are invalid because of selection bias. While he is correct that non-experimental designs like ours are never immune to bias, we took many steps to reduce it (for the wonks: matching based on propensity scores, difference-in-differences design and individual fixed effects) So we do adjust for differential motivation of program participants at baseline and the residual bias is likely to be small.

2. Do wellness programs reduce healthcare cost

According to our results, lifestyle management does not. I don’t want to repeat my argument that was made here: http://www.rand.org/pubs/research_briefs/RB9744.html But the results are pretty clear, and make intuitive sense.
Our Health Affairs paper provides a detailed critique of Kate Baicker’s paper that put that ludicrous 3:1 ROI on the map. http://content.healthaffairs.org/content/33/1/124.abstract While I have nothing but respect for Kate, this paper is deeply flawed. It includes studies all the way back to the 1970s, when the opportunities to improve health were quite different (think pre-statin era) and labels, for example, a study as high-quality that estimated productivity loss in a sample of retirees. So it should really not be considered as proof of concept.

3. Are there other financial benefits of wellness

Not clear, we find a small effect on absenteeism in the Pepsi study that generated about 25 cents return on every dollar invested. There is lots of speculation about effect on productivity, morale, retention, etc. But I have yet to see a study that convincingly demonstrate that wellness programs affect any of those outcomes.
Not to mention the fact that we don’t even know how to measure productivity http://www.ajmc.com/publications/issue/2007/2007-04-vol13-n4/Apr07-2472p211-217/

4. Do wellness programs create value?

Every employer will have to answer that question for themselves. Programs and contexts are different, and it is a free market economy. I just recommend two things: First, make up your mind why you want to have the program and measure whether these objectives are being met (preferably yourself rather than taking the vendors’ word for it). Second, as the financial returns are likely to be small, watch program cost like a hawk and resist being oversold ever more comprehensive offerings.

Guest
Feb 22, 2014

I think this discussion misses a dose of fundamental economics, especially in the ‘lifestyle management’ arena.

As my own recent blog post articulates https://www.themedicalguide.net/blog/, eating healthier foods like fruits and vegetables costs about $3000 more per person per year than eating unhealthier foods like chips and fatty meats. I base these estimates on actual food costs/calorie at my local supermarket surveyed in both 2010 and 2012..

The corporate wellness incentive would need to exceed this amount to motivate behavioral change, since unhealthy foods are often tastier and easier to prepare.

Then the exercise component: American urban housing and job densities are far lower than Canadian or European, for example, making typical American home-to-job, or home-to-shopping or entertainment trips much longer, and consequently less walkable. (Walking is traditionally human’s main form of exercise.)

I estimate that the ‘typical’ Canadian or European walks about 500 miles/year more than a similar American due to the demographic and zoning differences.

A corporate wellness program would need to invest about $1600/person/year to motivate someone to walk those 500 miles outside of work time. That’s at $10/hour, walking a reasonable 3 miles/hour.

Summary, the minimum corporate investment needed to motivate the desired lifestyle change:

* $3000 to improve nutrition, plus
* $1600 to motivate walking.

Plus the wellness program costs themselves.

Yes, healthier people are more productive and less medically costly. But no, corporate wellness programs are the wrong tool to achieve these desirable goals.

Too bad for that.

Guest
Feb 23, 2014

“Yes, healthier people are more productive and less medically costly. But no, corporate wellness programs are the wrong tool to achieve these desirable goals.

Too bad for that.”

Brilliant, Gary. Thanks!

Guest
Feb 23, 2014

Thanks. I actually think about this stuff A LOT.

Guest
William McPeck
Feb 22, 2014

Dr. Kumar, thanks for sharing from your conversations with CEOs, that most want to do worksite wellness because it is the right thing to do for their employees. That is encouraging compared to what I see today that most worksite wellness programs are being created in an effort to save employer healthcare costs.

The important point for me is that if they are in it for the right reason, then they should be open to looking at how to implement programs based on what the research has shown to work – the necessary components to successful worksite wellness programs. Again from my perspective, far too many worksite wellness programs are being launched today that are lacking comprehensiveness – these key core components identified by the researchers.

Guest
Feb 22, 2014

I just want to point out that Soeren Mattke has not said wellness doesn’t work. In his editorial on this same site he has clearly stated that “We recently published a study that included almost 600,000 employees at seven firms. We found that lifestyle management reduced health risk, like smoking and obesity, but no evidence that it lowered employers’ health care spending.”

And “If they want to improve overall employee health and reduce absenteeism, then lifestyle management may be an appropriate choice. But if the goal is to get a good return on dollars invested in the program, employers should target employees who already have a chronic disease and help them control it.”

He said much the same on a radio program I co-host.

I believe we all stand on common ground when we say employers would be wise to:

1. be very confident and clear about what their objectives are and design a health and wellness benefits and promotion strategy to meet them,

2. be responsible for understanding the available research on what’s effective, what’s safe, and what’s recommended, whether that’s for screenings or investments,

3. work with their employees to design and communicate elements, and

4. be ready to adjust and stay creative over time as research changes our understanding and approach.

f

Guest
Peter1
Feb 21, 2014
Guest
Feb 21, 2014

“According to the Wellness Council of America, a $1 investment in wellness programs saves $3 in health care costs.”

Dispositive, unbiased source. We can all just move along now; nothing more to see here, folks.

Just like “Clinical Studies From The Ponds Institute PROVE That Our Expensive Goop Will Make You Look Younger.”

Guest
Al Lewis
Feb 22, 2014

I know it’s not always about me, but my (and Vik’s) new book Surviving Workplace Wellness has a whole chapter on the Wellness Council of America. These guys are a laugh riot. To begin with, according to their website apparently they were founded by the inventor of the all-you-can-eat self-serve restaurant, Warren Buffet.

Guest
Feb 21, 2014

“According to the Wellness Council of America, a $1 investment in wellness programs saves $3 in health care costs. The Centers for Disease Control and Prevention estimates that more than 75 percent of an employer’s health care costs and productivity losses are linked to employee lifestyle choices.”
__

There you go.

Take that Hillary bumper sticker off your car, give me your Facebook password, drop down and give me 50, and then eat your broccoli before you work on that P&P revision.And, report to me what you did for entertainment over the weekend.

Doing away with minimum wage would also save money.

Guest
Al Lewis
Feb 21, 2014

I don’t think anyone denies that it is better to be healthy than not, and that workplaces that encourage people to be healthy are better than those that arent, and of course if you look at Surviving Workplace Wellness or anything we’ve written, that’s what it says.

What really steams me, though, is deliberately selective quotes to show that wellness saves money when ALL the legitimate data says this doesn’t.

He can add to the of deliberately quotes Soeren Mattke’s. Soeren of course just wrote a whole blog to clearly state his position so that it doesn’t get misrepresented any more

Guest
Feb 21, 2014

Money aside, what troubles me is the “lifestyle police” thing. Take that Hillary bumper sticker off your car, give me your Facebook password, drop down and give me 50, and then eat your broccoli before you work on that P&P revision.