For those of us who actually think wellness outcomes should be evidence-based, a landmark study was released today: the first evidence provided by a major organization voluntarily (as opposed to being outed by us, like British Petroleum and Nebraska) that wellness doesn’t work. January’s Health Affairs features a case study of PepsiCo, authored by RAND Wellness Referee Soeren Mattke and others, in which a major wellness program was shown to fall far short of breaking even.
The specific highlights of the PepsiCo study are as follows:
- Disease management alone was highly impactful, with an ROI of almost 4-to-1;
- Wellness alone was a money sink, with each dollar invested returning only $0.48 in savings;
- The wellness savings were attributed to an alleged reduction in absenteeism, as self-reported by participants. There was no measurable reduction in health spending due to wellness.
Even though the wellness ROI was far underwater, we suspect that the ROI was nonetheless dramatically overstated, for several reasons. First, the authors acknowledge underestimating the likely costs of these programs, focusing only on the vendor fees without considering lost work time, program staff expense and false positives. Second, no matter how hard one tries to “match” participants with non-participants (the wellness industry’s most utilized measurement scheme), it simply isn’t possible to compare mindsets of the two groups. We learned from one of Health Fitness Corporation’s many missteps that participants always outperform non-participants, simply because they are more motivated. Third, the absenteeism reductions were self-reported, by participants.
Finally, PepsiCo’s human resources department, having made the mistake of accepting Mercer’s advice to implement one of these programs, was already taking some political risk by acknowledging failure. Had they incorporated the adverse morale impact, lost productivity due to workers fretting about false positives, Mercer fees and staff costs, participant bias, and self-reporting bias, the ROI could easily have turned negative (meaning the program would have been a loser even if the vendor had given it away) and the HR staff could have been taking serious career risk.