Watch the recorded webinar archive anytime at: http://healthpromotionlive.com

1. What’s the Hard Return of
Employee Wellness Programs?
William B. Baun, EPD, CWP, FAWHP
University of Texas MD Anderson Cancer Center

2. What is Worksite
Wellness?
Wellness – a lifelong journey and Worksite Wellness – an organized
an active process of making program designed to assist employees
choices and commitments to be and their family in behavior change that
healthy and well. reduces health risks, improves quality of
life and maximizes personal potential
and impacts the bottom-line.

3. Successful Wellness Program
Clear definition of success – based on managements expectations
Participation
• Behavior change Impact Bottom-Line
• Culture of health
Direct Health Impact
• Improvement in
health status
• Reduction of Indirect Outcomes
healthcare utilization • Absenteeism
• Reduction of • Productivity
emergency visits • Turnover
• Job Satisfaction
• Morale
• Cohesiveness

4. Logic Model for Worksite Lifestyle Costs
Lifestyle Risk Factors Direct Health Impact
•Physical activity •Medical problems
•Stress •Health status
•Smoking
•Nutrition
•Seat Belts
•Multiple Health Risks
Indirect Outcome
•Health care utilization
Clinical Risk Factors •Health care cost
•Obesity •Absenteeism
•Blood pressure •Employee productivity
•Cholesterol •Job/life satisfaction
•Blood sugar •Other
•Musculoskeletal
*Anderson, D.R. (AJHP, 2004)

5. Questions most of us are asking…..
• Is there a “business
case” to be made for
worksite wellness?
• What is the evidence
and is it compelling?
• Can we develop an ROI
argument?

6. The State of Working
America
• USA has highest per person
healthcare cost of industrialized
world and ranked 37th of 91
countries, $1 out of $7 spent on
medical goods or services
• 1% of population account for 30%
of costs and 5% account for 70%
• Employers health benefits cover
3/5 nonelderly
• Healthcare spending by 2015
predicted at $4T, 20%GDP, $12,320 • Large geographical difference in
• Median age employee 40.7 ‘08 health spending and >$ not = to >
life expectancy
• 2016, 55+ = 22% workforce
• Presenteeism 18-60% of total
• 2006, 65-74, 22.8% employed health related costs
• 35% deaths attributed to poor diet, • Productivity losses related to
smoking, physical inactivity personal / family health $1,685
per employee
Healthy Workplace 2010 & Beyond PFP 2009

7. Chronic Disease in America
• More than 133 million Americans, Chronic disease accounts for 70% of all
45% of population have one or deaths and estimated 83% of total
healthcare costs or 5x individuals
more chronic diseases without chronic disease
• 23% have 1 chronic condition Top 5 Causes of Death
1980 2005
• 12% have 2 chronic conditions 1 Heart Disease Heart Disease
2 Cancer Cancer
• 6% have 3 chronic conditions Stroke
Hypertension Stroke
3 Unintentional Chronic
• 4% have 4 chronic conditions injury respiratory
disease
4 Chronic Unintentional
• 4% have 5+ chronic conditions obstructive injury
pulmonary
disease
Johns Hopkins University (2006)
Partnership for Solutions: Chronic Conditions
(2004)
7

8. Costs Increase With Risk & Age
Costs
$10,095
$12,000 $9,221
$10,000
$6,664
$7,268
$8,000
$4,130 $5,445
$6,000 $3,432
$3,601
$4,000 $2,741 $4,319 5+ Risks
$2,025 $3,366
$2,000 3-4 Risks
$1,247 $1,515 $1,920
Age 0-2 Risks
$0
<35 35-44 45-54 55-64 65+
StayWell 2006 (N = 43,687)

9. Iceberg Phenomenon
Direct vs. Indirect Costs
Direct Medical Costs
• Medical
• Pharmaceutical
Visible
Costs
Indirect Costs
• Presenteeism
• Short Term Disability Non-Visible
• Long Term Disability Costs
• Absenteeism
• Workers Compensation
Indirect Costs represents 2-3 times Direct Medical Costs

10. Total Value of Health
High Indirect Costs
Direct Costs:
Medical & Pharmacy
Workers’
Compensation
STD
Absenteeism
Presenteeism
LTD
Time Away from
Work
Edington & Burton (2003)

11. Questions most of us are asking…..
• Is there a “business
case” to be made for
worksite wellness?
• What is the evidence
and is it compelling?
• Can we develop an ROI
argument?

12. Modifiable Risk Status Change
• Goetzel Relationship Modifiable Health Risk Factors (2009) potential for medical &
productivity savings
• Goetzel Systematic Review (2008) modifiable risk factors account for 25% total
healthcare expenditure, employees with 7 (tobacco, no physical activity, high: stress,
blood pressure, CHO, blood sugar, body weight cost 228% more
• Baker Dow Obesity Mgt (2008) over 1 year 7 of 10 risk factors change total
projected savings of $311,755
• Burton (2006) 1.9% productivity lost at an annual costs of $950, “churn” of 33%
adding a risk factor
• Yen (2006) excess risk accounts for 25% of medical claims, non-participant 1.99
times higher, moderate risk 2.22 and high risk 3.97 times higher
• Body Mass Index Increases (2006) for each BMI unit increase medical & pharma
costs increase by $119 – adjusted for age / gender
• Dow (2005) small reduction in risk = big cost savings, estimate1% risk point each
year cost saving of $49.5 million, breakeven ROI would call for a reduction of only
.17% point per year
• Swedish American Health System (2005) reduction of chronic disease risk factors
(nutrition / physical activity) after 6 weeks and improvement after 6 month follow up
• GM (2003) change in low, med, high numbers over 3 HRA’s, short term & long-term
improvement in BP, stress, seat belt use, physical activity, life satisfaction, smoking,
alcohol
• Yen (2003) each additional point on wellness score cost $56, $88 per year of age,
$3,574 for major existing disease

13. Medical Care Costs
• Trogdon (2009) Workplace obesity interventions result in a reduction of
$90 for every 5% of body weight
• Naydeck (2008) Highmark wellness program four year cost savings
$1,335,524 showing programming lowers rate of healthcare costs
• Baker (2008) over 1 year, 7 of 10 health risks decreased for a total
$
savings of $311,755, 59% attributed to reduced healthcare
expenditures
• Dall DOD Health Risks Costs (2007) tobacco use $564m, obesity
$1.1b, alcohol $425m / non-medical excess of $965m
• Gibson (2006) IBD expressed in Crohn’s disease & Ulcerative colitis
cost between $18,963-$15,020
• Wang (2006) each BMI unit medical costs went up $119.70 and
pharmaceutical cost $82.60
• Musich (2004) BMI medical costs go up, reduce risk levels reduces
costs
• Musich (2004) 5 years for former smokers without chronic conditions
to reach non-smoker levels, 10 years for those with chronic conditions
• Wright (2004) high risk = costs 10 – 21% higher
• Goetzel (2004) high BP $392, CVD $392, depression $348, arthritis
$327

14. Absenteeism
• Baicker (2010) meta analysis of literature shows
every wellness $ spend reduces absenteeism by
$2.73
• Rodbard (2009) 15,132 ~ greatest impairment of
work and daily activities among obese individuals
• Kuoppala (2008) evidence that health promotion
decreases sickness absence / range .1 – 1.57
• Bachman (2007) health promotion interventions
provide cost savings from decreased absenteeism
rates
• Halpern (2007) impact of a smoking cessation
program resulted in a total saving in year 4 and
included reduced absenteeism
• Burton (2004) 10.6% reported missing 7.7 hours over
previous 2 weeks to care for sick dependent, care
giving associated with increase of health risk
• Aldana (2001) obesity 1.5 – 1.9 times higher, stress
14% of all absenteeism caused by stress, multiple
risk factors 15 – 23% of absenteeism associated
• Serxner (2001) 4 risk factors 1.75 times more likely to
have higher absenteeism than low risk

15. Disability Costs and Days
•Burton / Financial Service (2007) antidepressant
medication adherence, low compliance resulted in
almost 40% increase in chance of STD
•Finkelstein CDC (2007) odds of sustaining an
injury overweight 15% to 48% obese
•GlaxoSmithKline (2003) savings of $217 STD,
$545 LTD, average of $613, estimated savings of
$5.5 million
•Schultz (2002) each disability cost $200, average
savings per year $623,040 or a 2.3 to 1 cost ratio
•Serxner (2001) non-participants had 23%
increase in days lost, participants 6% increase,
projected costs savings over 2 years $1,371,600

16. Productivity
• Goetzel (2009) factor analysis identified relationship between increase in health risks and >
presenteeism
• Schultz (2009) the cost of presenteeism is much larger that the costs of direct healthcare
• Loeppke (2009) strong link between health and productivity / integrating productivity and
health data leads to development of effective programming
• Burton (2006) arthritis, 7 – 10% loss of productivity, proper medication / treatment only 2.5%
loss
• Musich Australian Population (2006) high stress, back pain, life dissatisfaction lead to
significant absenteeism & presenteeism
• Burton (2005) each health risk adds 2.4% excess productivity reduction, medium risk 6.2%
reduction, high risk 12.2% reduction, life dissatisfaction = 4.5% reduction, stress 4.1%
reduction, job dissatisfaction 3.1% reduction
• Ozminkowski (2004) losses from presenteeism much greater than absenteeism 5 – 7% of
average salary
• Allen (2003) allergies, no significant changes, but next generation programs better
communications between programs and community physician groups and longer time frame
to communicate
• Allen / Bunn International Truck and Engine (2003) productivity instruments valid

17. Recruitment & Retention
• O’Brien (2010) By creating a
generally healthier work
environment, data suggests that
these programs will also have a
positive effect on recruitment and
retention.
• Fortune and Working Mothers
magazines’ Best Companies to Work
For - work/life balance and wellness
programs as important in becoming an
employer of choice: 1) access to
lactation rooms 2) access to gym or
fitness resource
• Abstract, Canadian Life, AJHP (1993)
• Tenneco / Baun (1992)

18. Questions most of us are asking…..
• Is there a “business
case” to be made for
worksite wellness?
• What is the evidence
and is it compelling?
• Can we develop an ROI
argument?

19. What is ROI?
Return on investment (tangible financial benefits / tangible costs)
Where does it fit in Program Evaluation?
Categories of Worksite Program Evaluation
Basic
Process – qualitative & quantitative look at programming process
Impact – overall effectiveness indicating immediate effects
Outcome – stated long-term objective & goals met
Project Effectiveness
Claims analysis Chenoweth (2002) Evaluating
Risk factor costs appraisal Worksite Health Promotion
Financial Analysis
Forecasting / cost avoidance benefits
Cost effectiveness
Return on investment (tangible financial benefits / tangible costs)
Cost benefit analysis (tangible & intangible benefits / tangible & intangible costs

20. Meta Analysis or Review Studies
• Schaafsma (2010) 37 studies looking at back pain / analysis found severe
back pain improvements gained through physical activity programming
• Conn (2009) These findings document that some workplace physical activity
interventions can improve both health and important worksite outcomes
• Goetzel (2008) ROI $1.40 - $3.14, 80’s – 90’s study review
• Ichihashi Oral Wellness (2007) 2-4 visits $1.46 ROI
• Koffmann (2007) wellness programming $3 - $6 return over a 3 – 5 year
period
• Chapman (2005) 56 studies meta evaluation, 500,000 individuals, evidence
is strong for reductions in absenteeism, medical care costs, disability,
workers compensation, 2/3 of studies single variables
• Pelletier (2005) series of 6 reviews of clinical and cost-effective impact
studies, 122 articles 2000 – 2004
• Aldana (2001) looked at absenteeism, increase with obesity, stress, CHO,
multiple risk factors, 15 – 23% of absence due to risk factors that HP
programming can affect

21. Goetzel (1999) What’s the ROI?
A Systematic Review of ROI Studies
ROI studies of worksite  ROI estimates in these nine
wellness programs:
studies ranged from $1.40 -
$4.90 in savings per dollar
– Canada and North spent on these programs.
American Life
– Chevron Corporation  Median ROI was $3 in
– City of Mesa, Arizona benefits per dollar spent on
– General Mills program.
– General Motors
– Johnson & Johnson  Sample sizes ranged from
– Pacific Bell 500 - 50,000 subjects in
– Procter and Gamble
these studies.
– Tenneco
Goetzel (2008)

22. Aldana (2001) Financial Impact of Health Promotion
A Comprehensive Review
196 Peer reviewed studies pared down to 72 through scoring criteria
Scoring Criteria:
– A (experimental design)
– B (quasi-experimental – well controlled)
– C (pre-experimental, well-designed, cohort, case-controlled)
– D (trend, correlational, regression designs)
– E (expert opinion, descriptive studies, case studies)
Health promotion program impact on health care costs:
 32 evaluation studies examined – Grades: A (4), B (11), other (17)
 Average duration of intervention: 3.25 years
 Positive impact: 28 studies
 No impact: 4 studies (none with randomized designs)
 Average ROI: 3.48 to 1.00 (7 studies)
Goetzel (2008)

23. Chapman (2007) Proof Positive
An Analysis of the Cost Effectiveness of Worksite Wellness
C/B Ratio
20
18
16
Traditional
14
Newer Programs
12
10
Outliers
8
6
4
2
0
#1 #2 #3 #4 #5 #6 #7 #8 #9 #10 #11 #12 #13 #14 #15 #16 #17 #18 #19 #20 #21 #22
Study Number
Chapman (2007)

24. Towers Perrin High Performance Companies
Best Practice Worksite Program Success: Health benefit objectives,
employee engagement, satisfaction, attraction & retention
FA = Access to health expert to
70
help manage illness, chronic
60 conditions
50 FB = Health improvement
programs
40 High
30 Low FC = Health risk assessments
20
FD = Self-care / disease
10 management programs
0 FE = Customized care / disease
FA FB FC FD FE
management programs
Towers Perrin Health Care Cost
24 Survey 2008

25. Towers Perrin High Performance Companies
Creating Cultures of Health
80
QA = Motivating employees to
70 manage their health care
60 purchases responsibly
50
High QB = Supporting employees’
40
Low capability to make sound
30
health care decisions
20
10
QC = Focusing on employee
0 health management
QA QB QC
Towers Perrin Health Care Cost Survey 2008
25

26. Who Must be Impacted?
Families
Peers / Buddies
Individuals
Communities
Teams
Organizations

27. Who are these Individuals?
Supervisors
•Employee progress
•Employee productivity
Middle Managers •Support employees in their
wellness commitments
•Bridging role
Senior Managers •Knowledge transfer
•Build a supportive
•Vision wellness culture
•Strategic priorities
•Set stage for supportive Employees / Families
wellness culture
•Self responsibility
•Wellness commitment
•Be Supportive to others

28. Behavior Change
Core
Factors
Impacting Opportunity 40%
Self confidence
Individual Action
Behavior Skill 25%
Support
Change & Behavioral efficacy
Self efficacy
Creating a Motivation readiness 30%
Knowledge
Culture of Awareness 5%
Health Modified from O’Donnell
(2010) WELCOA

29. What is a Culture of Health?
WorkSet
Creating a Culture of Health
“In a culture of health,
employee well-being and
organizational success are
inextricably linked. It aligns
leadership, benefits, policies,
incentives, programs and
environmental supports to
reduce barriers to active
engagement and sustainability
of healthy lifestyles across the
healthcare continuum.” http://www.centervbhm.com/lb/workset.html
29

30. What is Corporate Climate?
“Strongly linked to Shared Vision - Emerges when employees have a
corporate culture, but not as chance to integrate their personal goals and
approaches with team or organization’s goal
deep or as stable. Woven
throughout the culture of an
organization and helps Positive Outlook – Drives individuals to look for
create the general feelings opportunities rather than obstacles – strengths rather
than weaknesses
and atmosphere. The yeast
in culture change!”
Sense of Community – Present when employees
feel they belong and can trust one another. Sense of
Judd Allen belonging, includes awareness that others care and
Cultural Psychologist that we have a responsibility to care for ourselves and
others
30

31. Both corporate climate and
culture have significant
influence on shaping of
health behaviors and
practices!
31

32. Promising Practices
 Integrating HPM into companies
operation
 Addressing individual, environmental,
policy & cultural factors
 Targeting continuum of health care
issues
 Tailoring to population needs
 Attaining high participation
 Evaluation programs based on clear
definition of success Director, Institute for
Health & Productivity
 Communicating successful outcomes Studies, Cornell
to key stakeholders University
Goetzel (2007) JOEM

33. Harvard Business Review
December Publication
√ 10 Organizations / Variety of Industries & Sizes
√ Wellness Programs Achieved Measurable Results
Biltmore (hospitality and tourism)
Chevron (energy)
Comporium (communications)
H-E-B (grocery retail)
Healthwise (health information publishing)
Johnson & Johnson (healthcare products
manufacturing)
Lowe’s (home-improvement retail)
MD Anderson Cancer Center (health care)
Nelnet (education planning and finance)
SAS Institute (software)
http://hbr.org/2010/12/whats-the-hard-return-on-employee-wellness-
programs/ar/1

34. Qualitative Study
• Individual interviews with many CEO’s , CFO’s,
and COO’s
• Interviews with individuals partnered with
wellness (safety, employee health, human
resources, benefits, vendors, etc.)
• Focus groups with wellness participants
• Focus groups with non-wellness participants
What works?
What doesn’t work?
What is the impact of wellness on the organization?

35. Six Essential Pillars
Foundation of Successful Programs
• Multilevel Leadership
• Alignment
• Scope, Relevance, and Quality
• Accessibility
• Partnerships
• Communications

36. Multilevel Leadership
Culture of health takes passionate, persistent, & persuasive leadership
• C-suite – “walks the talk”, policies & mandates,
shows an interest in employees wellness
behaviors – “how’s your wellness”
• Middle Managers – shaping mini-wellness
cultures
• Wellness Program Managers – expert who
develops, coordinates a comprehensive program
connected to company culture and strategies
• Wellness Champions – volunteer wellness
ambassadors serving as on-the-ground
encouragement, education & mentoring

37. Wellness Champs
Take Away: Foundational to successful programs!
• Act as a liaison between the wellness program
and departmental employees
• Be a contact person for their department
• Post wellness or marketing information on their
bulletin boards in high traffic areas
• Volunteer to perform minor administrative task,
such as program material distribution or
collection
• Volunteer to help with mass marketing efforts
• Volunteer to help during specific programming
events

38. Alignment
Wellness - natural extension of a firm’s identity & aspirations
• Planning and Patience – look for way to
permeate the culture with wellness,
emphasize early communications & clear
explanations, develop a long-term
comprehensive strategy
• Carrots not Sticks – positive incentives
promote trust & provide employees choices
• Complement to Business Practices –
wellness programming must make business
sense // sustaining a healthy, talented,
satisfied labor pool is a matter of corporate
responsibility & business necessity

39. Scope, Relevance, and Quality
Employee wellness needs vary tremendously
• More than Cholesterol – think beyond
diet & exercise, stress & depression
major sources of lost productivity
• Individualization – online health risk
assessment combined with biometric
data
• Signature Program – high profile, high
quality initiative fosters employee pride &
involvement
• Fun – never forget the pleasurable
principles in wellness initiatives
• High Standards – health related
services are personal, employees won’t
use substandard services, “no one will
come for free and lousy”

40. Targeting Continuum of Healthcare
Issues
33% - 59% of Next
Years Cost Group
Healthy Employees Employees Employees Employees
Employees w/ Health with Acute with Chronic on Disability
w/o Health Risks Illness/injury Disease Traumatic Injury
Risks Obesity Doctor visits Diabetes Cancer
Low risk Stress ER Visits Heart disease
Optimal Health High blood cancer
pressure
etc.

41. Stretching Limits of a Traditional Program Mix
Program Mix Program Lines
Awareness Stress
Behavioral Change Aging Well Tobacco
Environmental Support Parenting
Physical Activity
Nutrition and Weight
Art of Calm Management
Prevention
Working Mothers Rooms

42. National Wellness Institute Holistic
Wellness Model
Wellness is a lifelong
journey, an active
process of making
Occupational Spiritual
daily healthy
lifestyle choices
and commitments.

43. Accessibility
Convenience matters
• True On-Site Integration – carefully
consider your wellness model & how
best to integrate it across your
company culture
• Going Mobile – high tech tools
(virtual wellness programs & online
resources) not only deliver the
wellness message & provide
individuals tracking tools & individual
reports, but also complement the high
touch programs that unite individuals
in a culture of health
National Wellness Institute
Six Dimensions of Wellness

44. Core Delivery Channels
Program delivery should be organized to fit your
business environment and program goals!
Individuals
Customized
Div/ Dept
Interventions
Cultural and Environmental Focus

45. 21st Century – Program Delivery
Challenge
High Tech
High Touch
Multiple touch points / wellness opportunities to meet the
wide interest / needs, learning styles, readiness and
knowledge / skill base of participants

46. Partnerships
• Internal Partnerships – help wellness
gain credibility
• External Partnerships – enable staff to
benefit from vendor competencies &
infrastructure without the extra
investment
• Leveraging Resources – internal &
external partnerships help grow &
maintain comprehensive programs

47. An Institutional Attack
on Obesity
• Wide range of physical activity
options
• Walk, run & bike clubs
• “Speed up metabolism” class
• Buddy up Challenge
• Colorful Choice Challenge
• Wellness dietitian
Culture / Climate Focus
• Individual coach / counseling
opportunities
• Recognition of Rock Steady
• Multiple Weight Watcher locations departments
• Power Plate daily dining option • Foods that Prevent Cancer
• Healthy Choice vending machines • ‘Just4U’ point of purchase dining
• Reasonable costs of water, fruit, service system
vegetables • Bike Barns
• Supermarket Tours • (2) 20,000 sq. ft. Fitness Centers
• “Rock Steady” program

48. Communications
Must overcome individual apathy and personal health
sensitivity factors
• Tailor
Messages - to fit the
intended audience, hone effective
practices overtime
• Media Diversity – use a variety
of different communication tools
to reach the audience
• Embedded Wellness Clues –
wellness needs to become a “viral
thing” spreading throughout the
workplace

49. Marketing…. That Positions Your Program
Mass marketing – a marketing mix that aims
at everyone
Program Position
Target marketing – concentrated strategy “targeted”
on specific employee groups for certain programs,
interventions, products or services through a
targeted marketing mix
Tailored Marketing Messages – tailored messages
will reach deeper and “stick” better

50. Word of Mouth – WOM
Wellness Champ Strategy
• Employees who have a passion for
wellness and is “well connected”
• Serve as a direct link between
program and employees
• Help diversify marketing networks
• Works through the development of
contact spheres
• Focused on delivering sound bites of
information about the program that
Most Program Under Utilized builds program participation
“Grown Not Built”

51. Best Practice Lessons…..
• Successful programs are focused on behavior change and building a
culture of health
• Multilevel leadership provides the passion, persistence, and
persuasiveness to build & maintain a culture of health
• Wellness programs should be a natural extension of companies identity
and aspirations
• Fit is crucial for wellness needs and interest vary tremendously across
geographic, demographic, and different cultures
• Internal and external partnerships help leverage resources to grow and
maintain comprehensive programs
• Effective incentives need to fit the work culture
• Communication strategies that make wellness a “viral thing” spread
throughout the workplace
• Individual and aggregate data empowers “for what gets measured gets
done”

52. Your corporate climate and
culture have significant
influence on shaping of
health behaviors and
practices of your
employees!
52

53. Three Concepts that Drive
Behavior Change and Healthy Culture
Sustain behavior change
through appropriate
Engage employees in program design / delivery
a wellness partnership
Individuals
Teams
Organizations
Communities
Design / deliver programs that facilitate
employee Accountability for better
health & wellness practices