Design, implementation keys to wellness success

Science-based programs, proper staff essential

Research shows that employee wellness programming can not only improve the health of the worker population, but it can also yield significant financial returns. Of course, starting a fitness or lifestyle change program and calling it a "wellness initiative" does not in and of itself guarantee success in either area. It takes careful planning and implementation, says Ron Z. Goetzel, PhD, vice president of consulting and applied research in the Washington, DC, office of The MEDSTAT Group, based in Ann Arbor, MI.

"Globally speaking, wellness programs need to be science-based, well-designed and configured, and should use the best-known currently available research and science to support their foundation. That is often talked about but not so often done," says Goetzel. "People have tons of programs out there with very little evidence these things work. The extent to which documentation or theory foundation, or using objective methods, is employed for specific programming is one of the keys to success."

Proper implementation is also critical, he notes. "You can have great scientific underpinning, but the people [implementing the program] need to know what they’re doing, and they need to have the proper tools to implement the program," he advises. A subset of this is management support, which is also a critical element needed to ensure success.

Finally, notes Goetzel, poor (or nonexistent) evaluation can doom any program to failure.

Establish your baseline

A solid wellness program will typically begin with some form of screening, says Goetzel. "This can be anything from a self-reported HRA (Health Risk Appraisal) to more rigorous biometrics and screening," he notes. These baseline data will enable you to triage employees into different intervention programs that fit their needs. The data also will help you evaluate how serious the health risk is in individual cases. "Providing proper triage and customized intervention is very important," notes Goetzel. "That’s especially true for people at high risk, who require a lot of high-touch, one-to-one intervention — something more intensive than group learning."

Proactive outreach to your employee population will get more people involved, which will produce the best clinical outcomes and thus the best financial results, says Goetzel. "You need to get peoples’ attention — get them to participate," he asserts. "Only then will they begin changing their attitudes, mindsets, and behaviors."

There are clearly certain types of programs that will more readily yield quick results and/or a higher return on investment (ROI). These include prenatal care, obesity and stress, to name a few. However, Goetzel does not necessarily recommend such a "rifle" approach. "I advocate a program that targets multiple risk; I’m not a proponent of going out and changing one thing at a time," he says. "People walk into these programs with multiple risks — psychosocial, physical, and behavioral."

That doesn’t mean, says Goetzel, that if you have a population with a high percentage of diabetes or back pain you shouldn’t introduce programs that specifically target those conditions. What it does mean is that you try to address all the factors that contribute to the health risk of these individuals. 

Research shows the savings can be significant. In a MEDSTAT study of programs serving many thousands of employees, it found the following:

• ROI estimates for health management pro grams in nine studies ranged from $1.40 to $4.90 in savings per dollar spent.

• ROI estimates for demand management pro- grams (expanded use of self-care and giving beneficiaries greater control of health care usage) in six studies ranged from $2.20 to $13 in savings per dollar spent.

• ROI estimates for disease management pro grams in three studies ranged from $7.30 to $10.40 in benefits per dollar spent.

• ROI estimates for multiple component pro grams in three studies ranged from $5.50 to $6.50 in savings per dollar spent.

In one specific program at Citibank, MEDSTAT demonstrated savings of $8.9 million vs. administration expenditures of $1.9 million, for a net savings of $7 million. Of course, not every employer is Citibank, and, notes Goetzel, smaller employers have a bigger challenge. "My advice is to partner up with a national organization with a proven track record," he says. "If you go with vendor A’ and they can prove they’ve gotten a good ROI with larger populations, then you should be able to expect the same kind of program impact at your workplace if they administer it in approximately the same way they did for the bigger client."

In short, he says, these programs should be fairly standardized, so that you can expect the same design no matter where you see it – in much the same way that you see the same layout every time you step into a McDonald’s store. "There’s no need go around recreating things," he observes. "You should be able to assume you will have the same kind of results."

[For more information, contact: Ron Z. Goetzel, PhD, vice president of consulting and applied research, The MEDSTAT Group, 4301 Connecticut Ave. NW Washington, DC 20008. Telephone: (202) 719-7850. E-mail:]