A healthy skepticism is appropriate when examining the net cost benefits of wellness programs. It is difficult to design and execute true real world random trials of these programs and the other study methods have potential flaws. Studies to date have given inconsistent results, but the design and execution of wellness programs continues to improve and a number of recent studies seem to suggest that the programs can save money, although it remains unclear whether these are short, one to two year savings, or longer term, even lifetime savings. Research published in Population Health Management looked at a program operated by the Blue Cross plan in Hawaii. (Population Health Article)
The research covered about 166,000 members of the health plan and compared wellness program participants with non-participants on a mix adjusted basis. The wellness program was fairly typical, beginning with a health risk assessment and biometric screening, followed by individualized health education and coaching and other interventions designed to address specific conditions such as obesity or stress. Women were more likely to participate in the program and young people less likely. Participants in the program, after the adjustments, still had lower overall health expenditures and lower inpatient and pharmacy costs over the course of the study. Costs per participant per year for the wellness program were in the low two hundred dollar range.
The overall ROI of the program seemed to stabilize at around $1.50 saved for a dollar spent at the end of the study period. An analysis by the researchers indicated an ongoing lower health cost trajectory for program participants and the more years spent in the program, the lower the trajectory. There could be biases and confounders in this research but it appears well done. An even longer term following of the program participants would be more informative. Regardless of whether or not these programs have a net saving in medical costs, they almost certainly improve people’s health and the quality of their lives and should be supported for that reason alone. And employers may find productivity and other improvements that provide net benefits even if there aren’t long term health cost savings.