Wellness and disease management programs are still widely promoted for their cost-saving potential, despite a lack of research evidence. Researchers conducted a study of enrollees for over seven years in PepsiCo’s wellness program, which includes disease management and behavioral improvement components, and the results are reported in Health Affairs. (HA Article) Similar components of wellness programs are found at the majority of larger employers and they continue to grow in popularity. The design of interventions, however, and the variation in the populations addressed, makes sound research evaluation of the benefits of the programs difficult and past research has come to contradictory conclusions. These authors used a long-running program at PepsiCo for their evaluation. They had two years of baseline data and seven years of participation data for the people included in the study. The PepsiCo program is fairly typical, including a health risk assessment, wellness events, disease management aimed at chronic conditions, a 24/7 nurse advice line and lifestyle management programs including weight, diet, fitness, stress and smoking cessation. Wellness coaches assist enrollees telephonically. People participating in one or both of the disease and lifestyle management components were included in the study and matched with nonparticipants, on an adjusted basis.
Looking at per person monthly health costs, after the first two years costs for participants were lower and the gap widened as time went on. Costs for nonparticipants were flat over the study period but costs for participants actually declined. The average reduction was about $360 per year. Only the disease management component, however, was associated with lower costs, as it reduced spending by about $1632 annually, driven by a substantial decrease in inpatient hospital stays. People in both components had a slightly larger cost reduction, $1920 annually. There was a very slight improvement in absenteeism. Taking into account the cost of the program, a dollar spent on lifestyle management returned only 48 cents, but one spent on disease management returned $3.78. The study may be limited because PepsiCo is just one employer, in a specific industry, so the data may not be representative of the population as a whole. The lack of cost-savings should not in my judgment affect the desirability of using wellness programs. The critical factor should always have been whether they improved health. If so, then it is just a matter of whether the cost is worth the degree of better health.