An Evaluation of the Well at Dell Health Management Program: Health Risk Change and Financial Return on Investment

Abstract

Purpose.

To investigate the effectiveness of the Well at Dell comprehensive health management program in delivering health care and productivity cost savings relative to program investment (i.e., return on investment).

Design.

A quasi-experimental design was used to quantify the financial impact of the program and nonexperimental pre-post design to evaluate change in health risks.

Setting.

Ongoing worksite health management program implemented across multiple U.S. locations.

Subjects.

Subjects were 24,651 employees with continuous medical enrollment in 2010–2011 who were eligible for 2011 health management programming.

Intervention.

Incentive-driven, outcomes-based multicomponent corporate health management program including health risk appraisal (HRA)/wellness, lifestyle management, and disease management coaching programs.

Measures.

Medical, pharmacy, and short-term disability pre/post expenditure trends adjusted for demographics, health status, and baseline costs. Self-reported health risks from repeat HRA completers.

Analysis.

Propensity score–weighted and multivariate regression–adjusted comparison of baseline to post trends in health care expenditures and productivity costs for program participants and nonparticipants (i.e., difference in difference) relative to programmatic investment.

Results.

The Well at Dell program achieved an overall return on investment of 2.48 in 2011. Most of the savings were realized from the HRA/wellness component of the program. Cost savings were supported with high participation and significant health risk improvement.

Conclusion.

An incentive-driven, well-managed comprehensive corporate health management program can continue to achieve significant health improvement while promoting health care and productivity cost savings in an employee population.

Keywords

Return on Investment Health Management Program Wellness Evaluation Prevention Research Manuscript format: research Research purpose: program evaluation Study design: quasi-experimental Outcome measure: health care expenditures,productivity Setting: workplace Health focus: health management program Strategy: incentives,education,behavior change Target population age: adults Target population circumstances: workplace,employees

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References

ADP Research Institute . Why you should care about wellness programs. Roseland, NJ: ADP Research Institute; 2012. Available at: http://www.adp.com/tools-and-resources/adp-research-institute/research-and-trends/∼/media/RI/whitepapers/Why-You-Should-Care-About-Wellness-Programs.ashx. Accessed February 5, 2014.

Kaiser Family Foundation and Health Research & Educational Trust . Employer health benefits 2013 annual survey. Available at: http://kaiserfamilyfoundation.files.wordpress.com/2013/08/8465-employer-health-benefits-2013.pdf. Accessed February 5, 2014.

Mercer Health & Benefits LLC . Mercer's national survey of employer-sponsored health plans, New York; 2012. Available at: http://benefitcommunications.com/upload/downloads/2011MercerSurvey.pdf. Accessed February 5, 2014.

Anderson

Whitmer

Goetzel

. The relationship between modifiable health risks and group-level health care expenditures. Am J Health Promot. 2000;15:45–52.

Kowlesar

Goetzel

Carls

. The relationship between 11 health risk and medical and productivity costs for a large employer. J Occup Environ Med. 2011;53:468–477.

Goetzel

Carls

Wang

. The relationship between modifiable health risk factors and medical expenditures, absenteeism, short-term disability, and presenteeism among employees at Novartis. J Occup Environ Med. 2009;51:487–499.

Yen

Schultz

Schnueringer

Edington

. Financial costs due to excess health risks among active employees of a utility company. J Occup Environ Med. 2006;48:896–905.

Goetzel

Anderson

Whitmer

. The relationship between modifiable health risks and health care expenditures. An analysis of the multi-employer HERO health risk and cost database. J Occup Environ Med. 1998;40:843–854.

Pronk

Goodman

O'Connor

Martinson

. Relationship between modifiable health risks and short-term health care charges. JAMA. 1999;282:2235–2239.

10.

Goetzel

Pei

Tabrizi

. Ten modifiable health risk factors are linked to more than one-fifth of employer-employee health care spending. Health Aff. 2012;31:2472–2484.

11.

White

Hartley

Musich

. A more generalizable method to evaluate the association between commonly reported health risks and healthcare expenditures among employers of all sizes. J Occup Environ Med. 2013;55:1179–1185.

12.

Soler

Leeks

Razi

. A systematic review of selected interventions for worksite health promotion. Am J Prev Med. 2010;38:S237–S262.

13.

Loeppke

Edington

Beg

. Impact of the Prevention Plan on employee health risk reduction. Popul Health Manag. 2010;13:275–284.

14.

Schultz

Edington

. The association between changes in metabolic syndrome and changes in cost in a workplace population. J Occup Environ Med. 2009;51:771–779.

15.

Martinson

Crain

Pronk

. Changes in physical activity and short term changes in health care charges: A prospective cohort study of older adults. Prev Med. 2003;37:319–326.

16.

Finkelstein

Linnan

Tate

Leese

. A longitudinal study on the relationship between weight loss, medical expenditures, and absenteeism among overweight employees in the WAY to Health study. J Occup Environ Med. 2009;51:1367–1379.

17.

Edington

Yen

Witting

. The financial impact of changes in person health practices. J Occup Environ Med. 1997;39:1037–1046.

18.

Carls

Goetzel

Henke

. The impact of weight gain or loss on health care costs for employees at Johnson & Johnson family of companies. J Occup Environ Med. 2011;53:8–16.

19.

Nyce

Grossmeier

Anderson

. Association between changes in health risk status and changes in future health care costs. J Occup Environ Med. 2012;54:1364–1373.

20.

Elmer

Brown

Nichols

Oster

. Effects of weight gain on medical costs. Int J Obes. 2004;28:1365–1375.

21.

Haynes

Dunnagan

. Comparing changes in health risk factors and medical costs over time. Am J Health Promot. 2002;17:112–121.

22.

Edington

. Emerging research: A view from one research center. Am J Health Promot. 2001;15:341–349.

23.

Musich

White

Hardley

. A more generalizable method to evaluate changes in healthcare costs with changes in health risks among employers of all sizes. Popul Health Manag. 2014;17:297–305.

24.

Ozminkowski

Dunn

Goetzel

. A return on investment evaluation of the Citibank, N.A. health management program. Am J Health Promot. 1999;14:31–43.

25.

Naydeck

Person

Ozminkowski

. The impact of the Highmark employee wellness programs on 4-year health care costs. J Occup Environ Med. 2008;50:146–156.

26.

Baicker

Cutler

Song

. Workplace wellness programs can generate savings. Health Aff. 2010;29:1–8.

27.

Serxner

Alberti

Weinberger

. Medical cost savings for participants and nonparticipants in health risk assessments, lifestyle management, disease management, depression management and nurseline in a large financial services corporation. Am J Health Promot. 2012;26:245–252.

28.

Grossmeier

Seaverson

ELD

Mangen

. Impact of a comprehensive population health management program on health care costs. J Occup Environ Med. 2013;55:634–643.

29.

Henke

Goetzel

McHugh

Isaac

. Recent experience in health promotion at Johnson & Johnson: Lower health spending, strong return on investment. Health Aff. 2011;30:490–499.

30.

Lerner

Rodday

Cohen

Rogers

. A systematic review of the evidence concerning the economic impact of employee-focused health promotion and wellness programs. J Occup Environ Med. 2013;55:209–222.

31.

Baxter

Sanderson

Venn

. The relationship between return on investment and quality of study methodology in workplace health promotion programs. Am J Health Promot. 2014;28:347–363.

32.

Charlson

Pompei

Ales

MacKenzie

. A new method of classifying prognostic comorbidity in longitudinal studies: Development and validation. J Chronic Dis. 1987;40:373–383.

33.

Ashcraft

MLF

Fries

Nerenz

. A psychiatric patient classification system: An alternative to diagnosis-related groups. Med Care. 1989;27:543–557.

34.

Fairies

DEL

Haro

Obenchain

Leon

. Analysis of Observational Healthcare Data Using SAS. Cary, NC: SAS Institute Inc; 2010.

35.

Seeger

Williams

Walker

. An application of propensity score matching using claims data. Pharmacoepidemiol Drug Saf. 2005;14:465–476.

36.

Diehr

Yanez

Ash

Hornbrook

Lin

. Methods for analyzing health care utilization and costs. Annu Rev Public Health. 1999;20:125–144.

37.

Caloyeras

Liu

Exum

. Managing manifest diseases, but not health risks, saved PepsiCo money over seven years. Health Aff. 2014;33:124–131.

38.

Nyman

Abraham

Jeffery

Barleen

. The effectiveness of a health promotion program after 3 years. Med Care. 2012;50:772–778.

39.

Linnan

Bowling

Childress

. Results of the 2004 National Worksite Health Promotion Survey. Am J Public Health. 2008;98:1503–1509.

40.

Short

Goetzel

Pei

. How accurate are self-reports? Analysis of self-reported health care utilization and absence when compared with administrative data. J Occup Environ Med. 2009;51:786–796.