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									THE C ASE FOR


                AN E M P L O Y E R W H I T E P AP E R
                PRESENTED BY

                780 Township Line Road
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                                Executive Summary

Health promotion is an investment in human         Link between health risks and medical
capital and productivity. Employees in              care costs: Being at high risk for any single
optimal physical and psychological health           health condition is associated with higher
are more likely to be on the job and                medical costs. Those with multiple risk
performing well. They also are more likely          factors cost even more.
to be attracted to, remain with and value a        Changes in risk result in changes in costs:
company that obviously values them.                 The cost increases associated with increased
    Health and productivity management is           risk are greater than the declines associated
based on the concept that an “at risk”              with decreased risk.
workforce is a business liability with direct
                                                   Which employees should be targeted?
and hidden costs impacting productivity.
                                                    Many health promotion programs focus on
Thus, an essential component of
                                                    high-risk individuals, while others focus on
productivity management is managing
                                                    both high- and lower-risk employees. Some
employee health.
                                                    research indicates an effective strategy is to
                                                    focus on keeping healthy people healthy by
Dramatic ROI
                                                    preventing those in low-risk categories from
Health promotion programs are a proven              moving to medium- or high-risk status.
method for employers to help employees
                                                   Impact on health care costs: A
manage their health. Multiple peer-reviewed
                                                    comprehensive review of 72 studies last
studies have concluded that businesses can
                                                    year concluded that overall, health
realize from $3 to $8 for every dollar spent
                                                    promotion programs result in lower health
on health promotion. These savings
                                                    care costs and are considered a viable and
represent both direct costs — reductions in
                                                    effective method for helping employers
medical costs and claims — and indirect
                                                    reduce employee-related expenses.
savings in reduced absenteeism and
disability and increased productivity. Many        Impacts on productivity: In addition to
researchers believe the indirect,                   higher health care costs, negative impacts
productivity-related savings are double the         on productivity are a major, costly product
more easily measured direct health care             of poor health. Some researchers believe
costs.                                              productivity losses exceed actual health care
    Beyond ROI considerations, health               costs.
promotion programs also are ideal for
raising health awareness and getting                Worksite health promotion programs can
employees to be active partners in their own        improve productivity by attracting
health.                                             superlative workers, reducing absenteeism
                                                    and lost time, improving time utilization and
Research Conclusions Regarding                      employee morale, building goodwill toward
Health Promotion Programs                           management and reducing employee
 Impact on health risks: Numerous                  turnover.
   studies have demonstrated that well-            Absenteeism: A common yardstick to
   conceived health promotion programs              measure productivity and absenteeism
   can help workers reduce their health             includes missing time from work, such as
   risks.                                           personal illness days, as well as short- and
                                                    long-term disability and worker's
                                                    compensation days. Health risks bear the

HEALTH INK & VITALITY COMMUNICATIONS                                                            2
    same relationship to days absent as they      Match health promotion initiatives with
    do to health care costs: the greater the       health indicator issues.
    health risks, the higher the absenteeism      Utilize periodic health-risk assessment and
    rates. Conversely, health promotion            screening programs.
    programs have been shown to
                                                  Systematically funnel workers identified as
    significantly reduce absenteeism.
                                                   being at higher risk into appropriate follow-
   Presenteeism: This relatively new              up programs.
    concept considers the impact of workers
                                                  Measure and evaluate.
    who are present but not fully
    productive. On-the-job workers with
                                                   Depending on how comprehensive the plan,
    higher health risks have more
                                               there is a wide cost range associated with health
    productivity loss, and presenteeism is
                                               promotion programs. Some companies begin
    the major contributor to these
                                               with relatively simple and inexpensive
    productivity losses. Researchers who
                                               initiatives, such as distributing a wellness
    studied one firm's call center operators
                                               newsletter, which can be an effective way for a
    were startled by the type of conditions
                                               company to reach all of its employees and their
    that contributed most to presenteeism.
                                               dependents with proactive health messages.
    Lower cost, chronic conditions such as
                                               More comprehensive health promotion
    allergies, asthma, digestive disorders,
                                               programs can range from less than $50 to over
    back pain and mental health problems
                                               $400 per employee — a fraction of the $4,000
    were found to have a greater negative
                                               to $5,000 per year the average employer spends
    impact on productivity than did high
                                               to ensure productivity through health benefits,
    health care cost conditions, such as
                                               which continue to experience annual double-
    cardiovascular disease, diabetes and
                                               digit increases. Factoring in productivity losses
                                               due to health, these expenses could amount to
Instituting a Health Promotion                 $10,000 or more per employee per year.
 Experts suggest certain elements are
                                               As a means to reduce employees’ health risks,
    necessary for a successful health
    promotion program. These include:          curb health care costs and improve employee
                                               well-being, morale and productivity, health
 Determine your company's chief               promotion programs are a significant, viable and
    organizational health indicator issues.    cost-effective tool in employers' health care

HEALTH INK & VITALITY COMMUNICATIONS                                                           3

From a business perspective, health             medical shows like ER for years, there is no TV
promotion is an investment in human             show about public health.
capital.                                           “It’s not as exciting, not as sexy as the
    “Employees are more likely to be on the     immediate attention you get for saving a
job and performing well when they are in        person’s life, finding a cure or treating a serious
optimal physical and psychological health,”     disease,” says Ron Z. Goetzel, Ph.D., vice
the Partnership for Prevention, a nonprofit     president of consulting and applied research for
association of corporations, nonprofits and     the MEDSTAT Group in Washington, D.C.
state health departments, contends in           “But the reality is that the mundane, boring,
Healthy Workforce 2010: An Essential            common-sense things your mother told you to
Health Promotion Sourcebook for                 do 50 years ago — exercise, eat properly, don’t
Employers, Large and Small. “They are also      smoke, and balance your work, family and
more likely to be attracted to, remain with     social life — actually make a big difference in
and value a company that obviously values       your health and well-being.” All of which, in
them. In short, a company’s productivity        one way or another, health promotion programs
depends on its employees’ health.”1             address.

Top Reasons for Programs                        What About Results?
    According to the 1999 National Worksite         Intuitively this all makes sense. But it has
Health Promotion Survey, the top reasons        long been thought difficult, if not impossible, to
employers launch health promotion               quantify the financial benefits of health
programs are to improve employee morale,        promotion programs. What is the return on
retain good workers, attract good employees     investment, the ROI, of health promotion?
and improve productivity — all of which         While that may once have been hard to quantify,
worksite health promotion programs target.2     and to quantify in dollars and cents, a growing
    Such programs can be particularly           body of peer-reviewed studies has concluded
effective because, with a captive work force,   there is an ROI, often dramatic, for employer-
companies are dealing with employees who        based health and wellness promotion programs.
experience a consistent environment and         Multiple studies have shown that businesses can
social and organizational support. Worksite     realize from $3 to $8 in savings for every dollar
health programs also have one other             spent on health promotion. These savings
powerful feature workers find attractive:       represent both direct costs — reductions in
Employers, not the employees, pay for them.     medical costs and claims — and indirect savings
    As the Partnership for Prevention notes,    in reduced absenteeism and disability and
the field has even spawned new business         increased productivity. In fact, some researchers
management concepts. Health and                 believe the indirect, productivity-related savings
productivity management is based on the         are double the more easily measured direct
concept that an “at risk” workforce is a        health care costs.3
business liability with direct and hidden           “The data supporting the claim that health
costs impacting productivity. Thus, an          promotion programs can reduce medical care
essential component of productivity             costs and reduce absenteeism is of higher
management is managing employee health.         quality than the data most businesses have to
    Nonetheless, health promotion and           support other investments of similar cost,”
disease prevention have an image problem.       writes Michael O’Donnell, editor in chief and
While America has watched highly rated          president of the American Journal of Health

HEALTH INK & VITALITY COMMUNICATIONS                                                              4
    Joseph A. Leutzinger, Ph.D., director of    most software or databases don’t have it. We
health promotion at Union Pacific Railroad,     also don’t look for ROI for medical and surgical
agrees. “Most business leaders make a lot       procedures.”
more important decisions related to                But beyond the measurable ROI financial
monetary expenditures based on less data        numbers, health promotion programs are an
than they do for spending of health             ideal vehicle to enable and encourage
promotion programs,” he says. While he is       employees to be active partners in their own
an advocate of health promotion program         health — a goal of all employers.
evaluation and has conducted some                  Workplace health promotion, Leutzinger
impressive evaluations himself, Leutzinger      concludes, is simply common sense. “If you
is somewhat mystified by constant demands       look at what’s happening in business trends, in
to justify health promotion expenditures.       the coming years it’s going to be important for
    “Most companies spend on health             employees to have a certain core set of skills to
promotion what they spend on carpets and        make a company profitable. It becomes pretty
one-day company events,” he says. “Do we        intuitive that if the bar is going to be raised on
cost-justify all training programs, business    what’s required, if employees are not healthy or
equipment and all other discretionary           are dealing with health issues, obviously they
spending at the same intensity and rigor that   are not going to be able to perform at this
is required for health promotion? Typically,    expected and projected higher level.”
companies say everything has an ROI, but

HEALTH INK & VITALITY COMMUNICATIONS                                                             5
                        The Most Influential Studies on the
                       Financial Impact of Health Promotion
As we have said, a growing body of peer-                costs. They were followed by high blood
reviewed studies has demonstrated the                   glucose levels (35 percent more), obesity
financial impact of health promotion. Here              (21 percent more), tobacco use (former
are the dozen adjudged the most influential             smokers 20 percent more, current smokers
by an expert panel and summarized in a                  15 percent more), high blood pressure (12
May/June 2001 American Journal of Health                percent more) and poor exercise habits (10
Promotion paper by Thomas Golaszewski,                  percent more).5 “We thought obesity or
Ed.D., of the State University of New York–             smoking would be the most costly,” says
Brockport:                                              Bill Witmer, the HERO president. “The
 HERO Studies: In 1996 the Health                      study’s conclusion, though, was that the
     Enhancement Research Organization                                                      depression
                                                        psychosocial diseases such as Impact on Individual Health Care Costs:
     (HERO) was created after organizers
                                                                                                High versus
                                                        and stress are by far the most costly of the Lower-Risk Employees
     realized data existed to create a large,           typical controllable risk factors. That’s
                                                                              Individuals at high risk for
                                                           75% 70.2%          depression have 70.2%
     retrospective, multi-employer health               important because, in some cases, those at
                                                                              higher costs than
                                                                              lower risk
                                                        employers don’t even provide coverage for
     promotion research database. HERO                     50%         46.3%

     brought together the StayWell                                             a lot
                                                        mental health. It got 34.8% of employers
     Company, which had a large database of             thinking that they should start paying more
                                                           25%                        21.4% 19.7%
                                                                                                        14.5% 11.7%
     health-risk assessments (HRAs), and the            attention to depression and stress.”
     MEDSTAT Group, which had a large






     database of medical claims. The two

     companies were able to merge the
     health-risk assessments and medical                      -50%
     claims data of 47,500 employees of six
     large employers: Chevron Corporation,
     Health Trust, Hoffman La Roche,
     Marriott and the states of Michigan and
     Tennessee. All of the employees were
     enrolled in their employers’ fee-for-
     service, self-insured health plans
     between 1990 and 1996 and had
     completed one or more health-risk          Source: Goetzel et al. (1998)
                                                       Witmer notes that only 2.2 percent of the
    The first HERO study evaluated 10                   workers assessed admitted to the costliest
    risk factors, six self-reported and four            risk factor, depression, even though research
    biometric measurements (cholesterol,                indicates about 10 percent of the U.S.
    blood pressure, blood glucose and                   population at any given time is clinically
    weight). Participants were followed for             depressed.
    up to three years after completing their
    first HRA, following which data showed              Another HERO study used the same data
    that those with self-reported, persistent           and subject group to explore the relationship
    depression had adjusted annual health               between modifiable health risk and health
    care expenditures that were 70 percent              care expenditures. Employees with
    greater than those who didn’t report                modifiable health risks were responsible for
    being depressed. Highly stressed                    25 percent of total expenditures. Those
    individuals incurred 46 percent greater             employees who reported being under

HEALTH INK & VITALITY COMMUNICATIONS                                                                                               6
    constant stress with no methods for             to go from high to low risk cost an average
    coping were responsible for 7.9 percent         of $129 less per year; those that moved from
    of total health care costs; former              low risk to high risk cost $734 more per
    smokers, 5.6 percent; overweight, 3.3           year. Since then, ongoing studies by the
    percent; current smokers, 2.5 percent;          university’s Health Management Research
    high blood glucose, 1.7 percent;                Center have continued to show positive
    persistent depression, 1.5 percent; and         results.
    high blood pressure, 0.5 percent.              Johnson & Johnson Study: Between 1979
                                                    and 1983 Johnson & Johnson divided more
    “That 7.9 percent is enormous,” says            than 11,000 employees at different work
    Witmer. “It resulted in the Harvard             locations in 18 states into three groups to
    Business Review doing a series of               judge the value of interventions such as
    studies that concluded today’s                  health screenings, introductory lifestyle
    workplace is the most chaotic in history.       seminars, lifestyle improvement programs
    Mergers, acquisitions, downsizing and           such as smoking cessation and stress
    the taking away of retirement plans             management, and work environment
    almost overnight has created                    changes, such as healthier cafeteria foods
    unprecedented chaos, and there’s no             and exercise facilities. One group was
    question that’s going to generate stress        exposed to such interventions early, another
    and anxiety and take away from work             group received delayed intervention and the
    performance.”                                   third group received none. Analysis of
   HealthPartners Study: This HMO                  medical care and utilization data indicate
    based in Minneapolis studied 5,689 of           the groups that received interventions
    its members who were over 40 and had            experienced lower rates of increases for
    one or more chronic conditions to               health care costs, hospital admissions and
    determine the relationship between              hospital days. J&J saved $980,316 (in 1979
    modifiable health risks and health care         dollars), or $116 per subject over the four
    costs. Over an 18-month period: health          years.
    care costs decreased from the median by        DuPont Study: DuPont gauged the
    4.7 percent for every day of the week           effectiveness of comprehensive worksite
    subjects exercised; costs increased 1.9         health promotion on days lost to disability
    percent above the median for every              during the 1980s. Comparing more than
    increment in Body Mass Index; and for           29,000 hourly workers from 41 intervention
    current and former smokers, there were          sites to more than 14,000 from
    increases of 18 percent and 25 percent,         nonintervention control sites, DuPont
    respectively, over nonsmokers.                  concluded the interventions significantly cut
   Steelcase Study: University of                  disability days by .4 days per employee over
    Michigan researchers followed 796               two years. That saved 11,726 disability days
    employees at this office furniture maker        and resulted in a savings of $1.42 for every
    who completed health-risk assessments           dollar invested.
    before and after the 1985–1990 study           Birmingham, Ala. Study: The city
    period. Based on 10 lifestyle and               implemented a comprehensive health
    biomedical risk factors, such as blood          intervention program in 1985. Its elements
    pressure and cholesterol levels, the            included health promotion, such as
    workers were classified as either high or       mandatory HRAs, referrals for high-risk
    low risk (two or fewer risk factors)            individuals, a shift to managed care and
    during each of two periods: 1985–1987           other medical plan redesigns. Between 1985
    and 1988–1990. High-risk workers had            and 1990 the average employee medical
    high health costs. Those that managed           expenses were virtually unchanged (while

HEALTH INK & VITALITY COMMUNICATIONS                                                           7
    Alabama state employees’ health care          Travelers Study: In 1986 the insurer
    costs mushroomed 82 percent). During           introduced a health promotion program that
    that same period, both hospital                focused on both lifestyle and medical self-
    admissions (-55 percent) and hospital          care interventions to all 36,000 of its
    days (-38 percent) declined                    employees and retirees. The program
    significantly.                                 featured multiple communications vehicles,
   Citibank Study: In 1994 the financial          including newsletters, brochures, videos and
    corporation launched a mass                    a self-care reference book, committees and
    communication health promotion                 social events such as health fairs and
    intervention to all of its employees. It       contests, and a large fitness facility at the
    included a health-risk assessment;             corporate headquarters in Hartford, Conn. A
    targeted educational programming,              total cost-to-benefit analysis was completed
    including print material, telephone            for 1986 to 1990 and projected to the year
    counseling and telephone-accessed              2000. Researchers estimated the cost-benefit
    audio material, for those identified as        ratio at $3.4 for every dollar spent, a
    high risk. There also were follow-up           cumulative gain of $146 million by 2000.6
    letters and telephone information access
    for lower-risk employees, and follow-up
    HRAs, reports and self-care books for
    everyone. Comparing more than 11,000
    participants with more than 11,000 non-
    participants, researchers concluded that
    health care expenditures ultimately
    increased just 25 percent for
    participants but 43 percent for non-
    participants, a difference of $34.03 per
    person per month. Overall total savings
    were estimated at between $6.6 million
    and $7 million, with a return of between
    $4.56 and $4.73 for every dollar spent.
   CalPERS Study: The California Public
    Employees’ Retirement System during
    the early 1990s gauged the effect of a
    health-risk assessment and health
    promotion program on PERS employees
    and retirees both on and not on
    Medicare. Interventions included HRAs
    every six months, individualized reports
    and recommendation letters, as well as
    self-management/medical self-care
    books and materials. The results:
    Claims for the combined employee and
    retiree intervention group were $361
    lower than the controls; in just the
    retiree group, the difference was $758
    per member. The cost savings over the
    entire population was estimated at
    between $3.2 million and $8 million.

HEALTH INK & VITALITY COMMUNICATIONS                                                          8
                        What Researchers Have Concluded
                        About Health Promotion Programs
Researchers have looked at the impact of             Just three months after launching a 20-
health promotion in a variety of ways,                minute stretching program before its
including what effect they have on health             employees began repetitive work, Steelcase
risks, health care costs and productivity.            enjoyed significant declines in on-the-job
                                                      injuries. Such injuries were even halved in
Impact of Health Promotion                            one department, and workers reported their
Programs on Health Risks                              muscles ached less, they felt better
Numerous studies have demonstrated that               physically and were sleeping better.8
well-conceived health promotion programs
can help workers reduce their health risks.       Link Between Health Risks and
For example, a three-year study of nearly         Medical Care Costs
10,000 employees at four auto                     High risk for any single health-risk factor is
manufacturing plants compared four                associated with higher medical costs. For
different approaches at the sites: periodic       example, a collaborative 1995 study between
screening and referral only; such screenings      what was then the Chrysler Corporation and the
and awareness materials and classes; those        United Auto Workers Union concluded that
services plus individual follow-up                smokers generate 31 percent higher claim costs
counseling for at-risk employees and a menu       than non-smokers, and those with unhealthy
of interventions; and additional social           weights had 14.3 percent higher hospitalization
organization at the plant. Participation in the   utilization than those with healthy weights. 9
more comprehensive third and fourth                   Likewise, a study published in 2002
approaches was five times greater, and            concluded that a worker with diabetes generates,
substantially greater improvements were           on average, more than twice the medical,
achieved in blood pressure results, weight        prescription and disability costs as a worker
loss and smoking cessation. Persistent            without the disease. The tab at a Fortune 100
outreach and multiple contacts by                 manufacturing firm: $7,780 per year for workers
counselors were linked closely to risk            with diabetes, $3,370 for those without it.
reductions. 7                                     Nearly a third of the additional costs were
                                                  attributed to productivity losses.10
  Other examples:                                     Health promotion researchers such as Dee
 Coors’ eight-week “Lifecheck” program           W. Edington, Ph.D., with the Health
  significantly reduced its employees’ risk       Management Research Center, Division of
  of heart disease. Spending $32 each for         Kinesiology at the University of Michigan, have
  692 participants resulted in declines in        also classified employees according to multiple
  blood pressure, blood cholesterol and           risks. Those with five or more risk factors — the
  weight.                                         high-risk group — and those with medium risk
                                                  (three or four risk factors) cost employers more.
 Two years after the Minneapolis/St.
                                                  Researchers have calculated that the excess
  Paul Metropolitan area began a weight
                                                  amounts these groups cost employers above the
  control/smoking cessation program,
                                                  cost of the low-risk group (two or less risk
  program participants had lost an average
                                                  factors) have a mean of about 25 percent of total
  of nearly five pounds and 24 employees
                                                  corporate medical costs.
  had quit smoking. That represented only
                                                      Wellness scores, which most commercially
  a 2 percent quit rate, but at a cost of just
                                                  available HRAs calculate, also show a strong
  $62.50 per successful quitter.

HEALTH INK & VITALITY COMMUNICATIONS                                                            10
     correlation between wellness and health                Most health promotion programs, perhaps
     care costs.                                            understandably, focus on high-risk individuals:
                                                            trying to get smokers to quit, for instance, or
     Changes in Risk = Changes in Costs                     obese workers and/or heart patients to lose
     As risks increase or decrease, so do costs,            weight. “The whole health promotion field,
     according to the University of Michigan’s              which was begun initially to address
     findings, first with Steelcase and then with           cardiovascular disease, has been brought up
     other members of its corporate consortium.             thinking about risk reduction as more of a
     Interestingly enough, the cost increases               medical rather than a health promotion model,
     associated with increased risk are greater             trying to reduce medical problems rather than
     than the declines associated with decreased            promoting health,” says Edington.
     risk.11                                                    But Edington’s research suggests the most
                                                            effective strategy to increase the proportion of
     Lifestyle Accounts for 50% of Deaths                   low-risk people in a workforce is to prevent
                                                            those already in low-risk categories from
               10%                                          moving into medium- or high-risk categories. In
                                                            other words, he says we should focus on
                                                            keeping the healthy people healthy.
         20%                              Lifestyle
                                                                “Naturally, you want to prevent heart
                                          Biology           disease, lung cancer and diabetes, and most
                                          Health Services   corporations who sponsor these worksite
                                                            programs of course are interested in that,” says
                                                            Edington. But the only way to measure the
                                                            success of such efforts is over the long-term, 10
Source: CDC (1980)
    Source: CDC (1980)                                      to 15 years from now. But generally employers,
                                                            especially companies with high turnover rates
     How Soon Does ROI Appear?                              — two to three years in some cases — are more
     “When can we expect to see the benefits of             interested in outcomes over the next two or
     these programs?” Edington hears that                   three years, in such measures as short-term
     question all the time. The benefits of low-            medical costs or impact on productivity.
     cost programs often become apparent more                   Using such a yardstick, Edington’s
     quickly than those of high-cost programs.              preliminary results suggest that investing in the
     Both Steelcase and Progressive realized a              low- and medium-risk groups maximizes the
     savings-to-cost ratio of greater than 3.5:1            health promotion ROI. Only when programs are
     within the third year of some of their low-            able to spend more than $300 per year per
     cost programs. One company in the                      individual, he says, should health promotion
     University of Michigan consortium that                 programs target high-risk individuals.13
     spent less than $30 per participant                        Based on multiple risk factors, low-risk
     experienced a 3:1 savings-to-cost ratio after          employees represent at least 60 percent of the
     three years. While the return also was                 population, with 25 percent more in the
     positive for its more intense programs that            medium-risk category, according to Edington.
     cost up to $200 per employee, it wasn’t as             “These are your champions,” he says. “These
     high after three years. But Edington’s                 are your low-cost people who have low
     experience indicates savings will triple               absenteeism rates.”
     expenses within five years.12                              In reality, most companies that launch health
                                                            promotion programs try to address both groups.
     Which Employees Should We Target?                      Says MEDSTAT’s Ron Goetzel: “You need to
                                                            expend funds on primary prevention programs
                                                            to keep people healthy at the same time you

     HEALTH INK & VITALITY COMMUNICATIONS                                                                 11
spend money on high-risk people in order to
change their risk profile.

                         Impact of Health Promotion
                        Programs on Health Care Costs

    A comprehensive review of 72 studies by            difference in medical expenditures for
    Brigham Young University’s Steven G.               employees who had taken part in the
    Aldana, Ph.D., last year concluded, “The           program and those who hadn’t.
    implementation of health promotion              Duncan Aviation in Battle Creek, Mich.,
    programs seems to result in lower levels of        over several years saw health insurance
    absenteeism and health care costs.” While          costs for its 450 workers rise only 7 percent
    conceding there may be some questions              to 14 percent while neighboring companies
    about the actual causal relationship between       suffered 18 percent to 40 percent increases.
    health promotion programs and reduced              Duncan got the better rates, even though its
    health care costs, he concluded that “health       health plans are more comprehensive,
    promotion programs should be considered a          because over a 13-year period its health
    viable and effective method for helping            awareness program had eliminated 60
    employers reduce employee-related                  percent of its employees’ identified health
    expenses.”14                                       risks.17
        Aldana’s review of 13 studies that
                                                      As the Partnership for Prevention notes, even
    reported benefit/cost ratios indicated the
                                                   narrowly focused health promotion programs
    mean benefit was $3.72 in reduced health
                                                   can generate significant financial savings:
    care costs and $5.06 in reduced absenteeism
    costs per dollar invested.15 Another review     Sunbeam-Oster Co., a manufacturer of small
    of studies by Goetzel reported a median            electrical appliances with a largely female
    benefit of health promotion programs of            workforce, made it mandatory for its
    $3.14 per dollar invested, a median benefit        pregnant employees to attend prenatal
    of programs that addressed demand for              classes. They made it easy by offering the
    medical services of $4.50 and a median             classes on site during work hours, and paid
    benefit for disease management of $8.88.16         the women their full salaries while they
                                                       were in class. The result: In the eight years
    Consider these examples:                           after the program was launched, just four
                                                       premature births occurred, compared with
     When Citibank spent $2 million to
                                                       five in the two years before the program
       provide a health-risk appraisal and
                                                       began. Even including the cost of the pre-
       appropriate follow-up interventions for
                                                       natal classes, the company’s costs for
       chronic conditions to 40 percent of its
                                                       maternal and newborn care declined by 86
       42,000 employees, over a 38-month
                                                       percent in just two years. Average costs fell
       period it realized $12.6 million in
                                                       from $27,243 to $3,792 per program
       program benefits — mostly from the
                Short-Term             Long-Term    The Hanford Nuclear Reservation cut lost
                                                       workdays nearly in half among workers who
                                                       took advantage of flu vaccinations offered at
                                                       various worksites. Estimated savings per
 Demand           $2-$5                                person vaccinated were nearly $84,
Management        Year
                                                       including productivity gains and medical
                                                       care and prescription drug reductions.18
 Promotion               $3-$8
                       3-5 Years

    HEALTH INK & VITALITY COMMUNICATIONS                                                         13
    Impacts on Productivity                         Control Data estimates its StayWell
                                                     program saved the company at least $1.8
Besides health care costs, negative impacts          million over six years as a result of reduced
on productivity are considered a major, and          absenteeism among employees who had
costly, product of poor health. Some                 lowered their health-risk scores.
researchers even believe productivity losses        In the year after a health promotion program
exceed actual health care costs.                     was launched at multiple sites involving a
   According to the Partnership for                  police force, a chemical company and a
Prevention, worksite health promotion                banking firm, weekly participation in
programs can improve productivity by:                supervised exercise cut sick leave by an
 Attracting superlative workers.                    average of 4.8 days per person.20
 Reducing absenteeism and lost time.
 Improving on-the-job decision making
    and time utilization.                        Recently, researchers also have been focusing
 Improving employee morale and                  on the impact of presenteeism: workers being
    fostering stronger organizational            present at work, but not fully productive.
    commitments.                                 Measuring on-the-job productivity is difficult,
 Reducing organizational conflict by            and necessarily has to be job-specific. In a study
    building a reservoir of goodwill toward      of Bank One call center operators, University of
    management.                                  Michigan researchers found that workers with
 Reducing employee turnover.19                  higher health risks have more productivity loss,
                                                 and presenteeism was the major contributor to
             Absenteeism                         those productivity losses.
                                                     One of the most startling results of the Bank
One common yardstick to measure                  One study was the type of conditions that
productivity losses is absenteeism. That         contributed most to the presenteeism.
includes days missed from work, including        Researchers compared the impact of expensive,
personal illness days. It also encompasses       high health care cost conditions, such as
short- and long-term disability and worker’s     cardiovascular disease, diabetes and cancer —
compensation days. At Steelcase, for             conditions that many health promotion programs
example, researchers early on discovered         target — and lower-cost but chronic conditions
that the health risks bore the same              such as allergies, asthma, digestive disorders,
relationship to days absent as they did to       back pain and mental health problems. The
health care costs.                               results: The lower-cost conditions heavily
    Results of health promotion programs on      impact productivity. While a heart attack results
reduced absenteeism can be dramatic.             in high medical costs, after four weeks or so
Consider these examples gathered by the          most workers can return fully productive. 21
Partnership for Prevention:                          “But if you have a condition that affects you
                                                 on a daily basis, minute to minute, like
 A 1998 analysis of five absenteeism
                                                 headaches or back pain or irritable bowel
    studies concluded the programs
                                                 syndrome,” explains Edington, “you’re not
    averaged savings of almost $5 for every
                                                 going to be productive since your mind is trying
    dollar spent. A health promotion
                                                 to get through the pain before actually
    program at DuPont was credited with
                                                 concentrating on your work.”
    cutting days lost to illness or disability
                                                     Goetzel agrees: “If I’m at my desk eight
    by 14 percent. A rehab program Coors
                                                 hours a day and suffering from allergies,
    sponsored for 180 post-coronary
                                                 migraines or headaches, back pain or a host of
    patients cut lost days by 68 percent.
                                                 other issues, what proportion of my day is

HEALTH INK & VITALITY COMMUNICATIONS                                                            14
essentially unproductive because I’m not       these conditions without being effectively
performing at optimal levels? Some research    treated.”
indicates that may be as much as a quarter         Presenteeism, Edington concludes,
or half a day lost if you are suffering from   contributes more to productivity losses than
                                               absenteeism does.

HEALTH INK & VITALITY COMMUNICATIONS                                                          15
                          Instituting a Good Health
                             Promotion Program

Depending on how comprehensive the plan,            optimal levels — indicate the business and
there is a wide cost range associated with          program objectives are aligned.”
health promotion programs. Some                    Determine your company’s chief
companies begin with relatively simple and          organizational health indicator issues:
inexpensive initiatives, such as distributing       Some organizations, says Leutzinger,
a wellness newsletter. On the more                  determine these issues through an analysis
comprehensive side, multi-faceted health            of health claims data that might, for
promotion programs usually begin with a             instance, identify heart disease risk, high
health-risk assessment to benchmark the             cholesterol and/or obesity. Other companies
starting point and to guide future steps. The       might be more interested in productivity
costs for programs pale when you consider           issues, such as absenteeism, employee
what most employers already are spending            relations, or recruitment and containment.
to ensure health and productivity.
                                                   Match health promotion programs with
    “The average employer today is spending
                                                    health indicator issues: “If you’re most
between $4,000 and $5,000 per year on
                                                    interested in reducing claims from one year
health benefits. With annual double-digit
                                                    to the next, you probably want to install a
increases, in some cases over 20 percent,
                                                    self-care education program that can show
spending is going up dramatically on the
                                                    an immediate return. If that was your goal,
health care side,” says Goetzel. “If you
                                                    you wouldn’t want to open an 80,000-
factor in productivity losses due to health —
                                                    square-foot fitness center in the first year,”
absences, disability, workers compensation
                                                    says Leutzinger. “But if a company like
and items such as turnover costs — that
                                                    Microsoft was interested in recruiting and
figure can double to $10,000 or more per
                                                    retaining promising younger-generation
employee per year.
                                                    employees, being able to show off a large
    “When viewed that way, the cost of a
                                                    fitness center at the end of the interview
prevention program doesn’t look all that
                                                    may help persuade the candidate to take the
    Experts such as Goetzel and Union
Pacific’s Joseph Leutzinger suggest certain        Senior management must champion the
elements are necessary for a successful             program.
health promotion program. These include:           Champions at the worker level also must
 Align the program with the                        be passionate and enthusiastic: Their
     company’s purpose and mission:                 advocacy must be a meaningful part of their
     “You can’t have programs sitting off in        work.
     the backwoods in a trailer somewhere          Periodic health-risk assessment and
     where it’s very easy to get rid of them        screening program: Regular assessments
     when times get tough,” says Goetzel.           get as many employees as possible involved.
     “Companies whose mission statements            Incentives might be necessary. According to
     focus on human capital — such as being         Goetzel, Citibank offered employees a $10
     dedicated to attracting and motivating         credit on their benefit plan and generated a
     the best employees, being an employer          50 percent participation rate in their
     of choice, making sure employers work          assessment program; a Johnson & Johnson
     in safe and protected environments and         program that offered employees a $500
     making sure the employees are                  incentive generated a 90 percent
     physically and mentally performing at          participation rate. According to the

HEALTH INK & VITALITY COMMUNICATIONS                                                           16
    University of Michigan’s Dee W.                 employee involvement stimulates interest
    Edington, annual health-risk assessment         and ownership of the program; it’s
    participation rates of 20 percent to 30         contagious. Encourage advisory committee
    percent are common. Among long-term             members to talk up the program informally,
    employees at Progressive, over 10 years         even before a program starts. Word of
    80 percent of the employees participated        mouth often is the best marketing device.
    at least once; 60 percent did so at least      Ask people what they want and give it to
    twice and 40 percent at least three             them: A needs-assessment survey builds a
    times. So, given the chance, most               sense of anticipation and excitement that
    employees eventually will participate.          can help increase participation. Failure to
   Systematically triage and funnel                understand the needs and interests of
    workers identified as being at higher           potential program participants will almost
    risk into appropriate follow-up                 assure low program participation.
    programs.                                      Make the program fun: People enjoy
   Encourage individuals to participate            doing what’s fun. Use balloons, flowers and
    in multiple programs: This is a key             music to create a festive atmosphere for
    success indicator. At Progressive,              health fairs or health-screening activities.
    individuals who took part in programs          Provide incentives: Well-conceived
    multiple times over a nine-year period          incentives can be expected to increase
    had lower health care costs. For those          program participation rates by 12 percent to
    who participated in zero to three               35 percent. Incentives also can encourage
    programs during that period, health care        the completion of or attendance at multiple
    costs rose 7.8 percent annually. Those          program sessions and help participants
    who participated in four or more                adhere to long-term behavior change.
    programs saw health care costs decrease
                                                   Publicize the program in different ways:
    1 percent annually — a total savings of
                                                    Use multiple upbeat methods to promote the
    nearly $4 million over the nine years.
                                                    program to potential participants, including
   Measure and evaluate: “You can have             bulletin boards, pamphlets, payroll inserts,
    the finest program with the best science        voice-mail messages, electronic billboards,
    and motivated program managers, but if          etc. A creative program name and logo will
    you don’t have measures to document             help to create a positive image that can help
    the program impacts, in many ways               increase utilization.
    you’re wasting your money,” says               Wow, the boss is doing it! Small business
    Goetzel. “Eventually someone is going           owners or top managers who participate in a
    to ask ‘Does this work?’ Unless you             program encourage others by their example.
    have the data to support that it is             The general manager for a large refinery in
    working, both in terms of improving             Joliet, Ill., frequently told employees that
    health and potentially saving money,            anyone could talk with him while he is on
    you’re going to have a hard time                the treadmill where he works out virtually
    justifying the program.”                        every morning. Cultivate support from all
                                                    levels of management.
Tips to Increase Participation                     Remove barriers: Make health promotion
    Here’s some advice from the Partnership         and related activities easy to sign up for and
for Prevention on how to increase employee          conveniently located.
participation in health promotion programs:        Provide program choices: Don’t just offer
 Involve people in planning: Ensuring              a group smoking cessation program. Also
    good participation starts with the              offer guided self-help programs such as
    program planning process. Broad

HEALTH INK & VITALITY COMMUNICATIONS                                                           17
    video or audiotapes and workbooks that         participants liked best about the program,
    employees can use privately.                   what they liked least and also solicit
   Ask how you are doing: Routinely               suggestions for program improvements or
    measure program participants’                  new topics to address.
    satisfaction with the program content,        Why not? Ask some of the people who do
    instructors, logistical arrangements and       not participate, why not? Their answers can
    other program components. A simple             help formulate strategies to help ensure
    evaluation can determine what                  participation of non-participants.22

HEALTH INK & VITALITY COMMUNICATIONS                                                        18
                          Basic Components of
                        Health Promotion Programs
Following are some of the initiatives            6. Offer interactive services such as personal
included in corporate health promotion              menus for access to health encyclopedias.
programs:                                        7. Offer special topic-targeted supplements:
                                                    These enable employers to address special
Newsletters and Other Health                        needs within their organizations, such as
Education Materials                                 self-care cost containment programs,
Newsletters are an affordable first step and        chronic conditions, substance abuse issues,
an ongoing foundation for corporate                 productivity and seniors’ health.
wellness efforts. Newsletters or magazines
can combine news about company programs          Health-Risk Assessments (HRAs)
with general interest articles on timely         These gauge risks, health history and readiness
health topics. A wealth of print, online and     to change. Generally offered to employees on a
video materials also is available, including     voluntary basis, HRAs are the key to identifying
self-care guides, self-management advice         the health and lifestyle status of your workers.
for persons with chronic conditions and          They also provide immediate confidential
instruction sheets on wellness topics. Such      feedback that can get people thinking about their
educational tools can heighten awareness,        lifestyles and how choices they make affect their
enhance personal performance and reduce          health. By building such awareness, health
costly health care utilization. Such             assessments are the first step in encouraging
communication materials:                         employees to maintain their healthy lifestyles
1. Send a positive message: Employees            and to take positive steps to improve their health
     receiving such materials notice and         status.
     appreciate their company's concern for          Focusing on behaviors that people can
     their health and well-being and that of     change, assessments cover such areas as activity
     their families.                             and exercise; alcohol use; back care;
2. Educate people to make better health          demographics; driving; eating habits; height,
     decisions: As we ask people to take         weight and body frame; mental health; screening
     greater responsibility for their health,    exams; screening values; self-care skills;
     health and wellness communications          smoking/tobacco use; stress management;
     help them make better informed health       weight control; family history of chronic
     decisions, then reinforce such decisions    disease; and readiness to change.
     regularly.                                      When employees retake these assessments in
                                                 subsequent years, they receive comparative data
3. Enable companies to reach each
                                                 that illustrate how much or how little progress
     employee’s unique health interests:
                                                 they are making toward healthier lifestyles and
     To ensure that there's something for
                                                 reduced risk. Whether it’s the first or umpteenth
     everyone in each issue, most newsletters
                                                 time an employee has taken an HRA, the
     address a variety of important wellness
                                                 assessments reinforce positive scores; compare
     topics in each issue.
                                                 the individual to others of the same age and
4. Offer visual appeal: Bold formats are         gender; highlight each individual’s main health
     attractive and inviting to readers, both    risks; outline the benefits of changing risky
     employees and insured dependents.           habits; and suggest positive steps to take
5. Reach readers at home: This is where          immediately. Employees also are alerted to any
     health issues and health decisions occur.

HEALTH INK & VITALITY COMMUNICATIONS                                                            19
health conditions that warrant a doctor’s          Focused interventions: Phone-based and
prompt follow-up.                               on-site wellness coaching and mail-based
    Meanwhile, employers receive an             educational programs on lifestyle and chronic
aggregate data report on their workforce.       disease management issues targeted to risk level
The StayWell Company’s management               and tailored to individual needs. Intervention
reports, for example, highlight:                programs with health educators can include:
 Risk factors: Reports identify five            Weight management
    primary risks in the total workforce and     Nutrition
    among high-risk individuals, who — as        Exercise
    we have seen — usually cost more to          Stress management
    cover. The reports also outline the          Self-care
    degree of readiness to change at each        Smoking cessation
    risk level, which is key information for     Blood pressure management
    targeting behavior-change programs.          Cholesterol management
 Avoidable costs: Based on the                  Adult asthma
    company’s risk profile, the report           Type 2 diabetes
    estimates the direct health care costs,      Coronary artery disease
    indirect costs (such as absenteeism and
                                                 Hypertension
    low productivity), total costs associated
                                                 Chronic heart failure
    with behaviors that people can change,
    and the potential savings from reducing      Back care/occupation ergonomics
    risk.                                        Chronic disease self-management
                                                 Online services: Intranet or Internet-based
 Recommendations: By identifying the
                                                    health improvement tools include HRAs,
    most costly health issues and the degree
                                                    health and self-care information,
    of readiness to change, recommenda-
                                                    personalized health news and customer-
    tions are geared toward creating the
                                                    specific resources.
    greatest benefit for employees and the
    company. To control health costs and         Onsite services: Health screenings, health
    improve well-being, recommendations             fairs and events, campaigns and fitness
    might include behavior-change                   center management.
    programs for high-risk individuals,          Telephone services: Toll-free help lines
    education programs to increase                  employees can call for informational
    individuals’ readiness to change and            support, guidance and encouragement to
    organization-wide health promotion              motivate healthy lifestyle change.
    programs to motivate people to consider      Fitness center enrollment and
    the benefits of improved behaviors.             individualized fitness programs.
    Armed with such information,                 Single-session workshops
interventions and incentives can be targeted
                                                 Intensive group and self-study education
and the effectiveness of an employer’s
program can be closely monitored.                Periodic general and specific health
Health-Risk Assessment Follow-up                 Safety training
Once an initial assessment identifies a          Program management: Your health
company’s needs, various health promotion           promotion partner can help with program
programs can be implemented. These                  design and development, marketing,
include:                                            promotion, implementation management
                                                    and evaluation.

HEALTH INK & VITALITY COMMUNICATIONS                                                         20
Some elements of health promotion                contribute to the overall cost-effectiveness of an
programs can be hard to track, such as the       established health promotion program,”
percentage of employees who read a               Edington says. “Newsletters, bulletin boards and
newsletter or take part in a fitness activity.   telephone numbers are all part of maintaining
In an early UAW-GM study, the recorded           low-risk employees and creating an overall
cumulative participation rate after three        environment that keeps healthy lifestyle and
years was just 40 percent. But when              quality-of-life issues in front of people all the
employees responded to a randomly                time.
administered survey, self-reporting pushed           “They are a way to improve knowledge,
that percentage to over 80 percent.              awareness and attitudes, and once people move
    “These nontrackable components               through those these phases, you get behavior
provide an important benefit and likely          change.”

HEALTH INK & VITALITY COMMUNICATIONS                                                            21
The average annual health insurance              productivity, wellness programs represent a
premium in 2000 was $2,655 for single            significant, cost-effective tool.
coverage and $6,772 for family coverage in           Therefore, companies that purchase
private-sector companies, according to the       insurance plans, says Kenneth Sperling, health
Agency for Health care Research and              care practice leader at Hewitt Associates’
Quality. Those levels represent increases of     Norwalk, Conn., should select health plans that
33.3 percent for individuals and 36.7            have adequate disease management capabilities,
percent for families since 1996. Despite         since that can result in lower premiums based on
these increases, the percentage of private-      claims experience.
sector companies that offered health
insurance also increased, from 52.9 percent
to 59.3 percent. As a result, almost 90          “Those who don’t make time
percent of all employees worked for                for wellness will be forced
establishments that offered such coverage,
compared with 86.5 percent in 1996.23
                                                      to take time for illness.”
    Given such cost and participation
increases, it has become increasingly urgent         Likewise, Sperling says, the growing number
for both employers and employees to seek         of self-insured companies now have few options
ways to curb the spiraling cost of health        beyond health promotion programs.
care, which continues to significantly               "How am I possibly going to beat the
outpace inflation.                               inflationary trend if I don't manage the claims?"
    “Those who don’t make time for               he wonders. "In one sense, the market is driving
wellness will be forced to take time for         toward health promotion because that is all we
illness,” Jeff Null, manager of Dow              have left other than prescription drug strategies
Chemical’s South Charleston, W. Va.,             and cost sharing. Cost sharing changes the way
fitness center, asserts in the National Safety   the pie is divided up, but disease management is
Council’s Safeworker.24                          one of the biggest arrows in the quiver to reduce
    Clearly, as a means to reduce employees’     the size of the pie."
health risks, curb health care costs and
improve employee well-being, morale and

HEALTH INK & VITALITY COMMUNICATIONS                                                           22
                         The Union Pacific Story

Union Pacific Railroad opened its first            offers informational packets on key health
employee fitness center at its Omaha, Neb.,        numbers everyone should know in relation to
headquarters in 1987. It soon began to outfit a    good health, such as:
number of rail cars as fitness centers; the cars    80: Minimum desirable HRA score
would follow crew members who were
                                                    30: Recommended minutes of exercise
responsible for track repair. Since crew
                                                        most days of the week
members who used to live in bunk cars now
get a lodging per diem, Union Pacific has           24: Desirable body mass index
retired its fitness rail cars.                      8: Recommended hours of sleep
    But a program that originally started out          Union Pacific also conducts an active
just for rail workers now has grown to more        information campaign. Ten times a year
than 500 exercise facilities (mostly vendor        workers receive an exclusive Union Pacific
contracted) spread across 25 states. “We           newsletter, Well Workplace. It also produces
believe it’s the largest employer-sponsored        and distributes an on-line newsletter three
exercise program in the country,” says Joseph      times a week that features one or more health
A. Leutzinger, Ph.D., Union Pacific’s director     tips, a health article and news about the
of health promotion.                               company’s health promotion programs.
    That exercise program has remained the         Employees also receive region-specific
foundation of Union Pacific’s health               newsletters, and employees at the
promotion program — but it is by no means          headquarters can see a billboard-type TV that
the only health promotion element. In 1992         delivers about 100 health messages, usually
Union Pacific introduced Health Track, a risk      text messages, every five minutes.
identification/risk reduction program that             During the mid-1990s, Union Pacific also
targets 10 lifestyle risk factors and chronic      implemented a company-wide medical self-
conditions. Last year the company modified         care program. Five years ago it began to
its Health Track program to offer workers a        integrate its health promotion program with its
broader menu of approaches that vary in time,      alertness management initiatives — an
intensity and commitment. The modification         important priority for a company with railroad
is an attempt to reach workers who haven’t         operations. Integrating health into the core
completed a health-risk assessment and also to     operations of the railroad, the company
encourage those who’ve completed an                endeavors to help its employees see the link
assessment to do so regularly — every six          between lifestyle habits and fatigue, and the
months or at least annually for those with         critical relationship between health, alertness
identifiable risk factors.                         and productivity. Data still being analyzed,
    So far, 18,000 of Union Pacific’s 50,000       says Leutzinger, shows a relationship between
employees have completed at least one health       some of the risk factors identified through the
-assessment. But Leutzinger notes that is not      health-risk assessment, such as being
the only way employees can interact with the       overweight, and injury rates and severity of
company’s health promotion programs. To            injuries.
build health awareness, it also offers a “Know         The results of Union Pacific’s health
Your Numbers” promotion four times a year.         promotion initiatives have been impressive. In
It conducts presentations, produces videos and     1990 the company concluded 29 percent of its

HEALTH INK & VITALITY COMMUNICATIONS                                                           23
health care dollars were spent on known             health and health care,” says Leutzinger. The
lifestyle-preventable causes. Five years later,     ROI Union Pacific measured was similar to
after implementing several programs to              the results of other peer-reviewed, published
provide employees and spouses with                  self-care initiatives: a benefit-cost ratio of
assistance in reducing their respective risk        $2.77:$1.
factors, just 24 percent of the railroad’s health       It all adds up. Union Pacific also recently
care costs were related to poor lifestyle habits.   used the HERO database to project its health
Data just in indicates such habits contributed      care cost increases over the next 10 years
to only 19 percent of Union Pacific’s 2001          based on changing demographics and risk
health care costs.                                  factor profiles. The study tested four different
    The self-care program, meanwhile, was           scenarios. They ranged from what would
designed to help workers understand when it’s       happen if the company eliminated its health
appropriate to self-treat conditions, rather than   promotion program, to achieving a 1 percent
going to a doctor or emergency room, and to         annual reduction (or 10 percent total reduction
make sure that when they do visit a doctor          over the 10-year period) in total risks. The
they make the best use of that visit by being       result: a $77 million difference between
prepared for it. “We’re simply trying to make       eliminating the program and cutting risks just
the employee a more proactive consumer              1 percent per year, which, Leutzinger notes,
when it comes to his or her own personal            Union Pacific has been achieving.

HEALTH INK & VITALITY COMMUNICATIONS                                                             24
                             The Northeast Utilities Story
Northeast Utilities (NU), New England’s          lifestyle habits. Between 1998 and 2000,
largest utility company, won a C. Everett        4,125 individuals at NU participated in the
Koop National Health Award for its               HRA. Based on their modifiable health risks,
WellAware programming. 25                        StayWell estimates these participants
    After instituting the program for its        generated $8.8 million in avoidable direct and
employees in 1994, the company analyzed its      indirect costs.
impact on 1996 medical claims. It wanted to          During that same three-year period, 2,577
know:                                            participants completed a second HRA. Their
 Does the program produce a positive            overall average lifestyle score improved from
     ROI?                                        70 to 73, and they also experienced significant
                                                 reductions in risks, including:
 Did the estimates for how much the
     program would save the company jive          31 percent decrease in smoking
     with its actual health claims experience?    29 percent decrease in lack of exercise
 Have initiatives targeted at specific           16 percent decrease in mental health risk
     lifestyle and behavioral risks produced      11 percent decrease in cholesterol risk
     their intended results?
                                                  10 percent improvement in eating habits
    Examining annual per capita health
                                                  5 percent decrease in stress
benefits costs for the years 1992 through
1996, an analysis concluded that — during a          Also, the number of health risks for these
time when most employers were experiencing       repeat HRA participants improved.
per capita health care cost increases of 15      Participants with:
percent to 20 percent — NU experienced flat       less than three risk factors increased 6 percent.
per capita costs. Of the total savings, NU        less than two risk factors increased 9 percent.
experienced a $1.4 million reduction in           six or more risk factors decreased 4 percent.
lifestyle and behavioral claims.
    Conservatively attributing 70 percent, or        Based on the risk reductions of the 2,577
$1 million, of those savings to the positive     repeat HRA participants, StayWell estimated
effects of the WellAware program yielded a       annual savings to NU of more than $1 million.
return on investment of 1.6:1. The C. Everett        While completing an HRA alone has been
Koop National Health Awards concluded            shown to reduce health care costs, NU’s
WellAware’s expected impact on reducing          experience illustrates that completing an HRA
claims would grow greater with time.             and participating in a wellness activity
Broadening participation in programs, the lag    reduces risks even further. For example, NU
between the change in unhealthy behaviors        employees who completed an HRA,
and reduced health care claims for many          participated in at least one health education
preventable conditions, and opportunities to     activity and completed at least 12 weeks of
address high cost claimants all were thought     cardiovascular activity experienced greater
to be factors that could improve NU’s ROI in     risk reductions than those who just completed
the future.                                      a HRA in the following categories: blood
    The first step in participating in NU’s      pressure, cholesterol, eating habits, exercise,
WellAware program is the completion of           smoking and stress.
StayWell’s HealthPath Health-Risk                    Finally, NU’s program illustrates the
Assessment (HRA). The HRA provides an            effectiveness of telephone-based
assessment of important health risks that        intervention programs for workers at high
participants can reduce through changes in       risk in two or more health areas.

HEALTH INK & VITALITY COMMUNICATIONS                                                         25
1 Healthy Workforce 2010: An Essential Health Promotion Sourcebook for Employers, Large and Small.
Partnership for Prevention. Fall, 2001. Page 3.
3 Aldana, Steven G. "Financial Impact of Health Promotion Programs: a Comprehensive Review of the

Literature" in American Journal of Health Promotion, May/June 2001, Vol. 15, No 5: 296-320.
  Healthy Workforce 2010: An Essential Health Promotion Sourcebook for Employers, Large and Small.
Partnership for Prevention. Fall, 2001. Page 5.
5 Health Enhancement Research Organization,
  Golaszewski, Thomas. "Shining Lights: Studies That Have Most Influenced the Understanding of Health
Promotion's Financial Impact" in American Journal of Health Promotion, May/June 2001, Vol. 15, No.5:
  Anderson, David R., Seth A. Serxner and Daniel B. Gold. "Conceptual Framework, Critical Questions,
and Practical Challenges in Conducting Research on the Financial Impact of Worksite Health Promotion" in
American Journal of Health Promotion, May/June 2001, Vol. 15, No.5: 281-288.
  Healthy Workforce 2010: An Essential Health Promotion Sourcebook for Employers, Large and Small.
Partnership for Prevention. Fall, 2001. Page 5.
9 Healthy Workforce 2010: An Essential Health Promotion Sourcebook for Employers, Large and Small.

Partnership for Prevention. Fall, 2001. Page 6.
   Lippman, Helen. "Healthier Communities on the Horizon" in Business & Health: The State of Health
Care in America 2002, The Business and Health Institute:38,40.
   Edington, Dee W. "Emerging Research: A View From One Research Center" in American Journal of
Health Promotion, May/June 2001, Vol. 15, No.5: 341-349.
12 Ibid.
   Aldana, Steven G. "Financial Impact of Health Promotion Programs: a Comprehensive Review of the
Literature" in American Journal of Health Promotion, May/June 2001 Vol. 15, No 5: 296-320.
   Goetzel, R.Z., T.R. Juday and Ronald J. Ozminkowski. "What's the ROI? A Systematic Review of
Return-on-Investment Studies of Corporate Health and Productivity Management Initiatives." AWHP's
Worksite Health. 1999;6(3):12-21.
17 Healthy Workforce 2010: An Essential Health Promotion Sourcebook for Employers, Large and Small.

Partnership for Prevention. Fall, 2001. Pages 6-7.
19 Healthy Workforce 2010: An Essential Health Promotion Sourcebook for Employers, Large and Small.

Partnership for Prevention. Fall, 2001. Page 4.
20 Healthy Workforce 2010: An Essential Health Promotion Sourcebook for Employers, Large and Small.

Partnership for Prevention. Fall, 2001. Page 5.
21 Edington, Dee W. "Emerging Research: A View From One Research Center" in American Journal of

Health Promotion, May/June 2001, Vol. 15, No.5: 341-349.
   Healthy Workforce 2010: An Essential Health Promotion Sourcebook for Employers, Large and Small.
Partnership for Prevention. Fall, 2001. Page 29.
   Agency for Health care Research and Quality, "Health Insurance Premiums Rose More Than 30 Percent
Between 1996 and 2000," AHRQ press release, September 12, 2002.
   National Safety Council, Safeworker, August 2002.

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