Canadian HR Reporter

CANADIAN HR REPORTER JUNE 2019 6 NEWS Do wellness investments pay off? Large, randomized study shows mixed results, highlighting challenges of programs BY SARAH DOBSON ARE WELLNESS programs re- ally worth the investment? It's a broad question for a broad issue, but one study has found the gains might not be as hoped. And that could have a lot to do with the ob- jectives of such a program. "If employers were implement- ing these programs in the hopes that they would save money over the first year or two, we don't find any evidence to support that. If they were implement- ing these programs in the hopes of improving employee health behaviours and providing a ben- efit that employees value, we do find evidence to support it," said Katherine Baicker, co-author of the study and adjunct professor of health policy and economics in the Department of Health Policy and Management at the Harvard T.H. Chan School of Public Health in Boston. e issue of wellness and return on investment (ROI) is complex, said Farrell Cahill, post-doctoral fellow at Medisys Health Group and Horizon Occupational Health Solutions in St. John's. "A lot of the papers that come out saying that wellness is of no use means just that that well- ness approach… wasn't specific enough, wasn't tailored enough," he said. "We need to really, re- ally understand that we can't just create a standardized or generic wellness program. Maybe we can look at what are the minimum components — physical activ- ity, nutrition, stress reduction, all of those are important — but to just assume that they're going to change the KPI (key performance indicators), they're going to help with an ROI, they're going to make a reduction in health, and they're going to have people get healthier — you don't even know how many people participate." Randomized trial The randomized trial involved 32,974 employees at a large U.S. warehouse retail company, with randomly selected treatment worksites and control worksites that received no wellness pro- gramming. The 2016 program comprised eight modules focused on nutrition, physical activity, stress reduction, and related top- ics implemented by registered dietitians. e study looked at self-report- ed health and behaviours through surveys, while clinical measures of health were done through screen- ings. It also looked at health-care spending and utilization, and em- ployment outcomes from admin- istrative data. After 18 months, the rates for two self-reported outcomes were higher in the intervention group than in the control group: engag- ing in regular exercise (69.8 per cent versus 61.9 per cent) and ac- tively managing weight (69.2 per cent versus 54.7 per cent). However, the program had no significant effects in other areas: health outcomes and behaviours (including health, sleep quality and food choices), clinical mark- ers of health (including cholester- ol, blood pressure and body mass index), medical and pharmaceuti- cal spending and utilization mea- sures, and employment outcomes (absenteeism, job tenure and job performance). "We were not able to detect any improvements in health out- comes, like blood pressure or obe- sity. Nor in health-care spending, we didn't see any statistically sig- nificant reduction… nor improve- ments in employment outcomes, like reductions in the number of absentee days or increases in ten- ure at the workplace," said Baicker. "It's possible that those effects would manifest after a longer time period, and we've continued to study this population." Different measurements For employers keen to jump on the wellness bandwagon, these results may give them pause, said Zirui Song, co-author and as- sistant professor of health-care policy and medicine at Harvard Medical School. "It encourages them to ask the question: 'Do we know what the return on investment on our in- vestment will be? Do we have evidence of what the effects of the program we are about to purchase are?'" he said. "ese results ought to provide some caution that per- haps in the short run, the changes and the outcomes that they desire may not be realized as easily as they may have hoped." It can really depend on the em- ployer's objectives, said Song. "If an employer values behav- iour change, for example, without necessarily the need to have a re- turn on investment in health-care spending in the short run, then these results might be encourag- ing. Whereas an employer who values savings on health-care costs beyond other potential out- comes may find these results less encouraging." But there are many different types and designs of wellness pro- grams, he said. "(is study is) certainly not a final verdict on wellness programs that might be more targeted to- wards a specific subpopulation or disease condition or outcome... they could certainly lead to differ- ent results when they are designed differently and vary in intensity and implementation." It is hard to know what wellness programs are really accomplish- ing without a randomized con- trolled trial like this, said Baicker. "e type of person who volun- teers to participate in a wellness program may look different — in lots of ways — from the type of person who chooses not to par- ticipate. For example, if you just looked at a company that offers a wellness program, and saw the health of people who participated in, say, the free gym membership compared to people who didn't, and found that the people who participated in the free gym mem- bership are more physically fit, it would be tempting to say, 'Look, the wellness program increased physical fitness,'" she said. "But the type of person who's more likely to take up your of- fer of a free gym membership is probably the type of person who was more interested in exercising in the first place, and might have been going to the gym anyway. And so a lot of prior studies of the return on investment were forced to compare participants to non- participants, and get that poten- tially biased conclusion." One of the problems with well- ness programs is that no one bothers to measure adherence, because most people who fill out surveys are early adopters and al- ready physically fit, said Cahill. "We're not after them, we're not trying to move the needle with them — they're already healthy. We're trying to find a way to see if we can get everybody to par- ticipate. And we should be more worried about the fact that we're getting below 90 or 95 per cent participation than being happy with 30 per cent participation." Tips for employers Employers need to be clear on what the goal of the program is, said Baicker. "Is the goal to save money by reducing health-care spending and reducing absenteeism? Or is the goal to offer a benefit that em- ployees value? ose would lead to very different conclusions." Employers also have to be pa- tient, according to Cahill. "ere has to be a realistic ap- proach of what the culture will adopt… you have to take baby steps, if you will, to try to under- stand what you actually need. You have to try to find a way to cus- tomize your wellness to accept- able components that you think will actually help you, and then try to increase more and more of it as it becomes more applicable to your workforce, and the more you understand it." If, for example, there's a prob- lem around ergonomics, then that's a place to start, he said. "We're going to look at those workers that are experiencing those types of injuries and build wellness specifically around that to reduce the injuries, to reduce the cost that's actually coming out of your pocket. And then we'll have made a shift where wellness will be useful, it will help prevent injuries, and will help to be able to mitigate the injuries that are tak- ing place," said Cahill. "If it's specific in that way, well- ness works. But if wellness is going to be something that you're just going to try to sell a large com- pany, and the company is basi- cally buying it because they think, 'Well, it's good,' you're going to de- stroy what wellness really can be." e program needs to factor in the work environment, said Ca- hill. "People who work in the off- shore oil and gas industry cannot be treated the same way as people that work in a warehouse, or peo- ple who work for companies like Tim Hortons… they all have to be treated specifically based on their occupation." Connecting with participants is also key. e wellness program used in the study had a lot of outreach, said Baicker, includ- ing emails, physical posters and on-site registered dietitians. e latter is an important component in having great people employees can talk with, she said. "There was a nice in-person component that I think was prob- ably very important to encour- aging participation and helping implement the programming." Having people on site is critical, said Cahill. "One-on-one is the best ap- proach… there's a more mean- ingful interaction going on. And they're able to make sure that they're getting help rather than trying to read the material." And if that's not possible, a vir- tual portal can help in having hu- man beings to coach and support employees, he said. "If we can virtually communi- cate with them, we get a lot fur- ther than me giving them a web- site to maybe look at." "If an employer values behaviour change, without the need to have a return on investment in health-care spending, these results might be encouraging."

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