A key component of successfulworksite wellness programs is a deeper understanding of thebehavior you can change, and the behavior you can’t. (Photo:Shutterstock)

A recent study in JAMA showed that a largeworkplace wellness at BJ’s Wholesale Club failed to improveemployee health and deliver ROI. The study looked at the32,000-plus employees of BJ’s Wholesale Club and concluded thatwhile the company’s worksite wellness program did lead to higherrates of exercise and weight management, it did not have an impacton health behaviors, clinical markers of health, health spending orabsenteeism.

In short, the program and others like it was found to be nice,but not cost-saving. This study doesn’t conclude wellness doesn’twork, just that it hasn’t (so far) in this example. Yet mostmanagers shouldn’t be surprised by that when you look at the entirepicture.

ASIS and TOBE matter

As a CEO, I know that any change initiative designed without anunderstanding of the current process, its risks and costs, andpoorly defined improvement goals, is doomed. Successful programsuse data upfront to understand the “As Is” (ASIS), and set changegoals (the To Be, or “TOBE”) based on what the data shows(analytics), and then build a program to meet those goals. This waya business case can be developed before the project begins, todetermine its justification. The initiative should then always bemeasured along the way, so, if necessary, changes can be made toreach the goals. Only then can a final measurement, like the onepresented in the JAMA study, then be conducted to conclude if theproject was a success.

Related: How to secure a wellness program thatworks

It’s not clear whether the BJ’s Wholesale Club wellness programskipped the all important first step — the JAMA study just measuredthe outcome of a program already in place. Unfortunately, this isexactly how most companies have set up their wellness programs. Butthey can do better by following these steps.

Know your cost drivers

You wouldn’t expect a computer company to do an excellent jobsaving money on making computers if they didn’t know the full costof the components they used. You can’t improve what doesn’t getmeasured. And yet, so many companies embark on a worksite wellnessprogram hoping to improve their health care spending by helpingtheir employees with diet and exercise. This is always a laudablegoal, but it may not be a lever to reduce health care spending. Forexample, the employer who sees most of their health care costs comefrom spending on cancer care won’t see savings and ROI from awellness program focused on enhancing exercise; earlier detectionmay be the best course of action.

Get to the root cause of the health problem

Such an employer needs to recognize their population’s healthrisks and actions it can take to reduce them. Then the wellnessprogram can be designed to address those root causes with programslike free cancer screenings or incentives to join a smokingcessation program. Identify the real cost driver and focus onsolutions that specifically address it — that’s how you can getreal ROI.

Let’s look at a similar example. I’ve known employers concernedabout their workforce with a high rate of diabetes. The answer mayseem like it is essential to push lifestyle changes on theseemployees. But maybe if we peel back another layer of the onion atsome of these companies, we will find poor medication or checkupand testing adherence among their diabetic employees. They may beeating better but not taking their much-needed insulin or gettingregular checkups. In this case, a comprehensive wellness programshould also consider a redesign of the prescription drug benefit,and encouragement for routine testing to actively encouragemedication adherence.

Keep measuring

Here is another inside tip: the best worksite wellness programsdon’t stop when they see results. They measure, measure, and thenmeasure again. Over time, they track data – are more diabeticemployees taking their insulin, getting their A1C tests? What otherprogrammatic changes/incentives can be provided to continue toboost the adherence rate?

Focus on “moving the middle”

But even those programs that identify their employees’ healthrisks, measure and focus on the root causes don’t always see ROI orimproved employee health. A key component of successful worksitewellness programs is a deeper understanding of the behavior you canchange, and the behavior you can’t. As a general rule in anemployee population, 20 percent of employees are alreadyevangelical about their health. They eat healthily and see theirprimary care physician regularly. Twenty percent will never change.This is the group that may end up with multiple chronic conditionsand massive impact on your spending. Worksite wellness programsprobably won’t move this crowd; you are better off working withchronic disease management programs.

So the key is focusing on the health risks and opportunitiesamong the 60 percent of the members who fall in the middle. Whatare their major health care spending drivers? What are the rootcauses of these health issues? Then you can tailor your wellnessprogram accordingly. For this “middle of the bell curve” crowd,I’ve found that additional support – like health coaches — candrive behavior change.

Don’t neglect the silent members

Finally, it is important to note that in any employeepopulation, there is often a subset of members who are frequentlyoverlooked. We call these the “silent members.” They have had nosignificant health costs over the last few years because they havenot been in to see a doctor. That also makes some of them a tickingtime bomb. Without that annual mammogram, they are dangerouslyclose to a late-stage breast cancer diagnosis, for example.

When we look at the ROI of worksite wellness programs, we oftendon’t calculate the long-term cost of these “silent members.” Weassume that because they cost nothing last year, they don’t warrantinvesting in this year. We have to look at the statisticalprobability they will have significant health care costs in thecoming years, and then tailor programs that address their risks.This also means that the ROI calculation is a long term game. Itisn’t something that we can measure well year to year.

The JAMA study was no surprise—far too many worksite wellnessprograms don’t deliver ROI, which is why this “debate” continues.But wellness programs can deliver on their promises when employersstart by analyzing their costs and get smart about their wellnessprogram construction. They must then measure it on a regular basis,and meticulously recalibrate the program mid-stream, for the longterm.

JimPritchett is CEO of DHSGroup.

Read more: 

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• 4 trends in employee wellness programs for2019
• Real ROI is hard to find: Valuing employeewellness