people in bike and pedestrian lanes The most well-intentioned well-being programs are oftencookie cutter, offering canned solutions that are not personalizedto each individual and their unique lifestyles. (Photo:Shutterstock)

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We've all heard the adage, "No two snowflakes are alike." Thisrings true even for well-being programs and is a critical factor toconsider when deciding what type of program is right for youremployees. Every person is on a different journey to better healthand well-being, and this is why generalized and oversimplified programs miss the mark, becausethey are not targeting those who could benefit the most.

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Context is key, as one cookie cutter program does not reflectthe concept of well-being as a whole.

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For example, a 22-year-old female who spends her free timecompeting in CrossFit events will not have the same well-beingneeds as a 55-year-old male who is obese and has high bloodpressure. It simply doesn't make sense to think that the samewell-being program would work for both.

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Related: 10 unusual approaches to improving employeewell-being

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While a recent study published in the Journal of theAmerican Medical Association (JAMA) indicated that generic wellnessprograms do not work, the specific program components must beconsidered. The most well-intentioned programs are often cookiecutter, offering canned solutions that are not personalized to eachindividual and their unique lifestyles. So, what does it take tofind success with well-being programs?

How we even define a "well-being program"?

According to RAND, well-being programs are classified basedon whether or not they offer each of three services:

  • Screening to identify health risks
  • Lifestyle management services to reduce risks throughencouraging healthier behavior
  • Disease management services to support people who already havechronic conditions

The Kaiser Family Foundation and Health Research and EducationTrust (HRET) follows a different definition. A 2015 Employer Health Benefit survey conducted byKaiser and HRET found that well-being programs are most commonlyassociated with "tobacco cessation," "weight loss," and/or "otherlifestyle or behavioral coaching."

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This variance in definitions makes it difficult and confusing tounderstand what an organization means when it says it offers a"well-being program." Does it mean they just offer screenings,fitness programs, lifestyle management, disease management,condition management, or some combination thereof?

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Too often, well-being programs are broadly generalized based onpreconceived norms and targeted at the employee population inaggregate. This is counterintuitive because individual well-beingcannot be generalized. It doesn't boil down to just onestandardized measure, such as how much one person weighs comparedto another. We must remember that an individual's well-being isall-encompassing and includes sleep, diet, exercise and stress—allof which feed into holistic well-being and are based on uniquecircumstances. What works for one person will not necessarily workfor another—a true well-being program must cater to eachindividual's lifestyle. Not the other way around.

Disease management v. lifestyle management

To understand where well-being programs are coming upshort, we should also break down two of the most common types ofprograms: lifestyle management and disease management. Lifestylemanagement focuses on employees with health risks, such as smokingand obesity, and supports them in reducing those risks to preventthe development of chronic conditions. On the other hand, diseasemanagement is designed to help employees who already have a chronicdisease. This could mean, for example, reminding them to take theirprescribed medications or improving communications with theirphysician. While the two focus on different aspects ofwell-being , they are often still pigeon-holed under thesame "well-being " umbrella.

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A 2014 RANDwell-being program study that assessed PepsiCo'sprogram highlights why these two formats should be treateddifferently. Called "Healthy Living," the program offered separatechronic disease management and lifestyle managementinitiatives.

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RAND found that the combined disease management and lifestylemanagement programs showed a return of $1.50 for every dollarinvested in the program. However, the individual returns for theseparate programs were quite different, with disease managementshowing an ROI of $3.80, while lifestyle management had an ROI of$0.50.

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While 87 percent of participating employees were in thelifestyle management program and 13 percent were in diseasemanagement, 87 percent of the total health care cost savings camefrom the disease management program. Even with more employeesparticipating in the lifestyle management program, diseasemanagement is where the majority of health care cost savings camefrom. Essentially, it's not about the volume of a program or itsparticipation rates—it's about looking specifically for the rightvolume.

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This is a great example of how personalization based onindividual context and circumstance can lead to a successfulwell-being program with ROI. Once PepsiCo's programaccounted for targeted approaches for those considered high-risk,it really made a difference.

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A 2018 Illinois Workplace Wellbeing study also proved thatwhen generic well-being solutions are offered toeveryone—and not focused on the right people—they will not generatereductions in health care costs or improvements in healthbehaviors. The study evaluated a workplacewell-being program that was available to 3,300 Universityof Chicago and University of Illinois at Urbana-Champaignemployees, and researchers did not see changes after one year.

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"The lack of first-year cost savings should not be surprisingsince the study focuses on health screenings andwell-being activities such as fitness, stress management[and] smoking cessation for all employees rather than targetedstrategies for employees diagnosed with costly chronic conditions,"LuAnn Heinen, vice president at the nonprofit National BusinessGroup on Health and director of the group's Institute on Innovationin Workforce Well-Being, explained to SHRM.

Enter, condition management

In addition to lifestyle and disease management, conditionmanagement has emerged to introduce a third variation ofwell-being program. It emphasizes a specific group ofpeople who sit between healthy and sick—and, who make up themajority of health care spend. That's because many employees whoare "in the middle" demonstrate a combination of risk factors thatincrease the likelihood of costly chronic conditions and can resultin catastrophic health claims if they're not intervened withprior.

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Condition management blends the best qualities of lifestylemanagement and disease management. Like lifestyle management, itfocuses on changing habits to reduce the health risks that can openthe door to chronic conditions. This is the key to reversal ornormalization. Simply having the goal of taking medication orfollowing up with a doctor will not change the individual, it willonly control the symptoms. Condition management is focused on avery specific cohort of high-risk individuals and tailored to theirspecific needs and circumstances, which, as shown in the PepsiCostudy, is proven to drive ROI.

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A good condition management program includes guidance onnutrition, exercise, sleep and stress management, but how thoseareas are prioritized should depend on the individual. One of thekey implications of applying a lifestyle management program to atargeted group of people is that your implied goal is to change ormodify behavior to achieve outcomes. The goal is not to get anindividual to comply or adhere with medications or other externalfactors.

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The inherent suggestion is that if a condition managementprogram can change the behavior of a particular person, thencertain risk factors can be reversed or normalized, which couldalso reduce health care costs.

Helping employees and the company bottom line

Overall, employers must focus on the specific goals of theirwell-being programs. Do you want to deliver an employeebenefit that's suitable for everyone in the company? Or, do youwant to actually better the health of employees who need it mostand generate ROI? This single question is key to determining thecorrect metric to assess a program. If you are trying to generateROI, or affect claims cost, a one-size-fits-all program is not theanswer.

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The Pepsi study demonstrated that applying a focused solution toa group of people with specific needs is a critical element to anysuccessful well-being program. When you combine riskstratification with lifestyle programming (sleep, stress,nutrition, exercise) you can do more than simply manage acondition—individuals can normalize or even reverse certainconditions.

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This is what makes condition management, in particular, sovaluable. When employers can deliver solutions that are enhanced bybehavior modification, tailored closely to the individual, andoffer real-life skills to incur long-lasting and positive changefor employees, organizations can achieve value on theirinvestment.

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 Joe Marullo is vicepresident of analytics and operations at Zillion. For morethan a decade, Joe has been helping companies mine and utilize dataanalytics to support strategy development and operational planningand execution. At Zillion, he and his team work to betterunderstand what works best for customers, channel partners andmembers in improving health outcomes and reducing relatedcosts. 

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