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How cost-effective are workplace wellness programs? The debate over lifestyle management vs. disease management in wellness programs

Billions of dollars are spent each year on employee wellness programs, but the cost effectiveness of these programs is debated in a study from the Rand Corporation

Most employee wellness programs consist of two major areas: lifestyle management and disease management. While lifestyle management wellness programs - aimed at reducing risk factors such as smoking and obesity - typically show less immediate results, disease management programs – focused on preventing high-cost hospitalizations and ER visits - show a stronger return on investment (ROI).   

The Wellness Programs Study from the Rand Corporation, which included almost 600,000 employees at seven different employer organizations, shows that the two programs combined reduced an employer’s average healthcare cost by approximately $30 per member per month (PMPM), but that “disease management accounted for 87% of those savings.”

The discrepancy between the ROI between lifestyle management and disease management might be attributed to the fact that wellness programs typically attract people who are already (at least relatively) healthy, thus the short-term savings may appear low. 

Lifestyle management and wellness programs would show a greater financial impact if these were focused on attracting people who already have chronic conditions or those at risk for developing a chronic disease. For example, a typical disease management program may focus on the high-cost, high risk diabetes population—those individuals who are incurring hospitalizations. A more rounded program that combines disease management and wellness would also focus on individuals in the early stages of diabetes or those with pre-diabetes. Such programs could focus on prevention and coaching individuals to continue routine testing and treatment for any microvascular complications (i.e., diabetic retinopathy, nephropathy, and neuropathy) but also to participate in lifestyle changes, such as weight loss, medication adherence, blood pressure control, and blood sugar control to prevent progression of macrovascular risk factors like stroke, heart attack, and amputation. 

In the video commentary, “Beware the Silent Population,” Dr. Peter Goldbach discusses how the “silent population” can't be easily identified using claims-based healthcare analytics; these people aren’t healthy and aren’t taking care of themselves but they haven’t yet reached a critical stage and aren’t incurring high cost utilization (such as hospitalizations). If you can’t see them, you can’t engage them to participate in disease management programs, and your traditional wellness programs may not be designed to meet their needs.

Dr. Goldbach advocates that long-term wellness or lifestyle management programs can be extremely beneficial when designed for the right audience. Engagement with the ‘silent middle’ requires a shift in thinking, he says, and must meet individuals in the way they prefer to receive healthcare information.

To learn about the silent middle, check out Dr. Goldbach’s video commentary: https://insights.healthdialog.com/vimeo-all-videos/beware-the-silent-population

Approximately 150 million Americans now live with at least one chronic condition. In order to reduce related symptoms, further progression, and associated treatment costs of chronic conditions, disease management solutions must provide personalized interventions to help individuals better manage chronic diseases. 

Health Dialog addresses both lifestyle and disease management with a Chronic Care Management Solution, a NCQA-accredited Disease Management program that provides a suite of engagement tools to help individuals better manage chronic diseases and reduce costs. Programs range from a basic disease management service that meets NCQA requirements to a more comprehensive total population health management solution. For more information: https://www.healthdialog.com/solutions/chronic-care-management

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