A new study is adding more questions to the debate over the value of wellness programs, with mixed findings from the food and beverage conglomerate PepsiCo.
In one of the first long-term studies of a comprehensive wellness program, RAND Corporation researchers found evidence for cost savings from chronic condition management, but not necessarily that much from lifestyle improvement initiatives -- and there could also be unintended consequences.
"Workplace wellness programs have the potential to reduce health risks and to delay or avoid the onset of chronic diseases as well as to reduce health care cost in employees with manifest chronic disease," concluded three RAND analysts and two health directors at PepsiCo in Purchase, New York, writing in Health Affairs.
Based on a comparison of health plan data from PepsiCo's Healthy Living program, introduced in 2003, and from non-participating employees, the analysts found at least one of the disease and lifestyle programs associated with an average reduction of $30 per member monthly healthcare costs.
However, "When we looked at each component individually, we found that the disease management component was associated with lower costs and that the lifestyle management component was not. We estimate disease management to reduce healthcare costs by $136 per member per month, driven by a 29 percent reduction in hospital admissions," wrote RAND analyst John Caloyeras and colleagues along with PepsiCo's global wellness director Ellen Exum and senior director of health Megan Broderick.
PepsiCo's wellness program includes health risk assessments, onsite events, disease, lifestyle and maternity management, and a 24-7 nurse advice line, eligible to all employees and dependents except for the 10 percent of the workforce enrolled in an HMO through their union.
The disease management program, focused on improving self-care management with nurse coaching, is offered to employees with at least one of 10 chronic conditions: asthma, coronary artery disease, atrial fibrillation, congestive heart failure, stroke, high cholesterol, hypertension, diabetes, low back pain, and chronic obstructive pulmonary disease.
Participation typically ranged from six to nine months, with participants talking with nurses on the phone in short sessions, in addition to a 24-7 call line.
The lifestyle management program, based on the results of a health risk assessment, involve intervention strategies through mailed education resources, online programs, and coaching via telephone. By 2011, the company had five different lifestyle programs for weight management, nutrition, fitness, stress and smoking cessation.
Considering the cost savings and the costs for administering the program, the study estimated the lifestyle programs' return on investment at a combined combined $1.46 for every dollar invested -- $3.78 for disease management programs, but just $0.48 for lifestyle programs.
The study's authors also added several cautions to using this case to make decisions more broadly on wellness programs, whose costs and benefits have been debated amid studies with varying findings.
PepsiCo's programs "might not be generalizable to other organizations, particularly smaller ones," they wrote. "Even if the program they implement is very similar to PepsiCo's lifestyle management and disease management components, key differences in program implementation, design, and promotion to employees may affect results. For example, differences in program design and implementation might affect participation and dropout rates and intervention effects."
The authors also noted that the study did not examine health behavior outcomes, such as increased exercise or medication adherence, or the cost of the program staff, vendor fees, employees' time required for participation, or any costs from false positives found in screening.
More than half of small, medium and large companies are offering wellness programs of some sort, with the rate nearing 90 percent for large companies, according to RAND.
Wellness programs and lifestyle interventions in particular are evolving beyond the health risk assessment and coaching. Aetna is piloting a program for 500 high risk employees with metabolic syndrome, using technology and services from a Canadian startup called Newtopia. The employee will be given online health surveys and tested for genes linked with obesity, appetite, and behavior, and then receive personalized coaching therapies.