PHA Executive Director Fred Goldstein to present at 2014 HERO Forum

PHA Executive Director Fred Goldstein will present at the 2014 HERO (Health Enhancement Research Organization) Forum, which takes place Sept. 29 through Oct. 3 in San Diego.

Goldstein will be part of the panel Wellness, Social Media/Technology and Compliance on as part of the Innovators Workshops, on October 1, at 1:30 pm, to the more-than-400 employers, employee health management providers, industry professional organizations, and research experts who are expected to attend the HERO Forum.

“There is a “dark side” of mobile health that is rarely discussed,” said Goldstein. “While there is great enthusiasm for m-health and the data derived from these devices and apps; the use and potential abuse of this information has far outpaced current laws and regulations. Our panel will be exploring these issues, by presenting real life examples of the unique legal and compliance challenges brought on by the meteoric rise of technology clashing with the realities of the law as well as the objectives of the Affordable Care Act.”

The other panelists are Jim McSherry, Enquiron; Truth Fisher, Employment Law Attorney, Advisors Law Group, LLP; and Glen Nebel, Health & Welfare Employee Benefits Attorney, Advisors Law Group, LLP.

“The HERO Forum attracts the top minds in employee health management and gives employers a platform to ask questions of noted experts, to share experiences with other employers, and to learn about the latest research and trends in employee wellness,” said Jerry Noyce, president and CEO of HERO. “We’re thrilled to have (EXECUTIVE NAME) on our esteemed lineup of presenters this year.”

Goldstein is the Founder and President of Accountable Health, LLC. He has over 25 years of senior management experience in the health care industry encompassing Disease Management and Wellness, HMO, hospital and physician group operations, strategic planning, mHealth, marketing, product development, network development, and government affairs. He received a BA in Zoology from U.C. Berkeley and an MS in Health Care Administration from Trinity University in San Antonio Texas.

Registration information and a complete agenda for the HERO Forum can be found online at www.the-hero.org, or by calling HERO at 952-835-4257.

PHA strengthens its portfolio on data and analytics for Population Health Management

PHA Forum Logo Final-01Over the past couple of years, the Population Health Alliance have been actively following and researching the trends on data and analytics and their impact on population health management programs.

2014 has proven a fertile year in this field, and we want to make sure you do not miss out on the upcoming opportunities to learn from thought leaders on the data and analytics camp.

 

Join us for the FREE Webinar: Improving Population Health Value through Advanced Analytics

Speaker: Christopher Coloian, President and CEO of Predilytics, Inc.

October 2, 12 Noon, Eastern Time

As part of the Population Health Alliance’s PHM Virtual Brown Bag Series, Predilytics, a PHA member and a leader in advanced analytics, will discuss how consumer preferences, engagement, and conditions can be derived from data elements, spanning consumer, demographic, financial, and clinical sources.

Learn more and register today

 

Check out the PHA Forum 2014’s track “Analytics to Action for Providers and ACOs”

The Analytics to Action for Providers and ACOs track shows examples of how to turn big data into better health outcomes. It showcases real world examples of how the appropriate use of data and analytics is transforming the way healthcare is provided in a multiplicity of settings. Learn how to go far beyond the basics of identification and risk stratification to use data for the new levers of population health like provider and consumer engagement, payment methodologies, care settings and other actionable insights.

View the Track’s Presentations and Speakers

 

Exhibit at the PHA Forum 2014 Solutions Zone’s ‘Data Stream’ neighborhood

To fully realize the benefits of HIT for population health, we must focus on new models that maximize efficiency, encourage rapid learning, and protect patients’ privacy. Showcase hospitals as healthcare data HUBs; big data trends and tools for accessing information in real time; security innovations; storage solutions; predictive analytics; medical interoperability; wireless infrastructure.

Learn more and apply to exhibit

 

REGISTER for the PHA Forum 2014

 

Check out the Population Health Management Journal, best source for peer-reviewed articles on PHM

By Fred Goldstein, Population Health Alliance Executive Director

JournalPopulation Health Management has become one of the hottest topics in health and healthcare. It is the cornerstone of our work at the Population Health Alliance, and of that of our members. As the field expands, and we keep pushing for more abundant and more in depth research, the volume related literature grows. We have the best source for peer-reviewed articles on the topic: the Population Health Management Journal, edited by David B. Nash, MD, MBA, and the official journal of the Population Health Alliance.

Read his letter here:

Dear Colleague,

Now, more than ever, Population Health Management is a critical resource for healthcare leaders interested in keeping up with the latest developments in this emerging field. In order to stay ahead of the curve in the post-reform era, it is important to have an in-depth understanding of the latest improvements in delivery systems, care models, and prevention strategies.

Subscribers to Population Health Management enjoy access to articles focused on research that explores the value proposition for prevention and wellness activities, and describes innovative practices and strategies to promote patient engagement, including collaborations between employers, insurers, and community-based agencies focused on improving the health of Americans.

We are proud of the Journal’s success as documented by our rising Impact Factor, publication of groundbreaking research that has been cited in such prestigious media outlets as The Wall Street Journal and The New York Times, and a marked increase in the number of full-text article downloads from the Journal website. Our articles are cited on Capitol Hill and make their way into House and Senate testimony. The Journal is a recognized leader in organizing the healthcare system for the future, in a world characterized by transparency and public accountability.

The Journal welcomes diverse submissions, including research-based articles, articles on specific topics in the field, roundtables and perspective pieces. We are looking for high-quality, innovative submissions from the spectrum of healthcare stakeholders. We want to be a voice for the growing field of population health management.

As Editor-in-Chief and Dean of the Jefferson School of Population Health, I have always believed in the power of collaboration. I hope you will join me in being a part of the solution to our nation’s healthcare ills by subscribing or contributing your work to Population Health Management.

Yours truly,

David B. Nash, MD, MBA
Editor-in-Chief

 

 

 

 

 

 

 

 

 

DPS Health and Kognito to present at the PHA Population Health Management Framework Webinars

PHA Members Kognito and DPS Health will present complimentary webinars in September about tapping virtual humans to drive behavior change and improving the health of those with moderate risks, as part of the PHM Virtual Brown Bag Series.

The Population Health Alliance, the leader in advancing the principles of population health, today announced September’s lineup of webinar presenters for the Population Health Management Virtual Brown Bag Series: DPS Health and Kognito, on September 4 and 18, respectively.

This FREE webinar series features PHA member organizations presenting on the core components of the Population Health Management (PHM) framework and how they relate to their work and underpin their research in areas of identification, assessment, stratification, engagement, interventions, and evaluation.

On September 4, DPS Health’s webinar, titled Improving outcomes for patients with multiple chronic conditions who are not yet very sick, will be presented by company leaders Neal Kaufman, MD, MPH Chief Medical Officer, and Adam Kaufman, PhD, CEO and President.

The two will talk about how an integrated approach to outreach, education, engagement, activation and intervention improves short-term and long-term business and health outcomes when applied to the Moderate Risk segment of the population. The webinar is taking place on Thursday, September 4, at Noon Eastern Time.

On September 18, Kognito’s Co-Founders CEO, Ron Goldman and Director of Research, Glenn Albright, Ph.D., will present the webinar Conversations that Drive and Sustain Change: Can Talking with Virtual Humans Change Behavior?

The webinar will showcase how Kognito, for the past decade, is tapping emotionally responsive, fully animated Virtual Humans in challenging conversations about health to drive behavior change. The presenters will discuss how conversations that are occurring across the care continuum today can be made more meaningful; the learning methodology that incorporates principles of neuroscience, social cognition and game mechanics into the Kognito Conversation PlatformTM; and demonstrate their ground-breaking technology and evidence-based approach in recent work for health and behavioral health clients.

The webinar is taking place on Thursday, September 18, at Noon Eastern Time.

The webinars are FREE to attend and registration and detailed information for both webinars is available here: http://populationhealthalliance.org/webinars/phm-virtual-brown-bag-series.html

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About DPS Health

Founded in 2004, DPS Health is the leader in moderate risk population health services. The company works with health plans, healthcare providers and employers to identify, engage and impact individuals with, or at-risk for chronic disease reducing disease morbidity and healthcare costs. For more information on DPS Health, visit http://www.dpshealth.com.

About Kognito

Founded in 2003, Kognito is a leader in immersive learning experiences that drive positive change in health behaviors. Kognito’s award-winning online and mobile simulations with virtual humans prepare individuals and professionals to effectively manage challenging conversations about health. Kognito uses a science-driven, research-proven approach and currently has more than 450 clients in education, government and healthcare settings. The company has been recognized for its evidence-based programs, and is the only company with online simulations listed in the National Registry of Evidence-Based Programs and Practices (NREPP). Learn more and access demos at http://www.kognito.com.

Engagement, what was that again…and how do I know it when I see it?

By Fred Goldstein, PHA Executive Director 

Engagement has been on the spotlight for a while. In this new economy and ecology of companies invested in getting their clients to interact directly and constantly with the organizations and among themselves using various platforms, measuring engagement has become the angular rock of business. It has also become ever more elusive. Vanity measures – followers, likes – are no longer enough, and neither investors not customers are fooled by them.

If you are in the health care world, as I am, you know that engagement is paramount. You also know you would like to be able to define it, measure it, understand it, and figure out how it translates into better outcomes for your patients and employees.

It seems as if every organization reports on engagement in a different way, and the time for standardized metrics and homogenous methods has come. In order to define engagement, members of the Population Health Alliance have created a Workgroup on Engagement as part of the work of PHA’s Quality and Research Committee.

They are very happy to hear and receive continuous feedback from the organizations involved in worksite wellness, population health management, and others who are make strides to get engagement right. Get involved by contacting Karen Moseley, PHA Research Director, kmoseley@populationhealthalliance.org or just email me.

For PHA, 2014 is truly the year of engagement.

–       The theme of the annual conference, PHA Forum 2014, is Collaborate + Communicate = Engage.

–       Excelling in Engagement, an educational track at PHA Forum 2014, gathers presentations that discuss in depth engagement as an overall theme, including provider, engagement, health plan member engagement, incentive program design, and engaging the moderate risk population.

–       Engagement again! So, how do we do it?is the title of one of PHA Forum 2014 Walking Learning Labs of the Exhibit Hall, in which organizations will provide hands on demonstrations of how engagement works in real life.

Learn more about the PHA Workgroup on Engagement’s Charge.

The Wait Is Over: PHA and HERO Release Core Metrics for Employee Health Management

For the past two years, PHA has partnered with Health Enhancement Research Organization (HERO) to identify and recommend measures and standards for the assessment of employee health management programs for the employer community.

The employer dashboard covers 7 domains: organizational support, health impact, participation, satisfaction, financial outcomes, productivity and performance, and value on investment. The recommendations have been reviewed by several subject matter experts and are currently under review by stakeholder organizations and public comment.

Read the Program Measurement Evaluation Guide: Core Metrics for Employee Health Management (Executive Summary)

Read the Program Measurement and Evaluation Guide: Core Metrics for Employee Health (Handout)

PHA Forum Logo Final-01Why PHM in the workplace is the new black?

A discussion and in-depth presentation of the core metrics for employee health management and the work of PHA and HERO will be a centerpiece of the Workplace Healthcare and Benefits Institute at the PHA Forum 2014.

Population Health Management (PHM) is changing workplace wellness for the better. The Workplace Healthcare and Benefits Institute, a preconference event of the PHA Forum 2014, will provide HR and benefits managers and employers across the spectrum a solid basis to assess their wellness programs, as well as, for newcomers a review of core metrics, engagement strategies, and comparison of emerging and existing trends in wellness, incentives and more.

Check PHA Forum 2014 Schedule of Events

Register for PHA Forum 2014

 

Want to Contribute to the Industry’s Discussion on Value on Investment?

By Michael Connor, Dr.P.H., Senior Vice President, Alere Health and Bruce Sherman, MD, Medical Director, Employers Health Coalition

The Population Health Alliance (PHA) Quality & Research Committee has identified Value on Investment (VOI) as a key initiative for this year. The goal of this work group is to empower purchasers of population health management (PHM) programs to adopt a comprehensive value proposition, which more broadly captures the business impact beyond healthcare costs.  Initial objectives include defining the scope of the VOI construct and determining a compelling rationale that is embraced by PHM purchasers.

The Health Enhancement Research Organization (HERO) and PHA led a collaborative effort to develop guidelines related to value domains and corresponding core metrics. The VOI model encompasses all of these domains as outputs as well as a broad view of investment or inputs beyond program vendor fees and incentive costs.

The domains are organizational support, participation, health impact, productivity and performance, financial savings and satisfaction. The Organizational Support domain addresses the degree to which an organization commits to the health and well-being of its employees. Participation recommends measures and definitions related to meaningful program interventions. The Health Impact domain covers measures associated with preventable health conditions.  The Productivity and Performance domain provides an employee continuum ranging from absenteeism through optimal performance at work. Financial Health Care Savings incorporates claims data and modeling estimates.  Satisfaction addresses participant and provider perspectives.

Initial reactions have been very positive related to both the domains and the VOI approach. Most stakeholders are intrigued with the concept, and some have enthusiastically volunteered to pilot the process. Others have suggested the need to develop a more compelling business case to discuss with purchasers.  There are clearly data implications related to a broader set of outcome measures beyond the more traditional and narrower focus of financial health care savings.

Work group discussions have questioned whether organizational support is an outcome or rather an input within the VOI framework. Additional considerations have raised the need for a greater focus on participant program engagement as well as assessing program impact on employee engagement at work and other business outcomes.

So what are your thoughts regarding …

  1. What are the barriers to a purchaser acceptance of a broader value proposition and how these can be addressed?
  2. What practical measures and methodologies best assess value components and will be readily adopted?
  3. How do the value domains align with purchasers’ (employers, health plans and government) strategic priorities?

Comment here or email us your thoughts at kmoseley@populationhealthalliance.org

 

CCA Research Priorities for 2014 – Get Involved Today!

After a lengthy process of consultation with members and industry stakeholders, CCA Board of Directors have approved the organization’s 2014 research agenda, with a focus on engagement, value on investment and measure development. The research work will seek to address these issues as they apply across markets and to align with health care policy with an increased collaborative efforts with the CCA Government Affairs Committee.

2014 Research Agenda

In October, the Quality and Research area of CCA began the process to develop and seek comment on a 2014 Research Agenda. This three-step process has provided the opportunity for additional feedback from members.

  1. Hosted a strategy meeting with key Quality and Research volunteers in conjunction with CCA Forum 2013. During this meeting a list of draft research priorities was shared with the group for comment, feedback and potential additions to the list.
  2. Distributed the revised draft list in an electronic survey format to the Quality and Research Committee and the CCA database. The survey asked respondents to prioritize the list based on their own perceptions of the research needs of the industry and the CCA membership, as well as to comment on the areas or suggest topics not on the list.
  3. Summarized the prioritization and comments from the survey and convened a small group of members to use this feedback to develop the final 2014 research priorities list.

With feedback from the first group, a list of criteria was developed for the survey respondents and final prioritization in steps 2 and 3. Criteria included:

  • Important to industry.
  • Important to CCA members.
  • Feasible to accomplish within a reasonable timeframe.
  • Leverages existing research.
  • Potential to influence CCA advocacy efforts.
  • Potential for international relevance.

The outcome of this process is the following proposed list of priorities for Quality and Research in 2014:

1. Engagement (individual and organizational)

I.            Definitions & Measures

i.         What does it mean, within the context of population health management?
ii.          How can it be measured?
iii.           How can it be reported?
iv.           How does it relate to other elements of population health management?
v.          How does health improve engagement within the organization?
vi.           Use and effectiveness of technology

II.            How do you increase Engagement?

i.           Communication
ii.           Culture
iii.            Incentives (Outcomes Based)

2. Value on Investment

I.         What is it?
II.           How is it employed in the industry?
III.           Best practices / empirical evidence of concept
IV.            Case studies
V.           Role of technology

3. HERO-CCA Measure Development

I.          Pilot v.1 measures, survey employers to determine adoption, and update measures
II.            New definitions of health

The 2014 research agenda will seek to address these issues as they apply across markets and to align with health care policy (through the CCA Government Affairs Committee) as much as possible.

We also recommend the formation of a Physician Liaison Group. With the physician as the primary caregiver and bearing the burden of risk in the current health care system, CCA will create an advisory relationship with physician and provider groups for guidance on current research initiatives.

In addition, the CCA Data Advisory Board will continue to work toward final recommendation of the next research study and the requisite funding.

Rand Report on Workplace Wellness: What Employers Must Know (Part II)

Q&A about the Rand Report on Workplace Wellness (Part II)

What Employers Must Know

Read Q&A about the Rand Report on Workplace Wellness (Part I)

Questions and Answers: A Conversation with Soeren Mattke and Hangsheng Liu

How were the final sample sizes (N) determined?

Due to the potential for future publication of the study analysis, we cannot provide additional information that was not included in the final report. However, we can point you to Table B1 (p. 122) in the appendix and to the footnotes throughout the report for sample size data.

In Table B3 (p. 126), we see a column labeled, “Variables Not Balanced After Matching,” but no detailed percentages or averages are stated. Can we see the statistics on the matching variables before and after the match?

None were imbalanced between groups.

Other risk factors (e.g., glucose, blood pressure, alcohol consumption, overall health status, fruit/vegetable consumption) were provided in the data but not included in the report. Why?

There were several reasons. First, due to the length of the report we were unable to include all risk factors. We prioritized the list and analyzed the most common risk factors. Data availability was also a factor.

In the obesity analysis, Figure 4.17 (p. 50) indicates a 14% difference between the participant and nonparticipant rates. How does this relate to a 1-pound reduction?

Using the same regression analysis and underlying sample, we simulated a final analytic sample supposing all participants participated in the program all five years. This simulated hypothetical cohort of participants and nonparticipants was then projected over time. The dichotomy between the actual regression and the simulation makes it difficult to explain how the numbers were derived but provides an elegant way of translating parameter estimates in a nontechnical way. Since the model runs on BMI units, we then assumed the characteristics of a standard man and woman (based on CDC data) and translated the change in BMI to change in pounds. This finding of a 1 pound per year reduction is significant since it represents the average weight loss of participants compared to nonparticipants on a population level (i.e., 1 lb. times the number of participants). Furthermore, participants continued to lose an average of one pound/year in the first and second years after the year of participation.

Regarding the cost analysis (pp. 53-57). a. Is this cohort over the whole time horizon? b. Were outliers excluded? 3. Did you use company cost or company + employee cost?

a. Not all employees were involved for all years.

b. We used 99% threshold for outliers. 3. Analysis was based on allowable claims data, or company cost + employee cost.

Can you explain further the conclusion that incentives were associated with significant improvements in smoking, BMI and exercise, yet the effect size was small (p. 87)? How were these conclusions determined?

The challenge with this estimation was that the employers included in the analysis had little variation with incentives offered, both across employers and within each employer over time. Therefore, we had a large sample size with little variation to run the regression. Figure 5.19 (p. 87) indicates that higher incentives impact reduction in BMI with significant effect. When translated to pounds, we still detect a significant effect. However, given the small effect size and little variation, it is difficult to make a strong statement on the effect of incentives on health outcomes. Furthermore, employers in the sample used incentives for participation only, not outcomes.

Did you adjust for the differences in benefit plans between employers?

No, we did not have access to benefit information, but we did match by employer, candidate year, employee comorbidities, prior utilization and cost. While this limitation could confound the results, the problem should be minimal. One might speculate that analysis of the benefit design might show that the impact was underestimated. This would make and interesting empirical study for future research.

Was there any adjustment for cost differences for the same service in different facilities and regions of the country? For example, an individual living in a high cost region of the country pays $4,000/year with a 6%/year increase, while another living in a low cost region pays half the amount. Even in a difference-in-difference model, the analysis would indicate a cost increase when the % change favors the participant.

Yes, but the analysis matched on baseline cost also. However, this introduces another issue, which is matching on services or on baseline costs, not both. Ideally, the groups would be matched by geographical area, and in one regression analysis geographical region was considered.

How was participation defined? Without a minimal threshold of participation, there may be little to distinguish a participant from a nonparticipant, and thus little expectation of savings.

We used the definition from each respective data contributor, including their definition of minimal threshold, for the comparison group. We did consider the effect that the definition might have on the analysis and assumed program responsibility to engage the participant. With that technique, we arrived at a real-world estimate of the program’s impact. We would like to do further research to include a dose-response curve and examine efficacy of continuous participation.

Was there any attempt to measure presenteeism, absenteeism, or productivity impact other than asking employers what they liked about the program? Do you plan to do so in future research?

We did not have data on presenteeism or absenteeism. However, we would like to have this data for additional analysis. See Section 7.4.2 (p. 109) regarding future research.

Read Q&A about the Rand Report on Workplace Wellness (Part I)

Rand Report on Workplace Wellness: What Employers Must Know (Part I)

Q&A about the Rand Report on Workplace Wellness (Part I)

What Employers Must Know

The RAND Corp Workplace Wellness Programs Study, presented to Congress, brought about much needed discussion and questions about the state of workplace wellness programs, their outcomes, and their long term role in the transformation of our health care system and the attainment of a better health status for all in our Nation. Questions abound on the report, its methodology and its findings. CCA received and studied many of those questions and, on Wednesday June 19, convened a group of researchers and experts to go over the methodology, data and conclusions of the RAND Workplace Wellness Programs Study with the authors.

Soeren Mattke and Hangsheng Liu, senior scientists at RAND, answered the questions received and the follow up clarifications posed by those on the call. The following is a summary of that long and in depth conversation.

Read Q&A about the Rand Report on Workplace Wellness (Part II)

The RAND Corp Workplace Wellness Programs Study, presented to Congress, brought about much needed discussion and questions about the state of workplace wellness programs, their outcomes, and their long term role on the transformation of health care and the attainment of a better health status for all in our Nation.

Did anything surprise you?

I was surprised that the cost curve did not reach statistical significance, due to random noise in the model. Another surprise…high-powered incentives tied to health outcomes are much less common than the literature would have us think. Nine percent of employers use health contingent incentives and use them in modest amounts. Public debate is ahead of the actual state of the field.

Did the study look at all at components – online, in-person counseling, content, classes, support, communications, etc.?

No. The limited time and funding prohibited that level of granularity. Our wish list for future research includes amount of exposure, level of interventions, and level of exposure.

Among the nonparticipants who also receive the benefits of health promotion, a. Is there a motivation selection bias or in fact could the nonparticipants be receiving benefits? b. Could savings, therefore, be underestimated?

a. Yes, there is still the possibility of some bias because it was not a randomized, controlled trial. The difference-in-difference method is powerful in observing those, but we can’t rule out unobservable differences between participants and nonparticipants. It is possible that some nonparticipants were exposed to health promotion activities (e.g., better food offerings, exercise messaging) at the worksite but didn’t participate in personalized counseling program and would not be picked up by the analysis.

b. These estimates, given the research design used, reflect the marginal impact of a lifestyle management component. Changes in environment would impact both participants and nonparticipants, and we would have no way of comparing to other employers to get to that effect.

How does the report affect the current position of wellness in the market? For example, do you feel it does anything to temper the “rosy” expectations that came from earlier meta-analyses?  Will the current data in the report help us to better manage more realistic expectations around workplace wellness?

Some past numbers were too rosy. Look at what wellness programs are doing. It is not unrealistic that cost neutrality is a positive result because these programs are intervening in a workforce population that is not sick. These programs are a preventive effort to avoid future healthcare costs, so if we can get to cost neutrality and better health this is a good result for the industry and the programs.

Given the fact that some of these presentations are somewhat old now, a. What’s your thought about some of the newer strategies/approaches to wellness program engagement, including outcomes-based interventions? b. Were there sufficient data to look specifically at the outcomes-based programs for their impact on healthcare costs?

a. These types of programs remain rare, so there is not enough good data for meaningful statistical assessment.

b. No, there was not enough data and no employers tied to outcomes. A fine line exists between shifting risk and cost to more vulnerable employees and dependents and making employees feel compelled to take advantage of the programs offered. More research and more data are needed to find the right balance between appropriate risk sharing and inappropriate cost shifting.

a. What value do you think there’d be in formulating a clearly established list of wellness-sensitive conditions, so that outcomes can be more specifically studied? b. What about process measures – the outcomes of wellness on use of preventive care services, disease-specific preventive care, and medication adherence?

a. Hard question. In essence, we know many conditions are sensitive to health behaviors. The former surgeon general attributes 75% of healthcare costs to behavior. Many cancers, and potentially asthma and COPD, can be tied to obesity. We must find a way to quantify the strength of relationship in order to call it “wellness sensitive.” To begin to unpack the “black box,” we should define conditions and look more closely at what can be done for a quicker response versus what can be expected to happen later in the process.

b. The more clinical outcomes are better tied to disease management, the better, because that is the intervention strongly tied to medication adherence. There would be value in looking at the use of preventive services, either through employer screenings or healthcare providers, but really only those recommended by USPSTF.

I saw a tweet that approximately says, “…see? Wellness doesn’t work.” I would assume, seeing your presentations, that you would not make such a strong statement. Comment?

Workplace wellness involves complex interventions, and success will always depend on the particular intervention within the particular context and the particular measures of outcomes used. From what we see here, there is clear evidence for a qualitative and meaningful effect on health risks, but no strong evidence for savings of healthcare costs. Here we see a roughly cost neutral intervention that achieves a gain in health risk reduction.

a. What costs were or were not included in the cost analysis?  b. Were there any assessments of costs directly related to the interventions versus costs unrelated to interventions?

a. We included medical and prescription drug costs. We did not have data on work loss, workers comp, disability, etc.

b. We did not analyze whether changes in healthcare utilization were for wellness sensitive conditions. Rather, this was a high level look at overall costs without attempting to attribute at a more granular level. We did, however, take out years in which an employee was pregnant or participating in a case management program for high cost, high-risk conditions.

Can you comment on suggestions for future research?

Future research should seek to get more granular with related versus unrelated costs. Another area to consider is different type of outcomes, like productivity and other work-related impacts. A larger sample size may show significant effect on cost, so more employers in the database and a longer time series may indicate at what difference the curves converge and reach statistical significance. Also, we need to begin to unpack the black box. We can’t assume that all programs are effective or all programs are ineffective, and we need to understand the distinctions, i.e. how do employer (e.g., culture, support) and employee (e.g., health literacy, age, gender, ethnicity) characteristics drive changes so that targeting interventions becomes more effective.

Read Q&A about the Rand Report on Workplace Wellness (Part II)

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