Health and wellness or disease management interventions can result in both productivity and health expenditure improvements. In the U.S., research shows that the ROI for disease management is between $2 and $3 for every healthcare dollar spent. In terms of productivity, depending on what you are measuring and how you are measuring it, the ROI is between $3 and $6.
It is in your best interest as an employer to advocate for the collecting of health claims data. If there truly is an ROI savings of between $2 and $3 for every dollar spent, there is no better lobbyist than the private sector to recoup some of those wealth gains through tax credits and incentives.
Identifying the appropriate population. In healthcare research we know that the biggest determinant of the impact of any intervention is a population’s baseline risk. The higher the baseline risk, the greater bang for your buck.
The same holds true in corporations. A University of Michigan study shows that there is almost a linear relationship between the number of health risks and productivity loss. When one undertakes an intervention on highrisk individuals, productivity improvements are most dominant among those whose health risks are most improved. Therefore health status is the final common pathway to productivity in the workplace.
If we target our interventions most intensively on high-risk populations, we get earlier dividends and start seeing immediate payoffs.
Choosing the appropriate intervention. When you go in with an intervention you are targeting high-risk individuals because they are your costliest group. As employers, your business case is dependent upon a high-risk intervention— putting your dollars into those at highest risk to see early dividends (that is your disease management part). Your health promotion part is keeping people at the low-risk spectrum healthy. You don’t have to burn your cash on people who are low risk. Target the high risk and do something to prevent the low risk from becoming high risk.
Knowledge translation (cost and context). Knowledge translation refers to what the intervention and ROI mean to you. We usually attribute time in lost productivity to cost using the human-capital approach. But the research needs to get into an organization and understand costing at a much more granular level. These are very complex organizational costing initiatives, but it’s where we need to go both nationally and internationally for that knowledge translation to take a personalized, granular approach.
Finally, there’s the issue of context. Health and wellness is not a siloed intervention. What is compelling is the nesting of health and wellness initiatives with employee engagement initiatives. When one looks at health status and stress in the workplace, we see a relationship: poorer health is linked to more stress. There is also an interesting relationship between poorer health and an employee’s desire to embark on stress management initiatives in the workplace, which dovetails nicely into what employee engagement is really about.
What is missing from employee engagement surveys is this: to what extent is employee engagement impacted by health and wellness interventions? Two years ago presenteeism was the buzzword. Presenteeism was associated with a tremendous amount of productivity impairment. Now we are not hearing so much about presenteeism because no one knows what it means to place a dollar value on an employee’s unproductiveness because of his or her health. But presenteeism is actually an individual health metric of employee engagement: to what extent does your health affect your productivity at work?
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A good disease management program should have all the right components, including evidence-based consensus guidelines and reporting-and-feedback loops between healthcare providers, pharmacists and doctors. Ultimately, it rests on information and monitoring systems. A disease management program without the ability to track is useless. You are looking for a program that can track self-reported metrics, biometrics and physiologic parameters. You will need to leverage that against health and drug claims data. The only way to leverage health and drug claims data is to leverage relationships between drug claims providers and government. That is what the future holds in terms of health and wellness in Canada.
Dr. David Atler is chief scientific director of INTERxVENT Canada and a senior scientist at the Institute for Clinical Evaluative Sciences. He is also associated with the division of cardiology and the Li Ka Shing Knowledge Institute of St. Michael’s Hospital in Toronto, and the Toronto Rehabilitation Institute.
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