How is employee wellness supposed to work?

We still haven’t wrapped up our commentary on the Shape Up employer wellness survey. Things got stuck when it came to understanding the opinions employers expressed about health risk appraisals. In order to understand their opinions of HRA’s we need to know their expectations of HRA’s. And, to do that, it’s important to appreciate how health risk fits into the overall picture of employee wellness.

In fact, regardless of your interest in the ShapeUp survey, health risk and the measurement of health risk are so intrinsic to the framework of employee wellness that their deconstruction is essential, especially when so many of the professionals responsible for employee wellness have had limited opportunity to study what health risk really is, and why it is (or isn’t) important.

So this post is the first in a series exploring the role of health risk appraisal and employee wellness.

For starters, here’s the prevailing rationale, adapted from Goetzel and Ozminkowski, that serves as the framework of most employee wellness programs today:

1. Most health problems, and their associated costs, are preventable.
2. Modifiable health risk factors — such as tobacco use, sedentary lifestyle, and unhealthful eating habits — are precursors to many of these health problems.
3. Many modifiable health risks are predictive of higher healthcare costs and decreased worker productivity.
4. Employer sponsored wellness programs can reduce modifiable health risks.
5. Improvements in the health risk profile of a population can lead to reductions in healthcare costs and improved employee productivity.

Important to this understanding of employee wellness are a few other learnings about health risk and their impact on health and productivity:

• The number of health risks an individual has may have greater impact on financial outcomes than the severity of any one health risk. This is especially true for clusters of health risks related to heart disease, stroke, or psychosocial disorders (such as depression and anxiety).
• Keeping low-risk employees low-risk may be a more direct route to health care cost containment compared to trying to improve the risk profile of high-risk employees. This focus on the low-risk, advocated by Dee Edington, is counter to a commonly accepted approach in which high-risk employees are targeted — based on the theoretical efficiency of targeting the 20% highest risk individuals believed to incur 80% of health care costs.
• While it is unsurprising that risk is an indicator of future health problems, it is also is correlated — via mechanisms not fully understood — to near-term health care costs. In other words, one might expect that someone with cardiac risk factors is likely to incur higher health care expenses when they have, say, a heart attack, studies by Goetzel, Anderson, et al have shown that risk factors are associated with higher health care costs even in the near term, before the emergence of full-blown disease.
• In employee wellness, absenteeism and presenteeism are the most common productivity metrics.

The model described by Goetzel and Ozminkowski is not the only rationale for conducting employee wellness programs. It may not even be the best rationale. But as we move forward in the next few posts to understand health risk appraisals — what they do, what they don’t do, and how they are perceived by wellness managers — it is essential to understand modifiable health risk and its role in the proliferation of employee wellness programs.