Wellness Programs: Well Well Well, Not So Fast

Aaron Carroll, MD, MS and my all time favorite only second to Greg at Digital Tonto deconstructs Wellness Programs based on a review of randomized controlled trials. Carroll points out that Wellness programs are evident in nearly all large employers with 50,000 employees. While at the other end employers with greater then 50 only half offer them. And add to that the fact the ACA expands the use of Wellness programs. Wellness will be very prevelent in corporate America. 

RCT found Wellness programs had no significant impact on HTN, blood sugar, or cholesterol. Another study showed lifestyle programs that identified wight and activity saved little if any money.

Back in 2003 PepsiCo began a Health Living program with data being recently published. This program had two parts, one lifestyle and the other disease management. The way this worked was:

For the lifestyle component, assessments were provided to allow employees and their families to determine if they had risks. Online or telephonic coaching were offered in areas like weight, nutrition, or stress management, fitness, and smoking cessation. The disease management component was available only to employees with 1 of 10 chronic conditions. For 6 to 9 months, employees enrolled in this intervention participated in phone calls with nurses to improve medication adherence and self-care knowledge and abilities.

Here are the results

The overall result, which will please proponents of wellness programs, is that the program reduced health care spending by $30 per member per month, or $360 per year. For every dollar spent, $1.46 was returned in savings. This, of course, sounds great. Who wouldn’t want such a program? But a further analysis showed that things were not so simple. The disease management component accounted for almost all of the savings. Those who participated in that part of the program saw a reduction in health care costs of about $136 a month, or more than $1600 a year. This was driven largely by a 29% decrease in hospital admissions.

In fact, for each dollar spent on disease management, the company saw a return of $3.78. For each dollar spent on lifestyle management, they only saw a return of $0.48. In other words, lifestyle management cost more than they saw in return.

So as Carroll points out disease management works and works well both from a cost and outcome perspective.

Will we see the same type of evidence in the wearable tech sector such as FitBit, no significant impact on outcomes. And further patients with chronic illness consume a huge amount of data online and elsewhere are they doing better at lowering utilization costs since they are part of their own disease management? What Carroll presents here points to the benefits of good, careful, and well planned disease management in conjunction with the patient and a program. 

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