Do wellness programs work?

Questions about the efficacy of workplace wellness programs continue to pester employers: Are they worth the investment? Are they a must-have or a nice-to-have? Which initiatives have the greatest impact?

In taking a long-term look at the issue, a recent study provides encouraging results.

Released by Alberta Blue Cross, the study was done in partnership with the Institute of Health Economics and looks at a seven-year period from 2013 to 2020.

It involves an analysis of the impact of the benefit provider’s digital wellness programs on cost and volume of claims, as well as changes to health factors when engaging with the programs. The research also included a sensitivity analysis to control for the impact of the pandemic.

In the end, “measurable improvements” were detected for more than 360,000 of Alberta Blue Cross’s plan members who used the programs across four domains of wellness: respiratory, cardiac, mental and physical health. Programs include online health risk assessments, symptom checkers, online learning and content, wearable tracking devices, mental health support resources, health coaching and guides to manage chronic health conditions.

The institute found that 81.5 per cent of participants experienced improvement across the 30 months following the programs being in place for a wide range of health indicators.

“They are statistically significant improvements,” says Melanie Fuller, director of wellness at Alberta Blue Cross in Edmonton.

In tracking modifiable health risk factors for participants engaging in the platforms continuously, there were “significant changes” in their cardiorespiratory health, their good cholesterol along with improvements in their mental well-being, including stress levels, intensity of moods, the impact of stress, sleep health, pain, and physical well-being, she says.

The study also extrapolated a corresponding 14-per-cent reduction in claims volume resulting from healthier employee populations with reduced plan usage.

Overall, the return on investment occurred sooner than expected, says Fuller.

“We always anticipated to see these improvements, but they were even greater than we had anticipated,” she says. “Typically, people are motivated for maybe those six weeks or upwards to maybe three or four months, and then they dip off. But we saw that people were motivated and they were really consistent with their behaviours. And that led to higher results.”

Challenges of figuring out ROI

But figuring out the return on investment of these programs can be challenging because of the “incredible complexities” that directly and indirectly influence people’s wellness, says Fuller.

“Wellness is not a static thing, it's really an active process. So it's not only challenging to measure participation and engagement and programs over time, but it's challenging to measure individual behaviours, because these vary day to day.”

The key is to allow for the appropriate amount of time to accurately measure these types of outcomes, she says.

“Organizations typically put something in place and they're wanting to see these instant and largely impactful results in a year. But the reality is it takes longer than that.”

Generally speaking, research studies don't have the longitudinal lens to look at these types of outcomes, says Fuller.

“And they're not usually looking at things in a multifactorial way; they're usually siloed, they'll look at something like physical activity alone; they'll look at something like nutrition alone, or the importance of sleep. But no one's really taking… a broad, holistic approach to health and wellness and taking the amount of time that it takes to quantify some of these results,” she says.

“This doesn't happen overnight. It certainly takes discipline, it takes reinforcement and encouragement and, most importantly, leadership. So that's challenging.”

One of the reasons why there is so much confusion about the value of wellness investments is because the quality of the studies isn’t always great, often because they're not long-term enough, says Victoria Grainger, founder of Wellness Works Canada in Beaumont, Alta.

“If you're trying to reduce chronic disease or support some other different health outcomes and see the benefits of the investment, that's a long-term game, you don't see that result within a couple of months or even a year; it takes years usually. So, that was good about this study.”

Another challenge? The location of the study. A recent one out of the U.S. looking at the results of a three-year wellness program involving 26,000 workers found only marginally better health outcomes. But the country has a different health-care system.

“Their health system is incentivized to preventing and limiting the cost to treatment – the individual pays a lot more when their health is poor. In Canada, we don't have that same incentivization,” says Fuller.

The ’great resignation’

It’s also about looking at the “VOI” or value of investment in the short and midterm, which means meeting employees’ needs here and now, says Fuller, “because the more we look to support employee health and wellness, and we offer a variety of things or comprehensive solutions, that's what's critical to achieving ROI results in the long term.”

It’s important to look way beyond ROI and look at the value on investment, so not just looking at the decrease in costs for absenteeism, presenteeism and disability claims, but also thinking about the “great resignation” that's happening, says Grainger.

“That is one of the bigger reasons I think employers should consider investing in employee well-being, as a way to differentiate, to support their reputation, to help support talent and recruitment.”

There’s also a stronger connection when it comes to the impact on organizational performance, she says, “so not just the health outcomes of the employees, and then reduced costs, but how it really supports – especially when you invest in mental health… your engagement and how inspired you feel and connected to the organization.”

This kind of research is critical at a time when workplaces are struggling with the attraction and retention of talent, says Fuller.

“Employees, they are looking for organizations, and they want to stay at an organization, that shows they're caring for them, that's aligned with their values, and that value is largely attached to their well being,” she says.

“Because we know healthy and well employees are happy employees, and they in return drive business success and performance. So that's really why it was so critical.”

Employer programs for improving employee wellbeing are good for business overall, according to an Aon report.

Successful wellness programs

The organizations that see the biggest success are those that invest in a strategy versus a program, says Grainger.

“The siloed programs – like offering a nutrition program or a program to increase physical activity or reduce tobacco consumption – aren't really going to be that effective. if, for example, supporting employee well-being isn't a part of the policies, or if managers aren't walking the talk or if it's not expected to even participate in the program.”

Instead, it’s about taking a systems approach that looks at: “Where are we now? How do we need to support people, what are their biggest needs? And how does that relate to our overall overarching strategic outcomes?” she says.

Then it’s about supplementing that with training to make sure there's accountability for leadership to support people to not only use the programs or participate in training, but to support each other, says Grainger.

“Managers, leaders need to be held accountable for supporting employee well-being. As the old adage goes, ‘What gets measured gets done,’ and it rings true in this case… Then there will be uptake in those programs… because if everybody hasn't bought in, then it's not going to be effective.”

To help its roughly 3,500 store employees and 200 head-office employees across Canada in the pandemic, retailer Ardene decided to boost its benefits offering around mindfulness.