Business of Well-being

Outcomes, Innovation and Reliable Measures Fuel Growth of Wellness

Corporate wellness programs continue to proliferate, driven by increasing recognition of their benefits to employee health and productivity, as well as cost control. Even as the nation faced an economic climate in which businesses might have been expected to pare back on all but core employee benefits, health promotion programs held their ground and show signs of renewed growth.The analysis, "Population Health Improvement: A Market Survey Report," is DMAA's second annual survey and expands on findings from a similar 2008 study.

The comprehensive 2010 report, released in early March, projects that 73 percent of purchasers surveyed will offer wellness and other population-based programs over the next 12 months and that 76 percent will do so by the end of 2011. Of those who currently purchase programs, 84 percent expect additional purchases, signaling strong purchaser commitment to population health interventions.

The report also finds a trend toward population-based programs, rather than condition-specific interventions, and shows most purchasers consider incentives, such as premium discounts, critical to program success. The DMAA analysis collected responses from 135 purchasers and providers of population health and specifically wellness services and explores a variety of metrics, such as intervention types, use of incentives and measures of success.

The comprehensive analysis also examines market trends, including purchasing expectations, insourcing vs. outsourcing of services and use of integrated data platforms.

In other findings:

  • Purchasers and program providers alike strongly support physician integration in health and wellness programs. Nearly all purchasers view population health improvement as supporting the physician-patient relationship, and both groups ranked physician engagement highly as a critical component of program success.
  • When asked how they measure program value, purchasers most often cite improved program participation and reduced annual care expenses.
  • A majority of purchasers expect to see a financial return on investment in one to two years.

Drivers of Wellness Program Growth

Continuing purchaser commitment to wellness, disease management and other population health approaches reflects growing confidence in these programs. What is behind this rising comfort level? Evidence of positive outcomes, relentless innovation and industry consensus around reliable evaluation methodologies.

Evidence: The evidence base of successful interventions, particularly for wellness, continues to expand. In January 2010, a study in the respected journal Health Affairs found that medical costs fall by about $3.27 for every dollar spent on wellness programs and that absenteeism costs fall by about $2.73 for every dollar spent.

The study's authors concluded, "Although further exploration of the mechanisms at work and broader applicability of the findings is needed, this return on investment suggests that the wider adoption of such programs could prove beneficial for budgets and productivity as well as health outcomes."

Such findings have become the rule rather than the exception in the realm of worksite wellness, and employers have taken notice.

Innovation: Employers also have taken notice of and embraced innovation, and program providers have responded with new and diverse - and sometimes elegantly simple - strategies. For example, one manufacturing company with more than 1,000 employees instituted a nutrition and exercise program based on portion control without the need for technology, complex food plans or calculations; and regular exercise that required only walking.

A 12-month team challenge with non-monetary incentives resulted in total weight loss of more than 400 pounds in three months by 28 employees. Another organization redesigned its approach to weight-loss health programs by recognizing the critical need for a behavioral change element. Beginning with 10 face-to-face, professionally-facilitated sessions, exercise - not weight loss - was the identified behavior, with homework assignments focused on engaging in exercise.

Forty-seven percent of participants maintained their weight loss longer than one year.

Evaluation: A third driver of greater adoption and acceptance of wellness and other population health improvement programs has been industry consensus around measures of clinical and financial outcomes. This, in turn, contributes to the confidence program purchasers have in wellness, disease management and other interventions.

DMAA has spearheaded this effort through its Outcomes Guidelines Project, a transparent, consensus-based initiative the association launched in 2006. The DMAA Outcomes Guidelines Report, now in a fourth volume available freely from the DMAA Web site,, has won praise for striking a careful balance between scientific rigor and practicality.

It reflects the work of a broad-based panel of experts, including industry leaders, national accrediting and quality organizations, public-sector stakeholders and noted researchers. The Outcomes Guidelines Report fourth volume expands significantly on earlier DMAA work to define wellness programs and develop an approach to evaluating wellness outcomes.

Notably, it recommends a definition: Wellness programs are designed to help individuals maintain and improve their level of health and well-being by identifying health risks and educating them about ways to mitigate these risks; increase awareness of factors that can affect health and longevity; enable individuals to take greater responsibility for their health behaviors; prevent or delay the onset of disease; and promote healthful lifestyles and general well-being.

Typical program components include, among others, biometric screening (e.g., blood pressure, cholesterol), smoking cessation, weight loss, diet and nutrition, stress reduction, exercise and fitness programs and others. The document goes on to compare and contrast wellness and disease management programs, provide methodological considerations in the context of a Wellness Program Impacts Model, recommend approaches to study design and measures sets and discuss in detail numerous other aspects of wellness evaluation.

The guidelines' relevance to the expanding wellness market is particularly evident when seen in the light of the DMAA market analyses. The 2008 DMAA survey report found that health plans and employers measure the success of their population health management programs primarily through two metrics: reduced annual care expense and improved clinical outcomes.

In the 2010 report, respondents again ranked both measures highly, as well as participation rates. Access to scientifically sound evaluation methodologies and measures for real-world settings, such as the DMAA guidelines, gives employers and other purchasers confidence in the value of their programs and supports further expansion of these important workplace initiatives.

About Author

Tracey Moorhead is President and CEO, DMAA: The Care Continuum Alliance. She directs policy formulation and strategic advocacy efforts and represents the population health improvement community before the media, allied organizations and constituents and all levels of government for DMAA, a non-profit association representing more than 200 organizations and individuals. The 2010 DMAA industry analysis, "Population Health Improvement: A Market Survey Report," and Outcomes Guidelines Report, Volume 4, are both available through the DMAA Web site, at

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