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The Evolution of Worksite Wellness

Dr. Allan Khoury

Three doctors at a worksite wellness clinic discuss a patients charts.

Employers taking an interest in the health and fitness of their employees may seem like a recent development, but companies have long known that a healthy worker is a productive worker. Over the last century, however, that concept has broadened. What started as an emphasis on occupational injuries has grown to encompass many other aspects of health. Today’s workplace wellness programs reflect a holistic approach, caring for employees’ physical, mental and social well-being. The benefits include a better work environment, better health and reduced costs.

History of Worksite Wellness

After World War II, business executives saw the value in staying fit, and a number of successful companies built well-appointed gymnasium facilities complete with fitness instructors—at least for their top-level executives. Such programs grew throughout the 1970s and, while limited in their influence, were a precursor to today’s worksite wellness promotion programs.1

While some companies restricted such perks to upper management, others did extend their fitness programs to a wider range of employees. In 1879 the Pullman Company, known for its company town outside of Chicago, established an athletic association along with its employee-only housing, shops and schools. In the 1880s, the president of National Cash Register was known to meet employees for horseback rides before work; later, the company instituted twice-daily exercise breaks, built an employee gym, and in 1911 added a 325-acre recreation park for its workers. Hershey Foods built a recreation complex, complete with a swimming pool, in the 1930s. And in the 1950s and 1960s, such companies as Texas Instruments, Rockwell and Xerox instituted employee fitness programs. 2

The 1950s also saw the emergence of Employee Assistance Programs (EAP), which were initially created to help employees with alcohol programs but gradually expanded to address other work-life issues. The Occupational Health and Safety Administration (OSHA) was established in 1970 with an emphasis on avoiding workplace accidents and work-related illnesses. Workplace health centers tended to focus on occupational health to improve employee productivity and reduce costs. By the 1980s, all these influences could be seen in holistic wellness programs that offered employees a range of support, including smoking cessation, stress management, nutrition, weight management and the like.2

Today’s Worksite Wellness Centers

Today’s worksite wellness centers offer a continuum of care and can be seamlessly integrated with offsite resources. Preventive care services, such as immunizations and screenings, are commonly available, 3, as is treatment of acute medical problems, but chronic care and specialized services, such as travel medicine and physical therapy, can also be offered.

At some worksite wellness centers at large companies nationwide some the services that can be accessed depending on the plan design are:

  • Primary/urgent care
  • Occupational health
  • Pharmacy services
  • Preventive care
  • Health coaching
  • Disease management
  • Wellness programs
  • Physical therapy
  • Fitness programs
  • Dental services
  • Vision care
  • X-ray/radiology

Having a health center right at the workplace makes a big difference in actively managing health through continuous care. The traditional point of entry into the medical system is when a patient experiences early signs and symptoms of illness. But if screening, prevention and lifestyle intervention services take place before symptoms occur, employees can reduce their risk of disease and keep it low.

When disease is present, the worksite wellness center makes case management much more effective through better employee access and ongoing dialogue. Evidence shows that face-to-face support and coaching leads to greater adherence and reduced costs over traditional disease-management services.4

According to Allan Khoury, MD, PhD, Chief Medical Officer at Walgreen Co.,
“Worksite wellness centers are effective in all types of business, from manufacturing to finance. Employee satisfaction scores are uniformly high.”

More employers are looking to on-site health centers for longer-term health programs that focus on individual employees and encourage adherence to medication regimens and routines. They realize they have to better manage both short- and long-term health issues to get a handle on their healthcare costs.5

Benefits of Worksite Wellness Centers

Instituting a worksite wellness center can be a smart investment. “We have the ability to reduce cost while improving care. The availability of primary care providers reduces hospitalizations and specialist referrals. An emphasis on generic drug prescribing, medication compliance, risk factor reversal and the use of efficient specialists all result in decreased cost, as does evidence based treatment of chronic disease,” Said Dr. Khoury. According to Fuld & Company, on-site clinics offer employers immediate savings of 10 percent to 30 percent of their total healthcare costs—a $7 billion to $20 billion savings for the estimated 1,200 employers that operate on-site clinics.5 That’s critical, because employers know that the rising costs of healthcare can threaten a company’s viability.

Also, the current “silos” in which we purchase and perceive our healthcare delivery do not make it easy for either employers or employees to get the right information to make smart choices. As a result, employees may overuse or underuse medical services. More transparency and more data are necessary to get employees the right care at the right time.

Worksite wellness centers offer value for both employers and employees. They can help a company become an employer of choice by offering easy access to care through a trusted provider. They can help keep workers safe through medical surveillance and attention to ergonomics, and can speed their return to work after injury or illness. By capturing data on the employee population and keeping a close eye on established metrics, worksite wellness centers can drive clinical excellence. And they can reduce costs—both direct medical costs and indirect costs of lost time.

Here’s an example of how the system can work. Say an employee has an exacerbation of asthma. The can be treated at the worksite wellness center. If the asthma becomes worse on the weekend, the patient can be treated at a onsite clinic. The patient has received convenient, high quality care without missing a day from work, and emergency room costs have been avoided. Then, he can return to the health center at his workplace, and see the doctor or NP who provided the initial treatment. The employee can also be referred to a pharmacist if complicated drug therapy is prescribed. Each one of these clinicians has a daily opportunity to run into each other and the employee in the halls and cafeteria at the office – bringing the healthcare community to the patient. The various health professionals treating a complex patient can also schedule meetings to determine the optimal care plan.

Maximizing the Potential of Worksite Wellness Centers

There is work to be done. According to a study by Watson Wyatt, “significant gaps exist in the integration of the on-site health center with other health and productivity programs. A number of companies cite this lack of integration as one of the top challenges in operating an onsite health center.”4

The vision for worksite wellness centers is to make them part of a seamless, integrated system that harnesses the power of data to make the most efficient and effective use of healthcare resources. This improves the quality of care and quality of life for employees, helps the company better manage its healthcare costs and maintain productivity.

About the Author

As one of the leading workplace healthcare providers in the country, Take Care Health Systems provides a patient-centric approach to meet employee needs while maximizing employers’ return on their investment. We strive to help employers realize greater cost savings, improved employee productivity and enhanced employee-benefits programs. Many of our clients have become employers of choice, due in part to the depth and breadth of unmatched workplace health experience we provide.

Walgreens is a single-source provider of comprehensive pharmacy and healthcare services. Through our more than 7,000 community pharmacies, worksite wellness centers, mail service, specialty pharmacy, home infusion and respiratory services and pharmacy benefit solutions services, we offer health plans and employer groups cost-effective solutions to meet the changing needs of the healthcare industry. Our dedicated team of client support professionals is committed to creating the best customer experience possible.

Dr. Allan Khoury is currently the chief medical officer of Take Care Health SystemsSM. He was formerly the chief medical officer of Whole Health Management, Inc. Prior to joining Whole Health Management, he was the associate medical director of medical information and clinical innovation at Kaiser Permanente of Ohio. Dr. Khoury created the division of Population Care Management, Prevention and Research to oversee disease management, prevention, health education and clinical research.

  1. Sparling PB. Worksite health promotion: principles, resources, and challenges. Prev Chronic Dis. 2010;7(1).
  2. David H. Chenoweth PhD., Worksite Health Promotion. Human Kinetics Publishers, Champaign, IL. 2006.
  3. Realizing the Potential of Onsite Health Centers, Watson Wyatt Worldwide, 2008.
  4. Musich SA, Burton WN, Edington DW. Disease Management & And Health Outcomes. University of Michigan. 153-166, 1999.
  5. The Growth of On-Site Health Clinics, Fuld & Company. 2008.

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