The advantage of time is “perspective”. As I look back over a 35+ year career I realize that I have lived through an evolutionary process. Starting my career in clinical laboratory medicine the question “what do you do?” was easily answered.
Leaving the hospital environment and transitioning into “health screening and education” raised more questions than answers. In 1987, the term “wellness” did not register with the general population as activities that lead to better health and well-being.
Certainly there were others embarking on the same journey. Being a small group we interacted frequently. The opportunities were so abundant that the focus was more on collaboration than competition. One consistent thread was the focus on creating awareness and moving people towards a healthier life. At that point in time, that mindset was not shared by everyone.
I specifically reflect on a wakeup call in early 1991. Our largest client was a managed care company that was gaining market share and growing fast. In a meeting with a regional Vice President I presented a set of aggregate results from the previous quarter open enrollment programs. At that time the standard protocol was to test total cholesterol and blood pressure. It was a limited test panel according to today’s standards but offered value for risk profiling.
Ready to engage in a discussion related to “next steps” and “retesting” I was shocked by the response. “Did they walk away with an application?” I left with the sad realization that the focus was purely marketing – not health promotion. For me, this was the beginning of “screen and release” programs.
Thankfully the marketplace has changed, albeit slowly. The focus evolved to testing workforce populations because it was “the right thing”. Costs were a concern and it was logical to assume that people would initiate lifestyle change. The evolution continued when pharmaceutical manufacturers created interest in screening activities. Led by category market leaders these activities were still marketing focused. This was mirrored by retail programs supported by OTC products focused on chronic conditions. They were still “screen and release” programs but there was some satisfaction because participants were being directed to “take action”.
The proliferation of wellness companies and the focus on population health management, fostered activities designed to connect “at risk” employees with services designed to promote health. These programs include longitudinal tracking of clinical values and risk profiles. This is done for individuals and aggregated for analysis of population health. Engagement, or linking risk profiles with targeted programs, is a key element. Utilization of services correlates with validation for program expense. “Screen and release” is over!
However, the evolutionary process must continue. All too often worksite programs focus on inclusion rather than targeted intervention. Strategically sound programs will include:
- Individual risk assessment correlated to baseline biometrics
- Intervention strategies targeting individual and population risk factors
- Capture of T1 versus T2 biometric values
- Capture of intervention type by individual participant
- Correlating outcomes with biometrics to determine the efficacy of individual intervention programs
- Expanded use of programs determined to be effective
Measuring biometric change in worksite populations is common. Improvement has been documented in worksite populations of all sizes. Large scale programs typically include a myriad of targeted interventions across the spectrum of weight loss, nutrition, smoking cessation and exercise. However, the missing element in the ROI discussion is the effectiveness of individual programs. In other words, which programs work? The fact that many wellness efforts do not make the correlation between efficacy of interventions and reduced risk is intriguing. In many cases all the elements are present and it is simply a matter of data capture and analysis to determine correlation (or perhaps causation).
ROI for wellness has been elusive. Much has been written on this topic and a broad range of savings has been reported. The dialogue has been adjusted to include productivity, job satisfaction and more. However, the logical justification for ROI includes balancing the cost of data gathering, engagement and intervention with risk change in the population. Continued returns however will only be realized when the effectiveness of individual intervention strategies are measured and changes made accordingly.
The perspective of time tells me that the evolutionary process is slow, but logic dictates that this practice will become commonplace in the near future.