If you're like many workers in the United States, you typically spend eight-hour days sitting in front of a computer screen, pacing out snacks of cookies and chips to stay alert until 5 p.m.--and telling yourself you'll start exercising more next week. Tackling the chronic health problems that afflict affluent societies like the United States might require a dramatic rethinking of the workplace: shifting away from a cubicle-bound, convenience-food culture to one that encourages employees to take better care of their health.
For more than 20 years, the health product manufacturer Johnson & Johnson has run an employee-wellness program with the aim of instilling a "culture of health" company-wide, from warehouse floors to corporate offices. Many U.S. companies that offer employer-sponsored health insurance have embraced wellness programs as a way to lower health care costs. Yet most programs fail to either significantly improve health outcomes or to save health care dollars. The value of J&J's approach may lie not in medical cost-savings but in the idea that healthy workplaces can make for more-productive employees.
Johnson & Johnson's approach begins with an annual, online health-risk assessment. Employees self-report everything from their diet and exercise habits to cholesterol levels, which can be checked through on-site screenings. Compliance is near-universal, because if employees don't participate, they pay a penalty of $500 more toward their health insurance premium.
Employees with risk factors participate in follow-up conversations, by phone, with health care professionals who can give them advice on lifestyle changes. The data gathering also allows J&J to monitor health trends across the company. For example, if the data show that employees at a certain facility are more likely to be overweight, workplace leadership may launch a pedometer challenge at that location.
The rest of the J&J program involves connecting employees with health-focused resources. U.S. facilities often include gyms or rooms with Wii Fit players, which employees are encouraged to use during the day. Cafeterias and vending machines offer healthy choices, digital and phone-based health coaching is available, and an energy performance training program teaches workers how to fine-tune their bodies for optimal productivity.
Johnson & Johnson's executives say their comprehensive wellness program is worth every penny. "Investing in keeping the well well pays off," says Fikry Isaac, vice president of global health services. He believes that J&J's program can help workers address red flags — like weight gain or high blood pressure — before they develop into riskier conditions that are more expensive to treat.
The program achieved $565 in annual health care savings per U.S.-based employee from 2002 to 2009, according to an analysis from Johnson & Johnson and Thomson Reuters. J&J's medical spending grew at a lower rate than similar U.S. manufacturing companies, the study found, and J&J employees were less likely to be at high risk for high blood pressure, obesity, physical inactivity, and tobacco use. The study estimated a return on investment of between $2 and $4, but didn't publish a precise figure because J&J doesn't disclose the overall cost of its wellness program.
Such rosy evaluations have inspired the majority of U.S. companies to embrace workplace wellness. Ninety-four percent of U.S. companies with 200 or more workers have implemented a wellness program, according to the Kaiser Family Foundation. And in 2008, inspired by the success of its own program, J&J established a consultancy to spread the wellness gospel to other companies.
Despite corporate enthusiasm, much of the data on wellness programs doesn't stand up to scrutiny, and evidence is mounting that most lifestyle management programs have little effect on either health outcomes or cost savings. That's in part because "wellness" encompasses a broad range of employer investments, from simply e-mailing employees diet tips to subsidizing gym memberships to charging employees more for insurance if they don't meet certain health requirements, such as being nonsmokers.
"People who participate in the programs may be healthier and more likely — even without the wellness program — to reduce their health care costs," said Rachel Mosher Henke, director of research at Truven Health Analytics. It's also hard to tease out the impact of a wellness program from other factors that lower health-care costs, such as shifts in the structure of insurance plans or regional hospital billing practices.
UCLA law professor Jill Horwitz took a look at studies of wellness programs that give employees a financial incentive to change their behavior and found decidedly mixed evidence of health care savings. "It turns out that people with the health conditions that are commonly targeted by these programs may not even spend more money on health services than other employees," she says. Obesity, heart disease, and diabetes, become expensive with old age, not necessarily before retirement. In fact, wellness programs can sometimes drive up health care costs by leading employees to seek out additional care, such as doctor's appointments and screenings, a 2013 University of Arizona study found.
Johnson & Johnson doesn't ask less healthy employees to pay more for health insurance, but a zeal for cutting costs has led some other companies to do just that. The 2010 health care law may accelerate the trend. Starting in 2014, employers will be able to charge employees who don't enroll in wellness programs and meet certain health metrics up to 30 percent of their total health-plan premium — over $1,000 for the average employee.
There's a better way to think about workplace wellness. "We see this as one of our competitive advantages," Isaac says of J&J's focus on health. Healthy habits can make employees better able to manage stress, less likely to take sick days, and generally better equipped to get the job done. Lost productivity due to poor health can cost employers more than twice as much as medical and pharmacy expenses, according to research from Ronald Loeppke at the health solutions firm Alere.
J&J's ergonomics program has lessened injury rates on the factory floor and safe-driving initiatives have helped sales personnel avoid accidents. The biggest sign that an employer wellness program is making a difference, however, may be when that company's workplace culture changes to value healthy lifestyles. At Johnson & Johnson, that culture encourages cubicle-bound employees to get up from their desks, taking a break from their office work to work out. "When they see their supervisor or manager going to the fitness center for half an hour or an hour during working hours," says Isaac, "that is giving [other employees] permission to pay attention to their own health."