University of California Davis Workplace Wellness on Savings Generation Essay In one double-spaced page at the most, describe which of these sources, in yo

University of California Davis Workplace Wellness on Savings Generation Essay In one double-spaced page at the most, describe which of these sources, in your view, would be most likely to persuade your employees that a workplace wellness program is necessary. Why would your chosen source be best? Again, return to rhetoric’s three appeals, deciding for yourself which of them or which combination of them is likely to bring your employees around to your perspective.

the requirement detail i will drop the files.

https://www.youtube.com/watch?v=PII5nxeC8mA Screen: the first 5:37 of Youtube,this is “rhetorical reading” – of reading a piece of writing for its “how” – for the rhetorical choices the writer has made.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4093978/ this is the first article

https://health.gov/news-archive/blog/2017/05/five-reasons-employee-wellness-is-worth-the-investment/index.html this the second article

the third article i will drop the files PREVENTION
By Katherine Baicker, David Cutler, and Zirui Song
Workplace Wellness Programs Can
Generate Savings
Amid soaring health spending, there is growing interest in
workplace disease prevention and wellness programs to improve health
and lower costs. In a critical meta-analysis of the literature on costs and
savings associated with such programs, we 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. 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.
ABSTRACT
I
n an environment of soaring health care
spending, policymakers, insurers, and
employers express growing interest in
methods of improving health while lowering costs. Much discussion has taken
place about investment in disease prevention
and health promotion as a way of achieving better health outcomes at lower costs. President
Barack Obama has highlighted prevention as a
central component of health reform, as have major congressional reform proposals.1,2 Workplace-based wellness programs, which could affect prevention, have been showcased in these
reform proposals, the popular press, and congressional hearings.3,4
This enthusiasm for workplace programs
stems in part from the fact that more than 60 percent of Americans get their health insurance coverage through an employment-based plan,5 as
well as from the recognition that many employees spend the majority of their waking hours in
the workplace—which makes it a natural venue
for investments in health. There are several reasons that employers might benefit from investments in employee wellness. First, such programs might lead to reductions in health care
costs and thus health insurance premiums. Second, healthier workers might be more produc-
doi: 10.1377/hlthaff.2009.0626
HEALTH AFFAIRS 29,
NO. 2 (2010): –
©2010 Project HOPE—
The People-to-People Health
Foundation, Inc.
Katherine Baicker (Kbaicker@
hsph.harvard.edu) is a
professor of health economics
at the School of Public
Health, Harvard University, in
Boston, Massachusetts.
David Cutler is a professor of
economics at Harvard
University.
Zirui Song is a doctoral
candidate at Harvard Medical
School.
tive and miss fewer days of work. These benefits
may accrue at least partially to the employer
(such as through improved ability to attract
workers), even if the primary benefits accrue
to the employee.
These factors may motivate the increasing interest in such programs among employers—and
especially large employers. In 2006, 19 percent
of companies with 500 or more workers reported
offering wellness programs, while a 2008 survey
of large manufacturing employers reported that
77 percent offered some kind of formal health
and wellness program.6–8 Consistent with the evidence presented below, small firms seem slower
to offer such programs, and many of the programs offered are still quite limited in scope.9
Several well-publicized case studies have suggested a positive return to employers’ investment in prevention. For every dollar invested
in the program, the employer saves more than
the dollar spent. The Citibank Health Management Program reported an estimated savings
of $4.50 in medical expenditures per dollar
spent on the program.10 Studies from the California Public Employees Retirement System
(CalPERS), Bank of America, and Johnson and
Johnson have similarly estimated sizable health
care savings from wellness programs.11–13 Despite
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2 9 :2
H EA LT H AF FAIR S
1
PREVENTION
this anecdotal evidence of high returns, however, most employers do not engage in widescale workplace wellness promotion practices.
The 2004 National Worksite Health Promotion
Survey showed that only 7 percent of employers
offered comprehensive programs14 of the type
specified in the recommendations of the influential Institute of Medicine report Healthy People
2010.15 These include health education, worksite
screenings linked to appropriate medical care,
and the integration of the program into corporate or organizational structure.
Some empirical studies attempt to estimate the
return on investment for employer wellness programs more systematically, but shortcomings in
this literature leave the question unresolved.16 In
particular, most studies lack an adequate comparison or control group, and are thus not able to
account for possible unobserved variables or
alternative pathways that might be responsible
for observed differences in costs between wellness program participants and nonparticipants
(rather than those differences’ being attributable to the wellness program itself). This leaves
open the possibility of selection bias—for example, if the healthiest employees were most likely
to enroll in voluntary wellness programs, a comparison of participants and nonparticipants
might suggest that the programs are improving
health more than they really are.
Low response rates, inexact case-control
matching, and potential publication bias (studies finding high returns may be more likely to be
published) also call into question the evidence of
high returns. In addition, Sean Nicholson and
colleagues show that common methods used by
employers to calculate costs and benefits of
health-related investments might not reflect
the true impact of these programs.17 These shortcomings mean that even the limited evidence
available might not be robust or generalizable.
In this study we conducted a meta-analysis of
the literature on costs and savings associated
with employer-based wellness promotion policies. We began by screening existing studies
for analytical rigor, and then we compiled standardized estimates of return on investment from
those studies. We focused on studies for which
there was a comparison group of nonparticipants, and we examined effects of wellness program interventions on health care costs and
absenteeism.
We found a large positive return on investment
across these rigorous studies, which suggests
that the wider adoption of such programs could
prove beneficial for budgets as well as health.
That they have been implemented so selectively,
however, necessitates further research into the
likely effects of broader adoption.
2
H E ALTH A FFAI RS
F E B R UA RY 2 0 1 0
Study Data And Methods
We conducted a primary literature search from
prior peer-reviewed meta-analyses of employee
wellness programs, as well as a computerized
search of MEDLINE, Lexis-Nexis, and other
health and social science databases. Search
terms included “employee,” “wellness,” “workplace,” “disease management,” and “return on
investment.” This produced an initial sample of
more than 100 peer-reviewed studies of employee wellness programs spanning the past three
decades.
Among these peer-reviewed studies, we restricted our analysis to studies that satisfied
the following criteria: (1) they had a well-defined
intervention; (2) they had a well-defined treatment and comparison group, even if the comparison group was not strictly randomly assigned;
and (3) they represented analysis of a distinct
new intervention, rather than further analysis of
an intervention already examined in one of the
other studies. We performed additional analysis
on the subset of these studies that reported “difference-in-difference” estimates of the study outcome (comparing the change in the outcome
from before the program to after the program
in the treatment group to the change in the outcome over the same period for the comparison
group), or the raw data allowing for this calculation.18
Applying these criteria narrowed our sample
to thirty-two original publications. These studies
are listed in Appendix Table 1.19 Two of these
studies reported results of multiple separate interventions; we treated these as separate studies.
Several other studies reported the results of multiple interventions, but because participants
were allowed to self-select into intervention
arms, we treated these as a single case each.
Thus, the thirty-two original publications gave
us an effective sample of thirty-six studies. Of
these, twenty-two looked at employee health care
costs, and twenty-two looked at employee absenteeism (eight examined both).
We catalogued the characteristics of the firms
that undertook these employee wellness programs and the qualitative dimensions of the programs themselves. We analyzed the health care
cost and absenteeism studies separately, but we
also converted the absenteeism results into
dollar cost units using a uniform wage rate to
construct comparable estimates of return on
investment.
Study Results
SAMPLE CHARACTERISTICS More than 90 percent of
employee wellness programs in our sample were
implemented in large firms (those with more
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than 1,000 workers) . One-fourth examined wellness programs at employers with more than
10,000 workers. A number of industries were
represented: 25 percent of sampled employers
were in financial services; 22 percent in manufacturing; and 16 percent in school districts, universities, and municipalities. Other industries
represented included utilities, telecommunications, energy, pharmaceuticals, and makers of
consumer products. Ten studies took place
across multiple locations, often the employer
headquarters and satellite locations; some were
implemented across multiple employers.
CHARACTERISTICS OF WELLNESS PROGRAMS We
can characterize the employee wellness programs in the study sample along two dimensions: the method of delivery and the focus of
intervention (Exhibit 1). The method of delivery
characterizes how the intervention was carried
out. By far the most frequently used method of
delivery is the health risk assessment—a survey
that gathers baseline self-reported health data
from the employee, which are in turn used by
the employer to tailor the subsequent intervention.20 The health risk assessment is used in
80 percent of the studies in our sample; it most
commonly serves as the initial intervention or
requirement for participation in the wellness
program.
Participation is almost always voluntary
among employees at the treatment site, making
selection bias a major concern. Assessments are
commonly used in conjunction with a clinical
screening of risk factors, including blood pressure, cholesterol, and body mass index (BMI).
Importantly, the assessment tool provides the
employee with information on risk factors that
motivate participation. The majority of programs that did not use the assessment method
featured an on-site gymnasium or workout facility, which employees were encouraged to use.
The second most common wellness intervention mechanism was the provision of self-help
education materials, individual counseling with
health care professionals, or on-site group activities led by trained personnel. In our sample,
about 40 percent of studies included the use of
self-help materials; 40 percent offered individual
counseling; and 35 percent featured on-site
group activities, classes, or seminars. Most programs offered a combination of these interventions.
The use of incentives to motivate participation
was seen in 30 percent of programs. Incentives
were most commonly bonuses and reimbursements for program participation, but they also
included the payback of down payments prior to
participation. Such cases may involve an employer’s withholding a small portion of employee
compensation until program participation occurs. Incentives have become more common in
recent interventions.
The most common foci of the programs were
obesity and smoking, the two top causes of preventable death in the United States. More than
60 percent of the programs explicitly focused on
weight loss and fitness. All but three of the remaining programs focused on either multiple
risks or risks specific to the participant. Half
of the programs focused on smoking, often in
conjunction with obesity. Seventy-five percent of
programs focused on more than one risk factor,
including stress management, back care, nutrition, alcohol consumption, blood pressure, and
preventive care, in addition to smoking and
obesity.
IMPACT
OF
PROGRAMS
ON
MEDICAL
SPENDING
Twenty-two studies reported on the impact of
wellness programs on employee health care
costs (Exhibit 2). The average sample size of
intervention groups exceeded 3,000 employees,
and the size of comparison groups averaged
EXHIBIT 1
Summary Of Characteristics Of Worksite Wellness Programs Studied
Method of delivery
Health risk assessment
Self-help education materials
Individual counseling
Classes, seminars, group activities
Added incentives for participation
Percent of firms
81
42
39
36
31
Focus of intervention
Weight loss and fitness
Smoking cessation
Multiple risk factors
66
50
75
Authors’ calculations based on 36 studies described in Appendix Table 1, available online at http://content.healthaffairs.org/
cgi/content/full/29/2/hlthaff.2009.0626/DC1
SOURCE
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2 9 :2
HEA LT H AF FA IR S
3
PREVENTION
EXHIBIT 2
Summary Of Employee Wellness Studies Analyzed
Study focus
Health care
costs
Absenteeism
Number of
studies
22
22
Average sample size
Treatment
3,201
Comparison
4,547
Average
duration (years)
3.0
Average
savingsa
$358
Average
costsa
$144
Average
ROIb
3.27
2,683
4,782
2.0
$294
$132
2.73
Authors’ calculations based on studies described in Appendix Table 1, available online at http://content.healthaffairs.org/cgi/
content/full/29/2/hlthaff.2009.0626/DC2 aPer employee per year, costs in 2009 dollars. bAverage of the individual return-oninvestment (ROI) figures for each study.
SOURCE
about 4,500 employees. Although the studies
examined programs for three years on average,
most wellness programs continued (often indefinitely) beyond the study duration.
We grouped the studies into three types: those
that had a randomized controlled trial or
matched control group and pre- and post-intervention data; those that had a nonrandomized or
unmatched comparison group and pre- and postintervention data; and those that had post-inter-
EXHIBIT 3
Summary Of Findings From Studies Of Employee Health Care Costs, Pre- And Post-Intervention
Sample size
Health care
costs ($),
treatment group
(T)
Health care
costs ($),
control group
(C)
Change in health
care costs ($), T−C
Study number
Years
Treat
Control
Pre
Post
Pre
Post
Change, pre
Group A
1
2
3
4
5
6
7
8
9
4.0
2.0
3.2
5.0
1.0
1.0
1.5
1.5
1.5
1,890
340
11,194
8,451
919
21,170
301
180
295
1,890
340
11,644
2,955
867
719
412
412
412
1,531
1,739
2,736
247
2,171
2,336
1,891
2,036
1,986
2,907
1,459
3,411
655
1,695
2,937
1,621
1,283
1,485
1,427
1,198
2,896
253
1,881
2,048
1,970
1,970
1,970
3,429
1,107
4,136
1,234
1,995
2,905
1,710
1,710
1,710
−522
351
−724
−579
−300
32
−89
−427
−225
−626
−189
−563
−573
−590
−255
−11
−493
−242
10
11
12
13
14
15
Group C
1.0
0.5
6.0
3.0
5.0
5.0
392
2,586
1,272
3,993
388
667
142
50,576
244
4,341
355
892
294
1,616
2,140
1,620
1,159
695
296
1,185
2,337
2,008
2,397
1,687
295
500
1,825
1,647
825
605
396
419
2,908
2,596
1,701
1,977
−100
766
−571
−588
696
−290
−99
−351
−886
−561
363
−380
16
17
18
19
20
21
22
4.0
5.0
4.0
4.0
4.0
2.0
2.5
1,275
13,048
337
367
183
221
950
2,687
13,363
321
343
184
296
6,640
Change, post
Group B
3,222
4,176
2,078
1,772
1,128
1,256
1,413
3,909
4,454
1,672
1,346
979
2,424
1,396
−687
−278
406
426
149
−1,168
17
Authors’ calculations based on studies described in Appendix Table 1, available online at http://content.healthaffairs.org/cgi/
content/full/29/2/hlthaff.2009.0626/DC2 NOTES Table has been abridged because of space constraints. The full exhibit is available as
Supplemental Exhibit 3 in the online Appendix. All figures denote health care costs per employee per year, in 2009 dollars. Group A:
Randomized controlled trial or matched control group. Group B: Nonrandomized or unmatched comparison group. Group C: Postintervention data only.
SOURCE
4
H E ALTH A FFA IRS
F E B R UA RY 20 1 0
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vention data only but met our other inclusion
criteria (Exhibit 3). We standardized the costs
and benefits of each program to annual figures
in 2009 dollars, assuming a linear distribution of
both costs and benefits over time. We calculated
savings as the difference between treatment and
comparison groups after the intervention subtracted by the differences between the groups
before the intervention (when available). Using
reported figures for program costs, we calculated
a return on investment for each study.21
Averaging across all programs in which they
were reported, the interventions produced $358
in savings through reduced health costs per employee per year, while costing the employer $144
per employee per year. The average calculated
return on investment across the fifteen studies
that reported program costs was 3.37 (that is,
for every dollar spent, $3.37 was saved).22
An additional seven studies reported savings
but not costs, which made a direct calculation
of return on investment for these studies
impossible.
If we were to assume that they had the same
average cost of $144 as the studies that did report
costs, that would imply a slightly lower average
return on investment of $3.27 (although given
that these studies reported somewhat lower savings, we have no reason to assume that their
costs were the same). Only two studies reported
that employer wellness programs did not save
money.
Studies with random assignment to treatment
and control groups or with carefully matched
comparison groups are perhaps the most persuasive. In a typical randomized study, employees
were randomly assigned to the program and
control group, or in several cases to different
intensities of the wellness program. In matched
comparison studies, the comparison group typically comprises age- and sex-matched nonparticipants from the same employer identified
through a retrospective review of participation.
Nine of the studies in Exhibit 2 had such designs. This matching is an effort to limit the bias
introduced by voluntary self-selection of potentially healthier employees into wellness program
participation. However, self-selection remains
an important limitation in these studies. The
average program savings reported in these studies was $394 per employee per year, and the
average program cost was $159 per employee
per year. The average calculated return on investment for this group was 3.36.
Six studies used comparison groups that were
neither randomized nor matched, yielding $319
saved per employee per year and $132 spent per
employee per year (average return on investment of 2.38). Seven studies did not report base-
line data, thus allowing only for calculation of
post-intervention cost differences (averaging
$162 per employee per year).23 Study numbers
4, 10, and 15 reported lower health care costs
overall than the other studies, but they are
among t…
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