The bottom – Creating a solid business case


The foundation of the proposed pyramid model is based on research claims which argue that businesses misunderstand the positive impact of corporate wellness on their productivity and the return a company could generate of such an investment.  This proposal intends to add further proof to the arguments that measuring the impact of health improvements among employees has to go beyond direct medical and pharmaceutical claims.  Other key constructs to be observed are chronic health conditions, productivity measures, absenteeism and presenteeism, comorbidities, socio-demographics, body mass index, stress level, etc.  It is assumed that the analysis will provide positive quantitative measures for productivity and return on investment as a foundation for building a solid business case.  However, it is assumed that, though this step may spark interest in corporate wellness initiatives, it will not suffice to make it a business principle.  Even though this step is unavoidable, it won’t fulfill the overall objective of this proposal, and therefore can only be considered to be one step in the right direction.

Planned course of study.

Studies among multiple US employers evaluating the lost in productivity due to poor health have reported that businesses lack an understanding that productivity measures outweigh direct medical and pharmacy claims by far.  It has been argued that understanding those measures will give an incentive or even provide proof of results among executives to invest in corporate wellness.  It could been shown that for every dollar of medical and pharmacy costs spent, 2.3 dollars of health-related productivity costs in absenteeism and presenteeism are lost.  Other papers have discussed a three step approach to minimize the severe impacts of poor health:  First, to counter obesity and other health risks through corporate wellness; second, to implement an early warning system to diagnose negative health developments; and third, to tailor programs according to evidence (i.e. specific medical conditions and there particular treatment), rather than standardized programs.  Thus, this paper proposes to use those findings and analyze a specific company which has made some steps towards implementing such an initiative.  This first activity would primarily be based on the health and work performance relationship theory to account for the claim that program design should be evidence based.  It is herewith suggested to use a ‘Health and Work Performance Questionnaire (HPQ)’ to achieve a comprehensive overview of current health and fitness levels of the targeted company’s workforce.  Further, absenteeism and presenteeism may be measured with self-report assessment, given studies which have shown correlations for both a positive relation between absenteeism and payroll records as well as presenteeism and supervisor assessment.  Additionally, all medical and pharmacy claims would be matched with nation-wide databases to allow a mapping of conditions and expenditures in each category.

It is the assumption of the applicant that, though the measures proposed within the former paragraph are valid and important, a study has to go further and analyze the positive business impact of a corporate wellness program.  Past research has claimed that contemporary lifestyle changes have contributed to increased obesity, which in turn relate to a boost in overall health costs.  Those costs are, in general, the burden of employers, and thus it appears important that business owners think about corporate wellness as a valuable investment.  Statistics, however, have shown that US employers, despite offering some kind of wellness program, have failed to provide comprehensive ones.  It has been claimed that this is usually due to lacking proof of a positive Return on Investment (ROI).  The applicant agrees with this notion, but also argues that the results need to be adjusted by savings from improved productivity, reduced absenteeism or presenteeism, and increases in morale, job satisfaction, and overall health / fitness levels (cf. former paragraph).  Research to date has not been able to combine both methodologies: the health and work performance relationship theory and return on investment calculations.  It is assumed that this is due to the fact that identifying a company with the right ‘profile’, which can provide evidence for both areas, is difficult.  The business the applicant is looking for should have initiated some kind of corporate wellness, but is lacking both financial proof and high utilization of its initiative.  Additionally, a company in the health service sector might be preferred, because access to health and pharmaceutical claims might be easier.

For the adaptation of a ROI calculation tool the following is proposed:  First, to create two comparison groups within the respective company, one participating and another not participating in any wellness offering.  Second, a growth curve analysis should compare medical claims for participants of wellness programs versus risk-matched nonparticipants for a certain period of time.  Finally, the ROI should be calculated by subtracting program costs from savings of the ‘active group’.

Expected outcome.

In combining productivity measures, medical and pharmacy claims, stress and satisfactory levels, as well as ROI calculations, it is expected that the results of former studies will not only be repeated, but reiterated and strengthened.  As a matter of fact, it is argued that the data will allow for both building a solid quantitative foundation for a business case, as well as leading to some kind of early-warning system based on those numbers.  In particular, the latter will help companies to constantly measure results and improvements among their employees and thus have arguments for now and in the future to further invest in corporate wellness.

Along with the work of other researchers, some particular results may reveal the following:  Work performance may vary by employee socio-demographics (e.g. gender, age, occupation), consequently having an impact on the structure of a corporate wellness program (see next section).  Further, it is expected that the analysis will discover that employees with connected conditions account for a substantial proportion of all the work impairment associated with these conditions.  In general, health care expenditures are expected to grow more slowly for participants in wellness offerings than for non-participants.

Anticipated problems and alternative strategies.

The main issue of the suggested study might be the identification of a company which, though lacking financial proof, has started to implement a corporate wellness program; an obstacle which appears to have been prevalent for other researchers, consequently leading to a separation of studies calculating productivity measures and identifying ROI.  The applicant, however, can benefit from his connection with the Fitness Institute of Texas at the University of Texas, which serves mid-sized companies in the Austin area.  The institute assists corporate customers in the implementation of corporate wellness solutions and is doing business with companies which fit the company profile the researcher is looking for.

Some other, technical problems, which are anticipated, have as well been identified by other studies in particular:  Answers may vary if participants are asked if a doctor told them or if they believe they have a condition (in particular back or neck pain, fatigue, migraine which are frequently not diagnosed).  Further, though productivity measures seem to be reliable, it has also been argued that those numbers might be skewed because healthier and more motivated employees are the ones participating, and who most likely already score higher on those scales.  However, the study suggests combining productivity and ROI measures may lead to more reliable results.  Additionally, the suggested company profile allows integrating control groups, because it is assumed that corporate wellness is not fully utilized.