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Worksite Wellness Programs

Rising insurance costs are motivating many employers to invest in worksite health initiatives. These “wellness” and health promotion programs aim to improve employees’ overall health by discouraging unhealthy behaviors and promoting healthier lifestyles. Studies place the potential savings from such programs at hundreds of dollars per employee annually, from lower health insurance premiums, reduced worker compensation claims, reduced employee absenteeism and increased productivity.64

Companies use a variety of methods to encourage employees to become healthier, including health risk appraisals (HRAs), counseling, educational materials and disease management and weight-loss programs. Some even provide financial incentives for participation.65 Many firms also create worksite environments that promote healthy behavior, with on-site fitness facilities or subsidized gym memberships, healthy food in common areas and fitness breaks during the day.66

Return on Investment

Worksite wellness programs cost money even without major building improvements or financial incentives. The business case for these initiatives requires that reductions in insurance and absenteeism costs outweigh program costs, providing a positive return on investment (ROI).

Multiple studies of wellness programs have concluded that these programs produce positive ROIs. One review of 42 different studies found that wellness programs can reduce health care expenditures and absenteeism costs by 25 to 30 percent within an average of 3.6 years.

Generally, the ROI for spending on worker health promotion is believed to be about three to one, without considering factors such as improved employee morale and retention.67

Program Design and Development

The creation of a wellness program generally begins with basic planning to formulate objectives and gauge and build support among leadership and employees. Almost every program involves needs assessments, which in addition to HRAs can include employee input gathered through committee meetings and surveys, as well as calculations of organizational costs due to poor employee health.

Wellness initiatives can vary widely, depending on the characteristics of the company itself as well as the results of its needs assessment. Common elements include education or health counseling; workplace changes, such as ensuring that vending machines offer healthy snacks; subsidized or free weight-loss and smoking cessation programs; and fitness activities and facilities or rebates on gym memberships. Often, such programs offer incentives to participants — anything from T-shirts and cookbooks to reduced insurance premiums and gift cards.68

Successful Wellness Programs

Presented here are profiles of 12 different workplace wellness programs implemented in businesses and public or semi-public organizations.

These employers range in size from a few hundred workers in one city to hundreds of thousands of employees worldwide. Some are Texas firms and most employ Texas workers. The first four profiles examine programs initially described in the 2007 Comptroller report Counting Costs and Calories. These company programs have been revisited to highlight the lessons they offer, the most obvious being that the companies continue to see value in their investment in wellness programs.

Generally, successful worksite wellness programs incorporate most or all of the following elements:

  • comprehensive program design and a continuing commitment;
  • assessments of employee health status to identify risks;
  • individual counseling about assessment results, especially for high-risk employees;
  • risk-reduction strategies; and
  • marketing, incentives and changes to the work environment to encourage strong participation.69

USAA111

San Antonio, Texas
22,000 U.S. Employees
14,000 in Texas

Wellness Progam Description

USAA has learned some lessons since creating its award-winning wellness program, “Take Care of Your Health,” in 2002.

  • Even with 85 percent worker participation in 2009, USAA found that obesity is a particularly tough challenge.
  • Highlights: program integration with company benefit plans; collection of data on the health of employees and their families, allowing USAA to track progress and savings and identify problem areas.
  • Analysis of company health care spending suggests that obesity is a root cause of most expenditures.

Despite program’s successes, USAA workers were still gaining weight, so the company added two programs with financial incentives in 2008.

  • “Healthy Points” awards points for wellness activities. Workers earning 500 points in a year receive $300 premium reduction.
  • “BMI Reduction” is a weight-loss program for those with BMI above 26; workers get $250 cash bonus for 10 percent loss in a year.

Results/Return on Investment

  • Workers’ medical and disability cost increases have been held to just 3 percent, compared to 9 percent for adult dependents.
  • Early results indicate that those completing Healthy Points generally lower BMI as well as health care costs.
  • Participants in BMI Reduction lost a net 6,054 pounds in the first year. The three BMI risk groups all saw downward shifts; many participants dropped to next lower risk level.
  • Average BMI among USAA workers fell in 2009, for the first time in five years.

H-E-B Grocery112

San Antonio, Texas
70,000 Employees in Texas

Wellness Progam Description

“Healthy at H-E-B” offers employees a number of wellness initiatives.

  • These include company-wide health challenges; weight and care management programs; fully covered preventive health screenings.
  • Financial incentives encourage employee participation; 75 percent of employees participated in 2009.
  • Company made a concerted effort to connect with employees in 2010, a designated “Year of Health and Wellness.”
  • More than 600 employees serve as wellness champions, sharing information with colleagues and generating interest in wellness activities.

Results/Return on Investment

  • Healthy at H-E-B continues to provide positive returns after more than five years of operation.
  • H-E-B consistently outperforms other comparable employers in health spending, with costs increasing at a significantly slower pace.
  • From 2003 to 2010, health costs for large employers rose by a national average of 9.3 percent; H-E-B costs rose by just 3.7 percent.
  • Employees in the wellness program have reported improved health biometrics.

General Motors113

Detroit, Michigan
79,000 U.S. employees,
2,800 in Texas

Wellness Progam Description

General Motors has had a workplace wellness program in place for more than 15 years. Even after huge financial difficulties culminating in the 2009 bankruptcy, the LifeSteps program is still part of GM’s business structure.

LifeSteps is ongoing but scaled down. The program saw significant cutbacks in resources needed to track progress and outcomes in employee participation and health status. There have been no enhancements in the last two to three years, although new initiatives are being considered for 2011.

Results/Return on Investment

With the established track record of savings from LifeSteps, the business case for continued investment in worker wellness remains unchanged.

Dell, Inc.114

Round Rock, Texas
94,000 employees
worldwide, 25,000 in U.S.

Wellness Progam Description

Launched in 2004, Dell’s “Well at Dell” comprehensive wellness program gives employees access to a range of resources, including:

  • an on-site physician;
  • a 24-hour nurse hotline;
  • individual health coaching;
  • online health management programs;
  • worksite fitness centers;
  • cafeterias offering healthy food options.

In 2009, about 10,000 of 25,000 employees participated in Well at Dell.

The program uses health risk assessments and medical insurance claims to gauge employees’ health risks.

To combat obesity, Dell employs an innovative pricing strategy promoting healthy cafeteria choices:

  • healthy foods are usually less expensive than unhealthy options;
  • baked goods are less expensive than fried foods;
  • bottled water is less expensive than soft drinks.

Results/Return on Investment

As of mid-2009, 83 percent of employees receiving health coaching had reduced or eliminated at least one health risk. Of participants, 71 percent eliminated or mitigated hypertension risks and 56 percent met recommended goals for physical activity.

Of workers in Cardiac Management Program:

  • 86 percent improved total cholesterol levels;
  • 88 percent improved LDL cholesterol levels;
  • 72 percent increased exercise;
  • 64 percent either met their BMI goals or made improvements in their BMI.

Johnson & Johnson115

Brunswick,
New Jersey
117,000 employees worldwide

Wellness Program Description

Johnson & Johnson (J&J), created its first wellness program in 1979 to help its employees become “the healthiest in the world.” The company devoted substantial amounts of money to program, including careful evaluations of results.

In 1995, they began Health and Wellness Program (HWP), including:

  • health risk assessments;
  • referral to intervention programs for high-risk conditions or behaviors;
  • health education;
  • benefit coverage for screenings and preventive services;
  • financial incentives;
  • strong corporate messages to encourage participation.

In 1995-1999, about 90 percent of U.S. workers participated in HWP.

The effects of the program were tracked in detail by analyzing medical claims from of 18,000+ employees made from 1990 to 1999.

J&J’s program continues evolving. The new prevention program, Healthy People, includes:

  • a fitness campaign;
  • healthy food at J&J cafeterias, vending machines and events;
  • the “Worldwide Tobacco-Free Workplace” initiative with various smoking cessation programs offered (free in U.S.) to employees and dependents.

Results/Return on Investment

Analysis of outcomes from 1990-1999 found that some categories of health care usage, including doctor visits, actually increased in first year or two. However, costs for hospital stays fell dramatically.

Over time, J&J realized savings in all categories except emergency room visits. Savings after four years of HWP totaled $224.66 annually per employee. In addition, from 2006 through 2008:

  • the number of U.S. employees in high health risk categories fell from 1.4 percent to 1.1 percent;
  • the number of U.S. employees in medium health risk categories fell from 20.5 percent to 13.9 percent.

Texas Instruments116

Dallas, Texas
26,700 employees worldwide, 9,000 in Texas

Wellness Program Description

Texas Instruments’ Live Healthy Program targets unhealthy eating habits and inactivity through programs that engage the entire family. Employees and family members can log on to an online health portal that includes resources such as:

  • healthy recipes;
  • a food log;
  • nutrition games.

The company also:

  • sends quarterly mailings to employees’ homes featuring a “Live Healthy” section and other wellness info;
  • provides childcare at worksite fitness centers;
  • provides activities specifically for dependents, such as week-long summer camps, to encourage healthy lifestyles from an early age.

Results/Return on Investment

Health risk assessments in 2007 indicated that there were fewer employees considered “high risk” than in 2006. The share of employees at high risk fell from 40 to 35 percent. Forty-six percent of the employees were considered medium risk and 18 percent were low risk.

Dallas/Fort Worth
International Airport117

1,700 employees

Wellness Program Description

Dallas/Fort Worth Airport (D/FW) wellness initiative, LiveWell, launched in 2007. Program incorporates:

  • worksite fitness facilities;
  • online education resources;
  • wellness circulars;
  • an incentive award program.

After health-risk assessments, obesity was found to be biggest threat facing employees. In 2008, more than 75 percent of work force was obese or overweight. Of the most prevalent employee health risks, 53.7 percent related to body weight.

To create supportive work environment, D/FW built a 14,500 square-foot fitness facility housing:

  • indoor half-basketball court;
  • two racquetball courts;
  • three indoor and four outdoor tennis courts;
  • two volleyball sand courts;
  • an exercise studio;
  • three strength/cardio training rooms;
  • shower facilities.

At the annual health fair, employees can receive free health screenings and interact with service providers, including massage therapists and chiropractors.

Results/Return on Investment

Between 2007 and 2009:

  • the share of employees with high risks fell by 3.1 percent;
  • the share of employees with medium risks fell by 1.8 percent;
  • the low-risk group expanded by 4.8 percent.

IBM118

Armonk, New York
399,400 employees worldwide

Wellness Program Description

IBM uses a number of incentives to promote health among employees and their family members.

Employees can choose two of five cash incentive health programs, each awarding $150 annually for participation.

The Children’s Health Rebate Program targets dependents, as obesity is often a family disease. The program gives parents online tools set goals and help develop action plans for:

  • physical activity;
  • nutrition;
  • “screen time” (spent in front of TV);
  • “role modeling” (participation in healthy activities as a family).

Cash incentives encourage high rates of participation.

Results/Return on Investment

In 2008, company saw improvements across all of focus areas. The highest gains were for increased physical activity.

Employees demonstrate high levels of satisfaction with the program, which creates goodwill and contributes to a broader strategy of promoting “a culture of health.”

Between 2004 and 2007:

  • there was an estimated savings of $2.42 for every dollar spent on wellness;
  • for a total savings of $191 million for a $79 million investment.

City of Hurst119

Hurst, Texas
400 employees

Wellness Program Description

The city of Hurst, Texas provides its employees and retirees and their family members with a number of wellness programs and activities. Since the Hurst Employee Wellness program was established in 2005; city’s costs have decreased and employee eating habits and physical activity have improved.

Each year, the wellness committee decides program offerings based on worker medical data and health risk assessments. Program managers also gather employee input using an annual survey to gauge interests.

The city encourages participation with cash and gift incentives and additional paid leave. Participating employees:

  • can earn up to eight hours of paid vacation;
  • receive subsidies for gym and Weight Watchers memberships;
  • receive $75 that can be used for wellness-related expenses;
  • Weight-loss programs are popular with employees. The Biggest Loser competition, a 10-week weight management program, was particularly successful. Between 2007 and 2009, city employees lost 1,267 pounds. In 2009 alone, 35 percent of employees participated and lost a total of 423 pounds.

    Results/Return on Investment

    • The program counteracted rising health insurance and employee absenteeism costs.
    • Health insurance premiums remained at 2006 levels in 2007 and 2008, bucking general trend of rising health costs.
    • Between 2007 and 2009, employee absenteeism fell by 38 percent.

    Capital Metropolitan Transportation Authority120

    Austin, Texas
    1,075 employees

    Wellness Program Description

    The Capital Metropolitan Transportation Authority of Austin launched a worksite wellness program in January 2003, contracting with Health and Lifestyles of Austin Corporate Wellness, Inc. The program provides a comprehensive range of tools:

    • access to 24-hour fitness centers;
    • personal trainers, wellness coaches;
    • full body assessments;
    • on-site dietician;
    • Weight Watchers classes, healthy-eating workshops;
    • walking club, bike loan program;
    • cash incentives for losing weight and quitting smoking.

    The program also offers weekly discount coupons to be used toward purchasing healthy cafeteria food and ensures that at least 60 percent of vending machine offerings are healthy choices.

    Smoking cessation classes, free flu shots and stress reduction workshops are also offered.

    Results/Return on Investment

    Capital Metro has seen good results, including:

    • Savings of $2.43 for every dollar spent on the program since 2003.
    • Health care costs, rising precipitously before 2003, slowed then fell by 4 percent in both 2007 and 2008, and 5 percent in 2009.
    • Between 2003 and 2009, they saw a 24 percent net increase in health care costs instead of the projected 49 percent increase.
    • Absenteeism, rising prior to 2003, fell in each of past five years.
    • Absenteeism rates are 37 percent lower in 2009 than in 2003.

    Lincoln Industries121

    Lincoln, Nebraska
    400 employees

    Wellness Program Description

    Lincoln Industries, a metals manufacturing company, provides a prominent example of the value and possibilities of employee wellness programs.

    The wellness committee was formed in 1990 and full-time wellness manager was hired in 2000. Healthy lifestyles have been built into workers’ performance objectives for more than 20 years.

    The program won awards from multiple groups, including:

    • the American Heart Association;
    • the U.S. Department of Health and Human Services;
    • the U.S. Centers for Disease Control.

    Other features of the program:

    • Facilities went tobacco-free in 2002.
    • Quarterly health checks became mandatory in 2003; risk indicators such as weight, blood pressure, flexibility and tobacco use are monitored.
    • The participation rate for the mostly voluntary program was greater than 90 percent in 2009.
    • The Go! Platinum program’s tools help employees improve their health, moving into fitness rankings of bronze, silver, gold and platinum.
    • Employee health checks are accompanied by consultations to review wellness goals.
    • Health objectives are included in the company’s performance management system.
    • Tobacco cessation and Weight Watchers at Work programs are offered continuously.
    • Nonsmoking employees receive discounts and partial reimbursements for gym memberships or purchases of exercise equipment.
    • Stretching sessions are required before each shift.
    • Neuromuscular therapy is available on site.

    Results/Return on Investment

    The company has seen good returns on its wellness investment:

    • health care cost savings of more than $1 million;
    • tobacco use is down from 42 percent in 2004 to 17 percent in 2009;
    • workers’ compensation claims are down from $510,000 in 2003 to just $43,000 in 2009;
    • health care costs per person are about half, to less than two-thirds of industry average.

    City of Houston122

    Houston, Texas
    23,000 employees

    Wellness Program Description

    The city developed the “Wellness Connection” program for its workers in 2007.

    The program:

    • is built around known best practices, including strong leadership commitment, integrated incentives supportive organizational culture and data management and evaluation;
    • focuses on healthy eating, active living, stress management and tobacco cessation;
    • includes wellness programs (30 – 60 minute activities at city departments), coaching roundtables (wellness educator helping 10 or more workers at a time with behavioral changes) and Know Your Numbers (ongoing screenings to track biometrics);
    • offers a yearlong calendar of activities and events posted on Wellness Connection website, along with a feedback survey;
    • featuress consistent and pervasive education and communication, such as e-Motivation email messages and 250 Wellness Ambassador employees;
    • opens some events and activities to the community.

    Results/Return on Investment

    From July 2007 through December 2008, the program had 10,732 participants; from January through May 2009, 9,543 employees were involved.

    • In the pilot Active Living program, 42 workers completed an eight-week class and lost a total of 190 pounds;
    • 3,500 city employees participated in the 2010 Great American Smoke Out;
    • The joint city/Blue Cross Blue Shield Metabolic Syndrome (MetS) programs in the 2009 and 2010 saw the following results:
      • the majority reversed their syndrome (66 percent and 57 percent in 2009 and 2010, respectively);
      • average weight loss of more than 13 pounds (90 percent and 94 percent); and
      • total weight loss of 661 and 447 pounds.

    End Notes

    All links were valid at the time of publication. Changes to web sites not maintained by the office of the Texas Comptroller may not be reflected in the links below.

    • 64 U.S. Department of Health and Human Services, Prevention Makes Common “Cents,” pp. i-1 and 24; Texas Department of State Health Services, Building Healthy Texans: A Guide to Lower Health Care Costs and More Productive Employees; and Katherine Baicker, David Cutler and Zirui Song, “Workplace Wellness Programs Can Generate Savings,” Health Affairs (February 2010), pp. 1-2 and 4-7; and U.S. Department of Health and Human Services, “7: Educational and Community-Based Programs,” in Healthy People 2010: Volume 1, 2nd ed. (Washington, D.C., November 2000), p. 7-5.
    • 65 Kenneth E. Warner, “Wellness at the Worksite,” Health Affairs (Summer 1990), p. 71. (Last visited January 7, 2011.)
    • 66 Laura Linnan, Mike Bowling, Jennifer Childress, Garry Lindsay, Carter Blakey, Stephanie Pronk, Sharon Wieker and Penelope Royall, “Results of the 2004 National Worksite Health Promotion Survey,” American Journal of Public Health (January 2008), pp. 2-4; and Joyce Gannon, “Companies Offer Wellness Programs to Cut Insurance Costs,” Pittsburgh Post-Gazette (May 11, 2008). (Last visited January 7, 2011.)
    • 67 Ron Z. Goetzel and Ronald J. Ozminkowski, “That’s Holding Your Back: Why Should (or Shouldn’t) Employers Invest in Health Promotion Programs for Their Workers?” North Carolina Medical Journal (November/December 2006), p. 429; and Josh Cable, “The ROI of Wellness,” EHS Today: The Magazine for Environment, Health and Safety Leaders (April 13, 2007). (Last visited January 10, 2011.)
    • 68 U.S. Centers for Disease Control and Prevention, “Healthier Worksite Initiative: Introduction,” Shirley S. Wang; “J&J Folds Wellness and Prevention Efforts into Consumer Biz,” Wall Street Journal Health Blog (April 15, 2009), (last visited January 10, 2011); and Vermont Governor’s Council on Physical Fitness and Sports, “Council Honors Employers for Wellness Programs,” Burlington, Vermont, September 30, 2008. (Last visited August 2, 2010.) (Press release.)
    • 69 Catherine A. Heaney and Ron Z. Goetzl, “A Review of Health-related Outcomes of Multi-Component Worksite Health Promotion Programs,” American Journal of Health Promotion (March-April 1997), pp. 302-303 and 305; and U.S. Department of Health and Human Services, “7: Educational and Community-Based Programs,” pp. 7-18 and 7-20.
    • 111USAA: Peter Wald, vice president and enterprise medical director, USAA; Texas Comptroller of Public Accounts, Counting Costs and Calories: Measuring the Cost of Obesity to Texas Employers, p. 22; and The Health Project, C. Everett Koop National Health Awards, “USAA – Take Care of Your Health,”
    • 112H-E-B: Brooke Brownlow, vice president of Human Resources, H-E-B; and Erica Bartram, Benefits Strategy and Design, H-E-B.
    • 113General Motors: Alan Adler, media relations, General Motors; and Shelly Hoffman, director, Employee Benefits, Public Policy, Compliance and Communications, General Motors.
    • 114Dell Inc.: Tre McCalister, global benefits manager, Dell Inc.; and National Business Group on Health, “Well at Dell: Creating a Campus Culture of Employee Health,” Platinum Awards: Best Employers for Healthy Lifestyles 2009 (2009), pp. 1-4.
    • 115Johnson & Johnson: Johnson & Johnson, “Our Company,”; Ronald J. Ozminkowski, Davina Ling, Ron Z. Goetzel, Jennifer A. Bruno, Kathleen R. Rutter, Fikry Isaac and Sara Wang, “Long-Term Impact of Johnson & Johnson’s Health & Wellness Program on Health Care Utilization and Expenditures,” Journal of Occupational and Environmental Medicine (January 2002), pp. 21-28; and Ron Z. Goetzel, Ronald J. Ozminkowski, Jennifer A. Bruno, Kathleen R. Rutter, Fikry Issac and Shaohung Wang, “The Long-Term Impact of Johnson & Johnson’s Health & Wellness Program on Employee Health Risks,” Journal of Occupational and Environmental Medicine (May 2002), pp. 417-419.
    • 116Texas Instruments: Texas Instruments, “TI Fact Sheet,” LuAnn Heinen and Helen Darling, “Addressing Obesity in the Workplace: The Role of Employers,” Milbank Quarterly (No. 1, 2009), pp. 112-113.
    • 117Dallas/Fort Worth International Airport: Amanda-Rae Garcia, wellness manager, Dallas/Fort Worth International Airport; Health Management Research Center, DFW Airport: 2007, 2008 and 2009 3-Time Repeated Health Risk Appraisal Summary Report (Ann Arbor, Michigan; University of Michigan, June 22, 2009), p. 1; Texas Chapter of the Public Risk Management Association, “Congratulations to This Year’s Risk Manager of the Year!” Texas Prima Press (April 2010), p. 4, (last visited January 11, 2011); and Dallas/Fort Worth International Airport Board, 2008 Champions in Health Award Application: Non-Profit, Government/Education, Small Company, (DFW Airport, Texas, 2008), pp. 3, 6-8 and 21.
    • 118IBM: “About IBM,”; “Medical Highlights,”; “IBM’s Global Wellness Initiatives,”; “IBM to Provide Employees with 100% Primary Health Care Coverage, New Wellness Rebate,”; Childhood Obesity: The Way Forward, Susan Dentzer, ed., slides 37-41, available in PowerPoint format; and Martin-J Sepulveda, Fan Tait, Edward Zimmerman and Dee Edington, “Impact of Childhood Obesity on Employers,” Health Affairs (March 2010), pp. 516-518.
    • 119City of Hurst: Esther White, wellness coordinator, City of Hurst, Texas; and “City of Hurst, Texas, Wellness Program.”
    • 120Capital Metropolitan Transportation Authority: Kim Peterson, employee relations manager, and Michael Nyren, risk manager, Capital Metropolitan Transportation Authority; Capital Metropolitan Transportation Authority, “Capital Metro Wellness Program Recognized for Improving Employee Health and Reducing Costs,” Austin, Texas, June 4, 2009; and U.S. Centers for Disease Control and Prevention, “A Comprehensive Worksite Wellness Program in Austin, Texas: Partnership Between Steps to a Healthier Austin and Capital Metropolitan Transportation Authority,” by Lynn Davis, Karina Loyo, Aerie Glowka, Rick Schwertfeger, Lisa Danielson, Cecily Brea, Alyssa Easton, and Shannon Griffin-Blake, Preventing Chronic Disease: Public Health Research, Practice, and Policy (April 2009), pp. 1-5.
    • 121Lincoln Industries: Lincoln Industries, “Wellness,” Marc LeBaron, “Corporate Culture,” Inside Supply Management (September 2009), p. 10, and Institute of Management and Administration, “How Lincoln Industries Hardwired Wellness Into Its Culture,” Builder Jobs (May 13, 2010).
    • 122City of Houston: Nicole Hare-Everline, wellness director, City of Houston.
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