FAST TRACK ARTICL E
Do Workplace Health Promotion (Wellness) Programs Work?
Ron Z. Goetzel, PhD, Rachel Mosher Henke, PhD, Maryam Tabrizi, PhD, MS, Kenneth R. Pelletier, PhD, MD (hc),
Ron Loeppke, MD, MPH, David W. Ballard, PsyD, MBA, Jessica Grossmeier, PhD, MPH,
David R. Anderson, PhD, LP, Derek Yach, MBChB, MPH, Rebecca K. Kelly, PhD, RD, CDE,
Tre’ McCalister, MA, EdD, Seth Serxner, PhD, Christobel Selecky, MA, Leba G. Shallenberger, DrPh,
James F. Fries, MD, Catherine Baase, MD, Fikry Isaac, MD, MPH, K. Andrew Crighton, MD,
Peter Wald, MD, MPH, Ellen Exum, BS, Dexter Shurney, MD, MBA, MPH, and R. Douglas Metz, DC
Objective: To respond to the question, “Do workplace health promotion
programs work?” Methods: A compilation of the evidence on workplace
programs’ effectiveness coupled with recommendations for critical review of
outcome studies. Also, reviewed are recent studies questioning the value of
workplace programs. Results: Evidence accumulated over the past three
decades shows that well-designed and well-executed programs that are
founded on evidence-based principles can achieve positive health and ﬁ-
nancial outcomes. Conclusions: Employers seeking a program that “works”
are urged to consider their goals and whether they have an organizational
culture that can facilitate success. Employers who choose to adopt a health
promotion program should use best and promising practices to maximize the
likelihood of achieving positive results.
There is a brewing controversy about whether workplace health
promotion programs in the United States “work” or “do not
work.”1We have been studying and evaluating workplace health pro-
motion programs (also referred to as wellness programs) for nearly
30 years.* During our decades of research, we have learned that
some programs are well designed, consistent with evidence-based
practices, effectively executed, and properly evaluated.2These pro-
grams “work.” We have also observed far too many well-intentioned
programs that are poorly designed, executed in a haphazard fashion,
do not follow evidence-based best practices, are not evidence-based,
From Johns Hopkins Bloomberg School of Public Health—Institute for Health and
Productivity Studies (Dr Goetzel) and Truven Health Analytics (Drs Goetzel
and Tabrizi), Bethesda, Md; Truven Health Analytics (Dr Henke), Cambridge,
Mass; University of Arizona School of Medicine and University of California
San Francisco School of Medicine (Dr Pelletier); US Preventive Medicine
(Dr Loeppke), Jacksonville, Fla; American Psychological Association
(Dr Ballard), Washington, DC; StayWell (Drs Grossmeier and Anderson), St
Paul, Minn; The Vitality Institute (Dr Yach), New York, NY; The University of
Alabama (Dr Kelly), Tuscaloosa; Mercer (Dr McCalister), Austin, Tex; Optum
(Dr Serxner), San Francisco, Calif; Population Health Alliance (Dr Selecky),
Washington, DC; Exxon Mobil Corporation (Dr Shallenberger), Houston,
Tex; Stanford University School of Medicine (Dr Fries), Palo Alto, Calif; The
Dow Chemical Company (Dr Baase), Midland, Mich; Johnson & Johnson
(Dr Isaac), New Brunswick; Prudential Financial (Dr Crighton), Newark, NJ;
USAA (Dr Wald), San Antonio, Tex; IBM Corporation (Ms Exum), Somers,
NY; Cummins, Inc (Dr Shurney), Columbus, Ind; and American Specialty
Health (Dr Metz), San Diego, Calif.
Funding for this study was provided by American Specialty Health.
The authors declare no conﬂicts of interest.
Address correspondence to: Ron Z. Goetzel, PhD, Institute for Health and Produc-
tivity Studies, Johns Hopkins Bloomberg School of Public Health, and Truven
Health Analytics, 7700 Old Georgetown Rd, Ste 650, Bethesda, MD 20814
Copyright C2014 by American College of Occupational and Environmental
*Throughout the paper, we use the terms “wellness” and “workplace health pro-
motion” interchangeably, although workplace health promotion is the preferred
term among professionals in the ﬁeld. In addition, whereas we refer to these ini-
tiatives as “programs,” they are really broader “strategies” that employers put in
place to achieve positive health and well-being outcomes.
are inadequately resourced, are not culturally supported, and are
therefore not effective.†These programs do not “work.”
This paper addresses the controversy surrounding whether
workplace health promotion programs “work”—or not. Our intent
is not to provide an exhaustive review of the evidence on health
promotion programs. Rather, this paper addresses questions raised
by employers, beneﬁt consultants, academicians, and practitioners
in response to this controversy and to help employers assess whether
health promotion programs are worthy of implementation.‡
Speciﬁcally, we ﬁrst discuss what is meant when people say
a wellness program “works”—what are the outcomes expected from
these programs and should those outcomes be re-considered? Sec-
ond, we introduce the various techniques for measuring workplace
programs, and how these may affect perceptions about what “works.”
Third, we review best and promising practices in health promotion
and the importance of instituting a “culture of health” as a neces-
sary foundation for effective programs. Fourth, we provide exam-
ples of effective programs followed by an analysis of studies used
as evidence that these programs are ineffective. We then reference
literature reviews that suggest that health promotion programs can
“work” if they contain the necessary ingredients linked to success.
Finally, we conclude with recommendations for employers consider-
ing health promotion program adoption. We begin with a discussion
OUTCOMES EXPECTED FROM HEALTH
First, it is important to deﬁne terms. Workplace health pro-
motion programs are employer initiatives directed at improving the
health and well-being of workers, and, in some cases, dependents.
They include initiatives designed to avert the occurrence of disease
or the progression of disease from its early unrecognized stage to a
more severe one.3
What do workplace programs aim to accomplish? If we were
to gather key executives at a company who are informed about health
care and ask them what they expect a workplace health promotion
program to achieve, you would likely hear a range of responses,
similar to those voiced in previous studies.4For example, they might
say the following:
†It is noteworthy that many unsuccessful programs are not reported because of
publication bias, meaning that program managers are reluctant to publicize nega-
‡It should be noted that this paper is focused on US-based workplace health
promotion initiatives. Health promotion programs in Europe, and for that matter
other parts of the world, differ signiﬁcantly from those found at US companies.
For example, Northern European health promotion efforts place greater emphasis
on creating a positive work environment and the importance of including workers,
especially unions, when shaping company health and safety policies. Conversely,
in other parts of the world less attention is directed on ﬁnancial outcomes and
ROI largely because governments fund health care services, not employers. Nev-
ertheless, internationally, there is greater interest placed on productivity outcomes
(absenteeism and safety incidents in particular) because these directly inﬂuence
the organization’s performance and international competitiveness.
Copyright © 2014 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
JOEM rVolume 56, Number 9, September 2014 927
Goetzel et al JOEM rVolume 56, Number 9, September 2014
1. “Make workers aware of their health and how being in good
health improves quality of life.”
2. “Workers should take ‘ownership’ of their behaviors and be
accountable for health and cost outcomes.”
3. “High participation and active involvement in these programs.
People should take advantage of the many programs offered.”
4. “Employees should lose weight, stop smoking, exercise more
often, eat a healthy diet, better manage their stress levels, and
generally adopt healthy habits.”
5. “Medical claims costs should go down. The company should
experience a lower incidence of certain diseases linked to be-
haviors like diabetes, heart disease, cancer, chronic obstruc-
tive pulmonary disease (COPD), musculoskeletal disorders, and
6. “Workers will be absent less often, disability costs will be con-
trolled, accidents will be avoided, and injury rates should drop
7. “These programs will attract the best talent—and turnover rates
will be reduced because we are the employer of choice in the
8. “Workers will perform at higher levels—they will be happier,
have more energy, produce better results for our company.”
9. “Establish a culture of health and well-being, whereevery worker
feels valued and important to the enterprise—this will inspire
greater loyalty and a high level of engagement.”
10. “The program will produce a positive return-on-investment
(ROI) for the company—for every dollar spent, two or three
will be saved.”
The expected outcomes expressed are varied and optimistic.
It is unlikely that an employer would spend a few hundred dollars
per employee per year on a workplace health promotion program
and achieve all of these results. There is one expectation listed above
that may be especially challenging—that the program will not cost
the company a dime because it will achieve a ﬁnancial return far in
excess of what a company would expect from any other investment.
This is the expectation that health promotion programs alone will
produce a substantial return-on-investment (ROI), often in 1 year.
For those unfamiliar with the term, ROI is a ﬁnancial metric that
calculates the amount of money gained (or costs averted) relative to
the amount spent on any given investment. In simple terms, a 3:1
ROI means that the investor saves $3 for every $1 spent.
It should be noted that few employer-provided beneﬁts are
expected to produce a positive ROI. A typical US employer today
spends large sums on health insurance for workers—health care
premiums for US workers averaged $16,351 in 2013.* There is little
evidence that these expenditures on medical treatment produce a
positive ROI.5At a minimum, employers expect medical treatments
to be safe and effective.6At best, some medical treatments have been
shown to be cost-effective. Workplace health promotion programs,
on the contrary, are often held to a much higher standard of producing
a ﬁnancial gain, or “proﬁt,” calculated in dollar terms—to justify
their worth to employers.†
*Annual premiums for employer-sponsored family health coverage were $16,351
in 2013, up 4% from the prior year, with workers on average paying $4565 toward
the cost of their coverage, according to the Kaiser Family Foundation/Health
Research & Educational Trust 2013 Employer Health Beneﬁts Survey. Available
†McGinnis et al6discuss the various explanations for why prevention is held
to a higher standard than medical treatment. Among the reasons cited are the
following: the complexity of prevention interventions; interest group dynamics
(ﬁnancial motives abound for those providing care compared with those seeking
to prevent it); the need to inﬂuence public policy and not just individual behaviors;
and social preference, that is, people demand medical care when ill (an immediate
problem) but are reluctant to change pleasurable habits if there are no obvious
immediate gains from that change. In addition, having access to medical treatment
The above discussion provides background to the ongoing
debate in the blogosphere, news media reports, and conference pre-
sentations focused on whether ROI is considered the most relevant
metric determining whether workplace health promotion programs
work. When savings are not realized, some critics assert that the pro-
gram has failed.7Some go as far as to say that if workplace health
promotion programs do not achieve a positive ROI, employers should
get rid of them because workplace health promotion programs rep-
resent one of “the biggest scams” ever deployed by the health care
industry on corporate America.8This perspective errs in the as-
sumption that cost saving is the sole purpose of workplace health
promotion and, therefore, the only outcome of interest.
There are other yardsticks by which health promotion ini-
tiatives should be measured that may be more aligned with actual
program goals. These measures could help deﬁne a program that
works as opposed to one that does not. In the following sections, we
list some broad categories of measures that assess whether programs
have the right structures and processes in place, are consistent with
best and promising practices, and are likely to achieve a broad range
of desired outcomes.
MEASURING HEALTH PROMOTION PROGRAM
Workplace programs can be evaluated using a measurement
framework (published elsewhere)‡9–11 organized into the follow-
ing three broad categories: program structure, delivery process,
and expected clinical, health care utilization/cost, and productivity
An assessment of program structure focuses on whether the
program’s critical components are in place and whether they follow
best practice principles. Essentially, if the program is not structured
or designed properly, it is unlikely to produce positive results.
Relevant questions for the structural assessment include the
following: (1) What are the interventions and their component parts?
(2) Are those interventions aligned to the demographic and health
status characteristics of employees and family members? (3) How is
the program delivered to employees and are the operational under-
pinnings reliable? (4) What topics are coveredand are they relevant to
the population served? (5) Are the interventions evidence-based? (6)
Is there coherence, consistency, and integration among the various
program components? (7) If there are incentives in place, are they
appropriate to promoting health and well-being? (8) Are sufﬁcient
resources allocated and is stafﬁng adequate? (9) Are organizational
factors important to success integrated into the program design? (10)
Is the program a permanent, integrated feature of employee beneﬁts?
(11) Does the program ﬁt the “culture” of the organization? (12) Is
there an infrastructure in place to track critical measures necessary
to evaluate program outcomes?
The structural assessment draws on a combination of quan-
titative (eg, claims, health risk, epidemiological, disability, survey,
and absence) and qualitative (eg, interviews and observations) data,
complemented by “administrative” reports. For example, checklists
or scorecards produced regularly to keep program managers current
on the operation of the program could be an important source of
supplementary data for the structural assessment.
The process evaluation assesses how well the program is be-
ing implemented—is it executed and progressing according to plan,
and are operations and delivery systems handled smoothly? Impor-
tantly, is there a feedback loop that allows for ongoing reﬁnement
is viewed by many as a societal “right,” whereas “interfering” in people’s health
behavior choices may be viewed as an intrusion into a person’s personal affairs
and a limitation on freedom of choice.
‡Program evaluation guidelines, from which the current list of structure, process,
and outcome measures were derived, originate in the publications9–11 (as detailed
in the References section).
Copyright © 2014 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
928 C2014 American College of Occupational and Environmental Medicine
JOEM rVolume 56, Number 9, September 2014 Workplace Health Promotion Programs
and course-correction? A well-structured program that is poorly exe-
cuted would not work. Relevant questions for the process evaluation
include the following: (1) Are the programs engaging the right peo-
ple? (2) How many participate and complete the interventions? (3)
Do participants advance in their readiness to change behaviors, and
do they become more engaged in improving their health? (4) How
satisﬁed are they with the way the program is run and its relevance
to their needs? (5) Is the program delivered with sufﬁcient dose or
intensity to be noticed? (6) Is ﬁdelity high—meaning that program
components are delivered in a similar way across locations or busi-
ness units? (7) Does corporate and local leaderships endorse the
program? (8) Are communications and branding strategies robust
and sufﬁciently diverse to attract the attention of different popula-
tion segments? (9) Do programs yield sustained engagement over
time? The process evaluation largely draws on quantitative data (eg,
employee surveys), complemented by administrative reports and ob-
Next is an evaluation of outcomes, which is usually the pri-
mary concern of the employer sponsors (ie, key executives) and
program implementers. The goal of the outcomes evaluation was to
assess the extent to which program objectives are achieved within
a given time horizon. This highlights the need to understand the
outcomes expected by each stakeholder before beginning or renew-
ing a program. As shown above, the expected outcomes may differ
from organization to organization—some outcomes may be straight-
forward and easily achieved, whereas others may be unrealistic and
difﬁcult to measure. There needs to be agreement among all the
key players on what can be accomplished in 12, 24, 36, 48, and
Typically, program outcomes fall into three broad categories—
improvements in the health and well-being of workers; cost savings
through appropriate use of health care services; and enhanced indi-
vidual and business performance metrics. Other key human capital
outcomes may include improved quality of life; a more engaged and
motivated workforce; increased worker retention and attraction; im-
proved safety performance; improved manufacturing reliability; and
a healthier company culture.
Improvement in population health is measured by assessing
the degree to which the proportion of workers “at high risk” im-
proves (ie, is reduced) over time. This is done by collecting valid and
reliable baseline data on the target population’s health habits,such
as diet, exercise, alcohol consumption, smoking status, seat belt use,
and sleep patterns; biometric characteristics, which might include
total cholesterol, blood pressure, and blood glucose; and well-being
measures of stress, depression, and overall health status. Follow-up
assessments are then performed after an appropriate time interval to
determine shifts in the health proﬁle of the population.
Individual and business performance measures often involve
examining worker absenteeism, disability rates, safety incidents, and
on-the-job productivity associated with health issues, referred to as
“presenteeism.”12 Performance measurement involves gathering any
or all of these above data for the population of interest and tracking
changes over time, controlling for as many confounder as feasible.
Certainly, cost management is a reasonable expectation for
workplace health promotion programs. To assess program savings,
the following data sources can be examined, assuming relevance and
availability: medical insurance claims, absenteeism records, work-
ers’ compensation liability claims, disability incident and duration
reports, and presenteeism surveys. These data provide a valuable re-
source for estimating program savings from a number of sources, and
the savings may be additive when multiple outcomes are considered.
Conducting a rigorous and credible ROI analysis is time-
consuming, expensive, and requires a high level of expertise in
*The long time horizon is intentional as many of the key objectives of workplace
programs can only be realized after several years.
statistical analysis, health services research, econometrics, and ben-
eﬁt plan design. Well-designed ROI studies of workplace health
promotion programs are rare, and even the best of these studies
contains methodological ﬂaws simply because they are conducted
in real-world settings with limited ability to control for confound-
ing factors, such as self-selection into programs, high attrition rates,
changes in employee demographics, beneﬁt plan design modiﬁca-
tions, alterations in third-party fee schedules, lack of statistical power
to show effects, nonnormal distributions of data, and legal or practi-
cal constraints related to the conduct of randomized trials.
It is also important to note that the “I” (investment) in an
ROI analysis is not well deﬁned. When considering program costs,
it is not clear what should be included. Certainly, fees paid to ven-
dors that administer the program are a program expense. But, less
straightforward is the salaries of staff that manage the program inter-
nally, compensation to employees for their time to participate during
work hours, facilities costs, and incentives payouts to workers (as-
suming that these are incremental and not integrated into beneﬁt
design). These are all real programs costs and often complicated to
calculate. Ideally, ROI studies would measure costs and savings as-
sociated with each program component separately. This necessitates
attributing savings and measuring costs for each of (perhaps dozens
of) interventions introduced simultaneously, which is difﬁcult, if not
impossible, to do in a real-world setting.
A broader view considered by leading employers is moving
beyond ROI to the full value of the investment in improving the
health of a population. This approach, akin to assessing the cost-
effectiveness of programs as opposed to their cost-beneﬁt, reﬂects
the interest of these employers to adopt effective and efﬁcient ways
to achieve population health improvement for their workers and
Some studies have given us insights into workplace health
promotion program elements shown to produce positive results. A
review of these best and promising practices is presented in the next
BEST AND PROMISING PRACTICES IN HEALTH
Given the heterogeneity of programs that call themselves well-
ness or workplace health promotion, it is important to note the com-
mon features of effective programs. There is a large divide between
what is termed a “comprehensive” health promotion program and
one characterized as “random acts of wellness.”†We know that pro-
grams that merely administer health risk assessment surveys and/or
offer a health improvement Web site are generally ineffective. We
also know that “off-the-shelf” programs offered by a vendor also fail
if they lack leadership support and are not integrated into the culture
of an organization.
What works? According to the Healthy People 2010,14 a com-
prehensive workplacehealth promotion program includes the follow-
ing ﬁve elements:
1. Health education, focused on skill development and lifestyle be-
havior change along with information dissemination and aware-
2. Supportive social and physical environments, reﬂecting the or-
ganization’s expectations regarding healthy behaviors and imple-
menting policies promoting healthy behaviors.
3. Integration of the worksite program into the organization’s ben-
eﬁts, human resources infrastructure, and environmental health
and safety initiatives.
4. Links between health promotion and related programs like em-
†A term used by Mark Matson, Vice President of Human Resources, EWI,
Copyright © 2014 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
C2014 American College of Occupational and Environmental Medicine 929
Goetzel et al JOEM rVolume 56, Number 9, September 2014
5. Screenings followed by counseling and education on how to best
use medical services for necessary follow-up.
To understand more precisely the critical elements of effective
programs, the reader is referred to studies performed over the past
several years that have identiﬁed the common features of effective
programs.*15–17 These best or promising practice studies provide
needed speciﬁcity and alignment with the framework developed by
the Healthy People 2010.
On the basis of behavior change and organizational theory, we
know that effective programs have strong senior and middle man-
agement support and grass roots champions, include employee input
when developing program goals and objectives, have dedicated staff,
offer meaningful incentives that encourage workers and families to
participate, have a strong communication strategy consistent with
the corporate culture, and are regularly evaluated using well-deﬁned
metrics of success.18–21
A series of literature reviews and site visit studies support
this view. For example, the research by O’Donnell et al,20 conducted
in cooperation with the American Productivity and Quality Center,
identiﬁed the following 10 characteristics of sustainable programs:
(1) linking of program to business objectives; (2) executive manage-
ment support; (3) multi-year strategic planning; (4) employee input
when developing goals and objectives; (5) wide variety of program
offerings; (6) effective targeting of high-risk individuals; (7) incen-
tives to motivate employees to participate in the program, leading
to high participation rates; (8) program accessibility; (9) effective
communications; and (10) evaluation of effectiveness.
A later study, also conducted with the American Productivity
and Quality Center,†listed the following common themes found in
best performing programs (ie, those with documented evidence of
success): (1) organizational commitment, (2) incentives for employ-
ees to participate, (3) effective screening and triage, (4) state-of-the-
art theory and evidence-based interventions, (5) effective implemen-
tation, and (6) ongoing program evaluation.
A panel of experts assembled by the National Institute for
Occupational Safety and Health (NIOSH) in 2008 created a list of
Essential Elements of Effective Workplace Programs and Policies
for Improving Worker Health and Wellbeing. These experts from
public and private sectors identiﬁed 20 components of a compre-
hensive health protection and health promotion program. These 20
components were divided into the following four broad areas: (1)
organizational culture and leadership, (2) program design, (3) pro-
gram implementation and resources, and (4) program evaluation.‡
Importantly, the Essential Elements document underscored the need
for programs, practices, and policies to be “hard coded” into the
work environment and to complement individually focused health
In a separate project,9–11 the Centers for Disease Control and
Prevention (CDC) and the National Association of Chronic Disease
Directors convened a panel of experts and asked them to identify best
or promising practices in the workplace. That discussion produced
the following four successful strategies: (1) employing features and
incentives consistent with an organization’s core mission, goals, op-
erations, and administrative structures; (2) targeting the most impor-
tant health care issues among the population; (3) achieving high rates
of program engagement and participation in both the short and long
term; and (4) evaluating programs on the basis of clear deﬁnitions of
success, as reﬂected in scorecards and metrics agreed on by relevant
*New best practice and benchmarking studies are currently underway and their
results will be forthcoming shortly.
†The long time horizon is intentional as many of the key objectives of workplace
programs can only be realized after several years.
‡Readers are referred to the NIOSH website for a complete list of these essential
elements. Available at: http://www.cdc.gov/niosh/docs/2010-140/.
stakeholders. This project has led to the development of the CDC
Worksite Health Scorecard, which is available to employers on the
CDC Web site.§22
Not addressed by the above studies is how programmatic cat-
egories should be funded and where emphasis should be placed in
budgeting for workplace health promotion. For example, given lim-
ited resources, there is little insight offered on the proportion of
funds to be spent on individual counseling, biometric testing, ex-
ercise equipment, classes, subsidies for healthy food items, Web
sites, advisory group meetings, personal trainers, on-site clinics,
and incentives, to name but a few program investment alternatives.
More research is, therefore, needed to better understand which of the
above program components is most cost-effective in providing value
to workers, driving participation, and achieving speciﬁc outcomes.
In addition, research is needed to determine which program
components are most applicable for certain populations. For exam-
ple, best practices found in a manufacturing facility may not translate
well to call centers, universities, or hospitals.
The Importance of Establishing a Culture of Health
It is important to highlight one component of successful pro-
grams, which is frequently referenced in the best practices literature
reviewed above—establishing a culture of health. A culture of health
is deﬁned as one in which individuals and their organizations are able
to make healthy life choices within a larger social environment that
values, provides, and promotes options that are capable of produc-
ing health and well-being for everyone regardless of background or
environment.23 Comprehensive health promotion programs are built
on a culture of health that supports individuals’ efforts at changing
lifelong health habits by putting in place policies, programs, ben-
eﬁts, management, and environmental practices that intentionally
motivate and sustain health improvement.22
Improving population health requires more than simply con-
vincing people to take better care of themselves. It requires that the
organization where individuals spend a good portion of their waking
hours creates an environment where leading a healthy lifestyle is
the “default” option. As an example, a supportive company culture
is exempliﬁed by company cafeterias, where healthy food is abun-
dant, affordable, clearly labeled, tastefully prepared, and situated at
eye level at the checkout counter. When possible, these foods are
also priced lower than less healthy items. In addition, healthy and
appealing food is served at meetings, included in company-provided
overtime meals, and available in vending machines.
For companies seeking guidance on how to create a healthy
company culture, several organizational health tools have been de-
veloped and made widely available. These include the CDC Worksite
Health ScoreCard,24 the Health Enhancement Research Organization
Scorecard,25 National Business Group on Health’s Wellness Impact
Scorecard,26 Corporate Health Achievement Award,27 and NIOSH
Although these tools can drive important tactical changes
to the workplace, they do not deﬁne a healthy culture—creating a
healthy company culture is more than just checking off items on a
list. In recent weeks, a team of researchers (including the lead au-
thor) visited several employers, large and small, that embody healthy
company cultures in their businesses.¶These site visits are part of a
larger project funded by the Robert Wood Johnson Foundation.29 In
visiting these companies, the team observed that a culture of health
§Readers may wish to compare NIOSH and CDC Web sites when deciding which
tool is most applicable to their situation. The elements contained in the twotools are
complementary to one another. The NIOSH instrument is focused on occupational
health and safety, whereas the CDC tool is focused on speciﬁc categories of health
risks and improvement opportunities supported by evidence.
¶The companies visited were selected byan expert panel and many were winners of
the C. Everett Koop Award. They included Johnson & Johnson, USAA, Citibank,
Dell, Graco, Turck, Lincoln Industries, LL Bean, and NextJump.
930 C2014 American College of Occupational and Environmental Medicine
JOEM rVolume 56, Number 9, September 2014 Workplace Health Promotion Programs
and well-being is woven into the fabric of the organization. These
companies’ leaders genuinely care about the health of their workers
and their families—not because a program will save them money, but
because they think of their workers as part of a large family. They
say, for example, that they want their workers to leave their jobs
each day healthier in mind and body than when they ﬁrst came in.
They also lead by example by practicing healthy behaviors instead
of telling workers how they should behave.
Company executives create cultures of health not just because
it is “the right thing to do,” but because they believe that crucial
business metrics (revenue, proﬁt, stock price, company valuation,
and reputation) are enhanced when health and well-being are in-
grained in the company’s norms, values, and beliefs. Leaders also
believe that if they attract and retain the right people—those who ﬁt
well into the company’s culture and share common core values—the
enterprise will prosper. Not surprisingly, executives from these com-
panies reported that they are doing well as a business, referencing
stable health care costs, reduced accident rates, low turnover, and
high morale. To support these anecdotal claims, there is emerging
research showing that companies that build a culture of health by
focusing on the well-being and safety of their workforce also yield
greater value for their investors.30
It should be noted, however, that the cause–effect relationships
between programs and outcomes are not always clear. For example,
it may be that companies that do well ﬁnancially also have the nec-
essary talent and resources to run well-functioning health promotion
programs that, in turn, produce excellent results.
EXAMPLES OF HEALTH PROMOTION PROGRAMS
THAT WORK (OR DO NOT?)
The above studies highlight the essential elements of compre-
hensive health promotion programs. Readers seeking examples of
effective programs, with documented evidence that these programs
can improve population health and save money, are directed to The
Health Project Web site,31 where a list of more than 50 employers
that received the C. Everett Koop National Health Award can be
Recent examples of best practice programs include those at
Johnson & Johnson, Prudential Financial, The Dow Chemical Com-
pany, USAA, LL Bean, Lincoln Industries, Alcon Laboratories,
Union Paciﬁc Railroad, Highmark, Eastman Chemical, PepsiCo,
Vanderbilt University, The State of Nebraska, Dell Inc, Medical
Mutual of Ohio, The Volvo Group, and Procter & Gamble.
One of the earliest evaluations of a workplace program, au-
thored by Fries et al32 and published in The American Journal of
Medicine, focused on the Bank of America retirees. The randomized
control trial (rare in “real-world” studies) concluded that individuals
exposed to the workplace program (the intervention group) improved
their health risk scores by 23% from baseline to 24 months, com-
pared with controls. Cost reductions averaged 10%, as measured by
claims data, at 12 months, with a net savings of $179 reported for
employees in the treatment group.
Another example of a successful employer program, pub-
lished more recently in Health Affairs, is that of Johnson & Johnson,
whose workplace health promotion program has been in place for
more than 30 years. The evaluation spanned the period of 2002
to 2008 and found that the company experienced an average an-
nual, inﬂation-adjusted, growth in total medical expenditures equal
to 1.0%, approximately 3.7 percentage points lower than for other
similar large companies.33 The ROI from the Johnson & Johnson
study was estimated to be between $1.88 and $3.92 for every $1.00
*To receive the Koop Award, organizations need to provide documentary evidence
that their programs improved health and reduced costs through the application of
evidence-based health promotion and disease prevention interventions.
Despite the above examples of programs that work, many
programs do not employ best and promising practices.34 Of the in-
creasing numbers of workplace health promotion programs, many
are ineffective because of underinvestment, improper design, poor
implementation, and uneven evaluation.35 For example, the RAND
Corporation (RAND) recently published results of a national survey
of employers with 50 or more workers and found that 51% claimed
that they offer wellness programs.36 Other surveys have reported
similar results with one survey, showing that as many as 63% of all
companies offering health care beneﬁts have at least one wellness
Nevertheless, most of these programs are neither comprehen-
sive nor evidence-based and, therefore, unlikely to be effective (at
least in terms of their ability to save money).38 Linnan et al,39 in a
federally funded study published in 2008, found that just 6.9% of US
employers offer comprehensive worksite health promotion programs
as deﬁned by the ﬁve elements listed in the Healthy People 2010.
Several high-proﬁle studies have recently been publicized in
the media as examples of ineffective programs. Results of these
individual studies have been extrapolated to build a narrative that
all workplace health promotion programs are therefore ineffective.
Critics of workplace programs have written, “ . . . in addition to po-
tentially harming some employees—wellness won’t reduce corporate
health spending either. A leading health policy journal has exposed
vendor ‘get well quick’ schemes, and published studies with negative
returns at Barnes Hospital [BJC Healthcare] and PepsiCo. RAND
weighed in with a study showing only minor health improvements
and no cost savings.”40
Next, we review three studies that were highlighted by var-
ious popular and business media as examples of health promotion
The RAND Study
In 2013, RAND published results from a federally funded
study focused on workplace health promotion programs.37 The
project was multifaceted and involved a literature review, site visits
to companies, an employer survey, and analysis of a large multi-
employer database comprising more than half a million employees
whose medical and health risk records were analyzed over a period
of several years, resulting in 1.8 million person-years of data. In me-
dia reports, the study purportedly “delivered a blow” to the wellness
“industry” and “cast doubt” about programs’ effectiveness given the
Despite the media spin on the ﬁndings, the RAND study
reported “signiﬁcant,” “clinically meaningful,” and “long-lasting”
improvements in employees’ weight, smoking status, and physical
activity—but not in cholesterol values. In terms of ﬁnancial out-
comes, RAND found that participants had lower health care costs and
reduced service utilization compared with statistically matched non-
participants, but the results were not statistically signiﬁcant. There-
fore, the study authors were unable to conclude that the programs
saved money, although they inferred that they were probably cost
neutral. The small number of individuals included in subcompo-
nents of the RAND studies (eg, only 746 individuals were included
in the smoking analysis and 12,127 in the cost analysis—out of
567,506 employees in the database) impacts the generalizability of
results to the companies included in the study and to workplace
health promotion programs in general.
The PepsiCo Study
A January 2014 article published in Health Affairs also
introduced doubt about the effectiveness of workplace health
promotion—in this case, a study of PepsiCo employees.43 The focus
of this study was only on the ROI from PepsiCo’s program. The study
authors estimated the cost savings from the PepsiCo program, called
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Goetzel et al JOEM rVolume 56, Number 9, September 2014
“Healthy Living,” and concluded that the lifestyle management pro-
gram component of Healthy Living did not produce a positive ROI.
PepsiCo’s Healthy Living program contained the following
two major components: one focused on disease management and the
other on lifestyle management. The study tracked the experience of
about 67,000 workers more than 7 years. The 2014 study was an
update of an earlier analysis of PepsiCo’s program published in a
2012 issue of Population Health Management.44
As was the case in the RAND study, only a subset of employees
were successfully matched to a similar eligible nonparticipant pop-
ulation; 2610 individuals in disease management, 17,432 in lifestyle
management, and 2162 in both disease and lifestyle management.
The assignment of workers into one or another program was based
on health risks and the presence of a disease. For example, workers
with serious illnesses or prevalent conditions such as hyperlipidemia,
hypertension, and low back pain were assigned to disease manage-
ment, whereas individuals with weight, stress, smoking, eating, and
ﬁtness problems (often people who are less expensive at baseline)
were assigned to lifestyle management. Because this was an ROI
analysis, the researchers did not report on health improvements or
risk reduction in PepsiCo’s population so readers were left to wonder
whether the main purpose of health and disease management was
As noted above, the authors found net program savings for dis-
ease management but not lifestyle management. Lifestyle manage-
ment did save the company money but not enough to offset the cost of
the program. Nevertheless, for individuals who were in both lifestyle
and disease management, substantial savings were realized totaling
$360 per employee per year. Overall, the combined lifestyle and
disease management program produced a positive ROI for Healthy
Living—estimated at $1.46 saved for every dollar invested. Although
not highlighted in the analysis, this paper did report absenteeism re-
ductions among workers engaged in lifestyle management.
Forbes Magazine reported on the study with the headline,
“Healthy lifestyle adoption push may not save employers money.”45
The article noted, “Encouraging workers to adopt a healthy lifestyle
may not reduce health costs or lead to net savings.” Follow-up media
reports and blog posts further decried the results using such head-
lines as “PepsiCo’s wellness program falls ﬂat,” and “Workplace
wellness takes another hit.”46 Critics were quick to note that disease
management works, but workplace health promotion programs do
A main concern with the type of analysis performed with Pep-
siCo data is that it draws a distinction between the effects on health
care costs by individual program components and assumes that these
components work independently of one another, unless the member
participates in both programs. PepsiCo’s aim was to manage the
health of its entire population—a consumer-centric approach—not
one where artiﬁcial boundaries are drawn between vendors. The
question arises, where should an individual ﬁt if he or she has high
blood pressure, high blood glucose, heart disease, high stress, and
also has lifestyle habits that put him or her at high risk for exacer-
bating those conditions, like smoking, being sedentary, and eating
a poor diet? Where should that individual belong in the PepsiCo
program conﬁguration? Would the worker be qualiﬁed for disease
or lifestyle management—or both? Furthermore, how effective are
these programs in changing behaviors and increasing compliance
with evidence-based practices? And, other than reduced hospital ad-
missions, what is the source of “savings” from either disease or
lifestyle management programs? These issues were not addressed in
the published study.
Furthermore, other questions that would put PepsiCo’s pro-
gram effectiveness in a broader context were not asked by the re-
searchers. For example, What was the work environment for work-
ers who might have beneﬁted from these programs? Were supervi-
sors supportive? What policies were in place to encourage healthy
eating, physical activity, management of biometric measures, and
other health promoting activities? What elements of a “culture of
heath” were in place at PepsiCo? Were any of these issues consid-
ered in the analysis?
This missing information is essential in evaluating whether the
PepsiCo program “worked” or not. The study authors acknowledge
that, “reconciling these seemingly contradictory ﬁndings requires
not only asking, ‘do wellness programs work?’ but also, ‘which
program components have which effects under which conditions?’
Such an approach is particularly important given the heterogeneity of
offerings that can be subsumed under the label ‘workplace wellness’
and the variety of settings in which these programs are implemented.”
Interestingly, the earlier study of PepsiCo’s program, by many
of the same authors of the current research, concluded that the
PepsiCo program, which included disease, lifestyle and case man-
agement, did produce a saving of $456 per person per year along-
side signiﬁcant reductions in hospital admissions and emergency
department visits. In the earlier study, the authors cautioned that cost
savings are achievable from health and workplace health promotion
programs only after 3 years of program implementation. This vari-
able of program duration is often overlooked but is critical because
most positive ROI results are reported only after a program has been
in place for 3 or more years.47
The BJC Healthcare Study
In a 2013 study published in Health Affairs, Gowrisankaran
and colleagues48 reported on health care utilization and cost out-
comes from a wellness program in place after only 2 years at BJC
Healthcare, a large nonproﬁt health care organization in the Midwest.
Participation in the program, described as comprehensive, afforded
workers access to the most generous “Gold” insurance plan offered
by the organization.
In the second year postintervention, the investigators found
a signiﬁcant drop in hospitalizations resulting in a $22 per member
per month savings for conditions targeted by the wellness program.
Nevertheless, those savings were offset by a $19 per member per
month increase in noninpatient costs. As a result, the authors con-
cluded that the program did not save money for the hospital and
there was no positive ROI, at least not in the short run. This study
also focused on ﬁnancial outcomes and no health improvements
were reported, although widespread participation in health risk as-
sessments and health fairs was observed. It should be emphasized
that, although the program was characterized as comprehensive, it
was mainly structured as incentive-based—allowing employees to
enroll in a better grade insurance program following a health screen-
ing. Nonetheless, this study was also hailed as further evidence that
workplace health promotion programs do not work.
LITERATURE REVIEWS FOCUSED ON WORKPLACE
The three studies highlighted above reported both positive
and negative ﬁndings. It is troubling, although not surprising, that
the media focused primarily on the negative results because those
were newsworthy and challenging to conventional wisdom. Several
lessons can be learned from the above studies and among those
lessons are the following: (1) Multiple outcomes need to be consid-
ered in evaluating the overall impact of workplace programs; (2) a
long enough timeline (usually 3+years) is necessary to detect pop-
ulation health effects; and (3) transparency in the methods employed
when conducting evaluations is critical. Also, important is the need
to capture a full understanding of the intervention programs provided
so that reader can assess their adequacy in terms of ﬁdelity, dose,
and extent to which they adhere to evidence-based principles.
932 C2014 American College of Occupational and Environmental Medicine
JOEM rVolume 56, Number 9, September 2014 Workplace Health Promotion Programs
It should be noted that the conclusions drawn from the three
studies highlighted above are in sharp contrast to important literature
reviews published in recent years. A 2010 review by the Community
Guide Task Force, housed at the CDC, found that well-designed pro-
grams exerted a positive inﬂuence on a number of health behaviors
(eg, smoking, diet, physical activity, alcohol consumption, and seat
belt use), biometric measures (eg, blood pressure and cholesterol lev-
els), and ﬁnancial outcomes important to employers (eg, health care
utilization and worker productivity).49 The literature search yielded
4584 titles, and 334 were examined in detail. Of these, 86 studies
were included in the review.
A meta-analysis by Chapman et al50 in 2012 examined 42
studies and found that participants in workplace health promotion
programs had about 25% lower medical and absenteeism expen-
ditures than nonparticipants. A widely cited meta-analysis of the
literature on costs and savings associated with worksite health pro-
motion programs conducted by Harvard economists Baicker et al51
reported that medical and absenteeism ROIs amounting to $3.27 and
$2.70, respectively, saved for every $1.00 invested, over a 3-year
time horizon. The economists did acknowledge in their review that
the evidence was still young and that the research varied in quality
Other recent reviews by Lerner et al52 and Serxner et al53
examined the literature using different frames of reference. Lerner
et al found few methodologically strong studies focused on economic
outcomes. Nevertheless, of the 10 studies with strong designs, eight
documented positive ﬁnancial effects, whereas two reported negative
results. Serxner et al also noted a great deal of variability in program
design, execution, and evaluation but concluded that the overall body
of evidence suggests that well-formulated programs can achieve cost
savings, especially after several years of operation. Other reviews by
Serxner and colleagues54,55 are cited as references in this paper.
Although the evidence is still being compiled, and many more
and better designed studies are needed, the general conclusion of
evaluations conducted by leading economists and researchers is that
comprehensive workplace programs (those that adopt best practice
principles and create cultures of health) do exert a positive in-
ﬂuence on certain health behaviors and biometric measures, and
they also produce positive ﬁnancial outcomes important to em-
ployers (eg, reductions in health care utilization and productivity
RECOMMENDATIONS FOR EMPLOYERS
CONSIDERING HEALTH PROMOTION PROGRAMS
For employers considering implementing health promotion
programs, a take away from this paper is that some of these programs
work and some do not. Program success depends on the goals of
the program, program design and implementation, and importantly
how the program is evaluated. If the only expectation is that the
sponsoring organization will “make money” (ie, achieve a ﬁnancial
gain) in the form of lower health care costs by instituting a workplace
health promotion program, then implementing a best practice health
promotion program may not be worth the effort.
A second “take away” is that the program must ﬁt into the cul-
ture of the organization. If the culture is based on quarter-to-quarter
results, then a workplace program that requires several years to be-
come ingrained and well functioning may not be the right strategy
for that particular organization.
Assuming that expectations are clear, and the organization’s
culture is conducive to beginning or expanding a workplace health
promotion program, ongoing measurement and evaluation needs to
be built into program design and implementation. Tracking program
success metrics ensures that success is not left to chance but, instead,
based on explicit feedback loops and standard business practices
focused on quality improvement.
1. Khanna V, Lewis A. Keas poll on workplace stress and disease burden
provides an education. Available at: http://thehealthcareblog.com/blog/tag/
al-lewis/. Accessed April 10, 2014.
2. Goetzel RZ, Ozminkowski RJ. The health and cost beneﬁts of work site
health-promotion programs. Annu Rev Public Health. 2008;29:303–323.
3. Commission on Chronic Illness. Chronic Illness in the United States.Cam-
bridge, MA: Harvard University Press; 1957.
4. Goetzel RZ, Ozminkowski RJ, Asciutto AJ, Chouinard P, Barrett M. Survey
of Koop Award winners: life-cycle insights. Art Health Promot. 2001;5:2–8.
5. Cohen JT, Newman PJ, Weinstein MC. Does preventive care save
money? Health economics and the presidential candidates. N Engl J Med.
6. McGinnis JM, Williams-RussoP, Knickman J. The case for more active policy
attention to health promotion. Health Aff (Millwood). 2002;21:78–93.
7. Lewis A, Khanna V. Here comes Obamacare’s “workplace wellness.” Wa l l
Street Journal, online edition, June 20, 2013, 7:14 PM.
8. Lewis A. Wellness Programs Take a Punch to the gut at Pep-
siCo. Disease Management Purchasing Consortium, Inc. 2014. Available
take-a-punch-to-the-gut-at-pepsico#axzz2tnHjbNtw. Accessed April 8, 2014.
9. Ozminkowski RJ, Goetzel RZ, Dunn RL. SAMHSA/CSAP Workplace Man-
aged Care Financial/Cost Research Evaluation Guide. Division of Work-
place Programs, Center for Substance Abuse Prevention, Substance Abuse
and Mental Health Services Administration; August 1998.
10. Goetzel RZ. Program evaluation—Chapter 5. Health Promotion in the Work-
place. 2nd ed. Delmar Publishers, Inc. Published 1994.
11. Goetzel RZ, Ozminkowski RJ. Program evaluation—Chapter 5. In: Michael
P., O’Donnell P., ed. Health Promotion in the Workplace. 3rd ed. Albany, NY:
Delmar/Thomson Learning; 2002.
12. Cancelliere C, Cassidy JD, Ammendolia C, Cote P. Are workplace health
promotion programs effective at improving presenteeism in workers? A sys-
tematic review and best evidence synthesis of the literature. BMC Public
13. Loeppke R. The value of health and the power of prevention. Int J Workplace
Health Manag. 2008;1:95–108.
14. Healthy People 2010. With Understanding and Improving Health and Ob-
jectives for Improving Health. Washington, DC: US Department of Health
and Human Services; 2000. Available at: http://www.healthypeople.gov/2010/
Document/HTML/Volume1/07Ed.htm# Toc490550857. Accessed April 8,
15. Terry P, Seaverson EL, Grossmeier J, Anderson D. Association between
nine quality components and superior worksite health management program
results. J Occup Environ Med. 2008;50:633–641.
16. Terry PE, Grossmeier J, Mangen D, Gingerich SB. Analyzing best practices
in employee health management: how age, gender and program components
relate to employee engagement and health outcomes. J Occup Environ Med.
17. Goetzel RZ, Henke RM, Benevent R, et al. The predictive validity of the
HERO scorecard in determining future healthcare cost and risk trends. J
Occup Environ Med. 2014;56:136–144.
18. Goetzel RZ, Shechter D, Ozminkowski RJ, Marmet PF, Tabrizi MJ, Roe-
mer EC. Promising practices in employer health and productivity manage-
ment efforts: ﬁndings from a benchmarking study. J Occup Environ Med.
19. Goetzel RZ, Guindon AM, Turshen IJ, Ozminkowski RJ. Health and produc-
tivity management: establishing key performance measures, benchmarks, and
best practices. J Occup Environ Med. 2001;43:10–17.
20. O’Donnell M, Bishop C, Kaplan K. Benchmarking best practices in workplace
health promotion. Art Health Promot Newsl. 1997;1:12.
21. Loeppke R. Guidance for a reasonably designed employer-sponsored well-
ness program using outcomes-based incentives: consensus statement of the
Health Enhancement Research Organization (HERO), American College of
Occupational and Environmental Medicine (ACOEM), American Cancer So-
ciety and American Cancer Society Cancer Action Network, American Dia-
betes Association, and American Heart Association. J Occup Environ Med.
22. Centers for Disease Control and Prevention. The CDC Worksite Health Score-
Card: An Assessment Tool for Employers to Prevent Heart Disease, Stroke,
and Related Health Conditions. Atlanta, GA: US Department of Health
C2014 American College of Occupational and Environmental Medicine 933
Goetzel et al JOEM rVolume 56, Number 9, September 2014
and Human Services; 2012. Available at: http://www.cdc.gov/dhdsp/pubs/
worksite scorecard.htm. Accessed April 8, 2014.
23. Robert Wood Johnson Foundation. RWJF’s model for advancing a culture of
health. Available at: http://www.rwjf.org/en/blogs/culture-of- health/2013/05/
about culture ofhea.html. Accessed April 8, 2014.
24. Centers for Disease Control and Prevention. Worksite Health ScoreCard.
Available at: http://www.cdc.gov/dhdsp/pubs/worksite scorecard.htm.Ac-
cessed April 10, 2014.
25. The Health Enhancement Research Organization. NEXT GENERATION
HERO Employee Health Management (EHM) best practices scorecard in
collaboration with Mercer. Available at: http://www.the-hero.org/scorecard
folder/scorecard.htm. Accessed April 10, 2014.
26. National Business Group on Health. WISCORE: Wellness Im-
pact Scorecard. Available at: http://www.businessgrouphealth.org/
scorecard_v4/index.cfm?event=logon.landing. Accessed April 7, 2014.
27. American College of Occupational and Environmental Medicine.
ACOEM Annual Awards Recipients. Available at: http://www.acoem.org/
uploadedFiles/About ACOEM/Historical Info Awar d s and Grants.pdf .Ac-
cessed April 7, 2014.
28. Centers for Disease Control and Prevention. Essential Elements of Effective
Workplace Programs and Policies for Improving Worker Health and Wellbe-
ing, October 2008. DHHS (NIOSH) Publication Number 2010-140. Available
at: http://www.cdc.gov/niosh/docs/2010-140/pdfs/2010- 140.pdf . Accessed
April 7, 2014.
29. Robert Wood Johnson Foundation-Grants. Through our investments in our
grantees, we seek to improve the health and health care of all Americans.
Available at: http://www.rwjf.org/en/grants.html#q/maptype/grants/keyword/
workplace/ll/33.796,-84.328/z/13. Accessed April 10, 2014.
30. Fabius R, Thayer RD, Konicki DL, et al. The link between workforce health
and safety and the health of the bottom line: tracking market performance
of companies that nurture a “culture of health. J Occup Environ Med.
31. The Health Project. C. Everett Koop National Health Award Winners. Avail-
able at: www.thehealthproject.com. Accessed April 10, 2014.
32. Fries JF, Bloch DA, Harrington H, Richardson N, Beck R. Two-year results
of a randomized controlled trial of a health promotion program in a retiree
population: the Bank of America Study. Am J Med. 1993;94:455–462.
33. Henke R, Goetzel R, McHugh J, Isaac F. Recent experience in health promo-
tion at Johnson & Johnson: lowerhealth spending, strong retur n on investment.
Health Aff (Millwood). 2011;30:490–499.
34. PelletierKA. Review and analysis of the clinical and cost-effectiveness studies
of comprehensive health promotion and disease management programs at the
worksite: update VII 2004–2008. J Occup Environ Med. 2009;51:822—837.
35. Goetzel R, Chung Roemer E, Kent K, Smith K. Health Care Cost Savings
from Comprehensive Worksite Health Promotion (CWHP) Programs - Policy
Narrative. Comprehensive Worksite Health Promotion Program. Report to the
Bipartisan Policy Center; 2013. Available at: http://bipartisanpolicy.org/sites/
default/ﬁles/Worksite%20Health%20Promotion%20Programs 0 0.pdf .Ac-
cessed April 11, 2014.
36. Mattke S, Liu H, Caloyeras JP, et al. Workplace Wellness Programs Study:
Final Report. RAND Corporation; 2013. Available at: http://www.rand.org/
.pdf. Accessed April 8, 2014.
37. Kaiser Family Foundation and Health Research and Educational Trust. Em-
ployer health beneﬁts: annual survey 2012. Available at: http://ehbs.kff.org/
pdf/2011/8225.pdf. Accessed April 8, 2014.
38. Health Policy Brief: Workplace Wellness Programs, Health Affairs (Mill-
wood). Workplace Wellness Programs. The Affordable Care Act will ex-
pand the ability of employers to reward workers who achieve health
improvement goals. Available at: http://healthaffairs.org/healthpolicybriefs/
brief pdfs/healthpolicybrief 69.pdf. Accessed December 4, 2012.
39. Linnan L, Bowling M, Childress J, et al. Results of the 2004 national worksite
health promotion survey. Am J Public Health. 2008;98:1503–1509.
40. Lewis A, Khanna V. Will Workplace Wellness Actually Make Workers
Healthy? Available at: http://www.fastcoexist.com/3026401/will-workplace-
wellness-actually-make-workers-healthy. Accessed April 10, 2014.
41. Khanna V, Lewis A. RAND shrugged. Available at: http://thehealthcareblog
.com/blog/2013/06/19/rand-shrugged/. Accessed April 10, 2014.
42. Begley S. Exclusive: workplace wellness fails the bottom line,
waistlines— RAND. Available at: http://www.reuters.com/article/2013/05/
24/us-wellness-idUSBRE94N0XX20130524. Accessed April 10, 2014.
43. Caloyeras JP, Liu H, Exum E, Broderick M, Mattke S. Managing manifest
diseases, but not health risks, saved PepsiCo money over seven years. Health
Aff (Millwood). 2014;33:124–131.
44. Liu H, Harris KM, Weinberger S, Serxner S, Mattke S, Exum E. Effect of
an employer-sponsored health and wellness program on medical cost and
utilization. Popul Health Manag. 2013;16:1–6.
45. Lewis A, Khanna V. PepsiCo’s Wellness Program Falls Flat. Available
wellness-program-falls/. Accessed April 10, 2014.
46. Lewis A. Workplace Wellness Takes Another Hit. LinkedIn Discussion-
2014. Available at: http://www.linkedin.com/groups/Workplace-Wellness-
4dfa-9e9d-49b64fa99849&goback=.gna_3344903. Accessed April 16,
47. Grossmeier J, Terry PE, Anderson DR, Wright S. Financial impact of popu-
lation health management programs: reevaluating the literature. Popul Health
48. Gowrisankaran G, Norberg K, Kymes S, et al. A hospital system’s wellness
program linked to health plan enrollment cut hospitalizations but not overall
costs. Health Aff (Millwood). 2013;32:477–485.
49. Soler RE, Leeks KD, Razi S, et al. A systematic review of selected inter-
ventions for worksite health promotion. The assessment of health risks with
feedback. AmJPrevMed. 2010;38:S237–S262.
50. Chapman L. Meta-evaluation of worksite health promotion economic return
studies: 2012 update. Am J Health Promot. 2012;26:TAHP1–TAHP12.
51. Baicker K, Cutler D, Song Z. Workplace wellness programs can generate
savings. Health Aff (Millwood). 2010;29:304–311.
52. Lerner D, Rodday AM, Cohen JT, Rogers WH. A systematic review of
the evidence concerning the economic impact of employee-focused health
promotion and wellness programs. J Occup Environ Med. 2013;55:209–
53. Serxner S, Gold D, Parker K. Financialimpact of worksite health management
programs and quality of the evidence. In: Rippe JM, ed. Lifestyle Medicine.
2nd ed. Boca Raton, FL: CRC Press; 2013:1325–1336.
54. Serxner SA, Gold DB, Zakowski SL, Gray A. Do employee
health management programs work? J Health Promot. 2009;23:
55. Serxner SA, Alberti A, Weinberger S. Medical cost savings for par-
ticipants and non-participants in health risk assessments, lifestyle man-
agement, disease management, depression management, and nurseline in
a large ﬁnancial services corporation. Am J Health Promot. 2012;26:
56. IOM (Institute of Medicine). A Ready and Resilient Workforce for the
Department of Homeland Security: Protecting America’s Front Line. Chapter
4. Washington, DC: The National Academies Press; 2013. Available at:
Accessed April 10, 2014.
934 C2014 American College of Occupational and Environmental Medicine