Wellness ROI: Less than meets the eye

Commentary: The closer you look, the lower the return on investment for wellness programs. That’s the take-home message from a thorough, scientific review published by the American Journal of Health Promotion (June 2014). 

High quality studies calculated benefits nearly 90% lower than low-quality studies. The 18 studies that qualified as “high-quality” had an average ROI of 0.26, compared to 2.32 from 27 low-quality studies. The authors applied strict criteria on design and methods to 51 studies and 61 interventions. They had more than a quarter million people who participated in interventions and 122,000 who did not (“controls”). Nine industries in 12 countries were represented. This was no small undertaking.

Overall the studies showed a positive return for wellness programs. The weighted average ROI was 1.38:1; that is a 138% return on investment. This figure sweeps in all of the 51 studies, high-quality to low-quality and all the interventions, which also varied in quality. Thus, the 1.38 figure is not a useful gauge of wellness impacts. 

The highest quality studies found a negative return. The randomized control trials – the gold standard in study design – found that for every dollar spent, only $0.78 cents was gained in benefit. In the real world or wellness, it is very difficult and expensive to do a randomized control trial. 

It is possible, nevertheless, to do a high-quality study. Indeed, the quality of studies improved over the nearly 30 years that the authors reviewed. From 1984 through 2012, more high-quality studies got published. This also means that we will all become accustomed to more realistic ROI estimates.   

Outlandish ROIs will be seen as a sign that the study itself is low quality. The AJHP study is so valuable because it draws a connection between the quality of research and the results. It makes explicit what many experts have long believed and what has been shown in previous research: high ROIs for wellness programs are not realistic. Studies that conclude otherwise are poorly designed, fudged, or have math errors.

Wellness vendors who have been realistic and honest about ROI should feel vindicated.  Between this study and the recent debut of the Validation Institute, which reviews and certifies programs’ outcome estimates, wellness ROI estimates are going to slim down.

Wellness buyers can view the potential impact more realistically also.  Budgets may get trimmed in light of this, freeing money for higher value resources, or at least for resources that tout higher value. 

All in all, this study makes a huge contribution to wellness – more transparency, more realism, and more truth. 

Linda K. Riddell, MS, is a population health scientist for Health Economy, LLC.  Dr. Jon Robison has been working in the wellness field for a quarter century and is the co-author with Dr. Rosie Ward of the upcoming book, How To Build A Thriving Culture at Work: Featuring The 7 Points of Transformation. He can be reached through www.salveopartners.com.