Wellness enthusiasts and skeptics can find things to like in the
Score one for the enthusiasts: Disease management reduced health care costs by $136 per member per month.
Score one for the skeptics: Lifestyle management programs did not save money.
But I dont see the game ending in a tie.
The study, conducted by RAND Corporation, has plenty to recommend it. There were plenty of people in the sample: 14,455 participants in disease management, 22,880 in lifestyle management, and 9,324 in both. They had at least one baseline year and at least seven program years to analyze. They used sophisticated techniques to create a control group, comparable to the participants. They adjusted results to factor in differences between the groups. For a stats geek, it was pure delight.
Enthusiasts will be less than delighted that lifestyle management did not show strong results, except for a small reduction in absenteeism. Lifestyle management takes people with unhealthy habits and turns them in a new direction. These people do not already have an illness, but the theory is they are running toward one.
There is a straightforward reason that lifestyle management shows weak results here (and elsewhere): it costs more to work with hundreds of people on prevention than it costs to treat the dozens who are already sick.
Interestingly, the people who were in both disease management and lifestyle management experienced the most positive impact. It shows that success comes from focusing wellness resources on selected people. This will rub lots of people the wrong way the wellness program doesnt care about me until Im sick? However, there is another way to frame it: the wellness program cares about people who gain the most from it.
There is some research showing that preaching to the choir that is, keeping healthy people healthy is also worthwhile. Even if this is true, worthwhile investments are going to be pushed aside as benefit costs press profit margins and wages down.
Wellness programs are a complex physical-social-emotional-financial transaction. One study wont end all debate. We can only welcome the new insight the latest studies bring us. Score one for all of us.
Linda K. Riddell is a principal at Health Economy, LLC. She can be reached at LRiddell@HealthEconomy.net.
