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Outcomes Across the Value Chain for a Comprehensive Employee Health and Wellness Intervention: A Cohort Study by Degrees of Health Engagement

Long, D. Adam PhD; Reed, Roger W. BSN; Duncan, Ian B Phil

Journal of Occupational and Environmental Medicine: July 2016 - Volume 58 - Issue 7 - p 696–706
doi: 10.1097/JOM.0000000000000765

Objective: Evaluate a large employer's wellness intervention by studying outcomes across the value chain, and testing Health Engagement's (HE) dose–response relationship to outcomes.

Methods: Evaluation included 37 measures across eight outcomes domains (OD) using repeated measures, analysis of variance and logistic regression.

Results: Participants with higher HE had better pre-post percent changes than control: 1.7% higher for Motivation (OD1), 3.4% for Behavior (OD2), 1.0% for Emotion (OD3), 5.8% for Biometrics (OD4), 6.3% for Compliance (OD5), and 5.2% for Claims (OD6). They also had 0.5% less Productivity loss (OD7), and odds of Turnover (OD8) one-quarter to one-half that of control. A dose–response relationship with degrees of HE was also shown.

Conclusions: Three outcomes domains (OD6 to OD8) can be monetized for cost-benefit analysis. Authors recommend, however, staying focused on driving HE and using metrics from all OD to assess value.

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H2U|Health to You, LLC, a Subsidiary of HCA (Dr Long, Mr Reed), Strategic Pricing & Analytics (Dr Long), Physician Services Group, HCA, Inc., Nashville, Tennessee (Mr Reed); and University of California Santa Barbara, Department of Statistics & Applied Probability (Mr Duncan).

Address correspondence to: D. Adam Long, PhD, HCA Inc, SP&A Clinical Alignment, 1 Park Plaza, Bldg. 1, Nashville, TN 37203 (

First and second authors were employed by the wellness vendor administering the intervention; the third author served as an advisor to the wellness vendor on matters of program evaluation.

Some results were presented at the Population Health Alliance's annual PHA Forum, December 11, 2014, in Scottsdale, Arizona.

The authors report no conflicts of interest.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Website (

Copyright © 2016 by the American College of Occupational and Environmental Medicine