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Response to Harris Allen, PhD

Goetzel, Ron Z. PhD

Journal of Occupational and Environmental Medicine: January 2015 - Volume 57 - Issue 1 - p e8–e9
doi: 10.1097/JOM.0000000000000358
Letters to the Editor

Truven Health Analytics, Johns Hopkins University, Bethesda, MD and Institute for Health and Productivity Studies, Johns Hopkins Bloomberg School of Public Health, Washington, DC

Address correspondence to: Ron Z. Goetzel, PhD, Truven Health Analytics, Johns Hopkins University, Bethesda, MD 20814 (

Readers are invited to submit letters for publication in this department. Submit letters online at Choose “Submit New Manuscript.” A signed copyright assignment and financial disclosure form must be submitted with the letter. Form available at under Author and Reviewer information.

No funding was provided for this manuscript.

The author declares no conflict of interest.

I appreciate Dr Allen's careful read and commentary related to the article, “Do Workplace Health Promotion (Wellness) Programs Work?” published in the September 2014 issue of JOEM. I also appreciate Dr Allen's review of Navistar's sustained efforts at implementing comprehensive health and disease management programs and how these programs have influenced the growth trajectory of health care costs for the company.

I worry, however, when extraordinary claims are made in regard to these programs. Specifically, Dr Allen reports a return on investment (ROI) of 341 to 1 in health care costs alone for the period of 1999 to 2009. Most reasonable people would question such an extraordinary ROI, which, I believe, contributes to the skepticism surrounding cost savings claims for health and disease management programs. Dr Allen goes further when stating that when productivity savings are considered, the ROI grows to 400 to 1. If we take this figure literally, a $1.0 million program investment in 1999 would have produced a $400 million return for the company (not inflation-adjusted or dollar-discounted, which would yield even higher savings). If the above were true, and replicable, every chief financial officer in the country would immediately invest in a wellness program.

My response to Dr Allen's letter is not focused on the value of Navistar's program and the commitment senior management has made to the program, which are both extraordinary, but rather to claims made about savings and ROI. Given my research on this topic, as well as a recent literature review by Australian economists,1 I believe that a more realistic expectation from health promotion programs (which may encompass disease and case management) is closer to a 1.0 to 2.0 to 1.0, over 3 to 5 years. I would argue that a break even program, that is, one that does not impose additional costs to the company but produces significant population health improvement, is a worthy investment.

Again, I wish to emphasize that I applaud and appreciate the approach taken by Navistar to manage employees' health and well-being using evidence-based practices and a continuous quality improvement process. These programs are exemplary, and Navistar's success in implementing an integrated approach to health and cost management can serve as a model for other companies wishing to achieve similar results. My main caution is for researchers to be more circumspect when attributing large savings and ROI to such efforts. These proclamations feed skepticism about claims made about the value of workplace health promotion (wellness) programs.

Ron Z. Goetzel, PhD

Truven Health Analytics, Johns Hopkins

University, Bethesda, MD and Institute for

Health and Productivity Studies, Johns

Hopkins Bloomberg School of Public

Health, Washington, DC

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1. Baxter S, Sanderson K, Venn AJ, Blizzard L, Palmer A. The relationship between return on investment and quality of study methodology in workplace health promotion programs. Am J Health Promot. 2014;28:347–363.
Copyright © 2015 by the American College of Occupational and Environmental Medicine