While a recent study published in the Journal of the American Medical Association (JAMA) indicated that generic wellness programs do not work, the specific program components must be considered. The most well-intentioned programs are often cookie cutter, offering canned solutions that are not personalized to each individual and their unique lifestyles. So, what does it take to find success with well-being programs?

How we even define a "well-being program"?

According to RAND, well-being programs are classified based on whether or not they offer each of three services:

• Screening to identify health risks
• Lifestyle management services to reduce risks through encouraging healthier behavior
• Disease management services to support people who already have chronic conditions

The Kaiser Family Foundation and Health Research and Education Trust (HRET) follows a different definition. A 2015 Employer Health Benefit survey conducted by Kaiser and HRET found that well-being programs are most commonly associated with "tobacco cessation," "weight loss," and/or "other lifestyle or behavioral coaching."

This variance in definitions makes it difficult and confusing to understand what an organization means when it says it offers a "well-being program." Does it mean they just offer screenings, fitness programs, lifestyle management, disease management, condition management, or some combination thereof?

Too often, well-being programs are broadly generalized based on preconceived norms and targeted at the employee population in aggregate. This is counterintuitive because individual well-being cannot be generalized. It doesn't boil down to just one standardized measure, such as how much one person weighs compared to another. We must remember that an individual's well-being is all-encompassing and includes sleep, diet, exercise and stress—all of which feed into holistic well-being and are based on unique circumstances. What works for one person will not necessarily work for another—a true well-being program must cater to each individual's lifestyle. Not the other way around.

Disease management v. lifestyle management

To understand where well-being programs are coming up short, we should also break down two of the most common types of programs: lifestyle management and disease management. Lifestyle management focuses on employees with health risks, such as smoking and obesity, and supports them in reducing those risks to prevent the development of chronic conditions. On the other hand, disease management is designed to help employees who already have a chronic disease. This could mean, for example, reminding them to take their prescribed medications or improving communications with their physician. While the two focus on different aspects of well-being , they are often still pigeon-holed under the same "well-being " umbrella.

A 2014 RAND well-being program study that assessed PepsiCo's program highlights why these two formats should be treated differently. Called "Healthy Living," the program offered separate chronic disease management and lifestyle management initiatives.

RAND found that the combined disease management and lifestyle management programs showed a return of $1.50 for every dollar invested in the program. However, the individual returns for the separate programs were quite different, with disease management showing an ROI of $3.80, while lifestyle management had an ROI of $0.50.

While 87 percent of participating employees were in the lifestyle management program and 13 percent were in disease management, 87 percent of the total health care cost savings came from the disease management program. Even with more employees participating in the lifestyle management program, disease management is where the majority of health care cost savings came from. Essentially, it's not about the volume of a program or its participation rates—it's about looking specifically for the right volume.

This is a great example of how personalization based on individual context and circumstance can lead to a successful well-being program with ROI. Once PepsiCo's program accounted for targeted approaches for those considered high-risk, it really made a difference.

A 2018 Illinois Workplace Wellbeing study also proved that when generic well-being solutions are offered to everyone—and not focused on the right people—they will not generate reductions in health care costs or improvements in health behaviors. The study evaluated a workplace well-being program that was available to 3,300 University of Chicago and University of Illinois at Urbana-Champaign employees, and researchers did not see changes after one year.

"The lack of first-year cost savings should not be surprising since the study focuses on health screenings and well-being activities such as fitness, stress management [and] smoking cessation for all employees rather than targeted strategies for employees diagnosed with costly chronic conditions," LuAnn Heinen, vice president at the nonprofit National Business Group on Health and director of the group's Institute on Innovation in Workforce Well-Being, explained to SHRM.

Enter, condition management

In addition to lifestyle and disease management, condition management has emerged to introduce a third variation of well-being program. It emphasizes a specific group of people who sit between healthy and sick—and, who make up the majority of health care spend. That's because many employees who are "in the middle" demonstrate a combination of risk factors that increase the likelihood of costly chronic conditions and can result in catastrophic health claims if they're not intervened with prior.

Condition management blends the best qualities of lifestyle management and disease management. Like lifestyle management, it focuses on changing habits to reduce the health risks that can open the door to chronic conditions. This is the key to reversal or normalization. Simply having the goal of taking medication or following up with a doctor will not change the individual, it will only control the symptoms. Condition management is focused on a very specific cohort of high-risk individuals and tailored to their specific needs and circumstances, which, as shown in the PepsiCo study, is proven to drive ROI.

A good condition management program includes guidance on nutrition, exercise, sleep and stress management, but how those areas are prioritized should depend on the individual. One of the key implications of applying a lifestyle management program to a targeted group of people is that your implied goal is to change or modify behavior to achieve outcomes. The goal is not to get an individual to comply or adhere with medications or other external factors.

The inherent suggestion is that if a condition management program can change the behavior of a particular person, then certain risk factors can be reversed or normalized, which could also reduce health care costs.

Helping employees and the company bottom line

Overall, employers must focus on the specific goals of their well-being programs. Do you want to deliver an employee benefit that's suitable for everyone in the company? Or, do you want to actually better the health of employees who need it most and generate ROI? This single question is key to determining the correct metric to assess a program. If you are trying to generate ROI, or affect claims cost, a one-size-fits-all program is not the answer.

The Pepsi study demonstrated that applying a focused solution to a group of people with specific needs is a critical element to any successful well-being program. When you combine risk stratification with lifestyle programming (sleep, stress, nutrition, exercise) you can do more than simply manage a condition—individuals can normalize or even reverse certain conditions.

This is what makes condition management, in particular, so valuable. When employers can deliver solutions that are enhanced by behavior modification, tailored closely to the individual, and offer real-life skills to incur long-lasting and positive change for employees, organizations can achieve value on their investment.

 Joe Marullo is vice president of analytics and operations at Zillion. For more than a decade, Joe has been helping companies mine and utilize data analytics to support strategy development and operational planning and execution. At Zillion, he and his team work to better understand what works best for customers, channel partners and members in improving health outcomes and reducing related costs.