ORIGINAL ARTICLE The Workforce Wellness Index A Method for Valuing US Workers’ Health Ron Z. Goetzel, PhD, Gary T. Pickens, PhD, and Niranjana M. Kowlessar, PhD Objective: To devise a methodology to create a single health risk–cost score that can be applied to health risk assessment survey data and account for the medical costs associated with modifiable risks. Methods: We linked person- level health risk assessment data with medical benefit eligibility and claims data for 341,650 workers for the period 2005 to 2010 and performed mul- tivariate analyses to estimate costs associated with high risks. We used the estimated costs and risk prevalence rates to create a composite Workforce Wellness Index (WWI) score. Results: Increasing obesity rates among em- ployees was found to be the most important contributor to increased health care spending and the main reason the WWI score worsened over time. Conclusion: Employers that address employees’ health risk factors may be able to reduce their medical spending and achieve an improvement in their WWI scores. W ith the passage of the Patient Protection and Affordable Care Act (ACA) of 2010, several initiatives are currently under- way to improve the health of Americans and prevent the onset of preventable chronic disease conditions. 1 Nevertheless, the economic justification for health promotion and disease prevention continues to be challenging, especially in an economy and political climate that favor cost cutting over increased investment in programs that may produce long-term cost savings. Today, almost all the health care spending is directed at treating illnesses rather than prevention. 2 This one-sided emphasis is at least partly due to the lack of valid data supporting an economic rationale and justification for health- promotion and disease-prevention efforts. As Thorpe and Howard 3 have illustrated, almost two thirds of the growth in national health care spending over the past 20 years can be attributed to Americans’ worsening lifestyle habits and, in particular, the epidemic rise in obesity rates. Over many years, poor lifestyle habits manifest themselves as chronic illnesses, which impose an extra cost burden on society, including businesses that pay for workers’ health insurance. On-the-job impairment caused by poor health is estimated to account for 60% of total benefit-related costs for common health conditions such as diabetes, hypertension, and heart disease. 4 Stewart and colleagues 5 estimated that productivity losses related to personal and family health cost US employers $226 billion in 2006, equivalent to $1685 per employee per year. There is a growing need to develop financial models that demonstrate the cost of poor health and the potential financial ben- efits of risk reduction in a population. It can be argued that, as a broad philosophy, prevention and health promotion can provide high value to society because lives are improved inexpensively relative to From the Truven Health Analytics (Drs Goetzal and Pickens), Washington, DC; and Institute for Health and Productivity Studies (Dr Goetzel), Rollins School of Public Health, Emory University, Washington, DC. No external funding was provided for the preparation of this article. The opinions expressed in this article are of the authors and do not necessarily represent the opinions of Truven Health Analytics or Emory University. Address correspondence to: Ron Z. Goetzel, PhD, Institute for Health and Produc- tivity Studies, Rollins School of Public Health, Emory University, and Consult- ing and Applied Research, Truven Health Analytics, 4301 Connecticut Ave, NW, Suite #330, Washington, DC 20008 (ron.goetzel@truvenhealth.com). Copyright C  2013 by American College of Occupational and Environmental Medicine DOI: 10.1097/JOM.0b013e318278274e medical treatment. 6 There is also increasing evidence that American businesses can realize a financial return from evidence-based and comprehensive health-promotion and disease-prevention programs made available to their workers. 7–10 Many more employers are now introducing programs in which the main emphasis is placed on avoiding disease and promoting good health practices through primary prevention. This prevention effort involves convincing workers that it is in their best interest to manage their weight, be physically active, eat a healthy diet, not smoke, drink moderate amounts of alcohol, manage stress, and, in general, live a healthy lifestyle. Very few of these behaviors require the services of medical personnel but their adoption can reduce the likelihood of contracting chronic and debilitating diseases and incurring high health care costs. Data supporting the success of these culturally ingrained initiatives have been reported in peer-reviewed articles and compiled in literature reviews. 11–13 DEVELOPING VALID ECONOMIC MODELS To further the research focused on prevention and health pro- motion, it is useful to develop sound economic models that quantify the effects of population health management programs. It is widely accepted that behavioral and biometric risk factors are associated with increased health care and productivity costs. 14–17 Over the past several years, economic models have focused on the relationships between common risk factors and consequent medical expenditures. These models use mathematical techniques to identify, measure, value, and compare the costs and outcomes of alternative policies, programs, and services focused on risk reduction. 18–20 It is now widely accepted that many clinical preventive services achieve considerable health benefits at a relatively low cost. 10,21,22 Community-based health-promotion programs, in par- ticular those delivered at worksites, have also been shown to be cost effective and, in some cases, cost saving. 4,23–28 Examples of financial modeling studies using employed populations include those conducted with Union Pacific Railroad, 29 Motorola, 30 Dow Chemical, 31,32 American Specialty Health, 33 Novartis, 34 PepsiCo, 35 Johnson & Johnson, 36,37 and Mayo Clinic. 38 These modeling stud- ies have led to several initiatives by employers to establish worksite health indices that are quantitative in nature and built upon person- level research that combines health risk and cost information for employees. The quantitative health index model described in this article is distinguished from qualitative health indices or scorecards that are based on organizational factors such as leadership support, com- pany policies, program-design elements, and measurement systems. ∗ These qualitative self-assessment tools are borne out of a need by employers to keep up with the evolving science of worksite health promotion and compare their efforts against benchmarks. Common qualitative health index tools include the Health Enhancement Re- search Organization (HERO) Scorecard, National Business Group on Health (NBGH)’s Wellness Impact Scorecard, and National Institute for Occupational Safety and Health (NIOSH) Essential Elements *See, for example, the HERO Scorecard (http://www.the-hero.org/scorecard.htm) or the National Business Group on Health Wellness Scorecard (http://www. businessgrouphealth.org). Copyright © 2013 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited. JOEM  Volume 00, Number 00, 2013 1