Employee benefit costs continue rising and health related expenses affect bottom line more than ever.  Innovative ideas have stemmed from the need to address employee concerns within cost constraints.  Thanks to Craig Fallon, NJ Biz, I recently attended a dinner honoring The Best Places to Work in New Jersey where I witnessed several initiatives to improve employee productivity.  Concierge services for employee errands; telecommuting, work/life flexibility initiatives, flex time, job sharing; personalized professional development and mentoring, social networking, college coaching.  Of interest, workplace wellness initiatives are on the rise.  These entail simple approaches that provide regular education and lifestyle advice to coordinated disease management programs targeting employee issues such as obesity, diabetes, hypertension, and low back pain.

Several companies in NJ, including some the Best Places to Work in NJ,  have implemented wellness initiatives either independently or in partnership with outside organizations.  In fact, a literature review prepared for the World Health Organization demonstrates that several national and international companies are following this route13.   Quad/Graphics, a self funded company, successfully implemented an on-site wellness program in 1991 that reduced health care costs twenty percent while increasing employee satisfaction and overall value1.  More important, early intervention saved this company 2 million dollars in estimated costs.  American Standard created a three year strategy to create awareness, change behaviors, and drive participation in their wellness initiative.  More importantly, they customized their approach to meet the needs of their employees.  This program created an estimated savings of 1.6 million in their first year2.

According to Prudential, the economy’s negative impact on business culture has led to a reduction/freeze of benefit spending and staff size as well as a reduction in perceived value by plan sponsors and employees3. Cost containment remains a top priority and will likely continue to play a significant role in the coming years3.  Health prevention via education, lifestyle coaching, pre-habbing, and wellness initiatives represent the most cost effective strategy for addressing benefit costs3,4,5,6,20.

It is common knowledge that health affects every aspects of life:  employment, relationships, mental state, and leisure.  The best way to protect assets, income, and lifestyle is to stay healthy3,4,11,13,20.  Prudential’s benefit study reflects this basic concept.  They show a growing employee interest in health/wellness3,4.  In fact, healthcare ranks in the top three employee concerns and is the second reason, next to salary, for job consideration3,6.  Moreover, employees view early retirement as less likely.  This makes health an important factor in employment since people may be working past the traditional retirement age3.

Good news:  prevention saves money.  For low back pain, conservative care increases the value of insurance by providing better outcomes with significantly lower cost effectiveness ratios versus physician care 5.  Ironically, this study notes that even with a five-fold cost increase, conservative would still be a more cost effective option in the long run 5.  The value of prevention holds true whether addressing pre-hypertension, obesity, metabolic syndrome or back pain.  It also holds true for screening procedures that catch potentially serious conditions early on 5,6,9,11,15,17.  Work place wellness initiatives that incorporate education, lifestyle coaching, and/or link business goals to benefit value increase savings as well as the perception of value for the employee1,2,6,7,11,20.

Consider the case.  According to the National Health Interview, only 10% of persons in all ages considered themselves in fair or poor health 8,9.  Not terrible.  However, only 32% of adults over 18 engage in regular leisure-time physical activity8,9.  Nothing new right.   We already know most people should exercise more.   Moving on.  21% of people over 18 currently smoke 18.   In adults over twenty, 34% are obese18 and 32% have hypertension19.  These three factors combined make the ten percent number noted earlier less likely.  The health statistics also note that 37.3 million persons were limited in their usual activities due to one or more chronic health conditions7.  About 12.3 million adults aged 18–69 years were unable to work due to health problems, and 6.9 million were limited in the kind or amount of work they could do because of their health7.  Perhaps people are less healthy than they think.  Actually, 34% of people over twenty show evidence of metabolic syndrome, a combination of health indicators associated with the leading causes of death in US:  heart disease, cancer, stroke, diabetes, respiratory disease, hypertension12.  This syndrome is preventable.  In fact, 90% Americans have preventable risk factors and the average employee has at least 2 preventable risk factors8,10.

Not convinced.  Consider the following points.  Spending on spine related problems reach 85 billion dollars annually 5. From 1998 to 2005 the Workplace Safety & Insurance Board (WSIB) reported a 38% increase in the proportion of injured workers who remain on benefits at least 12 months, with low back pain the most common cause of persistent disability claims 20.  Cigarette smokers are 2 – 4 times more likely to develop coronary heart disease than non-smokers and cigarette smoking approximately doubles a person’s risk for stroke14.  Cigarette smoking is also linked to almost every major cancer.  About 90% of all deaths from Chronic Obstructive Pulmonary Disease (COPD) are attributable to cigarette smoking17.  Poor diet and physical inactivity cause 310,000 to 580,000 deaths per year and are major contributors to disabilities that result from diabetes, osteoporosis, obesity, and stroke15. A study conducted by the Diabetes Prevention Program (DPP) showed that weight loss through moderate diet changes and physical activity can delay and prevent type 2 diabetes16.  Heart disease, cancer, stroke, diabetes, respiratory diseases, and hypertension are a few of diseases that stem from chronic unchecked, lifestyle induced inflammation—metabolic syndrome–that could be diverted with simple lifestyle changes12.  Does the picture look different?

In 2007, business goals to reduce health cost superseded interest in improving employee health4.  However, employee health drives cost and is a major factor influencing productivity 6,11,13,20.  Research consistently demonstrates that prevention and early, specific intervention outweigh treatment in terms of cost and effectiveness.  Healthy employees are cheaper to insure 6,11,13.  They have less unplanned absences due to sickness or injury6,11.  Healthy employees are less likely to utilize Short Term Disability, Long Term Disability, or Worker’s Compensation3,4,6,13,20.  Prudential’s study notes that companies doing more to integrate services achieve more success and demonstrate better results in each survey category.  They specifically note a significant increase in employee health and employee responsibility for health3.  Those companies highly involved in running integrating wellness models showed the highest ROI (Return on Investment) and increases in productivity3.  From a numerical standpoint, wellness initiatives and disease management programs lead results in terms of integrative approaches3,4.  Interestingly, annual medical expenses for persons with BMI of 30 to 34 cost $1,400 more (25% greater costs) then those of ideal weight persons.  Raise the BMI and cost goes up.  Persons with BMI > 35 cost $ 2,267 more then ideal weight persons.  While ideal weight is arguable the numbers are not.  This increase represents 44% greater costs, but hope exists.  High risk employees who convert to low risk, lower costs by as much as 30% within 2-5 years11.

In the wake of economic turmoil, health is returning to the forefront.  Chiropractors have been long-time advocates of preventative care.  We are hands down the best health practitioners for back pain, neck pain, and headaches21.  In light of a looming shortage of family doctors due to over specialization, evidenced-based Chiropractors can help fill the gap.  As healthcare providers, we rule out serious illness and refer people to appropriate specialists22.  We can add value because we have musculoskeletal training that most family doctors do not have22.  More importantly, we focus on lifestyle modifications– smoking cessation, smarter nutrition, stress reduction, and physical activity–to reduce health costs by improving health.


  1.  Zastrow R, Quadracci L.  Engaging Quad/Graphics Employees in the Improvement of their Health and Healthcare.  J Ambulatory Care Manage. May 2006.  29:3.
  2. Thompson M, Checkley J. Employer Driven Consumerism:  Integrating Health into the Business Model.  Benefits Quarterly.  Second Quarter 2006.
  3. Study of Employee Benefits: 2009 and Beyond.  The Prudential Insurance Company of America.
  4. The Market for Integrated Health Care and Disability Management. The Prudential Insurance Company of America. January 2007.
  5. Choundry N, Milstein A.  Do Chiropractic Physician services for treatment of low back and neck pain improve the value of health benefits plans:  An evidenced-based assessment of incremental impact on population health and total health spending.  Mercer.  October 2009.
  6. Woolf S, Husten C, Lewin L, Marks J, Fielding J, Sanchez E. The economic argument for disease prevention: distinguishing between value and savings.  Partnership for Prevention, 2009.
  7. Adams PF, Heyman KM, Vickerie JL. Summary health statistics for the U.S. population: National Health Interview Survey, 2008. National Center for Health Statistics. Vital Health Stat 10(243). 2009.
  8. Summary Health Statistics for the U.S. Population: National Health Interview Survey, 2008 Appendix III table V
  9. Early release of selected estimates based on data from the National Health Interview Survey, data tables for figures 7.1, 8.1, 9.1
  10. National Health Interview Survey, 2001;Am J Prev Med 2004;27(2S)
  11. Parkinson M.  Obesity Worksite Interventions: Perspective From the Health Care Front.  Presentation. Lumenos, Inc.  2004
  12. Ervin RB. Prevalence of Metabolic Syndrome Among Adults 20 Years of Age and Over, by Sex, Age, Race and Ethnicity, and Body Mass Index: United States, 2003–2006.  National Health Statistics Reports. 13.  May 5, 2009
  13. Engbers L, Sattelmair J.  Monitoring and Evaluation of Worksite Health Promotion Programs – Current state of knowledge and implications for practice. World Health Organization 2008
  14. Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion. Retrieved at http://www.cdc.gov/tobacco/basic_information/health_effects/heart_disease/index.htm
  15. Promoting Healthy Eating and Physical Activity for a Healthier Nation. Division of Nutrition and Physical Activity. National Center for Chronic Disease Prevention and Health Promotion. CDC.
  16. National Diabetes Information Clearinghouse. Retrieved at http://diabetes.niddk.nih.gov/dm/pubs/riskfortype2/index.htm
  17. U.S. Department of Health and Human Services. Reducing the Health Consequences of Smoking—25 Years of Progress: A Report of the Surgeon General.
  18. Health, United States, 2009, table 72
  19. Health, United States, 2009, table 68
  20. Amendolia C, et al.  Designing a workplace return-to-work program for occupational low back pain:  an intervention mapping approach.  BMC Musculoskeletal Disorders 2009, 10:65
  21. Bronfort G, Haas M, Evans R, Leiniger B, Triano J.  Effectiveness of manual Therapies: The UK Evidence report.  Chiropractic & Osteopathy 2010, 18:3
  22. http://www.drgrisanti.com/mddc.htm