This document summarizes research on worksite wellness programs conducted over several decades. It discusses: 1. Studies implemented in over 100 worksites of various sizes, reaching over 100,000 people and achieving participation rates of 75% or more. These studies reduced cardiovascular disease (CVD) risks by 50% or more. 2. Later research tested different models of worksite wellness programs and found that programs offering personal outreach, counseling, and ongoing follow-up achieved greater improvements in health risks like high blood pressure than programs relying only on health education. 3. Subsequent studies confirmed that worksite programs can effectively address health issues like alcohol use when they incorporate screening, individual outreach, and a

1. The Evidence and Science
Ken Holtyn
Holtyn & Associates, LLC

2. BEST PRACTICE RESEARCH WHAT WORKS
University of Michigan
Researchers: John C. Erfurt, Andrea Foote,
Max A. Heirich, Ken Holtyn
 Began research interventions 1977
 Implemented in over 100 worksites
 Small, Medium, Large worksites
 White & Blue Collar
 Reached over 100,000 people
 Participation rates 75% or more
 CVD Risk Reduction 50% or more

3.  Worker Health Program, Institute of Labor and Industrial Relations, The University of Michigan,
Ann Arbor 48109.
BACKGROUND. Worksite wellness programs vary considerably in their design. This study tested
four models to compare effectiveness at controlling high blood pressure, obesity, and cigarette
smoking. METHODS. Baseline screening was conducted in four manufacturing plants. Site 1
offered screening only, with referral recommendations for those found to have CVD risks. Site
2 also provided health education information and classes. Site 3 added routine follow-up
counseling and a menu of intervention types, and Site 4 added social organization within the
plant. Random samples of 400 to 500 employees were rescreened at the end of three years.
RESULTS. Major improvements in risk levels were found with the addition of routine follow-up
counseling and a menu of interventions (Sites 3 and 4, compared with Sites 1 and 2). More
hypertensives entered treatment and showed greater reductions in blood pressure.
Participation in worksite weight loss and smoking cessation programs was significantly
increased, and those who participated showed significantly better maintenance of
improvements where follow-up was provided. DISCUSSION. The program models that offered
short-term interventions promoted through local media suffered in comparison with models
that included personal outreach to people at risk, a variety of health improvement intervention
modalities, and ongoing follow-up counseling to help people make decisions and sustain
health improvements.
Publication Types:
 Clinical Trial
 Multicenter Study
 Am J Health Promot. 1991 Jul-Aug;5(6):438-48
PMID: 10148672 [PubMed - indexed for MEDLINE]

4.  Erfurt JC, Holtyn K.
Institute of Labor & Industrial Relations, University of Michigan, Ann
Arbor 48109-2054.
Wellness programs were tested in three sites, representing three
different types of small businesses. The sites ranged in size from 296 to
5 employees. The program at each site included: 1) wellness screening,
2) referral to community physicians for high blood pressure or
cholesterol, 3) on-site wellness programs, and 4) long-term follow-up
counseling. At sites 2 and 3, the respective company paid the full cost of
these services; at site 1, the company's financial support was limited to
50% of the cost of screening. Results showed that participation in
screening was severely reduced in the third company, and participation
in follow-up and wellness programs dropped to zero. In contrast, there
was full participation in all facets of the program at the two sites that
paid all costs. Twelve-month follow-up data showed improvements in
blood pressure, cholesterol, cigarette smoking, weight control, and
oxygen uptake.
 J Occup Med. 1991 Jan;33(1):66-73
PMID: 1995805 [PubMed - indexed for MEDLINE]

5.  Heirich M, Sieck CJ.
University of Michigan Worker Health Program, Ann Arbor 48109, USA.
 This study addresses the question of worksites as an effective route to alcohol abuse prevention.
Hypotheses tested include: (1) Cardiovascular disease risk reduction programs provide effective access
for alcohol behavior change. (2) Proactive outreach and follow-up have more impact on health behavior
change than health education classes. (3) Ongoing follow-up counseling produces the most behavior
change. (4) Screening alone produces little change. The study population included 2000 employees,
recruited through cardiovascular disease health screening, who were randomly assigned to individual
outreach or classes interventions. Changes in the organization of work required more visible outreach,
which produced demands for counseling services from many employees who were not in the original
group targeted for outreach. After 3 years of intervention, rescreening results strongly supported
hypotheses 1 and 2. Spill-over effects from counseling produced plant-wide improvements, so that
hypotheses 3 and 4 were not confirmed. This demonstrates that highly visible outreach provides a
cost-effective strategy for cardiovascular disease and alcohol prevention.
Publication Types:
 Clinical Trial
 Randomized Controlled Trial
 J Occup Environ Med. 2000 Jan;42(1):47-56
PMID: 10652688 [PubMed - indexed for MEDLINE]

6.  Screened for CVD risk factors, educated and individually
counseled 275,000 small business employees.
 Implemented in over 12,000 small business worksites
where majorities of Michiganians are employed.
 Identified 36% of participants to be at high risk for CVD
 Achieved a 73% successful medical referral rate
 Achieved 53% CVD risk reductions
 98% high approval rating by participating worksites
 97% would recommend program to other companies
 200 approved wellness vendors

7.  Improved employee morale 73%
 Improved employee health 72%
 Increased productivity 51%
 Decreased absenteeism 51%
 Decreased health care costs 41%
MDCH Worksite Community Health Promotion Program 2000

8.  Small firms:
• Represent 99.7 percent of all employer firms.
• Employ half of all private sector employees.
• Pay 44 percent of total U.S. private payroll.
• Generated 65 percent of net new jobs over the past 17 years.
• Create more than half of the nonfarm private GDP.
• Hire 43 percent of high tech workers ( scientists, engineers, computer
programmers, and others).
• Are 52 percent home-based and 2 percent franchises.
• Made up 97.5 percent of all identified exporters and produced 31 percent
of export value in FY 2008.
• Produce 13 times more patents per employee than large patenting firms.
Source: U.S. Dept. of Commerce, Census Bureau and Intl. Trade Admin.;
Advocacy-funded research by Kathryn Kobe, 2007
(www.sba.gov/advo/research/rs299.pdf) and CHI Research, 2003
(www.sba.gov/advo/research/rs225.pdf);U.S. Dept. of Labor, Bureau of Labor
Statistics.

9.  Decision to implement made quickly
 Ease of program communication
 Significant health outcomes achieved quickly,
as little as 3 months
 Strong loyalty created
 High participation, 70% - 100%
 Family atmosphere
 Supportive culture created rapidly

10.  Mercer's 2010 national survey of 2,800 company
employer-sponsored wellness plans, 27% of small
business report doing wellness activities
 2004 National Worksite Health Promotion Survey. They
examined a national cross-section of worksite wellness
programs. The results showed that only 6.9% of
American worksites offered comprehensive programs.
Only 8% of small worksites offered any wellness
activities.

11. 1. Employ features and incentives that are consistent with the
organization’s core mission, goals, operations, and administrative
structures.
2. Operate at multiple levels, simultaneously addressing
individual, environmental, policy, and cultural factors in
the organization.
3. Target the most important health-care issues among the
employee population.
4. Engage and tailor diverse components to the unique needs
and concerns of individuals.
5. Achieve high rates of engagement and participation, both in
the short and long term, in a defined “core program.”
6. Achieve successful health outcomes, cost savings, and
additional organizational objectives.
7. Are evaluated based upon clear definitions of success, as
reflected in scorecards and metrics agreed upon by all relevant
constituencies.
*Advisory Panel for the Centers for Disease Control and Prevention and the Chronic Disease
Directors Association, Worksite Health and Productivity Management Project, March 2005.

12.  Works to measurably improve the culture and
environment of worksite
 Something for everyone
 Gives choices - individual coaching, small group,
classes, internet programs offered.
 Periodic evaluation of its results
 Program emphasizes follow-up
 Program offers support for the employee as
long as he/she is employed.
Research Studies have shown this approach
to be highly successful.

13.  Biometrics (with actual fitness measurement via polar fitness test)
percent fat measurement
◦ Initially 4 x per year with one CVD risk (70-80% of employees)
◦ Second and subsequent years 2 x per year
◦ Health survey integrated into coaching and biometric session
 Engagement (75% of employees or more)
◦ Defined as completing Health Survey, Biometric Screening/Coaching session 1 x per
year
◦ 99.0% in person face to face, one to one private session. Telephonic and internet
not as effective as face to face but used sparingly primarily as outreach
 Culture
◦ Without a culture of wellness, health improvements are not sustainable, no matter
what the incentive is, or program design. Measure and report on culture and
environmental improvements
 Engagement strategies
◦ Fit ticket and drawings
◦ Recognition (success stories)
◦ Teams
◦ Worksite vs. Worksite
 Around the World in 80 Ways (online tracking)

14.  One to One in person face to face biometric assessments with measured
fitness and coaching. Follow up appointments set at time of assessment
 Multiple opportunities to participate (waves of biometric assessment and
coaching)
 Health survey done at time of biometric assessment with wellness coach.
 Evaluation of program health outcomes and employee satisfaction
survey: baseline, 6 months, 1 year. Semi annual or annual thereafter’
 Coaching protocols: MI, Self-efficacy, Stages of Change
 Follow up with all participants at least annually, to include rescreening,
coaching and medical referral (report on medical referral success rate)
 Culture and environmental survey
 Wellness committee established, staffed by vendor company health
professional
◦ Meets twice per month at the start of program
◦ Then monthly and can eventually go to quarterly in mature programs
◦ 2-4 wellness events per year
◦ Community tie in to health events. 24 hour cancer relay, pink awareness, go red for
women

15.  Fitness (measured)
 Blood Pressure
 Cholesterol
 Glucose
 Weight/BMI/Waist
 % Body fat
 Stress level
 Nutrition
 Preventive services
Holtyn & Associates
HIPAA Compliant

16.  All employees
◦ No risk 2 x/year
◦ At risk 4 x/year
 Monthly e messaging
 Goals
 Skills training
 Medical referrals
Holtyn & Associates

17. www.Michiganstepsup.org www.healthyculture.com
Holtyn & Associates

18.  As health risks increase in work populations health
care costs increase
 As health risks decrease in work populations health
care costs decrease
 High risk persons are high cost (medical claims)
 Low risk maintenance programs are important in
lowering costs.
 Risk is not static. Without effective wellness
programs to help low-risk individuals maintain
their low-risk status, 2 percent to 4 percent of an
employee population is likely to migrate from low-
risk status to a higher-risk status within one year
 Productivity findings follow same direction as
medical costs
University of Michigan Health Management Research
Dee Edington, PhD

19.  Agree on metrics of success
 Focus on health risk reductions
 Focus on creating a culture of wellness
 Focus on creating a healthy environment
 Timely reporting on all the above

20. 2005 DHHS Secretary's Innovation in
Prevention Awards Healthy Worksite

21. Swift Worksite Assessment and Translation
(SWAT)
Center for Disease Control and Prevention
“Best Practice Worksite”

22. Kalamazoo Valley Community College
Prevalence of Multiple
Heart Disease Risk Factors
Multiple risks geometrically increase health related costs. Holtyn typically targets
50% or more of the workforce with zero heart disease risk factors. Measured risks include,
poor fitness, high BP, cholesterol≥200, waist at risk, smoking, elevated glucose.
KVCC Employees

23. GOAL 75% Participation
CURRENT 94% Participation Goal achieved
 GOAL70% No or low risk for 12 Lifestyle
risk factors
CURRENT 77% Goal achieved
GOAL 50% No CVD risks
CURRENT 66% Goal achieved
Best CVD Outcomes in the country
GOAL Culture of Wellness
CURRENT “Achieving and in process” High
Support and Peer Scores
 GOAL Maintain all above goals

24. Fit for Life

25. Trend in Twelve Lifestyle Health Risks
Flexfab Corporation Hastings MI
Multiple lifestyle health risk factors are being eliminated at Flexfab.
Multiple risks geometrically increase health related costs. Measured risks include, poor fitness,
high BP, cholesterol≥200, waist at risk, smoking, elevated glucose, high stress, low coping,
depression, high alcohol intake, high fat consumption, low fruit/vegetables/fiber consumption.
Flexfab Employees

26. Cultural Support – Touch Points
Cultural Touch Point Questions: % Reporting Strong Agreement or Agreement
Survey Item Oct 2005 Oct 2009 Oct 2011
My company leaders are models for a
healthy lifestyle. 33% 53% 62%
This company demonstrates its
commitment to supporting healthy lifestyles 65% 85% 88%
through its use of resources such as time,
space and money.
People at this company are taught skills
needed to achieve a healthy lifestyle. 42% 79% 83%
New employees at our workplace are made
aware of the organization's support for 34% 68% 75%
healthy lifestyles.
People are rewarded and recognized for
efforts to live a healthy lifestyle. 35% 75% 82%
Flexfab
Employees

27. Cultural Support - Peers
Peer Support Questions: % Reporting Agreement or Strong
Agreement
Survey Item
Oct 2005 Oct 2009 Oct 2011
My immediate supervisor supports
my efforts to adopt healthier 47% 59% 66%
lifestyle practices.
Coworkers support one another in
efforts to adopt healthier lifestyle 54% 75% 75%
practices.
My friends support one another in
efforts to adopt healthier lifestyle 65% 79% 85%
practices.
My family members and/or
housemates support one another 76% 86% 87%
in efforts to adopt healthier lifestyle
practices.
Flexfab
Employees

29. Prevalence of Multiple
Heart Disease Risk Factors
Multiple risks geometrically increase health related costs. Holtyn typically targets
50% or more of the workforce with zero heart disease risk factors. Measured risks include,
poor fitness, high BP, cholesterol≥200, waist at risk, smoking, elevated glucose.
Hastings Fiberglass Employees

30. Trend in Twelve Lifestyle Health Risks
Multiple lifestyle health risk factors are being eliminated at Hastings Fiberglass.
Multiple risks geometrically increase health related costs. Measured risks include, poor fitness,
high BP, cholesterol≥200, waist at risk, smoking, elevated glucose, high stress, low coping,
depression, high alcohol intake, high fat consumption, low fruit/vegetables/fiber consumption.
Hastings Fiberglass Employees

31. Cultural Support – Touch Points
Cultural Touch Point Questions: % Reporting Strong Agreement or
Agreement
Survey Item Start 2005 Oct 2011
My company leaders are models for a healthy 49% 74%
lifestyle.
This company demonstrates its commitment to 64% 94%
supporting healthy lifestyles through its use of
resources such as time, space and money.
People at this company are taught skills needed to 25% 92%
achieve a healthy lifestyle.
New employees at our workplace are made aware of 47% 68%
the organization's support for healthy lifestyles.
People are rewarded and recognized for efforts to 34% 94%
live a healthy lifestyle.
Hastings Fiberglass Employees

32. Cultural Support - Peers
Peer Support Questions: % Reporting Agreement or Strong
Agreement
Survey Item Start 2005 Oct 2011
My immediate supervisor supports my efforts to 49% 74%
adopt healthier lifestyle practices.
Coworkers support one another in efforts to 48% 79%
adopt healthier lifestyle practices.
My friends support one another in efforts to 68% 86%
adopt healthier lifestyle practices.
My family members and/or housemates 82% 95%
support one another in efforts to adopt
healthier lifestyle practices.
Hastings Fiberglass Employees

33. GOAL 75% Participation
CURRENT 100% Participation Goal met
GOAL 70% No or low risk for 12 Lifestyle factors
CURRENT 82% Surpassed goal!
GOAL 50% No CVD risks
CURRENT 45% Multiple risks being eliminated
GOAL Culture of Wellness
CURRENT Improvements in all categories
GOAL Maintain all above goals for multiple years
CURRENT Results improving
 GOAL Fun!
Hastings Fiberglass Employees

34.  Comprehensive Model, Evidence/Science
Based
 Face to face assessment and coaching
 Culture and environment focus
 Long term commitment, minimum 3 years
 Budget
 Investment $350 per employee
 Impeccable Execution
 It takes time even in small worksites

35. Wellness Outreach At Work
SAMHSA’s National Registry of Evidence-based Programs and Practices
http://nrepp.samhsa.gov/ViewIntervention.aspx?id=56#Study 3
Reaping the Rewards of Worksite Wellness
http://www.hopehealth.com/pdf/FreeReports/RewardsofWorksiteWellnessReport.pdf
Wellness Manual: Successful Workplace Wellness Programs
http://hopehealth.com/pdf/FreeReports/SuccessfulWorkplaceWellnessProgramsReport.pdf
SWIFT
http://www.cdc.gov/nccdphp/dnpao/hwi/programdesign/swat.htm
Promising practices in employer health and productivity management efforts: findings from a
benchmarking study.
J Occup Environ Med. 2007 Feb;49(2):111-30.
http://www.logisens.com/resourceFiles/PromisingPracticesGoetzel.pdf
Workforce Wellness Index
http://healthpromotionlive.com/2011/08/ron-goetzel-of-emory-universitythomson-reuters/

36.  Ken Holtyn
 Holtyn & Associates, LLC
 ken@holtynhpc.com
 269. 382-5897