ANN ARBOR—Lose those excess pounds. Quit smoking. Walk your way to fitness.

With messages like these, many work-site wellness programs are squarely aimed at the least healthy employees. Study after study shows that individuals with the highest health risks account for most of a company’s health care costs.

But now, the University of Michigan Health Management Research Center, the same group that documented the high risk/high cost connection, is urging a different tactic: design programs to keep the low-risk employees in the low-risk category.

“Moving the medium and high-risk employees to lower risk categories is still a priority, but we should not overlook the low-risk individual,” says HMRC Director Dee W. Edington. “The most effective way for employers to contain health care costs is to target all members of the work force.”

What makes a person “high risk or high cost”? Having a combination of five or more risk factors such as being overweight, using tobacco, drinking more than 14 drinks a week, having high blood pressure or cholesterol, and existing medical conditions such as diabetes or heart problems. Other characteristics include feeling stressed, reporting low job or life satisfaction, and not using a seatbelt.

“Medium risk” individuals are those who report three or four of these conditions, while the “low risk” group has two or below.

The low-risk folks are often neglected because they have no visible needs or problems. They seem healthy and well-adjusted, rarely miss work, and display no bad habits. But Edington warns that this group is not immune from future health risks. Low-cost devices such as health newsletters or educational seminars can go a long way toward helping workers feel appreciated and helping them maintain a healthy lifestyle.

“It is much easier to help a low-risk person remain low risk than to try to change a high-risk person to low risk. The ultimate measure of how well a population is doing is the percent of the population at low risk. If a company or any organization can maintain 70 percent or more of its population at low risk, they will have higher levels of productivity and lower health care costs,” Edington says.

Since its beginnings in 1976, the HMRC has collected lifestyle behavior, productivity and health-care utilization data on over 2 million individuals. But some of the most powerful findings come from 7 to 18 years of longitudinal data involving the HMRC’s corporate consortium. The current members include General Motors, UAW-GM, Bank One, the Progressive Corporation, Steelcase, Honeywell, Genesys Health System, and Foote Health System.

“Our first longitudinal study with Steelcase, now replicated in each of the partner companies, shows as employee health risks increase or decrease over time, health care costs change in the same direction,” Edington reports. “Some of the most potent health risks are psychological factors such as high stress, self-perception of health, use of medications to relax, and job dissatisfaction.”

Employers bear the cost of high-risk employees two ways: medical claim costs and productivity loss. High health risks are associated with days absent from work, including personal illness, short- or long-term disability, and worker’s compensation days, Edington says.

“What our corporate partners want to know now is, what works? What strategic interventions will produce cost savings, and how long will it take? How do we best allocate limited resources for maximum results?”

While researchers are still seeking the specific answers, Edington says the most important indicator of success is participation in multiple programs.

“Individuals who participated in multiple wellness programs during 1990-99 at Progressive Corporation saved more than $4 million in health care costs over the nine-year period,” he says.

“This comes back to our major recommendation to employers: create an environment that moves people into the low-risk category and reinforces those who are already low-risk to stay there.

“In other words, the most effective strategy for employers is: keep the healthy people healthy.”

Edington’s article, “Emerging Research: A View from One Research Center,” appeared in the American Journal of Health Promotion. For reprints, contact dwe@umich.edu or the U-M Health Management Research Center, 1027 W. Huron St., Ann Arbor, MI 48104-1688.

Health Management Research CenterDee W. EdingtonAmerican Journal of Health Promotion