ANN ARBOR—Programs designed to help employees quit smoking, lower stress or lose weight have long been a staple of work site health promotion.

Reducing health risks has seemed to be the key to containing health care costs. Risk reduction is just part of the equation, say experts at the University of Michigan Health Management Research Center. It is even more critical to prevent low-risk individuals from becoming high-risk, HMRC Director Dee W. Edington said.

“Low-risk people make up about 60 percent of almost every employee population,” Edington said. “Helping them maintain their healthy status needs to be a high priority component of every work site health care program investment.” The HMRC groups individuals based on the number of risk factors they report on a health risk appraisal—risk factors such as smoking, alcohol use, body weight and medical problems, as well as attitudinal factors like job satisfaction and life satisfaction. People with zero to two risk factors are termed low-risk; three or four are medium-risk, and five or more are high risk.

“In every analysis, individuals who are at low-risk status for any of the risk factors or behaviors are less costly than those at high-risk status,” Edington said. Many components of the typical work site health program already promote low-risk maintenance, he said. These include clinical preventive services, screening, physical activity spaces and better nutritional options in cafeterias and vending machines. Additional employee risk factors translate to additional cost for employers.

“When individuals are grouped according to the number of risk factors, the costs move higher for those at increased risk levels. This holds true for medical costs as well as productivity measures such as absence days, short- and long-term disability, and worker’s compensation. When groups of individuals change their overall risk status, the cost measures described above change in the same direction.” HMRC researchers are able to track changes in risk status when employees of any given organization fill out two or more health risk appraisals over a period of time. Repeat appraisal participation provides an incentive for employees to monitor and improve their health. It also shows employers whether more people changed from high risk to low risk or in the other direction.

“If the cost of low-risk status is used as a base, and all higher-risk employees moved to low-risk, assuming costs follow risks, an organization could save up to 25 percent in its health care costs and significantly improve productivity,” Edington said. “The Case for Low-Risk Maintenance” by HMRC Director Dee W. Edington and Senior Research Analyst Shirley Musich appeared in the April 2003 issue of Absolute Advantage, published by Wellness Councils of America. Contact Edington at dwe@umich.edu or Shirley Musich at smusich@umich.edu. The HMRC phone is (734) 763-2462, and web address is http://www.umich.edu/~hmrc/