Category Archives: Wellness

Which Comes First — Better Health or Better Job Performance?


Better Health or Better Job PerformanceThere’s a strong link between better health and better job performance, according to a study by HCMS Group.

People who rated in the top 20% on year-end performance reviews also had the lowest medical costs and the lowest health risk scores, HCMS researchers found. The analysis covered several thousand professional workers in the HCMS database over 12 months. The performance evaluation system classified the group in three performance bands—the lower 20%, middle 60%, and upper 20%.

There are two ways of looking at the findings. One is that high job performance correlates with a high sense of responsibility, so the better workers try harder to maintain good health. The other is that healthier people are simply better able to perform at a high level in the workplace, while for others illness may cause productivity to suffer.

There’s been relatively little research on the connection between work performance and health. One study by Brigham Young University’s department of health science found that employee engagement, health behavior, and physical health were significantly associated with job performance and absenteeism. The research was based on 20,000 employees of three U.S. companies who completed surveys between 2008 and 2010.

For each of the three performance groups in the HCMS study, researchers calculated the average annual medical costs and the average risk score, using the Human Capital Risk Index® (HUI, patent pending). The HUI score takes into account about 300 variables for each individual, including medical diagnoses, health plan costs, compensation policies, and use of disability and workers’ compensation benefits. The average risk is 1.0.

Risk Score Health Plan Cost by Performance Group

Medical costs for the entire group averaged $5,455 for the year. Those in the top-performing 20% had average health expenses of $4,100, more than a third lower than the middle group’s $5,600. People in the lowest performance band had healthcare costs 41% higher than those in the middle band.

Similarly, the HUI risk scores average 1.0 for the top-performing group, or 17% lower than for those in the middle group. The lower-rated band had average risk scores 17% higher than those in the middle. The research also found that those in the middle and lower performance groups were two to three times as likely to have a disability claim. Workers’ compensation filings were twice as high for the bottom group as for the upper two categories.


— Robert L. Simison, HCMS Communications

On behalf of HCMS Data Analytics



Higher Education, Lower Risk to Health


Human Capital Risk Index EducationA college education doesn’t just raise your earnings potential. It may also lower your risk of poor health.

Health risks for people with a bachelor’s degree are 20% lower than for those with a high school education, and more than 27% lower than for people who didn’t finish high school, according to research by HCMS Group LLC. Holders of doctorates have risk scores 10% lower than for people with a bachelor’s degree.

The findings are based on the HCMS Group research reference database. Health risk reflects the company’s Human Capital Risk Index® (HUI, patent pending). The index weights more than 300 characteristics on each individual, including clinical diagnostics, medical and pharmacy benefit use, workers’ compensation claims, and disability time used. A score of 1.0 represents average risk across the entire database of 3.7 million people. The analysis of education level was based on a database subset for which the average risk score was higher than 1.0.


HUI Risk Scores by Education Level

For people who didn’t complete high school, HUI risk scores were 1.82, almost double the overall mean. The lowest score for any group was 1.19, for those with Ph.D.’s.

Other researchers have documented the link between higher education and better health. This month, the National Bureau of Economic Research published a working paper, “Education and Health: Evaluating Theories and Evidence.” The authors calculated that the health returns on education increase education’s total value by 15% to 55%. Earlier research sponsored by the Robert Wood Johnson Foundation examined the role in this phenomenon of health knowledge and behaviors, employment and income, and social and psychological factors.

The conventional wisdom is that a higher degree of formal education correlates with a higher degree of health knowledge. Our research also suggests a significant compensation impact. Employees with a higher level of education are more likely to have higher-paying jobs with more compensation at risk through incentive compensation structures. These workers have a stronger incentive to protect their health to ensure continuing success.

The HUI score, based on more than a decade of research by HCMS Group, is the most accurate person-centered risk score available. It is central to the company’s 5|50 Solution™ which is designed to address the 5% of any population that accounts for 50% of employer’s benefit costs.

— Robert L. Simison, HCMS Group Communications

On behalf of HCMS Group Data Analytics.



Health Risks and Cost Risks are not the same


The weak association between health risks and near-term health care utilization

There is a widely-held belief that companies can reduce healthcare costs by encouraging healthy behaviors. This presumption is based on decades of research showing that:

a) Health risks (such as smoking, inactivity, and obesity) increase the chances of chronic disease      over time

b) Health risks are associated with higher costs. This body of evidence fuels the multi-billion   dollar wellness industry and dictates the types of programs offered to employees.

But how strong is the relationship? And can it help with short-term cost management?  Continue Reading


When it comes to health, what numbers do most of us REALLY need to know? Entry 12 – 2010


In a 2009 study of a heart disease risk, low-income women were screened at baseline for hypertension, high cholesterol, and diabetes (1). Participants were given their biometric “numbers” by their physicians at the time of screening. One year later, researchers asked the women about their risk status. A majority of high-risk women reported that they had never been told they were at risk!

  • 66% of those with hypertension reported never having been told they were hypertensive.
  • 54% of those with high blood glucose reported never having been told they had high blood sugar.
  • 45% of those with high cholesterol reported never having been told it was high. Continue Reading


One minute left in the game. Score: Patient Education 100, Patient Accountability 0. Entry 11 – 2010


There is a sad irony in new healthcare reform provisions released last week. It rewards (or at least relieves financial pressure on) health plans for virtually every bit of educating, assessing, coaching and reminding it does with patients. Then, it penalizes them for trying to give consumers purchasing power.

The issue: the definition of MLR.
Medical Loss Ratio (MLR) is a term used to describe the portion of the total healthcare premium spent on “medical services” as opposed to other expenses usually referred to as administrative services. MLR is actually expressed as a fraction or percentage indicating what portion of premiums is spent on supposedly REAL value delivered to covered members, compared to operational costs, profits, or inefficiencies.

In national healthcare reform (now referred to most commonly as ACA, the Affordable Care Act), legislators decided to mandate a minimum MLR: 80% (or 85% depending on the size of the group being insured). A plan achieving a lower MLR will incur a penalty, to be paid to members in the form of rebates. Continue Reading


No child left (with a small) behind. America’s future workforce unfit for duty. Entry 9 -2010


Obesity is now a top reason that recruits cannot qualify to serve in the military (1), along with failure to finish high school and having a criminal record. Nine million young people are too overweight to serve and each year 1200 recruits are dismissed because of persistent weight issues. One former surgeon general describes obesity as moving beyond an epidemic to a “state of emergency” (1).

What will workers look like in ten or twenty years? Are we building a capable, healthy workforce? By many indications, no. Employers in Maine estimate that the rate of obesity (defined as a Body Mass Index of 30 or more) in their state workforce could reach as high as 80% within ten years (2).

Consider these statistics: Continue Reading


Redefining Wellness: Giving workers more control over their day and rewards for a job well done. Entry 6 – 2010


Why do work bonuses influence exercise and smoking?
In this blog space, we have written many times about the connection between performance-based pay and positive outcomes, including higher productivity (1) and fewer absences (2). We’ve also seen examples where the structure of compensation seems to influence healthy behaviors (3). We often get questions about why or how pay and health might be connected.

Connecting a few more dots.

The standard answer: when good health translates into a greater opportunity for personal gain (incentive), workers value their health more. While our research shows this to be true from an economic perspective, I’ve always wondered: what is the psychological explanation? So, for those readers with a curious mind, a recent study connects the dots a little better. Continue Reading


Recess, breakfast and fewer bullies: why the keys to student achievement point the way to workforce engagement and productivity. Entry 5 – 2010.

Human Capital (definition): the reservoir of capacity each human has to contribute to the well-being of his community, job and/or family.  It is comprised of three types of assets: skills, health and motivation.

A belated thank-you note
Thirty or forty years after the fact, I’d like to thank teachers who made learning fun, coaches who converted lessons into games I wanted to play, and school officials who kept us safe and engaged. I was one of the lucky ones who learned a lot, came home both mentally and physically tired, and suffered mostly from typical stresses (like pop quizzes) and not fears of bodily harm. Best of all, I was surrounded by people who believed – and convinced me – that hard work would result in a rewarding life and career when I grew up.

In other words, without knowing it, my learning environment at school allowed me to develop strong human capital assets that continue to serve me well today.

Lots of kids aren’t so lucky.
According to a recent report called “Healthier Students are Better Learners” (1), many children in the U.S. face circumstances that limit their opportunity to develop and build human capital assets, be it skills, health, or motivation. Continue Reading


Why savings estimates for improved health miss the big picture. Entry 3 – 2010


To see wonderful illustrations of why the “good health = lower cost” equation is an oversimplification of reality, take a peek at the contents of the past two issues of the Journal of Occupational and Environment Medicine.

First, there are several articles reinforcing the widely-accepted direct link between health status and the cost of healthcare.

Four studies show that people WITH a health condition have higher costs than those WITHOUT the condition. Patients with diabetes, fibromyalgia, low back pain and poor sleep, have higher costs and/or absences than patients and workers without those conditions (1, 2, 3, 4).

But that’s just the tip of the iceberg. A potpourri of other studies reminds us how complex the topic really is: Continue Reading


Getting real: the reasons companies rarely find actual dollar savings with health-improvement programs. Entry 26 –2009


Today’s blog is a response to benefits managers and corporate medical directors who have (and will in the future) exclaimed “these programs were supposed to save us money, so why are your data saying they don’t? Is there something wrong with your analysis?”

While I am formally trained in Evaluation Methodology, I recognize that only a few kindred spirits share my passion for this field. This blog doesn’t require that you LOVE evaluation, but it is a little more detailed than usual, because it seems important to explain why our direct evaluations so infrequently show (expected) measurable savings from health improvement programs. There are three overarching reasons, each of which I will highlight briefly. Continue Reading