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Service Delivery Innovation Profile

Corporate Health and Wellness Program Attracts High Levels of Participation, Significantly Reduces Health Risks and Overall Health Care Costs


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Summary

Johnson & Johnson, a large, multinational health care corporation with 275 operating companies in 65 countries, operates a comprehensive, holistic integrated employee health program that combines health promotion, performance and energy management, occupational health, and mental health services. Fully integrated within the organization's culture and operations and overseen by a centralized department, the program includes global core deliverables and additional services tailored to the site-specific and employee needs. In the United States, participants receive a financial incentive to complete a health risk assessment. Employees with specific health risks have the opportunity to speak with a health adviser to review their risk areas and readiness to change and refer them to the appropriate resource or services. The referral typically involves encouraging the employee take advantage of up to three appropriate health and wellness resources offered centrally or by the sites, including ongoing coaching and support, fitness centers, dietary programs, tobacco cessation programs, and other health promotion offerings from the integrated approach. The program has achieved very high participation rates, significantly reduced risk factors (such as physical inactivity, smoking, high blood pressure and cholesterol), and led to lower overall corporate health care spending, more productivity, and a positive return on investment.

Evidence Rating (What is this?)

Moderate: The evidence consists of pre- and post-implementation comparisons of participation rates, along with long-term trends since program introduction in the following: the prevalence of specific risk factors among employees, comparisons of overall health care costs for participants and nonparticipants, and rates of absenteeism among employee assistance program users.
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Developing Organizations

Johnson & Johnson
end doJohnson & Johnson introduced its first wellness program, known as LIVE FOR LIFE®, in 1979. The program has evolved continually since that time, including being recast to incorporate financial incentives for employees and to better integrate employee health, wellness, disability management, employee assistance, and occupational medicine. This retooled program, formally introduced in April 1995, is known as Johnson & Johnson Global Health Services.

Problem Addressed

Poor diet, physical inactivity, smoking, and other lifestyle-related behaviors increase the health risks of employees and their dependents, leading to increased costs, higher levels of absenteeism and "presenteeism" (when employees show up to work but perform at less-than-optimal effectiveness due to health issues), and lower productivity. Worksite health and wellness programs can be effective in reducing such risks, but relatively few companies offer them and those that do typically attract few participants. Financial incentives can help boost participation, and many companies in recent years have started to offer them.
  • Link between lifestyle-related risk factors and costs, presenteeism, absenteeism: Employees with many health risk factors tend to use more health care resources, miss more days of work, and perform at less-than-optimal levels of efficiency and productivity. For example, a study of employees at Novartis Corporation found a significant, consistent link between common risk factors—including high biometric laboratory values (e.g., cholesterol, blood glucose, blood pressure), cigarette and alcohol use, and poor emotional health—and increased presenteeism, absenteeism, and health care costs, with medical expenditures being between 13 and 22 percent higher for at-risk men and women.1
  • Unrealized potential of worksite wellness and health promotion: Well-constructed worksite health and wellness programs can be effective in reducing risk factors among employees and dependents. For example, a recent systematic review found that worksite nutrition and physical activity programs yielded a modest reduction in employee weight status and body mass index.2 Yet relatively few companies offer such programs, and those that do typically attract relatively few participants. Financial incentives can help to boost participation,3,4 and many companies in recent years have started to offer them.

What They Did

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Description of the Innovative Activity

Johnson & Johnson (J&J), a large, multinational health care corporation with 275 operating companies in 65 countries, operates a comprehensive, holistic integrated employee health program, called Global Health Services, that combines health promotion, performance and energy management, occupational health, and mental health services. Fully integrated within the organization's culture and operations and overseen by a centralized department, the program includes global core deliverables and additional services tailored to the site-specific and employee needs. In the United States, participants receive a financial incentive to complete a health risk assessment. Employees with specific health risks have the opportunity to speak with a health adviser to review their risk areas and readiness to change and refer them to the appropriate resource or services. The referral typically involves encouraging the employee take advantage of up to three appropriate health and wellness resources offered centrally or by the sites, including ongoing coaching and support, fitness centers, dietary programs, tobacco cessation programs, and other health promotion offerings from the integrated approach. The program has achieved very high participation rates, significantly reduced risk factors (such as physical inactivity, smoking, high blood pressure and cholesterol), and led to lower overall corporate health care spending, more productivity, and a positive return on investment. (Updated November 2013.) Key elements of the program are outlined below:
  • Financial incentive to complete health risk assessment and health advising process: U.S. employees who agree to complete a voluntary assessment that includes biometric screening and followup health advising if needed based on risk, qualify for a $500 medical benefit plan discount. The online assessment tool covers the following risk areas: obesity, cholesterol, glucose, hypertension, tobacco use, physical inactivity, stress, alcohol use, unhealthy eating, safety belt usage, and depression. Those at risk for identified complex or chronic conditions receive a referral to the company's CareConnect care management program. Members enrolled in certain company-sponsored medical plans can receive an additional incentive deposited into their Health Reimbursement Account (HRA) plan if they or their covered spouse or partner actively participate in the case management process or if the pregnant employee or covered spouse or partner actively participates in the CareConnect maternity management program. Other benefits incentives are provided for members aged 50 and older who obtain a preventive colonoscopy. (Updated November 2013.)
  • Ongoing advice, plan of action: Participating employees with identified health risks connect by telephone with a health adviser who reviews their assessment and readiness to change and refers them to the appropriate resource or services. All employees have access to their Operating Company integrated Global Health Team consisting of occupational health nurses, fitness professionals and health educators as well as employee assistance counselors. Ongoing consultation is offered face to face, via telephone, or via e-mail through the Global Health Services onsite staff. 
  • Broad menu of integrated services and support, customized by site: To help employees execute their plans of action, employee health is supported from executive leadership, which sets the tone, values, and norms that make up the culture of the organization. The culture is coupled with a broad menu of integrated services and support, including wellness and health promotion, occupational health, performance and energy management, and mental health services. With support and oversight from corporate Global Health Services staff, each site offers a core set of services along with additional services based on the specific needs of the employee population and the unique culture of the specific site. (More information on how Global Health Services works with the sites can be found in the Planning and Development Process section.)
    • Core offerings for all employees: Each J&J operating company offers a wide array of core services, as outlined below.
      • Integrated professional team support: Employees have access to an EAP professional, a wellness professional, occupational health professional, and round-the-clock mental health/well-being counseling. Employees can access such services in a manner that is most comfortable to them, be it in person, over the phone, through e-mail, or other Web-based mechanisms. These professionals work together as a Global Health Services team to provide ongoing counseling, advice, referrals, and other support tailored to the individual's needs.
      • Robust education, awareness, coaching activities: Employees can tap into a variety of sources of knowledge and advice on wellness, health promotion, chronic disease management, and the like. Offerings include both online and onsite programs designed to promote healthy lifestyles, such as nutrition coaching, health fairs, seminars, and other activities timed to coincide with specific health-related events. Sites also offer periodic training designed to raise awareness of the dangers of drug and alcohol abuse.
      • Fitness centers: Most J&J operating companies have a staffed, onsite fitness facility or exercise room that allows employees to engage in cardiovascular, strength-training, and other activities. In the United States, if an employee lives or works more than 10 miles from a J&J fitness center, they can apply for $200.00 reimbursement of the costs of joining an external fitness center or purchasing approved exercise equipment.
      • Onsite biometrics: Some operating companies offer onsite, instant biometric screenings, including measurement of height, weight, body mass index, blood glucose, and cholesterol.
      • Resilience and stress management training: Some operating companies offer training and support related to managing stress and increasing resilience. Additionally the "Energy for Performance in Life" program provides a program that teaches participants how to maximize their personal energy and become more aligned with their personal mission. The practice of energy management can produce employee engagement, resiliency and the potential for greater employee innovation, creativity and optimal performance.
      • Nutritional support: Where available, employees are supported in their efforts to eat healthier through the on-site food service offerings as well as through online programs, one-to-one consultations, group workshops, and multiweek challenges. J&J developed the "eatcomplete" program in the United States, which provides employee cafeterias with guidelines for serving nutritionally dense whole foods in an appealing and easily accessible manner. Employees can enjoy a greater variety of these foods while in the workplace or whenever food is served at a company function. Insightful health communications at the point of sale encourage employees to choose foods that optimize their energy and improve their health throughout the day. Eatcomplete audits are conducted for the café and for vending and catering services by the food service manager and wellness professional; audit score achievement is a key performance indicator built into the food service vendor contact.
      • Tobacco-free campuses: All J&J operating companies worldwide ban any use of tobacco products while on company property via a global, harmonized tobacco-free policy.
    • Additional support for high-risk individuals: High-risk individuals receive additional support, as outlined below:
      • Ongoing risk/disease management: As noted, individuals found to be at high risk during the health risk assessment or via a review of health care claims are invited to participate in the CareConnect program, which provides ongoing support in managing identified risks and chronic diseases/complex conditions. CareConnect is designed to encourage eligible individuals with complex or chronic health conditions to work with a nurse health coach.
      • Postevent management: Anyone who experiences a major health event, such as a hospitalization or emergency department visit, receives additional support designed to facilitate recovery and prevent a recurrence, including ongoing medical case management, assignment to alternative/modified job duties if necessary, referral to appropriate programs (e.g., risk management, EAP), periodic functional assessments to gauge progress, etc.
    • Optional, site-specific services: Individual locations may offer additional services based on the needs of employees and the culture in place within the operating company. These services are typically added in response to specific problems being faced by employees, which are identified as part of an ongoing data collection, analysis, and reporting function spearheaded by J&J Global Health Services. (More information on this process appears in the Planning and Development Process section.) Examples of customized, site-specific services include group exercise classes (e.g., yoga, tai chi), preventive stretching, ergonomic reviews, individual plans of action, and focused educational programs targeted at healthy eating or tobacco cessation.

Context of the Innovation

Johnson & Johnson is a multinational health care corporation with roughly 110,000 employees, with over 40,000 in the United States. Through its more than 275 operating companies, J&J produces a wide variety of consumer products (including personal care products and over-the-counter medications), pharmaceutical products, and medical devices and diagnostics (e.g., joint replacement devices, sutures, blood glucose monitors). The company's products touch approximately 1 billion consumers each day. The roots of the present-day wellness program go back to the late 1970s, when the company's chief executive officer, Jim Burke, articulated a vision calling for J&J to have the healthiest workforce in the world. Mr. Burke believed that by offering onsite, integrated health and wellness programs designed to address the needs of individual workers and encourage them to be active partners in their own health, J&J could reduce costs and improve employee productivity, recruitment, and retention. In 1979, J&J introduced its first comprehensive health and wellness initiative, known as the LIVE FOR LIFE® program. In 1995, J&J introduced a recast version of this program integrating employee assistance, occupational health, wellness, and health promotion, formally known as the J&J Health and Wellness Program. In 2004, J&J began a global expansion of this program through Global Health Services. In 2008, J&J began a new business platform called Wellness & Prevention, Inc. The holistic approach to health and wellness now includes a full suite of online resources through HealthMedia® and a unique approach to increasing engagement and physical and emotional capacity through the Human Performance Institute® Corporate Athlete® Energy Management principles, which are branded internally as “Energy for Performance in Life.”

Did It Work?

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Results

The program has achieved very high participation rates, significantly reduced risk factors (such as physical inactivity, tobacco use, high blood pressure and cholesterol), and led to lower overall corporate health care spending, less absenteeism, and a positive return on investment.
  • High participation rates: Shortly after introduction of the $500 financial incentive in 1993, participation rates in the program reached roughly 90 percent, up from 26 percent under the LIVE FOR LIFE® program (the predecessor program introduced in 1979).5 Participation rates have remained between 80 and 85 percent since that time, well above the levels achieved in the typical corporate wellness program.
  • Significant reductions in risk factors: The percentage of J&J employees who exhibit key risk factors has declined significantly between the 1995–1999 time period and 2007–2011, including reductions in the percentage of employees who are sedentary (from 39 to 20.9 percent), use tobacco (12 percent to 3.6 percent), and have high blood pressure (14 percent to 6.4 percent) or high cholesterol (19 percent to 6.2 percent). In addition, from 2006 to 2011, the percentage of employees at “low risk” (defined as 0 to 2 risk factors) increased from 78.1 percent to 87.5 percent, the percentage at moderate risk (3 to 4 risk factors) fell from 20.5 percent to 11.7 percent, and the percentage at high risk (5 or more risk factors) fell from 1.4 percent to 0.8 percent. Each of the 2007–2011 figures is well below the average for the entire U.S. population. An earlier evaluation of the J&J program found similar results, including reductions in the percentage of employees exhibiting poor aerobic exercise habits; using any type of tobacco product; having high blood pressure or total cholesterol; failing to use seat belts; and drinking and driving.6 A separate analysis found that 78 percent of employee assistance program clients saw an improvement in their mental health status.
  • Lower health care spending, positive return on investment: Based on a longitudinal study of our U.S. Health and Wellness Programs (2002), J&J saved about $225 per employee per year (U.S.) from reduced health care utilization. In 2007, this would equate to an estimated $400 savings per employee per year, or over $250 million in cumulative savings over the last decade. In a recent outcomes study analyzing data between 2002 and 2008, U.S. health and wellness programs at J&J achieved an estimated return on investment of an average of $1.88 to $3.92 for every $1.00 invested. The annual savings per employee per year was estimated at $565. Additionally the outcomes study showed significantly lower average growth in medical and pharmaceutical costs (3.7 percent) each year between 2002 and 2008 compared to benchmark.

Evidence Rating (What is this?)

Moderate: The evidence consists of pre- and post-implementation comparisons of participation rates, along with long-term trends since program introduction in the following: the prevalence of specific risk factors among employees, comparisons of overall health care costs for participants and nonparticipants, and rates of absenteeism among employee assistance program users.

How They Did It

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Planning and Development Process

Since its introduction, the program has been subject to an ongoing oversight, evaluation, and refinement process designed to standardize core program offerings throughout the organization and integrate them into the company's culture and operations, while simultaneously supporting individual business units in customizing services to meet site-specific needs and fit within site-specific cultures. Key elements of this ongoing process include the following:
  • Centralized oversight and contracting: A centralized group, Global Health Services, located at J&J World Headquarters, oversees all aspects of the program, including developing corporate policies related to health and wellness, such as having tobacco-free facilities. This group partners with individual operating companies to implement the core bundle of services. These agreements include a set performance metrics and deliverables for each operating company, thus promoting consistency of service across the organization. (Sites annually complete a Global Health Assessment Tool, which helps headquarters to ensure that they are offering all requisite core services and provide support where needed.) At the same time, operating companies essentially become "customers" of Global Health Services, which provides leadership, consultation, guidance, and support to the operating companies and works with them to customize offerings to best meet their individual needs and cultures.
  • Regular performance feedback to guide offerings: Global Health Services regularly collects, analyzes, and feeds back site-specific data to help identify unique problem areas that may be facing employees. Global Health Services then works with company leaders to develop new programs and/or modify existing ones to better address these areas. For example, if high cholesterol is prevalent within the population, special efforts may be made to develop or expand programs emphasizing physical activity and healthier eating.
  • Executive-level feedback: Each year, Global Health Services leaders present information on the program to J&J's chief executive officer, executive committee, and board of directors, including a review of how the program has performed with respect to its stated goals and objectives. This process allows senior leadership within J&J to provide guidance on how to improve the program. For example, in 2004, these leaders encouraged Global Health Services to figure out how to expand the initiative to the over 60,000 J&J employees who work outside the United States. This expansion effort continues today.
  • Formal assessment to orient new locations: As part of the process for expanding the program overseas and to newly acquired companies within the United States, Global Health Services leaders engage in conversations with the leadership of the specific location or operating company in question. The goal is to educate them on the J&J culture, including the key role that health plays as a part of the organization's overall business strategy. In addition, J&J administers an internal tool, known as the Global Health Assessment Tool, designed to gauge the degree to which the company in question has a culture of health. This evaluation, which includes a review of current employee health status (e.g., population health risks) and available health-related programs and policies, concludes with the development of an action plan for transforming the location into a part of the J&J community. (Updated November 2013.)

Resources Used and Skills Needed

  • Staffing: As noted, the program involves staff at both J&J headquarters and each of its more than 275 operating companies. At headquarters, the vice president of Global Health Services leads the Global Health Team. At the operating company level, J&J contracts with external partners to provide the EAP counselors, wellness professionals/health advisers, additional occupational medicine staff (to supplement the J&J employees serving in this role), and others who support employee health needs. Staffing is managed based on the size and nature of operations within each of the operating companies.
  • Costs: Data on program costs are unavailable. J&J views the health of its employees as a major and essential component of its culture and as inseparable from the health of the corporation. Consequently, leaders view the funding of this program as an investment rather than a cost.
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Funding Sources

Johnson & Johnson
The program is funded internally by Johnson & Johnson.end fs

Tools and Other Resources

For more information on how J&J cares for its employees, visit: http://www.jnj.com/sites/default/files/pdf/healthy-people-20130328.pdf (If you don't have the software to open this PDF, download free Adobe Acrobat ReaderĀ® software External Web Site Policy.)

Adoption Considerations

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Getting Started with This Innovation

  • Engage senior leaders: The program cannot succeed without leadership support, both at the corporate and operating company level. J&J engages a senior leader from each of the regions around the world (North America, Latin America, Asia Pacific, Europe Middle East, and Africa) to serve as health champion. The regional health champion communicates the importance of employee health, promotes participation, and acts as influencer within the business to keep health on the business agenda. Local health champions are identified at the operating company facilities to support the local approach and help link employee health with the local business goals. (Updated November 2013.)
  • Develop a health strategy linked to overall business strategy: A company's strategy for health and performance should be explicitly linked to its overall business strategy. As noted, J&J's chief executive officer made this link 30 years ago and it continues with the current CEO, resulting in health and wellness becoming an integral part of the company's culture and everyday operations. If such a link is not made, health and wellness will always be considered an "add-on," and hence, subject to wavering commitment over time.
  • Develop guiding policies and principles: Corporate-level policies and principles should guide program execution. For example, J&J developed a policy calling for tobacco-free facilities throughout the company.
  • Take a holistic approach: J&J program leaders believe strongly in the need to take a holistic approach that integrates EAP, wellness and health promotion, performance and energy management, and occupational health. This strategy becomes especially important as companies seek to blend programs related to mental and physical health.
  • Consider financial incentives: Positive financial incentives can drive participation. As noted earlier, participation rates jumped significantly after J&J introduced the $500 incentive.
  • Set up measurement systems that evaluate impact broadly: Before putting anything in place, develop systems to collect, analyze, and report performance data for the individual program or service in question. For each offering, developers should be able to articulate what the program is, why it is being put in place, what the company expects to get as a result, and how performance with respect to those expectations will be measured. Measures should go beyond cost savings to incorporate the impact on "value," including presenteeism, absenteeism, and productivity.
  • Develop and demonstrate systems to maintain confidentiality: Employees must be made to feel confident that all communications and employee-specific data will remain confidential. Otherwise, they may refuse to participate.

Sustaining This Innovation

  • Work with sites to customize offerings: Programs and services should vary by company based on the unique needs of the employee population and other unique aspects of a particular location, including size and culture. Programs also need to be "scalable"—i.e., they need to be structured so that they will work at both large and small locations and with different types of employees. For example, educational programs need to effectively service those who prefer to attend an onsite seminar and those who prefer to access information at home via a Web-based application.
  • Assess company readiness before expanding program: Program leaders should visit with company leaders and conduct a formal, site-specific cultural readiness assessment before expanding the initiative to a particular business unit. To "prove" their readiness, leaders need to view health and wellness activities as being critical to achieving their core business objectives.

More Information

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Contact the Innovator

Fikry W. Isaac, MD, MPH, FACOEM
Vice President, Global Health Services, Johnson & Johnson
Chief Medical Officer, Wellness & Prevention, Inc.
410 George Street, GS- 1050
New Brunswick, NJ 08901
Phone: (732) 524-3404
Fax: (732) 524-2961
E-mail: fisaac1@its.jnj.com

Innovator Disclosures

Dr. Isaac reported having no financial interests or business/professional affiliations relevant to the work described in the profile other than the funders listed in the Funding Sources section.

References/Related Articles

Isaac F. A role for private industry: comments on the Johnson & Johnson's wellness program. Am J Prev Med. 2013; 44(1 Suppl 1):S30-3. (Added November 2013.) [PubMed]

Fabius R, Thayer R, Konicki D, et al. The link between workforce health and safety and the health of the bottom line. J Occup Environ Med. 2013; 55(9):993-1000. (Added November 2013.) [PubMed]

Carls, GS, Goetzel, RZ, Henke, RM, et al. The impact of weight gain or loss on health care costs for employees at Johnson & Johnson Family of Companies. J Occup Environ Med. 2011 Jan;53(1):8-16. [PubMed]

Henke, RM, Goetzel, RZ, McHugh, J, et al. Recent experience in health promotion at Johnson & Johnson: lower health spending, strong return on investment. Health Aff (Millwood). 2011 Mar;30:3490-9. [PubMed]

Ozminkowski RJ, Ling D, Goetzel RZ, et al. Long-term impact of Johnson & Johnson's Health & Wellness Program on health care utilization and expenditures. J Occup Environ Med. 2002 Jan;44(1):21-9. [PubMed]

Goetzel RZ, Ozminkowski RJ, Bruno JA, et al. The long-term impact of Johnson & Johnson's Health & Wellness Program on employee health risks. J Occup Environ Med. 2002 May;44(5):417-24. [PubMed]

Isaac F, Flynn P. Johnson & Johnson LIVE FOR LIFE Program: now and then. Am J Health Promot. 2001 May/Jun;15(5):365-7. [PubMed]

Footnotes

1 Goetzel RZ, Carls GS, Wang S, et al. The relationship between modifiable health risk factors and medical expenditures, absenteeism, short-term disability, and presenteeism among employees at Novartis. J Occup Environ Med. 2009 Apr;51(4):487-99. [PubMed]
2 Anderson LM, Quinn TA, Glanz K, et al. The effectiveness of worksite nutrition and physical activity interventions for controlling employee overweight and obesity: a systematic review. Task Force on Community Preventive Services. Am J Prev Med. 2009 Oct;37(4):340-57. [PubMed]
3 Seaverson EL, Grossmeier J, Miller TM, et al. The role of incentive design, incentive value, communications strategy, and worksite culture on health risk assessment participation. Am J Health Promot. 2009 May-Jun;23(5):343-52. [PubMed]
4 Taitel MS, Haufle V, Heck D, et al. Incentives and other factors associated with employee participation in health risk assessments. J Occup Environ Med. 2008 Aug;50(8):863-72. [PubMed]
5 Ozminkowski RJ, Ling D, Goetzel RZ, et al. Long-term impact of Johnson & Johnson's Health & Wellness Program on health care utilization and expenditures. J Occup Environ Med. Jan 2002; 44(1):21-9. [PubMed]
6 Goetzel RZ, Ozminkowski RJ, Bruno JA, et al. The long-term impact of Johnson & Johnson's Health & Wellness Program on employee health risks. J Occup Environ Med. 2002 May;44(5):417-24. [PubMed]
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Disclaimer: The inclusion of an innovation in the Innovations Exchange does not constitute or imply an endorsement by the U.S. Department of Health and Human Services, the Agency for Healthcare Research and Quality, or Westat of the innovation or of the submitter or developer of the innovation. Read more.

Original publication: June 23, 2010.
Original publication indicates the date the profile was first posted to the Innovations Exchange.

Last updated: January 29, 2014.
Last updated indicates the date the most recent changes to the profile were posted to the Innovations Exchange.

Date verified by innovator: November 06, 2013.
Date verified by innovator indicates the most recent date the innovator provided feedback during the annual review process. The innovator is invited to review, update, and verify the profile annually.

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