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Research & Evidence: Overall Outcomes & ROI

Together, companies can influence health care policies and reimbursement and industry practices to support the fight against cancer.
Employers' Role in Cancer Prevention and Treatment—Developing Success Metrics for Use by the CEO Roundtable on Cancer
Henke, Rachel, PhD; Ron Z. Goetzel, PhD; Janice McHugh;Deborah Gorhan; Malinda Reynolds; Jaclyn Davenport; Kate Rasmussen; and Fikry Isaac, MD
Population Health Management


Warren, MD, PhD, Graham W.; Kathleen B. Cartmell, PhD; Elizabeth Garrett-Mayer, PhD. "Attributable Failure of First-line Cancer Treatment and Incremental Costs Associated With Smoking by Patients With Cancer." JAMA, April 5, 2019.

The cost of cancer treatment is increasingly associated with unfavorable financial outcomes in cancer care,but whether increased costs reflect increased value is unknown. Principles for value-based care in oncology include patient-centered solutions, optimal care, and cost-containment strategies that do not limit patient access or innovation. Guidelines have been developed to define clinically meaningful outcomes in cancer care, but a recent analysis of drug approvals by the US Food and Drug Administration between 2014 and 2016 showed that many drugs did not meet survival goals.  Whereas drug cost and efficacy have been the primary focus for considering value in cancer care, relatively little consideration has been given to other potentially modifiable factors that could affect cancer treatment costs, including health behaviors such as smoking.

The US 2014 Surgeon General’s report concluded that continued smoking among patients with cancer caused adverse outcomes including increased overall- and cancer-specific mortality, risk for second primary cancer, and associations with increased toxic effects from cancer treatment. Smoking cessation in the general population is known to improve health outcomes and create significant reductions in health expenditures. Whereas many studies found that smoking cessation after a cancer diagnosis can improve survival, to our knowledge, there have been no evaluations of the association between continued smoking among patients with cancer and the costs of cancer treatment. Understanding the financial effects of smoking among patients with cancer is needed to develop value-based approaches that could lead to improved cancer treatment outcomes. The objective of this study was to model the additional attributable first-line cancer treatment failures associated with continued smoking and to estimate the attributable incremental cost associated with the need to treat first-line cancer treatment failures attributed to continued smoking.


"Winning With Wellness." US Chamber of Commerce, May 5, 2016.

Compelling evidence exists that wellness programs work and prevention pays off when done well and in the right ways. This publication delineates the attributes of successful and effective workplace wellness programs, discusses how workplace wellness can be a win-win for employers and employees, and outlines the legal and regulatory parameters associated with such programs. Significant converging financial, political, and cultural trends drive the importance and the urgent need for more pervasive employer-driven, evidence-based workplace wellness initiatives.

Ron Z. Goetzel, PhD, Raymond Fabius, MD, Dan Fabius, DO, Enid C. Roemer, PhD, Nicole Thornton, BA, Rebecca K. Kelly, PhD, RD, and Kenneth R. Pelletier, PhD, MD (hc). "The Stock Performance of C. Everett Koop Award Winners Compared With the Standard & Poor's 500 Index." American College of Occupational and Environmental Medicine, January 1, 2016.

Workplace health promotion programs are designed to improve the health and well-being of employees and their dependents. Companies that excel in their workplace wellness efforts can apply for and win recognition through numerous vehicles including earning the C. Everett Koop National Health Award (Koop Award). The Koop Award is conferred annually by The Health Project, a nonprofit organization founded in 1994 to promote employer achievements in improving population health cost-effectively. The hypothesis tested was that companies applying for and winning the Koop Award, thereby earning the distinction of having outstanding workplace health promotion (wellness) programs, would realize financial gains that extend beyond those simply offering traditional employee benefit programs.

Fabius, Raymond MD, Ronald R. Loeppke, MD, MPH, Todd Hohn, CSP, Dan Fabius, DO, Barry Eisenberg, CAE, Doris L. Konicki, MHS, and Paul Larson, MS. "Tracking the Market Performance of Companies That Integrate a Culture of Health and Safety." Journal of Occupational and Environmental Medicine, January 1, 2016.

This article tests the hypothesis that the stockmarket performance of companies that achieve high-scoring assessments in either health or safety during the Corporate Health Achievement Award (CHAA) process will be superior to average market-index performance.


Towne, Samuel D. Jr., PhD, MPH, CPH, Kelsey E. Anderson, Matthew Lee Smith, Deborah Vollmer Dahlke, Debra Kellstedt, Ninfa Pena Purcell and Marcia G. Ory. "Changing organizational culture: using the CEO cancer Gold Standard policy initiatives to promote health and wellness at a school of public health." BMC Public Health, September 3, 2015.

Worksite wellness initiatives for health promotion and health education have demonstrated effectiveness in improving employee health and wellness. 


"IBI Chronic Disease Profile: Cancer." Integrated Benefits Institute, March 2014.

A growing recognition of the impact of workforce health on business performance has increased interest in workplace interventions and management strategies for chronic health conditions. In support of this broadened value proposition, IBI is drawing on a variety of information sources to publish a series of “disease profiles” for employers and their benefits partners. The profiles highlight the prevalence, full costs, co-morbidities and intervention approaches for key chronic health conditions. This month we profile cancer in the workforce.

Workplace wellness is a $6 billion dollar industry in the United States. Employers offer the programs to improve the health and well-being of their employees, increase their productivity, reduce their risk of costly chronic diseases, and improve control of chronic conditions. In 2012, half of all employers with at least 50 employees offered programs, and nearly half of employers without a program said they intend to introduce one.


Fabius, Raymod, MD; R. Dixon Thayer, BA, Doris L. Konicki, MHS, Charles M. Yarborough, MD, Kent W. Peterson, MD; Fikry Isaac, MD; Ronald R. Loeppke, MD, MPH; Barry S. Eisenberg, MA; and Marianne Dreger, MA. "The Link Between Workforce Health and Safety and the Health of the Bottom Line: Tracking Market Performance of Companies That Nurture a “Culture of Health”." Journal of Occupational and Environmental Medicine, September 9, 2013.

A growing body of evidence supports the concept that focusing on the health and safety of a workforce is good business. Engaging in a comprehensive effort to promote wellness, reduce the health risks of a workforce, and mitigate the complications of chronic illness within these populations can produce remarkable effects on health care costs, productivity, and performance. The literature is replete with examples demonstrating that the health of employees impacts their performance and productivity. In addition, for the majority of the employers who pay for the cost of health care provided to their employees, there is a direct impact on the bottom line.

Henke, Rachel, PhD; Ron Z. Goetzel, PhD; Janice McHugh;Deborah Gorhan; Malinda Reynolds; Jaclyn Davenport; Kate Rasmussen; and Fikry Isaac, MD. "Employers' Role in Cancer Prevention and Treatment—Developing Success Metrics for Use by the CEO Roundtable on Cancer." Population Health Management, August 13, 2013.

As evidence accumulates on the risk factors for cancer, it is becoming clearer that employers can play a significant role in the fight against the disease by creating a workplace conducive to lowering health risks. The CEO Roundtable on Cancer’s CEO Cancer Gold Standard Program defines what companies can do to prevent cancer, detect it early, and ensure access to the best available treatments for those who are afflicted with the disease. This article describes how Johnson & Johnson incorporated the Cancer Gold Standard Program into its existing health promotion initiatives.

This commentary is in response to the March 5, 2013 Health Affairs article, "Wellness Incentives in the Workplace: Cost Savings through Cost Shifting to Unhealthy Lifestyles."  In that article, Jill Horwitz and coauthors express concerns about new rules governing workplace health promotion (wellness) programs due to take effect in 2014 as part of the Patient Protection and Affordable Care Act of 2011, Public Law 111-148 (“ACA”). 

In this post, I explain how well-designed wellness programs can benefit both employers and employees, and I offer some suggestions to ensure that such programs are both effective and fair. 


Berry, Leonard L.; Ann M. Mirabito and William B. Baun. "What’s The Hard Return on Employee Wellness Programs?." Harvard Business Review, December 1, 2010.

The ROI data will surprise you, and the softer evidence may inspire you.

Katherine Baicker, David Cutler, and Zirui Song. "Workplace Wellness Programs Can Generate Savings." Health Affairs, February 1, 2010.

Amid soaring health spending, there is growing interest in workplace disease prevention and wellness programs to improve health and lower costs. In a critical meta-analysis of the literature on costs and savings associated with such programs, we found that medical costs fall by about $3.27 for every dollar spent on wellness programs and that absenteeism costs fall by about $2.73 for every dollar spent.


Charles E. Kupchella, PhD. "Colleges and Universities Should Give More Broad-Based Attention to Health and Wellness-At All Levels." Journal of American College Health, September 1, 2009.

Higher education needs to give more broad-based attention to health and wellness. Our graduates will all have to deal with the facts that the general state of health of Americans is not good and our national health care system is badly in need of reform. We should offer innovative approaches to helping our graduates establish positive, lifetime health habits and we should demonstrate to them our own model approaches to promoting health and wellness through more effective health insurance and worksite wellness programs.


Mello, Michelle M., JD, PhD; Meredith B. Rosenthal, PhD. "Wellness Programs and Lifestyle Discrimination - The Legal Limits." New England Journal of Medicine, July 10, 2008.

In this article, we examine the ex­tent to which employers and health plans can pro­vide rewards or otherwise adjust individual health insurance costs based on the steps employees or plan members take to reduce their health risk. 

C-Change’s ―Making the Business Case initiative documents why employers should consider including scientifically proven cancer prevention and early detection services in their respective employee health insurance policies. Research has shown that prevention and early detection services, such as tobaccofree policies, tobacco cessation, as well as regular screenings, are proven methods of decreasing cancer risk among employees and increasing early diagnosis and associated medical care outcomes. The data also suggest that these cancer prevention and early detection services are effectively decreasing direct and indirect costs associated with cancer.