Employees of Blue Cross and Blue Shield of Indiana 

• Health Insurance Company 
• Included risk assessment, referral to intervention classes on nutrition, weight management, smoking, fitness and medical care where appropriate alcohol and drug therapy was handled through an EAP program 
• Approximately 15% of those screened participated in an intervention program for a minimum of three sessions and became participants 
• Uses American Health Foundation Model for health promotion 
• Program included: publicity health risk assessment, feedback, selective referral to intervention programs and post-intervention telephone contact 
• Both experimental group and control group consisted of >90% female with average age 30-35 
• Time Frame January 1978 to September 1982 (60 months) 
• Sample Size: N=667, Comparison Group: N=892 

• Study: ---OXOXOXOXOXO 
• Controls: OXOXOXOXOXO 

• Average medical benefit cost per individual per year 
• Discounted per year health claims amounts 

• Participants averaged 15% higher benefit payment than non-participants prior to the intervention 
• During the first six months, participants experience 74% higher benefit cost than non-participants presumably due to medical care referrals generated by the screening 
• Over the five (5) year period the participants averaged 24% lower per person health benefit cost 
• Cost benefit ratio based only on health costs is 1:2.51 

• Lacks randomization of subjects 
• Level of intervention is not standardized 
• Significant spill-over effects were likely 
• Does not compare changes in health risk prevalence 
• Limited use of inferential and power statistical analysis 
• High female content in subject population 
• Uses of parametric statistics with non-parametric data 
• Does not include out-of-pocket cost sharing 
• Self-selection bias is likely 
• Short baseline period (i.e., six months) 

Chapman LS. Proof Positive: Analysis of the Cost-Effectiveness of Worksite Wellness. Summex Corporation P.O. Box 55056, Seattle, WA 98155. Highly recommended book with quantitative comparative evaluations of the 30 best studies identified by formal meta-analytic search.