Best Practices in Local Government Wellness Programs: The Benefits of Organizational Investment and Performance Monitoring
| Author | Imane Hijal-Moghrabi,Meghna Sabharwal,L. Douglas Kiel |
| Published date | 01 March 2019 |
| DOI | 10.1177/0734371X16682817 |
| Date | 01 March 2019 |
| Subject Matter | Articles |
research-article2016
Article
Review of Public Personnel Administration
2019, Vol. 39(1) 24 –45
Best Practices in Local
© The Author(s) 2016
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https://doi.org/10.1177/0734371X16682817
DOI: 10.1177/0734371X16682817
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Programs: The Benefits of
Organizational Investment
and Performance Monitoring
Meghna Sabharwal1, L. Douglas Kiel1,
and Imane Hijal-Moghrabi2
Abstract
Over the last 25 years, municipal governments responded to an environment of
increasing health care costs by implementing workplace wellness programs. Research
reveals that workplace wellness programs can produce performance benefits ranging
from reduced health care costs to productivity improvements. However, there is no
systematic study of local government wellness programs that identifies the practices
that produce cost reductions and productivity improvements. This article presents the
results of a national survey of wellness programs in U.S. municipalities. We develop an
index of program success using performance data from our sample. Statistical analysis
reveals that targeted investments and performance monitoring, at both the individual
and program level, serve to reduce costs and improve employee productivity. This
research, thus, provides evidence for best practices in local government wellness
programs. Given the array of potential benefits of wellness programs and the locus of
employers in the provision of health care benefits, it is necessary to further investigate
wellness programs in U.S. local governments.
Keywords
wellness programs, health care costs, productivity improvement, behavioral
monitoring, disease detection, workplace safety education, local government
1University of Texas at Dallas, Richardson, TX, USA
2University of Texas of the Permian Basin, Odessa, TX, USA
Corresponding Author:
Meghna Sabharwal, Associate Professor and PhD Advisor of Public and Nonprofit Management, School
of Economic, Political and Policy Sciences, University of Texas at Dallas, 800 W. Campbell Road, GR 31,
Richardson, TX 75080, USA.
Email: meghna.sabharwal@utdallas.edu
Sabharwal et al.
25
For more than 25 years, U.S. local governments have faced continuing growth in
health care costs. From 1987 to 2012, health care expenditures increased by 260% on
an inflation adjusted basis for state and municipal governments (Pew Charitable
Trusts, 2014). During this same 25 year period, health care spending as a share of
revenue for both state and local governments rose from 16% to 31% (Pew Charitable
Trusts, 2014). The Government Accountability Office (2013) reports that for local
governments’ health care spending is the “primary driver” of the long-term fiscal chal-
lenges municipalities face. These increasing costs risk “squeezing out” other impor-
tant governmental programs and public needs (Boyd, 2014).
During this quarter century of health care cost increases, U.S. local governments
implemented wellness programs in an effort to reduce rising health care costs (Coleman
& Kemp, 2013; Moore, 1989). The research literature reveals that a large proportion
of U.S. municipal governments now maintain wellness programs. Roberts (2004)
found 58.9 % of the cities in his sample maintained wellness programs. Benavides and
David (2010) reported that 81% of cities with a population of more than 10,000 in a
major U.S. metropolitan area reported maintaining a wellness program.
A large body of evidence shows that workplace wellness programs serve to both
reduce health care costs (Aldana, Jacobson, Harris, Kelley, & Stone, 1992; Baicker,
Cutler, & Song, 2010; Chapman, 2012; Chiappetta, 2005; Pelletier, 2011) and improve
employee productivity (Baicker et al., 2010; Chapman, 2012; Pelletier, 2011).
Additional performance benefits accrue from wellness programs including reduced
absenteeism, increased job satisfaction, and improved clinical outcomes for participat-
ing employees (Mills, Kessler, Cooper, & Sullivan, 2007; Pelletier, 2011). Research
also reveals that wellness programs are associated with the reduced use of sick time
and reduced turnover (Goetzel et al., 2007). Thus, workplace wellness programs are
potential sources of productivity improvement and cost reductions that are essential to
government performance improvement.
However, little, if any, empirical evidence exists concerning the best practices that
produce beneficial outcomes in U.S. local government wellness programs. As
Benavides and David (2010) noted, “ . . . a void . . . exists in the literature on research
devoted to wellness programs at the local government level” (p. 293). The small body
of existing literature is descriptive, includes some program output data, and adds
insight into the elements of local government wellness programs. More importantly,
there is no identifiable effort in the research literature to identify the program elements
and organizational activities that constitute a successful municipal government well-
ness program. In short, U.S. local government wellness programs represent a potential
source of health care costs savings and productivity improvement. However, the rele-
vant literature is devoid of systematic efforts to define best practices that can lead to
improved program performance (Kapucu, Volkov, & Wang, 2011).
Workplace wellness programs appear as the archetypal government program in the
current era of performance management. Wellness programs appear to achieve two
primary goals of the performance management paradigm. These primary goals of cost
reduction and productivity improvement can, now, be assessed via a review of perfor-
mance data across a variety of local government organizations. Determining the
26
Review of Public Personnel Administration 39(1)
factors that engender positive performance outcomes in a sample population leads to
the definition of best practices (Kapucu et al., 2011) that are transportable to other
organizations.
This research attempts to fill the aforementioned void in the literature, in part, by
identifying the evidence-based practices (Julnes, 2007; Vanlandingham & Drake,
2012) that lead to successful local government wellness programs. The data for this
research emanate from a national survey of U.S. municipal government wellness pro-
grams. Local governments with wellness programs, generally, maintain performance
data including total health care cost data, employee hospitalizations, and numbers of
health insurance claims. Wellness programs also maintain data regarding employee
absenteeism and a percentage of employees participating in the cities wellness pro-
gram. An aggregation of these data allow for the development of an index of program
success. We, then, identify the programmatic and organizational practices associated
with this index of program success. Given the numerous individual and organizational
level benefits that accrue from workplace wellness programs, it is necessary to better
understand the program and organizational practices that lead to both reduced costs
and improved productivity. Furthermore, identifying best practices expedites the
improvement of performance management systems requisite for achieving high per-
formance (de Waal, 2010; Van Dooren, 2011).
Local government wellness programs represent a unique nexus between local gov-
ernment and national policy. First, as workplace wellness program now represent a
node in the complex network of the U.S. health care system, it is increasingly impor-
tant to investigate the practices that lead to successful wellness programs. Second,
workplace wellness programs ask employees to change behaviors previously consid-
ered non-work-related, while also asking employees to provide information that raises
privacy concerns. Third, the Affordable Care Act of 2010 (ACA) allows employers to
use financial incentives to reward employees for participation in workplace wellness
programs. Knowledge of the efficacy of such incentives allows for a determination of
this particular national policy intervention. An increased understanding of how local
governments, now, fits into this health care system is of further importance given that
municipal government in the United States employs approximately 5,300,000 citizens
(U.S. Department of Labor, Bureau of Labor Statistics, 2015). Producing effective
workplace wellness programs is critical if local governments are to reduce health care
costs, enhance productivity, and improve employee wellness.
Literature Review
The earliest identifiable study of U.S. local government wellness programs is Moore’s
(1989) sample that included 75 U.S. cities with populations of more than 100,000.
Moore’s research detailed the variety of wellness program services provided by
municipalities in his sample. Fifty percent or more of the cities in Moore’s survey
provided the services of first-aid training, safety precautions, alcohol and drug abuse,
and stress management or hypertension screening. Moore found employee participa-
tion rates in the programs he examined to be, generally, less than 30%. Moore noted
Sabharwal et al.
27
that the primary focus of municipal wellness programs in the mid-1980s was health
care cost containment.
Streib (1996) reported the results of 1993-1994 International City Management
Association (ICMA) national survey of specialty health...
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